FFF Friday: “Formula is fun”

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 Amanda Koppelman-Milstein, the author of the following post, should make a video of her “Formula is Fun” song and put it on YouTube. 

Just sayin’.

Happy Friday, fearless ones (and for once, you might actually feel happy after reading an FFF Friday rather than wanting to stick your head in the oven, thanks to Amanda’s awesome sense of humor),

The FFF

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 Formula is Fun

by Amanda Koppelman-Milstein

When it turned out I could not exclusively breastfeed, I felt that I needed to launch a mini-publicity campaign for my son so that he would appreciate the benefits of formula. No sucking on manure-contaminated goat’s teats, being farmed out to wet-nurses, or starving to death for my baby—formula exists! We live in a community saturated with breast-is-best messages, and I didn’t want him to feel inferior. In addition, I wanted to cheer myself up in the face of well-meaning advice about increasing my milk supply that made me sob uncontrollably. As I prepared the bottle of formula for my baby’s three AM feeding, I sang my son one of the pro-formula songs I wrote for him:

Breast is best but formula is fun!

Breast is best but formula is fun!

Formula is made by giant evil corporations

But without the formula, you would face starvation.

I had always imagined myself breastfeeding my kids for years, giving them all possible benefits they could obtain from breast milk regardless of the costs to modesty or sanity. Unsurprisingly, I had never dreamed of singing “Yakety Yak (Similac)” while cleaning bottles and praying for a bigger milk supply. However, when I got ulcerative colitis in my second trimester of pregnancy, it became clear that at some point, post-birth, that I was going to want to take some drugs that neither I nor my doctor thought were compatible with breastfeeding. I thought I’d try and get a few months or weeks in of exclusive breastfeeding in before what I referred to as “bringing in the good drugs,” but it turned out I made next to no milk.

In the weeks after he was born, my dedicated son nursed for up to twenty hours a day. My husband held him to my body as I attempted to sleep. After five consecutive hours of nursing, he was still rocking his head back and forth and screaming in hunger. My mother, who was staying with us, announced that this was actually not how breastfeeding was supposed to go, and called in a lactation consultant who arrived the same day our pediatrician said it was time to start supplementing with formula. The lactation consultant mixed him his first bottle, and told us our first priority should be getting our kid fed, and that I had many risk factors for not making enough milk.

We decided to partially breastfeed and hold off on my treating my colitis properly for a few months. Waiting wasn’t a brilliant decision in terms of my own health, but I found breastfeeding addictive. It made the baby so happy! It was so snuggly!  It made him stop crying! It made him go to sleep! It was magic.

Not being able to breastfeed him fully made me feel inadequate. My husband grew entirely bored with the nights when I sat around pumping and crying, saying “We are so fortunate that we have a healthy child (sob). I am so grateful that he is so wonderful and that you are so wonderful, I just wish we didn’t also have to use (sob) formula.”

“WAHHH!” added the baby,cheerfully sucking on whatever was presented to him.

While breastfeeding is magic, formula has a certain amount of magic to it as well. There is a reason public health campaigns need to push breastfeeding in a way they don’t need to push activities that are more compatible with working, sleeping, eating, or running to the subway. Formula is, to some extent, fun. You can give it to the baby anywhere without taking your boobs out, which is endlessly convenient at funerals, police stations, and other places where wearing a shirt is just objectively better. 

I didn’t think I was the sort of feminist who thought formula feeding was good for feminism–I always thought that was an extremist point of view that disregarded the health of infants–until I experience the joy of my husband being responsible for half of the night feedings, and saw what being just as good of a food source as I was did for his relationship with our son. This is not to say I don’t support breastfeeding–just that since I couldn’t, I was able to appreciate the upsides.

Eventually, I hit the illness wall and had to start weaning the baby, which he was extremely gracious about. By this point his appetite massively exceeded whatever milk I could make, and he grinned and bounced a bit when I unlatched him to give him the bottle.

His positive attitude about weaning dissipated when we ran out of the milk I had pumped and frozen before starting with my new medicine. The mainstay of his diet is a vile tasting hypoallergenic formula that turned him from a colicky grump into the happiest and most gregarious baby I have ever met. It smells like rancid mac and cheese. Once that was the only thing going into him, he began inspecting visiting females for signs of lactation, and in a moment of misplaced hope, gave my father-in-law a hickey on his arm. Even once we introduced solids, he pulled down the shirts of visiting females and looked at them as if to say, “Please, would you consider being my wet-nurse? I know this is a sensitive issue for my mom,but we could keep it just between the two of us… Have you seen this soy-free lactose-free stuff they’re giving me? Did you know breast milk is best for young babies, such as myself? Wanna give it a go?”

Due to my months of sadness about only partially breastfeeding, I am more than a little defensive about my “choice”—although I don’t really consider not trying to treat my illness in the long term or letting the kid starve to have been reasonable options. The other week a houseguest made a relatively innocent remark (“At least you got to give him colostrum”) and I ran to the other room to cry. 

Writing this now, when my son is the happiest baby to ever exist, it’s hard to channel the incredible sadness I felt when I couldn’t make enough milk and when I weaned him.  However, recently my doctor suggested switching my medicines, with perhaps a short hiatus between drug-that-has-not-been-shown-to-be-safe and drug-that-you-wouldn’t-breastfeed-on-unless-you-truly-were-insane. “I had a drop of milk come out the other day—maybe I could pump for like two days straight and then breastfeed him for a week or two and then wean him again…” I said to my husband, the days of sobbing while pumping nearly forgotten. However, after I thought about it, it seemed like instead of two straight days of pumping, or whatever it would take to restart the milk supply of someone who has done nothing milk-related for months, my time is perhaps better spent playing peek-a-boo. Formula isn’t the only thing that is fun.

Bad medicine: Why the AAP’s new statement on breastfeeding & medication is puzzling

“The benefits of breastfeeding outweigh the risk of exposure to most therapeutic agents via human milk. Although most drugs and therapeutic agents do not pose a risk to the mother or nursing infant, careful consideration of the in- dividual risk/benefit ratio is necessary for certain agents, particularly those that are concentrated in human milk or result in exposures in the infant that may be clinically significant on the basis of relative infant dose or detect- able serum concentrations. Caution is also advised for drugs and agents with unproven benefits, with long half-lives that may lead to drug accumulation, or with known toxicity to the mother or infant. In addition, specific infants may be more vulnerable to adverse events because of immature organ function (eg, preterm infants or neonates) or underlying medical conditions.”

 

- Source: The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics Hari Cheryl Sachs and COMMITTEE ON DRUGS. Pediatrics; originally published online August 26, 2013; DOI: 10.1542/peds.2013-1985

The preceding is the conclusion to a new report released by the American Academy of Pediatrics, which has given birth to a number of ecstatic headlines – “Most medications safe for breastfeeding moms”. “Medications of nursing mothers do not harm babies”. “Top Pediatrician’s Group Assures Most Drugs Safe While Breastfeeding”. Reading these, one might assume that a plethora of new research had been released, provoking the AAP to make a blanket statement about risk and benefits.

One should read the actual report before one gets too excited.

Other than the introduction and conclusion, which basically explain that studies are limited on most medications and how they affect a nursing infant, but that the benefits of breastfeeding outweigh the risks, the report reads like one giant warning.

Let’s start with antidepressants:

“Previous statements from the AAP categorized the effect of psychoactive drugs on the nursing infant as “unknown but may be of concern.” Although new data have been published since 2001, information on the long-term effects of these compounds is still limited. Most publications regarding psychoactive drugs describe the pharmacokinetics in small numbers of lactating women with short-term observational studies of their infants. In addition, interpretation of the effects on the infant from the small number of longer-term studies is confounded by prenatal treatment or exposure to multiple therapies. For these reasons, the long-term effect on the developing infant is still largely unknown…Because of the long half-life of some of these compounds and/or their metabolites, coupled with an infant’s immature hepatic and renal function, nursing infants may have measurable amounts of the drug or its metabolites in plasma and potentially in neural tissue. Infant plasma concentrations that exceed 10% of therapeutic maternal plasma concentrations have been reported for a number of selective serotonin reuptake inhibitors…”

As stated in the first sentence of this section, the evidence hasn’t really changed from when the last AAP statement on drugs and human milk was released, circa 2001. But the conclusion sure has. In 2001, the authors advised that “(n)ursing mothers should be informed that if they take one of these drugs, the infant will be exposed to it. Because these drugs affect neurotransmitter function in the developing central nervous system, it may not be possible to predict long-term neurodevelopmental effects.” In 2013, the author states “Mothers who desire to breastfeed their infant(s) while taking these agents should be counseled about the benefits of breastfeeding as well as the potential risk that the infant may be exposed to clinically significant levels and that the long-term effects of this exposure are unknown.”(p. e799)

This is where I start getting nervous. The last thing I ever want to do is discourage someone who needs antidepressants or another lifesaving medication from breastfeeding – especially considering I personally chose to take the small risk and feed my newborn breastmilk while I was on Zoloft (one of the many SSRIs that are categorized in both reports as “Psychoactive Drugs With Infant Serum Concentrations Exceeding 10% of Maternal Plasma Concentrations”, meaning that the levels of the drug getting into a newborn via breastmilk are clinically significant and of potential concern for a growing neonate). These are the risk/benefit scenarios we often discuss here on FFF – decisions that parents need to make (and deserve to make), armed with solid information and free from paternalistic admonishments that don’t have real world meaning. But I don’t feel that the new AAP statement – or the way that the media is reporting it – is allowing for a truly informed decision.

Notice the emphasis of the newer AAP statement – the advice given is to counsel the mother on the benefits of breastfeeding first, and then inform her of the potential risks and unknowns of nursing on her medication. Anyone with a grade-school understanding of psychology can figure out what that would sound like. (“Breastfeeding is extremely important and will save your child from every ill imaginable! But I should warn you that if you choose to nurse while on Zoloft, we can’t confirm or deny that your baby may turn into a werewolf when he reaches puberty. Your choice!”)

Maybe I’m arguing semantics here, but why couldn’t they avoid the paternalism of both the 2001 and the 2013 statement and simply advise doctors to inform parents of the risks and benefits of both feeding options, as well as the risks of nursing on medications, in an accessible, understandable way? And then help them mitigate the risks, no matter what path they choose?

Moving on… painkillers. The AAP is now agreeing with what I freaked out about in Bottled Up – Vicodin and newly postpartum, breastfeeding women are not a match made in heaven. And before you post-C-section mamas beg for the Darvocet, that won’t fly, either. Turns out that infants whose mothers used these commonly prescribed drugs  for managing postpartum pain have popped up with cases of unexplained apnea, bradycardia, cyanosis, sedation, and hypotonia; one infant died from a Vicodin overdose after ingesting the drug through mother’s milk. But hey- you can take (moderate) doses of Tylenol and Advil to manage that post-surgical pain, so no worries.

Are you starting to see why “Medications of nursing moms do not harm babies” might not be the most accurate headline?

Ummm…. Herbal remedies! Those have to be okay, right? They’re natural, after all!

Not so fast, sugar.

“Despite the frequent use of herbal products in breastfeeding women (up to 43% of lactating mothers in a 2004 survey), reliable information on the safety of many herbal products is lacking…The use of several herbal products may be harmful, including kava and yohimbe. For example, the FDA has issued a warning that links kava supplementation to severe liver damage. Breastfeeding mothers should not use yohimbe because of reports of associated fatalities in children…Safety data are lacking for many herbs commonly used during breastfeeding, such as chamomile,black cohosh, blue cohosh, chastetree, echina- cea, ginseng, gingko, Hypericum (St John’s wort), and valerian. Adverse events have been reported in both breastfeeding infants and mothers. For example, St John’s wort may cause colic, drowsiness, or lethargy in the breastfed infant…Prolonged use of fenugreek may require monitoring of coagulation status and serum glucose concentrations. For these reasons, these aforementioned herbal products are not recommended for use by nursing women.”

Wait. It gets worse. You know those galactagogues you were prescribed to increase your milk supply? Flush them down the toilet, says the AAP. The safety of Domperidone, for example, “has not been established.”

“The FDA issued a warning in June 2004 regarding use of domperidone in breast- feeding women because of safety concerns based on published reports of arrhythmia, cardiac arrest, and sudden death associated with intravenous therapy. Furthermore, treatment with oral domperidone is associated with QT prolongation in children and infants.”

The authors aren’t overly enthusiastic about other galactagogues, either, and instead encourage moms struggling with supply to “use non-pharmacologic measures to increase milk supply, such as ensuring proper technique, using massage therapy, increasing the frequency of milk expression, prolonging the duration of pumping, and maximizing emotional support.”

I’ve read the report 10 times now, trying to see where they could possibly come to the conclusion that this is a game changer; that it is at all newsworthy; that this is what counts as progress. To my untrained eye, it appears to be little more than a re-framing of old information to fit in better with the “breast is best at all costs” mantra, rather than a landmark “update” of an antiquated policy paper. Based on this report, how are pediatricians supposed to tell patients, in good conscience, that there is adequate evidence that it’s safe to breastfeed on “nearly all” medications?

For most of the meds in question, it probably is safe- similarly to how the risks of infant formula are scary on paper and far less daunting in real life, I honestly believe that we’d be seeing a lot of seriously messed-up kids if your absolute risk of nursing while on antidepressants was high. Just like many of us have made carefully weighed decisions to formula feed, feeling the weight of misery in one hand and balancing that with an increased risk of ear infections in the other, so shall we handle questions of breastfeeding and medications. The problem is not with moms making choices based on the facts we have- the problem is when respected, policy-creating organizations create false narratives that render us unable to make those choices in a truly informed way.

The report leans heavily on the work of Thomas Hale and LactMed, fantastic resources for research on these issues. I’m grateful there are people dedicated to focusing on this research – research that matters so much more than yet another associative study attempting to show that breastfed babies are smarter than formula fed ones. We desperately need more research on how commonly prescribed medications affect breastfeeding infants, not so that we can “forbid” women from breastfeeding, but so that we can help them reach their breastfeeding goals. This might mean timing medications so that they are mostly metabolized prior to nursing, or pumping for some feeds, or even -god forbid- using a little formula or donor milk for the feeds that have a higher amount of the drug coming through milk (these are tough things to figure out, sometimes, as people metabolize differently, as do babies, but it’s a good goal to have on the horizon). Maybe it means finding better medications. Or it might just mean allowing parents to ponder their own risk/benefit scenarios and respecting their decisions, whatever those may be.

Before we can do that, though, someone has to remind the AAP that they are doctors first, breastfeeding advocates second. Let the science speak, not the zealotry, and maybe we can start helping parents make truly “informed” choices.

 

FFF Friday: “I never expected people to be so quick to blame me for not trying hard enough.”

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. 

One of the changes I’d like to see from the I Support You movement is better access to truly supportive support groups for all new parents- whether they are breastfeeding, combo feeding, or formula feeding. It’s a tough thing to discuss, because what constitutes “helpful” and “supportive” for some does not mean the same to another – I’ve talked to some people who are adamant that if anyone had given them “permission to quit” by not emphasizing the importance of breastfeeding/danger of supplementation, they wouldn’t have met their breastfeeding goals. And yet so many women in the FFF community (and beyond) talk about their breastfeeding support groups and Mommy & Me classes with a distinct but subtle bitterness; a strange hybrid of nostalgia and anger. For every woman who “permission to quit” would’ve been detrimental, there’s another woman who desperately needed that permission.
I hope to see more neutral groups sprouting up – get-togethers that are truly about supporting each person’s unique journey, needs, and desires rather than pushing ideologies. It sounds like in Julia’s (who blogs at Pugs Not Drugs, one of the best names for a blog ever) case, a group like that would’ve allowed her to make decisions which were right for her family without so much heartache. I think that’s something worth fighting for.
Happy Friday, fearless ones,
The FFF
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Julia’s Story
I had always planned to breastfeed, but in the back of my mind I knew it wouldn’t be easy, as so many friends have so openly shared their struggles with me.  I read books, took the breastfeeding class offered at our hospital, and had the name and number of a highly recommended lactation consultant programmed into my phone just in case.  I didn’t register for or buy any bottles, and I threw away any formula samples that I received in the mail or at the doctor’s office.  I’d read that having it in the house was a black mark against one’s chances for successfully breastfeeding, and I wanted to do everything I could to make breastfeeding successful.

My daughter came into this world just shy of 36 weeks at 5lbs 13 oz and we did immediate skin to skin contact just like all the books recommend.  She latched right away the first time and I felt so much relief. I gave birth in the middle of the night on a Sunday and all the nurses were extremely helpful in getting her positioned and latched as it became more difficult to do after that first time.  Since she was born so early they were watching her blood sugar and temperature very closely.  Both were low and I was encouraged to feed her every 3 hours.  Because she was so sleepy and not sucking very well the nurse brought me a pump to see if I could express some colostrum to give her through a cup or a syringe.  I got nothing from the pump so we started supplementing with ready to feed formula via cup feeding, thinking we’d only need to do it for a day or so until my milk came in and the baby was over her sleepiness and then we’d be set.

The next day a lactation consultant came by my room to observe a feeding. She said we had a good latch, handed me a folder of info, and said we’d be well on our way once my milk was in.  No mention of renting a pump or any information about the breastfeeding support group they had weekly.  There was a flier for the support group in the folder but it did not state where or when it met, simply that it existed.  My daughter’s temperature and blood sugar were improving by the middle of the day and even though she was always asleep, we knew that was a normal and figured she’d wake up and get more interested in eating soon.

When her blood sugar and temperature regulated and we were discharged from the hospital with instructions to keep breastfeeding every 3 hours and supplement with formula via cup feeding after she nursed until my milk came in.  We took all the formula samples we could fit in our bag home in hopes we wouldn’t have to buy any formula ourselves.  I was still running pretty high on adrenaline at this point but the lack of sleep was catching up with me.  We knew we were fortunate that she had spent zero time in the NICU despite being a late term preemie, but we were so nervous about taking home such a small baby and having to care for her ourselves.  She was just so tiny and fragile.

The day after discharge we saw the doctor in the office and learned that my baby was quickly losing weight (down from 5 lbs 13oz to 5lbs 6 oz) and becoming jaundiced, so we had to come in daily that week for blood draws and were told to breastfeed/supplement every 2-2.5 hours around the clock.  My daughter had plenty of wet diapers but hadn’t pooped since birth.  I scheduled an appointment with the LC I’d heard good things about for the end of the week.  The doctor encouraged us to go to the breastfeeding support group for a weighed feeding and told us where and when it took place.  At one point I thought my milk had come in, but it was wishful thinking. My breasts felt fuller but I wasn’t getting anything when I tried to hand express and my baby was growing increasingly frustrated at the breast.
Again the next day we were back in the doctor’s office for more blood work to check her billi levels.  She was turning a nice shade of orange by this point and we were in full freak out mode.  I had consulted with many of my friends online about our breastfeeding issues at this point and they were so incredibly helpful and encouraging, however, over and over I was hearing  from them and reading online that I should be pumping if I was supplementing.  Moms that had been in a similar situation as myself had been sent home with a pump and instructed to pump every time they supplemented with formula so that their supply would not suffer.  The LC at the hospital never mentioned that.  They’d sent me home with the pump flanges and tubing from my one failed attempt at pumping in the hospital but I was given no info on pump rentals.  When I called the information desk at the hospital to inquire I found out I could rent a pump at the BF support group where we were headed that afternoon.

My daughter would.not.wake.up. during the group so I didn’t get to do a weighed feeding.  I did weigh her and was so upset to learn that she had dropped another 2 oz, down to 5lbs 4oz.   I did get my pump from the LC but no instructions on how to use it.  Thankfully youtube filled in the gaps for me!  I started pumping right away (after every feeding, day and night) but just got a few drops of colostrum as my milk still wasn’t in yet. Fortunately I got a call at the end of the day that her billi levels were leveling off and we breathed a sigh of relief.  Goodbye jaundice!

Five days after her birth my milk still hadn’t come in and my baby was screaming and crying when I brought her to the breast (and by that point I was crying too!)  When she wasn’t screaming and crying she was fast asleep and difficult to arouse for feedings, typical of late term preemies.   I got so tense and filled with dread before every feeding.  I was letting her breastfeed for 10-15 minutes per side (although I had to pull her off and wake her up every 2-3 minutes since she kept falling asleep) and then we’d supplement with the cup.  15-20 ccs after every feeding.  She gulped it right down.

The LC was amazing.  We met with her for 90 minutes and she helped me improve our latch, gave us tricks for keeping our sleepy baby awake and sucking, and taught us about doing compressions to bring the fatty hind milk forward.  I felt so encouraged during that one feeding in her office.  It was a weighed feeding but at the end when we weighed her she had gained nothing.  Nothing at all. She hit her lowest weight yet: 5lbs 2 oz.  I was armed with information and new techniques to try but no milk, the key ingredient to breastfeeding!

During our consultation the LC asked lots of questions about my medical history including a question about whether or not we’d had difficulty getting pregnant.  As a matter of fact, we had.  After going off birth control in early 2011 I never ovulated on my own and I needed Clomid to get pregnant.  The doctor suspected PCOS but while I had some of the classic signs, I didn’t have any cysts on my ovaries or irregular lab work, so it was never an official diagnosis.  The LC informed me that many women with PCOS have problems with low milk supply.   Other issues she noted were that my breasts never changed in size while I was pregnant  and I’d had zero leaking of colostrum during my third trimester.   Both of these things can be normal and not indicative of one’s ability to breastfeed, but sometimes they are a clue that difficulties are ahead.   She gave me some mother’s milk special blend supplements and detailed instructions on how much to take and how often.  She also fitted me with a hands free pumping bra and told us it was okay to use bottles instead of cup feeding.  Less messy and unlikely to cause nipple confusion if we used the right kind of bottles. I can honestly say if we hadn’t met with this LC we would have given up breastfeeding before the end of that first week.  She armed us with enough strategies and confidence to persevere, at least until my baby reached her due date, the first goal we set for ourselves.

My milk finally came in a week after my daughter was born, but I was never engorged and never leaked.  I was only pumping about an ounce a day.  I went to the BF support group weekly for weighed feedings and they were depressing.  One week she got 2/3rds of an ounce.  Another week she got about 1/3rd of an ounce.  The milk just was not there.  I was taking the supplements, pumping, drinking a shitload of water, but to no avail.  My milk supply was not increasing despite my best efforts.

I cried a lot during those first weeks and wanted to quit breastfeeding so badly but held on to the advice friends gave me, especially “never quit on a bad day.”  My husband hugged me and gave me pep talks and finally my daughter’s due date arrived.  She did wake up some, but it wasn’t a drastic change as I’d hoped for.  My pump rental was expiring and I returned it to the hospital.  I was so done with that thing, it had done nothing to increase my supply and all the time and effort I was putting in for approximately 1 oz a day was not worth it.  We needed much more than that to supplement so we had to rely on formula.

Bonding with my baby was extremely difficult that first month.  I was growing to resent her and resent the pump.  My husband got to snuggle her and play with her and was clearly bonding with her and I was stressed out and in tears worried about how much she was eating.  The grueling feeding schedule was taking its toll on my mental health.  I remember crying while she cried during a feeding one night thinking “I just want to be able to enjoy my baby.”  Breastfeeding was not the warm, lovey dovey, bonding experience the books had promised it would be.  It was anything but.  When I turned the pump in and accepted that supplementing with formula was just what we were going to have to do, things really started to turn around for me mentally and emotionally.

Around 6 weeks I stopped going to the breastfeeding support group.  The weighed feedings were depressing and stressed me out.  The LCs leading the group offered me no advice that I hadn’t already read online. One mom in the weekly group was regularly pissing me off and making it a very hostile environment for several of us (many of us attending had premature babies with latch/supply issues).  She openly criticized those of us in the group that were supplementing with formula.  I dreaded the group and wasn’t getting anything from it but more frustration.

I was slowly reaching the acceptance stage by this point and was just breastfeeding on demand and following up every feeding with a bottle.  She was gaining weight thanks to the formula and I was grateful.  Around 12 weeks my daughter started refusing the breast.  She was hitting a growth spurt and going on nursing strikes for 12-24 hours, leaving me with clogged ducts and rock hard breasts.  She was screaming at my breasts and happily sucking down her bottles of formula.  I knew it was time to wean and over the course of a few days we did.  Sudafed dried me up and just like that we were exclusively formula feeding.

During those first three months of my daughter’s life I got some really great advice and encouragement from friends and family.  I also got some horrible advice, was judged by other moms, and felt so much guilt and disappointment over how things were playing out.  I soaked in encouraging words like “every drop of breast milk you give her is a gift” and “it gets easier” (and it did get easier after about 6 weeks just like everyone said.)  ”Don’t quit on a bad day” was probably the best advice I received.

some of the hurtful advice I was given when people learned I was struggling with my supply:

  • I needed to spend more time with my baby (24/7 wasn’t enough??)
  • I needed to just stop formula feeding altogether and trust my body to produce milk (so starve my child in the meantime??)
  • I needed to pray harder for God to increase my supply (what the…I still have no words, this is SO insulting and I heard it from multiple people.)

I didn’t respond to those comments.  I honestly could not think of a response that wasn’t “go !#@$ yourself” in many cases, so saying nothing was the better road.  I never expected people to be so critical and quick to blame me for not trying hard enough.

I am so happy I was able to breastfeed for 3 months when at one point I didn’t think I’d get past the first week, but I also wish our breastfeeding relationship hadn’t ended so soon.  I was disappointed that I didn’t have the “easy” and “natural” breastfeeding experience that so many books and friends touted nursing could be.

I knew going into it that breastfeeding could be difficult, but I was expecting difficulties such as cluster feeding, cracked nipples, clogged ducts, and oversupply/engorgement (lol, as if).  I really had no idea how exhausting it could be and I certainly had no idea what kind of emotional toll it would take.

My daughter is now 9 months old and happy and healthy.  She is thriving on formula and I am so grateful to live in a time and place where we have easy access to ways to feed our babies when breast milk is insufficient.  I really have a heart for new moms dealing with breastfeeding difficulties and guilt over using formula.  Being open with others about my own experience has led to so many great friendships and connections with other moms.  I hope sharing my story can provide encouragement to others to share their story and be a voice for formula feeders.

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If you’d like to share your story for an upcoming FFF Friday, feel free to shoot me an email at formulafeeders@gmail.com. 

Guest Post: On HIV, stigma, and the pressure to breastfeed

If people read one post on this blog, I hope to god it’s this one. I didn’t write it – it was submitted by Megan DePutter, who works as a Community Development Coordinator at a Canadian AIDS Service Organization – and therefore it tackles so much more than the usual mommy-war crap I tend to drone on about. 

Please read this, and talk about it, and share it as much as you can. As Megan says, as we advocate and empower women to breastfeed, we cannot simultaneously allow women who are already marginalized feel more shamed and judged. This doesn’t hold true only for women living with HIV, but those dealing with a whole slew of medical and emotional conditions that might make breastfeeding difficult or contraindicated. Sort of puts a new spin on the saying “the perfect is the enemy of the good”, doesn’t it?

- The FFF

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On HIV, Stigma, and the Pressure to Breastfeed

By Megan DePutter

I work in a small-ish community (about 130,000 people) in a town about an hour outside of Toronto, in Ontario, Canada.  Locally, provincially and nation-wide, “baby-friendly initiatives” in health care and social service institutions aim to encourage and exclusive breastfeeding for 6 months. Bypassing for now the unfortunate name of the initiative (which seems to insinuate that any other approaches to feeding are “baby un-friendly”), I understand that these initiatives are evidence-based and well-intended. The problem is that, for the women I aim to support, these initiatives can create further isolation and shame to people who are already marginalized. The women I am referring to are women living with HIV.

See, while the complexity of the HIV virus is still stumping scientists who are working towards the distant prospect of a vaccine or cure, HIV has become primarily a social and a political problem, rather than a biological one.  Canada is one of the best places in the world to be living with HIV – although it’s far from perfect. But here in Canada we have readily available treatment – treatment that is more effective and easier to manage than ever before.  HIV can still pose health risks even with treatment, and the side effects can be unpleasant to say the least, but someone who is diagnosed today with HIV, takes their medication regularly, doesn’t smoke and takes care of their health can expect  a near normal lifespan.   This means if someone living with HIV today has access to treatment, health care and other necessities of good health, such as good food and stable housing (and these are big ifs for a lot of people), they can enjoy a full and productive life. They can work, they can love, they can even have children.  That’s right – they can have children! HIV positive women can – and do – give birth to HIV negative babies. In Canada, with proper treatment, the risk of giving birth to an HIV positive baby is reduced to less than 1%! This is great news for women who are HIV positive and want to have a family. However, because HIV can be transmitted through breastmilk, it is important that they do not breastfeed.

Let me back up for a minute. HIV – which stands for Human Immunodeficiency Virus – is the virus that attacks the immune system and, left untreated, causes AIDS (Acquired Immune Deficiency Syndrome). The distinction between HIV and AIDS is important because today, with proper treatment, the virus can be successfully suppressed.  Without treatment, the immune system breaks down, leaving the individual vulnerable to life-threatening opportunistic infections, at which point an individual is said to have acquired AIDS, and without medical intervention, will likely die.  With treatment though, someone can live with HIV for decades and never develop AIDS. So, if AIDS isn’t the biggest threat to people living with HIV, what is?

The answer is unequivocally stigma.  Contrary to a lot of myths, HIV is not spread through casual contact such as sharing sheets, linens, clothing, food, dishes or cutlery, bathwater, swimming pools, or toilet seats. HIV is not spread through touching, hugging, or kissing. HIV is not spread through coughing, sneezing, urine or feces, sweat, tears or saliva.   Moreover, the effective use of condoms are a successful way of preventing HIV transmission during sex, and viral load suppression through medication further reduces the risk of transmission to a near impossibility.  Methods of getting pregnant for couples who are sero-discordant (mixed HIV status) are plentiful. In other words, there is no reason to be afraid of living with, loving, or building a future with someone who has HIV.  Yet HIV positive people continue to face rejection upon disclosure of their HIV status – from potential partners, from family members, from friends, from their church and from entire communities.  People face discrimination in accessing housing and in the workplace and even from health care workers.  Whether out of fear, lack of knowledge, or judgments around how someone may have acquired HIV (which often stems from racism, homophobia, sexism and/or stigma around sex or drug use,) social exclusion can be an everyday part of the life of someone living with HIV. It is impossible for me to overstate the impact that stigma has on the health and wellbeing of people who are positive, even at a time when people with HIV are at their healthiest.

Let’s get back to breastfeeding.  For women living with HIV, motherhood can raise a gaggle of other complex social and emotional challenges. I’ve already mentioned that stigma impacts people living with HIV, but what about women specifically? People might assume that she’s a drug user, that she’s been a prostitute, that she’s been promiscuous. Given the judgments and attitudes that are often formulated around women’s sexuality, you can imagine what a woman living with HIV might face. For mothers, this stigma is intensified. And, since women with HIV must not breastfeed (although the best-practice around this differs depending on what country you live in; the guidelines are different for women living in countries without access to clean drinking water or formula) women living with HIV often face added judgment around their inability to breastfeed.

Since most women will not want to disclose their HIV status to others, they cannot divulge the very good reason they have for not breastfeeding when facing scrutiny.  The questions they are inevitably asked by friends, family, and health practitioners cause anxieties for women who are attempting to keep their HIV status a secret. In some cases, people can be very pushy about it; I have even heard stories where family members or friends may get so involved as to physically attempt to place the baby on the breast and have the baby feed without consent.  If a woman does disclose her status, she would, unfortunately, very likely face further stigma and judgments about her HIV status.  And if word got around (which it often does), she could be virtually expelled from her community. For women who are newcomers, do not speak English fluently, or are living in poverty, community engagement is often an imperative component of physical, mental and emotional wellbeing. When it comes to keeping HIV a secret, there is a lot at stake.

Furthermore, pregnancy and motherhood can bring up feelings of guilt and shame about the illness; in addition to facing external stigma, many women experience internalized stigma, and may feel guilty for not being able breastfeed. Feeling guilty about not being able to breastfeed is problematic enough for any mother, but for women who are already marginalized, further feelings of guilt and shame add to an already pretty big burden.  Some women may be tempted to breastfeed despite the risks. Others may withdraw from social circles. Others may be reluctant to access social services or health care where they are made to feel guilty about formula-feeding or pressured to discuss their personal reasons for formula-feeding.  For women living with a disease that needs to be managed through access to treatment, good health care, food, housing and community supports, social isolation can be dangerous.

HIV is not something a lot of people think about today, but it still exists – it’s just hidden.  Unfortunately a lot of health care workers in our community are unaware of HIV, the scientific developments in prevention and treatment, and the social implications of the disease.  HIV workers aim to help support women through these challenges, but we need our communities to be aware of these issues and help create supportive environments. Just because women living with HIV do speak openly about their illness does not mean the problem has gone away.

Mothers who are living with HIV need proper information and support around formula-feeding, and they need this information offered in a non-judgmental space. When programs are designed they need to take in to consideration the multitude of needs that may be spoken or unspoken.  I believe it is important that health-promotion programs, including those that support breastfeeding, be designed in an inclusive way. Women already face extensive social and political control – particularly around our bodies, sexuality, and children. It is important that social and health care programs foster independence, support diversity, and create a safe atmosphere that is free of judgment and respects the privacy and confidentiality of all women.  This is about respecting the critical health priorities of women who may already have extensive trauma issues and already experience marginalization.  I know there has been a lot of important and empowering work done towards providing better support and education on breastfeeding that is free from the outside influences of companies who sell formula, but we need to prevent the pendulum from swinging towards exclusivity.  I hope to educate health care and social service providers in my community to share information and create spaces that are built on models of inclusivity and support, rather than stigma and shame.

Please feel free to contact me at communitydevelopment (at) aidsguelph.org for more information or if you have tips or suggestions to share on how service providers can create a supportive environment for all women!  For more information about HIV and AIDS, you can also contact your local AIDS Service Organization. Other great resources are thebody.com and CATIE.ca.

FFF Friday: “How I choose to feed my child is mine and my husband’s decision alone.”

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’m a worrier. I worry that I don’t support all of you in the ways you need to be supported. If I focus too much on those who wanted to breastfeed and couldn’t, I worry those who made a choice to formula feed aren’t feeling supported. If I rant about the “choice” to formula feed, I end up offending those who are mourning the loss of a breastfeeding relationship and are protective of how hard they tried to nurse. Either way, I end up giving someone the shaft. And it sucks, because there is so little support for anyone who uses formula- whether they supplement,  or do it fully by choice, or feel forced into using it as a last resort, or anything in between. 
What I love about Katie’s story, below, is that it demonstrates the importance of us banding together in the formula feeding community to demand better practical support. It doesn’t matter why we ended up using formula; we ALL deserve to be given better education and resources for alternatives to breastfeeding. It’s not “us against them” when it come to breastfeeding vs formula feeding, and it sure as heck isn’t “us against them” between formula feeding moms. It’s essential that we form an inclusive community, because if we don’t do it, no one else will. 
Happy Friday, fearless ones,
The FFF
Katie’s Story
I wanted to share my perspective/story on my crash landing into motherhood and formula feeding. I think it’s important to share perspectives of those that chose to formula feed vs. cannot breastfeed. While both are important, I feel that it’s hard to find those that share my perspective.

I totally fit breastfeeding mama stereotype. My husband and I are liberal, trying to live a green lifestyle in an urban community. We walk to work, opt for natural remedies and eat organic. During pregnancy I read up on attachment parenting and felt informed about all my pre-motherhood decisions. So why did it shock everyone so much that my baby registry included bottles and not a breast pump or formula instead of nursing covers? Is it because I couldn’t breastfeed? Did I not have enough support?

Could I physically nurse? Perhaps.To me, it was simple, how I choose to feed my child is mine and my husband’s decision alone. My son is now 8 months old and happy, rambunctious, full of movement, dislikes veggies and loves fruit, ready to giggle at a moment’s notice and very observant. He’s hit every milestone in the book (that I stopped reading at 4 months due to information overload and sleep deprivation) and we have an incredible bond. I am smiling just thinking about it! I don’t feel any need to justify my decision and I am very happy with our feeding experience.

While I do not feel the need to justify my decision to formula feed, I do feel it’s important to share my story, so that moms in a similar situations, making the same decisions, do not feel alone. My formula journey began somewhere at 9 months pregnant and freshly unemployed. As if the third trimester is not scary enough – especially 3 states away from any family and as an unemployed family breadwinner, I was terrified. Luckily, the decision was not made hastily and my husband and I knew that it would be challenging, but it was the best decision for us. I was leaving a job, seeking a new position (interviewing at 9months? Piece of cake – and it was!), and embarking into parenthood. With all of the changes and stress, I wanted to ensure that the fourth trimester (newborn – 3 months) would be as stress-free as possible. So I launched into prepared mode… some might call this extreme nesting.

When time came to welcome our little man to the world, things didn’t go as smoothly as we hoped and 1.5 weeks late, rapidly decreasing heart rates, and 7 hours of labor turned into a c-section. During the 7 hours I of contractions, I had to announce that I was formula feeding, not breastfeeding (accompanied with stern looks) 5 times. I also had to share it twice while I was strapped to the table half zonked out and cut open. I understand the need for them to know, I didn’t understand the unsupported nature of the request.

The days that followed brought so much joy, a fairly easy recovery and lots of questions. New parents have lots of questions. As a “breastfeeding friendly” hospital, they assumed everyone is breastfeeding. I had to ask them to remove the “I’m Breastfed” sticker from my child’s cart multiple times, erase it from my nurse info white board (also multiple times) and request a special formula delivery each time the baby needed fed – causing several unnecessary cries of a hungry babe. My husband even had to walk around the nursery for a half hour in search of the formula. I asked how much the baby should need each feeding and I received a how much to supplement information from a lactation consultant… I never did get a clear answer.

Without a clear answer on how much to feed our baby, we headed home in a sleepless daze. Our little guy screamed… cried… fought and twisted.I immediately felt that it was my fault, that maybe he was gassy, that the formula was hurting him. We didn’t know if we fed him too much or too little, since we didn’t know how much to feed him, it wasn’t easy to google on the internet and I had little 3am support on formula (had I wanted 3am breastfeeding support… I knew where to get that). Luckily, the little guy was telling us he was HUNGRY! After a few trial and errors we were right on track and able to get into a strong feeding groove. It was so wonderful to share this experience with my husband 50/50. It was the right situation for our little family. When I had to job interview on site at 6 weeks postpartum, it wasn’t an issue.

It hasn’t always been 100% easy, though. We had a blood-in-spit up-situation when all I could find online was about blood on nursing mother’s nipples, launching me into a panic because I couldn’t find anything about spit up, blood and formula. The doctor also assumed this as I was crying and had to explain, again, that he was formula and that my nipples were in tact (note: all is well, just an issue with reflux). I also had the hardest time finding strong resources that compare name brand/off brand formula. Turns out the cheaper off brand was a better fit for him, anyway, as learned from more trial and error. Lastly, when we moved to a new city my little guy was 5 months old and I was dying to meet some new moms in the area. There were several nursing friendly groups and and Le Leche Leauge groups that I don’t dare show up to with bottles in tow. I found like-minded moms in other ways.

This has been a big year for my family. New baby, new home, new job, new… everything! I have never regretted my decision to formula feed but I did have a few tiny moments of ridiculous guilt. New mothers should never be made to feel guilty or embarrassed. We should not have to justify healthy, but perhaps different, decisions. Most of all, it’s time to stop judging and time to start truly inclusive supporting. Through sharing my story, I hope not to justify my decisions, but to provide an example of how formula feeding is just one more healthy decision among the zillions of decisions new parents make and maybe we just need more resources for Fearless Formula Feeders.
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Feel like sharing your story? Email it to me at formulafeeders@gmail.com.
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