I found out I was pregnant with my first child in January of 2008. Despite being only 19 years old at the time I knew from the start that I wanted to breastfeed her. I naively didn’t spend much time reading or learning about breastfeeding. I did ask my doctor about my breasts, they aren’t like other women’s breasts and I was concerned. One is long and tube shaped (kind of like a golf ball in the end of a tube sock) and is a small B cup; the other is prepubescent flat. They are also very widely spaced (almost 4 inches apart) and my areolas are huge in proportion to the rest of my breast. I also noticed that the “boob fairy” never came during my pregnancy. I gained stretch marks but had no change in size. I pointed out all of these things and was told that all breasts make enough milk, no matter what the size or shape. I happily went on my way, sure that my doctor was right. I had been told to trust my body, that everyone’s milk comes in, that breastfeeding would come naturally, and that everyone can breastfeed. I believed that completely. No one ever told me that there might be bumps along the way, or that some women are physically incapable of making enough milk.
My labor with her wasn’t how I had imagined it would be. At 19 I knew enough to know that it wouldn’t be easy, but never in my wildest dreams did I think it would be as hard as it was. I was in active labor for 22 hours. Twenty-one of those hours were unmedicated. At the 21 hour mark I got my epidural (I had been begging for the epidural since hour 8 or 9 but was told I couldn’t have it because they didn’t want to “stall” my labor…I was stuck at 3.5cm for the entire 21 hours prior to receiving my epidural, to this day I don’t understand why I had to suffer without pain medication, I was already failing to progress, what damage could an epidural have done?), and some gravol and morphine. Forty-five minutes later I was fully dilated and ready to push, and my daughter was born 15 minutes later. She was born “sunny side up” and I tore badly and hemorrhaged after I had her (the placenta wouldn’t come out), and I was so drugged at that point that I barely remember seeing her for the first time, let alone holding her or breastfeeding her. She was supplemented with formula from the start and after a few weeks I gave up, thinking that I wasn’t successful at breastfeeding because I just didn’t try hard enough (I really didn’t try that hard at all). During that time I also had a uterine infection and a late hemorrhage at 6 weeks postpartum as a result of the infection; I attributed my lack of production to a combination of the long labor, the first hemorrhage, the infection and the second hemorrhage.
The hospital staff and my OB were extremely supportive of me, no matter how I fed my daughter. They didn’t push any method of feeding her, I felt absolutely no pressure to breastfeed or to formula feed, they simply asked me what my plan was and made sure I knew where to go for help if I needed it. My daughter’s doctor, however, was a different story. During her appointment for her 8 week vaccinations he asked me if I was still breastfeeding. I told him that no, I had stopped breastfeeding two weeks prior when I had the second hemorrhage. I felt compelled to explain that I was extremely anemic, I fainted regularly, I was exhausted, I was still in a lot of pain from the tearing, and that I just wasn’t making enough milk to satisfy her so I decided to spare us both the pain and suffering and give her formula. He was aghast. He told me “you should go back to breastfeeding, it’s not too late, just cut out the bottles! You’ll love it, she’ll love it, and putting her needs over your feeling tired is what being a mom is all about”. I was crushed. I was already extremely unsure being a first time mom and being a teen-mom at that, I felt like I failed her and like I had been selfish for giving up so soon.
My daughter grew normally and rarely got sick until just after her first birthday. She started getting recurrent ear infections, skin infections, GI infections, bacterial pneumonia (she had pneumonia three times in less than six months), and an abscess in her skull.; she would also frequently lose weight (10-15% of her body weight at times) and then have difficulty gaining it back. There was a period of about a year where she had no net gain, she had actually lost 2 pounds (net) in that year. She was tested for every condition under the sun, from cancer (leukemia/lymphoma) to cystic fibrosis to HIV. Every test came back normal. During this time I received a few comments along the lines of “if you had breastfed her, her immune system wouldn’t be so weak”. These comments NEVER came from her care team, the staff at the children’s hospital (the IWK in Halifax, NS) were beyond fantastic and always told me that her getting sick so often was in no way my fault, that sometimes kids just have a string of bad luck. Despite the support and reassurance from my daughter’s care team, I still felt like it was my fault she got so sick and that it was my fault she had to go through so many tests, hospital stays, surgeries, and needle-sticks.
Fast forward to December 2012 and I found out that I was expecting my second child. This time around I was 100% committed to breastfeeding, I convinced myself that my son wouldn’t go through what his older sister went through, that if I breastfed him he wouldn’t get sick the way she did. I read everything I could about breastfeeding. I spent hours reading the pamphlets and books given to me by the perinatal clinic nurses, I saw a lactation consultant about breastfeeding during my pregnancy, I watched countless how-to videos showing me the correct way to latch and the correct way to pump, I made my doctor aware that I wanted skin-to-skin immediately after birth and I that I wanted to breastfeed my son ASAP. Again I noticed no breast growth but was assured repeatedly that it didn’t matter, that everyone’s breasts can make enough milk to feed their babies. That size and shape didn’t matter.
My pregnancy with my son was complicated. I went into preterm labor at 29 weeks and had to be taken by ambulance to a bigger hospital three hours away from my home (again, to the IWK in Halifax), it is the only hospital in the province capable of looking after a 29 weeker. When I arrived at the hospital they did an ultrasound and discovered that my son was breech, so they had me sign the consent forms for a c-section in case they couldn’t get the contractions to stop. I was beyond terrified for my son and again I felt like a failure. I wondered why I couldn’t keep him safe until he was ready to be born and I wondered what I did to cause the preterm labor. Thankfully, the doctors and nurses at the IWK were able to stop my contractions with a cocktail of drugs that made me feel like death, they were able to get the set of two steroid shots into me to help his lungs mature, and after four days and five nights in hospital, I was able to go home. I went into preterm labor several more times and spent weeks at 3-4cm dilated with bulging membranes, but my son stayed put until 39+4.
Labor with my son, Harrison, was the complete opposite of labor with my daughter. My labor was 4 hours, start to finish. I had an epidural placed but my son came before it had time to kick in. I didn’t hemorrhage this time and I immediately had skin-to-skin time with my son; and with the help of the hospital’s lactation consultant, he latched like a champ and breastfed for the first time about 20 minutes after he was born. I was so confident in those early days. Everything had gone to plan with his birth. I had done everything right. I just knew that this time things would be different, this time I would be able to exclusively breastfeed my child; I would be able to give him the strong immune system that I didn’t give my daughter. I was wrong.
Before we were discharged the pediatrician came to see us for Harrison’s discharge assessment and to go over his blood work with my husband and I. He had dropped just under 10% of his weight and was mildly jaundiced at that point. The pediatrician assured me that he probably dropped so much weight because he was jaundiced and to wake him up to feed every 2 hours, round the clock. So I did.
We went home on a Saturday and the the public health nurse came for a weight check the following Monday. He hadn’t gained any weight, in fact he had lost another two ounces. She assured me that it can be normal for jaundiced babies to take a while to gain back to their birth weight and that my milk was just late coming in. He was having enough wet and dirty diapers (barely) so she said to just stay the course.
A few days later I was concerned because he looked more jaundiced to me so I took him to his doctor. They tested him and his bilirubin levels were in the 280s (μmol/L). His doctor gently suggested that I think about supplementing Harrison’s feeds with formula. I pleaded with his doctor to let us try a little longer and his doctor reluctantly agreed, but I had to bring Harrison back to retest his bilirubin levels every second day. His levels spiked at 297 and then fell down to the 280s again and remained there.
During this time I was completely convinced that I was doing something wrong. I saw the lactation consultant almost every second day trying to perfect his latch, I pumped after every feed, I chugged water like it was going out of style, I took supplements, I tried everything and nothing worked. Still, I plowed forward, blind to the fact that my son was suffering because of my desire to exclusively breastfeed him.
At his three week appointment he was still 4oz below his birth weight, he was dehydrated and his fontanel was sunken, he never cried (he didn’t have the energy), and his bilirubin levels were still in the 280s. He was starving. His doctor sat me down and said that I had to either start supplementing immediately or we needed to admit Harrison for IV hydration. I cried harder than I ever had before as I gave him that first bottle.
I started looking online for a reason why and I stumbled across the blog “Diary of a Lactation Failure”. Suddenly it all made sense. I had every marker for IGT. Every single one. I went back to the lactation consultant and asked her point blank if she thought I had IGT and she replied that yes, she had thought that for quite some time. Why it never occurred to her to tell me about it I’ll never know. To her credit she was amazingly supportive. She told me that supplementing didn’t mean that I couldn’t have a breastfeeding relationship with my son, and that it was ok to switch to formula if that is what I felt I needed or wanted to do. She gave me the tools to make a homemade SNS and showed me how to set it up and use it. She also told me about domperidone and I had my OB call in a prescription for me. I was on the maximum dose of domperidone (4 10mg pills 4x/day, 160mg per day in total) but it didn’t do much to increase my supply, but that wasn’t a surprise because it tends to be much more effective for women with hormonal issues affecting their supply as opposed to the anatomical issue of simply not having enough glandular tissue. I also found the IGT and Chronic Low Milk Supply support group on facebook, that resource has been the most helpful of all; I wouldn’t have made it past the first week after being told that I have IGT without that support group.
As I’m writing this I’m providing the timeline and the facts surrounding my breastfeeding journey with my son but I’m having a hard time accurately articulating just what I felt like during that time. I felt like a complete failure. I was broken. I felt like less of a woman, less of a mom even, because I couldn’t do the one thing I’m supposed to be able to do for him. I couldn’t nourish him. I needed formula from a can to nourish my son. I hated my body then. I hated it because it had failed not just me, but it had failed my son as well; it has tried to force him out into the world before he was ready and then it stubbornly refused to nourish him adequately. I felt like my son didn’t need me, like anyone could just pick up a bottle and replace me in his life. I felt completely useless to him as a mother. I also felt overwhelming jealousy of full supply moms. I wanted to tell them all to shut up, that they didn’t know how lucky they were to be able to breastfeed; I’m ashamed to admit it but I hated that they could breastfeed their babies and I couldn’t breastfeed mine. Jealousy is an ugly thing; the simplest things would set me off. If I was shopping and I saw a mother breastfeeding her baby I would have to duck into a bathroom or dressing room to avoid crying in public. If another mom from my mom and baby group mentioned how much she could pump in a session I would spend the rest of the day beating myself up about not being able to pump as much as her. I also had a deep animosity towards moms who chose to formula feed their babies, I felt like it was unfair that they had perfectly functional breasts and chose not to use them. I judged them harshly, and I am NOT proud of that. I also put his formula in the medela bottles that came with my pump so that if anyone saw me getting his formula ready, they would think it was breastmilk. If I anyone asked me “do you breastfeed?” I always lied and said yes. Using formula to nourish my son became my dirty little secret. I didn’t want anyone to know because if they knew they would see me for the failure and fraud that I was, or that I felt like I was. I was deeply ashamed of supplementing with formula.
During those three weeks I was told by everyone (except for the hospital lactation consultants, they were very supportive and repeatedly told me that I was doing a great job and that feeding my son was more important than breastfeeding him) who knew about my supply issues that I should be pumping more, that I just needed to put him to the breast more often, that it was because I gave him a paci, that it was because I had an epidural, that whatever I do, I should NOT supplement. Everywhere I turned the message was the same: I just wasn’t trying hard enough, that somehow the low supply was my fault, that I was doing something wrong. I felt so guilty. I felt guilty for starving my son while trying to exclusively breastfeed him and I felt guilty for supplementing with formula. The message I had always gotten is that mothers who supplement with formula are taking the easy way out, that they are giving up, that they just didn’t want to try hard enough or work hard enough to breastfeed. I had joined a few mainstream breastfeeding support groups on facebook at this point, the “support” I received in those groups was downright abusive at best and dangerous at worst. The abuse consisted of them basically “shushing” me. If I asked a question about how to maximize supply with IGT, they’d tell me to go somewhere else, that I was “fear mongering”, and that I didn’t belong in their group if I supplemented with formula. I once replied to a mom who posted about her baby showing signs of inadequate nutrition (low/no weight gain, below normal wet/dirty diaper count, lethargic, etc) and told her that feeding her baby was more important than exclusively breastfeeding her baby and that low supply IS a real problem and that her baby needed to get fed first, before she figured out what the problem was, and that she wasn’t a bad mother for needing to supplement. I was attacked, ridiculed, accused of being a “poison pusher”, and discredited because I wasn’t a “real” breastfeeding mom. I left the group immediately after that incident. The scary advice consisted of several women suggesting that I take donor milk from strangers on the internet, because surely that was better than the “poison” I was feeding him. Several women also suggested that I make my own formula from scratch using goat’s milk, chicken broth, raw egg, and some other ingredients (I cannot remember the whole recipe), because apparently a recipe given to me by an untrained stranger on the internet containing raw egg was better than formula, which has decades of science showing that it is nutritionally complete and safe. Thankfully, I wasn’t so deeply entrenched in the “lactivist” mindset that I believed that a stranger’s milk or making my own formula would be better or safer for my son.
Over time the feelings of failure and inadequacy lessened and I learned to block out the usually well meaning advice from full supply moms who just don’t get it. I began to come to terms with the fact that I would never have a full supply, and that I would never be able to exclusively breastfeed any of my children. Those feelings still creep up, though, from time to time but I try to remain focused on the positive.
As those feelings lessened, I realized that the people propagating the idea that if you have been unsuccessful at breastfeeding then you’re simply not trying hard enough are dead wrong. They have NO right to tell me or anyone else that we are inferior mothers because we couldn’t, or chose not to, breastfeed. I would have loved it if one of those women could have spent 24 hours on my schedule in the early days. My son had to be fed every two hours, whether he woke on his own or not, because of his jaundice. Before I supplemented with formula he would nurse on each side for about 40 minutes, leaving me with less than an hour to sleep before the next feed. After I began supplementing I would breastfeed my son for 20 minutes on each side (40 minutes total) then I would introduce the SNS and let him take his supplement which took about 15 minutes. I couldn’t introduce the SNS at the beginning of the session to save time because then he would fill up on formula instead of emptying my breasts first, which would worsen my low supply. After breastfeeding without, and with, the SNS I would pump for 20 minutes. I was lucky enough to be able to purchase a double pump, it would have taken 40 minutes to pump if I only had a single pump. Then I would rinse my pump parts out with hot water, put them in a zip-lock bag, and put them in the fridge (putting them in the fridge between pumps meant I only had to wash the pump parts once per day, this saved me precious minutes between feeds to sleep), then I would wash the SNS, refill it, and store it in the fridge for the next feed, which took about 10 minutes. So each feeding session took about 1.5 hours. Remember, at this time I was feeding every two hours. So I only had thirty minutes between each feeding session to sleep. Not only was I lucky enough to be able to have access to a double pump, but I also had an incredibly supportive family. My husband and mother both stepped up and helped me look after my daughter and keep up with household chores. I would love for one of those hateful “militant lactivists” to have spent a few days on my schedule and then tell me that I just wasn’t trying hard enough.
I kept up that rigorous schedule for months. I felt like it would have been selfish for me to back off, that it didn’t matter how tired I was (emotionally, mentally, and physically), that being a good mom meant I had to give him every drop of breast milk that I could. Finally, one day when my son was six or seven months old, my daughter broke down crying. She asked me why I never spent any time with her anymore and why I didn’t love her anymore. My desperation to exclusively breastfeed had not only hurt my son, but it had hurt my daughter as well; not only had I been blind to my son’s suffering, I had also been blind to my daughter’s. She was only five years old, she needed me just as much as my son did, and I had been pushing her aside for months in favor of maximizing my breast milk production. The message you always get from lactivists is that breastfeeding makes you a good mom and not breastfeeding makes you an inferior mom, that breast is always best; I think it was this message that made it so difficult for me to see the damage I was causing to my children in my quest to exclusively breastfeed my youngest. If “breast is always best”, how could striving to exclusively breastfeed hurt either of my children? The two are mutually exclusive, if breast really is best, then it shouldn’t hurt the baby you are trying to feed or your older children. So, if it was hurting my children, maybe breast isn’t always best after all. Maybe what is best is dependent on the situation. This realization was incredibly liberating for me. I stopped pumping the day my daughter broke down, and everyone was a lot happier for it. I still breastfed and I still used the SNS, but I also began bottle feeding my son so that I could share feeding responsibilities with other family members. In doing so, I was able to give my daughter the time she needed and deserved and I was able to give myself the time I needed and deserved. The realization that exclusively breastfeeding (or relentlessly striving for exclusive breastfeeding when circumstances beyond your control make it impossible) wasn’t what was best for my family opened me up to the idea that maybe it isn’t always what is best for other families either. It opened my eyes to the fact that the only person who gets to decide which feeding method is best is the mother, she knows her family and her situation better than anyone else, certainly better than the anonymous lactivists on the internet who mean to shame her for her choices.
I have learned so much from trying to breastfeed and the struggle to come to terms with the fact that my body just can’t make enough milk. I have learned that I am irreplaceable as my children’s mother because no one can love them like I do, no matter how much milk I do or don’t make. I have learned a new level of empathy, and that has gotten me over my jealousy of “full supply” moms and it has gotten me past my animosity towards moms who choose formula from the start. I don’t know their struggles, I don’t know if they have lost babies to miscarriage or stillbirth, I don’t know if they have suffered infertility, maybe they had to go through years of IVF to get their baby, who knows? Maybe they also couldn’t breastfeed their child, maybe they didn’t have the resources or support needed to breastfeed, or maybe they just didn’t want to. I learned that a mother’s reasons for choosing formula or breastfeeding are absolutely none of my business, their decision is their own and I don’t get to judge whether or not their decision is “valid”. I have also learned that I don’t get to hate the ability of some women to breastfeed just because I don’t have the ability to do it. I have also learned that, while breastfeeding is natural and wonderful, it is not perfect. Breastfeeding doesn’t always work perfectly and that’s ok too. My breastfeeding relationship with my son may not be “perfect”, but it is perfect for us.