Last month, I received a PM from a woman named Sarah. She wrote:
“It is hard to describe how depressed and lost one feels when someone takes it upon themselves to remind you of how exclusive breastfeeding halves the risk of SIDS, when they know you will be formula feeding. And when you tell them you don’t have a choice they just keep reiterating. As though you are choosing to kill your baby willfully and wantonly. And you start to doubt if you should even be a mother at all if you can’t breastfeed exclusively. It’s a lonely place.”
My heart broke for her. She was expecting her baby in the next few weeks, and I hoped against hope that when he or she arrived, all this self-doubt would wash away.
And then, yesterday, she sent another message. She agreed to let me share it as an FFF Friday of sorts, even though that wasn’t her intent. I share this not to scare anyone who is currently expecting, because when Baby Friendly is done right, it can be a really positive experience. I share this to show that when Baby Friendly is done wrong, it’s done very wrong, and we can’t allow the good to overshadow the bad. It doesn’t matter that 20 women have a good experience if 5 are put through this kind of hell, because this kind of hell is inexcusable. End of story. And if anyone thinks what Sarah went through is acceptable, I doubt their opinions are malleable or their empathy is intact, so there’s no real reason to debate about it.
Happy Friday, fearless ones.
** Please note – the names of everyone involved in this story have been changed, and the author refers to her baby as “they” rather than her or him to protect the child’s identity as well. Just so you don’t think she had twins! : ) **
My baby, R, was two weeks old at 9.31pm two nights ago. Yesterday I lay next to them on our bed, watching them sleep and kissing their teeny tiny face, their squishy belly, their downy head and relishing them. I am still getting to know them, and our bond is still slowly growing as each day passes. Formula is largely responsible for being able to connect with them like this.
I would like to tell you about my experience so far of motherhood and feeding my baby while it remains fresh in my mind, because formula is at the centre of my story; formula and my breasts, and the both truly negligent and outstanding care I received – all within the same hospital.
There’s background to how feeding and by association, attachment, has gone down for me. I have a difficult history around fertility and mental health. I had two traumatic miscarriages before this baby was conceived, and their conception happened after painful, invasive fertility testing. A lot of emotions rode on the creation of their new life, and my pregnancy with them felt heavy every day with fear of loss. I found it difficult to connect with them as they grew inside me, and sought counselling to help me do so.
I also have mental health issues that I take daily medication to treat; medication that, while it does an excellent job at keeping me functional and well, passes into breast-milk, with unknown long term consequences for breastfed babies (not enough studies have been done, and even short term studies are limited in number and scope). Women who take these medications are generally advised to limit breastfeeding or use formula, though that information varies depending on who you talk to. The idea that breast-milk is the elixir of life weighs heavily in the “risk vs benefit” equation which means I’ve been told by some doctors that breastfeeding would be “worth it”.
After months of discussion with my husband (who has always maintained that breastfeeding or using formula was ultimately an issue of bodily autonomy and thus, my choice – I highly recommend being married to a feminist) I decided I wanted to breastfeed a little bit after our baby was born, but mostly use formula and let my supply dwindle naturally. This was for two reasons: so I could get enough rest to mitigate the likelihood of developing post natal depression and post puerperal psychosis, which I was in a high risk category for, and to minimise how much exposure our baby was getting to my medications.
The circus around advocating for this feeding plan began well before I gave birth. I raised it with one of the midwives handling my antenatal care and she refused to tick the “not breastfeeding” box on my antenatal card, insisting I speak to the lactation consultant. I left the appointment angry and disheartened at being patted on the head in this way. However, this LC was wonderful; she listened to my concerns, and said she would work with me to teach me how to bottle feed, and how to express colostrum which I was still keen to give our baby – provided I get advice saying it was safe to do so (I did). I spoke to a leading expert who recommended I breastfeed more than I was comfortable with (because breast is best, of course) and met with the LC again, who wrote a plan that included pumping – which I’d also never wanted to do -and demand feeding during the day, using formula at night to assist sleep. This was the start of the parade of conflicting, confusing and ultimately destabilising advice around feeding that marked the next few months.
My labour with R was long, intense and difficult. I didn’t eat or sleep for three days and was in labour for around 30 hours, with my waters breaking, my labour stalling and ultimately being induced with syntocin when everything stood still. By the time my little one was lifted onto my chest – a purple, heavy, wet and warm tiny human still attached to me by our shared cord that pulsed with lifegiving blood – I was completely exhausted. But they were here, finally, after so much fear that we’d never meet. During that first hour of skin to skin, they had their first breastfeed. Looking into their face in that moment I felt such a rush of love and contentment that I’ve never experienced before and don’t think anything will ever rival again.
I wish I could say my stay in hospital ended on such a high note; unfortunately it didn’t. I was transferred to the post natal ward for a long stay, with my husband staying on the fold-out beside my bed and R in a tiny cot on wheels at the end of my bed. Nobody in those first couple of days seemed to put two-and-two together and note my mental health history, detailed in my file, and the fact that I hadn’t slept at all in days. I was, as we say in Australia, completely knackered – but I’d anticipated this happening, having brought in seven syringes of precious colostrum I’d expressed ante-natally for my husband to drip feed R, and thinking we could use formula as well. Right? Wrong.
Our precious syringes of colostrum were (apparently accidentally) defrosted all at once. What was supposed to last days had now to be used up in the next 12-24 hours, which scuttled our plan. Then, the first nurse I asked to make up a bottle of formula so I could get some sleep flatly refused. I didn’t know how to reply. She said she’d only give the remaining expressed colostrum I’d brought and when I expressed concern that this wouldn’t be enough to feed our baby she said I’d just have to wake up and express more and the baby would have to “make do with a snack” and I’d have to have a shorter sleep. Beyond tired, I agreed and walked back to my room wondering what had happened. Hadn’t they read the lactation plan our LC had written?
Over the next few days I was awake every few hours, wildly expressing, and trying to latch a hungry baby on to nipples that increasingly felt razor-shredded with shaking anxious hands. I had loved that first breastfeed and had such confidence in our plan, but now I was doubting myself, and hating breastfeeding on demand. Eventually we found a midwife that would make us up a bottle of formula but I now felt I was doing the wrong thing by giving R a bottle. A different LC visited and heavily encouraged breast-feeding even though I kept mentioning the lack of longitudinal safety data surrounding my medications. My sleep debt was growing and so was my despair at our plan going out the window.
On day three the baby blues hit, compounded by sleep deprivation, and I felt my attachment with R withering away. I didn’t want to touch them or look at them or tend to them because every cuddle had now become about providing food – and it hurt, and I struggled with the latch, and I was so so worried about how much of my medication was coming through in my milk. Expressing so often encouraged my milk to come in, big time, and soon I was painfully engorged and living with ice packs down my bra to deal with the excruciating sensations. I was not coping.
Day four came and I was officially a mess. The tipping point came when I sat on the bed watching my husband have a long, warm, stress-free cuddle with our baby while I was hooked up to the pump feeling like I was going to pass out from lack of sleep. I began to cry in that ugly-cry way you do when you feel like you’ve hit bottom. My husband began to cry too. And this is where one heroic midwife entered the picture.
Jill* walked in at that exact moment to do some observations, and seeing our faces and our tears, nestled herself into the armchair by the window and asked “what’s happening?” I explained how tired I was, how this was never our plan, how much I hated pumping, and how I felt I was losing my attachment with my baby and it scared me. She listened as I spilled forth my distress in an angry rush, and paused, considering my words carefully and choosing her own just as carefully. This after all was a Baby Friendly Hospital and she was supposed to recommend breastfeeding.
She told me then the following: breastfeeding is not motherhood. Motherhood is about so much more than how we feed our babies.
She then went on to recommend I stop breastfeeding or dial it right back, and switch to formula. She said it was time to take the stress out of feeding and that I really, really needed to get some sleep ASAP. She also said she was going to call one of the obstetric doctors and someone from the psych team to come and talk to me because she was worried about how things were going mental health wise for me.
The doctor came first after being called and brief on the situation, and there are no words to describe how negligent and inadequate she was in how she handled her care of me. When she walked in I was curled up under the covers, having cried continuously for hours and still going.
She tried to get my husband to leave the room (which by instinct I didn’t allow – and am so glad I didn’t). He sat close by, holding R and listening. She then launched into a rehearsed sounding spiel about why breastfeeding was best for babies and why formula was detrimental. I felt myself inwardly curl away from her – she was not here to help, it was very clear. I said I needed sleep, I was not coping and she replied in a patronising tone “you do know that someone needs to feed the baby every four hours, whether you’re breastfeeding or using formula, don’t you?”
What a ridiculous, insulting question – as if I had intended to starve my baby? As if I didn’t have a perfectly capable partner sitting beside me, also quite able to hold a bottle and feed our child? Clearly, in her view, feeding was entirely the responsibility of mothers. I was pretty pissed off at that point, which only intensified when she turned to my husband and said “and how do you feel about your wife stopping breastfeeding?” My husband arched his eyebrows so high I thought they would pop off the top of his forehead, and replied bluntly “I feel like it’s her choice, not mine.” She then read some compulsory questions in a bored tone off a piece of paper like “have you had any thoughts of harming yourself or your baby?” and then when she’d ticked all her boxes, she left. I was in even worse shape, now full of rage.
Then someone visited me from the psych team. He was wonderful. He suggested that formula was the best, safest option at this point and he pieced the last week together for me. The long labour. The three days with no sleep or food. The difficulty breastfeeding, the stress from pumping, the concerns about medication, the continuing lack of rest…as well as worries about our baby being jaundiced and having some investigations on a sacral dimple over their lower spine (all of which turned out fine). With all of this laid out, he said it was understandable that I wasn’t coping.
He and our midwife Jill suggested that we send our baby to the Special Care Nursery overnight so we could both “reset” ourselves with a full night of sleep. We were both pretty horrified by the suggestion that we have our babe removed from our care so young…and I felt like a failure for things having gotten this far. I didn’t want to agree to this. We both initially said no. Eventually, after a lot of discussion, we agreed – knowing that if we didn’t, things would probably get worse.
Leaving my baby in the nursery that night with the very kind, gentle nurses who would attend to R while we were apart was easily the hardest thing I’ve ever done. After nine months of fearing I would lose them, of thinking miscarriage or stillbirth would rip us apart, it had turned out that my mental health (or so it felt in that moment) was what had done it. I sat clinging to R before walking away, unable to look at or speak to the nurses with fat hot tears rolling down my face. How had we gotten here? Once we were back in my room I was given two sleeping tablets to calm me down and sent to bed to sleep. We picked R up at 6am the next morning, practically sprinting back to the nursery.
Now with some sleep under my belt, I was able to function again and advocate properly for myself. Everything looked better and I could think clearly for the first time in about a week. I knew then that I wasn’t going crazy; this wasn’t my fault. It was about the feeding and the sleep, it wasn’t about me.
After that everything improved. Another wonderful midwife – Harriet – took to the task of teaching us to bottle feed properly, showing us tips and tricks to do it well. We researched, we read, we tried to learn what we needed to know to move things forward and away from the dark place we’d been in as a family and to right what had felt like a sinking ship. Jill had barred the useless second LC from visiting again and unhelpful people were kept away. My fantastic parents wholeheartedly backed our decisions, and gave us lots of pep talks.
We’ve been at home for two weeks now. We are formula feeding 95% of the time, but I sometimes breastfeed because I want to, for a burst of ten minutes a day, once or twice a day. I lay down on the bed to do it, as it makes for an easier latch. I stop when I get frustrated, because that time is precious and intimate and I do not want it to be marred by anxiety. Such tiny periods of time also limit any effects from my medication and mean my supply is slowly fading away, and I’m getting my head around that. I know it’ll stop eventually, and I’ll find a way to be ok with it. I’m working on my bottle feeding technique, and using that time for attachment, looking into their eyes, kissing them, chatting to them. Just getting to know each other.
Reflecting now on the turbulence of that first five days, and how it nearly wrecked me, I am overwhelmed with both anger at some of the care I received around feeding, and gratitude for the midwives who stepped out of line with hospital policies to connect with what was really going on, and helped me. There’s a Carl Jung quote which feels so apt here – “Learn your theories well, but put them aside when you touch the miracle of a living person.”
If only more health care providers could set aside their theories when they touch each mother’s nuanced, lived experience, so many more women would be flourishing as mothers rather than falling apart. Hell, if they even just read the file, that would be a start. As it is, I’m going really well now, and repairing the hurts my bond with my child sustained in that first five days. It could have been very different for me if it hadn’t been for Jill though; and this is what is core to my story.
Every midwife, every doctor, every LC, should be like Jill. Promoting feeding that sustains and nourishes the child, the mother, and the bond between them – not forcing both of them into a slow-motion train-wreck neither may survive. Thank goodness for the rebels. Maybe one day they’ll be the norm.
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