Fearless Formula Feeder

Formula advertising isn't evil; it's just stupid.

2012-01-21T22:42:00.000-08:00

My inner capitalist is about to rear her ugly head, so brace yourselves (and just for the record, so I don't provoke an Occupy FFF - I am 100% part of the 99%.)

A reader emailed me the other night regarding a shady website sponsored by Abbot (the makers of Similac). Called "Night Nurse Nation", the site is designed to offer information for night nurses. Now, I'm not sure if they mean the kind of night nurses that people hire to stay in their homes (like my friend Kristine), or the nurses on the night shift in hospital maternity wards. These are two very different professions; one is a private, in-home service provider adept at dealing with newborns and employed in order to let new parents get some much-needed sleep; the other is a hospital employee and medical professional. The distinction is key, because very often, people hire night nurses for the express purpose of having them deal with night feedings (although just as often the night nurse may be a doula or LC who is hired to help with breastfeeding); unless the mom is pumping, her night nurse may very well be using formula. Seems like a plausible excuse for this type of marketing, at least.

On the other hand, if the "night nurses" in question are the hospital employee type, the site takes on a more insidious meaning - because formula companies should not be blatantly marketing their products to nurses dealing with new moms; not so much because this will discourage breastfeeding, but because it may result in them pushing a particular brand of formula. For example, the site has a page about colostrum which doesn't really explain anything about colostrum, choosing instead to focus on lutein, which is apparently REALLY important and oh yeah, guess what, it's also in Similac formula.

That's kind of, well, sketchy. But I'm not sure we should expect anything less from a formula company. I don't doubt that they have teams of brilliant marketing execs sitting around expensive conference rooms, plotting how to sell more formula. But I also don't give a crap, and here is why: Formula companies are big corporations. If Big Formula were a Beatles song, it wouldn't be All You Need is Love, but rather Money. Okay, better analogy - if this industry were an animal, it would be a shark rather than a furry bunny rabbit. We wouldn't expect a shark to snuggle up to us and wiggle it's nose for a carrot, right? So why do we expect a company to go against its Darwinian instinct to make money and sell, sell, sell?

Interestingly, when I told Fearless Husband about this post, he shook his head. "I don't think all they care about is money," he said. "If all they cared about was money, they'd stop doing R&D." But as much as I'd like to agree with him, I think that logic is flawed. Better product means better sales, which means - you guessed it - more money.

Let me make one thing clear: I do not in any way believe that these days, formula companies are the reason for sub-par breastfeeding rates (unless you believe their very existence, and hence the availability of formula itself is to blame...if you believe that, then I doubt you care too much about what I have to say anyway). But I do think they are guilty of misguided, and sometimes slimy, behavior in their quest to sell product. And that's okay. We can't expect them to behave any differently from other big industries. They should not have to be held to a higher standard simply because the product they hawk is controversial.

Just because I'm a realist about how these companies operate, though, doesn't mean I don't wish they would find some less-gross ways to market themselves. We do not adhere to WHO Code in this country; therefore the formula companies should not have to stoop to bottom-feeding lows like running "breastfeeding help lines" (seriously?) or websites directed at care providers working with postpartum moms. I believe they have a right to do these things, but I also think it's plain dumb that they do. They aren't fooling anyone by pretending to champion breastfeeding; they are certainly not going to pacify anti-formula lactivists no matter what they do (except for dissolving their consumer product departments and become prescription-only), and as I've said before, it alienates their already-formula-feeding customer base.

So how should they market? Well, I'm going to pretend to be an ad exec for a moment (see, I knew my years of being a struggling actress and auditioning for commercials would pay off someday!) and present my concept for a great formula ad campaign:

Open on quick flashes of different women, with words showing up alongside their images: Had a mastectomy....On lifesaving, but contra-indicated medication... Insufficient Glandular Tissue... Sexual Abuse Survivor.... Combo-feeding...Difficult work situation....Child has severe food allergies...

After each woman's image and corresponding tagline is shown, their "scene" become part of a tapestry, with all of the women visible on-screen. And these words appear, superimposed against the tapestry of women : Loves her baby with all her heart.*

Screen goes black, and we see a picture of a formula can, with the words: When breastfeeding isn't an option, try Simifamilstart.

*Please note that the campaign I would run, if I ran the world, would use the words "None of your damn business, asshole" rather than "Loves her baby with all her heart", but I doubt that would make it past the FCC)

Look. There's no escaping the truth that formula companies have done horrible things in the past, and they will probably do many more shady things in the years to come. But other than the Nestle scandal - which was indescribably evil, no doubt - I'm not convinced that what formula companies are doing is any worse than other forms of corporate marketing used by other industries. (While we're talking about this, I think it's far more questionable to allow prescription drugs to be advertised every which way, as if they were consumer products, than it is to allow formula to be advertised freely. Is there a WHO Code for pharmaceuticals?) But I think if we could start approaching formula companies with more realism and less hysteria, and in turn, they could stop being so obtuse about making lame attempts at sly marketing (I mean seriously, Abbot... what's with that Night Nurse Nation site? It's beyond stupid) then maybe we'd get somewhere.

Here's an even better idea: maybe the formula companies could just run innocuous ads on tv and stop spending money on "creative" marketing experts who get them into these ridiculous debacles, and instead start investing that cash into research and development? Come on, now. Don't make a liar out of Fearless Husband.

FFF Friday: "Hating on formula makes new moms' lives miserable."

2012-01-20T10:50:00.000-08:00

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.

You might have read FFF Krista's fantastic and funny post on her own blog about formula feeding, and now shares her personal story of how she became a fearless formula feeder.

I'll be back this weekend with a post about why formula companies are indeed evil, and why we shouldn't give a crap that they are. Fun weekend reading. ;)

Happy Friday, fearless ones....

***

I knew before I ever got pregnant that I would breastfeed. I wanted to for the bonding, the supposed weight loss benefits, and because it was cheaper than formula. And because there was so much literature out about how you have to breastfeed because it's the best for your baby. And the literature that said everyone can breastfeed, even people who don't think they can, they just have to "try harder" by pumping and stimulating and taking supplements like fenugreek. A lot of women leak while pregnant; I never did.

Towards the end of my pregnancy, I should have bought a pump and some nursing bras and tanks. But I was gun shy, that's a lot of money. What if it didn't work? Then I'd be stuck with a 300 dollar pump and a ton of nursing stuff I'd never need. I figured I'd buy it when I needed it.

Fast forward to after my daughter was born. I had no milk. Not even colostrum. So I had to start supplementing with formula. And she started refusing the breast, getting milk out of a bottle was so much easier, so I started pumping my empty boobs. The lactation consultants were very helpful, and helped me however they could. But it just wasn't happening.

Still nothing after 3 days, when we finally got to bring her home. We were sent home with some formula, and went out to get more, even though we were hoping my boobs would get the memo that they needed to make some milk. We also rented a pump from the hospital.

I was a slave to my pump, and getting barely anything after my milk came in 6 days after having her. She was only getting about 1 bottle of breast milk a day at 2 and a half weeks. And I started slacking on pumping, because it made me depressed. Because I felt like I was always pumping.

I already had a nasty case of the baby blues, and not being able to provide nutrition for my baby was only exacerbating the problem. Because everything I had read up until that point implied that moms who formula fed were lazy and quitters. And my 90% formula fed baby did not have a lazy quitter mother.

Until one day when my daughter was 3 weeks old, I had enough of the pump and my daughter refusing to breastfeed and doing fine and growing great on formula. I was like "eff this pump wasting my time." And put it away. I'm pretty sure my husband was secretly glad because seeing his wife crying with her boobs out and pumping probably wasn't the best thing for him to come home to.

I've had some regrets since and thought about relactating in the early days. Mostly because of guilt, and all the pro-breastfeeding propaganda. I knew I was doing the best thing for my baby, you know feeding her enough food, but the guilt was still there.

Luckily everyone who mattered (like my doctor, and my daughter's pediatrician) were fine with me stopping and didn't try to guilt me into continuing making myself miserable. My doctor told me that even a little bit has a huge benefit, and the pediatrician told us to call her if we had any questions about switching formula.

My child is perfectly healthy and gorgeous. And she would have been healthy and gorgeous if I had been successful at breastfeeding as well.

Since having her and getting over the guilt I've come to realize that whether or not my child was breastfed isn't going to be a topic of concern later in life. I can't imagine being at the park in 5 years and have some one ask me if I breastfed or not. Because in the grand scheme of life, it doesn't really matter how they were fed as infants.

Formula saves lives. Hating on formula makes new moms' lives miserable.

***

Are you fearless? Trying to be? Why not write a post about it? Email me at formulafeeders@gmail.com.

Why you should take experts with a grain of salt (and a FFF team project!)

2012-01-16T14:21:00.000-08:00

As I've mentioned in previous posts, I recently switched from freelancing to a more steady form of employment. I'm lucky enough to have found a job which allows me access to some of the foremost experts in the parenting world, as well as an incredible roster of parents with unique situations and viewpoints.

These past few weeks, I've been a fly on the wall as these folks have been interviewed about their areas of expertise and experience. It's been truly enlightening, both as a parent and someone who finds it fascinating to pick apart the human psyche. Some key observations:

1. Just because someone is a "world-renowned expert" does not necessarily mean they understand the real-world implications of what they are advocating.

For obvious reasons, my favorite example of this is the Male Breastfeeding Expert. There's nothing like having someone with testicles school you on why it isn't that big a deal to breastfeeding exclusively for six months. Or the 75-year-old parenting expert who tries to compare the way the world was at the time she was raising her sons to how it is now. Oh- and the expert who was born and raised in wealth and privilege, scoffing at the idea that poor, urban parents can't find ways to feed their children healthier meals and get them 2 hours of exercise.

Look. These days, it doesn't take much to be proclaimed an "expert". You write a few books, get a few prominent clients, get yourself on the Today Show, and viola! World-renowned expert. Degrees help, but even these can be misleading - a PhD in philosophy can call herself a doctor and become an expert on child health with nary a pre-med course under her Prada belt. (Think of Dr. Linda Folden-Palmer, the woman who claims that formula feeding has killed more American babies than anything else in the world. She wears that "Dr." title like a badge, neglecting to mention she's a Doctor of Chiropractic.)

Even for those select few who really do have the research, education, and experience behind them to qualify as experts, it doesn't necessarily follow that these folks have a clue what life is like outside their ivory towers. Theory and practice are two different animals, altogether. This doesn't mean they don't know what they are talking about - to the contrary, they can probably speak eloquently and informatively on their given subject. But academia tends to be insular; psychologists aren't necessarily talking with anthropologists; biologists aren't always having brainstorming sessions with sociologists. It's a shame, really, because when it comes to parenting "science", we need interdepartmental cooperation. As someone who has read research from a variety of fields on infant feeding, I can attest that hardly anyone is listening to anyone outside of his or her field. Even within the medical field, there's stuff happening in gastrointestinal journals that is barely referenced (or likely noticed) by those who read Pediatrics. It's a real shame.

2. Personal bias is universally prevalent

No matter how open-minded you may be, it's very, very difficult to stop your own experience from coloring your opinions. This happens on a subconscious level, so while you might make a concerted effort not to do so, you'll have visceral reactions to certain ideas which will in turn inform your point of view. For example, last week, we interviewed a well-respected expert on fatherhood. He was a great guy with an impressive resume and plenty of relevant life-experience to boot - the ideal parenting expert, if you will. At one point, we asked him a question about what to do if your partner isn't taking care of herself during pregnancy. I took this question to mean, "What should I do if my partner isn't eating enough, taking care of her health, stress level; working too hard; not following doctor's orders in regards to pregnancy complications, etc." The expert proceeded to give a speech about making sure your wife doesn't "let herself go" during pregnancy - i.e., what men can do to ensure that their wives/girlfriends aren't packing on too many pregnancy pounds or forgoing the gym. Obviously, what "taking care of herself" meant to him was something quite different than it meant to me. It's all about perspective.

As for the parents we've interviewed, they have all been lovely people, but they've also shown me how our own hangups, successes, and failures end up informing our parenting philosophies. A woman who had a successful first pregnancy in her mid-40s spoke freely about how if other women just did more yoga and ate better, they'd be able to conceive as late as they wanted to, and that there'd be no need for extra precautions or the label of "high-risk". I bet she would have been singing a different tune had she spent seven years in fertility treatments, or actually had a high-risk pregnancy. (As I've had. Twice. And I did plenty of yoga.) She also had an a-hole doctor, and a wonderful midwifery experience, which made her an advocate for home-birth and low medical intervention. The things that went right gave her strong opinions, as did the things that went wrong. It's human nature.

3. To change minds, accentuate the positive

The most valuable lesson I've learned from my job thus far, though, is that no matter what your experience is, you need to own it.

The company I work for is committed to showing all sides of the story when it comes to parenting issues; this has exposed me to people on every end of the spectrum. The ones who are passionately positive are the most effective speakers. I personally had no interest in cloth diapering, but after I saw our cloth diapering expert interviewed, I ran home and tried to convince Fearless Husband it would still be worth doing for our one-year-old (I abandoned the idea as soon as I saw how expensive the cute accoutrements were - that was really what attracted me to the prospect. Those diaper covers are freaking adorable). She was non-judgmental, sweet, warm, and so excited about how she covered her baby's ass that it was infectious.

The ones who live in a space of negativity come across as overbearing and unlikeable. They may convince someone to change out of fear or insecurity, but I believe that in most cases, they end up simply preaching to the choir. The people who are not already following their philosophy feel judged and condemned; that's not a healthy space in which to make changes.

Once I realized this, I began worrying. As bottle feeders, we spend so much time defending ourselves; fighting against untrue stereotypes; struggling with guilt and fear and grief over not being able to breastfeed, or not being able to conform to what society has decided is Good Parenting.

Defending. Fighting. Struggling.

Not very positive words.

Which brings me to the end of this post, in which I will implore you to start using some positive words in regards to bottle feeding. Doing so is not anti-breastfeeding; it's pro-doing- what's- best-for-your-baby-and-you (not a catchy slogan, but I'll work on it). I'm working with the brilliant team over at Bottle Babies to create a video using our beautiful combo-fed, exclusively pumped-fed, tube-fed, and of course formula-fed kids to show the world that bottle feeding can be a beautiful, strong, healthy choice. It's time to give ourselves permission to feel proud of our method of feeding, whatever that method happens to be.

We're trying to keep the details a bit under wraps for now, so if you are interested in participating (it would require taking a specific type of photo of your kiddo or kiddos) just email me at formulafeeders@gmail.com and I will send you the details.

I hope some of you will be willing to take a stand, because what could be more fearless than telling the world that you don't have to feel guilty or incomplete - ah crap. Scratch that - what I meant to say is, what could be more fearless than telling the world that you feel proud and complete as a bottle-feeding mother? (This turning negativity to positivity is harder than it looks, people.)

FFF Friday: "Formula made it possible to continue breastfeeding..."

2012-01-13T23:07:00.001-08:00

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.

Excuses, excuses. That's all I'm good for lately. All I can say is that I have the utmost respect for all you full-time working moms out there. Keeping it all together with freelance/part time work was no biggie, but I'm full time temporarily and it is absolutely kicking my ass and taking names. Well, one name. Mine. I'm waving the white flag, and really, really want to return to only answering to bosses who I love and whose crap I don't mind cleaning up.

Anyway - to get us back on track, here's an incredible FFF Friday submission from Miriam, who blogs over at mommd.com 's "Maternity Scrubs". What makes me smile about this story is that the author found a way of feeding her baby which worked for her family, even though it took some creativity and open-mindedness to do so. Things do not need to be black and white, and it makes me sad to think that so many more women could find a more satisfactory and rewarding feeding experience if the experts didn't insist on seeing the world like a giant checkerboard.

I mean, come on. If you're gonna play a giant parlour game, play Giant Connect Four. Geesh.

Happy Friday, fearless ones...

The FFF

****

My FFF saga, begins, like so many others, with a non-latching baby in the hospital and a milk supply that just never came in. There were many of the vaunted “booby traps” along the way- a pediatric nurse practitioner who told me I should only pump 4 times per day (with a non-latching baby?), woefully inadequate LC support in the hospital, a postpartum nurse who warned me that if I tried too hard to breastfeed, I’d just wind up with post-partum depression. The first week was serious hell. I kept waiting and waiting for my milk to come in, and pumping the tiniest drops of colostrum, which changed to milk with no appreciable increase in volume over a few days. I had the worst hospital pump in the world, the Ameda Lact-E, which looked like a refugee from 1970. The night we came home from the hospital, my mom was pushing the baby on me to latch every 3 hours while I desperately pumped and syringe-fed drops of colostrum. It wasn’t enough (is it ever?) and my son was seriously dehydrated and lethargic by the time we got him to the pediatrician the next morning. We were told to supplement, and my poor little dude could barely stay awake to finish a whole ounce from an Enfamil nursette. We had to keep waking him up during the feed by taking off his clothes and blowing on him. I felt, like so many other moms, like a complete failure, like my attempts to breastfeed were selfish.

Still, I was determined to make it work. My family was in town and everyone except me kept feeding the baby, totally ignoring my “breastfeeding friendly” bottle-feeding techniques I found on the internet and was trying to enforce. One family member even showed me how “if you poke the nipple in again, you can get him to finish the bottle!” Bottle-feeding FAIL!

Somewhere around day 11, with the help of a saintly local IBCLC, I got a nipple shield and a decent latch going on a consistent basis and thought, ok, great! I’m nursing now! No more supplementing, no more pumping, let’s just do this! And I settled in to nurse. I thought things were going great! The little dude seemed happy and satisfied, there were drops of milk in the nipple shield whenever he came off the breast, and he didn’t look dehydrated or lethargic like he was the first few days before we started supplementing. I happily and proudly bundled him up to go to lactation group on Thursday and measure his intake on the scale. I forgot the pre-feed weight that day, so I never knew what he got. Something, however, struck my IBCLC as not quite right, and she told me that she’d like me to come see her on Sunday, after a weekend of nursing on demand.

She weighed the little dude, then sat me down in her office with a feeding pillow and a comfy chair. I got out my shield and began to nurse my son. She came back 30 minutes later to re-weigh him and check his intake- the scale reading hadn’t changed. At all. He’d gotten absolutely nothing in 30 minutes of nursing. So here we were, two weeks postpartum, with no detectable milk transfer from nursing and no pumping at all for the last 6 days, during which I’d felt no engorgement or buildup of milk. I started to cry. I’d been starving my son! My feelings of guilt and remorse and shame at failing to lactate and failing to see my son’s distress overwhelmed me. I’d stopped supplementing (which, come to think of it, was pretty stupid to do without consulting a health professional), and the little dude hadn’t lost weight, but hadn’t gained anything either. My nipple shield turned out to have been too big as well, so he couldn’t pull milk out effectively. I didn’t know that there weren’t just supposed to be drops in the shield, it was supposed to be FULL of milk.

My IBCLC brought out a Symphony pump, which managed to extract 10 ml of milk total. I cried again. I knew I had to keep feeding my little dude by any means necessary, but I was also determined to keep nursing going as long as possibly could. I bought fancy bottles that were supposed to eliminate nipple confusion. I changed my status with WIC to “partially breastfed” and stocked up the kitchen with formula. (The breastfeeding advocates at WIC, for what its worth, were incredibly supportive of my mixed feeding and continued, throughout the year, to supply lavish support and praise and help along with cans of formula and breastfeeding advice.) I rented a Symphony and pumped 8 times per day. That next week was my last week of maternity leave before I had to return to medical school with a 3-week old baby, but I devoted the whole week to getting my milk supply off the ground in any way I could. I ordered domperidone and fenugreek and blessed thistle and goats rue and did breast compressions during pumping and nursing. And it even worked a little! I was up to 15 ml, then 20 ml, then a full ounce, once I increased my pumping sessions from 15 to 20 minutes. My son was getting plenty of formula but still seemed interested in nursing whenever we had time, and I tried to nurse as often as I’d pump.

I LOVED nursing my son. His latch issues were resolved and I even stopped having to use a nipple shield. I’d come home from school and we’d cuddle up and nurse for a good hour or more and I felt like I finally got what all the cozy bonding stuff people talk about nursing was all about.

Formula gave me a very special gift- being able to nurse my son without worrying about being his only source of food. And every day, I got to feed him a bottle of breast milk that I’d made! Still, I think about those early days and I just feel exhausted. I blogged elsewhere about the craziness of taking an eating-every-two-hours infant to a medical school library. I’d nurse him, then pump while I mixed up and fed him a bottle of formula, then change him and put him to sleep, then study for an hour while he slept, then he’d wake up and we’d do it all over again. I couldn’t go anywhere without my Symphony pump, lanolin, breastmilk bags, cleaning wipes, and a cooler. I had a special rabbinical dispensation to turn my pump on on Shabbat. I pumped everywhere and all the time- in class, in lab, while studying at Starbucks, (always under a flowered nursing cover). I was bound and determined to keep it going, because I loved nursing, and whatever benefits there were to breastmilk and to nursing, I wanted my son to have them as long as I could do it, even though I never made more than ⅓ of his caloric needs per day.

Around 6 months, when the little dude started solids, I gradually cut back on pumping. I wanted to be able to go out for an afternoon without strapping a 7-pound pump to my back. I had a new goal now- I wasn’t even trying to produce any significant proportion of my son’s nutrition, I just wanted to keep nursing, at some level. And I knew, because my son was mostly bottle-fed, that I had to keep pumping to do it. I cut back to 3 or 4 pumping sessions per day, so I was making a 6 oz bottle every other day, which still felt significant to me. Meanwhile my son was thriving. He was growing into a curious, active, crawly, reachy, grabby litte guy who only had the patience to nurse in the early morning and at night, when he was sure not to miss anything exciting. We did baby-led solids and he fed himself every variety of yummy healthy food like a champ. At 9 months, when I dropped to two pumpings per day, the pumped milk collected to about two bottles per week. At 11 months, I gradually stopped pumping altogether. We still nurse early morning and at night, but not every day, and I’ll keep it up as long as he’s still interested.

As we transition from bottles of formula to cow’s milk in a sippy cup, I guess I will no longer qualify as an FFF, but my experiences with being a fearless formula feeding mom, exclusive pumping mom, and nursing mom, all at once, have given me insight into the worlds of all three modalities of babyfeeding. Formula made my baby grow healthy and strong and always have enough to eat. Formula also made it possible to continue breastfeeding, with the help of a pump and meds.

***

Ready to take the leap and share your story? Email me at formulafeeders@gmail.com. I'll be your best friend. For realz.

2012 Resolutions

2012-01-07T11:44:00.000-08:00

My parents are in town, so we have free babysitting. Which meant movie night for me and Fearless Husband. We chose to see "Young Adult", thinking that it would be light and funny; 90 minutes later we were about to poke our eyes out with hot coals, since that would have been less painful. Or at least less emotionally draining. Great acting, but one hell of a downer.

The film got me thinking on a myriad of levels, and one particular element of the script provoked me to come home and visit the blog (much to Fearless Husband's chagrin, but what can you do... date night or not, I haven't spent quality time with FFF in quite awhile. Sometimes it feels like I am in a polygamous relationship, I tell ya). Charlize Theron's character, Mavis Gary, is unlikeable in about one thousand different ways, but you end up feeling sorry for her because she is completely delusional. At the same time, Mavis feels just as sorry for everyone else around her, because she thinks they are ignorant, small-minded simpletons. It's a weird dynamic to experience as the moviegoer, because you aren't sure who to identify with: if you empathize with Mavis you're a cold-hearted egomaniac; relating to the rest of the cast makes you feel like kind of a loser. In the end, you realize that it is all a matter of perception. You can be the hero in your own story, but to everyone else you might be the villain, or even worse, just an ancillary character.

So how does this pertain to our little infant feeding blogosphere? I think the flawed communication and general lack of empathy on the part of many involved on both sides of this debate comes from a similar egotistical P.O.V. as Charlize's unlikeable character. Perceptions are vague and/or downright incorrect, colored by our own experiences, our own realities. I know full well that some see this blog, and all other formula feeding support, as something vicious; others, as something that should be pitied or handled with kid gloves. And on our end, it's easy to dismiss all breastfeeding advocates as intentionally obtuse; privileged; limited in scope.

There are many gray areas to this debate, and I think that my New Years Resolution is going to be that I will strive to give that gray some much-needed color. That means more bottle-feeding research rather than simply tearing down breastfeeding studies. (Although this will be hard to do, when studies like this one pop up. Completely aside from breastfeeding, I simply cannot fathom how such a clumsy study has gotten both funding and media attention. I don't think I need to explain the ridiculousness of what the researchers did here, but if anyone wants to discuss it we can do so on Facebook. Suffice to say - where the hell was the control group of non-exclusively breastfeeding kids who DIDN'T chug sugary drinks? And what's with the dig about juice? How many leaps did it take to get to the conclusion that this proves anything about the link between breastfeeding and long-term obesity?...Aw, crap. Why do my resolutions never last longer than my neighbor's Christmas tree?) More attempts to reach out to experts and pick their brains about specific subjects. More support for combo feeders.

Of course, this all can only happen if I get off my ever-growing butt and focus on the blog a little more. Considering I'm only now writing a New Year's resolution post and it's a few minutes before January 8th, maybe that should be resolution #1.

FFF Friday: "I feel very let down by the professionals..."

2012-01-06T13:02:00.000-08:00

In today's FFF Friday post, FFF Susanne wonders if bottle feeding could possibly do more harm to a child than having a miserable mother. I think she came to the right conclusion. But I really think this is what this debate comes down to, more times than not. We can argue biological superiority, statistics, and health outcomes on the population level until we run out of breath, but at the end of the day all that matters is the individual mother and her individual situation. And if that situation is making her miserable, she needs to be given the opportunity to make a decision which could alleviate her stress without being made to feel guilty, or given misleading information.

I'll be back next week with new posts... thanks for your patience as I adjust to being back at a "normal" job...!

Happy Friday, fearless ones!

The FFF

***

I'd gone into hospital to give birth with every intention of breastfeeding my baby. Bottle feeding was just not an option. I was practically militant on the breastfeeding issue. It's the most natural thing on earth, it's what breasts are for, it's a wonderful bonding experience and best for the baby... So how did I end up leaving hospital with a bag full of formula bottles?

Well, combine anaemia from an emergency c-section with a hungry ten pound baby who is so distressed he can't latch on, add in the pressure of being told he must be fed every two hours because his size could be due to gestational diabetes and it could be dangerous if his blood sugar levels drop, and later that he must be fed regularly because he had jaundice.. But he still can’t latch on properly and still the milk hasn't come in... Ultimately I didn't feel like I had a choice. And I'm no quitter either, I tried and tried until I bled, I got every kind of help available to me, I spoke to the breastfeeding support workers and buzzed so often for help from the midwives they got sick of me. I knew the "nipple to nose" advice of how to achieve a good latch inside out, but that unfortunately was the only advice they seemed capable of giving. Other than it being nice having someone to talk to, unfortunately I didn’t find them very helpful at all. And I went through quite a few.

But me and my hungry little fella fought back on our own. Yes he left hospital a bottle fed baby, but once back at home we practiced and practiced until we got it right. It was far from easy, I was always told babies loved breastfeeding but he would scream at me, claw at me, grunt and practically fight me. I often felt horribly rejected and as though he hated me. But I was utterly determined. Eventually the formula decreased, the breastfeeding increased... and increased, and increased... He would feed for hours and hours on end, with my husband back at work I barely ate, barely drank, obviously I barely slept (all of these things I now know exacerbated the problem, though not one health visitor or breastfeeding support worker mentioned these factors) I didn't leave the house, I was too embarrassed to feed in public in case he started the screaming, grunting, fighting me thing. And he just fed for so long I literally couldn’t go anywhere. The breastfeeding support workers came around again with their "nose to nipple" advice (yeh, we've got that down now thank you!), the health visitor said it was a growth spurt and would last maybe 48 hours (ignoring the fact it had already lasted weeks and I’d told them that). No one seemed to have heard of a baby who liked to spend practically all of his waking hours feeding, I was just urged to keep going and told I should be proud of myself.

By 3 months we'd done away totally with the formula and settled into a routine of one hour on, one hour off, then back on for the entire evening. I didn't deliberately set out to do the attachment parenting thing, but he was pretty much permanently attached anyway. Last Christmas I opened our presents with him attached, ate my Christmas dinner with him attached… you get the picture. And actually I was ok with this. I worked on my supply by ensuring I ate properly, drank loads of water, did relaxation exercises (things I’d researched on the internet). The fighting and screaming had stopped. We were winning!

Then a block duct led to thrush, which due to misdiagnosis and then the wrong prescription led to mastitis. After a month of crying in agony through each feed (which is a lot of feeding for my boy) it almost destroyed the breastfeeding, decimated my supply and put him back on the bottle.

Once eventually cured I set about trying to build the feeding up again, but he would scream at me in hunger and frustration, claw at my chest and grunt as he had done before (you should have seen the state of my chest, I looked like one of my cats had attacked me! I thought breastfeeding was meant to be a beautiful experience??) Anyway I just couldn't put him through all that again, just so I could pat myself on the back and say my child was breastfed, when even at best he needed to spend most of the day feeding just to get his fill. Barely anyone saw his face until he was four months old! And I was utterly miserable, my sanity was seriously fraying around the edges. Was breastfeeding really the best for him? I was a bottle fed baby and my mum suffered depression for years, I know which did me the most harm and it certainly wasn’t formula. I was losing my marbles and I didn’t want my own child to grow up with a mentally ill mother as I did.

So I decided to stop. But my god I was heartbroken, utterly devastated. I felt like I'd failed. I’d failed to give birth naturally and now I’d failed to fully breastfeed. Maybe I wasn't supposed to become a mother? I didn’t feel like a proper woman, a feeling I’m still struggling with.

Actually we didn't fully stop breastfeeding until he was around 7 months old. I kept on feeding him at night until he started sleeping through and then we stopped altogether. And with a combination of breast and bottle my little fella was contented at last. In fact he came on leaps and bounds. He wasn’t so angry and unhappy anymore, he smiled all the time and is an utter joy to be around. I feel sad we didn't fully breastfeed, but it was the right thing to do and no one can tell me otherwise. And I’ve also learned some valuable lessons in humility and not judging others along the way. It brought me down a peg or two.

I do still believe breast is best, but formula is a close second and if breastfeeding is causing you and your baby so much distress, then perhaps that outweighs the benefits? Looking back I feel very let down by the professionals, the antenatal classes were so busy bigging up the benefits of breastfeeding they never once mentioned how difficult it could be – but if I’d had more honest, realistic information perhaps I could have avoided the pitfalls.

When it came to feeding him formula I felt abandoned – I was sent home from hospital with mountains of literature about why you should breastfeed, and one miserly leaflet printed in the 80s (it looked that way at least!) about formula feeding. I felt embarrassed to bottle feed in public. Even Boots refuse to give you points on your loyalty card when buying formula because they want to encourage breastfeeding. They will reward you for buying absolutely anything else in the shop but not formula. I was livid. How dare they judge me? Are they saying I’m a bad mother for giving my child formula? Would I be a better mother if I let him go hungry? Would they prefer that?

I could go on and on (I already have!). I truly wish the most extreme of breastfeeding fanatics, as well as doctors, midwives, breastfeeding advisors, health visitors etc. would spend some time reading through all these accounts. It isn’t that we’re too vain to do it, aren’t prepared to make sacrifices for our babies, don’t want the best for them… perhaps if they understood the real reasons they’d be able to help or support rather than judge? And if governments are serious about improving breastfeeding rates then this would be a perfect place for them to start researching better ways to achieve that rather than shaming mothers who are already struggling.

***

Start your new year off right by becoming a FFF Friday participant. Send your story to formulafeeders@gmail.com.

FFF Friday: "'Any weight gain is good' (is) another dangerous myth"

2011-12-30T11:53:00.000-08:00

The last FFF Friday of 2011 comes from Ella Blood, who is a frequent and valued contributor here at FFF and also on Bottle Babies. Her story highlights the point that not only is breast not best for every mother, the saying is also incorrect for some babies. As she says in her story, what happened to her daughter is a unique case - but all babies are unique in some way, and what makes us good parents is our willingness to be flexible and adjust to our children's individual needs.

Happy Friday (and happy New Year), fearless ones,

The FFF

***

I was determined to breastfeed my daughter. From day one, she wouldn't latch on; after 5 days in hospital we tried nipple shields, and she actually started to drink properly. We were told off by everyone, though, because nipple shields are almost as evil as formula, apparently. And then over the weeks we noticed that my daughter was putting on very little weight. But hey, any weight gain is good, right?

The nurses/ health visitors wouldn't say the word " formula" ...The advice was "there's something wrong with your breastfeeding, get rid of those nipple shields, spend days in bed with her, wake her up every three hours no matter what, force-feed her, top her up with expressed milk!" I was told to "concentrate solely on breastfeeding and not go out" ( a depressing prospect, but extreme lactivists will no doubt brand me selfish for admitting to feeling like this).

And here is what, to this day, still makes me furious, because it's still happening: breastfeeding advocates, everywhere you look, tell you that WEIGHT DOESN'T MATTER, that any weight gain is good, that come on, you don't want your baby to be obese anyway, and the charts are based on formula fed babies anyway so they don't count, etc, etc...

A nursery nurse LIED THROUGH HER TEETH, telling me " Okay, she's dropping a few centiles but it's already looking up so keep persevering"...that was at a time when my daughter had gained 2 oz ( 60 grams) in ten days.

That's what really gets me, the whole " Breastfeeding is so great that if your baby doesn't put on weight it doesn't matter, don't bother with the scales" Seriously, that advice is EVERYWHERE, and the people who share it are not always fanatic breastfeeding advocates; they are decent, clever people who genuinely believe that myth. At the age of eight weeks, I found out that my daughter had a hole in the heart which would require open heart surgery. Turns out she was using up all the calories from breastmilk to breathe, therefore not putting on weight. Turns out waking her up every three hours was making her more tired and forcing her to deal with extra fluids she couldn't handle. Turns out she wouldn't latch on - hence nipple shields- because breastfeeding was just too bloody hard for her.

What she needed was high-calorie, prescription formula. Breast milk alone just wasn't enough. I expressed up to six times a day and added formula powder for a few weeks, but that was really hard and punishing- and I didn't get to spend any quality time with my daughter, which is important to all mums anyway, but even more so for me since I had found out, the hard way, just how precious she was.

So, I quickly moved on to the high calorie formula, which really helped with her weight gain. At the age of ten months she had her open heart surgery: A success, thank goodness. The surgeon did warn us that although it was a pretty straightforward procedure, there was a 2% chance of our daughter not making it. ( Interesting figure, considering that apparently "only" 2% of mothers can't physically breastfeed. One chance out of 50. That number was never negligible to me or my husband...)

Needless to say, I'm very angry, and so was my doctor when she found out how rubbish the medical staff had been. One health visitor, just one, who was so pro-breastfeeding that she had exclusively pumped for her son, dared suggest formula- and that was after I asked about it. She actually hinted that she was glad I was mentioning it because she was, basically, as a professional, not supposed to! That goes to show that you can be very pro-breastfeeding and still realize that in some cases, formula is indeed a very good alternative. ( Other myth: all health visitors are rubbish and don't know what they're talking about...well, that one was very good )

Anyway, I appreciate that my daughter's case is not typical and that some babies will put on little weight over a couple of weeks and actually be OK. But we have to stop saying that weight gain is meaningless.

When my daughter was "failing to thrive", I was thinking it was because I couldn't feed her properly. It was down to me. It's meant to be natural, it's meant to be that way, like that stupid ad suggests "all babies are meant to be breastfed"... There is a lot of controversy surrounding formula advertising; it's been suggested that educated, mature women will fall for the whole formula con, and believe that formula is just as good, if not better than breastmilk.

Well, this educated mother here listened too hard to the breastfeeding propaganda and myths.

***

Start off the new year on the right foot: send your story to formulafeeders@gmail.com. It's cathartic, I swear!

So there's this nationwide nurse-in at Target....

2011-12-26T22:20:00.000-08:00

This was supposed to be a post about a nurse-in provoked by an incident that occurred at a Texas Target, where a mother was apparently sitting unobtrusively in a corner (albeit on the floor) nursing her infant under a cover. The woman was asked to move to a dressing room, and when she refused, she was treated rather rudely by the Target staff. According to a letter from the mother herself which was posted on Best for Babes' website:

"Briefly I will say that 2 female employees came and verbally asked me to move. The 2nd one told me that Target employees had been told/trained to interrupt nursing and to redirect mothers to the fitting rooms. Even after I informed the 2nd employee of my legal right to nurse in public she still suggested me moving closer to the jean display, turning to face another direction, and also turn my basket a certain way which would have put me practically underneath the jean display and totally barricaded me in. Employee #2 even hinted in a threatening way “you can get a ticket and be reported for indecent exposure” when nothing was being exposed and there was more boob showing from low cut shirts several shoppers were wearing that night. This does not include the other 3-4 employees besides the 2 verbal ones who were all watching and making a spectacle of my nursing by standing around pretending to do something and giving me mean looks and shaking their heads no back and forth. In a side note not a single non-employee customer ever saw the incident so I’m not sure why the employees were trying to act like I was offending “the public” and that it was their job to step in."

When she contacted Target headquarters, they informed her that their rules were not necessarily one and the same with state laws. The mother approached Best for Babes, and through grassroots efforts, an international nurse-in was planned for Wednesday, Dec. 28th at 10am.

I heard this story and immediately thought, awesome. There have been cases where I thought a nurse-in was a misguided approach; a recently publicized situation in Washington D.C. springs to mind, when it was apparent that the issue was not breastfeeding in public, per say, but rather loitering in the hallways of a government building. I think that the power of this particular sort of protest is lost when used too often for the wrong things; I also believe that nursing moms deserve the same rights and privileges as everyone else - not less, but also not more. If the goal is to normalize nursing, let's normalize it, not glorify it.

Yet, I have said many a time that if there were a way for a bottle-feeding mama to voice her support for a woman's right to nurse in public, I'd champion whatever it was. This kind of seemed like "it". I don't know this mother from Adam; I don't know if there was another side of the story; I don't know if she's telling the absolute truth about how it all went down. But I've seen enough scorn directed at women who are nursing in public to feel that this is a plausible scenario. So I think it's at least worth encouraging bottle-feeding moms who do want to support the cause to go for it, and to let them know that they (hopefully) would be welcome to join their nursing sisters down at the local Target to make a statement.

I posted as much on Facebook, and boy, was it not the reaction I was expecting.

The first argument that popped up was that some readers felt a nurse-in was unwarranted. Many felt the issue was that this mother was parked on a floor feeding her baby; had she been accosted in, say, the cafe area, or on a bench, it would've been a different story. I wholeheartedly agree with this. Large retail chains need to follow some basic safety rules, and having someone sitting in aisle could be a fire hazard. It may be a stupid rule, but that's not really the point. For example, a Target employee recently embarrassed me terribly by telling me rather loudly that "my child needed to sit down in the cart right now". My son is shy as they come and not rowdy in the least; he had stood up for a split second to point at a shirt he wanted. I was pissed, and felt simultaneously ashamed and outraged. Who was this kid to tell me how to parent? was coupled with "What kind of parent am I that this kid has to tell me to abide by basic safety rules?"

But from what this woman has said, and Target's response (or at least what the media has reported as Target's response), I don't think this had much to do with her sitting on the floor. My litmus test is imagining what would've gone down if she was feeding her baby a bottle on the floor... and somehow, I really can't imagine the situation evolving in the same pattern. Maybe I'm wrong; maybe this is only because a bottle-feeding mom would know that it wasn't anything to do with antiquated ideas about public indecency, so she would just think it was Target being asinine about regulations. In my gut, though, I feel that this was about breastfeeding, and if so.... that is not okay. And I think a statement should be made to show the world that mothers won't take this sitting down (no pun intended).

Look. If we strip down all the mommy war bullshit, the sad fact remains that all mothers are disenfranchised, in one way or another. If we don't stand up for each other, who will?

But, um, on the other hand...FFF Sara voiced something on the Facebook thread that gutted me (and I hope she doesn't mind me re-posting it here):

"I know that fff doesn't want to contribute to the bf v. ff animosity that is so prevalent. And I respect that. But sometimes it feels so one sided to be a ff mama who supports bf rights. We have to explain and defend ourselves, our decisions, our reasons for ff all the time in a motherhood culture where "breast is best!" and "formula is poison" are constant refrains. And we need to make sure they know we support their right to bf lest we sound politically incorrect and disloyal to the sisterhood. Yet I so rarely see the bf community sticking up for the ff mama's. Maybe when they stage a bottle in at a so called baby friendly hospital...maybe when they stop comparing ff to child abuse...maybe when they stop saying "formula should only be available by prescription only"....maybe when I can say I ff my kids without getting dirty looks from other mamas, without having to go into an explanation about my depression meds being contraindicated with bf, and wax pathetic about how I really wished I could nurse too just like the real mamas just so I can pass some kind of deserving of motherhood test that women with kids inflict on each other..maybe then I will begin to care more deeply about the plight of nursing mothers on the floor of Target...I wish that support was more mutual. And bf moms have so many advocates, groups,organizations,consultants. We ff mamas have you."

Touché. And ouch.

Reading that, I felt like an asshat. I realized I never should have posted about a nurse-in without explaining myself first.

Guys, I know it seems like I am getting all riled up about breastfeeding moms when I should be focusing on the injustices that formula feeders are facing. Both types of feeding come with their own particularly noxious pile of crap. Breastfeeding moms get nasty looks when trying to feed their babies in public; bottle-feeding moms get nasty comments from physicians, the media, and the parenting literature. It shouldn't be a battle over who has it worse.

I know that many of us feel we don't get the same solidarity or compassion from the bulk of the lactivist community. And you know what? We don't. But I want to stand up for the women who do give us support; the ones who do stand up for us on a daily basis on breastfeeding blogs; the ones who frequent this blog and our Facebook page and Bottle Babies and offer positive commentary on a daily basis. I want to stand up for our breastfeeding friends who are being harassed for nursing in public, just like they stand up for us when people start hurling "breast is best" admonishments at grieving mothers. I don't have blinders on; I realize that most of the women involved in this particular nurse-in probably don't give a rat's ass about me or any other formula feeding mom; I know that many probably think we perpetuate the same bottle-feeding culture which alienates them in the first place; many are the same folks who have berated us time and time again, who have pretended to support us and then belittled us behind our backs.

I don't care about them. I care about you guys. But I also care about creating a future where mothers do have each others' backs. I know it's probably futile and Pollyannic and all, but I can't help myself. I hope you can at least trust that if I didn't think that standing up for a breastfeeding mom's right to nurse in public would make things better for all mothers, us included, I wouldn't bother to bring up the protest in the first place.

I take the credo of this blog very seriously. "Standing up for formula feeders" means that FFF is first and foremost a blog that supports and protects formula feeding or combo feeding mothers. But the second half is important as well - "Without being a boob about it" means that I will fight for breastfeeding rights too, because I don't want anyone feeling ashamed or marginalized, because of the way they feed their babies.

That said, all I ever wanted to do here is spread the word about the nurse-in, in case that some non-breastfeeding moms would like to participate or show support. That's it. It was never meant to be a huge issue, and certainly never meant to hurt any of you, or make you think my focus is blurry. Information on the protest can be found here; I would love to hear about how it goes if any of you do attempt to join the demonstration; otherwise, case closed, ok?

And just wait until I have an opportunity to stage the "bottle-in" that another reader jokingly referred to on Facebook. I'm chomping at the bit for that one.

FFF Friday: "I formula fed her and enjoyed her, and it was the best decision I ever made"

2011-12-23T20:06:00.000-08:00

I've saved Melissa's FFF Friday entry for right before the holidays, because I feel like it is a perfectly packaged, lovely gift: beautifully written, honest, and with the exact message I've been trying to impart since day one of writing this blog (although she did it better in one attempt than I've done in 2.5 years of posts. In fact, her last sentence is almost word-for-word in the introduction to my book, but I kind of like how she said it better. Maybe I should have her write my foreword? ;) ). The story is also a primer on the variety of breastfeeding complications which can make nursing a challenge for some moms, which absolutely sucks for Melissa since she had to live through it all, but also gets me all fired up as a researcher. (Sorry, Melissa....!)

Merry Christmas, Happy Hannukah, and a very fearless New Year to you, fearless ones...

The FFF

***

When my oldest was born, I was a pretty young mother (18) and came from a staunch formula feeding family. Much to my mother's chagrin, I planned on breastfeeding - in fact, I knew I'd breastfeed, it was that simple. However, I figured it came "naturally" (it's natural, right? That's what they tell us!) and did absolutely nothing in the way of preparation outside of reading a few websites and buying lanolin and a hand pump for times when I needed to be away from the baby. To everyone's surprise, my baby was born four weeks early due to PROM. At 36 weeks, she was a hefty 8lb, 4oz, and as expected, her blood glucose levels were poor. Right after birth, she was taken to Special Care to be given glucose and formula, despite my stating that I wanted to nurse her right away.

When I finally got my hands on her at four hours old, she already had a full belly and was completely uninterested in nursing. The lactation consultants weren't available as she was born over the Christmas holiday, and the nurses were cold and at times downright rude to me due to my young age. I actually had a nurse laugh in my face when I expressed frustration that my breasts were so floppy and hard to manage when trying to get her latched on (this would have been a key warning sign to a lactation consultant that something was amiss - but they weren't there...) At five days old, despite nursing and pumping, I had no milk, no engorgement and she was jaundiced as a little Oompa Loompa and had lost almost a full pound. I was an emotional mess, she wasn't latching or interested in eating, and my mother convinced me to go get some formula. And that was it. I pumped for two weeks (and despite pumping 8-10x a day, never gained anywhere near a normal supply.) I was frustrated and stopped at that point. I brought it up to my OB that I never had enough milk and he sort of shrugged it off, stating that I just had never gotten a good nursing pattern going.

When she was four months old, wracked with guilt and fighting severe postpartum depression and feelings of inadequacy that I couldn't nurse my daughter, I relactated using galactogogues and frequent pumping. I again never gained a full supply, but we used an SNS to get most of her nutrition in, and a nipple shield to get her to latch. I continued pumping and nursing her for three months, until mastitis beat me into submission. I never enjoyed it, and it was stressful and at times I even felt downright resentful - but I was receiving the feedback from so many sources (mostly online, which as a young, isolated mother, was much of my support system and where I turned for advice) that real mothers nursed and that formula was inferior, so I did it.

When my twins were born, I was DETERMINED TO NURSE and swore that nothing would dissuade me. This was apparently a recipe for disaster. They were born full term, after 24 hours of labor, by C-section. My milk "came in" when they were two days old and I was thrilled. I wasn't broken! However, it became clear that something wasn't right pretty quickly. The hospital we went to didn't have an LC on staff, but I knew that despite their latches looking fantastic and how alert they were, something was off. I was able to express milk, but despite a perfect latch, they didn't seem able to get anything out. I was frustrated but resolved to get through it. We got an LLL-recommended LC up there and she reassured me that everything looked great. She noted that my breasts were not as heavy/hard as she'd expect for that stage, but assured me that it would come. So I kept nursing. They lost weight, but not enough to be concerning, and they didn't get jaundiced because I would literally sit there and express milk into their mouths while they attemped to suck. This, unfortunately, meant I did almost nothing but feed them, and by the end of the hospital stay I was a basketcase.

We went home and things started to fall apart. Their latch still looked awesome, but my nipples looked like raw hamburger. The babies were hungry and I was losing my mind with worry. I took a 24 hour break from the whole thing, called another LC and made an appointment for the next day, and pumped so my husband could feed them and I could sleep (between pumping sessions, anyway.) This LC came and, bless her heart, she was able to figure out that the babies were getting almost no milk out on their own because they both had high "bubble" palates and tongue ties. I still have no idea how I was lucky enough to give birth to fraternal boy/girl twins who both had oral conditions that made nursing difficult... but there you have it. I decided to move forward and pump and bottlefeed expressed milk to avoid fighting their oral issues while nursing. And from there on, I did almost nothing but pump and obsess. Freezing milk, thawing milk, cleaning my pump, galactogogues, will my domperidone get here on time? Are they eating enough? I, again, never had a full supply, but it was almost enough for the first few weeks with the help of a combination of teas, fenugreek and a high dose of domperidone given to me by a local nursing mom. And when my milk ran out, this mom also donated some milk to me, which I was so grateful for. I was DETERMINED not to use formula, or to use as little as possible.

When they were 10 weeks old, I had a "delayed postpartum" hemmorhage that ended in a blood transfusion. When I told my primary care doctor at my follow-up appointment that I was on domperidone, he called me back a few hours later to let me know that there was a rare but documented link between that class of drug and excess menstrual/uterine bleeding. I was miserable, but I threw the pills out, because I knew that I was no use to my babies in a hospital bed. My supply almost immediately tanked. I stopped pumping about a week later, exhausted by the blood loss and defeated by the fact that I had literally made myself sick trying to give the babies breastmilk. We switched to formula and my husband put the pump parts in the trash - I was done having babies (so I thought!) and he wanted to remove my temptation to relactate again, because he knew the kind of special hell I'd put myself through with our oldest.

Three years later - surprise pregnancy! At this point I had gone from being a stay-at-home mom to working full-time at two jobs. From the start, I decided I would nurse in the hospital and what happened after that was up to fate and my breasts. After a difficult pregnancy, my youngest daughter was born by C-section a few days before my scheduled date, at 38 weeks. She was a big baby and very alert, her latch was fantastic, she had no oral issues and no issues getting colostrum out. I was thrilled, but again, made no promises or statements about continuing to nurse, because I knew where that had gotten me the last two times! She had no bottles or formula at all in the hospital, which I was proud of... but she was nursing constantly, and my milk, again, wasn't coming in. I was blessed with a very easy C-section recovery, and we went home three days postpartum. Still no milk, and I had no pump and no intentions of buying or renting one, so we kept nursing and syringe fed her formula after feedings. Finally, at six days old, when my milk still wasn't in and her diaper count was no longer passable, I sent my husband to the store for some bottles and more formula, and that was that. I was slightly sad, but I knew intellectually that something was physically wrong with my breasts that six days of nursing hadn't produced a milk supply or breast changes. But I didn't pursue it, I didn't obsess over it. I formula fed her and enjoyed it, and enjoyed her, and it was the best decision I ever made.

When she was 11 months old, I went to the OB/GYN that had delivered my youngest after finding a breast lump. Thankfully, the lump was nothing, but after examining my breasts he asked me whether or not I had breastfed my children. When I told him that I had had major issues, he told me that he believed I had a condition called IGT, based on the spacing and shape of my breasts and the fact that he couldn't feel much glandular tissue. I was floored and flabbergasted - how had several LCs missed this? (I believe the answer is that I am obese, and so my breasts are significantly larger due to fatty tissue than what LCs see in the typical IGT moms they help.) I went through a lot of emotions with this discovery - anger that no one had figured it out earlier despite so much contact with doctors and LCs over my nursing problems, relief that I had an "excuse" now for not breastfeeding, happiness that I had been flexible and willing to throw in the towel and enjoy my youngest instead of beating myself up over what she ate.

I'll always agree that breastmilk is made for babies, and that breastfeeding has its benefits. I'm a breastfeeding supporter and believe in a woman's right to nurse where she wants, when she needs to feed her baby. But for me, breastfeeding was a heartbreaking, painful experience, whereas formula was freedom and happiness and the ability to enjoy my babies. I look back on the early days of my first three children with regret and confusion. Was I really that determined to give them all-important breastmilk, to the detriment of enjoying their newness? That - not failing to breastfeed "right" - is my biggest regret. And if I do have another baby, I will formula feed from birth without apology. The shame I was made to feel - being told that I was "booby trapped," inadequate, not doing enough to nurse successfully - as a young new mother is something that will never leave me, and it's the biggest reason I am determined to normalize formula feeding by choice OR by necessity to the subset of society who feels that nursing is the yardstick with which to measure one's motherhood.

***

All I want for Christmas is (my daughter to get her) two front teeth (because she's driving me crazy with her night wakings). And also, a new crop of FFF Fridays to sink my own teeth into. Send them along to formulafeeders@gmail.com... thanks!

Walmart recalls formula after infant death: Is your baby at risk?

2011-12-21T22:15:00.000-08:00

If you haven't heard the news, you're about to. I'm sure the Mommy-blogs will be buzzing in the morning about the terrible tragedy that occurred in Missouri, where 10-day-old Avery Cornett died from a bacterial infection. Avery was formula fed, and the family was using Enfamil Newborn which was purchased at their local Walmart. The authorities made it clear that the case is still under investigation; the bacterial infection could have been contracted from the water used to mix the formula (doubtful) or from the way the formula was handled (plausible, and this is not because of any fault of the parents; hardly anyone follows WHO protocol for formula feeding, because a. they are not informed about it and b. typically, it isn't a problem) - not to mention some other non-formula-related exposure - and not necessarily the powder itself.

Not that these facts make it any less scary.

Look. There's no doubt about it: it could turn out to be that the bacteria (a particularly dangerous type called Cronobacter sakazakii) was indeed in the powdered formula. This is even more gut-wrenching when you consider that the type of formula affected was one specifically marketed to newborns, who are most susceptible to bacterial infections.

Formula is a manufactured substance, and it is handled by humans in all stages of it's "life". This means it is prone to human error. There can be bug parts. There can be bacteria. It can happen.

These things also happen with other manufactured food substances, of course. It's just that when a food is specifically designed for babies, you are dealing with a whole other can of worms. Sometimes literally...ahem, Similac....

I'll be awaiting the verdict on whether or not the bacterium was in the powder or not; Enfamil claims that the batch (which has been recalled from all Walmart stores nationwide) was tested prior to its shipment to stores, but who knows. Ultimately, even if a tiny bit of the bacterium made its way into the powder, using extra-vigilant formula prep could reduce the risk of your baby getting sick. Bacteria has to grow and thrive; things like proper sterilization, using distilled or boiled/cooled water, and cleaning bottles, bottle brushes, nipples, etc extremely well can stunt that growth or murder the little buggers outright. This paper on Cronobacter sakazakii explains:

Though the contamination in infant formula has often been attributed to the dried powder, the origin could well be the environment in which the formula is prepared for feeding. Delays between reconstitution of the formula and the actual feeding may allow growth of the contaminants, particularly if the formula is kept warm. Naso-gastric feeding tubes may be left in place for long periods and initially low numbers of C. sakazakii in the formula could attach to feeding tube and reach levels capable of threatening infant health through biofilm growth on the internal bore of the tubes. As the biofilms grow, individual cells or lumps can slough off and re-enter the formula stream. The infant's digestive tract is thus continuously inoculated with the bacteria. Infection is likely to be exacerbated by the weak immune system and lack of mature competing intestinal microflora in neonates.

For all the talk about the "risks" of formula, I'd say that this risk - the risk of contamination due to human error - is the only one most of us in the developed world truly should worry about. But please, for the love of all things, don't let anyone berate you about this being yet another reason formula is dangerous, another reason we should all be breastfeeding. There can be risks to breastfeeding too, especially if you're using women like us as a sample group. Women whose babies were starving due to insufficient milk; women who were withholding vital medications from themselves because they thought breastfeeding was more important than maternal health; women who suffer emotional trauma each time they attempt to bring a baby to their breast. These risks are small; most women who want to breastfeed will be able to do so without suffering any ill effects.

But most women will also be able to formula feed without facing the threat of bacterial contamination from powdered formula sold at Wal-Mart. We can't make decisions based on worst-case scenarios. If we did, none of us would be traveling for the holidays, and if the Los Angeles freeways and the cost of my plane ticket to Chicago are any indication, this isn't the case.

Think of how many millions of babies drink formula every day. Now think about the last time you heard about a formula-related death due to bacterial contamination. Just as it would be ridiculous to use the story about a woman breastfeeding woman smothering her baby to death on a plane (or in the hospital) as an argument for formula feeding, it would be equally stupid to co-opt this tragedy in the name of lactivism. The real attention should be placed on what we could do to safeguard formula manufacturing from these egregious errors, and more importantly, on Avery and his parents, who must be suffering unimaginable grief.

The FFF Quick-and-Dirty Guide to Formula Feeding: Differences between formulas and bottles

2011-12-19T21:10:00.000-08:00

I've promised quick and dirty, and instead I've delivered Ivory soap-flaked novellas, haven't I?

Sorry about that. This "chapter" will be as short and to-the-point as I'm capable of.

Two issues I want to cover here: how to pick the right formula, and how to choose the right bottle, for your child. First the easy one....

1. Do different bottles really make a difference?

I've raised two primarily bottle-fed babies and yet standing in the bottle aisle still makes my head spin. There are just so many darn choices, and all of them are so... different. I am a sucker for a cool-looking design, so I went for a rather space-age looking set with my younger daughter. Come to find out that space age also means drippy and aggravating.

It really boggles the mind. Anti-colic, anti-gas, with vents and without, glass or BPA-free plastic… But just like there is no one-size-fits-all method of infant feeding, there's no one-size-fits-all bottle. Even the one that gets the best reviews online may end up being wrong for your particular baby. That's why it's hard to say which bottles are the “best”; there was one interesting study conducted by one company which appeared to suggest that their bottles maintain vitamins and antioxidants better than others, but then again, nearly every big-name company claims to be "clinically proven" to lead to less colic or gas. I'd love to see a large-scale, independent study on what bottles really do offer the best health-related benefits, but I'm not aware of any at the moment.

But while we can't say one is "best" across the board, bottles certainly do differ. Some babies prefer the shapes of certain nipples better, for example (and in fact if you are either combo-feeding or switching from the breast, studies suggest that babies prefer a nipple shape which resembles the mother’s own nipple - this is valuable info for parents of babies who do not transition well). Baby bottles also differ in how much air gets allowed into the bottle by the mechanics of the nipple (this is where all those discs, vents, rings, etc. come into play), which can definitely affect gassy or refluxy babies, at least according to moms I've talked to. (For the record, nothing helped my severely refluxy baby, and we tried every bottle on the market. I have a feeling these things make a difference for kids with mild reflux or who are getting gas/discomfort from feeding postures, awkward latches and so forth, but I'm not convinced a bottle can really "cure" a baby with clinical GERD.)

Other than that, bottles differ in how easy they are to clean. The more parts they have, the more aggravated you'll be at the end of the day when you have 6 bottles to wash and just want to go watch Grey's Anatomy.

Best advice? Don't commit to any brand too soon. Before your baby is born, read the reviews online, and choose one to start with. ONLY BUY ONE OR TWO. Don't make the same mistake I made with the space-age ones and fork out $50 for the 6-bottle set. (Most babies will like whatever they are first exposed to, so if you go for the cheapest BPA-free ones, more power to you.) If your baby likes the bottle you chose, go buy more. If not, try and figure out what he doesn't like about it. Is the flow too fast? (If so, you may want to see if the company makes a slower nipple; that may solve the problem). Too big? Is the nipple too big for your baby's mouth? Does it seem like he is swallowing a lot of air, or gulping? Or is the problem on your end - is it an awkward shape for you to hold, or is it drippy?

Sounds lame, but whatever your issue is, Google it. I guarantee you'll stumble across Babycenter or Facebook threads discussing that very problem, complete with numerous rants and raves about bottles that address your specific concern. Buy one of the bottles you see recommended a lot, and hope for the best. It may take a few tries to find the one that works for you.

You may also want to check out my post on changing nipples and formulas as your baby grows...

What are the differences between formulas? Aren’t all formulas the same?

There’s this mythology out there that all formulas are the same.

They are not.

Yes, all commercial formulas must meet certain nutritional standards, so all of them will nourish your child. Generics are fine, and there is no reason to pay full price for a name brand if you can get the same result from the cheaper version. But there are indeed differences between brands and types which, although sometimes small, can make a significant difference, especially to a sensitive child.

There are several categories of formula. The first are standard milk-based formulas. Within this category, some manufacturers have different formulas designed for age range – the differences in these is usually that the proteins are a little easier to digest in the newborn version, and there may be more or less of certain vitamins for different age ranges. There are also thickened formulas for reflux, which are just normal, milk-based formulas with added rice starch to help the liquid stay down; and organic versions, which typically use an organic milk source. Not all ingredients in these formulas are organic, however.

While still milk-based, the next category is comprised of “gentle” formulas marketed for babies with sensitive tummies. Depending on the brand, some are made with partially broken down proteins which are easier to digest. Recent studies have suggested that babies fed formulas with these types of protein – called partially hydrolyzed proteins – fare better in a few key ways. So they might be worth considering. You want to look for the words ‘partially hydrolyzed whey or casein” on the label – these are types of milk protein.

Next up, there’s soy formula. There is some question on whether giving babies so much soy protein is a good thing, so these are usually only recommended if a baby is truly lactose intolerant, or allergic to milk protein, or if the parents are vegan. My personal view is that like anything, these should be assessed with a risk/benefit analysis - if you can find another type of formula that works for your baby, it's probably not worth the (incremental) risk of having her consume too much soy. But remember- this is a small, small risk, so if there are other immense benefits to using soy (for example, your child can't tolerate milk-based formulas and you can't afford the hypoallergenics), you can still choose it with confidence.

Then, we have hypoallergenic formulas which are made with completely hydrolyzed milk protein – meaning it’s broken down so much that even babies allergic to milk protein can tolerate it– or a prescription version for severely food allergic babies, made from amino acids rather than milk or soy proteins. These are seriously life-saving for babies with severe allergies or food intolerances, but they are quite expensive and smell pretty nasty (especially when you drip them all over your car. Not that I'd know from experience or anything...) so these should only be used if you really need them. They are also marketed for "colic symptoms"; unless the "colic" is caused by a food intolerance which is exacerbated by regular formula, they probably won't do all that much for you. Then again, since no one really knows the cause of colic, I could be dead wrong about this. If colic is some sort of gastrointestinal issue, then a hypoallergenic (or "hydrolysate") formula could feasibly make life easier for a stressed-out baby gastro system. It's worth a shot. Usually, if these formulas are going to help, you'll know withing 24-48 hours of trying them. It's often a quick and dramatic change for the better.

Lastly there are specialty formulas - some for premature infants or infants who are having trouble gaining/maintaining weight (sometimes doctors will have parents use regular formulas and just mix up different ratios of formula to water or add other elements to make them more nutrient dense - which should ONLY be done with a doctor's supervision), and lactose-free formulas for kids who are lactose-intolerant. Most children are reacting to the milk protein and not the lactose (although certainly not all - lactose intolerance does indeed occur in babies, it's just not as common as milk protein allergy) and will not do any better on these formulas; they will need a hypoallergenic formula to make them more comfortable.

What’s the difference between ready-to-feed, concentrated, and powdered formula?

Formula can come in three forms: powder, ready-to-feed, and concentrated.

The most common and economical option is the powdered formula, where you mix specific amounts of powder with (safe) water to make the formula.

Ready-to-feed is exactly what it sounds like – the formula is ready to go as is, so all you need to do is pour it from the container into the bottle, or some companies make “nurser” bottles, where you just attach a nipple directly to the bottle the formula comes in. These are often used for newborns, due to their ease and safety – if there is no water or mixing involved, there is less chance for human error or contamination. I think if you can afford to use them, they are the best bet for the first few weeks. There's a lot less to worry about when you're using these, and what new parent couldn't use a little break from all the worry?

The last kind of formula, concentrated, isn’t all that common these days, but it is kind of like condensed soup – it comes in liquid form, and you need to add water to make it drinkable.

There are actually some differences in the formula itself when in different forms – some sensitive or refluxy babies do better with ready-to-feed, for example, because it isn’t clumpy and tends to be smoother and creamier in consistency than the powdered version. Also, most powdered formulas contain anti-caking agents – often corn-derived – that certain babies might be sensitive to. But for most babies, the powdered version will work just fine, and it is certainly the most economical option.

Bottom line: formulas and bottles do differ by type, brand, etc. This doesn't mean one is necessarily better than the other, but there are fundamental differences, so if you are having feeding problems, don't despair. It may be a case of trial-and-error (and if you're like me, there may be a lot of error) but eventually you will find a feeding system that makes the heavens open and the sun shine down. Well, maybe not that good, but at the very least, you'll find a system that allows your baby to be comfortable and fed.

FFF Friday: "I was very confused...."

2011-12-16T17:13:00.000-08:00

Censie Sawyer's FFF entry made me think about the argument against formula samples. In a self-reported study, she'd probably have provided data in favor of the samples-impede-breastfeeding hypothesis. But there were obviously multiple layers to her story; if there was no formula in the house, she would have probably sent her husband out to get some (and he sounds like a sweetheart so I bet he would've done it even at 3am in the snow, if that had been when Censie asked for it). This mother tried breastfeeding even though she had no real vested interest in the practice; she gave it a fair shot and had ample assistance, and in the end, found that formula was a better option for her family. And she's still open to breastfeeding the next kid, so perhaps formula saved her from the hell that has made some of us so adverse to giving it another go.

Thanks to Censie for sharing her story, and as always...

Happy Friday, fearless ones,

The FFF

***

I am a Fearless Formula Feeder. I am proud to say that I fit that category perfect! Let me start from the beginning with a little introduction of myself and my family.

My name is Censie (pronounced Kenzie) I am married to Jeremy and we have a son named Jude. Jude was born on June 25^th 2010! We fell in love instantly when he arrived. You can find more of Jude and our stories on our family blog called Building Our Story . (For the record the reason there are turtles everywhere is because we love Turtles and that is Jude’s nickname- since about 1 month he has been "Turtle"!)

My pregnancy went just as planned and pretty much the normal. I never had any medical problems and Jude was healthy the whole time too. Now when I first got pregnant I started reading everything I could about pregnancy and birth and about bringing an infant home. I was prepared – I am a bit anal like that! One example – Jude’s nursery was planned at 10 weeks! Lol Yeah I am a planner too. Well because that is my personality it also led into how I would be feeding my son as well.

Okay – another background story. I am adopted. My brother is also adopted. Breastfeeding and nursing has never been a topic around my family, in fact I never remember talking to my mother about nursing EVER.

Well because of my up-bringing I honestly was not really committed to nursing from the beginning. Now this is where the pro-breastfeeding groups would just ring me. I wasn’t committed, I can say that now. I look back and I was nervous about nursing – maybe because I couldn’t imagine myself in the mall or out to dinner with a baby attached to my boob or maybe because I knew that my womanly support (my mom) had never done the nursing thing either. On top of that it was pretty clear that my brother and I were alive and healthy so formula must work fine! ;)

Now for the story of feeding baby Jude. Jude was perfect (duh!) ;) He latched on perfectly and ate well while we were at the hospital – even had a few of our nurses praise Jude and me for the great nursing! Fantastic! I left the hospital happy, excited, and proud of myself and my baby. Our first night home was great. The second day was HORRIBLE. This child would not stop crying! He would not latch. My boobs were sore and huge and my milk was in.

I was very confused. Yay for my milk but OMG what happened to my happy latching baby? Talk about tear fest! My poor hubby! We were lucky enough to have a home nurse visit us every day for the first 4 days at home after our release from the hospital – THANK GOD! I am pretty sure we would have been back in the hospital with a screaming baby in tow if we didn’t have those nurses visiting us at home.

Now the nurses helped a ton but they too were very confused. This kid wanted to eat and from our notes it was clear that he was a GOOD LATCHER. I had those nurses all up in my junk, tugging at my boobs, pushing my baby onto the nipple, trying new holds, massaging my boob, ect. Yeah truly exciting – all with a screaming baby! The nurses were at a loss. I was too.

It was decided on the 2^nd day home that Jude needed more food. He had lost a lot of weight – more than a pound. Thankfully we had a sample can of formula. Jude drank that formula like he was one starving baby. For the next 2 days the nurses tried to help me get him to latch. He wouldn’t. Queue one sad and frustrated mommy! I wanted to feed him but I couldn’t. It is funny, like I said I wasn’t completely committed in the beginning but when it came down to it I think I really did want to excel at this nursing thing. It just didn’t work.

Over the next couple of days of Jude’s life we decided that I would exclusively pump and then supplement with formula. Actually it became more of using formula and then supplementing with breast milk. I just wasn’t producing much at all. In a whole day of pumping in would maybe end up with 5 ounces of breast milk. So frustrating! I even tried taking Blessed Thistle and Fenugreek in hopes of a little help but nothing seemed to do the trick. I did this exclusive pumping routine for almost 6 weeks. It was seriously the most exhausting 6 weeks of my life. I don’t know if I will do that again because of how much work it was for the little amount of breast milk that I produced.

I look back at how I was feeling and now I have used that experience to help other friends with struggles in the nursing department. The bottom line is that you need to feed that life you created – bottle or boob! No matter how you do it that kid has to be healthy and happy and so does mom (and dad!). We are going to start trying to conceive in the beginning of 2012 – God willing we will have another baby soon and with that birth I hope that nursing works. But if it doesn’t there is formula. And formula provided my son with nutrients and food for 12 long months and let me tell ya, he is one healthy 16 month old now.

Maybe Breast Feeding isn’t for you. Maybe it is. Either way remember to be respectful of every woman’s choice.

I am honored to be a Fearless Formula Feeder!

***

Viva la revolution. Send your story to formulafeeders@gmail.com.

The FFF Quick-and-Dirty Guide to Formula Feeding: How much and how often should you feed your formula-fed baby?

2011-12-14T20:53:00.000-08:00

There are a ton of charts and calculators online claiming to help you figure out how much you should be feeding your baby. Unfortunately, they are all missing one fundamental message: your baby is an individual. He probably doesn't adhere to static feeding rules any more than you do. For instance, I tend to eat barely anything during the day, but I chow down like a Sumo wrestler at night. Although this runs contrary to all advice given by nutritionists (I think the breakfast like a king, lunch like a pauper, dinner like a peasant concept is pretty well-accepted across the board), this seems to work for my body and my metabolism. Likewise, there are some kids who eat more, some who eat less, some who eat a ton and then throw it all up because they have god-awful reflux, and some who comfort eat due to stomach distress. The latter two might need some medical help (or a formula switch) to remedy their issues, but my point is that not all babies play by the Baby Rulebook.

I hesitate to give a formal "guide" on how much you should feed your baby, because I believe that for the most part, parental instinct is superior to over-generalized prescriptives. But I know there's a need for non-judgmental practical advice, so here goes.

Before talking amounts, let's just go over some basics:

1. You cannot overfeed a newborn. You cannot make a newborn fat. Yes, I know there have been recent studies linking rapid weight gain in infants to later obesity, but come on, people... how many scrawny people do you know who were chubbilicious babies, and vice versa? Newborns do not have the brain power to binge eat. They eat when they are hungry (there is one exception to this, which I will talk about in a second, so bear with me), and when they are full, they will pull away from the bottle or, when they are teeny tiny, they may just unlatch. I've heard the warnings about formula feeding parents forcing their kids to finish the last few ounces while the poor babies flail and choke helplessly, but the fact is, any baby who is strong enough to to do the "breast crawl" or handle breastfeeding can make it pretty clear when they are done with a bottle. Just watch your baby - if she pulls away or suddenly doesn't seem interested in eating, that means she's done. Doesn't matter that the feeding guide that came with your formula says she should be eating 3 oz in a sitting; if she acts finished after 1.7 oz, that's all she needs at the moment. On the other hand, if she downs the 3oz you prepared and is still screaming at you or sucking desperately at the nipple, offer her another few ounces (this is where a formula pitcher or even just a salad-dressing mixer comes in handy - if you make like 10 oz at a time, you can offer smaller amounts off the bat and give only an ounce or tow more at a time, so as to avoid wasting formula.

2. As for knowing when to feed your baby, that's a matter of learning his hunger cues. All babies have them; the most common ones are "rooting" (moving his head from side to side or opening his mouth wide like a guppy, especially when you touch his cheek or chin); shoving his hands in his mouth; sucking on whatever is in reach; crying (this is what many baby sites deem as a "too-late" hunger cue, implying that if it gets this far you must have been negligent in some way); fussing; or my favorite, sticking out his tongue.

3. As your baby gets older, hunger cues aren't always so easy to read - babies lose the rooting reflex at a point, and sometimes it can be hard to tell what's hunger-related fussiness versus plain old fussiness. This is where it's easy to fall into the trap of giving a bottle for comfort and not hunger. It's unfair, because one wonderful perk of breastfeeding is that you can pop a baby on the breast at the first cry and no one thinks anything of it; do the same with a bottle and you'll be warned against obesity and blamed for your child's emotional eating problem in 20 years. Fun times. Professionally, I know the right thing to say is that giving a bottle to calm a baby is probably not the best idea - in fact, I kind of think giving the breast to calm a baby would have many of the same negatives. But personally, as an ardent supporter of Path of Least Resistance Parenting, let's just say I would never fault someone for giving a comfort bottle when their baby is screaming bloody murder in the car or whatever. Sometimes, you just need to calm the kid down, and if other things aren't working... well, do what you need to do. As long as it isn't a daily habit, I wouldn't worry too much about it.

4. Okay, remember I mentioned there was an exception to the stuff I've been saying? That exception is if the baby has an underlying GI or health issue which may make eating challenging in any number of ways. For example, if your baby has an allergy or intolerance to formula, or severe reflux, the "classic" presentation is that she will refuse the bottle altogether, and show signs of failure to thrive. But sometimes this can manifest in what's known as comfort feeding. Imagine that you're a baby, and your stomach is constantly hurting or your esophagus feels like fire. And then imagine that when cool, smooth liquid is running down your throat, and you have that lovely sucking motion going on.... not all babies are going to make the association that it's eating which is causing all the pain to begin with.

Reflux is tricky too, because some kids may eat a ton and throw up the majority of it; it might appear that they are over-eating, but really they're keeping down the bare minimum of daily calories. Confusing matters further, kids who do eat too much for their little bellies will simply spit up the extraneous amounts; some might assume this is reflux - and a vicious cycle can begin. But I'll tell you a little story: my Fearlette was consuming about 32 oz of thickened formula (fed in frequent, small amounts) a day. About 15 oz of that was getting regurgitated on a daily basis. She was the scrawniest baby you've ever seen, sometimes scarily so. But to read the "how much should they be eating" charts, you'd think I was doing everything wrong.

Bottom line? There are exceptions to every rule. I'll say it again - every child is an individual. It's far more helpful to focus on getting to know your kid- her quirks, her cues, her special needs - rather than knowing what the experts say you "should" be doing.

I know you've probably skimmed to the end of this novella and are probably wishing I'd get to the point - FFF, just shut up and tell me how much and how often should I feed my baby, dammit - so here you go. The basic rule of thumb for formula feeding:

For every pound your baby weighs, s/he should be eating approximately 2.5 oz of formula. So if she is 10 lbs, that's 25oz per day. Most kids top off at 32 oz; the general consensus is that anything between 16-32 oz per day is in the realm of "normal" (god, I hate that word). In terms of how often, most sites/experts advise every 2-4 hours in the beginning, with longer stretches at night as the baby grows. Again using our 10-pounder as an example, this might mean five 5-oz bottles per day. But some kids are snackers, so this could also mean feeding a baby every 2-3 hours with 2-oz bottles. Just depends on the kid.

Let's assume you have the most textbook child on the planet, though; in this case, your best bet would probably be to distribute those 25 oz primarily in daytime hours, assuming the 10- pounder is at least 8 weeks old and can go longer stretches at night. You might do a 5oz bottle at 9am; 12pm, 3pm, 6pm, and then top him off with 3 oz around 9pm to help him go through the night, with probably another 2oz around 5am. Figure out the schedule that works best for your baby; my point is just that many kids will only be able to handle a specific amount at a time, and at certain times they may want more than others. Many breastfed babies do what is called "cluster feeding", meaning they have numerous short nursing sessions all clumped together in a short time period. Formula fed babies can do this too (obviously), by drinking smaller amounts every hour or so. (If she usually takes a 4oz bottle every 3 hours, you can do a 3-oz bottle an hour before bedtime and then another 2 right before she goes down.) Some claim that this allows babies to sleep longer stretches at night; kind of the equivalent of carbo-loading before a marathon. I did find with both my kids that if they did some cluster feeding around bedtime, they slept better. Could have been a fluke though.

During growth spurts, you may find that your typical amount isn't enough. I think that as long as you have spent time getting to know your baby's hunger cues, you can feel pretty safe just feeding on demand. But also keep in mind that kids can get might ornery during these growth spurts, so it is possible that they will cry a lot and it won't necessarily mean they are hungry. Do whatever it is you do to comfort them, and if it doesn't work, let them eat. Babies don't play mind-games: if something else is wrong, your baby will probably keep freaking out despite your sacrificial offering of Enfamil. If she's hungry, she'll eat and hopefully sleep... well, you know.

Like a baby.

Whatever the hell that means.

Could environment or genetics affect milk supply? (File under, "will never be answered in our lifetime.")

2011-12-11T21:42:00.000-08:00

I'm a real estate fiend. I peruse the MLS like it's a covert issue of Playboy. I love watching the prices rise and fall; seeing how trends change; and I especially adore reading the descriptions of properties and how they are marketed. Realtors often highlight the "walkability" of a location, the proximity to good schools, and any unique features of the home. I have yet to see any real estate professional describe a listing based on its health merits... but maybe they should start.

Last summer, an article on Harvard Health pointed out the health ramifications of where we live. "Laden’s research group has found a number of links between environmental factors and health," the authors explain. "For example, the results of one study showed that greater exposures to UV light correlate with a higher incidence of squamous cell carcinoma. In some regions of the U.S.—for example, the Southwest—people are more exposed to UV light and thus face a higher risk...Other research from Laden’s group has shown an association between fine particulate levels in the air and mortality rates—the more fine particles, the higher the rate. The researchers found relationships between particulates and increased levels of cancer, renal failure, coronary heart disease and cognitive decline. They also observed associations of some negative health outcomes—for instance, rheumatoid arthritis and diabetes—among people living closer to highly traveled roads. In regions of the U.S. where air pollution has decreased over time, Laden said, there has been an improvement in public health."

This makes sense: your health can be affected by where you live, and how you live, and who you are. Not only does your environment play a role in health, but your gene pool may, as well. For example, since both my husband and I are Ashkenazi Jews, we had to get a "panel" of genetic testing done prior to conceiving to ensure we weren't both carriers of a few key diseases which tend to strike only members of our ethnic group. Black Americans have to worry about Sickle Cell Anemia. And my husband has an eye condition which typically only strikes people descended from British of Irish stock (making us suspicious that someone in his family tree must have slept with the redheaded mailman, considering his peeps ain't from that part of the world).

I'm talking about all of this because I came across another study today - this one of the "self-reported", survey breed - which claims that 72% of new parents surveyed in a group encompassing mothers from the United States, South Africa, Egypt, U.S., Brazil, China and India wanted to breastfeed for as long as possible. "The main reason that stopped women from breastfeeding within the first three months was pain, whilst lack of supply commonly caused women to give up breastfeeding between three and seven months," states the study, which was funded by Philips (the makers of Avent bottles and pumps). However, "67% of American women compared with 40% of women globally reported that their reason for stopping was a lack of milk supply, and in comparison to 41% of mothers globally, 73% of American women completed a breastfeeding course."

Hmm.

Something doesn't quite compute, here. American women were more likely to be educated about breastfeeding, and also more likely to cite lack of supply as a reason for quitting. Presumably, the more educated about breastfeeding you are, the more you'd know about what constitutes a true lack of supply; how to pick up on hunger cues; how to recognize growth spurts; and how to avoid the "booby traps" which could adversely affect supply. So either these classes we're taking are teaching all the wrong things, or American women really are having more trouble with supply.

If it is a widely accepted belief that genetics and environment can impact health both positively and negatively, why do we have a hard time believing that on a population level, one country's breasts might be short-circuiting? It could be something social in nature; maybe it is something as simple as a lack of good breastfeeding help in the hospital, which is impeding the second stage of lactogenesis (the process which the body must go through to start producing milk). Even this would be good to know, because regardless of the cause being an avoidable one, it speaks to the point that women are having trouble with supply and are not just using it as an "excuse". But maybe it is something in our water or environment. Maybe lack of supply is more prevalent among certain ethnic groups or geographic cohorts - have there been any studies done examining "perceived" lack of supply in eastern versus western states, for example? The rural south versus the Pacific Northwest? I'd be interested in that. Or you know what else would be cool? A study which actually examined the breasts and overall physical health, down to the cellular level, of women who "claim" insufficient supply. Maybe we could find enough proof for people to stop accusing new mothers of lying or giving excuses, and actually make some real strides for women who want to breastfeed and find themselves unable to do so without going to extreme lengths.

A girl can dream, right?

FFF Friday: "What's best is what works for the whole family"

2011-12-09T09:51:00.000-08:00

FFF Christina's story is a perfect example of how "legitimate reasons" for choosing formula don't need to be physiological in nature, nor do they need to be deemed "legitimate" by a medical professional or government official. She made an educated choice to breastfeed, gave it a fair shot, and decided it wasn't the best choice for her family. That's really all we should be asking for when we advocate breastfeeding. Give women the resources they need, the support they want, and the autonomy they deserve.

Happy Friday, fearless ones,

The FFF

***

My background: I am a first time mom. Both my sister and sister-in-law formula fed. Most of my close friends (let's say 3 out of 4) exclusively breastfed. When I found out I was pregnant, I did my research. Breastfeeding was the obvious, inexpensive and natural choice for me. And it was the one part of having a baby that I planned. I figured I would pump when I went back to work. Easy, right? I should have known better.

I was a natural at breastfeeding. My milk came in on day 3, and my baby had a great latch. We had a rough Day 2 (she didn't eat for 8 hours in a row), but quickly overcame that. We came home, and I spent my days and nights nursing. When I wasn't nursing my baby, she was crying. She barely slept. And when she did sleep, it was such a light sleep that she would only sleep on me. I forged on, thinking that my baby just didn't like to sleep. My breastfeeding friends admired my daughter's latch, and told me to keep going, despite the fact that I expressed feeling uncomfortable and that my baby had dark circles. My mom even expressed her concern that the baby wasn't sleeping enough. I brushed her off. She had her last kid 30 years ago! She doesn't know, I thought.

Something didn't feel right. I didn't have the magic bonding feeling. I felt trapped to my chair, to my bed, to the couch. I went to a family barbecue and spent the ENTIRE day breastfeeding. Sitting in a chair, with a hot baby attached to my chest. I have large breasts and felt uncomfortable pulling them out even around friends to feed her. Because she was crying all of the time, my mom suggested cutting out caffeine, chocolate and dairy to see if it helped her. To have someone else dictate what I could and couldn't eat me irrationally angry. I thought I was a horrible person because I didn't want to "get over my issues" to give my daughter the best. I was feeling almost resentful of my daughter, when I finally realized that what I was really resenting were the demands of breastfeeding.

Add to that the anticipation of guilt because I thought my breastfeeding friends would judge me for using formula... and I was feeling crazier than a postpartum woman should have to feel. (Fortunately, my friends are awesome-- no judgment at all). Don't forget the screaming baby who couldn't be put down because all she wanted to do was nurse.

I love my pediatrician. At our first appointment, I sat in her office crying while breastfeeding. She asked me what was wrong. I said I felt trapped and didn't know if I could do this. But I was overcome with guilt. She asked me point blank: "What will happen if you feed her formula for a few feedings to give yourself a break to pump or relax?" I thought about it for days after. I thought about how helpless my husband felt every time I was unable to eat a meal because I needed two hands to breastfeed, or if I wasn't breastfeeding I was pumping. How about that? A medical professional telling me that formula was OK. I had convinced myself that breast milk was THE ONLY acceptable food for my baby.

One day, I decided to supplement with formula for a handful of feedings. I figured I would start building a breast milk supply-- hopefully to eliminate my discomfort with nursing in public and me feeling tied down. But my gut was telling me something else. I gave her formula for a whole day. She ate like a champ and slept longer than she ever had. It hit me like a ton of bricks-- she was hungry, and wasn't getting enough from me. She was hungry, and I finally fed her. I felt free. And happy. And sane.

What I was afraid of was that people would think that I was uneducated and unaware of my options. To the contrary, I'm keenly aware of the promoted benefits of breastfeeding. I read like a fiend while I was pregnant. I watched videos of babies breastfeeding. I knew what a good latch looked like and felt like. I was also afraid that it would be assumed that I didn't have enough breastfeeding support. I had more breastfeeding support than one person needs! I had a doula on call, actively breastfeeding friends, and breastfeeding support groups at my fingertips. I chose formula not just for me, not just for my baby, but for my whole family's health.

What I realized is that I should be proud that I trusted my instincts. I fed my baby, and today she is a happy, bouncy 4 month old who went from barely sleeping/napping to sleeping through the night. I know now that breast is not necessarily "best" for everyone. What's best is what works for the whole family.

***

Share your story for an upcoming FFF Friday - send it over to formulafeeders@gmail.com.

Father Knows Breast: Men have breastfeeding angst, too

2011-12-05T20:36:00.000-08:00

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

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

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

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

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

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

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

It's okay to feel left out.

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

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

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

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

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

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

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

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

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

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

Paging Dr. Freud....

FFF Friday: "Breastfeeding wasn't an all around fail..."

2011-12-02T20:55:00.001-08:00

Oh man, did I need a good FFF Friday submission to cheer me up! I apologize for how late this post is going up (especially as it is so darn awesome) but I'm battling a sinus infection and Mother Nature, who decided to send hurricane-force winds to the east side of Los Angeles and destroy our power for two days. We're finally back home and electrified, so I'm happy to be able to post this incredible essay by FFF Siobhan - I am in awe of her ability to admit some really uncomfortable feelings, and I think it demonstrates how a lot of us felt before facing our own challenges. I agree with her that a silver lining of struggling with breastfeeding is that it humbles you, making you that much more wary of judging anybody's choices.

Happy Friday, fearless ones,

The FFF

***

My story begins with me on the other side of the spectrum. I was a hardcore-formula is poison-if you give your baby formula s/he will never feel any sort of bond with you-will be obese-dumb as dirt-sickling-lactivist who never actually had a child or breastfed. When I found out I was pregnant and my dad told me he'd go to Costco and stock up on diapers and formula for me I politely declined, but thought to myself how could an educated man be so ignorant. Let me stop here for a minute, he could be so ignorant because my sister and I were formula fed - but obviously that's why I have a horrible relationship with my mother (not the fact that she's emotionally unstable, selfish, and abandoned my sister and I when we were young children). I didn't want my child feeling about me the way I felt about her and breastfeeding was going to prevent that. One of my best friends gave birth 3 months before me and she talked to me about her troubles with nursing and eventually choosing give her daughter formula. I listened to her and said all the right, supportive things, then would babble on to my fellow lactivist crazies that "she wasn't trying hard enough," "she doesn't want what's best for her child," "there's no such thing as not being able to produce enough milk." My fire was fueled when I took a breastfeeding class at my local hospital. The lactation consultant regurgitated all those breast feeding half truths. She told us as long as we got the latch right it would be easy. We'd always make enough milk. A feeding beginning to end would be no more than a half hour. It would be blissful. It was make us feel good. It would be beautiful.

Fast forward to D-day, my beautiful, healthy, 7lb 14oz daughter made her entrance into this world as planned - natural and completely unmedicated. She latched immediately and the nurses re-assured me it was "perfect". I nursed her every 2 hours day and night as instructed and everything was as I expected - except it hurt....like a lot. My 2nd night in the hospital I noticed uric acid crystals in her diaper, she was jaundice, and wouldn't stop crying. When I asked the nurse (Ratchet) what to do she told me I was "starving her, and should feed her more." So, I did. She was attached to me for the rest of the night and the next morning. Whenever I put her down to shower or eat or get 20 minutes of sleep, she would just cry. Finally the day nurse, Winnie - my angel - suggested offering her formula, to see if she would take it because maybe she needed a little extra. She even offered to cup feed her to avoid nipple confusion. My daughter gulped it down in a minute. I began to cry - not because she was given that devil formula - but because she was finally stopped crying. My daughter had lost almost a pound in 2 days, so the pediatrician wanted me to supplement until my milk came in, but reassured me with a little effort it wouldn't affect my supply. She was over her birth weight within a week.

For the 1st 4 weeks of life my daughter was exclusively breastfed. I hated every minute of it. I hated the way it felt. I was doing it right and it still hurt. I hated that it was so time consuming. She would nurse for more than an hour most of the time. I hated that I couldn't get more than an hour of sleep at a time because I was the sole provider of food. I hated that no matter how much I fed her, she would cry, and cry, and cry, if she wasn't nursing. I hated I had no bond with her. I hated that I felt like she was becoming a burden. Finally, after a month, I noticed she wasn't growing into her clothes. I couldn't take the crying anymore and made an appointment with her doctor. At her weigh in, she was a few ounces below her birth weight again. At that point, she should have been over 8lbs. After talking it over with the doctor and my husband we decided I would pump and we'd supplement with formula. A weight had been lifted. I would know she was definitely getting what she needed to thrive and I could finally get some sleep, while my husband fed her.

I convinced myself I could pump my supply up and she would be fed exclusively breast milk again - but in a bottle - within a few weeks. I pumped and pumped and pumped and hated it even more than breastfeeding. At one point I was pumping 8 hours a day and only getting 2oz max a session. I tried everything natural: oatmeal, fenugreek, tea, different ways of pumping. I became consumed with increasing my supply. I had to do this. I could not fail. My child had to have breast milk or else (I'm still not sure what the "or else" was). THERE WAS NO SUCH THING AS NOT BEING ABLE TO MAKE ENOUGH MILK. I began looking into Reglan and Domperidone and that was when my good natured husband put his foot down. He wouldn't let me go that far. We got into a bit of a disagreement about it, but it made me stop long enough to see that this had become an unhealthy obsession. I spent more time pumping and researching than holding and playing with my baby. I was finally beginning to bond with her, but breast milk was starting to supersede her in priority.

I stumbled across this blog and in reading the other mother's stories, I realized there's nothing wrong with feeding your baby formula. After 4 weeks of pumping hell, I packed up my supplies and stocked up on the Similac. While I knew this was the right choice for my family, I still went through a grieving process. I even nursed her a few more times - not for her, but for me. Her first few days on straight formula were a little rough. She was spitting up and was constipated - you know, things that "never" happen to breastfed babies. I cried while feeding her the formula. I was began second guess my decision. How could I do this to my child? Then, after 2 or 3 days on the formula after a particularly, cry-heavy feeding session, I put her down to change her diaper. She looked up at me and let out an honest to goodness loud belly laugh, then giggled. It was the 1st time she laughed or even giggled. I'm sure the timing was purely coincidental, but I took it as a sign - like she was telling me, "It's alright, Ma. I'm going to be juuuuuust fine." She's so happy and healthy. She's reaching all of her milestones on time or early. She's bonds with me and my husband more and more everyday. She's everything her breastfed counterparts are and more.

Breastfeeding wasn't an all around fail. It taught me a really valuable lesson. Whenever I feel the urge to start running my mouth about things I have no experience with or other people's parenting decisions, I stop. I listen and I try to understand where they're really coming from.

***

Make like a second grader and participate in our version of show-and-tell. Send your FFF Friday submission to formulafeeders@gmail.com and you'll earn a gold star!

Letter to the Editor of The Providence Journal: "Ban the Bags" Announcement Shames Women, Ignores Lived Realities

2011-12-01T15:43:00.000-08:00

To the Editor:

Several days ago, Rhode Island became the first state to officially ban formula sample bags from hospitals. This decision was lauded by the state’s First Lady as a way for Rhode Island to “have healthier children, healthier mothers, and a healthier population as a whole.” AP reported that “formula will still be available to new mothers who experience difficulties with breastfeeding”, and a lactation consultant/nurse interviewed for the story assured the public that the “new policy isn't intended to force women into nursing their children, “ but was rather designed to “(help) mothers decide what's best for their child.”

As a mother who faced numerous challenges attempting to breastfeed her first child, and an author/blogger who has immersed herself in the breast/bottle debate for the past three years, I’m worried about the impact of this announcement. My problem is not that hospitals are opting to cease giving away commercial goody bags; as Marsha Walker, RN, commented in the AP story on the ban, “hospitals should be marketing health and nothing else”. My problem lies in the gleeful rhetoric used by a government spokesperson to announce this ban, and the growing anti-formula sentiment the ban represents.

While the AAP, WHO, and other major health associations have come out strongly in favor of breastfeeding – and well they should, considering it is a truly amazing gift a mother can give her child – the fact remains that the decision to breastfeed is not made in a vacuum. According to a 2009 article in US News and World Report, only 8% of American companies offer paid maternity leave; the average woman takes 6.6 weeks of unpaid maternity leave. Many breastfeeding experts agree that there is a learning curve for breastfeeding; that breastfeeding is a lost, and learned, art; something that does not come naturally to many women in our society. Some feel that it takes up to 6 weeks for breastfeeding to be established; this is 2-3 weeks longer than some women have off of work, altogether. And when they do return to work, they will have to pump at regular intervals to maintain exclusive breastfeeding - a feat which remains difficult for women in waged labor positions, despite Obama’s recent passage of a new workplace lactation policy. This new policy only applies to women working in companies with more than 50 employees, and disregards the inherent difficulties of expressing/storing milk while working as, say, a barista or factory worker. Not all working women are white-collar workers in female-friendly environments.

Additionally, many women have physical or emotional barriers to breastfeeding that have nothing to do with “predatory” marketing by formula companies. The phrasing used by the lactation consultant quoted in the AP piece, that banning free formula is “helping mothers decide what's best for their child,” implies that what is best is breastfeeding, full stop. This is not always the case. What about mothers who must choose between contraindicated psychopharmaceuticals and nursing? What is better for that child – a healthy, sane mother, or a mother who is breastfeeding? What about a mother who is a survivor of sexual trauma, for whom feeding an infant from her breast brings back devastating flashbacks of abuse? Or what about a single mother with older children at home, who has a rough start breastfeeding, and who does not have the time, energy or resources to attend breastfeeding support groups or obtain in-home visits from lactation consultants? Or the mother who belongs to the supposed 1-5% of women (I personally believe it is a far greater number) who are physically incapable of producing enough milk?

These are all problems which may not be noticed by those working in maternity wards, or acknowledged as “medical reasons” for “needing” formula in the first few days postpartum. Yet they are real problems that real women face. These women come to my blog in states of despair: some feeling like negligent mothers for their failure to provide “the best”; some having watched their newborn babies lose precious weight while well-meaning lactation professionals have warned them against supplementation. And while taking away their opportunity to bring home free samples of formula may not be a big deal on the surface, taking away their opportunity to make a choice which is right for them, and right for their families, without being made to feel they are acting against medical orders, is a big deal.

Promoting breastfeeding does not have to mean clucking our tongues at the choice to use formula. There are numerous other risk factors which affect a child’s health and well being: having parents over the age of 40; going to daycare; living in the city versus the country; living in poverty versus wealth; being born anything other than white and middle to upper class. Just like with breastfeeding, these factors influence statistics about child health, any yet we don’t have government campaigns suggesting that all good mothers have babies in their prime childbearing years, or move to rural Ohio after giving birth. (Imagine posters announcing “Having a baby at the age of 21 reduces the risk of birth defects! Reproduce before college!” or, “Babies born to mothers living in high traffic areas have increased risk of low birth weight, prematurity, and respiratory problems. Country Living is Best for Babies!”) We all do the best we can with the circumstances we are given. While breastfeeding advocates insist that formula’s prevalence in our society is harming breastfeeding rates, I’d submit that a lack of public health care, paid maternity leave, individual circumstance, maternal health, and personal preference have just as much impact, if not more.

Take away the formula bags, if you must (although I’d still like someone to tell me why we can’t simply have them available upon request, if the formula companies are willing to provide them), but it’s time we started speaking up for the women who cannot, or choose not, to breastfeed. Anyone with an internet connection has gotten the message loud and clear: science has proven that breast is best. Now it’s time to let us take that information for what it is worth, perform our own risk/benefit assessment, and feed our children in the way we deem appropriate. Removing the temptation of formula freebies is not going to stop women from formula feeding, but it certainly will make women think that formula feeding is something to feel ashamed about. If that is the goal, then well done, Rhode Island.

Suzanne Barston

The FearlessFormulaFeeder.com

Fun and games with Kaiser's new breastfeeding policy

2011-11-30T12:04:00.000-08:00

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?

Blasts from the past: Best of FFF, 2009-2011

2011-11-29T11:10:00.000-08:00

As 2011 comes to a close, I thought it might be fun to go back and revisit some posts. The FFF community tends to be rather transient... once people are out of the formula/ breastmillk era, they don't stick around. Makes sense - there are far more pressing things to worry about in the toddler years, like potty training, tantrums, etc. And of course, there's (unfortunately) always a new crop of stressed, isolated new moms stumbling upon this page after a failed 3am feeding....

Point being, I think there might be a lot of folks who are searching for posts on a specific issue that we've already covered at some point in the past 2.5 years. So, in your honor, newbies - here are some oldies but goodies you might find useful:

Dealing with formula feeding fear, guilt, and hate:

What do formula, IVF, pregnancy after 30, and working moms have in common? - Examples of other maternal "choices" which carry some degree of risk, to show that we make decisions every day which might not be the most ideal, but which work best for our individual situation.

A public health threat, of the male persuasion- In response to an ongoing tirade of comments from a male lactivist, I wrote this post, comparing the "risks" of older men fathering children to formula feeding. It's written with my tongue firmly lodged in my cheek, but I think it's actually a good example of relative risk.

Formula is the 4th best choice and other fallacies - Some thoughts on WHO's hierarchy of infant feeding

The Top 5 Formula Feeding Myths Debunked

A collection of the top formula-related insults and misconceptions

For those considering bottle feeding from the get-go

The Giant Misunderstanding Behind Breastfeeding Guilt- If you're sick of people whining about how they can't talk about breastfeeding without some formula feeder telling them they are making her feel guilty, send them this link.

....But if you DO feel guilty, check this one out: On letting go of guilt

About the FFF

Nursing old wounds: my story - The tale of Fearless Child, or, How I Became The FFF

The Big Reveal - Fearlette's story

FFF Musings on Breastfeeding

Why we should support (positive) lactivism

Public displays of affection - nursing in public

Extended breastfeeding

Breastfeeding promotion tips from a formula feeder

Milk sharing

Random thoughts, studies, and current events

Quick thoughts on the Similac Recall - Remember Buggate 2010? Ah, memories.

WHO Code, Old Navy, and the Case of the Renegade Onesie -My opinion on WHO Code, in response to the mass freak-out over a cute little onesie.

Stress and breastfeeding failure: related or not?

Feminism and lactivism - why the two -isms have such a crappy relationship

Formula feeding and obesity: a big fat lie

The Bottlefeeder in Room 1 - a personal account of a woman who gave birth at a baby-friendly hospital, which led me to write this:
Surviving the baby friendly hospital: tips for those planning to formula feed

Formula feeding logistics

Bonding on bottles

Nipple Confused? Here's some "supplementary" info - supplementation and the reality of nipple confusion

Bottle weaning

Night weaning

Homemade formulas: recipe for disaster or interesting alternative?

Hyping hydrolysates: All about hypoallergenic formulas

Are soy formulas safe?

Toddler formulas

Choosing the right bottle for your baby

Changing formula and nipples as your baby grows

Formula feeding and reflux

Tips for drying up breastmilk

The two-hour rule: part one and part deux - why you shouldn't leave a bottle out longer than a few hours (I got properly schooled on this one....)

The FFF Documentary: Message in a Bottle

This was a little film I made a few years ago, attempting to give the FFF Friday voices another medium....it's long, so it's in three parts....
Part 1
Part 2
Part 3

FFF Friday: "Surely we should all be a bit more understanding?"

2011-11-25T16:43:00.000-08:00

It kills me that FFF Shane still feels "slightly guilty" about her choice to formula feed, even though her son is thriving, happy, and healthy. Today, Fearless Husband and I were talking about some very dear friends who are going through their own 3-days-postpartum struggle with feeding. I confided that while I wanted to give this new mother the support she needed to switch to formula, I also worried that in the long run, she'd have an easier time breastfeeding - because the guilt you have to live with as a formula feeder (especially if you decide to stop when your body and baby are still allowing breastfeeding to be a possibility) cancels out the relative "ease" of it in the beginning. Fearless Husband thinks I'm nuts... what do you guys think? If a friend of yours was struggling with breastfeeding and wanted to switch to formula, would you encourage her to "persevere", or throw in the nursing cover? How do you meet a woman where she is at, if you can't really know where she is at due to the enormous pressure put on mothers these days, coupled with those postpartum hormones and the transition to new motherhood? I think these questions matter, because Shane's point about the sisterhood of women being mucked up by the breast/bottle war is excellent, and maybe we should start thinking about how best to support our friends and fellow moms. Start the revolution that way, rather than just railing against the powers that be.

Regardless - I hope Shane's guilt will fade... she made a decision which put an end to a great deal of stress for her and her family, and all three members of that family are happy, fed, and loved. Full stop, as they say in her neck of the woods...

***

I have 3 sisters who all have children - and who have all breast fed successfully. My mum had five kids and she breast fed too (apart from my little brother - she gave up after two weeks as 'he was a greedy bugger and I couldn't keep up with him'.) I naturally assumed that breastfeeding was the way forward for me - hell if all my sisters could do it why couldn't I?

Throughout my pregnancy I was bombarded with breast feeding info from the NHS and Bounty packs which I read up on, I attended a breastfeeding class, read books, the internet and quite frankly I thought I had it sussed.

So when the happy day arrived (when England was rioting - I was in labour when all hell was kicking off 5 minutes down the road..) I ended up having an emergency c-section which I think may have played a part in why I really struggled to feed him,(As an aside - could
emotional stress affect the production of milk? I was still grieving for my dad who had passed away a couple of months earlier from a sudden illness).

Everytime I voiced my concern to the midwives I was told to keep persevering. I had midwives shoving my boobs into his mouth and pulling me into different positions. When I got home my delicious son was starving. After the 2nd sleepless night my husband and I bought formula with heavy hearts. It felt like I had failed at parenting at the first hurdle.

But the joy of knowing our son was eating overwhelmed us - but I was still ridden with guilt and desperately tried to feed him - I tried pumping (by hand and electronically). I was still encouraged by the home visiting midwives to persevere (and not one piece of advice about
alternatives!) which I tried to do but I was producing so very little after two hours it really wasn't worth it. So after a week of struggling my husband and I switched onto formula. It did help that I had my mum visiting from Scotland at the time who was an excellent
voice of reason.

I went through periods of feeling fine about the formula (My husband could feed him! We could go out and about! I wouldn't have to wear maternity bras! I could have that extra cup of coffee/bar of chocolate/glass of wine!) and then an overwhelming sense of guilt burbled up from my stomach to my heart (Is he going to be plagued with illnesses throughout his childhood? Is he going to be the dunce of the class? Will he be a mutant?).

I've talked to my friends about it and they have all been very supportive - some even admitted that they wished that they had gone onto formula sooner after they spent months struggling with breastfeeding.

3 months down the line I still feel slightly guilty about it but my beautiful baby boy is healthy and content. He sleeps well, he eats well and is a happy and healthy boy.

My concern is at a time when mums and mums-to-be should be supporting and understanding each other, there is this one-up womanship regarding feeding our children - surely we should all be a bit more understanding?

***

Thanksgiving may have come and gone, but you can still give thanks to all the brave women who've shared their stories by sharing yours (and if you aren't American and therefore could care less about Tofurky Day, well, you get the point) - email me at formulafeeders@gmail.com.

Bottle Holding is Not Bottle Propping (and neither is the end of the world)

2011-11-22T22:47:00.000-08:00

I won't lie to you guys - there were many, many times in FC's babyhood when I would have killed for a device like this. Judge all you want, but when stuck in Los Angeles traffic on the 405 and your kid is screaming in hunger and you know all he needs is a little formula...

Anyway. I never did bottle prop, but I can't say I wasn't tempted. And I rejoiced when he started holding his own bottle around 5 months of age; it made those long car rides exceedingly easier.

(This is one of the rare cases where I didn't envy my breastfeeding friends, by the way. At least if Fearless Husband was driving, I could sit in the back and hold a bottle for FC. Considering you can't take the baby out of the carseat while driving, I'm not sure there would be any way to breastfeed on the road without pulling over. In LA, this isn't always the easiest thing to do... there are long stretches of my commute where pulling over would mean putting myself at major risk, what with being a woman alone with a baby and the violent crime statistics of the neighborhoods. Obviously not a huge problem as you can always just feed your baby before you begin your journey, but if you get stuck on the 10 freeway for two hours - a daily occurrence here - and you have a newborn in the car.... you can imagine why I felt a bit less bitter about bottle-feeding during those times.)

Now, when FC started holding his own bottle, it was pure awesomeness, because he would still let me hold him and snuggle him while he ate. It was the best of both worlds - since I didn't need to hold his bottle, I had both hands free to play with his feet, hug him tight, or even read him a story while we cuddled.

My fearless, feisty little Fearlette is a whole other can of tomatoes, though. She started holding her own bottle around five or six months as well. Fearlette loves to be held, but only on her terms; she has to look out into the world, has to be in control. And when it comes to her bottle time, that is hers and hers alone. She can't really be bothered to drink a whole bottle anyway (which has made the whole weaning onto sippy cup thing disgustingly easy this time around), so she'll grab it from me, crawl or cruise away into a corner, take a few sips and throw the bottle on the floor, usually face-down (I have Stanley Steamer on speed-dial). I've tried in vain to make her let me hold her - waiting until she's ravenously hungry to offer her a bottle, as if I could lure her into my arms via her gurgling stomach.... but she just wiggles her way out.

I miss those warm, snugly feeding sessions. Oh god, do I miss them. And yeah, I suppose if I were breastfeeding, I'd still have them, because she'd be forced to have physical contact with me while feeding.

But on the other hand, I get sort of a kick out of her independence. Forcing her to be close to me isn't going to make her bond with me; if anything, it's going to smother her. We have plenty of snuggle time, just not while she's eating. Food and comfort do not need to be one and the same, at least after you get through the newborn stage.

Bottle holding is not bottle propping, at least in the psychological sense. You are not depriving your child of bonding time or physical proximity just because his hands are holding the food-dispensing apparatus. If he still lets you hold him while he eats, then there is no difference at all between feeding a child who does not hold the bottle and one who does. If he doesn't want you to hold him, and has the ability to a) hold the bottle and feed himself and b) physically move away from you so that he is eating somewhere other than your arms, it's okay to allow him this freedom. Considering no newborn on earth can feed herself, we are talking about older babies, here; ones who are learning to crawl, figuring out their own place in the world, and at least in the Fearless Chidrens' cases, becoming their own little hard-to-please individuals. Fostering autonomy is just as important as cementing bonds that are most likely already set in stone, by the time a baby is capable of holding his own bottle.

Physiologically, however... it's a bit of a trickier distinction. Fearlette only wants to drink her bottle lying down, flat on her back. I have no freaking clue why this is; I always held her with picture-perfect bottle-feeding posture, fancying myself a formula feeding "expert" and all: close to my chest, slightly elevated, right at boob level... the whole shebang. And yet the minute she was able, she grabbed the bottle from me, sprawled out on her back, and went to town. For months, I tried to amend this behavior, even attempting another kind of "propping" - baby propping, where I'd prop her up on some pillow so her upper body was appropriately elevated. She'd have nothing of it. It was either eat flat on her back, or not eat at all.

I was - and still am - less than thrilled about this situation. According to one anti-bottle-propping brochure from Intermountain Primary Children's Medical Center:

If you bottlefeed your baby while she is lying flat, she will be more prone to ear infections. Your baby has little openings from the back of her throat to her ears called a Eustachian tube (pronounced you-stay-shun tube). Adults have these tubes, too, but your baby’s Eustachian tubes are shorter, wider, and flatter. When you feed your baby with a propped bottle, the liquid pools in the back of her mouth. The liquid can then back up into her ears through the Eustachian tube. This is bad because bacteria can then enter through the tube into the ear, and cause an ear infection.

This sounds plausible. I've said before that I believe the correlation between ear infections and formula feeding is due to the mechanics of formula feeding, not the lack of breastfeeding. I would like to have research done on babies fed breastmilk in bottles versus babies fed formula in bottles, to see if there is a significant difference in the number of ear infections between the groups. My own purely anecdotal evidence, the Fearless Family Sibling Study, found that the baby who did not insist on drinking all bottle flat on his back has had no ear infections in all three of his years on this planet, while the baby who prefers drinking while supine has had three in her not-quite-one.

And then, there's this, from a guide for WIC professionals dealing with infant feeding:

It is not advisable to give infants a bottle (whether propped or not) while the infant is lying down at nap or bedtime or while the infant is lying or sitting in an infant car seat, carrier, stroller, infant swing, or walker. In addition to possibly causing choking and ear infections, these practices can lead to dental problems if there is milk, fruit juice, or a sweetened beverage in the bottle.

Aw, crap. Really? The highlighted part pretty much outlines the only places my daughter will drink a bottle.

But a closer look at this passage - one used to inform "professionals" about counseling bottle feeders - finds some incongruities. First of all, why does a baby holding her own bottle and drinking in a swing, carseat, etc, have more of a risk of dental problems than that of a baby whose mother is holding her during a feeding? Only one citation is used for this passage, and it is a manual from the American Dietetic Association. No studies of note.

In fact, I couldn't find any studies specifically looking at the dangers of bottle propping or bottle holding, except for one from 1968 (oh and if anyone can get the full text of the study without paying exorbitant fees, let me know... I'd be curious to read it).

So I'm a little confused. Where is the evidence that bottle propping actually causes choking, dental disease, or ear infections? I'm not saying it doesn't, because some of the theories and hypotheses out there sound perfectly reasonable, but until we have research, that is all they are: theories and hypothesis.

Look. The only people I actually know who bottle prop are a) daycare providers and b) moms with multiples. If I had to take care of more than two infants at one time, I'd be wanting more than just a bottle propper. (Like a bottle of Jack Daniels and some Valium.) These women are using actual bottle proppers, designed to keep the bottle at the proper angle. I would assume that this would help with the choking and ear infection risk, as long as the baby was being properly observed - not just left unattended with a propped bottle. That would be child endangerment, not poor feeding technique. I can't see why using an apparatus that allows for hands-free feeding would be physically dangerous in the hands of a responsible adult, so the only thing left to worry about is that elusive "bonding" aspect. Considering we can't really do a study which measures the effect of occasional bottle propping on the emotional state of infants, I'm not sure there is empirical evidence to back up these warnings.

As is the case with most infant-feeding-related stuff, these recommendations are so mucked up by the moralistic tone of parenting advice, that it's hard to discuss them without people getting defensive or judgmental. Bottle-propping needs to be discussed and studied on a purely logistical level, as does bottle holding. Framing these recommendations as "good parents do this" and "bad parents do this" helps no one; neither do vague admonishments about ear infections, choking, and obesity; and it certainly isn't helpful to use the two terms interchangeably.

Until I see some good, clinical research about why bottle propping is dangerous, I'd approach these recommendations a little more realistically. Yes, it's better to hold younger babies while you feed them, if and when it is possible. If you're a mom of six kids, or a babysitter of triplets, or in some situation where this might not be possible all the time, go ahead and prop a bottle when necessary - just do it safely. Make sure the baby is old enough and strong enough to turn away from the bottle when he's finished, and keep a close eye on him to make sure he's not choking (or use a slow-flow nipple - it takes like seven minutes for a drop of formula to come out of the newborn Avent nipples, for example. It's not like buckets of formula are going to be pouring out of one of those bad boys).

As for those with older, independent bottle holders, if they let you hold them once in awhile, more power to you. Otherwise, hug, love and cuddle your kiddo in every other way possible. It'll be okay.

Seriously, though, it will.

FFF Friday: "The balance around talking about infant feeding is completely off-centre..."

2011-11-18T10:42:00.000-08:00

This contributor asked to remain anonymous, but I seriously wish I could shout her name from the rooftops, in Streetcar Named Desire-esque fashion. Her sentiments are exactly what I want FFF to be about - finding a modicum of practicality, honesty, pathos and humor in the breast vs bottle conversation.

I think after all the seriousness and academic discourse of the past week, we all deserve a little levity. It's rainy and gray here in LA today, but reading this makes me feel like the sun is shining and there is hope for humanity. Dramatic? Yes. But well deserved.

Happy Friday, fearless ones,

-The FFF

***

I’ve started to write this so many times, and every time I did it started well but almost immediately became long and boring, which isn’t my style...the long bit anyway, I’m averagely short; my husband will confirm that I’m an incredible bore. I want this post to be a light hearted account of triumph over zealous lactivists, and an ode to my superb family and all the stuff I love about them.

I thoroughly enjoyed my pregnancy; it was easy and fun. I got to be fat and not care, my boobs were enormous, I was a little spotty but hey ho, my stomach moved of its own accord! I planned to breastfeed and read up on it, went to support groups (where they had knitted boobs no less!), but I wasn’t actually all that fussed. This is where my Mum comes in; she’s always said about the whole pregnancy/childbirth/breastfeeding thing (paraphrased):

“50% of the population are going to do it at some point, you’re not special, people survive, get on with it try not to have Pethodine and breastfeed if poss. If it’s not possible don’t whinge, you weren’t, your sister wasn’t but your brother was and he’s got all my allergies, oh and you’re the cleverest one [thanks Mummy, no favourites then!]”

She’s actually right about my brother, he turns into The Gruffalo at the mere mention of a hamster but otherwise he’s a very nice individual. I can’t offer any insight into the comparative states of our various tracts, nasal passages, earholes etc. but I’m assuming his are OK because he hasn’t mentioned them to me of late. Currently, he’s more worried that I’m going to get a PhD., that would bring us to a whole new level of sibling rivalry and one he’s not sure he can entirely be bothered with. Maybe I should just tell him that Mummy already thinks I’m the cleverest and it’s a lost cause? Anyway, that’s a whole other story and I digress.

DD was born after a text book, but long labour. The high point was when I turned into the girl off The Exorcist when my husband came into the room with a bowl of cornflakes. The low point was the two times I got sent away from the hospital because I just wasn’t ready to be in there yet. Once DD was (finally!!!!) born she was put straight onto my chest and there wasn’t a peep out of her, she just looked at me like a tiny alien. I was absolutely ecstatic and more proud of myself and our new family than words can say.

After I was put into the bed and given tea and toast someone popped into the room and told me that she might quite like to be fed now. I thought that was about right and so my beautiful, wide-eyed, 7lb 5oz baby girl was manhandled into getting her tiny mouth around my enormous boob. The midwife looked momentarily pleased with her effort, said “there you go!” ticked a box on my chart and left. We got the camera for the obligatory photo continued with our ecstatic daze. I suspect the midwife was momentarily chuffed because the simple tick of the box added another stat to the ‘initiate breastfeeding’ rates, job done.

Things got a bit trickier when we got home, mainly because I had no idea whatsoever of what I was doing and despite the classes, research, and midwife; I had not heard a single realistic account of what it’s like to breastfeed. The first four days went something like this: she woke up, I sort of managed to stick it in, and she went back to sleep. In fact, she slept for almost a whole three days on my husband’s chest whilst I sat next to them twiddling my thumbs and waiting for the whole ‘Motherhood’ thing.

By the fourth day, DD woke up and was starving. I mean STARVING. She wouldn’t stop crying and I didn’t know what to do, my milk wasn’t in. A midwife came round to check on us and responded to my exhausted and tear-puffed face with: “They only need a teaspoon-full at the moment; you’ve got all she needs, keep going”. The moment she left my husband was dispatched in search of a box of Cow&Gate. I already had the bottles in (naughty naughty!) because I’d listened to my Mother, she’d also firmly informed me that “Cow&Gate babies are happy babies” (she says the same thing about Marmite and Fishfingers and sleep). DD downed 4oz immediately, it didn’t touch the sides. I was incredibly relieved that I had ignored the midwife and my baby was now able to sleep peacefully whilst my scabby nipples recuperated before the next onslaught.

On the fifth day my milk did come in and my breasts were incredibly painful, it was worse than labour itself. I think Hugh Heffner would have marked me highly for the enormous ball shaped protrusions on my chest but I may have lost marks for the diagonal, puss-filled, bleeding scabs across each nipple. A little off-putting I imagine. I started with the pumping, I gave bottles, I cried a bit, I kept trying to get her back on again, I cried a bit more, I did it in private, I had a go in public, I did cabbage, I did hot water bottles, I did ‘on demand’, I did timed and anyway, eventually, it’s all a bit of a blur now, I got the latch, or whatever it was that was difficult, right. By that point the EBF ship had sailed.

There were points where I was furious with myself for giving her bottles, to points where I felt defensive about using bottles to points where I would claim to be fine about it and then internally beat myself up and get depressed about how thick and fat I was going to make her. I called myself possibly every name under the sun and then some. However, after a while I noticed that everyone was seeing how beautiful DD was (is!), and telling me how relaxed and happy we both seemed and that I was a ‘natural’ mother...yeah, natural and only 80% of the nipple time! Finally, I stopped growling stuff containing the words ‘misogynist’ and ‘testicles’ and ‘sandpaper’ and ‘vinegar’ to my husband and our marriage started to get that twinkle back. From that point I quit with the naval gazing (Mother’s advice again) and accepted that I mixed fed, that DD was happy and that we had an awesome little family thing going on.

I actually consider myself to have been really successful; I managed to breastfeed for over a year and really genuinely enjoyed it. I supplemented with bottles and DD thrived. I don’t think this would have been possible had I not had a superb midwife (day six) who was superbly pro-choice. She told me everything I needed to know about bottle feeding, gave me the number of my local breastfeeding support group for when I was ready and wrote “sore ++” and “discussed” in my medical notes so that other midwives wouldn’t give me any stick. I wish there were more midwives like her and think that FFF and books like Joan Wolf’s “Is Breast Best?” are superb resources for women and should be required reading. The balance around talking about infant feeding is completely off centre and that’s why we need to be talking about our experiences and engaging with research positively, that means with constructive criticism as well as praise.

On account of my success I would also like to thank my superb family, especially my Mum for her fantastic advice. Her body is similar to mine and she’s done it three times before, she was so right and so supportive (although not ‘supportive’ in the way lactivists would like). Seeing her face when she was able to give DD a bottle herself was beautiful, she was full of pride and love and that is a priceless memory.

My Dad deserves thanks for never failing to make me laugh, intentionally and unintentionally! He gagged when he saw bottles of expressed milk in the fridge (unintentionally hilarious) and thoroughly enjoyed shouting ‘BITTY’ whenever he liked (inappropriately, but intentionally hilarious). We never made breastfeeding into some sort of sacred act of Motherhood to be worshipped and revered, it just happened sometimes and was funny because it’s a bodily function with wobbly bits involved.

I would like to spare a thought for my fantastic husband who put up with a lot of breastfeeding nonsense from me. I would also like to say that I loved watching him feed our baby and love that he still enjoys feeding babies now; he’ll give any baby going a bottle he really will. I’m very proud of myself for letting him discover that pleasure. I’m also really proud of the way he approaches the whole “breast is best” debacle with a healthy dose of cynicism. He went from being a staunched “breast is bester” to a more moderate, “thank you for trying your hardest”. I love that he appreciates my efforts and that we’ve started this journey together (can I have DD/DH 2 now pleeeaaaase?).

Finally and most importantly, I’d like to thank my wee girlie. I’ve been hugely fortunate in seeing DD grow stronger, funnier and more wilful every day and I have the privilege being able to love her with all my heart. Just some of the more random things I love about DD are that, she’s almost phobic of yoghurt, not allergic, just extremely hateful of it. She LOVES swimming, but not on her back because, try as she might, she can’t open her eyes when she’s on her back in water (not even in the bath). Her favourite song it Regina Spektor, Fidelity, she listens to it on repeat. She’s superb at baking. She loves all animals, even snakes! If I go out without her, even to the shops, I get greeted with an enthusiastic “Mummy! You’re BACK!” as though I’ve been to the moon. She says ‘Hopigus’ instead of Octopus and thinks Batman is called Fatman (she also suspects that her Daddy actually is ‘fatman’ on account of a t-shirt bearing a certain bat-shaped logo). Oh, and she’s not fat, she’s top of her class, she’s got perfect teeth and she’s rarely ill (although I would still love her with all of my heart if she weren’t those things).

My hope is that should someone stumble across this post in their darkest breastfeeding hour, they can take comfort from it. Breastfeeding is awesome, it’s cuddly and warm and once you get the hang of it, very handy when you’re out and you realise that you’ve forgotten the baby’s drink (I have an almost 100% record for that), it can also mean that you don’t have to get out of bed at night. However, bottle feeding is also awesome, your significant other, Grandparents and friends can all enjoy feeding your tiny one, it gives you a well earned break whenever you like and it feeds your baby when you simply feel like you can’t. Supplement or no supplement, just find a balance that suits you and your growing family.

My biggest boob related hope for the future is that we all find some sort of middle ground and realise that boob, bottle or both, we all just want the same thing, the best for our babies. I also never want to hear “breastfeeding is free” or “breastfeeding is the most natural thing in the world” or “only 1% of women don’t have enough milk” or “breastfeeding causes obesity” or “breastfeeding reduces crime” etc. ad infinitum/nauseam....might that be asking too much?

To finish with, if any pregnant Mother asks me for my breastfeeding advice I now say:

“Do your best, but don’t beat yourself up. Breastfeeding can be amazing, but that doesn’t make it easy and sometimes it won’t feel natural at all. Listen to, and don’t dismiss the advice you’re given, if the shoe fits you can try it on, if it doesn’t, say Thank you and leave it there. The most important thing is that you give your baby your love and attention and make a happy home, whatever form that may take.”

From the bottom of my bosom, thank you for reading this.

***

Feeling in inspired to share your story? Email me at formulafeeders@gmail.com. Come on...all the cool kids are doing it....

Criticism and comments on "Emergency preparedness for those who care for infants in developed country contexts"

2011-11-16T22:02:00.000-08:00

To: Whom it May Concern

Re: Criticism and comments on Karleen D. Gribble and Berry, Nina J.; "Emergency preparedness for those who care for infants in developed country contexts". International Breastfeeding Journal 2011, 6:16.

From: The collective voices of FearlessFormulaFeeder.com

We the undersigned are gravely concerned with the assumptions, myths, and potentially harmful information presented in the paper, ""Emergency preparedness for those who care for infants in developed country contexts", appearing in the International Breastfeeding Journal on November 7, 2011 (henceforth referred to as "the paper").

In the course of the past week, we have been engaged in an online discussion with the lead author of this review, Karleen Gribble. While her intentions are clearly admirable, and her willingness to debate is appreciated, we feel strongly that her paper has the potential to do far more harm than good.

Who we are

This commentary was compiled through the feedback received on a post at FearlessFormulaFeeder.com, a website dedicated to supporting women who have either struggled to breastfeed or have made a well-informed choice to formula feed for a variety of personal reasons. The international readership of this site encompasses a wide range of feeding experiences (many of the readers are/were exclusively breastfeeding mothers or are "combo feeders" who supplement with formula, but primarily breastfeed) as well as ethnic and socioeconomic backgrounds. The author and members of this site are steadfastly in favor of protecting and supporting breastfeeding; however, we are also concerned with the impact the "breast is always best" mentality has had on Western society in terms of both the emotional and physical health of mothers, fathers, and babies; and on public discourse and policy surrounding feeding choices.

The paper

This review paper, according to Gribble, is written to give emergency management authorities information to "provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency."

We don't doubt that, provided a mother is physically and emotionally able to breastfeed her infant in the wake of a disaster, breastfeeding is a safer and more economical way to ensure that the nutritional needs of an infant are met. However, rather than simply illustrating this point and providing logistics for those who cannot exercise this option, the authors have offered a biased, embarrassingly inaccurate portrait of what formula feeds should entail in times of disaster. We feel that this paper not only adds to a growing body of breastfeeding literature that relies on a limiting, unrealistic, one-size-fits-all view of infant feeding, but could also 1) lead parents to spend needless money on emergency supplies 2) contribute to the already despicable lack of knowledge surrounding formula feeding and 3) mislead breastfeeding mothers into being ill-prepared for disaster situations.

Lack of impartiality

The paper begins with the WHO recommendations for infant feeding. This frames the remaining information as a diatribe on the dangers and inconvenience of formula, rather than what the paper claims to be (a manual of sorts, providing real, useful, and necessary information for all parents). Instead of explaining the reasoning behind the authors' recommendations vis-à-vis actual disaster data - possible time frame of being left without aid, clean water, shelter, etc - the message we are left with is "breast is best", not only in terms of disaster preparation, but "in general". This seems punitive; while many women in our society do combo-feed (both formula and breastfeeding) and may be able to choose one over the other, women will either be breastfeeding or formula feeding at the time a disaster strikes, many others will have no choice but to continue their previously initiated method of feeding. Relactation is indeed possible (1), and was in fact recommended by UNICEF as a strategy superior to formula donation and distribution during the 2010 disaster in Haiti (2). However, there is no available data on mass, post-disaster relactation that provided evidence for the efficacy of this recommendation, and the experience of the women who frequent this website suggests that relactation is difficult in the best, most privileged of circumstances. Even the WHO document cited above (2) states, "(l)ittle research has been conducted specifically into the physiology of relactation in humans" and later advocates ensuring that a relactating woman should have "enough rest and relief from other jobs while she re-establishes a breastmilk supply." It seems logical that the reality of a disaster situation might make an already arduous process more difficult, and possibly unrealistic, at least in the short term.

In our online discussion (3) on FearlessFormulaFeeder.com, Gribble infers that the heavy-handed focus on the superiority of breastfeeding was in part a logistical tactic to discourage unnecessary use of formula - a practice which can, in theory, sabotage breastfeeding. Again, we do not argue that breastfeeding should be encouraged and protected during disasters; however, we are concerned that the overwhelming bias of UNICEF and like-minded aid organizations is coloring the determination of what is "unnecessary" or inappropriate. We cannot blur the lines between breastfeeding promotion and post-disaster survival.

Gribble admits that UNICEF will not "touch" donations (even of ready-to-feed, single-serve formula containers which would negate the need for washing and sterilizing during the formula prep process - more on this later) from formula companies. "UNICEF's sponsorship policy places companies that breach the International Code of Marketing of Breastmilk Substitutes as more untouchable than tobacco companies because of the impact of their unethical marketing practices on the wellbeing of children. They purchase what they need at market prices," she states (3). In our opinion, this speaks to an obvious bias: if the aid organizations in question would refuse help due to moral convictions, what does that say about their worldview? If formula is an instrument of the proverbial devil, then anything formula-related is going to be looked as an avoid-at-all-costs evil. UNICEF does have a large body of research and documentation regarding the unethical promotion of formula in third world countries (4); this is not an argument about their reasoning, but rather the bias inherent in the way they approach infant feeding in every situation, including disasters. We feel that especially in the developed world, where "unethical marketing" of formula is a matter of debate (5) depending on where you stand on the issue of infant feeding choice, it is irresponsible for aid organizations to deny contributions which would help infants and mothers, instead opting to spend precious dollars on buying formula at market price.

Lack of due diligence

The authors spend a good portion of the paper detailing what a formula feeding parent needs for their emergency preparedness kit: A breastfeeding mother needs only "100 nappies and wipes"; in contrast, the formula feeding parent needs "56 serves of ready-to-use liquid infant formula, 84L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 ziplock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900g tins powdered infant formula, 170L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/ lighter, 14kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes", which will cost $250 (Australian dollars) for the powdered version, and $550 for the ready-to-use liquid.
We do not disagree that a laboratory-perfect, sterile preparation of formula would be ideal in a situation where sewage is present and resources for hand-washing are scarce; however, we believe that this list of supplies (and the corresponding instructions on how to prepare feeds) is misguided at best; deliberately misleading at worst. Firstly, many of the "dangers" of formula feeding in both disaster situations and resource-poor areas are due to contaminated water sources; using ready-to-feed formula would minimize most of these risks. Gribble also argues that water is needed for cleaning hands (something breastfeeding mothers need not do, apparently, even if they are breaking a latch with a finger; we also question whether a breast could not be similarly germ-ridden as a hand, considering both are covered by the same epidermal layer). Depending on the disaster in question,couldn't antibacterial wipes (6) be sufficient for cleaning hands prior to preparation of ready-to-feed formula in disposable bottles? Considering many of us were given ready-to-feed nursers in maternity wards with pre-sterilized nipples, and given no instructions except to attach the nipple to the bottle, it seems odd that this would be good enough for an hours-old baby and yet deadly (in a statistically significant regard) for a 5-month-old trapped in his home after an earthquake.

When we presented Gribble with the suggestion of ready-to-feed single-serve nursers (available from all three major formula companies in the United States) and disposable, pre-sterilized nipples, she claimed that these were not available in Australia or Japan, and were in fact illegal to purchase in Australia. A reader of the FFF blog did a few hours of research on this matter, and discovered that in Australia:

"...You can purchase Ready to feed formula in disposable bottles from here: http://www.fishpond.com.au/Lif.... I rang Australian Quarantine and Inspection Services and Steve on the floor in Brisbane said that milk imports from USA are fine at the moment unless the value is over $1000 in which case it maybe looked into but probably passed as long as there is a legit reason for that quantity." (3)

This is a far cry from "unavailable" or "illegal"; a parent provided with the right resources could easily obtain this much safer and more economical option. Within the United States - one of the countries that this protocol is presumably directed towards - these products are readily available. A baby under 4 months could likely survive on 20 oz/day. To do this with Similac 2-oz nursettes, this would come out to be about $250; with Good Start, which makes 6-oz nursers, it would be under $200. Another option is a pack of 48, 2-oz nursers which come with a ready to use nipple and ring - Similac offers a pack of 48 for $41.94 on Amazon.com (7).

Even if a mother is relegated to using ready-to-feed formula which does not come in serving-size nursers, the same Australian mother did a breakdown of costs for this method and found the following:

A five month old will need approximately 42 250ml RTF cartons. The standard way to calculate how much formula a baby needs is 150mls - 200mls of formula x body weight of baby. According to my Queensland government personal health record chart by the National Center of health Statistics a 5 month old averages about 7kgs. 7kgs x 200mls (to be on the safe side) equals 1400 mls per 24 hours or 6 250ml cartons/day (again to be on the safe side) x 7 days equals - 42 cartons.
COST: $41.75 from Chemist warehouse. (this cost is based on buying them in lots of 6 - I am sure you maybe able to find them cheaper in bulk.)
WATER
To wash hands: I DID THIS and I used approximately 100ml to thoroughly clean my hands. (Give it a go - see how much you need)
To clean preparation surface: again DID THIS and used another 100 mls.
Approximately 200mls of water per feed for cleaning - 1.2L a day or 8.4L a week
COST: 10L (with a little extra just in case) - $6.09 (Coles)

BOTTLES
You can buy disposable sterile bottles (50 for about $50) or my local Crazy Clarks (a discount chain) sells 6 250ml standard plastic bottles for $6.95
COST: $48.65 for 42 bottles

A storage container $11.00 (crazy clarks)
50 Large Zip lock bags - $5 (Coles)
Paper towels - 400 $4.70 (Coles)
Detergent - 1L $1.06 (Coles)
Antiseptic Wipes - 80 pack - $10.68 (Coles)
Packet of strong sharp disposable knives - 50 pack - $3.20

TOTAL COST: $132.13

This is based on one mother's research, and we are concerned that if her cost assessment was significantly different than Gribble's (both women are from the same country), something is amiss. Perhaps a little non-biased, real-world perspective might go a long way in honing these recommendations. We wonder if formula feeding recommendation written by admitted breastfeeding activists is really the way to go?

Lack of adequate information

As many of us are, or have been breastfeeding mothers, we are also concerned with what we feel is a lack of information (and a lack of realism) about breastfeeding in the developed world. Many women have a steep learning curve with breastfeeding; it is often a learned skill (8). Some of us have struggled with insufficient supply in the best of situations; we wonder how a brand new mother, possibly dealing with the death of loved ones, a loss of a home, etc, would be able to handle successful breastfeeding in the worst of situations? Furthermore, what would happen if an exclusively breastfeeding mother were at work or out at the time the disaster hits? Or if the mother is severely injured or killed? If a baby is separated from its mother, an alternative food supply will be needed; it seems that it would be far safer to suggest that even breastfeeding families have a supply of formula on hand.

Dehydration and stress can also have a deleterious effect on breastfeeding. While stress has not been shown to impede milk production, as Gribble points out in our discussion, it has been shown to cease lactation in a few documented cases (9) and has been proven to inhibit letdown response (10); by Gribble's own account, handling this problem requires support from those knowledgeable in lactation. Regardless of the mechanics involved, if the milk is not flowing, a baby is not getting fed. Considering the amount of psychological and physical stress in times of disaster (11)(12), we wonder: how many lactation professionals will need to be deployed to meet the needs of every struggling lactating mother? It may be true that for a mother who has already established breastfeeding, even times of extreme stress and lack of food and water will not affect the nursing dyad; we are concerned with the new mothers who suddenly find themselves trapped in their homes, and who are struggling to breastfeed in the way we all have (13) in much more comfortable situations (and our experiences run the gamut). If these mothers have been told not to have an emergency stash of formula in case of disaster, what will happen? It is a well-known argument that having formula in the home can discourage breastfeeding (14), but we feel that a paper focusing on disaster prep, not breastfeeding promotion, should look beyond a few self-reported studies and concentrate on the worst-case scenarios.

Ultimately, while no one here is arguing the fundamental point of this paper - that breastfeeding is a better disaster preparedness strategy - we feel it is obscenely dismissive of the lived realities of most women in "developed" nations. To suggest that a woman delays weaning in case of emergency is inane. To ignore the possibility that a breastfeeding mother may not be able to breastfeed her baby, either due to injury, emotional state or separation/death, is unrealistic. To ignore the options available to formula feeding parents, and to the aid organizations themselves, out of a disgust for formula companies or formula feeding as a practice, is irresponsible.

We ask that this paper be amended to include better, less biased information that is truly concerned with helping all babies rather than presenting yet another reason why breastfeeding is best. If nothing else, we hope that government agencies dealing with disaster preparedness will think seriously about the points we have illustrated, and refrain from using this biased, poorly-researched paper as a reference for recommendations.

Sincerely,

The Readers and Author of FearlessFormulaFeeder.com

Sources

1) http://www.ennonline.net/pool/files/ife/who-chs-cah-98-14-relactation-document.pdf

2) http://www.ennonline.net/pool/files/ife/joint-statement-iycf-haiti.pdf

3) http://www.fearlessformulafeeder.com/2011/11/formula-feeding-in-disaster-situations.html

4) http://www.unicef.org/nutrition/index_24824.html

5) http://www.fearlessformulafeeder.com/search/label/WHO%20Code

6) http://www.homefrontemergency.com/sadexanwi.html

7) http://www.amazon.com/Similac-Advance-Newborn-2-Fluid-Packaging/dp/B000N351WQ

8) http://www.bestforbabes.org/prepare-the-learning-curve-of-breastfeeding

9) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307254/pdf/westjmed00150-0094.pdf

10)http://www.sciencedirect.com/science/article/pii/S0031395505702960

11) http://psycnet.apa.org/journals/amp/39/3/252/

12) http://www.ptsd.va.gov/professional/pages/phases-trauma-reactions.asp

13) http://www.fearlessformulafeeder.com/search/label/FFF%20Friday

14) http://health.usnews.com/health-news/managing-your-healthcare/healthcare/articles/011/09/26/breast-feeding-boost-fewer-hospitals-handing-out-free-formula

FFF Friday: "Have a sense of pride with whatever choice you've made."

2011-11-11T10:35:00.000-08:00

FFF Dara found breastfeeding a lot more challenging than she expected. I wish she didn't feel that being under-prepared was her fault; the way we are taught about breastfeeding in our culture is for the most part unrealistic and dismissive of individual experiences. No matter how much you "prepare", you never know what your personal limits or stressors may be. I also think the fact that Dara had no family around is key to her story... I've often thought that the biggest social impediment to breastfeeding is not formula advertising, lack of maternity leave, or a puritanical culture, but rather the fact that so many of us are essentially on our own - no family or close friends who can help us out in a meaningful way postpartum. Our partners have less time off than we do, so who is there to help when your baby is screaming, you're in pain, and you just can't get him to latch? Maybe if the government wants us to breastfeed so badly, they could provide paid leave for partners or free in-home baby nurses to help out. That might be more effective than the current strategy (i.e., guilt-tripping moms).

Happy Friday, fearless ones!

- The FFF

***

Like many, I desperately wanted to breastfeed. That’s what I’d planned on doing from the moment I found out I was pregnant. I made a list of everything breast-feeding related to get—everything. But I neglected to really do my research.

I suppose I never really knew how difficult it was to breastfeed. I thought it would be simple—baby’s born, he latches on and bam, simple as that. Boy was I wrong.

My son was born big—8 and a half pounds. He had a difficult time latching. Even the lactation consultant made a brief comment about it. Why wasn’t it as easy as I thought? Why couldn’t I do it? The LC showed me all the positions to try—cradle, football, etc. all the while extolling the greatness of breastfeeding.

I asked her if I could start pumping and she told me flat out “Don’t even consider it for at least six weeks. You shouldn’t need to.” What?! I could see the look on my husband’s face…he wanted to be as much a part of bonding with the baby as I was. By that time my little guy was getting hungry. He still wasn’t getting much—my milk hadn’t come in yet and he was already displaying the signs of having a large appetite.

My husband and my mom tried to help me but we couldn’t get him to latch. And when he did—the pain was almost excruciating. I was told it would be uncomfortable but not that painful. Every moment I was consumed with thinking about the next feeding and if my son would even get anything. My husband already suggested getting formula after seeing how stressed I was but I told him no.

I think the most painful part of those days in the hospital was the last day. My parents were heading back home 3 hours away and I was in tears trying to get my little guy to latch. He was screaming, I was crying, my husband was frustrated and I had to say goodbye to my parents that way. The look of pain on my mom’s face—that’s something I’ll never forget. A time that’s supposed to be happy ended up being partially ruined by the stress of getting my little guy fed.

I think the thing that irritated me the most about the whole situation was the complete lack of understanding by the LC. Looking back at it now, she definitely was not open minded to anything but breastfeeding. The fact she didn’t even want to consider me pumping for six weeks just boggles my mind. She did in the end get me a pump set that went along with the hospital pumps, which she gave to me for free because she felt bad for me for the difficulties I was having. Still, she urged me not to give up, to wait the six weeks and to keep breastfeeding even if my little guy cried for awhile. She said “It’ll get better.”

Hours later, when my husband and I were finally home, my son screamed for milk. I kept trying and trying to get him to latch and he kept pulling away. This went on for at least an hour, if not longer, as his screams became more desperate.

By this point, I just wanted him fed. I felt like I was going to have a breakdown already—and it was only the first night home! After many moments of wrestling with my guilt and having my husband convince me that our son needed fed, I opened one of the little bottles of formula the hospital gave us. My son drank the 2 oz in less than 10 minutes. Two days later, he was already eating 4 ounces of formula every 2 hours.

For days—weeks even--I was so wracked with guilt for giving up so soon. I kept asking myself, “What if I tried a little longer?” and feeling like I was weak. I mean, most moms can at least breastfeed their little ones for a few weeks—why couldn’t I?

I think that sense of guilt stayed with me for those first weeks until it finally sank in—I’m feeding my baby, he’s happy (and BIG!) and healthy. Why in the world was I beating myself up over it?

The way I see it now, I probably would’ve had to give up breastfeeding rather soon anyway. I do not think my milk production would’ve kept up with my son’s rapidly growing appetite. Who knows…maybe it would’ve but there’s no sense in playing the “what if” game anymore. Time has passed and I know I’d make the same decision again. My son is now four and a half months, slightly over 18lbs and has a full 8 oz of formula every 3 to 4 hours.

Anyway, I wholeheartedly support breastfeeding moms and have a new appreciation for the work it takes. I truly wish that there was a sense of understanding on both sides of this feeding debate (although I still don’t get why there should be one!) and maybe, just maybe, my story can help others see that it doesn’t matter whether your child is fed from the boob or the bottle—all that matters is he or she is fed and happy and that you, as the mom, have a sense of pride with whatever choice you’ve made.

***

If you feel like sharing your story, email me at formulafeeders@gmail.com, and join a community of brave women (and the occasional man) who have brought greater understanding to the breast versus bottle debate.

Formula feeding in disaster situations: Is there a dose of reality in your emegency kit?

2011-11-09T21:55:00.000-08:00

I hope there is a correlation between formula feeding and developing a good bullshit meter, because guys - you all need one to survive what's going on in the world of infant feeding.

Someone emailed me today about emergency preparedness. She was in the process of weaning, after an extremely difficult struggle with breastfeeding and an emotionally draining decision to stop the madness. There were storms where she lived, and she got to thinking that in the case of emergency, she'd need formula. So she did what any educated, concerned, modern mother would do: she googled. And instead of finding practical information on what should be in a formula feeding parent's emergency preparedness kit, she found endless supplies of breast-is-best admonishments.

Her email could not have come at a more opportune time, because later in the day, I came across a series of Tweets about a "new study" outlining the specifics of emergency preparedness for both breastfeeding and formula feeding moms. The tweets linked to articles alluding to this paper from the International Breastfeeding Journal (surprising, isn't it?), which the media presented as a "study" about how dangerous it is to be a formula fed baby in a disaster, even in a developed country.

Erm, no.

The "study" is actually a paper talking about the stuff mothers should have in stock in case of emergency. Now, it's perfectly understandable that breastfeeding is far more ideal than formula feeding in emergency situations. Formula feeding in times of disaster, especially when water and supplies are scarce, is terribly difficult. But the way that this paper presents these facts is highly offensive, as it reads like a bad joke: What do formula feeding moms need in disasters? $500 worth of gasoline, formula, bottled water, cleaning supplies, a tool kit, knife, and Davy Crockett. What do breastfeeding moms need? Diapers and wipes.

There's truth to this, of course. The abstract states that "Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants." Fair enough... I agree that it is vitally important that parents and emergency workers know how to prepare and provide safe formula to babies.

Going back to that bullshit meter, though, mine was registering a 9/10 for this "study". As early on as the introduction, the authors reveal their bias:

"In an emergency situation, infants who are exclusively breastfed have their health and well being protected by the food, water and immune factors provided by breast milk. Breastfeeding also mitigates physiological responses to stress in both infants and their mothers, helping them to cope with the stress of being caught up in an emergency situation... mothers who are exclusively breastfeeding are able to continue to provide food to their infants regardless of the stress they might be experiencing and their own access to food."

Based on WHAT? They do not cite any studies for the latter claim; as for the one about breastfeeding mitigating stress, the only citation is an e-pub by one of the same authors as this study, in a journal called "Disasters." I'll have to track it down, because I'm curious what evidence they have for this dubious statement. Frankly, knowing the trouble most American women have initiating breastfeeding successfully, I kind of doubt a mom with a 5-week-old would find breastfeeding less stressful than trying to prepare formula safely (even if she had to use a knife and liquid petroleum gas, as this paper suggests).

As for the assertion that a mom can produce adequate milk no matter if her own food supply is insufficient or if she is under extreme stress, I again cry bullshit. What about this study, which shows that stress hinders letdown? Or this one, which talks about the effect of dehydration on lactating mothers? (Let me not the scarcity of studies on maternal stores... lots of them on goats, but not so much on human females. Doesn't seem to matter if the mom drops dead from malnutrition or dehydration as long as the baby is getting enough, apparently.)

Then, the authors begin to delve into what appears to be their real agenda - discouraging formula donations, even from the formula companies themselves. They claim it's because breastfeeding moms may receive the samples and sabotage their breastfeeding abilities (okay, I will concede that point, but what about the moms who are having trouble keeping up supply for the reasons above?), and also because it might be distributed to those who don't know how to properly store and prepare it. Bullshit. If it's between a baby starving to death or taking the risk that the parents don't know you're supposed to slice the top of the formula jar with a knife cooked to 100 degrees celsius, well, I think the answer is pretty obvious. A parent will either know this stuff because the message has been adequately imparted, or they won't. Not having enough formula is not going to change that. The authors recommend that money be given to the "proper" organizations instead, who can correctly distribute the formula. No offense, but UNICEF has not impressed me with their knowledge or concern for formula feeding or non-breastfeeding Western women.

Speaking of non-breastfeeding Western women, I also wanted to know - especially in light of that Tweet about the Japan earthquake I talked about yesterday - what all of this hullabaloo was based on. The authors of this study cite a case (no citation, so I can assume this was something the authors heard word-of-mouth) from Katrina where a 3-week-old baby starved to death after being stranded on a roof with its mother and no formula. Apparently, the woman's breasts were full of milk, but "initiating breastfeeding had not occured to her."

Maybe that happened. If it did, that is horribly tragic. But we're talking about disasters. Disasters. People do not think straight. That woman was stuck on a roof with a baby. Even if she had been successfully breastfeeding, god knows what would have happened. It seems really inhumane to me to take stories like this and turn them into cautionary tales against formula feeding.

The authors claim that "(t)he purpose of this paper is to detail the supplies needed by the caregivers of breastfed and formula fed infants in an emergency situation where essential services such as electricity and clean water supplies are unavailable and to discuss some of the practicalities of caring for infants in emergencies. The amounts provided for each emergency item are based on the clinical experience of the authors’, the author’s trial of the procedures, and the manufacturer’s instructions." So again, I'm not convinced that any of this is based on actual empirical evidence, but rather assumptions and vague reasoning from people with an obvious axe to grind against formula feeding. Bullshit.

As for practical advice on what should be in your own emergency preparedness kit, I'll work on it, peeps. Besides the normal emergency stuff (tons of bottled water, etc) I personally have a week's worth of bottles of RTF formula, a few packs of disposable bottle liners and the bottles you use with them (you know, from that company that rhymes with Shmaytex), and about 10 nipples. I also have antibacterial wipes, in spades. That's probably not the safest way to go about things, so I will look into the realities of what this paper recommends. Somehow, I don't think it would cost $550 Australian dollars (about $569 USD) to ensure a formula fed baby's safety for a week. But I'll have to look at it more closely, because I seriously know nothing about disaster prep.

Until then, I'd be more concerned with honing your bullshit meter than worrying about a natural disaster. Statistically, it's a fair assumption that you'll be needing the former way more than the latter.

The tale of the asshat pediatric GI

2011-11-08T22:47:00.000-08:00

Recently, the Academy of Breastfeeding Medicine held their annual conference. I followed the Twitter stream from the conference, and some of the soundbytes coming out of there were frightening, even more so because they were coming from the mouths of medical professionals. One speaker was quoted in numerous tweets for spouting this lovely tidbit: "I don't say, 'breastfeeding is so protective for mothers.' I say, 'Formula feeding is so dangerous.'" This came from a woman whose CV mentions an interest in the "responses of women to life stressors such as trauma." Sounds about right; she can traumatize them with comments like that, and then study them to see the effect.

My main problem with this conference is that I think calling it the Academy of Breastfeeding MEDICINE is misleading. If it's the Academy of Breastfeeding Medicine, let's talk medicine. Presentations like "The Dermatology of the Breast" and " Exclusively Human DIET (EHD) for Infants <1250 grams to Prevent Nectrotizing Enterocolitis (NEC)" sound perfectly suited to this event; "Effect of Delaying the Bath on Exclusive Breastfeeding Rates" and " A Report from Japan: What We Learned from the 3.11 Disaster"? Not so much.

Okay, quick irrelevant aside, because I just can't let it go. According to the abstract, the "findings" of the latter report were:

The myth that the artificial milk was safe collapsed in the developed country such as Japan. Though the information that indicated the safety of breastfeeding at the time of a disaster was easily accepted, the assertion to be said not to receive liquid milk donated from foreign countries was hard to be understood not only by general public but journalists. The problem about nuclear accidents is now going on.

Maybe it's a language barrier, but isn't this stating that that the public and journalists were pissed off that UNICEF was discouraging formula donations - ready-to-feed formula donations, to be specific? Did they not see why people would be pissed? (And yes, I know the reasons why UNICEF has it's protocol for infant feeding in disasters; I'm on the fence about it, actually. But it isn't a totally black and white issue, either.) Am I reading too much into this abstract and the tweets coming from its presentation if I say these folks sounded mighty gleeful that the disaster "collapsed the myth" that formula was safe?

Anyway. Back to the reason this makes me so uppity... I worry that by morphing together breastfeeding advocacy and breastfeeding science, we are coloring the judgment of those who should be treating us on a case-by-case, individual basis.

And speaking of case-by-case, here's a case in point. A little story about the FFF in my Fear-ful days, when I was a brand new mom; a floundering mess with a child who wouldn't stop crying and a pump which wouldn't stop screaming "YOUSUCKYOUSUCKYOUSUCK" every time I turned the blasted thing on.

Fearless Child had been miserable pretty much since the 4th hour of his life. First, he'd been starving; once we realized he'd never latch and resorted to exclusive pumping, he gained weight fast, but he never seemed healthy. He had a weird rash all over, never slept, screamed before, during and after feedings, and had mucous-filled diarrhea about 15 times a day. My doctor suggested cutting out milk, soy and nuts; I did so for two weeks, to no avail (actually, I'm about 90% vegan to start with, so there was little dairy in my diet to begin with. Soy was a lot harder for me to cut out.). The third or fourth time I visited our pediatrician about FC's stomach issues, she looked at the poor little guy, still screaming his rashy head off; felt his tight, gurgly abdomen; and suggested that we see a pediatric gastroenterologist. As she wrote down the contact info for the referral, she told me she’d also give me a sample of a special, hypoallergenic formula, to try in the interim. “The guy we refer to will probably have you try this for 48 hours to see if there’s a difference, rather than putting FC through a lot of invasive testing. You might as well try it out while you’re waiting for an appointment – no need for him to suffer any more than he already has, and it’s worth a shot.”

Within twenty-four hours, we pretty much already had our diagnosis. The hypoallergenic formula stunk to high heaven, but FC lapped it up like it was chocolate milk. And after he finished the first bottle of the special formula, he slept for a record four hours. That night, although he still fussed a bit, like normal babies do, Fearless Husband and I were able to sit down and eat dinner for the first time in weeks. FC let us put him in his swing – practically unused, up until this point – and he stared up at the attached mobile, eyes clear and wide. We knew better than to declare victory. Instead, we held our breath and hoped, hoped, hoped.

We came close to cancelling our appointment with the specialist many times in the following week. FC was an entirely different baby, a smelly-and-expensive-formula-induced changeling. I began realizing why people would actually choose to be parents. It was kind of fun when the kid wasn’t miserable and wailing twenty-four hours a day. His rash cleared up and his diapers no longer scared us. It seemed that we had our answer, and it came in a purple can with a $30 per week price tag.

Still, we figured it couldn’t hurt to get a definitive diagnosis so we would know what the future held. What happened to dairy and soy intolerant kids when they were weaned off formula – were they sentenced to a life of rice milk and birthday cake deprivation?

After a two-hour wait, we were taken into a small room where FC was weighed and measured. It appeared that in the week since we’d seen the pediatrician, he had apparently shrunk an inch. When we asked the nurse about this, she just shrugged her shoulders and said that measurements could be off between offices.

A few moments later, a young woman entered the room and introduced herself as the doctor’s resident. She spent a half-an-hour obtaining a ridiculously detailed history of our son and his feeding issues, stopping several times to excitedly tell us that this was “classic” milk/soy protein intolerance behavior. FC even added his two cents to the discussion in the form of a dirty diaper, which the resident encouraged us to hold onto for testing. Considering we’d been on the hypoallergenic formula for a week, and his system was free and clear of all offending foods, she wasn’t sure this would be an accurate diagnostic tool, but she wanted to doctor to have the option.

By the end of this warm-up act, we were even more geared up and anxious to hear from the illustrious doctor himself. The resident seemed pretty enthusiastic, too – she told us that it was clear our pediatrician had diagnosed this correctly, but she wanted the doctor to confirm and explain the condition to us in detail. She left the room to go over her notes with him, and promised to return, doctor in tow, in a few minutes.

My memory of what happened next is fuzzy. I know the doctor came into the room, and proceeded to school us on Baby Basics 101. He referred to what FC had as “colic”, suggesting that I “call my mom to come help me out if it’s too much for me”; when we explained we had no family in the area, he blithely quipped that we should “just hire someone.” (We could barely afford FC’s formula at this point, let alone a caregiver for a newborn.) He refused to even look at the detailed history the resident had taken (she stood behind him, mouth agape, and sending apologetic glances in our direction); he threw out the diaper we’d kept for his inspection without even looking at its contents. I remember pleading our case, trying to get a logical answer as to why FC had rashes and mucousy diapers for so long, and recovered so remarkably once he was switched to hypoallergenic formula. “The peak of colic is about 6 weeks,” he responded, a condescending smile never budging from his lips. “It was probably just good timing.”

“So you’re saying that he went from a screaming, rashy mess to a calm, happy baby in one day by chance? And it had nothing to do with switching him to hypoallergenic formula?” I asked, the anger churning in my belly so powerfully that I probably needed my own visit with a gastroenterologist.

“Yes, that’s what I’m saying,” Everything out of his mouth sounded syrupy sweet, between his velvety accented English, and the icy smile that capped every sentence.

“You don’t even want to look at the history we just spent 30 minutes rehashing?” Fearless Husband piped in. The doctor shrugged his shoulders and opened the folder containing the resident’s careful, thorough notes. He scanned the first page – simply detailing FC’s height and weight stats – and conceded that there could indeed be a problem, although not the one we suspected.

“You’re overfeeding him,” he proclaimed. “He’s overweight. He’s in the seventy-fifth percentile for weight, but his height-to-weight percentile is closer to the ninety-fifth. Do you know what that means? Only 5% of babies his height are fatter than him.”

“I think your nurse may have mismeasured him, actually,” my husband muttered. We both knew this was a lost cause. It was no use suggesting that FC may have been comfort eating for the entire time he was on pumped milk – a pattern that had ceased as soon as we’d switched to the hypoallergenic. Or that the poor kid had been growth restricted in the womb, and probably had been making up for lost time (or food, in this case) now that he was able.

Then came the kicker. “It’s a real shame you gave up on breastfeeding,” the doctor sighed. “It’s best for the baby, and so much easier on their stomachs.”

Next to me, I could feel my husband’s entire body tensing up. “That’s funny,” my husband retorted, coldly. “He was the most miserable on her breastmilk. And as we’ve tried to tell you about five different times, now that he’s on hypoallergenic formula, he’s doing great. I’m not sure what you don’t understand about that.”

“Well, I can only tell you what I think,” said the doctor, snapping the file closed.

Three years later, I can only tell you what I think. I think that guy was an asshat. But beyond that, I think this experience was what provoked me to start this blog, more than any mommy-war drama, more than any study I've seen misrepresented in the news. It was seeing how a doctor could immediately dismiss you, immediately judge you, simply because they were married to the party line regarding breastfeeding.

And unfortunately, if the tweets from the ABM conference are any indication, there is an awful lot of dismissive judgment going on in the medical field. Unless you're an exclusively breastfeeding, educated, white, middle-to-upper-class mother; then you'll be given a gold star.

FFF Friday: "This time, the choice will be mine."

2011-11-04T09:47:00.000-07:00

This submission comes from Lynne, one of the admins for the wonderful Bottle Babies group, and a long-time contributor to the FFF community. I know I usually write an introduction about the themes that appear in these entries, but Lynne's story kind of defies categorization. If anything, I think it just reiterates our ongoing discussion about how the "breast is best/breast is normal" meme can be just plain WRONG in certain cases. But more importantly, this meme ignores the fact that even when it isn't best, or normal, many mothers still want to do it. We need to stop pushing breastfeeding and instead, focus on helping women like Lynne achieve their goals in a sensitive, individualized, and positive way.

***

Hi, I’m Lynne and I’m a survivor of childhood sexual abuse. On my good days, I focus on the “survivor” part. I did survive, I’m still here, and that’s what matters. On my bad days, I feel like that should sound like “Hi, I’m Lynne? I’m a survivor of childhood sexual abuse? Is that, like, ok? Sorry? Um....” Because on those days, I feel like I wear it on my forehead, and everyone can see the scared little girl instead of the strong, grown-up woman.

So what has this got to do with breastfeeding, you may ask? The answer is: LOTS. Fully deserving of the capitals. I could cite studies (including ones by the almighty research goddess Cheryl Tatano Beck) on the detrimental effect a history of abuse has on not just breastfeeding, but labour and birth too. I could give you statistics, I could bore you to tears with the psychology of it all. But I won’t do that. I’ll talk about me, and MY story. It’s also my daughter’s story, and my husband’s story, and the partially untold story of the baby who is due in March next year. But first and foremost, it’s my story.

I’ve had negative associations with my breasts since the moment they appeared. Because the moment they appeared, they were abused. I was abused. But lots of it focused on my (as yet) fairly undeveloped breasts. I hated them. I blamed them. If they hadn’t grown so quickly, they wouldn’t have attracted him. It was THEIR fault, those irritating, painful, obvious signs of impending womanhood. And they hurt. All the time. Oh yes, growing breast tissue does hurt, tenderness is something a lot of girls live with. Mine were bruised. And bitten. And scratched. My breasts were the hidden, yet unhidden sign of everything that was wrong with my world.

Fast forward 10 years (from the time that it stopped – I was 16 when I finally said “Don’t” and to my utter shock, that was all it took). I was 26 and expecting a very unexpected baby girl. Hubby and I had been told we needed ICSI to conceive. Imagine our surprise when, 5 days after filling out all the forms and making all the decisions about how many embryos we’d transfer, I have a positive pregnancy test. It’s a miracle!

A few friends of mine had recently had babies. They’d talked about breastfeeding (or not breastfeeding), and I didn’t really get it. What’s the fuss? Why are you going on about it? What does it matter? Having not yet delved into the murky world of the online parenting community, I lived in blissful ignorance of the BF vs FF debate.

Then I had my first midwife appointment. I was 6 weeks pregnant. And the “Breast is best (aka breast is The One True Way)” message started. DVDs, check. Books, check. Leaflets on breastfeeding, check. List of pros and cons of breastfeeding and formula feeding given, check (that’d be all the pros of breast and all the cons of formula, and nothing mentioned of the cons of breast or the pros of formula). There was a checklist in my maternity notes which had little sections for the midwife to sign, to say that she had imparted all of the knowledge about how amazing breastfeeding is. And I drank it all in. Sure, I would breastfeed. Why wouldn’t I? Still didn’t get what the big deal was, but yeah, I’d breastfeed. Oh, did I mention that I was abused as a child and suffer from ongoing Post Traumatic Stress Disorder as a result? It’s in my notes? Fab. Yes, I heard you say that breastfeeding has so many benefits... Never again did a single healthcare professional involved in my care mention that part of my notes. I didn’t bring it up. Why would I? How could I associate something so terrible with this amazing miracle growing inside me?

Fast forward 8 months (roughly). I’d planned a calm, peaceful hypnobirth. The calm bubble lasted until I was flat on my back on a bed in hospital, with someone sticking their fingers up me. Imagine my calm bubble turning to glass, and shattering. Things went downhill from there. Roo turned back to back. Her cord began to prolapsed and the resulting compression with every contraction led to her being in distress. I ended up with an epidural and ventouse delivery. But hey, baby was here and healthy, so that’s all that’s important, right? (It never ceases to irritate me how a woman’s feelings about her birth can be completely ignored as long as the baby is alright in the end). I wanted to try and breastfeed right away. But my midwife was busy writing up her notes, and was too busy to help. I’d be able to feed her on the post-natal ward, apparently. OK, midwives know best...

So, down to the ward. It’s 4am, 2 and a half hours after Roo was born. I explain I want to breastfeed, and midwife says “OK”, grabs my breast and my baby’s head, and applies baby to boob. Yowser. That feels uncomfortable. And I feel weird, because in general, people don’t just grab your breasts. But, hey, look, baby is feeding. Yay.

I didn’t sleep at all that night. Or the next night. I occasionally managed to get baby latched on myself, but it was ALWAYS sore. I would buzz for help, and generally got an irritated auxiliary nurse asking what I wanted, then tutting and going to get a midwife when I said I needed help latching her. Oh yes, we don’t have lactation consultants in the UK. Any breastfeeding counsellors don’t work weekends either. So it was midwives or nothing. Come Sunday night, I was exhausted, traumatised, and sobbing because I wanted to just go home and sleep. A midwife tells me I can sign myself out, but leaving hospital too early is one of the most common reasons for breastfeeding to fail, and “You don’t want to be a failure, do you?” I can’t tell you how long those words haunted me.

Hubby and I decided we were going home. And the agony of feeding (psychological and physical) continued. My milk came in with a vengeance, and I was so engorged that poor baby was bouncing off as she tried (badly) to latch. Even just moving my breasts caused pain, and suddenly I was a teenager again. I had to somehow find the words to explain how much I hate the feeling of my breasts being touched. I had flashbacks. I was in pieces. By 3am on Wednesday morning, I was sobbing, baby was screaming, and my husband was just about crying with frustration himself. I don’t remember who eventually said to get the carton of formula. But what I do know is that for the first time, I could feed my child without wanting to hurl her to the floor. The sense of relief was absolutely indescribable.

At least, until a breastfeeding counsellor came along to my next home visit with the midwife. She was brought into my house uninvited, with no explanation of who she was. I said that in desperation we’d given formula that morning, as Roo wasn’t latching properly and I was in bits. The disapproval in the room could’ve been used to make ice, the atmosphere got that chilly. I couldn’t say to these stone-faced women that actually, I was really struggling with feelings about my childhood abuse which I’d thought were long-resolved. That somehow, labour and breastfeeding were leaving me feeling just as violated as I did when I was a child.

The breastfeeding counsellor sat with me for hours. But baby didn’t want to feed, she was full and happy, thanks very much. I sat, and this woman pinched and tickled baby’s feet to try and make her wake up and feed (to check the latch, of course). I hand-expressed drops of milk into baby’s mouth. She wasn’t having any of it. Eventually, the woman left with the parting shot that if baby hadn’t fed by X o’clock, I needed to take her to A&E. Obviously the formula may have damaged her tiny, fragile tummy.

Out of sheer guilt, I tried one more feed. I didn’t know that would be the last one, but I’m glad it was. From that point on, my daughter was formula fed. There was a brief period about 8 weeks later when I had full-on Mummy-guilt, bought an expensive breast pump with my saved-up store points, and tried to re-lactate. I took fenugreek and blessed thistle. I scoured the internet for tips. I bought nipple shields to see if it would help. But baby had other ideas. Why go back to that scary, maple-syrup-smelling squishy thing, when that lovely bottle gave her all she needed? Nuh-uh, no way. So I expressed until it became apparent that it wasn’t working. I grew to hate the pump. I felt like I wasn’t spending any time with my child, as I was pumping so often. In the end, I chose to enjoy my baby, take solace in the fact that myself and my husband were both formula-fed with no obvious ill-effects (darn that anecdotal evidence!) and sold the breast pump.

That baby is now 2 years old, and one of the brightest, happiest, healthiest children I know. Far from being obese, she is absolutely tiny, in both height and weight. I know she loves me (because she tells me so!) and she’s obviously not fussed about what was in her bottles! So I now take my cues from her. She is happy, I am happy.

I hope to breastfeed my next baby, who is due in March 2012. Another unexpected miracle (we’re not doing badly for an infertile couple, eh?). But this time, no tears over spilt milk. The first time around, breastfeeding became something else he took from me. This time, I’m going in with the attitude of forewarned is forearmed, and my eyes are wide open. This time, my breasts are mine. This time, (barring unexpected complications) the choice will be mine.

***

FFF Friday S-bmissions: What's missing is "u". ;) Email your story to formulafeeders@gmail.com.

Formula Feeding and Reflux: Regurgitating the basics, FFF-style

2011-11-01T22:54:00.000-07:00

Let me tell you a little something about infant reflux: it blows chunks.

My second child, Fearlette, had severe GERD and delayed gastric emptying. It was so awful that my husband used to go around singing "Buh-lemic baby/she's a buh-lemic baby/startin' em young, here in sunny C.A....yeah, he's inappropriate, but I love him).

For awhile, we thought it was "normal". Most babies have some form of mild reflux, and spit up quite a bit. This is because the lower esophageal sphincter, or LES (a little ring of muscles which opens and closes, allowing food in - and in the case of reflux, back out - of the stomach) is immature, and weak, like most of my ex-boyfriends. In some babies, the LES is really underdeveloped, or doesn't mature fast enough. That's still within the realm of normal (i.e., just a laundry problem). What isn't normal is if your baby is visibly uncomfortable - gulping or choking during or after feedings, crying before/after burps, refusing to eat - or is not gaining adequate weight. Also, amounts matter: take a tablespoon of formula and spill it on your counter. Does this look like what is spewing out of your kid's mouth every hour? That's considered "normal" (seriously...whoever decided this was "normal" needs to come shampoo my carpets...). If your baby is throwing up a lot more than that per feeding, or if the spit-up is "projectile" (i.e., shooting across the room), then this also may suggest a problem which requires treatment.

If you have a "happy spitter", and that happy spitter is gaining weight sufficiently, you kind of just have to wait it out. Usually, things get better for kids like that once they start eating solids. (I'd suggest signing up for as many formula coupon resources as possible, because otherwise every time your kid spits up you're going to see dollar signs. I think watching my daughter vomit entire bottles worth of 30 bucks a can hypoallergenic formula caused me more pain than her reflux ever did to her.) You'll probably drive yourself nuts switching formulas, when chances are that nothing will help. However, I also am a strong believer in mommy-gut, and if you feel in your heart that your baby's propensity for geyser-like streams of warm formula could be better handled, then seek help. There are a lot of myths surrounding infant reflux (and infant feeding in general), and if your baby doesn't seem well, it's important not to fall victim to those myths.

Onward.

Pretty much every internet resource for reflux will start off by saying you should be breastfeeding. Breastfed kids apparently get less reflux, which is weird, considering how many posts about reflux I see on Kellymom and Mothering.com from breastfeeding moms... but whatever. Anecdotal evidence aside, it's the accepted first line of defense against reflux. So who cares about formula? No matter which kind you use, it's a lost cause. You already screwed it all up, lady.

In all seriousness...true reflux is a physiological issue, and while breastfeeding may prevent the harmless spit up caused by improper bottle technique (things like overfeeding, nipples with too fast a flow, etc.), the fact is that liquid is liquid. If the LES is underdeveloped, it will allow food to come back up - and it won't really matter if that food is breastmilk or formula. Now, some studies have shown that the severity of the reflux episodes are lessened in breastfed babies - this one even posits a pretty plausible theory that this is due to breastmilk digesting more quickly than formula (as a side note, though, another study states that extensively hydrolyzed whey protein formulas provide similar benefits in that they lead to quicker gastric emptying, which is related to reflux). Regardless, though, the fact remains that breastfed babies get reflux too - and your formula feeding did not "cause" your child to have an under-developed sphincter.

Now that we've gotten you over that little guilt roadblock, let's talk about which formula and bottle to use.

That was a joke.

There is no one-size-fits-all magic bottle and type of formula for reflux. Sure, there are formulas marketed for reflux - these are just normal, milk-based formulas with rice starch added as a thickener. You can also just add your own thickener (on your pediatrician's recommendation, of course); this allows you to adjust the thickness of the formula and also use a thickener which works for you. You don't have to use white rice, necessarily - some people use oatmeal, whole grain cereal, Simply Thick, etc. But again, PLEASE ask your doctor first. Adding cereal to a bottle is not a good idea unless it's done in a controlled way (and if you have a premature infant, it can be incredibly dangerous if not done under the auspices of a physician). Why? Because while thickened feeds have been proven helpful, they can actually make reflux worse. As this article courtesy of Gaining & Growing states,

...(R)espiratory symptoms associated with GER may be worsened by the addition of cereal to infant bottles. Orenstein et al. (1992) found increased cough in infants with respiratory disease who were given thickened feedings. The addition of cereal to formula feedings may decrease gastric emptying time and actually increase episodes of reflux and aspiration.

And, according to this report from Pediatric Nursing:

Rice cereal used as a thickener increases the caloric density of formula and may cause constipation. Thickened formulas also require enlarged nipple holes to feed, potentially resulting in greater ingestion of air or formula, which can favor regurgitation. Because rice cereal- thickened feedings have 150% of the caloric density of un-thickened feedings, only 65% of the volume needs to be fed per meal; thereby decreasing gastric volume (Orenstein, 2001).

Adding thickener to formula also necessitates finding a nipple which allows the thickened feed to come through without your poor kid having to suck with all his might, or choke because it's coming through too quickly. This is much harder than it seems, because while most bottle companies offer a cross-cut or y-cut nipple for thickened feeds, some work better than others. The bottles we'd invested in for Fearlette didn't make a nipple for thicker liquids, and after mutilating- erm, I mean modifying - a slew of normal nipples after reading online that you can "just widen the hole yourself, we broke down and bought a whole new system. For what it's worth, we found that the Avent variable-flow nipples worked perfectly - these are actually "slit-cut" (sounds creepy, but whatever), and even the thickest feeds seem to come through just fine. There is a good discussions of this topic here.

Another thing to consider is that reflux might be related to a food intolerance or allergy. Nearly half of all infants with GERD detailed in a 2002 review article had a milk protein intolerance - and in fact, the milk intolerance was provoking the reflux in some of those cases. This was true in both breastfed and formula fed babies. This is where it gets complicated, because if reflux is being exacerbated by other GI issues, it may help to move to a specialty formula. I always recommend a 24-48 hour hypoallergenic "challenge" rather than engaging in invasive testing right off the bat for any suspicion of formula-related GI issues. The way you do this is to buy one or two bottles of a quart-sized ready-to-feed hypoallergenic at the drugstore or grocery store (there are only two on the market in the US - Similac Alimentum and Enfamil Nutramigen), and try them for 1-2 days. Do not give your baby anything but this special formula, otherwise it complicates the "test". If you see a marked improvement, you have your answer. At this point, if you want to engage in further medical testing to get a definitive diagnosis, you can go ahead and do so.... just be warned that it's REALLY hard to get a definitive diagnosis of a milk allergy in an infant, unless your kid is one of the rare ones who will test positive on a skin-prick test. Milk allergies are weird, and some experts aren't even sure if they involve the same reactions as other allergies or are their own separate animal. Not to mention that a severe milk intolerance will often exhibit the same types of symptoms, even though it isn't a true allergy. See? Told you it was confusing.

As for bottles... during my time perusing the internet, I discovered that Dr. Brown's and Born Free are the winners in reflux circles. They certainly are great bottles (albeit horrible to clean) and are designed to keep your baby from swallowing too much air, gulping too fast, and so forth. I really do feel that bottles are like relationships - what works for you may not work for me. I go for funny, sarcastic and artistic men, you might like confident, athletic, professional men/women. We all have our preferences. Same with bottles. I have yet to find a study that looks at the relationship between brand or type of bottle and reflux, so I can't really give much advice on this. I'm honestly not sure it matters - again, if we're talking true reflux here, as long as that liquid is going in, it's gonna come out.

However, there are some mechanical things that make a difference. Feeding your baby at a slight angle - NOT sitting up at a 90 degree angle, as that can make things worse; keeping her upright after a feeding so that the gravity will help keep the liquid down (slings and infant carriers come in handy for this); burping at regular intervals (we would do it after every ounce or two in the beginning, when things were really bad... it never did seem to help, but every medical resource says to do this, so I felt I should mention it). Basically, all just basic good bottle feeding techniques, except for having to keep your baby upright and immobile after feedings. That part sucks. Young babies often fall asleep during feedings, and older babies want to play. Both scenarios pose challenges. That's why the sling works so well - for younger babies, they can sleep while held at least kind of upright; for older babies, you can keep them upright and somewhat immobile yet still engaged.

I know it all sounds confusing, and it is. As I said before, infant reflux really blows. But the good news is, almost all babies grow out of infant GERD before their first birthday. Although it will probably take a bit of trial and error, I promise you - with the help of a good pediatric GI and some experimentation, you will be able to make your own Bulemic Baby much more comfortable.

FFF Friday: "Losing my sanity was not something I could afford..."

2011-10-28T10:09:00.000-07:00

Wow. After my plea for entries last week, I got a slew of incredible stories delivered to my inbox. (In related news: You guys ROCK.) One of these amazing submissions was Chelsea Allen's. I always appreciate hearing stories about the psychological impediments to breastfeeding, because these are as real and valid as the physical ones - and seldom understood. Body-image issues, anxiety disorders, PPD... all of these things can be that proverbial straw that breaks the breastfeeding camel's back (a breastfeeding camel. Now THAT would be a cool sight...). The more these stories are shared, the less alone the next mother who is suffering through something similar will feel. I'm humbled by Chelsea's willingness to share her very raw feelings with me, and with all of us.

Happy Friday, fearless ones.

- The FFF

***

I have two little boys. With my oldest, I never tried to breastfeed him because I had huge fears of nursing him in public because of my weight and breast size. I had some major self esteem issues going on with my body and just didn't want to torture myself. When I got pregnant with my second born, I decided I would try to get over those fears and breastfeed him because well...breast is best right? I educated myself very thoroughly. Went to classes about breastfeeding, read and read about it, how to latch the baby properly etc etc. When it finally came time to nurse my baby, I demanded he be brought to me immediately so I could have the skin to skin contact that was so important and try to latch him. He flat out refused! So I tried again a little bit later and finally I got him on with the help of the nurses. He nursed for a good 20 minutes, which the nurses said was wonderful. However, I was a nervous wreck! I suffer from extreme anxiety anyways but when he was nursing I was having a hard time breathing, I became covered in sweat, my heart started racing and I just...I dunno I was shaking very badly. I pushed it aside though and tried to continue nursing him. While I was in the hospital, I had the nurses in there every time it was feeding time to help support and encourage me because I literally had these anxiety attacks every time it was horrible!

When we got home the anxiety attacks only got stronger. I was by myself without the nurses and had an older child the required attention at well. My anxiety was through the roof, even when I wasn't nursing him. What didn't help was that he was literally wanting to nurse every half hour, for a good 25 minutes each time. Getting comfortable was also impossible, which stressed me out even more and because I was stressed, my son was too. He cried and screamed and would get so upset he wouldn't latch for the longest time. I went through five days of this and it was turning me into a monster, towards my significant other and other little one. I began to resent my baby, didn't feel like I was bonding with him at all. My significant other finally was like, Chelsea, you need to just give him the bottle. Put him on formula, he said. I felt like the biggest failure. Yet, the moment when I gave him that bottle it was like...a whole new world for us. It felt like the sun was finally shining. After having anxiety attacks like I was, I was finally able to relax and just enjoy my baby. I suffered from a bad case of PPD though and it was a struggle for me to get back on my feet, and still to this day I struggle with it (although its under control).

If I ever have baby number three, I will never ever try to breastfeed again. It was one of the worst experiences of my life and I will never put myself or my baby through that again. When I tell people my story, they have a hard time believing it. Saying awful things like "You should have just dealt with it instead of giving up." Yea maybe I should but I had another child to worry about and losing my sanity was not something I could afford to lose. And resenting my baby was also the worse feeling ever. I wanted to love and bond with him, not look at him with disgust and resentment.

It's taken me several months to get over my failure and now I don't let those people get me down. I made the best choice for my baby and myself.

***

Inspired to share your story? Good, then. Send it along to formulafeeders@gmail.com.

Breastfeeding is worth it

2011-10-26T10:42:00.000-07:00

The lovely Ashley Poland over at Domestic Chaos recently mentioned this blog as "a good resource for mothers." This was incredibly sweet of her, especially considering that Ashley is a (wonderful, positive) breastfeeding advocate. In her description of FFF, she also admits that "it's hard sometimes to read the entries. As someone who would love to see more people interesting in and trying breastfeeding, I occasionally interpret the attitude is Breastfeeding is useless."

This comment stopped me in my tracks. If this was someone who just performed a cursory reading of the blog, it would be one thing. But Ashley is a loyal reader, one with an incredible level of intelligence, sensitivity, and self-awareness. If she is getting that impression, then I think it's safe to say that I am (however unintentionally) giving that impression.

I spend my days attempting to prove that formula feeding is a safe option for parents, that the claims about breastfeeding are often misinterpreted, and that our ideas about infant feeding are (unconsciously or consciously) stuck in the mire of nostalgic, and ultimately limiting, ideas about women and motherhood. I care most about women who've been abused by the system, and harmed by the breastfeeding rhetoric, having those precious first day/weeks/months of motherhood stolen from them by a tornado of judgment, fear and expectation. I don't really care about promoting breastfeeding, because I feel like that's being done - and done to such an extent that it's harming parents and sometimes even children, and allowing our society to put responsibility for the health of the nation onto the already overloaded shoulders of women.

But do I think that breastfeeding is useless? Hell no.

Actually, I would tell any prospective mother who is on the fence about how to feed her child to give breastfeeding a fair, educated, eyes-wide-open, and optimistic shot. Because all things being equal, formula feeding SUCKS. It's inconvenient. It's messy. It's expensive. It's confusing. And choosing to formula feed pretty much guarantees you a lifetime of explaining yourself; feeling judged; and questioning your dedication to motherhood (not that I condone any of these things - they are exactly what I'm trying to destroy through this blog - but this is the reality, at least for now).

I was thinking about this the other day, as a few of my good friends are adding solids to their breastfeeding babes' diets. One mentioned how inconvenient and annoying solids could be - remembering to bring food along on outings, etc. I was confused for a minute, until I realized that duh, this woman was used to being able to walk out the door anytime and have food readily available for her son. As long as she was there, he could be fed. Awesome. Who in her right mind would chose a path requiring sticky, expensive powder, and a feeding method which requires bottle-washing, wondering about the right kinds of water, comparison shopping and trying a zillion formulas and bottles before finding the right one for your kid - when the other choice simply requires holding a warm, delicious baby near your naked chest? All things being equal, breastfeeding is not useless; breastfeeding is by far the easier, more rewarding choice.

But all things are not equal, for many women. The reason I feel so strongly about protecting formula as a choice is because I feel so strongly that breastfeeding rocks. If someone either actively chooses to formula feed, or ends up formula feeding due to extenuating circumstances, then there is a reason that they are doing so. These reasons are not mine to judge, nor are they anyone's (especially the clerk at the grocery store, your pediatrician, or random snarkettes on the interwebz). That said, I operate under the assumption that mothers (and prospective mothers) are well aware of the benefits and advantages of breastfeeding. If they don't know the beauty and satisfaction that it provides, that is sad; I hope that breastfeeding advocates can take a hint from that, and perhaps stop harping on about the dangers of formula (a tactic that doesn't really work, if our long-term breastfeeding rates are any indication) and begin extolling the positive, empowering, enjoyable aspects of the act.

Since anyone with an internet connection (i.e., anyone with the ability to read this blog) knows why they should be breastfeeding, I think it stands to reason that if they aren't, there's a pretty damn good reason. Now, that reason may be something seemingly trivial, like a fear of not being able to return to eating nothing but SlimFast and Diet Coke. But for a recovering anorexic? That's a pretty significant fear. I'd much rather they formula feed than force themselves into a psychological mind-fark. Or what about the woman who has to go back to work 3 weeks after giving birth? She might not want to sludge through the inevitable 6-week "learning curve" for breastfeeding (and there is one, for most women. I think coming clean about the realities would help keep women breastfeeding, rather than scare them off it. I had one friend who pushed through 2 months of exclusive pumping and futile attempts to nurse, but who ultimately succeeded in having a beautiful nursing relationship with her son. She also had tremendous support from friends who had similar struggles, and were open about it, and this is what helped push her through), but rather enjoy the short time she has with her baby. These are the choices women make, and the ones they should be respected for making, because they are making them in the context of the formula feeding is risky/breastfeeding makes you a perfect mother meme. You better believe that these women had good reason to choose what they chose.

Make no mistake: breastfeeding is not "useless". Breastfeeding is incredible. I just want breastfeeding to be promoted without stooping to overstated scare tactics, or relying on poor science. In fact, I don't think we should promote breastfeeding for it's "health benefits" at all. We've all gotten the message. It's turned into something we have to do, rather than want to do, and that makes me sad. I know too many women who love breastfeeding to believe that it has to be treated like going to the dentist.

Make no mistake: breastfeeding can be easy, and instantly gratifying. I just want breastfeeding researchers and care providers to look beyond their own experience, listen to what women are saying, and react accordingly. Women are not lying about insufficient supply, latching issues, pain, and allergic reactions to human milk. If we stop living in denial and do proper R&D into these problems, perhaps we could help women work through them without too much emotional duress on their parts (because no new mother needs additional stress, in the world we live in. A world, incidentally, which is in no way similar to many of the environments used to back up the "natural", "instinctive" nature of breastfeeding... there is such a thing as social evolution).

I hope that we can do these things, because make no mistake: breastfeeding is worth it. But so is a mother's sanity, health, and sense of autonomy. One does not supersede or cancel-out the other.