FFF Friday: Mental health, bottle feeding and self care

I don’t think this post needs much introduction. I specifically chose it to run this week, because it explains why I feel that the “I Support You” campaign is so integral to World Breastfeeding Week. Only by approaching each woman’s journey as an individual, personal, and valuable experience, can we hope to properly support mothers in their breastfeeding goals. 

Thank you so much, Anne Marie, for allowing me to share your story – and I hope the FFF audience will also check out her blog, “Do Not Faint”,  as she is a tremendous advocate for maternal mental health.

Happy Friday (and happy Breastfeeding Week, and “I Support You” week), fearless ones,

The FFF

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Anne-Marie’s Story: Mama’s Mental Health, Bottle Feeding, and Self-Care

Many excellent, well-informed doctors helped me take care of my mental health before, during and after my pregnancy, and I feel both grateful to them and proud that I have become such a good advocate for myself. My talent for advocacy came in particularly handy when it came to making decisions about how we would feed our baby, because I received so much conflicting advice that I once burst into tears at the idea of another doctor giving me more information. To be fair, I did a lot of planning before we even tried to get pregnant, because I depend on twice-weekly therapy, anti-anxiety meds and antidepressants in order to function as a human being. In other words, there were many people over many months with many opportunities to offer advice, information and opinions, solicited and unsolicited.

Here is a list of my decision, in chronological order, based on the advice of various “professionals” and “experts”–

  1. Exclusive breastfeeding.
  2. Exclusive bottlefeeding: formula.
  3. Exclusive bottlefeeding: donated breastmilk from a close friend.
  4. Exclusive bottlefeeding: the hospital’s donated breastmilk during our stay (lawyers refuse to allow us to bring our own, but the head nurse in postpartum recovery managed to get permission to get me access to the milk bank because the whole thing was patently absurd) followed by our friend’s donated milk when we got home.
  5. Short-term breastfeeding, followed by bottlefeeding: a team of midwives, nurses and lactation consultants meet to discuss the stupidity of the hospital’s liability fears dictating our choices about feeding our son and it occurs to someone that a few days of my colostrum might actually do more good than harm, for me, my baby and everyone’s stress levels.
  6. Breastfeeding and bottlefeeding, followed by exclusive breastfeeding, once we have established that our son and his tiny liver are doing ok with the medicine that is in my breastmilk.
  7. Breastfeeding with intermittent Dad-administered bottles of my own pumped milk or formula.

The point of it all, really, is that this combination of my milk, donated breastmilk and formula has worked really well for us. But a combination like that would never have occurred to me without all the expert help and opinions I had, and I don’t think that many mothers consider doing anything like what we have done. Shouldn’t it at least be an option? Why is it breastfeed or formula feed? And why does “bottlefeeding” always mean formula?

My midwives talked with nurses and lactation consultants, because I had so much anxiety about feeding my baby. That wonderful team directed me to a pediatrician who specializes in breastfeeding medicine, and it is she who changed my entire outlook. The psychiatrists who warned against breastfeeding on meds meant well, but they knew about adult-sized doses and side-effects. My first clue should have been that one of them actually said, “Lots of our generation, including me, had formula, and we are all fine!” Can I get an eye roll for that line? This was hardly the evidence-based reassurance I was used to getting from the same doctor who had once handed me a whole stack of pages of medical journal articles on pregnancy and psychiatric medications. The pediatrician who helped us, an actual expert in actually feeding actual babies told me that the nursing relationship only works well if everyone is relaxed and happy. This is why she was thrilled to tell me that I could breastfeed on my medicine with safety, as far as the evidence showed, and that we could use our freezer full of precious donor milk to give us peace of mind.

She also taught me to relax about breastfeeding before I gave birth, because in her experience, a mother/infant pair can learn to breastfeed even if (heaven help us!) an infant should have a bottle or pacifier early in his life. That came in really handy when my son was born with a tongue tie that the hospital staff failed to notice. He could not, would not latch. The nurses fretted. I pumped colostrum and tried to stay calm, but it wasn’t until our breastfeeding expert clipped that tongue tie that we could nurse comfortably. In the meantime, we were happy to feed him from a syringe or a bottle, and we loved seeing his grandparents participate.

For the first three months of his life, my son had bottles of donor milk, and he breastfed, every day. I pumped for the ounces he drank to keep up my supply. By the time we ran out of donor milk, we were thrilled to see that he was showing no sign of any side effect from the medication in my milk. Unfortunately, he quickly began cluster feeding for hours right around the time I was getting used to exclusively breastfeeding. I had no time to pump for bottles; he was always nursing. After a night during which he nursed from 11 pm to 4:00 am, stopping only to switch sides or scream while his diaper was changed, I arrived at my therapist’s office in despair. I can’t manage my anxiety without sleep. Every doctor had told me that without at least a four-hours-in-a-row chunk of sleep every night, my mental health would suffer. My therapist asked about formula. I cried about how hard I had worked to feed my son only breastmilk. Then, I thought about sleeping, and bought formula immediately after leaving my therapist’s office.

I ask my husband to give our son a bottle when I’m feeling very anxious or stressed, or when I would just like a break, or when I would like to finish what I am writing. When I need to sleep or recover from a migraine, all I need to worry about is keeping myself comfortable, because I know that our son will be fine with the loved ones who care for him and feed him. Usually, I find that breastfeeding strengthens my bond with my son, that we both enjoy it and, for us, it’s extremely convenient. I also find that my anxiety and depression are much easier to manage when I have had enough sleep. My husband and I both get at least one break, every day, when we are “off-duty” and responsible for none of the parenting. When it’s my turn, that often means a bottle of formula. I am still trying to figure out why so very many people get so very upset about that. I honestly do not understand.

Mom, Dad and Baby are happier with the way our family does feedings. That short-lived experiment with “EBF” was absolutely miserable for me. It was a huge moment for me when that switch in my head flipped from “breastmilk or formula” to “do whatever it takes to be healthy and happy,” because I stopped believing that I could sacrifice my mental health for my child. All three of us suffered when I made myself a martyr.

Everything we learned about feeding babies along our rather strange journey has helped my husband and I in other areas of our relationship and family life. We check in with each other and stay creative in how we try to balance the trickier parts of this child-raising business. Sometimes, that means that one of us takes on responsibilities that may be uncomfortable so that the person who is ill or exhausted can try to get from “miserable” to “uncomfortable. A few bottles of formula have not transformed us into people who are happy all the time. But our approach to feeding our son has made us more creative problem-solvers, and that has definitely made us happier.

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If you’d like to share your story for an upcoming FFF Friday, please send it to formulafeeders@gmail.com.

FFF Friday: “I thought there must be something wrong with me…”

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 are also 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.

Happy Friday,
The FFF


After reading this FFF Friday submission from Amber, I am reminded of how important a topic breastfeeding pressure is for the postpartum depression community. Amber speaks of the dichotomy between feeling like giving up nursing will help your PPD, but also feeling so guilty because of it (which certainly doesn’t help the depression). Anyone using the argument that we shouldn’t stop pushing breastfeeding simply because it might make moms feel guilty should keep one thing in mind: postpartum mood disorders are prevalent in our society. It’s one thing to care less about making a healthy bottle-feeding mom feel guilty, but those with PPD often have no ability to put things in proper perspective, and that same guilt can take on epic proportions. We need to be protecting mothers in the thick of postpartum hell just as much as we need to be protecting breastfeeding. We can’t sacrifice one for the other, in either direction… so maybe it’s time to rethink how we are approaching things, you know?

This was originally posted on Amber’s blog, along with a follow-up post – so check it out for an update on this fearless mama…

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Before I was pregnant, when having a child was just a hypothetical notion filed under “one day,” I always assumed I would breastfeed. I never thought of breastfeeding as a “crunchy” thing or something associated with a particular parenting style. It was just what you did. Everyone nowadays breastfeeds, at least for a little while. Beyond that, I didn’t give it much thought. The activist and rabble-rouser in me looked forward to flagrant public nursing, a copy of Ga. Code An. § 31-1-9 tucked into my hypothetical diaper bag. At some point when I was heavily involved in the feminist blogosphere, one of my favorite bloggers at the time wrote a post about how it might not be breastfeeding itself that’s so beneficial to babies, but the things that usually go along with it in the U.S.: social and economic privilege, a well-educated mother who is willing and able to go the extra mile for her baby and has access to preventive medical care, and that studies linking health benefits with breastfeeding have failed to control for these factors. This made sense to me and I filed it under “interesting and thought-provoking” in the back of my mind.

When I was pregnant, my breastfeeding goals were: definitely breastfeed for the first six weeks, and ideally breastfeed without supplementation for the first six months. (Up until my 36th week of pregnancy, I was planning to return to work after 10 weeks maternity leave, and I knew that some women see their supply decrease when they return to work and have to find time to pump during the day.) It was important to Rusty and me to share parenting responsibilities equally, so we planned to introduce a bottle at around three or four weeks. Beyond that, I had no plans or goals, preferring to take a “play it by ear” approach. I never envisioned myself as someone who would nurse past one year, and certainly not into the toddler years. Like many mothers-to-be, I wanted to give my baby the benefits of breastfeeding during the critical early period. I never viewed formula as “poison” or felt the need to refer to it with derogatory euphemisms such as “artificial milk,” and I felt strongly that no mother should be judged for feeding her baby formula, because there are a million complicating factors – physical, emotional, socioeconomic – that can necessitate its use (and of course it did not escape my notice that it was always mothers, not fathers, who were judged). The fact that breast milk was better than formula made sense in an obvious way, since it is created by the mother’s body specifically for her baby, but placing a value judgment on a particular feeding method was not something I was interested in. I simply wanted my baby to gain the benefit of immune system building and other early developmental benefits of breastfeeding.

I was nervous about breastfeeding for a few reasons. I worried that being the only person who could feed the baby in the first few weeks would take a toll on me in various ways and possibly strain my relationship with Rusty or hinder him in building confidence in his parenting ability. I tried not to get too caught up in these worries, reminding myself that it would only be that way for a few weeks and we have the rest of our lives to be egalitarian parents. I knew that women with thyroid conditions sometimes have problems making enough milk due to hormone levels. I reminded myself that I was on medication for my hypothyroidism, therefore putting my hormone levels where they should be. I tried to focus on preparation and education instead of worry. I read articles, blog posts, and book excerpts; Rusty and I attended a couples’ breastfeeding class (where I was disappointed that much of the class was a sermon against formula feeding rather than a practical how-to session, and where one of the instructors compared not breastfeeding to not using a car seat); I attended a La Leche League meeting; I talked with friends who had breastfed about their experiences, including getting a run-down from my friend and coworker Rochelle about the quirks of the “new moms room” (aka the Lactation Cell!) at work.

My dreams during pregnancy included a lot of anxiety-based dreams about “forgetting” the baby and leaving him/her somewhere for hours; but despite my low-level anxiety about breastfeeding during my waking hours, in all my dreams about it (and I did dream about it quite a few times), breastfeeding was going really well and was remarkably easy. As someone who has had prophetic dreams before, I took this as a good sign.

Fast forward to May 1. Fitz was born at home. He had a drug- and intervention-free birth and postpartum period. He was placed skin-to-skin with me immediately after birth and lay draped across my chest as I was getting stitched up. Theoretically, the stage was set for a positive nursing experience. I don’t remember exactly how long it had been after his birth the first time I tried to nurse him, but it wasn’t long. He didn’t seem interested. The midwives said not to worry and to just keep offering. When they left a few hours later, he still hadn’t nursed for more than a few minutes at a time, and something just seemed “off” to me, even though everyone was telling me not to worry.

When the midwife came back the next day for the first postpartum visit, Fitz had nursed a total of six times. We’d had two “good” nursing sessions, about 45 minutes each, where I could tell a difference in his suckling – instead of feeling nothing and being unsure that he was actually latched on at all, I felt an uncomfortable tugging, slightly painful. I told myself that I just needed to get used to the feeling of breastfeeding. People on Facebook told me he’d start eating more in the next few days. Still, my gut was telling me something was wrong.

On day 3, I crashed. I know now it’s a textbook case of the onset of postpartum depression, when the hormone levels plummet by something like 10,000% at 48 hours postpartum. Attempting to breastfeed was becoming increasingly painful. Fitz was popping on and off the breast, arching his back and screaming. I knew PPD had gotten ahold of me and I was downing placenta pills as often as I could but it wasn’t helping. I was following all the latching techniques from the breastfeeding class but still Fitz was a screaming banshee. I thought there must be something wrong with me, or I wasn’t trying hard enough, or somehow I was a failure no matter all my best efforts. Rusty called our postpartum doula. She came over that night and I broke down sobbing and told her I hated breastfeeding and wished I didn’t have to do it, I shouldn’t have had a baby, I wanted to run away and leave Fitz with Rusty. She helped me have our one good nursing session, propped in the glider with a million pillows and rolled towels and the Boppy and Fitz and I both stripped nearly naked. I thought there was no way I could go through this production every time, but I at least felt a little more confident that maybe things could turn around.

The next time Fitz was hungry, I tried everything she had shown me. But it didn’t work this time. I dreaded having to feed him and tried to delay it as long as possible with the pacifier. I began to have panic attacks when bringing him to the breast. I cried constantly. That night, I was done. I couldn’t take it anymore. Fitz wouldn’t stop crying and I couldn’t get him to stay latched on. My mom was still in town and she walked around the house with my screaming baby as I begged Rusty to go to the 24-hour Kroger and get some formula. I went to take a shower and collapsed in the bath tub, heaving with tears.

On the morning of day 4 we took Fitz to the pediatrician and in the waiting room, I met Anna, and I am so grateful for that chance meeting and our now friendship. She started talking to me and asked if I was breastfeeding and I broke down crying and said it wasn’t going well. She said that she and her son had a lot of problems with breastfeeding but were able to do it thanks to working with a wonderful IBCLC, whose name and number she gave me. We were called back into the exam room and while waiting for the doctor, Fitz wanted to eat again. I tried but it was still painful and didn’t feel right. When the doctor came in and saw us, she said, “That looks good!” and I broke down crying again. Like everyone else (except Anna), she said not to worry, it would get better. But we found out Fitz had lost 10% of his birth weight (and since I didn’t have IV fluids in labor, that’s an accurate number) and I did worry.

When we got home I read an email from someone purporting to help, telling me that giving Fitz a bottle was the best way to ruin a breastfeeding relationship and I should feed him with a syringe. That seemed so outside the realm of possibility that I felt completely abandoned. I had Rusty call Ann, the lactation consultant. When she called back, I sobbed on the phone with her and told her I hoped she wouldn’t be disappointed in me for giving Fitz formula. It was such a relief to hear her say that of course she wasn’t disappointed, and that she was glad I had done it, because the most important thing is that the baby has to eat.

She came out the next morning. Looking back, I don’t know what I would have done without her. She was the perfect combination of compassionate and professional. She had no judgment. Maybe after being in her field for over 40 years, she’s past the judgment and just wants to help. She presented information clearly and completely. She examined Fitz’s mouth and told us he had something called type 4 tongue tie. I felt such relief; I wasn’t crazy, something was wrong, and it wasn’t that I wasn’t doing everything right, it was that my baby had an actual physical impediment to breastfeeding! Ann said this kind of thing runs in families. She found that I had it too, but no one had ever caught it with me, because I was never breastfed. (Some babies with this type of tongue-tie have no problems with bottle-feeding, but Fitz had trouble with a bottle, too.) She explained the frenotomy procedure. She explained the possible effects if we decided not to do the frenotomy. She taught me how to hand-express. She showed me how to nurse with nipple shields. She found the correct size flanges for me to use with my pump, showed me the best way to pump to increase my supply, and sat with me while I did it. She taught Rusty and me the best way to bottle-feed Fitz. She presented cup feeding and syringe feeding as options and described each. She left photocopied articles about tongue-tie and frenotomy, and written instructions covering everything we had discussed. She held my hand as I sobbed and asked, “What if I just don’t want to breastfeed?” and answered that whatever I decided, she would support me and help me do it safely.

That morning with Ann was the last time I fed Fitz directly at my breast. The mere thought of breastfeeding had become too much of a trigger for me. I turned my attention to pumping. I pumped every 2-3 hours using the techniques Ann had taught me, and sure enough, just like she had said, my supply increased overnight. For the next three weeks, I pumped enough milk that we didn’t have to give Fitz any formula. I borrowed a huge trash bag full of milk storage bottles from a friend because I was rapidly using up all the ones we had. I started freezing milk. I was really good at pumping and my body responded really well to the pump. Even though these were my absolute darkest days of PPD and most of the time I felt like a worthless mother, pumping was the one concrete thing I was able to do for my baby.

With Rusty’s return to work looming on the horizon, though, I knew something was going to have to give. I knew I couldn’t keep up this pumping schedule while home alone with Fitz. I decided to wean off the pump. With Ann’s help, I came up with a plan for a gradual weaning process. It took me seven weeks to wean off pumping. I also started seeking donor milk through the peer-to-peer milksharing networks Human Milk for Human Babies and Eats on Feets. I pumped for the last time on July 17. It was a bittersweet moment. For several weeks afterward, I still leaked milk, especially in the shower. I thought of all that milk going to waste. A few times on “good days” I considered starting pumping again, but reminded myself of all the reasons I had stopped and how it was helping speed my recovery from PPD.

I feel like I should close with some grand statement, but now that I’ve written this all out, I’m emotionally exhausted. In my heart of hearts, I feel with 100% certainty that I made the right decision. The guilt and doubt creeps in when I see the ceaseless posts about breastfeeding being best, from people who probably have good intentions but don’t realize how hurtful and alienating they are being. I still don’t know how to handle those situations. It wears me out to constantly “speak up” when I see thoughtless comments. My therapist says maybe the reason this was so traumatic for me is because I didn’t have a plan B. I had a backup practice and hospital in case the home birth didn’t work out, so that was my plan B for the birth; but we had no formula in the house. I don’t think that’s it, though. We also didn’t have any disposable diapers in the house but I can’t see myself being such an emotional wreck about it if cloth diapering hadn’t worked out.

I fed my son directly at my breast for five days. I gave him my milk for two and a half months. But what I’ve come to realize is none of that matters nearly as much as the fact that on a daily basis I give him my love in the unique way that only I can, because I am his mama. My baby needs a healthy mom more than he needs my milk. I am inching toward recovery, even though I still have days where I feel like a worthless mother. On those days, I try to remember these words from a recent Daily Hope email from Katherine Stone of the blog Postpartum Progress:

“Use what talents you possess; the woods would be very silent if no birds sang except those that sang best.” ~ Henry Van Dyke

Your baby would have very little without his or her mama. You are SO important, even if you feel like you’re blowing it. You have talents — you are feeding and clothing and speaking or singing or rocking or strolling or reading or bathing or whatever it is that you have done or will do. Keep on doing whatever you can do to the best of your ability. To you the things you are doing may seem like they don’t measure up, or they aren’t enough or you don’t have the right thoughts in your head when you’re doing them. To your baby, they’re like birdsongs in the woods.

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Share your story for an upcoming FFF Friday: email me at formulafeeders@gmail.com.

Milk sharing, shmilk shmaring

I’ve been trying my hardest to avoid tackling the hot topic of milk sharing (or milk banks), but it seems to be the issue of the day. Hell, even Wired got in on the action. Typically, I’d take the fact that breastfeeding was discussed in Wired as a sign of the Apocalypse, but since the whole May 21 thing turned out to be a bust, I’m not banking on it. (Ha. “Banking”. And we’re talking about milk banks. Get it? That’s the extent of my wit when I’m all doped up on Tylenol Severe Cold.)

The reason I haven’t wanted to touch this topic with a ten-foot pole is that I’m honestly not sure what to think about it. My whole m.o. is wrapped up in this live-and-let-live mentality; it shouldn’t matter that I personally would be skeeved out to feed my baby milk from some random other mama, as long as you’re comfortable with it. I think informal milk sharing between friends or relatives – like my good friend, who donated some of her enviable freezer stash to her sister-in-law – is pretty awesome. But I do have an issue with how a misrepresentation of risk is deluding women into thinking that buying breastmilk off the internet is “safer” than using formula. And since, according to Wired, breastmilk is turning into quite the commodity, I think its time we had a little talk about some harsh realities.

First of all: breastmilk and breastfeeding are two separate concepts. I have seen these two terms being thrown around as if they are interchangeable, and that is just. not. true. Frequent readers of this blog know that one of my biggest complaints about breastfeeding medicine is that we spend so much time, money and energy on (mostly flawed) studies “proving” the superiority of breastfeeding over formula feeding, rather than performing more interesting, controllable, and ultimately helpful studies on the properties of breastmilk that are performing these magical feats. For example, there is strong and ample evidence that breastfed kids have a lower risk of ear infections. But what is providing this benefit? Is it something in the milk itself, or is it simply the delivery system? Is there a study comparing kids fed breastmilk out of bottles to those breastfed, in the most literal sense? And if it is indeed the milk, then wouldn’t it be cool to know what constituent of the milk is protecting little baby ear canals?

This is relevant to the topic of milk sharing, because until we understand the benefits of breastmilk versus breastfeeding, we can’t know the benefits of giving our kids donated milk. And for parents shelling out $32-60 a day to feed their babies human milk, I’m assuming these benefits matter. Even for those who have managed to find generous donors and are getting the milk for free, the potential health costs of unmonitored milk need to be weighed against the benefits.

Speaking of health costs… this is a sensitive subject. But just as I will freely admit that there are risks to formula feeding if one does not handle the formula properly, or uses bad water, or dirty bottles; or a company allows bug parts to get into their supply or what have you, I think we also need to be realistic about consuming a bodily substance from a stranger. Says Wired:

Screening milk donors turns up a surprising number of infectious agents—pathogens that could be passed on to a baby. A 2010 Stanford University study examined data from 1,091 women who applied to donate milk to a bank in San Jose, California. It revealed that 3.3 percent were rejected after their blood samples tested positive for at least one of five serious infections: syphilis, HIV, hepatitis B, hepatitis C, and human T-cell lymphotropic virus. And if these pathogens are in a donor’s blood, they can be present in the milk, too. 

 This doesn’t even begin to explain the potential risks of OTC and prescription medicines, herbal supplements, and diets – things that are considered “irrelevant” in much of the breastfeeding literature, despite a mind-boggling lack of evidence to back this “irrelevancy” up. For example, nicotine does get secreted into the breastmilk of smokers; so do some antidepressants, painkillers, etc. It is up to every mom to decide if the benefits outweight the risks when breastfeeding their own child, but just because I feel that taking Prozac while nursing is cool, it doesn’t necessarily mean you do. And if someone feels that it is perfectly safe to smoke, drink, or take certain meds because Kellymom or LLL or a message board tells them that it is, chances are they won’t think its worth mentioning in a Craigslist ad hawking their own breastmilk. This is not to say that milk donors aren’t altruistic – I would bet that most really are, that they truly want to help babies deprived of breastmilk… but even the milk of human kindness can be tainted with things that we might not want our kids ingesting.

Here’s a confession: I have found all four of the incredible babysitters I’ve used in the past 2.5 years through Craigslist. My friends think I’m nuts, but meanwhile, I have managed to find some of the best, most loving, educated and responsible women around to care for my kids. Sure, I had to interview a lot of duds, but even that wasn’t too arduous a process.  But many of my friends feel, understandably, that trusting someone you find on Craigslist with their babies would be utter stupidity. I think that’s probably a common belief. (Yet, how many women would take donated breastmilk from the same site with nary a second thought?) My point, again, is that many people may have great luck getting milk through a free internet site. But we shouldn’t make women feel that they are better mothers because of it. Just because I had a good experience on Craigslist finding childcare doesn’t mean that there aren’t baby snatchers scouring that same site. I felt comfortable with the candidates I found, but that’s partly because I can work from home and keep a close eye on what’s going on, sans teddy-bear nanny cams. I would never tell another mom to use this method of finding a sitter because it was “perfectly safe”, because my situation is a unique one.

Another issue we have to think about is that breastmilk straight from the tap differs from breastmilk that has been stored for days or weeks. Studies (controlled, in vitro studies, not observational ones like the kind most breastfeeding-related beliefs are based on) have shown that certain vitamins and antioxidants do not hold up well when breastmilk is frozen (although in the case of antioxidants, the frozen breasmilk still beat formula. You listening, Enfamil? Similac?). So unless you’re able to afford an actual wet nurse, your baby may not be getting the 24-karat liquid gold. Maybe more like gold-plated.

Now, obviously, one could argue that even gold-plated is better quality than the sterling silver that is infant formula. That’s absolutely your call. I personally like the look of sterling silver, and think it holds up better in the long term, but its a matter of preference. I definitely don’t think the government has a right to interfere in milk donation; parents have a right to buy and sell (or donate and accept) breastmilk just as much as I have a right to choose to formula feed. But I do worry about the repercussions of a formula-is-poison atmosphere as this breastmilk “niche industry” develops. Eavesdropping on a popular adoption baby board recently, I saw a disturbing discussion about donor breastmilk which completely misrepresented/misunderstood the risks of milk sharing, and could easily lead to adoptive mothers feeling derelict for not seeking out a source of breastmilk rather than formula feeding.

All I’m saying is that we need to approach these decisions realistically, with bifocals rather than blinders on. Someone recently commented on the FFF Facebook page that while breastmilk is a nutritionally superior substance, its not a morally superior one. I love this. But when it comes to donor milk, I also want to make sure that parents are fully informed and 100% sure that breastmilk is, actually, the nutritionally superior product – or more accurately, the overall superior product, with all the risks of human-derived bodily substances factored in. I suspect that processed, screened breastmilk from a reputable bank, as described in the Wired piece, is indeed superior to formula. But that still involves quite a bit of scientific intervention (and cost):



Collecting the milk is just the beginning of a lengthy process that also involves analyzing, purifying, and standardizing the product. Once a donation has been tested for microbes and found to be pure, a small sample is analyzed by a machine called a MilkoScan FT 120. It looks like an espresso maker and uses an interferometer to scan the milk. The result is a readout showing the proportion of protein, fats, lactose, and calories, which can vary from 12 to 38 per ounce. To sell to hospitals, banks must provide milk with a specific, consistent balance of nutrients and calories. To achieve that, the banks use a technology called target pooling—blending donations with various nutrient profiles until the optimal caloric value (around 20 calories per ounce) is achieved. Finally, they pasteurize the milk with a special technique that heats it to about 144.5 degrees Fahrenheit, minimizing the destruction of antibodies while killing viruses and other pathogens.

In sum, I think milk sharing is none of my business, or the governments, and is probably totally safe and fine for the most part. Which is what I think the attitude towards formula should be as well. Both are just food. Both need better science and better jurisdiction to make them truly safe and superior products. Neither make you a better parent for using them.

And frankly, I’m all for a breastmilk “market”. I imagine that if it is profitable, companies will start analyzing the constituents of breastmilk and discovering exactly what’s in the stuff that makes it so amazing. Considering the breastfeeding experts seem to have little interest in doing so (and would rather keep churning out poorly-designed studies that just provide fodder for lactivist blogs), I’m just glad someone will be performing these studies – even if its for profit-driven reasons. Just like that song in Cabaret says, money makes the world go round – and you know what? I’m fine with it.

Formula is the “4th best choice” and other fallacies

FFF Brooke recently wrote an amazing blog post on her breastfeeding/formula feeding experiences. She says some extremely profound things, like this:

We have become a Breast is Best society without realizing that we are causing a backlash of incredible mommy guilt when the breast doesn’t work out. And for some families it doesn’t work out because of nonmedical reasons. If I was working full-time, I wouldn’t pump. In my opinion, one of the benefits of breastfeeding is that bonding time, and excuse me if I don’t feel the same way toward the plastic parts suctioning my breast. (And for what it’s worth, I think it’s possible to have the same bonding time when bottle-feeding.)

Formula did for moms what the pill did for those not wanting to become moms (at that moment). It gave them a choice. I think it’s time we stop judging others for those choices and making them feel like formula is a punishable mommy offense. I shouldn’t have to defend my choices the same way you shouldn’t have to defend your right to nurse in public.

I stood up and applauded after reading this (and by the way, Brooke’s blog is always great, so check it out if you have a chance). Unfortunately, an anonymous commenter had to weigh in, completely missing Brooke’s point and putting a damper on the beautiful mood this post put me in.

“The thing is FF shouldn’t (be) a choice. What I mean by that is if a medical condition or a true supply issue comes up in your Breastfeeding relationship that isn’t a choice “you” made. You HAD to give formula for the health and well-being of your child. That to me wasn’t a choice it was a matter of life or death really. But people who chose to give formula from day one…those people know they are giving their children second best(actually 4th best). It is to me like saying well I am going to chose to buy my child a second rate car seat because well I can it is my choice after all.”

 Oy vey, Anonymous. Seriously? As I said in my response to Brooke’s post, this “4th best” rhetoric is utter crap. According to this theory, the order of preference for infant feeding substances is as follows:

1. Breastmilk (fed directly from the breast)

2. Pumped breastmilk
3. Donated breastmilk (from some other woman or a milk bank)
4. Formula

(Oh, and just to add insult to injury… Jack Newman likes to talk about how formula may not even BE the fourth choice over cow’s milk; that it is only “theoretically” superior to cow’s milk for an infant. Are you KIDDING me? Cow’s milk can cause kidney failure in babies. Formula can’t. What is theoretical about that?)

There are a few things that strike me as idiotic about the order of these substances. First, the fact that breastmilk and pumped breastmilk take up two different slots. Considering there are very few stay-at-home moms in this day and age, this is basically saying that the efforts of millions of working moms are only somewhat valiant. How would it make you feel to read that you are giving your baby the “second” best while hooked up to a pump for the 3rd time that day?

As for the third option… when I responded to Brooke’s anonymous commenter that using banked milk is cost prohibitive for most women (this will run you around $100/day, which makes my kid’s hypoallergenic formula look downright cheap), she directed me to Milkshare.org, a site that encourages random women to donate milk to each other.

The ethical, legal and medical repercussions from this boggle my mind. I personally cannot fathom giving my child milk from some woman I do not know, without some sort of advanced screening process involved. But I digress. If you feel comfortable doing so, that is absolutely your choice, and more power to ya. However, this site contains a plethora of terrible, inaccurate propaganda that I (of course) can’t ignore. Like this lovely nugget of wisdom:

Formula is static, is often not tolerated well, and does not contain live white cells and antibodies to fight diseases like breast milk does. In contrast, breast milk is species-specific for humans and changes according to the infant’s needs!

That may be true, Milkshare. But considering you are telling women this information in order to encourage them to use donated breastmilk rather than formula, don’t you think it would be nice to explain that the milk they will be feeding their babies from another woman, which has been stored, frozen, etc, probably doesn’t have many “live” cells left, if any at all?

According to a 2004 study from the Fetal and Neonatal Edition of the Archives of Disease in Childhood that examined stored breastmilk, antioxidant levels are severely impacted by the storage process:

But while antioxidant levels of formula milk remained stable whether refrigerated or frozen, levels in fresh human milk fell the longer it was stored and the colder the temperature at which it was stored….Compared with fresh milk, human milk frozen for seven days had the lowest antioxidant levels. And refrigeration for seven days was equivalent to freezing for 48 hours in terms of the effects on antioxidant levels.

They conclude that in order to preserve its antioxidant content, expressed breast milk should be stored no longer than 48 hours at refrigerator temperature, and that it should not be frozen.

Now, this study concerns antioxidants, not live blood cells. But here’s another excerpt from a 2004 study on the composition of breastmilk after storage:

To conclude, our study has shown that storage of expressed breast milk caused a decline in vitamins A and C concentrations after 24 hours in a refrigerator (4 °C) and a decline in vitamins A, E and C after 1 week in a freezer (–4 to –8 °C)….Further studies are needed to understand the effect of different temperatures and durations of storage on different constituents of expressed breast milk.

 My point is simply that before stating that donated breastmilk (oh, and the above study also explains that milk varies from woman to woman and day to day – kind of negates the whole “breastmilk adjusts to meet the needs of the baby” thing if you aren’t using your own milk) is a vastly superior choice to formula, making women feel that they need to take financial or liability risks to get this “liquid gold”, we might want to do a wee bit more research.

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