Saturday, April 20, 2013

The B Word

No, not THAT one.  In fact, with Asher's love of the ABC's, my life is full of a lot of B words right now.  But the one on my mind at the moment is BREASTFEEDING.  It came up a few times at work this week, which reminded me that it was one of topics I most wanted to talk about here because I think (or at least hope) that my input has helped a lot of my patients keep their sanity.  However, I have to admit that I'm a bit nervous to post this publicly because breastfeeding is such an emotionally-charged subject these days.

So that none of you miss the take-home message of what I'm about to say, it's this: Breastfeeding is best, but for some of us, it's hard, and although breastfeeding has a bazillion benefits over formula, the most important thing for your child is having a sane mother.

First of all, I am totally pro-breastmilk.  Aside from being cheap, convenient (no supermarket runs at midnight when you run out), and safe (no need to worry about contaminants in the water), it delivers immunoglobulins and other substances that even the best formula can't and apparently even boosts your kid's IQ.  Nursing has even more benefits: bonding time for mom and baby and even more convenience.  Plus, there are long-term health benefits for mom as well, including, but not limited to, increased calorie-burning = postpartum weight loss, decrease in the risk of postpartum depression, and decrease in the risk of breast cancer.  When breastfeeding goes well, it is a great experience for mother and baby, or at least that's what I've been told.

My experience was not so great.  My kid latched almost as soon as he was placed on me in the recovery room.  I thought it would be a breeze.  Then the actual nursing started.  Latch was good, but for some reason, day after day, my little guy lost weight.  By day 3, he had lost 12 ounces of his whopping 5 pound, 5.5 ounce birth weight.  Finally the pediatricians admitted that something wasn't right.  That's when the pump came out.  I was instructed by lactation consultants to nurse him for as long as he wanted, then pump and give him by bottle whatever I got out.  Then they left the room.  And left me all alone with a starving newborn.

My first word of advice is that if your kid is hungry and there is no milk available, give formula.  Fortunately, I had a pacifier (taboo, I know) with me, so I shoved that in his mouth to keep him "pacified" while I pumped. I quickly realized that at some point, I was going to have to pump a little extra in order to get ahead so that there wasn't a delay in getting him a bottle after our attempt at nursing.  With my milk just barely coming in and feeding every 2 hours, that wasn't an easy task.  I finally got around to that the following day.  In the meantime, every feeding was a bit of a nightmare for all involved, but I was determined not to give evil formula!

And so it went on.  Every 2 to 3 hours, nursing, bottle-feeding, pumping.  The whole routine took about an hour.  With a baby who was barely sleeping, this meant almost no sleep for me either.  Meanwhile, he was growing in size and appetite.  He was fussy and crying.  The amount of milk I actually pumped was pathetic, just 1-2 ounces total after half an hour.  Finally my husband convinced me to let him open the formula canister.  I felt like a total failure, but I was exhausted and had started to realize that Asher was getting almost all of his calories from the bottle and not from nursing.

At that point, I decided to do an experiment and skip the nursing part of the feeding altogether, just to see how much he needed to become satisfied.  Immediately it became apparent that he was probably getting nothing from the breast.  As I was slowly losing my mind from chronic sleep deprivation, I realized that if I was going to give him breast milk, I was going to have to be an "exclusive pumper."

It turns out that the exclusive-pumping club is not as exclusive as one might assume from the name, but the membership roster is short because very few can stick with it for long.  A lot of my patients have latch issues; eventually their nipples are torn to shreds, and they resort to pumping for a while to let themselves heal.  For a few weeks, it seems like pumping is an easier alternative than trying to get their babies to latch properly.  But in order to make it work well, you have to pump at least 10 times a day, which also means getting up in the middle of the night.  Any less than that, your supply won't come in and stay in. Add that to the nighttime feedings and playtime, and you are only getting a couple of hours of interrupted sleep each night.  Even with a supportive partner helping you out at night, it's exhausting.

Those were my nights.  Crockett took the early shift, from about 9-1; my shift was the second part of the night, though I still had to set an alarm to get up at some point during his shift to pump.  It was easier during his shift because all I had to do was pump.  My shift was harder.  I would get up with the baby, but if he didn't go to sleep after his bottle, I was up trying to entertain him while also trying to pump for 30 minutes.  Many nights I was hooked up to the pump while bouncing him around--thank goodness for those pumping bustiers--and trying to make sure I didn't spill any milk.  A lot of milk got spilled, and there were a lot of tears.  Very little sleep happened.  I continued to lose my mind, and my milk still didn't come in as planned, despite pumping 12 times a day and taking fenugreek religiously and staying nourished and hydrated.  I was incredibly frustrated and exhausted and cried a lot.  I loved Asher dearly but sometimes wondered if I had made a terrible mistake.  So much time was spent attached to the pump that I couldn't enjoy the newborn stuff as much as usual, and in some ways, it was a sad time.

A little over three weeks into it, my brother got married, and amid the stress of preparing to spend a weekend in a hotel for the first time with our newborn, I realized that I could not continue down this road.  A new experiment: what would happen if I pumped less often?  Amazingly, I produced as much milk over the course of the day but with much less effort.  And so I embarked on a new normal: pumping about 6 times a day and supplementing with formula as needed, which was about 50% at that point.  Asher continued to grow and thrive.

When Asher was 7 weeks and 6 days old, I returned to work.  Being self-employed has its benefits, and some flexibility in my schedule is one of them.  I don't have an office of my own, so I would shut myself in one of the exam rooms while I was pumping and charting.  Eventually the medical assistants learned that if the exam room door was closed before office hours or at lunchtime, I was pumping and they should just leave me alone.  Every activity was planned around my pumping schedule, and a pump went with me basically everywhere I went.  I even rented a hospital-grade pump to leave at work, and I bought enough extra pump supplies so that I only had to wash them once a day.

However, by the third month, my supply had begun to dwindle.  The day before we were supposed to leave on our first cross-country flight with Asher, I came home from work with only one ounce of milk to show for a total of an hour pumping.  I made the decision to stop.  It was one of the hardest decisions I ever made, but I realized that the stress of scheduling life around pumping was doing me in, and it just wasn't worth it anymore.  I cried as I bottle-fed Asher that last ounce.

And so started a period of shame.  I felt like not breastfeeding was my first failing as a mother.  I was depriving my son of the number one best thing I could give him.  I had trouble cutting myself slack and wouldn't give myself credit for trying as hard as I could and using every trick in the book.  I also felt like I was a hypocrite and terrible doctor.  How was I in any way equipped to counsel women about breastfeeding when I couldn't do it successfully myself?

Gradually, I began to see that I wasn't alone, and I realized that I was able to use my challenging experience to help my patients not just be more successful with breastfeeding but also be more forgiving of themselves when they were struggling.  I was also able to see when it was truly ruining a woman's experience with her newborn and felt more qualified to give her "permission" to supplement with formula or to stop nursing entirely.  I had a distinctly new sort of empathy.

It turns out that no matter how much you know about breastfeeding, there are some factors that are beyond your control to some extent, including your baby's cooperation and your supply.  And even if you have all the support in the world and follow all of the recommendations, sometimes it just doesn't work out.  That can be a very hard thing to accept as a new mother.  It seems like the most dire problem at the time, but in the grand scheme of things, it's a minor point.  A lot of us were formula fed and turned out pretty awesome (my brother and I were both formula-fed, and we both turned out OK).  What really screws kids up is having absentee parents or parents who are too stressed to connect.  Making yourself physically and emotionally available for that connection is far more important than what you feed your child.  It's easy to see now in retrospect but was difficult to understand in the moment.

When my incredibly bright child snuggles up with me to drink his sippy cup of milk (now, cow's milk), I know I did OK.

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