I don’t think I can possibly explain how much I love the following entry from longtime contributor, FFF Antigone. I knew she was rad, but this is beyond rad. I promise you’ll feel empowered after reading this one….
I am different than most mothers here in that I knew from the beginning that I would probably have problems breastfeeding. You see, I had a breast reduction right before I went away to college, 11 years ago now. I will not tell you the whole story of my surgery, but I will say that my breasts were grossly out of proportion with my body, causing me intense discomfort, both physical and psychological, and my insurance covered the surgery as medically necessary. The more modern procedure with the anchor scar was used. Thus my nipple was not removed, which was less likely to cause a loss of sensation and a complete inability to breastfeed. Even so, I was warned before the surgery that I would probably not be able to breastfeed. Being a teenager at the time, and a formula-fed one at that, this didn’t faze me in the least. I could blame the whole thing on childish ignorance, but I won’t. Even knowing that the surgery did ultimately render me unable to breastfeed, I would not take it back for anything. I am still glad I did it, glad that I did not spend the last 11 years suffering, glad that I am not doomed to years more of suffering until I’m finished having children.
I guess that is why, in my heart of hearts, I feel attacked when militant lactivists attempt to separate the sheep from the goats, the innocent women who truly couldn’t breastfeed compared with the selfish hussies who just didn’t want to, or didn’t try hard enough. I bridge the gap between both worlds. I physically could not breastfeed. I produced a comically low amount of milk. But the reason I physically could not was a surgery that I chose to have. And I would choose again.
For a long time I wondered whether to try breastfeeding at all. Did I mention I also have PCOS and had to use fertility drugs to get pregnant? This also, apparently, lessened my chances. I read the Breastfeeding After Reduction book and visited the website. I saw a lot of extraordinarily dedicated women who were willing to pay substantial costs – economic, physical, psychological – in order to get just a relatively small amount of breastmilk into their babies. There were a few who were able to exclusively breastfeed, especially with subsequent children, but most settled for just a fraction breastmilk – usually 30-50%. They spent tons of money on galactogogues, some of which aren’t FDA-approved (domperidone) and/or had unpleasant side effects. They hooked themselves up to pumps constantly. It seemed my vision of having a natural, normal breastfeeding experience was going to be impossible. Now there was the question – was it worth it to try for even this limited breastfeeding experience?
I debated with myself for a long time. I was afraid of making a stressful time more stressful. I have a history of depression and thus have a higher risk level for postpartum depression. I was afraid of not knowing when to supplement and starving my baby. Ultimately my research led me to believe that some formula was probably inevitable. So I bought bottles, started reading FFF, and defended formula feeders wherever I was.
I didn’t make the decision until a few weeks before I gave birth. In the end, I had to know for sure if I could breastfeed or not. I think if I didn’t try, I would always question and feel bad about it. My daughter was much-wanted and long-awaited and as I felt my due date approaching, I wanted to give her my best. But MY best. Not what some other woman thought my best should be. I vowed not to let myself sink into depression. I vowed to be reasonable in my efforts and not drive myself crazy. If I had milk, I would give it to my baby. Maybe I would be one of the lucky ones, the few who are able to fulfill most of their child’s need through breastfeeding despite the reduction. I tried to stay hopeful.
So when I checked into the hospital that December day, I told the nurse I planned to breastfeed. My daughter was born at 9:34 pm, a normal vaginal delivery after a fast labor. We put her right to the breast. The latch was weird but they assured me I’d get some help in the morning. I continued to put her to the breast all night long.
The next morning a LC visited me, brought a pump and a bunch of informational packets. I was instructed to put her to the breast for 15 minutes each side every 2-3 hours and pump afterwards to simulate milk supply, which I dutifully did. She told me it would be 2 weeks before I would know the full extent of my supply post-surgery. 2 weeks, I told myself. I can do this. The first day I got colostrum, a small syringe full which I fed to my baby. It still seemed my supply of colostrum was smaller than what I had been told to expect, and I felt the latch was not good. The LC brought a nipple shield and some breast shells to help my nipple stick out. Later that evening I was informed that my daughter’s glucose levels had dropped and we would need to begin supplementing, small amounts, just 15cc per feeding. I guess many breastfeeding advocates would scoff at this and fight it. But as one of my fears was not getting my daughter the nutrition she needed, I complied right away. Then in the wee hours of the morning my daughter was diagnosed with jaundice. Fortunately they were able to bring the isolette with the bili lights into our room so that we would not have to be separated. We were recommended to increase the supplementing because it would help her to expel the bilirubin.
I continued to nurse and pump. I was visited by another LC who helped me with my latch. It was still frustrating as the baby was rather sleepy and had a weak suck, but the LC was kind and filled me with confidence that we could do this. However, it was obvious to me that my colostrum was drying up. The previous day I’d been able to pump a few CC of colostrum, now I was getting only drops. I hoped and prayed that the baby was getting more than I was, but I had a sinking feeling that she wasn’t. Her increasing hunger was apparent, and her formula consumption continued to increase. That evening I was “discharged” since my 48 hours post vaginal delivery had elapsed, but my daughter was kept behind due to the jaundice. Since the hospital had extra rooms, I was allowed to continue to stay with her.
The next morning (3rd day post delivery) my colostrum was completely gone. I was getting nothing. Constantly pumping a dry breast was giving me blisters and I was crying from the pain. The LC was kind and said I could put it on the lowest setting, it was okay. If nursing hurt I could use the nipple shield, it was okay. I kept on as best I could. That evening we were discharged. By then we were supplementing a full ounce of formula at every feeding. And I was on the roller coaster. Nurse, supplement, pump, wash pump parts.
It was not until the next afternoon (4th day post delivery) that my milk “came in.” Instead of nothing, I was getting whitish fluid, but not much of it. I felt engorged, but only tiny amounts were coming out. I had my husband make some lactation cookies, and buy some fenugreek. The milk situation did not seem to improve. The most I ever pumped was a whopping 5cc; most pumps yielded between 1 and 2cc. No that’s not a typo. We’re talking mL here, nowhere near even a fraction of an ounce. This is with a top of the line, hospital-grade pump.
Many would say that pumping is not indicative of supply, that my daughter was getting more than I pumped. In my case, I’m not so sure. I visited the LC at my pediatrician’s office when she was a week old. I was having problems latching without the shield, probably a result of the bottles. The LC was not able to get her to latch without the shield either. We did a 30 minute nursing session with her while using the shield and weighed the baby. She had not gained even a fraction of a gram on the digital scale. After the nursing session, the LC brought a 2oz formula bottle so my daughter could have something to eat. She drank it all.
Meanwhile fatigue was setting in. I was not able to keep up with pumping all night and often for night feeds I skipped it, or skipped nursing, or just told my husband give her a bottle I need to sleep. My husband’s return to work approached and with it an impending sense of dread. Merely the thought of being alone with the baby all day and all night (since my husband needed his sleep for work) left me a sobbing mess. I knew that there was no way in Hell that I could continue with this nurse, supplement, pump, clean pump parts routine, which would take up at least half of the 3 hour cycle, all by myself with no relief. My supply was not improving. The writing was on the wall. But still I couldn’t stop. I had to keep going the full two weeks. I had to prove to myself that I had tried my best.
The day before my husband returned to work, I finally gave up the ghost and packed up the pump. Returning that pump was the best decision I ever made. It brought the light out of the clouds to know I would never have to deal with that monstrous machine again. From everything I’d read, I knew I would not be able to maintain or increase my “supply” without it. Since I was still using the nipple shield, I wouldn’t get adequate stimulation. So I accepted that this was it for me. I was not one of those women who could breastfeed after reduction, not even for a small percentage of my daughter’s need.
I continued to nurse though, because the truth is I actually enjoyed it. I was afraid it would hurt, but after the first couple days, it didn’t. At 3 weeks old, my daughter was finally able to latch without the shield. The situation did not really improve, though. Oh sure, when you squeezed my breast, a tiny bit of milk came out. But my daughter was consuming as much formula as a fully formula fed baby, according to all the charts I found. Whether I nursed before giving her a bottle made no difference in her consumption. It was obvious that what she was getting from me was not significant. I continued on, although part of me felt like I was just pretending to breastfeed, a giant faker trying to fit into the club. But it was relaxing and was one way to spend time with my daughter when she was too little to do much else. And the pediatrician assured me that even the tiniest amount of antibodies would be beneficial to my baby. Some might find this admirable, others might find it crazy. I can’t explain it and even I would never have thought I would continue so long under such circumstances. Something about the postpartum hormones and my fierce love for my daughter led me to do things that previously I didn’t think I would.
Even so, I knew that she wasn’t getting much of anything from me. Probably not much more than the few CC that I had pumped. Our feeding routine was far too lengthy and often my daughter would fuss at the breast because she was hungry. I told myself I would stop at 2 months, after her vaccines. So I did, gradually dropping one session after another. She hardly noticed at all, and her formula intake didn’t change noticeably. She is now almost 6 months old. When I think about it now, I am still a little sad that I wasn’t able to breastfeed her. On the other hand, formula feeding has gone smoothly, my daughter is healthy, and I beat the baby blues. I feel absolved of guilt because in my heart I know I did the best I could, and it was not even a close thing.
What frustrates me is that when you say you weren’t able to breastfeed, particularly because of low milk supply, the usual reaction from the breastfeeding community is not to just accept it, but to question and assume that you simply didn’t try hard enough. 98-99% of women are physically capable of breastfeeding, don’t you know? Why didn’t you try an SNS? Domperidone? A different LC? More milk plus? Mother’s milk tea? Why didn’t you pump more often? Try more skin to skin contact? Drink more water? Improve your diet? Etc. In my case, my supply was so hopelessly low that I truly believe that none of this would have made any difference. Even if I’d been able to follow all of this advice simultaneously, exactly to the letter, I would not have had nearly enough milk.
I resent feeling defensive, feeling the need to constantly explain my whole story and that yes, I really truly had almost no milk supply, that yes, if I wanted my daughter to live she needed formula. But you know what I really resent most of all? The notion that there are “good” and “bad” reasons to formula feed, and therefore “good” and “bad” formula feeding mothers. (Often, the code words “could not” breastfeed and “chose not” to breastfeed are substituted for “good” and “bad”—but we know what they mean). And who has the right to judge which reasons are good and which reasons are bad? Not the mother herself, who surely has the most information on her own situation. No, random strangers REALLY know whether you had a good reason or not. And the assumption tends to be that you didn’t have a good reason. Because 98-99% of women are physically capable of breastfeeding, so there’s a very good chance that you were, if you’d only tried hard enough! That’s why I’m done with defending myself. I’m done with trying to persuade anyone that I’m one of the “good” ones, or that formula feeding women shouldn’t be demonized because there are several “good” reasons to do it. I truly believe that we as a community of formula feeders should stand together, and not turn against each other by pointing out which reasons to formula feed are valid, and by implication, which aren’t. If you give your 2 month old Coca Cola in a bottle, you should have to explain yourself. Formula specifically balanced to meet an infant’s nutritional needs? Not so much.
I trust women. While there are a few bad apples out there, most of us love our children and want to give them our best. I am supportive of breastfeeding and am supportive of efforts to assist women who want to breastfeed in being successful. But I am NOT supportive of labeling or bashing ANY formula feeding mother.