The Breastfeeding Bargain

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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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The end of maternity leave: The most important work

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The bags are carefully packed and are waiting by the door.  The pump bag filled with bottles and pump parts and cleaning wipes and the hands-free bra, the bag with extra clothes with carefully ironed-on name labels, the bag with diapers and wipes and coconut oil, my backpack with my laptop and all of the hospital bills I still need to pay when I get a spare moment… and tomorrow I’ll fill a cooler bag with the bottles of breastmilk I have measured and re-measured a million times, unsure of how much to actually send.  Oh yea, and my diaper bag and purse.  Tomorrow I’ll be the bag lady.

Tomorrow I go back to my job outside the home – I won’t call it going back to work, because I’ve been doing work.  Important work.  The most important work in fact.  The work of giving birth.  The work of recovering.  The work of building bonds with my baby.  The work of establishing my milk supply.  The work of learning how to balance parenting two children.  The work of laundry. So. Much. Laundry.

I’ve done this before.  The night before going back to your other job can feel a lot like the first day of school after a long summer…  Who are these new people?  What are these new policies?  Will they recognize me?

That last one might sound silly… of course they’ll recognize me, on the surface.  But underneath, deep down, I’ve been transformed.  And each child transforms you differently.  With my daughter, I was utterly transformed by this feeling that I would go to the ends of the earth for this tiny human being.  Her birth changed me into someone who at all costs, believed in myself.  My breastfeeding journey with her showed me the deepest reserves of strength I never knew I had.  As someone who previously struggled with my own perception of my body, I now viewed it as this amazing temple that could perform the biggest of miracles.

My miscarriage transformed me.  I was no longer invincible, no longer innocent.  But I learned how to grieve, and how to heal.

With my son, I’ve been transformed again.  His birth showed me how to harness my power.  Breastfeeding him has taught me how to trust my instincts.  I hold my parenting convictions more deeply; I’m unapologetic about my bedsharing, and even more outspoken about how the postpartum period should be.  My heart has grown astoundingly bigger, for another tiny human who I love just as fiercely as the first.

So yes, I wonder if they’ll recognize me.  Motherhood has changed me.  They might notice that all of these big feelings, this other job of mothering, impact my work.  It means that I’m more efficient with my time.  It means that I can multi-task at a whole new level.  It means that I’m a more nurturing teacher.  It means that I’m less likely to second-guess my instincts.  It means that I’m more willing to be flexible when circumstances change.  What makes me a better mother also makes me a better employee.

Everyone has asked me if I’m ready.  I don’t know if you can ever be ready.  I’ve already cried 3 times in the past week, and I’m sure more tears will be shed in the morning.  But I remind myself that this is a choice I am making.  I am privileged that it even is a choice for me.  Despite how glorious the last 19 weeks have been, I have spent it feeling sad and angry for my friends who do not have the choices I do.  We live in a country that does not respect new motherhood as the most important work. 

For the mothers who only got 2 weeks off… I am sorry that you weren’t given a chance to recover from birth. I am sorry that you were not allowed to get off the hormonal roller coaster first.  I am sorry that you had to go back to work on a paltry amount of sleep while your baby still had their days and nights mixed up.  I am sorry that you likely had very little “choice” in how you fed your baby.

For the mothers who only got 6 weeks off… I am sorry that recovery from birth is apparently the only thing that matters, and that many of you still won’t be recovered by this point.  I am sorry that you had to leave just as you were getting to know your baby.  I am sorry that just as it was starting to get easier, it got harder.  I am sorry that if you had any breastfeeding issues, you may not have had enough time to resolve them.  I am sorry that you didn’t get the optimal chance to firmly establish your milk supply; I am sorry that you may have to wean earlier than you intended.

For the mothers who only got 12 weeks off… I am sorry that you’ve likely taken much of this time unpaid.  That despite your desire to spend more time with your baby, the threat of losing your job is forcing you to go back.  That even if you have the flexibility to take more time off, that the financial burden of doing so unpaid is too stressful.  I’m sorry that you may have had to put your baby in daycare during the height of cold and flu season.  That your first weeks back at work were actually spent at home taking care of your sick baby.  I’m sorry that if you got through the hardest part of breastfeeding, through to the part where you absolutely love nursing your baby, that you have to pump multiple times a day to maintain that relationship.  I’m sorry that this will be a source of stress, and that some of you will have to fight hard for every ounce.

For the mothers who own their own businesses… I am sorry that there is no safety net for people like you.  That some of you never quit working, despite having given birth to a human being.  I hope you were able to assemble enough support.

So yes, I am lucky that I had a choice at all.  I chose to take 19 weeks off.  I am privileged to have been able to take 13 of those weeks unpaid.  I am choosing to go back to my job, which I love.  My bags are packed and waiting by the door.  But there’s an invisible bag I’ll be carrying with me tomorrow.  This heavy baggage in my heart, this feeling of disappointment that every mother does not have a choice, this sorrow that they are not being allowed the time and space to transform.  I hope that some day soon, our country will realize that this is the most important work. 

 

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