The Breastfeeding Bargain

bargain2

A good friend of mine recently asked me, “How is my wife supposed to feel when she sees you’ve been breastfeeding for 21 months and she couldn’t even do it for 2 weeks?”

This conversation stopped me in my tracks.  I realized that part of the problem is that while breastfeeding advocates like to talk about how a breastfeeding-failure is not an individual one, but a systemic one… they often talk about breastfeeding-success as a personal victory, not a societal one.

I’ll admit that even I am guilty of this.  Because society unequivocally failed me during my first nursing experience, I most definitely made the mistake of talking about exclusive pumping as a personal victory.  Pumping is inherently a more private experience, so at the time, I claimed the success largely as my own.  And that’s what happens when you feel anger about being let down… the reaction is pride for accomplishing something despite the odds.

But I’ve got a lot more experience under my belt now.  And it’s clear to me that in an ideal world, breastfeeding is anything but something that individual women achieve based on their own aptitude and perseverance.

We often talk about the village.  But breastfeeding requires so much more than a village – it requires our entire society.  And every player must hold up their end of the bargain of this social contract – this contract that presumes we all care about our mothers, our babies, & our future.

If breastfeeding didn’t work for you… who didn’t keep up their end of the bargain?

And if it did work… who do you owe?

I owe breastfeeding success to my husband.  I can’t even begin to list the myriad of ways that my husband has supported me. But since he’s a private person, I’ll spare him the laundry list, but from birth to bedsharing and everything in between, it wouldn’t have been possible without his support.  My husband kept up his end of the bargain.

 

Breastfeeding Starts With Birth

Only 18% of U.S. Hospitals have been designated as Baby-Friendly, and support recommended breastfeeding practices.

I owe breastfeeding success to my midwife.  She encouraged and supported a birth plan free from interventions that might have caused my baby to be less alert at birth, to have a depressed rooting reflex, or to have a diminished ability to suck, swallow, & breathe in a coordinated manner.  She avoided the use of synthetic hormones that could have interfered with my body’s own ability to produce the hormones necessary for abundant lactation.  She allowed cheered me on to push in the right position for me, avoiding an instrument-assisted delivery that could have harmed my baby’s head & neck, which would have made nursing painful for him.  Ultimately, she protected me from a traumatic birth that would have delayed my milk.  My midwife kept up her end of the bargain.

I owe breastfeeding success to my hospital’s policies and labor & delivery nurses.  They didn’t require the routine use of IV fluids during labor, which can cause excessive swelling of the breasts and make latching difficult.  They didn’t perform intrusive suctioning, which could have created an oral aversion for my baby.  After birth, they gave us more than a full hour of skin-to-skin and nursing time before weighing him.  He was given the time to regulate his temperature & respiration so his body could produce glucose from his energy stores until we established breastfeeding.  Basically, they avoided interfering with my body & my baby laying the groundwork for this intensely biological process.  My labor & delivery nurses kept up their ends of the bargain.

I owe breastfeeding success to my postpartum nurses. They respected my wishes to delay my baby’s first bath for several days, so that his sense of smell wouldn’t be confused.  They respected my wishes to not keep mittens on him, so he could actively use his hands to find my breast.  They were supportive of me keeping him skin-to-skin on my chest in a kangaroo care top, so that I could respond quickly to his cues, get decent sleep, and encourage my milk to come in quickly.  They only took him away to the nursery for 45 minutes for his hearing test, but used my pumped colostrum as a back-up instead of offering a pacifier or sugar water.  My postpartum nurses kept up their ends of the bargain.

I owe breastfeeding success to my in-hospital lactation consultant.  She was there in under 8 hours from birth.  She encouraged me to have her paged as soon as baby was ready to nurse again so she could observe.  She provided me with reassurance and concrete tips to improve my baby’s latch and my comfort… which is just as important as a “perfect” looking latch.  She followed-up multiple times during our hospital stay.  She didn’t give up on us.  My lactation consultant kept up her end of the bargain.

I owe breastfeeding success to my in-hospital pediatrician.  Upon hearing my concerns about a possible tongue or lip tie, he examined my son’s mouth and helped us rule it out.  He had evidence-based answers to my questions, and made his own knowledge about breastfeeding a priority.  The pediatrician kept up his end of the bargain.

*I was failed by every single one of these people during my first birth.  However, don’t freak out if you’re in this position right now.  Even if the odds were stacked against you at birth, with the right support, many issues can be fixed.   

 

Coming Home

I owe breastfeeding success to every visitor we had.  My visitors respected the fact that I was breastfeeding, and didn’t ask to feed my baby a bottle.  They made me feel comfortable nursing in front of them, not making me feel like I needed to excuse myself to a private room while in my own home.  They weren’t there to hold my newborn the whole time, which would have interfered with my ability to learn and read his early nursing cues.  They entertained my older child, helped with what was needed, dropped off a meal, and left quickly.  My visitors kept up their end of the bargain.

I owe breastfeeding success to every visitor we didn’t have.  I wasn’t on the clock of a social calendar.  I could nurse on-demand, without regard to a schedule that would have limited my supply.  My friends realized that I was recovering from birth, and it wasn’t imperative that they meet my son immediately.  I was able to soak up the fourth trimester, just being with my baby.  My friends kept up their end of the bargain.

I owe breastfeeding success to my local breastfeeding support group.  Having a lactation consultant as a free resource on a twice-weekly basis gave me a sounding board for little nagging questions.  Weekly weigh-ins gave me reassurance and confidence.  Sharing challenges with other breastfeeding mothers gave me a community.  My community kept up their end of the bargain.

I owe breastfeeding success to every person I ever breastfed in front of in public.  For never giving me the side eye, for never confronting me, for never suggesting I go feed my baby in the bathroom, and for never making me feel ashamed.  Every waiter I encountered was friendly, made eye contact with me, and didn’t flinch if I was nursing my baby at the table.  They made me feel like a real person, one who could go out and participate fully in my life, not having to retreat to my car or house.  The public kept up their end of the bargain…(I was one of the lucky ones).

I owe breastfeeding success to my healthcare providers.  Positioning in the womb can affect neck muscles, and my son’s head was tilted for a few weeks after birth, making it more difficult from him to nurse on one side.  Our pediatrician identified the issue and recommended stretching exercises.  My chiropractor performed 2 gentle adjustments, and his neck was freed to nurse comfortably on both breasts.  Months later, we faced another (significantly more painful) challenge with twice-recurring thrush.  The urgent care physician saw me and my baby during the same visit, listened compassionately to our symptoms, and prescribed us the right (nursing-friendly) treatment.  My eye doctor, my dentist, my NP… whoever it was, they knew what prescriptions were and weren’t safe for nursing, and always took that status into account.  Whether it’s clogged ducts or mastitis or “what cough medicine won’t affect my supply”… you need the right answers for sustained nursing.  I had the right healthcare providers at the right time, and they all kept up their ends of the bargain.

 

Back To Work

Only 12% of U.S. employers offer paid maternity leave.

I owe breastfeeding success to the Affordable Care Act. For providing me with a breast pump to effectively pump milk & sustain my supply while away from my baby. My insurance company kept up their end of the bargain.

I owe breastfeeding success to my employer. Despite no laws requiring them to, they paid for 6 weeks of my maternity leave, and allowed me to take as much unpaid time off as I needed to.  19 weeks at home with my baby allowed me to establish a robust milk supply, which could weather illness and long-term challenges.  My employer kept up their end of the bargain.

I owe breastfeeding success to my co-workers.  Because even though I pump behind a closed door, my experience pumping at work was anything but closed.  I’m thankful for co-workers who were willing to acknowledge it, talk about it, and normalize it.  They more than accommodated my pumping breaks, were always considerate about our meeting times, and never diminished the work I did simply because I had a new priority in my life.  Because pumping at work wasn’t made unnecessarily stressful, my body responded well to the pump and I had enough to send to daycare each day.  My colleagues kept up their end of the bargain.

I owe breastfeeding success to Mamava pods in the airport.  For making the stressful experience of pumping while traveling a little more tolerable.  For providing a clean, private space to pump in, so that I didn’t need to choose between pumping in a bathroom or clogged ducts, mastitis, and a decrease in supply.  My home airport kept up their end of the bargain.

I owe breastfeeding success to my son’s caregivers.  For welcoming me into the room every day to nurse my son at lunchtime.  For practicing paced bottle-feeding so he wouldn’t get used to a fast flow and start to prefer the bottle over breast.  For handling my milk with care, and making every effort to avoid waste.  For leaving the choice up to me about how long I would send breastmilk to school, instead of trying to force my hand because of his age.  My son’s caregivers kept up their end of the bargain. 

*Even with a perfect scenario of paid maternity leave and pumping breaks, every woman does not respond to a pump.  There’s a ton of work to be done here… from onsite daycares to job-sharing and flexible work schedules, we need to create more time and space for women to just be with their babies.    

I Did Not Do This On My Own

Why are we placing this pressure on individual women?  Why is it this crowning personal achievement to breastfeed your child?  True, the odds are often against us.  But our ability to breastfeed is steeped in privilege & access to support.  When it happens in an ideal environment, it’s a communal achievement.

81% of women in the U.S. start to breastfeed at birth, which means most initially believe enough in breastfeeding to want to try it.  But only 22% are exclusively breastfeeding at 6 months.  Whenever I see a ‘fed is best’ article, I worry that we’ve given society a pass.  That by spreading this message that is meant to assuage individual women of their own guilt, which comes from placing the blame on themselves, we’re simultaneously forgiving doctors, hospitals, governments, employers, and our society at large for not keeping up their end of the bargain.  We’re telling society – it’s okay that you didn’t invest in me and my baby. 

But I’m not going to give them that pass.  My friend’s wife was forced to cut her journey short at 2 weeks not by choice, but because she came up against a wall.  I’m not here to convince anyone of the benefits of breastfeeding or shame any woman for any choice she makes of her own free will… I’m here to break down the wallBecause I need to hold up my end of the bargain.

 

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Breastfeeding Success: Shaming or Inspiring? Formula-Feeding: Guilt or Anger?

Breastfeeding Shame

World Breastfeeding Week is technically over, but it’s still National Breastfeeding Month, so I’m writing one last post on the subject.  There was one particular article going around this past week that really rubbed me the wrong way – it was in TIME, and it was written by a doctor.  I refuse to actually link to it because it’s filled with gross inaccuracies and twisted data.  But the main message was that World Breastfeeding Week shouldn’t be celebrated because it makes mothers feel guilty if they weren’t able to breastfeed.

Hold up.

Since when is celebrating one person’s success shaming someone else?  That’s like saying “I refuse to support The Biggest Loser because it makes others feel guilty that they’re sitting on the couch, not losing weight.”

Who decides if something is shaming or inspiring?

Because I know I’ve been inspired by other women’s breastfeeding stories.  At 6 weeks postpartum I met another woman who had exclusively pumped for a year, and thought wow, maybe I can do this.  I’m inspired by mother-and-baby duos who were able to move on to a successful nursing relationship after having a tongue-tie revised.  I’m inspired by friends who struggled with their first baby but had a smooth journey with their second baby.  None of their success shames me or makes me feel guilty.

And if it did make me feel guilty, is the answer to walk around with my hands over my ears in an effort to avoid hearing anything that might hurt my feelings?  How do we ever hope to learn new things if we allow our guilt to get in the way?  And why should 1 person’s guilt prevent others from hearing the message?  I don’t feel guilty when I learn about the benefits of directly nursing over exclusively pumping; I know that the way I did it wasn’t the ideal, and I’m glad to know that information.  Do you really want to live your life in the dark?

Like I said in my first post on this topic, 85% of new mothers want to breastfeed exclusively for 3 months or more, yet only 32% meet their goal.  If you’re in that 53% who didn’t meet your goal, it’s not my place to tell you how to feel about it; you’re entitled to your feelings.  But I do want to tell you how I’d feel about it.

Maybe you feel guilty because you thought you couldn’t make enough milk to satisfy your baby during those early weeks, because they wanted to eat all the time.  I’d feel angry that we live in a culture that teaches women that our babies need to be on schedules right away.  That we don’t educate women about cluster feeding and about growth spurts and about how milk production actually works.  That we don’t encourage on-demand breastfeeding.  That we don’t set the expectation that every mother-baby duo is different, and will feed at different intervals.  I’m angry that an un-educated relative casually suggested a formula top-off because your baby seemed hungry.  That person didn’t know that the formula would cause your baby to suckle less, thus demanding less milk from your breast, thus reducing your milk supply, and fulfilling the issue that you didn’t have to begin with.  I’m angry that someone didn’t tell you that how much you pump isn’t an indication of how much milk you are making or how much your baby is getting.  Breastfeeding is an age-old biologic process, not one that listens to our 21st century clock or technology.  These are all cultural problems; we’ve gotten so far away from breastfeeding that we’ve lost our knowledge about it, and our expectations are all out of whack.  So I wouldn’t feel guilty, I’d feel angry.

Maybe you feel guilty because you were pressured to start giving formula in public, because someone stared at you or sneered at you or had the gall to actually say something ugly to you when you tried nursing your hungry baby while (gasp) living your life.  I’d feel angry that we live in a culture that has over-sexualized breasts to the point that everyone has forgotten about their function.  That mothers have to fear being wrongfully kicked out of an establishment because some employee doesn’t know the laws protecting a mother’s right to breastfeed in public.  That we even need laws protecting our right to feed a hungry child.  That most of the laws don’t have enforcement provisions, so you have no legal recourse if you are kicked out of somewhere.  I wouldn’t feel guilt, I’d feel angry.

Maybe you feel guilty because you couldn’t keep up with your baby’s demands when you went back to work.  I’d feel angry that we force women back to work before they’ve even had a chance to establish their milk supply.  That we’re the only industrialized nation in the world that doesn’t mandate paid maternity leave.  That despite new laws requiring employers to provide reasonable break times and a place to pump at work, not everyone is on board yet.  That many mothers still have to pump in a bathroom, are forced to pump at times that don’t match their body’s needs, and are discriminated against and have hours cut because of their requests.  That as a nation, we have so little respect for women and children that we don’t do everything we can to support this critical time (we can’t all work at Netflix).  I wouldn’t feel guilty, I’d feel angry.

Maybe you feel guilty because you listened to bad advice from a professional you trusted.  I’d feel angry that the American Academy of Pediatrics recommends 1 year of breastfeeding but then does very little to actually support it.  That I constantly hear about pediatricians making recommendations about infant feeding that aren’t evidence-based.  That we still have to worry about postpartum nurses “sneaking” formula bottles to our babies in the nursery, when their stomachs are still the size of a cherry. That the billion-dollar formula industry is the one actually pulling the strings; they’re in our doctors’ ears, in our hospital discharge bags, filling our shelves with samples before our babies are even born, preying on a mother’s worst insecurities at her most vulnerable moment.  That they cast a cloud of doubt on our abilities, that they make us lose trust in our bodies.  I wouldn’t feel guilty, I’d feel angry.

Or maybe you did everything you could, and despite your best efforts and doing everything right, you truly couldn’t produce enough milk.  Or your baby was born prematurely and wasn’t coordinated or strong enough to make breastfeeding successful.  Or you had to take a medication that prevented you from breastfeeding, or your child had some other medical complication.  Nature dealt you an unlucky hand.  You got a raw deal.  Guilt isn’t the right emotion here; it might make you feel sad, but I hope it never makes you feel guilty.

Maybe you feel guilty because you’re done having kids and won’t have the opportunity for another “do-over.”  Maybe you don’t have an opportunity to find inspiration from others’ success.  But don’t you care about what the experience is going to be like for your daughters?  For your granddaughters?  I know you do care, because you’re a good mother, regardless of how you fed your children.  Please let go of your guilt for their sake, for progress sake.

Or maybe none of these roadblocks were in your way.  Maybe the decision was entirely yours from the get-go not to breastfeed.  Or life circumstances meant you made a decision to stop when you were ready.  These things are all your prerogative.  Breastfeeding is a relationship, which means it has to work for both partiesNo one is impeding on your freedom to make your own decisions – I just hope that it was truly your decision, and not one made for you by our society’s cultural expectations.  And a decision you make of your own free will should never make you feel guilty.  If you were confident in your decision, then there’s no reason that World Breastfeeding Week should offend you.  I’ll support you if you support me. And I’m sorry about all of those ugly people who do actually directly shame you for formula-feeding.  They undermine the entire cause.

There’s a million and one other scenarios that I didn’t cover.  But as you can see, I’m of the mindset that guilt has no place here.  How will we ever improve our breastfeeding rates if we’re too afraid to share information for fear of making someone feel guilty?  In just a decade, Cambodia was able to increase their exclusive breastfeeding rates in the first 6 months from 11% to 74% through the use of a national media campaign, extensive health-worker training, and establishment of mother support groups.  It takes educating an entire society, not just the mothers.  They certainly wouldn’t have accomplished this if they were too afraid of offending a few people.

So it’s your choice.  You can either feel shamed by stories of breastfeeding success, or you can feel inspired.  You can either feel guilty about what happened to you, or you can feel angry toward the system and culture that is failing so many of us.  Although it’s not enough to stop at anger, it’s not a good emotion to dwell in; it has to be turned into positive action.  Become a more active participant in your healthcare, and have more meaningful conversations with your doctors. Demand more from our lawmakers and our employers.  Normalize breastfeeding so that some day, our daughters won’t have to fight for where they can feed their children.  I can’t wait to see that day.

Failed by the System: A Breastfeeding (Pumping) Journey Part 2


Pumping

I am already overwhelmed and humbled by the response to my last blog post.  The multitude of friends who have had bumps along the road in their own breastfeeding journeys reaffirms why we need to be talking about this.  I promised a follow-up with the specific details of my breastfeeding journey.  It’s longer than I anticipated, but I wanted to remember the details while I still could.  And I had a friend message me today with questions about a situation similar to mine, so I wrote this in a hurry for her.  So here goes…

My daughter’s first breastfeed during our golden hour after birth was more like a breast-lick.  She never really got latched on in the delivery room, but I didn’t have time to worry about it.  I was in the middle of a postpartum hemorrhage, and she had to be taken off my chest so that they could more effectively massage my belly down.  Truthfully, it was all a haze.

After we were transferred to our postpartum room, our attempt at breastfeeding started in earnest.  Immediately she was screaming while I tried to get her latched.  My nurse stacked some pillows up, sandwiched my boob in her hand, and tried to shove it into my daughter’s tiny mouth.  She stayed on for maybe a minute, then popped off.  Try again.  On. Off.  Try again.  On. Off.  So went the next 4 hours of cluster feeding.  In between each “feed” my fingers were flying across my phone’s keyboard, desperately trying to figure out what might be going on.  I knew she wasn’t getting much, if anything.  She wasn’t content at all, she was just falling asleep in between feeds from exhaustion.  Nothing about her latch was correct.  She couldn’t open her mouth wide enough to get deep enough, and her upper lip was never able to flange out.  At 3 am, about 12 hours after her birth, I buzzed the nurse practically in tears.  I need a spoon.  Show me how to hand express. 

I expressed my liquid gold into a plastic spoon and my daughter gulped it down.  Ahhhh.  I could finally feel us both relax a little bit.  First thing in the morning, she was taken away briefly for her pediatrician exam.  A little while later the pediatrician came to my room and discussed his exam.  Everything’s great, she’s perfectly healthy.  But she’s lost 7% of her birth weight already, so we need to keep an eye on that. 7%?  Already?? I thought we’d have more time to figure this out.

Shortly afterwards, a lactation consultant came to see us.  Oh thank God you’re here, help us. She reviewed our chart and the pediatrician’s notes.  Your pediatrician has suggested formula supplementation due to weight loss.  What?  Already?  You’ve got to be kidding me.  It’s been less than 24 hours, and you’re already giving up on me?

She observed our feeding, and wrinkled her nose a bit.  I’m going to come back again in a few hours to watch you again.  She rolled in a hospital-grade pump and showed me how to use it.  I hadn’t brought my hands-free bra to the hospital, so I had to hold the flanges up while I pumped.  I didn’t care though – at that moment, I was supremely grateful for technology.  This amazing thing called the breast pump would save me.  More liquid gold.  More gulping.  More relief.

A few hours later the lactation consultant came back and observed us again.  Afterwards she stuck her finger in my baby’s mouth and felt around.  She has a bubble palate.  Your nipple isn’t long enough to hit her palate and stimulate her sucking reflex.  So you’re basically telling me that my body is incompatible with my baby’s?  How is that even possible?  I didn’t even know that was a thing.  She provided no explanation, she just said it matter-of-factly and then pulled out a nipple shield – think of it like a little silicone sombrero for your nipple.  The idea was that it would help “reach” her high palate and trigger her sucking reflex better.  We tried the shield for the next few feedings – and while it made it less painful on me, it didn’t seem to make my baby’s latch any better.  She continued her pop on, pop off routine.  I asked the LC about why my baby’s lip wouldn’t flange out, because I knew that was a key to making a tight seal.  She just shrugged her shoulders and told me I needed to keep flipping it out manually until she learned that was the way it was supposed to be.  Despite all of my manual manipulations, her lip always returned right back to where it was.

We survived another night, struggling with latching, pumping, and spoon-feeding, with a revolving door of postpartum nurses who would pull and prod at my breasts.  The next day before discharge, I desperately asked the LC  – If she’s still not latching well once my milk comes in, what should I do? 

This is the moment where this first lactation consultant failed me.  She could have observed that the pump flanges she had given me were not the right size, and that they’d eventually contribute to sore and cracked nipples.  She could have suggested syringe feeding so that we could avoid nipple confusion.  She could have told me about paced bottle feeding so that my baby wouldn’t develop a flow preference.  She could have introduced me to the idea of a Supplemental Nursing System (SNS) to help keep my baby happy & full at the breast, and prevent a breast aversion.  She could have told me that there was probably more to the story than just the bubble palate.  She could have suggested I go ahead and make an outpatient appointment for lactation, that they’d be able to tell me more after we did some before & after feeding weighs to see how she was transferring milk.  She could have told me that the earliest appointments available for lactation were at least 14 days out.  14 days is a lifetime in a nursing relationship – that’s at least 112 feeds.

Instead, in this moment when she could have said so much, she handed me a bag filled with disposable bottle nipples.  It spoke louder than all of the things she could have said.  A screaming vote of no-confidence.  A lactation consultant, a trained professional who was supposed know about breastfeeding, was essentially telling me that she didn’t think there was another way besides the bottle.

And then literally moments later, the nurse walked in with my discharge paperwork and a “gift bag” to send me home with.  Inside this bag were some pamphlets, and a 4-pack of formula bottles.  I was hearing the message loud and clear: We don’t know how else to help you, and now you’re on your own.  No wonder so many women quit breastfeeding before they even leave the hospital.

Once we were home, we tried just nursing the entire first night.  By morning, my nipples looked like a new tube of lipstick, but raw and cracked, and my baby was not content.  However, my milk had come in, so spoon feeding didn’t seem like it was an efficient option anymore.  I reluctantly reached for that first disposable bottle nipple and screwed it onto the first bottle of milk I had pumped.  I hadn’t planned on introducing a bottle for at least 3 weeks; everything I had read said that I needed to establish breastfeeding first.  But when your baby is eating every 2 hours, for an hour at a time, there’s no time to figure out another solution on the fly.  The first priority is always to feed the baby.

Our pediatrician’s visit on day 3 indicated that she had lost 10% of her birth weight.  However, I assured the pediatrician that we’d get it turned around; my milk had come in, and now we could ensure she was getting it.  She said I wouldn’t have to supplement if I’d come in for weight checks every other day until she was back up to birth weight.  There was that threat of formula supplementation again, without any suggestions of what else to do.  I was resolved to do whatever it took to avoid it – my body was making milk.

So we settled into a new normal; I ordered more pumping parts (this time sized correctly) on Amazon (thank God for Prime), and started pumping around the clock.  Baby would nurse, then I would pump, then I would feed the pumped milk in a bottle.  Maybe a 30 minute or hour break, and then repeat.  Breaks were mostly devoted to self-care; recovering from a bad tear & postpartum hemorrhage are no joke.  I had lost so much blood that I needed to take iron supplements to keep my energy up.

Soon I got 1 bottle ahead, and the routine changed a bit.  Baby would nurse, I’d feed the bottle I pumped the previous session, and then pump for the next feed.  Eventually I got coordinated enough to feed a bottle and pump at the same time.  Eight times a day on days I felt I was making enough milk, 10 times per day on days I got nervous about my milk supply, 12 times per day during growth spurts.  I mimicked her feeding pattern – if she ate, I pumped.  My sweet husband washed all of the bottles and pump parts several times a day, changed diapers, ensured I remained fed and hydrated, and comforted me whenever I fell apart.  Soon my daughter was back at birth weight and climbing.

I read everything I could on milk supply and pumping (thank God for kellymom.com).  If I couldn’t successfully nurse my baby, then I was determined to kick ass at this making milk thing. I did everything I could to reduce my stress and relax (by binge watching Arrested Development in 15 minute increments). I learned how prolactin levels are highest between 1 and 5 am, and how activating prolactin receptors is the key to long-term milk supply.  So I set my alarm for 1, 3, and 5 am, and diligently pumped.  I learned about power pumping, and did 10-minute on / 10-minute off sessions for an hour during baby’s naps.  I took fenugreek supplements and my supply practically doubled overnight.  I learned about how to massage while pumping, and doubled it again.

It was the hardest thing I had ever done in my life.  And that’s saying something, considering the fact that I had just given birth to a 10 pound baby without drugs.  This was much harder.  All jokes aside though, my birth actually had a large role to play here.  Whenever I felt like I couldn’t do it anymore, when I wanted to just sleep through my next date with my pump, I drew strength from my birth.  If I could do that, I can do anything.  My birth had unleashed a power inside of me that I didn’t know existed.  It made me ferocious and confident in my motherhood.  Besides, this was my job right now.  To feed my daughter.  This was a brief moment in time, and I was going to figure it out.

I should note that bottle-feeding was not going great.  My daughter still couldn’t flange her lip out, which meant she couldn’t get a tight seal on the bottle, which meant she was getting lots of air, and lots of milk was dribbling out of her mouth.  And her high palate meant that I had to constantly keep an eye on the bottle to make sure she hadn’t compressed it to the point where nothing could come out.  We tried at least 5 bottle types before finding one that she couldn’t compress.   Unfortunately, my nipples were not so lucky.

2 weeks in, I finally had an outpatient lactation appointment, this time with a different consultant.  We weighed my baby before I nursed, she nursed for 30 minutes, and then we weighed her again.

½ an ounce.  In 30 minutes.  My heart sank.  I was making plenty of milk; she just couldn’t transfer it efficiently.

The lactation consultant suggested that I rent a scale for a week and see if it was just a fluke, or if it was a consistent issue.  She also confirmed that the issue was likely due to a high palate, and suggested that I wear soft shells in between feedings to help draw out my nipples more.

I weighed her before and after nursing sessions for the next week.  The story was the same every time.  30 minutes.  0.4 ounces.  0.5 ounces.  Never more than 0.6 ounces.  I went back to lactation, returned the scale, and hoped for another suggestion.  The LC thought that my baby could benefit from occupational therapy to strengthen her suck.  Another week went by before I could get in to see the OT.  She gave me some tongue exercises to do with my daughter, and told me to start doing suck training with a gumdrop pacifier.  None of this added up to me.  But why does she have a weak suck?  She wasn’t born prematurely, she was 10 pounds for crying out loud. 

Suck training made the problem even clearer to me.  My daughter couldn’t hold a pacifier in her mouth for longer than 10 seconds on her own.  It kept popping out of her mouth, much like my breast would.  The tongue exercises would quickly exhaust her, and it was obvious that she had very little mobility with her tongue.  And besides being exhausted, she was angry.  She was starting to scream at my breast, and physically push me away.  She hated nursing, and I started to dread it.  I remember collapsing into my husband’s arms one day, sobbing she hates me.  I stopped trying to nurse at night, it was too much for both us – I just pumped and bottle fed.  During the day I’d bring her to the breast after her bottle, and tried to associate the feeling of being full and happy with the feeling of being snuggled up to me.   We were skin-to-skin constantly.  And when she wasn’t in the nursing position, she was the happiest baby you’ve ever met.

One thing kept me going at this point: surprise flowers with a note from my daughter.  It took me a week to figure out which friend had sent them to me.  This note held so much power for me, and I’m eternally grateful for this friendship.

Note

Another OT appointment came and went.  The LC at that appointment (a new one to me), was surprised that I had still managed to avoid formula.  You know, pumping may not be sustainable long term.  My pediatrician basically said the same thing to me that same week.  Lady, I’ve made it this far, and I’m tired of people telling me what I’m capable of doing.

My abundant supply did not come without its costs.  I frequently suffered from painful clogged ducts that would trap me inside the house all day while I tried to relieve them.  Once again, I learned all I could about how to work them out, and eventually got them under control with a few key tips (lecithin supplements, rice socks as compresses, pumping after hot showers, pumping at different angles, no bra around the house.)

Week 5: I finally got unchained from my pump for long enough to make it to the breastfeeding support group that they had told me about at lactation.  It was my lucky day; it was the last group that was being led by a veteran LC who was retiring.  There were also several other LCs in the room, but they were there as mothers to their own little ones.  I was so nervous to speak and share my story because I was afraid that I would start crying before I could spit it all out.  When I finally re-lived what the last 5 weeks had held, their words surrounded me like a warm hug.  What you’re doing is amazing.  You should be proud of yourself. We know you can do it.  I didn’t know it, but it’s what I had been waiting for.  For someone with authority to tell me I was doing the right thing.  Doing a good job.  To have confidence in me. None of my pediatricians, lactation consultants, or occupational therapists had said anything like that to me.  All of their doubt was erased in a single day by the words from this room of amazing women.  Why couldn’t one of you have been my lactation consultant? 

And then the answer came.  She might be tongue-tied.  They’re sometimes hard to diagnose if it’s not an anterior tie.  She might have a posterior tie.  It’s the kind of thing you can have evaluated by a Pediatric ENT, and they can clip the tie, releasing the restriction on her tongue, and allowing it to become more mobile.  They’re often accompanied by upper lip ties and high palates.  And if she’s still willing to latch, you also might want to consider using an SNS to try to avoid breast aversion. 

Yes.  Yes.  Yes.  That night I read all about tongue-tie.  I compared the symptoms with what I was experiencing.  Check.  I compared the pictures with what my daughter’s tongue and upper lip looked like.  Check.  I called and made an appointment with a Pediatric ENT.  We’d have to wait 2 weeks.  Damn.

While we waited for our ENT appointment, we went to lactation again.  My daughter was still willing to latch, but it was clear that she was developing a bottle preference and a breast aversion.  I asked about trying an SNS, but was met with skepticism.  They’re really finicky to use.  We typically only recommend them for people who need to build more supply, and you have plenty of milk.  And she’ll be taking bottles when you go back to work anyways, so let her get more practice with the bottle.  I left feeling defeated again, but hopeful for answers at the ENT.

But by the time our appointment rolled around in week 7, it was too late.  My daughter had developed a full-fledged breast aversion.  She screamed every time and pushed me away.  I’m glad that we went ahead with the revision of her posterior tongue tie and upper lip tie.  The procedure (in-office, local anesthetic, quick snip to the tight frenulum under her upper lip and her tongue) allowed her to bottle feed more easily.  She could finally flange out her upper lip and keep a tight seal.  She could finally keep her pacifier in.  She could drink from the bottle faster than she ever had before.  I knew in the future it would help prevent dental and speech problems.  Her tongue had been freed.  And I had the answer I had been looking for all along.

I’ll never know for sure if it could have saved our nursing relationship had it been diagnosed earlier.  But in my heart I know it would have.  A few days after the procedure, I marched into my final lactation appointment and demanded to use an SNS.  But my daughter wouldn’t latch on for long enough to give it a chance.  I walked out of there angry and resentful.  They should have seen it.  They should have supported keeping her at the breast.  They should have known their own limitations and referred me earlier. 

At 10 weeks I finally decided to stop torturing both of us, and stopped trying to nurse.  I decided to become an exclusive pumper, for the sake of my relationship with my daughter.  I’ll never forget the last time she nursed.  I tricked her – she was still asleep, and so I attempted nursing in a side-lying position on the bed with her.  I started with the shield so that she’d think it was a bottle, and then slipped the shield off.  She was sleepy enough to nurse peacefully for 10 minutes.  I’ll remember those 10 minutes forever. But then she woke up and pushed me away.  It was the last time I’d put her in a situation to push me away.

I eventually came to peace with my decision.  Not trying to nurse her anymore saved me hours each day, not to mention heartache.  Our bond grew quickly, in large part due to bedsharing (which is another journey for another post), and I actually got to enjoy the rest of my maternity leave.  At 12 weeks I finally felt confident enough in my supply to drop from 8 pumps a day to 7.  By the time I went back to work at 17 weeks, I was down to 4 pumps a day, without losing any output.    When she started on solid food at 6 months, I was down to 3 pumps per day, and still making enough to put 2 bottles per day in the freezer.  It almost felt unfair – somehow exclusively pumping had made it easier on me than on my friends who were nursing.  They had to nurse morning and night, and then pump 3 times during their work day, and were struggling to keep up.  I donated milk to two such mothers.  This time around I plan on donating any extra milk I make to a milk bank that serves NICUs.  But even though pumping became easier, I desperately wished I could have nursed.

Stopping pumping was more emotional than I thought it would be.  12 months rolled around and I wasn’t ready.  I even switched daycares because our original one wouldn’t allow breastmilk in the toddler room.  Like hell you’re going to tell me when I have to wean. I fought for this. My daughter could sign for milk, and asked for it while she watched me pump.  She knew where her milk came from, and that meant the world to me.  But I still hadn’t gotten my cycle back, and I wanted to get pregnant again.  I pumped for the last time on the day she turned 16 months old.  It’s been over a year since I pumped, but since I became pregnant, she has asked me for my milk 3 times.  It’s amazing that she remembers, and even more amazing that she can sense / smell that my milk is back now, preparing for her baby brother.

I know that I’m one of the lucky ones.  I was lucky that I didn’t suffer from postpartum depression. I was lucky to have a husband that supported me. I was lucky to be able to afford a good pump, extra pumping supplies, lactation support, and enough unpaid time off of work to be able to figure it out.  I was lucky to have a workplace that supported pumping.  I was lucky to have a work schedule that accommodated pumping.  But it’s sad to me that we have to fight so hard for something that should be supported more in our society.

I feel hopeful for my next breastfeeding journey.  I have confidence.  I have a plan.  I have a new pediatrician who understands breastfeeding.  I now know more great lactation consultants than I can count.  I’m armed with more breastfeeding knowledge than I know what to do with.  But I also know that I could encounter an entirely new set of issues.  Maybe my son will be the type of baby who refuses bottles.  Maybe I’ll get mastitis.  Maybe he’ll have reflux.  Maybe he’ll have a dairy allergy.  Who knows?  But now I have a village.  A village filled with a lot of seriously kick-ass mothers who will help me fight whatever I’m up against.

We all have our own journeys.  What worked for me may not work for you.  But if you’re a new mother reading this: This is a time-sensitive issue.  Find help quickly.  I hope you find your village in time.

*In addition to an in-person support group, I highly recommend finding a closed Facebook group you can join.  There are a ton out there, and there’s nothing more helpful than other moms who are also up at 3 am nursing their babes to help you with your questions.  The larger the village, the more likely you’ll be to find someone who has experienced your specific issue. 

Failed by the System: A Breastfeeding Journey Part 1

Breastfeeding Journey

It’s World Breastfeeding Week, so I felt compelled to share this now. This post has been incredibly difficult to start writing.  I just have so many intense emotions about my first breastfeeding journey with my daughter, I don’t even know where to start.  Even now, I’m surprised by the hot, angry tears rolling down my face as I recall the pain and frustration that I went through.

Ultimately, the system let me down.  I did the preparation.  I took the breastfeeding class at the hospital.  I read all about successful breastfeeding.  I got advice from friends who were successful at breastfeeding.  Everything I read and everyone I encountered just said “If something isn’t working, talk to your pediatrician or a lactation consultant.”  That was the back-up plan.  Educated professionals would be able to help me through if I had issues.  I would put my faith and trust in them.

Like I said, the system let me down.

I learned the painful way that you absolutely have to be your own advocate – I didn’t realize that I needed to know how to diagnose and solve my own breastfeeding problems.  Pediatricians are not trained in infant feeding – and I quickly found that mine were no help at all.  And lactation consultants are not all created equal.  It took me 3 lactation consultants, 2 occupational therapists, and hundreds of dollars before I figured out what the issue was.  And yes I said I.  Because I was the one who ultimately had to figure out the issue, and seek the appropriate care.  But by the time I did, it was too late for our nursing relationship.

Where did I finally find help?  There’s a plain stark room tucked away in a church in a suburb of Atlanta.  Inside, every week, a group of new mothers convenes with the tiniest of humans, hoping to glean some comfort and confidence in their journey.  We go around the circle introducing ourselves and our babies.  Some babies are being bounced in wraps, some are giggling on their tummies on the floor.  Some are nursing happily while others are nursing angrily, while others are tucking into a bottle.  Mothers get up and down to weigh their babies before and after their feeds, anxiously waiting to see how many ounces were (or weren’t) guzzled down.  A lactation consultant walks around and helps with positioning and latching, and then the floor is open for questions.  The first rule is always to answer a question with more questions.  How old is your baby?  What have you already attempted?  What is your goal? 

That last one is the most important question.  What is your goal?

In my 5 tumultuous weeks of new mommy postpartum haze, no one had ever asked me this question until now.  In fact, my goals didn’t seem to matter to any of the professionals I had seen.  They placated me with empty compliments and made false assumptions. You’re going back to work anyways, so at least she’s drinking well from a bottle. (But I want her to nurse).  Exclusive pumping isn’t sustainable long-term, so don’t be afraid if you have to give formula. (But I don’t want to give formula). Using an SNS is too much work, just stick with the bottle. (I am willing to do whatever work it takes, don’t discount my willpower).  Everything they said seemed to be said for the purpose of assuaging the guilt that they assumed I had.  They were trying to let me off the hook.  But I didn’t want them to make me feel better or to let me off the hook – I wanted them to help me meet my goals.  When the advice you give is not tailored to a person’s goals, then you will fail them.  Plain and simple.  And for the record, I had zero guilt.  My failure is theirs; the guilt should be on them.

And who finally suggested the answer I had been looking for all along?  Another mother who had the same issue.  I can vividly remember the words coming out of her mouth, and the wave of relief and realization that struck me at that moment.  That’s exactly it.  That sounds like the only explanation. Why hasn’t anyone else told me this? And now you’re telling me there might be an answer?   

This was my mistake: relying on the stories of people who had been successful at breastfeeding.  Sure they had encountered the usual hiccups, and had warned me about those.  But once things got on the right track for them, it was mostly smooth sailing.  What I had needed all along was someone who had struggled.  Struggled so fiercely that they had retaliated by learning every single thing there was to know about breastfeeding.  They’ve been there, in the most desperate hour of the night, struggling to feed their hungry child.  It’s these mothers, the ones who struggled, and yet overcame, who have the answers.  Because they’ll fight for you.  They’ll fight for your goals.  They’ll help you find the answer even if they don’t know it off hand.  These are the women you need in your village, in your corner.

Don’t be surprised if you’re just a few days postpartum, coming off of your hormonal high, and you get a message from me checking in to see how it’s going.  I can’t help but wonder if you’re in a place where you need help.  Where all you need is someone to reach out and offer it.  I never set out to be a breastfeeding advocate, but that’s where my struggle has led me.  To be fiercely passionate about this brief moment in time in a mother’s life, when a multitude of forces are working against her, and no one’s asking about her goals.  85% of new mothers want to breastfeed exclusively for 3 months or more, yet only 32% meet their goal.  That many women not meeting their goals is not a result of individual failures – it’s a wholesale failure of the system.

In the long run, I was able to exclusively provide breastmilk for my daughter for 16 months.  But the path was nothing like I imagined.  Most of you probably have no interest in all of the ins and outs of lactation, so I’ll save it for my next post for those of you who are. (This is your fair warning not to read it if you don’t want to hear any talk about nipples). At the end of the day, all I hope is that it helps someone else meet their goals, whether you want to nurse for 3 months or 24; I’m in your corner. 

Failed by the System: A Breastfeeding (Pumping) Journey Part 2