FFF Friday: “No one told me about the possibility of this not working…”

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. 

There’s a lot that bothers me about the way breastfeeding is presented to women (which I suppose is, erm, rather obvious), but the whole “only 1-5% of mothers can’t breastfeed” is definitely near the top. Not only is this statistic based on limited, shaky research, it is also completely misleading. Lou Gehrig’s Disease (ALS) affects .002% of the population, and there are telethons for it (as there should be, of course). Women with lactation failure are ignored, ridiculed, and told it’s all in their heads. I’m certainly not comparing ALS with lactation failure (please) but merely making the same point Lisa Watson of Bottle Babies did in her brilliant post about this issue: 1-5% of women is nothing to scoff at. 

As Karly writes in her beautiful, raw post below, “This was my baby and my body, and I knew them both best.”. It’s odd to me that this same sort of rhetoric is used to justify so much of the natural birth movement, but it is turned on it’s head when the subject is breastfeeding. Maybe some of us need to take a long hard look at our own hypocrisy, as feminists and maternal health advocates. 

Happy Friday, fearless ones,

The FFF

***

Karly’s Story

Now that my breastfeeding journey is coming to a close, I feel I finally have the emotional stability to tell my story. I never thought I would be writing something like this when Olivia was only 7 weeks old, but you know the saying, “the best laid plans are laid to waste.” And for me, this was no exception.

I’ll start out by saying that I truly believed that because I so deeply wanted to breastfeed, that I could just do it. I embraced the La Leche League belief system that all woman could breastfeed and that very few woman had actual supply issues that kept them from doing so. I threw out all the free formula I got in the mail, didn’t register for any non-Medela bottles on my baby registry, and did my share of breastfeeding classes, book reading, and research. I told everyone I knew that I wanted to breastfeed for accountability. I was so excited to partake in something so “natural.” I didn’t realize that there was much more to it than a willing heart and a pair of boobs.

My breast feeding journey didn’t start out the way I had planned, and since becoming a parent, I realize that not much does follow the way of our intentions! When Olivia was born, she had accelerated  breathing and was immediately whisked to the far side of my delivery room for monitoring. After she settled down, I was able to spend 10 minutes with her before she was taken to the transitional nursery for 5 hours. I desperately had wanted to nurse her right away, because that’s what everyone says you’re supposed to do to establish a good breastfeeding relationship. I was a little worried I wasn’t able to, but my maternal instinct was already rearing its head and all I was truly concerned about was her being healthy. When I was finally able to spend time with her, it was 10pm and there were no nurses around to help me. I buzzed my less than helpful and attentive nurse and she showed me the football hold and told me that Olivia wasn’t really nursing and couldn’t I tell? “See,” she said, “her cheek muscles aren’t really moving and you can’t hear any swallowing.” I was already starting to feel awful about my abilities to properly nurse. She told me a lactation consultant would come around the next day.

Around 11am the next day, a LC arrived and spent a reasonable amount of time with me. She ascertained that Olivia didn’t have tongue tie (good news) but that she had a high palette, which made it difficult for her to latch because her mouth was so small, and I have slightly retracting nipples.  She gave me a nipple shield and it seemed that Olivia was able to finally grab on to something. I tried nursing all day and it “seemed” to be going well, but I couldn’t really tell.

The next morning the pediatrician made his appearance and when we told him that Olivia wasn’t really producing that many diapers, he was concerned. He suggested supplementing with a 1/2 ounce of formula to prevent her from being dehydrated. I had to suck back my tears until he left. I was devastated. All the books and websites and avid breast feeders had “warned” me this might happen, and to not give in. When my newly on-shift nurse arrived, I cried with her. She was super understanding and reminded me that I needed to make sure Olivia was taken care of.

This was the first time I realized that a commitment to breast feeding can sometimes jeopardize your child’s health. If I hadn’t decided right then to make sure my child’s health came before my desire to only breastfeed, Olivia could have ended up hospitalized for dehydration (and I know this happens because I’ve heard first-hand about it). This is by no means a judgment on people who decide to take a different route than I did when listening to their doctor. However, I personally, could not justify it.

To abate my fears, my nurse showed me how to supplement the formula with a syringe and straw, so that Olivia would still practice her breast feeding skills and not be at risk for nipple confusion. She wouldn’t even notice what was happening. But I did- and no matter what I told myself, I felt awful. I hadn’t wanted to even touch formula, and here I was, supplementing in the first 30 hours of Olivia’s life. I felt inadequate and crippled. Everyone had told me that babies stomachs were the size of marbles and that the small amount of colostrum I had would surely be enough. But it wasn’t, so what was wrong with me? I had pumped what little colostrum I could relinquish, and it was about a 1/4 ounce (less than 8ML). It almost made me feel worse to actually see how little I had.

Everyone assured me that my milk would come in over the weekend, days 3-4, and not to worry.  I kept up hope, but still worried. As soon as it came in, I could stop supplementing. When I got home, the syringe and straw didn’t feel so easy anymore. It was near impossible to get it into Olivia’s mouth where she would do all the work and suck the formula out. After a few attempts, we started just squirting it directly into her mouth. I cried every time I had to attempt the syringe because she would unlatch when I accidentally poked her in the mouth. When she got frustrated she would bob her head and grab at my breasts, ripping off the nipple shield. I don’t think I’ve cried so much as I did those 4 days at home. The worst part was, I would nurse for an hour+ each time, and she would cry and root after each session because she was still hungry.

As the weekend ended, I knew something was amiss. There had been no change in my breasts at all- no engorgement, no let down sensations, no happy baby at the end of a marathon nursing session: only a hormonal wreck of a first-time mom who realized that her breasts were letting her down.

I signed up for a breast feeding workshop and was elated at the thought of some help and encouragement. The LC weighed Olivia before and after a 40 minute feeding and I was horrified to learn she had only taken in a 1/2 ounce in all that time. Add to it the fact that she had lost 9 ounces of her birth weight and had not gained any back in a week, meant I left the workshop in tears. My husband was so encouraging, but let me know that breast feeding was something I may have to just let go of. I wasn’t ready to hear it and sobbed the entire way to the health food store, where I purchased Fenugreek and Blessed Thistle supplements in hopes of increasing my supply. We committed that day to supplementing after every feeding to get Olivia’s weight up to par. Prior to that I fought every supplement because I had wanted to be enough for her alone.

When Olivia was 9 days old, we weighed her again at the Mother Baby Assessment Center in our hospital. She had only gained 1/2 an ounce in 2.5 days since we were last there. I was beginning to feel worse than a failure. I had been taking the supplements but wasn’t noticing much of a difference in Olivia’s satiation at the breast, or when I pumped.

The stress of even the idea that breastfeeding wouldn’t work was beginning to consume me. I spent hours on the internet trying to read other people’s stories of how they overcame supply issues, or how I could produce more. I couldn’t sleep well enough to feel rested, which I’m sure only made milk production worse. I knew that if I didn’t overcome this, I would be entering into postpartum depression. That day, I made a private appointment with a LC for the following Tuesday. But when I made it home, I didn’t even think I could make it that long. I wanted to quit, and quit right then. My husband wouldn’t let me, telling me he would be disappointed in me if I didn’t make it to my appointment, which was right around Olivia’s 2 week birthday. It hurt to hear him say that, because all I wanted was a way out. But I realize now that he didn’t want me to look back and regret quitting, but to do it when I was emotionally stable (as if that’s even possible in postpartum days!).

I reached out to a La Leche League leader in my area, who pretty much verbally vomited the same things I had read in the Womanly Art of Breastfeeding: very few woman have supply issues, just keep putting the baby to the breast, don’t supplement, feed on demand. She made me feel worse than I already did, because if “most woman don’t have issues,” then either something was wrong with me or I wasn’t trying hard enough. She couldn’t really say much when I told her that Olivia wasn’t even producing enough diapers- the tell tale sign that babies are getting enough breast milk.

I’m proud to say I made it to my appointment! I have to admit, I went with the intention of quitting as soon as it was over. The LC could tell I was on the verge of losing it. We nursed and weighed Olivia again and this time she took in 1 ounce, instead of 1/2 like the week before. Obviously, Olivia was growing and was only going to need more, and even this clearly wasn’t enough. The LC looked at me and told me that any milk Olivia got was good. It didn’t matter if I could exclusively breastfeed or not. She told me if all I could handle was nursing 1x per day then pumping, that was ok. She said it was my baby, not hers, and she wasn’t going to tell me to do something I couldn’t. She diagnosed me with a lactogenesis disorder, or a milk production problem.  She gave me a way out and made me feel like I could finally let go.

After that appointment, I felt a weight lifted. This WAS my baby and my body, and I knew them both best. I knew there was something wrong with my milk production, no matter what any La Leche League leader told me (which, coincidentally was to nurse EVERY HOUR. That’s not even humanly possibly as a new mother, and especially not emotionally possible for the wreck that I was at the time). Because the stress of exclusively breastfeeding was gone since I knew it wasn’t possible, I moved to only pumping.

Even then, I would pump 5-6x per day and still only get 5-6 ounces for the entire day, less than a quarter of what Olivia still needed. I started to walk down the road of depression again when my milk supply wouldn’t increase, no matter how frequently I pumped or how much fenugreek I took. Pumping made me feel almost embarrassed in a way, watching my ugly, not quite working nipples be tortured into giving up droplets of breast milk. When I found blood in my preciously stored milk (which is completely normal and not harmful for baby), I decided my days of breastfeeding/pumping were done. It was like the blood signified everything I was willing to put aside to just make it work- and it made me feel horrible. So I packed up my pump, bottles, and flanges. I put them out of sight and don’t plan on looking at any of it for a long while. It’s all over.

Formula feeding was never the issue for me. I don’t think its poison or that it contributes to obesity. If it was truly unsafe, it wouldn’t be on our shelves. It really wasn’t even about Olivia. I was mostly thinking about myself and what breast feeding was for ME. My sweet baby doesn’t care how I got the liquid in her bottle, only that I love her enough to give it to her when she needs it. And let’s be honest- when she’s in kindergarten I’m not going to be looking back and constantly thinking about how I couldn’t really breast feed. I needed a little more perspective.

The real issue is that I was truly uninformed about breast feeding. True, most women can breast feed in some form- but it’s not true that most women can exclusively breast feed. Many women have supply issues. Once I started having issues, all my girlfriends started coming out with the problems they had as well. Where were they all when I was standing on my soapbox, proclaiming my imminent success as a breast feeder, while secretly judging people who gave up? And on top of it, I had major guilt about all the breast feeding supplies we’d spent money on that would be useless to me. We had JUST bought a $250 breast pump! No one told me about the possibility of this not working! As my husband puts it, the books I read on breast feeding were selling something: an idea that sounds perfect, but that is rarely ever obtained. I dealt with feeling duped and stupid because I bought into it.

I ran the gauntlet of feelings the last 7 weeks. Emotionally, I had times of resenting my new baby, my body, and my husband. Physically, I was exhausted and bitter at my anatomy. I went through the stages of grief: denial, in that I never thought it could be happening to me; anger and bargaining with God; shameful depression; and finally today, acceptance.

I wanted to finish this post as I let my milk dry up. The physical pain is what I wanted from the beginning- to signal an imminent, successful breast feeding journey. Instead it’s a bittersweet end to something that I need to move on from. I started writing this in the throes of my post partum hormones. Now, 5 weeks later, I’m finishing it. When I went back to read what I started, tears started streaming down my face as I remembered the anguish I was feeling. I never want to feel that way again, and am so glad I am on my way to accepting God’s plan for motherhood, even though I’m still a little sad about it now and then.  I can finally put down the breast pump and spend time with my Olivia.

***

Have a story you’d like to share? Email me at formulafeeders@gmail.com.

 

Can breastfeeding concerns be overcome with support? Depends on what “support” means

Guess what? Women are having trouble meeting their breastfeeding goals.

Contain your excitement.

Apparently, this is news to the American Academy of Pediatrics, and every major news outlet in North America. The study causing such shock and awe came out this Monday in the journal Pediatrics. Researchers used self-reported data (i.e., interviews) from 532 first-time moms giving birth at a particular medical center (can’t find where, and due to geographical differences in levels of breastfeeding support and acceptance, I think this is vital information that at least one of the articles could have shared with us). The women were asked prenatally about their breastfeeding intentions and concerns, and then re-interviewed at 3, 7, 14, 30 and 60 days postpartum. According to Reuters:

During those interviews, women raised 49 unique breastfeeding concerns, a total of 4,179 times. The most common ones included general difficulty with infant feeding at the breast – such as an infant being fussy or refusing to breastfeed – nipple or breast pain and not producing enough milk.

 

Between 20 and 50 percent of mothers stopped breastfeeding altogether or added formula to the mix sooner than they had planned to do when they were pregnant.

 

Of the 354 women who were planning to exclusively breastfeed for at least two months, for example, 166 started giving their babies formula between one and two months.

 

And of 406 women who had planned to at least partially breastfeed for two months, 86 stopped before then.

Given these results, the study authors come to the conclusion:

Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum. (Source: Pediatrics)

 

The headlines, as usual, were both amusing and infuriating. “Nursing Troubles May Prompt New Moms to Give Up Sooner”. “Early breastfeeding challenges make women quit.” “Some moms discontinue breastfeeding within two months die to nursing difficulties”. And my personal favorite, “95% of breastfeeding problems are reversible.”

One might easily blame the media for their usual skewering of the science to make for a juicier headline, but one can hardly blame them when the experts giving interviews about this study say things like, “It’s a shame that those early problems can be the difference between a baby only getting breast milk for a few days and going on to have a positive breastfeeding relationship for a year or longer… If we are able to provide mothers with adequate support, 95 percent of all breastfeeding problems are reversible.”

So, what’s my issue? I think the study is fine. Sort of a no-brainer, considering they could’ve came to the same conclusion years ago had they just listened to moms instead of insisting we just needed more convincing of the benefits of breastfeeding, and we’d all magically lactate to the satisfaction of the World Health Organization. But the quote above (from Laurie Nommsen-Rivers, one of the study authors) makes me wonder if the results of the study are being taken in the wrong context.

The focus is on moms not getting enough support –  something that I 100% agree needs to be focused on. Like, yesterday. But where the experts quoted in these articles and I part ways is on what type of support is needed. This passage from NPR illustrates my point:

The researchers didn’t do physical exams of the moms and babies, so they don’t know what was happening for sure. But they speculate that some of the first-time mothers may have misread the babies’ cues, mistaking fussiness for hunger, for instance, or thinking the babies weren’t getting enough milk when they’re doing just fine…

 

Once again, the assumption is that women are wrong about their bodies, and about their babies. The study authors surmise that access to lactation consultants in the first week postpartum, after hospital discharge, will be the solution to many of these problems. Again, I absolutely agree that this is a great start. And yet – reading through the scores of FFF Friday stories, I have to wonder… is this really going to make a difference, given the current state of our breastfeeding culture? How many LCs have we all seen, cumulatively? How many were bullied or shamed by medical professionals? How many of us have been told our babies were fine, only to end up in the ER with a dehydrated infant? How many of us were told – by professional lactation consultants and pediatricians – that every woman can breastfeed, and that we should just keep on nursing and it will all work out?

Looking at this study, this is what I see: a ton of women are claiming to have pain, trouble latching, and concerns that their babies aren’t getting enough milk. NPR also reports that the group with the least amount of reported problems was comprised mostly of women under 30, and women of Hispanic origin. That begs for further research, doesn’t it? Could age and legitimate lactation failure be associated? What about race/ethnicity? Are there conditions more prevalent in older, non-Hispanic populations that are also associated with breastfeeding problems?

And this is what I also see: We have an opportunity – no, a responsibility- to look at the type of support these women are getting. Is it truly evidence-based? Or is it based on dogma; on the belief that “95% of breastfeeding problems are reversible”? (By the way, I am super curious about the research backing up that claim.) Are the individuals giving the support truly listening to the mothers, examining them, considering the delicate balance of hormones necessary for lactation, or the effect of emotional or physical trauma around birth on a woman’s ability to withstand latching pain or her infant’s cries? Is there nuance? Are these mothers being seen, or are they being treated as uniform breasts, needing to be “handled” so that they can fulfill their duty of providing exclusive breastmilk for 6 months?

I’m not knocking a study that advocates for more support for moms. I simply want us to open up the discussion, rather than going in circles, with the same researchers and the same experts telling us the same things – if mothers only knew better. If they could only be taught to recognize their babies’ cues. If they would only listen to us. 

I think it’s time they listened to us, instead. Which brings me to what I’d really like to see from this study: a follow-up where they ask the women who “failed” to meet breastfeeding recommendations what they think would have helped them reach their goals. Because without that piece, I really don’t think we can get very far.

 

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
***
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.

***

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

FFF Friday: “I didn’t have the confidence or the mental clarity to stand up for myself.”

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.

All I can say about Amy’s story, below, is THIS. THIS is why breastfeeding support must be secondary to supporting moms, full stop. THIS is why the medical community and the breastfeeding advocacy machine is failing us. THIS is why there are “defensive formula feeders” peppering message boards, attempting to share their truths, and being accused of making up stories and scaring other women out of nursing. THIS is why women are getting angry and fighting back. THIS is why people are starting to think the pendulum has swung so far and so hard that it’s bonked us all in the head and made us stupid. This. This. And THIS.

Read on, rage on, and don’t stop reading and raging until the world stops acting like a petulant child and realizes that new mothers are being trampled on, right and left; that women are being told that they don’t know their own bodies; that we’ve completely missed the forest for the trees.

Happy Friday, fearless ones,

The FFF

***

Amy’s Story

My sweet, healthy, formula-fed little boy is now one year old. For the first seven months of his life, I supplemented his formula with whatever small amount of breastmilk I could muster through insane efforts.

Looking back, I know that exclusive breastfeeding was never going to work for us. I have two conditions that interfere with milk production: insufficient glandular tissue (aka hypoplastic breasts), and hypothyroidism. But none of the dozen or so professionals I turned to for help during my son’s first weeks  – midwives, doulas, nurses, doctors, lactation consultants – listened to me carefully enough to tell me that exclusive breastfeeding was probably not a realistic goal, given my medical profile. Instead, they repeated the mantra that might be helpful to many but is infuriating to me (and is also untrue): “Exclusive breastfeeding is always possible if you work hard enough, and working hard at it is always the right choice.”

My first inkling that we would have nursing problems came early in my pregnancy. I had many of the typical symptoms (nausea, heartburn, exhaustion), but I wasn’t experiencing any breast changes. At every checkup, I told the nurse, midwife or doctor that I wasn’t feeling any swelling, tenderness, size increase…nothing. And each time I mentioned it, I got one of two responses: either “I’m sure it’s nothing” or “You MUST be having at least SOME changes”. I’m not sure which of those was worse – the total dismissal of my concerns, or the claim that I was not an accurate reporter of my own symptoms. No one told me that my lack of symptoms might be a sign of insufficient glandular tissue, a condition that can seriously hinder milk production. I can only imagine how much easier my first weeks of parenthood would have been if someone had just said to me, while I was pregnant, “Why don’t you give breastfeeding your best shot, and we’ll give you all the support we can. But just so you know, some women whose breasts don’t change during pregnancy have IGT and can’t produce as much milk as their babies need, but they can still be great moms.” But it seems that everyone is too convinced of the infallibility of breastfeeding, and too convinced that unmotivated women will give up at the first hint of trouble, to say anything like that.

After my son was born, it was obvious that I had been right to worry. Despite near-constant skin-to-skin cuddling and frequent attempts at nursing, by the time he was 3 days old, he was not in good shape. He had turned orange, he had lost more than 10% of his weight, he wasn’t peeing or pooping at all, he was passing uric acid crystals (a sign of dehydration), and he would latch onto my breasts but wouldn’t swallow. And I knew it was because I had no milk for him. He desperately needed formula. I went to CVS at 6 AM in a state of panic and tried to buy formula there, but they keep it in a locked cabinet (as if I didn’t already feel like a criminal), and anyway I didn’t know what kind to buy or what to do with it once I bought it. So instead, I walked out, empty-handed and sobbing. There were many friends I could have called at the crack of dawn for breastfeeding support, but I couldn’t think of anyone to call for formula-feeding support. I had no idea what to do, and I was terrified for my hungry, dehydrated baby. My sweet husband was out-of-state for an exam he couldn’t reschedule, and he convinced me to go back to the maternity floor of the hospital where I’d given birth and ask the nurses there for help. I took a cab to the hospital, and a kind nurse – who wasn’t technically allowed to help me because I wasn’t a patient anymore – gave me some liquid formula, which got us through that scary day.

The following weeks were a blur of friends and professionals telling me to just try harder. Talking to them was like talking to customer service representatives working out of an overseas call center, reading off a piece of paper, and not knowing how to deviate from that script. I began every conversation with “I don’t have enough milk.” The reply was always some version of “Oh, I’m sure you do! What makes you think you don’t?” And then I’d have to list all the ways I knew I didn’t have enough milk: my baby was losing weight, he wasn’t peeing or pooping, he was agitated, he had a depressed fontanel, he was latching well but not swallowing at all, my breasts hadn’t changed, when I squeezed my breasts almost nothing came out. It broke my heart every time I had to repeat that list. But, just like the customer service people reading off a script, they were ready with their automatic (and completely unhelpful) responses: Weigh him before and after you nurse him, you’ll see that he really IS getting enough. (Tried it a few times. He got a bit less than an ounce at each feed – about a quarter of what he needed.) Try nursing more often. (I was nursing constantly.) Drink more water. (I was drinking as much as I possibly could.) Take fenugreek. (Not an option; it’s not safe for people who have peanut allergies, which I do.) Pump every time you nurse. (I pumped for 10-20 minutes 8-10 times a day…and never got more than about 3 ounces a day. It breaks my heart to think about those hours I could have spent holding my newborn. Or sleeping.) They didn’t always say it in this many words, but it was clear that they all wanted me to buy the mantra: “Exclusive breastfeeding is always possible if you work hard enough, and working hard at it is always the right choice.” It didn’t seem to occur to them that I might be part of the 5% of women who just can’t produce enough milk.

My baby and I settled into a routine of nurse, then supplement with 2 ounces of pumped milk and formula, then pump for later – every 2-3 hours, around the clock, often while the two of us were home alone. As the weeks went by and my supply didn’t improve (despite customer service’s promises), we added more interventions. With each new step, customer service promised that THIS would be the one that would finally make it work. I took Domperidone; it didn’t make any difference. I used a Supplemental Nursing System; it didn’t help and it drove me completely nuts. When my son was about 2 months old, I stopped asking for help. In my vulnerable state, I just couldn’t deal with any more conversations with people who wouldn’t listen to me or believe me.

And even though they wouldn’t or couldn’t hear me, I was spending a lot of time in the company of nursing moms, and I knew that my body just wasn’t doing what theirs were. Listening to the conversations of nursing moms felt like the days in high school when I showed up unprepared for a test in a class I didn’t understand. I would walk out of the test knowing that I hadn’t written enough on my paper to even get a passing grade. I would hear my classmates discussing what they’d written for each specific question and I wouldn’t even understand the words they were using. That’s how I felt – and, a year later, sometimes still feel – listening to women talking about the breastfeeding secrets that are normal to most nursing moms, but that I never experienced: their discomfort when their milk first came in, the feeling of their breasts filling with milk between feeds, the feeling of a let-down, waking up with milk-soaked pajamas, needing to wear nursing pads for leakage, storing and freezing pumped milk (I couldn’t pump enough in a day for even one full feed), losing weight quickly because their baby was sucking out all their calories (salt, meet wound). I was nursing all day long, but for me, none of those things ever happened. I knew with certainty that there was something different about my body, and I was frustrated that all the professionals insisted I was normal, but I was an exhausted brand-new mom and I didn’t have the confidence or the mental clarity to stand up for myself.

As the months went on and I emerged from my new-parent fog and re-entered my old brain and body, I began to clarify the story that customer service couldn’t or wouldn’t listen to. I realized that while everyone I had talked to had asked if I had any underlying medical conditions (one of the questions on their script), they had no response when I told them about my hypothyroidism; they didn’t tell me that there’s a high correlation between thyroid conditions and lactation failure. They asked about breast changes during pregnancy (another scripted question), but didn’t tell me that women whose breasts don’t change during pregnancy often deal with very low milk supply. Maybe they didn’t know these things about thyroid conditions and breast changes, or maybe they did know but they kept it from me because they were worried the knowledge might lead me to – gasp – quit breastfeeding.

My husband and I hope to have more children. Now I know that exclusive breastfeeding isn’t a realistic goal for me. I’ll try to give my next baby as much breastmilk as my body can produce, but I won’t pump, take pills, or tape tubes to my breasts. I’ll give my baby formula at the first sign that he or she needs it. If I need support from a professional, I hope I can find one who is able to listen. And in the meantime, I’ll continue to tell my pregnant friends that I am the person they can call in the middle of the night for formula-feeding support.

***

 We may not have much power, but the power we do have is in our words. Speak up. Email me your story at formulafeeders@gmail.com.

Study says: Breastfeeding problems aren’t serious. And are probably your fault, anyway.

One of the most interesting interviews I did in my research for Bottled Up was with a physician who had studied breastfeeding-related neonatal hypernatremia (severe dehydration leading to electrolyte imbalance). We discussed the fact that these days, this condition is typically caught early and can be treated successfully. But the doctor also cautioned that while the prognosis wasn’t usually dire in terms of long-term health (thanks to modern medicine), we shouldn’t forget about the emotional and financial effects on the parents. He worried about a first time mom, trying to do the best for her child, who ends up seeing that baby hospitalized – sometimes for weeks- due to what she might perceive as her own failure to nourish him adequately.

I’ve been thinking about this interview since I read several articles yesterday, detailing a new study about the same condition. According to the Guardian (“Breastfeeding problems rarely lead to serious illness, study says“), a new paper on neonatal hypernatraemia found that “Very few babies become dehydrated and seriously ill because they are not getting enough milk from breastfeeding…Dr Sam Oddie and colleagues found only 62 cases from May 2009 to June 2010, a prevalence of seven in every 100,000 live births… the babies were admitted to hospital, mostly because of weight loss, and some were intravenously fed…However, all were discharged within two days to two weeks having gained weight and none had long-term damage.”

Seem like good news, right? Put on the Def Leopard, because we’re about to start headbanging.

Source: http://www.yaindie.com/2012/12/banging-your-head-against-wall-is-it.html

Banging-my-head-against-the-wall Problem #1: 

Okay. So, correct me if I’m wrong, but having a 2-week-old newborn in the hospital hooked up to an IV for a week or two isn’t considered serious? And as for long-term effects – these babies were born between 2009-2010. The study is not available online, so I don’t know what the details are in terms of how the researchers followed up with the subjects… but considering studies on breastfeeding and intelligence have tested kids at the age of 8, I think one could fairly say the jury is still out on this sample of 4 and 5-year-old kids. And how were they assessed in terms of long-term effects? Psychological? Emotional? Physical?

With all the focus on mother-child interaction in the first days, and the effect of fatty acids on brain development, the superiority of breastmilk in the first weeks… doesn’t it seem a little ironic that we’re so quick to dismiss a condition which a) separates parents from babies through NICU stays and b) starves/dehydrates a child in those same “fundamental” weeks?

I understand that we’re talking small numbers here – 7 in every 100, 000 is admittedly a reassuring statistic. But while we’re talking about that figure… what exactly does it mean?

Banging-my-head-against-the-wall Problem #2:

First, without access to the study, I can’t tell you if this statistic means 7 in 100,000 of ALL LIVE BIRTHS – meaning EBF, formula-fed and mixed-fed infants, inclusive. The UK has lower breastfeeding rates than many countries, so if this was the number of babies in all live births, it doesn’t mean anything substantial. What we need to know is the number of babies admitted who were exclusively breastfed before we can start making statements about breastfeeding, milk supply, and what needs to happen to avoid this risk.

Banging-my-head-against-the-wall Problem #3: 

Even if this study did look only at EBF babies, there are major limitations in what we can fairly assess from the data.  We can’t know how many women can adequately produce milk so that their babies aren’t at risk, because most people would supplement before it got to the point of hospitalization. What the researchers did discover is that the babies hospitalized could nearly all breastfeed successfully:

Almost every baby is capable of breastfeeding, Oddie said. “In only a few cases were there special features of the baby that made it likely that there would be a severe feeding problem. [One of the babies, for instance, was found to have a cleft palate.] Normally all babies can get established with breastfeeding with the right support.”

Again, I’m a little confused. If there were only a few cases of this condition, what exactly is a “few” of a few? Of the seven babies hospitalized in a group of 100,000, does that mean one of them had a “special feature” which created a feeding problem? Was it a statistically significant number?

Then, the Deputy Manager of UNICEF’s Baby Friendly Initiative weighed in:

Anne Woods, deputy programme manager for Unicef’s Baby Friendly Initiative (BFI)…said the number of babies who could not feed was negligible and only a very small percentage – about 1% – of women would struggle to make enough milk. “The numbers who breastfeed in this country do not reflect the numbers who could breastfeed if they had effective support,” she said.

Where there are problems, she added, “it fundamentally boils down to the fact that the baby is not attached to the breast effectively. The whole of the baby’s mouth has to make contact and draw the breast tissue into the mouth.”

But because we have a bottle-feeding culture in the UK, she said, some women do not realise this and “try to bottle-feed with their breast”, so the baby takes only the nipple and does not get enough milk.

The other problem is when babies do not feed often enough. After a difficult labour or pain relief, the baby may be sleepy. There is also an expectation she said, that a baby will feed and then sleep.

Ah, right. It’s the mom’s fault. Who cares that this study proves – hell, even suggests – nothing about the true incidence of physiological lactation failure. The researchers are talking about the baby’s ability to feed, not the mother’s ability to produce milk. That doesn’t stop Anne Woods from hurling the 1% (the lowest number bandied about regarding lactation failure, by the way – she could’ve at least given us a break and used the higher end of the oft-cited 1-5% assumption figure) statistic at moms who’re already feeling like failures for landing their babies in the hospital. And of course, the mom probably can’t be bothered to feed as frequently as needed – not that it’s entirely her fault, since the formula companies have convinced her that her breast is actually…wait for it… a bottle!

Banging-my-head-against-the-wall Problem #4: 

I know, I’m being snarky. And I do appreciate that the lead researcher of this study, Sam Oddie, emphasized the need for better breastfeeding management and support. I’m fully on board with that. But I’m also concerned about what Dr. Oddie was saying back in 2009, when he embarked on his study:

Dr Sam Oddie, a consultant in the neonatal unit at Bradford Royal Infirmary, who is leading the study, said: ‘Once we understand the scale of the problem we can work out what to do about it – how to spot it, and how to act on it. But as far as I’m concerned the answer isn’t more formula feeding, but increased support for breastfeeding from the outset in the form of counsellors.” (Marie Claire, 2009).

I don’t disagree with him, necessarily, but going in to a study on hypernatraemia with a strong desire to avoid formula supplementation – even if that ended up being the best course of treatment – implies a certain degree of bias.

One could argue that there’s no harm in a study like this making the news; it will bring attention to those experiencing early breastfeeding problems and perhaps make medical professionals take them more seriously. But as we’ve seen so many times, these studies have a way of creeping into the breastfeeding canon and being misused as “truth” to back up future claims. I can already see Dr. Oddie’s quotes as being taken out of context, being used as “proof” that “all babies can breastfeed” and that the risk of inadequate feeding isn’t all that serious (so there’s never a need to supplement, even if your formula-pushing pediatrician tells you that there is).

Still think I’m overreacting? Here are the headlines from the other two major news sources covering the study:

Most mothers who struggle to breastfeed WILL be providing enough milk for their babies, say experts (The Daily Mail)

Dehydration risks from breastfeeding are ‘negligible’, study finds (The Telegraph)

Would you like me to move over and make a little space for you on the wall? Come on over. Bring some Metallica, and wear a helmet.

 

Read more about neonatal hypernatraemia:

http://fn.bmj.com/content/87/3/F158.full http://pediatrics.aappublications.org/content/116/3/e343.full

 

 

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