FFF Friday: “One thing I have in abundance is love and concern for my child.”

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.

Jennie is this Friday’s guest poster, and she makes a great observation about how easy it is to feel like modern parenthood is all about worry. From the first prenatal appointment through the day s/he graduates college (and I assume far beyond that, for many parents), we assume that our child’s “outcome” is solely based on what we do as parents. No, scratch that – as mothers. I don’t think most fathers are plagued by the same sort of mommy guilt (I blame Freud).

But like Jennie so beautifully illustrates in her story (whether she’s conscious of it or not), good parenting is somewhat unquantifiable. For every socially-endorsed “right” choice we make, there will be ten “wrong” ones made out of necessity, or because it ends up being the right choice for your particular circumstances. You really can’t win- so why play the game? Making your own decisions- ones rooted in “love and concern” and not based on fear or guilt- can not only be freeing, but also sets a tremendous example for your children. Strength, resilience and love are arguable the most valuable traits you can give a kid. Nine out of ten experts agree. Kidding.

Happy Friday, fearless ones,

The FFF

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Jennie’s Story

Despite my “advanced maternal age,” (I was almost 40 when my son was born), I had an uncomplicated pregnancy and delivery, and expected to breastfeed with no problems.  At the hospital, everything seemed to fall into place.  The biggest surprise was my son’s size – we had been expecting a seven pound baby and one who weighed a little over nine pounds is what emerged.  The nurse placed my son on my chest after all the cleaning/weighing was out of the way and he latched on immediately.  I felt very proud and confident, despite that fact that the initial latch-on caused a searing pain that curled my toes.

By discharge date, two days later, my son had lost about half a pound.  Not too alarming. By chance, the lactation consultant at the hospital offered a complimentary weight check for the following day.  I don’t know what would have happened if she had not, for the pediatrician that I had selected was not interested in seeing the baby for another two weeks.  At that complimentary weigh-in, we discovered that my son had lost an additional four ounces, and the lactation nurse was concerned.  So was I.  With the lactation nurse’s help, we set up an appointment with the pediatrician for two days later and in that time, I breastfed constantly, even though my nipples were cracked and bleeding, and when I pumped, blood mixed in with the milk.

Soon, I started hearing from friends and family about their breastfeeding woes.   Of all my friends, only one had started out with effortless, successful breastfeeding. Everyone else had endured some combination of pain, latching problems, and low milk supply.  Some of those women succeeded in eventually being able to exclusively breastfeed their children.  But not all.

At the pediatrician’s office, we learned that my son had not lost any more weight, but he had not gained either. The pediatrician told me to start supplementing with formula.  This hit me pretty hard, even though I had been very laid back about things like receiving the epidural during delivery.  My husband, thank goodness, is a no-nonsense type of guy, and he told me that the pediatrician would not recommend formula if it was harmful and that supplementing was not going to erase any of the benefits of breastfeeding.  (Being a scholar, he also started sending me links to Google searches about infant malnutrition in the 19th century caused by breastfeeding problems…)

It seemed that my problem was low milk supply.  I was producing enough milk to maintain my son’s weight, but not enough to enable him to grow.   I will never know why. My age? I have a history of thyroid problems but recent bloodwork showed me to be within the normal range.  We began a long and tiring saga of supplementing, weight gain, no weight gain, more supplementing, pumping exclusively, using a supplemental nursing system, taking fenugreek and blessed thistle, probiotics, eating excessive quantities of oats and almonds, and all the havoc that that particular diet caused to my digestive system.

One of the things that I continue to dwell on, even now, is the lack of synchronization and coordination between the various medical professionals involved in the childbirth and postpartum process. I wish there was a way to make the entire process more clear and easy to follow.  While my OB was wonderful and supportive throughout my entire pregnancy, once the baby was born, the OB had little interest in what happens next with the actual baby.  The OB’s role is to tend to me, the mother, and my gynecological health.  Despite the fact that the baby’s food source is physically connected to the mother, the pediatrician had little to offer in terms of breastfeeding support.  And while the lactation consultants in my hospital were very down-to-earth, they had no knowledge of my medical history.  At one point, one of the lactation consultants suggested that I might be developing thrush, based on some redness on one breast.  She suggested that I start to treat it by applying an antifungal cream and vinegar. When I visited the pediatrician, she examined the baby’s mouth and did not see signs of thrush, and had no interest in examining me.  Just thinking about who I would or should call if I developed mastitis or some other problem kept me awake at night.

While the hospital where I gave birth had a lactation consultant group consisting of three nurses, I find it troublesome that this is somehow an “extra” service.  Initial consultation is free, but after that, it’s treated almost like a spa – if you want to splurge the extra money for a full consultation, you can do so (and I did), but doing so made it feel like some sort of odd luxury, instead of necessary medical assistance.  And while the lactation nurses were on call 24 hours, due to a mixup no one visited me that first evening after my son was born, despite my repeated asking, and the non-lactation nurses did not seem to be able to help.  So I was left alone in my room, still exhausted and sore from the birth process, with a hungry baby, and little idea of what was normal.  I had a difficult time understanding the breastfeeding lingo – I realize now that it is because I was not really experiencing “let-down,” for example.  My breasts rarely felt full, and once my son started nursing, I never really felt any sort of sensation to indicate that milk was flowing.  Concerned by the tiny amount of breastmilk that pumping produced, it was difficult to find sources that would indicate what “normal” output should be for a new mother.  Another thing that caused problems for me was figuring out which breastshield to use with my breast pump. The standard size was too small, and there was no way to test alternate sizes. I blew money on every size, and am still not sure I was using the correct one.  You would think that the lactation nurses might have had sample sizes to test with, but even after I showed them how the shields were working with my pump, they seemed non-committal as to whether I was using the correct size or not.   “Free” breastfeeding cost me quite a lot of money in the end.

After five weeks of struggle, my milk supply increased only slightly.  It was inconsistent.  My brilliant son figured out how to use the supplemental nursing system tube as a straw, and he really, really seemed to enjoy the bottle more than anything else.  I think he liked the angle and that he could look at me as he ate. I agonized over how much milk he might be taking from the breast at each feeding, and seriously considered buying my own infant scale to make sure he was gaining weight.  My pediatrician, seeing how distraught I was, and also noting that formula now comprised at least 70% of my son’s diet, told me that the stress was not worth it and encouraged me to switch to formula full-time. I appreciated her support.

I had originally given myself until I used all of my vitamin supplements as the deadline for stopping any attempts at supplying breastmilk to my son.  But at around six weeks, I reached the end of my supplemental feeding tube, so to speak.  By that time, I was only pumping 2-3 times per day,  and producing about 6-9 ounces of breastmilk, total.  My gigantic baby needed at least 30 ounces, and sometimes more.  My mother-in-law was dying, and I had returned home with my son after a day-long visit to see her.  My husband had remained behind to be with his mother.  Twelve hours had passed since I had last pumped, and for probably the first time, my breasts actually felt heavy. I thought I would try one last time to see if my son would nurse. No dice.  Then I tried unsuccessfully to pump while feeding my son his bottle – I’d read about women doing this all time – how hard could it be?  After two minutes, I threw the breast shield across the room in frustration, angry that in the 21st century, no one had invented a more efficient way to extract breastmilk from women.  Then I realized that infant formula and bottles were the technological innovation I had been seeking.  I decided it was time to end the era of breastmilk and move boldly into the future: exclusive use of formula. It helped that I had stumbled upon the Fearless Formula Feeder website the day before.

No one in my immediate circle of friends and family gave me any pressure or guilt about the formula. Everyone was supportive and encouraging.   My mother fed me and my sisters formula. My husband’s mother fed him formula.  We are all healthy, allergy-free, and, I think, intelligent.  The guilt and drama stemmed from my attempts to learn more about the medical benefits of breastmilk over formula and encountering awful statements all over the Internet from people who zealously believe that formula is the devil’s milk.  Funny how comments from complete strangers could upset me so much?

As a parent, the worry begins before the baby is even born.  Will my age or my husband’s age affect our child’s health? If I drink this cup of coffee, will it somehow affect my child’s development? Epidural during delivery? Looking back, I find it difficult to believe how much I agonized over each of those things (especially the epidural – turns out, I loved the epidural).  The worry doesn’t stop.  Following my pediatrician’s advice (which went against the advice of thousands of Internet know-it-alls), I started my son on solids at 14 weeks.  I tried avocado and sweet potato and banana, because it seemed like it might be “healthier” than the rice cereal. Guess what he likes best? The plain old rice cereal (and I agonized for fifteen minutes in the grocery store over which rice cereal to buy… I finally chose Beech-Nut, and I don’t remember why).  Then there’s work and daycare.  I returned to work four weeks ago.  My work is four hours from my home, and I commute with my son (we spend three days at my parents’ house while I work on-site, and then the rest of the week at home, while I telework).  He attends two separate daycares, sleeps in two different cribs at night, and only gets to see his father four days a week.  I feel conflicted about all of these things, but mostly I am proud that I am able to provide for my son, and I hope that he will understand that my husband and I have chosen this lifestyle in part so that we can offer him as many opportunities as possible.

At four months, my son has already doubled his birth weight.  He is thriving.  With all of the coordination, preparation, change and anxiety of returning to work, I was relieved not to have to add pumping breastmilk into the equation.  I am filled with great admiration for those friends I have who managed to return to work and continue nursing, but thankful that I do not have to add that to my list of worries.  And I am now confident that I have made the right and best decisions for my son.  All of those breastfeeding troubles feel like they happened to someone else, a long time ago, and my only regret is that I made both of us struggle for as long as I did.  There are so many other things that contribute to a child’s well-being and development besides breastmilk, including caring parents, and one thing that I have in abundance is love and concern for my child.

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

A couples therapy session for Science and fed-up parents

You know how I’m always harping on and on about how we could be doing studies that actually help us protect infant health, rather than guilt-tripping mothers? My fairy godmother must’ve been listening, because today I stumbled upon an interesting article, courtesy of Mammals Suck (maybe she is a fairy godmother? Scientists can be fairy godmothers, can’t they?)

Featured on Nature.com, the article described two findings about the sugars in breastmilk. The first discovery was that one of the human milk oligosaccharides (HMOs) – the sugar molecules present in breastmilk –  can actually increase the chance of mother-to-child HIV transmission.

The molecule, called 3′-sialyllactose (3′-SL), is found in varying concentrations in the milk of different women. In a study in Zambia, HIV-negative newborns breastfed by HIV-positive mothers are twice as likely to catch the virus during their first month of life if the mother’s milk has an above-average level of 3′-SL1.

Doesn’t sound like the most positive news, but wait: only certain women’s milk contains significant enough levels of the sugar to place their babies in danger. Plus, other sugars have a positive effect:

The same study in Zambia found that five more of the 150-odd complex sugars in breast milk seem to have a protective effect. HIV-negative infants who consumed these sugars had a better chance of reaching their second birthday than did HIV-negative babies who drank breast milk lacking those sugars irrespective of their mothers’ HIV status. (Once a baby had caught HIV, however, breast-milk sugars had no influence on survival.)

 

The second part of the article described research into why some babies are not able to fight off necrotizing enterocolitis (NEC), despite being fed human milk. Breastmilk contains oligosaccharides that fight off this deadly infection – but as it turns out, not all women produce these sugars:

 (A team) reported an association between a dangerous gut disease in babies called necrotizing enterocolitis (NEC) and the inability of affected infants to secrete a suite of oligosaccharides in their mucus. These babies are considered particularly likely to benefit from drinking the sugars via breast milk, but about 10% of European women cannot make them in their milk…

 

Okay, so this is where it gets really interesting. Both of these examples suggest that depending on the composition of a particular woman’s milk, the health benefits of breastfeeding may not be identical across populations. A researcher quoted in the article hypothesized that “(t)he often confusing literature on breast feeding’s impact on disease will be largely explained by this underestimation (of the variation in human milk).” The article also explains how “(s)everal labs are trying to identify how variation in the prevalence of the large sugar molecules in breast milk… influences infant health. Once clear links are established, clinical trials to test HMOs as health-boosting additives in infant formula milk can be drawn up.”

Say WHAAAAAAAAT??

Yep, you read it correctly, FFFs. And I think we can all take a moment for a collective sigh of relief. Not all researchers are so entrenched in their  public policy advocacy efforts that they forget to see the forest for the trees! Not all lactation scientists are lactation consultants! Some are – dare I say it – scientists.

I fear that this is the type of research that gets pushed under the rug, because it requires critical thinking. There isn’t an easy soundbite that can appeal to the masses – in the first example, the answer is not to tell HIV+ women in developing countries to use formula until they are tested for the specific HMO, because formula feeding in resource-poor countries with contaminated water is a high-risk activity. But perhaps more research could lead to some sort of treatment which would help these women lower their levels of 3′-SL and increase the beneficial HMOs.

Similarly, what if a preemie’s mom wanted to get her breastmilk tested to see if it contained the necessary HMOs to protect her baby? And if she found that she was part of the 10% who didn’t produce these beneficial sugars, perhaps that could allow her to make an informed decision about using donor milk, while either pumping to keep up her own supply, or deciding to switch to formula once the baby was older.

Research like this allows for progress. It allows us to understand exactly what it is about breastmilk that makes it so beneficial, which might lead to better, more biologically “equivalent” options for women who can’t or choose not to breastfeed. But even taking it away from the infant feeding choice powderkeg for a minute, I think it’s an interesting thing to ponder why certain people are so uncomfortable with the suggestion that not all breastmilk is perfect milk. I mean, I understand it – who the hell is science to tell a woman that her milk isn’t “good enough”?

But people – this is exactly why we can’t be wishy-washy about whether breastfeeding is a personal act or a monitored, medicalized event. If we are going to pitch it to women based on statistics, telling parents that science has proven the medical necessity of nursing our young, then we must accept the risk that science could turn around and say “erm, you know what? I messed up. That’s only true for some women. Some gals just produce inferior milk.” While we might want to say screw you, science, and the horse you rode in on, we can’t. Because we used science in some very dirty ways when it suited our needs, and now it is hanging around like a rebound boyfriend who just doesn’t take a hint.

On the other hand, if we don’t allow medical authorities to lay down moral indictments based on the way we feed our babies, then we can easily kick science to the curb when it tries to tell us that our milk may not be all it’s cracked up to be.

Personally, I don’t think either scenario is great. As that Facebook group with the funny memes says, I f**king love science. Because I don’t think it’s true science that is messing things up for women. I think it is zealotry dressed up as science – people who are so committed to a cause that they are unable to come into research with the open, curious mind so integral to the scientific process.

So, I think as women, as mothers, it is safe for us to applaud research like this. We have to trust that knowledge can be power, as long as it is handed to us free of extrapolation. It’s not scary to hear that formula fed babies aren’t protected from NEC if donor milk is made available to preemie parents, or if we know that good old science is doing its best to create a supplement that could offer our tiniest babies protection regardless of the quality or quantity of a new (and often highly stressed, given the circumstances) mother’s pumping efforts. It’s not guilt-inducing to hear that breastfed babies have a higher IQ if we know exactly why this is – if it is an association, or something about the physical closeness during the act of nursing (which could easily be recreated by a bottle-feeding parent using a bit of imagination and less clothing) or something specific in the milk (in certain milk? Do some women increase their baby’s intelligence, and some women decrease it? Who the heck knows until we look into it?).

We can’t be scared of science, and we can’t abuse it. And scientists can’t be scared of staying neutral, and can’t abuse their power. If we can give each other this mutual respect, maybe we can turn this into a beautiful relationship. Even if it did start out as a rebound…

 

 

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