FFF Friday: “Formula felt like failure.”

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 also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so.

I saw the most awesome tweet today, from a Canadian physician named Dr. Daniel Flanders. “Want to improve #breastfeeding rates without guilting moms who choose not to breast feed?” he asked. “Think ‘SUPPORT’ not ‘PROMOTE’”.

I don’t know this guy from Adam, but I wish I could buy him a pony out of gratitude. (Provided he wants a pony, of course. They might be kind of messy and expensive to feed.) There is a marked difference between promotion and support, and this is the fundamental problem in how breastfeeding is being handled in today’s society. Laurie, whose story is below, could have been spared a lot of grief and bother – and may have had a better breastfeeding experience all around – had there been care providers around her armed with better research and skills.  When we focus so much on raising breastfeeding rates, rather than on fixing the common and (not actually so) rare problems which can impede or destroy a mother’s attempts to do what she feels is best for her baby – well, we’re the failures, not the moms. 

There is no reason women like Laurie should be left feeling guilty, and yet they do. Not that I advocate guilt, but honestly? If anyone should be feeling ashamed, it’s those championing a system which put zealotry above real research, and statistics above individual experiences. 

Support, not advocacy. Wise words.

Happy Friday, fearless ones…

The FFF

Laurie’s Story

I was determined to nurse my first child.  I had no desire for an unmedicated childbirth, but I was all for breastfeeding.  Best-laid plans…after a very long labor in which my epidural failed miserably, I got to the pushing stage and then, before I knew what was happening, my baby’s heart rate had dropped dangerously, and I was going into shock and being rushed into an emergency C-section.  It was such an emergency, in fact, that they hadn’t even finished putting me under before they started cutting. Turns out, I had a uterine rupture.  After a few very scary hours (for my family, not for me — I was unconscious!), it seemed certain that I would pull through.  And, thankfully, my son was just fine.

So…Evan was perfect, but I was not. In fact, before long, the breastfeeding thing really had me discouraged. In my breastfeeding class, we were told that holding your baby skin-to-skin within the first two hours of birth would increase your likelihood of breastfeeding success by 80%. Well, guess what? I was unconscious the first several hours after his birth and didn’t even get to see him until 6 hours later, so that didn’t happen.

When we did try nursing, it did not go well. Evan seemed to latch on but then would get frustrated and scream. The lactation consultant at the hospital was not very encouraging. Leaving aside her pronouncement on my shortcomings (inverted nipples, if you care to know), she informed me that Evan’s mouth was too small to keep a latch and as he got older and bigger he might be able to nurse, but in the meantime I should just pump.  A few weeks later, the pediatrician diagnosed tongue-tie, and we got that fixed, but things were no better.  Every time I tried to nurse, Evan just screamed.  I originally tried to follow the La Leche leader’s advice and feed him only with a medicine dropper so that he wouldn’t get nipple confusion, but do you know how long it takes to feed a baby even two ounces with a medicine dropper? By the time I finished, it would be time for the next feeding!

But pump I did, with the hospital-grade pump I rented, every 3 hours around the clock. At most I was getting 2 oz. at every pumping, and Evan soon needed at least 24 oz. a day, so, if you do the math, you will see that I had to supplement with formula. I tried to boost my production by taking a zillion herbs, eating oatmeal, drinking lots of water, even drinking beer, but nothing seemed to help. My doctor called in a prescription for Reglan for me, and I was told that if I followed the dosing schedule, my production should double within 5 days. Alas, I am allergic to Reglan. I took my first dose and woke up with a red, itchy rash all over my neck and chest.

I threw in the towel at 6 weeks. Formula felt like failure. I know lots of people were given formula and turned into healthy, contributing citizens (I’m one of them, actually!), but I also knew (perhaps you’ve heard?) that breast milk is best. So, even though Evan is a now very healthy toddler who has only had a handful of colds and one ear infection in his life, I held out hope that things would go better with my next child, at least on the breastfeeding front.

Unfortunately, I had another rocky start with my second son — he was born at 30 weeks, so I didn’t even get to try to nurse until he was 4 weeks old.  It was just me and that darn pump again.  Once I was able to try, though, I found that Ben latched immediately and was a very good nurser. While he was in the NICU I got to nurse him once every day when I visited, and he was getting bottles of my pumped milk.  At first my supply seemed pretty good, but it never increased to more than 2.5 oz per pumping session.  I tried nursing him around the clock  when he came home, then supplementing with what I pumped, but he was losing weight because he had to work so hard to get very little. The NICU LC was the first one to tell me that my problem is not low supply, it’s the fact that my nipples are so inverted that I have an exit problem. (Apparently, this only happens “in very rare cases.”)  The milk is not able to exit, which signals my body to stop making so much milk, which means that even though I was pumping religiously, the amount I was able to pump kept dropping.  A lightbulb went on when I got this diagnosis — that’s why with Evan I kept getting plugged ducts even though I thought I had a supply problem.  I was sending my body mixed messages.

My preemie is 21 weeks old now, a whopping 12 lbs., and I bid the pump adieu more than two months ago. I am not beating myself up about it this time around, but I am sad that my problem wasn’t detected before; apparently I could have had surgery to correct it in between pregnancies, but it’s too late now.  I am glad that my preemie was fed breast milk exclusively for the first 7 weeks of his life — at least he got all those touted immunities when he was most vulnerable. But now when someone asks if I’m breastfeeding (and people do, even mere acquaintances who really don’t have any business asking about the functioning of my breasts), I can just say, “No” and not feel the need to go into the whole sordid story so that they know it’s NOT MY FAULT.  Having gained a little perspective after my first child, I now know that the time when my babies are getting only liquid nutrition is fairly short in the grand scheme of things, and my breastfeeding “failure” was only the first of many, many opportunities for mommy guilt.

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Share your story for an upcoming FFF Friday: email me at formulafeeders@gmail.com. 

 

The two headed chimera of infant feeding studies

It’s been a crazy week here, and I was really hoping to pull some pithy, short post out of the exhausted recesses of my brain. So when a study came across the wire touting extended formula feeding as a risk factor for a certain kind of childhood leukemia, I stuck my fingers in my ears. (Well, I posted about it on the Facebook page, but that’s kind of like the passive aggressive form of social media, isn’t it?) And a day or two later, when the Interwebz started buzzing about the British version of the infamous Burden of Suboptimal Breastfeeding “study”, I shoved a pillow over my head and sang the soundtrack of Beauty and the Beast really loudly (that’s what’s popular with the Fearless Children these days. It’s a great soundtrack and all, but seriously, how many times can a person hear Be Our Guest without going nuts? Although I did recently discover this YouTube gem, which has given Little Town – or, as Fearlette calls it, “Belle Sahwng” – a whole new meaning…).

One is named “Twitter”, the other “Parenting Science”

Unfortunately, I’m realizing that there is far too much inaccuracy and fear mongering going around to ignore. I don’t think I have the mental capacity to write a whole long diatribe, but I do want to address a few memes that are spreading like a California wildfire.

Courtesy of the UNICEF “Preventing disease, saving resources” report, I recently saw a discussion of how in the UK, only 1% of women are breastfeeding exclusively at 6 months. The consensus was that since formula feeders are so obviously in the majority, there is no need for them to feel marginalized.

I was shocked at that 1% statistic, and when I first heard it I was seriously blown away. But let’s look a bit closer at what the report actually says:

“….the proportion of women still breastfeeding at six weeks after birth increased by only a few percentage points between 2000 and 2005 – to just under 50% (Bolling et al, 2007). Rates of exclusive breastfeeding are much lower – only 45% of women reported that they were breastfeeding exclusively at one week after birth; fewer than 1% were still doing so at six months (Bolling et al, 2007). The rapid discontinuation of breastfeeding in the early days and weeks after birth, seen consistently since national surveys began in 1975, has only marginally improved to date, demonstrating that women who start to breastfeed often encounter problems, whether socio-cultural or clinical in nature, and stop. Ninety per cent of women who stop breastfeeding in the first six weeks report that they discontinue breastfeeding before they want to (Bolling et al, 2007). As a consequence, women can feel that they have failed their babies (Lee, 2007), and the great majority of babies in the UK are fed with formula in full or in part at some time during the first six months of life, and by five months of age, 75% of babies in the UK receive no breastmilk at all.” (p. 35)

First things first: notice the amount of 2007s in that paragraph. Yup, the stats they are citing are from a 2007 report, which offered statistics gleaned from a 2005 infant feeding survey. 

Aw, come off it FFF, 2005 wasn’t that long ago.  Things can’t have changed all that much in 7.5 years. 

Well, let me just say this: I want to see statistics from at least 2010. (They have them, but these 2010 survey results do not include information on duration, just initiation.) I have a gut feeling, from my reading of the research and observations I’ve made from the sheer number of emails I get from our UK sisters, that things have changed. In a Twitter conversation tonight, someone with an adolescent son mused that if social media had been around when she was a new mom, her postpartum experience would have been markedly different. The advent of social media has changed the infant feeding world – yes, it may only be on a sociological level, and we may not yet be seeing huge statistical jumps in breastfeeding rates, but both breastfeeding awareness and pressure have increased since new mothers began spending more time on Twitter and Facebook than in mommy-and-me groups, or with their sisters, friends, or mothers.

Additionally, the last sentence of the paragraph – perhaps the most jarring- carries no citation. If we don’t know what they are basing this on, it’s hard to say if it’s hard fact, or merely an assumption by the authors. (Oh- and that reference to women feeling like they have “failed their babies” rather diminishes its citation, Ellie Lee’s landmark 2007 paper about how morality plays into the infant feeding debate. From what I gathered from her work, these women do feel they failed their babies when they switch to formula because they are MADE to feel that way by society- not because they have an innate sense of wrong-doing. I think this allusion ignores a large piece of the puzzle, and allows the authors to pay lip service to formula feeders while simultaneously perpetuating the cycle of shame. Then again, I’m already ornery, so maybe I’m over-analyzing this.)

What strikes me as odd is that I recently saw this press release, also from Unicef, applauding NHS for achieving a landmark: 8 out of 10 British babies are now breastfed, thanks to the Baby Friendly Initiative. Obviously, this is referring to initiation rates, not duration, so it’s apples and oranges. Any yet, the difference in tone confuses me – if the rates are going up, and it’s a cause for celebration, why the pessimism in this new UNICEF report?

I don’t doubt that UK breastfeeding rates are lower than most Western nations. That’s been the case for awhile. But even in Norway, exclusive breastfeeding rates at 6 months are pretty abysmal. That’s because… wait for it… most babies have received some solids by then. Even before the 6-month “ready for solids” party line started being questioned, most moms were letting their babies try a bit of rice cereal or some veggies between 5-6 months. Exclusive breastfeeding means exactly that – exclusive. As in NOTHING BUT BREASTMILK. This 99% of women not exclusively breastfeeding at 6 months back in 2007 was not necessarily a group of supplementers or early weaners – they could just as well have been people who cheated a bit on the 6-month rule for solids. (And more power to them if they did, considering some experts – and many moms- believe that when to start solids should be an individual thing, and based on a baby’s readiness anytime between 4-6 months).

The thing that scares me is that this paragraph – oh bloody hell, this whole report – is based on the assumption that no journalist or policy maker is going to take the time to dig up every cited study, or to pay attention to where the statistics are coming from. I would say the majority of people (shall we say 99%?) are going to assume that this paragraph translates to only 1% of women nowadays, in 2012, are making it to 6 months without using formula and that, my friends, is simply not the case.

Stupid thing to obsess about, right? Well, it might be, except this kind of confusing rhetoric is used throughout the report. They make a big stink about only using “quality” evidence, stating that the costs to British society would be far greater if they were able to use the plethora of less-conclusive scientific literature which links “not breastfeeding” (the word “not” is italicized every time it appears in this context. Kinda weird…) with things like ovarian cancer, SIDS, adult obesity, and Celiac disease. As it stands, they have calculated the health care costs of treating diseases primarily seen in non-breastfed babies: ear infections, gastrointestinal infections, respiratory disease, and necrotising enterocolitis, as well as breast cancer in mothers.

But what exactly does this “robust evidence” consist of? The authors thoroughly vetted the studies they used to determine the rates of specific diseases – so much so, that the outcomes were often based on one or two studies (like in the case of ear infection), as well as a few used for “corroborative evidence”. This report was not trying to determine the quality of breastfeeding research, nor does it purport to offer new evidence for the correlations they site. Rather, they are simply going through, deciding which studies to use based on specific criteria, and using those outcomes to determine economic savings.

(FYI, the authors admit that they leaned heavily on the Burden of Suboptimal Breastfeeding methodology to calculate their own costs. Please refer to our friend Polly over at MommaData for a good breakdown of why this method is inherently flawed.)

The report, which was distributed to and covered by every major media outlet in the UK, is lengthy and exhaustive – great for researchers, not so great for journalists. I doubt many who reported on this study read all 104 pages, including citations; I doubt many understood that the goal of the report was not to determine whether any of these conditions are actually caused by not breastfeeding versus being a matter of correlation too muddled by confounding factors, but rather it went under the assumption that these diseases/conditions were in fact PROVEN to be directly influenced by suboptimal breastfeeding. Get it? Report= economic case for breastfeeding. This is not a study proving anything new.

I admit that this report is far more palatable than its Yankee counterpart. There is legitimate attention paid to why women aren’t breastfeeding, and it even references studies and literature about the guilt and feelings of failure which occur when women cannot breastfeed (if somewhat incorrectly – see above reference to Ellie Lee). I appreciate that. But just as I worried (justifiably, it seems) with the Burden of Suboptimal Breastfeeding, I fear that this will be adopted into the infant feeding canon, and used incorrectly to support a myriad of other studies. This is how it works, unfortunately.

I also want to mention that the lead author of this study is Mary Renfrew, who has been quoted as saying that “women are born to breastfeed”. To me, this rings of bias, which can easily lead to confirmation bias. And when you’re basing a report on the opinions of a few key people as to what is considered “quality” evidence… I wonder if a neutral party would have given this study more gravitas. Good luck finding a neutral party in this field, though…

Moving on. The next hot new thing on my Twitter feed is a study which links childhood leukemia with a longer duration of formula feeding. This study may very well be credible. I have no idea, and neither does anyone else commenting on it – because it isn’t published. It isn’t even peer reviewed. And yet it is flying through the airwaves, causing squeals of “formula feeding causes cancer!!” in a manner that echoes with thinly veiled I-told-you-so’s.

But that’s not even the interesting part. Let’s go under the assumption that this study will come out and be stellar and scientifically sound (because we can’t really do anything in terms of dissecting it until we can see the damn thing, anyway). According to the study, do you know what also carries a comparable risk of childhood cancer development? Later introduction of solids, regardless of infant feeding method. Breastfeeding alone did not have a significant effect, but rather the length of time using formula, and the length of time the child went without solids in their diet.

I haven’t seen one freaking tweet about the solids thing. Not ONE.

I may well be a Defensive Formula Feeder, as one beloved lactivist blogger has knighted me, but here’s what I don’t get: one of these (assumed) correlations supports advocating for an act which often involves major social, emotional, physical, and economical sacrifice on the part of women. (It shouldn’t, but right now, in our society, it often does.) The other correlation just implies that you need to start giving Junior a daily dose of butternut squash around 6 months of age. Why are we so focused on the one that is complicated by socio-biological factors, and not one the one which would be easy for most parents to incorporate into their child-rearing?

I’m not pissed about the studies, people. I’m pissed because THIS is how we’ve arrived at this place. This place where women are being pitted against each other; this place where we are made to feel responsible for the wealth and health of the nation, so that our governments can spend a few bucks pressuring women to breastfeed rather than figuring out real ways to enhance socioeconomic disparities; this place where one can’t question the intentions or quality of a research paper without being accused of being anti-breastfeeding or anti-mother or anti-science.

Speaking of Beauty and the Beast…this game of championing-research-which-can-mislead-and-and-scare-new-parents-before-stopping-to-fully-comprehend-it reminds me of The Mob Song (my son’s favorite). As the townspeople march towards the Beast’s castle with fiery torches, they sing: “We don’t like what we don’t understand- in fact it scares us, and this monster is mysterious at least… here we come, fifty strong, and fifty Frenchmen can’t be wrong…”

Imagine those Frenchmen with Twitter and Facebook accounts, multiply them by about 1000, and you have a great explanation of what’s wrong with social media and parenting science, my own personal two-headed Chimera.

 

 

 

FFF Friday: “All of our decisions were made with an eye towards ensuring breastfeeding success.”

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 also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so.

Of all the misconceptions and untruths running rampant in the parenting community regarding breastfeeding, one bothers me more than any other. It’s the “you just didn’t try hard enough” sentiment, often heard alongside it’s ugly stepsister, “Nearly everyone can breastfeed if they just are willing to put in the work.” 

My analysis of these insulting adages? They usually come from a) people who have never breastfed themselves, b) women who had some minor breastfeeding issues and were able to work through them or c) women who breastfed effortlessly. When I encounter such attitudes, I always feel like screaming the immortal words of MTV’s Diary- you think you know, but you have NO idea.

Amanda’s story gives us yet another example of an intelligent, educated, dedicated breastfeeder who ended up turning to formula. She did everything right, and was still made to feel as if she did something fundamentally wrong. What’s even more ridiculous is that Amanda is still pumping (at least as of her submission date to FFF), trying her damndest to give her baby the “best”, and yet it’s still not considered breastfeeding “success.”

Well, that buck stops here, folks. Let’s take back the word “best”. Best is subjective. Best means your personal best; how best is defined for your family; what is best for your particular child. Your “best” is…well….best. (FFF Desiree Johnson came up with that one a few weeks ago on the Facebook page, and I think it’s pretty spot-on. )

I’ll be back with my own posts next week… focusing on the book promotion crap at the moment, but I don’t want it to be at the expense of the blog…so I promise to kick my butt in gear soon.

Happy Friday, fearless ones…

The FFF

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Amanda’s Story

From the moment my wife and I decided to start trying to conceive, I just knew I would breastfeed.  First, we generally fall on the attachment-parenting-hippie-crunchy end of the parenting spectrum, and breastfeeding seemed like a natural fit with that.  Second, we live in a community where breastfeeding is very common, and breastfeeding support is truly first rate. Third, we are frugal people…throughout my pregnancy, we referred to my breasts as “the best coupons ever”.  I honestly never considered any other options.

I have PCOS (we’ll call that “warning sign #1”) so we guessed that getting pregnant would be a bit of a challenge for me, but 12 days after our very first IUI we got our positive pregnancy test. I was still hesitant to relax – my progesterone was low (warning #2), and miscarriage rates are incredibly high in women with PCOS.  When the first trimester ended, I breathed a gigantic sigh of relief…I’d overcome my big PCOS hurdle, or so I thought!  My pregnancy was mostly uneventful – a bit of nausea once or twice, some body aches, but nothing to write home about.

All of our major decisions were made with an eye toward ensuring BF success.  I chose my OB/midwife practice because they delivered at a birth center inside a Baby-Friendly hospital, and we hired an amazing doula so we could stay home as long as possible, because I was determined to avoid epidurals or a C-section.  The pediatrician we chose is married to an IBCLC and is incredibly pro-BF.  We took our childbirth classes and breastfeeding classes, and I read just about every major pro-breastfeeding, pro-unmedicated-childbirth book that I could lay my hands on.  I told my wife I wanted to donate all of our formula samples before the baby arrived –I wouldn’t need them, after all, and research showed that if I even had them in the house, I’d be jeopardizing my BF chances (she, wisely, said “Well, let’s keep them, just in case”).  I had my breastfeeding pillows, lanolin, breast pads, and a pump all ready to go, along with multiple boxes of milk storage bags for my soon-to-be-overflowing freezer supply. Meanwhile, my breasts had gotten a bit fuller, but not nearly as much as I’d expected(warning sign #3).

After 5 days of prodromal labor, things picked up in earnest.  We had an active labor at home.  I ended up arriving at the hospital at 9.5 cm, and they just managed to get the tub filled when he was ready to be born.  His birth got a little hairy – first the cord was around his neck, then his shoulders were stuck for about a minute and a half and he was born “stunned”, so had to be taken immediately to the warmer (he was just fine, we were both just a bit worn out from the ordeal). Then, probably because of the 5 days of prodroming, I hemorrhaged (warning sign #4).  My 8 lb, 4 oz son was put to my breast and immediately latched on, which was great, because it helped to control the bleeding.

All of the nurses at the hospital had lactation training, and they all commented on what naturals we were.  My doula said that I had “perfect” nipples for breastfeeding, and the IBCLC told me that our latch was great.  I kept waiting for painful fullness (that’s #5), but eventually we ate the cabbage that I’d bought anticipating engorgement…it just never materialized.  Our son fed CONSTANTLY, but didn’t appear to be dirtying diapers nearly as much as was expected (#6). The advice nurse told us that as long as he was wetting diapers, we were still fine. At our first post-discharge appointment, the baby had lost 7 ounces, but the doctor said he wouldn’t worry unless he was still losing at the two week appointment.  Nevertheless, he continued to poop less than expected, nurse for hours on end, and be hard to rouse for and during feedings (#7) – we resorted to rubbing him with cold washcloths, to try to keep him sucking for more than a minute or two at a time.

At his two-week appointment, he had lost 5 more ounces, and the pediatrician was officially concerned.  He suggested that I buy a Supplemental Nursing System to give him a little formula until we got my supply up, and asked us to come in for a re-weigh in 3 days.  I cried my eyes out all the way to the specialty mom and baby store, cried in the car while I made my wife go in to buy a short-term SNS and an expensive herbal tincture to increase production, cried on the ride home, cried while I mixed up the formula, and cried while I struggled to tape on the SNS.  My son ate like he was starving (which, you know, he was) and then fell fast asleep while I called the pediatrian’s  IBCLC wife.  She gave us a ton of suggestions on increasing supply, all of which I followed – water, hours of skin-to-skin, using the SNS, pumping every two hours or after every feed, whichever was more frequent, enough Fenugreek that I smelled constantly of maple curry, Goat’s Rue, and a prescription of domperidone at a dose that cost us roughly $5 a day.  With that, he was still drinking about 20 ounces a day of formula, so we think I was producing maybe 5 ounces total per day.

With the formula supplements, he started gaining right away, and became a totally different, much more alert, much happier baby.  I, however, was becoming exhausted and depressed.  We were completely tied to the house – even if I could somehow bring the pump, SNS, tape, and formula out with me, I was so mortified to be “failing” at breastfeeding that I refused to feed him in public, or even in my living room if anyone was there other than my wife. I began to dread the sound of him waking up, knowing that each time he cried from hunger, it would start an hour plus session of feeding, pumping, and washing all of the bottles and pump parts. He was super-alert and playful right after his feedings, but of course I missed all that, having handed him off to my wife to hold and play with while I pumped.  9 times of 10, he was asleep again before I was done.  I found myself yelling at him and getting angry and frustrated when he’d spit out the tube in the middle of the night, knowing it was going to be a battle to get him re-latched onto the finicky, leaky SNS.

And then there were the judgments. I posted on a few message boards about my troubles, and got a whole lot of “well, you gave into the pressure to give him formula, so his gut bacteria are already ruined, and it’s no wonder your supply tanked after you supplemented” and “before formula existed, people found a way, so there’s no reason you can’t make it work if you want to”.  Once, a woman who spotted my can of formula in my shopping cart told me that she “just feels so bad for children whose parents are too lazy to feed them properly.”

We slowly accepted that this was not going to be quickly resolved and bought a new, permanent SNS. I resigned myself to rashes on my breasts from taping on the tubes, cracked nipples from the pump, and allowing my wife all of the bonding time with my son, still convinced that my supply would increase and we’d eventually be able to have a “normal” nursing relationship.  Several times, I put him to my breast, only to have him scream and cry when almost nothing came out…which of course made me cry more.  I kept trying, convinced that if I just did everything right, things would all work out. At my 4 week follow-up with my midwife, I cried when I saw the “It’s Easy to Make Plenty of Milk” poster hanging in her office, and felt the need to explain to her all of the things I had tried, afraid she was going to judge me for my failings (she didn’t, and was awesome, as were the lactation consultants.  All of the medical professionals in my life were much kinder to me than I was).

With all of this, after 4 more weeks, my production was up to maybe 12 ounces a day.  One night, in a haze of exhaustion, I accidentally put part of the SNS down the garbage disposal.  My wife exploded about how much my breastfeeding failure was costing us in supplements, Canadian drugs, formula, and expensive nursing systems, I cried for 2 hours, and we eventually decided that paying another $70 to replace it just didn’t make sense.  I resigned myself to pumping and giving my son whatever I could make.

Funnily enough, once we dropped the SNS and I let myself accept that I wasn’t going to ever breastfeed him as I’d imagined, my supply jumped (I think the stress of the whole SNS/pump/wash cycle, combined with the worry over whether my supply was increasing or decreasing, playing a big role).  We got a car adapter for the pump so we could leave the house, I started timing my pumping so that I could spend time with the baby while he was awake and alert, and I started to really enjoy feeding times, where all I had to do was focus on him, instead of on whether the SNS was leaking, whether the tube was in his mouth right, or how long it would be before I could be done feeding and pumping, because I only had 2 hours before I had to be up for work.    And I slowly started “coming out” as a partial formula feeder, talking about my experience with a few other new moms, always starting with a long diatribe of all of the things I’d tried to make feeding work.

I still combination-feed my son, who is now 3 months old, with about half of his diet coming from formula, and the other half coming from what I pump.  I work from home, so I am able to pump whenever necessary, and for another, my wife is staying home with our son, so I have extra hands to help me with feedings that take longer than normal…otherwise, I have no illusions about whether we’d be able to continue this way.  For us, this is what works best.  But I am still working through my phobia of giving him bottles in public.  Today, I gave him a bottle in the middle of our Farmer’s Market…baby steps!  I am so incredibly grateful to FFF and other websites providing support for women who are feeding formula, wholly or partially – I truly believe that this site was a big part of me regaining my sanity around feeding my son.

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Tell the world why your best was best. Send me your story for an upcoming FFF Friday – formulafeeders@gmail.com.

FFF Friday: “I would appreciate people accepting that the pain I endured was real “

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 also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so.

This week I had the pleasure of participating in an interview on the Lamaze International-associated blog Science and Sensibility. The comments got a bit heated (as one might expect), and I found myself frustrated by the refusal of some folks to separate a criticism of specific types of advocacy from a criticism of breastfeeding. That’s why I was so thrilled when I realized Cathy’s story was next in the FFF Friday queue. She so beautifully articulates why it’s so vital for breastfeeding advocates to understand how it feels to “fail” at breastfeeding. And her ultimate message is so profoundly simple, and so seemingly obvious- yet for some reason, it’s a difficult one to impart. I appreciate how clearly and intimately she illustrates a point that so many of us want to make, and find ourselves too frustrated, fed up, or defeated to defend.

Happy Friday, fearless ones,

The FFF

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Cathy’s Story

Well, my breastfeeding journey started 12 years ago, before the birth of my beautiful daughter. We lived in Canada at the time she was born and a “Breast Is Best” type of incentive was already in full swing. I had been informed well before conception that it was the ideal. After reading endless parenting books and scouring the information that my doctor had provided me, I had come up a list of priorities for my upcoming birthing experience. At the top of that list was breastfeeding. I had another important incentive. My mother had been diagnosed with breast cancer the year before I became pregnant. I knew that in addition to all of the positive benefits for the baby, breastfeeding my baby would also help me reduce my already elevated risk for developing breast cancer. I had read about the difficulties that one may encounter; cracked nipples, bleeding nipples, poor latch, thrush, mastitis, engorgement, avoiding bottles of expressed milk to avoid nipple confusion, etc. Nothing deterred me. In fact, I was so committed to the idea that I hired a doula. I cannot stress enough how important breastfeeding was to me, even before giving birth.

Fast forward, to the vaginal birth of a 9 pound 7 ounce baby. I just have to say, my body went through a lot. I did not have an episiotomy. My body was allowed to do what it needed to allow for Baby B. to enter this world. I am keenly aware that if I had not been fortunate enough to give birth in modern times, I would have likely bled to death. I was in rough shape, but my doula helped me with the first few breastfeeding sessions in the hospital and I was grateful. Even though I felt like I had been run over, apparently I got a gold star for breastfeeding. There were no swag bags. There was no crib-side formula. The nurses also checked to see if Baby B. was latching correctly. She sure was latching and even the expertly packed, medical grade lanolin was not helping my very sore nipples. I didn’t have much milk, but I knew that I shouldn’t until my milk came in. The baby was very intolerant of my lack of milk. They say baby size doesn’t matter, but I felt like my sizeable baby was hungry and angry at my boobs for not providing. She did survive, as I was told she would. And my milk did come in. It was the pain that was unbearable. I had to nurse in private because I cried with every feeding. But, I had read that the pain goes away if you are nursing properly. I was also assured by my doula and my doctor that the pain would subside. I had my gold star for Baby’s latch, so all I needed was to give my breasts time to toughen up.

Once home, I broke out in hives from head to toe. I’ve never had an allergic reaction. Not ever. I was not only miserable from the painful recovery and excruciating pain from nursing, but now I was an itchy mess. An itchy, pink mess because I could not and would not take anything for the hives while nursing. I was told I could apply calamine lotion, hence my pink and messy state. It was a really tough time, but I remained committed to breastfeeding, through tears and gritted teeth. Unfortunately, the pain never went away. As many lactating women know, there’s this little device called a nipple shield. It is supposed to help. I was so hopeful that it would, but I cannot even tell you the pain that I endured with that little devil. Now, if you are in the midst of a struggle yourself, I would still recommend trying the nipple shield, because for many it is a godsend. I have many friends who swear by the shield to help alleviate the pain. I cannot tell you why it didn’t work for me. I have tried it with each subsequent baby and it has remained that way with me with each attempt. On baby number four I even bought two different brands. I would have tried 20 different brands to find one that worked! I tried pumping…both a manual hand pump and an electric pump. I was hesitant knowing about nipple confusion, but I was at a point of desperation. I have been through three different electric pumps and one manual pump over the course of this 12 year BF journey. The manual pump is the only one that ever allowed for alleviated pain, but in a one hour session, I’d be lucky to get half of an ounce.

Apparently I wasn’t suffering from a poor latch, mastitis or thrush. I felt extremely anxious and guilty for not being able to endure the pain. My milk supply started to dwindle. I believe that my stress level was so great at this time that my body started to fail me and I felt like I was failing my baby. My doula kept encouraging me, but eventually I started to supplement with formula. I was crushed. This was in no way my goal. I had some pretty hefty reasons for nursing and it was one of the lowest moments in my life.

Baby number two and number three, wash, rinse, repeat. Baby number two also coincided with the return of my mom’s breast cancer and her eventual death. I was more determined than ever to make it work…and it never did. I was living in the U.S. by this point and I sought a lactation consultant. Surely my doula and my doctor had missed something the first time around. With each pregnancy I would get myself pumped up to breastfeed, somehow hoping that, this time, I would be able to endure the pain and sustain my babies without formula.

I just had baby number four. All of my babies have been big and Baby E. has kept that trend up. No Gestational Diabetes or excessive weight gain, just big babies! Once again, breastfeeding was my goal, but this time I decided not to beat myself up if it didn’t work out. My husband could not have been any more supportive. He fully believed in my ability to decide what was best for Baby E. As he had previously, he left the entirety of the decision up to me. I cannot tell you how wonderful it feels to have that kind of support from someone and I am beyond thankful for him, even if that support cannot completely alleviate my feelings of guilt.

The pivotal moment in this long, hard journey came from a well- intentioned family member. This family member is a lactivist and upon hearing I was in tears after pumping blood, she approached my husband about a L.C. My husband told her to please not approach me about, as he did not want any additional pressure placed on me. He knew my twelve year battle with my boobs and he did his best to deter the offer. Still, the family member did contact me to “gift” me a consultation. This stung me almost as much as the nipple shield had so many times before. It was insulting, not because I was opposed to help, but because I had just had baby number four. It was insulting for her to assume that I had never sought help before, that I just needed to be informed. I could not and did not reply to her offer. As well-intentioned as I believe she was, there is no place for this over-stepping of boundaries. When will it ever be alright for a woman to say that she gave it her all and for others to believe her?

I am now in a place where I am more content. I look at my four beautiful, mostly formula fed children and know that breastfeeding is not so exceedingly better for a child. No one would ever know that I am mostly a formula feeder unless I told them. It doesn’t mean that I still don’t still grieve over it, but I can now state that I formula feed without feeling like I need to explain why. I am fine with sharing that breastfeeding hurt more than giving birth without an epidural. I can say it because I have done it. I don’t want a medal or super-hero status, but I would appreciate people truly accepting that the pain I endured was real.

One of the most hurtful aspects to me personally is, knowing that people think that because I am 100 percent behind a woman’s right to choose how she feeds her infant, that I am anti-breastfeeding, and NOTHING could be further from the truth. I envy any woman who is able to breastfeed. DO YOU HEAR ME??? I ENVY YOU!!! I feel guilt, I feel sadness and I truly grieve over not being able to breastfeed for as long as I wanted to. My guilt has been almost crippling at times. Please don’t put me in a box marked, “Bad Mommy.” I’ve already felt enough guilt and sadness to last me a lifetime. I celebrate breastfeeding successes. But one person’s success doesn’t give anyone the right to berate a woman for her feeding choice.

There was recently a post online stating that breastfeeding requires “effort.” I have known that for my entire adult life and I went far and beyond putting in “effort.” We are not lazy. We are not uninformed. Just as formula shouldn’t be pushed on a woman, neither should breastfeeding. Should it be promoted? Absolutely! But in our promotion of BF, we need to make sure that it is never at the cost of a woman’s feeling of self-worth.

To all of you who can relate to my story, we are sisters. So many of you have shared your struggles and they seem so far beyond anything that I endured. I will cherish these stories forever, because knowing that I am not alone has been the biggest part of my continual healing.

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I love what Cathy says about the “sisterhood”. There is power in community- share your story and become an integral part of ours. Send it along to formulafeeders@gmail.com.

Ready-to-feed formula may prevent Cronobacter infection in babies

I love when I’m right. I mean, it happens so infrequently (at least according to Fearless Husband).

Even before the Cronobacter scare of 2011, I’d dramatically changed my tune about formula preparation and safety. The research I read surrounding bacterial infection in babies due to formula or bottle use made me see just how piss poor our education on bottle feeding truly is; this is what spurred my interest in starting some sort of pre or post-natal educational workshop/literature for bottle feeders, and also made me suspect that there was an astonishingly simple – albeit prohibitively expensive – solution to the bacteria problem.

Safety, thy name is Ready-To-Feed.

Until now I’ve merely been able to suggest that my personal belief is that ready-to-feed nursettes are the safest bet for newborns, and especially for late pre-term babies or those with any sort of compromised immune system. Now, a study published in Pediatrics gives scientific credit to my completely unscientific gut feeling.

I’d say squeeeand do a little dance of egotistical joy,

but unfortunately I can’t. Because we are talking about infant safety here, and the solution which this study is suggesting is not going to be feasible for many parents due to the cost involved. This is turning my happy ego dance into a sad waltz. Which sucks, because who doesn’t enjoy a good happy ego dance?

The study, Prevention of Invasive Cronobacter Infection in Young Infants Fed Powdered  Infant Formulas, looked at the records of 68 babies infected with invasive cronobacter between 1958-2003, and 30 babies between 2004-2010. A couple of things to note before we get into the nitty-gritty of the study:

1. Invasive Cronobacter infection is extremely rare, and usually affects pre-term babies and very young neonates (all of the infants reflected in these records were under two months old).

2. This study had some significant limitations, considering that it was conducted using records from a variety of international organizations (CDC, USDA, WHO, as well as “personal communications” and “publications”. Definitions might have varied, as well as the quality of the information. This might explain the shocking disparity between the cases reported in the older batch (1958-2003) and the newer batch (2004-2010).

Now that the caveats are out of the way, let’s continue. The study found very different statistics in the two chronological batches. In the older batch, only 24% of the babies were full term; out of the more recent cases, 58% were full term. That’s a radical leap. Plus, while in the 1958-2003 group only 21% became symptomatic at home, that percentage jumped to 52% between 2004-2010. This may have something to do with the fact that there were half the number of cases in the more modern group versus the older one; if bacterial contamination was becoming more rare, then perhaps we’re dealing with a newer or more virulent strain in the new millennium. But I also wonder if part of the disparity between the characteristics of the cases has to do with the lack of formula feeding guidance. The resurgence of breastfeeding since 2000 has led to many fantastic outcomes, but the downside, as we’ve discussed before, is a refusal to address the needs of formula feeding parents. Historically, concerns about bacterial infection were focused on NICUs; the tubing used to deliver food to the tiniest babies could easily become contaminated if the utmost care wasn’t taken, and given the fragile systems of premature or sick infants… well, it wasn’t a great combination of risk factors. But looking at the statistics used in this study, it seems that in the past 12 years, full-term babies in their parent’s care – at home – were equally at risk. I think it merits further reflection, at least, to consider if these cases might have been due to parents being given no guidance or support with formula feeding. We know from our numerous conversations here, and on the FFF Facebook page, that most of us were given ample education on breastfeeding (even if we didn’t get much practical support); very few of us were instructed on how to formula feed safely, sometimes with the excuse from more intolerant healthcare professionals that there was no “safe” way to formula feed.

Regardless, even if we were given better instruction on safe bottle feeding practices, very young infants fed powdered formula are at significantly higher risk of becoming ill from invasive cronobacter. The Pediatrics study found that out of all infected infants studied, 26% had received breastmilk, 23% had received RTF, and 90% had received either powdered infant formula or human milk fortifier (which is another caveat I forgot to mention – powdered human milk also posed a significant risk, not just powdered formula. Apparently Cronobacter loves powder of any sort).

Okay- just so we are crystal clear here – the lowest percentage of infected babies came in the group fed ready-to-feed formula only. It even beat breastmilk (not by much, but I think it should be mentioned, since it would be if it were the opposite). So it’s a no-brainer that the study’s author then recommends the following:

Invasive Cronobacter infection is extremely unusual in infants not fed powdered infant formula/Human Milk Fortifier. RTFs are commercially sterile, require minimal preparation, and are competitively priced. The exclusive use of breastmilk and/or RTF for infants <2 months old should be encouraged.

I’ve been advising that newborns use RTF whenever possible for awhile now, but every time I do I feel like a classist a-hole. Because let’s be honest – the stuff is expensive. Even if you buy the 32-oz containers rather than the more costly (but sterile) nursettes, you’re still talking a major difference in cost for the recommended two months of use. And those first 2 months, there is a lot of wasted formula – babies are erratic, not on a schedule, parents are still figuring out hunger cues… it takes a few months before you know Junior will take exactly 4 oz every 4 hours. Powdered formula is significantly cheaper. And god help you if your baby ends up on a hypoallergenic – buying the RTF version of that stuff will seriously kill your bank account.

The big elephant in the room, of course, is that the formula typically given away in those controversial hospital swag bags is ready to feed – often in the form of sterile nursettes. Not that the amount in the bags would feed a baby for the entire two month window of risk, but the bags I received – generously “supplemented” by the maternity ward nurses since our breastfeeding-friendly hospital didn’t have many formula feeding mothers and there were plenty of leftover bags – gave me enough formula to get us through the first few weeks. Every little bit counts.

Now, I’m not naive enough to believe that the formula companies are giving away RTF out of the kindness of their hearts. But considering that the Ban the Bags movement has grown in popularity, and hospitals are going Baby-Friendly right and left – they are going to need an alternative way to market their products. Why couldn’t we set up a program which would give parents that have chosen to formula feed (or supplement) before leaving the maternity ward to request a “gift” of ready to feed formula? Formula companies could still reap the rewards of brand loyalty, and look somewhat altruistic in the meantime. The parents who receive these samples could be the same ones who already were forced to sign documentation which labeled them as formula feeders, so what would be the harm?

There needs to be a way to provide supplementing and exclusively formula-feeding parents with the safest breastfeeding substitutes possible. In the first two months of life, ready-to-feed formula is the safest commercial alternative. If the formula companies would be wiling to provide at least a few weeks of RTF to take the financial edge off, it might help parents afford RTF for the subsequent 6-7 weeks.

Seems like a no-brainer to me, but then again… you know what Fearless Husband says. I’m hardly ever right.

 

 

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