With full transparency, here are my thoughts, feelings, questions, and reflections on my breastfeeding experience. I have decided to share my journey so far, partly as a therapeutic exercise for myself, partly to help empower any other women or couples who may have struggled, and to offer advice for mamas-to-be!
Throughout medical school, we learned about the benefits of breastfeeding for both baby and mom. It always seemed like such a beautiful experience for a mother to share with her child. I had every intention of breastfeeding...but for us, it didn’t quite work out as planned.
Brooks made a speedy and early entrance into the world. He was born at 37 weeks and 4 days, after only a few hours of labour (read “Our Birth Story” post for the full story!). Because of this, we had a few challenges right from the start. For the first 48 hours, Brooks mostly just slept and was not too interested in feeding. I had planned on starting to express colostrum (the super nutrient-rich milk initially produced) before delivery, but Brooks came so soon after "term" (37 weeks) that I didn't have a chance. In the hospital, I started hand expressing colostrum but was only producing a very small amount. It felt silly to collect, literally, droplet by droplet, but colostrum is considered "liquid gold” due to all the benefits and protection it provides for a newborn, and so I tried to collect the drops in a tiny syringe. So here we had a baby that didn't want to nurse, and a mom that was barely producing any colostrum. A baby's stomach is only the size of a chickpea at birth, so not much milk is needed, but given that I was barely producing anything, the nurses suggested topping-up with some formula. During medical school we had also learned to emphasize "fed is best" rather than “breast is best”, and although I preferred to breastfeed my baby, I understood the need for a top-up. Things seemed to be going okay, and we were hoping for an early discharge.
This is about the time things started to go sideways...
A physician came in to check on us, and when she asked about how feeding was going, I mentioned that Brooks had taken about 2 mL of formula as a top-up, since I wasn't producing much milk yet. This led to a lecture about how women should treat breastfeeding as if they are cavewomen: "No clocks, no pumps, just feed your baby when they are hungry". She went on to tell us how one dose of formula can set a baby's gut bacteria back by 2 weeks, and how the incidence of irritable bowel disease is significantly higher in formula-fed babies. She inferred that the nurses on the ward "push formula" too much.
After our lecture from the doctor, we had a lactation consultant come see us. She recommended a number of things to try, including a nipple shield (a flexible silicone nipple that is worn over the mom's nipple during feeding, which can help if a baby is having trouble latching), trying to stimulate milk production by using the hospital-grade electric pump, and buying a different flange size (the part that attaches to the breast) for the pump we had at home. Unfortunately, she kept getting called away to other rooms, and we were left without much guidance. Brooks still wasn't breastfeeding well, and I hadn't had much success with the pump yet. At this point, I was tired, hungry, and very eager to get out of the hospital. Once the lactation consultant returned, we expressed that we wanted to go home as soon as possible. She made an exasperated comment saying "You have to feed your baby!". This struck a nerve for me. I felt extremely confused and frustrated by the different messages I was receiving from different healthcare professionals. I felt vulnerable. I was exhausted, overwhelmed, and had so many expectations of myself and from others surrounding breastfeeding. I remember tears were running down my face, and yet the lactation consultant didn't acknowledge anything. She left, and thirty minutes later she was back with a printed handout and we were discharged.
We had an appointment to see the public health nurse the next day. Brooks' weight was down 11% from his birth weight. The nurse seemed concerned; he was slightly lethargic and was showing some signs of dehydration. I felt even more guilty for not being able to produce enough food for him. She was calm, professional, and reassuring. I explained the experience I had in the hospital, and she responded, "Formula is not the devil, it is a Godsend". She stressed that "fed is best". We came up with a clear plan for feeding him: I would try to breastfeed first, and if he was getting frustrated or not latching well, we would switch to giving him a bottle, and I would pump. I learned later that this is referred to as "triple feeding". We tried really hard to do this. It was exhausting and so time-consuming. On the bright side, my milk came in around day 5, and Brooks was getting a combination of breastmilk and formula, and gaining weight right on track. He still wasn't latching super well or taking much breastmilk from actually breastfeeding (he was mostly taking my expressed milk in a bottle), so I made an appointment to see a physician at the Lactation Clinic.
I ended up seeing two different physicians at the Lactation Clinic. The first physician was friendly and knowledgeable. One thing she said that stuck with me was: "Breastfeeding is like trying to complete a puzzle, but the puzzle pieces keep changing". We were hopeful that with time and as Brooks grew, that he would feed better, my milk supply would increase, and I could exclusively breastfeed. By the end of the appointment, I felt overwhelmed by the information, though. She thought Brooks might have a mild posterior tongue tie, and she went over the implications and discussed the options for treating it. She offered different herbal supplements and prescription medication to help with my supply, she suggested "paced feeding" and using a "premie nipple" for the bottle to help slow down his feeding, and she recommended using a different size nipple shield. Given that Brooks was gaining weight and on track, I took her advice and purchased the premie nipples and different size nipple shields, but opted for a "watch and wait" approach with regards to any tongue tie procedure, or medications. I left with more questions than answers, but I was still determined and hopeful to breastfeed successfully.
One week later I had a follow-up appointment. Unfortunately, I was not able to see the same doctor I had seen previously. I was exhausted from trying to triple feed, and I didn’t have a lot left in the tank. It felt like every day, the whole day was spent breastfeeding, bottle feeding, pumping, and cleaning bottles and pump parts. I had started bottle-feeding rather than trying to breastfeed first, as breastfeeding was so time and energy-consuming. I was only getting a few hours of sleep at a time, which was also starting to take a toll. I was probably in a very sensitive and emotional state at this appointment, but I felt judged by the physician when she asked me about how often I was breastfeeding versus bottle feeding. Brooks was beginning to gain weight - actually more weight per day than "average". I also felt guilty about this, as she inferred that we could be overfeeding him with formula. Again I found myself in tears. And again, they were not acknowledged. I know that being emotional, postpartum, is par for the course, but I felt like my needs were not being met. Instead of asking me how I was feeling, she started recommending another special accessory tube that I could purchase which would help supplement but feel more "natural". I left and broke down to Devon in the car. Breastfeeding was not supposed to be this way. How could something so “natural" require: a breastfeeding pillow, four different size nipple shields, an electric pump, a manual hand pump, different flange sizes, bottles, different bottle nipple sizes, AND special tubes? Devon listened and reassured me, and it felt good to have the support and be reminded that I was trying my best and doing a good job.
A turning point for me was speaking to a friend who had a very similar experience breastfeeding as I did. After trying to breastfeed, she ended up mostly bottle feeding her baby with expressed milk, and topping up with formula. Her baby was thriving, and she was feeling great. She had also felt the pressure to breastfeed, and the guilt and shame surrounding bottle feeding and formula. It felt so good to chat with a friend about something we had both experienced; something that is not openly discussed. She also recommended a few Facebook groups for physician moms, which were extremely helpful. So many women had struggles with breastfeeding - I was not alone in this. Other moms talked about the challenges of triple feeding, tongue-tie controversies, low supply, oversupply, and formula feeding. There were so many supportive moms writing about their own experiences and helping others - it was really inspirational. A few clogged ducts, and a new pump later, I finally gave myself permission to accept the situation we were in; Brooks would be 100% bottle-fed.
Currently, I am exclusively pumping. This means that I am hooked up to an electric breast pump for 10-20 minutes every few hours. The expressed breastmilk is then given in a bottle. Up until 2 months, we were supplementing with formula as well, but since I got a new breast pump which is working much better, my supply increased and I began building a freezer stash of extra milk. Brooks is feeding well and gaining weight like a champ. He is thriving, and we couldn't be happier. It still feels awkward explaining why I am not breastfeeding to some people (and yes, people ask!), as electric pumps are a relatively new phenomenon. It also still feels awkward thinking about pumping in public, as it doesn't have the same acceptance as breastfeeding in public. At least, my new pump is quieter, so if I have to pump in the bathroom of a restaurant while we are out, it isn't quite so obvious. A part of me still wishes that I could breastfeed, but I also really enjoy the conveniences of pumping. Feeding Brooks is overall a relaxing bonding experience, rather than a stressful experience where both of us end up covered in breastmilk. Because Brooks is bottle-fed, Devon gets to feed him and be part of the experience. Also, Brooks' grandparents and aunts and uncles can feed him and bond in that way, too. I can be flexible with my schedule and plan ahead, and I can be away from Brooks for more than a few hours at a time. I, fortunately, haven’t had to deal with cracked or painful nipples, candida infections, or mastitis. On the other hand, pumping and bottle feeding is a lot of work. But right now, it’s working well for us.
Now that the dust has settled, so to speak, I can reflect on my experience and come to some conclusions:
1. Breastfeeding is HARD.
The expectation to "exclusively breastfeed" can cause a lot of unnecessary stress, and is unrealistic for many women. Why is the term "exclusive" even used? Is it some sort of club? I wish that expectations around breastfeeding would have been one of the first things they discussed at our prenatal classes. Managing the expectations that society, friends and family members, and pregnant mothers put on themselves, is a huge challenge. Knowing the common issues and learning some troubleshooting tips beforehand would help women and couples prepare. There are so many different paths to take, and no single opinion or method is “right”; each woman and couples' experience will be unique.
2. Fed is best. End of story.
There is so much emphasis on babies being fed breastmilk. Do we know if Albert Einstein had breastmilk or formula as a baby? Does it matter? We live in a modern society where we can supplement nutrients when needed. If a mother chooses to breastfeed and it works for her and her family – great! If not, that’s okay too! If it is a combination – fine! As long as the baby is gaining weight and healthy, and the family are thriving, I don’t see the big deal. The judgment needs to stop.
3. It is important to talk and gain support from others who have had similar experiences.
I can’t stress enough how important it was for me to connect with friends and hear from other women who were going through a similar situation. I needed to share my story and talk through the emotions, and hear other women’s experiences, as well. I am connecting with other new moms, both online and in-person. I don’t think there is a single mom out there who had an “easy” time breastfeeding. The shared experiences, as well as the variety of experiences, reinforces the importance of talking about breastfeeding.
4. New moms and parents are in a fragile state - please be kind.
One of the hardest parts of having a new baby is sleep deprivation. Your brain isn’t working quite as quickly as usual, let alone your memory. Emotions are high. Yes, this is normal, but also not something to be overlooked or ignored. Things that normally keep us well such as exercise, a healthy diet, and good sleep, are basically out the window. You can help support a new mom by asking how she is doing (not just asking about the baby), bringing food and prepared meals to the family, and letting them know that there is no pressure to visit, text back, etc. While advice (if solicited) and anecdotes from previous experiences can be helpful, always make sure to ask whether the person is open to hearing them. Be cautious with your word choice, as what you may think are small inconsequential comments, can be taken to heart.
Well, you made it to the end! Wow! These are my thoughts and opinions, and I hope that reading this has been eye-opening and helpful. I know that going forward in my career I will definitely approach postpartum visits through a different lens. At the end of the day, remember that whatever way works for you to feed your baby, is the right way for you.