FFF Friday: “If I don’t try everything, I haven’t done enough…”

Posted on March 31, 2012 by Suzanne Barston

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 Lisa’s submission highlights a condition called Insufficient Glandular Tissue, or IGT (also called “mammary hypoplasia” or “tubular hypoplastic breasts”). I had never heard of such a thing until I started this blog, and unfortunately, neither have most of the women I’ve encountered who have it. What’s truly unfortunate is that there are physical characteristics which can indicate IGT, and none of us are alerted to this prior to giving birth. If any of the women who’ve struggled to breastfeed with IGT were told by their OB/GYNs during routine prenatal visits that they may have this condition, imagine how better prepared – both physically and mentally – they could have been for the challenges ahead. These are the things that should be talked about in regards to breastfeeding initiatives, and yet they are only discussed in hushed voices in internet chat rooms and blogs.

But I’ll shut up about that for now, because Lisa’s story isn’t really about IGT. It’s about triumphing over the pressure to “try everything” in order to breastfeed, and doing what you feel is best for yourself and your entire family.

Happy Friday (or Saturday, in most timezones), fearless ones.

The FFF

***

When I was pregnant with my first son, I had never even heard of insufficient glandular tissue. I also never thought for a moment that my PCOS could hurt my chances to breastfeed. I just figured it would work for me like it had worked for all of my friends. The fact that I had had no breast change over the course of the entire pregnancy left a small, nagging feeling in the back of my head, but I just ignored it and continued on the breastfeeding path. After three unsuccessful days of laboring, a magnesium IV for high blood pressure, and a pitocin IV that proved to be useless, I had a c-section. Over the course of the next three days at the hospital, I needed help from a nurse to get him to latch every time. Every time, he would suck voraciously for a few minutes, then fall asleep. I started to wonder if he was getting anything to eat, but every time I asked a nurse, I got the same response: ”Everyone can breastfeed. Your milk is coming in. Just be patient.”

To make a long story short, I got home and couldn’t get him to latch (surprise, surprise!). I called my pediatrician in tears at 4:00 in the morning, and he told me to give him some formula. We had some formula we had received in the mail, so my husband mixed up a 2 oz. bottle and gave it to our son. He completely inhaled it, and then immediately fell asleep. Needless to say, I cried for most of that day (ok, week, but who’s counting?). I had failed. I spent the next few weeks searching the internet, calling my doctor, trying to figure out what I could do to salvage my breastfeeding relationship with my son. I received an endless list of suggestions, many of which I tried, but nothing worked. I spent a great deal of time on the LLL site, which proved to be a bad idea for me. They are very nice and well-meaning, but I was left with a feeling of “If I don’t try EVERYTHING, I haven’t done enough”, which was not good for me in the mental state I was in. I became very depressed, and bonding with my son became very difficult. I am so thankful that my husband was there to pick up the slack, because I was not “all there”. After a few weeks of trying various suggestions with no results, I quit trying to breastfeed and just moved on, but in the back of my mind, I was always thinking about my plans for the next baby.

When I got pregnant the second time, I immediately started doing research. I read all of the best breastfeeding books. I believed all of these women that told me “just because you have problems with the first, doesn’t mean you’ll have problems with the second” (even though I, again, had no breast change at all). My husband was worried about me. He saw what I went through with the oldest, and he didn’t want me to be disappointed again. When my second was born, it was perfect. A scheduled c-section, a perfect latch, and….still no milk. I stayed in the hospital for 4 days talking with every lactation consultant numerous times, trying everything they said (different positions, breast compressions, etc, etc), until one very nice LC came in to help me and told me something that completely shocked me. She felt my breast and said, “Well, you’re really soft for 4 days postpartum“. I mentioned to her that I had PCOS, and she told me that that could be what’s affecting my supply. She also made a comment about the shape and spacing of my breasts. ”You can only do what you can do. Not everyone can breastfeed”. Well, this was news to me! Where was she last time I was at the hospital!? I was shocked. And, just like with my first, my milk never came in, and I was disappointed again.

This time, I did a different type of research. After looking into my symptoms and talking to my doctor, I learned that I most likely have IGT, and I would probably never be able to solely breastfeed. I think my husband was hoping that this revelation would help me move on, but it didn’t. I now started looking into information on IGT, and searching for any information on women who have breastfed successfully with this condition. I knew we wanted a third child, so I was determined to be prepared this time. I joined internet sites where women talked about the many things they were trying to do in order to get past this condition, from drugs to supplemental nursing to milk sharing. Reading all of the posts, I was inspired, but also nervous. Many of these women were greatly affected by the fact that nothing they tried was working. They were so hard on themselves, and you could hear the desperation and sadness in their posts, and I just didn’t want to go down that road again. I tried to push those feelings aside and tell myself, “This is what I need to do as a mother. I need to fight this battle”. I read about domperidone, reglan, goat’s rue, you name it. I felt like if I didn’t try all of these possible cures, I would always wonder, “What if…”.

One night, when I was doing research on one of these medications, my husband came in and sat with me. He said, “Are you sure you want to do this? You don’t know if any of this is going to work, and what the possible side effects are”. I told him that I really wanted to breastfeed our last baby, and I felt like I had to look into every possible solution in order to have no regrets. With that comment, he pointed over towards our sons. Our 2 1/2 year old was wrestling with our 15 month old, laughing and giggling, both strong, healthy, happy…and formula fed. It finally started to hit me: Why am I spending this much time and energy on this? What outcome am I hoping for, and will it be worth it? Am I going to miss those precious first few weeks pumping, taking supplements, weighing the baby, analyzing diapers, doing more research, etc, etc. And for what? I have proof that babies can thrive on formula, so why am I going through all of this? Guilt? Validation? My husband isn’t pressuring me, so why am I pressuring myself? My husband doesn’t care if our babies have breastmilk or formula, as long as they’re happy, healthy, and thriving. He would also like a happy, calm, non-neurotic wife, which he unfortunately didn’t get with the first two babies.

So here I am, 22 weeks pregnant, and I’ve decided to give my husband a gift…a wife who is happy, calm, and neurosis-free. He was there for both myself and the boys when I wasn’t able to breastfeed, and he was always the patient voice of reason. This time, I’ve decided to let it go. I’m going to relax, breath, and just enjoy being a mom. My baby will get some breastfeeding at the hospital, and when that is not enough, he or she will get formula. No herbs or medicines, no power pumping, no internet searches at 3 in the morning…nothing. That is my gift to my sons, who need a mom who is present and there for them. It is a gift to my husband, who has held my hand, listened to me as I cried, and has been a tremendous support. Most of all, it’s a gift to me, so I can just enjoy motherhood this last time around and have no regrets. Since having this revelation, I am now more excited than ever about having this baby. I have stopped reading information on the condition, stopped my association with IGT and PCOS-related internet groups, put my books away, and have made a conscious decision to accept what I cannot change and focus on enjoying this time with my kids, because we all know how fast it goes. It took me a long time to get here, but I’m glad I made it!

***

If you feel like joining the ranks of the bravest guest posters in the Interworld, shoot me an email with your infant-feeding-related story: formulafeeders@gmail.com.

Newborn jaundice: To supplement or not to supplement, that is the question…

Posted on March 26, 2012 by Suzanne Barston

Most of us come into the world red, wrinkly, and hairless. From a purely aesthetic point of view, it’s not a great look – and yet parents usually think their offspring are gorgeous. I don’t know about you, but I sometimes look at newborn photos of my kids and think they had more than a slight resemblance to Benjamin Button (not the hot Brad Pitt version, but the weird old-man baby in the beginning). And I clearly remember thinking both of them were the cutest newborns ever born.

This baby grows up to be Brad Pitt, so it’s all good.

At my daughter’s recent 15-month Well Baby visit, I was utterly shocked to find out that she’d dropped from the 25th to the 10th percentile for weight. I’d actually been joking about how adorably chubby she’d been getting… but as soon as I saw the number on the scale, it was like my eyes refocused; I suddenly thought she looked so scrawny.

When it comes to judging how our kids are doing purely by looking at them, I don’t think parents are really hardwired to be objective.

I’ve been thinking about this the past few days as I’ve researched the topic of neonatal jaundice. Jaundice is a relatively common problem in babies, and therefore is a frequent discussion point in the online parenting world. The other day, I read an online discussion where someone spoke of a baby who sounded pretty darn dehydrated and jaundiced. The advice given was mainly to handle the problem at home or through consulting peer breastfeeding counselors; there were warning about unnecessary interventions which would harm the new breastfeeding relationship. The fear of formula supplementation was palpable. I’m a strong believer in mommy gut and standing up for your parenting philosophies, so on many levels, I understand where these women were coming from. There are a fair number of overloaded, poorly read-up, and even downright crappy medical professionals out there, and it’s likely that many women are pushed into supplementation when there are other methods which would ultimately achieve the same result.

However, taking matters into your own hands, or downplaying the seriousness of jaundice, is not the answer. I don’t think a newly postpartum, first-time mom who is already struggling with a poorly-feeding, jaundiced baby is in a position to ascertain her child’s medical status, merely based on appearances. (I don’t recall thinking my son was particularly yellow; in fact, my daughter, who wasn’t jaundiced, looked far more mustard-hued than her brother ever did.) Nor is it fair or noble of us to expect that of her, considering the misinformation and bias running rampant in parenting media.

Jaundice is a problem which pops up in a number of FFF Friday stories, so I decided it was relevant and necessary to discuss it on this blog, even though it is primarily a breastfeeding mom-related problem (mostly because formula feeding is one of the most common, and most controversial., therapies used to treat it; if you’re already bottle feeding, chances are you’re not freaking out about supplementation). But I know there are some pregnant women and prospective moms who frequent the blog, and you never know who’s going to stumble upon this post in the middle of a frantic newborn night… so this one’s for you. Oh yeah – I figure it’s pretty obvious, but just in case – please note that I am in no way, shape, or form a medical professional (although my dad’s a doctor, so if medical knowledge is passed down genetically I may have an edge up in that respect). The following piece is merely what I’ve gleaned from about 4 days of research and reading, mixed with a little personal knowledge and a hefty dose of opinion – so do with it what you will.

There’s a wide range of opinions on how best to treat jaundice, and much of the debate centers on how affected babies should be fed. But we’ll get to that in a moment – first, let’s define what we’re talking about.

Um, what is frock is ”jaundice”?

Newborn jaundice typically comes in one or some combination of three forms - breastfeeding jaundice, breast milk jaundice, and Type ABO jaundice. In the most general sense, newborn jaundice occurs when your infant has high levels of bilirubin (the substance which is created during the process of blood cell “turnover”) in the blood. The body usually gets rid of the excess bilirubin, but in newborns, this function doesn’t always operate smoothly. That’s because the placenta handles the job while in utero, and once your baby is of the “outside” varietal, his body might not have completely figured out how to handle this process. Hence, the mildly yellowish hue so fashionable in the under 48-hours-old set. Newborn jaundice (also called physiological jaundice) usually resolves in a few days, but sometimes it can be exacerbated by other problems.

One of these problems is a blood type incompatibility between mother and infant, called Type ABO jaundice. My son suffered from this type of jaundice; I am blood Type O, and he’s Type A. When our different types of blood merged during the birth process, my body basically created antibodies against his blood type, which caused a break down of his red blood that made extra bilirubin build up in system. He grew jaundiced. It sucked and I cried… but I digress.

Jaundice also occurs in a different form called “breast milk jaundice“, which MedLine Plus defines as “long-term jaundice in an otherwise healthy, breast-fed baby. It develops after the first week of life and continues up to the sixth week of life… It is probably caused by factors in the breast milk that block certain proteins in the liver that break down bilirubin.” This type of jaundice is typically harmless, and shouldn’t be confused with breastfeeding jaundice, which is caused by insufficient feeding, usually due to poor latching or supply issues, or as some sites somberly state, due to spacing out feedings too far apart or not co-sleeping. The body needs to flush out bilirubin, and it can’t do so if there is inadequate waste output. If a baby isn’t properly hydrated or fed, she can’t poop or pee. So in the case of bilirubin, the saying is actually want not, waste more.

I don’t recall being told much about jaundice in my prenatal classes; it certainly was not discussed in its relation to breastfeeding. This is odd, considering physicians have noted an increase in jaundice since the early 90′s, and severe jaundice is also suspected to be on the rise.

How do I help my baby stop looking like an Oompa Loompa?

Jaundice is treated one of three ways: formula supplementation, phototherapy (having the baby hang out underneath a special kind of light or biliblanket) and exchange transfusions (usually reserved for the most severe cases). The old-school approach to handling newborn jaundice was to supplement with formula; this is one of the quickest and easiest ways to help rid the body of excess bilirubin. You can also use donor milk (just not sugar water or other rehydration substances, which were historically also used as a means of hydration and jaundice therapy), and administer it through a supplemental nursing system (SNS), so “supplementation” doesn’t have to mean formula or bottles. But the new protocol for newborn jaundice is to take more of a wait-and-see approach; the AAP’s position is that breastfeeding should not be interrupted unless absolutely necessary, and that phototherapy be used as a curative measure:

In breastfed infants who require phototherapy, the AAP recommends that, if possible, breastfeeding should be continued (evidence quality C: benefits exceed harms). It is also an option to interrupt temporarily breastfeeding and substitute formula. This can reduce bilirubin levels and/or enhance the efficacy of phototherapy (evidence quality B: benefits exceed harms). In breastfed infants receiving phototherapy, supplementation with expressed breast milk or formula is appropriate if the infant’s intake seems inadequate, weight loss is excessive, or the infant seems dehydrated.

Many internet parenting and breastfeeding sites reassure parents that formula supplementation is hardly ever necessary, and this is probably true in a literal sense; most cases of jaundice will resolve with little intervention, and for those that don’t, there are other treatment options besides formula. But it’s important to know that these other treatments also carry risks, as this review article published on Medscape explains:

Phototherapy is not without disadvantages.. Under fluorescent tubes infants must wear eye protection and are usually separated from the mother in the nursery. Phototherapy may take days to exert the desired effect and, once the phototherapy lights are stopped, rebound hyperbilirubinemia may occur as bilirubin moves from the tissue into the blood. Risk of photooxidative damage to lipoprotein and red blood cell membranes is possible and data suggest that conventional phototherapy (with fluorescent tubes) may decrease postprandial mesenteric blood flow response that may adversely impact the neonatal GI tract.

The same paper also suggests that phototherapy “may not be as successful in decreasing serum bilirubin levels in breastfed infants due to increased enterohepatic circulation; supplementing with formula in addition to phototherapy may be more efficacious in these infants.” This is kind of scary, because is phototherapy doesn’t work… well, that leads me to the next question.

**Why do I have to care about jaundice? Maybe I like the color yellow.**

The problem with jaundice is that it isn’t a serious problem until it is. Explains the AAP:

Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus… is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment…

Pretty much the only presenting sign of jaundice is a slight yellowing of the skin and eyes. The other symptoms appear when bilirubin levels get dangerously high, putting your baby at risk for brain damage and other serious medical problems. WebMD tell us that the symptoms of jaundice-which-has- gone-too-far (the medical terms for this are “kerincterus” or “acute bilirubin encephalopathy”) include fever, sluggishness, poor feeding, irritability, shrill crying, and arching of the back. Which, except the fever, sounds like how almost every FFF Friday contributor has described her newborn when feeding problems were present. It might be hard to differentiate actual medical risk from normal newborn craziness or other feeding-related issues, and this complicates matters further.

According to the AAP, “immediate exchange transfusion is recommended in any infant who is jaundiced and manifests the signs of the intermediate to advanced stages of acute bilirubin encephalopathy (hypertonia, arching, retrocollis, opisthotonos, fever, high-pitched cry) even if the TSB is falling.” TSB is total serum bilirubin, used to determine the severity of jaundice; this means that even if the levels are falling, if your baby is exhibiting these symptoms, doctors may recommend an exchange transfusion. Exchange transfusion is basically a blood transfusion; it can be lifesaving when jaundice becomes dangerous, but it also carries the risk of anemia, air embolism…and even death. These are rare side effects, and even getting to the point that you need an exchange transfusion is relatively rare. But on the other hand, a 2009 study out of the Netherlands found that “all healthy newborns are at potential risk of kernicterus if their newborn jaundice is unmonitored and/or managed inappropriately…we have estimated that 1 in 700 well newborns can develop extreme hyperbilirubinemia; these infants can be at major risk for kernicterus if there are no failsafe, system-based protocols.”

**Okay, okay. Say I don’t want an oompaloompa baby. What’s my best plan of action?**

First of all, know your risks. The AAP states that “infants at less than 38 weeks’ gestation, particularly those who are breastfed, are at higher risk of developing hyperbilirubinemia and require closer surveillance and monitoring.” This risk increases significantly if you are having feeding problems. A 2009 study published in BMC Pediatrics found that “significant weight loss increase(s) approximately 4 times the risk to develop severe non-hemolytic hyperbilirubinemia in breastfed term infants and it seems to be worst when the cut point to define significant weight loss is higher (infants with a weight loss of 10% have odds 4.2 times higher). Both hyperbilirubinemia and feeding problems persist worldwide despite well-intentioned guidelines for care…” And, if you’re blood type O, you also are at higher risk for Type ABO jaundice.

Now, here’s the controversial bit: while it’s true that the major medical organizations are no longer recommending formula supplementation as the first line of treatment, you also have a right to know that providing formula or donated milk does improve jaundice. If your baby is feeding well, it’s probably not necessary to supplement; the phototherapy will most likely do the trick. But if things are not going well with breastfeeding, supplementing – in some way, shape or form – can help.

I fully comprehend why breastfeeding experts frown on supplementation. Interrupting the breastfeeding relationship in its literal infancy is not a great idea. Let’s look at this another way for a minute, though:

1. If the jaundice is caused or exacerbated by feeding issues, the breastfeeding relationship is already in jeopardy. A hungry, dehydrated, frustrated baby is often not a patient or energetic baby; how would you feel if you had fasted for 2-3 days? (Impressionable Fearless Husband has talked me into juice fasts a few times and I was certainly no fun to be around, nor did I have the “focused energy” all those diet plans promised…) I have yet to meet a woman whose baby wasn’t latching or whose milk didn’t come in, and had the situation spontaneously turn around without first ensuring that the baby was fed. I have, on the other hand, met several women who did supplement, and with some work and a good lactation consultant, got the baby to latch, improved their milk supply, and went on to exclusively breastfeed.

2. Having your baby end up in the hospital under the phototherapy lights, being monitored for a significant amount of time, is counterproductive to a struggling breastfeeding relationship, too. Phototherapy (as well as jaundice) can make a baby too tired to suck efficiently, and having a newly postpartum, stressed out mom is never a good thing, either. Phototherapy and hospitalization is a necessary evil for many of us, but if the medical authorities admit that supplementation (especially with a hypoallergenic formula, interestingly) will hasten the process, we have a right to know this. Some may still choose to stay away from formula, and I get that – as a vegetarian, I personally would do whatever I could to avoid giving my child a steak. (Although to be honest, if his life depended on it, I would be shoving veal cutlets down his throat. I love baby cows, but I love my son more.) But for those of us who don’t see a little formula as the be-all, end-all to child health, it is important to have this knowledge.

3. I have to wonder if the current recommendations regarding jaundice and supplementation have more to do with the demonization of formula than actual evidence. As a purely medical issue, we have a cure with no real, quantifiable risks – even if you believe that the risks of formula are 100% proven without a doubt, a small amount of the stuff administered as a one-shot deal hasn’t been proven to cause physiological harm (except for that whole virgin gut theory, about which I’ve yet to see any quality evidence). The breastfeeding relationship has been shown in studies to be affected by early bottle feeding, but this research is also somewhat questionable - the concept of nipple confusion has been questioned by breastfeeding guru Marianne Neifert herself.

4. There is so much conflicting advice regarding jaundice, and I worry that parents are seeing jaundice prevention/treatment and breastfeeding protection/promotion as competing entities. This is not true, and it is detrimental to all parties involved to think this way. A passage from a physician-penned article about the clinical presentation of jaundice explains the relationship between the two rationally and clearly:

Identifying the infants who become dehydrated secondary to inadequate breastfeeding is also important. These babies need to be identified early and given breastfeeding support and formula supplementation as necessary. Depending on serum bilirubin concentration, neonates with hyperbilirubinemia may become sleepy and feed poorly… The most rapid way to reduce the bilirubin level is to interrupt breastfeeding for 24 hours, feed with formula, and use phototherapy; however, in most infants, interrupting breastfeeding is not necessary or advisable… Detailed history and physical examination showing that the infant is thriving and that lactation is well established are key elements to diagnosis. Breastfed babies should have 3-4 transitional stools and 6-7 wet diapers per day and should have regained birth weight by the end of the second week of life or demonstrate a weight gain of 1 oz/d.

In summary, newborn jaundice is not a serious problem for most babies, which is why all those breastfeeding sites tell you that supplementing isn’t necessary. Some even suggest that breastmilk jaundice is biologically normal, and we just don’t realize it because no one has been breastfeeding much for the past 50 years. But jaundice can become serious, and you might not be able to distinguish serious jaundice from feeding issues or fussy-newborn-ness, so please don’t shy away from medical observation because you’re scared they might make you supplement. Your best bet is to find a breastfeeding-friendly pediatrician prior to giving birth; this way, you’ll know you can trust that the two of you have the same goals in mind. Lactation consultants are not experts in jaundice (unless of course your LC is a really well-trained, thoroughly-researched RN or an MD, which luckily some are), so it’s probably not safe to rely on them or your postpartum doula to judge whether your baby needs medical intervention.

Chances are no one will force you to supplement, but since you may have the ball thrown into your court, make sure you are able to weigh your options without misinformation or subtle pressure in any direction. Opting against supplementation is probably not going to lead to terrible medical consequences, unless you’re in a very specific, very serious situation. On the other hand, a few bottles of formula given in the span of a day or two is not going to put the kibosh on your breastfeeding relationship, and it may get rid of the jaundice faster and with less extreme interventions – which will allow you to get back to forging not only a breastfeeding relationship with your newborn, but a relationship, plain and simple.

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000995.htm

http://pediatrics.aappublications.org/content/114/1/297.full:

http://emedicine.medscape.com/article/973629-overview#a0199

http://archpedi.ama-assn.org/cgi/content/abstract/153/2/184 -

http://www.bestforbabes.org/fast-facts-how-to-deal-with-common-breastfeeding-issues

http://www.nejm.org/doi/full/10.1056/NEJMct0708376

http://www.medscape.com/viewarticle/497028_6

http://www.indianpediatrics.net/jan2007/jan-32-36.htm

http://www.biomedcentral.com/1471-2431/9/82

http://www.nature.com/jp/journal/v20/n7/abs/720041

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01230.x/abstract;jsessionid=B04E9CEFBDE7EFE1F2EEA02364908DDE.d01t01?systemMessage=Wiley+Online+Library+will+be+disrupted+24+March+from+10-14+GMT+%2806-10+EDT%29+for+essential+maintenance

http://www.clinchem.org/content/50/3/477.long

FFF Friday: “…I am filled with regret and disgust at my body’s inability to do something that comes so naturally…”

Posted on March 24, 2012 by Suzanne Barston

When discussing breastfeeding “failure”, we hear a lot about who’s at fault. It’s the fault of the formula company for tempting women with insidious marketing. The fault of the doctors for being too quick to supplement. The fault of the mother for not doing her homework; for accepting medical interventions; for not trying hard enough.

If you read through the FFF Friday archives, however, it seems the fault lies more in seldom-mentioned places. Lactation consultants who refuse to see the mother as more than a pair of lactating (or non-lactating, as the case may be) breasts; dogmatic and often incorrect advice doled out over the internet; a disenfranchised society that makes it virtually impossible for women to have the social, emotional, and physical support necessary to overcome severe breastfeeding impediments.

In FFF Wendy’s story, she speaks of feeling guilt and anger. The guilt is understandable given the current climate of breastfeeding promotion, but she has no reason to feel guilty. She does have reason to feel angry. Stories like this exemplify the insult of superfluous studies that waste research dollars which could be better spent on finding solutions to real, physical breastfeeding problems. It’s why so many of us feel abandoned by the medical establishment which convinces us of the importance of breastfeeding and then ignores the fact that our bodies are not machines, and “natural” processes don’t always happen naturally. And as she explains below, it’s why providing parents with evidence-based, unbiased advice on the practicalities of formula feeding is essential.

Wendy’s story is why this blog needs to exist, and why all of you – as a support system – are so valuable. As long as women are falling through the cracks in the system, we need to be there to catch them; remind them that they are great mothers; and reassure them they are not alone.

Happy Friday, fearless ones.

The FFF

***

When I was pregnant I never thought twice about NOT breastfeeding, of course I was going to breastfeed, no question. Everyone I know does. I am a stepmom to my husband’s two kids from a previous marriage and he has shared with me that their mother did not BF them, much to his disappointment, because she just simply didn’t want to. Both of my stepkids have suffered mightily with asthma and ear infections out the wazoo and my stepson at age 8 still has a speech articulation disorder that is a direct result of his many ear infections. My husband and I always kind of had this attitude that all this is pretty much their mother’s fault for being so selfish and choosing not to BF them because she didn’t feel like it. I guess the Breastfeeding Karma Bitch came to bite me in the butt over my judgment of her.

So pregnant with my son I took the classes, I bought the high end pump, I read the books, and most of all I talked to all my friends who BF. One of my best friends had a baby 10 weeks ahead of me and in talking to her about all the nitty gritty details I knew breastfeeding would not be easy. I was fully prepared it would hurt like hell after she shared with me that her sore nipples hurt worse than her labor. Minus the initial soreness, she had a relatively easy experience breastfeeding her child, no problems with supply or latching, but she was not shy about telling me the truth. I felt fully prepared and ready to do this for my kid.

I never in a million years expected or even considered it might simply not work for us. I completely fell for the line that “if you just try hard enough (and/or suffer enough) it will work! “

I had a really hard birth with my son. While his body was in the right position his head was not, it was turned, and they had a difficult time getting it in the right place. I hemorrhaged and lost a significant amount of blood–what amounts to 40%. I was on the borderline of needing a transfusion. In retrospect I wish they had gone ahead and done it as it might have made things different, although my doctor is hesitant to do transfusions unless absolutely necessary. I suffered a broken tailbone along with the expected tearing and hemorrhoids. They had to use the vacuum to get my son in the right position.

No one told me or seemingly even considered that the significant amount of blood I lost might make breastfeeding difficult. It wasn’t until day 9 when I still had only drops of milk and was having a terribly traumatic time that my dad, a retired cardiologist, consulted his medical resources and raised the possibility that I had Sheehan’s Syndrome, where the blood loss impairs the pituitary gland’s ability to produce the hormones necessary for milk production. Once that possibility was raised it all made sense— along with the nursing troubles I had classic symptomology of Sheehan’s Syndrome.

By this time I was already in what I call the third realm of hell–Unsuccessful Breastfeeding. Backtracking a bit: My son had colostrum in the hospital and while they told me my nipples were “short”, his latch seemed okay and we didn’t really have any problems. We had several sessions with hospital lactation consultants while still in the hospital and things were going okay. The first two nights we had him home he was fussy and didn’t sleep much, and I had trouble getting him latched. I never thought to put two and two together to realize that the colostrum was gone but there was no milk. By the third day we were home he was refusing to latch at all, he would just scream and rage. I would sit there sobbing uncontrollably with a very pissed off infant trying to get him latched while my husband looked on helplessly, or tried to give him what little milk I could express in a syringe like they had shown us in the hospital. In retrospect I can understand why my baby was so angry, I would be angry too if I was hungry and someone was shoving an empty boobie in my mouth. My breasts were still flaccid and when I pumped (after every nursing attempt) I barely got anything–usually nothing more than 1/2 an ounce if that.

Then my son began having bright orange streaks in his diaper, and an anxiety and tear-ridden visit to the pediatrician on day 5 of his life revealed he was very dehydrated. I was horrified. We were very close to a re-admission to the hospital. We immediately began supplementing with formula (while being told I could work on my supply and get back to EBF). The change in my son after receiving formula was dramatic and immediate–suddenly he seemed content, stopped fussing, slept soundly (if not for very long!). Every time I think about how simply hungry he must have been I feel terrible.

We continued the cycle the LC’s had recommended to us: try to get him latched for at least 15 minutes on each side, then give him supplemental formula, then 15 minutes pumping. It would take so long to get him latched (IF we could) that often the attempted nursing sessions alone ran 45 minutes to an hour, then add on the pumping (my husband would feed him the bottles while I pumped) and the cleanup of the pumping materials and I would have about 15-20 minutes to snooze before starting all over again. I didn’t mind the sleep deprivation as I was just so highly anxious and upset about the feeding process and working so hard to get a milk supply. I was actually pretty wound up most of the time. I was already taking all the herbs, drinking the tea, staying hydrated, had rented the hospital grade pump, etc and was considering the prescription drug Reglan.

On the 3rd post-discharge visit with the hospital LC I mentioned my dad’s suspicions about me having Sheehan’s Syndrome. She seemed surprised at my history of blood loss and said that she wished she had known that but admitted she had not read my chart. She told me based on that information she wasn’t sure I’d be able to get milk at all but that I should do everything in my power and give it my best shot, which of course I fully intended to do.

We continued the hellish cycle for as long as we could. I ran intermittent fevers during this time and was still just in general very weak due to the blood loss. We considered Reglan as advised and decided against it after learning it can exacerbate anxiety and depression. I have no history of depression but am a highly anxious, high strung individual to begin with, and my anxiety over all this was already through the roof. My husband in particular was adamant about not potentially making it worse with the drugs.

Nearly three weeks into my son’s life I was still just getting laughably miniscule amounts of milk on the pump, and he simply wouldn’t latch at all. After many tears we finally decided we had given it our very best effort and it was time to stop beating our heads against the wall. The LC’s were somewhat disapproving but not unkind, and they gave me instructions on how to “dry up” my milk supply. In retrospect that still makes me laugh because I guess they failed to understand the entire problem was I never really got a milk supply to begin with. My breasts remained flaccid and it was only a matter of about a day and a half before I had nothing left in them at all. Not even a few drops I could rub on his baby acne.

I grieved, and still do grieve, terribly that I couldn’t breastfeed my baby. Every time I look at my breasts I am filled with regret and disgust at my own body’s inability to do what comes so naturally, what should be so normal. I feel like my body betrayed me. Every time I glance at the pump still sitting in the nursery I am filled with a mix of emotions: anger, guilt, shame, and terrible grief. More than anything I am just SAD that nothing about my son’s delivery, his eating, or first few weeks went as expected. I am envious of my friends who breastfeed with seemingly no problems, even after a few initial bumps. I despise envy in myself but I feel it, strongly.

Prior to all this, I never really had a problem with formula or those who use it, it was simply just a non-issue to me. To be honest I didn’t think much about it at all. I know that while I was pregnant there was a tainted formula scare with Enfamil, and the only thing I could tell you about it is that I blew right past it and paid no attention because I never thought I’d ever have to worry about something like that. Thank God we had some samples of formula that had been mailed to us that I’d put up in a cabinet “just in case”. As much as I didn’t and still don’t really want to give my son formula I’m so glad it exists because without it he would be starving.

I also feel like the medical establishment failed us in that everything we learned about safely bottle-feeding formula we had to learn on the internet on the fly. I am ashamed to say those first few days of bottles we were so ignorant we didn’t even know to sterilize bottles, we were just rinsing them in hot water. Nobody ever told us anything about the logistics of formula feeding. If I had been half as educated about that as I was about breastfeeding maybe my anxiety wouldn’t have been so high.

My story echoes so many others of women who desperately wanted to breastfeed but simply couldn’t: grief, anger, regret, embarrassment, fear of judgment by others. I am a huge people-pleaser and a non-confrontational person to begin with but if I ever face blatant judgment or disrespect over giving my son a bottle I really think I just might lose it on anyone who says anything. Because I tried my damnedest to nurse my baby and I couldn’t. I remember many times sitting strapped to that hateful pump, tears streaming down my face at what wasn’t coming out of my breasts, and the thought that just kept repeating itself over and over in my head was “you can’t squeeze blood from a turnip and you can’t force milk from an empty boobie”. No amount of “trying harder” or “really wanting to” would have magically replaced the blood I lost or magically put milk where there wasn’t any.

I know logically that failure to breastfeed my son was not my fault, but it doesn’t stop me from feeling terrible and less than a mother/woman about it. I am still working on accepting this reality. It’s comforting to me to read stories on the FFF blog about other women who have been through what I have and still have healthy, thriving, and bonded babies. I read a quote the other day that I thought was so meaningful (sorry I do not know the original source/credit):

“This is a brick wall.
It’s in your way.
You can climb over it.
Or tunnel underneath it.
Or kick it down.
Or try to walk around it.
Or you can sit down on the ground in front of it
and weep bitter, life-is-not-fair, brick wall-hating tears.

But let’s be honest:
When you cry, your mascara runs.
And so does your nose,
and your eyes get red and puffy.
And when you are done,
That brick wall will still be there.
In your way.

But the choice is yours. “

***

Becoming an FFF Friday contributor is as easy as pie. And who doesn’t like pie? Simply email your story to formulafeeders@gmail.com to contribute to this collection of stories from truly fearless parents.

FFF Friday: “It felt like formula was okay as long as you tried your best…”

Posted on March 17, 2012 by Suzanne Barston

This FFF Friday contributor asked to remain anonymous, for understandable reasons. Her story highlights the fact that you NEVER know what is behind someone’s decision not to breastfeed. This woman’s reasons for choosing formula were deeply personal and specific, and in my opinion (not that my opinion, or anyone’s opinion, should matter) emotional discomfort with breastfeeding is equivalent to physical pain.

Both are hard. Both happen. And neither should be ignored.

Happy Friday, fearless ones…

The FFF

***

I have always known I would not breastfeed, not because I couldn’t, because I didn’t want to.
I have always had problems with my breasts. When I was going through puberty, I had some borderline molestation/fondling issues with a family female. She would feel my chest when she thought I was sleeping, it made me deeply self conscious about my chest. That was coupled with the fact that I was a late bloomer, so I would get nasty comments from boys about having no chest, then all of a sudden, boom! I inherited my family’s “blessing” of large chests and boys made gross comments about them, so I always tried to cover up and I developed terrible posture from trying to hide them. For a very long time I was ashamed of my breasts.

Before I even got married or got pregnant, I knew I didn’t want to breastfeed. The idea of it gave me the heebie jeebies. I know the research behind breast being best, but when I got pregnant I knew I still didn’t even want to try to breastfeed and I started preparing myself for all the naysayers who I thought would attack me for choosing formula.

I come from a family who strongly supports breastfeeding and my mom breastfed all five of her kids. Surprisingly, my mom never made any comments about my decision not to breastfeed. My father tried to convince me once, to at least try breastfeeding for a few weeks, but after I told him I was not going to do it, he never brought it up again. I was so surprised with how kind everyone else was when they heard about my decision. My OB asked at my first appointment if I planned to breastfeed to which I responded no and began awkwardly trying to explain. She immediately stopped me and said, you don’t need to explain at all. At that moment, I dropped all my defenses about it and decided to be confident when people asked the typical question perfect strangers think it is okay to ask a pregnant woman, “what is your plan with your private anatomy?” I only came up against one holier than thou woman who was vocal about the “fact” that formula is poison and how it will give my child diabetes and leukemia.

After I had my baby, I was a little worried because I had heard that the hospital I delivered at was notorious for their lactation consultants guilting new moms. Again, I was happily surprised that no one ever made a comment about my decision to not try breastfeeding. I loved formula feeding. My husband was able to jump right in with feedings and he loved feeding our daughter. She was small for gestational age so we had to closely monitor her consumption which was simple with formula, plus we used a high calorie formula to help. Night feedings we wonderful since my husband and I could switch off.

Around 8 weeks postpartum, I went into my OB for postpartum depression. It was one of the most difficult times of my life. During that time, I began doubting my decision to formula feed. If I had breastfed would I have gotten PPD? Whenever I sought out support for myself as a formula feeder, the web was full of support…… support for those who tried their hardest to breastfeed, tried until they cried and bled. Staunch proponents of breastfeeding made comments along the lines of formula is okay, if you gave it your all and you biologically can not breastfeed. It felt like formula was okay as long as you tried your best, but not fine if you chose it outright. With medication and therapy I got past my PPD and became more confident again.

I have loved the freedom that came with formula feeding. My husband bonded with our daughter and was truly a 50/50 parent because he was able to feed her so we were able to split parenting responsibilities. She was able to get a boost on weight gain with the higher calorie formula. I am so happy with my decision, I will definitely formula feed my next child. My daughter is a smart, healthy 14 month old and she actually gets sick much less often than friends’ children who were breastfed. I believe feeding your child is a deeply personal decision. I try not to ask pregnant mothers what their feeding plan is. If it comes up, I never ask them to justify their decision and I will never justify mine to anyone who asks me.

***

Waiting to submit your story? No time like the present… email it today: formulafeeders@gmail.com.

The healthcare experiences of formula feeding mothers: an interview with researcher Lisa Wirihana

Posted on March 14, 2012 by Suzanne Barston

Within its recently updated statement on breastfeeding, the American Academy of Pediatrics (AAP) issued a plea for universal adoption of the Baby Friendly Hospital Initiative (BFHI). If you’re interested in my thoughts on the BFHI, click here, but here’s the Cliff’s Notes: While I love the idea of better support for breastfeeding in theory, in practice, I do not think these “10 Steps to Successful Breastfeeding” will be all that successful. More urgently, I’m concerned for the parents who have made an informed choice to formula feed, and for the women who go in intending to breastfeed, but who have an unexpected, dramatic, physical or emotional reaction to the act itself (i.e., D-MER, flashbacks of sexual abuse, nerve damage). And I’m concerned for their babies. Because if formula feeding parents are not given proper support and guidance, mistakes can be made, and there can be serious consequences.

That said, I was pleased as punch to stumble across a study entitled “Women’s perceptions of their healthcare experiences when they choose not to breastfeed”, which was published in the March 2011 edition of the journal Women and Birth. “The purpose of this study was to explore the postnatal

experiences of women who do not breastfeed and to gain an understanding of women’s perceptions of their care and support in their choice not to breastfeed their baby. The research focused on a group of women who are representative of those who have made the decision not to breastfeed by the time they are discharged from hospital. This demographic is often excluded by the current health care focus on

breastfeeding,” the study begins. While this qualitative research study only examined a small group of women in one hospital, the authors speak to significant need for further exploration of this topic:

If women are not supported, and educated in their choice not to breastfeed, both mother and infant are put at risk. The realization of this risk may result in future hospital admissions. If the correct preparation and storage of infant formula is not followed, infants are compromised from bacterial infections, diarrhoea, hypernatraemia or hyponatraemia or under nutrition. Mothers who do not breastfeed and do not feel they were supported in their choice are also at risk. The potential risks for the mother involve feelings of guilt, anger, worry, uncertainty and a sense of failure.

Once I’d pinched myself sufficiently to ensure that this wasn’t just a fantasy – that there was actually a published study which not only acknowledged formula feeding mothers as something other than truants or morons, but also addressed a very real, and very current need for formula education – I contacted the lead author, Lisa Wirihana. She very kindly agreed to answer some questions for us about her study, as well as offering some thoughts on the BFHI and how formula feeding mothers are being approached. I hope Lisa’s work will begin a healthier conversation about how breastfeeding can be encouraged and protected without throwing the formula fed baby out with the bathwater.

***

FFF: Why did you become interested in this topic?

LW: When I had my children, I breastfed, because that is what my mother and sister did and what I thought I should do. I enjoyed breastfeeding, and I did not experience any problems with it. I had friends who bottle fed their children and I was interested in their stories of how they felt they were treated. Many years later, when I was working nightshift as a midwife on a Maternity ward, one of the other midwives came into the office. This midwife was concerned because she had just spent a lot of time with a bottle feeding mother who had been upset by what she called ‘breastfeeding nazi’s’. At the time I was studying for a Master of Nursing and was searching for a topic for a research project. I was really interested in the topic, because for me, I think it is a matter of equity. All mothers and babies should have their needs met, regardless of their choice of infant feeding.

FFF: How is the system currently affecting women who decide not to breastfeed? What are the possible detrimental effects of the current status quo, both to mothers and babies?

LW: I think it is important not to underestimate a woman’s desire to be seen as a good mother. When women are made to feel that they have made a poor decision regarding infant feeding it puts them at risk psychologically. By not arming a woman with the correct information on how to sterilize feeding equipment and how to make up a formula safely, babies are being put at risk for gastrointestinal illness and other forms of sepsis.

FFF: Did your findings support your initial thesis, or were you surprised by what you discovered?

LW: When I started interviewing women and asking them to describe their experience with bottle feeding in a maternity hospital setting, I was actually surprised by one factor. Almost all of the women really liked the hospital and really liked the care that they had been given. They expressed a great respect for most of the midwives. In the next breath they would say that they got no information about how to make up a bottle and were not permitted to obtain their own bottle from the milk room. They felt that they were not supported in their decision to bottle feed. I am surprised that those two factors can go together.

As far as the need for more teaching and support and the desire not to be pressured into feeling like they should breastfeed, I was expecting those results.

FFF: Did you speak to any healthcare workers while conducting your research? What was their take on the situation?

LW: I had a mixed reaction. There were some midwives who were very in favour of the research and even helpful to find participants and show me posters that they were concerned with. There were a few that were less helpful. I was told subtly that I needed to be careful as midwives who appear to be pro bottle feeding could be at risk of losing their midwifery registration.

FFF: In your opinion, how do you think healthcare providers should approach the infant feeding decision? If a woman has expressed an interest in formula feeding, how should this be handled?

LW: I think when a woman expresses the desire to formula feed a gentle questioning of what her reasons behind that decision should be explored. It may be from lack of information that the decision has been made. If the woman fully understands and can make an informed decision to formula feed, (for reasons that are important to her) all efforts should be made to support her in that decision. This should include documentation that she has made an informed decision, so that she does not need to be questioned again.

FFF: How has the BFHI changed women’s experiences in the hospital?

LW: I believe the introduction of BFHI has had an effect on women’s experience. For breastfeeding mothers, I think that effect is a positive one. Much more support and education has been developed to promote, protect and support breastfeeding. For mothers who are bottle feeding, I believe there has been a less than positive effect. All information regarding formula feeding is seen as a risk to mothers who are breast feeding. The policy is that no breastfeeding mother should be exposed to anything related to bottle feeding. This has had an effect on the treatment of all mothers. I believe that not only is this detrimental to the psyche of bottle feeding mothers, it also contributes to the lack of knowledge that they receive. However, it must be said that BFHI guidelines clearly state that once a woman has made a decision to bottle feed she should be educated and supported in that decision. I think there are variations on how that is interpreted. Also, the promotion, protection and support of breastfeeding is incredibly important. However, that should not be done at the detriment to those who do not breastfeed.

FFF: Has this study been well received?

LW: The study has stimulated a lot of discussion. If it achieves nothing more than making people aware of the needs of bottle feeding mothers, it will have been a success.

***

I want to thank Lisa once again for participating in this interview. She tells me she is currently looking to enroll in a PhD study to examine the culture of infant feeding within western society, and I seriously hope that she continues down this path. We need more people with this level of sensitivity, nuance and intelligence contributing to the infant feeding discourse.

And what about you, FFFs? How would you envision a truly baby – and mother – friendly hospital operating? How would you have wanted to be approached by healthcare providers when it came to your feeding decisions (or lack thereof)?

Fearless Formula Feeder

Infant Feeding Support

Monthly Archives: March 2012