Doctors can be fearless, too

When it comes to having emotional responses to posts about formula feeding, I’m pretty stoic. After reading so many heartbreaking stories you start disassociating – you have to, or you’d go crazy with outrage and frustration.

But tonight, I cried as I read this post. Happy tears. Tears of relief. And then, tears of frustration as I read the comment section.

The post in question was entitled “Let’s stop the war between breastfeeding and formula feeding”, and it was on a blog sponsored by MedPageToday. Pediatrician “Yolanda MD” wrote a rational, calm, but still impassioned post about how crazy the pressure to breastfeed has become, explaining that while she believes breastmilk is “incredible stuff” – she nursed her baby exclusively until suffering a supply dip after returning to work – breastfeeding is not always possible:

I still do everything I can to encourage mothers to breastfeed. I want to help them get through the ups and downs. But obstacles do arise. Obstacles abound. Breastfeeding does not come naturally for many, and life can often throw a wrench in the most well-intentioned plans. Severe pain and slow healing. Minimal time with a lactation consultant. Discouragement from family members or even medical providers. Postpartum depression and stress. Insufficient glandular tissue. Illnesses and hospitalizations. Medications. Returning to work. Limited support for pumping at work.

The idea that every woman can nurse is a hurtful myth….

Which is, of course, no shocker to anyone who reads this blog. But then, she says this:

I was fortunate and did not have difficulties with breastfeeding. But that’s all I can call it — fortunate. My ability to nurse my baby did not make me a more successful or more loving mother than someone who decided to use formula…The mark of a mother is not whether she dons a nursing cover. The mark of womanhood is not whether her breasts are able to produce enough milk. Since when did mothers need to prove that they care?

Amen, hallelujah and sing it sister!

Of course, then the comments began. It was exactly what you’d expect ….”Formula is a marginally adequate nutritional supplement for breastfeeding. But formula feeding has significant health risks for babies and mothers. We must remove the barriers and allow all babies and mothers to have a NORMAL, healthy breastfeeding relationship as long as possible for each mother and baby.” said one visitor (also an MD). “I’m sorry but can someone explain to me why mothers who are successful at breastfeeding, despite all of the obstacles in their way…aren’t allowed to be proud of their accomplishments? Please! I salute every mother who meets her personal breastfeeding goals and she should be proud and deserves a pat on the back for doing what is best for her, her baby and society at large,” said another.

These were only the first of many, I’d bet, which will miss Yolanda’s point entirely. Nowhere did she say breastfeeding wasn’t “best”. Nowhere did she say that women should not feel proud of their accomplishments. She only suggested that to make breastfeeding the mark of motherhood was unhelpful and pointless.

Herein lies the reason that we will never, ever get anywhere in this “debate”. There is no room for alternate opinions. There is no room for sensitivity, or moderation, or nuance. If a person merely hints that bullying women into breastfeeding – by making them feel like inferior mothers (women) if they don’t, or by misrepresenting the “risks” of formula so dramatically that they deserve an Oscar – is wrong or misguided, they are immediately dismissed as being Enfamil’s pawn or a women-hating moron. And if that person happens to be a doctor, god help us all.

Do they not see that this is censorship in the most naked sense? What could be so scary about acknowledging that the experience of one woman is not any less valuable than another? Does the stress caused by not breastfeeding compare to the stress of breastfeeding? Was my pain worse than yours? Who the fark cares? It’s pain, and pain sucks.

It is easy to win an argument when you are wearing earmuffs. Taking them off and hearing – really hearing – what the other side has to say takes true courage. Although I don’t know how you could turn a deaf ear to the breastfeed-at-all-costs zeitgeist, I think we should all make a concerted effort to hear, and comprehend, that point of view. Maybe if they see that we are willing to do this, they will take off the noise-canceling Bose earphones and finally have a real conversation. Not that I am holding my breath.

Regardless, go visit Yolanda’s blog and show her some love. She deserves it.

A Tale of Two Cities

One of the most repetitive arguments we’ve seen on FFF is that there is no such thing as an anti-formula-feeding culture; that breastfeeding mothers are always the minority, no matter where you live in America. I find myself living a lactation-centric Groundhog’s Day as I try and explain that infant feeding trends vary greatly, depending on the city. I also add the caveat that while there are, indeed, many parts of the country where bottle feeding is still the norm, and I understand why breastfeeding moms might feel marginalized and angry….even in areas where bottle feeding is prevalent, women can still feel guilty and defective if they do not nurse.

I’m visiting my in-laws right now, who live in the Northwest suburbs of Chicago. About half of our childbearing friends live in the city; the others are back in the ‘burbs. They run the gamut with breastfeeding; most nursed for 3-6 months, with some supplementation; one breastfed exclusively, and a few others pumped and bottle fed, later turning to formula. Some say they felt pressured to breastfeed at the hospital, but for the most part, none of them appear to have struggled too dramatically with their feeding decisions.

On Sunday, my in-laws threw us a party, a kind of “meet-and-greet” for Fearlette, who was visiting her midwest posse for the first time. I got into quite a few conversations about my work, since all of my friends either had small children and wanted to reflect on their experiences, or are currently pregnant and facing these inevitable decisions. By the end of the party, I was starting to think that some of the FFF critics were right – I must live in some odd sort of ivory tower (milky white, maybe, instead of ivory) where breastfeeders are the majority, where breastfeeding pressure is so insidiously rampant. It seemed as if Chicago, despite its status as a progressive, urban, intellectual hub, was still a place where bottlefeeding was universally acceptable.

Then, on Monday, Fearless Husband and I left FC in the burbs with his grandparents, and took Fearlette with us to visit a few city-dwelling friends – including one couple who had just had their first baby 10 days earlier. We stopped at a baby store to buy said couple a gift, and somehow, my stupid clumsy self managed to trip while holding the 5-month-old Fearlette, and knocked her beautiful, fragile face on the cold, dirty Chicago sidewalk. (Incidentally, not breastfeeding is nothing compared to dropping your infant on its head on the Parental Guilt Scale. But don’t worry, I’m not going to start the Fearless Baby Dropper blog or anything.)

We ended up seeing a friend’s pediatrician for an emergency visit, and Fearlette was luckily fine, except for a small bruise on her forehead and a tiny scratch on her adorable nose. As the doctor was checking her out, she asked us how Fearlette had been in the time between the accident and arriving at the pediatricians office (about fifteen minutes, with Fearless Husband barreling down Michigan Avenue, cutting off bird-flipping cabbies and honking furiously). I told her that I’d fed her and she’d ate well. That was all I said – “I fed her, and she ate normally.” To which the doctor replied, “Oh, cool… so she finished her bottle like normal?”

Say what??

To my ears, this was shocking. Why would she assume I was bottlefeeding? Did my reputation proceed me? Maybe breastfeeding moms didn’t drop babies on their heads? Could she tell Fearlette was a formula-fed kid? Was the trademark Alimentum smell permeating the room?

But you know, I don’t think it was any of those options. I think it was simply a normal default response, just like how at my Californian pediatric office, the default is to assume you’re breastfeeding.

Again, I wondered: maybe it is just Los Angeles, New York, and parts of the Pacific Northwest that house overwhelmingly breastfeeding-prevalent cultures. Which didn’t make my blog very relevant, or bode well for future book sales.

After we confirmed that Fearlette was no worse for the wear, we continued on to our friends’ loft, to meet their new bundle of joy. The new mom was calmer and cooler than I’d ever been, and seemed to have her head on straight in an incredibly admirable way. She told me she was pumping, but only managing to provide a small amount (her daughter had never been able to latch, despite the assistance of the hospital lactation consultants; they’d told her to consult with a private LC who charged $200/visit, to which she replied no freaking way), so they were feeding a combo of breastmilk and formula. She told me that they’d pushed breastfeeding at the hospital, but she’d wanted to do it, so it hadn’t bothered her. Later though, she admitted that her friends kept telling her she should keep pumping, keep trying to get her daughter to latch, asking her about it constantly, telling her how important it was… and these were all Midwesterners. Living in the supposedly bottle-feeding Heartland. Hmmm.

We later stopped by another friend’s house, who didn’t have kids of her own, but told me about her three closest friends, all Midwestern new moms, who had struggled, “failed”, and felt morally compelled to breastfeed. How depressed they’d been. How they’d felt like failures.

Today, while the kids were napping, I checked out the Facebook site of a Chicago-area expectant mom’s group, where it mentioned that the thing most of their members were most stressed out about was breastfeeding. I reread an email I got from a Chicago-dwelling professor I interviewed, who spoke of her own exclusively-nursing peer group in a way that reminded me, eerily, of mine.

Later in the day, we went to a suburban children’s museum where there were “nursing areas” in every corner of the building. And yet I didn’t see any moms using them. I did see a couple of other parents bottle feeding.

And I realized: I have no clue if Chicago is a bottle-feeding or breastfeeding “culture”. These things are constantly in flux; for all I know, the friends who gave birth three years ago might have lived in an entirely different environment than the ones giving birth now. Heck, my own hospital in Southern California had gone all Baby-Friendly in the two year span between my two births. You just never know what the winds of change will bring.

Coming from Los Angeles, I felt far more comfortable bottle-feeding in the suburbs of Chicago. But that doesn’t mean that my friend doesn’t feel comparable pressure from her breastfeeding friends and pro-breastfeeding hospital, even if her general environment is not 100% anti-formula.

We also don’t know what is in somebody’s heart. If you are a person who desperately wanted to nurse, who always saw yourself as a “counterculture mama” and now feel like you don’t qualify as one because your boobs don’t work, living in a “bottle feeding culture” isn’t going to help.

I realize this post is going nowhere. I’m still feeling kinda out of sorts for causing even a small moment of pain for my daughter (I’m turning in my sling and wrap for a bucket seat – attachment parenting is apparently not for klutzes). I guess what I’m trying to say is that the number of baby-friendly hospitals, or pediatricians who allow formula samples in their waiting rooms, is not necessarily indicative of what “culture” we live in.  So much depends on your individual OB, pediatrician, and hospital. On your own peer group. On where you work, what neighborhood you are in. Where you went to college, and what blogs you read. Social pressure comes from many places, and in this global world we live in, we just can’t know what someone’s “culture” really is.

In the meantime, I am retreating to my breastmilky-white ivory tower of Los Angeles, where we mostly drive in cars. I can’t be trusted to walk on sidewalks.

Middle America speaks out…

I’m kind of embarrassed to admit it, but I used to be a TheBump.com addict. I had a rough time conceiving Fearless Child, and their Pregnancy Loss chat room was a lifesaver, offering support when I had none. Eventually, though, the girls I’d grown close with on this board decided to break from the coroporate wedding/baby/domesticity giant and start our own private message board; I haven’t given much thought or attention to Bumping lately.

But now, the Bump is celebrating Breastfeeding Awareness Month in their trademark style (read: glossy, dumbed-down, vague and dismissive), complete with celebrity “breastfeeding stories” and a survey of “thousands” of Bump readers regarding their attitudes towards infant feeding.

Surprisingly, I actually think their survey is interesting and worthwhile. Mostly because of the demographics involved. To be clear, I could not find any detailed demographic info for the site, other than the obvious (American women between the ages of 25-35, mostly college educated and married). After spending every waking moment for approximately 18 months logged onto the site, though, I feel I have a decent understanding of the people who frequent TheBump. Most folks I encountered in my online sojourns were white, middle-income, and from the heartland. The local boards with the least amount of activity were for places like Los Angeles and New York City (although NYC still had a much better representation than LA). So while this is hardly a scholarly analysis, I think it’s a fair assumption to say that any survey of Bump members will reflect middle-class, middle America pretty disproportionately.

This latest poll on breastfeeding is being used, as you might expect, to support assertions that we need more breastfeeding awareness in our country. And on certain levels, I agree with this assessment. For example, this little tidbit:

But what really shocked us? Despite being considered so natural and beneficial, breastfeeding anywhere but home still makes some mamas think twice. Not only did 40% of new moms say they would only do it in public if absolutely necessary, but 23% refuse to do it at all! What’s more, 20% of non-moms answered “Eww, in private please!” when asked what they thought of public breastfeeding. Which begs the question: How can something most of us see as so “natural” still be considered so taboo and uncomfortable – especially by other women?

This is troubling, especially when you consider another finding from this survey – “79% of women polled felt that breast milk is healthiest for baby, while 19% believe formula to be just as healthy.” In other words, we have a vast majority of women who believe in the superiority of breastmilk, and yet a significant portion of them don’t feel comfortable nursing in public. I’m not as surprised by that 20% of non-moms who think like 12-year-old boys, because I actually believe (and feel quite saddened by this) that women are often the worst culprits of making NIP (chat room code for “nursing in public”) difficult for their breastfeeding sisters. I’m not sure why this is; I assume it has a lot to do with our puritanical society and general queasiness about bodily functions. (many of the non-moms I know also get pretty squeamish about childbirth; I’ll admit that in my twenties, when a coworker had a baby and was talking about delivering the placenta and waiting for her newborn son’s belly-button to “fall off”, I had to immediately stop eating my Panera veggie sandwich for fear of projectile vomiting. Now, of course, I can converse about baby poop and egg white cervical mucous like a champ. Things change.) But for nursing moms to feel this way? It’s awfully disturbing, because that implies, at least to me, that these women could easily feel housebound or trapped by their inability to do the necessary work of feeding their babies outside of their own homes. Which is why I will gladly fight for a woman’s right to nurse in public and receive RESPECT for doing so.

But I digress. What bothers me about the interpretation I’ve seen of this survey online is that I think it’s missing the forest for the trees. I read one blog outlining the horror of this finding:

46% of women polled (and 54% of moms) think breastfeeding moms are pressured to wean before they’d like to.

The blog in question railed against a system that would make these women feel like they had to wean early. Which I will agree is pretty messed up. But here’s where reading the result a bit more critically would have helped: the survey didn’t ask mothers if they felt that THEY were pressured to wean early. It simply states that 46% of the women polled (including non-nursing moms, currently nursing moms, non-mothers, etc) THINK that breastfeeding women are pressured to wean before they wanted to. This is a huge distinction, and to ignore it is either poor reading comprehension or a conscious desire to reframe the story.

One last interesting finding, one which none of the blogging pundits mentioned, far as I know: “56% of first-time moms reported trouble BFing and 41% still had issues with Baby #2 and beyond.” I suppose booby traps could be blamed for some of these, but 76% of these women with trouble also mentioned they’d had “help from a lactation consultant or coach in the hospital”, so at least some support is being made available to the majority of moms. I think one could argue that if more than half of first time moms had trouble nursing, 76% of those whose problems started in the hospital (hence, within the first few days), it’s sufficient evidence to reconsider the assumption that breastfeeding is “easy” or “natural”, at least in the environment we are currently living in. Again, I don’t see admitting this as being anti-breastfeeding, but rather an important step in providing the right support for those who want to nurse and who may very likely encounter problems.

Aside from the survey, the Bump decides to post 10 reasons for breastfeeding, which they oh-so-cutely entitle “10 Reasons Breastfeeding Doesn’t Suck”. They state these as facts, with no citations or links, and make a myriad of misleading statements likeIt saves lives — and government money!
If just 90% of US mamas breastfed exclusively for 6 months, not only would an estimated 900 babies live, but the United States would save $13 billion per year. (Yep, $13 BILLION.)” 

…And there we have it: reason #1 why complex methodologies like Bartick’s can be dangerous. The results of studies like hers have a way of creeping into pop culture, in the hands of those who don’t have the education or sensitivity to explain their true meaning.

But hey. It’s the Bump. Who’s gonna listen to the Bump, right? Not like it’s one of the biggest baby-related websites in the world or anything, and considered gospel by thousands of new and expecting moms… nothing to worry about at all. Back to your Saturday evenings, FFFs. Have a drink for me. I could really use one right now.

Public displays of affection

Apparently, the Carnival of Nursing in Public is currently in full swing. I’m not really clear on what a “carnival” is, but I’ve read some interesting posts from bloggers participating in this festival of sorts, and it’s gotten me thinking about the hot button topic of nursing in public, or “NIP”, like the cool kids are calling it.

As anyone who reads this blog regularly knows, my biggest pet peeve is hypocrisy. It kills me. Makes me switch political affliliations more often than Carrie Bradshaw switches shoes. (Actually, you could blame most perceived “flightiness” on my part – a trait for which I am well known – on my hatred of hypocrisy.) And this nursing in public controversy screams of hypocrisy, at least to my highly sensitive eye.

As mothers, we are inundated with conflicting messages: Be a supermom/Don’t over-parent. Stay home with your kids/Go back to work. Get back in shape/Relax, your kid should come first. Nurse for at least a year/Don’t let anyone see you nursing.

It’s ridiculous. We put all this pressure on women to breastfeed exclusively, and then we urge them to be discreet about it. After watching nearly every one of my friends nurse their children into early toddlerhood, I think I can safely say that even if you WANT to be discreet about it, it’s damn near impossible to do so. At the beginning, you and your babe are still figuring it all out – how the heck does anyone expect you to get a good latch when the parts involved in the process are covered by a sheet, even if it is a designer Hooter Hider? In my case, it took about an hour of fumbling and several highly trained adults to get my child to even latch a little bit. If I’d had to do it alone and sight unseen, forget about it.

By the time you perfect the art, the kid has probably become a little more in control of their bodies and minds, which means they likely have an opinion about being all hidden away from the world. I wouldn’t want to eat in the dark (although I seem to recall a weird trend in the early part of the decade where people purposely ate at expensive, completely darkened restaurants… but I think that trend died out pretty quickly. Probably because it was messy. I feel bad for the busboys at those restaurants). It’s probably pretty stuffy under those things, too.

I don’t even want to get into the whole nursing in a bathroom thing, because it just infuriates me. No one should have to hang out in a public restroom for more time than it takes for a quick pee, let alone a small infant who needs to eat.

I think the problem is that America, like it or not, is still a puritanical society. And unfortunately, I don’t know if promoting nursing as “normal” is going to solve the problem, as much as I believe it needs to be solved. I know that’s an unpopular opinion, but I hope that by discussing these things, we can try and figure out a way to alleviate the angst of this rock-and-a-hard-place situation for nursing moms, right here, and right now.

Our society is messed up on so many levels; we’re a nation of extremes. There’s no reason that near-pornographic fashion ads should be allowed on giant billboards in Times Square, while a mom can be made to feel weird about feeding her child in public. But that’s the world we live in. While for new parents, pediatricians and breastfeeding activists, it may seem like everyone cares about how we feed our kids, the fact is that most people just don’t. Even parents of older children tend to forget about all the drama over bottle vs breast as they start to deal with other battles, like learning and behavior difficulties, school budget cuts, and the REAL causes of childhood obesity or it’s ugly cousin, eating disorders. Ask your typical father of a 14-year-old girl what parenting causes he cares about, and I highly doubt breastfeeding rights will be tops on his list (even if 14 years ago, he cared deeply about this as he watched his wife struggle). And that’s a parent. What about all the childless folks who think kids are just annoying, short versions of adults that disrupt their meals, movies, shopping trips, etc.? (And come on, now… can you blame them? I wouldn’t want to be seated next to my child in a movie theater, which is why I’d never take him to one. )

This is not to say that any of this serves as an excuse, that we should just give up on trying to change public perception or cultural norms. My point is just that these issues go far deeper than breastfeeding, and we need to try and address our cultural attitude to the human body first and foremost. That may take awhile. And while it’s in the process of happening, I worry about the moms who actually need to deal with NIP at this very moment.

So, in the meantime, while smarter people than I work on the larger issues at play, I think it might be useful to address some of the more personal aspects to the NIP conundrum. Because here’s the thing: I live in a very pro-breastfeeding area, where we see people NIP constantly – and yet many of my friends never felt comfortable without a hooter hider, even if it was just a bunch of us girls hanging out in someone’s house. It struck me as strange, especially as time went on and it was just the status quo, nothing novel… I mean, at this point we were all friends, all thought nursing was “normal”…. and yet my friends were still more comfortable covering up, even 11 months into the whole breastfeeding thing.

I’m afraid that’s the thing no one talks about when they discuss NIP: it’s not always other people that make us feel weird about nursing publicly. Sometimes, it’s our own hangups about our bodies that are the true culprit.

I have more than just respect for those who are comfortable feeding their children, sans cover, in front of others. I have envy. I’ve had body image issues my whole life, and they’ve only gotten worse in my post-natal state. So when I see women who are strong enough to either not have those demons at all, or overcome them in order to feed their babies more freely, I want to cheer. But I also think we need to acknowledge that even if we change society’s attitude, right now, in our generation, there are women who are not going to feel comfortable being seen with their shirt off, or even just pulled down, in public. Even if it is in the name of love and nourishment for our children, for some of us, breasts are something we’d rather not share with the eyes of the world. And that needs to be okay.

Therefore, rather than dwell on what other people think of nursing moms, in the spirit of the Carnival of NIP, I’d like to propose two ideas to help new moms feel more at ease with their own feelings about this issue:

1. Encourage all malls, hospitals, and office buildings to have “Mom Suites” – places where all moms of infants or toddlers are welcome (both nursing and bottle feeding), with comfortable seating, and privacy. I’ve been in a few of these and I think they are the coolest. It couldn’t be that difficult to designate a small space for this purpose, could it?

2. As part of breastfeeding support groups or pre/post-natal classes, include help/advice/support for women with body image issues or particular anxiety about exposing their bodies. Rather than making them feel ashamed for not having the emotional fortitude to nurse in public, help them find solutions – ways to serve their babies’ needs without giving themselves more anxiety, because what new mom needs more of that? I believe this would help increase nursing rates among those who are afraid breastfeeding will chain them to the house; if there was some way to help them feel more comfortable in public situations, maybe it would make a year of nursing seem less daunting.

Anyway. Just two measly cents from someone who never got the chance to even attempt NIP (although I did actually nurse in front of a camera – we were the subjects of an internet series on pregnancy and they did film me that first week with one of the lactation consultants I saw… they never used the footage though, as it was probably too darn pitiful, what with the tears and screaming and all). I would’ve had to pump in public (PIP??). Now THAT would be an accomplishment. If I ever witnessed a mom pumping in the middle of Starbucks, I’d buy her a Venti Frappucino. Full sugar and all. She’d deserve it.

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