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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Breastfeeding: The first week

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It’s the question I’ve been asking myself for so long… how will breastfeeding go with my second?  Well let’s start at the beginning.

After a most amazing and unexpected waterbirth (to be recounted in a separate post), Baby B spent a few minutes on daddy’s chest while I got dried off and into bed.  Then he was on my chest for the next 2 hours, uninterrupted.  I cannot tell you how amazing it was to have this time with him.  No one was whisking him away to get him measured, no one was swaddling him up like a burrito or putting mittens on him.  It was just as it was meant to be – on mama’s chest, skin-to-skin.

The first and most important task was obviously to deliver my placenta and prevent another postpartum hemorrhage like I had with my last birth.  Oxytocin is required to produce the contractions necessary to expel the placenta, and nipple stimulation is a key component of producing oxytocin.  Given my history, and with a larger-than-average placenta, it seems I might need more than a typical amount. Many babies don’t breastfeed well until closer to the end of the “golden hour,” and that was certainly the case with Baby B.  However, I came prepared.  When my midwife told me I was on the verge of having excessive bleeding, we pulled out my manual breast pump and got to work.  Within minutes, the bleeding stopped.  When it started again 10 minutes later, we used the manual pump again, and it stopped the bleeding once more.  The plan had worked.  No postpartum hemorrhage.  No synthetic Pitocin necessary.  And the icing on the cake – no stitches needed either!

Even though Baby B had been on my chest this whole time, and I had been trying to get him to latch, I think all of the commotion had been too distracting.  With nurses pushing on my abdomen, me shrieking every time they did, and the imminent threat of hemorrhage, it was probably too much to expect a perfect latch at this time too.

After about 45 minutes, everyone had cleared out of the room. I was exhausted and ravenous – my husband and doula supplied me with a constant rotation of juices and crackers to help keep my energy (and blood pressure) up.  And now we were finally able to focus on breastfeeding.  We had collected a little bit of colostrum using the manual pump, so we put some on a spoon and dripped it into Baby B’s mouth to get him interested.  It seemed to grab his attention, and we were able to finally get a good latch in a laid-back breastfeeding position.  He nursed on and off for about an hour.  At first blush, it felt like it was going better than it did with my daughter, but I was wary.  We’d see how the next 24 hours went.

The next 2 feeds in our postpartum room were not great.  My heart sank.  My attempts to get him to latch in a laid-back position were not working.  They had worked the first time, why weren’t they working now?  I always heard about friends saying immediately after their own births, he nursed like a champ. I’ve always hated this expression.  What does it mean?  Does it mean that if my baby doesn’t nurse well right away, like a champ, that we’ll never get there?  Does it mean that it’s an innate behavior, not a learned one?

Now, I’ll admit it.  I had a moment of panic.  A moment of I-just-had-a-baby-8-hours-ago-and-the-hormones-are-making-me-crazy. A moment of what if this is like the last time.  I looked around in his mouth.  I’m not a professional, and I can’t diagnose tongue-tie and lip-tie.  But my first instinct was to call the pediatric ENT and make an appointment, just in case.  I knew it’d be a 2-week wait anyways, so there was no harm in making the appointment for a consultation.

And next, I pulled out my trusty old double-electric pump.  As soon as the colostrum began flowing, I relaxed.  It would be okay.  We’d get through it, we’d figure it out.

The lactation consultant happened to come in while I was pumping.  Baby B was fast asleep, so she couldn’t look in his mouth.  But she stayed and gave me some tips for the next feeding (cross-cradle position works well for newborns, here’s how to do the c-hold, etc.).

And… it worked.  Maybe it was the tips the LC had given me. Maybe I was more relaxed. Maybe my technique was better this time. Maybe I was more relaxed. Maybe he was more awake.  Maybe I was more relaxed. Maybe it was the little bit of colostrum I had dribbled into his mouth right before the feed to get him interested. Maybe I was more relaxed. I had set aside the great expectations of the perfect first latch, focused on the here and now, and let the panic subside.  His fourth time nursing after birth, and we were finally on our way.

The LC stopped by again before our fifth feeding.  And she said all the right things.

You have great technique.  He doesn’t look tied.  He has a nice, broad palate.  Keep doing what you’re doing.

It was exactly what I needed to hear in that moment.  And then more people told me what I needed to hear.

From my postpartum nurses: The first 24 hours they’re really sleepy, don’t worry about the number of times he nurses. It’s the second day that they really wake up. 

From my pediatrician: His tongue and lip look fine, there’s nothing here that I see that needs to be addressed. 

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We made it through the first 24 hours, nursing and spoon-feeding the pumped colostrum.  Maybe we would have been fine if I hadn’t panicked and pumped.  But it did 2 things for me: 1. Gave me a tool to help wake him up for more productive nursing sessions. 2. Gave me the reassurance and confidence that he was going to get what he needed, and keep his blood sugar up.

And I can’t over-emphasize that confidence enough.  The reassuring words from my healthcare providers and the confidence that we could figure this out is what has carried us through this first week.

The first week of nursing is different every single day.  There’s the way you nurse when it’s just colostrum.  There’s the way you nurse when your milk comes in and makes your breasts engorged, making it difficult for baby to latch on.  There’s the way you nurse when your milk is flowing fast, and you have to angle your baby just so, so that they don’t sputter and choke.  There’s the way you nurse when your breasts have softened during a long cluster feed, and you have to use compression to keep the milk flowing.  There’s the way you nurse when you have a clogged duct, and you have to massage it out while keeping baby latched.  There’s the way you nurse in the middle of the night, when you’re trying to figure out a side-lying position so that you can get some sleep.  There’s the way you nurse when you’re in the Target parking lot, without your nursing pillow.  There’s the way you nurse on your left breast vs. your right breast.  There’s the way you nurse when your baby is sleepy vs. wide awake.

And most importantly, there’s the way you nurse when you’re panicked vs. relaxed.

My point is, the first week is a huge learning curve. It’s not about nursing like a champ; it’s about learning like one.  And it takes a lot of confidence and support to get through it. It’s about not watching the clock, and watching your unique baby. It’s about learning their cues, listening to their sounds, and understanding their needs. It’s about your family never questioning is the baby eating again or didn’t he just eat. It’s about feeding on demand, even if that looks like this:

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I stopped using the tracking app right after Baby B’s first pediatrician appointment, on day 4.  His birth weight was 8 lbs 10 oz, his discharge weight was 8 lbs 3 oz, and his first weight at the ped was 8 lbs 8 oz.  He was doing great.  And I was confident.

There’s still a long way to go.  Breastfeeding is a journey, and it’s going to change from week to week.  I’m sure there will be other challenges. But we survived the first week.  More than survived, thrived.  We laid in bed all day, we cuddled, and we snoozed.  I listened to his quiet breathing, his sweet gulping, and all of the other uniquely newborn sounds that will soon fade away.  I breathed in his hair, stroked his feet, and kissed his cheeks.  I soaked in everything I could about this moment in time that I’ll never get back. I’ve learned so much this week, this first week of my baby’s life.  I’ve learned the power of a reassuring word and some confidence.  If you can provide that to a mother and her new babe, please do.

 

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