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It was late on a Saturday night, close to 3 a.m. to be exact. My son was 4 days old, and it was time for him to eat. A newborn’s need for nourishment outweighs its need for sleep, so doctors insist that, if necessary, parents wake them every two to three hours to eat, but neither my husband nor I could rouse our son. I picked him up and put him to my breast. He had nursed ravenously the day and night before. Now he was lethargic, limp, like a rag doll.
I tried to remain calm but had started to tremble. My husband and I couldn’t figure out what was wrong. In the hospital, we had been told that it takes longer for some mothers’ milk to come in than others’, but just before being released, I had asked the pediatrician why my son’s mouth was a little white. I was concerned it was a sign of thrush or yeast infection, which can develop during breast-feeding. She examined his mouth and said cheerfully, “That’s not thrush, that’s your breast milk!”
Though we had been told that I had milk, I pulled out my breast pump just to double-check. I should have had milk, but I had none. Forty-five anguished minutes later, a few droplets sputtered forth. I put my son to my breast immediately. He suckled vigorously, but briefly. Too briefly. I howled with panic inside. Four days into motherhood, and I was already failing my baby with the most natural and obvious expression of mother’s love known to every mammal: giving him my milk.
We were lucky enough to get an appointment with our pediatrician early that day. She was calm as she explained that the baby was not only starving; he was dehydrated, which explained the lethargy. It’s natural for newborns to lose some weight soon after birth, but our son had lost nearly 20 percent of his birth weight in a matter of days. And because he hadn’t peed in a while, we were told to take him straight to the emergency room if he didn’t urinate soon.
When I was pregnant, I had resolved to exclusively nurse my son for at least six months, the minimum recommended by the American Association of Pediatrics (AAP) and the World Health Organization (WHO). I took a class with an International Board Certified Lactation Consultant (IBCLC) and avoided many of the so-called booby traps that can wreck a first-time mother’s attempts. But no one, from our IBCLC instructor to the doctors to our fellow parent friends, had prepared us for the possibility of our son’s getting dehydrated or mentioned how dangerous and terrifying this situation could be. Rather, we had just been told — repeatedly — that every woman can breast-feed.
I was now faced with a few mixed messages, one more pressing than all the others: The IBCLC, our doula and various breast-feeding friends had all said that any bit of formula or bottle-feeding in the first few days of our son’s life could jeopardize his ability to breast-feed. But now his life was in danger. We got the formula and fed him immediately.
Over the following days, which then became months, I felt as if my son’s life were in my breasts. I saw an IBCLC the same day as the pediatrician and, soon after that, Dr. Mona Gabbay, who specializes in breast-feeding. My lactation consultant advised me to nurse my son via a supplemental nursing system, which consisted of a bottle that I filled with formula and little tubes that attached to the breast. This enabled my baby, who had an excellent latch — which is how the baby attaches to the breast to nurse — to receive sufficient nutrients at the breast while maintaining the hormone stimulus necessary to establish and maintain breast-feeding. It also helped to keep his sucking capacity strong.
After each feeding I pumped my breasts with a hospital-grade pump in the hopes of building my milk supply. I repeated this ritual every two to three hours around the clock, while also throwing back handfuls of herbal supplements like goat’s rue, blessed thistle, fenugreek and fennel. I ate a steady supply of galactagogues, or foods that are supposed to boost milk supply. I tried “lying in” with my son or being in bed with him skin-to-skin and doing nothing but nursing and eating my mother-in-law’s traditional Chinese foods, which were intended to boost my supply. I started chomping down domperidone — what Gabbay called my “last resort,” a drug that I had to order from abroad because it is not approved by the Food and Drug Administration.
By the time my son was 10 weeks old and I returned to work part-time, I had a definitive answer about my milk supply: All of these efforts combined had boosted it from a meager one to two ounces a day to three to four at most — for a baby who needed approximately 24 ounces of daily nutrition. I had done my best to do everything right, but I was nowhere near being able to breast-feed my son exclusively, which is the medical definition for breast-feeding success. I was diagnosed with mammary hypoplasia/insufficient glandular tissue, a rare condition caused by insufficient glandular-tissue development during adolescence. There is no cure for it.
Though we are told that every woman can breast-feed if she just makes it a priority, in spite of this being a particularly challenging time, it’s simply not true; I am proof of this.
Everyone says that the time after you have your baby is the most magical time of your life, but for most women this initial postpartum period is extremely difficult, both physically and emotionally. Breast-feeding, which is incredibly time-sensitive, must be established during this highly vulnerable stage. Though we are told that every woman can breast-feed if she just makes it a priority, in spite of this being a particularly challenging time, it’s simply not true; I am proof of this. But even women who don’t have my condition face myriad obstacles to meeting the AAP and WHO’s minimum recommendation. According to a 2013 report released by the Centers for Disease Control and Prevention (CDC), 77 percent of American babies breast-feed during their postpartum hospital stay. By six months post-birth, 49 percent of babies are partially breast-feeding. Only 16 percent are still breast-feeding exclusively.
Breast-feeding is natural, we think. What could be so hard? Yes, it’s natural, but establishing and maintaining it can be complex. According to a January 2014 study in the Journal of Perinatal Medicine, 80 percent of all breast-feeding mothers experience some sort of problem. While most of these mothers go on to resolve whatever issue they face, 15 percent of women experience some sort of lactation failure, according to Dr. Elizabeth Hunt, a pediatrician and IBCLC in South Burlington, Vermont. This is no small figure.
Doctors divide lactation failure into two classes: primary and secondary. The aforementioned booby traps (a lack of breast-feeding education and support); poor sleep, nutrition and hydration; maternal anxiety; or a bad latch and suck on the baby’s end can lead to secondary failure. Cesarean birth, infertility treatments and starting birth control too soon, all of which can lead to lactation failure, also fall under this classification. Then there are women like me who fail for primary reasons. Breast irregularities, breast surgery, endocrine problems, insulin resistance and retention of the placenta during birth are some of the causes for primary lactation failure. According to Hunt, we constitute up to 5 percent of women. Try as we may, we will never produce enough milk.
Even with my diagnosis I continued to try to breast-feed my son. Before his birth I had thought I could pump at work without a problem, but pumping never produced more than drops for me, which rendered it out of the question.
“Why keep putting yourself through all of this?” my husband asked as the stress to maintain my supply became more acute. It was a fair question. Ultimately, my desire to breast-feed had less to do with breast milk’s superiority to formula, which would be challenged by an Ohio State University study that was released shortly before my son was 3 months old, and everything to do with — well, it’s complicated. Some deep, animal part of me simply could not let breast-feeding go. The connection I felt sustaining my son’s life, even if it was just a small fraction of what he needed, was rapturous. Plus, my body wanted to be breast-feeding; it just didn’t make much milk. At times, simply thinking about my son would immediately cause my breasts to begin “letting down” the little milk I had. Breast-feeding was a beautiful rivulet from his life in the womb that continued flowing — or, more accurately for me, dripping — between us. From birth, mothering is one long process of separation, and I didn’t want this separation to go that quickly.
There are always things we don’t talk about when we talk about motherhood.
There are always things we don’t talk about when we talk about motherhood. For me it is the dehydration scare I went through with my son and my subsequent struggle to breast-feed. I continue to contend with feelings of guilt, shame and inadequacy for not being able to produce sufficient milk. These difficult emotions are made worse whenever I tell other mothers about my predicament. Often, I sense that they either don’t believe my response or they direct blame back at me. Once, when I was trying to explain my biological incapacity to make sufficient milk to one mother, she said that bottle-feeding my son had resulted in his having “a lazy suck.” I tried to brush her admonishment at both of us aside, explaining that I had hardly bottle-fed my son at all. Thanks to the supplemental nursing system I had set up with my IBCLC, I knew his suck was plenty strong. But the mother still looked at me as though I was missing something.
In the annals of motherly unmentionables, I also rarely venture to state that formula saved my son’s life. In her 2011 memoir “Bossypants,” Tina Fey hilariously describes formula this way: “Invented in the mid-1800s as a last-ditch option for orphans and underweight babies, packaged infant formula has since been perfected to be a complete and reliable source of stress and shame for mothers.” Lynda Curnyn of Austin, Texas, whose full breast milk supply never came in even after weeks of ardent nursing and pumping, says, “I always feel a need to explain why I'm bottle-feeding, even if no one asks. I want people, because of their judgment, to know I tried for a long time. I didn’t just turn to formula lightly; I didn’t have a choice.”
Even adoptive mothers can be pressured against using formula in favor of breast milk, though banked milk is primarily intended only for the most vulnerable babies, such as preemies. Liz D’Arcangelo of Brooklyn, New York, who is Caucasian, was grocery shopping while wearing her adopted African-American daughter in a baby carrier. When D’Arcangelo put formula into her shopping cart, a perfect stranger approached and said, “Have you considered breast milk?” D’Arcangelo replied, “I adopted my daughter.” The woman then said, “You can get breast milk if you want it.” As D’Arcangelo tells it, “I said, ‘No, I don’t want breast milk.’ This woman had no idea what I went through to adopt my daughter. I didn’t feel any shame that I was not able to breast-feed her, but I did feel like that was the start of my interactions with women who feel like their experience is superior to mine because I was not breast-feeding.”
Whether the reasons are primary or secondary, mothers are still getting blamed for not being able to breast-feed.
As the CDC reports, more mothers are getting greater support for breast-feeding, but sometimes the judgment and blame can come from the very professionals who are in the best position to help them. Joy Parisi, a mother of twins in Montclair, New Jersey, recalls, “The first lactation expert I had consulted told me that supplementing formula and not getting help soon enough caused my failure to nurse. I was too busy adjusting to caring for my twins to get to her any sooner. I was in a pit of despair, but I kept at it and continued to seek help. Of all the professionals I consulted, only one suggested that I may be someone who could not breast-feed, no matter how hard I tried.”
Brooklyn mother Julia Fierro, author of “Cutting Teeth,” a novel about contemporary parenting, writes, “When I was at the height of my struggles nursing my three-month-old son, I told a prominent pediatrician that my son was crying every time I tried to nurse him. My husband came to the appointment with me, and we were both very stressed. This doctor actually said, ‘Maybe it is your own anxiety that is the problem. Have you tried to relax?’ I was so upset. My husband was livid. It felt like this doctor was saying it was my fault. Now, after successfully nursing my second child, I can see that maybe he was partially correct. I was nervous, as many first-time mothers are, but the way he dismissed me just made things worse. Six years later, I still feel anger.”
Whether the reasons are primary or secondary, mothers are still getting blamed for not being able to breast-feed. “Lactation failure can happen to anyone, just like a rough birth or a child with chronic illness,” says Hunt. But even the medical terminology is censuring. “I have problems using the word ‘failed’ to describe mothers who have gone to heroic lengths to sustain breastfeeding,” wrote Dr. Allison Steube, a fellow with the Academy of Breastfeeding Medicine, on the academy’s blog. “We also need to step back from assertions that every mother can breastfeed, if she just tries hard enough.”
My son is now nearly 6 months old. While I’ve made strides in my ability to breast-feed, my condition remains unchanged. Still, I refuse to consider myself a failure. I did everything possible to nurse my baby. Most important, I’m confident that my son will be just as smart, capable and healthy as any exclusively breast-milk-fed child. I should know; I was formula-fed. And I dare say I didn’t turn out so poorly. My mother couldn’t breast-feed me, either, and though for most of my life I thought she had simply formula-fed me as most mothers did in the 1970s, it took my having breast-feeding problems of my own for her to tell me the truth: She had nursed my older siblings and tried but ultimately failed to nurse me. Hers is 40 years of silence too long.