Feed me: the impact of a mother's choice to breastfeed. Or not.

I keep putting off writing until I've done more research, read the pile of books I just bought or I have an uninterrupted hour or two. But that's not very likely to happen soon, so the thoughts are only to keep me from doing and, therefore, failing. I just need to keep going, and bash out a bit more writing or my confidence will shrivel up and this will be a thing I once tried to do. Also, even with a year's more research I won't be close to being an expert, and that isn't what I'm trying to be anyway. I'm a supportive lay-person, someone who knows how to get the information you need, someone who cares about you and is your advocate. If I stick to being that person, and not worrying about trying to represent every scientific theory and every person in a couple of paragraphs, we should be OK. 

So here we are, I have fought through the self defeating procrastination and I'm now faced with the you're-rubbish mind-demons (that just autocorrected to Desmond, maybe he's the chump chatting shit about me in my head? Eff off Des). 

I want to talk about feeding babies. More specifically about how mothers want to feed their babies. How they want to feed them but don't. Lets be clear; I am one person with a very limited experience and a 5 month backlog of sleep debt. If I say something that sounds like I'm being cruel or judgmental - I might have phrased myself badly. I want to support you in your choices and to help you feel better for making them. Maybe one day I can be part of making those choices better too. 

I don't want to be misunderstood, but I fear I might be, just because there are so many well-worn paths of discourse around feeding babies. What I want to say is slightly different to what I have read/talked about to others before, but I can't be the only one to think it. I want to see if my view resonates with anyone - or if it is incorrect and hampered by privilege and a sheltered ignorance.  I suppose the two are not mutually exclusive.

I am not talking about the mothers who want to feed with formula, I am not talking about the women who cannot breastfeed. I am talking about the mothers who want to breastfeed and would do so for longer if they were given adequate support, and the ones who would start if given more information. 

The pile of conversations with strangers, relatives, friends, acquaintances - initiated by them - about how I would feed my baby is what has triggered this post.  Strangers would ask me when they had confirmed that I was pregnant, "so, are you planning to feed him yourself?". A question that baffled me the first time (why would I not be the one to feed him?) and, once I understood, (ohh, feed him WITH myself), thought it a weird question. Why did they care? And why was it phrased with such a negative bias towards formula feeding. I had a line for people that asked; that I knew I might not be able to breastfeed, but I would be kind to myself and do the right thing for our baby if that happened. I didn't really know what 'not being able to' meant, I just knew people said it and had read the term low supply, heard people talking about hungry babies. I also knew that if I was one of those women with one of those babies - low supply, bad latch, tongue-tie, etc. - I would be devastated. Specifically, conversations with four mothers come to mind and made me want to write this.

The first is a new mother who I met up with again when my son was around 3 months old. She was impressed that I was still feeding and told me, with a tone of admitting doing something wrong, that she had wanted to carry on longer but had felt that her baby wasn't getting enough from her. She said her mum kept saying "oh is she hungry again" multiple times a day and suggested that she should combination feed. When I had seen her when her baby was around 3 months old, she had told me she had low supply and had a hungry baby so had needed to supplement. This woman is strong, a force and wonderfully open. I felt a bit awkward during the conversation. I replied with lots of, "it doesn't matter how long you fed for", "she is such a gorgeous kid, you obviously did the right thing for you both" statements, which I felt was true. However, when you've made different choices I feel like saying those things can seem shallow and false (however much I really did mean it). More importantly to me, I didn't want to minimize what she was saying and feeling. 

The second is a mother with a 20 something year old who I saw when my son was a month or so. She was clearly agitated that I was feeding the baby so frequently and before she had left had told me that I should just try to give him formula; "if he takes it, you'll know he is hungry". This is what her health visitor had told her. She did not explicitly say so, but this suggestion and her comments about my baby's small size (he was and has always been between 9th and 25th percentile), led me to think that she was worried about his health and my parenting. This woman is eminently sensible, what you might call no-nonsense.  The advice hit me on a day when I was feeling pretty low and it chimed with my own (fairly common and normal, I now understand) doubts and worries.

The third is a mother with a 35 year old who I see now and again for a casual nice-day-isn't-it when walking the dog. When I was pregnant she would engage me in conversations about how cabbages were good to stop your milk, and how it was OK to stop breastfeeding as she had not been able to do it for long. On meeting the baby at around 3 weeks, she asked if I was still breastfeeding and how it was going, reminding me that I didn't need to carry on. Perhaps I had given a I'm-not-coping vibe when replying with "its great, tiring, but he's doing really well". I had a lot of these little interactions along exactly the same lines. Each time I felt like it was another little push towards switching to formula. What I heard in my heart was that they thought I was making the wrong choice and they were trying to dissuade me. It is a fine line between providing someone with options and sharing your story to show it is OK to feel that way, while not making one of the options looks more acceptable or your story look like the right way. 

The fourth mother has three 30 something year old daughters and on lots of our frequent meetings she asked me if I was going to breastfeed and when I told her I was going to try, she would say a variation on, "well I couldn't do it, but my girls turned out OK didn't they?". She told me a couple of times that the best thing to do for some sleep is to give extra formula just before bed to keep them nice and full, and that this had worked on all her girls, who had slept through the night from 4 weeks old in their own cots. (I had various unsolicited advice on this, putting a crumbled rusk into a bottle of formula, adding an extra spoonful so it is thicker, etc.). Since meeting my son, she has asked when I will switch to formula and about his weight gain multiple times. It may be my motherly paranoia, but I'm sure she is concerned and nervous about him not getting enough from breastfeeding alone. When asked, I tell her he is generally sleeping well, only waking a few times a night and I'm met with a tut and frown. The recommendations of formula come out again and I end up wondering if maybe I am doing something wrong. 

My final anecdote for this collection is about my baby's first feed. I had an emergency cesarean section, after which I had 30 minutes of skin to skin, round my neck, in the theater while they sewed me up, and then 30 minutes of skin to skin in the recovery room, where I was able to bring him to the breast. In the recovery room it was discovered that I had a high temperature and therefore I, and baby-no-name potentially had an infection and had to go to the NICU immediately. The part of that I want to explore today is that after another 30 minutes I was told by an NICU nurse that they had to feed the baby. I asked to be allowed to collect colostrum to give him, and after being moved to a ward, my husband and I proceeded with collecting colostrum in a syringe. The NICU nurse came back to ask to feed the baby again about 20-30 minutes later, by which point we had collected 0.5 mil. We were told he would be fed with formula and asked what type we wanted, I don't remember now which ones were offered. I asked what the differences were and was told that it was just down to personal preference, so I picked one I'd heard of essentially at random. I felt pushed into doing something I didn't want to do. I didn't understand why he was hungry when I thought babies only needed a tiny bit of colostrum at first. I felt dazed, scared and out of control. Something that I had been lucky not to feel very much throughout the labour. 

There is nothing particularly remarkable about these stories, but I think they are systemic of our injured antenatal and maternity care services. The immense vulnerability of birth opens us to particular trauma in labour and the months after. Then the tidal wave of hormones and varying degrees of sleep deprivation increase the likelihood of new parents being open to emotional triggers or new traumas. And perhaps there are echoes of our own powerless cries as infants, as we nurse and pace and sing and rock to comfort our child, to try to fix and soothe them. 

I don't think anyone is in any doubt - having a baby (in any way, biologically or otherwise) is emotionally charged. So I suppose the ways in which we care for them and keep them alive will also be fraught with emotion; worry, guilt, shame, pride...

When pregnant, my reasons for breastfeeding were: that's what my breasts are for, it is easier than preparing bottles, it is cheaper than formula, my baby is human (not a cow) so presumably my milk will be better for him, I believe that my antibodies will protect him from some illness, I want to comfort him in times of stress or unhappiness. I also wanted to prove to myself that I could do it, out of some self-enforced female-membership requirement. This latter point is an odd machismo that I haven't been able to shake yet.  

So here comes the controversy. In one of many conversations with my husband, I said, "I don't judge anyone else on how they want to feed their baby but, why don't they want to breastfeed if it's better?". He immediately called me out on my obvious hypocrisy. I was judging people, I was making a judgement that one way is better than the other and that their reasons for doing something else were not good enough. My feelings and thoughts are more complicated now, but to some degree I still feel this way now after 5 months breastfeeding and all the difficult realities that go with it. I am not denying that it is intense, physically draining, isolating, painful. I still think people should do it, for all the reasons I said before. 

I have wrestled with this thought a lot. I am always supportive of other choices if the conversation comes up (as it frequently does), but a part of me wants to ask questions about why; I always want to delve past the polite chat about how its hard and fed is best. I want to ask people that say they breastfed for a week but it was too hard, what support did you have? I have always held back; it's plain rude, I don't know their personal circumstances and their children are FINE. They are healthy, happy, beautiful children so why does it matter so much to me? But somehow it does, and it keeps on flicking up in my thoughts and nagging at me. 

And now, having researched a little longer and lived through it, my issue seems two pronged.

  1. My knee-jerk reaction that if you have a choice you should choose to breastfeed because I think it's better and

  2. I think that mothers are inadequately supported in making and maintaining that decision.

Stay with me, don't be cross just yet? Let me do some dodgy maths a second here to show you what my judgey brain was trying to figure out...

There are 700,000 births a year in the UK, and prevailing wisdom is that 1% of women cannot breastfeed due to a physical issue like milk supply, which would be 7000 women per year. There are 65 million people in the UK and 1.5 million people living in Kent (where I live, and come across other mothers), 2.3% of the total population. 2.3% of 700,000 is 16,100 births in Kent, 1% of 16,100 is 161.

161 should be the approximate number of women in Kent that have given birth in the last year and have a physiological reason for not being able to breastfeed.

I have met more than 50 mothers, with babies under 1, at groups and sessions in the last 5 months, so you would think that I might have come across one mother (0.5 people being 1% of 50) who is formula feeding due to physical reasons. And even then, I may not have spoken to her about that, or she might not have shared that with me.

So, says my brain, most of people (so far I've counted between 15 and 20) who have talked about having too low a milk supply to keep their babies fed must have been wrong, misdiagnosed or feeling ashamed about stopping right?

I am cringing writing this - I can hear you all thinking, "can I have some evidence please?" and "it's none of your business if they could or couldn't" and maybe "no wonder they didn't tell you if you are this judgmental...". It's either you, or Des is at it again. But I'll try and get to my point.. 

1) Is the 1% number I've seen in antenatal / breastfeeding literature utter bollocks? The only studies I've found talk about 15% of women struggling, with 4% having chronically low supply. Statistics are dangerous. People like me cling to numbers and ignore the facts, the skew, the story. If 1% is false, why?

2) Why are so many mothers that talk about formula feeding, with the little head dip and shoulder shrug that says "I know, but I'm trying my best", ashamed at all? Do they wish they could have carried on and feel a loss? Do they just feel judgement from belligerent breastfeeding activists and aren't sure they are doing the right thing? (Who is though really?)

3) Do people have enough physical and mental support to breastfeed? I think (and we have established that my thoughts are based on not very much except my experience and a couple of books), that breastfeeding takes quite a lot of physical support to keep you going. I think it is quite physically draining, and if you are cutting calories, not staying hydrated, and not getting enough sleep (lol, right?), it will have an effect on your supply. If you are sitting or lying feeding your baby every 20 to 40 minutes for 8 weeks or so, as I was, then you can feel pretty isolated and it is hard to look after yourself and feel well enough to continue. 

I have been incredibly well supported by my husband, mother and the NHS. In the first two weeks I had my husband at home bringing me all my meals and keeping my water bottle filled. He brought me my medication so I didn't forget, he injected me with anti-coagulant after my C-section. He would take the baby and dog for an hour long walk on Saturday mornings so I could sleep. He asked me if I needed to get help when I was crying with painful feeds. I snacked like there was an impending snack crisis. He stayed home for two weeks after the birth, then my mum arrived for a week. She fed me and made me nap. She cleaned the kitchen and bathrooms and walked the dog. She drove me to clinic to get the baby weighed - you know that bit when you are just sweating trying to get the baby out of theirs clothes as professionally as possible with no crying, suddenly I would forget how to get his arms out of a baby grow?!

I had various levels of support and information from the NHS - midwives, NICU nurses, health visitor, GP. One particular NICU nurse was completely wonderful and said exactly the right thing when I needed it. Most professionals effectively told me to keep breastfeeding and that it would get easier. If I told them that I was worried he was getting enough milk, they reassured me and said it was all OK and he was good. One problem I found, was that lots of professionals told me that if there was pain then something was wrong. I don't think this is true. It wasn't true for me. My baby's "perfect" latch (as claimed by multiple midwives and a health visitor) bloody hurt (like, made me cry hurt) for weeks. As a good friend said to me, "if someone sucked your toe for 20 hours out of 24 it would get a bit sore wouldn't it". 

We aren't perfect by a long stretch, but I think I was in a very privileged position. 

In conclusion, our breastfeeding journeys are all as different and as similar and as complex as we are. A lot of women choose not to breastfeed, and other choose to do it, but some seem to have their choices taken away. This is a point of social justice for me. Women have the right, for example: to move in labour, to choose to be examined or not, to breastfeed or not. A new mother deciding to breastfeed needs to be supported in order for it to be successful. It is not enough to tick a box and it is not acceptable to try to encourage her not to, however well meaning. The women who've had their choices quashed, who were not "allowed" to breastfeed, are feeling that loss decades later. To have our autonomy taken away, our motherly purpose in a way, can be traumatic in the right circumstances. If we speak out about our choices to one another, if we listen without judgement and share without shame, then we have an opportunity to find out how a person actually wants to be supported and to hold each other in right way. 

These thoughts were some of the triggers for encouraging me to make the leap to my doula training.  If I could be there and mother the women the way I was mothered, then maybe they will get the chance to breastfeed longer if they want to. Maybe I can help start taking some of the shame out of this and healing some of the hurt that has been done in previous generations. I hope that I will never be guilty of assuming what someone needs, but instead listen to their thoughts and choices before supporting them in those.