We’re reminded constantly that ‘breast is best’. The ads plaster the Metro, viagra 100mg hospital walls and my Facebook feed. Breast milk is touted everywhere these days as liquid gold, the ambrosia of life granting a sacred bond between mother and child. So of course when I was pregnant with my first child in 2015, I planned to nurse my baby. I took the classes, bought milk freezer trays, researched gear in preparation to milk myself at work for the next two years, per WHO recommendations. However, six days after the birth of my child – I changed my mind.
Baby Aria was born via emergency C-section after 22 hours of labor at Johns Hopkins Hospital with a mild case of jaundice – a condition that commonly affects babies of Asian and African descent. As a rookie mom, so I consulted every nurse and lactation consultant who came through the door. I gathered lots of advice, even though some even seemed to conflict with one another. With each new nurse shift, my list of instructions grew longer until I was nursing for 40min, followed by pumping for 30min, repeated every 2.5 hr. Exhausted, I asked a nurse when I was supposed to sleep during all of this, she replied something all new mothers have heard and loathed – sleep when the baby sleeps (but you just told me to pump after nursing?). During the next four days, baby Aria had alarmingly few wet diapers and alternated between being with me and going back to the nursery for 24-hr light therapy sessions to treat jaundice. Throughout this time I was reassured that I was “doing a great job”, that nature had taken its course and my bleeding nipples were ‘normal’ according to one inexperienced nurse.
It seemed that baby got sick each time she came back to me. On day four, an inquisitive nurse weighed Aria before and after a long nursing session, confirming my nagging suspicion that she wasn’t getting any milk from me (<5g weight difference). I had come face to face with the fact that I had starved my child for three days, exacerbating her condition by dehydration. I thought this information would bring change to our care. But nothing happened. I would have felt better if a doctor came running in shouting – “Breastfeeding hasn’t been working for you!” Instead I was urged to continue as I’ve been told and I was still ‘doing a great job’.
On the eve of day five, we are still at the hospital due to her unrelenting jaundice. Severe sleep deprivation from pumping endlessly, cliff-diving hormones combined with guilt from harming my newborn created the perfect storm leading to a breakdown. I couldn’t understand why no one around me responded to reason, to empirical evidence. I lost faith in my healthcare providers’ judgment and my body’s ability to function like a mother. My head buzzed and my legs shook at the mere mention of breastfeeding. I stopped everything I was doing and asked to see a psychiatrist.
In the last 30 years, US hospitals have heeded the call to arms by the Surgeon General to promote breastfeeding. This includes the Baby-Friendly Hospital Initiative, a campaign launched by UNICEF and the WHO in 1991. This 10-step program includes posting breastfeeding literature in hospital rooms, training staff to support breastfeeding, giving other no food or drink to nursing infants unless medically indicated and giving no pacifier or artificial nipple. While these steps are well-intended, there is very little science behind these guidelines.
When anxiety became incapacitating, we decided to go for bottle-feeding. We were given dire warnings about nipple confusion, which could seal an infant’s fate to the bottle. A meta-study from last year examined 14 studies on ‘nipple confusion’. Firstly, this is not a medical term. Secondly, it’s a misnomer since babies are less ‘confused’ than prefer the bottle, which is likely an indicator of difficulty and stress associated with nursing. The authors contended, “despite the limited and inconsistent evidence, nipple confusion is widely believed by practitioners” and concluded that causality is difficult to establish in these studies. JHH includes an Avent pacifier in every welcome packet, technically violating the initiative guidelines. Their argument is that pacifier use may help to prevent SIDS, as suggested by research from the APA . So who is the authority on these topics? UNICEF? The CDC? Individual Hospitals? Medical studies? If some of the guidelines for the Baby-Friendly Initiative are outdated, shouldn’t there be review and revision for such a pandemic program?
All controversies aside, in our case the JHH staff continued to encourage nursing – which was in fact not working, while it was clearly medically necessary to feed my child somehow to prevent potential brain damage from jaundice. I agree that breastfeeding is ideal if possible. This is a mother’s choice. However in a hospital setting, if healthcare providers choose to ignore clinical signs to pursue political agendas, there is a conflict of interest. For us, the very thing that was supposed to provide nursing support instead endangered my child’s well-being and contributed to my not being able to nurse at all. I believe this was never the intention  of the hospital. Given a choice today, I would have traded my swanky single room for an L&D environment that hosted group nursing activities supported by lactation consultants and local support groups.
Pushing for breastfeeding is deeply ingrained as our healthcare legislation. While I am a strong supporter for Obamacare, subsidizing just breast pumps at the hospital is unfair since it excludes a significant group of parents – such as GLBT, adoptive families, and those unable to breastfeed due to tongue-tie, latch issues, inverted nipples, medication and countless other reasons. A free breast pump isn’t always the answer when alternatives such as subsidized formula and milk banks are not accessible to all families. Ideally, all parents will have reasonable family leave (at least three months or past the ‘fourth trimester’) and there will be no stigma against working mothers taking several hours a day to pump at work. This is not yet the case in America. While we need to make those changes happen, it’s important to keep in mind not every family has a lactating mother overflowing with milk. We need to give help to all parents because all babies need to eat.
It’s been nine months and Aria is a spunky little girl who spends most of her mornings chasing after our cat at a steady crawl. I have been off meds for post-partum depression for 3 months and life is finally starting to feel normal again. I have talked to many local moms in Baltimore and discovered more than a handful of us feel bullied at the hospital and ended up feeling inadequate or had failed. On my morning commutes, I talk to Aria’s daycare teachers, Metro train conductors, coffee shop clerks and medical professionals. I realize it’s a huge challenge for moms at these presence-demanding jobs to can step away to pump for 30min every 3 hours in a private room in order to maintain an adequate milk supply. We all want to give our children ‘the best’, but what happens when this is not possible? If we are graced with #2 some day, I will prepare myself to nurse again. But if it doesn’t work out despite my best efforts, taking up the bottle certainly won’t be the end of the world this time around.
Jennifer is a neuroscientist at Johns Hopkins School of Medicine.
1. Zimmerman E, Thompson K. J Perinatol. (2015) Clarifying nipple confusion. Nov;35(11):895-9.
2. American Academy of Pediatrics Task Force on Sudden Infant Death S. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005; 116(5): 1245–1255.
3. Bass JL, Gartley T, Kleinman R. Unintended Consequences of Current Breastfeeding Initiatives. JAMA Pediatr. 2016 Aug 22