Tuesday, June 22, 2010

If you think you might want to breastfeed. . .

. . . even if you are just slightly considering it . . . DO IT! (But you might want to read this first.)

When I got pregnant, I passively assumed I would breastfeed. Although I was not nursed, most of my friends with kids had nursed their children and one of my closest friends had recently become a La Leche Leader. I didn't think about whether it was going to be hard or not: I had always had large breasts and I was eager to put them to good use -- or at least a more dignified use than making boys stare.

Everything changed for me and my pregnancy when I saw a video in Lamaze class that showed a newborn crawling up a mother's chest and self-latching just after delivery. It was at that moment that an unmedicated birth, and breastfeeding, jumped to the top of my list of priorities. Make no mistake, I'm not a crunchy, earth-mother. I ate at McDonald's throughout my pregnancy and in a normal week (pregnant or not) I consume more french fries than granola. But something about that video changed me. It also made me realize that if I were serious about breastfeeding, I needed to plan ahead.

I wanted to exclusively breastfeed Nora for six months and then add solid foods; I had hoped to avoid using formula/artificial baby milk altogether. Despite my good intentions, my best efforts and fantastic support (both professional and personal), I started supplementing just before Nora turned 4-months old and stopped breastfeeding altogether just before she turned 8-months old. Although I didn't make it to my "goals," and I often struggle with regret, I did learn a lot and I am an even bigger believer in breastfeeding than I was before.

If you want to breastfeed, but don't know what to expect, maybe my experiences can help you prepare. (If haven't considered breastfeeding or you are not sure that you want to, but may be interested, check this out for what I believe is an even-keeled perspective on the benefits of breastfeeding.)

Here are some things to think about and look out for:

One of the biggest problems I had in the first few months of new motherhood was figuring out who to turn to for advice that made sense to me, my life, my baby and my family. By the time I became a mother, I had had quite a bit of life experience and for the most part, I knew who to ask to get the answers I trusted and/or wanted to hear on any number of issues. But with motherhood and breastfeeding, I didn't know what kind of mom I wanted to be (aside from a good one) and I didn't know what I would be willing to go through to make breastfeeding work. Knowing that the answer you get often depends on who and how you ask a question, I was lucky to have a knowledgeable lactation person (E) guiding me through the early months.

Many in the medical field are quick to give breastfeeding advice whether or not they are qualified. When I was in the hospital with Nora, who was crying quite a bit in those early days, a nurse told me something along the lines of: "You can't feed her every time she cries. You'll have to figure something else out to comfort her." Really? In those early days, before my milk came in, my breasts needed as much stimulation as I could give them and Nora needed to be as close to me as possible as much as possible. I was lucky that my amazing E had already told me, very sternly and very seriously, "You are going to hear a lot of things about breastfeeding from a lot of people. Don't listen to any of them but me." At the time it sounded territorial and self-aggrandizing; in retrospect, it was some of the best advice she gave me. Without a trained, consistent voice, I think I may have been easily lead astray.

This became incredibly apparent when a friend told me about her lactation person who had put her on a strict feeding schedule that provided for feeding the baby every three hours except in the middle of the night when you skipped a feeding and the baby slept for six hours straight. Hmmm, I thought, this sounds really interesting, and much more humane than the "schedule" I was keeping. Things became clear, when, upon pressing further, I figured out that her "lactation person" was actually a "baby nurse." Knowing that different people have different specialties/priorities which aren't always obvious was a huge learning moment for me as a mom. The reason her schedule sounded so much more humane than mine was because her advice was coming from someone who was looking out for the mom's rest rather than what would work best for breastfeeding. The fact that these two things can be at odds can be a bitter pill to swallow. (More below in Boobie Bootcamp.)

Doctors can fall into the same pitfalls as nurses. Although the AAP (a mainstream American medical group) recommends exclusive breastfeeding for six months and encourages breastfeeding for a year or longer, most pediatricians that my friends and I have encountered are quick to jump to bottles of formula when a newborn shows any sign of weight loss (a common and rarely serious phenomenon). My milk didn't come in until late on Day 5. On Day 3 E came over and realized that Nora was getting into the "danger zone" of weight loss that would prompt all sorts of nonsense from my pediatrician (heel pricks, bottles of formula, possible hospital stay, etc.). To get more nutrients into Nora while still preserving her ability to latch and suck, E put us on a syringe feeding regiment that was hard, but worth it. It involved Nora "latching" to my nipple and "sucking" breastmilk while Sam squirted formula from a syringe into her mouth. Would she have been ok if we gave her bottles from the outset? Maybe? But if she lost her ability to nurse, the process that would have been necessary to get it back could have broken my spirit. That is not to say that syringe feeding was easy, but it certainly made everything after it seem easier! Had E not visited that day, I'm not sure how that first doctor's visit would have gone or what advice I would have been given or what path I would have followed.

I have heard all sort of things that doctors have told my friends that are just untrue and absurd. My favorite one was when a doctor told my friend that her baby's poop was green because of something she (my friend) ate. FYI: That's not how it works, no matter how many Yahoo! Answer Responders say it is. Similarly, a doctor who tells you that it's not important to nurse your baby eight times in 24-hours is not looking out for your ability to nurse. FYI: Your baby will probably still thrive on seven feedings a day, but your supply will not.

We live in a very permissive era. Unlike women who were having babies in the 90s who were led to believe that they could do anything and everything that they wanted to do, all at the same time (think "Soccer Mom" and "Super Mom") those of us who are having babies in the '00s and '10s face a different dynamic. We're told "You can do whatever you want, but you can't do it all. Make whatever choice works for you and we'll stand by you whatever you choose. Nothing is really 'better' than anything else."

It's a culture of "anything goes" combined with well-meaning, but sometimes misguided, support. In this culture it's not surprising to hear a friend or a grandma say to a new mom "Oh, don't worry about breastfeeding, the formula they are making these days is just as good as breast milk." But here's the thing: it isn't. That doesn't mean you are a bad person if you use formula, but it does mean you've made a choice.

In an era when kids gets trophies for just showing up, it's hard to say that something is "better" than something else. But in my mind, some things just are. It became very clear to me very quickly that parenting is a string of choices: some I made after much research, some I made from the gut and some I made not even knowing I had made them. For me, this choice mattered and I was committed to seeing it through.

To be clear, yes, there are some people who CAN'T breastfeed, and yes, formula provides nutrients and sustenance for a newborn. Babies who are never nursed go on to Harvard and Yale just like babies who were nursed past one year. But there are things that are done every day in US hospitals during the labor, delivery and the immediate post-partum processes that work against a woman's ability to breastfeed. For me, these things cloud the notion of "can't." Who is to say what you can and can't do if you're not given an opportunity to try?

A few months ago I read Peaceful Revolution: Motherhood and the $13 Billion Guilt. It is an important and moving piece. I recommend it to anyone who has had a child or is thinking about having a child. I especially recommend it to anyone who has already had a child (or more) and is considering have another child (or more).

It is an eye-opening article detailing what does happen when most women give birth in US hospitals vs. what could happen. As Melissa Bartick says ". . . if you compare what should happen when a woman gives birth, versus what actually happens, you can appreciate how tough it can be for US women to breastfeed, but how much easier it could be if only things were a little different around here."

Beyond the issues created by the birth industry, for many of us whether or not we breastfeed is a series of choices made over a course of hours, days or weeks when we are hormonal, sleep deprived and feeling the strain of being newly responsible for another human being. Most of us don't have the information we need to make informed decisions and many of us end up doing small things to get through the day that have large unintended consequences.

Another thing I learned through this process (and my wonderful E) is that if you truly want to breastfeed, you can't even think about stopping before six weeks post-partum. That is not to say that anyone else's breastfeeding experience will be as rough as mine (and certainly some will be rougher), but given the new mom's I've spoken too, it seems to me that, in general, breastfeeding is much harder than people expect. Being prepared for this is helpful, but I have found that it is hard to walk the line between preparing someone for the challenge and scaring them away from it altogether. For me, having a professional on hand who knew me and knew my goals was key. For others it's peer support groups like La Leche that get them through. In general, from what I've heard, relying solely on the hospital lactation people is not generally sufficient to educate new moms or give them an awareness of some common pitfalls that they may encounter, which can be minor if caught early and addressed appropriately.

I remember sitting with a friend when our babies were about three months old and she was complaining that her daughter nursed for really long periods of time and often fell asleep on the breast and when she took her off she woke up hungry. I asked if she was sure she was "transferring" (or swallowing breast milk as opposed to just sucking) and she had no idea what I was talking about. I explained how you could "hear a swallow" which would help you determine if you baby was actually getting any milk and she had no idea what I was talking about. Breastfeeding was very important to her and she had been happily nursing for three months but no one taught her how to make sure everything was going ok. As we talked more I realized that she had had one visit from a lactation person in the hospital and that was it. In my mind there's just no way you can take everything in that you need to know about breastfeeding in one visit which happens less than 24-hours after you give birth.

Upon complaining to my friend the La Leche leader that I didn't understand why the whole process wasn't easier she told me something that made perfect sense but that I hadn't considered until she said it. To paraphrase her: "Hunting and Gathering is natural, but if someone dropped you in the middle of the forest and expected you to survive, you might be a little overwhelmed." Similarly, managing breastfeeding, working, commuting and like doesn't really bear a whole lot of resemblance to the life our breastfeeding ancestors led. Although there were many moments I was frustrated and many moments that I didn't think I was capable of managing new motherhood, work and nursing/pumping, feeling guilty about needing help just made it worse. Take any and all help that is offered, provided the person is qualified and in sync with your beliefs and goals.

This is the La Leche League's mission statement:

Our mission is to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.

I have heard that people think of La Leche as militant women who force people to breastfeed and openly look down on working moms. That has not been my experience. Although I haven't been to a meeting, I spoke to my friend who is a leader whenever I had a problem nursing and I have referred many friends to her for good, sound advice. They found her to be knowledgeable, objective and helpful. Although I shouldn't speak about the organization without having visited a meeting, I recently read an interesting article by Elissa Gootman in the New York Times called "The Breast Whisperer," that pinpointed for me where the misconception about the group may have started:
A century ago virtually all American mothers nursed their babies, but by the 1950s, formula was the norm. Then a group of breast-feeding evangelists formed La Leche League to teach what they saw as a lost art, promoting its health and emotional benefits. Their efforts were helped by the natural childbirth movement of the 1970s.

As more women tried nursing, more women had problems nursing, and La Leche volunteers — many of them mothers who found breast-feeding as natural as breathing — could not always solve them.
This idea that "many of them . . . found breast-feeding as natural as breathing," helps me understand how they got such a bad rap. It makes sense to me that those who excelled at nursing (and for whom it came easily) would want to pass their knowledge on. But for those who did not struggle, it may be hard to understand what someone who IS struggling is going through. Still, if you need low/no cost help, I would not hesitate to visit a meeting, call a leader and check it out. These aren't the people who are going to give you tacit permission to stop nursing, but they are the people that can support you through the rough moments and celebrate your success with you.

If you're like me and you have to go back to work and you want to continue to provide breast milk for you baby, it will take lots of advanced planning. Some of this I did well, some I did not.

I had started pumping early to help my milk come in, but once it did, I stopped pumping in favor of nursing alone. Nora ate so frequently and finding a time to fit a pumping session into an already full day just wasn't a priority for me. This was one of those decisions I made to get through the day without thinking about the long term consequences it would have.

Around five weeks old we started replacing one nursing session a day with a bottle of breast milk and a pump session. Our goal was to get Nora used to the bottle in preparation for day care. Although this worked seamlessly and didn't interfere with her willingness or ability to nurse, it didn't allow for the build-up of a freezer stash because what I was pumping during that session, she was drinking at the next session. I couldn't figure out how, logistically, to get in another pumping session or two during the day but really I just didn't make it a priority. This came back to bite me in the butt when Nora started day care. While we were apart she consumed two to three times as much as I could produce. This meant that what freezer stash I had dwindled quickly and along with it my hopes of keeping her on breast milk only until six months.

Whether she needed to consume that much while we were apart is debatable. Where you put your child in day care (or who you hire as a nanny) will have an impact on your ability to exclusively feed your child breast milk. Again, I didn't make breastfeeding a priority when choosing a child care option. In general we are very happy with our day care arrangement, but at the cost of my ability to nurse. Some people would have made very different choices, we did what we thought was best and what we could afford. Do I wish that she would have used methods other than feeding her to comfort her? Yes. Was she necessarily overfed or was I just plain not producing enough? I don't know.

Another factor that impacted my ability to stick with breastfeeding was my job. I didn't realize what a big impact not having my own office would have on my ability to pump. Actually getting up and walking away from my desk was no small task. And my employers, though I believe they were trying their best, were, for all intents and purposes "old white men" who didn't understand my struggle to be a good employee while also being a good, breastfeeding mom. If I could have sat behind a closed door, checked email and returned phone calls while pumping twice a day, I think I may have been able to keep my supply up. But alas, that was not my situation.

And to be sure, this is not about blame. I have made peace with my part in all of this. I know that I set my priorities, no one else set them for me. I have heard tales of police officers and grade school teachers who have been able to make time to pump. I did not. I know where I drew the line.

One of the hardest things I learned through nursing Nora and talking to other moms who nursed or didn't is how much easier the formula/bottle route can be. I can honestly say that my life as a working mom changed dramatically when I stopped pumping and then later when I stopped nursing. I wish it weren't that way, but it was. I could stay later at work. I could go out alone. Sam could share more evenly in the baby-care arena.

So if formula feeding seems so much easier, why am I so sad that I only made it to eight months with Nora? Because breastfeeding was amazing. What I was providing in the way of nutrients and antibodies is unparalleled. The closeness I experienced with Nora in the wee-hours of the morning was something I had never shared with anyone ever. The empowerment that I felt knowing I was giving her something that no one else could was amazing. But it was hard.

E sometimes shares with me things she goes through with other clients (anonymously, of course) and one of the things that I have come to realize is that hiring her to help you breastfeed is like hiring a trainer to get you in shape. A trainer is going to make you do things you don't want to do (get out of bed, get off the couch, squats!) and so is a good lactation person (wake the baby to nurse her when she and you would much rather be asleep!), but doing things you don't want to do and having someone holding your hand through the process has its rewards. One of the things E laments the most about her lactation clients is that she is often called too late. Problems she sees could have often been avoided with early intervention. In the same way I wish everyone having a baby knew how helpful (and in my mind, indispensable) having a birth doula is, I wish women knew that lactation support is more than a class or a visit from a hospital staff person.

Breastfeeding might be hard. It might push you to the limit of what you thought possible at a time when you are already up against the impossible every day. But for most people it can be easier if you have help. And without a doubt it comes with the greatest reward.


  1. This is GREAT entry - thank you for writing it :) tiff

  2. Thanks for your comment, Tiff. It took me FOREVER to write this piece, but I'm pretty happy with how it turned out. Thanks for reading!

  3. Awesome, thank you.

  4. julie (from pgsa)June 25, 2010 at 8:42 AM

    I can tell you worked hard at this post! Wow!
    I am glad you got the experience of bfing and sad that you did not get to do it as long/the way you wanted.
    My mom and her mom could not bf (supposedly, but I'll take their word for it). I figured it would go the same for me. All 3 of my babies were premature and spent weeks in the NICU. I was well-advised by the NICU nurses and hospital lactation consultants to pump right away and frequently, and I was surprised to see that I had LOTS of milk. The latching we worked on for a long time - had lots of help. My babies took milk from the breast and the bottle alike. My 2 yr old still nurses a couple times a day (though we will be discontinuing soon, I think). So sometimes strange circumstances or a difficult family history of bfing don't really matter. Like you say, if you want it, then go for it, and if you can make it work somehow it's really great.

  5. hey julie,
    thanks for reading and commenting. 3 babies in NICU and still breastfeeding -- amazing! i trust everyone is well now. thanks for being in touch.

  6. Oy, I just posted a comment that got sucked into the void, boo!!
    Ok start over...

    Thanks for your honesty, this is a very thoughtful post. I related to a lot of what you said, and not just because we had the same doula ;-)

    For me, breastfeeding was non-negotiable, for many reasons, including the big booby reason you mentioned and also because my birth went in a completely different direction than I had planned. I had heard both from E and from my sister (who had 2 kids and had done extensive research on the subject) that you just have to suck it up for those first 6 weeks (no pun intended) even though it is painful and exhausting and might possibly drive a person insane-which it nearly did for me. Even though I had no supply issues, breastfeeding for me was never an easy experience and I often had feelings of jealousy towards people who chose to formula feed since I knew their lives were just so much easier than mine.

    That being said, I'm glad I did it for as long as I did. I'm about to have a second baby and I plan on bfing again for as long as it feels right. I do hope that I can find some ways to make certain things easier for myself. For example, my first born didn't take a bottle, and nearly every ounce of breast milk I forced myself to pump in order to give myself some freedom went down the drain. Literally. My baby also slept (and still sometimes sleeps) really poorly. Almost every time he woke up for the first 6-7 months, I shoved my boob in his mouth to get him to go back to sleep. Did I make him a bad sleeper? Maybe? Maybe not.

    On another note, we saw this today at a local farm in Vermont:

    So don't feel guilty for however long or short you were able to go!

  7. hey naomi,
    thanks for reading and commenting. i know what you went through and i'm glad you are going to stick with it with number 2.
    i like this idea of breastfeeding being "non-negotiable," because sometimes that's what it takes to make it work. when i was talking to a friend who is a nurse about whether i would get an epidural or not his response was that the only women who don't get them are the ones for whom it is non-negotiable. i wouldn't say that BFing is as hard as delivering drug free, but i think that with respect to the commitment they take, they might be very similar.

  8. Jamie - this is such a beautiful, honest and informative post. Really poignant and clear insights, both sociological and personal - and your suggestions/things to look out for are absolutely spot on. Thanks for putting this out there - I know it will help other new and to-be moms.

  9. Thanks, Amy. I hope one we're back on the east coast-ish our paths will cross again. I would LOVE to meet your family and catch up.

  10. Hey - saw your blog thru a friend of a friend. w.r.t pumping to create a reserve - I too would Love to know how people do this. My lil guy (now 10 mths old, still BF) ate about every 2-3 hrs those first 6 months - anything I pumped when right to him for his next feeding. I too had no reserve for when he started daycare at 6 months. And while I also wonder if he's overfed (drinks 2x as much milk there vs w/me), I pump round the clock to keep up. I pump 3x at work (lucky I have a job that allows me to get away), and then again at night - that's the only way I can drop off 16 oz for his time at daycare. I love BFing, but HATE pumping and have decided to stop pumping when he turns 1 yr old (but will still nurse when together). Would love to know logistically how people build a reserve - 10 mths in and I got a mere 8 oz in my freezer!!!

  11. Hi Melissa,
    Thanks for reading and commenting. I'm totally with you on loving BFing and HATING pumping.
    At about 4-months in my friend told me his wife had been pumping 3 times a day since the beginning and my heart broke because I felt so behind!
    Best of luck to you and congrats for getting this far! Being a working mom is so rough! (Though I've heard being a SAHM is rough, too and I'm about to give that a try!)

  12. From what Ive heard and experienced, I'm not sure there is a way to overfeed a breastfed baby. They take what they need, that's part of the beauty of it. IF your kid is constantly feeding (like mine did) I would assume that he needs it, for whatever reason, comfort or food because I think in the beginning it really is hard to separate these two concepts. Yes there are other ways to comfort your baby, but bfing is a beautiful and extremely useful way to do so...

  13. i think what melissa is talking about is how our kids are overfed while they're at day care. i remember feeling like my freezer stash was cocaine. i watched it like a hawk and would freak out if there was any left over (and unusable) in a bottle when i picked nora up at day care.

  14. And who started the saying "no use crying over spilt milk" - I am always nearly inconsolable if I accidentally spill some breastmilk - nearly had a heart attack when I lost 2 oz after pumping!!!