My battle to breastfeed

Breast is best. The message that is synonymous with infant feeding. Breast is best. There is no point in denying it or trying to argue with this simple, three worded statement. There is no need for me to write a literature review on the benefits of breast milk and why it is nature’s perfect food because it is, at least as far as I am aware, a universally known fact. Many may argue points about “weak” breast milk, but there is no such thing. The only problem with breast milk, in my experience, is when there is not enough…

During my pregnancy, I was quite open-minded about two of the most judged aspects of having children: the methods of delivery and feeding. It is so easy to get caught up in the sanctimonious bullshit or the guilt-laden excuses that accompany the various for and against arguments. We live in an age of contradictions in which we rely on our smart phones to get us through the day, but we keep trying to “get back to nature”. Caesarian section births and infant formula are unnatural – they are from the Devil! And we need to show our vitriolic damnation of these evil things to like-minded individuals to fuel our self-righteous opinions, and we do this via the internet… conveniently accessed via our indispensable smart phones. One cannot simply just reproduce and enjoy the arduous, yet rewarding occupation of raising children anymore without everyone having (and sharing) their opinions on it and judging you for how you are doing it. 

Too posh to push? Because being cut open is a better option...

Yes, this is the variety of garbage pushed out by so-called breastfeeding "advocates' 

It's terrible being a new parent or expectant parent and seeing commentary which basically states that women who have C-sections are not real mothers or cannot claim to have given birth because they were cut open and did not push – as if all C-sections are unnecessary when in reality they are often life-saving interventions. The same goes for using formula, reading commentary about how formula fed children are doomed to lives of mediocrity because their mothers did not care enough to give them breastmilk. While I have already said that there is no point in denying that breastmilk is the best nutrition one can offer a growing infant, to infer that a mother choosing to formula feed (for whatever reason) does not care about her child is downright horrible! I decided that I would not go into parenthood with preconceived ideas about how things “should be” because I had reached a stage in life in which many of my friends and family members were either having or had already had children and I had had the opportunity to dispel my own naïve views regarding these highly controversial decisions. I decided that as far as delivery went, I would try for natural birth but would accept it if a C-section was needed, and as far as feeding went I would try to breast feed, but would accept it if I had to resort to formula – I would do whatever was necessary for my child to be healthy.

After attending antenatal classes, I was determined to breastfeed. Between what was taught in class and the books that I read on the subject (La Leche League’s The Womanly Art of Breastfeeding and Marie-Louise Steyn’s Breastfeed your baby), I felt empowered to breastfeed my child when she arrived. I knew that friends of mine had struggled to breastfeed, but I also knew that very often mothers fell prey to poor information about breastfeeding (the “weak” milk story) or were pressured into using formula, often resulting in many mothers assuming that they were unable to breast feed when some simple, or in some instances more difficult, interventions would have resulted in successful and enjoyable breastfeeding experiences. Despite my determination, I still opted to wait until the birth of my baby before buying products needed for breastfeeding like nursing bras or a breast pump, I did not want to spend a rather large sum of money on things that I might not have been able to use – what if my milk never “came in”?! I knew that some women produced milk prior to their babies being born and I had hoped that I might discover a little leakage to assure me that I would be producing milk, but I had to resign myself to the fact that I would only find out when my baby was born. I was relieved when, on the delivery bed, the midwife gently squeezed my areolar and confirmed that I had milk moments after my daughter arrived into the world. 

Holding my daughter for the first time

It was as I had hoped it would be! My daughter came out healthy AND hungry. Within minutes of her birth, following the required examinations by the paediatrician, my little girl was laid upon my chest and started rooting. The midwife assisted us with the latch and, just like that, I was breastfeeding my daughter. My husband, being very supportive of my desire to breastfeed, was more than willing to help me latch her again on the other side when there were not any nurses available (I was, unfortunately, not fully able to do it on my own as I had had to have a C-section due to my little princess being a breech baby, thus at that stage I was lying flat on my back waiting for feeling to return to my legs and somewhat dopey from medication to boot!). A nurse arrived a few minutes later to help and, after seeing that she was happily suckling away, remarked that I was “cute for a first time mom” and commended me and Nik for being such a good team. I was delighted that things were going so well! As the first few days rolled on, I decided that I had not given birth to a little girl, but rather to a hobbit – she needed to feed more than just breakfast, second breakfast, elevenses, lunch, afternoon tea, dinner and supper! Her blood sugar was good and her in-hospital weight loss was normal. The Monday following my discharge was our first outing – we were going to buy nursing bras! 

But my elation was cut a bit short when, upon visiting the paediatrician on the Tuesday, we discovered that Eliana had lost a little bit more weight than the accepted 10% of birth weight. We had needed to see the paediatrician earlier than the normal two week follow up as he needed to confirm that her hips were sufficiently stable because her breech position had resulted in her having hip dysplasia. He advised that I should continue to feed on demand and to give him a call if I needed drug-assistance to help boost my milk supply, but in the interim to ensure that I was eating and drinking properly (which I had not really been doing). I decided to increase the number of brewer’s yeast tablets I was taking and ensured that I ate my required number of meals along with at least two litres of water each day. I did, unfortunately, have to resort to using formula once during that week as there was a night when El sucked me dry and was still hungry. I fervently hoped that it would the first and last tin of formula we had to buy. 

We arrived for a weigh in at the paediatrician the following week… and my heart sank. While El had not lost any more weight, she had unfortunately not gained so much as 10 grams from her previous weigh-in. Sitting at 13% birth weight loss at two weeks, it was time to give her formula top ups and for me to take medication to try boost my supply and hopefully return to exclusive breast feeding. Her doctor asked for us to bring her back for another weigh in the following week. I contacted my antenatal class sister and asked for her advice for supply-boosting and she even went as far as to loan me both an electric and manual breast pump so that I could test each out before going to buy my own. Thus began the exhaustion induced by the prolactin-boosting drug along with stimulation pumping after each feed while my husband stepped in to give our daughter the formula. 

The next weigh-in brought relief – Eliana had gained 300 grams in one week and was just shy of her birth weight. Her doctor was pleased, but requested that we bring her in to be weighed again the following week just to be sure that her weight was on track. I let my antenatal sister know and she was pleased, but also concerned that the formula was doing most of the work so we set up a lactation consult which confirmed that in addition to a low milk supply, El was not latching completely. It had seemed to me as though she had had a good latch, but advice given by one of nurses in hospital was to push breast tissue away from baby’s nose to ensure it did not block her breathing, but all this resulted in doing was removing breast tissue from her latch, making it less effective and less stimulating. After correcting this, I hoped that together with the other methods I was using, my supply would increase sufficiently. I left the consult feeling more positive and went to buy my own breast pump.

Brewer’s yeast, ginger ale, at least 2 litres of water a day, metoclopramide, power pumping, sulpiride, rooibos tea, stimulation pumping, Similac Mom… I did it all. I contacted a Le Leche League leader and requested further advice when I started doubting the effectiveness of the sulpiride and was advised to try removing milk, even little bits, as often as possible to improve my body’s positive feedback mechanism to produce more milk. But I was still only managing to cumulatively pump out about 30ml of milk, even after power pumping. While I was aware that a baby is a more effective milk remover than a pump, I could not see that El was getting much more than that and, while sufficient for the first week of her life, 30ml was not enough to feed my growing baby.

I started seeing the formula tin as an enemy; a loathsome reminder that I could not provide nutrition for my daughter the way that nature intended. It was a reflection of the failure that I felt. I felt betrayed by my body – I had been open minded and waited to be sure that I could breastfeed and had then committed to breastfeeding only to be let down by my own body! The emotions were raw – I felt despair and shame, leaving me feeling very depressed. 

With no improvement in sight for the breast feeding and seeing my beautiful little girl growing healthily as a result of her ever-increasing formula top ups, I started wondering if the problem was one which could actually be overcome. I had heard the term “insufficient breast tissue” and decided that it was time to explore the possibility that, despite my hopes and intentions, exclusive breastfeeding was not going to be an option I could entertain. I knew that some women had this problem, but I also knew that simply having small breasts did not immediately mean that one did not have sufficient breast tissue – after all, my own grandmother had managed to breastfeed both my father and one uncle with breasts no larger than my own. I looked up the signs which may indicate breast hypoplasia:

· Widely spaced breasts
· Breast asymmetry
· Presence of stretch marks on the breasts in absence of breast growth (during puberty or pregnancy)
· Tubular breast shape (“empty sac” appearance)
· Disproportionately large or bulbous areolae
· Absence of breast changes in pregnancy, postpartum or both

Breast asymmetry, stretch marks, tubular breast shape and absence of breast changes during both pregnancy and postpartum – DING! DING! DING! I remember noticing a stretch mark on one of my breasts during the earlier stages of pregnancy and wondering if it meant that my breasts had grown, but I did not see much evidence to support this. As my pregnancy progressed, I did have to change my bra size, but only to increase the band and not the cup. My husband reported that they were slightly bigger, but I definitely did not get the “pregnancy boobs” that some women either love or hate. And I always felt that my breasts had somewhat of an empty sac appearance… thank goodness for padded bras! Suddenly things were making more sense and my six week visit to my gynae reiterated this possibility when I discussed it with her. She was cautious in her response, especially given that it is a difficult condition to determine as the glandular tissue can extend as far back as the armpits, meaning that even women with itty bitty titties such as myself are often able to successfully breastfeed. But she acknowledged that with the breast examination it did not feel like there was much breast tissue. I had been feeling exceptionally down about it at that point, to the extent that my doctor noticed and urged me to please contact her about a prescription for antidepressants if my mood did not improve, but I assured her that it was not an everyday occurrence. I cried a little bit in her office, she told me not to feel like I had failed, especially since it was not a matter of not trying but rather my body being uncooperative. I moped about it for the rest of the day; I needed to process it all emotionally. 

The next aspect to consider was whether or not to continue breastfeeding. My daughter was getting little more than an appetizer from me and receiving more than the bulk of her nutrition from the formula – was there any point? I contemplated it all and eventually decided that I would resign myself to being just that – an appetizer, a snack for my daughter. I was not and am still not quite ready to give it up completely. It may not be much, but I know that she gets precious antibodies and nutrients from me that formula cannot mimic. 

But now, like I felt prior to the birth of my daughter, I am firmly on the fence in the breastmilk versus formula debate. How can I be judgmental or biased against formula when it is the sole reason for my child's growth? Maybe there are mothers who decided to use formula without any consideration for breastfeeding, but who am I to question their decisions? It is easy to make assumptions and fall into a self-righteous trap, but before you judge a parent's decision to use formula, you should not discount the possibility that doing so might just be eating away at them inside. And even if the choice to use formula was made without any consideration for breast feeding, if the child is not your own you have no right to comment. I could not meet my daughter's needs so I had to do what was best for her even if it left me feeling heartbroken and like I had failed her.

The fate awaiting me as a formula-feeder from the nameless populous ready to judge me for it.

There are days when I wonder if there is much merit in continuing to breastfeed, if I should just reclaim my breasts and return to wearing normal bras while also eradicating the need to wear a bra at night? But for now I have chosen to persevere. I often hear about how every drop of breastmilk counts, so I am making the drops count. Is it making a huge difference for my daughter? I do not know, but I hope that it is. Does it make me less of a mom? Some days it does hit my confidence levels quite hard, especially when I see posts on Facebook by other breastfeeding moms wherein they complain about only getting out 100ml of milk after a pumping session! I often feel like telling them that they should be thankful that they can get out a full feed, even if it is less than what they are used to pumping out, but then I remind myself that people do not need my negativity – they need support when they are concerned, not someone telling them not to complain. Will I ever have to pack spare breast pads into the nappy bag when I go out? Highly doubtful, one pad can last me from day into night without even being slightly soggy! Do I need to justify giving my daughter formula to complete strangers on social media? Hell no! Am I doing the best that I can? I think so.