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 wonder how many other mentally ill mamas fall through the cracks…”

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 story addresses something that is often ignored or dismissed in conversations about choosing whether of not to breastfeed: mental illness. For someone who struggles with any number of psychiatric disorders, pregnancy and lactation, with all the hormonal and emotional upheaval they bring, can be downright toxic. Or, as Caitlin puts it, a “living hell”. Making the choice to formula feed can be a matter of survival; while some medications are compatible with breastfeeding, others aren’t – and it’s overly simplistic to tell women (as many popular breastfeeding resources do) that “if your medicine is contraindicated, you should probably be able to find one that isn’t”. Treating psychiatric conditions medically often requires “cocktails” of drugs; it can take years to find the right meds, the right doses, and the right combination. We can’t allow the rhetoric to drown out the voices of women who are struggling, and who are trying to tell health care providers (and other members of the peanut gallery) that breast simply isn’t best for them or their babies.

And I won’t even start in on the lack of education and assistance Caitlin was given, because it may well drive me to drink. I’m already *this* close to cracking open a bottle of wine and I still have three hours of “day job” work to do, so that will end badly for everyone. I think Caitlin’s story does an excellent job of making the point I’d want to make, anyway, so I’ll let her go to it.

Happy Friday, fearless ones,

The FFF

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Caitlin’s Story

I wanted to share my story – the story of someone who knew from the very beginning of her pregnancy that she would not be able to breastfeed her child.

To say that psychiatric problems have plagued me my entire life would not be far off course – I was diagnosed with bi-polar disorder at the onset of puberty at the tender age of eight. It was a long, hard struggle for me and my care providers to find just the right medications that would work for that, along with my anxiety disorder and my later-acquired post-traumatic stress disorder.

When I found out I was pregnant, that carefully-sought combination of medications had to stop. The psychiatric medications that were safe for pregnancy – and subsequently breastfeeding – would not work on their own without careful balancing by other non-baby-safe medications. In fact, they make my issues worse.

So I knew I was in for a rough haul, but never expected my nine months of pregnancy to be a living hell with daily battles against suicidal ideations. That said, my care providers knew from the beginning that it was of paramount importance that I start my medications, as one doctor put it, “as soon as the placenta hit the bucket.”

Despite the fact that it was well-known I would not be able to breastfeed my child, I was given no support or education on how to properly formula feed her. I was met with comments ranging from pity – “It’s a shame you won’t be able to breastfeed. You’ll miss out on some important bonding” – to outright derision, with one nurse even outraged that I would dare put my “imaginary” mental health problems above the well-being of my child.

At the time, I was too tired and too miserable and too out of my right state of mind to be outraged. Every time I think back on those moments, my blood boils. My care providers KNEW for nine months that I would be unable to formula feed. I spent several days in the hospital (courtesy of a crash C-section) wherein I was given no advice on how to feed anything other than the pre-packaged, already mixed formula that came, at great frustration and humiliation, from asking a nurse each time my child was hungry because they would not stock formula in the rooms.

But I endured. And my daughter endured. And everyone who was closely involved with my pregnancy knew that the best thing for my daughter was to have a healthy mother to care for her. So I tried my best to keep my chin up and remember that I was doing what was best for both me AND my daughter.

And lest I be accused of not advocating for myself, every time I asked for guidance or education, I was met with a brush-off, or a “we’ll talk about it later” or even just that withering look that said I was barking up the wrong tree. Or even just a shrug and an “I don’t know what to tell you.”

I was lucky – I had a team of mamas at my disposal who had “been there, done that” with their own children, and their children’s children. They were able to guide me and teach me the ins-and-outs of what to do and what not to do when it came to properly formula feeding my child after we left the hospital.

But sometimes – like now – I wonder how many other mentally ill mamas fall through the cracks, like I almost did? I wonder how many others don’t have that same support network to bolster them and give the education needed to properly formula feed their child? At a time when hormones and serotonin and dopamine are already imbalanced, how many other mentally ill mamas just snapped under the pressure?

I made it through – and almost a year later, my daughter (who is also lactose-intolerant and was fed exclusively soy formula) is thriving and ahead of her development, both mentally and physically. And most importantly, she has a sane mama to help her grow into a wonderful human being.

“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: “If someone wants to judge me…that’s their choice.”

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 I hope we can all give them the space to do so.



D-MER, or Dysphoric Milk Ejection Reflex, is a problem that is seldom discussed in breastfeeding literature. It’s a tricky condition to diagnose, because other things can make breastfeeding a negative experience – postpartum depression, psychological responses to physical pain or sensations, associations with past abuse, body image issues…  D-MER, however, causes a “dysphoric” response (depression, anxiety, anger, negativity) with milk let-down, and it typically subsides as soon as that physiological process ends. In my opinion, this is a vastly under-diagnosed condition due to the perception that these feelings are shameful or “abnormal”, because we are told that breastfeeding should be a lovely, enjoyable bonding experience. Further, the vast majority of D-MER resources operate under the assumption that weaning is not an option, and that it can be resolved through medication. For those who want to continue breastfeeding, this is wonderful – but for those who do not feel comfortable taking certain medications while nursing, or at all, this advice may cause more frustration than comfort. 

FFF Andrea’s story, which unfolds below, demonstrates the conflicted feelings of a woman who wants to breastfeed, but also wants the happy, emotionally-attuned family life she so deserves. I hope that her willingness to share her journey will encourage other women living with D-MER to come out of the closet regarding their true feelings and experiences. This is a real problem, affecting real women, and it’s time we had some real, honest discussions about it – because in many ways, it is the most literal “booby trap” of them all.

Happy Friday, fearless ones….

The FFF
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Andrea’s Story
I formula fed my first and for the most part didn’t mind.  I knew he was turning out healthy and he was advanced for his age too.  I had no doubt that formula was a good alternative for those that didn’t want to or couldn’t breastfeed.  However a part of me always sort of wished breastfeeding worked out for me.  However I had depression only during breastfeeding and it just got worse as the days went on.  After a bit of research sometime later I found out that it was D-MER and was a bit relieved that I wasn’t abnormal and others experienced it too.
Fast forward a couple years and we had our second on the way.  I hoped that breastfeeding would work out and was determined off and on to exclusively breastfeed.  I researched D-MER and found out that if you had it before you would likely get it again.  That thought scared me quite a bit because I remembered how miserable I felt and the dread I felt before he latched on.  I found out that Wellbutrin had some good results with D-MER though and started researching the use of Wellbutrin while breastfeeding.  I took it for ADD already with great results, but had stopped before I got pregnant.  However, I just couldn’t find enough research to make me feel comfortable with that.  I knew only a little transferred through the milk, but I couldn’t help but wonder how much it affected a baby’s brain since they were so tiny and still developing quite a bit.  My education background made me wary as well.  To me, formula honestly seems to be a much safer alternative because it doesn’t have a drug in it that affects the dopamine levels in her brain.
Fast forward again and my daughter was born at a very healthy 7.11 pounds and 20.5 inches.  She had (still does have) the cutest chubby cheeks!  I decided to go ahead and let her latch on and she did, very fast and pretty good, too.  I remember telling the doula that we would take it one day at a time and wistfully stating that I hoped it would work out.  It was an experience I wanted to have.  I knew I’d bond with her just as well with formula; in fact it would be better than breastfeeding if the depression came.  We were in the hospital for 2 days and she breastfed really well; in fact I’d say she had a voracious appetite.  She had a wonderful latch, but she went at each feed so thoroughly that I got peeling and cracked nipples.  It only hurt when she latched on fortunately and sometimes that was because she’d just inhale the nipple.  On the third day I was pretty much couch- bound with a baby that was feeding pretty often for short cluster feeds.  If she wasn’t feeding she was using me as a paci or insisted on sleeping with her head right next to the nipple.  I could get up to maybe use the bathroom, but that was it.  My milk had started coming in and I began to feel those same depressing thoughts and I had some random bouts of anxiety as well.  Faint as they were at that moment, it was still undesirable.  I also found myself really hating the couch-bound aspect.  I couldn’t find a position that didn’t hurt since I had a couple stitches.  I also had a son that needed me.  My husband was helping out a ton, but my son insisted on having me help him go to bed at night and to pat him back to sleep if he woke up.  I wanted to be with him at bedtime and more as well, but with the way my daughter was feeding, it was very hard.  So midway into the third day we switched to formula.  Admittedly I felt relieved.  I wasn’t tied to the couch and my mood started improving with the slowly diminishing letdowns.  The more my milk dried up the better I felt.
A few days later though it was clear the formula wasn’t agreeing with her.  She was comfort feeding so much that she would drink about 6 ounces over a couple hours between fussing.  Then she’d cry and fuss herself to sleep.  We tried paci’s and all, but she wouldn’t take them.  I also noticed that she had silent reflux.  I decided to try Similac Sensitive since that was what my son was on.  I remembered that he didn’t do well on Enfamil Gentlease so maybe it would be the same with our daughter.  It seemed like she improved briefly, but she actually got worse.  So as a last option I bought a can of Alimentum and gave that a shot.  She started doing so much better.  It was an amazing improvement.  I fell in love with the formula, she is such a happy and calm baby now.  She does just as well on Nutramigen as well, which is a bit more affordable.
Part of me felt bad though.  I occasionally wonder if she’d have had this problem if she were breastfed.  I also wished a bit that breastfeeding had worked out.  I wanted that experience and the convenience as well.  I felt a bit guilty that I enjoyed holding my daughter more now that she wasn’t attached to me and voraciously feeding almost all the time as well.  She had such a high demand and was always tugging and pulling at me as well as feeding quite hard at times. 
I can’t help wonder if some of the guilt I feel is because all my friends breastfeed.  The only person I could talk to about the whole breast or formula dilemma while pregnant was with my mom, who had done both with my brother and me.  I tried talking to a friend, but she wasn’t very helpful.  I got some clear anti formula comments from another friend as well.  I laughed it off, but it did hurt a bit.  I know part of me feels envious because I did hope it would have worked out.  It’s just an experience I wanted to have that wasn’t tainted with depression or random bouts of abnormal anxiety.  At this current moment I’m trying hard to not get down that it didn’t work out.  It is so nice that my husband can help with feedings.  It’s nice that I don’t have a baby attached to me almost all day as well. It’s especially nice that my mood isn’t going downhill and that I won’t wonder someday if the Wellbutrin changed her brain at all.  I can help out more with our son too.  I do enjoy feeding her much more now.  It’s a wonderful bonding experience and as I say, since you need two hands for feeding with a bottle you can’t read a book or surf the web like you can while breastfeeding.  Sure you can watch TV, but I rarely pay attention to that, I love watching her and it helps keep me aware of her cues on when she needs to burp or is done. 
Overall, I know that this is better for me emotionally.  While most don’t understand DMER or why I won’t breastfeed while taking Wellbutrin, I know the truth.  If someone wants to judge me on my reason for not breastfeeding, that’s their choice.  I hope that someday moms won’t feel this huge push for breastfeeding and have more support for formula feeding.  We have enough to deal with as moms, how one chooses to feed their baby shouldn’t be one of those nerve-wracking issues that can be laced with guilt if the choice isn’t breastfeeding.
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Share your own experience for an upcoming FFF Friday. Email me at: formulafeeders@gmail.com.
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