Sunday, March 30, 2014

Feeding Daniel

"What's wrong?"

I hear him ask me, but I can't bring myself to answer him.

"What is it?" he says this time.

I just point helplessly at the wasted bottle, walk to my side of the bed and collapse, head in my hands. I'm a failure. I know it now.

When he sees the bottle he understands and comes to hold me, saying all of the right things. "I know, you worked so hard to get that milk. Now you feel like your time and effort was wasted. Remember what the pediatrician said: even if he only gets a little bit it's okay. You're doing your best." He knows me; he's predicted every thought racing through my head and he's doing his best to chase them away. But I'm my own worst enemy here, and I fixate on that paltry amount. Forty minutes of pumping for an ounce and a half. So much time for so little, and now it's for nothing.

I'd forgotten it on the bookshelf well past the time it can stay out. If only I'd caught it in time I could have put it in the fridge, but I didn't, and no more has come today. This is the first day my son will only drink formula, and it's my fault.


On the websites I see women who can "pump and dump." That is mom-speak for when you've perhaps ingested something that you think will be harmful to the baby (it probably isn't), so you throw away the breast milk that comes in the next pumping session.

I resent anyone who intimates that they have the ability to pump and dump. I could never throw away my hard-earned breast milk that way.

A woman in the local mom's group mentioned that she pumps about 9 oz. in 20 minutes and GOODNESS is it annoying to store up that much.

At my best, it took me 40 minutes to an hour to pump 2.5 oz. I produced maybe 5 oz a day, which is just over the amount Daniel takes in ONE feeding. Of which he has 6 a day. I have a hard time feeling sorry for Ms. Nine Ounces in Twenty Minutes.

This is the story of how I feed my son. Getting here was not easy. Things could have turned out a lot differently, or maybe they wouldn't have at all. There's no way of knowing, and it wouldn't be fair for me to blame any one thing (or any one person) on my low milk supply or my son's disinterest in nursing. However, it is cathartic for me to talk about it, so let's start in 2005.


Yes, my lack-of-nursing story starts nearly ten years before kids were on my mind. At 16 I had a breast reduction. My breasts were gigantic, cumbersome, and a pain on so many levels. My self-esteem was in the toilet, and insurance approved the surgery, so I was totally on board for it. My doctor made in clear that breastfeeding after reduction surgery was not a guarantee. I wouldn't know for sure -he said- until I had a baby.

I share that to say I knew not to be invested in nursing. I was willing to do formula immediately, and I've never regretted my surgery. My mistake was expecting an all or nothing situation. If I couldn't breastfeed then I was fine with that, but if I could then I assumed that I would have a full and easy supply like every other able-breasted woman. Therein was the flawed assumption.

Early in my pregnancy it was evident that I would in fact get breast milk. So we took a breastfeeding class, ordered a mechanical pump, and stocked up on nursing bras. I still can't say that I was "all about" breastfeeding. I looked forward to it, but I didn't get caught up in the idea of developing a sacred, mystical bond that only I, his irreplaceable mother, could have with him through breastfeeding.

However when you have a baby, particularly -I think- after a c-section, you're in a very vulnerable place. Suddenly you're susceptible to comments and opinions that wouldn't have mattered in your non-hormonal, unmedicated state. It didn't help that my c-section was not handled well. The operation itself was fine and the people were great, but things happened before and after that severely damaged the trust I had in the hospital. That's a story for later, but suffice to say it put me in a bad place mentally immediately before he was born.


We were only separated for a little over an hour, and when we first did skin-to-skin I recall it being pretty laid back. My doula helped us find a good hold, he latched off and on, and it was all very experimental. I felt no urgency and my son seemed content. Riding on the success of those first moments, we nursed like that for the rest of the day. I had no idea if he was getting anything from me, and he wasn't really that into trying, but he seemed fine and I didn't worry. That night, I -exhausted from giving birth-, he -exhausted from being born-, and Tim -exhausted by proxy- slept through the night. I remember waking up feeling like the three of us had done what we needed to do. Even better, we'd done it together. I was excited for our first full day together.

Then the nurse came in.

I'll preface this by saying that there were certain nurses that were just wonderful and will always be special to me, and no nurse was "bad." But while the hospital has adopted new policies that are considered to be pro mom-and-baby, they still enforce policy over the individual needs of each mother and child. When hospitals do that, it doesn't matter how progressive the policy is, it is still closed-minded and oppressive.

Well, the nurse freaked out when I told her how long we'd all slept, and insisted I try to nurse immediately or my supply wouldn't come in. I was stunned. With the way she'd said it, you would have thought that he was starving and that I'd ruined everything. If you know me, you know that being aggressive with me is possibly the least effective way to interact with me. And "normal" me would make sure you knew it. But this wasn't normal me. This was hormonal me. This was medicated me. This was tired me. This was in-pain me. This was new-mother me. And even though my instincts told me that I'd done nothing wrong that night (our FIRST night together), the seed was planted.

My supply is in danger because I didn't wake him up to nurse.

He was hungry and I didn't feed him.

He must eat now... if I can't get him to latch now it'll sabotage our entire breastfeeding relationship.

He wasn't ready to eat but I tried to nurse him. He would not eat.
"Have you hand expressed?" the nurse asked.
"Um... no," I answered timidly. "I don't know how to do that."
"Did you pump through the night?"
"No, we all slept through the night."
"Well, if he doesn't eat soon and you're not sure you're producing, we'll have to give him formula."

Something in my mind broke. I don't know how else to describe it, but that was the moment I stopped being good enough. It would be weeks before I felt confident with my own child again, before I could tell myself that I know him best and mean it.

This nurse did not suggest formula. She stated it as a fact. The hospital that had bragged about not giving formula unless it was asked for (and pushed breastfeeding in a way that I also didn't agree with) had changed its tune very quickly. One night and suddenly I could not do this. One night and I'd wrecked my supply forever. Desperate, I told her that my lactation consultant would be there any minute to help, and that we would not be giving him formula.

That entire morning of breastfeeding was unsuccessful. He would latch easily but become frustrated when nothing came out immediately. If he got too upset he'd bite on my nipple... which hurts exactly as much as you imagine it does.

My lactation consultant arrived and I was so ready to be told to trust in me and my baby. What I heard was more of the same: I should have started pumping during the night, I should hand express to see how much colostrum I'm getting, and maybe I wouldn't be able to breastfeed after all. She watched me nurse and he bit down on my nipple almost instantly. She examined him and said that his suck was inconsistent and that he probably had a tongue tie. She showed me how to use my pump, arranged for a specialist to come look at him later that day. Looking back I know that she didn't realize how delicate I already was. If I'd asked for her to come back she would have, but I began to feel the urge to isolate myself.

The specialist visited us and said he did have a minor tongue-tie that didn't really need to be fixed. When she described the process of fixing a tongue-tie I almost cried, and said that we would definitely not put him through that if it wasn't necessary.

The rest of the day I got used to pumping and kept nursing with mixed success. That evening we had one really great nursing session, where he aggressively ate for about an hour. It was just my parents and I in the room. They urged me to just relax, and to forget what everyone else said. We dimmed the lights and quietly he ate. I sighed with relief, hopeful that this was the point where it all turned around.


That night he screamed and I couldn't make it better. Another nurse came in.

"Have you nursed?"

"Yes, but he doesn't want to nurse."

"We can put some formula on your nipple to encourage him to nurse. We can also try a pacifier."

I'm been told stories of formula and pacifiers like they were Halloween horror stories. Evil things that would ruin my son's latch and destroy our nursing relationship. This nurse wasn't asking either, she was aggressively suggesting. I told her I wanted to wait longer.

"Call me when you're going to nurse again," she said, with the tone that I needed her input as I fed my child.

He screamed some more and would not nurse. The nurse came in with a bottle of pre-made formula and a pacifier. Without really asking, she reach forward and dropped formula on my nipple. A stab of failure went through me as he latched and started to eat. It had worked, but I'd given him formula. What if he needed formula now? We continued to use drops of formula, and he would latch and eat. Until he wouldn't. Then he screamed again. These screams weren't the same as before. My instinct told me he was gassy. I recalled that the formula we'd used for the drops was a brand I hadn't been able to tolerate as a baby (according to my mom). We held and burped him but nothing seemed to help.

The nurse came in again and commented that she'd heard him screaming, as if this were a situation unique to us. Somehow we were the only parents on the floor up with a crying baby, she implied. "We can give him a cup of formula."

Thankfully Tim spoke up, "We're not ready to try that yet."

She shrugged with an "everyone gives in eventually" expression and said once again to call her before we tried to nurse.

I knew he was gassy but I doubted myself again. What if I hadn't given him enough? His cries wouldn't stop. The nurse came in again, "Do you want to nurse?"

"NO," I said, not even raising my head to look at her. I was tired of being pushed by her, tired of him relying on me, and not being able to give him what he needed. I knew what she would suggest, and I knew I had to say yes. If I wouldn't nurse him, he obviously had to eat something. She gave him a cup of formula while I looked away. He stopped crying, a sign that I was doing everything wrong.

But when he was done he still screamed, stronger this time. I suggested that he must be gassy, seemingly to the air because the nurse said, "Well if he's not hungry I don't know what to tell you," and she left. At one point that night, she came and took him out of the room while we watched, too tired and broken to say no. I berated myself for not keeping him with me, and hated that someone else could calm him, especially someone I found so invasive and irritating.

Any calm he felt that night was short lived. As night began to fade, Tim and I sat there watching him cry. Gently Tim suggested that, if I felt ready, we should try the pacifier. No one's opinion mattered but ours, and we should do what we felt was best. Bolstered a little by his confidence in us, I said yes. We gave it to him, and he calmed down for a while then.


Our daytime nurse the next morning was lovely, and by far our favorite. When she came in and introduced herself she could tell we'd had a rough night, and asked how she could help. I told her that I didn't have the energy to nurse. There was no judgment, she just gave him a cup of formula and chatted with us. She encouraged us to trust our instincts about the pacifier and not worry about who said to do what.

That morning I was also visited by a hospital lactation consultant. She asked how we were doing, and I skimmed over all the "rules" we'd broken the night before. She gave me all of the advice I'd already gotten from books and breastfeeding classes. She made a small comment about the lactation consultant I'd brought in from a private practice. It seemed like they had an issue with "outsourcing."

Nursing didn't really work or not work that day. I honestly don't remember because that day was much worse for me health wise. As bad as it sounds I didn't spend a lot of that day worrying about how he ate. I do remember specifically telling them he needed something for gassy babies, so he must have gotten formula, though I'm sure I also nursed at some point.

Throughout that day our nurse continued to be incredibly supportive. When I was at my lowest moment (receiving a blood transfusion, but that's a story for later), she told me "I know this doesn't help you now, but I'm going to say it anyway. This is temporary. All of this is temporary, and it will be better." I took deep breaths and tried to make that my mantra.


The following morning (the day of discharge) he nursed so happily that once again I thought we'd made a breakthrough. The problem was that my milk still hadn't come in. With a c-section baby it can take up to five days, and I couldn't imagine him sticking with me for that long. Even during his best nursing sessions we had to constantly keep him attentive. He didn't want to work to eat, and he was pretty stubborn about it.

At some point another hospital LC came in, said some textbook things that I'm sure were meant to be new information, and left without observing us nursing or doing anything personable or hands-on.


Our first night home, there was nothing we could do to keep him awake at my breast. My instinct told me that when he was hungry enough he would eat, but the professionals had told us that he HAD to nurse every two hours or he would shut down from exhaustion. Bottle-feeding MUST wait a minimum of three weeks or the baby will stop nursing. Not that my baby was nursing anyway. I worried over how much he was getting. When you're breastfeeding you have no visual and no guarantee that your baby is getting enough, and he already didn't nurse well.


The next morning, seeing that I was exhausted, sitting with me while I cried silently for no reason and every reason, my mom told me to forget what others had told me was the right thing to do and decide for myself. I hesitantly thought of my plan. Really it didn't make sense for me to exclusively breastfeed. My son didn't like it, and I'd be going back to work in eight weeks anyway. I also decided that I was having too much anxiety over him not eating enough. Tearfully, I said I wanted Dad and Tim to go get some supplementing formula to try.

When they brought it back, Mom fixed a bottle and gave it to me. I put it in his mouth and saw my son truly eat for the first time. I wept then, so sad and so relieved. He ate vigorously, and stared up into my eyes, so peaceful and alert. For once he wasn't stressed; he was just being nourished. My anxiety lessened when I had a visual of how much he was drinking.

My milk came in that night. I pumped, excited that soon I'd make enough milk to stop using formula. I'd make enough to freeze and send with him to daycare!


We returned to the hospital the next day to get his bilirubin levels checked. The nurse who came in happened to be one of the LCs I'd seen during my stay. She immediately asked if we were breastfeeding. I said no, I was pumping.

"You're pumping enough to feed him?" she asked in a surprised tone. I couldn't help but feel like she was pushing for me to admit something. After all, he'd be getting the same amount if I were breastfeeding, but I doubt she would have asked then.

"We are supplementing," I said shortly.

"Well... [your outside LC] is great, but if you think you'd like to give it a try again, just let us know."

I could read between the lines, whether or not it was intentional. I was having these problems because I didn't trust the hospital. I wasn't trying enough. I didn't want it enough. The milk from my body wasn't good enough if it wasn't straight from my breast.

Thankfully we went straight from that appointment to his first appointment with our pediatrician. She was instantly supportive. "Whatever you can give him is fine. Even a little bit makes a big difference." And that was that.

I was feeding my baby, and however I did it was fine.


I never pumped more than 3oz at a time. As my health deteriorated my supply dwindled. Stomach spasms kept (and continue to keep) me from eating and drinking enough to even maintain where I started. I realized that sooner rather than later I would be a formula mom. I'd been okay supplementing, but I couldn't handle the thought of giving him none of my milk. During that time I forgot my pumped milk on the bookshelf and fell apart. I popped fenugreek pills and ordered Mother's Milk tea in bulk. I still never produced more than 3oz a session, and even that much was only once a day. Every other pumping session I would get maybe 1.5oz.

I tried to nurse every now and then, because I knew I wouldn't be able to do it much longer. When I put him to my breast he looked up at me with an expression I'd only seen before on sixteen-year-olds who couldn't believe I'd given them homework. A look that said I couldn't possibly be suggesting that he do this crazy thing. That's when I knew he was much more laid back about this than I was, and I needed to let it go.


And then on a random night when he was three weeks old, Daniel nursed. He was fussy (out of character for him), I was basically too lazy to get out of bed and fix a bottle, so I offered him my breast experimentally. I was shocked when he calmed down and latched. To this day I don't know if he actually got anything, but he nursed for an hour as he peacefully soothed himself to sleep. He's almost six weeks now, and I doubt he'll do it again. I've stopped offering on a regular basis, satisfied with the way his big grey eyes stare up at me when I give him a bottle. He trusts that what we're doing is okay.

Today my left breast leaked for the first time in almost a week. I've gone without pumping for almost two weeks. At the end I was pumping for an hour at a time, and only getting may half an ounce. It stopped being worth it, and its worth was only what I gave it anyway. I was fortunate to have no real issues or pain when I stopped. I was fortunate to have a pediatrician and OB who understood and were nothing but positive about what I'd already done. My body gave me what it could, and now it's done.

My big boy ate 6oz of formula during his last feeding. He's become a real chunk, and is well on his way to sleeping through the night if he keeps up these larger daytime feedings. Since bottle feeding he's completely regulated himself to a predictable schedule. He's a happy, alert, cuddly baby. I know I'm lucky that he is good, and rarely fussy. More than that though, I know that he is secure and confident because I am becoming secure and confident. At this point I have mostly overcome the embarrassment, shame, guilt, and anxiety that was triggered. I know that everyone meant well, and I don't think I resent anyone even if they were careless. I've relearned that I know my baby best. I wish I'd never forgotten.


I want to emphasize that if someone around you has just had a baby you should always assume a supportive role. That does not mean an advisory role. The time after birth is very delicate for new mothers physically, mentally, and emotionally. Even advice if not presented in a thoughtful way can be damaging. So just support her. Listen. Attend to. Protect. Breastfeeding is mostly a confidence game. If a mom is being encouraged to do what works for her then it is more likely to go successfully. "What works for her" might include not doing it at all, and she should be confident in that choice. Help her to have that confidence.



I published this on 3/30. Goodness, how far we've come! I wanted to update, clarify, and state some new thoughts before I open this up to a new audience.

The "stomach spasms" have since been diagnosed as ulcerative colitis, and potentially Crohn's disease. It's since gotten much better (the condition is chronic but also sporadic), but by the time I was able to eat more my supply was gone for good. I still refuse to eat until I'm home from work in case it triggers a flare up. I'm starting medication next week when school is out, so I'll be at home to deal with potential side effects.

I also want to further clarify that I respect the intentions of the professionals I encountered those first few days of my son's life. I'm sure some (even most) women find them to be helpful and indispensable. Is it possible that our personalities just didn't gel? Yes. It's possible. What's more likely is that all of the extenuating circumstances (both mine and theirs) worked out in such a way that our interactions were not successful. I only know my side of course. My impressions at the time are no less valid for acknowledging this, but it is something I want to reinforce nonetheless, to ensure that my heart holds no undeserved bitterness.

My newest thoughts involve the responses I've received about formula feeding now that I'm out in public again. Firstly, no one seems to think that this is a private issue. Many many people (practical strangers, bless them) have asked me if I'm breastfeeding. I always answer, because if I don't it will seem as though I'm ashamed. Still, I hear the strategically placed hint of disappointment in my tone. It's deliberate, a signal to my counterparts to withhold their judgment for those other moms. I had no choice after all. Sometimes I wish I did, so my choices would be my own and so nosey strangers would be knocked off of their high horses. Many upon hearing I was unsuccessful apologize. Many upon hearing I was unsuccessful are immediately affirming, praising me for doing what I needed to do for my son and not putting the Almighty Plan above his needs. Many upon hearing I was unsuccessful have a tangible sense of relief flood into their eyes. "Me too," they confide softly. I like those the best. Someone who was previously alone isn't alone anymore, including me.

Rarely someone will begin to run down a checklist of "Things You Must Do Before I Will Excuse Your Resorting To Formula," and that's about where I run out of patience and politeness. Please, never, EVER, ask a mother who was unsuccessful in long-term breastfeeding if she tried x, y, and z before she switched to formula. First of all, IT DOESN'T MATTER. Second of all, what good will your suggesting x, y, and z do now that I'm completely dried up? Honestly at this point if you do that I'm immediately convinced that you just want to sound smarter and better than me, and I won't be held responsible for how far my eyes roll. Or, if you're doing that because you've mastered time travel, please use it for something more beneficial than sending me back to talk to a fourth lactation consultant or buy a nipple shield (no, I didn't try nipple shields-- gasp). Thirdly, IT DOESN'T MATTER. Your criteria is not mine, nor does it have to be.

It's easy for me to slip into judgment now that I've experienced judgment. I'm infinitely more sensitive to the advice of breastfeeding moms. I cringe when I hear them suggest doing things that, to me, mean babies are going hungry, which is unacceptable. When they chide a mom for supplementing, or even pumping, my claws come out. That's not the way I should be, and it's something I need to work on. I am thankful however for the boldness that my pain has given me. This is my voice, and I will use it. Not just for formula moms, but any mom who receives criticism for feeding her child differently from what is popular. I don't give any advice apart from "feed your child." The rest is just gravy.