Sunday, May 25, 2008

Why some mothers don't breastfeed

Breastfeeding is a brilliant invention of evolution, isn't? Mammalian mothers can magically nourish their offspring with food produced by their own bodies, and that food turns out to offer optimal nutrition.

But sometimes it doesn't work. If you have ever had a scornful thought when you saw a woman feeding her baby with a bottle, please read Julie's post, "The breast-laid plan," and the comments thread. When nursing works out, I hear it's a lovely thing. But for the unlucky women for whom it simply doesn't work—for a slew of reasons, including low milk supply, pain, poor suck, medical complications, and prematurity—the societal pressure to breastfeed can exert a huge psychic cost.

If you have never known the tyranny of the breast pump (and not the pumping-at-work set-up—I'm talking about round-the-clock pumping), you are lucky. If your body actually produced enough milk to meet a baby's nutritional demands, you are lucky. If breastfeeding was natural and beautiful, you are lucky.

I was not lucky. I had problems that were addressed by four separate chapters of The Womanly Art of Breastfeeding, and one or two more problems that the book didn't cover. There was no chapter entitled "What To Do When There's a Perfect Storm of Problems and It's Simply Not Working Out"—the message was that quitting is not to be contemplated, even when it's ruining a woman's quality of life.

The pumping/lactation phase of my life lasted only about two or two and a half months eight years ago, but it remains the most traumatic period of my life. I think Ben's early months would have been much less stressful if my doctor had said, "Listen, your body is in no shape to make this work." But that didn't happen, and I put so much pressure on myself. On the bright side, Ben thrived despite our rough start, and he thrived when he got formula instead of milk.

So if you see a woman in public mixing up a bottle of formula for her baby, don't assume that she's selfish or shallow or unaware of breast milk's advantages, or that she takes a cavalier view toward caring for her child. She might've adopted that baby. She may be taking vital medication that's not safe for the baby. She may have tried like hell to breastfeed and failed Dairy Cow 101 anyway. She might've had breast surgery that precludes nursing. Informing her that "breast is best" or that she's robbing her child of 6 IQ points and improved immunity? That's deeply hurtful and certainly poor manners.

If you know a pregnant woman, sure, go ahead and make the case for breastfeeding's advantages. But don't suggest that she'll be failing her child if it doesn't work out. And once the decision has been made—for whatever reason—don't presume to second-guess it. Respect the woman's ability to make the best choice for her and her child.

23 comments:

dr_igloo said...

% I think the biggest part of the problem is actually that most women are deprived of getting really good support for breastfeeding, and it ends up being more difficult than it needs to be. If lactation consultants were more widely available, if physicians actually knew anything about breastfeeding (which 90of them do not), issues related to milk supply, pain, poor latch, and others that cause people to stop breastfeeding could be addressed and make the breastfeeding relationship work.

I've been involved in a lot of breastfeeding groups and volunteered as a breastfeeding peer support person, and I cannot tell you how many times women have told me about things their doctors did and advised that were tantamount to sabotage. Not deliberately, of course. But most MDs have so little knowledge of breastfeeding and so little confidence in it that the advice they give often does more harm than good. And many hospital practices and policies about birth and the immediate post-partum period can impede efforts to establish a good milk supply as well. Heaven help you if you have a preemie; they make it virtually impossible to establish good breastfeeding, and most women immediately post-partum don't have the energy to keep up the constant arguments with the nursing staff that are required to get the access you need.

If every woman who wanted to breastfeed was able to work with a lactation consultant at the first sign of trouble, I think a lot more women would be able to breastfeed. Not all of them, certainly, but definitely more, and probably most.

When I see a mom mixing up formula instead of nursing her baby, I usually think to myself "goddammit, what did the doctor say to that woman to fuck things up?"

Orange said...

Dr. Igloo, in my case, the hospital was incredibly encouraging about breastfeeding. Many of the NICU nurses were skilled in helping on that front, and there was always a lactation consultant on call. There were several LCs who rotated through the NICU daily, offering assistance. There were one or two industrial-strength Medela pumps and a private pumping room, and women could also pump in the unit. There were so many women dealing with lactation woes during my son's tenure in the NICU, the head LC even started up a support group. We all knew about Reglan and fenugreek to boost supply; we knew what the woman with mastitis was going through; women who'd brought their own pumps shared them; and there was a communal freezer where we could store our milk. Despite all that, no, breastfeeding doesn't always work no matter how hard you try and how much support you get.

dr_igloo said...

Oh absolutely I agree, sometimes it's just not meant to be. Looking at my circle of friends and breastfeeding acquaintances, however, it's clear that the lack of support and the poor advice from physicians has been the largest factor for most of them. Maybe that's related to my experiences having been primarily in smaller communities where there was not a critical mass of breastfeeding-positive docs.

bitchphd said...

Or even her right to make choices that aren't the "best" but that are "good enough"....

Becky..AMHW said...

I was a pro breastfeeder with my first...that is until he weaned himself at around five months. You would think a baby that tiny wouldn't do such a thing, but mine struggled with being so confined while eating at that point. He was already crawling. Holding him to eat? No way. He held his own bottle and was happy even if I felt bad about it, and engorged.

The second nursed past a year old. I weaned him when he thought that biting my nipples and causing deep puncture wounds was very funny. Sure, I could have suffered a few more bites and taught him different, but I was done.

The third ended up on bottles at three months when my milk inexplicably dried up. The same happened to my sister with her third...so who knows. I might have sought out a lactation consultant, but I didn't feel too bad about it. I didn't want to struggle with it and the baby was fed regardless.

I was a bottlefed baby because my mother had a kidney infection which dried her up. I have a rather high IQ and never suffered an ear infection until I reached adulthood.

I've coined a new term for women that are sharp as marbles...estro-tards...and I'll add militant breastfeeders to the list.

Mamasquab said...

Orange, have you ever read a wonderful book by Rebecca Kukla called Mass Hysteria? It's a great debunker of this truly oppressive ideology new mothers are expected to buy into about how to do it "right." The culture of self-sacrificial motherhood is Not Feminist, and nobody should have to apologize or explain why their baby is bottle fed. Now I have to go stand in the corner and see red for a minute.

Feral Mom said...

For breastfeeding twins until they were 18 months and change, I got all sorts of adoration. Which I tried to mitigate with the truth: it was luck. Dumb luck. The kids latched on, and the milk came. I didn't even read any books. Breastfeeding certainly benefits from encouragement and doctor support (which I also had) but I submit, with Orange, that much depends on luck.

I did, also, drink a few Polish beers. But that's correlation, not causation.

Vandelay said...

Can I condemn her for depriving me of some nice side-boob?

(Sorry)

E. said...

I got lucky, too, twice. O. latched on, milk came in, Roo has been the same. (Though she's a challenge to nurse in a way that O. never was b/c she's so damn interested in whatever else may be going on in the room, unlike her nip-focused brother.) But I try to remember that I've been lucky, and I never assume anything about why a woman is using formula. I don't know what her situation is, and I certainly can't judge. For me, breastfeeding is like so many other issues related to women and their bodies: an issue of choice. I know that often using formula is a choice made with sadness, after every effort has been made to breastfeed. But whatever the circumstances and the attitude, it's the woman's choice and her business.

Still, I'd encourage anyone to try to be somewhat sympathetic to militant breastfeeding advocates. I know that they can be totally annoying; I myself have been the target of correction by a La Leche Leaguer. (And how I managed that, despite nursing my son 'til he was almost three, is a story in itself. But with a hardliner, you can never toe the party line quite precisely enough.) Some of them are just know-it-alls like any group or field has, from grammar holier-than-thous to Star Trek supergeeks. But some of them have been made militant by a culture that often is at best unsupportive of and at worst hostile to breastfeeding. It doesn't make it any less wrong if they guilt a woman for not breastfeeding when it's none of their damn business, but before you smack them over the head with a bag of frozen milk, remember that there's a context.

That said, I think Orange's point here is excellent. Orange, you should offer to add a much-needed chapter to The Womanly Art of Breastfeeding.

flea said...

Word.

mutter mutter said...

Hooray for this! Breastfeeding totally ruined my life for a good six months. I was manhandled and guilted by various nursing paraprofessionals, out hundreds of bucks in supplements and pumps, and stressed out by lack of time, sleep and the missing 6 IQ points. Feh, I say. Little dude is totally fine. Yay cows!

Mignon said...

BPhD, I bridled when I read your comment, because I was all, "What the hell?" I had a very hard time. Lots and lots of blood and two babies with crappy latching technique. But that's because I strive to be superhuman best at everything in the world. Not fair to hold others to that standard. "Good enough" created the likes of my intelligent, kind, handsome younger brother (who was an incredibly lazy eater, and could barely gain weight even with a bottle with the end cut off). So yeah. Moving on.

Around here, the majority of women I see using bottles are either 1) very young, 2) lower income, or 3) Native American (our only visible minority in Montana). This tells me that dr_igloo is right about the system in our state. Those experiencing troubles with breastfeeding typically have to reach out beyond the confines of the hospital and dr's offices to get support, and those without the education, support or resources to do this opt out. But then, so what? From what I'v seen, they're still nourishing and snuggling their babies, right? Right?

Orange, I try never to assume the negative. Unless the mom is smoking. Holy shit.

E. said...

Mignon, I think Bitch PhD was holding up "good enough" as a good thing. Like sometimes "good enough" is better than quote-unquote "best" if "best" comes at the expense of a mother's wellbeing or sanity (in which case, it's not really "best," and suddenly "good enough" seems a whole lot better.)

That's how I interpreted her, anyway.

And by the way, your observations about how class plays into the issue are so worth bringing up. What used to be the domain of the well-to-do mother (formula) has become much more common for poor folks who can least afford the expense of formula (and this seems to be true both nationally and globally).

Brenna said...

Can I just bring up the other side of this? What deeply upsets me isn't a mother with the best intentions who, because of lack of support or medical concerns or the like, has to prematurely end the breastfeeding relationship. It is the women who proclaim, as soon as the stick turns pink, that they aren't using their breasts for THAT. Heaven forbid. Women with the time and resources necessary to provide in this way for their vulnerable child who never try, not even the colostrum, and speak about breastfeeding as gross or lewd. Those are the women that make me see red and break my heart for all the young women or seasoned mothers or future fathers around them, who walk away a little less sure of breastfeeding as the best option and start thinking that "good enough" is preferable.

Orange said...

Thanks for bringing up that side of it, Brenna.

Closely related to that is the other people (not the new mom) who think breastfeeding is obscene, as seen in this Dear Amy column today. I grew up in a family where my aunts nursed their babies at family gatherings and nobody batted an eye about it, so that whole "Eww! Don't do that in front of people!" vibe is foreign to me.

Laura said...

I just found your blog, and I'm already excited enough to leave a comment. What a timely commentary (... Ok, perhaps I find it timely because there was a Law & Order rerun this morning where a young mother was tried for murder because her child starved to death because she felt pressured to breastfeed and ... moving on), but still! Excellent post.

Another thing to keep in mind is that sometimes it is not the mother who determines whether the child can breastfeed, but the child him or herself. One of my good friends breastfed her oldest child, but her youngest has severe multiple food allergies. I don't mean "food allergy" as in "Timmy gets a rash when he eats pineapple," either - I'm talking having your kitchen, your car, your oldest child, and yourself covered in blood because your two-month-old has started projectile vomiting.

For several months she tried to breastfeed by subsisting on a Total Elimination Diet: sweet potatoes, rice, pears and free-range turkey. (This was not some self-sacrificing uber-mom deal; the only formula her infant could tolerate was astronomically expensive and not covered by insurance). However, even on this strict diet, her son continued to have allergic reactions. He has been on hypoallergenic formula for the past few months and is doing quite well. So before women pass judgment on the mother feeding her infant a bottle, perhaps they should consider the fact that not doing so has the potential to be life-threatening for some children.

Feral Mom said...

Mignon, my sister in law used to change diapers with a lit ciggie dangling from her mouth. Holy shit, is right.

Good points, everyone above. I am reminded now of a grad school colleague whose family actively discouraged her from breastfeeding because "it looks like you can't afford formula." I did most of my tandem nursing at home and/or among hippies, but the few times I had to whip out both tits in the park or a restaurant or something, I definitely felt the low level murmurs of disapproval.

So...what the fuck? We're all just trying to get these damn kids fed. Who else is gonna do it?

Joceline said...

Had my own terrible breast feeding experience - baby wouldn't latch (despite the help of several lovely lactation consultants and a slew of supportive friends and my pro breast feeding pediatrician) and so I pumped and pumped and pumped to attempt to give my daughter breast milk. Finally stopped at 3 months - she was very reflux-y and the only thing that helped ease it, despite my strict elimination diet, was the hypoallergenic formula.

And I just felt terrible about it. Liked I had failed in my first job as a mother. Hadn't seen enough lactation consultants (had 3 of them). Didn't spend enough time trying to get her to latch (too busy pumping 10 times a day). I look back and wish I could give myself the gift of perspective - dear self, please do not waste a second of those first 3 sleep deprived months feeling like you didn't do enough. The 40 bags of frozen breast milk in your freezer says you did just fine.

To this day I hate "The Womanly Art of Breastfeeding" - I would page through it, nipples bleeding, baby not latching, trying desperately to find some words of wisdom, and instead I would find a chapter covering "how to keep breast feeding if you have to have surgery." Never in my life has a book failed me so miserably. For me the book's few useful tips were outweighed by the fact that it central theme is that if you love your baby enough you will find a way to succeed at breast feeding. I spent 3 months trying as hard as I possibly could, sanity and sleep be damned; I still failed.

While I appreciate the sentiment behind an earlier commenter's contention that if the system were more supportive of breast feeding more mothers would succeed, I think there's a whole slew of us out there who have everything going for them and still aren't able to breast feed. I couldn't have done more to reach out (and get) help, support and Fenugreek, and yet still I was left smelling like maple syrup with a freezer full of useless breast milk.

I'll never know if my 4 year old would have been .05 IQ points smarter or had a 1.2% better immune system had I been able to breast feed. But I do know the second I admitted things weren't working out for us I was able to relax and start enjoying her babyhood more. And that's good enough for me.

Anonymous said...

I breastfed, not without difficulty, until my child was 1. Yeast, mastitis, poor latch, Yada yada. I'm not all that judgmental about other people's feeding choices as long as the baby is thriving. I'm babysitting a child right now whose mother is in total denial about her supply issue. The baby is underweight and the doctor's are worried. It's really frustrating. She restricts the formula because she doesn't want to "compromise the breastfeeding" - it's already compromised. And no wonder, the woman never pumps. She'll be out and about for 5 hours and not pump once. I had to pump or breastfeed every 31/2 hours or else I had a shirt full of milk or major pain. She's not feeling it - because she's not making it - and she's under so much "pressure" to breasfeed, and in so much denial about how inconvenient that is that she won't just make the decision to formula feed. I use to look down on my Sister in law for choosing not to breastfeed b/c she didn't like sitting around that much and it was boring. Now I just think - well, her baby was never critically underweight because of her decision. She thought it through.
Best,
CathyDallas

Anonymous said...

I am actually envious of moms who can breastfeed their babies. Every time another stay-at-home mom looks at me funny because I am bottlefeeding, I am humiliated. Even without that, I feel like I have failed as a mother. I've had two children, and I couldn't manage to feed either one of them "naturally". My son lost weight and had failure to thrive. I was so worried about my daughter that I resorted to pumping and tried the supplemental device to nurse her and give her formula. She hated it. Nothing worked. In retrospect, maybe I could have done more (or done things differently if I could turn back time). But, I did what I thought was right. And, I still feel like CRAP about it. Some people just can't nurse! Maybe, if I'd had a team of people, and I'd had prescriptions to increase my milk supply, and I'd had a nanny so I could rest more and produce more... We just didn't have all those resources, as most people don't. I just wish people would realize every bottle-toting mommy is not someone who didn't want to nurse!
Now that I've totally ranted, I feel better.
By the way, my son is a genius (no kidding) and healthy. It's too early to say how my daughter will be, but I'm going to try not to worry anymore.

Anonymous said...

My wife just had twins. I will say that we both made the decision for her not to breast feed as soon as she found out she was preggos. Even with one she wouldnt want to at all. Why? Because there is formula out there that is just as good as breast milk.

Do we care what anyone else thinks? Yeah no, we are the one's paying 100 bucks every 2 weeks for formula.


Breast feeding is a hassle as I have witnessed it with my friend and her child.

Go with formula! it will save you alot of hassle/stress/visits to breastfeeding specialists/and sleep.

Anonymous said...

Here is a whole other side of this situation to think of. I have a 22month old son. I tried to breastfeed him, with the help of several lactation consultants both in the hospital and once we came home. After a week of excruciating pain for me (bleeding, engorgement, can we say size ee from a c cup?) and frustration for me, we started pumping so I could heal and get some relief. When we tried again when I was healed, with nipple guards, without, you name it, it was a nightmare. So I started pumping full time. I cannot tell you how heartbreaking it was to be pumping for his next feeding while he was lying next to me crying, and I couldn't pick him Up. It was awful. And I did that every 2 hours. Then my milk started drying up, and I took fenugreek like it was candy, tried tried tried to make it all work because I felt such pressure to do so. After 3 months of staying at home with him, spending 30 minutes pumping, then another 15 feeding, then another 10 washing everything up every 2 hours, I just couldn't take it anymore. It was my entire existence. Family party? Oh excuse me while I disappear into the back room to pump for a while. I got so depressed. I felt as though I couldn't go anywhere, because where was I to pump? And what would I do with my son while I pumped? We switched to formula, and honestly I never looked back. I missed out on the enjoyment of my newborn because I was so focused on " doing the right thing." I am not disputing the research, but I also know that my son has never been sick except the occasional cold, and I also know friends of ours who have kids who were breastfed for longer and have been in the hospital for croup, ear tubes, you name it. I am about to have our sec d child, and everything in me says not to breastfeed, as I will be a better happier mom this time around, able to enjoy my child instead of resenting the pump. I really think that everyone needs to quit judging in this category---- you never know what someone has been through. And ps---I was formula fed, I have never been in the hospital, and my IQ is 130 :)

Orange said...

Sorry you had a rough time too, @anonymous. You might find that breastfeeding works great the second time around—I know others have had radically different experiences with subsequent children—but if it doesn't work instantly and easily, the most important thing is being happy and focused on the baby. What you feed him/her is secondary (provided it's not, say, Mountain Dew!).