“Where is the mother in the discussion?” An interview with Walker Karraa on maternal mental health and infant feeding

Some of you may know Walker Karraa from her comments on our Facebook community page, or from her fantastic posts on Science & Sensibility. But I doubt you’re aware of the full magnitude of her bravery and dedication to issues surrounding maternal mental health. I recently interviewed Walker for a short piece on formula feeding and postpartum adjustment, and was so blown away by her answers – I was only able to use a few of her wise words due to word count constraints, so I’m thrilled she’s agreed to let me post the interview in full here on FFF.

Walker is a doctoral candidate at Sofia University, where she is conducting a study on the transformational dimensions of postpartum depression. She was also the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth, and is a perinatal mental health contributor for Lamaze International’s Science and Sensibility, Giving Birth With Confidence, and the American College of Nurse-Midwives (ACNM) Midwives Connection. Like that wasn’t enough on her plate, Walker also served as social media manager for the Integral Leadership Review, and has her own social media consulting business, On My High Horse, and is currently working toward co-authoring a book regarding PTSD following childbirth with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA. 

I’m exhausted just reporting all of that. And did I mention she has two kids and is a breast cancer survivor? Yeah, she’s all that and a bag of reduced fat potato chips.

I hope you guys will appreciate the revolutionary nature of Walker’s discussion here – her opinions, while brilliant, probably seem uncontroversial to those who follow this blog, but they are quite “rogue” in the birth/maternal-child health community. I can’t thank her enough for being a dissenting voice and speaking up for the benefit of all women. 

FFF: Here on FFF, we see stories almost weekly which discuss how a perceived “failure” to breastfeed can lead to depression, anxiety, and self-esteem issues. Do you think the maternal mental health community has recognized how breastfeeding (or lack thereof) can affect the emotional state of new moms?

Walker Karraa

WK: I think that overall breastfeeding is very well addressed in the health psychology, and developmental psychology fields. What’s lacking is the reframe of the research to integrate more qualitative data, and methods, into the consideration of the full range of implications of breastfeeding from multiple perspectives—including the woman’s perspective.

In a 1985 Lancet article on maternal mortality, Allen Rosenfield asked the famous question, “Where is the ‘M’ in MCH (Maternal Child Health)? In the discussions of MCH, it is commonly assumed that what is good for the child is good for the mother.” (Rosenfield & Maine, 1985, p. 83). In many ways this is relevant in the discussion of breastfeeding and maternal mental health. Where is the mother in the discussion? And in what ways do we still assume what is good for the child is good for the mother? For me, this is all about reproductive rights and a deeper issue about our discomfort with women’s sovereignty over their reproductive, physical, and mental health.

The mental health community has responded to the growth in published data regarding infant health and breastfeeding. This has also been the funding stream for a large part of the last 20 years. But maternal mental health has yet to directly address a woman’s infant feeding choice as a part of her reproductive choice, rather than discrete periods of time that occur with as a continuum of events that are inextricably woven through reproductive events—none of which, taken by themselves, gives either the best data on mental health.

FFF: What do you feel needs to change in order for new mothers to be better supported in terms of mental health in general?

WK: I think one of the first calls to action must be for maternal care providers to get support in knowing that perinatal mood and anxiety disorders are common and create the conditions for morbidity and mortality for mother and children. This is starting to happen, but still very slow. I think new models of medical care such as Dr. Michael C Lu’s life course model, which places the woman at the center of care, not the doctor. And, she is treated across the lifespan, not merely when she is pregnant. This facilitates better reproductive health in preconception and interconception, and uses a reproductive life plan for women and families from an early age. At puberty, to have a conversation with medical, nutritional, mental health providers as to planning one’s reproduction (girls and boys) would be ideal.

FFF: Many women struggle with the decision of whether to treat postpartum or prenatal depression/anxiety with psycho-pharmaceuticals, especially when they are breastfeeding. Why is there such mixed information and messaging about what drugs are safe, and what the relative risks are (ie, breastfeeding without meds vs breastfeeding on meds vs formula feeding and taking the meds)?

WK: Not having good information is a barrier to care for everyone involved. The OB/GYN or midwife, the social worker, the woman, her partner and family—when we don’t have good information, we cannot make informed choices. And for women in poverty, the risk is twofold. Specifically regarding breastfeeding, but also education across the board regarding psychopharmacology, pregnancy, and lactation. With organizations such as OTIS (Organization of Teratology Information Specialists) and Motherisk, there really is no excuse for not having current evidence-based data regarding risk and benefit of untreated depression and anxiety, as well as risks and benefits of medications used to treat them.

Byatt et al. (2012) did a wonderful grounded theory study regarding community mental health provider reluctance to providing psycho-pharmacotherapy. 28 obstetric care providers (nurses, OB/Gyns, etc.) shared how they perceive community mental health practitioners as obstacles to psychopharmacology for perinatal women. The participants felt community mental health providers “99% of the time” discontinued a patients’ medication, and put women at risk of relapse. Secondly, Byatt et al., (2012) reported that participants perceived a lack of collaboration and communication between community mental health care providers and OB/Gyn providers, and that pharmacists also “further impede or delay depression treatment by not filling needed psychotropic prescriptions, often exacerbating women’s mental health symptoms” (p. 3).

FFF: Why do you think so many women express grief, guilt, and feelings of failure around the subject of infant feeding?

WK: Because that is their experience! And I attribute all of it to social constructs that are completely ingrained in medical, social, and mental health systems that have been made for and by men. The intentions of those men is not necessarily nefarious, and not really the point. It is that the constructs we have to measure ourselves (abilities and weaknesses) are made by men. We tell women from the get-go that they need us to be good mothers. They need our insight, knowledge, treatment, book, video, technique, services, product to be taught how to mother. This is so ironic, because so many of the birth movements have evolved from a call to empower women. But to empower, we have just made more systems of knowledge that mimic the ones we refute. That is not very popular to say, but it is true. The messages still given to women is that if they “know” something analytically, they are devoid of femininity, and if they “know” something inter-subjectively, they are devoid of ration.

Shame is a powerful force for women. And at no time in her life is a woman more susceptible to shame than early motherhood. If they are lucky enough to find a safe space to share their feelings without judgment, such as your blog, they are given the gift of voice. They can speak their truths.

FFF: Any tips for a mom who is having a tough time reconciling her use of formula?

WK: You know, when I was a doula, I had clients ask me to go buy formula for them so they wouldn’t be seen in public. When I was diagnosed with breast cancer shortly after the birth of my second, I underwent two mastectomies before she had turned one. I learned that my body parts have nothing to do with my inherent ability to love her. My breasts were gone—off of my body, one in one hospital and another at a hospital down the road. I fed, nurtured, attached with, loved, and parented without them…and still do! So my advice is to write down on a piece of paper: My breasts have nothing to do with my love for my child. And keep it where you can see it. Memorize it, know it.

FFF Friday: “I felt like my body was failing me, yet again.”

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 think there’s something to Shelley’s point here about going through fertility treatments. If it weren’t for many interventions, my kids probably wouldn’t be here, and I definitely felt more compelled to breastfeed my first in order to “prove” that my body could do something right. But what is that about, really? Are we judging ourselves on how we conceive, as well as how we birth and feed? So, what – women who conceive with candles and roses are superior to those who conceive in the back of a Chevy, or in a sterile doctor’s office?

It’s pretty ridiculous that we are judging our self-worth on how our babies are brought into the world and how they eat for the first year, rather than focusing on parenting with love, respect, and positivity for the rest of our lives. Maybe it’s time we all took a few giant steps back and looked at the big picture.

Happy Friday, fearless ones,

The FFF

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Shelley’s Story

After two years of trying to conceive using IUI (artificial insemination) my husband and I finally turned to IVF. We were one of the lucky ones, successful with our first attempt, and are now parents to a beautiful, healthy, spirited 4 year old daughter.

Anyone who has been through assisted reproductive technology can tell you that the process is a difficult one that lacks empathy and takes no prisoners. Its unnatural in so many ways and for many women, the drug-laden, vagina probing process makes us feel less womanly. That inability to have what I like to call a “sex baby” can sometimes make me feel insecure in both my womanhood and my “motherliness”. With that in mind, it is no surprise that when I learned I was finally pregnant, I felt compelled to have the most natural pregnancy, labor & delivery possible.

I had horrible nausea/vomiting for the first 18 weeks of my pregnancy. I turned to acupuncture in lieu of anti-nausea medication. I hired a midwife and doula. I used natural lotions and ointments, refused unpasturized cheeses and when I found my daughter was breech I spent 4 days per week for 2 weeks with a chiropractor that specialized in the Webster technique. My husband and I took 12 weeks of Bradley Method child birth courses and learned about baby wearing. Of course we took a breastfeeding course and I purchased a Boppy with three (THREE!) covers! I DIDN’T purchase bottles or pacifiers — after all, I’d be breastfeeding! Why would I need either of those things?! I was doing everything NATURALLY. In my mind’s eye I saw myself a happy, breastfeeding mom to an infant and then a toddler. I saw the two of us smiling as we sat in the mall food court, her nursing while I enjoyed my decaf Starbucks latte.

At 39 weeks I was told, reluctantly by my midwife, that if I didn’t go into labor on my own at 40 weeks they would want to talk about induction due to my very high blood pressure. Of course I had NO interest in that so I sought out my acupuncturist. At 39 weeks and 3 days my acupuncturist did her magic and a mere 8 hours later my water broke. The only problem was that my contractions wouldn’t start. Almost 24 hours later my doula and I finally agreed I should go to the hospital. We tried everything to get contractions started but to no avail. Finally I was started on pitocin (the naturally laboring mama’s nemesis!). 12 hours after the start of pitocin my labor was finally rocking. Shortly thereafter I felt the urge to push. I had not had an epidural or any kind of pain management medication. I pushed for 4 hours and 12 minutes. Without an epidural and on pitocin. I.was.determined to have my baby NATURALLY. I actually broke a record for my midwive’s practice for pushing without an epidural. I finally delivered my healthy daughter and brought her to my chest. We let the umbilical cord stop pulsing, donated the blood to the research hospital and with the help of my doula I attempted to feed my daughter for the first time. OUCH. Using all of the knowledge from my breastfeeding classes and my doula, I spent the next 2 days in the hospital putting my baby to my breast every hour. She screamed in between. She was never satisfied because I had not yet begun to produce ANY milk, at all. In the midst of the screaming, instead of marveling over the miracle that was my new daughter, I cried at the pain breastfeeding. Remember, I had just pushed a 8 pound baby out, sans medication and had 3rd degree tears but my BOOBS HURT MORE.

We brought her home and this process continued for 2 more days. Me in agonizing pain — my breasts screaming for relief. For 2 more days my baby screamed because she was hungry and I put her to my breast every.single.hour. She was exhausted. I was MORE than exhausted. But I was NOT going to feed her FORMULA! That poison! I had endured 4 hours and 12 minutes of pushing without an epidural for this child! SURELY I could breastfeed her! I hired a lactation consultant to the tune of $250. I then hired a better lactation consultant for $300. Then I rented a hospital grade pump so I could pump in between my daughter’s 45 minute feeding sessions only to turn around and do it all again an hour later. At 7 days out, my milk STILL had not come in. I took fenugreek, drank mother’s milk tea, had a glass of wine, massaged my breasts and looked at my baby while I pumped. Nothing. At 8 days post-partum, with a hungry, screaming baby who had lost 15% of her body weight and my breasts hurting so badly that I cried through each feeding, I realized I was resenting my child every time I had to take her to the breast. Can you even imagine how guilty, how depressing it is to think back over all you endured to have your baby and then look down at her gnawing on your breast and feel nothing but resentment? How is that possibly worse than cracking open a can of Similac? And yet I had doctors, nurses, friends, STRANGERS both implying and outright telling me that if I didn’t breastfeed my child, I was not doing enough for her. That it would “get better” in a few weeks. I would sit and stare at these people, incredulous that I was to endure this level of pain for WEEKS. How was it possible?

Both then and now I wonder why breastfeeding has become such a hot topic. Even though having your baby vaginally is shown to be exponentially healthier for mother and baby than a c-section you don’t find doctors, strangers and other mothers tsk tsk-ing a woman for her childbirth choice. No one ever berates a new mom for not laboring long enough. No one ever says ” Oh come on! Just endure that horrible contraction pain for a little longer! I promise it will be worth it in the end!”. No, they give the woman the epidural she asks for! Some have the determination to power through, some do not. Some have an easy labor and delivery, some do not. Why is it that breastfeeding is where the judgement begins? In my case, in those weeks after giving birth, my friends would marvel at my birth story and I would brush them off, instead begin crying about how hard and painful breastfeeding was.

After 8 agonizing days of trying to feed my child without excruciating pain, my lactation consultant said what I needed to hear: “Feeding your baby formula does not mean you love her any less than any other mother loves her child”. Can you believe that NO ONE had yet said that to me? A light bulb went off for me that moment. I continued to pump 6 times a day until my milk came in more than just a dribble (10 days post-partum) but I supplemented with formula. 6 months later I was still pumping because even though I was a more confident mom than I was at the start, I still had many, many outside influences telling me “breast is best”. I felt like my body was failing me, yet again. I couldn’t naturally conceive, I couldn’t naturally feed my baby. With great reluctance and guilt, I finally made the decision to stop trying to put my baby to my breast.

What I realized shortly after making that decision though was that it took me LETTING GO of breastfeeding to finally start to bond with my daughter. To this day I feel RELIEF that I let go of breastfeeding. I feel so lucky to have not wasted my daughter’s infancy feeling sad and frustrated and in pain. I chose to feel happy. Formula provided me the ability to revel in the miracle that was my baby and I am grateful for that opportunity. While I would never discourage a new mother from breastfeeding, I never hesitate to remind her that how she feeds her baby doesn’t dictate how much the love their baby. What a woman can endure is different from woman to woman. A woman is no less or more a mother because she conceived naturally, unnaturally, adopted, had a c-section, had a natural birth. She’s no more or less a mother because she breastfeeds or formula feeds. She’s a mother because the child is hers and she loves that child.

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When you’re ready to share your story, email me at formulafeeders@gmail.com. Until then, make sure and comment on these Friday stories to let the guest posters know they aren’t alone. 

A slightly curmudgeonly rant about the drama over Save the Children’s “Superfood for Babies” campaign

The problem with writing a post which criticizes an organization which strives to help starving kids is that it makes you feel like the Grinch. Or Gargamel. I feel like I should be stroking an acrimonious cat and arching a pair of overgrown eyebrows inward.

Save the Children does a lot of wonderful things for children in dire straits, and I don’t want to come down on them too hard. And in many respects, I applaud their recently announced “Superfood for Babies” initiative. I do believe that breastfeeding is a hugely important part of improving childhood mortality in resource-poor nations, and the report supporting the program offers some excellent perspective on the challenges of raising exclusive breastfeeding rates in these areas.

In public health circles, there’s a lot of discussion on messaging – how to make PSAs culturally appropriate, sensitive, and effective. The thing is, this doesn’t only hold true for at-risk groups – it also applies to the middle-class factions of western nations. It’s just as ineffective (and inappropriate) to try and graft a message addressed to people living in tribal societies with problematic water sources onto a secretary in suburban Iowa as it would be to do the opposite. Yet, this is what happens – repeatedly – in our international discussions of breastfeeding. (Incidentally, this is at the root of my beef with Unicef and WHO, and why I feel it’s necessary to amend the Baby Friendly Hospital Initiative set forth by those organizations to be more culturally appropriate to developed, Western societies.)

This brings us to my scroogey analysis of the “Superfood for Babies” campaign.  I would encourage everyone to read the literature – it offers some truly excellent insight into the specific issues at play in a variety of developing nations, and makes it clear (whether or not it intends to) that formula is not the only barrier to encouraging exclusive breastfeeding. In some cultures, there are beliefs that breastfeeding for the first few days of a babies life is detrimental; in others, women feel pressured to produce as many babies as possible, thus making the fertility-restricting nature of breastfeeding a downside; and in others, it’s not formula which is used as a supplement but raw animal milks or concoctions of grains.

Save the Children (STC) did a lot right with this report. They addressed the need for social change; advised that governments subsidize breastfeeding women so that those in unstructured agricultural jobs (which don’t exactly come with a 401k or paid maternity leave) don’t need to return to work immediately, and have to choose between making a living and feeding their babies; and they press for better education and involvement from medical workers and midwives. I think their motives were great, and they did their homework.

Unfortunately, in their excitement, they lost perspective in three key areas…

1. They were (intentionally or unintentionally) vague about the research

Look, I would never argue that breastfeeding isn’t the best choice – by far – for babies in places where food is scarce, infection and disease runs rampant, medical care and antibiotics are severely limited, and the water source is questionable. Formula feeding is dangerous in these settings. But since breastfeeding advocates and orgs like WHO have made breastfeeding a global issue, we have a responsibility to be honest about what our body of research actually says. There are numerous instances in the STC report where claims are simply not held up by their citations. For example, this quote, on page vii of the report’s introduction:

It is not only through the ‘power of the first hour’ that breastfeeding is beneficial. If an infant is fed only breast milk for the first six months they are protected against major childhood diseases. A child who is not breastfed is 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhoea[2]. Around one in eight of the young lives lost each year could be prevented through breastfeeding,[3] making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths[4].

Let’s take a closer look at the citations. The first one, #2, is from a UNICEF report on diarrhea and pneumonia- not a study, but a report. So it took a bit of digging to see exactly where they were getting their data from. I *think* this figure comes from a table attributed to a Lancet piece, which “estimated”  that “Suboptimum breastfeeding was… responsible for 1·4 million child deaths and 44 million disability-adjusted life years”. I couldn’t get the full study on this one, but again – it was an estimate, most likely based on other studies – not hard data.

Citation #4 is the one that’s bothersome, however (#3 is just a footnote with the definition of “exclusive breastfeeding”). The sentence “making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths” is most likely read as “breastfeeding is the most effective way to prevent child death”. That’s quite emotive. The citation leads you to a Lancet paper on child survival, which does have some dramatic data and charts regarding the interventions which would most reduce infant mortality in the developing world. Breastfeeding is shown to offer the most dramatic reduction in risk- but there’s one important point to consider: while this report focuses on death in children ages 0-5, the majority of these deaths occur in the first few months of life. Exclusive breastfeeding, as opposed to mixed feeding or exclusive feeding of substitutes including goat or buffalo milk, paps, or formula (important to note that in many of the countries STC is concerned about, traditions include feeding neonates animal milks or solids within hours of birth – so I think it’s arguable that the issue here is the risk of giving a baby anything but breastmilk via the breast, rather than breastfeeding being the “magic bullet” the report dubs it to be. Otherwise, we probably wouldn’t see consistently poor outcomes in mixed-fed kids, as a “magical” substance would compensate) is going to reduce the risk of infections that cause death in very young babies. In other words – if the most deaths are in newborns, and breastfeeding saves newborns more than any other interventions like vaccines, clean water, etc – then there will be a disproportionate representation of “babies saved by breastmilk” in the results. This is not to say that breastfeeding isn’t an incredibly worthwhile and effective solution to reduce infant mortality, but it’s a bit of a stretch to suggest that breastfeeding alone will be the most effective intervention for ALL childhood deaths, which is exactly what the STC report does.

2. They didn’t consider the societal implications of their recommendations, beyond the scope of infant health

I was taking notes as I read the STC report, and my heading for the section which included this quote was “OMGOMGOMG”:

Many women are not free to make their own decisions about whether they will breastfeed, or for how long. In Pakistan, a Save the Children survey revealed that only 44% of mothers considered themselves the prime decision-maker over how their children were fed. Instead it is often husbands or mothers-in-law who decide….

 

….To overcome harmful practices and tackle breastfeeding taboos, developing country governments must fund projects that focus on changing the power and gender dynamics in the community to empower young women to make their own decisions.

Changing the power and gender dynamics sounds like a fantastic idea, and I would support any program that attempted to do this. But STC has to realize that “empower(ing) young women (in developing countries) to make their own decisions is a complex and uphill battle that extends far beyond infant feeding. I fear that by placing an emphasis on UNICEF-lauded solutions like warning labels on formula cans/making formula prescription-only, and on educating fathers/elders on the importance of breastfeeding using the current overzealous and often misleading messages, in these countries – places where, all too often, females are already considered “property” and subjected to any manner of injustices – it will create an atmosphere where women who are physically unable to breastfeed will be ostracized, shamed, or penalized. I agree that we need to empower women, but I think that we also need to be verrrry careful about presenting “suboptimal breastfeeding” as a risky behavior in certain cultures.

In another section, the authors report that breastfeeding rates have gone up in Malawai despite poor legislation on maternity leave, breastfeeding rights, etc. – that these improvements are based solely on strict implementation of WHO Code. I’d like to be reassured that as women are being given no option other than breastfeeding without any of the protections which would make EBF feasible while working, this isn’t having a deleterious effect on their lives. It’s wonderful that breastfeeding rates are up, but what about correlating rates of employment, poverty, and maternal health?

3. They failed to differentiate between resource poor and resource rich countries

I’ve seen a wide range of opinions on the STC program online in the past few days. Most of the drama is over British media reports which mention putting large warning labels on all formula tins – not just the ones going to resource-poor countries. Some feel that these labels will cause unnecessary upset in the West; others argue that when it comes to saving starving/sick third-world babies, privileged mommy pundits should STFU. And others keep insisting that the STC report was misrepresented, and that the labeling stuff was a minor part of the larger plan and shouldn’t be harped on.

All of these arguments are valid, and yet all are missing the nuance necessary to have a productive conversation. We need to realize that not breastfeeding has quite different implications in certain parts of the world. We also need to acknowledge that a woman’s rights are important no matter how much money she has or where she lives, and that we all have a right to stand up for what we believe – it’s rather useless to play the “eat your dinner because children are starving in Africa” game, and rather un-PC as well.

But STC also needs to take responsibility, here. The fact is that the report does not really differentiate between resource-poor and resource-rich countries when it is discussing WHO Code and formula marketing.  For example, this passage on p. 45 describes laws which STC wants implemented worldwide:

Breast-milk substitute companies should adopt and implement a business code of conduct regarding their engagement with governments in relation to breast-milk substitutes legislation. Companies should include a public register on their website that outlines their membership of national or regional industry bodies or associations, any meetings where the WHO Code or breastfeeding is discussed, and details of any public affairs or public relations companies they have hired, alongside the nature of this work… Any associations (such as nutrition associations or working mothers’ associations) that receive funding from infant formula companies should be required to declare it publicly. In addition to this information being made publicly available on the websites of individual companies, the International Association of Infant Food Manufacturers should publish a consolidated record of this information, updated on a quarterly basis.

Personally, I think the money spent on a “governing association” in order to police this policy would be better spent on funding literacy programs to help parents read the labels we’re arguing about. Some of these countries have literacy rates of like 30% – which makes me wonder exactly who the labels are geared to, if not the Westerners for whom formula feeding is far, far less of a risky endeavor.

Don’t mistake me – the evidence given in this report about the shady practices of formula co’s is alarming. There needs to be something done about unethical marketing practices in parts of the world where information is limited, education is a true privilege, and options are a joke. Yet, in the STC report, there is ample (and quite good) evidence that the unethical efforts of formula companies are only one slice of a thick-crust, Chicago-style pizza. There’s a lot of gooey, barely distinguishable elements which all combine to make a rather heavy problem, and focusing so much on one of them will leave you with the policy equivalent of Domino’s.

Further, the situation with breastfeeding in the developing world is markedly different from what’s going on in Great Britain, the US, Canada, and so forth. The online arguments are proof of this. I’ve seen the same people who argue that breastfeeding is a global issue turn around and tell concerned Americans and Brits that they have no idea what’s appropriate in Peru or Ghana. This may be true, but so is the reverse. International groups like STC have to remember that when they release papers making global recommendations about infant feeding, that they are inviting commentary from a global audience. That’s why we can’t make blanket statements about infant feeding and child health, or try and implement the same rules in order to get the same results. We wouldn’t go into a rural village where families share a 300-square foot hut and start lecturing them about the dangers of co-sleeping, and yet we assume that the same one-size-fits-all public health messaging is fair game when it comes to infant feeding. Breastfeeding might indeed be a global issue, but the type of issue it is varies greatly depending on what part of the globe you’re on.

 

FFF Friday: “Not putting pressure on a mom to breastfeed can go a long way…”

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 is Michelle’s second FFF Friday contribution, and it describes a very different experience than she had the first time around. I hope this will inspire breastfeeding advocates and healthcare workers to consider approaching moms with more sensitivity and individuality. Because by doing so, both my goal and he goals of breastfeeding advocates can be achieved: more women will be empowered to breastfeed, and all women will be treated with the respect that they deserve. 

Happy Friday, fearless ones,

The FFF

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Michelle’s (Second) Story

With my first daughter M, I had my mind made up from the beginning that I was going to breastfeed for 2 years. No problem. I was always told it was natural. It ended by the time she was 6 weeks by bouts of reoccurring double mastitis, low milk supply, a screaming baby, and me on the brink of PPD by wondering why couldn’t  I do this one natural thing.

A year later , I was diagnosed with Chronic Lyme’s Disease. Given the reoccurrent mastitis, I was on antibiotics while nursing M. This may have been a blessing in disguise as she did not contract this disease from me. I completed successful treatment of Lymes Disease. Come 2.5 years later I am pregnant again. Hooray! I can move forward and give M a new sibling. I  was always happy about this new mystery baby, but I have a pregnancy condition that is known as hyperemesis gravardium. It’s when you have severe nausea and vomiting that does not go away by normal methods of treatment and you face severe dehydration and weight loss. I had it with my first up until about 24 weeks. No one ever told me it became worst with each subsequent pregnancy.   I spent the first 2 trimesters being hooked up to a Zofran pump and on IV fluids on and off. By the time I was 32 weeks I was hospitalized for 3 days for severe dehydration. There were times I would lay there in my stupor with the haunting fact that I was going to have to breastfeed. Wait did I say. “Have to”? There were times I was so miserable I decided that I just wasn’t going to do it at all.  I did not care who said what about it and I was ready for the defense.

Labor Day came. It came on really fast.   I checked into the hospital at 4:30am in complete denial about being in labor and by 6:36am E was born. They ran many tests on her because when I had her I was anemic, deficient in protein and calcium. Miraculously E was given a battery of tests and was completely healthy and was born 8lbs. 6 oz which was actually a ½ pound lighter than my first. I loved her to pieces.  I really enjoyed looking at her while still in shock at the same time. The nurse asked me, “So would you like to start breastfeeding?” I just looked at her stunned and told her that I needed time to process all of this first.  Honestly, I sort forgot about breastfeeding at that moment.  A few minutes later I told my nurse and OB that my last breastfeeding experience was horrible and I felt tremendous pressure to do it and to keep making it work when it just was not working so now I just didn’t know what I was going to do. The nurse kindly nodded and my OB said, “Well, you just have to do what you think is the right thing and only you can decide that.” Maybe that was a monumental turning point for me.  I just felt so comfortable and accepted. There was no judgment in the room. Twenty minutes later I put E up to breast and she was eager to be breastfed.  It felt so normal after having 9 months in an abnormal situation.  I had a wonderful stay at the hospital and stayed there the whole 2 days. I decided to combo feed from the beginning. No one gave me a bad time about this. As a matter of fact, one nurse said, “Yeah, I’m old school, and I think you are doing the right thing.”

During the next 3 days drawback #1 happened, E was breastfeeding well, but losing weight. I also had a nipple injury. Before having E I thought I would just give up if things weren’t going right, but for some reason after having her I just couldn’t. She was a baby that really loved to breastfeed and I just wasn’t ready to end that relationship. So I did something I never thought I would do. I made an appointment with a Lactation Consultant. The whole time I was in the hospital I just couldn’t bear to speak to an LC because of my previous experience. When I had my first daughter I spoke to 2 LCs and it did not go well. I basically was scolded for giving M formula and told I was not giving her a good start. I remember her arguing with me and walking out of my room as I was saying “No, she is hungry. She really is hungry.” I went the LC appointment with my husband and I figured if I didn’t like her I could walk out unlike being the confines of the hospital room.  I told my LC right from the beginning, I do not really enjoy breastfeeding, but I can tolerate it so I want to go a little longer and now this has happened what should I do? The LC said, “Well at least you’re honest.”  She fully examined me and we discussed my goals. She identified the problem with my nipple and helped me get the right technique down for making it work. She was very patient and positive. My husband was so helpful and really diligently following the instructions she gave us.  I had a few more visits with her and her partner and they treated me with a lot of patience and openness that I really felt for the first time that I can do this.

Then Drawback #2 happened.  I sustained a severe nerve injury in my arm that left me with an auto-immune disorder. Without wanting to go into any debate, it is vaccine related, but also having Lyme makes me a target for autoimmune disorders.  So after 3 weeks of breastfeeding that was getting on the right track, I was told the only way I could get better was to go to physical therapy and go on prescription medicine that unfortunately was not breastfeeding friendly. It was devastating news for me, but I knew that with the excruciating pain I was in and not having the use of my left arm, I was facing another problem: How on earth can I take care of my 2 children? So that was it. My mind was made up and I quit breastfeeding and went on medication.

The next day or so I felt I was mourning a breastfeeding relationship and I would see E eagerly trying root for me and it would leave me with a void. I thought to myself “What if I could actually get better and re-lactate?” Some people encouraged me to do it. I had my industrial strength pump and realized that maybe I could make it work. So I pumped and dumped everyday and I used natural methods without medication to increase my milk supply.  I was getting better at a fast rate.  Five weeks later I was able to wean off the dangerous breastfeeding medication. I put E up to my breast and sure enough she never forgot how to latch! Her latch was a little weak at first, but once she had it down she was back to being the good nurser she always was. I never got back the milk supply I once had and always had to supplement with formula, but I didn’t care. Our breastfeeding relationship was back and that’s all that mattered.  For the next couple of months I breastfed with no stress and formula fed with no guilt.

E one day decided at 4 months that she was not much into nursing anymore. She was fussy and wouldn’t take my milk if I used certain herbs and one day she didn’t want my milk at all.  It was then I decided to wrap up all my nursing supplies and be done with nursing as there was no point in forcing my baby to feed.  I have no regrets and never looked back. I went from only bfing for 6 weeks my first  to making it to 4 months with my second! I felt like I really made a huge accomplishment and it was very much a good quality breastfeeding experience and not about the length of time I did it for.

Breastfeeding went much better the second time around. What was it I did differently? I had no breastfeeding timeline goal! My goal was to have a good bfing experience and that could’ve meant breastfeeding for 1 day or 1 year. While I many women make goals like EBFing for 3, 6, 12 months, I realized that would’ve put tremendous pressure on me and would’ve made me miserable. I also want every breastfeeding advocate to know that approaching a mom with an open mind and not putting pressure on a mom to breastfeed can go a long way. I really felt like if I was pressured or told it was hospital policy I would have panicked and would have not attempted to breastfeed my baby.  Most of all, I am very happy I attempted to breastfeed again and I grateful to all those who helped make it happen one of them being my husband.

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Feel like sharing your story? Email me at formulafeeders@gmail.com.

FFF Friday: “I sincerely doubt that not being breastfed has affected our bond.”

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’s FFF Friday is a bit different. Anna’s not a mom yet, but has some strong feelings about the pressure to breastfeed from a different perspective- that of a formula-fed child. She writes: ”I feel like so many women have palpable guilt about not being able to breastfeed, that I just wanted to write a reminder that formula fed babies grow up to be okay… I won’t be having kids for a few years, but the pressure to BF is so palpable.  In fact, I’m already getting pressure from my boyfriend’s mother (she breastfed both of her kids).  I have a few issues with my breasts that may interfere with future breastfeeding, and knowing that there’s a place to find honest discussion of the facts and support for whatever decision I have to make is so empowering. “

It should go without saying that babies don’t measure their bond with their parents by how they were fed (because that would mean none of us had a strong bond with our fathers), but it’s easy to lose faith in that due to the current atmosphere. So I hope you guys will find Anna’s point of view both refreshing and reassuring, even if it bothers me to no end that this even needs to be said.

Happy Friday, fearless ones,

The FFF

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Anna’s Story
Prior to my conception, the OB-GYN had told my mother that she probably wouldn’t be able to deliver naturally.  Due to lack of insurance, my mother took part in the hospital’s pre-payment plan for natural births and hoped things would work out.  When my mom was 7 months pregnant, the OB-GYN says there was no way I’d be born naturally without severe brain damage due to my size.
My mom went into labor one week past my due date.  Because of the insurance issue, the hospital wouldn’t perform a c-section until I went into fetal distress.  I was fine, but my mother had a severe reaction to the epidural.  We are separated for several hours until she stabilized, during which time I’m fed a bottle of sugar water by dad.  At almost 10 lbs, I was a big, hungry baby.  During our stay in the hospital, my mom tried to breastfeed, but I refused to latch.  Due to a nursing shortage, I wasn’t taken to the nursery our second night, and mom spent an entire sleepless night with a screaming, hungry infant who refused to breastfeed.  By day 2, I had lost more than 15% of my body weight and my mother hadn’t slept in 36 hours. The pediatrician ordered a bottle of formula.  I drank the entire 4 oz bottle in under 2 minutes.  The nurses called mom to tell her because they didn’t believe a newborn could eat that fast.  My mother hung the phone up on them and went to sleep.

My mother only had one week of maternity leave.  Given that we were already having such a rough start, and the fact that my grandmother would be watching me nine hours out of the day, I was exclusively formula fed from that point on.

You’ll be happy to know that, contrary to what hardcore natural child birth advocates and lactivists might tell you, I’m not a fat, stupid, detached sociopath (ok, I might be a bit chunky, but let’s try to be body positive).  In fact, I’m applying to medical school to pursue a career in psychiatry.  At 24, I can tell my mom anything and everything, and I still go to her for advice.  Now that I’m grown, my mother has become one of my best friends.  I sincerely doubt that not breastfeeding has affected our bond.  See, I don’t remember being born or being formula fed.  What I do remember is how my mom was always there when it counted.  I could share countless stories about how wonderful she was, but it would take several blogposts to truly capture my mom’s awesomeness.  Suffice to say, our bond is strong due of the relationship we’ve shared over the years.

In 1989, my mother wasn’t aware that she was supposed to feel guilty for not breastfeeding.  In 2013, not only am I already getting pressured to breastfeed my future children–never mind that I’m at least five years away from having them–but I have people tell me they’re sorry for me when they hear I was formula fed and born via c-section!  I don’t feel like I was deprived.  I have a mother who loves me, and that’s all that matters, then and now.

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Ready to share your thoughts and experiences regarding infant feeding? E-mail me at formulafeeders@gmail.com.
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