I know breastfeeding is the natural way to feed our babies. I know it can be a beautiful bonding experience. I know it has many health benefits. As an OB/GYN I also see the extreme pressure women feel from society and health care workers to exclusively breastfeed. Hospitals must report a high rate of exclusive breast feeding to maintain their Baby-Friendly status so there is an extra incentive to encourage moms to leave the hospital without using formula. Most of my patients and friends have wanted to exclusively breast feed their babies. I did as well. I wanted to make sure my baby received my antibodies as I happen to have an amazing immune system from growing up with two parents who worked in the hospital and a family dog (yes, dogs do help your immune system!) I also wanted to check the box that made me a good mom and gave my child the best chance of getting into the university of her choice and succeeding in life.
My personal experience with breastfeeding has made me a more empathetic person and I am now better able to counsel my patients and discuss this topic that women tend to have strong feelings about. I personally did not have a radiant glow around me during my days of lactation nor did I feel the intense bonding experience many women report. My experience with breastfeeding felt more aligned to that of a dairy cow whose body is no longer their own and whose daily routine revolves around the cycle of producing milk and consuming calories to produce more milk.
Postpartum day one: I had a c section right before midnight but made sure that bright and early the next morning while I was sleep deprived, still in shock, and with my incision feeling like a hot knife was cutting into me I slowly made my way down the hall to meet with the lactation consultant. I was NOT going to miss the group breast feeding class as that would mean I was already failing at being the best mom possible. Six brand new moms who had never met each other sat around in a circle with the lactation consultant whom we had also never met before. She introduced herself and immediately encouraged us all to drop our shirts so she could examine our nipples and squeeze them to see if colostrum came out. She cheered for those who easily expressed colostrum and demonstrated colostrum release on their breasts to the class. She reassured those whose bodies were not as successful at on demand performance. She then taught us the different positions for holding the baby while breastfeeding and went around again to help us latch our babies. That day I lost any remaining modesty I had briefly held onto after my birth experience. It was in this class that I realized I would never again have the same level of bodily privacy or autonomy I had maintained for my entire adult life. But this seemed normal and rational- being selfless is part of the societal definition of being a good mom. It is only natural that you should embrace exposing your breasts to a room full of strangers in the pursuit of breastfeeding. I can only imagine how this experience must feel for women who do not spend their days as a professional giving other women breast exams, those women who are from more conservative cultures, and those who have a history of trauma, abuse, or body shame. Perhaps breastfeeding is empowering to them. Perhaps they are as bewildered by this experience as I was.
Postpartum day two: Milk let-down. I really do not have adequate words to fully describe how this felt but I will try my best. I looked in the mirror at my huge, rock hard, painful breasts and felt like a porn star from the 80s with a bad boob job. Where had my body gone? Now I no longer had just the 12 centimeter red, swollen, bruised, fresh scar on my abdomen, the puffy, edematous body, and the dark circles under my eyes, I also now had a new pair of breasts that did not resemble my own in the least. It was such a disorienting experience. All of the nurses encouraged me that this was great- my milk had come in so quickly! Some women wait anxiously for five days for their let-down. There was no room for thinking about my rapidly changing physicality in the world of being a new mom. I should only feel lucky at the abundance of milk I was gifted and feeling anything else would be selfish.
Going Home: I was discharged from the hospital and had a baby nurse at home to help me while I recovered. A stranger whom I had never met, in my home, watching me as I struggled to walk around, fresh from major surgery, with my robe agape and my huge, painful, leaking breasts on display. My lovely and very enthusiastic baby nurse informed me it was best to breastfeed and then pump to increase my milk supply. This completely destroyed and remade my nipples. Those soft, sensitive structures packed with nerve endings experienced sharp pains, chafing, cracking, and bleeding. This lasted during the first few weeks until they “toughened up” (yes, this is a real thing- all moms who have breastfed can tell you your nipples are never the same after). I also mastered a meticulous routine with nipple creams and figured out the proper settings and flange size on my breast pump. I was an enthusiastic student eager to do everything right and continued the double feeds throughout it all even as my body tried to tell me to slow down. Our breasts work on a supply and demand model in conjunction with our individual anatomically determined milk storage capacity. Combined these variants determine how much milk each woman can produce under optimal circumstances. I unknowingly had a family history of being “over producers”, or having a large milk storage capacity. I rapidly began producing more milk than one baby could ever need. My daughter could not even latch and properly feed as she was choking on the forceful milk being expelled by my breasts. She was frustrated, I was frustrated, and my breasts were just angry.
For the rest of the moms out there, If you aren’t producing a lot of milk you may have low storage capacity, which is not proportional in any way to the size of one’s breasts. Please do not blame yourself or feel like a failure if after you try everything you still are only getting a few ounces a day. Sometimes it is just your anatomy and there is nothing you can do to change that.
The struggle to find a balance: I eventually learned a routine that worked best for me- pumping and bottle feeding the breast milk, freezing the extra. Throughout my maternity leave I pumped and stored a whole deep freezer full of milk that was eventually thrown away with many tears and curses when I realized my daughter would not drink it due to the high lipase levels in the thawed milk (something else I had never been warned about). Throughout my maternity leave I continued to arrange my daily schedule and activities exclusively around my dates with the breast pump. I also experienced airports that did not have pumping rooms or an outlet in the bathroom so my milk was literally backed up into my armpits and I was crying by the time I reached a safe, clean place to pump. When I returned to work I returned to an employer that did not give me pump breaks or a relaxing place to pump in the few minutes I could steal away between patients. I quickly cut back and then stopped pumping during the day so my daughter would get breast milk in the morning and evening as by this time my production slowed enough that she could tolerate latching, and she eventually stopped wanting to latch at 8 months. I was fine with this. I did not mourn the loss of the bonding time and was quite happy supplementing her diet with formula.
This was my experience. I should feel lucky. I produced enough milk to exclusively breastfeed my child for her first three months. She did not have colic, allergies, an elevated bilirubin or weight loss and we did not require intervention from the pediatrician or a lactation consultant, or the exhausting trial and error of finding the perfect formula that a very sensitive or small baby requires. Many moms would have traded anything to have my milk supply. I speak to women every day who are on the verge of an emotional breakdown, exhausted and feeling like a failure as a mom and woman because they have low milk production, problems latching, or both. They devote their entire day and night to trying to get breast milk for their babies, even resorting to triple feeds recommended by lactation consultants (for those of you unfamiliar with the term this means nursing, then pumping, then bottle feeding, and for newborns who feed every two hours by the time you are done the cycle it is time to start the process all over again). They use the nipple shields, massage their breasts with epsom salts, and try every sort of supplement (teas, pills, powders, and even cookies) marketed as having properties to increase milk supply. I have seen countless women with postpartum depression on the brink of a nervous breakdown due to struggles with breastfeeding and the lack of sleep that ensues. I try to talk them off of the ledge with some of the sentiments below. Please share my words or your own encouraging variation with friends and family members who may need permission to stop their downward spiral of mom shame and guilt:
Sleep deprivation, stress, guilt, depression, and anxiety are not good for your baby-your mission to exclusively breastfeed or to continue breastfeeding may be causing more harm than good for both of you.
You are still an amazing mom and woman if you supplement or stop breastfeeding. Treat yourself with compassion and stop judging yourself or worrying about others judging you.
Give yourself permission to not force breastfeeding if it’s not working for you or you just don’t like it. Moms are not meant to be martyrs. Having a happy thriving mom is the most important gift you can give to your baby.
I do not deny that breastfeeding may be a beautiful and natural bonding experience that has numerous benefits for your growing baby. I am in awe of every mom who does it so easily and without complaint. But it’s not for all of us. Would I do it again? I’m not sure. Is it selfish to formula feed? Not from my point of view. Sometimes not breastfeeding is a much needed form of self care. I always ask patients if they are breastfeeding at their postpartum visit and discuss any questions or concerns they may have. Often if a woman is not breastfeeding or is supplementing she will apologetically or guiltily will report this and feel the need to explain why. However, once I had a mom respond:
No. I graduated from breastfeeding
She said this with a smile on her face. No guilt, shame, or justification offered. This mom was free and thriving. She did what was right for her and her baby, no matter the reason, and without fear of judgement. I loved her attitude and the grace and self-compassion she displayed in that simple response.