Tale of Two Births

Melissa Bartick, MD, chair of the Massachusetts Breastfeeding coalition, wrote a great series on breastfeeding in the US.  I recommend this article that describes two hypothetical births--one in a baby-friendly hospital and one not, because it shows how our society, communities, and medical system all come together to set a new mom up for success, or failure.

A higher level of barriers

In a previous post, I talked about the most common reasons moms quit breastfeeding: latching problems, breast refusal, low milk supply, and pain.   Looking back, I realize that I stopped because of extreme pain caused by latching problems from extreme engorgement and a frenetically, energetically hungry baby with a very strong suck.

United States Breastfeeding Committee commissioned a new report to help "combat the barriers to breastfeeding success."  It lists the major barriers as "hospital practices, provider skills, social and workplace support, and media and marketing."  These are the societal barriers that either cause or hinder solutions to the many personal or physiological problems (like pain) that new moms deal with when trying to breastfeed.

At the time my son was born, I felt that my hospital gave me good support, I think because I was so emotionally overwhelmed that I mistook good emotional care for good medical care.  (The hospital where Sam was born is not recognized as a Baby-Friendly Hospital by Unicef, though they did meet many of the Ten Steps.)  But with a year of hindsight, asking myself whether the medical services did the best they could for me and my baby, the answer is no. Here's why:

1. There was one lactation consultant on staff at the hospital, but she was also a full-time nurse with regular shifts and only saw nursing moms in her spare time between rounds or as overtime.  During my stay at the hospital, I saw her once a day, and afterward, once a week.  What I needed was access to a certified lactation consultant round the clock while at the hospital (anytime I tried to nurse) and on call at home.  Initiating breastfeeding is an hour-by-hour challenge.
2. The other nurses tried to help with breastfeeding, but their advice was, though well-meaning, inconsistent and not very helpful, except for the emotional aspect.   A commonly-cited article from the Journal of Obstetric, Gynecological, and Neonatal Nursing reported that "nurses have limited knowledge of breastfeeding, although no variable consistently predicted breastfeeding knowledge."  (Anderson, 1991.)
3. The nurses gave Samuel colostrum mixed with glucose water, despite medical recommendations against glucose water to prevent hypoglycemia.  (Orr, 1997.) 
4. One of my symptoms was edema, which made engorgement worse and latching extremely difficult.  The lactation consultant said the IV fluids I was given contributed to this, but I don't recall edema being one of the potential side effects of my pain treatment.  (Walker, 2000.)
5. I expected my doula to see when there was a problem and help me find solutions, but her job was done after the baby was born, except for one follow-up visit.  Next time I will secure my own help (from doula or otherwise) for longer.

These fall under "hospital services" and "provider skills," I could also list other problems I experienced under "social and workplace support" and probably even "media and marketing."  What combination of problems did you experience, and which of the higher-level barriers (hospital practices, provider skills, social and workplace support, and media and marketing) did they fall under?

1. Orr, Edie and Crase, B.  "Hypoglycemia and the Breastfed Newborn." From NEW BEGINNINGS, Vol. 14 No. 4, July-August 1997, pp. 107-8

2.  Anderson, E., N, MS and GEDEN, E., RN, PhD, FAAN^{.  "}Nurses' Knowledge of Breastfeeding."  Journal of Obstetric, Gynecologic, & Neonatal Nursing, Volume 20, Issue 1, pages 58–62, January 1991.

3. Walker, Marsha, RN, IBCLC.   "Breastfeeding and Engorgement.  from Breastfeeding Abstracts, November 2000, Volume 20, Number 2, pp. 11-12.

International travel while breastfeeding

I'm heading to Paris and London in a week for work and am worried about managing pumping breast milk.

First, I am anxiously eying my freezer supply to make sure there is four days' worth of milk for the time I am away.   Then, I am uneasy about the flight there, during which I will most certainly have to pump in public.  Breastfeeding in public is one thing, but the almost bovine aspect of pumping is altogether another.  I will need to get over this unease, fast.  Next, once I arrive at my destination, I will either need a power adapter or a boat load of batteries to keep the pump running for four days.  I started looking into the power adapter option but it's so complicated that I think I'm better off buying a big pack of batteries and hauling them in my suitcase.  I'll also have to bring supplies to wash parts in the hotel.

But the biggest worry is what to do with all the pumped milk, probably 80-100 oz.  The most sensible and convenient option is to dump it.   But can a breast milk fanatic mom like me actually bring herself to do this?  I am imagining complex ways around dumping: I could buy a good cooler bag, milk storage bags, and lots of Ziploc bags, continually refresh the ice from the hotel ice machine, assuming my room has no refrigerator.  Then there is the matter of getting back through security with the milk.  (I should be thankful that it's not 2004, when the TSA barred more than 3 oz. of breast milk unless you were traveling with a baby.  Except if a mom is traveling with her baby, she wouldn't need to bring a pump and all the pumped milk!)  And what if after all this the ice doesn't hold up for the 12-hour trip?  I would probably just check the baggage and hope for the best.

What would you do?

Breast pump recommendations

The right breast pump is an important part of a breastfeeding plan and can even bail you out in the case of latch problems like I had.  (Disclaimer: I am not a doctor or lactation consultant and all views below are from my own experience and research.)

Your first question might be: do I need a pump?  Some say no if you are not planning to be apart from your baby, but I would suggest every nursing mom should have one on hand in case of unexpected separation or problems nursing.

The next question is whether you need an electric or manual pump.  Do you plan to be away from your baby for more than a few hours at a time at any time during the period you hope to breastfeed?  If so, you need a double electric pump (double means can pump both breasts at once) to maintain your supply and make regular pumping realistic and manageable.  If you will be home with your baby, you may be able to use a manual pump for brief outings--these are fairly inexpensive, $30-$60.  Electric pumps cost more ($60-$350) but are generally faster and more effective at extracting milk. 

My desk with PISA.

Double-electric pumps can be rented from some hospitals, and home models are almost as good at extracting milk.   A good way to start your search for an electric pump is by calling your hospital or birthing center and asking what pumps they provide to new moms, because you may end up taking home from the birthing center a set of parts that will fit home pumps, too.  For example, Medela parts that a hospital provides will fit home Medela pump, a cost savings and convenience.  You could also inquire about rental. (It's also just good to ask your birthing center what they do to help new nursing moms--whether they offer pump instruction, have lactation consultants on staff to help you, etc.  You will rely heavily on these services in those first few days.)

Finally, decide which brand/model is right for you.   I use a Medela Pump in Style (PISA) and have been pleased with it, though there are several good brands of double electric pumps.  When reviewing your options, here are some features to consider.

• Hands-free: some pumps offer hands-free devices so you can read, use the computer, drive, etc. while pumping, which is important as pumping sessions can be long and boring.  However, I found it easy to make something like this for my PISA out of an old tube top or sports bra.
• Bottles: you may want to choose a brand that has bottles you like for feeding so that you don't have to pour milk from one kind to the other.  Some bottles are interchangeable with other brands' nipples and vice versa.  For me, I prefer a wide-mouth-style bottle for feeding (Born Free) but Medela bottles are narrow-mouth, so I "store and pour."  (Bottle choice could be a whole other post, but in short, some bottles have research behind them that shows them to be better for babies who switch back and forth from bottle to breast; other considerations include air management, number of parts that need washing, BPA-free, etc.)
• Portability/style: If you work, this thing will be over your shoulder a lot.
• Power: Look for a model that has an alternate power source such as a car charger or battery pack because you will almost certainly face having to pump in a bathroom stall, storage closet, car, etc. during your time as a breastfeeding mom.

I do not recommend purchasing or borrowing a used pump since there is a risk of disease transmission through home pumps' open airflow system, unlike hospital-grade pumps which have a closed airflow system.  If cost is prohibitive for you, I suggest looking into renting a hospital pump, or putting your pump (or cash toward a pump) on the top of your baby shower list.

Afterward, if you choose a pump and find it's not working well for you, you may need to fine-tune the horn sizes, power, or even try another pump.  Different arrangements work better for different people.

The bottom line: if you don't set yourself up for success in maintaining milk supply, which requires frequent emptying of the breast by baby or pump, you could be looking at making another big investment: baby formula.

(For more information on pumping, kellymom.com is a great resource.)

Balance

Many of my readers have encouraged me to leave guilt behind.  There's no question they are absolutely, unequivocally right, and when I look at it in a logical moment, I am proud of what I've done for my baby.  Part of the reason I write this blog, though, is to acknowledge that new moms often face powerful emotions that defy logic and influence decisions.  Guilt, in particular, arises out of the perceived trade-off between one's self-interest and one's child's interests.  Before I was a parent, for the most part, I was the only one who experienced the consequences of my actions, good or bad.  But as a parent, there's someone else--someone whose future is in your hands, and someone who you love more than you ever loved anything before or ever thought you could--who experiences them too.

This perceived trade-off permeates big decisions and trivial ones alike.  For example, do you feed your baby formula or breastfeed him despite serious inconvenience, difficulty, or pain?  Do you take a few moments for yourself while your toddler watches TV, or do you sit down to read him a book?  Do you take him to a playgroup even though you're not big on socializing with other parents?  Do you put him in a better school much further out of your way?  Do you dip into your retirement money to send him abroad to study? The happiest families are probably great at finding a balance of sacrifice and self-care, and finding solutions that are win-win for parent and child.

In this way, my experience with breastfeeding has been the ultimate crash course in parenting.

Humbled by a milk supply struggle

In a previous post, I talked about how it is easy to see why milk supply can be such a concern for new moms.  But recently, I've gained new perspective and been humbled by a supply problem of my own.

After dropping to three pumps per day a few months ago, my supply dropped, and I started dipping into my  freezer stash.  I had envisioned that by age one, Sam would reduce his milk intake in favor of solids.  To the contrary, he's thirstier than ever.  Then a few weeks ago, I got hit with a nasty cold and suffered another drop.  I decided to up pumps to try to increase supply.  A week went by, then two, without an increase; meanwhile, we were topping off bottles with cow's milk left and right.  I started to feel like throwing in the towel and just letting him have 75/25 or 50/50 human/cow--and feeling pretty bad about it right after my post deriding cow's milk for babies.  You get to a point--and I remember this from the early days--where you start changing the story you tell yourself about how important breast milk is, and guilt rears its head, too.  One minute you've convinced yourself it's totally fine, and another you are reading a study showing a correlation between extended breastfeeding and intelligence.  It's so not fun, and gives me new respect for moms who persevere despite supply issues.

In the end, the milk ticked up, but only after three weeks of trying.

A flexible machine

It's amazing to think about how flexible our bodies are about energy input.  We can fill up on almost anything and the engine will keep on going for a good long while.  Imagine if you could put any old liquid in your car--gasoline, Coke, tequila, milk--and it would just go!  But we know there is a price to pay for less than perfect nutrition.  So we try to eat well and hope for the best.

But there's one group of humans for whom we DO understand perfect nutrition: babies.  Millions of years of evolution have perfected human milk.  This seems like a unique opportunity.  

There are some big differences in animal milk and human milk.  Human milk has a much smaller percentage of protein and calcium and more iron and fat.  Goat milk is a little closer to human milk on these, but it's closer to cow's milk than human milk.  According to trusted breastfeeding resource kellymom.com: "All the nutrients of human milk are significantly more bioavailable than those of cow's milk because it is species specific (not to mention all the components of mother's milk that are not present in cow's milk). "

So to this opportunity for perfect nutrition, I say game on until life dictates otherwise.

The problem with guidelines

"The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond." -cdc.gov

And here we are, at 12 months.   Some people may be wondering when I'm going to quit exclusively pumping milk.  I think, first, that would be mixing up the maximum and minimum from the above statement.  Second, guidelines are based on the average baby.  (Mine is definitely not average, and neither is yours I am sure!)  Finally--it's gotten to be such a part of the routine that another few months won't hurt.

Like I did before starting solids, I am watching for signs that Sam is ready for something new.  When I see things like eating solid food as if he's actually hungry and not just playing, tasting, and practicing.  When he starts drinking out of a cup without choking.  When he says "no thanks" to the bottle a little more often. I'm not seeing any of this yet, so he'll keep getting breast milk for now.

"Power of normal"

Sitting in my son's pediatrician's office, I noticed a half dozen cans of sample baby formula on the counter.  I frowned, not because I think formula feeding is wrong, but because I think formula feeding being the norm is wrong.

Why is normal so important?   Seth Godin, a marketing blogger I follow, posted about the "power of normal" in a recent post.  (The other way I spend my time, after being a mommy, is head of marketing for a nonprofit.) He used the example of taxi cabs that now take credit cards and offer tip amounts of $2, $3, and $4.  "You can decide to be a cheapskate and hit the $2 button.... Except that if you had paid cash, you probably would have tipped 75 cents for that $4.25 ride."  The button cues us to what is normal and we fall in line.

So what do cans of formula in a pediatricians cue us to?  That formula feeding is normal, and we should fall in line.  How can we change this?

First, next to those cans of formula should be breastfeeding posters and literature, all with pictures of women breastfeeding.  The information should include helpful resources such as videos, books, and websites--and most important, access to one-on-one help by phone (a hotline that can give basic information and referrals to lactation consultants or other professionals, 24 hours a day, would be a great start).

Eventually, move those cans of formula into the medicine cabinet, leaving only the breastfeeding stuff.  If every pediatrician and hospital in America did this over the next five years, just through the cueing alone, we could make great strides toward our goal of getting 75% of new moms breastfeeding exclusively for the first six months of life.

One year of babyfood.

Then...










...and now.  Happy first birthday Samuel, my wonderful little boy, my inspiration.

Garden helper

Samuel enjoys digging potatoes from our garden, though he doesn't like to eat them.  He does enjoy sampling the dirt now and then, though!

And here are some purple beauties we grew.

Sadness

It seems like the longer I exclusively pump breast milk for Sam, the more I wish  I could nurse.  At first, when we couldn't nurse and I figured out pumping, I was so relieved to have a solution that I didn't mourn nursing too much, holding out hope Sam and I could eventually try again.  When he was three months old, I did try again, but had so much pain with nursing that I stopped.  When he was six months old, I tried a third time, but my breast was as foreign to him as if I'd just offered him milk in a shoe; that ship had sailed.

There are a lot of moments when I've felt sad about it.  For example, when Sam was just a few weeks old, I went to a breastfeeding support group, and felt like a complete outsider, sitting in that room with all those nursing moms, and me with my baby and his ridiculous bottle.  Other times, I feel sad when I am tied to the pump and someone else is feeding, caring for, playing with my baby.  I also worry about lost nutrients, bottle contamination, and other negative effects of putting a bunch of plastic between my son and his milk. 

But more broadly, I feel increasingly sad about the lost opportunity for bonding and connection as Sam grows more communicative.  While I am sure we made up for it in other ways, there is just no substitute for the nursing experience.  The good news is, I feel it is my loss and not so much my son's.  I know now that the failure to nurse resulted from a bad latch combined with a few other negative factors like edema, and if I had found the right help, it's possible it could have worked.  Maybe, next time?

Formula as an intervention

Lately I've been hearing the phrase "risks of not breastfeeding" a lot. This is different than talking about "pros and cons of breastfeeding," as it is often presented.  It was presented this way in the book I used during pregnancy, From the Hips by Rebecca Odes and Ceridwen Morris, which cited "more margaritas" as a "pro" to formula feeding; I think it was meant to be irreverent or humorous, but given what I know now  about the significant health differences between the average formula-fed baby and the average breastfed baby, I question its validity. (Though, this book did a good job overall on the whole in its breastfeeding section.)


What if infant formula were considered an intervention by the medical community? Then, the risks of using it could be listed, much like a medicine. The choice still belongs to the mother, but the argument is framed such that breastfeeding is the norm and formula is the intervention. For example, the natural way to keep our cholesterol low is eating a healthy diet high in fiber and low in saturated fat. But for some people, that isn't enough, and for others, sticking to a diet isn't feasible. In either case, there is medicine to help, for which the patient can understand the risks.

Of course, the "patient" in the case of breastfeeding is not one's self but one's infant. Does this change our responsibilities?  It it irresponsible not to attempt to breastfeed?  I'm not sure, but even if it is, it doesn't seem right to place this kind of accountability with individual moms when our society fails to support it.

Mommyfood

I just finished reading Eating Animals by Jonathan Safran Foer.  It's a report on meat production in the US and a philosophical and ethical viewpoint on eating meat.  The author turns to vegetarianism because it's the only way for him to avoid supporting factory farming, by which the vast majority of our meat is produced cheaply by externalizing huge ethical, humanitarian, and environmental costs.  While I have not created any new "rules" for myself, it has caused me to think more carefully about the food I eat.

We are extremely fortunate to be able to source and afford meats, dairy, and seasonal vegetables directly from local farms whose practices are acceptable--organic when possible and, with animal products, the animals are always pasture-raised, fed a natural diet, and cared for by actual human farmers and their families. Sweetwater Farm, Robinson Farm, Diemand Farm, Carter and Stevens Farm, and Adams Farm supply us with fantastic food here in central Massachusetts; Localharvest.org is also a great resource.)

On my food choices: where did it come from?  What did it cost the animal, the environment, the workers to make?  What will it cost my health (and thereby my child's health) to eat it?  Asking these questions could be a step in reducing my impact and being healthy, and also teaching my child about food.

The most "whole" babyfood

Sam has been actively experimenting with food this summer.  I try to give him the most whole version of the food (without posing a choking hazard, of course) so eventually he will have an idea of how food grows: he has plucked blueberries from bushes straight into his mouth, slurped on garden tomatoes, gnawed on pork ribs, and popped corn kernels off the cob. 

Sweet corn is a huge hit!













At 10 months, breast milk is still the biggest part of his diet, but we're sure having fun with the solids now!

Burying my head in the sand

A defining element of motherhood for me has been the intense emotions that some from the "infant survival" instincts.  Any thought of harm coming to my baby, or anyone else's, sends my anxiety through the roof.  I experienced these emotions to an awful degree in the high-SIDS-risk months.   It's also what kept me in such a state of high anxiety--and depression--when I wasn't able to breastfeed my baby well in his first weeks.

Lately, it kicks in whenever I hear a news story about a tragedy involving a child.  For example, last night I watched a Dateline NBC show about a deranged woman who murdered a man after he ended a relationship with her.  The story was told from the perspective of the man's parents, who left their home to move closer to their son's killer and her baby, their only grandchild, born after the murder.  The show was filled with home movies and pictures of the baby, chubby and cherubic like Sam.  It ended in absolutely the worst way possible: a murder-suicide by the woman, stripping from the grandparents the one ray of hope in their lives and depriving an innocent child of his future. This morning I can't stop thinking about this poor child every time I look at Sam.

A few weeks ago, I found myself agonizing for days after listening to a radio interview with a female author of a memoir who discussed in detail aborting a baby in the fourth month of pregnancy after testing positive for a genetic disorder.

And last week, I read an article in Time magazine called "the only child myth," which discussed some things parents consider when deciding whether to have more than one child.  I thought, morbidly, that it did not mention the risk of child loss as a reason for having more than one.

Things like this rarely crossed my mind before I became a mother, and news stories certainly didn't send adrenaline coursing through my blood.   Of course, harm comes to children every day, and lots of it, because of humanity's imperfections.  Not long ago I read The Poisonwood Bible by Barbara Kingsolver, which takes place in mid-century Africa, where women give birth to nine children in the hopes that two will survive to adulthood.  What are the mechanisms that allow people, especially mothers, to cope with the reality of children who suffer, and children who die?
Maybe it will get easier for me to face the truths of the world as Sam gets older. But for now, the only thing I can bring myself to do is turn off the radio and TV and bury my head in the sand.

Pumping at work

I happened upon interesting view into trying to work and be a breastfeeding mom at the same time.

A requirement for managing this is either having your own office or working for one of the few companies that provides dedicated space. We can't expect to have attitudes like this in the workplace and increase breastfeeding rates in any significant way.

Foraging for babyfood

The wild blueberries in our backyard have ripened early this year, and Sam can't get enough of them.  We're not sure if he even bothers to gum them up before swallowing, with the speed at which he shovels them in.  The wild strawberries last month were even better--they are softer and taste like candy--though there weren't as many to enjoy.  He also loved the raspberries we had at Gran and Papa's house in western New York last weekend, picked from their woods.  I'm trying to think of a way he could enjoy some of their wild black cherries that doesn't involve me pitting them by hand.  Maybe a mortar and pestle?  (He also "foraged" some Mountain Laurel recently, which, according to the very helpful poison control operator, is toxic, but only in large quantities.)

Since babies get most of their nutrition from milk or formula during the first year, feeding solid food before one year of age seems to be mainly for training purposes.  If that's the case, I want to make a variety of textures and flavors available (not just mushy food) so he can practice and learn.  It's also important that we eat the freshest and most wholesome food we can manage, for the best nutrition and flavor.  Foraging for berries has been one fun way to eat good things, appreciate our country surroundings, and (eventually) learn where food comes from.

It's my dream that good food will become just a normal, enjoyable part of life for him, as it is for me.

Your humble blogger, quoted in Newsweek

One of my readers pointed out that I was quoted in a Newsweek article on milk donation a few weeks ago. Read the article here:

http://www.newsweek.com/2010/06/16/others-milk.html

I did an interview with the reporter awhile back and forgot all about it! I am happy to see this topic being covered.

Lactation Consultations by Skype

In a previous thread on increasing breastfeeding rates, one commenter remarked about the first days of breastfeeding: "It's usually those hours you need someone that no one is available."   I remember one evening calling my birth hospital in desperation.  A caring nurse spent time on the phone with me, though all she could offer was general advice and emotional support.  This helped, but it would have been wonderful to have a lactation consultant to speak to.

A company called Milkalicious is offering lactation consultation appointments by Skype.  The cost is $45 per hour, and a check of their availability showed same-day appointments.  I'm sure LCing by computer can't compare to having an expert with you in person (I remember mine moving things around to try to guide us), but having that kind of resource could at least provide some strategies and support to new moms.

There is also a National Breastfeeding Helpline: 800-994-9662.  La Leche League-trained Breastfeeding Information Specialists can answer "basic breastfeeding questions."  Unfortunately, it's not a 24-hour hotline.  The US government also offers an "Easy Guide to Breastfeeding."  Online support forums can also be a support system, though the advice is usually from other moms, not trained professionals.

It's those times when we are forced to make hard choices about newborn baby feeding that have far-reaching effects for both baby and mom.  If every new mom left the birthplace with a contact of a trained support person available around the clock, we would have a better chance of working through those difficult moments and coming out the other side as nursing moms.

Backpedaling

The exclusively-pumping world refers to "dropping pumps" as the slow process of reducing the number of times we pump per day.  Interestingly, many moms experience an increase in supply as they drop pumps.  However, there is a point at which supply decreases.  I pumped four times a day for quite a few months, getting about 40 ounces consistently each day.  Recently, I started pumping three times a day from time to time, when my schedule didn't allow four.  Then I went three times for a week straight, and suddenly, my supply dropped to under 30 ounces per day. 

This is just about exactly what Sam eats, and we have a freezer full of milk too.  So he has plenty to eat now.  But I've been daydreaming about pumping past the one-year mark--and what if my supply continues to dwindle?  I also had my heart set on donating more milk--those preemies need milk more than I need my 20 minutes back!

So, I am backpedaling, pumping four times a day again in hopes of getting my supply back.  There's definitely no guarantee though, and I am feeling slightly guilty about getting lazy and overconfident and allowing this to happen.
I will try, but if I'm down to 30 for good, I will accept it and carry on. 

Yours Truly

Some of my readers know me only as Babyfood, so maybe you'll indulge me to share a bit about myself.

My name is Lynne and I'm 33.  I live and work in rural Massachusetts, near the Quabbin reservoir.  My husband Max is a full-time dad to our eight month old son, Sam, and part-time freelance recording engineer.  But what happened before this picture might surprise you.

I was a kid of divorced parents and grew up commuting between Richmond, Virginia and rural western New York.  I struck out for New York City when I was 20 to pursue a career in the music biz; I worked in music studios and played bass in a string of rock bands.   I met Max in 2000, where we were both working in the same studio.  In September, 2001, from the rooftop of our downtown Manhattan apartment, we watched the twin towers burn and fall, and my life turned a corner.  I envisioned a person who could break the mold she created for herself.  I accepted Max's spontaneous marriage proposal on a trek in Costa Rica and started dreaming big. We got married on his parent's farm in Massachusetts and daydreamed about living here one day.  I was 26, and incredibly lucky in so many ways.

I went back to school to earn my MBA at Columbia Business School.  I now had earning power outside the city and I started looking for work near where Max grew up--and found it as head of marketing for a non-profit.  We bought a house, got pregnant, and the rest you know.

Life couldn't be any better, thanks to Max and Sam.  And our families.  And our 2 acres near a small New Englad town, where I grow a ramshackle garden, cook, sew, and raise my baby with a natural, common-sense style. 

Thanks for reading, as always.

Me & my babe Sam, May 2010.

Road Trip while Exclusively Pumping

Nursing instead of pumping sure would have made my packing list for the trip we're about to take a lot shorter.  The downside of pumping has always been a lot of part hauling and washing, but on the road will be even more of a pain.  Not to mention all the milk handling questions. (Will it stay fresh in a cooler? Is using someone else's fridge for breast milk kosher?)  I had to make a spreadsheet to track all of the stuff!  Here's just  the "baby" portion of the list.  Am I going overboard?

stroller
booster seat
toys
blankie & stuffed elephant
detergent for washing diapers
big ziploc for dirties
trash bags for dirties
fuzzibunz diapers
disposable diapers
diaper liners
onesies, pants, jammies, socks, sweatshirts
hat
blankets (fleece & swaddle)
baby wash
wipies
baby outfit to wear to the wedding
travel crib
sheets for travel crib (2x)
baby bjorn
backpack carrier
shoes
sunscreen
hairbrush
bibs
baby tylenol
monitor
sling
nail clipper
Pump
Parts,bottles & ziplocs
milk storage bags
wee cooler for breast milk
bottle brush
dish detergent
kitchen towels for part washing
plastic bins for part washing
bottles, nipples, & plastic inserts
ice packs and cooler
cheerios
fresh fruit
snacks
fruit cups/applesauce
water bottles & cups
utensils incl sharp knife for fruit
paper towels

Mechanics of breastfeeding

New ultrasound video (above) shows that infants create a vacuum to suck our the milk rather than pressing or squeezing the milk out.  It also may show why breastfeeding is so painful for some women, like me.  "They're strong suckers," said Donna Geddes, Research Assistant Professor, School of Biomedical, Biomolecular and Chemical Sciences.  Some babies also crunch too hard on the nipple. This information could lead to design of new aids to help new moms with this problem.

Supply

The second biggest reason moms choose to formula-feed is not being able to tell if the baby is getting enough milk, according to the same article (Arora, 2000) that cited fathers' feelings as the biggest reason (see February's post on Dads).  "Mothers should be educated about assessing the adequacy of milk supply by listening for an audible swallow, noting urine production by the number of diapers changed per day, and by recording weight gain at well-child visits."  Easy enough?  Not really, even if you're informed.

Imagine: you are in your first week of trying to breastfeed your new baby. Of course, you can't see the milk, and you have yet to learn your baby's feeding cues. Your newborn, like many, is very sleepy, and often falls asleep at the breast, leaving you wondering whether he is full or just got tired of trying to extract nonexistent milk.  You are counting pee diapers; but premium diapers feel so dry--does that really count as a pee?  He screams for food 45 minutes after a feeding, causing you to question whether he got enough at the last feeding.   At his well-baby visit, he comes in at the 30th percentile for weight (based on averages of both breastfed AND formula-fed babies).  The pediatrician says it's fine, but you are definitely concerned now that he isn't getting enough milk.  In a moment of panic, you feed him some formula.  The formula brings you a sense of relief because now you are certain your baby is getting the calories he needs.  It's comforting to view and measure the feeds.  Formula supplementing becomes part of your routine.  Meanwhile, your body is adjusting its supply to the milk demanded by the baby.  Since the baby, sated by formula, demands less, your body makes less.  Concerned still, you supplement a little more.  Eventually, it begins to feel like nursing is just for comfort, and maybe, you stop.

It's a vicious cycle.  And maybe you never had a supply problem at all!  It is easy to understand how this can happen, given how powerful the need is for a new mother to nourish her baby.   Of course, supply problems can be and are real in many cases, but the treatment for low supply is more nursing, not less.  In yet another situation, the combo of support and information is the key: knowing the signs of a well-fed baby AND having someone there to coach you along saying, "He's eating well, and you're doing great."


Arora, S.; McJunkin, C.; Wehrer, J.; Kuhn, P. “Major Factors Influencing Breastfeeding Rates: Mother’s Perception of Father’s Attitude and Milk Supply.” From the Family Medicine Department and the Research Center, Hamot Medical Center, Erie, Pennsylvania. 2000.

Guilt

Many mothers I talk with about baby feeding mention the guilt they felt when they could not, did not, or had to stop breastfeeding. (One or two of my regular readers will say they did not feel guilty, but sadly, they are in the minority.)  It makes sense: most moms understand breast milk is the healthiest choice, so we set our hearts on it, and if it doesn't work, we feel like we've failed our babies.

We are told that "breast is best," but we aren't all able to do what's "best," for reasons I've already talked about--first, the problems that can occur with breastfeeding, and second, the lack of help to solve them.  To me, this is like to telling someone to build a house without providing blueprints, skilled help, or materials. 

Maybe the message "breast is best" is in itself flawed, as this article points out.  It suggests that "breast is normal" might be better.  But for this to be true, breastfeeding would have to become the new norm--and the only way that can happen is through the information and support that will set new moms up for success.  (This article also points out that, interestingly, formula-fed babies, rather than breastfed babies, are the control groups in most studies.)

Meanwhile, we should remind ourselves that none of this is easy, and that a mother's love isn't diminished by what she feeds her baby.

Donating breast milk: update

Moments ago, Fedex arrived at my house and picked up two 20-lb boxes of milk (around 400 oz.), headed for the Mothers' Milk Bank at Austin, TX.  It took almost two months from the inquiry into donating to actually delivering the milk, but it's all been worth it!  What an amazing feeling!  Big thanks to all the staff at Mothers' Milk for making it possible.

The biggest challenge was sourcing the dry ice for shipping.  The closest outlet is about an hour from home.  Shipping was a lot of work too, getting everything packed, forms filled out, Fedex arranged, etc.  It would be wonderful if there were more banks so pumping moms could drop off locally, not to mention the benefit to the community of having milk available to babies in need.  How can we make this happen?

Study: Breast-feeding would save lives, money

Last week, the journal Pediatrics published a study that concluded that "the lives of nearly 900 babies would be saved each year...if 90 percent of U.S. women breast-fed their babies for the first six months of life..."  It attributes these potential lifesaving benefits to the prevention of diseases that breastfeeding offers, like ear infections, diabetes, asthma, and others.

But how can we get to 90% (WITHOUT making new mothers feel guilty or pressured)?  It probably starts with support and positive influence in the birthplace.  Many hospitals still offer newborns bottles even when mothers intend to breastfeed, and some do not offer the level of support and education on breastfeeding needed to set new moms up for success.  Then, many other changes would be required at home, such as a higher rate of support from dads and other family members, as well as acceptance in the workplace and of breastfeeding in public.  Essentially, a 90% breastfeeding rate would require a huge shift in cultural norms.  (And, by the way, wouldn't it just be nice if women's bodies were respected as much for their life-supporting abilities as their sexual attractiveness?)  Maybe the best we can do is to keep talking about it.

Starting solids

Ever since Sam emerged from the "newborn" phase, people have been asking me when we were going to start feeding him solid food. As with other questions, I turned to books.  Your Baby's First Year Week by Week by Glade B. Curtis, M.D. and Judith Schuler, M.S. suggests starting at 4-5 months, and says that by 6 1/2 months (his age now) babies can enjoy a variety of solid foods. Child of Mine: Feeding with Love and Good Sense by Ellyn Satter recommends basing starting solids on what your child can do (such as sitting up on his own).  Family members suggested starting even earlier by putting cereal in his bottle.

We started offering cereal by spoon at around 5 months. "Cereal" refers to a mashed, cooked, single grain, such as rice, blended with breast milk or formula. We tried making our own, but found boxed baby cereal preferable as it's quick and there's less waste. Some days he seemed to really enjoy it, opening wide for the spoon; others, he just played with the food, or the spoon, or the whole bowl; still others, he cried to get out of his high chair.  It wasn't going great, but we decided to let him go at his own pace.

Then, just last night, Sam's first tooth emerged, peeking out of his bottom gum. I had this thought: wouldn't it make sense that babies are biologically ready for food beyond milk when they grow teeth rather than by some arbitrary time line or unrelated skill development?  I haven't found any research on this so far, but my mommy intuition tells me he'll be more ready for solid food soon.

Donating breast milk

One of the best side effects of being an overproducing mom is the ability to donate milk.  I have stashed in the deep-freeze at least 100 oz. of milk per month since September—some months up to 200 oz. or more, depending on Sam’s appetite.   Since I don’t plan to quit pumping, I decided to donate my extra.  

 

My freezer stash

In the US, there are two ways to do this.  The first time I donated, I connected with a mom of an adopted baby through milkshare.com.  I shared some basic info about my diet and documents showing I was HIV/HEP negative.  She sent me everything I needed to ship the frozen milk—cooler, coolpacks, etc.—and I just packed it up and shipped it at her expense.  Her adopted baby enjoyed about 250 oz. of milk, probably a week or two’s supply.

The other way to donate is through a milk bank. Donor moms are tested for disease and are screened for other factors, such as medications.  The milk is then processed at a lab and dispensed by a doctor’s prescription.  According to the Human Milk Banking Association of North America, “Common reasons for prescribing donor milk include prematurity, allergies, feeding/formula intolerance, immunologic deficiencies, post-operative nutrition, infectious diseases, and inborn errors of metabolism.” According to the World Health Organization, "Breast milk is particularly important for pre-term infants and the small proportion of term infants with very low birth weight; they are at increased risk of infection, long-term ill-health, and death."

Last week I had my phone screening with the Mothers’ Milk Bank at Austin, Texas (the closest bank accepting out-of-state donors).  Next they will send me paperwork to fill out and an order to have blood drawn at a lab close to me.  Once my results are verified, they will send me packaging and instructions to ship the milk.  I’ll get some dry ice, package up the bags of milk, and send it off.  This may seem like a lot of effort, but compared against the option of NOT helping sick babies with milk I don’t need, it seems manageable. 

Donating milk to an adopted baby was an immensely rewarding experience, because he will have the benefits of human milk, even if just for a short while, and the milk (and all my efforts to pump it) did not go to waste.  Donating to a bank may be even more rewarding since the babies who will eventually receive it may have a better chance at health because of it. I consider myself fortunate to be able to help other human beings in a way that most people never could.

“The milk that you sent to my son saved his life.”

– Premature recipient’s mom

 8 oz. of frozen milk

Formula-feeding support

If two-thirds of new moms initiate breastfeeding, the other third feeds formula right from the start.  What’s more, only 7.2% exclusively breastfed for six or more months (CDC, 2008); the 2005 Infant Feeding Survey in Britain showed that only 1% of babies were exclusively breastfed for one year.  That means that the vast majority of babies eat some formula during their lives.

Given this, we would expect that formula-feeding moms would have plenty of information and support.  However, according to a 2009 survey of data on formula feeding, “Many mothers who bottle-feed their babies reported receiving little information on bottle-feeding and did not feel empowered to make decisions…some healthcare providers noted that the WHO/Unicef code discourages active dissemination about bottle feeding.”  (Lakshman, 2009.)

The result of moms being uninformed is that hygiene and safety guidelines in bottle-feeding aren’t always followed. This includes using warm tap water, heating prepared bottles in the microwave, and over or under concentrating feeds.  Some mothers also changed formulas frequently which is not recommended. (Lakshman, 2009.)

Anecdotally, when I left the hospital with my newborn, there was not one document on formula feeding in the reams of paper I received on all things baby, nor had anyone at the hospital discussed it with me.  I went by the instructions on the can, though I still don’t know what the risks are if I, say, over concentrate feeds by adding the water after the powder.

It would be a shame if part of the effort to encourage breastfeeding meant a failure to address the needs of bottle-feeding moms.  Withholding of information about alternatives isn’t usually the best way to encourage something.  I think we’d be better off if new moms knew at least a little about both feeding methods, because most of us will feed formula at some point, and we owe it to our kids to get it right.

1.     Lakshman, R; Ogilvie, D; Ong, K. K. “Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies.” Archives of Disease in Childhood, 12 May 2009. 
2.  Center for Disease Control. 2008 Pediatric Nutrition Surveillance, National Summary of Breastfeeding Indicators, Children Aged less than 5 years [Data file]. Retrieved from http://www.cdc.gov/pednss/pednss_tables/html/pednss_national_table3.htm

BFF: My pump & me.

A few stars aligned for us to be able to bottle-feed breast milk. First, before Sam was born, I received a very generous gift of a Medela Pump in Style double electric breast pump from my step mom who said simply, “You’ll want a nice one.”  Second, Max was home during Sam’s first weeks and helped me immeasurably by taking care of the baby while I pumped and encouraging me to keep going.  Third, at work, there is a private place to pump, a dedicated refrigerator, and a culture that accepts breastfeeding.  Finally, I found an online community where I discovered I did not invent exclusively pumping.

At first, I pumped 7 or 8 times a day for about 20 minutes each. By 5 weeks, I was in much less pain and the engorgement had eased, so I dropped to 6 pumps a day, 10 minutes each. Now at 5 months, I am down to 4 pumps, without getting up in the middle of night to pump. It takes me about an hour a day to get 35-40 oz. of milk, a bit more than Sam eats.

The benefits of exclusively pumping are that Sam gets human milk, best for his health; it might be healthier for me too; I quickly returned to pre-pregnancy weight; other people can feed Sam; we can observe how much he eats; it’s free (or only the cost of the extra calories I eat); I get to bond with my baby while feeding without being in terrible pain; and I got to donate breast milk to another baby.  The detriments are that we wash a lot of plastic parts for the pump and bottles every day; I have to drag the pump and parts around and tuck myself away at certain parts of the day; some benefits of breast milk may be lost when it is stored and fed at another time; I have to buy bottles and milk storage bags; and we have to bring milk and bottles with us when we’re away from home. 

There are moments when it seems totally ludicrous to be attached to the pump.  For example, in the middle of one night when I was up pumping and Max was up at the same time feeding Sam, it all seemed especially kooky.  I was sad at those moments that I couldn't breastfeed. 

I tried nursing again when Sam was about three months old.  The pain returned and after a few feedings, and things just didn’t feel right. I called off the experiment.  We had our system, and it worked for us.

Dads

A 2000 study of new moms in Pennsylvania showed that the primary reason for initiating bottle-feeding over breastfeeding was the mother’s perception of the father’s preference (Arora, 2000).  Dads’ education and interest in baby feeding naturally have a big impact on the decision to breastfeed and the success of the breastfeeding effort.  It can be direct: a knowledgeable dad can play a direct role in baby feeding, such as by observing and assisting with latching positions.  It can be indirect too: a supportive dad gives encouragement and anticipates needs (Tohotoa, 2009), like taking care of housework or holding the baby while mom showers or rests. Another highlight of the 2009 Tohotoa study was that “fathers participating in the study all wanted to be involved with parenting and parenthood, but many of them felt they were unprepared and lacked the relevant information to be effective in their parenting role.” If we could do a better job of educating fathers, moms could be more empowered in baby feeding. 

I would never have gotten as far as I did with nursing if it weren’t for Sam’s dad, Max.  The two of us together agreed while I was pregnant to breastfeed, based on evidence that breast milk is healthier for the baby. During the two weeks we spent trying to breastfeed, he was extremely supportive.  He sat in on sessions with the lactation consultant and reminded me of her advice during feeding sessions.  He provided physical support, arranging the baby, pillows, and even Sam’s jaw and lips, helping get the job done, around the clock.    Moreover, he provided critical emotional support, listening patiently to my outpourings about how much pain I was in, how awful I felt, how desperately I wanted to feed my baby. And when we thought we would need to switch to formula, he supported that too.  Later, when I started pumping full-time, he continued to encourage me and took care of Sam while I pumped.  He deserves a big chunk of the credit for us eventually finding a system that worked. 

He told me recently that he never really understood exactly how I felt.  I tried to explain the pain and resulting emotional torment as presenting your arm, once every two hours, to have a cigarette put out on it--for the first few times, you can endure it, but eventually you begin to feel beaten down, depressed, intimidated.  I think he understood the analogy, but the truth is that real empathy can only come from other women who have been through it.  (More on support from other women later.)  Nonetheless, he was a full partner in every way he could be, and my son and I are lucky to have him.

1.      Tohotoa, J.; Maycock, B.; Hauck, Y. L.; Howat, P.; Burns, S; Binns, C. W. “Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia.” International Breastfeeding Journal 2009, 4:15.

2.     Arora, S.; McJunkin, C.; Wehrer, J.; Kuhn, P. “Major Factors Influencing Breastfeeding Rates: Mother’s Perception of Father’s Attitude and Milk Supply.” From the Family Medicine Department and the Research Center, Hamot Medical Center, Erie, Pennsylvania. 2000.

Stopping breastfeeding

According to the CDC, about two thirds of new moms made some attempt at breastfeeding in 2008.  But as babies grew from newborns into young infants, breastfeeding rates dropped sharply.

Why?  One 2008 study of breastfeeding mothers showed that the most frequent reasons for stopping breastfeeding among those who stopped were latching problems or breast refusal (39% of moms), low milk supply (37% of moms), and pain (27% of moms).   Returning to work was cited as a reason by 20% of moms and satisfaction that the child was old enough to wean by 19% of moms (Lamontagne, 2008).  I interpret this to mean that weaning is more likely to be prompted by a problem rather than a lifestyle decision.


Most of the pregnancy books I read framed baby feeding as a lifestyle choice but emphasized that it’s generally accepted that breastfeeding is better for the baby.  But I don’t remember ever reading that breastfeeding problems could make the choice for us.  I’ve heard other moms say that they felt this seeming lack of information was intentional, a sugarcoating, so that new moms wouldn’t shy away from trying. I am not sure about this, but I do know that information given to expectant and new moms by medical professionals and experts is not always consistent (more on this in another post). 


These numbers would have surprised me before I had my own experience, but now they don’t at all.  I’ve been amazed at how many people empathized when I shared my breastfeeding difficulties.

The women in the study who were not able to overcome problems reported feeling “dissatisfied and disappointed.”  “My problem never really got solved,” said one mother who stopped breastfeeding at six weeks postpartum.  Some felt guilty or as if they had failed: “I took it as a failure, because I wanted to give this child the best of everything,” said another mom who quit at 2 months.  These mothers are left dealing with a range of emotions after trying and not succeeding to breastfeed for which many, like myself, are unprepared.  Sometimes, no matter how dedicated we are, breastfeeding doesn’t work.  If this happened to you, how did you feel about it?

1.  Lamontagne, C., Hamelin, A., & St-Pierre, M. (2008). “The breastfeeding experience of women with major difficulties who use the services of a breastfeeding clinic: a descriptive study.” International Breastfeeding Journal.

2.  Center for Disease Control. 2008 Pediatric Nutrition Surveillance,

National Summary of Breastfeeding Indicators,Children Aged less than 5 years. Retrieved from http://www.cdc.gov/pednss/pednss_tables/html/pednss_national_table3.htm

About this blog

The care we give children in their first years of life is formative and critical to their development, to the success and well-being of the next generation.  This blog is part of a project to talk about and to learn more about human infant feeding through research, stories, and public discussion.  I plan to post on topics that affect infant feeding decisions, including support (family, friends, fathers, other mothers, medical personnel, support groups) and physical issues (baby issues like latch problems and mommy issues like pain and illness); as well as emotional, cultural, and financial factors.  I have posted a short version of my own baby-feeding story and will certainly draw more on my own experiences.  Comments are welcome as are suggestions for interesting baby-feeding topics.  Thanks for reading and welcome!

My baby-feeding story, abridged

Day 1

The focus of pregnancy for many women is childbirth, as it was for me.  I read the books, took the classes, imagined all the possible scenarios through which my child could be born. I felt that if I could get through childbirth, I could get through anything.  Parenthood, including breastfeeding, was a bridge I would cross when I got there, but felt sure that with a good partner and support system, it would be manageable.

My son’s birth was much like I expected: it was one day of the worst pain of my life, and then he was there, Samuel Sleigh, strong and healthy, with dark, observant eyes.

After he was born late in the evening, I held him skin to skin.  My doula, my nurses, and my husband Max kept encouraging me to place him at my breast, but I thought he would make his own way there, the way newborns did in the birth videos we watched in childbirth classes.  I thought it was only a matter of time and he would be suckling away, a hungry little baby.  Finally, I maneuvered him to help him get started.  He got mouth in the right place but would not suck.  He only fell asleep over and over again.  So, we let him sleep, and we slept.

Sam, Day 1

Day 2

The next day, my milk came in. The nurses were a bit surprised, as this normally does not happen until day 3 or 4.  I took it as a good sign; I was excited because I knew then I could feed my baby as soon as he was ready--no worries about lack of milk.

But all that day, Sam slept, and when we managed to rouse him and get him to my breast, he still would not suck.  The pediatrician and nurses assured me that this was not cause for alarm and that he would nurse soon.

Day 3

On day 3, the hospital’s lactation consultant, Suzanne, visited me.  She showed me how to manually express milk to entice the baby to nurse. She put on a latex glove and gently touched the roof of his mouth with her pinky.  He did not suck, which puzzled her.

She suggested I try a breast pump to get some colostrum—the early, nutrient rich milk--for Sam.  The nurses introduced me to a Medela hospital-grade pump and showed me how to use it.  I marveled at the few drops of yellow liquid, amazed yet again by my own body. 

The nurses mixed that tiny bit of food with some sugar water and fed it to my baby with a tiny plastic cup.  Watching this I felt sad, already feeling that I’d failed somehow.

Day 4

The next day, the pain started.  I thought now that I was starting to heal from the birth, I would feel better all around soon.  But trying again and again to nurse made my nipples tender and sore, and the fullness had escalated to engorgement.  My breasts were hard to the touch, the skin stretched and shiny.  

Early that morning though, with the help of a nurse and in just the right position, Sam nursed.  It was a tiny victory, the first in a series of battles to come.

Suzanne returned and examined me.  She said the engorgement was made worse by a case of edema, or water retention from the IV fluids I received during labor.  This also made it harder for Sam to latch—like trying to suck on an over-inflated balloon.  We kept nursing though, and I breathed through the pain.

On day 4, we took Sam home.  We were on our own, away from Suzanne and the caring nurses at the hospital.

Days 5-7

The first few days at home were like a dream, the three of us waking and sleeping at odd hours, not eating real meals, not leaving the house.  I made a home on the couch where I napped and tried again and again to feed the baby.  He would latch, then fall away, and latch again a short while later, each time more painful than the last.  It made my toes curl.  I would get into the shower afterward and cry.  I called the nurses at the hospital, but all they could tell me was that it would get easier soon.

I would work myself up for a feeding, and with Max maneuvering Sam’s tiny little mouth, nurse him through the excruciating pain.  I began to dread feedings.  I started to feel afraid of my hungry baby.  My nipples were broken and cracked like a boxer’s knuckles, and the engorgement persisted.  I was feeding him, but I wasn’t sure how much longer I could stand the pain.  It was a rollercoaster of emotions.  A disastrous one would follow a successful feeding.  It wasn’t getting better.

Days 8-10

On day 8 I went back to the hospital for a consult with Suzanne.  She suggested I try pumping with my Medela double electric pump for 24-48 hours to let my nipples heal, and cup- or syringe-feeding Sam the milk.  She also suggested heat to get the milk flowing followed by cabbage leaves and ice for the engorgement.  She demonstrated putting downward pressure on Sam’s lower jaw and flipping out his lip for proper positioning.  I also got two prescription ointments, “gelpads” for sore nipples, and a bit of silicone called a “nipple sheild.”  It seemed an arsenal, and I felt hopeful.

Newborns need to eat every 2 hours.  That meant 30 minutes of heat, then pumping for 20 minutes, then applying medicine, then lying with ice packs and cabbage leaves pressed to my chest for an hour, while feeding the baby the pumped milk.  This involved tricking him into sucking on a finger while sneaking the milk into his mouth on the side with a large plastic syringe. (We were warned of “nipple confusion” in which a baby rejects the breast after being introduced to a bottle too early.) He seemed confused and overwhelmed, milk overflowing from his mouth, and I felt awful for doing it.  This was our routine, around the clock.  I barely ate or slept for 2 days.

On day 9, my damaged nipples had begun to heal, but since everyone had told me that the pump isn’t as efficient as the baby, I felt I had to start nursing again to ease engorgement.  The searing pain in my nipples began anew.  Not so much as a cotton shirt could touch them without stinging.

Sometime in this week Sam developed a new habit of flailing wildly when hungry, making nursing even more difficult.  Each feeding became an upheaval in our house, with baby and Mommy crying and Daddy assisting as best he could. My doula and family members said, “It will get easier, just hang in there.”  I began to wonder how we would cope, and started thinking about giving up on breastfeeding. I was facing failure. At this point I became undeniably depressed. I was afraid I would be unable to do the only thing I cared about then: feeding my baby.

Days 11-13

By late in Sam’s second week of life, the pain was nearly unbearable.  We researched infant formulas, unsettled by the long ingredient lists.  I began to mourn breastfeeding, gradually accepting potential failure.  I didn’t know how much more I could handle, physically and emotionally.  I was afraid it was affecting my ability to bond with my son.  I began to feel intimidated by him.

The day before he turned 2 weeks, early in the morning hours, I stopped nursing, pumped breast milk, and fed Sam with a bottle. We had just had an awful late-night feeding, with howling baby and weeping mommy. This is just not working, Max and I said to each other.  We were giving up.

That day, I felt a sense of relief for the first time since first trying to nurse.  The depression lifted.  It wasn’t what we’d hoped for, but we had a feeding solution.  I would gradually stop pumping and Sam would be one of the many healthy, happy, formula-fed babies of the world.

Week 3

Then, during the week after I stopped nursing, something happened: the Medela pump started to work.  I kept pumping at regular intervals, and gradually the engorgement eased. The pump was much gentler on my body.  There seemed to be plenty of milk, and the baby slurped hungrily at his bottle.  Gradually, the pain subsided. We didn’t need the formula after all. I thought I had accidentally invented a new baby-feeding solution.  But as it turns out, I was not the only new mom to exclusively bottle-feed breast milk. 

This is how I came to feed Sam breast milk from a bottle, exclusively.

Prologue

How did it happen that the hardest thing I would ever do would be to feed my child? Was it a shock because I was unprepared? Because everything else went so smoothly? Or does every new mom run the physical and emotional gauntlet of trying to meet the nutritional needs of her baby?

When I was pregnant, I read a few books about pregnancy, childbirth, and babies. All said that breastfeeding is best for both mom and baby for dozens of reasons, and most went on to explain the choice between breastfeeding and formula feeding. But what choice? Who would actively choose what is NOT best for her baby?

But according to the CDC, only 19% of new moms in 2008 were still breastfeeding after 12 months.

What else is at work here? Why do new moms not breastfeed? In the four months since my son was born, I discovered, there are too many to count—and you only need one.