Category Archives: postpartum depression

Carnival of Evidence-Based Parenting: What the science says (and, more importantly, doesn’t say) about breastfeeding issues, bonding, and postpartum adjustment

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As I sat down to write a piece for this month’s Carnival of Evidence-Based Parenting on the connection between breastfeeding problems and postpartum depression and adjustment issues, I realized something: everything I wanted to say in the post, I already said in my book. So, the following post is actually an adapted excerpt.

Before we get into it, though, I’d like to add that I think breastfeeding difficulties can also affect women in far less dramatic ways. Nearly every mother I know says that the early postpartum period is all about nursing – learning to latch, worrying about weight gain, and soldiering on through cracked nipples and marathon cluster feeds. And nearly every mother I know also tells me that after 4-6 weeks, it got infinitely better; that she and her baby got the hang of things, and breastfeeding became the wonderful, easy, pleasant experience people promise it will be. I think we need to be honest with women about this adjustment period – 6 weeks can feel like an eternity, and to tell new moms just to “hang in there” isn’t going to cut it. Not all of us have adequate maternity leave, familial support, and the money to pay for private lactation consultants. If we are serious about raising the breastfeeding rates in this country, we need to think more critically about how to help women handle these first 6 weeks, and get them through the “learning curve”. Otherwise, I believe we will be causing two things to happen – more mothers will suffer from stress-induced depression and anxiety, and more women will quit nursing way before they had planned or desired to do so. Neither of these are outcomes are beneficial to anyone. 

 

A few years ago, a study published in the aptly titled journal Medical Hypotheses claimed that the cessation of breastfeeding simulates child loss. According to the authors, from a biological, anthropological perspective, “the decision to bottle feed unwittingly mimics conditions associated with the death of an infant.” And since “child loss is a well documented trigger for depression particularly in mothers,” the findings of the study joined the “growing evidence [that] shows that bottle feeding is a risk factor for postpartum depression.”(1) The ominous takeaway message rang out over the Internet. “Does bottle feeding cause postpartum depression?” asked one natural parenting website’s headline;(2) “Mothers who bottle feed their infants in lieu of breastfeeding put themselves at risk of developing postpartum depression,” warned another site, directed at general consumer healthcare.(3)

Two years later, a different study examining the same issues offered a less evolutionary-based (and less daunting) explanation for why not breastfeeding seems to be linked with postpartum depression. Dr. Alison Stuebe, a respected member of the Academy of Breastfeeding Medicine, found that women who reported trouble breastfeeding in the first weeks after giving birth had a 42 percent higher risk of developing postpartum depression than those who enjoyed nursing their babies. Stuebe told Time that although it was important to advocate for breastfeeding, clinicians should “look not just at baby’s mouth and the boob but to also look at mom’s brain” and urged providers to take a more personal approach to infant feeding recommendations: “If, for this mother, and this baby, extracting milk and delivering it to her infant have overshadowed all other aspects of their relationship, it may be that exclusive breast-feeding is not best for them—in fact, it may not even be good for them.” (4)

Back in the 1960s and 1970s, theories on infant “attachment” and the “maternal/infant bond” posited that there was a “critical period” when babies formed either secure or insecure attachments to a primary caregiver—in most cases, for obvious reasons, the mother. Based on the work of John Bowlby, it was thought that a securely attached infant would use his mother as a sort of “home base”; he could explore the world, depending on his mother for comfort and security when things got too intense. If a kid was insecurely attached, the mom-as-safety-net concept didn’t hold; an insecurely attached baby would actually avoid physical contact with his mom and take longer to recover from periods of distress. (5)

By the 1980s, most experts had officially dismissed this “attachment theory,” especially the idea of a critical period beyond which there is no hope of correcting problems, because the original studies that formed the basis for this theory were flawed. (6) But the ideas behind attachment theory still permeate breastfeeding literature, which is chock-full of references to the “maternal-infant bond” and “attachment.” (Ironically, Bowlby himself believed that attachment was formed through the inter- actions of the primary caregiver and the child, rather than the act of feeding in and of itself, or “individual differences in feeding, such as breast or bottle.”) (7)

Later research into attachment discovered that “sensitively and consistently” responding to our infants’ cues—cues like crying, smiling, and eye contact—creates that coveted secure attachment; being unresponsive, unpredictable, disengaged, or, on the other end of the spectrum, overly intrusive results in insecure attachment (8)… and a hefty bill from the child psychiatrist somewhere down the line.

Interestingly, the behaviors blamed for causing insecure attachment not only are related to postpartum depression but could also be attributed to breastfeeding problems. Extreme nipple pain, clogged ducts, or mastitis can cause feedings to be unbearably painful; insufficient milk can be anxiety-provoking. Is it too much of a stretch to suggest that physical pain and anxiety could cause a mom to act “overly intrusive,” “unpredictable,” or “disengaged”? Sociologist and researcher Stephanie Knaak says that despite numerous claims in parenting literature that breastfeeding leads to better bonding, “It’s not going to be the same for all women. For some women, it’s not at all about closeness and bonding, because they don’t actually enjoy breastfeeding. They don’t enjoy the physical aspect of it.” (9)

Many of the moms featured in the FFF Friday posts here on this blog talk about formula allowing them to “finally be a mom”; about how all their energy had gone into breastfeeding, a process that often took so much out of them physically and mentally that they had nothing left to give to their babies. For those of us who have had extreme physical difficulty or emotional discomfort with breastfeeding, formula may allow us to stay calm, connected, and responsive to our children in a way that breastfeeding can’t. Some women have also told me that they believed their breastfeeding struggles made them better mothers, leading them to focus more intensely on meeting their babies’ needs in other ways. Irvin Leon, of the University of Michigan, argues a similar point regarding the benefits of adoptive parenting:

Biological parents may be inclined to believe that their genetic connection with their offspring will inevitably solidify the emotional bond with their young. It may feel a bit less important to parent when one is so assured of being the parent. Adoptive parents, not having that genetic connection, must rely on the actual parent- child bond as the principal determinant of parenthood. Attachment theory . . . make[s] it clear that in the eyes of a child the sense of Mommy and Daddy is based on who takes care of that child, meeting that child’s needs, and knowing that child’s uniqueness and individuality in moment-by-moment daily interactions.(10)

Yet, we are forced to balance our desire to connect and bond with our children in a way that actually works for us with what society – and parenting research- tells us is the “proper” way to bond.  In a review of breastfeeding’s impact on the mother-infant relationship, Norwegian behavioral scientists found that out of forty-one papers discussing breastfeeding and the maternal bond, twenty-two of them made “general statements on the positive effect of breastfeeding on either facet of the mother-infant relationship without a reference to empirical studies supporting this claim.” (11) The study authors then examined the papers which did provide evidence backing these claims, and came to the conclusion that “breastfeeding may promote the maternal bond, but mothers who bond better with their infants may also be more likely to choose to breastfeed over bottle-feeding.”

Think about it—a mother who is already nervous, depressed, or stressed may have a tougher time bonding with a newborn. This mother may ultimately turn to bottle-feeding to control at least one aspect of her new, overwhelming life. Or consider how a baby having trouble feeding may act on a daily basis. A hungry, frustrated baby does not a happy baby make (or a happy mother, for that matter). In both cases, the maternal bond may be affected and bottles may replace breastfeeding. So although it is true that the mothers of these bottle-feeding babies may exhibit less positive, “bonded” behavior toward their children, is it the fault of the bottle? Or was it the situation that led the mom to the bottle that also caused difficulty bonding?

The same question holds for the connection between breastfeeding and postpartum depression. Some researchers have found a correlation between lack of breastfeeding and higher incidence of depression; however, the majority of these studies don’t factor in why the mother isn’t breastfeeding in the first place. A 2009 study found that women who exhibited pregnancy-related anxiety or prenatal depressive symptoms were roughly two times more likely than women without these mood disorders to plan to formula feed. (12) “Prenatal mood disorders may affect a woman’s plans to breastfeed and may be early risk factors for failure to breastfeed,” the researchers point out. And even if the intention to breastfeed is there, multiple factors inform infant-feeding choices once a woman leaves the hospital.

Feeling like a failure, dealing with pain, frustration, and exhaustion, and having a baby who screams at the sight of her, could make any mother feel overwhelmed, let alone one who’s already on the brink of actual PPD. Maybe for those of us more prone to anxiety or depression, the stress of breastfeeding struggles is just the camel’s dreaded straw.

(Excerpted from “Of Human Bonding” in Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t. University of California Press, 2012.) 

Want to read more on the topic of new parenthood from people far smarter than I am? Check out this post from Jessica at School of Smock, who is hosting this months’s carnival – she will link you to the contributions from the rest of the Carnival of Evidence-Based Parenting bloggers:

Introduction to this month’s carnival: http://www.schoolofsmock.com/2013/05/13/evidencebasedparenting

The Transition to New Motherhood (Momma, PhD)

Bonding in Early Motherhood:  When Angels Don’t Sing and the Earth Doesn’t Stand Still (Red Wine and Applesauce)

The Connection Between Poor Labour, Analgesia, and PTSD (The Adequate Mother)

For Love or Money:  What Makes Men Ready for New Fatherhood (Matt Shipman)

No, Swaddling  Will Not Kill Your Baby (Melinda Wenner Moyer,  Slate)

Sleep Deprivation:  The Dark Side of Parenting (Science of Mom)

The Parenting Media and You (Momma Data)

Reassessing Happiness Research:  Are New Parents Really That Miserable?(Jessica Smock)

40 Long Days and Nights (Six Forty Nine)

Also, “like” us on Facebook – we’re trying to bring fresh perspective and research-based insight to the parenting blogosphere. Plus we’re all really nice. It’s really a no-brainer.

 

Sources

(1) Gallup, Gordon G., Jr., R. Nathan Pipitone, Kelly J. Carrone, and Kevin L. Leadholm. 2010. Bottle feeding simulates child loss: Postpartum depression and evolutionary medicine. Medical Hypotheses 74 (1): 174–176.

(2) Nelson, Cate. 2009. Does bottle-feeding cause postpartum depression? August17.http://ecochildsplay.com/2009/08/17/does-bottle-feeding- cause-postpartum-depression/

(3) Harutyunyan, Ruzanna. 2009. Bottle-feeding mimics child loss. Emax Health. August 15. www.emaxhealth.com/2/84/32867/bottle- feeding-mimics-child-loss.html

(4)Rochman, Bonnie. 2011. Time Healthland: Is breast always best? Examining the link between breastfeeding and postpartum depression. August 5. http://healthland.time.com/2011/08/05/do-depression-and-difficulty-breast-feeding-go-hand-in-hand/

(5) Sonkin, Daniel. 2005. Attachment theory and psychotherapy. California Therapist 17 (1): 69–77.

(6) (8) (11) Jansen, J., C. D. Weerth, and J. M. Riksen-Walraven. 2008. Breastfeeding and the mother-infant relationship—A review. Developmental Review 28 (4): 503–521.

(7) Britton, Cathryn. 2003. Breastfeeding: A natural phenomenon or a cul- tural construct? In The Social Context of Birth, edited by Catherine Squire, 305–317. Milton Keynes, United Kingdom: Radcliffe Publishing.

(9) Knaak, Stephanie J. Telephone interview – September 10, 2010.

(10) Leon, Irving. 1998. Nature in adoptive parenting. Parenting in America. 1998. http://parenthood.library.wisc.edu/Leon/Leon.html

(12) Fairlie, Tarayn G., Matthew W. Gillman, and Janet Rich-Edwards. 2009. High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initation. Journal of Women’s Health (Larchmont) 18 (7): 945–953.

 

 

 

 

 

 

 

 

“Where is the mother in the discussion?” An interview with Walker Karraa on maternal mental health and infant feeding

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Some of you may know Walker Karraa from her comments on our Facebook community page, or from her fantastic posts on Science & Sensibility. But I doubt you’re aware of the full magnitude of her bravery and dedication to issues surrounding maternal mental health. I recently interviewed Walker for a short piece on formula feeding and postpartum adjustment, and was so blown away by her answers – I was only able to use a few of her wise words due to word count constraints, so I’m thrilled she’s agreed to let me post the interview in full here on FFF.

Walker is a doctoral candidate at Sofia University, where she is conducting a study on the transformational dimensions of postpartum depression. She was also the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth, and is a perinatal mental health contributor for Lamaze International’s Science and Sensibility, Giving Birth With Confidence, and the American College of Nurse-Midwives (ACNM) Midwives Connection. Like that wasn’t enough on her plate, Walker also served as social media manager for the Integral Leadership Review, and has her own social media consulting business, On My High Horse, and is currently working toward co-authoring a book regarding PTSD following childbirth with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA. 

I’m exhausted just reporting all of that. And did I mention she has two kids and is a breast cancer survivor? Yeah, she’s all that and a bag of reduced fat potato chips.

I hope you guys will appreciate the revolutionary nature of Walker’s discussion here – her opinions, while brilliant, probably seem uncontroversial to those who follow this blog, but they are quite “rogue” in the birth/maternal-child health community. I can’t thank her enough for being a dissenting voice and speaking up for the benefit of all women. 

FFF: Here on FFF, we see stories almost weekly which discuss how a perceived “failure” to breastfeed can lead to depression, anxiety, and self-esteem issues. Do you think the maternal mental health community has recognized how breastfeeding (or lack thereof) can affect the emotional state of new moms?

Walker Karraa

WK: I think that overall breastfeeding is very well addressed in the health psychology, and developmental psychology fields. What’s lacking is the reframe of the research to integrate more qualitative data, and methods, into the consideration of the full range of implications of breastfeeding from multiple perspectives—including the woman’s perspective.

In a 1985 Lancet article on maternal mortality, Allen Rosenfield asked the famous question, “Where is the ‘M’ in MCH (Maternal Child Health)? In the discussions of MCH, it is commonly assumed that what is good for the child is good for the mother.” (Rosenfield & Maine, 1985, p. 83). In many ways this is relevant in the discussion of breastfeeding and maternal mental health. Where is the mother in the discussion? And in what ways do we still assume what is good for the child is good for the mother? For me, this is all about reproductive rights and a deeper issue about our discomfort with women’s sovereignty over their reproductive, physical, and mental health.

The mental health community has responded to the growth in published data regarding infant health and breastfeeding. This has also been the funding stream for a large part of the last 20 years. But maternal mental health has yet to directly address a woman’s infant feeding choice as a part of her reproductive choice, rather than discrete periods of time that occur with as a continuum of events that are inextricably woven through reproductive events—none of which, taken by themselves, gives either the best data on mental health.

FFF: What do you feel needs to change in order for new mothers to be better supported in terms of mental health in general?

WK: I think one of the first calls to action must be for maternal care providers to get support in knowing that perinatal mood and anxiety disorders are common and create the conditions for morbidity and mortality for mother and children. This is starting to happen, but still very slow. I think new models of medical care such as Dr. Michael C Lu’s life course model, which places the woman at the center of care, not the doctor. And, she is treated across the lifespan, not merely when she is pregnant. This facilitates better reproductive health in preconception and interconception, and uses a reproductive life plan for women and families from an early age. At puberty, to have a conversation with medical, nutritional, mental health providers as to planning one’s reproduction (girls and boys) would be ideal.

FFF: Many women struggle with the decision of whether to treat postpartum or prenatal depression/anxiety with psycho-pharmaceuticals, especially when they are breastfeeding. Why is there such mixed information and messaging about what drugs are safe, and what the relative risks are (ie, breastfeeding without meds vs breastfeeding on meds vs formula feeding and taking the meds)?

WK: Not having good information is a barrier to care for everyone involved. The OB/GYN or midwife, the social worker, the woman, her partner and family—when we don’t have good information, we cannot make informed choices. And for women in poverty, the risk is twofold. Specifically regarding breastfeeding, but also education across the board regarding psychopharmacology, pregnancy, and lactation. With organizations such as OTIS (Organization of Teratology Information Specialists) and Motherisk, there really is no excuse for not having current evidence-based data regarding risk and benefit of untreated depression and anxiety, as well as risks and benefits of medications used to treat them.

Byatt et al. (2012) did a wonderful grounded theory study regarding community mental health provider reluctance to providing psycho-pharmacotherapy. 28 obstetric care providers (nurses, OB/Gyns, etc.) shared how they perceive community mental health practitioners as obstacles to psychopharmacology for perinatal women. The participants felt community mental health providers “99% of the time” discontinued a patients’ medication, and put women at risk of relapse. Secondly, Byatt et al., (2012) reported that participants perceived a lack of collaboration and communication between community mental health care providers and OB/Gyn providers, and that pharmacists also “further impede or delay depression treatment by not filling needed psychotropic prescriptions, often exacerbating women’s mental health symptoms” (p. 3).

FFF: Why do you think so many women express grief, guilt, and feelings of failure around the subject of infant feeding?

WK: Because that is their experience! And I attribute all of it to social constructs that are completely ingrained in medical, social, and mental health systems that have been made for and by men. The intentions of those men is not necessarily nefarious, and not really the point. It is that the constructs we have to measure ourselves (abilities and weaknesses) are made by men. We tell women from the get-go that they need us to be good mothers. They need our insight, knowledge, treatment, book, video, technique, services, product to be taught how to mother. This is so ironic, because so many of the birth movements have evolved from a call to empower women. But to empower, we have just made more systems of knowledge that mimic the ones we refute. That is not very popular to say, but it is true. The messages still given to women is that if they “know” something analytically, they are devoid of femininity, and if they “know” something inter-subjectively, they are devoid of ration.

Shame is a powerful force for women. And at no time in her life is a woman more susceptible to shame than early motherhood. If they are lucky enough to find a safe space to share their feelings without judgment, such as your blog, they are given the gift of voice. They can speak their truths.

FFF: Any tips for a mom who is having a tough time reconciling her use of formula?

WK: You know, when I was a doula, I had clients ask me to go buy formula for them so they wouldn’t be seen in public. When I was diagnosed with breast cancer shortly after the birth of my second, I underwent two mastectomies before she had turned one. I learned that my body parts have nothing to do with my inherent ability to love her. My breasts were gone—off of my body, one in one hospital and another at a hospital down the road. I fed, nurtured, attached with, loved, and parented without them…and still do! So my advice is to write down on a piece of paper: My breasts have nothing to do with my love for my child. And keep it where you can see it. Memorize it, know it.

FFF Friday: “We have to do what’s right for our family, not what’s right for others.”

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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.

Shannon’s story describes – in exquisite, painful detail – how different pregnancy can be when dealing with a prenatal mood disorder. With all the talk of mental health lately, I find it discouraging that we still pay so little attention to maternal emotional well-being. I think when we become pregnant – and again once the baby is born – we become invisible. We are no longer women, with our own needs, desires, and emotional struggles; we become incubators, and then feeding receptacles. It’s okay to subjugate ourselves, because it’s self-serving to do anything but. We are expected to be happy, glowing, and head-over-heels in love with our offspring, ready to do whatever it takes to give them the best. 

But there is so much more to it than that. There is so much more to us.

Thank you, Shannon, for giving us a glimpse into how too many women suffer during their pregnancies, and beyond. And most of all, thank you for doing what you needed to do in order to take care of yourself as well as your child. 

Happy Friday, fearless ones,

The FFF

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Shannon’s Story

Most women are fully aware of post-natal depression and are highly oblivious of prenatal depression and anxiety. You see, pregnancy is supposed to be this happy thing. You glow. You are growing a baby. You are becoming a mom. Total strangers are quite curious creatures and want to know about mom-to-be. Your family members spread the news among their friends. Prior to the first appointment, our entire group of friends knew. Who then, in-turn, spread the ‘wonderful’ news to their friends. All of whom made me the center of attention, which was what I was trying to avoid. I wanted life to continue as normal. I am not the center-of-attention type of person nor am I a type-A personality. Unfortunately, my pregnancy was beyond normal filled with severe prenatal depression, anxiety attacks and suicidal thoughts. It was horror from the beginning.

I had major tendon reconstruction in my left foot a mere two weeks prior to conception. You would think two doctors in the same network with computerized access to my files would understand the predicament. How could I assume that? They were not on the same page; not even in the same book. My OB wanted a minimum of 35lbs. My podiatrist, on the other hand, wanted a maximum of 20lbs. That particular foot was braced and wrapped for my first three OB appointments. Both the OB and her nurse noticed and commented, but could have cared less. Quite possibly, could that have been my first red flag about how bitchy and cold this OB was? Maybe. However, I continued to go to her appointments.

Although I was discharged from the Air Force Reserves a few months prior, I still had the military mentality of being a gym-rat and keeping my weight in-check. Yes, in this day in age, that is great. Work out, be healthy; Eat right, be healthy. It was in-grained into my lifestyle. That almost perfect, athletic body was gone. I could not see past the ever-growing alien. Nor did I develop an understanding that I was supposed to gain weight. The weight gain was only the start of my life-altering struggles.

When I wasn’t highly denying the pregnancy to family friends, I raised my voice in terror. I wanted to disappear from this Earth; never wanting to leave the house, not talking about the pregnancy. To blatantly put it, I was becoming depressed caught up in the anxiety attacks, trapped in my own place, and terrorized by cameras. The flags where there. Yet, my OB, who I trusted with both of our lives to, ignored them. She asked the same questions every appointment. Never once asking about my mental health. I brought up the depression; she ran out of the examination room. She mentioned that my depression was not ‘deep enough’ for a mental health treatments. From that point on, I was repeatedly bitched at for lack of weight gain, for losing 10lbs prior to the 3rd month, hospitalized for dehydration and extreme nausea and most importantly, for continuing to use the gym. For me, the gym made me happy by equalizing the hormones in my brain. I felt normal for 2-3 hours. I swam competitively, ran on the treadmill and tossed 20lb weights like they were candy. Pregnancy is not a handicap, why must this OB believe I couldn’t do anything except walk? I cried prior to every appointment in fear of what new development to be horrified about. I cried after each appointment because I wasn’t gaining weight like I was supposed to. I checked into every appointment, but wanted to turn around and leave. My husband was actually supportive, listened to the complaints, witness the crying and was clueless on how to speak pregnancy without me overreacting in horror and terror. My pregnancy was far from normal and she wanted nothing to do with it. I could have followed a family request to switch, but I remained under her care.

I couldn’t get time off for the anatomy sonogram. I was on a days shift rotation at that time and worked 12 hour days. Needless to say, my work schedule didn’t sit well with either the scheduling nurse or the OB. They wanted the sonogram report yesterday. I didn’t want it done. Most importantly, I didn’t want to find out the sex. I was wishing this alien would leave my body. The earlier, the better. I was wishing for the sonographer to not find a heartbeat.  After the sonographer blurted out the sex of our child, I cried. I found out that we were having a baby girl. By this time, both families were extremely anxious for baby showers. Against our families wishes, I refused the baby showers. With my mental angst against the world, baby showers were out. I wasn’t in the mental capacity to act happy nor was I thrilled to see a camera. I was horribly petrified of cameras and mirrors. I didn’t want to see myself. There was no way that I could have gotten through a baby shower without crying or disappointing party go-ers. I was lectured about the so-called importance of baby showers and was called selfish for not putting my unborn child first.

I’m extremely anti-pink, so pink was immediately out. To blatantly put it, my husband owns more pink than I do. A baby girl is beautiful. She doesn’t need to wear tutus and pink to prove that. The thoughts of pink from my family members echoed sin and sorrow in my mind. My mother-in-law threw herself a grandmother shower and basically forced me into Babies R Us, Wal-Mart and Target to get ‘ideas’. The rule that I refuse to budge — absolutely NO pink. I painfully picked out some needed supplies. Did I get those supplies? No. What did I get from her co-workers? Ugliness, pure pastel pink ugliness. I do understand the thought was there, but why is it so difficult to respect the new mother’s decision? This made me hate my unborn child even more. I cried as I realized that my unborn child had to be photographed in clothing that resembled pepto-bismol vomit.

After being hospitalized for pre-term labor at 29 and 30 weeks, my OB’s colleague was appointed my care due to her vacation. He was an idiot and tried giving me medication I was highly allergic to. The doctor had zero bedside manner. None. He didn’t read my charts, missed the bright red band on my wrist with my drug allergy and refused to listened to the nurses who believed my daughter was well ahead of the suggested gestational age. By this point, my husband and I were discussing a switch to another OB. We finally had the third strike. How could we trust this colleague to possibly deliver our baby if he doesn’t understand medical allergies? He put me on bed rest. Four days later, I took myself off. The medication given to slow the progress of pre-term labor did nothing to ease the contractions. I returned to her care and 34 weeks, I immediately switched OBs. Granted it should have been MUCH sooner, but regardless, I stuck it out. Every legitimate complaint I had about the pregnancy was pushed aside. My daughter’s foot was painfully wedged in between my ribs, ripping apart the muscle. She acted blind about the problem, not feeling for my daughter’s foot or giving a suggestion about re-positioning her foot. Never once during my antenatal care, did she feel the position of the baby. Only measuring for growth.

I was debating about breastfeeding pumping at first, but soon felt trapped with my mother-in-law as she tried to take my bras into Babies R Us to find the ‘perfect’ pump. Neither one of her boys were breast fed. Quite honestly, she was living vicariously through me. She wanted the best for her grand-daughter, not some laboratory formula. She also had to take pictures of everything– Including the delivery (which I immediately shut down) and me feeding our newborn ‘properly’ with human milk. Every time my mother-in-law brought up the front row seat at the delivery, the terror re-surfaced. I screamed at her. I told her to watch the paint dry at her own place. I told her son will be the ONLY visitor until we go home. I wanted to deliver at a hospital without her knowledge.

The new OB immediately noticed the flags. She stepped in and talked with my husband and I about formula feeding. She mentioned that because of my imminent threat to develop postpartum depression, breastfeeding would have been the death of me. She understood the predicament and questioned the surgical scar on my foot. By delivery, I had gained only 22 lbs. Most importantly, I was still in MY clothing. Due to the severe depression and the painful position of my daughter’s foot in my rib cage, I was medically induced at 38weeks. She saved my life. Come to find out, she also saved my daughter’s life. Her placenta was in the process of rupturing. I had no symptoms to question that my daughter’s health was in jeopardy, just my typical every few minute Braxton Hicks.

As I checked into the hospital, the assigned nurse asked about my feeding preference. I gave her my formula requirement. All but one nurse happily understood. The night nurse was a so-called breastfeeding nazi and tried everything to get me to give my daughter the colostrum. The moment she woke me up to feed my daughter and pushed breastfeeding, I asked her to leave. The lactation consultant was nice enough to give me pointers on how to dry up my milk, if, and when it did come in. As my almost 9lb daughter was being examined by the pediatrician, she quickly noticed my daughter was approximately 41 weeks gestation. That would explain the partial placenta rupture.

As I talked with the OB the next morning, she made a comment that has stuck into my mind. Happy Momma = Happy Baby = Happy Family. My delivering OB in her greatness, worked with my husband and I on how to alleviate postpartum depression. Breastfeeding was out. Leaving our place with a newborn in tow was in. Talking to friends and family was a must. After the tumultuous pregnancy, our marriage has thrived and my husband taught himself how to bond with his daughter. My husband became a stay-at-home father for eleven months. Yes, it was a role reversal, but financially, it was our only option because I carried the insurances. He could feed her without needing me to pump. Most importantly, he could bond and developed his own style of parenting and feeding. After a year of infant and parental development, anxiety and challenges, I can happily say that postpartum depression has not reared its ugly head.

I’m all for breast is best for baby, but what many people fail to understand, in some situations, breast is not best for the new mother. Some mothers cannot breastfeed due to a medical condition, severe mastitis, surgery or a crazy work schedule. Some infants do not accept the mother’s breast. I could not stay home any longer than 6 weeks. Pumping in my line of work is not appropriate nor accepted. I work corporate aircraft flight planning and cannot step away from the flight planning desk for a five minute lunch break, let alone ten minutes to pump. We do not have a pumping room and work a twelve hour swing shift rotation. Pumping in traffic was also not an option. We have to do what’s right for our family, not what is right for others. Our daughter is an extremely healthy and active one year old. She’s absolutely perfect, formula baby.

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Share your story for FFF Friday. Email me at formulafeeders@gmail.com.

FFF Friday: “The last people who should be against you are your fellow moms.”

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Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.

I haven’t posted this week, because it has been a rough one for me and my family. A few days ago, we had to say an unexpected goodbye to our beloved dog. I don’t usually bring up my personal life on this blog, unless it has to do directly with infant feeding, but in a weird way I do associate Fearless Pup with my struggle to breastfeed. While in the midst of my postpartum depression, and trying desperately to feed FC, my only refuge was when I retreated to the bedroom to pump every 90 minutes. Fearless Pup would trail after me, jump up on the bed alongside my hospital-grade Medela, and lick my tears away as I cried. He was the only creature that was able to reach me when I was so entrenched in the hell that is PPD. He was there through those dark days with his soulful brown eyes looking up at me, willing me to get through this, to heal, to do whatever it would take to swim back to shore. He was my furry lifejacket, and I honestly don’t know how I would have made it through those first few months without him.

Anyway – this has nothing to do with the following post by Erin, but I wanted to share this memory with you because to me, it is the iconic image of my postpartum depression. Erin’s story is wonderful on many levels – I love her positive response to the “mommy wars”. But I think the most important aspect of her submission is that she associates her postpartum mood disorder with breastfeeding. I’ve said it before and I will say it as many times as I have to: breastfeeding is a different experience for different women. While studies may show that for some women, breastfeeding keeps the PPD and postpartum anxiety demons at bay, for others of us it can be a major trigger. And unfortunately, not everyone has a furry lifejacket to help them crawl back to safety.

Happy Friday, fearless ones…

The FFF

*****

Erin’s Story

I am 30 years old and just had my 2nd child, a boy 2 months ago.  I have a daughter who will be 3 in August.  When I was pregnant with her, I was one of those people who thought I would breastfeed with no problem.  I didn’t buy a single bottle.  I talked endlessly about breastfeeding with my friends and even found myself tempted to belittle someone on a website who said they didn’t plan to breastfeed at all.  How could they?  Didn’t they KNOW how much better it is for their baby?  Well I knew and I had every intention of feeding her for one solid year.

My baby was born and it was the best day of my life.  I couldn’t wait to feed her!  She tried to latch on and couldn’t without a shield.  This began the downfall of my breastfeeding experience.  By the time I left the hospital, not only my nipples, but every part of my breast that was sucked into the shield was cracked and bleeding.  My daughter cried at every feeding and never seemed full.  I kept at it, determined that I would make it work.  At her first check up she was 5 oz under weight her birth weight.  At her two week check up she was still 4 oz under her birth weight.  My nipples hurt so badly that I would sob when I fed her.  I dreaded each and every feeding.  That’s about when the postpartum depression/anxiety set in.  I have never experienced anything so intense in my life.  I felt like I was going insane.  I couldn’t concentrate, worried about everything, couldn’t sleep, lost interest in my baby and my family and my entire life.  I cried all the time.  I wished I could go check myself into the hospital.  And it all centered around the fact that I did NOT want to breastfeed but was too ashamed and stubborn to admit it.  After her 2 week check up, the doctor told me to pump my fore milk out and start her out with the hind milk, then feed her the bottle of fore milk.  So I did.  And that was the last time my daughter EVER latched onto me.  She got a bottle in her mouth and never went back.  She loved drinking from a bottle because she could actually drink!  And she wasn’t drinking my blood.  I started pumping and thought I would just try pumping as long as I could.  But my postpartum issues were taking over my life.  I would pump one feeding and couldn’t at the next.  I was a mess.  I went on an anti-depressant/anti-anxiety pill and it helped tremendously.  I remember reading recently that breastfeeding helps with postpartum depression.  For me, it was the cause of it.  And I don’t buy that information because when I was having so many issues and called my OB doctor, the first question out of her mouth was “are you breastfeeding?”  Apparently she’s seen this before!

I remember calling a Le Leche League representative that someone gave me a phone number for.  I told her my problems and her first question was “did you HAVE to have an epidural?”  I said “Um, I gladly received one!”  She said, “Well epidurals cause babies to stay drowsy and not very alert for weeks and makes it hard to breastfeed.”  At that point I dismissed her as a complete idiot and said “thanks for your time.”  That night my husband and mom sat with me while I cried and both advised me to just quit.  My husband did a lot of research on breastfeeding and determined that the risks did not outweigh the benefits in our case.  I went to formula that night and NEVER went back.  I felt horrible guilt and judgement, mostly self inflicted, but deep inside I felt relief.  I finally bonded with my baby girl.  I started to fall in love with her and started to love motherhood.  I put the pump away and let my breasts return to their normal selves :)

With my son, I attempted breastfeeding again but went into it with a totally different attitude.  I didn’t assume it would work, I just thought I would see how I felt and if it worked it worked, if it didn’t, it didn’t.  He latched on like a champ and I fed him solid for 2 weeks.  Unfortunately I dealt with the same postpartum anxiety again.  I apparently am very sensitive to hormonal changes in my body.  After a near kidney infection, a back injury, and my anxiety at an all time high, I made the same decision to not breastfeed.  And I immediately began to heal once I made that choice.  My mind started to ease, I was able to take the medication I needed for my infection, my back, and my anxiety that I couldn’t take while nursing.  I felt better.

For me, breastfeeding is directly in correlation with my anxiety and both times I have not felt better until I totally quit.  I can let myself feel like a failure, or I can realize that this is so small in the scheme of things.  It is a tiny insignificant part of what makes me a good Mama.  I adore my children.  I stay home with them, I spend all of my time with them, and I love motherhood.  I take hundreds of pictures every week of my kids.  When they go to bed at night, I watch the videos that I took of them that day and cry because they are growing up too fast.  I miss them while they nap.  They are beautiful, healthy, smart, perfect.  No part of me thinks I did them a disservice by not breastfeeding them for longer.  I do not regret it.

My husband who was not breastfed an ounce and is 6ft 6 inches and a college athlete likes to make the joke that if only he had been breastfed maybe he wouldn’t be so small and weak :)   I think about all the moms in my life that I love.  Whether or not they breastfed isn’t something that comes to mind when I consider how they are as a mother.  My own mother who I truly believe is one of the most selfless people on earth did not breastfeed any of her kids for much time, or at all. It does not matter.  What matters is your heart, your love for your kids, and your commitment to family. There is a lot more to this life than whether your babies drank out of your boobs.  I have so many friends who breastfeed and I support them wholeheartedly.  And they support me.  The only thing I ever ask of them is not to pity me because it didn’t work out.  I adore feeding my baby a bottle, it’s wonderful!

Whatever you’re story may be, the last people who should be against you are your fellow moms.  It is our own insecurities that cause these “mommy wars” to begin with.  I support moms who love their babies.  Whatever your methods or reasons for each little decision, if those choices are made in love, they are the right ones.

 *****

You know what would really cheer me up? A great FFF Friday submission. Send one over to formulafeeders@gmail.com. 

Fun and games with Kaiser’s new breastfeeding policy

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This image was used in conjunction with this story, about how Kaiser Permanente (an American health system which prides itself on being Baby Friendly) is now promoting breastfeeding as a means to fight obesity.

For our first game, I’ll give you two guesses as to where I am heading with this one.

The article states that “The breastfeeding-obesity link is now recognized by key government agencies such as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).” True dat, as they say. The LINK between reduced chance of obesity and breastfeeding is certainly recognized by the CDC and AAP (although last I checked, the AAP was not a “government agency”, but rather an independent association of pediatric physicians). But, um, a link is not a cause or cure. It’s a link.

The CDC’s own document on the breastfeeding/obesity link states:

…Breastfeeding is associated with a reduced odds of pediatric overweight; it also appears to have an inverse dose-response association with overweight (longer duration, less chance of overweight). While more research is needed, exclusive breastfeeding appears to have a stronger effect than combined breast and formula feeding, and the inverse association between breastfeeding and overweight appears to remain with increasing age of the child. The three meta-analyses reported in these review articles suggest a 15% to 30% reduction in odds of overweight from breastfeeding.

If you read the entire report, you’ll see that several of the studies in question reported a reduced risk of obesity with breastfeeding initiation – meaning that if women just breastfed in the hospital, there was less of a chance that the child would be overweight. And all studies were observational in nature, as the report authors go on to explain:

There are several possible explanations for why breastfeeding appears to reduce the risk for overweight, but conclusive evidence is not yet available. The studies presented in this brief are limited in that they are based on observational studies and cannot demonstrate causality. One possible explanation for why the literature indicates that breastfeeding reduces the risk of overweight is that the findings are not true but instead are the result of confounding. It may be that mothers who breastfeed choose a healthier lifestyle, including a healthy diet and adequate physical activity for themselves and their children. This healthier lifestyle could result in a spurious relationship between breastfeeding and reduced risk of overweight. The results of Arenz et al. and Owen et al.,however, suggest a true relationship between breastfeeding and reduced risk of overweight, because after adjusting for potential confounding variables, significant inverse associations remained. For example, Arenz et al.reported a significant adjusted OR of 0.78 (95% CI: 0.71, 0.85) among nine studies that adjusted for at least three of the following confounding or interacting factors: birth weight, parental overweight, parental smoking, dietary factors, physical activity, and socioeconomic status/parental education. Similarly, when Owen et al.30 conducted a subanalysis of six studies that controlled for possible lifestyle confounders, the significant inverse association between breastfeeding and pediatric overweight remained, but it was smaller than in the unadjusted analysis. While randomized clinical trials are required to adequately test this relationship, it is unethical to randomize infants to a group with no breastfeeding because of breastfeeding’s known health benefits…

Fair enough. But then the paper launches into a slew of hypotheses about why breastfeeding confers a protective effect against obesity (none of them proven, or even studied, in some cases) and continues with a lengthy discussion about how to improve breastfeeding rates. So what can we gather from this paper?

1. Breastfeeding is associated with a lower risk of obesity.
2. We don’t know why.
3. Breastfeeding rates are low.

Hardly evidence-based proof that we should be promoting breastfeeding as a means of reducing obesity, and yet, here we are again, beating the same dead horse. Somebody should probably call PETA.


Time for the next game… going back to the image at the top of this post… can you spot the misleading or outright false claims?
First of all, breastfeeding does not “prevent” asthma. In fact, several studies (like this one and this one) have suggested that longer breastfeeding may increase the risk of asthma in babies whose mothers have the disease. One meta-study recommended that short-term breastfeeding (4-6 months) was optimal for asthma prevention, but that breastfeeding longer than that may have a reverse effect; another, published in 2011, “(did) not provide evidence that breast feeding is protective against wheezing illness in children aged 5 years and over.”
Breastfeeding also does not “prevent” postpartum depression; this particular claim is outright dangerous. If women believe that breastfeeding protects them from getting PPD, they may fail to seek treatment when symptoms arise. The only studies I’m aware of show an association between breastfeeding cessation and PPD; all this proves is that women who already are showing symptoms of PPD are more likely to quit breastfeeding (another plausible theory is that breastfeeding failure may be a risk factor for PPD).
I’m not sure how this image is being used, but it concerns me…. this is exactly how misleading information spirals out of control. If policymakers and physicians do not have the good sense to differentiate between “links” and causalities, what hope do we have for the general public having a decent understanding of what will impact our health?
Breastfeeding may be good for baby, and good for mom. But please, can we stop with the false advertising? It’s not fair for the formula companies to do it, but it’s just as unfair for the government or health authorities to make unsubstantiated claims. Maybe even worse – we are taught to be skeptical of big corporations, but most of us still have a blind faith that doctors and health organizations are 1) honest and 2) out for the common good. I still believe #2 but I am highly doubtful of #1. And I’d still prefer the truth, even if does make for a less convincing “sell”.

One more little postscript…. my friend J is exclusively breastfeeding, and is a member of Kaiser. Despite the fact that you can’t go two feet in a Kaiser hallway without seeing a breastfeeding promotion poster, she was recently prescribed an allergy medicine that killed her milk supply. She couldn’t understand why her son seemed fussier all of a sudden, until she tried pumping first thing in the morning (her son sleeps through the night, so she hadn’t nursed for over 6 hours and should have been full) and only got a few drips. When she called Kaiser to inform them of this development, they told her that since the meds she was given weren’t contraindicated for breastfeeding, they were deemed “safe” even though she was a nursing mom. She asked what was safe about not having enough milk to satisfy her baby, and the nurse on the phone told her that “she could always just give him formula.”
Interesting. I guess she can blame that nurse if her son is chubby at the age of 5, huh?
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