Telling a new mother to breastfeed AND pump is barbaric!

Breast pump to increase milk supply for breastfeeding isolated background

Warning! Warning! Warning! Personal opinion ahead!

Every breastfeeding post I write leads to multiple comments about the physical and mental gymnastics some new mothers put themselves through in order to breastfeed. I hear about women who breastfeed every two hours PLUS use a SNS breastfeeding assist system PLUS pump their breasts afterward to further stimulate milk production, typically on the advice of a lactation consultant who found breastfeeding relatively easy.

Have lactation consultants lost their minds? Their “advice” is barbaric, cruel and not in any way justified by scientific evidence.

Let’s start with the baseline reality:

IN FIRST WORLD COUNTRIES, BREASTFEEDING IS SIMPLY NOT THAT IMPORTANT!

There. I said it. The claims about the benefits of breastfeeding are NOT supported by the scientific evidence, which is weak, conflicting and riddled with confounding variables. All things being equal, breastfeeding is best, but then all things being equal naturally occurring 20/20 vision is best, too.

But in real life, what’s best isn’t necessarily what happens. Eyes may be perfectly designed to see 20/20, but fully 30% of Americans are nearsighted. That’s why we have glasses and contacts. They are not ideal when compared to naturally occurring 20/20 vision, but they are close enough that it really doesn’t matter.

Similarly, in real life, breasts may be perfectly designed to provide adequate breastmilk, but 5% or more of women don’t make adequate milk. That’s why we have formula. Though formula is not ideal when compared to natural occurring exclusive breastfeeding, it is close enough that IT REALLY DOESN’T MATTER!

I realize that the income of lactation consultants depends on pretending that breastfeeding is vitally important, but it isn’t. Lactation consultants appear to have become every bit as unscrupulous as the formula companies they claim to despise. They promote their product far beyond what any scientific evidence shows, without regard for the impact of that advice on either babies or mothers.

Let’s add in another baseline reality:

BEING A NEW MOTHER IS HARD!

It is a tremendous physical and emotional adjustment, compounded by hormonal changes that can lead to the “baby blues” or true depression.

If we want to SUPPORT new mothers, and we claim that we do, we should be supporting their physical recovery and emotional adjustment. That means ensuring that they get enough sleep to fully heal, enough support with ALL aspects of mothering to feel competent, and enough reassurance that the most important each baby needs is maternal love, NOT breastmilk, and not a perfect mother.

Really supporting new mothers would ensure that they get enough sleep to function, that their babies are fed to satiety, and that they enjoy the time they spend interacting with their babies.

You will notice that breastfeeding is not among those vital needs. So will someone please explain to me how people and programs that claim to support new mothers, from lactation consultants to the Baby Friendly Hospital Initiative, IGNORE women’s most vital needs?

The reality is that they do, and they should be ashamed of themselves because they do.

The sad fact is that these people and programs are NOT supporting new mothers, they are supporting the breastfeeding industry, with its consultants, and equipment, and supplements and aids. And in their near religious devotion to the idea of breastfeeding, they are so cruel as to be barbaric.

All newborns must room in in order to support breastfeeding? How can a new mother get desperately needed sleep if she isn’t allowed to hand her baby off to professionals for a few hours? She can’t and that’s cruel.

Formula must be locked up in hospitals? How can a mother soothe a baby screaming from hunger before he or she learns to nurse effectively without formula? In many cases she can’t, and she becomes frantic with anxiety even before she leaves the hospital. That’s cruel.

Every woman must visited by a lactation consultant? Why? Did her right to control her own body come out with the placenta? It’s no one’s business whether a woman breastfeeds except her own. Anything else is profoundly antifeminist.

Every woman must exclusively feed breastmilk, and must engage in an endless cycle of feeding, supplementing with SNS and pumping? Are you people insane? It places the value of breastmilk above a woman’s emotional and physical health, and her ability to bond with her baby. That is barbaric!

There are so many people to blame for this barbarism, that’s it’s difficult to know where to begin. Obviously lactation consultants and lactivists organizations like the Baby Friendly Hospital Initiative (talk about an oxymoron!) bear the brunt of the blame. It’s business for them, and they put the health of their business ahead of the health of their patients, both babies and mothers.

But there’s plenty of blame to go around. Many physicians have elevated breastfeeding to the “holy grail” of mothering going far, far beyond what the scientific evidence shows. Many research scientists start their research papers with the conclusion that breastfeeding must be encouraged and that women should receive more breastfeeding support (in other words, more business for the lactivist industry) and simply ignore the actual findings that show that while breastfeeding has beneficial effects, in industrialized countries, those benefits are trivial. Public health officials have gotten far out in front of the scientific evidence, grossly exaggerating the benefits and importance of breastfeeding, and using weak, contradictory data riddled with confounding variables to do so.

Let’s finish with what I consider the most important baseline reality:

THE KEY TO A HEALTHY, HAPPY, THRIVING INFANT IS A PHYSICALLY AND EMOTIONALLY HEALTHY MOTHER. That means a mother who is getting enough rest, whose mental health needs are being addressed, and who is able to enjoy substantial amounts of time happily bonding with her child.

Breastmilk is NOT necessary, NOT necessarily best for every mother-infant dyad, and the effort to produce it is positively harmful in some situations.

Do we care about mothers and babies or do we just care about breastmilk?

I care about mothers and babies, and that’s why I’m not afraid to proclaim that telling a new mother that she must breastfeed and use a supplementary feeding system and then pump is cruel, barbaric and not justified by science … not matter how beneficial it is for the lactivism industry.

  • Mariana

    I did all of these things, use a sns with formula, pump and nurse every hour with my first child for 6 months. Then the minute she learned how to drink from a bottle, at 6mo I threw it all out and bottle fed her formula. What a waste of time all that was! Had I found this blog then I would have quit the fist month and had 5 other months to bond with and love my baby. With my second I vowed to stay away from all of this, he’d either drink breastmilk from the tap or not at all. Surprisingly it all worked out great and I never pumped once! He did get one bottle of formula each day, but I didn’t agonize over that and it meant I could sleep for 5 uninterrupted hours each night!

  • Green Fish

    Before the birth of my son I never thought much about breastfeeding. If it would work – fine, and if not, there’s formula. And then it didn’t work, partly due to me falling ill and needing surgery, and I suddenly felt, I was not ready to “give up” on breastfeeding yet.

    So I continued to breastfeed, we supplemented with formula (little rascal shouldn’t go hungry) and I also pumped. Did I get less sleep because of it? Oh, yes!
    But in the end I did what I wanted and I also got what I wanted. I could breastfeed exclusively after a while (a hard while).

    Yes, being a new mom is hard, and I certainly didn’t make it any easier for myself, but in the end, the decision to pump and to try was mine, and I think that’s the important thing: Nobody told me what to do. Everybody just supported my decision.

    And that’s what I would wish for every woman out there whether she breastfeeds or not: SUPPORT. Support of her decision.
    Support of your decision seems to be nearly as important as sleep maybe. And I did miss that sleep. A lot.

  • Amy Tuteur, MD
    • KeeperOfTheBooks

      That poor, poor woman. I wish I could reach through the screen and hug her.

    • Elizabeth A

      Oh god, that poor family. I’m glad she finally got help and embraced formula.

      Success and failure in having children are only worthwhile concepts if they’re based on outcomes. You succeed at feeding a baby properly when the baby is satisfied, healthy, and growing.

    • The Bofa, Being of the Sofa

      The only people who told me I was a success was my husband my mother
      and my new friends who were not crunchy. “You did it for 3 months! You
      did it! You succeeded, not failed!”

      YES! This is what I always think, too. We should celebrate what they have done, instead of focusing on what they didn’t do.

      And again, it is this inexplicable obsession with “exclusive” breast feeding forever. A drop of formula does NOT ruin a baby.

  • Still tired

    What I usually say to moms who are thinking about quitting is ‘There is more than one way to feed your baby and they are all perfectly fine ways’. For our clients, often not wanting or not being able to breastfeed creates an enormous amount of guilt. Especially someone who wanted to have a ‘natural birth’, ended up with a section and on top of that isn’t able to efficiently breastfeed. They tell me, ‘my body cannot do anything right’. They label themselves ‘failures’ and put themselves through so much in order to make that extra few ounces – out of town trips to the best LC, supplements, domperidone, testing, D&C for possibly retained tissue, pumping night and day, come up with insane ‘homemade formula’ recipes, watching their babies not thrive like they should…for those women, telling them that BF isn’t actually all that important is akin to questioning a dogmatic belief. They will label the provider as ‘unsupportive’ or outright evil and will continue to struggle. It gets frustrating.

    • KeeperOfTheBooks

      Yep. This. Ten times over.
      When a nurse at the hospital finally suggested and then insisted on formula supplementation, I initially fought it tooth and nail because “she’s just trying to make me give up!”
      None of the other nurses had suggested formula, and all of them had insisted that my production of minute amounts of milk and my daughter’s nonstop screaming and her persistent weight loss were normal. Why? ‘Cause breast is best, don’tcha know. So when this nurse pushed supplementation, I decided that she didn’t want me to succeed, she didn’t know what my baby needed, etc.
      BS. In retrospect, I know exactly why she pushed it when others didn’t. She was Indian and hadn’t been in the US for very long. Since she was Indian, I assume that she had almost certainly seen babies die from poor nutrition; at the very least, she would have known of women whose babies had died for that reason. As a result, her priorities were much more in order and she didn’t have the first-world privilege idea that everything must be 100% in keeping with a certain totally arbitrary standard. To her–as it bloody well ought to be to any healthcare provider–the important things were a) the baby was hungry so b) the baby needs appropriate food, and since mom obviously wasn’t producing nearly enough milk, we need to get baby on formula. Duh. I resented her hugely at the time, but now I wish I had had her as a nurse earlier in the process.

      • Belle

        I’ve been working in Obstetrics for quite a few years, and I’ve experienced this reaction from patients too.. sigh… it’s very frustrating indeed…

        • fiftyfifty1

          It is frustrating. At the same time it makes so much sense. They’ve been warned by lactivists ahead of time that EVERYONE EVERYWHERE will try to sabotage them, especially in the hospital.

          • Young CC Prof

            I had a conversation on Facebook the other day in which someone actually literally accused me of sabotaging nursing relationships when I claimed that it was concerning for a 5-6 month old baby to still be feeding every hour or two around the clock.

            I should have called her on it much harder than I did. The lactivists continue to occupy a moral high ground by presenting nursing as a radical choice, when in fact it is not only an upper-class choice but a prime means of oppression and class warfare.

          • Belle

            Very true.. and it’s the same with the super-crunchy home-birth-gone-wrong folks who come to the hospital with complications.. they are openly hostile to us… so brainwashed.. one of my colleagues said one told her she was “shocked at how nice we were to her”! Go figure…

      • Leslie

        I had GD, so they tested my baby’s glucose levels repeatedly after he was born. At one point, the nurses came to me and said that his glucose levels were too low and dropping, and that without formula my baby might suffer brain damage. Very hesitantly, the nurses asked if I’d agree to let them supplement with formula, even though i’d said I wanted to breastfeed.

        I looked at the nurses like they were insane. Give the baby formula to prevent potentially permanent brain damage? For the love of heaven, YES! Do it now! Why are you standing around hesitantly asking me??

        The relief on the nurses’ faces was unbelievable — they’d seriously been worried that my husband and I would elevate breastfeeding over avoiding brain damage. It was only later, in chatting with the charge nurse, that I was aghast to learn that some similarly situated new mothers do just that and refuse the supplementation.

        • Young CC Prof

          When my son was born, I knew he was at risk of neonatal issues, so I immediately made it clear that, although I wanted to breastfeed, I also wanted him supplemented as necessary.

          Somehow this translated into discharging us without telling me about his excessive weight loss, because obviously my psychic mom powers would just know when it was time to supplement. Yay completely preventable overnight NICU stay.

          • theadequatemother

            When my second and I were discharged his bili was moderately high and the RN giving us the discharge instructions launched into some long winded plan about bf and having him weighed and checked and rechecked as per the paediatrician. And I stopped he. And said, “don’t worry. Im just going to offer him formula until my milk comes in” and then there was a big sigh of relief. See they aren’t allowed to suggest formula because the hospital is trying to become baby friendly. Because making a new mom with a toddler schlep her newborn and toddler around for weights and testing and whatnot is way better than a couple of bottles of formula…even though early supplementation seems to improve bf.

          • S

            Wish i’d done that. =( We were lucky that grandma was already visiting the day mine was readmitted, but it was confusing for the toddler — baby comes home, baby goes away again; is mom going away too?

            I had asked the LC about supplementing because of a vague concern about hydration, and without taking my history (breastmilk jaundice in the first child, good supply, commitment to breastfeeding), and without looking at my son (who i didn’t realize was jaundiced), she told me his output was fine, supply/demand etc. You can be sure i’ve been kicking myself for the last two months for listening to her. (And yes, i complained to the hospital as well as my OB practice… baby friendly my ass.)

        • S

          Wow.

  • emmom

    I didn’t sleep for more than one and a half hours at a time for the first two months of my daughter’s life. My husband got little more sleep himself. This cycle of nurse, supplement, pump was brutal. No one suggested just formula feeding. My self esteem fluctuated with the ounces I pumped. I am glad that breastfeeding eventually worked for me but only because it became a convenient way to feed my daughter. And cheap. I totally support the moms who gave up breastfeeding in order to actually enjoy parenting.

    • KeeperOfTheBooks

      Yes. I think I will probably try to nurse the next baby because a) it would be nice to not fuss around with bottles and b) I am a cheapskate and would rather not buy formula if I don’t have to. However, if it doesn’t work smoothly for both of us, I will not go to extremes. Absolutely no pumping or SNS ever. again. I want to remember my next baby’s first month as a tiring but wonderful time, not as a tear-filled, painful, exhausting time.

  • anon

    Thank you for this, Dr. Amy.

    When my twins were released from the NICU two weeks post-partum I was pumping every two hours and was basically producing nothing. It would take me two to three days to get enough for a single feed. I never heard anyone saying to just give it up and that everything would be fine. Instead I was sent home with instructions to nurse, then bottle feed and then pump. Lactation consultants and my pediatrician told me that even the tiniest bit of breast milk my babies got was worth it as it was “liquid gold”. Despite the enormous pressure, I ended up quitting after only 10 days at home – I just couldn’t keep it up. I was spending every moment of the day trying to keep up with feedings – by the time I finished pumping and washed everything it was time to feed again.

    I was both relieved and devastated when I gave up – and I’m certain that this experience triggered a year long bout with fairly severe depression. Thank goodness my girls were very healthy and did not even get as much as a sniffle until they were over a year old. If they had been sick I would have blamed myself and my “defective” body and who knows what would have happened as I was already borderline suicidal. Oh, just thinking back about this time makes my heart break a little – even almost seven years later.

    Luckily, I finally came to my senses as I watched my formula fed babies grow strong, healthy, robust and smart. They are now almost seven years old and I barely think about breastfeeding vs formula feeding anymore. I do sometimes want to point out to all the people who told me how important breastfeeding is and that I just didn’t try hard enough and that the supply issues were only in my head and that if I just had talked to one more lactation consultant it would have worked out and didn’t I read that article that showed a big point IQ difference in formula fed kids vs breastfeed kids to look at my awesome, smart, strong kids and tell me that formula hurt them one little bit.

  • carovee

    But its just so much easier to push breastfeeding than actual tackle the structural problems that prevent women from getting the real support that they need like maternity leave and adequate health care.

    • Cobalt

      Bingo. It’s like the 39 week rule. Now they can say they’re doing something, even if it accomplishes nothing.

      • Anka

        What’s the 39 week rule?

        • Cobalt

          It’s a rule pushed by March of Dimes to decrease the prematurity rate by banning elective deliveries before 39 weeks. It’s the only cause of prematurity they’ve been able to really impact. A major problem with it is defining ‘elective’. Now getting any early delivery short of an immediate life threatening emergency is difficult at most hospitals, so babies who would have been delivered earlier are being stillborn.

          All so they can point at a declining prematurity rate. They leave off the bit about the increased death rate. Dr. Amy has a few posts about it in the archives.

          • Anka

            Thank you! That’s horrifying. Now I remember reading about it in the archives while pregnant, but I had untreated-and-not-for-lack-of-trying perinatal anxiety/depression and blocked it out.

  • Alexandra

    Amen! Excellent article, I couldn’t agree more.

  • moto_librarian

    I’ve been feeling rather reflective the last couple of weeks because my oldest child is about to turn five years old. He is very curious about what he was like when he was a baby, so I’ve been thinking about it as I tell him stories. My greatest regret about his newborn period was not going solely to formula feeding after it became clear that my milk was never going to come in. I was in that living hell of pumping, putting a screaming baby to breast, and finally supplementing. The amount of time spent washing pump parts and bottles, the feeling of dread that I felt when I knew our son was going to be ready to eat again – I feel awful just thinking about it. I spent time when I should have been snuggling my newborn stressing about how I was feeding him, and sobbing my eyes out from exhaustion and frustration. The only consolation is that I was able to learn enough from that experience to be able to let the idea of exclusive breast feeding go when I encountered the same problems when his baby brother was born two years ago.

    I look at my son’s friends and realize that I don’t have a clue about how they were born or how they were fed. It is utterly inconsequential to who these bright little kids are today. That is what we should be focusing on.

    • carovee

      Thank you moto_librarian. I could have written that post myself. I wish I could get in a time machine, hand my younger self a bottle and tell me its not a big deal. Relax, feed your baby, enjoy your time together.

      • KarenJJ

        Same. Second time around was much easier.

  • Elaine

    The idea of pumping to “boost supply” when there isn’t any supply to begin with doesn’t make a ton of sense. I question whether a mom whose baby is getting 75-100% formula because she’s producing drops will ever make it to EBF or even close to EBF. If she was going to produce a full supply, she already would be producing something decent, right? There never seems to be a story of doing this feed/pump/SNS cycle that actually ends with “I was able to exclusively breastfeed”. I do hear some stories where the pumping was because baby wouldn’t latch and they eventually got baby to latch and then were able to EBF, but in those cases mom had an okay supply already.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      This is a major point. Women do not all have the same number of milk-producing cells [indeed, large-breasted women tend to have more fat cells than milk-producing ones, so size is no indicator]. Any given cell can be stimulated only so much, no matter what a woman does. In olden times, women who did not produce much milk either watched their babies become malnourished and die, or found someone else who could nurse the baby for her. There never was a “golden age” where every woman who’d given birth magically produced gallons of milk. A LOT of babies died before their first birthday, and some of those died of starvation.

      • Rita Rippetoe

        There is a reason that old herbals are full of listing for herbs to increase milk supply. If it hadn’t been a problem there would not have been a need for a remedy. In some cases, of course, the real problem was that the woman or even the whole village was undernourished, and all the herbs in the world won’t coax milk from a starving woman.

        • Anj Fabian

          The Native Americans had many herbs that they used for snakebite remedies. I don’t know that any of them are effective at all, but I see it as an indicator of how common and serious snake bites were.

    • Young CC Prof

      Definitely. Pumping to build supply makes sense if the baby physically can’t nurse right away, either because he can’t latch or must be separated from his mother for medical care. But if the baby is more than a week old, you’ve been consistently stimulating, and there’s still hardly any milk, it’s not likely you’re going to get lakes of it just by pumping more.

    • gms

      I am that person. For reference, I had a semi-elective C-section. (I wanted one from day one, and my dr was open to it, but health issues unrelated to the pregnancy probably would have forced the issue anyway.) I think natural childbirth is as silly as an unmedicated root canal. I was committed to nursing, however.

      Here’s what happened. Post Cesarean, I stayed for the allotted four days, nursing the entire time. I had extremely sore nipples, never felt my milk “come in” (nor have I ever felt any let down at any time thereafter), noticed that he would have happily suckled pretty much 24-7 (which I was warned not to allow), but at no time did I feel that I had any issues, nor did it seem like my son did. As we were waiting to be discharged, he suddenly appeared jaundiced. I was discharged, he was not, but they let me stay in my room as a “mother in residence” and breastfeed, although he was under the lights at all non-feeding times (and feeding time was pretty limited) for about 36 hours. We went home with him about 10% below birth weight, which I understood to be normal.

      Due to the jaundice, we had quite frequent ped visits/bilirubin tests over the next week. Pretty quickly, the ped decided he wasn’t gaining fast enough and his poop wasn’t changing to the yellow seedy stuff fast enough. She said until he regained his birth weight, he had to nurse every two hours (measured from start of one feed to start of the next), sleeping or not, with one three hour stretch permitted for my sleep/health. We were in a vicious cycle: to lower bilirubin, babies must excrete. Until the bilirubin is lower, they remain sleepy. When they are sleepy, they don’t eat. When they don’t eat, they don’t poop (as much). When they don’t eat, mother’s supply doesn’t increase.

      So, I tried everything to get him to wake up and eat. Tickling toes, cold washcloths, the works. NOTHING WORKED. He’d fall asleep right after opening his eyes. Soon, my ped said that if I wanted to continue nursing (and she suggested formula/supplementing almost right away), I had to pump with every feeding and offer whatever I pumped via bottle after nursing. (Never tried or was offered SNS, even though I stayed in contact with the hospital LCs.) This was still only about day 6 or 7. This is when things got bad. I was a little paranoid about the pump part washing and didn’t have that many sets yet. I didn’t know about stashing them in the fridge, etc. I’m a single mom, and I had lots of help from family, but pumping was time consuming and stressful, I barely pumped anything, and washing parts/putting them together was terrible. And it wasn’t really enough milk to make a difference. The dr insisted I start supplementing. I did what I was told at all times, but I was still determined to exclusively breastfeed eventually. So now, I was, at minute 1, nursing, giving a bottle of whatever breastmilk I had, giving 2 oz of formula in another bottle, pumping. By the time I was done, it was basically time to start again. The only sleep I got was when my mom and/or ped insisted that I skip one cycle a day and just give the formula or have someone else do it.

      On day nine, I had a very no-nonsense LC come to the house. She was NOTHING like the ones who insist you should never supplement, etc. It’s hard to remember all the details since I was so exhausted, and I can’t remember if she thought I would ever exclusively breastfeed. My ped basically just thought I should nurse as much as a could and supp the rest, indefinitely.

      I kept the cycle going. In addition to exhaustion, I was concerned that my supply would never be enough, and/or that I would never know if it was. At this point, I have no idea how I would even know if my supply was enough — I certainly didn’t want to test it out by taking away the formula and finding out by making him suffer. Still, over the next several days, I could tell my supply was improving by how much I was pumping and by him being less interested in the bottle (although it was generally NOT the situation that he would devour the bottle ravenously due to being starved by the breast.)

      So, at this point, I tried to get advice from dr, hospital LCs, home LC … when can I stop? Eventually I realized that at this age, and given how often he had been weighed, it would be pretty easy to tell just by his weight. I started giving less and less formula and then one day gave none to no ill effect and tried to have him weighed at the dr’s office. We weren’t due back for a few days and they refused to weigh him without a dr’s appointment (which still burns me up!). The hospital LCs agreed to weigh him. I knew what the target weight should be (I think he was still at the point where he was supposed to gain about 2 oz a day.) When they weighed him, he was over his birth weight, which was actually above the target. I was super excited. I continued to nurse every two hours (and pumped quite often, both to keep supply up and to build up a stash for when I went back to work), but did not supplement with formula or breastmilk. At his two week dr appoint, he was right on target and over birth weight. Dr gave go ahead not to wake him to eat anymore, and he promptly slept nine hours straight, totally freaking me out. I actually called to make sure going THAT long was OK, and she said it was fine. And it was. From that point on, we exclusively breastfed on demand (well, he had pumped milk when my parents babysat, but no bottles when I was with him), and he slept through the night until he was about 4.5 months old when I stopped swaddling him (because the day care wouldn’t swaddle and don’t get me started on that).

      To make a long story longer, he went into full time day care at 5.5 months, and I was able to produce enough milk to keep him fed at day care. It was hard at first, but by the time he was in toddler 1s (where they stop giving pumped milk) I had so much frozen that I ended up having to toss tons as it hit a year in the freezer (as I couldn’t possibly go through it all without them giving it to him, and I kept pumping at work so as to avoid losing my milk). I *did* worry about and take steps to avoid him self-weaning when he transitioned at school, but at the end, it wasn’t a real issue. I also only stopped pumping at work very gradually, and when I finally stopped altogether, it also wasn’t an issue. By the time he hit 2, I was willing to let him self-wean, but he wasn’t. He’s now 3.5 and we are down to wake-up and sleep time and sometimes skip one of those, but he generally objects. It makes me sad, but I will wean fully before he turns 4. I never intended to nurse this long, but did hope he would wean himself. In all this time of nursing, my breasts have *never* felt full. When I would be away from him without pumping, they never hurt. I never once leaked. I never once felt a let down. And I never was got a copious amount of milk from pumping. About four ounces (total) per feeding from a fancy pump was my standard. I had to pump 4x a day at work (luckily had private office).

      Anyway, the comments section is an obscure place to type this long story, but actually, I thought that was a good point that you made in that you never really do hear my story — the one where there seems to be no supply and you are going crazy but keep with it and are ultimately successful. And, I had no idea if it was possible, as I apparently had the one LC in the world that doesn’t just spread fairydust and tell you anyone can nurse. If anything, I felt a lack of support for figuring out when I could just go back to nursing, and am still mad that I felt like the only option to do was to experiment with the baby. (Of course, if he had had any change in demeanor/wakefulness, I would have gone back to supplementing immediately.)

      One HUGE difference between my story and a lot of the ones I see is that my exhaustion crisis/supply issue was resolved in two weeks. I never had mastitis. I didn’t have another child to care for. I didn’t have any post Cesarean complications. I would never tell another mother that she should/could do what I did. And I don’t know how much longer I could have kept it going if it hadn’t resolved itself. But in any event, it can be done.

      • Young CC Prof

        I’m glad it worked out for you. But yes, it sounds like your milk just took a few days longer than average to arrive, and by a week after birth, you were producing meaningful amounts with the pump. There’s nothing inherently wrong with nursing and pumping for a very short period of time.

        However, nurse-pump-feed forever, when you’re only pumping a trickle, THAT’s not a good plan. In fact, it’s impossible.

        • emmom

          I did have just a trickle. 0.25oz was a great pumping. And my nipples felt like they had been dipped in battery acid. I would nurse for 15-20 minutes on each side, then hand a hungry baby to my husband for formula while I pumped for 30 minutes. There was about1.5 hours before I had to start the process over. I used the time to change diapers and clean pump parts. We were the walking dead. No one ever said it was ok to give up.

          • Young CC Prof

            They should have. They also should have suggested supplemental formula BEFORE your baby got too sleepy to nurse effectively, since that might have headed the whole thing off.

    • emmom

      I am that person too. It worked, but I was a sleepless bundle of nerves and self-hatred for nearly three months. It would not have worked without my selfless husband and his six weeks of paternity leave.

  • Sarah

    OT but there’s an excellent short correspondence out called Caesarian section- truth and consequences (Dickinson, J) which the readers of this blog may be interested in.

    • Alannah

      I googled that and found nothing. Maybe post a link?

      • Sarah

        Ah okay it’s just out in the latest ANZJOG journal I’ll try to post a link. You might need access as well :(

  • namaste863

    There’s always the option of saying “Do I look like a motherfucking dairy cow?!!!”

  • D/

    As a lactation consultant, I regularly listen to breastfeeding stories like those posted here. It is among the most unpleasant things that I have to do and can nearly bring me to tears (and those shared here are no exception).

    I hate the fact that so many families are left feeling tortured in the care of lactation consultants (at times even to the point of being uncomfortable with sharing the fact that I am one). I take every story that I hear to heart though and intentionally use the lessons of those terrible experiences to provide better support to the families I work with.

    So to those whose stories I have “heard” here … Thank you for sharing your experience and for helping me be a better lactation consultant in the process.

    • Amy

      An LC was the first person to give my baby formula. She could she we were both in trouble, baby physically, and me mentally. I was so relieved to hear something other than “just keep nursing.”

    • Still tired

      I’m a midwife and I can relate to what you are saying. I have seen many of my colleagues push BF onto clients or lose interest in supporting them as soon as women make a choice to formula feed. I hate this. It’s non-inclusive, it’s demeaning, it’s cult-like. It undermines the fundamentally ethical principle of informed choice. It gives my profession a bad name.

      • The Bofa, Being of the Sofa

        It’s non-inclusive

        Yep. “Come to mom’s group. Oh, you are giving formula? No, sorry this is for breastfeeding moms only.”

        • KarenJJ

          One story from an internet mums group I was a part of had one mum whose milk never came in (her mum was the same). At two weeks old her formula fed baby was badly constipated. They took their distressed infant to their local regional hospital who waved them through to the maternity ward and the midwives, who then asked if they were breastfeeding and when told ‘no’, waved them back to the ER where they waited with their screaming infant for an hour before someone could come an assist. The mum was besides herself and so angry at their treatment.

          It might have been, in retrospect, that the midwives couldn’t have done anything even if the baby was breastfed, but to be asked that question and then turned away with a tired mum and distressed infant is heartless.

  • Smoochagator

    Reading this post and the many comments from mothers (here and elsewhere) who suffered through extreme pumping/feeding schedules with minimal success (or great success at the expense of their sanity) makes me very glad that I just went ahead and started formula feeding as soon as breastfeeding/pumping got to be difficult and frustrating. Over and over again I have wondered if I’d have been able to make more milk if I’d just pumped more often or tried more supplements (or off-label meds, yikes) and I occasionally feel like a bad mom for not going to the great lengths that other mothers have. But then I remember how freeing it was to finally be able to feed my babies until they were physically satisfied and not have to constantly fret about when I had last pumped or attempted to nurse. I was happy and my children were happy and it was awesome. And from now on every time I think about regretting my decision I’m going to remember how awesome that felt and be glad that I didn’t torture myself (or my kids!) any longer.

  • deafgimp

    Interesting, there’s an AMA (ask me anything) on Reddit with a homebirth midwife right now http://www.reddit.com/r/IAmA/comments/2edvob/im_a_homebirth_midwife_ask_me_anything/

    • Sue

      Here’s a gem from that thread:

      “As a doula, I rarely go against midwives, but it will let the client know if a doctor is bullshitting.”

      Sigh.

    • Sarah

      At least she seems less woo-y than most! She’s actually done three years training too and she’s not happy with people who go out there with no training to catch babies which is reassuring.

      • Guesteleh

        She’s in Florida, which seems to have more stringent regulations than most states. Surprised the hell out of me, tbh.

    • Guest

      She seems to be a CNM.

    • D/

      This actually made me LoL …

      “The only part of nrp I can’t preform is a tracheotomy. I carry an o2 tank (2 actually 1 for mom and 1 for baby) as well as ppv and delees.”

      She is at least a conscientious *Basic* NRP provider armed with O2, bag/mask and delee (but probably not a pulse oximeter), but evidently wasn’t even curious enough to notice the (optional) *Advanced* chapters in the same book that address endotracheal intubation, umbilical line placement, administration of resuscitation medications and special neonatal conditions yet somehow recognized she can’t do a *tracheotomy*!

  • MLE

    Speaking of pumping, has anyone had luck with those hands-free pumping bras, or do you know of a good DIY equivalent? Looking for alternatives to the time suck (ha) that is holding up a pump.

    • Dinolindor

      Yes, definitely worth it. I’ve heard you can cut holes in a sports bra to get an equivalent, but I haven’t tried it. Back when I was exclusively pumping, I figured out how to set up the hands-free bra with the double pump going while holding my son to feed him a pumped bottle from earlier. And watch Netflix.

      • MLE

        Ahh! Oh breastfeeding, so easy!

    • Young CC Prof

      I took a too-small sports bra (like pre-baby size!) and cut nipple holes in it, just big enough for the back of the flanges. Worked fine. Left my hands mostly free, though I still needed to rub to get more milk out.

      Kinda looked like a fembot gun bra, actually.

      • MLE

        Awesome! I’m doing this, thank you!

      • Mom of 2

        That is genius!

      • LovleAnjel

        I did that, too. Before pumping I would walk up to my husband and “shoot” him with my fembot nipple guns.

    • Bombshellrisa

      Old navy maternity tanks and tops have this great panel that you can tuck your flanges into. Worked great for me

    • Life Tip

      I used a sports bra. But I have a pretty tiny chest. I could use a sports bra and a nursing cover to pump hands-free in the car while I drove to/from work. Saved me time bc I wasn’t really able to pump at work.

    • Mom of 2

      Yes! It worked great for me. I worked as a nurse and would heat up my lunch then get all set up in the pumping room and eat while pumping. The hands free bra was life changing. It never made a mess, either–holding the pump myself I always seemed to drip a little. I also taped the milk bags right to the flanges, to skip the step of transferring milk from bottles to bags.

      That was 4 years ago. Knowing what I know now, both from learning about the minimal benefits of breastfeeding, and with more experience as a mom, it seems insane that I went to that much trouble.

    • Guestll
    • Hannah

      The Simple Wishes/Lansinoh one is pretty good. It creates some compression pressure so you don’t have to massage so much. I’ve tried ‘em all and this is the best one so far.

      The homemade hacks didn’t work for me.

  • Guesteleh

    https://www.facebook.com/FearlessFormulaFeeder/posts/942579292425218

    I am going to share my recent brief experience with the lactation consultant who works for my pediatrician. The LC is active and admired in my city. When I went to see her for the second time, with bleeding nipples and one areola rubbed raw from my breast pump, she performed a yield and my son transferred a minute amount of milk. As I cried, she asked my what my goal was: obviously to exclusively breastfeed – why else was I suffering so much? I told her as much, but added that I also did not have the physical and emotional energy to devote all of my time to making milk, as I did for 4 months with my daughter before switching completely to formula. I told her that I have to think of my daughter as well and that I want to be a happy mom, instead of the sleepless, depressed mother I was for 6 months after her birth. I told her that my 5 year old daughter is extremely healthy, smart, and all-around amazing.

    She looked at me and said, “But imagine how much more amazing she would be if she had been breastfed.”

    • MLE

      I cried a couple tears of rage when I read this.

    • Cobalt

      That is so profoundly wrong. I’m sorry you were exposed to that idiot.

      • Guesteleh

        It wasn’t me! Someone wrote the Fearless Formula Feeder and she posted it to Facebook. I just couldn’t get over the assholery of insulting a client’s 4 y.o. kid.

        • Cobalt

          Well, whoever it was, that LC doesn’t deserve to work with babies. A child’s value has no relationship to their source of calories, and a mother’s job is to provide nutritious food NOT haul around bloody breasts.

        • MaineJen

          It just shows how deep into the woo some of them fall. They can’t even hear themselves any more. When someone tells you they were severely depressed and non-functional, and all you can say is that they should have tried harder…yeesh. Brainwashing.

  • fiftyfifty1

    My theory is that lactation consultants who set up impossible pumping and feeding schedules for moms with low supply do it for 1 of 3 reasons:

    1) They believe that mom truly has some biologic problem causing low supply and they truly believe that the crazy round-the-clock pumping schedule can help them overcome it. It’s just that they have never stopped to think how damaging such a schedule can be.

    2) They believe that mom truly has some biologic problem causing low supply and they truly believe that the crazy round-the-clock pumping schedule can help them overcome it. And they realize how damaging such a schedule can be, but they don’t care because they believe breastmilk is worth more than the mother herself.

    3. They don’t believe the mother for a minute when she says she has low supply despite putting the baby to the breast frequently. They secretly believe that the mother must be feeding the baby much less often than she claims. So they prescribe an impossibly frequent schedule of pumping and feeding never believing the mother will ever really do it, but hoping that it will “inspire” the mother to at least feed more often than they assume she does.

    • MLE

      Exactly. 2&3 being the most common in my experience.

    • Young CC Prof

      That or just some sort of “try-everything” theory. Most women, choosing with clear minds, do NOT want to go to such extremes to breastfeed, but the more ideological LCs do not admit that too difficult is a thing. “See, I’m doing you a favor. This way, if you wind up quitting, at least you know you really tried everything! If I tell you to give up now, you’ll regret it forever!”

    • D/

      I admit I do include “triplet” feeding plans- nursing, supplementing and pumping- in the discussion of potential *options* for dealing with some problems … in particular, with production issues related to inadequate/ ineffective breast stimulation or babies with milk transfer issues related to calorie deprivation. This should to be a *very* temporary plan (days, not weeks) with a defined goal and end-point in mind from the beginning and needs intentional re-evaluation every day as to whether it is remotely manageable or helpful.

      If it’s going to work, it works. And if not, it’s time to consider other options. Recommending a continuation of barely survivable efforts that are producing little to no positive results (or in many cases, negative results) is not just a poor plan of care … it’s a version of torture as far as I’m concerned.

      • lawyerjane

        I hope that you also take into account the particular mother before you make the triplet plan recommendation. A mother who is already struggling with extreme sleep deprivation, post-partum anxiety and depression, maybe a very difficult birth recovery, or no help at home, should maybe not even be offered the “triplet plan.” Maybe there should be some best practices that the “triplet plan” is only recommended where a mother has a plan in place to get additional rest and does not show signs of (or preexisting vulnerability to) PPD. At the very least, the mother should be fully informed that supplementing with formula can be a healthy choice and does not mean the end of breastfeeding.

        • D/

          Definitely! I jealously guard sleep, and any LC that isn’t recognizing what a huge piece of the assessment physical exhaustion is should quit as far as I’m concerned. I had a mother this week, in fact, that laughed about me being her sleep consultant too.

          I have to admit that didn’t learn this as an LC though. My “expertise” in hospital-acquired sleep deprivation was actually developed during my mother’s last hospitalization. She became so completely disoriented within 5-6 days that she did not even recognize her sister whom she saw regularly and spoke to almost daily. Her nurse started to educate me on little old people and sun-downers syndrome to which my response was “WTH are you even talking about?! My mother is not some dementia patient out of her nursing home routine. She was mentally fine when we started this 5 days ago!”

          I took a leave of absence that day, stayed with her 24 hours a day for what ended up being the last 22 days of her life. I announced at a care conference that she would be managed like a preemie … Hands on time/ Hands off time. She was to be left undisturbed for a minimum of 6 consecutive hours after the bedtime assessments/ meds were completed, and I policed her care like the bitch I am.

          The first night that I stayed with her I counted 6 different people attempting to come in for “something” in the first 1 1/2 hours that she slept. I moved my cot in front of her bed when the 3rd one got to her before I realized she was in the room (definite disadvantage of being hard of hearing). Within 3 nights of connected sleep my mother was back and was mentally as sharp as she ever was until she was literally dying. In fact, less than 48 hours before she died, she recognized an estranged brother whom she hadn’t seen in probably 25 years the instant he stepped through the door.

          As an LC I’m in the room with folks long enough to recognize how crazy all the interruptions during a hospital stay are. We completely sabotage the opportunity for mothers to rest up in those first few days by waking them up all day and all night until they leave. At our hospital we’ve actually made a do not disturb policy on the postpartum unit. When families are ready to nap, tell your nurses to come do whatever they need to you *now*, hang the do not disturb sign on the door and make us leave you alone! … and I police that plan like the bitch I am too ;)

          • D/

            Oh and by the way, I also think that any LC who doesn’t recognize when formula needs to be in the mix whatever the reason (and implement it) needs to quit too!

          • KeeperOfTheBooks

            I so wish you were my LC. My nurses at the hospital where I had my DD were awesome (the LCs…less so…), but they and the support staff kept. coming. in. the. room. My temp. Baby’s temp. Check my bleeding. Check my IV. Wake me up at 5 AM to take out my catheter (what the…this couldn’t wait another two hours WHY?!). Patient satisfaction survey. Housekeeping. My doc. Baby’s doc. I kept trying to nap while lying down/football holding on pillows because I kept being told to get some sleep, but then twenty minutes later someone else would come in to check on us/take out the trash/whatever. I know that a lot of that stuff was important, but…dang, couldn’t some of it (like my and baby’s temps) be consolidated into a visit or two?

          • D/

            I hear you. My mother told me after she was coherent again that her vital signs were every 4 hours, but they did her O2 sats about and hour after everything else plus a tech had (apologetically) woken her up the first three nights at 3:00 am for her bath because “The day shift gets mad if all they aren’t done before they get here.”

            WTH! I’m surprised anyone actually gets well if they are in a hospital for very long!

          • Young CC Prof

            Some nurses think if they open up the door, see you’re asleep, then close the door again, that this is somehow OK. Nope, you’ve just cost the patient an hour of sleep at least.

          • me

            I always pleaded for early release for time served ;) With my first I thought it might be nice to stay in the hospital for the whole 48 hours. Silly me. When my doc visited me the morning after she was born I asked him “How soon can I get out of here?” I was out by early evening. With my second and third children I knew to ask for early release as soon as baby was born (and doing well). I was out within 36 hours of their deliveries.

            Sucks that going home to a 5 year old and a 2 year old is more restful than staying at a fully-staffed hospital. I know they have to do what they have to do, but geez, if my newborn will give me 4 uninterrupted hours, why can’t the 35 year old nurse? And of course most of the time they’d succeed in waking baby too, so it’s not like you can go right back to sleep….

          • fiftyfifty1

            Yep, hospitals need to do a better job of grouping needed tasks. My own example was when I was postpartum after my c-section. I needed vitals more often than usual due to that. Because I was also GBS positive, my baby also needed more frequent vitals. In addition, hospital policy was that a s/p c-section mom needed to ambulate by a set certain hours after the CS. They refused to group my vitals with the baby’s because a different nurse was in charge of that. So I asked them to bring the baby to the nursery so I wouldn’t be disturbed every time they checked the baby in addition to every time they checked me. They said that I could chose to have my baby in the nursery, but if I did their policy was to wake baby every 3 hours and bring it to mother for nursing. If I wanted to feed baby only on demand rather than on this schedule, then baby had to room in with me. And then the nurse announced she would be coming in at 3am to ambulate me. What a mess!

          • D/

            The up vote is only for your first and last sentences, btw.

    • KarenJJ

      For lactation consultants I suspect it’s more 3, because they just don’t seem to listen to concerns about a mother’s mental health and meeting her own needs and seem to think that giving impossible goals mean the mother will work harder at it no matter whether they reach the “goal” or not.

      For volunteer breastfeeding consultants I suspect it is around 1, because the advice I got from the breastfeeding association here was only good in theory (ie express for ten minutes before feeding baby and then top up baby after a feed with this expressed milk) because I wasn’t going to hold my baby off from a feed and express for ten minutes while she got increasingly distressed while I just sat there hands tied to the stupid breastpump.

      For the nutters that blog about AP on the internet it’s 2.

    • Alannah

      I was put on the infamous schedule while still in hospital, so it was plain for everyone to see I was following it exactly as prescribed.

      I`m afraid it was 2: they ddn`t give a rat`s ass whether I sank or swam as long as they could count me towards their `EBF at discharge` statistic. Thanks BFHI!

  • SisterMorphine

    One of DH’s sisters (they are Quiverfull) was actually encouraged to keep pumping WHILE she was in a psych ward for Postpartum Psychosis. Her hallucinations were so bad (ad terrifying) that she had to be heavily sedated while the antipsychotic meds took effect, yet the LC (she was in the same Baby Friendly Hospital where she gave birth) actuaLly came over to the war to wake her up and encourage her to pump so her milk wouldn’t “dry up.” Finally her dr. got wind of it & told the LC that w.the meds my SIL was on, she wouldn’t be able to breastfeed anyway…but that she even had to go through that–all I can say is that somebody in that BFH really dropped the ball.

    • guest

      That’s really disturbing. I am sorry to hear that that happened to her.

    • Guesteleh

      Who the hell is controlling access to the psych ward? That should never happen.

    • Alannah

      I work in ICU and we have to kick LC`s out on a regular basis because they want to come in and do this to new moms trying to recuperate from near-death experiences at birth. We tell the LC`s that they are not allowed to wake our patients between the hours of midnight and 6am and we always get a lot of lip. Usually we have to involve a doc to make them go away. It is outrageous.

      • Cobalt

        I can see offering a pump if engorgment is coming on, because that’s an additional pain that could be relieved. I would think that drugs in the milk might preclude feeding it, though, and if you’re in ICU you need the meds more than baby needs the milk.

        And really, not breastfeeding for the first days before the milk comes in wouldn’t stop a lot of breastfeeding relationships anyway. The milk is coming if it’s coming, no matter what you do beforehand. Moms who never put the baby to the breast still have milk come in.

        Let those women sleep!

        • Elaine

          Yeah, I don’t get that bit. Milk will come in. When I had my daughter, she was pretty sleepy and not all that interested in nursing frequently. The nurses kept flipping out about how she needed to nurse more often or she wouldn’t get enough milk and I would have supply problems. Neither of these were the case. She did nurse when she was hungry, and my milk came in with a vengeance (something I wasn’t prepared to deal with, btw, since you always hear about low supply but nothing about the opposite).

          • Allie

            Yeah, my daughter barely nursed at all the first few days. Thankfully, a wonderful nurse who was the voice of reason said “why don’t you give her some formula?” She brought it to us and it was like when you water a droopy plant and it instantly looks better. Her cheeks got rosy and she looked happier and livelier. We continued to supplement over the next few days until we both got the hang of breastfeeding and once she got started I couldn’t get her to stop! So the claims that supplementing will only lead to exclusive FF are poppycock. (I had an abundant supply, too, because she seemed to spit up far more than she ever drank, but she put on weight rapidly and thrived).

        • Medwife

          I know a woman whose baby died shortly after birth. The baby was never well enough to attempt latching, and there was only a little skin-to-skin time (one of the saddest things I’ve ever heard, the whole scenario). My point being she still had her milk come in in a big way 2 days later. Lactogenesis is a force to be reckoned with.

    • moto_librarian

      If I had been her psychiatrist, I would have kicked that LC’s ass out of the ward and reported her behavior to her supervisors. This is so fucking outrageous!

      • SisterMorphine

        Sorry for the bad grammar/spelling in my original post, I’m still getting used to a new keyboard. I think the psych ward *thought* the LC was there helping pump a barely conscious woman prevent breast engorgement, w/o realizing that the LC was giving it to hubby to cup-feed their newborn (4 in 5 years). The shrink was livid–I doubt the residue of Risperdal and Ativan is good for a baby, even in supposedl magic breastmilk. It may or may not surprise you to know that my SIL’s birth was a homebirth that ended in a transfer that barely saved mom & baby (son was over 1 lbs). In Quiverfull circles homebirth attended solely by dad & maybe a few female relatives/church members is often a badge of honor. SIL was depressed before, & while I’m not discounting a biological cause, I think the fact that she had to transfer and thus “failed” (her hubby was apparently pretty ticked) might’ve pushed her over the edge. There but for the Grace of God…another Yates tragedy. Of course, they’re planing more kids.

        • Guesteleh

          That’s horrifying. That poor woman.

        • moto_librarian

          Her husband needs to have his ass kicked.

    • KeeperOfTheBooks

      What. the. everloving. F***.

  • Guesteleh

    http://www.ivillage.ca/parenting/breastfeeding-contract-bc-hospital

    This article made me realize that I don’t think lactation consultants are doing any kind of health screening before they start offering women advice. Considering the prevalence of PCOS and other medical conditions that can impact milk production, it’s kind of amazing that none of the LCs I consulted asked me anything about my medical history. No use giving latching tips to someone who will never be able to produce enough milk. And they should also be taking a psych history as well. Someone suffering from PTSD shouldn’t feel pressured to breastfeed if it makes them feel triggered.

    • Medwife

      I totally agree. I recently had a postpartum woman come to me who had low supply. Her LC told her to ask me for domperidone. She had two significant disease processes going on that we were dealing with that each on their own could have caused her low milk supply. The LC would have known that had she done any kind of medical history screening.

      • The Bofa, Being of the Sofa

        These comments and the ones above raise a question that I wonder about. OK, maybe my experience is jaded, but the LCs I’ve seen are all nurses. Yet, when you hear these stories, you wonder, what kind of health care practitioners are these? You would think that a nurse would understand the importance of working from the framework of a medical history, right?

        And why is it when push comes to shove, you consult a doctor who sets the nurse straight? Shouldn’t doctors and nurses be collaborating? Why do doctors need to come and rescue patients from LCs? Shouldn’t the LCs be an extension of medical care?

        • Medwife

          I think part of the problem is actually the fault of the system. Once a woman is discharges from the hospital, we back way off. We are available but once they’re out of the hospital they are pretty much on their own unless they reach out to us in the office. The LCs make home visits during those vulnerable weeks after the baby is born.

          Feeling guilty about this.

        • D/

          In the hospital setting most LCs are experienced Maternal-Child nurses. It’s not at all the case though for private practice LCs, and unfortunately even in the hospital setting there is a developing willingness to hire non-RNs and even non-IBCLCs.

          My primary employer is a Level III NICU facility with (a pretense of) an out-patient lactation service. LCs are exclusively RN/IBCLCs but staffing has been cut almost every year for several years now to the point that we are now at 60% of the recommendation lactation staffing for a Level I nursery facility with our number of deliveries that is providing only in-patient lactation services. It is in no way unusual for an LC to be responsible for 20- 25 couplets during a 7- 8 shift many of whom have not been assisted even once in any meaningful way before finally being seen at 24 hours (or more) of age.

          After our most recent “restructuring” the LCs were instructed by the nursing director of Maternal-Child that chart reviews were *only* to include “weights, voids and stools” and there was to be no “chatting” with nurses about lactation assessments as the nurses didn’t have time for that and can review our (primarily checkbox) EMR note if they have questions. And finally there was a sincerely delivery suggestion to one LC that if the stress of this job wasn’t manageable, “Maybe you should work in a coffee shop or something … No seriously, I don’t mean that in a bad way. I know people who love working in coffee shops”.

          In the hospital’s defense it really just comes down to money though … I am a dinosaur. My salary has been topped out for years, and I earn the maximum in vacation time and other benefits. Frankly I am an enormous expense to a hospital needing to squeeze proverbial blood from its revenue turnip to provide a deficit-generating service that many consider on par with the photo studio and providing postpartum massages.

          I do the best I can which frankly most days is embarrassing. I certainly include more than weights, voids and stools in my assessments (which incidentally I still *report* to the nurses) and intentionally collaborate with the physicians. I have absolutely no trouble though imagining why LCs in many hospitals miss things and end up taking pretty crappy care of people. … especially the less experienced ones or non-RNs and even the good ones to be honest.

          • SisterMorphine

            TBH, I’ve never had an LC, nor do I know anyone who has had an LC, who was an experienced maternal-child nurse, or for that matter, a nurse at all. I admire you, D/, and the way you do your job under such stressful conditions. (In the same situation I know I’d either turn into a slacker “box checker” or…go work in a coffee shop.) But are you in a big city, or a very well-heeled hospital? When I had my only son in ’98 (not, thank heaven, in a BFH) I had heard horror stories of aggressive LCs–I think there was even a Law & Order episode about one–so I asked my dr. to make a note on my chart that I would not be breastfeeding at all, due to the meds I take for epilepsy. Either he forgot or the LC barged in anyway with the “breast is best” lecture. When I explained my circumstances and which meds I took, the young lady (she appeared to be about 23) said, “Couldn’t you get get your doctor to switch you to, um, Depakote?” Now, I’m no doctor or any kind of health professional, nor do I consider myself remotely “educated” on the topic of pharmacology, but do own a PDR so I can at least look up meds that I have to take. I told her that from what I *understood* (I could be wrong) Depakote was contraindicated for both pregnancy and breastfeeding. She apparently went and asked someone something, came back giggling and said, “Oh yeah, well, I’m not a doctor.” I asked if she was a nurse, and she said no, but she had three exclusively breastfed children. I assume she had some kind of other certification–at least I hope she did–but I didn’t have the heart to ask what. The only person I knew who had an LC who was also an RN was a college friend who hired one privately. (Just for kicks, I looked up my former LC–she’s had two more kids and now advertises her wet-nursing and frozen breastmilk services. Is wet-nursing even legal???)

          • D/

            Thanks for the compliment. I *really* try hard, and families are regularly complimentary toward me. Truthfully though recognizing the gap between what was actually needed and what I was eventually able to deliver just leaves me even more frustrated that anyone would be grateful for the crap-for-care that most days turn into … I’d be lying to say I don’t fantasize of becoming a slacking box checker at a coffee shop every_single_day- lol.

            It’s different everywhere though. I’m in a multi-county metropolitan area that is growing exponentially, and my primary employer is part of a national network of *very* well-financed hospitals. My particular county’s population has increased ~40% in the last ten years (with a corresponding increase in the number of deliveries). During that same time the comprehensive lactation program was reduced more than 30%, essentially wiping out a busy out-patient service that was utilized by both our own patients and by families as much as 1.5 hours away who did not have LCs at their outlying rural hospitals.

            My secondary employer is a smaller community-owned hospital affiliated with a tertiary center that is over an hour drive for me, has the same number of LCs responsible for half the deliveries and pays me *significantly* more. It’s worth 2+ hours on the road to leave at the end of the day feeling like I actually made a difference … plus it’s truly a beautiful drive that I’m technically paid much for as if working at home!

            Both facilities are financially sound, but intermittently communicate a frantic cash-strapped message to the employees and each have had lay-offs (essentially every year with my primary employer). I fully expect things to get worse … but I really can’t imagine what that will actually translate to :(

  • Guesteleh

    http://www.cost-ofliving.net/normal-birth-and-breast-is-best-the-neoliberalisation-of-reproduction/

    Although originally rooted in attempts to empower women, today’s
    approach to ‘natural’ birth and breastfeeding puts intense pressure on mothers who cannot achieve these goals, often for structural reasons such as poverty and social disadvantage, family or other burdens or medical issues affecting mother or infant. Furthermore, in a neoliberal milieu that depends on economic and social competition and individual responsibility, these women do not receive empathy but are berated for making the wrong choices, and defined as both ignorant and lazy. The reproductive experiences of the Duchess of Cambridge and other celebrities then become ammunition in these ‘Mummy/Mommy wars’, which are very much a product of the age.

  • lucy logan

    theres also D-MER; dysphoric milk ejection reflex. i had it but only when pumping. i only discovered it was a “thing” much late,r but whenever i pumped, id litterally have sudden intrusive thoughts of suicide. so i stopped pumping, continued breasfeeding and suplemented with formula.

    • lucy logan

      amazingly supplementing with formula didnt prevent me from breastfeeding for eleven months. go figure.

  • sadlady

    Pumping is good for going out and leaving baby with dad. Why? Because your body knows how much to makes tomorrow based on how yesterday went. So if you do formula for daddy time, plan to make less milk the next day. Simple as that. That’s why I do both. I don’t stockpile the stuff. I don’t lie to my body and tell it that I’ve got twins to feed! Which is essentially what over -pumping is. Pumps should be to facilitate Normal breastfeeding, not be a second job. And on the other hand supplementing reduces supply. Fact. Mom just has to know that and be ok with that. To not inform her would be a cruel trick and could cause heartbreak when she dries up slowly without knowing why. We just need the information. We don’t need to be told what to do.

    • fiftyfifty1

      [...] “your body knows”…[...]…”Simple as that.”…[...]…”Fact.”…[...]…

      I wish it were as simple as that.

    • MLE

      Obviously there are lots of problems with this, but I have just one question. How does one stock up for many days away, such as for business travel, if you can only pump to keep up with each day?

      • Box of Salt

        MLE “How does one stock up for many days away, such as for business travel, if you can only pump to keep up with each day?

        Start well in advance and freeze the milk.

        I never did have to be away even just overnight, but I always had a freezer stash – at least until it became clear my second child would never drink from a bottle and I quit both pumping and cleaned out the freezer

        • MLE

          How long did you breast feed then if you never had enough to be away? I never had a frozen stock, and I pumped as well as breast feed exclusively. No supplementation. There were times when my son was drinking milk I had pumped earlier in the day because I couldn’t keep up and my supply dropped in the evenings, and when I was stressed from work, which was all day. Thus I was tied to him for 9 months (I work from home) and couldn’t even use pumped milk for conference calls. Awkward! I had to wean him so we could participate in a wedding. So Sadlady’s comment about tricking your body into thinking you have twins made me laugh. Apparently mine thought I had a gerbil. Now I have a job where I need to travel a lot and unless something is different this time, it will be formula after about 6 weeks…

          • Box of Salt

            MLE “How long did you breast feed then if you never had enough to be away?”

            One year each. I was also unemployed during those two years (not consecutive). I considered my lack of employment as the extended maternity leave US mothers ought to have. I also know I was lucky that (a) my husband had a well paying job and (b) the workforce welcomed me back just when I was ready to rejoin it (both times).

            I was tied to the “no way is an artificial nipple going into my mouth” baby until weaning – directly to sippy cups, at one year old, just before I went back to work for the duration.

            Oh, and I will point out lack of employment does tie into not “being away” – no business travel. And I couldn’t justify going away without the kids just for fun on the reduced income – especially since I live in So Cal (other people pay good money to visit where I live).

      • fiftyfifty1

        That’s a trick question of course!

        The obvious answer is that a Good Mother doesn’t leave her baby for a business trip.

        (I’m being snarky of course, but really this is a common view in the philosophy of NCB/lactivism/Attachment Parenting)

        • MLE

          Right??? That’s the obvious answer. I should stop working so I can breast feed. Unfortunate side effects may include a drop in supply due to lack of food purchasing and consuming abilities.

          • fiftyfifty1

            In the world of Lactivism, every woman has a husband who makes plenty of money and worries about all that boring stuff like a roof over your head and food on the table, so you can concentrate your efforts on making the Liquid Gold (but not stockpiling pumped milk, because that’s a form of lying or something, I’m not sure what exactly, but it must be something bad for some reason ’cause it’s not Natural).

          • Hannah

            Don’t forget that said husband also needs to get up with you all night long and then go to work lest he be accused of being unsupportive of lactation.

      • lawyer jane

        Well, you need to separate out the goal of maintaining your supply with the goal of feeding your baby exclusive breastmilk. The sensible approach would be to pump on the trip to maintain your supply, and have our baby eat a combination of formula and any stash you did manage to build up while you’re gone. If you’re insistent on not a drop of formula, then yes, it’s going to be very difficult if you don’t have an abundant supply that let you build up a stash. You’ll have to add in extra pumping sessions in the weeks leading up to the trip.

    • Box of Salt

      sadlady, you are overgeneralizing from your own experiences, Mine are similar to yours: my supply was very sensistive to demand, and to hydration. But I know plenty of moms who had significant oversupply, and could skip a feeding with the kid never knowingn the difference the next day. Your admoninition just does not apply to them.

      The upside of the supply-just-meets-demand is that I had no use for those leakage pads you put inside your bra. I gave the case I’d been given (by someone who did need them) to someone else who also needed them (both blessed with oversupply).

      I agree with what fiftyfitfy said.

    • carr528

      I teach elementary school. I could only pump once per day (when my students were at specials) since I eat lunch with my students. My kids obviously ate more than once while they were away from me. Yet, somehow, I was able to BF for almost a year. (I quit when I just got plain tired of not being able to get my work done during my planning since I was pumping. Guess that makes me selfish.)

  • guest

    <3 Sleep deprivation is a form of torture. It's unavoidable that parents suffer some sleep deprivation, but there is just no need for it to start while still in the hospital. Let the mothers choose, without judgement, whether they wish to send baby to the nursery for a few hours, or keep it by their side.

    • Siri

      Or when mum goes home with baby still in SCBU, and is told to pump around the clock as often as a newborn will feed… I ask her, does she want to do this? Is it feasible to combine this with daily trips to see the baby? Would she prefer to pump more often during the day and get lots of sleep overnight? Would she prefer to determine on a number of pumping sessions and stick to that? Sometimes you can tell by the way someone tells you something that they’d actually like a second opinion.

  • Jocelyn

    Just today I decided that for my next baby, I’m just going straight to formula. I never enjoyed breastfeeding with my first daughter, and yet I did it for 11 months. 11 months of D-MER, low milk supply, stress, exhaustion, and feeling tied-down and socially deprived. With my second daughter, allergies/an elimination diet that killed my milk supply caused us to go to an all-formula diet since she was two months old. AND I LOVE IT. Even though we have to buy the expensive allergy formula. I STILL LOVE IT. And I don’t like breastfeeding. And I especially hate the D-MER and how it makes me feel, and I never want to feel that again. And it’s as simple as that.

    • amazonmom

      I hear you! I quit breastfeeding my son due to D-MER

    • KarenJJ

      First baby – combo fed for six months. Second baby combo fed for one week and then formula only until he started solids around 4.5 months.

      Both happy and healthy pre-schoolers and about to ride our bikes to the park. Baby hood was a much happier time for all of us for baby number 2.

    • Siri

      D-mer is horrible! 5 years after breastfeeding my last baby I STILL get spontaneous letdowns occasionally, always preceded by powerful feelings of hopelessness and despair. Midwives and GPs always assumed it was a symptom of ambivalence towards breastfeeding, but I knew it was hormonal.

  • Pseudonymous BC

    Thank you for this post, Dr. Amy. I breastfed both of my children, but was dismayed to find out that early breastfeeding is not uncomfortable, it’s downright painful!! I fought with cracked and bleeding nipples just to be told I was doing it wrong, that baby wasn’t latching properly and I should remove my newborn and relatch (even more painful than the first so-called lousy latch). I was fortunate to have access to a top-notch hospital, however, I was amazed how difficult it was to hand off my daughter for care in the nursery after our 11pm c-section. I wanted sleep, and even on a morphine pump and recovering from surgery, nurses expected me to care for my newborn! With my second, we had a slightly easier time handing him over for a few hours, but i think the chocolate for the nurses had something to do with it. I shouldn’t have had to resort to that, however, to earn a few hours sleep after giving birth (again at 11pm). Baby friendly is a joke. Anyone who insists that moms be pressured to be super moms is not at all baby friendly.

  • yentavegan

    If I could reach through the computer and give Dr. Amy a high five, fist bump or a smooch I would. I am a volunteer breastfeeding support resource. I get so many calls from desperate mothers who turn to me after they’ve been “helped” by paid lactation professionals. Sometimes the infant is no more than 3 days old and already these mothers are finger feeding, pumping , using a nipple shield and crazed from lack of sleep. Lactation professionals through the bowl of spaghetti at the wall to see what sticks in order to charge money for their services.
    I go ballistic when mothers tell me they are taking off label medications /herbs/ supplements to increase their milk supply. Or dragging their infant to quasi allied health professionals for chiropractic adjustments or ignoring their doctors explicit instructions to supplement the baby’s feedings.
    It was not this bad years ago before lactation became another vehicle for money making. Back when I became a LLL Leader there was no big push to think of ourselves as anything but helpful mother to mother volunteers. We were and still are instructed not to diagnose or treat anything. We don’t have nor sell anything, including breastpumps, finger feeders, sns’s .

    • Young CC Prof

      It was probably a great idea back in the day, especially when mothers, aunts, doctors and nurses had little to no experience with nursing and a woman trying to breastfeed might lack even the most basic information, like what plugged ducts are, or how long it’s supposed to take milk to come in. A woman who’s done it before and read a couple books could offer substantial help.

      • Trixie

        My mom was an LLL leader back in the day, and this is pretty much what she tried to do. In those days, hospital lactation advice was pretty spotty in hospitals, and there weren’t lactation consultants, and few professional resources. It also wasn’t a subject that got a lot of money for research.
        There are still major problems with the IBCLC, but the idea of having trained professional breastfeeding consultants is a good step forward.

        • yentavegan

          I have found that there are too many IBCLC’s that step outside their scope of practice and over diagnose every normal Breastfeeding obstacle as tounge tie or torticollis.

  • Cobalt

    OT: I had my baby! We almost made it to 37 weeks, but he’s doing great. Such a totally amazing little person. Placenta sent to pathology, it was huge and very difficult to deliver, with calcifications, clots, and necrotic areas. So glad he came when he did and my doctor was on board with delivery, I fear what would have happened if he had stayed in another week with that placenta. I was actually getting flak from one of the nurses in labor about how it was really too early and a pregnancy is really supposed to be 40 weeks.

    • moto_librarian

      So glad that your son is here and doing well! I hope you told that nurse to STFU!

      • Cobalt

        We had some trouble. She also decided I wasn’t really in labor because I wasn’t having regular contractions or a lot of pain (which is normal for me for labor) and told my family I would be sent home soon. My OB straightened her out and I got a different nurse. And a totally perfect baby.

        • Lily

          Congratulations!
          My baby was born at 36 weeks. She was 5.5 Ib. The ammonic fluid was low and I had regular contractions with the baby in breech position. Thank god she was healthy and didn’t need hospitalization.

    • Susan

      Congratulations to you!

    • Young CC Prof

      Awesome! Congratulations! (And yes, it sounds like your doctors knew when to tell him to be born.)

    • Karen in SC

      OMG You broke the 39 week rule?? And what did it get you??

      A healthy baby. Congrats!

    • Siri

      Welcome Baby Cobalt! Name? Weight? If you’re happy to share, of course. Well done mummy and mummy’s new little boy.

      • Cobalt

        5lbs, 12oz. He’s tiny for a newborn, but a good size for his gestational age. No breathing or eating issues, and only spent an hour in the warmer. Did take a bit of formula to bump up his blood sugar.

        I can’t shake the feeling that we got lucky, the placenta didn’t look that bad on ultrasound, but the doc’s face when examining it was.

    • Box of Salt

      Congratulations to your whole family and Welcome baby Cobalt!

    • Amazed

      Congratulations! Welcome little man!

    • Mishimoo

      Oooh! Congratulations!! Also glad that he arrived when he did, and that you’re both doing well. Welcome kiddo!

  • KeeperOfTheBooks

    Thank you SO much for this!
    I had a similar experience when DD was born. Little supply, constant pressure (both from myself and from people around me, though not DH or my OB) to breastfeed, and a baby who, poor kid, just wanted to eat. I’d feed her via nursing and the SNS, which would take about an hour to an hour and fifteen minutes, try my best to transfer her to her bed/nap-n-play/wherever without waking her, pump for 20-30 minutes, wash the SNS (though it was impossible to properly clean, a stupid setup for a newborn feeding apparatus, no?) and the pump stuff, and then have all of 20 minutes or so before she’d wake up hungry. Got a yeast infection in my breasts from a combination of the insanitary SNS and not showering for several days at a time due to the schedule, and the infection made latching and the first few minutes of nursing sheer agony. (And she’d unlatch/relatch a half a dozen times a side per session…OUCH.) Took fenugreek like it was going out of style, ate huge amounts of oatmeal and milk every day…and nothing really helped. I was having emotional breakdowns nearly every day, and sometimes multiple times per day because I was in such physical and emotional pain. Honestly, five months later, I still have near-obsessive thoughts about the whole situation, and I’m seriously considering counseling just to figure out how to get past it all. The pressure moms are put under to breastfeed at all costs is intolerable. NO ONE should have to deal with such pressure, much less over something that just isn’t that important in the long term, and most especially at a time when they’re incredibly vulnerable to begin with.

    • lawyer jane

      Oh you poor thing!!! Do get counseling if you feel you need it. At just 5 months it could still be PPD. I hope you’re enjoying your baby and getting some more rest now!

    • Lily

      My DD is almost 5 months and she never sucks even if latched. This lead me to pumping and trying different nipple sheilds. I had mastitis and cracked nipples the whole six weeks even though formula was the major feeding method because of pumping. My supply was low and dropped increasingly while my baby’s need increases. But didn’t want to give up trying to increase the supply (everybody claim it is rarely a real supply problem!). And so I tried to pump more while taking all these herbs but nothing changed. I thought my hormones were not the same as 4 weeks back, so why not taking a drug like (motilium) and I took it like a candy. Again, nothing changed not even by 1 ml. So I just stopped at 6 weeks and EFF. but my baby blues (due to my failure in breast feeding like what natural women just do) didn’t stop me of thinking, grieving, and searching and this is how found this website. I am totally aware that formula is not harmful. My first child latched immediately but I had to EFF for health and recovery issues and she is healthy and happy preschooler. But it is me who keep pressuring myself because I wanted to do what everyone claims is the best and couldn’t meet my high expectations. Sometimes I just think about not trying next time after this experience. Thank god I didn’t know SNS exists!

  • Guest

    Thank you for this. When my son was small, his latch was awful. No matter how much we worked at it with the SN, he couldn’t get milk out. I’d spend an hour crying because nursing hurt so much, and then I’d pump, and then it would be time to feed him again, and I got to watch half of what I’d worked to pump dribble down from his mouth. By the time he was ten weeks old, my breasts were bruised and bloody and he was not thriving. Finally, after a series of LCs who said “keep trying,” we got a referral to a feeding specialist who advised a switch to bottles. We did switch, but I felt so guilty I continued for months to pump milk. I had no life because I was always pumping. He had no other kid friends until he was a year old because we couldn’t leave the house for more than two hours. The whole experience was miserable. If I had it to do over again, I would try pumping for maybe just those newborn months when the sleep schedule makes going out hard anyways, and then I’d switch to formula so we could have gotten out a little more. But at the time, I totally bought into the whole idea that I would ruin his future if he didn’t get breastmilk. It’s really harmful to new moms and babies when supposed experts push this kind of idea.

    • fiftyfifty1

      Yes, pumping can be very isolating. It also creates a chunk of time when the mother simply can’t parent because she is tied to the pump. Someone else will need to be tending to the baby if it has needs, or if they are home alone, the baby will have to go untended. Or the swing etc.

      • KeeperOfTheBooks

        Yep. I remember sitting on the couch and pumping with my sobbing newborn propped in front of me, and crying along with her. She needed to sleep but had woken up too early and wanted to be held, but I had to pump so I couldn’t hold her. I was sitting there with tears pouring down my cheeks because if I stopped pumping and picked her up, I’d be a bad mom for not pumping, but while I kept pumping she was lying there and crying her heart out because mama wasn’t holding her and she couldn’t understand why, plus mama was crying. Never. Again.

        • KarenJJ

          I had the same thing happen to me. It’s what they’d don’t tell you about pumping (well I wasn’t told this) – you are literally unable to do anything else including play/cuddle with your baby – even with a double electric pump. I decided to drop all but one pumping session in the evening when my husband one home. And weren’t they fun evenings *sigh*. I gave up at six months.

      • Trixie

        I used to make my older kid breakfast while pumping. Hands-free pumping bra and a long extension cord or battery pack.

        • fiftyfifty1

          Yep, if you get creative with the accessories there are some things you can do while pumping. Unfortunately cuddling a baby is not one of them.

          • Hannah

            Yup. I am exclusively pumping right now and the biggest issue I have with it is that I can’t cuddle her, I can’t burp her and no amount of hands free bra changes the fact that there are flanges attached to your front.

  • melindasue22

    Little typo I think, “all thinks being equal “…. was it supposed to be “all things”? I love this article. Says it all. It is spot on.

    • Amy Tuteur, MD

      Fixed it!

  • Susan

    If we are telling them 2-3 hours from beginning of one feed to beginning of next… it usually looks like this. Attempt to get baby who isn’t feeding well to feed. pump, then feed pumped colostrum to baby either with syringe, bottle or SNS. Then, what gets me, is they have to get up and WASH the damn stuff! Honestly, if I have time I will wash it for the mom, these women are beyond exhausted.

    • MLE

      Exactly. And just try getting to sleep after all that activity.

    • Bombshellrisa

      That was me a few months ago-I counted exactly thirty mine minutes after that cycle was done until I had to start the entire process again. Plus mom has to be able to take a bathroom break and have a snack or meal too, not to mention deal with well meaning but clueless people who keep calling or dropping by unannounced to “hold the baby while you get stuff done”.

      • Amy M

        Didja tell them that you would hold the baby, while THEY got stuff done for you?

        • Bombshellrisa

          Haha, I would tell unannounced visitors that nobody was allowed to hold the baby (partially true, it was part of the late preterm care guidelines, although from what I was told, a late preterm baby would wither without breast milk too so…..) and usually they didn’t want to stay after that.

          • Young CC Prof

            “No, I’m sorry, doctor says no one except primary caregivers is allowed to hold the baby. You know what would really help, though? If you’d run a few loads of laundry, wash the bottles, and cook me something that isn’t a sandwich or cup of yogurt.”

          • Bombshellrisa

            Baby Prof was a late preterm too, right?

          • Young CC Prof

            Early term low birth weight. And born in the middle of simultaneous local outbreaks of H1N1 and RSV, so random acquaintances were NOT holding him.

          • Bombshellrisa

            Of course not! Plus you just can’t have a baby born early getting passed around, too much stimulation.

  • Jessica

    Oh, this post brought back memories (which are only a couple of years old). My son and I fumbled around at breastfeeding in the first few hours following his birth, and my increasing fatigue and the inability to sit properly in a hospital bed (especially with stitches in my perineum) did not help. Because he was not nursing well I was discharged with donor milk and a pumping kit for the Lactina at home. By three or four days postpartum the private LC I’d hired instructed me to attempt to nurse, then supplement with either formula or expressed milk if I had enough, and then to pump for 20 minutes. Around the clock. And I did.

    It was exhausting. Utterly exhausting. But I so desperately wanted to breastfeed that I refused to give it up, even though my husband, my mother (who breastfed me for 16 months), our pediatrician, and my own OB-GYN were all very supportive. I was just flat out stubborn. Fortunately I had a very healthy milk supply so I figured if I could just get my son to figure out how to latch, we’d be golden. He did not consistently nurse at the breast and refuse the supplemental feedings until he was about four weeks old. I went on to nurse him until he was 19 months old, an experience I treasured and enjoyed immensely. It wasn’t easy, but I don’t regret the early days of pumping because I really did love breastfeeding. It was absolutely my choice, and I’d do it all again.

    That being said, I know there are a lot of women who are pressured to do the nursing, supplementing, pumping routine far longer than they want to, and whose desire to breastfeed is more tempered, and they shouldn’t have to do any of that if they don’t want to. I’ve often said that what I experienced was so hard that any woman who would have chosen differently would be well justified in doing so, and I stand by that.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      My daughter has gigantic, completely inverted nipples — there is literally nothing for a baby, unless he’s got the mouth of a whale, to latch onto. With her first child, she pumped and fed the breast milk via bottle for three months [when suddenly she dried up completely for no reason we can think of]. Now, with her new baby, she was determined to nurse with breast shields. Milk supply is not the problem; she has plenty. The shields did make nursing possible, but it was not easy, and he was swallowing large amounts of air and becoming colicky. This lasted for about 3 weeks, because she realized that, by the time he burped, she had maybe 45 minutes before she had to start over. She’s pumping again, and there are two big benefits: she can pass the actual feeding onto others while she gets to have a shower, meal, or brief nap at least once a day, and she is spared the stress, frustration and anxiety of the never-ending “latch-on” battles. My grandson is definitely less colicky.

      This is the victory of common sense over ideology. Just do what works. Grandson Ilan is thriving magnificently, and my daughter is much more relaxed than she was initially and enjoying feeding, instead of dreading it.

  • Forgetful Guest

    This actually brought me to tears. Which is saying a lot, because I hardly ever cry. Things could have been so different if I had known this 13 years ago. Maybe I could have bonded better with my baby and (I know, it’s a radical idea) actually enjoyed him after a very difficult pregnancy. Instead, my memories of his early days all revolve around the pressure and ultimately the failure to breastfeed. He didn’t have an emotionally or physically healthy mother, that’s for sure, and at least some of that was caused by all the feeding dramas. Fuck you lactivists, fuck you sadists in the guise of health professionals who cause so much trauma grief for mothers and babies because OMG, breast milk.

    Also, I exclusively fed my second child on pumped breast milk for a while, but you know what, apparently that wasn’t good enough either because OMG, no breast! At least by that stage I had stopped buying into the hysteria surrounding breastfeeding and didn’t let it affect the bonding process. I just wish I had known this with my first and I wish I could go back and make things better. :-(

  • moto_librarian

    I think that lactation consultants have a similar problem to midwives. A significant proportion of those working in lactation are more interested in the sanctity of the breast above all else. If a woman is interested in breast feeding, I want her to get support from a LC or IBCLC, but the quality of these interactions is all over the place. I had a terrible hospital LC with my first child, and she left me feeling incompetent and upset. She did not tell me that pph is a significant factor that can impede lactation, did not ask any questions about my breasts (which did not change all that much during pregnancy), and recommended fenugreek despite the fact that I have asthma. Since then, I have heard of many women who have had terrible experience with lactation.

    I know there are some great LCs out there who give correct information to moms about breast feeding, supplementing, and formula. So how do we make them the norm?

    • Young CC Prof

      I don’t know. You could make another credential, but nothing stops students from putting the “right” answers on the test and then turning around and doing something totally different. (Certain DEMs turn CNMs, for example.)

      I think maternity wards are the key. If hospitals stop deliberately staffing terrible LCs, if the ward nurse or someone else with a little common sense actually observes what’s going on, that can help.

      ETA: I don’t mean hospitals are hiring terrible ones on purpose, I mean they are hiring them without regard to quality.

      • Maria

        The only negative experience that I had with my second daughter’s birth was the LC who started heading into ideology land in her advice to me. i made sure to detail that on the survey they sent me after my hospital stay.

      • melindasue22

        They could take it one step further and make the better LCs that they screened available after one is discharged from the hospital. So many people get help from whackadoodles after they have their babies and the docs are hit or miss providing advice. And maybe staff enough so they are available. I asked for the LC for a few questions I had with baby number two but she was too busy in the NICU and with first time moms and I got out of there pretty quick that I never got to talk to her. Good thing the nurses were pretty well educated.

    • DiomedesV

      I think that lactation consultants are similar to homebirth midwives in at least one other respect: a lot of them are just not very smart or very imaginative.

      Honestly, what are the qualifications for becoming an LC? The only people I know who did that are women who chose not to work when they had kids and then wanted to make money doing the only thing they really knew how to do. Sounds to me like it takes very little training to set up as an LC.

      • D/

        In fact, it can take *no* training at all. Anyone, and I do mean *anyone* can call themselves a ‘lactation consultant’, hang out a shingle and start “helping” mothers … especially out of the hospital setting. It not a trademarked term, and it does not require licensure (at least not yet).

        There are lactation education programs from ‘educators’ to ‘counselors’ to ‘specialists’- typically with 10- 90 hours of education and many with absolutely no requirement of clinical competencies- that can be confused with a lactation consultant, and frequently this confusion may not be corrected by the individual in question. I regularly find myself explaining those distinctions to families who were led (or allowed) to believe that a completely unqualified individual was a ‘lactation consultant’. Requirements for IBCLCs are more rigorous comparatively, but there may still be a *great* disparity of education and clinical experience even among individual IBCLCs.

        For me, the doctors I work with would ride me out of town on a rail if I pulled any crazy crap with their patients, and frankly I’m glad that is the case.

  • Guesteleh

    This whole thing reminds me of the hysteria over weight. There isn’t a lot of good evidence that weight by itself is a good predictor of long term health outcomes and yet doctors and nutritionists still shame fat people. Of course, weight is correlated with social class so hating on fat folks is a convenient way to express your racism or classism without owning up to what you’re doing. Same factors apply to breastfeeding.

    • Anka

      I have thought this for a long time! I even say it IRL and get bIank stares (or worse, lectures on how “weight issues” are ruining the public health system). It’s great to see someone else saying it!

  • KarenJJ

    Thinking about this further – one outcome that should be measured by hospitals is anxiety and depression levels of new mothers – at say 2 and 6 months. Maybe hospitals could be rated as “mental health friendly” and exclusive non-use of anti-depressants by mothers for the first 6 months after birth could be rated as a significant outcome for infant health.

    Sure there might be a few issues measuring that. Maybe some mothers have circumstances not conducive to good mental health, such as money/relationship issues. Some mothers might also have pre-existing underlying condition (diagnosed/undiagnosed) that make them more prone to mental health issues after birth.

    But ya know, EVERYBODY can have good mental health if they REALLY want it. Only 1% of people are truly unable to have good mental health.

    • Elizabeth A

      Exclusive non-use of anti-depressants in the first 6 months post-partum is going to backfire like crazy. Mostly, it will make the facility reluctant to prescribe them.

      Otherwise, I agree with you.

      • KarenJJ

        Yes – it would be stupid to measure that. In the same way I think it’s stupid to measure “exclusive” breastfeeding for six months.

        I think I wasn’t sure where I was going with that comment – it started out with one idea that probably makes some sense and then turned sarcastic..

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      There is also something unofficially known as ‘delayed-onset postpartum depression” that seems to manifest itself as much as 6 months after birth. I am now convinced that I experienced this with my second, although at that time I’d never heard of it. One has to wonder whether some of the causal factors are related to success or failure of breastfeeding [in my case, I developed mastitis, and pneumonia, shortly after giving birth, and could not continue to nurse] I don’t know whether there is any research on this at all.

      • Amy M

        I heard that its considered PPD if the onset is within the first year after the birth. My PPD began about 5- 6mos pp, It was triggered by sleep dep (as you can probably figure out if you’ve read my impassioned posts on the matter.) I asked my OB if I had PPD at that point, and she decided I was just exhausted. As a result, I put off getting help until my boys were 21mos old, because once things start to get worse, its pretty hard to admit you have a problem, and motivate yourself to get help even if you do recognize you need it.
        I didn’t want to be one more twin mom, who’d gone through fertility treatments, ending up with PPD.

        I still regret that I didn’t get help sooner. What a waste-I didn’t enjoy my children’s babyhood as much as I wanted to, hell, I don’t even remember too much. What stands out most in my memory is the one month of hellish sleep problems my sons developed at 5mos old. That’s sad.

      • Dinolindor

        Besides what Amy M says below about PPD in the first year, I think a lot of women experience another round of blues (or more extreme) when their milk dries up. I certainly did 3 years ago when I finally admitted that exclusive pumping was making me frantic and miserable 3 months out. And I did this time last week when I decided to stop breastfeeding my now 3-week old because it just wasn’t right and I can’t deal with the uncertainty of breastfeeding. Granted this time the no-more-milk-blues was also wrapped into the postpartum baby blues. But it was obviously related for me, and I know several women who have felt the same, even without the fraught relationship with breastfeeding.

        • jenny

          I think I have had the no more milk blues. After I weaned my first two babies I had intrusive suicidal thoughts. I went on zoloft for 8 weeks after I stopped pumping for my second. (She had died a month earlier and I was donating her milk, but I’d been holding steady until I weaned.) After weaning my third to formula, I ended up going on celexa because my anxiety was still through the roof a month later. For future babies I was planning on pumping and then going to formula but I wonder if it would be better for me to skip pumping all together and try to dry my milk up as fast as possible….

          • Medwife

            You and your caregiver could also discuss your going on an SSRI a few weeks before weaning. Just a thought though. Tough situation.

          • jenny

            That sounds like a good compromise. I will bring it up if I have another child.

    • Sue

      ”Maybe hospitals could be rated as “mental health friendly” and exclusive non-use of anti-depressants by mothers for the first 6 months after birth could be rated as a significant outcome for infant health.”

      Karen, this is an awesome post!

  • KarenJJ

    Oh gosh, I had a tear in my eye reading this.

    New mums are so hard on themselves and so desperate to do the right thing by their babies. People like lactation consultants prey on those anxieties and feed into them and keep shifting the goalposts such that a mum never gets the feeling that she is doing an adequate job. It’s an awful setup for mental health of new mums. We need to help mums look after themselves as well as their babies.

    My eldest was very far from the book (a cat napper that was a very slow feeder) and apparently I needed to “fix that” according to vary child health nurses, infant/lactation consultants – except that it was just how she was and she grew out of that and even though she only cat napped in the day she slept pretty well over night…

    The vast majority of baby care advice is complete crap, in my opinion.

    • Young CC Prof

      Even from the well-thought-out professional sources, a lot of it is…not so much wrong as overly specific, prescribing in detail things that aren’t really important.

      Like introduction of solids. As I understand it, the science on introduction of solids goes something like this: Start somewhere between 4 and 6 months. Introduce foods one at a time, pay attention to textures and choking hazards. If you are breastfeeding, iron sources are important, overall aim for a variety of nutritious foods. By 12 months, solids should be the primary source of nutrition and consumption of milk/formula should have gone DOWN somewhat.

      And yet all over you see these details and strict, precise guidelines that people basically made up without any real evidence. Meanwhile, those guidelines work great for some babies, but not all, thus creating unnecessary stress.

      • rh1985

        My due date club has so much hysteria over solid foods, is it too soon, blah blah, it’s ridiculous.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          #1 son was so ravenous that he was taking cereal + 300 cc of milk by three months; #2 daughter refused all solids [we literally tried prying her mouth open with the spoon] until 8 months and drank only a ladylike 100 cc. When they had the same weight at one year [and their birth weights had been almost identical], I threw all the books away.

          Children are all different, therefore the childraising methods need to be different, too.

        • KarenJj

          Considering my Aunty was putting rice cereal in the bottle of her kids from 6 weeks because she thought they were going hungry. I suppose if she hadn’t done that they’d have been 7 feet tall instead of their stunted 6’4″ and have gone onto brain surgery instead of physiotherapy.

      • KarenJJ

        “Even from the well-thought-out professional sources, a lot of it is…not so much wrong as overly specific, prescribing in detail things that aren’t really important.”

        That was my experience too. Even so much fuss over “sleep associations”. We were told the “Feed, play, sleep” routine by the maternal health nurses. It didn’t work for us because my baby liked to fall asleep feeding. Apparently that’s meant to be a bad “sleep association”.

        However, I also feel sleepy after big meals so it just seems more natural to wake up, play a little and then some warm milk and have a nap. When I tried to follow the feed, play, sleep routine I was trying to feed a baby that wasn’t hungry, play with a dozy bub that was spitting up milk and then trying to calm down a wide awake baby and get it to sleep somehow.

        It feels like so much baby advice is setting up women and babies to “fail” at something. My mum fed us a bottle and we’d go to sleep and then wake up and do whatever babies do until we got hungry again. We survived it and mum didn’t feel like she was doing the wrong thing all the time.

        • Sue

          How well I recall that ”feed, play, sleep” mantra, that seemed counter-intuitive.

          Get the kids cosy, with a full tummy, just about to drop off to sleep, then stimulate them with play so they aren’t sleepy any more, then desperately try to get them off to sleep for the next cycle…

          Setting up to fail, indeed.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      The vast majority of baby care advice is complete crap, in my opinion.

      Amen to that.

    • melindasue22

      I agree. With my first I was told to nurse every 2-3 hrs in the beginning. I realized later that I almost lost my mind those first few days with sleep deprivation and that I could give myself a break with number two. But then number two only nursed once twenty minutes after she was born and then all she wanted to do was sleep for the next two days. I freaked out. Thank goodness one of the nurses finally told me she will be okay. Her weight is good so don’t really worry until like day 3. So I was like woo hooo I am going to sleep! If I had stuck with the old advice I would have went nuts. My milk supply was never as good as it was with my first but I had an 18 month old to worry about and I needed sleep. Looking back that totally fits her personality. She turns four on Tuesday and is still stubborn about doing things on her own time and loves to sleep.

  • Guesteleh

    FUCK YEAH!!!

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    Slow clap … And it extends to the whole nine yards that demands women give birth without an epidural and be denied the choice of planned mode of delivery.

  • TsuDhoNimh

    How can a mother soothe a baby screaming from hunger before he or she learns to nurse effectively without formula?

    … if you are going to use the “naturalistic” fallacy to promote eating placentas and skipping pain meds, I’ll use it right back at you.

    Because this is all about “natural processes” … ask any farmer how many “orphan” lambs they end up feeding because the mum turns around and walks off with no interest. How many are because the mum has no milk or energy to nurse yet because of a difficult birth. Versus the small number of true orphans.

    The process for introducing a orphaned lamb to a foster mother or a delayed intro to its dam involves feeding the critter until it is not frantically hungry … then aiming it at a well-filled nipple. If you have a starving lamb, they are too frantic to have a useful nursing instinct. Why should a human baby be any different?

  • The Bofa, Being of the Sofa

    This has been a fascinating post. Look at all the responses like Kara’s below, saying “thank you for saying this. I wish I could have heard that sooner”

    Just goes to show how many people who feel this way but are silenced for whatever reason.

    • The Bofa, Being of the Sofa

      I should add, it’s not just the Usual Gang of Idiots** or the minions chiming in. We have a lot of comments from folks with less than 50, 40 30 comments (even someone with their FIRST comment! Welcome PinkAndOrange!)

      This post is really giving a voice to a silent crowd. Good job!

      **20 PCM points to the first person to identify the reference

      • http://kumquatwriter.wordpress.com/ Kq

        MAD magazine?

        • The Bofa, Being of the Sofa

          A winner!

  • Kara

    I wish you had been my health care practitioner when my daughter was born. Hearing exactly what you said would have changed my perspective and I would have been much happier.

  • antigone23

    YES! I did the nurse, supplement, pump routine for exactly two weeks with my first child – the two weeks my husband was able to take off work to support me. And I often skipped the pumping in the middle of the night because I was exhausted and I never pumped more than a few drops anyway. It sucked up almost every minute in the day and I have no idea how women do this for any period of time. With my second child I had no reason to believe it would be better and I didn’t want to waste my precious recovery time so I went straight to formula.

    When I was going through this, I really wanted some medical professional to come out and tell me that it wasn’t going to work and that I didn’t need to keep trying. I did stop pumping after two weeks and stopped nursing after another 2 months because I wasn’t producing anything. But medical professionals are so afraid to appear less than wholly supportive of breastfeeding that they will not give you permission to quit. So even though I saw the lactation consultant in my pediatricians office and my daughter gained no weight whatsoever after being on my breast for 30 minutes, she wouldn’t come out and say it. She just wouldn’t.

    • RNMomma

      It makes me extremely grateful for the support I’ve had from our family doctor… I haven’t really had issues breastfeeding, but introduced some formula at around six months for the sake of mental health. I would get terrible anxiety about not having a freezer stash (couldn’t ever figure out how to pump while nursing on demand… not sure how all you moms did/do it), and not ever getting time away from my child. I don’t offer that info up to many, but when I told the doc she just said, “You’ve done great. Baby has gotten any antibodies that she’d benefit from and you need to do what works for you.” Love her.

      • FormerPhysicist

        I pumped while nursing on demand, but I didn’t *do* anything special. I just had a huge oversupply and had to pump out after feeding every few days or my breasts would *never* feel empty and non blown-up beach balls.

        When I was nursing and working, I would regularly pump more than 2 bottles in a 15 minutes session. My kid pretty much refused bottles during the day and went to reverse schedule feeding – she’d feed tons at night and just take enough to survive during the day.

        It wasn’t all it’s cracked up to be. I loved my pump, but I would have love not needing it so much, too.

  • Mollyb

    Yup. This was me. I remember the LC giving me a pumping, finger feeding, nursing schedule that left me exactly forty minutes every four hours to myself. I remember saying, with exhausted tears in my eyes, “When am I supposed to sleep?”. The LC didn’t even answer me. She just gave me a look as if I had asked when I was supposed to get my nails done or do my facebooking.

    • amazonmom

      I have had more than one NICU dad come to me saying ” this pump schedule is destroying my wife and I need your help”. That’s when I have to step in and tell mom to get two four hour chunks of sleep per day and pump more frequently when awake. These are moms who really want to maintain full milk supplies , so I do my best to help them out. I tell the moms to have the LC come talk to me if they don’t like it! Guess what, no LC has ever had to guts to come confront me over it.

    • TsuDhoNimh

      “schedule that left me exactly forty minutes every four hours to myself.”

      Ain’t NOBODY got time for that!
      (insert appropriate picture here)

  • Renee Martin

    And no one even mentions how much even a little supplementation helps. The whole insistence on zero FF is so harmful, especially to those that want to BF long term.

    • Julia

      Yes! There is so much nonsense out there about how one drop of formula destroys all breastfeeding benefits, blah blah… Guilt free supplementing can help maintain everyone’s sanity and happiness.

      • The Bofa, Being of the Sofa

        Yes! There is so much nonsense out there about how one drop of formula destroys all breastfeeding benefits, blah blah..

        Yeah, I don’t even know how that would work…

        It’s kind of like the time when a Jewish friend of mine went to a Catholic church, and said, if I put my hand in the (holy) water, will it burn up?

        • Ash

          Well….did it?

          • The Bofa, Being of the Sofa

            I was hoping for a face melting scene like in Raiders of the Lost Ark, but, alas, no.

        • Sue

          I’m sure the evil Big Formula companies put something in there that poisons the antibodies from the breast milk, don;t they?

          • Young CC Prof

            Anti-antibodies. Or would those just be “bodies”?

        • toofargone

          The water will burn up just like the microbiome of the gut will be destroyed if baby gets a drop of formula.

    • RNMomma

      Yes, from me as well! I wrote above about introducing occasional formula to mine for the sake of my mental health even though breastfeeding was going great. It’s not something I talk about much, since so many mothers work themselves into the ground with pumping, breastfeeding, and sns.

    • nomorequestionscatherine

      Yes! I replied similarly to YoungCCProf on yesterday’s post – formula made breast feeding possible for me.

      And we used a lot of formula. A lot. Be we also still nursed until 19 mo.

  • Renee Martin

    Couldn’t agree more.

    I had my son in a hospital without a night nursery and it wasn’t just miserable, it was DANGEROUS. I have seen this happen elsewhere, as it’s becoming common to force rooming in, whether there is staff to support it, or not. As if a sleep deprived woman, who just went through labor, a CS, or BOTH, and mush of a year pregnant, is in any shape to care for a helpless newborn.

    As for putting women’s needs last- if at all- why is anyone surprised? Our ENTIRE culture does this, and we are better than most worldwide. Everything comes before what a women needs! Until women are seen as humans in their own right, this will keep happening. Right now we are only useful and worthy if we are supporting someone else’s needs.

    AS for BF
    I ended up loving BF, because in my situation it WAS easy. Even as a preemie, she latched on and nursed from the first time she saw a boob. No pain, no mastitis, and she always slept 6 hours a night. I was always home, and without help, so it was also convenient. I actually enjoy it, and DD does too (to much, she is still at it at 2.5).

    This is when I realize how many things have to line up just right in order to have an experience like mine. And its obvious to me why EBF is not that common. My first was EFF and it was fine too.

    • RNMomma

      I often tell new moms that breastfeeding is hard, even when everything goes right! I’ve struggled with guilt for thinking about giving it up after breastfeeding came so easily to me, especially when so many moms work so hard to make it happen.

    • Liz Leyden

      My kids were born in a hospital that had been very big on rooming-in, until a bunch of exhausted new Moms dropped their babies. The still pushed rooming in, but the rooms had signs telling Moms to ring the nurse immediately if they felt sleepy while holding their baby.

      • Susan

        Amen. Family member was told fine to be asleep with newborn in the bed (medicated; post op) my tongue is still bleeding.

  • lawyer jane

    I am SOOO glad you wrote this post! I my city there is a well-known and frequently recommended breast feeding center that has new moms pumping and nursing around the clock. A friend of mine (different city) was doing this and almost drove herself mad. Her husband actually drove into a light pole because he was so fatigued from getting up to help her pump and bottle feed.

    • Guesteleh

      We’re probably in the same city. The women who run that center need an ass-kicking. They told me formula was poison for the gut and that I needed to cosleep to be a good mother. And then failed to diagnose what should’ve been an obvious problem with my son’s latch. He eventually had to see an OT to learn to eat solid food and the OT told me “you were never going to be able to breastfeed him.” Every time I think of it I feel like driving to the center and torching it.

      • Anka

        I often use words like “feel like torching it” when describing my similar feelings about my hospital and my experience with lactivists, but it seems to put people off, even though I explain that I won’t ACTUALLY torch anything. It’s like we’re not supposed to be angry, even after such bad experiences in which our trust was abused by people in power over us at a vulnerable time, and in a way that significantly reduced our quality of life and ability to bond with our babies. Whatever–I feel like torching all of it. (Not that I’ll do it.)

  • Susan

    The key…helping a mother who wants to is good nursing care. Shaming a mother who doesn’t want to is barbaric. Allowing a mother who has decided it’s too much work and is making herself crazy with this regime to bow out gracefully is kindness itself.

    • fiftyfifty1

      I look forward to a day when a woman can just plain old decide to quit breastfeeding when she wants, and doesn’t need anyone’s help to allow her to bow out gracefully.

      • Susan

        Well said! We sure make it damn hard for moms to do that.

  • jenny

    Thank you.

  • anh

    Love this! Dr Amy, this is fantastic!

  • wookie130

    My son just turned a week old a few hours ago. He has not yet had a drop of breastmilk, and is contentedly sleeping on my chest with a tummy full of formula. He is happy, I am happy, and we’re both sleeping wonderfully. With my first child, I went through the living hell of trying to breastfeed, pump, use a SNS, only later to discover I had IGT…this all led to many tears shed by both my daughter and I, and a bout of PND that took months to shake. To me, formula this time means that I’m a happy mother, and I’m available physically and emotionally for my toddler too…formula off the bat is the best decision I could have made, and if I could, I’d go back in time and redo those early weeks w/my daughter during the nursing debacle. Live and learn!

    • RebeccainCanada

      Awesome! Thank you this is so encouraging! I’m 33wks w/twins and planning to formula feed them. There’s so much pressure to breastfeed, last night I got the hospital intake call, and was expecting pressure about my MRCS and formula feeding plan, but she didn’t raise an eyebrow. I had two friends who had twins tell me in hushed tones that they formula fed, and it was the best thing! Meanwhile how many breastfeeding mothers are exhausted, babies not gaining, and miserable with lack of sleep?

      • Amy M

        I formula fed my twins. Originally, I thought I’d combo-feed, if I could pump enough, but I couldn’t, so that didn’t happen. I had no regrets at the time, and still don’t. I just don’t see the big deal here, why breastfeeding has been elevated to be-all/end all. You can bottlefeed two babies simultaneously more easily than breastfeeding two at once. Sure, it’s possible, but the learning curve is steep and many mothers of twins that I know of did not do that. Being able to have one person feed them both at the same time allowed my husband and I to take shifts, in the effort to get both of us as much sleep as possible. My boys are about to start kindergarten next week, and they are bright, happy children.

        Oh, and no one in the hospital gave me crap about supplementing—the hospital staff were the ones that gave me the supplemental formula, wo/even saying anything, because with my two little preemies, they needed to eat. I didn’t even blink an eye or give it 2nd thought. Maybe I am lucky to be surrounded by people who don’t care, but no one I know ever said anything about how I fed the babies or anything else.

  • Zoey

    I did the (attempt to) breastfeed, supplement, pump regime when my son was born 4 years ago. He was 36 weeks, severely jaundiced and so sleepy that I had to practically shove a bottle of pumped milk into his mouth every 2 hours and tickle and poke him until he drank it. I feel like I didn’t sleep for a month. It was hell.

    But luckily my problem wasn’t milk supply, and once his jaundice cleared he took to breastfeeding easily and he nursed until his first birthday. At the time I was so grateful for the lactation consultants and home visit nurses that came every day for a month to try to get him eating. But now I think back on that barely remembered, incredibly stressful month and the post-partum anxiety it triggered for months afterward and think that it was not worth it.

    When my daughter was born 2 years later, I decided I wouldn’t do heroic measures to breastfeed again. It would either work or I would combo or formula feed with no guilt. Ultimately breastfeeding did work with my daughter easily, but it was so much less stressful that I had “permission” from myself to feed my baby however *I* needed to. I have Dr. Amy and the commenters on this page to thank for helping me to realize that it was even an option to think this way.

    • The Bofa, Being of the Sofa

      When my daughter was born 2 years later, I decided I wouldn’t do heroic measures to breastfeed again. It would either work or I would combo or formula feed with no guilt.

      If there were any lesson I would want people to take away from Dr Amy’s blog, it’s this.

      There’s no need to be a hero over this. Try what you want and do your best, sure, but you don’t need to walk over the broken glass with bare feet like John McLean. And shame on those who expect you to.

      (the reason why it applies so well to this blog is you can say the same thing about epidurals)

  • sleuther

    Preach on Dr. Amy!!!!! Truth dot com.

  • Julia

    The pressure to go through all kinds of contortions to exclusively breastfeed is indeed insane. I know so many women who drove themselves crazy.
    I was lucky to have very little problems breastfeeding – so it was a convenient and enjoyable way to feed my child for me. But it took me about two weeks before my supply was sufficient. My one week old baby screamed for hours – until I sent my husband to Safeway at 11 pm to buy formula. 5 minutes and 4 ounces later I had a peacefully sleeping infant in my arm – still makes me happy to think about. I was a bit nervous telling the lactation consultant about it, but to her HUGE credit she said that I did exactly the right thing, gave me some more formula and told me to use it whenever I felt it was needed. So, lactation consultants can actually be helpful – I wish more women had reality-based non-guilt-tripping ones like I did.

    • sleuther

      Yes, my LC was very helpful and she agreed that continuing to try to force it (in my case) wasn’t a good use of anyone’s time or energy. I remember her saying “The important thing is that the baby gets fed.”

      I don’t know why so many people see this as something to judge harshly. I see it as “There are many valid options, and as long as baby, mom, dad and pediatrician are all happy, I say yay.” And if there’s a compromise in there, so what? There will be MANY compromises as you raise your kids!

  • http://www.antigonos.blogspot.com/ Antigonos CNM

    In my experience, the single biggest factor in milk production is maternal exhaustion. There are other factors, of course, some physical and some psychological, but turning a woman into a zombie almost guarantees a diminuition in milk supply.

  • Alexicographer

    You know, I was one of the women who commented in the last post that I BFed every two hours, used a SNS breastfeeding assist system (maybe for a month?) and pumped (for much longer) to further stimulate milk production. I did those things on the advice of LCs and my doulas, both of whom I feel gave me good advice (just in general) and because I wanted to. And I was fortunate to have a wonderful support system, to be entirely unabashed about nursing — wherever, to live in a community that is also unabashed about women nursing — wherever, to have good (by US standards) maternity leave, to have a husband who got paternity leave (!!). And since this was my first (and, as things turned out, though not by choice) last child, I just had the one to care for.

    And I’d do it again, though I suppose it would be useful to have the counterfactual — could we have continued BFing (which I valued) past his first birthday (which we did) had I not been so persistent? Who knows? If yes, I’d have done less, sooner, certainly. But if not — I’m glad I chose to persist.

    But I did *choose* to persist, and I did have a ton of support (looking after me, not pressuring me to BF). And that matters — a lot. Because, right. Even with all that, it was hard. And no woman should be told its something she needs to do when other safe options are available.

    (I think I’ve recommended the book here before and will do so again: having read Sarah Blaffer Hrdy’s Mother Nature book long before I became a mom, I was (and remain) entirely clear that we should be nothing but grateful that in the contemporary developed world we do have options in addition to breastmilk that provide us safe ways to feed our babies.)

    • Susan

      To me that’s it, in the past there was no help like this. But we need to be assisting people who really WANT to be assisted, not pushing our agenda onto moms to the point that we make what should be a magical memorable time in a family’s life sheer hell.

  • Michele

    I have started openly telling people who ask if I am planning to breastfeed this baby that “I’ll give it a shot but frankly the only reason I have for doing it is that I lose weight.” Pumping was the best diet I’d ever been on. I’d have quit a lot sooner if it hadn’t worked that way for me.

    • Bombshellrisa

      You are too nice-I refuse to answer that question (unless it was coming from one of the healthcare providers who have to know that stuff).

      • Michele

        I kind of enjoy the mental gymnastics I see lactivist types go through when I say it. They want to approve of the breastfeeding but not the selfish reason. But then I also enjoy referring to my upcoming scheduled repeat c-section as “baby extraction day” around NCB types.

        • Susan

          I can just imagine how “sorry” they feel for you!

    • Guesteleh

      “No, I figured I’d start him out on Coke and Mountain Dew.”

    • Kesiana

      Second bonus that sounds no better: breastfeeding makes for poopy diapers that smell MUCH less gross!

  • Cody

    “THE KEY TO A HEALTHY, HAPPY, THRIVING INFANT IS A PHYSICALLY AND EMOTIONALLY HEALTHY MOTHER”

    Yes, this.

  • Trixie

    I would just add the caveat, that this is the case for full-term, healthy babies. Breastmilk really does make a big difference in preemies, and right now at least, there isn’t enough donor milk to go around. So if possible, it is medically beneficial for the mother to pump. Of course not every mother can, and that’s why we need to improve hospital-based milk donation programs. We also need to educate women with extra milk to give, that Craigslist and Facebook aren’t the appropriate donation avenues, and that the way to help babies in need is to give to real milk banks. AND we need more research into breast milk so that better formulas can be developed to lessen the gap between human milk and formula for preemies, and to match donors whose milk composition is ideal to babies who need it.

    • ivorygirl

      Trixie, while that’s very true, typically the preemies who are risk of NEC are also in the NICU, rather than being cared for solo by their parents. Pumping frequently becomes a lot more feasible when you can sleep in between sessions undisturbed because highly trained medical professionals are caring for your child. Plus, babies that early generally aren’t nursing at the beginning, so you’re just talking about pumping, which is more manageable. I pumped and combo fed (with some nursing mixed in) for my twins’ first year, but they were in the hospital for the first six weeks. By the time they came home, I was at the point where I didn’t have to pump every two-three hours at night just to maintain supply, and on the nights we were able to have paid help, I got quite a bit of rest for a new mom. I do agree with your larger points, though — if you can figure a way to make formulas mimic breast milk more closely, all babies will benefit, but preemies most of all.

      • Trixie

        Yes, you’re right about the mother’s schedule allowing for more sleep if she’s not also nursing. My point was just that there IS a population for whom breastmilk can be lifesaving, so let’s find ways to get the needed milk to them (whether through mom pumping or screened donor milk). I’m a former milk donor and I know that real milk banks almost always have shortages.

  • Mary Schreiner

    I did the nurse, sns, pump, supplement regimen for 2 weeks with my second baby, before dropping out the sns and continuing the rest for another 9 months. I regret it. I regret not giving up earlier and switching to formula. I regret being unable to stay sane and happy, walking around like a zombie cow for months just hoping I would snap out of it. I regret convincing myself that if I couldn’t nurse or if I gave up I was a bad mother. I regret believing that my bond with my baby HAD to be breastmilk based. I regret feeling scared that if I gave up I would be shamed by my pediatrician and lc (who were really actually wonderful individuals).

    The only thing I don’t regret is that eventually I was able to nurse, so I wasn’t ever starving my child. But really, why did I put myself through all that??

  • Amy M

    This is excellent, and if any of my friends/family that are having babies mention any difficulties, or worries about difficulties, I will send a link to this post. Sometimes hearing it from someone else makes it easier for the women to ask for help, or stop doing something they don’t like. Like they need permission.

    And thanks also, for acknowledging that mothers have needs too. During pregnancy, a lot of people would say “Get sleep now! You won’t later!” I knew that newborns wake a lot at night to eat, and that my husband and I would be getting inadequate sleep for a while. But knowing that is different than actually experiencing it, because until it happens, you have no idea how you will handle it.

    So first society warns mothers-to-be in a joking way, that they won’t get enough sleep. Then, when they are new mothers, and exhausted, they are not allowed to complain, or to want more sleep. It’s like new mothers are being punished for having babies. “If you wanted more sleep you shouldn’t have had a baby!” “Real/good mothers can handle the sleep deprivation–if you can’t, you must be pretty weak/lazy/selfish/a bad mom.”

    Selfish is ALWAYS the word bandied about, to shame new mothers. It’s the worst thing a new mother can be, and if she confesses to having needs, or wanting anything that might mean that someone else must look after the baby for few hours, she is selfish. Taking shortcuts or doing anything for convenience is also selfish. It doesn’t apply to dads—if he helps with the baby, he’s Superdad and deserving of high praise, and if he off working and needs his sleep so he can function at work, he’s not selfish, he’s just human. This is a highly offensive double standard.

    • Dinolindor

      You are spot on about needing permission to stop. In addition, for me to really accept it I think it had to come from someone who breastfed her children, for some reason.

      • Life Tip

        I recently had a strange conversation with a friend. Since I breastfed my kids, and was open about the problems/struggles we had, I have had a couple friends call me for help when they had breastfeeding issues. One of my closest friends called me recently and asked if I had any suggestions for helping her get more from the pump. So I was listing some things that worked for me or I’d heard might work, and she kept bringing up more problems. Then she finally just said, it’s not like formula is that bad anyway. At which point I realized, she doesn’t really want more solutions. She just wants to quit. And it would make her feel better if someone tells her that it’s ok.

        What crap that societal pressures are so strong that a smart, capable, independent woman like my friend would feel like she needs justification or permission for how she uses her breasts.

    • The Bofa, Being of the Sofa

      Speaking of dads… I HATE the description “involved dad.” No one ever sees a mother at the store with a baby and says, “It’s so great you are an involved mom.”

      • Amy M

        My husband feels exactly the same way you do. He’s been a part-time SAHD since the boys were babies, and he just parents, like I do. We have some differences in style, but at the end of the day, we are mom-n-dad and there’s nothing remarkable about it.

        • The Bofa, Being of the Sofa

          We have some differences in style

          “The key to parenting is not to think alike, but to think together.”

          • Maria

            Nailed it!

            I get very irritated at people, including other mothers, who only talk about what “moms” do and how “moms” take care of kids, etc. How condescending to dads! My husband it my children’s dad. He is a parent and I am a parent. The only thing he can’t do is breastfeed, but he can give a bottle of formula!

      • toofargone

        Yes! My husband has been a stay at home dad for 5 years. He is a father just as much as I am a mother.

  • Steph Montgomery-Loder

    I have IGT. When my daughter was a newborn, I breastfed, supplemented with an SNS and then pumped – 12 times a day. When it was over and I finally stopped pumping I literally destroyed my pump Office Space style. I HATED that pump.

    • lawyer jane

      Ha ha, I love it! I HATED pumping at work so much – it was a rental pump though, so I had no way to engage in ritualistic violence against it when I finally quit. I am quite sure that pumping contributed a lot to my PPD and the general misery of returning to work and a ton of lost productivity.

  • PinkandOrange

    Thank you for this. There were times that I cried over the tiny drops that I produced with the breastpump.

    I do have to say that the lactation consultants and the nurses at my “baby friendly” hospital were amazing. Yes, my daughter roomed with me…but the wonderful night nurse took her for a few hours each night so that I could recover from my hours of labor and eventual c-section.

    The lactation consultant helped me learn to breastfeed for the first time. But, when I came back a couple of days later crying in her office, she gave me some formula samples and told me that everything was going to be okay. She helped me create a plan that worked for my family – it included some breastfeeding, some pumping and some formula feeding.

    The horror stories about these mean LCs and nurses make me so grateful that even though I had to go through PPD, I had the best OB/GYN, nurses, LCs and family to help me.

    • Alannah

      By taking your baby and allowing you to rest they broke the BFHI rules. They would get a serious reprimand if their supervisor found out. . They are wonderful nurses working in a cruel system.

      • Renee Martin

        Yep, a mom I know here was told by the nurses they weren’t allowed to touch the baby! Even so she could shower! It was so horrible, she checked out early and went back to her FARM with her other 6 kids- where she got more help than this BFHI hospital!

        A nurse took my son on rounds with her, because I was unable to even move, but was supposed to care for him all night! This is not a good solution. I am sad to say I felt relief when he went to the NICU, as I knew he wood get cared for, not hurt.

        • The Bofa, Being of the Sofa

          Yep, a mom I know here was told by the nurses they weren’t allowed to touch the baby!

          In what universe?

          Jeez, what a crock of shit.

          Notice my comments from earlier today: in fact, the BFHI guidelines don’t actually require rooming in! Only that it is “allowed.” This is crap that the hospital is making up.

          In that situation, I recommend calling the pediatrician. I am willing to bet a significant amount that the ped would kick the shit out of the nurses who claimed this.

        • Young CC Prof

          Not allowed to touch the baby? The baby is a patient, too! How exactly do they take vitals without touching him? Do they seriously not have any baby nurses in the regular ward?

    • Susan

      How it should be! Hope you are from my town!

  • Young CC Prof

    Every pregnant woman needs to understand this, BEFORE the baby arrives. Because after a week or so of doing a nurse-pump-feed system 2 hours out of every 3, around the clock, a woman has no more capacity for rational thought or reflection.

    Many of these “experts” refuse to ever suggest quitting, insisting it’s the mother’s job to figure out when to give up. Meanwhile, the mother can no longer figure out which pants to put on, which is why she’s not wearing any.

    So, if you are expecting and want to breastfeed, great! But if at first you don’t succeed, you don’t HAVE to keep trying indefinitely. And for sure, the indefinite pump-and-nurse routine is madness.

    • Mac Sherbert

      All things within reason. After my DD was born she was too sleepy to nurse and didn’t always nurse well. My LC told me to use my cheap pump to stim after a poor feed and supplement her at the breast. After a few days everything started clicking and I stopped pumping and supplementing.
      I absolutely can’t imagine pumping after every feed for more than a few days! Incidentally, I kind of enjoyed the pumping sessions at first because I was alone and it was it quiet as my husband would take the baby and my son.

      • Trixie

        Yeah. I agree. As a short-term solution it can bridge the gap until baby gets to the breast. If mom wants to try it.

  • Elizabeth A

    Thank you so much for illustrating this article with the picture of the Lactina Ultra. That’s the machine the LC sent us home with when my son was small. My milk wasn’t in yet (48 hours post-partum), and she wanted me to pump every two hours. The moment I looked at that machine, I mentally captioned it “Breastfeeding: It Ain’t Cute.”

    This machine is not what anyone envisions when they think of nursing their infant. If you’ve gotten to that part of the road, a kind person would sit you down and really sketch out the alternatives. Maybe this thing is temporary. Maybe a day from now you will wind up where you thought you’d be. Or maybe some formula would make the difference between snuggling your baby or sobbing over a breast pump at night-time feedings.

    The Lactina Ultra isn’t a bad machine. It does what it’s supposed to do – apply powerful suction. This has very little to do with the desired result, which is a healthy baby with a healthy mother.

    • Trixie

      Was there a specific reason she sent you home with the pump? Just curious.

      • Elizabeth A

        Because my milk wasn’t in. And since it had been two whole days, of a process that frequently takes 3-5 days, obviously we were doomed if I didn’t pump. Every. Two. Hours.

        I wound up with a massive, unkillable case of oversupply. We’d have been better off just waiting.

        • Trixie

          Yeah, that’s surprisingly bad advice. I’m sorry that happened to you.

    • lawyer jane

      “This machine is not what anyone envisions when they think of nursing
      their infant. If you’ve gotten to that part of the road, a kind person
      would sit you down and really sketch out the alternatives.”

      Excellent point, and exactly why I think a lot of working mothers should think through whether they really want to pump. I did it because it seemed like everyone else did it, I had an office with a door that closes, and a generally family friendly workplace. But I would not do it over again, because it wasn’t actually a rational choice about what was best for my baby. I think for me it was almost a way to abate the guilt of leaving a small infant to return to work – as long as I was pumping it was like I was still trying to mother him while at work.

  • The Bofa, Being of the Sofa

    All newborns must room in in order to support breastfeeding?

    I just commented about that in the last post. There was a link to a list that was said to be the requirements for the BFHI. Item 7 was that a Baby Friendly Hospital must “allow” for rooming in.

    As I asked there, how did this suddenly become a mandate that they MUST room in?

    In fact, that BFHI does not, it seem, to REQUIRE rooming in. This is just hospitals using it as an excuse to cut out their nursery and save money.

    It’s the Business of Being Born, right?

    • Susan

      I get a sick feeling sometimes it’s because it’s one less warm body that gets a paycheck that night….

      • The Bofa, Being of the Sofa

        I don’t think that is just a hunch, it is pretty clearly the case.

    • Ash

      http://www.ncbi.nlm.nih.gov/books/NBK153476/

      More specifically,
      http://www.ncbi.nlm.nih.gov/books/NBK153476/bin/sec3_section3.2-fm6.pdf

      Seems like the ultimate goal is 100% rooming in, no? Also note the term “normal birth”…sigh.

      • The Bofa, Being of the Sofa

        See the thread yesterday, where this came up. There was a link to a hospital that refuses to do the BFHI, and they listed the requirements for what is needed. It was very clear that rooming in had to be allowed, and it was not mandated.

        • Ash

          BFHI criteria for evaluation (from their website) for rooming-in are as follows. “Justifiable reasons” are not defined. “Justifiable” is preceded by “Medically justifiable” elsewhere in the document. So I don’t know if “mother requests infant be placed in nursery care overnight” is considered justifiable.

          1) Of randomly selected mothers with vaginalbirths, at least 80% will report that
          their babies were not separated from them before starting rooming-in, unless
          there are medical reasons for separation.

          2) Of all randomly selected mothers with healthy term babies, at least 80% will
          report that since they came to their room after birth (or since they were able to
          respond to their babies in the case of cesarean birth), their infants have stayed
          with them in the same room day and night except for periods of up to an hour
          per day for facility procedures, unless there are justifiable reasons for a longer
          separation.

          3) observations in the postpartum unit and any well-baby observation areas and
          discussions with mothers and staff confirm that at least 80% of the mothers and
          babies are rooming-in or, if not, have justifiable reasons for being separated.

          Interestingly, this AZ document specifically says to not have a nursery

          http://www.azdhs.gov/phs/bnp/gobreastmilk/documents/AzBSBS-Model-Hospital-Policy-Guide.pdf

  • GiddyUpGo123

    I spent $400 on a breast pump and an exorbitant amount on an SNS, which was really just some bags and a plastic tube that probably cost less than a buck to manufacture. Three weeks in I had nipples that looked like raw hamburger and dreaded nursing so much that I would just let my baby sleep all day even knowing she’d be up all night long if I did, because the thought of waking her up to nurse was terrifying. Eventually I started giving her a bottle once a day despite all the cries of horror from lactivists (nipple confusion!) and that one bottle feeding was so beautiful and quiet and loving that I don’t know why I didn’t just stop the rest of that nonsense knowing that real bonding happens when you can cuddle and love on your baby and not when you’re squealing in agony and wishing for it to be over. Now my only regret is not that I breastfed with so little success, but that I’d bottle fed more.

    • Guesteleh

      Three weeks in I had nipples that looked like raw hamburger and dreaded nursing so much that I would just let my baby sleep all day even knowing she’d be up all night long if I did, because the thought of waking her up to nurse was terrifying.

      This was me, only I stopped after a month. And the guilt nearly crippled me for my baby’s first two years. I had some preexisting risk factors for PND but my breastfeeding “failure” was a huge contributing factor. Of course today my son is fine. I wish I’d been able to enjoy his first years instead of weeping through them.

  • Pktaxwench

    So true! Screw breast feeding. It is anything but pleasant. I like pumping on my schedule, and not being tied to my offspring. I am of the ‘milk matters’ camp, but when I go back to work, will happily switch to formula.

    • Trixie

      I respect that you find it to not be pleasant. But, this isn’t universally true. I enjoyed it immensely.
      It’s kind of like how some people love being pregnant and others don’t.

      • The Bofa, Being of the Sofa

        I respect that you find it to not be pleasant. But, this isn’t universally true. I enjoyed it immensely.

        And no one says otherwise. The problem is, and what I see from Pktaxwench, is that she finally feels free to say, “I thought it sucked”

        How many places can you actually say that these days and not get jumped on? Try that at your local mom’s group sometime.

        Of course she’s talking about everyone, she’s clearly talking about herself. And the reality is, yeah, you know what? There are plenty people who feel the same way.

        Until we can get past this santimommy-lactavist crap, people like Pktaxwench will benefit from having a place where they can be honest.

    • guestk

      Hear, hear! I hated every moment of it (for all 8 months I did it).

  • guest

    So true, every word! I enjoyed breastfeeding my baby, but it was a colossal effort to get started, and I don’t see how anyone can have the nerve to tell a mother that she HAS TO do that in order to be a good mother. (I did it because I chose to–MY decision.) Thanks for another great article!

  • amazonmom

    When I begged an LC to let me formula feed because I had done that exact regimen for a week straight with no break… She said “your baby won’t love you the same, don’t you want her to love you?”. The severely depressed me heard “the baby won’t need you if someone can formula feed her” and thought the baby wouldn’t miss me if I died. I turned out ok, no thanks to the lactivists who ignored my pleads for help.

    • The Bofa, Being of the Sofa

      She said “your baby won’t love you the same, don’t you want her to love you?”.

      I hope you are willing to provide the name of this person and their location.

      That nurse needs to be advertised as everything that is wrong with lactation consultants. Every LC needs to see that and say, “Don’t be this asshole!”

      • amazonmom

        The person was eventually fired or quit. I work at the same facility and as a staff member my complaint matched up with other patient complaints. This person also justified lying about my daughters weight loss because she didn’t want me to supplement.

  • attitude devant

    Printing this one out for my exam rooms. Thank you!!