Moving away from all or nothing

Many excellent, well-informed doctors helped me take care of my mental health before, during and after my pregnancy, and I feel both grateful to them and proud that I have become such a good advocate for myself. My talent for advocacy came in particularly handy when it came to making decisions about how we would feed our baby, because I received so much conflicting advice that I once burst into tears at the idea of another doctor giving me more information. To be fair, I did a lot of planning before we even tried to get pregnant, because I depend on twice-weekly therapy, anti-anxiety meds and antidepressants in order to function as a human being. In other words, there were many people over many months with many opportunities to offer advice, information and opinions, solicited and unsolicited.

Here is a list of my decision, in chronological order, based on the advice of various “professionals” and “experts”–

  1. Exclusive breastfeeding.
  2. Exclusive bottlefeeding: formula.
  3. Exclusive bottlefeeding: donated breastmilk from a close friend.
  4. Exclusive bottlefeeding: the hospital’s donated breastmilk during our stay (lawyers refuse to allow us to bring our own, but the head nurse in postpartum recovery managed to get permission to get me access to the milk bank because the whole thing was patently absurd) followed by our friend’s donated milk when we got home.
  5. Short-term breastfeeding, followed by bottlefeeding: a team of midwives, nurses and lactation consultants meet to discuss the stupidity of the hospital’s liability fears dictating our choices about feeding our son and it occurs to someone that a few days of my colostrum might actually do more good than harm, for me, my baby and everyone’s stress levels.
  6. Breastfeeding and bottlefeeding, followed by exclusive breastfeeding, once we have established that our son and his tiny liver are doing ok with the medicine that is in my breastmilk.
  7. Breastfeeding with intermittent Dad-administered bottles of my own pumped milk or formula.

The point of it all, really, is that this combination of my milk, donated breastmilk and formula has worked really well for us. But a combination like that would never have occurred to me without all the expert help and opinions I had, and I don’t think that many mothers consider doing anything like what we have done. Shouldn’t it at least be an option? Why is it breastfeed or formula feed? And why does “bottlefeeding” always mean formula?

My midwives talked with nurses and lactation consultants, because I had so much anxiety about feeding my baby. That wonderful team directed me to a pediatrician who specializes in breastfeeding medicine, and it is she who changed my entire outlook. The psychiatrists who warned against breastfeeding on meds meant well, but they knew about adult-sized doses and side-effects. My first clue should have been that one of them actually said, “Lots of our generation, including me, had formula, and we are all fine!” Can I get an eye roll for that line? This was hardly the evidence-based reassurance I was used to getting from the same doctor who had once handed me a whole stack of pages of medical journal articles on pregnancy and psychiatric medications. The pediatrician who helped us, an actual expert in actually feeding actual babies told me that the nursing relationship only works well if everyone is relaxed and happy. This is why she was thrilled to tell me that I could breastfeed on my medicine with safety, as far as the evidence showed, and that we could use our freezer full of precious donor milk to give us peace of mind.

She also taught me to relax about breastfeeding before I gave birth, because in her experience, a mother/infant pair can learn to breastfeed even if (heaven help us!) an infant should have a bottle or pacifier early in his life. That came in really handy when my son was born with a tongue tie that the hospital staff failed to notice. He could not, would not latch. The nurses fretted. I pumped colostrum and tried to stay calm, but it wasn’t until our breastfeeding expert clipped that tongue tie that we could nurse comfortably. In the meantime, we were happy to feed him from a syringe or a bottle, and we loved seeing his grandparents participate.

For the first three months of his life, my son had bottles of donor milk, and he breastfed, every day. I pumped for the ounces he drank to keep up my supply. By the time we ran out of donor milk, we were thrilled to see that he was showing no sign of any side effect from the medication in my milk. Unfortunately, he quickly began cluster feeding for hours right around the time I was getting used to exclusively breastfeeding. I had no time to pump for bottles; he was always nursing. After a night during which he nursed from 11 pm to 4:00 am, stopping only to switch sides or scream while his diaper was changed, I arrived at my therapist’s office in despair. I can’t manage my anxiety without sleep. Every doctor had told me that without at least a four-hours-in-a-row chunk of sleep every night, my mental health would suffer. My therapist asked about formula. I cried about how hard I had worked to feed my son only breastmilk. Then, I thought about sleeping, and bought formula immediately after leaving my therapist’s office.

I ask my husband to give our son a bottle when I’m feeling very anxious or stressed, or when I would just like a break, or when I would like to finish what I am writing. When I need to sleep or recover from a migraine, all I need to worry about is keeping myself comfortable, because I know that our son will be fine with the loved ones who care for him and feed him. Usually, I find that breastfeeding strengthens my bond with my son, that we both enjoy it and, for us, it’s extremely convenient. I also find that my anxiety and depression are much easier to manage when I have had enough sleep. My husband and I both get at least one break, every day, when we are “off-duty” and responsible for none of the parenting. When it’s my turn, that often means a bottle of formula. I am still trying to figure out why so very many people get so very upset about that. I honestly do not understand.

Mom, Dad and Baby are happier with the way our family does feedings. That short-lived experiment with “EBF” was absolutely miserable for me. It was a huge moment for me when that switch in my head flipped from “breastmilk or formula” to “do whatever it takes to be healthy and happy,” because I stopped believing that I could sacrifice my mental health for my child. All three of us suffered when I made myself a martyr.

Everything we learned about feeding babies along our rather strange journey has helped my husband and I in other areas of our relationship and family life. We check in with each other and stay creative in how we try to balance the trickier parts of this child-raising business. Sometimes, that means that one of us takes on responsibilities that may be uncomfortable so that the person who is ill or exhausted can try to get from “miserable” to “uncomfortable. A few bottles of formula have not transformed us into people who are happy all the time. But our approach to feeding our son has made us more creative problem-solvers, and that has definitely made us happier.

You can read more from Anne Marie on her blog, Do Not Faint, where she tackles issues on pregnancy, motherhood and mental health.  It’s brilliant.

For more information on donor breast milk, you can visit Human Milk for Human Babies, a wonderful informal milk sharing network.

A spare arm

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Let me begin.  Bump number one… Born after an easy-ish induction but a lowsy end to my pregnancy as I had chronic itching and no sleep for 6 weeks due to Intrahepatic Cholestasis of Pregnancy.  I weighed 5 kilos less then when I signed up for midwifery care.  Bump arrived and promptly had a fit and was sent to NICU where they had no chairs (hard to BF there). Oh and he had no suck reflex, so “had to be bottle fed”.

I got the ‘baby blues’ when the milk came in which no one had said would include visual and aural hallucinations, palpatations, and further total insomnia.  Scared the living poop out of me as I truely and genuinely felt that Daddy would have to take Bump home alone and leave me in a padded cell.

Thus began our breast-feeding journey.  Milk arrived in what seemed like an abundance but would not leave my body.  My brain chaos thought that the habit Bump had of rolling his eyes whilst bottle-feeding was his judgement of me poisoning him with evil formula.  Every time he screamed and forced my nipple out of his mouth felt like a physical rejection.  And I thought PMT was scary.

We eventually got latched once at home but really the fight was lost.  I was making 10-20ml of milk each pumping session which doubled on Domperidone.  There was one splendid feed where he had everything I pumped over 24 hours and it satifsfied him.

Once my milk had gone, at about 4 weeks or so, I wrote down some 50 reasons to bottle feed (and there are some very good reasons) and bought myself some beautiful matching underwear.

We’d always wanted two children so I read and researched the possible causes of my low milk production but, as no doctor wanted to do any tests (prolactin, blood sugar, metabolism…) then I was working blind.  I decided that, given no information, to decide that it had been purely due to the stress and lack of feeding from my breast, i.e. it would be fine next time if I obeyed the rules.

Bump 2 is twelve weeks now and we’ve had a journey too.  Terrible pregnancy (same itching problem for about 20 weeks plus hypertension, severe anaemia and diabetes), marvellous induction, calm start. Ignored the fact that I’d had no breast development.  I put her to my breast every time she cried and she latched with a mighty suck.  She latched almost continuously for the three days in hospital, by which point milk had arrived (and the second batch of hormonal crazies had ended).

We had about a week of a happy, settled child between feeds but then feeds became longer and closer together until at about three weeks we were spending (no word of a lie) about 90% of the day joined.  Not easy with a four-year-old too.  Oh, and she didn’t poo.  Nothing yellow and grainy for weeks, she was yellow though and wasn’t getting any better.  She was gaining weight but so slowly, and, to be fair, it was probably all poo.

So people said “top her up!” and I said “NO! Its against the rules!”. I had faith that the hard work would end and life would get better.  I rested, fed lying down, pumped the other breast whilst feeding, drank litres, went on a very low GI diet, thought about waterfalls and fed and fed.  Well, we found that another week went by and there was no change.  I seem to make very low levels of prolactin.

At three and a half weeks I had to admit defeat as all of the world said to give her a bottle of formula if she didn’t settle after feeds even whilst taking Domperidone again.  Pleasingly, she looked disgusted with formula on every occasion for about a week and because we did so much breastfeeding she doesn’t seem to have had any nipple confusion.

Gratefully I’ve not got the strong feelings of grief at the lack of milk that I had last time.  I know that might sound dramatic especially as nothing awful happened but I’d been indoctrinated to think that hard-work was all you needed to succeed.  This child got all the hard-work and a much wiser lactator and it still didn’t work.  Somehow that’s easier to take.

Nine weeks on and I have made peace with things a little more.  Somehow I’d made failing my fault and resented the plastic bottles I had to wash and sterilise, but now, knowing that I’d given it the best chance and it still didn’t work, I’m a bit happier.

We are, for the moment, mixed feeding.  If I don’t take double rations of Domperidone (about 8mg per day) then baby rapidly loses interest in feeding.  She’s having seven or eight feeds a day (twenty minutes BF before a 4oz bottle) and from what remains in the bottle, I guess she’s having 1-2oz from me per feed.  Given the situation, I’m really glad to have got this far.

However, not always having the spare arm that breastfeeding gives you is chuffing annoying.