Mommies, beware: Actually liking your job might harm your breastfeeding success!

Not sure how I missed this, but the news outlets were recently abuzz about a study that correlated going back to work earlier with a lower likelihood of breastfeeding.

I was hoping that this study would divulge something interesting; maybe some tibit nursing women could use to their advantage in scoring longer maternity leaves (and non-nursing women could just lie and say they were nursing to reap the same rewards – considering your employer has no right to ask what you’re doing with your boobs, I think it’s well within your rights to indulge in lies of omission. Or at the very least, you shouldn’t go to hell for doing it. Actually, you’re going to hell for formula feeding, anyway, so I doubt that a little white lie will add fuel to the eternal hellfire…).

Instead, this is what the study apparently showed, according to MSNBC:

Mothers in the study who went back to work within six weeks were less likely than other women to start breastfeeding – and when they did start, they were less likely to continue.

By comparison, moms who stayed home for at least nine months, or even 13 weeks, were more likely to predominantly breastfeed their babies for three months or more.

My first question was (obviously), “did they include pumping and bottle feeding as ‘breastfeeding’?” Because if not, erm, yes, women who went back to work sooner would have lower rates than those who took longer leave. It’s hard to nurse when you’re in the middle of a meeting, or waiting tables, or what have you.

And I had more questions. How was breastfeeding defined? What confounding factors were controlled for? Because those able to take nine months probably differ from those who went back prior to 6 weeks, for many reasons… job security, socioeconomic status, education level, seniority, etc. According to MSNBC, “In the current study, the authors used statistical tools to try to eliminate the influence of factors that could affect a woman’s ability to nurse, such as her age, ethnicity, income, and the child’s birth weight, for instance.” Okay, so I suppose income level might give some vital insight… but certainly not everything.

I read through the entire study (appearing in a May 2011 issue of Pediatrics) and it turns out that they didn’t address type of employment at all. They did adjust for income and education level, as well as a myriad of other typically-included factors for infant feeding studies. Interestingly, once they did adjust for these, the majority of their findings proved insignificant:

In unadjusted analysis… any maternity leave was positively associated with breastfeeding. The odds of initiating breastfeeding were higher among women who took 13 weeks…and 7 to 12 weeks…of total maternity leave, compared with women who took 1 to 6 weeks. After adjusting for maternal characteristics and all control variables, however, these relationships were no longer significant….

Women who had (7 or more) weeks of paid maternity leave had greater odds of
initiating breastfeeding than women who had 0 weeks of paid maternity leave…In analyses adjusting for maternal and for maternal plus child and community characteristics, this relationship was no longer significant...

And so forth. There was one association which did hold up, though, and rather dramatically:

There was no variation in the duration of any or predominant breastfeeding according to total or paid maternity leave length; nevertheless, the highest proportion of mothers continuing to breastfeed beyond 6 months was among women who had not yet returned to work by the 9-month interview (46.7%) and the lowest proportion was among women returning within 7 to 12 weeks (30.1%)

Okay, so, fair enough. And I was actually happy about this finding. Trust me, I think it would be incredible if we were offered paid maternity leave for 9 months. In-flipping-credible. I then read on to see what the authors were recommending, based on their findings:

…(T)o the extent that the maternity leave length is positively associated with time of return to work, as observed in our posthoc bivariable analysis of maternity leave length and time of return to work, leave policies (unpaid/paid maternity leave) should be instituted at all governmental and organizational levels…

Okay, awesome. That’s great! I’m with you all the way, guys.

….to enable women to take sufficient time off work after delivery to properly nurture their infants...Studies in Canada and the United States support the notion that an increase in maternity leave length mandates in the United States would likely result in a greater proportion of women staying at home longer after delivery.

Hold up.

Properly nurture their infants?? And excuse me for harping on semantics, but “would likely result in a greater proportion of women staying at home longer after delivery” sounds awfully prescriptive to my ears. I would have felt a lot more comfy if that had read “would likely result in a great proportion of women being able to stay at home as long as desired after delivery.”

I bet you’re sitting there shaking your head, thinking, “Come off it, FFF. You’re reading way too much into this. Stop blogging this nonsense and get on your elliptical as you were planning tonight. Your ass could use it.” At least that’s what I was saying to myself. Until I started reading some quotes from the study authors in various news outlets:

One factor they couldn’t control for, said Ogbuanu, was the mother’s intention to breastfeed, and it’s possible that women who knew they wanted to breastfeed “would find avenues to stay home longer.” (MSNBC)

“Many women have to return within six weeks of giving birth,” said Dr. Deborah Campbell, director of neonatology at Montefiore Medical Center in New York City…”Even with high rates of breast-feeding initiation, when women have to go back to work, they often choose to combo-feed with bottle and breast, and the bottle undermines breast-feeding.” (HealthDay)

However, the authors did not find any relationship between breastfeeding and total allowed maternity leave, paid or unpaid. The findings focus instead on the amount of time women took off before returning to work. Some women, for example, who have 12 weeks of maternity leave might not take all of it right after the baby is born. Some of them might return to work sooner, explained Ogbuanu. Others might have had to use some of their leave time before giving birth, if they needed to be on bed rest, for instance…In general, Ogbuanu and her colleagues believe, if new mothers delay their return to work, then duration of breastfeeding among mothers in the U.S. may lengthen… (MSNBC)

There seems to be an underlying message (or maybe not so underlying) that women should be prioritizing breastfeeding over anything else. And I’m not just talking the old work-versus-stay-at-home nonsense, here. The problem is, as the researchers themselves state in the study, the correlation they found is not between length of maternity leave and breastfeeding – it’s between the time a woman goes back to work and breastfeeding.

Yeah, some women may return to work sooner – because they find that their sanity depends on it. I have quite a few friends who feel strongly that they are better moms because they work, and that is their right to decide. Maybe you get 4 months, but you know that taking the full four months will just make you stir crazy, or kill your chances of becoming partner… how would you feel about a policy that forces you to take a specific amount of time off so that you can nurture your baby in a way that someone else believes is appropriate?

Frankly, I think it would be awesome to have a leave policy where you could “bank” your time – say, only take 4 weeks off after birth, but then be able to work reduced hours, or do 4-day work weeks. Or even take additional “banked” time off a few months later, when your baby started the really fun stuff, like smiling, babbling, crawling…that’s when motherhood actually gets fun, for many of us.

Don’t get me wrong – this was a good study, an honest study… and I want to give the researchers props for that. But I also think it may have been a useless study, and a tad paternalistic. What about a study that examines breastfeeding rates from those couples who get ample paternity leaves, as well? My best friend’s husband got 6 weeks off. PAID. I bet if more women had that luxury, a lot more would be successful at breastfeeding.

But hey. Let’s just put it all on women’s shoulders (er, chests). Why fix what isn’t broken?

FFF Friday: “Suddenly it all didn’t matter anymore.”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.


As I’m sure you all know by know, postpartum depression is one of my Achilles heel issues. The minute someone starts in about how breastfeeding is necessary for preventing PPD, I see red. And the following FFF Friday entry from Shelly, also posted over on her blog, The Aspiring Life exemplifies why. No matter how you feel about breastfeeding and it’s relationship with depression, the pressure we put on women to nurse only compounds things. I can’t see why this is even a source of contention. Honestly, I just can’t.

Thanks, Shelly, for this honest take on your experience. I know firsthand the power in reading stories from other women who’ve been in the PPD trenches, and I am so grateful strong women like you are willing to share your experience.

– The FFF

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This post is about how breastfeeding failed for me and Baby B. I set such unattainably high expectations for myself as a mother, one of which was a perfect breastfeeding relationship. For me, the failure of breastfeeding is where my battle with postpartum anxiety begins.

There was a lot to be anxious about in the first few weeks after we brought Baby B home.

I knew that I wanted to breastfeed. I knew that it wasn’t easy for every woman and I knew there might be struggles but I was ready and willing to do whatever it took to make it work. Imagine my pure glee when Baby B latched on flawlessly while we were still in the hospital. The house pediatrician couldn’t believe she was my first child when he saw how easily breastfeeding came to us. When we went home things continued to seem perfect. I had this perfect little family and this perfect little life. PERFECT.

Baby B was born on a Monday morning. On Thursday we took her in for her first pediatric appointment. She had lost a little more weight which did not surprise the pediatrician since my milk had not yet come in. We made an appointment for her next checkup a week from that day and went on our merry way.

Then my milk didn’t come in soon enough. On Friday night we were up all night with an infant screaming for food that I simply not producing. We had to give her formula, because the poor child needed something. I was devastated by this, and felt like that small amount of formula amounted to total failure on my part. When my milk finally did come in, Baby B started refusing to latch. She would scream because she was so hungry, but getting her to latch was a fight every time. When she was 7 days old we went back to the hospital to work with a lactation consultant.

Things seemed to get better after that. The lactation consultant suggested swaddling Baby B while she was nursing , because if she was not swaddled she would flail around and push herself off of the breast with her arms. This worked well and solved a major problem for us, but unfortunately since she was so warm and cozy while nursing she started falling asleep frequently. Feedings started taking at least an hour because I would have to stop every few minutes to wake her up. Sometimes a cold washcloth would be enough. Sometimes I would have to unswaddle her, walk around with her for awhile, then reswaddle her and put her back to the breast. Despite my best efforts, most of the time she wouldn’t nurse for more than a few minutes without falling asleep. Still, we pushed on and Baby B spent so much time at the breast that I was sure things would finally work themselves out.

Imagine my complete shock when we took her back to the pediatrician to find out that not only had she not gained her birth weight back, she had lost more weight. I was devastated. I had been unknowingly starving my daughter. How could I not know that she wasn’t getting what she needed?

The next couple of weeks are a complete blur. Since my milk came in late our pediatrician thought that might be the problem. She suggested that I nurse Baby B every two hours around the clock and supplement with 1 ounce of breastmilk or formula. It took nearly an hour to feed Pumpkin since she would often fall asleep at the breast and I pumped after every feeding to try to get my supply up. After each cycle of nursing and pumping I was lucky to have fifteen minutes to myself to sleep or shower before it was time to start the cycle all over again. Thank goodness my husband was willing to patiently give Baby B her supplement from a syringe (to avoid nipple confusion, of course) or I wouldn’t have even had that. It all seemed worth it when we took her back for her weigh in on Saturday and she had gained a few ounces.

Still, I wanted to make sure I did everything that I could to insure that I would be successful at breastfeeding. I found the only IBCLC (or International Board Certified Lactation Consultant, the supposed gold standard of lactation consultants) in my area and made an appointment. That Monday we drove Baby B across town to see the woman that could solve all of our breastfeeding problems (according to the lactavists that insisted that I must be doing something wrong, that is). The IBCLC told me that her latch was perfect and that I was doing everything right. She weighed Baby B before I fed her, and again after in order to determine how much she was getting from me. When she put Baby B on the scale after the feeding, the first words out of her mouth were “I’m sorry.” She then told me that the difference was just over half an ounce, which is nowhere near adequate intake.

Later that day, the IBCLC emailed me with more bad news. She told me that she believed that I had insufficient glandular tissue and that she was not sure that I would ever be able to exclusively breastfeed Baby B. I was destroyed. Nobody told me that this could happen. Everything I read, and everything that I was told in the breastfeeding classes I took told me that if I could get the baby to latch properly and if I nursed her often enough my body would give her what she needed. Why was I unable to nourish my daughter? Isn’t this one of the most basic functions of a mother?

More discouraging news came on Tuesday when we took her back for another weigh in and her three week check up. Baby B had lost weight again. The pediatrician told us that at this point I could still nurse her, but that we had to start giving her full feedings of formula. There it was, the final nail in the breastfeeding coffin. Between long nursing sessions, pumping and supplementing after the feeding I hadn’t slept in days. I had no fight left in me. We never planned for this, so the bottles we did have were still in the packaging. We came home from the pediatrician and went through the frustrating process of boiling the bottles to sterilize them while Baby B screamed out of hunger. I made my husband give her that first bottle. I was a failure and I didn’t want to watch my poor daughter drink inferior formula because I could not give her breastmilk. My husband knew how devastating this was for me and told me that if I did not start feeling better in a couple of days he wanted me to call my OB about postpartum depression. I agreed with him and promised I would.

We took Baby B in for another weigh in the very next day. Despite being exclusively on formula for twenty four hours, she lost another ounce. We were sent to the pediatric hospital immediately. It was AWFUL. Watching as nurses started an IV and drew blood from Baby B broke my heart. She cried and I cried. I held her little hand the entire way, but I felt helpless. After that it was a lot of waiting. We were told to feed her as normal and a technician came by to check her vitals every hour. We slept in the hospital room with her and one of us was by her side always.

After the first night they weighed her. She gained an amazing 9 ounces over night. The hospital pediatrician wanted to observe her a second night to make sure she kept gaining, so we stayed a second night. She gained again after the second night, and all of her test results came back normal. After we were discharged we returned to the pediatrician for two more weight checks, both of which showed gains. At this point the pediatrician told us she was no longer concerned and we were put back on our normal pediatric checkup schedule.

I cannot describe the relief that I felt. Suddenly it all didn’t matter anymore. I no longer cared that I was unable to breastfeed. My daughter was healthy and thriving and gaining weight. My husband and I mused that the hospital stay was a blessing in disguise because it served as sort of a reset button. Now that he could help with night feedings and now that it wasn’t necessary for both of us to be up every two hours (me nursing and pumping, him washing pump parts and supplementing) we were both finally able to get the first significant stretch of sleep either of us had since Baby B’s birth.We both left well rested, and I was so relieved that she was happy and healthy that it seemed that I dodged the postpartum depression bullet after all.

Little did I realize that through all of this I was already experiencing symptoms of postpartum anxiety, probably because there was so much to be legitimately anxious about in those early days.

We were home, and it seemed that my little family was perfect once more. Just perfect.

Check out Shelly’s blog for more on her postpartum journey.

***

Beware of Biased Breastfeeding Advice

“Formula feeding causes obesity, heart disease, diabetes, and childhood cancer. Yet ppl would rather see moms feeding it than #breastfeeding”.

This is what popped up when I did my daily search for “formula feeding” on Twitter today. From an IBCLC, no less. One that is also a RN.

The “gold standard” of lactation consultantancy (is that a word??) is the IBCLC. I highly suggest going to their website to check out the necessary qualifications one must have to be a certified lactation consultant under this organization. They have recently changed the rules, but it used to be that one needed no formal medical training or understanding of statistics, etc, to become part of the preminent organization for lactation education. And considering the blatant disregard for the concept of correlation versus causation (forgetting, momentarily, the shoddy science and inconclusive evidence backing up all four of the above associations), I worry that the majority of individuals responsible for providing guidance to us and our babies in our most vulnerable days are equally dismissive (or woefully undeducated) about interpretation/reporting of the facts.

I understand why many breastfeeding moms feel abandoned by their pediatricians. The fact is, pediatrics must concern itself with children, not maternal health; breastfeeding involves a dyad (mom and baby) and this is a perplexing situation for the way our medical system is set up. Family or general practitioners might be better equipped to handle the nursing dyad, but from what I’ve heard in the blogosphere, women (and babies) are not receiving great advice or care from the majority of medical professionals. So where does this leave the breastfeeding mom? In the hands of an LC.

Now, when it comes to the practice of breastfeeding, you can’t beat a good LC. They can be life savers. The good ones are supportive and approach every dyad individually, figuring out specific issues and providing invaluable assistance with a process that can be the farthest thing from “natural” for many of us. (Although I do wonder, incidentally, if we have made breastfeeding too much of a managed practice; my one friend who did a home birth and was adamant about figuring it all out for herself was also the one who had the easiest time nursing.) But it seems that since much of the breastfeeding advocacy community has become so suspect of doctors (unless they are Drs. Sears, Newman or Lawrence, of course) that LCs are becoming de facto medical authorities for many women.

I would imagine that there are some great, responsible LC’s out there who feel just as frustrated and uncomfortable by this current state of affairs as I do. It puts the profession in jeopardy, frankly; they should be gaining respect for the amazing and specfiic help they can provide, rather than provoking suspicion about motives and malpractice because of a few overzealous bad eggs.

I don’t know about you, but I wouldn’t want a chiropractor giving me a colonoscopy. We’re talking two different knowledge bases here. Lactation consultants are the best professionals in the world when it comes to breastfeeding problems. But that does not mean they are qualified to give medical diagnoses, or even assess medical studies properly. There are some LCs who are also RNs (and I’d hope, and assume, that these are a bit more based in reality than the one who posted that bizarre comment), and I’m sure that there are also some who have impressive degrees in relevant fields like epidimiology or psychology. But that is not a necessary qualification to become an IBCLC.

I’d also worry that someone with such an obvious bias (ie, believing that formula feeding causes cancer) may not be the best person to dole out impartial, coolheaded advice on infant feeding. When the stakes are that high, it changes the thresholds. Asking a woman to avoid a medication that would alleviate PPD in the name of breastfeeding does not seem like a lot to ask when we’re talking life and death risks for an infant. Likewise, I’d be the worst person on earth to ask for breastfeeding advice. I’d like to think I champion breastfeeding, and go to great lengths to encourage my nursing friends, but I am also the first person to say STOP at the first sign of trouble.

I’m not sure what the answer is, here. Better – and by that I mean evidence-based, impartial – education for pediatricians? New forms of medical practices which treat both postpartum mothers and babies? A new professional organization for lactation consultants which requires at least a pre-med level degree?

Until one of the above ideas comes to fruition, I’d suggest that we need to be our own advocates. Have a team that you trust – that might mean an OB, psychologist, pediatrician, LC, and your mom or best friend, all working together to help you – and beware of wolves in sheep’s clothing. Especially wolves who purposefully misrepresent risks. Or sheeps who don’t know that correlation doesn’t equal causation.

Baahhhhh.

FFF Friday: “Formula is another F word…”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.

FFF Julie recently sent me this great submission, originally posted on her own site. Her mention of the Old Navy “Formula Powered” onesie brings back memories, doesn’t it? 😉

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The first question people ask you when you’re pregnant is “When are you due?” and the second question that is most often asked is “Are you planning to breastfeed?”.  If you’re like me and it’s your first child, chances are your answer is a resounding yes. And why not? When you’re pregnant, you’re surrounded by the message that breastfeeding is the best for your child and that it’s the only thing you should give your baby until they are 6 months old. Whether it be posters at the mid-wives office, handouts from the pre-natal classes or different organizations at baby shows – the message is clear – you have to breastfeed your baby (period). As a new mom, this was definitely my plan. I had no illusions, I was told that breastfeeding would be difficult. What ended up happening was not at all what I had expected – and not only that – the emotional toll was much more challenging too.

When you’re pregnant, you are fed messages about how terrible formula is and how you should be doing everything you can to breastfeed exclusively for 6 months and continue for 1 -2 years.  The benefits of breastfeeding are many and are very well documented. And this becomes your mantra – I must not give my baby formula, I must exclusively breastfeed, no matter what.  This breastfeeding vs. formula controversy was ignited this fall with the Old Navy Powered by Formula Onesies. Mommy bloggers were outraged by the sale of such an item (someone was buying it though, as it was already sold out at one location). I’ll admit, I was bothered by it as well. Of course this was before I became a mom.

Céline was born at our local hospital and when the paediatrician came to see her the day after she was born, she recommended that if I was going to breastfeed that I top her up with formula – especially since she was premature. We completely ignored this advice and were offended that she would suggest formula for our beautiful child – who was going to be exclusively breastfed. When Céline was only a few days old, she dropped over 10% of her body weight and developed a serious case of jaundice. She had to be readmitted to the hospital and she needed food to grow. Although my milk had come in, she was too little and had trouble latching. And even though I was pumping, I was barely getting 10 ml every two hours.  She needed at least 30 ml of food, every 2 hours, in order for her to get better. So we started to supplement with formula.  I cried. I was so upset, frustrated, angry – you name it – that I didn’t have enough milk for my child. In our case, without formula, there is little doubt that she would not have been able to get better.

So, I gave in. I realized that I would have to supplement with formula. But I wasn’t ready to give up, in fact I started to attend the breastfeeding clinic at the hospital to get some help with breastfeed and increase my milk supply.  I started taking the herbs (fenugreek and blessed thistle) and the drugs (domperidone) to increase my supply. The clinic is a wonderfully supportive environment, that encourages your success, whether you are exclusively breastfeeding or not.

Here we are with an 8 week old infant, who receives about half her nourishment from breastmilk and half from formula. And we will be doing this as long as possible – but probably not for a year. I am tired of comments about how formula is terrible and the formula companies are just out to make a buck, and basically that formula is another F word. What many people don’t realize is that many of us who are supplementing with formula or are exclusively formula feeding, may have tried everything possible to exclusively breastfeed. But at the end of the day – our babies need to eat!!

So next time you’re thinking about judging someone who has stopped breastfeeding after a few weeks, or is supplementing with formula – just think about this: It costs me more to breastfeed my child than it does to give her formula – not only in dollars (herbs, drugs, purchase of an electric breastpump – which I use up to 8 times a day) but it also costs in time – 30 min at the breast, 15 min of pumping plus all of the cleaning and preparation.  If I had an abundant milk supply and breastfeeding was easier for me, I would be overjoyed.  But it’s not – and I know I’m not alone. And I’m over feeling guilty or feeling that I’m not a great mom because I’m giving my daughter formula.

Finally, I found out that I was only breastfed for 6 weeks – my mom also suffered low milk supply – and in those days, there was no one to help her if she wanted to continue.  Seems to me that I turned out just fine!

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Running low again, folks. Send your stories to formulafeeders@gmail.com. All perspectives are welcome!