Breastfeeding

This is worth a post in itself.

Before I gave birth, I made a promise to myself. I would try to breastfeed. I would give it my best shot. If it didn’t work, I would use formula and that would be that. I vowed that I would not drive myself crazy with pumping and supplements. I wound up not enjoying Aliza as much as I should have because I was so upset about nursing. I wasn’t that optimistic, because things seemed to be heading down the same road as the first time—no breast growth again.

When I was admitted at 32 weeks, they sent the LC down to see me in case I delivered. She was helpful but a little pushy—I got an eye roll when I said I might be having a 37 week repeat CS. She also said it sounded like I hadn’t had enough stimulation at the breast and she did say she thought I would need to pump this time. I think she saw me as another potential failure who was going to drop at the first hurdle, but I was okay with that. She was pleasantly surprised that not only was I aware of the Making More Milk book, but that I had read it.

After delivery, I nursed. He latched well, things were going okay—except I was sick and I sent him to the nursery. I didn’t feel guilty then and I don’t now, because I was just so sick. There were times that first day when I didn’t trust myself to hold the baby at all because I was so dizzy. I had some trouble positioning him on my own the next couple of days, but I did it. The problem was, he was hungry. The LC rolled her eyes at me when I said that, but this is my second child. I know that hungry scream, and my mother heard it too. I tried telling her, “His stomach can only hold a tablespoon; he can’t be hungry because he’s just nursed.” She just looked at me. He screamed and screamed, and I asked for a bottle, and he drank 25ml and slept. The LC dismissed it with “Of course he drank it, it’s easy.” I’m not convinced. I’ve tried to shove a bottle in the mouth of a full baby, and it doesn’t work. This was a jaundiced newborn. I’ve done that before, and you nearly have to drip the formula down the back of their throat half the time, because they are so sleepy and don’t want to eat, no matter how easy you make it. At one point I got resentful and thought I would just go to formula when I got home, because it was difficult, I was post-surgical and I felt discouraged.

I got home and we were still trying, but not really as much as we should have; with my parents there, and a small house, it was extra hard. I really thought about quitting. Then on Saturday, my milk actually seemed to be in, and my husband even said “hey, I think they are bigger” and I had a change of heart. He nursed well, and I thought, “maybe it’s different this time.” Starting on Sunday he was nursing but not terribly well. He was sleepy, so he’d drop off every minute. I decided to try pumping for a little bit. Not a month again, but see if maybe I had more supply, enough to make it worth it. A week later, I was forced to concede that I didn’t. He didn’t want to nurse much, and I think he knew. LCs will mutter about the bottle and the faster flow, but I tried the “supplement first” technique and it didn’t work either. Intuitively, that made sense even without the reasons I’d read for it—a hungry, frustrated baby is difficult to latch. By taking the edge off, the baby is calmer and more willing to cooperate. I think he was frustrated by getting so little, and he associated nursing with sucking for nothing. I was on the couch, trying to get him to latch on, and Aliza asked what I was doing. I told her. She said, “Why don’t you just give him a bottle?” I said, “This is better for him.” She looked at us and said, “I think he likes the bottle better.” That made me cry. Maybe he wasn’t willing to work hard enough to get what little was there. I was supplementing because I knew that I certainly did not have a huge supply, the ped was concerned with how much weight he’d lost so quickly, and I wasn’t willing to starve him into submission, even temporarily.

That opens up the “What If” Pandora’s box. What if I had nursed nonstop after delivery? What if I had pumped right away rather than resisting it? I’m never going to know. I have come to the conclusion that while maybe it would have helped, it’s unlikely to have changed things that dramatically. I’ve heard that the initial phases of milk production are hormonally driven, and production really kicks into the equation a little later. I also hear about women whose milk comes in whether they want it to or not. I was facing an uphill battle. Perhaps I could have achieved more supply, but I wasn’t just going to feel a full supply arrive on its own by breastfeeding more in the initial days. The fact is, I never felt anything the books and articles told me I was supposed to. I never really felt my milk come in; I discovered it almost by accident when I was trying to latch him on. I was never engorged by any stretch of the imagination. I never felt full before nursing, or empty afterwards. I never felt let-down. I saw his jaw move, so I know that he was actively sucking, but almost never heard swallowing. I know that none of these things are definitive, but all together, I’m suspicious.

That begs the second question: How much effort is worth it? There’s an unspoken assumption from some breastfeeding advocates that any effort is worth it. I don’t think it is. The advice dispensed for low supply is simply impractical. Nursing, supplementing, and then pumping eight times a day was difficult enough with one child; it was a disaster with a second to look after as well. I made the mistake of searching for information on low supply and insufficient glandular tissue. I didn’t think I would find anything terribly useful, or that was very different from what I’d found nearly 5 years ago. What I found were breathless, chirpy descriptions of pumping and donor milk and using an SNS. They didn’t make me feel better; they made me cry. They depicted a worldview where breastfeeding reigned supreme and whatever you needed to do to achieve it, or even preserve the illusion that you had, was the most important thing. They pointed out, “Only 3% of women are physically incapable of breastfeeding!” If you’re in that 3%, it doesn’t make you feel any better to be a freak, and if it is situational, is that any better? There’s a hidden subtext: If you can’t at all, then it’s acceptable. Not okay, just acceptable. Maybe, if you can prove that your situation this time totally stopped lactogenesis, then we’ll pat you on the head and tell you better luck next time. The rest of you? No excuses! At best, there’s blame for “the system” which I find infantilizing. It’s as if some breastfeeding advocates are incapable of envisioning a situation where someone makes a genuinely informed choice to feed formula. As far as they’re concerned, either you were pushed into it, or your decision making process was corrupted by our pervasive culture of formula. I even found posts doubting the numbers of women with IGT and accusing some of using it as a convenient excuse, which I find hard to believe. IGT is not widely known. Even OB/GYNs and LCs are often poorly versed in it. Why would someone go to that trouble, rather than just make up an easy, plausible excuse (if an excuse is what they want)? All of it seemed to shy away from the question of how far you should go. It’s obviously a personal decision. Some women are willing to use an SNS, and some are not. But very little of it faced the issue head on, or discussed how you should make that decision, or what steps were reasonable. They simply told you what you could do. It’s nice to think  that they’re just leaving the decision up to the reader, but it didn’t feel that way. It felt like all these approaches were being handed out as a bloc.

I view breastfeeding primarily as a breastmilk delivery system. The bonding is nice, but as a second time mother, I can’t read paeans to the sacred breastfeeding relationship with a straight face. Maybe there’s a magical level of bonding I could have achieved with my first and which I will never know, but once I got used to bottle feeding, it seemed okay to me. I learned to enjoy the quiet cuddling time. I used a binky for that all important “suck on something to keep quiet” time. (Which reminds me of a line from the postpartum care booklet I got: “Babies do not use their mother as a pacifier. A pacifier is a plastic substitute for a mother.” It rubbed me the wrong way.) That doesn’t mean it’s all or nothing, but if I’m mixing formula after every nursing session, then the effort is outweighing what I get from it. It’s just twice the work. At that point, it’s all about the “relationship.” If that matters to you, that’s fine, but it’s not important enough to me to go to those lengths, and the breastfeeding webpages made me feel like I was a lazy slacker for thinking that way. I don’t hate breastfeeding, but I don’t love it, either. It’s fine. It’s tolerable. Again, I just don’t know what it would be like to nurse for any length of time, and to get past the initial hump—as people have (rudely, in some cases) reminded me. I’m on the outside looking in, and it’s not all that fun.

That winds up making me feel guilty. Because I’ve only experienced breastfeeding negatively, I feel alienated from my friends who talk about breastfeeding. When they complain about all night nursing, or being pestered by toddlers, I secretly feel relieved that I don’t have to deal with it. I have said “gosh, these women are really not selling anyone on breastfeeding when they talk about how they haven’t slept a full night in two years” about some Mothering crazies, but I can’t be open about feeling that way during much less extreme discussions. There are circles where breastfeeding is gross and everyone is open about how terrific and liberating formula is. I don’t know many people like that. The majority of my friends breastfeed, and the ones who don’t at least pay lip service to the “breast is best” ideology. I’m not a fan of those comment pieces about the tyranny of breastfeeding and how women are guilted into pretending to like it, because this is a very limited phenomenon—in my experience, middle class white women in urban areas, particularly in the Northeast and the West Coast. (For the record, I loathed that Hanna Rosin piece that got around the blogosphere a couple of years ago.) By and large, society is not forcing women to breastfeed. But, if your friends do, it feels wrong to talk about how much you love formula. In that context, it almost feels like judging another woman’s choices. It’s also because I didn’t choose formula; I had it foisted on me, and it’s complicated to have positive feelings about a choice you didn’t want to make. If I had chosen to use formula, I could feel good about it, the way I’m pretty much okay with my section. It wouldn’t be that breastfeeding didn’t have positives, it would be that I had made a considered decision about which things were important to me. But since I didn’t choose, my ambivalence makes me uncomfortable; I almost feel like if I had been that committed to breastfeeding at any cost, it would have worked.

Oddly, what made me feel a little better was not chirpy or uplifting. In fact, in other contexts, it would have been depressing. What was helpful were studies and reports on women like me. I actually found a few this time. Women who fit my profile (one had the case studies listed individually) had poor results with breastfeeding. It was fairly consistent. That at least made me feel like it wasn’t me. I got let down by a cruel trick of biology, but it wasn’t failure of effort. It took the responsibility off me, and let me quiet the what-ifs. Maybe I could have achieved partial supply with superhuman effort, but it wasn’t going to be 100% by any means. That external validation made me feel better, more than just my friends saying “You’re doing a great job, you have a gorgeous baby, and all that matters is him being fed.”

If you’ve made it to the end, you’ve earned a drink.

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