FFF Friday: “Why I am suggesting my wife stops pumping.”

Lately, I’ve seen more discussion about the roles fathers (and partners) play in supporting breastfeeding. But I fear that there’s something missing in this discussion, a rather large elephant in the room that everyone is stubbornly ignoring despite the odor coming from the large pile of elephant dung in the corner. 

Having a supportive partner is absolutely fantastic when you’re trying to breastfeed. But what does being supportive really mean? Does it mean being a breastfeeding cheerleader, reminding your partner of the benefits and imploring her to keep going? Or does it mean stepping in when you see her emotionally disintegrating before your eyes? How do we help our partners truly support us – by indoctrinating them on the importance of exclusive breastfeeding, or by educating them on postpartum mental health, and the importance of the emotional stability of the family? 

My husband struggled with this. It’s something I’ve talked about before, but probably not to the extent that I should have. In our case, he took the breastfeeding classes and was entirely convinced that formula was NOT an option for our family. Plus, I’d told him I wanted to breastfeed. This meant that he believed his role was to keep reminding me of these things; every time I burst out in tears, wanting to quit, he’d say “this is what we decided” or “I have to think of FC, and what’s best for him.” As I was already halfway down the rabbit hole of PPD, these were not helpful statements. I resented him, and felt even more like a failure when things didn’t work out. 

Six years later, Fearless Husband can’t even discuss what I do for a living. He’s still drowning in anger about it all; he feels like he was manipulated, which led him to put his wife’s emotional health (and his son’s physical health) at risk because of what society and the “experts” told him was absolute truth. I can look at my own experience with perspective; the passion I feel about this topic is no longer personal, but about feminism and justice and truth. For him, it’s still personal. 

Our partners can be part of the solution, or part of the problem. They can’t win. They are doomed if they push us to keep going when we really need to stop, or if they push us to stop when we want to keep going; when they don’t have an opinion either way, or when they have too strong an opinion. So what can we do to help them help us? 

I’d love to hear your ideas, and to collect them in a post that can be shared with concerned fathers and partners. Leave them in the comments below, or on the FFF Facebook page. 

To start this conversation, I want to share a unique submission I received from Jeff, a father who is dealing with this exact Sophie’s choice of a situation. I am grateful to him for sharing his thoughts, and for supporting his wife in the best way he can. 

Happy Friday, fearless ones,

The FFF

Jeff’s Story

We wanted to breast feed our baby for six months. We were committed to it. In fact, I was worried that as the dad, I wouldn’t have enough to do in the first months to care for our baby. And it hasn’t worked out that way…

I am completely fed up with what breastfeeding – exclusive pumping – is doing to my wife. Some background – our baby is 7 weeks old. We had a normal, uneventful delivery, and she’s healthy, gaining weight, and a perfect angel! But she just won’t latch. Let me tell you – we have tried. For hours, doggedly and desperately. Nipple shields, syringes and tubes, pillows, massage, hand expression, “lactation cookies”, lecithin, goat’s rue, countless cups of tea, rain dances and magic invocations… The few times she did latch, she did not get enough milk to satisfy her. After weight loss, dry diapers, and a lethargic baby, we started supplementing with formula. Our stress level went down, and our baby sprang to life!

We have seen four lactation consultants (two in the hospital, and two since we got home). They gave us terrific support – hours of individual attention and lots of moral support. They are wonderful, encouraging, and compassionate people – and I would not say we’ve felt bullied into breastfeeding. I’m very thankful to our insurance (Kaiser Permanente) for providing the support, because we didn’t want to give up. Our pediatrician and an ENT specialist checked for tongue-tie, and found nothing amiss. They also worked with us on the pump, so we’ve really given this an honest effort. We just don’t know where the issue is.

Both baby and mom have been in tears after attempt after attempt – robbing them of pleasurable bonding time. I’ve watched my wife in tears over the pain of engorgement and plugged ducts, a bout of mastitis, and the frustration and embarrassment of being hooked up to a pump while I get the pleasure of holding and feeding our baby. We haven’t had to supplement with formula much after the first week, but it’s come at a huge personal cost.

So, my wife became an exclusive pumper. Maybe our experience is atypical, but pumping takes forever. She spends close to an hour per session, many hours a day, just to keep abreast (pun intended) of the demand. It takes at least half an hour before she gets any flow. There simply are not enough hours in the day for her to pump, sleep, and hold the baby. So in the name of “breast is best”, our baby is being deprived of the comfort of her mother’s arms.

We blindly subscribed to the “breast is best” philosophy. Since these problems stated, however, I went back and read the primary literature on breast milk versus formula (I have a PhD in immunology, and my wife has a MPH and worked for the World Bank in the nutrition hub). I was surprised at how weak the evidence for breast milk over formula was! The most convincing evidence I can find is that breast milk protects babies from GI infections, which makes sense if you don’t have a clean water supply as a basis for your formula. That’s not a significant concern in the developed world, however. For nearly every study I read, the differences in IQ and every other measure are less than the test-to-test variation seen in individual children. (i.e., the difference seen between a breast fed and a formula fed baby is less than the difference seen if you tested the same baby twice.) Even if you believe those differences, the link between intelligence and breastfeeding is confounded by the many other variables that cluster with extended breast feeding, especially socioeconomic factors.

I’ve reached the conclusion that this is not serving my wife or our baby’s best interests. So, I am going to tell my wife tonight that I think she’s done a fantastic job giving our baby nothing but breast milk for the first 7 weeks, but that I am concerned that “extraction” of breast milk is dominating their relationship to the detriment of both of their health. I would rather see my daughter held in the arms of her happy mother drinking formula than look across the room at my wife’s teary eyes while I feed the baby breast milk sucked from her body.

I still support efforts to encourage breast feeding, but we have to be wise enough to recognize when it isn’t serving the best interests of the mother or baby. Public health recommendations are based on large groups of people – they cannot (nor do they try) to predict the best action for all people in all situations. If breastfeeding works for your family, that is wonderful and I’m genuinely happy for you. Please respect that it does not always work, despite desperate desires to the contrary. We didn’t want or choose this outcome, but I don’t feel bad for making a decision that protects my family’s physical and emotional health.

That’s why I think it’s time to support my wife and baby by suggesting she’s done enough, and that it’s time she put down the pump and picked up the baby.

***

Want to share your thoughts or story about infant feeding? Email me – formulafeeders@gmail.com. 

“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.

Father Knows Breast: Men have breastfeeding angst, too

I’ve been re-reading Joan Wolf’s book, Is Breast Best: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood. The first time I read it I was doing so in order to review it for this site, and also as research for my own book; this second reading is simply for enjoyment. And I have to say, it is a damn good study. If anything, its downfall is that it is too comprehensive; she covers so many issues so thoroughly that it almost gets overwhelming. But that’s a pretty good fault to have, kind of like when an recruiter asks you what your faults are and you say “Huh…well, um, I guess I’m a perfectionist…”

Anyway, one of the (many) arguments she makes is about the gender-specific nature of the breastfeeding-begets-bonding rhetoric. How come we never consider the “bonding” behaviors of fathers in regards to infant feeding? It got me thinking… we seldom discuss the male POV here on FFF, and maybe it’s time we did.

On the few male-written blogs on breastfeeding I’ve seen, the blogger always refers to the “myth” that breastfed babies can’t bond with their fathers, and how this wasn’t true for him/didn’t matter if it was true for him because nature designed it that way and it was all worth it in the end. These guys usually talk about how it makes them even more in awe of their wives; how they were able to help out in other ways (diapering, cleaning the house, bringing the baby to their wives in the middle of the night); how “real men” support breastfeeding.

Most of these sentiments are really beautiful, and I don’t doubt that all of them are 100% true. For some men. But just as with women, I think it’s unfair to assume that every man’s experience with breastfeeding is going to be identical.

I’m sure there are men who do feel left out, when only their wives can provide the comfort and food to their new infants. Babies don’t do much but eat (and poop, but changing a diaper isn’t much of a bonding activity) at the beginning; with first babies, most willing and able dads will be involved in breastfeeding because it takes time for their wives to get the hang of it (I know my own Fearless Husband was quite adept at maneuvering my nipples into my son’s mouth by the end of the first week). But after breastfeeding is established, dads don’t really get to do much in the way of feeding unless pumping and bottles are involved. I’m not saying this is a “reason” to bottle feed, or an indictment of breastfeeding, but I also believe we should feel free to voice any and all feelings about individual experiences with breastfeeding. It is an intimate experience, like birth, and sometimes it helps to tell our stories- even if that means saying things that are politically incorrect.

These are tricky subjects, in even trickier situations. We can’t censor ourselves for fear of appearing anti-breastfeeding. I actually think that in some ways, doing so is anti-breastfeeding – because if we aren’t honest about our experiences and feelings and challenges and concerns, how the hell will breastfeeding ever become the “norm”? “Norm” meaning normal, right? Normal things can be made fun of; looked at analytically; debated. Normal means that we can talk about the uncomfortable truths.

So, just in case anyone with a penis should ever stumble across this blog, I want to make a few things clear, since it’s highly unlikely anyone with actual authority will have the balls to do it:

  • It’s okay to feel left out.

  • It’s okay to feel a bit squeamish that a body part which was once an integral part of your intimate, sexual relationship with your wife is now simply a feeding tool /public domain, being seen, discussed, and manhandled by a myriad of medical professionals and lactation consultants.

  • It’s okay to wish that you could do “the most important thing for your baby”, that you could shoulder some of the responsibility for his/her future health and intelligence.

  • It’s okay to question whether this “most important thing” is really all that important, and if it will have that much impact on your child’s future health and intelligence.

  • It’s okay to feel confused about how best to support your wife when she is crying over bleeding nipples/insufficient supply/frustration/pain/mastitis/spilled milk, when part of you just wants to give the kid a damn bottle and tell her to quit already, she’s been through enough; it’s okay that you aren’t sure whether she really wants to quit or needs you to be the rock and push her through this roadblock.

  • It’s okay to feel concerned about your baby’s welfare if your wife is having trouble breastfeeding or is telling you she simply doesn’t want to do it. When every parenting book and birth-prep class you took has informed you that formula fed babies are sickly, emotionally stunted and stupid, how could you not worry?

  • It’s okay to feel uncomfortable when you see your wife’s friends nursing. Two months ago if you’d seen their boobs it would have been a federal case; now you’re supposed to think nothing of it…?

  • It’s okay that you can’t understand why your wife cares so much about what other people think of her and what she is or isn’t doing with her breasts.

  • It’s okay that you feel resentful that fathers are barely acknowledged in all the talk about infant feeding and early development, especially if you are a gay, single, or primary caregiving dad. It’s not right, it’s out-and-out sexist, and it just sucks.

We can’t leave fathers out of the conversation, because they inevitably become part of the conversation. Yes, breastfeeding is a woman’s issue, but it has become a social and medical issue revolving around babies. Babies who often have both a male and a female parent, and sometimes only a male parent, or two male parents. The physiological act of lactation is exclusive to women; feeding babies is in the purview of both genders. I hope more fathers start to weigh in on how the pressure to breastfeed is affecting them, as well.

Oh – and also – while writing this, I couldn’t help but think: First we ask men not to fixate on our breasts as sexual objects; then we ask them to fixate on our breasts as a means to a healthier, wealthier child; a healthier, wealthier nation. Either way, the attention is all on the breasts.

Paging Dr. Freud….

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