Saturday, February 20, 2010

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.

Monday, February 15, 2010


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.

Thursday, February 11, 2010

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

Sunday, February 7, 2010

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.

Wednesday, February 3, 2010


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.