Why do lactivists treat women like cows?

image

A new study recently published in the Journal of Human Lactation, is making the rounds in lactivist circles. However, the study, in addition to being underpowered to reach any conclusions, treats lactating women as if they are nothing more than cows, reducing them to the characteristics of the milk they produce, without any regard to their pain, needs and desires.

The study is Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation by Li et al. and the findings are:

Overall, 23.4% of women in our sample experienced DOL. Compared with women who delivered vaginally and received no labor pain medication, women who received labor pain medications had a higher odds of experiencing DOL: vaginal with spinal/epidural only (aOR 2.05; 95% CI, 1.43-2.95), vaginal with spinal/epidural plus another medication (aOR 1.79; 95% CI, 1.16-2.76), vaginal with other labor pain medications only ([not spinal/epidural]; aOR 1.84; 95% CI, 1.14-2.98), planned cesarean section with spinal/epidural only (aOR 2.13; 95% CI, 1.39-3.27), planned cesarean with spinal/epidural plus another medication (aOR 2.67; 95% CI, 1.35-5.29), emergency cesarean with spinal/epidural only (aOR 2.17; 95% CI, 1.34- 3.51), and emergency cesarean with spinal/epidural plus another medication (aOR 3.03; 95% CI, 1.77-5.18).

The authors concluded:

… [M]others who received pain medications during labor and delivery were more likely to report that they experienced DOL. Because 83% of mothers in the U.S. use pain medication during labor and delivery, the implications of a link found between labor pain medications and onset of lactation, if causal, is of public health and clinical impor- tance.

How did the authors assess delayed onset of lactation? They used a notoriously unreliable method, a questionnaire, which asked mothers to recall the answer to a remarkably vague question:

“How long did it take for your milk to come in?” (1 day or less, 2 days, 3 days, 4 days, more than 4 days).

That’s only one of the six serious limitations to the study acknowledged by the authors:

This study is subject to at least 6 limitations. First … the study sample is not representative of the US population … which prevents generalization of our findings to the entire US population. Second, IFPS II [the questionnaire] did not collect information regarding dose of labor pain medication used ..; therefore a dose-response relationship between pain medication dosage and risk for DOL could not be examined. Third, while overall this was a large study, there were relatively small percentages of mothers exposed to some of the pain medications, which … limited our ability to evaluate the effects of specific medications. Fourth, because we are unable to separate cesareans from labor pain medication use, we are unable to evaluate the effects of the medications used independent of method of delivery. Similarly, we are unable to separate the pain associated with labor/delivery from the use of labor pain medications; therefore, we are unable to tease out whether it is the pain or the pain medications leading to the associations that we observed with DOL. Fifth, data regarding labor course were not collected in IFPS II; therefore we were unable to adjust for labor characteristics such as length of labor, length of second stage labor, or labor/delivery stress, all of which are known to be associated with DOL. Finally, all data were self-reported; hence outcome and exposure misclassification are potential limitations of the study.

So the design of the study itself renders the conclusions virtually useless, and that’s even before we get to the fact that the study is so underpowered that the conclusions are statistically useless.

image

The number of women in the study as a whole was small, and the number of women in each subgroup was tiny, rendering any conclusions highly suspect from a statistical point of view.

The bottom line, therefore, is that the conclusions of the study are meaningless.

Let’s leave aside for the moment the fact that the authors failed to adequately support their conclusions, and failed to demonstrate that the parameter they are measuring was even remotely clinically relevant (since they never looked at the health of the babies). The study does shed some light on another important issue: the tendency of lactivists to treat women like cows, obsessing about the quality and quantity of their milk, with no regard to the well being of the women themselves. I cannot think of any other study in the literature that rests on the presumption that treating excruciating pain is optional and possibly undesirable, but that is the foundational assumption of this paper. The implicit message of the authors is that women should forgo pain medication in order to “optimize” their breastmilk.

This is especially ironic in light of the confluence between natural childbirth advocacy and lactivism. Evidently the mother’s “birth experience” and desire to avoid lifesaving interventions and C-sections is supposed to take primacy over the baby’s interest in being born alive and neurologically intact. But the situation is magically reversed when it comes to breastfeeding. The mother’s experience is completely irrelevant and all that matters is optimizing the breastmilk that the baby receives.

How, in good conscience, can any group of investigators completely dismiss the mother’s pain in labor? How can they, in good conscience, presume to sway women against pain relief in labor in favor of a highly theoretical benefit that they are incapable of demonstrating even exists? It’s apparently very easy. In the world of lactivism, the wellbeing of the milk producer is irrelevant; only the consumer matters. Here’s what I’d like to know: how is that different from treating women like cows?

  • observer

    This post reminds me of this picture! lol.

  • corn_flakes

    BECAUSE IT IS A STUDY COMPARING PAIN MEDS DURING THE WOMAN’S BIRTHING PROCESS TO HER QUALITY OF MILK AFTERWARDS! If those two things are related at all, wouldn’t you as an expecting mother kindof like to know if there is a connection?? Even if that study was poorly executed, it is still a viable question. Sheesh! Why drag cows into this?? I am a 23 year old female with no medical or baby experience whatsoever. Because I was bored & home alone on a Friday night, I watched that Business of Being Born documentary & somehow after that wanted to hear the other side, wound up hearing about you & reading several of your various blogs/bloggy articles. I’ve read some of your articles back to 2010 tonight. It was a waste of my time & I’m sorry I wanted to hear your side at all. I have to honestly say, you feminists are all the same & I’m tired of the tripe. Why the cows? Why blaming men for natural birth & breastfeeding movements as some kind of misogynist propaganda? Do you really think the cows or the men or the people (probably some women) who did this particular study care? Your medical feminist movement is old, dusty & stale. Men & poorly executed studies & cows are NOT holding women back. Feminist hatred towards certain types of women IS holding women back. Every single one of your articles that I read was just filled with spitting rage towards the “empowered” woman who thinks she’s a goddess for having a natural birth, or the mean ugly man who’s keeping women in her place by enforcing natural birth, yada yada. If a woman is concerned about the quality of her milk after taking an epidural & might like to see a study about that, according to you she must just think of herself as a fat dumb cow! But the cows are innocent, I tell you! They’re innocent!! Men compare themselves to other men all the time & oddly enough never blame feminism for it – why do we women have to blame anyone besides ourselves for our high standards that we set – OURSELVES? That, I suppose, is the point where you & I differ – you would like to blame misogynist men & women with a different lifestyle than yours for setting certain standards. I would like to point out that each of us human beings is perfectly capable of setting up our own impossible standards without anyone else’s goddamned help, thanks. Open your eyes to a culture that just plain hates itself, & you might begin to show more empathy towards it! & do us all a favor, get a hug from somebody or snuggle a cat before you write your next article for chrissakes.

    FYI, I frequently like to post randomly on blogs & then get the hell out of there as fast as I can because I don’t like responding to livid hatred. So pardon me as I get my ass out the door =/ I will allow any angry internet patron of this blog to punch my internet face & have the last word so I can cowardly avoid a nasty conflict.

    • Young CC Prof

      I would respond to this comment if I had any idea what it was about.

      • S

        Personally i prefer to just revel in its incoherent awesomeness.

    • S

      COWardly, did you say?

      (I guess i lied. Sorry.)

    • the observer

      Cornflakes, c’mon. The Skep-OB, hasn’t been a practicing physician in many many many many years. Her credibility has expired. She’s a worthless source for quality information and is obviously very pathetic. It’s written by ACOG that it’s improper for any obstetrician to discourage or demean the importance of a woman to breastfeed. Clearly, she doesn’t do much of her research

      “Evidence continues to mount regarding the value of breastfeeding for both women and their infants. The American College of Obstetricians and Gynecologists strongly supports breastfeeding and calls on its Fellows, other health care professionals caring for women and their infants, hospitals, and employers to support women in choosing to breastfeed their infants…Obstetrician–gynecologists and other health care professionals caring for pregnant women should provide accurate information about breastfeeding to expectant mothers and be prepared to support them should any problems arise while breastfeeding.”

      http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health%20Care%20for%20Underserved%20Women/co361.pdf?dmc=1&ts=20140603T1047535066

      So, chill. She’s a uneducated bitter moron, who displaces her anger at her miserable existence on natural parents. And as a feminist, I can say, not all of us are the angry bitter anti-everything stereotype. Trust me.

  • corn_flakes

    BECAUSE IT IS A STUDY COMPARING PAIN MEDS DURING THE WOMAN’S BIRTHING PROCESS TO HER QUALITY OF MILK AFTERWARDS! If those two things are related at all, wouldn’t you as an expecting mother kindof like to know if there is a connection?? Even if that study was poorly executed, it is still a viable question. Sheesh! Why drag cows into this?? I am a 23 year old female with no medical or baby experience whatsoever. Because I was bored & home alone on a Friday night, I watched that Business of Being Born documentary & somehow after that wanted to hear the other side, wound up hearing about you & reading several of your various blogs/bloggy articles. I’ve read some of your articles back to 2010 tonight. It was a waste of my time & I’m sorry I wanted to hear your side at all. I have to honestly say, you feminists are all the same & I’m tired of the tripe. Why the cows? Why blaming men for natural birth & breastfeeding movements as some kind of misogynist propaganda? Do you really think the cows or the men or the people (probably some women) who did this particular study care? Your medical feminist movement is old, dusty & stale. Men & poorly executed studies & cows are NOT holding women back. Feminist hatred towards certain types of women IS holding women back. Every single one of your articles that I read was just filled with spitting rage towards the “empowered” woman who thinks she’s a goddess for having a natural birth, or the mean ugly man who’s keeping women in her place by enforcing natural birth, yada yada. If a woman is concerned about the quality of her milk after taking an epidural & might like to see a study about that, according to you she must just think of herself as a fat dumb cow! But the cows are innocent, I tell you! They’re innocent!! Men compare themselves to other men all the time & oddly enough never blame feminism for it – why do we women have to blame anyone besides ourselves for our high standards that we set – OURSELVES? That, I suppose, is the point where you & I differ – you would like to blame misogynist men & women with a different lifestyle than yours for setting certain standards. I would like to point out that each of us human beings is perfectly capable of setting up our own impossible standards without anyone else’s goddamned help, thanks. Open your eyes to a culture that just plain hates itself, & you might begin to show more empathy towards it! & do us all a favor, get a hug from somebody or snuggle a cat before you write your next article for chrissakes.

    FYI, I frequently like to post randomly on blogs & then get the hell out of there as fast as I can because I don’t like responding to livid hatred. So pardon me as I get my ass out the door =/ I will allow any angry internet patron of this blog to punch my internet face & have the last word so I can cowardly avoid a nasty conflict.

  • InfiniteSovereign

    Today one of my Facebook “friends” posted that formula should be available only by prescription and they women who choose formula over breastfeeding are “selfish” and “unmotherly.” I never heard anything so cruel and absurd. Breastfeeding has always been very important to me. My milk didn’t come in till day 5. My baby screamed in hunger those first few days. My mother suggested giving him a bottle and I made her feel bad for suggesting I feed him something so “inferior.” I struggled to breastfeed through tongue tie and upper lip tie, inadequate weight gain, shallow latch, and chronic low supply. I took drugs to to increase my supply. I attended LLL meetings religiously. I would not give up on breastfeeding. What do I have to show for it? A 15-month-old who won’t drink out of a bottle or cup, so strong is his preference for the breast. I want to get off the drugs, but I’m afraid to because I can’t count on my son to drink out of not-my-boob. I’ve tried weaning him unsuccessfully several times to the point that I’ve just given up on that. And now for the first time, I’m experiencing excruciating nipple pain, bumps, pustules, and scabs and going back and forth with lc’s trying to figure out what’s causing it. Although, there are advantages to breastfeeding that I enjoy, I can’t tell you how often I regret not just giving him a bottle for all the grief it caused, and continues to cause me.

    • Guest

      Drinking alternatives – has he tried straws? My son was/is a fiend for drinking with straws.

    • Sandra

      Sounds like you have a baby with a tongue tie…. And if that’s the case, maybe he can not even drink out of bottles an cups…..

  • Stacy21629

    I asked some of these questions the other day when someone posted this abstract in the comments section:
    Delay of lactation – yea, so what? Who cares? Does that matter? Did the babies of these mothers have increased weight loss, more jaundice, slower return to birth weight, etc etc etc.?

    What – if any – is the supposed significance of a delay in lactation?

    What a piece of garbage paper this is.

    I still want the epidural. Thank you very much.

  • OldTimeRN

    I always when moms come in to deliver after reading all the books and blogs. Going to the breastfeeding classed and advice from anyone who was pro breastfeeding. The baby latches perfectly and Mom’s says “I don’t think she’s getting enough?” Did they skip the colostrum days on the blogs? Or another one “You mean I have to feed her again? I just finished” Parents are surprised about babies losing weight the 1st 3 to 4 days. They don’t seem to understand how tired they are going to be. How frustrating breastfeeding can be in the 1st few days.
    I have no problem teaching them all about breastfeeding. But it’s harder when Mom’s come in with preconceived notions and “know” all about breastfeeding, because of what someone told them or what they read in a book. More times then not they cry and feel like failures, while I’m trying to explain it’s completely normal and part of the process. They have themselves set up for perfection then have meltdowns when it doesn’t go as planned. You gotta relax and go with the flow.

  • Sarah

    Had two hospital births: one spontaneous, one induction. No epidural for either, as I am terrified of the idea of a needle in my spine. Had a shot of nubain for the induction but otherwise just powered through. I did everything “right” and expected that someone as prepared and educated as I was would be able to breastfeed exclusively for 10-odd weeks, then pump and combo-feed from the breast and bottles of expressed milk. And then reality happened. In all the reading and all the classes I never really got a sense of just what an extreme hormone bomb would go off in my body. I never read about post-partum anxiety and how damaging it can be. And I sure as hell never heard of Dysphoric Milk Ejection Reflex. My milk didn’t come into until day 5 (FIVE!) with either of them and I powered through both times without supplementing, nursing half-naked nearly around the clock. Quit after 3 weeks with baby #1 because I started crying one afternoon and couldn’t stop for 2 days. Quit after 10 days with baby #2. I was standing at the sink washing pump parts (feed 40 minutes, pump 20, wait 60, repeat until insane) when I heard her cry from her basinet. My milk let down. I retched into the sink. I was half-way out the front door when I realized my fight-or-flight response had kicked in and I had chosen flight and my baby was still crying.

    Wow, thanks for letting me vent. All that to support the idea that this is poorly researched, correlative “data.” Women aren’t cows and should never be studied as such, yet so many of my friends and mother-cohort do, thinking breast milk is the end-all be-all. Their disdain for me and my bottles of formula were palpable.

    • Jessica S.

      (((Hug))) Seriously, that’s a lot of crap to go through. I skipped it all, b/c I knew what I nutcase I would become and it would make me a lousy mother. I formula fed as planned from the start and I never regretted it. I’ll do the same for the bun in the oven, in just a few short months. I can only imagine the things some women must think but let me tell you, that one “selfish” decision I made to not breastfeed was probably one of the best things I could do for my baby, knowing my risks for PPD (which was bad enough, even on my regular anti-depressants and anti-anxiety meds!). My son is healthy as a horse and smart as a whip – too smart, if you ask me. 😉 Thanks for sharing your story. I’m glad you worked it out!

      • sandra

        I don’t think formula feeding is in any way “easier” than breastfeeding so I don’t see why anyone would call you selfish for waking up to prepare bottles in the middle of the night and spending your day washing them…. And with medical issues on top….

  • DiomedesV

    It’s 2014, not 1995. Why are scientific journals still accepting retrospective studies, and underpowered ones at that? The perils of this approach are well known. As you say, the study is effectively meaningless.

    That is one of the most damning lists of study limitations I have ever seen…. could that actually have been a precondition to acceptance and publication? Did the reviewers insist on it? What could be the motivation for adding this study to the literature? It’s hard to imagine any other motive than making the press and getting coverage.

  • Young CC Prof

    You know, the biggest thing I take away from this thread is how little we really know about breastfeeding and solving breastfeeding problems. Even in a solidly science-based group with a lot of interest and experience in the topic, there’s so much that’s based on conjecture or anecdote.

    When did the breastfeeding advocacy organizations throw the real biologists out of the party? Was it when they decided that they needed to demonize formula as well as promoting and supporting breastfeeding?

    How much more would we know if La Leche League had embraced the tools of science rather than rejecting them? How many women who struggle to breastfeed and get conflicting advice would be able to do it better?

    • Jenny_from_da_Bloc

      The La Leche League lady made me cry. I really think they are a freaking cult and give the WORST advice on breast feeding.

      • yentavegan

        And I love La leche league! I learned so much from my LLL Leaders and I always found their home spun folksy approach to breastfeeding and mothering comforting.

        • Jenny_from_da_Bloc

          Yeah they were pretty nasty to me and really put me over the edge that day. I didn’t like being admonished for having a c-section and told I wasn’t trying hard enough. I went right to Publix afterwards and bought some SImilac, it really helped with my son’s screaming and sleeping problem

          • Young CC Prof

            I think that individual members and local groups vary considerably.

          • Jenny_from_da_Bloc

            Probably, but I’m sure the meeting I went to was taking things to a whole other level and I just couldn’t deal with the woo. It wasn’t even really a breast feeding meeting. It was more like “who is the best mother meeting.”

          • Young CC Prof

            Yup, and there are two problems:

            1) Lactation “experts” may not have anything like standard training or expertise

            2) Even the ones who aren’t religious about it may be handing out advice that’s a matter of opinion and works for some mothers but not others. In which case it comes down to luck, whether you get advice that works for you.

          • Jenny_from_da_Bloc

            Very true, sadly I was expecting something much different and it turned out to be a negative experience for me. I thought I was getting something along the lines of expertise, but it just was not the kind of situation I was lead to believe. If LLL helps people other people that is beyond great.

          • yentavegan

            I was never admonished by LLL for having 2 c/sec’s! My LLL Leaders were all level headed altruistic volunteers.

          • Jenny_from_da_Bloc

            These ladies were not, at all even close to being altruistic or nice for that matter.

          • yentavegan

            Perhaps the women who were not nice were not La Leche League Leaders, but just attending the meeting. Some LLL Leaders might not have the skills to shut down non-supportive discussions. La Leche League Leaders are not scientists and do not give medical advice. It is against the rules of being a LLL Leader.

          • Jenny_from_da_Bloc

            I was referred by the lactation consultant at the hospital to the LLL in my area. It just was not what I thought it was going to be and it wasn’t very helpful to me. I felt like they were picking me apart instead of being supportive and offering nursing advice or whatever. Maybe in your area they had better leaders or maybe it had to do with the ladies in my area. Maybe, I don’t know, but to each their own. I’m glad it worked out so well for you, seriously 🙂

      • yentavegan

        I am sorry that your experience with LLL was so unsatisfactory. I wish you had come to one of my meetings b/c I am a long time LLL Leader. Back in my day, our training was extensive but clearly not a substitute for medical intervention.

  • Guestll

    My milk came in on day 3. I had a failed epidural. Tons of milk. My baby thrived. Got my period back at 10 weeks postpartum (despite bedsharing from birth, carrying her in a wrap or sling for much of the day and sometimes night, and of course, EBF) and my milk production went south. Baby dropped from 90th percentile to borderline FTT, because I was getting a great deal of bad advice, including the words of my own then-GP and his NP, who encouraged me to try various supposed remedies for upping production as opposed to using formula. Met with a very famous breastfeeding doc and Domperidone was what ultimately enabled me to continue breastfeeding for 15 months. But hey, I had *awesome* milk production in the beginning, and right on time. Victory, amirite?

    • Anna T

      I had the same experience with my first baby: period came back when she was only 4 months old, and my milk production sharply declined. I was able to boost it by 24 hours of very frequent nursing and a supplement of fenugreek. However, I don’t often hear people talking about how getting your period back might mean bad news for breastfeeding.

      • Guestll

        Fenugreek worked, but only a little. Not enough.

        I have low prolactin levels. I know this because I was a fertility patient and it was one of those routine blood tests that was administered along with a bunch of others over a period of about a year. I didn’t know that low prolactin levels could cause diminished milk production, or a return of menses. Apparently my GP never made the connection either, because he didn’t run any tests, just recommended fenugreek and some other stuff. It wasn’t until I met with Very Famous Breastfeeding Doctor that he made the connection after asking a few questions and prescribed Dom, which worked really well.

        The only people I know who talk about getting your period back early do so with a hint of damnation — you’re doing it wrong! — if you EBF on cue, it shouldn’t happen, they say. Wrong-o.

        • Anna T

          I don’t think I had low prolactin levels to begin with, but my baby started sleeping through the night very very early (like 3 months), and later I’ve read that nursing during the night is especially important to boosting prolactin levels and the delay of one’s period coming back.

          Sure enough, my second didn’t sleep through the night until much later (7-8 months), and my period never returned until that happened.

          Again, I love love love breastfeeding and think it’s wonderful, but after going through my share of breastfeeding hurdles, I know it can also be tricky. I don’t think expectant first-time moms should just be told “breast is best” and how fun and easy breastfeeding is. They deserve to know what they should really expect, so that they aren’t disappointed.

          • Guestll

            My daughter didn’t sleep for more than 3 hours at a stretch until she was 9 months old, so long stretches without nursing didn’t happen for us.

            I loved breastfeeding, too, and I agree, women should be better equipped to understand the pros and cons. Breastfeeding came easily to both of us, I had no issues other than low supply — which is the whole point of the exercise, really — but too many “professionals” focused on the lack of other issues in pushing us to continue.

        • Laural

          I believe getting one’s cycle back quickly despite exclusively nursing on demand is truly a ‘variation of normal’ lol. It is common and one reason I very much agree with ‘young cc prof’ and wish real scientists would study human lactation.

  • Jessica L

    It seems to me that when milk comes in would also be influenced by whether mom is a primip or not and if she has successfully breastfed a previous baby, but I don’t see that mentioned. With my first baby my milk didn’t come in until day 4 (induction for low amniotic fluid, vaginal delivery, epidural). Baby did fine though without supplementation. Second baby, milk came in on day 2 (induction, epidural, c-section for failure to descend due to being a giant!). He was 12lbs 8oz. and every nurse that came in the room said I would have to feed him formula. Except for the lactation consultant who said I would be fine since I had breastfed before. She was right, I never had to supplement him either. Third baby, planned c-section, 10lb 9oz. baby. He came out obviously starving, sticking out his tongue, rooting around and practically slurping the air. We did ok in the hospital, went home the second day around the same time my milk came in but it was obvious that this baby was ravenously hungry in a way that my first two never were. So I supplemented him with formula twice in the first 2-3 days and a couple more times at 1 week old so my bloody nipples could heal. I waited for lighting to strike me but nothing happened. 😉 I didn’t bother with any extra pumping (I don’t even own a pump!). We went on to breastfeed very successfully and are still at it (he is now 7 1/2 months). I think it would be really nice if hospitals, nurses and lactation consultants would teach moms the right way to supplement with formula and still breastfeed if that’s what they want. I think a little formula would probably save a lot of breastfeeding relationships. Breast or bottle, no one should feel guilty as long as the baby is getting fed!

    • Jessica S.

      Goodness! #2 was a big, bouncing baby indeed! How much did your first weigh?

      • Jessica L

        My first was a 7lbs 10oz girl so #2 was a big shock. I was not diagnosed with GD, I took the 3hr gtt and passed but found out much later that it was probably done wrong(they didn’t give me enough glucose). Luckily other than being big, my boy had no issues. With #3 I passed the 3 hr gtt, done right this time but I followed the GD diet anyway and checked my blood sugar on my own because I was so paranoid about having another huge baby. I gained 20 lbs less than with my 2nd, exercised every day and had perfectly normal blood sugar control. I am 5’7″, husband is 6 ft tall and both of us are thin, but together we make big tall boys!

        • Jessica S.

          I have to go and do a three hour GTT tomorrow. Early this week, the ultrasound estimated the baby at over three weeks ahead of my due date. But my son (our first) was 10lbs 10oz, and I was negative for GD. I really hope the GTT is negative for this one, but I’m still considering asking her to recommend a diet to help keep her (and mine!) weight from sky rocketing!

  • ccccat

    The authors didn’t bother to look at the obvious outcome measures: bf feeding subsequent to let down and infant health measures. Both are available in the IFPS II study. Or they looked at those outcomes and didn’t find any meaningful differences. I blame the reviewers for letting this shoddy paper through. Anyone reviewing for a journal called Journal of Human Lactation should be pretty familiar with IFPS.

  • moto_librarian

    The breastfeeding rhetoric almost broke me after my first was born. I had achieved the supposedly elusive “prize” of an unmedicated, vaginal delivery (in a hospital, no less!), but because of all of the complications, I was feeling very flat and confused about the experience. I was also dealing with a difficult recovery due to blood loss and severe perineal and cervical pain from lacerations. My son was in the NICU for two day for TTTN. In retrospect, I think that I was hoping that breastfeeding would somehow redeem me as a good mom (yes, I know this is seriously screwed up thinking, but that’s how it was).

    So I started pumping in the hospital and putting baby to the breast in the NICU. I was getting drops of colostrum, which was fed to him, but he was also being supplemented with formula because he had to be able to eat to be discharged. I had no supply established when we went home on day four, but I was determined to keep at it. And thus began a cycle of true misery. Put baby to the breast and endure his screaming because there was no milk. Give baby a bottle with the quarter to half ounce I was able to pump in a half hour, top off with formula. Wash and sterilize bottles and pumping equipment. Pump every three hours. It was sheer hell. I was so full of anxiety about it that I couldn’t sleep. I was absolutely certain that my baby was going to get H1N1 because he was too young to be vaccinated and his only hope was getting antibodies from me and my flu shot. I sobbed for an entire day about it – my eyes were nearly swollen shut. My husband wanted me to quit, but he was afraid to be too forceful about it and upset me. Finally, my mother was able to talk some sense into me by saying that my baby didn’t care HOW he was fed, he just needed to eat. I finally gave up the unproductive pumping and started to get some much needed rest. It was only at this point that I felt like I could finally start to bond with and enjoy my son.

    When I was pregnant with my second son, I decided that I would try to breastfeed again since it was possible that my milk never came in because of the pph. If I am being truly honest, I have to concede that I felt like I had to try again or I wasn’t a good mom. Despite an easy delivery (thank you, epidural!) and recovery, my milk failed to come in again. It was much easier to give it up the second time, and part of me wishes that I had just acknowledged that it’s better for my own health to get as much sleep as possible, and that alone is a good enough reason to feed formula.

  • Dr Kitty

    I really don’t know how good/useful the self reported survey is.

    Was my milk “in” on day 2 when I was feeding the baby for 30 minutes every 2 hrs night and day and additionally able to pump 4-6oz twice a day, but I didn’t feel sore or engorged, or was my milk “in” on day 5, when I woke up looking like Lolo Ferrari and my breasts were rock hard and tender until I expressed 2oz from each one before I was comfortable enough to feed the baby?

    Clearly, my supply was abundant from the get go despite the elective CS, and judging when the milk came in was very subjective.

  • Elaine

    Also, they’re missing how pain meds might be a marker for a more painful/prolonged labor. If mom has a long labor, gets pain meds, and then it takes longer for her milk to come in, was the delayed lactation onset due to some hormonal issues that were also making labor take longer, or was it due to the pain meds? Or some other factor entirely?

    And, like you said, clinical significance. A friend of mine (who did have pain meds, though not an epidural) gave her son one bottle of formula in the hospital. I remember being worried at the time when she blogged that. But she is still breastfeeding her son who is now 2 1/2, so offhand I’d say they did okay with breastfeeding.

    I had two short labors, no pain meds, milk started to come in on day 3 or so, I think? I don’t entirely remember with my son (who is only 3 1/2 months old, mind, so I am not exactly super-trustful of self-reported retrospective data). I only remember with my daughter because I know we took her to the ER that day for an unrelated issue and were battling engorgement at the same time that we were there.

    • Jennifer2

      “Similarly, we are unable to separate the pain associated with
      labor/delivery from the use of labor pain medications; therefore, we are
      unable to tease out whether it is the pain or the pain medications
      leading to the associations that we observed with DOL.”

      They acknowledge that they can’t determine whether it is pain or pain medication (or some other factor) influencing the data they received.

  • Mishimoo

    3 SVDs, tried pethidine with the first (apparently it’s fine for people with codeine allergies, which confuses me because it’s still an opiate. I didn’t react to it, but it didn’t do anything other than make my eyes unable to focus properly + I felt slightly dizzy). Went without pain relief for the next two who both needed pitocin augmentation. Milk came in within 24 hours for the first and last, took 48 for the middle. I blame the liverwurst 😉 I had incredible cravings for it after they were born. Smeared it on toast, and my milk came in a few hours later.

    I recently had a lactivist try to shame me for the first time ever! I ‘gave up’ on breastfeeding the youngest at a day shy of 9 months old because he indicated a preference for formula by attempting to give me a fun new piercing and screaming every time I offered him a nipple.

    • Pethidine (Demerol) is a synthetic compound based on the same chemical background as morphine, which is itself an opium derivative. Codeine comes from a different family of plants altogether. Technically, codeine has an opiate EFFECT but isn’t an opioid.

      • Mishimoo

        Thanks for explaining it so well. 🙂

      • theadequatemother

        Codeine is metabolized to morphine by the body and it’s the morphine metabolite that is analgesic. 10% of Caucasians lack the enzyme to turn codeine into morphine and those people will get no pain relief.

      • The Bofa on the Sofa

        As noted, codeine/morphine/heroin are VERY similar chemically. In my class, I show morphine, I think, and then point out how heroin and codeine are different. It’s pretty small differences.

        Demerol is not all that chemically similar to the morphine class. It is nominally an alkaloid, yes, but then so is a bunch of other stuff. It has some similarities, but, nah. As similars go, it’s nothing like codeine/heroin/morphine.

        Even dextromethorphan (active ingredient in cough syrup) is more similar to codeine.

  • Anna T

    Wait, wait, wait, wait… they ADMIT they didn’t separate Cesareans from receiving pain medication in labor??

    What kind of crap is that?!

    It is known that mothers after a planned Cesarean often experience a delay in their milk “fully” coming in. Not always, but it happens. There is a logical reason for that. Their body does not go through the process of labor, with all the hormones involved, so it takes a little while for the milk to “catch up”. I’m not a professional so I’m using very crude terms here, but I’ve read up on this and it does make sense, and health care providers should KNOW about this.

    Why?

    A friend of mine recently had a planned C-section for placenta previa in an Italian hospital that is very strongly pro-breastfeeding. (locked-up formula, you need to sign a special form to give it, mothers are strongly discouraged from giving a bottle, and so on). Now, I’m very pro-breastfeeding too. I’m not sure you could call me a lactivist, but I sure love breastfeeding and would like every mother who wants to breastfeed to succeed if at all possible.

    Having said that, I realize that if the baby is physiologically designed to receive the full volume of milk by the 3-rd or 4-th day, but his mother’s milk has not “come in” yet, a supplement may be needed.

    However, my friend’s health care providers put very strong pressure of her not to give formula, and claimed that it’s perfectly fine for a baby to live for 5 days or more on colostrum alone (why they think so I have no idea). By the fifth day, my friend was desperate. Her son was constantly howling with hunger, she was breastfeeding *all* the time, which gave her cracked nipples, she wasn’t getting any sleep, and still her son wasn’t getting the sustenance he needed. It took a considerable loss of the baby’s weight until the nurses relented and gave her some formula. Needless to say, she was humiliated and devastated by that attitude, which was both irresponsible and ignorant.

    That was the last thing she needed to deal with while recovering from a Cesarean and caring for a newborn. And what was all the grief for? For 24 (!) hours during which she needed to supplement with formula, after which her milk came in and she no longer needed the dreaded evil substance to feed her son. Now, a couple of weeks later, her problem is engorgement!

    A second major flaw I see in this study is, as Dr. Amy said, the pathetic questionnaire. Memory is a tricky thing and after birth I wasn’t my usual self. I was adjusting to having a newborn, riding a hormonal and emotional rollercoaster, and time didn’t pass the way it usually does. For the life of me I can’t remember exactly when my milk “came in”, except that it was at the right moment and my babies got what they needed when they needed it. It was definitely under 4 days, but whether it was 2 or 3 days I don’t recall.

    Some mothers in the ward, I remember, were absolutely hysterical about having so little in the first couple of days. It’s OK because the volume of colostrum is supposed to be small, but a mother who is fearful of not having enough milk might mistakenly feel it took an abnormally long time for her milk to “come in”.

    So, I don’t think this study treats women like cows, exactly. If C-sections and pain meds during labor might delay the onset of lactation it would be good to know, in particular for militant health care providers who lock formula up and think it’s OK to starve babies if their mothers don’t “get” their milk at the normal time. However, the study is flawed and unreliable and more thorough research is definitely needed.

    • NoLongerCrunching

      In my experience, most mothers don’t think they have milk until the milk is much lighter than colostrum. So even if they’re making a good volume of colostrum, they don’t count that as milk.

      • Mac Sherbert

        My experience was exactly like Anna T’s friend. With my 1st I had colostrum, but by day three he was constantly nursing and fussing, miserable. By day 5 he was getting dehydrated. Life would have been better, if I had supplemented starting on day three for a couple of days and saved my nipples. It may have saved our breastfeeding relationship. As it was my nipples couldn’t heal from the desperate nursing sessions and after 5-6 weeks of constant pain I was done.

        Sure he lived, but at what cost? Why the needless pain and misery? I should have just done what my mom told me…give him a bottle, but no I believed the whole one bottle will ruin your milk supply it will kill your breastfeeding efforts.

        • NoLongerCrunching

          I had low supply with my third kid. she was fine on day three, though nursing constantly. By Day 4with no stool, I started supplementing and pumping. I couldn’t imagine withholding nutrition from her until my supply increased. The “just one bottle” theory, is just a theory with no evidence behind it, and it is cruel to withhold nutrition from a newborn baby.

          • Mac Sherbert

            Sure it’s just a theory, but look at the Hospitals that are withholding formula because it will hurt breastfeeding. It’s ridiculous and it needs to stop.

            Any mom that wants to give formula for any reason should be able to without having to justify. I’m sure there are moms that think they have low supply when they don’t, but maybe letting them give a little supplement will put them at ease and make learning to BF easier. Rather than locking it up why not just educate women about how to supplement properly? It’s insulting to women to treat them like children…No you can’t have any candy ummm formula!!

          • Anna T

            Personally, I don’t believe supplementing with formula should be encouraged when a woman only *thinks* she has low supply. There are other reasons for a miserable, fussy baby. My second, for instance, had a short frenulum – “tied tongue” – which made her swallow loads of gas.

            Neither do I think the mother’s concern about a low supply should be brushed off, like my friend’s was, with the nurses saying, “oh, I’m sure you’re OK, you’ve got colostrum and that’s like liquid gold for your baby!”

            Rather, the mother should see a competent lactation consultant to assess whether there really is a problem.

            If this really is a case of low supply, much can be done in order to increase it. However, obviously in the meantime a baby cannot go deprived of nutrition.

  • rh1985

    The second to last paragraph is so damn true.

  • OBPI Mama

    I’ve always teased and said if I was one of my husband’s cows, I would have been hamburger by now…. stuck calf/bad birth, unable to produce milk to feed it if it was able to be saved. Butcher city.

    • Siri

      No, he’d have kept you for a pet! Far too fond of you to turn you into bbq products… 😉

  • Jessica S.

    Isn’t it enough, everything a new mother has to endure in the first few weeks after delivery, that we don’t need to add to her pile? “Endure the pain, resist the surgery, skin-to-skin for at least the first hour – fight those nurses off! – breastfeed, breastfeed, breastfeed, breastfeed, you have to always be trying or you’re not trying hard enough, forget sleep b/c it could interfere with breastfeeding, don’t ruin the virgin gut, the tiniest amount of formula will ruin EVERYTHING FOREVER, no vitamin K or hep-B vaccine, no eye gel – haven’t you done your research?? And for the love of ALL that good and holy: DON’T PUT A G*DDAMN HAT ON THE BABY!!”

    God help the women who fall for this over-the-top nonsense. I’ll be waiting here in GoodEnough-ville for whoever crosses over. Look for me on the corner of Whatever Works for You & Happy Mom=Happy Baby. I’ll bring cupcakes and wine.

    (*Obviously, I’m using hyperbole, although it’s all things I’ve read countless times in forums and blog posts and in comments, etc. There are some reasoned arguments to be made for some of those items, albeit much lighter gradations. End of disclaimers.)

    • Elizabeth A

      I’ll be there in good enoughville, with chocolate and questionable media for children. Old McDonald is sung by Sinatra, Han shot first, and The Italian Job is a good family film.

      • Jessica S.

        Sounds like a plan to me!

      • Siri

        I flew to Norway with my toddler once, and when there was a delay in opening the cabin door, she called out, You’re only supposed to blow the bloody doors off!

    • OldTimeRN

      Sadly it’s not hyperbole. It’s what is out there and the hospitals are caving and giving in to these scare tactics.

      I hope I’m still around and a practicing nurse when the tide turns(again) and it’s realized this was all a load of bullish*t.

  • Zornorph

    I’m still waiting for my milk to come in and I didn’t have any pain medication at all.

    • Jessica S.

      Oh YOU! Ha!

    • Siri

      You won’t get any either, after falling into a vat of morphine as a child….

  • Amy

    Two c-sections. Milk came in on the second day (within 36 hours) after the first and within 24 hours after the second. WHEN my milk came in wasn’t an issue the way inverted nipples were.

  • PrimaryCareDoc

    I have no friggin’ clue when my milk came in for either of my kids. No memory at all. Between the sleep deprivation and constant breastfeeding and crying and painful perineum…who the hell can remember that?

    • Haelmoon

      With my first it was definitely 3-4 days, I was post-op for a cord prolapse with a very sick baby in the unit. I pumped a lot, but it turned out the size of the pump was wrong, soon as I switched, the milk came by the litre. I really was a cow.
      With my second, it was within 24 hours.
      With my third, I had so many contractions before she actually came at 29 weeks due to chronic abruption that I was leaking significant amounts before she was born. I pumped 50cc the night she was born, and it kept coming easily. I was lucky that postpartum was something I was good at, because I was generally lousy at the pregnancy part. My kids however, were lousy breastfeeders, always preferred dad with the bottle. I really was the cow (and bread winner, by the last, I just planned to return to work early since I had a very supportive pumping environment and dad was better with the babies anyways)

      • Amy M

        Mine was 3-4 days too, despite pre-term birth and an epidural. And fairly significant blood loss. And a previous diagnosis of PCOS (which has since been rescinded so who knows about that.)
        The hospital didn’t give me a pump until sometime on Day 2 I think? Not that I got anything until after I went home anyway. But yeah, I thought that that was a pretty normal amount of time, especially considering the anemia and preemies. I doubt the epidural had much influence there. It would certainly be hard to separate out from all the other factors.

    • me

      I remember with my first – the engorgement was very memorable. It was the morning of day 4. With my second and third child it happened earlier (day 3) and the engorgement wasn’t nearly as bad. I suspect the “delay” of a day was more due to being a premip than the induction and epidural (that did not recur with subsequent deliveries).

    • Jenny_from_da_Bloc

      Lol, I’m with you on that! Who can honestly remember when their milk came in after giving birth and all that jazz? I was on a “rockstar roller coaster” after my c-section, I could barely remember my name! Though my husband did say I was quite funny and very witty that afternoon!

  • yentavegan

    Full disclosure here: I am a leader with an internationally known breastfeeding support non-profit organization. During my training I was told that it is normal for a mother not to have a initial early milk production for up to 8 days post partum. Until the mother’s milk “comes in” the baby can thrive on colustrum and as long as the baby is wetting, passing meconium and as long as the baby is latching and sucking there is nothing wrong.
    So now this new study comes along and re names a biologically normal process as delayed onset! What malarkey!

    • Jessica S.

      How interesting, thanks for pointing that out. It is malarkey!

    • Trixie

      If the baby is wetting copiously and passing meconium, then the mother’s milk probably is in. That requires a pretty high volume of liquid. Whether it looks like colostrum or not.

      • yentavegan

        yes!

  • Jenny Star

    Recently a friend on facebook posted some pro-breastfeeding article – something about not picking on women for public breastfeeding or something. I said what I would really like is for everyone on both sides to stop shaming women, both for bottle or breast feeding. She said she had never heard of anyone giving women a hard time for not breastfeeding. Within minutes, friends of hers jumped in talking about how women who don’t breastfeed shouldn’t even breed. They made my point for me better than I ever could have, it was perfect.

    • Jessica S.

      Haha, that is hysterical! She was probably thinking “thanks a lot for ruining my high perch here!”. And argh, I can’t comprehend how small minded one must be to actually think people who don’t BF (I’m one of the most evil in their eyes: I didn’t even try!! Gasp!) shouldn’t breed.

      • Life Tip

        Awesome. Reminds me of a thread on mothering . com where someone posted asking if those who had homebirths would reconsider if new research showed it to be more dangerous. Amid the “that would never happen”/”the study would be so bias toward hospitals” post, one poster claimed that the original poster was trying to trick everyone into admitting that homebirth was about the mother’s experience rather than safety, and that no one would ever say that because homebirth mamas are educated and evidence based and whatever. Cue the next posters stating that they would continue homebirthing no matter what the evidence said because they had wonderful experiences and the process was important, not just the outcome.

  • EllenL

    I know too many women who had epidurals and were epic
    breastfeeders for that study to elicit anything but a big “ho hum”.

    • Alenushka

      I had an epidural twice. I made so much my milk that my mama used to joke, that if I was cow in Russia, I would win Soviet Prize for Agriculture.

    • guest

      I had an epidural. My milk took 5-6 days to come in, but then I produced so much that I had plenty for kiddo and also was able to donate 400+ oz over the next 6 months. (And even if I wasn’t able to produce so much, um, big deal?) Agree with you on the ho hum!

      • guest

        Oh yeah, and the pediatrician said that my kiddo needed a little bit of supplementation with formula in those first few days. I remember sobbing partially from relief (breastfeeding was very, very painful for me) but mostly from fear that it was going to ruin breastfeeding. And did disaster strike? No it did not. Everything was fine.

  • Renee

    They care only about women hewing to the ideology than they do about any actual human, and their real life needs.

  • The Computer Ate My Nym

    I remember not having much in the way of milk the first 1-2 days. Small one got dehydrated, got a mild fever, scared the crap out of everyone. She got one bottle of formula and was much better, but the pediatrician suggested giving her 4 more bottles of pedialyte to make sure. In the mean time my milk came in and we went home. I wanted a nap when we’d settled in at home so gave small one to my partner who said he’d give her some pedialyte while I slept. An hour or so later he came in looking mildly frazzled and said, “I don’t think she’s THAT thirsty and she REALLY doesn’t like pedialyte.” Sniff. Baby’s first act of rebellion.

    • Gene

      Because it tastes like salty koolade. It’s vile.

      • The Computer Ate My Nym

        Well, yeah, there is that. But if you’re thirsty enough…

  • Alannah

    There is no `reversal` or discrepancy in the NCB/lactivist views. The common theme is suffering. The best moms are those who martyr themselves the most. In any given situation the natural childbirth/lactivist/AP crowd promote the option that causes the greatest possible amount of pain, inconvenience, sleep deprivation or indignity for the mother. Be it birth (only acceptable when mom is in unmitigated screaming agony throughout), infant feeding (breast only no matter what the cost to mom, without any possibility of help from others), waste management (diaper-free with mom on 24/7 potty watch with cloth as a barely acceptable second), and child rearing (nothing less than full AP will do).

    • fiftyfifty1

      “The common theme is suffering”
      I would agree that a common theme in suffering. But there is also an opposite theme which is bliss: The orgasmic birth, the blissful bonding of breastfeeding (which should NOT hurt or you’re doing it wrong!), the unmatched coziness and love of the family bed.
      I think the theme that ties it all together is COMPETITION. I’m either the most blissful mom on the planet or I’ve suffered more than anyone since Joan of Arc. Either way I’m way better than plodding old you.

      • I agree about competition. But I would argue that the “bliss” is supposed to be the outcome of the suffering.

        In a world largely influenced by 2000 years of venerating the Suffering Mother of God in religion, the stereotype has been transferred to ordinary women. Suffering is mandatory; bliss is optional.

    • Jacob Wrestled (Danielle G.)

      Yes. In fact, I think there are three common themes that link together natural parenting views, which tend to play off of each other and reinforce one another. The idea you cite is one of the three.

      1. The major doctrine that links the natural parenting camps views together is the concept that what is “natural” or “folk practice” (because folk cultures are more “tied to nature”) is always superior to what has been tampered with or innovated upon in relatively recent history by affluent western societies. Thus, it seems to them that no pain medication is “natural,” while medication is “unnatural;” that an herbal medicine is a “natural remedy,” while a prescription drug is “unnatural”; and that breast milk is natural, while formula is an inferior substitute. The natural is usually beneficent, and the unnatural likely to be inferior or poisonous. As fiftyfifty notes, there’s often a spiritually layered on top of this idea: people want to feel “connected” to nature and to derive a spiritual experience from this connection. The products of science, by contrast, seems sterile.

      2. As a corollary, natural parenting ideology assumes that whatever has been invented recently, particularly by elites (doctors, companies, etc) rather than the people (moms, the herb lady, a midwife), is suspect. Thus, the ideology empowers the common person– “thinking mom” and the lay entrepreneur–while reducing the influence of the professional classes.

      3. Because natural parenting advocates tend to rejects innovations that were designed to overcome common medical and logistical problems, natural parenting practices require more time, effort, and pain for at least some parents. But this is not a deterrent to proponents: it simply marshals longstanding anxiety over the influence of “good mothers” and “bad mothers” and provides a new set of standards for defining good parenting. This is attractive to people, esp. women, even though it presents them with problems. One might be required to spend more time or endure pain, but at least one then knows that one is a good parent and not a “lazy” one.

      The way I wrote that, I sound like someone who rejects all the natural camp affirms; in fact, I actually follow some of their practices (tried very hard to breastfeed, or at least pump; did some baby wearing; did cloth diapers until they seemed to be causing diaper rashes for our kid; wound up co-sleeping despite plans to the contrary). However, I do think the assumptions driving that movement’s rhetoric are shaky, and shouldn’t be allowed to become social dogma.

      • Young CC Prof

        Never mind the fact that modern Western breastfeeding culture almost completely died out in the mid 20th century and was rewritten from scratch in the 70s and 80s.

        • AmyP

          How long did pre-formula Western mothers actually breastfeed? I strongly suspect, not nearly as long as modern Western mothers are being encouraged to breastfeed.

          • attitude devant

            Someone (Antigonos?) linked once to a whole bunch of scholarly research on the history of formula. Supposedly there were recipes for formula in ancient Egypt. As long as there have been babies, women have been looking for alternatives (formula, wet nurses) to breastfeeding.

          • araikwao

            I’ve seen some scarily malnourished babies at a provincial hospital in a developing country. One I definitely remember was cared for by a relative after the mother had died…fed on paw paw juice. That’s more ” natural” than formula, I suppose, but it sure didn’t help him reach his developmental potential, or gain healthy amounts of weight, or meet his nutritional requirements.

          • Jessica S.

            Well, sure, I guess that makes sense! If there are women today unable to BF, as in “my baby will starve if there’s no alternative” then that had to be the case in all of history. Who knows, I’m sure there’s at least one person who’d argue that women were flawless before man invented “fill-in-the-evil-technological-progress-blank”. But in the real world, bodies don’t always perform like we might like.

          • It wasn’t me, but I might point out that the grandmothers of most of our Breastzillas of today, and a great many of their mothers, were bottle fed, and not with today’s “customized” formula, but with the older evaporated milk/water/corn syrup concoctions made at home, as written up in Dr. Spock’s manual. In the 30s to 50s, bottle feeding was regarded as the modern, scientific way to feed a baby.

            Amazingly, [it seems] we all survived the experience.

          • NoLongerCrunching

            My MIL was told to feed her baby soy formula and 7-up (?!).

          • Young CC Prof

            The 7-up is a little strange, (OK, it’s a terrible idea) but one of my relatives was apparently one of the first babies saved by soy formula. Severe digestive disturbances, minimal weight gain. The doctor sent them to another doctor who suggested this new kind of formula, and it worked like magic.

          • Young CC Prof

            No, not usually, not as I understand it. (Of course, they were sometimes weaned on to a porridge whose primary ingredient was unfortified flour, which was not good for them at all.)

          • Irène Delse

            Also it probably varied a lot according to resources available. European nobility (and the rich in general) could afford wet nurses with ample supply. But it would have been different for peasant women, who had to work long hours and may often have been undernourished themselves.

          • Trixie

            DH’s 87 year old German grandfather weaned at age 3.

          • Dinolindor

            This reminds me of what a friend told me – she was editing a translation of a 15th-century German manuscript with advice for mothers and was struck by the declaration that if a child can pull up a stool to demand to be breastfed, that child has been breast fed too long.

          • Young CC Prof

            Proof that there have always been mommy wars…

          • Trixie

            It varied pretty widely, but breastfeeding til 2 would have had advantages when there wasn’t safe drinking water, and children were weaned directly onto small beer.

        • Irène Delse

          Anecdata time: one of my grandfathers was born in a village in western Europe a little after the beginning of the 20th century. His parents were small farmers with two older children. Now according to great-grandma, my grandad was breastfed until age three. Of course, that didn’t mean exclusively breastfed, but if circumstances made it possible, some children were sometimes given breastmilk even as toddlers. (The fact that my grandad was the youngest child and the only boy after two girls probably played a part. He was definitely the favorite, from what I’ve heard of family lore.)

          • me

            My grandfather was born in Massachusetts in the 1920s. He was bf until age 4. My great-grandmother apparently nursed until she became pregnant again, and my grandfather was the youngest, so he nursed the longest.

            Me, I’m happy to wean around age 2. By then I’m done with it and ready to move on. None of my kiddos have complained.

      • araikwao

        Nicely put

      • Jessica S.

        Good points!

        “One might be required to spend more time or endure pain, but at least one then knows that one is a good parent and not a “lazy” one.”

        Yeah, I’m fine with being lazy. And look, other women can look at me and feel superior – isn’t that SO NICE of me? 🙂

    • Kq

      You forgot one key component of the martyr process – you have to keep smiling and singing the whole time. Let that smile fade and your sainthood is in jeopardy.

  • AllieFoyle

    Pain relief versus timely lactation? Pain relief, pls, thx.

    Am I alone in not even remembering when my milk came in? Maybe there’s some recall bias here as women are often told that cesareans interfere with breastfeeding, so those who’ve had one might be more likely to notice it specifically and remember it later, whereas someone with a vaginal birth would have a higher threshold for noticing and remembering.

    • Trixie

      My milk came in as I was pushing. That was a weird feeling.

      • Karen in SC

        so your baby had no colostrum?

        • Trixie

          It was colostrum-y milk. There was just a lot of it. It’s not like it’s colostrum one moment and milk the next. It’s a continuum. My milk was orange-ish for weeks after birth until it gradually got whiter.

    • Elizabeth A

      With my son, my milk hadn’t come in by day 2 post-partum, which caused a lactation consultant to get us a prescription for a breast pump, and tell me to pump every two hours, round the clock.

      The resulting oversupply was epic. I can’t say enough how much I wished I’d just given him a little formula and been patient.

      • yentavegan

        Your experience reflects what I am seeing as a volunteer breastfeeding support counselor. Mothers are getting too much help/interference in the hospital that they call me on day 7 having been finger feeding, nipple shield wearing, power pumping and generally having been over counseled to the point of exhaustion…

        • lawyer jane

          Yes, that is what I have been hearing about on listserves in my city too! Our local “star” lactation consultants seem to counsel all moms to pump around the clock as a matter of principal. One of my friends was nursing AND pumping after every session AND doing supplemental formula for months. I don’t know how she survived it. ANYONE who would recommend anything to a new mom that takes away precious sleep is just sadistic. I am very grateful that I found a lactation consultant who wasn’t like that, and expressly told me NOT to pump.

          • Mac Sherbert

            It sounds like a one size fits all approach. If had to pump for months I would have switched to all formula fast!!

            My baby just wouldn’t wake up to nurse. So, my LC told me to supplement at the breast then pump after feeding. She said I only needed to pump after a feed where the baby didn’t nurse well and she never told me to pump round the clock. She also told me that pumping wasn’t about how much milk I got and that any cheap pump would do as we were just making sure my body knew it needed to work. Once my baby started nursing well (around 3 or 4 days) I quit both pumping and supplementing.

            I wonder if they over estimate the amount of simulation needed to get the milk flowing. I know moms that never once put their babies to their breasts and yet their milk still came in.

          • Young CC Prof

            My milk came in, real white milk, at 3 days after the birth despite:

            1) No-labor c/s
            2) Morphine
            3) Not pumping
            4) A baby who couldn’t latch or suck properly

            Literally, the only things that stimulated my milk were placenta delivery and the baby making an attempt to eat that was, in retrospect, more like rubbing his lips on me than really feeding. And due to that, milk coming in was announced with rock-hard plugged ducts, which probably should have been a clue that he wasn’t drawing anything out.

            Of course, I didn’t know anything, and the actual professionals chose to ignore the situation and not even hint to me that there was a problem until it was so bad he needed bili lights and IV fluids.

        • Elizabeth A

          When my daughter was in the nicu, a friend sent me an article that recommended that preemie moms sleep at least six hours at night, lest milk production suffer. If you wake up anyway, it said, go ahead and pump and call the unit to see how the baby is (protip: if the baby is not fine, they will call you. This will not stop you from calling to ask.). Do not set an alarm.

          It was good advice. I don’t really know how much the sleep affected my milk supply, but it did wonders for sanity.

      • R T

        It might not have made a difference! My milk came in on the second day, but my big GD baby needed more than the little bit I was producing. I was patient and gave him formula. Within a couple weeks, I ended up with over supply so bad I wanted to quit nursing! It would spray out several feet and I smelled like spoiled milk all the time, lol! My baby was practically drowning every time he tried to nurse. God it was awful! I had an emergency csection, but it didn’t stop my insane milk supply!

    • Jessica S.

      I don’t recall, but I also did not breastfeed so I was more focused on hoping it wouldn’t be too painful or long until it dried up. I had a c-section, so everything from the first week is a bit of a drug-fog blur anyhow. 🙂

      This is off-topic a bit, but I do vaguely remember it coinciding with my pain med Rx running out a week after his birth and realizing I probably should’ve been tapering off, or at least could have. I was so focused on not missing a dose so I wouldn’t get behind managing the pain, it didn’t occur to me that I may not need as much those last couple of days. “I think I’ll ask for a little more guidance on that this time around; I didn’t like feeling so drugged up but I also was fearful of not managing the pain enough.) What’s more, now that I could think straight, I realized I had not adjusted (increased) my meds for depression and anxiety to the pre-pregnancy levels as I’d discussed with my p-doc. So add in the milk coming in (I assume there are hormones associated with that? I don’t know. Too many confounding factors to know what influenced what.) and I walked around for a week in tears most of the time, saying “I’m really not terribly sad, I just can’t stop crying!!” 😀 I’m SO looking forward to that again. *rolls eyes*

    • araikwao

      Mine came in the same time after my scary unmedicated VBAC as it did after my evil CS, on day 3. (I think it wasn’t until day 6 or so post-CS I had the “watch out, she’s gonna blow” feeling, which I didn’t the second time around, but that was probably because I was prepared for oversupply.)

    • Jocelyn

      It came in…sometime.

    • Houston Mom

      Mine took over a week to come in and even then there was very little. My son wouldn’t latch for 7 weeks, so I pumped the tiny amount of breast milk I had & added it to his formula. It was a pain but I did enjoy nursing once he started latching.

    • Jessica

      I only know because I started puImping early on as my son was not latching well. It was coming in within 72 hours of birth. I had an epidural, too.

  • LibrarianSarah

    I find lactivists udderly annoying.

    I’m sorry I couldn’t help myself.

  • Mac Sherbert

    As a mom that had DOL…Would I have rather had my milk come in earlier or had pain meds? Pain Meds!!

  • fiftyfifty1

    I wish lactivists would treat women a little more like cows. I doubt a dairy farmer would care if a cow’s milk came in a day or two later than average. And at least dairy farmers understand that there are genetic factors that play a large role in milk production. They don’t accuse cows of “not trying hard enough”.

    • Mel

      Since we have to pump and dump for the first week, a day or two doesn’t make much of a difference.

      • The Computer Ate My Nym

        Dumb city girl question: why do you have to pump and dump the first week? And is there any way to allow the calf to, well, breast feed but still get milk out of the cow?

        • Awesomemom

          Having Colostrum in your babies milk is good but not in milk you want to drink from a cow. Some farmers let the calf drink from mom the first few days but then want to move on to milk replacer to get them used to it.

        • Mel

          We save the colostrum to feed to the calves. I’ve heard of ways to manage a calf and get milk on a small farm by letting the calf nurse when you milk the front teats or separating the cow and calf at night and keeping the milk from the am milking for personal use since milk cows produce enough milk for around 5 calves per day.

          With more than a few cows, the logistics become impossible. We raise the calves separately from the cows. We move the cow away from the calf within the first 90 minutes so the mom does not bond strongly. The calf stays with other pregnant cows who will lick and cuddle with the calf, but don’t bond with it. The cows will look for a calf for 12 to 24 hours after we separate them, then they stop. The calves decide humans must be their mom since we are bigger than them and give milk from a nipple.

          It sounds cold as I write it, but cows aren’t humans.

          • Irène Delse

            I don’t think it’s all that cold. The calves get new ‘moms’, and cows don’t miss them for long, as would happen in nature if a calf was stillborn. Allowing the cow to feed the calf and then taking it away would be less humane.

          • The Computer Ate My Nym

            So the milk from the first week goes to the new calves and the calves bond with you? Seems like that should work reasonably well…This may be TMI, but when I was breast feeding, I made more milk than the small one could use and I’m not even bred for milk production (jokes about the size of my tracts of land aside) so I wondered if you could basically let the calf eat and then pump the rest and just continue pumping after the calf lost interest and was weaned. The logistics of that might be pretty untenable though. Honestly, if the cows, calves, and farmers are all reasonably happy, I don’t see any reason to change things. I’d had the impression that the cows were miserable for weeks after the calves were taken away, but as I said, I know all crap about farming.

          • Mel

            There are health-related reasons we don’t use milk from the cows to feed the calves. There is a bacterial disease in cows called Johnne’s (prounounced Yo-knees) that cause severe diarrhea and often general metabolic collapse in cows postpartum after their 2nd or higher order calf. The problem is that it can be passed from cows to calves through colostrum/milk and the only test for Johnne’s isn’t accurate until the cow is old enough to have had her second calf. In short, a first calf heifer can be infected and we have no way knowing.

            So, we dump colostrum from first-calf heifers. We keep colostrum from 2nd or higher order cows that have tested negative for Johnne’s AND don’t pool colostrum. We track which calf got colostrum from which cow so that on the rare occasion that a mature cow suddenly tests positive for Johnnes we can test any calves that may have been exposed.

            We could, theoretically, buy a pasteurizer and pasteurize ‘abnormal’ milk – postpartum milk – and feed it to the calves. We’d worry too much about bacterial contamination, though, and storing extra milk would be tedious. Instead, we feed calves formula – or ‘milk replacer’. I like it because you can make as many or as few bottles as you need at a time and because the powder smells like white cake mix.

          • Trixie

            Days like today that I especially don’t miss a certain vegan commenter.

    • Mel

      On our farm, our assumption is that if the herd average drops, it’s OUR fault, not the cows.

  • Mel

    “The study does shed some light on another important issue: the tendency of lactivists to treat women like cows, obsessing about the quality and quantity of their milk, with no regard to the well being of the women themselves.”

    Minor dairy farmer quibble:

    They didn’t measure the quantity OR quality of the milk. All they measured was the mother’s subjective idea of when her milk came in. On the farm, we measure both the quantity of the milk in pounds produced by a cow and the quality of milk in terms of butterfat, protein, and somatic cell count.

    I’d be much more interested in a study that looked at quantity and quality of milk produced by women. I suspect it would be eye-opening to the lactivist types to find out that women produce a wide range of amounts of milk ranging from “LOTS!” to “Not enough to feed a baby”.

    • Young CC Prof

      But pumps are inefficient! Even if the pump is hardly drawing anything, your baby must be getting enough! (Yes, some women let down better for the baby than for the pump, but I’d hesitate to just assume it is so, especially if you have reason to be concerned about low supply.)

      • Trixie

        It is true that it can be much, much harder to let down for a pump, and generally you get less milk pumping than an efficient nurser gets.

        • Trixie

          And, dairy cattle are bred for their ability to let down lots of milk to artificial milking machines, whereas humans aren’t, so they’re probably better at it.

          • Mel

            Some are; some aren’t. A small number of cows on the farm (less than 10%) need a small dose of oxytocin to stimulate let-down. The need for the shot isn’t correlated with ability to re-breed the cow or amount of milk produced AND it’s a cheap procedure so we haven’t really done much breeding around that, per se.

        • Therese

          Sometimes the baby is an inefficient nurser and the woman can pump more efficiently than the baby can nurse. Lactivists never want to talk about those cases though.

          • Trixie

            Oh, certainly. In general, though, exclusively pumping is harder for most women to maintain a full supply after the initial rush of hormones of the first few weeks.

          • Michele

            That was my situation with baby #1. I could have fed triplets with what I pumped. According to some people I ran into online, it didn’t count though because it wasn’t straight “from the tap.” I couldn’t tell you what day my milk came in either or if the nurses gave him formula in the hospital.

          • Spamamander

            Most definitely with my second child. Babies with Down syndrome tend to have lax muscle tone, so getting a firm latch and suck was close to impossible. I pumped and produced like a Jersey cow until I just couldn’t cope with being attached to the pump anymore and went to formula. (And amazingly she did just fine)

      • Mel

        That’s because babies – no matter how young – are great at stimulating milk let down instinctively!

        I think of that fallacy every time I’m trying to bottle feed a calf that responds to a finger or nipple in their mouth by licking it….or biting it…..or doing nothing at all.

        And then there was that set of bull twins that would move the nipple to lay perpendicular to their muzzle (think the base of the nipple against one cheek, the middle of the nipple across the tongue and the hole in the nipple in the air outside the other cheek) and proceed to spray milk all over their pen – for three freaking days after they were born.

        Oh, and that calf that attached himself to a cow’s dewlap (that extra skin between the front legs) and tried to nurse from that. He got pissed and started headbutting the cow – who wasn’t his mom – to try and stimulate milk let down.

        • Young CC Prof

          Like that scene from Ice Age?

          “I thought you were a female!”

        • Jessica S.

          Hilarious!!

    • Jacob Wrestled (Danielle G.)

      Yes. Am I missing something obvious here… Why does it matter when your milk comes in? I thought all the breastfeeding books said, “It takes two or three days, but don’t worry, your baby will be just fine.”

      I would be more curious to hear more about how much milk production and content varies between women, and what affects this.

      (I have no medical knowledge to go on, but I can’t imagine pain medication has anything to do with this longer term problems.)

  • Young CC Prof

    As they note, the study could not control for the difficulty of labor. More difficult labor–> more likely to use pain medication AND more likely that mother and/or child will have health problems in the first few days after the birth, which can interfere with time spent attempting to nurse, either because mother or child is too ill or because they need to be separated for treatment.

    • araikwao

      That was my first thought, too. Is there anything scientific to support the concept of delayed or absent lactation after traumatic birth? I’ve certainly heard plenty of anecdata

  • attitude devant

    The ideas addressed in the study follow a particularly nasty trope in the lactivist community: if you take your own needs as a person into consideration (needs for sleep, needs for pain relief, needs for medication for your other medical problems) breastfeeding will be delayed, limited, whatever, and you will have failed. Failed, I tell you. The only true path is the path of suffering.

    • Renee

      Just like NCBers, pain is good. It’s hateful, misogynist clap trap I have heard, I am surprised it didn’t come out of MRA forums.

    • Alenushka

      Yes indeed. I waited way too long to wean even thought I needed thyroid med.

  • moto_librarian

    Talk about much ado about nothing! This study is worthless by the investigators’ own admissions. What exactly was the point in conducting it and reporting on it other than to fan the flames of the Mommy Wars?

    • Young CC Prof

      I think you’ve put your finger on it: It was to create a headline that could serve to shame mothers.

      • Amy M

        I think they should do a study where:
        1)they’ve determined what truly delayed onset of lactation actually is and
        2)perhaps attempt to separate the women into separate groups (I know, not ethical) to deal with said DOL. Examples might be a pumping group, a supplementing group, a nursing on schedule group, a nursing on demand group, whatever.

        Then, see if these women can successfully breastfeed despite the delay, since that is what women in real life care about anyway, if breastfeeding is one of their goals.

        Or, if they want to do a study to determine causes of delay, then they need to address all the issues they already brought up in this paper, as well as health conditions of the mother and the baby.

        Really, what did they think would achieve with this study, other than shit stirring? Come up with a genuine hypothesis and then get back to us.

        • Young CC Prof

          I’ve got a genuine hypothesis: Actually teaching women how to supplement, either as a temporary measure or as long-term combination feeding, will result in more breast milk inside of more babies.

          Teaching that it’s possible and allowed would help, but I realized only after my son was born that I didn’t know HOW. I knew he might have problems and need formula in the first few days, but I (stupidly) didn’t learn about how to do it and just sort of trusted that the baby nurses in the hospital would take care of it if I gave them permission to.

          • Mac Sherbert

            This a thousand times! Let women know that supplementing in the first few days is not failure and can actually help them achieve their goal of breastfeeding!

            My lactation consultant very gently/hesitantly talked to me about supplementing until I pointed to the little open bottle of formula by my bed hiding behind my water bottle…then she just relaxed and was like do this!

          • Amy M

            Yeah, I kind of expected that this would be the case also. For us it was, because early twins, and I didn’t have any lactivist nurses bothering me about them, but I learned shortly after that it was not that way for everyone. I just didn’t (and still don’t) see the big deal about a little supplementation.

          • NoLongerCrunching
          • Young CC Prof

            10 mL at a time by syringe. That sounds like a good way to do it. My husband tried to get the same effect by offering the bottle very briefly, followed by pacifier, to give the baby the idea that he needed to work for his milk. Didn’t work, maybe nothing would have.

            And of course, the responses to this article are lactivists freaking out about how it’s a plot by formula companies to undermine exclusive breastfeeding by… selling one small package to mothers who then go on to have a long and satisfying breastfeeding relationship.

          • Renee

            And they wouldn’t even be SELLING that one package if those idiots didn’t ban the free ones…

          • Pilo

            I absolutely agree! I have a friend who is an intelligent college-educated working professional and also a mother. She has a medical condition that is severely aggravated by lack of sleep. None of the hospital staff members, the pediatricians, the La Leche League leader, or the THREE different lactation consultants that she met with told her about supplementing. No one even presented it as an option. Everyone just emphasized that “breast is best.”
            When she went to her six week postpartum visit with the OB, she told the OB that she had switched to formula-feeding the day before and asked for something to help dry up her milk. Her other medical condition was out of control from the lack of sleep (and hormone changes), and she had reached a breaking point.
            The OB–6 weeks after the birth–is the one who taught her about supplementing. The OB didn’t push the issue but presented it as a “have you thought about this?” idea. This resulted in baby being breastfed during the day and bottlefed by dad at night. This set-up worked for everyone involved, and kiddo is headed to kindergarten this fall.

    • Jacob Wrestled (Danielle G.)

      They spent time running the study. Need a publication to show for it!

    • Rebecca

      You’ll notice that the first author is affiliated with something called the CDC’s Epidemic Intelligence Service. My guess is that this journal article was her EIS project, for better or for worse.

      “The Epidemic Intelligence Service (EIS) is a unique 2-year post-graduate training program of service and on-the-job learning for health professionals interested in the practice of applied epidemiology.

      Since 1951, over 3,000 EIS officers have responded to requests for epidemiologic assistance within the United States and throughout the world. EIS officers are on the public health frontlines, conducting epidemiologic investigations, research, and public health surveillance both nationally and internationally.”

      • Rebecca

        Ah, here it is. http://www.cdc.gov/eis/more.html

        One of the requirements of the EIS program is to “Write and submit a scientific manuscript for a peer-reviewed journal as first author.”

        • Irène Delse

          Now, if only it had been: ‘write a non-crappy article for a peer-reviewed journal’…

  • Irène Delse

    The situation is reversed indeed! Good job pointing this inconsistency. Great article.

  • Amy M

    Also, is 3 or 4 days for milk to come in really delayed? I thought that was within the range of normal? Isn’t that one of the things the lactivists tout? Don’t feed formula right away!! Newborn’s stomachs are the size of marbles and the few sips of colostrum they are getting for the SEVERAL DAYS it may take for milk to arrive is sufficient!! No?

    Here we go, straight from the horse’s mouth:
    “Milk production begins around the midpoint of pregnancy. For most
    mothers, milk will “come in” (increase in quantity and begin the change
    from colostrum to mature milk) between days 2 and 5.”
    and
    “Milk production normally begins to increase (biochemically)
    between 30 and 40 hours after delivery of the placenta, but it may take a
    little while for the changes to become apparent to the mother.
    Milk “coming in” generally refers to the time when the mother notices
    increased breast fullness (and other signs) as milk production begins to
    kick into full gear– this usually occurs 2-3 days after birth, but in
    as many as 25% of mothers this may take longer than 3 days.”

    That’s from kellymom, the go-to source on all things lactivist in the NCB world, as far as I know. So, maybe 4 days might be considered delayed onset, but evidently isn’t very uncommon either.

    • Renee

      If you are dedicated to avoiding even a drop of formula, then its OK that it takes a week or two to have milk.Baby be damned. It’s all about hewing to ideology.