Monthly Archives: August 2014

I wish I had been a Fearless Formula Feeder

In talking about breastfeeding, I also wanted to talk about formula feeding. Like the mythological Ancient Greek character Tiresias, who has lived as a man and a woman, I have lived as a formula feeder and an exclusively breast feeding mom. It is a unique perspective.

I think parents who formula feed should never, ever feel guilty. But yet, we do. I certainly did. Whether it’s the little bit of formula we give to make up for a supply or pumping deficit, or if a baby is completely formula fed from the moment of birth, so many moms feel guilt.

If I had returned to work 40+ hours per week, as I did after my first child, my baby would be getting formula. I need to pump 2-3 times to get the amount my baby takes in one feeding. I would have continued nursing, and pumping, but formula would have made up the differential in the pump-to-feeding ratio.

There is also a prevailing thought that formula companies’ relentless marketing is what makes mom switch. While this may be true for some moms, and I do not doubt there are “formula pushers” in our midst, this vilifying of formula companies is a little ridiculous. Honestly, who should formula companies market to? 60 year old men? Or, since we operate in a free market economy, marketing to the target consumer base-women 18-35 who are the most likely to have kids…yup, that would make sense.

There is also this one simple fact: babies and mothers who could not breastfeed before formula was invented often did NOT have happy outcomes. As long as there have been babies and moms, there have been problems with breastfeeding, and moms looking for solutions. Also, let us not forget the high maternal mortality rates that long plagued women. Wet nurses, goats milk, homemade concoctions- none were as fail-safe as modern formula. Formula saves lives.

I could reiterate the millions of GOOD reasons women formula feed, but the good folks at The Fearless Formula Feeder have already done this. This is an amazing website. Everyone should read it.

Instead, I’d like to share the benefits that I’ve found to formula feeding.

1. You really can co-parent with your partner. In my home, we split it all-night feedings, mealtimes, formula prep. I have found this impossible to do while exclusively breast feeding.

2. You have the certainty of knowing how much your child is eating at each time of the day. This does wonders for a new parent’s state of mind.

3. You can include other caregivers in feeding your baby with little to no issues. As a working mom whose second baby refused a bottle, let me tell you, this is huge.

4. I think it’s easier. This is widely disputed on breastfeeding websites. I’ve had very little trouble nursing on the second go-around. I still found formula feeding easier.

5. Your body becomes your own again. As a person who is very sensitive to hormonal changes as it pertains to my mental health, and in ways I didn’t anticipate as it pertains to my physical health and comfort, I have found breastfeeding to keep my body in a constant state of flux. This is challenging in ways that has nothing to do with my ability to feed my baby.

All parents who love, feed, and take care of babies are awesome. Period. Let’s make the baby feeding game “No shame, no blame,” from here on out.

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The Breastfeeding Posts: Reflections on Self-Judgement and Forgiveness

The most difficult part of writing about my breastfeeding experiences was silencing my defensiveness and self-judgement about my first go-around. How could someone like me, who has been studying and has been an active member of the “women and children” health community in some way since I was 19 years old be so blindsided, so unprepared, so sideswiped? I mean, I read all the motherfucking books. I have a master’s degree. Shouldn’t I have known better?

Maybe. But I didn’t. I had no experience. I had no new-mom friends to be like “Hey! Sometimes things go wrong.”

I had to revise these posts many times to remove defensiveness about my choices. Who was I defending myself against? Nobody but myself, and my own sanctimonious self-talk about formula, and bonding, and how I “wasn’t mom enough.” What that voice really covers up is a deep sadness about the days, weeks, months of my life I spent enshrouded under the shadow of post-partum depression. Time with my first child I will never, ever get back. A time I’ve tried to write about many times and I’m still not ready to reference as more than an aside.

I am still working on forgiving myself. I’ll get there.

My tiny formula-fed preemie is three now, and is healthy, smart, huge, and beautiful (of course I think so. I am her mother.) A recent study comparing siblings where one was breast fed and one was formula fed has found that the home environment appears to be a stronger indicator of child health and intelligence than infant feeding methods. A free full-text link to the study itself isn’t available that I can find, but for those of you motivated to access the study the abstract and citation is here.

It has helped with my forgiveness process.

Breastfeeding is hard, even when, like with my second baby, the “mechanics” come together easily. It’s a sometimes crushing responsibility to be another person’s food source. It’s exhausting. It’s emotionally taxing. If I had had to go back to work full-time, if my baby had food allergies or reflux, if, despite my planning, I relapsed into depression and anxiety…If I had decided that disliking breastfeeding was affecting my ability to care for my baby. Any of these would have brought about a different ending. I was truly privileged to have the opportunity and the support to organize my life this past year around my children and their needs. Too many moms never have that chance.

Also thank you. To all of you who reached out to me, for being encouraging, supportive, loving. You rule.

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Breastfeeding Part 4: Second Chances and Success

When my first daughter was 18 months old, I became pregnant with my second child. Armed with much more information about maternal mental health, and the confidence about taking care of children that only comes with experience, I readied myself for welcoming my second baby girl. I was determined to have a different experience, and assembled a team to care for my physical and mental health.

Mothers who have had one premature baby where, like in my case, prematurity is due to unknown causes, have a 25% chance of having another premature birth. Or, as my awesome OB/GYN pointed out, a 75% chance of having a full-term baby.

Knowing what I had faced before, I made plans for feeding my baby. My extremely wonderful neighbor works in an OB/GYN office and offered me two cases of formula samples, which I gratefully accepted. The place I took childbirth classes for my first child had finished its transmogrification and re-opened, offering a list of resources for obtaining pasteurized breast milk from milk banks if I wasn’t able to supply my own. My NICU had begun to offer donor breast milk for preemies. These alternative sources of breast-milk were unknown to me when I stopped nursing my first daughter. Mothers who were willing to donate their own breast milk “mom to mom,” was also an option we discussed, but didn’t agree upon as a first-choice option for our family.

After a pre-term labor scare at 32 weeks, my second daughter arrived at 37 weeks on the dot. She was placed on my chest, at which point she rooted around, found my nipple, and immediately latched on and began to gulp. Thus began one of the easiest, most uneventful nursing relationships one can hope for with a baby. My baby latched, nursed, and gained. She didn’t even lose weight in between birth and out discharge from the hospital! After my previous journey, I can only describe this feeling as magical, a miracle, and a complete gift.

My own breastfeeding goals were modest. Every day I said to myself, “I am going to nurse today, and maybe tomorrow.” This time around I again had dysmorphic milk ejection reflex, but as I did not also have post-partum depression and anxiety, I was able to breathe through the passing feelings of panic. Around 3 months the feelings passed entirely. I also had painful let-down, where I felt shooting pains at the beginning of each feeding in each breast. Again, around 3 months, this too passed.

My biggest hurdle came from my need to pump. Until the time came to pump for my new baby, I didn’t realize I had pump-related trauma associations from the NICU. I was unable to turn the pump on, to hear the motor. I began slowly, first by hand pumping, then by doing short stints, then longer with my electric pump. I took a pumping workshop at the childbirth education center. I worked through it in therapy. I still hate it, but I’m able to pump successfully.

Along with my pregnancy support team, I was also able to return to work part-time as opposed to full-time. This is a luxury I did not have after my first child. In charge of my own schedule, I was able to nurse, go to work, come back to my baby, nurse, and return to work. I brought my baby everywhere with me, including work meetings and trainings.

My baby will be one in two and half weeks (what?!?) and we are still nursing. She rejected a bottle at 3 months and with the support of my family, and the flexibility of my workplace, I’ve never had to push the issue. When she wants to nurse, she smacks my chest with her hand, as if knocking on a door. Her big sister is also an advocate for her, yelling, “Mamma! She needs the boob!” Her sister and I are currently teaching her the sign for “milk.” Since she still nearly always rejects breast milk from any container other than the breast, when I’m away and I pump, I give the breast milk I pump to my oldest mixed in with her cows milk. I figure it’s never too late for some of Mamma’s milk.

Tomorrow: some wrap-up reflections.

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Breastfeeding Part 3: PTSD, PPD, Panic, and the End of Nursing

I honestly don’t remember what day in the hospital it was, but somewhere around Day of Life 4, as the doctors call it, things started to crumble quickly for me.

My baby was continuing in the NICU because she had what is called “apnea of prematurity.” Basically, she would randomly stop breathing, mostly while in a deep sleep, and would have to be picked up and patted awake, after which she was fine again.

Even after I started nursing my daughter, she got one bottle with vitamins in it each day. This was to make sure she drank it.

I was giving her this bottle when suddenly, she went limp in my arms. The NICU nurse with me grabbed her and flipped her over and patted her back until she started breathing again. While I was feeding her, she forgot to suck, swallow, breathe.

Sometimes, though, I’m not sure I’ve ever started breathing again from that moment.

Simultaneously with this, my milk came in. At each pumping and each feeding, I started to feel like I was having a panic attack with each let down. I know now that this is actually a “thing,” called dysphoric milk ejection reflex. However, as I was exhausted, and guilty, and overall in a bad space, I didn’t mention it to anyone.

Besides, breast is best, right? How could something so “natural” do this?

I kept on trucking, and after ten days in the NICU, we were sent home.

Once home, anxiety started to take over all my days and nights. I started having panic attacks multiple times per day, and combined with the bad feelings I got with each milk letdown, I was afraid to be alone with my baby. One of the few non-negotiables of breastfeeding is that you have to eat and drink to make milk. I was so anxious I could barely eat, and my supply was not that great. My baby was constantly nursing for hours at a time, day and night.

Finally, after a day where I slept for 20 minutes in 24 hours, I broke down and finally started the process of getting help. That is another story for another time, but that resulted in my needing medication, first to sleep, then to get the panic attacks under control, and finally, long term to treat the anxiety. I had post-partum depression and anxiety, along with PTSD from my premature birth and my baby stopping breathing in my arms. I was not in good shape.

No doctor I met with could inform me about medication transmission in my breast milk. I was exhausted and scared. And so, when my baby was three weeks old, I stopped breastfeeding her.

The guilt that I felt at what I perceived to be yet another way I was failing as a mom was incredible. Looking back, it was the best decision I could have made with the supports and information I had available at the time.

But it didn’t feel that way.

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Breastfeeding: Part 2: The NICU

This is where the hard stuff begins.

When I became pregnant with my first child, I was determined to feed the baby breast milk. Since this was all pre the Obama-care free breast pump days, I researched pumps, I had my IBCLC-to-be/doula friend on speed-dial, I got all psyched up for the whole kit and kaboodle. My baby registry was stocked with breastfeeding items. I was ready!

Then, at 35 weeks gestation, my daughter made a completely unexpected entry into the world. She came out of my womb, stopped briefly in my arms, and went into the neonatal intensive care unit (NICU).

I was completely unprepared. I hadn’t even had my baby shower.

But, after she was deemed pretty ok, just small and yellow, I went up to the NICU to try and feed her for the first time.

Premature infants are born without the layers of fat that make babies all roly-poly and keep them satiated with small feedings until a mother’s milk comes in. They also often experience difficulty self-regulating their own body temperature, and having unstable blood sugar levels. Mothers of premature babies often experience a longer wait time for milk to come in because your body has to catch up with your baby. Also, you have just experienced a majorly stressful event, which also is difficult for the body.

Therefore, you have to feed them something. The protocol for feeding premature infants address all of these issues. At the NICU I was at, and at most NICUs, that something is what I call “milkshake formula,” pumped up with extra calories preemies need to compensate for their early arrival.

There are NICU programs now that only feed preemies pasteurized donor breast milk. This is a good thing, but it was not an option for me the night my daughter was born.

To help with making the milk come in, lactation meets you at the NICU immediately. My IBCLC was brusque, but incredibly helpful. She hooked me up to a syringe system where I could simultaneously breastfeed and formula feed until my milk came in. A little hose was taped to my nipple and my baby sucked while I slowly let formula down the tube.

This went okay. At that time, however, like with many preemies, “suck, swallow, breathe,” was not a strength for my baby.

This is an important fact that comes up later, so remember it.

Then, I got schooled in The Pumping.

When your baby is in the NICU, you are told to pump at least 8 times per day if you are intending on breastfeeding. Also, your baby is fed on-demand, or woken up after 3 hours to feed. To increase supply, and to make sure the nursing staff has breast milk when you are not there (sometimes you have to shower, and you often can’t sleep over,) you are instructed to pump about 15 minutes after each feeding. Feeding my daughter took at least 30 minutes at a stretch, because I had to wake her up, keep her awake, and slowly dispense the formula while she nursed on what colostrum I had. Then I waited 15 minutes and went to pump for 20 minutes. Then, I had to wash everything, because the NICU is sterile, and turn in my tiny bottles of almost nothing. When I was at home, I set my alarm for every three hours through the night (not that I could really sleep) and hooked myself up to my hospital-grade free rental pump (oh, the perks of preemie birth) and pumped away.

When my milk finally came in, we stopped the formula, but I gave permission for it to be used if I wasn’t there and she drank more breast milk than I had provided. As suck, swallow, breathe continued to be a challenge, the IBCLC gave me a nipple shield to use until her latch became more powerful.

This helped.

But it was rough. I spent 12 hours a day sitting in a grey room basically naked from the top down holding my baby on my chest and watching my baby sleep, and feeding, pumping, washing-labeling-rinse-repeat.
Then I went home and woke myself up every three hours for more pumping-washing-labeling.

And this was my breastfeeding life. Not exactly the pillows-snuggles-and Enya experience I had pictured.

And that’s what I can give today. More tomorrow.

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Breastfeeding: Part 1-It’s Complicated

I have, thus far, stayed away from Hot Button Issues (mostly) in my writings.
But it’s World Breastfeeding Week, and I am feeling the need to reflect on my own journey, as I have both succeeded and failed at breastfeeding.

I am always hesitant to write about breastfeeding because I’m worried people will feel like I am “parenting at them.” I am afraid people will try to educate me about breastfeeding. I am worried I’ll trigger someone with breastfeeding trauma. (Or I should say, I’ll trigger someone ELSE with breastfeeding trauma, as I used to be triggered).

Please know this: I think every mom makes the best decision for herself and her baby with love in her heart. I know, in my decisions, that I did. Secondly, while I learn new things about breastfeeding, children, and babies in general daily (let’s be honest, I learn things about EVERYTHING daily),I do my damnedest not to present a “fact” that isn’t something I actually can cite. In certain circles in which I travel, breastfeeding has become so political that simple facts about breast milk and nursing are challenged if they aren’t “Lactavist-y” enough. At the end of the day, we are mammals, and therefore we lactate. Just like cats, monkeys, goats, or three-toed sloths. Unlike other mammals, however, we have other things to do besides lie on our sides and nurse after we have babies. Also our babies can’t walk within hours of being born.

But I digress.

Lastly, this is much more personal than my general flippant rants and/or mushy hallmark moments that I share. Given conversations I’ve had with Mammas and Mammas-To-Be be in my life recently, I am moved to share my experiences because they have been both incredibly traumatic and incredibly healing. I’ve received feedback that sharing my story has been helpful.

I’m nervous, but this is a part of my own process I’m ready to tackle. Writing, sharing-it’s all part of the journey for me.

Those of you who have encouraged me to talk, to share- thank you.

More tomorrow.

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