Book Club Discussion # 2: Who should intervene when women have trouble breastfeeding?

In this post, I include an excerpt from my forthcoming book, “Becoming Mother: A Journey of Identity,” (coming in August 2015) followed by commentary. I intend this post to be a springboard for a book-club-like discussion, so feel free to contribute!

From the chapter entitled, “Feeding”:

“So…” the pediatrician looks at the computer screen before she turns back to me. “Your daughter has lost eleven percent of her body weight in four days. That’s cause for concern,” she nods as she says this.

I am so relieved. I’m not crazy. I knew that she was hungry. I’m not crazy.

“Do you have any idea how much milk you’re producing?” she asks.

I shake my head. “We’ve just been trying to keep our heads above water, so I haven’t even tried pumping.”

“Okay… okay.” She is quiet for a moment. “Have you tried hand expressing any milk?”

“The lactation consultant said that I have flat and inverted nipples, so that’s why I wasn’t able to do that.”

“Okay… So I’d go ahead and try pumping just to get an idea of what you’re producing. It’s not going to be as much as what your baby can pull out, but it will do a few things. It will give you an idea of what you’re producing. It will give you a break from these marathon nursing sessions. And it will keep stimulating milk production.”

She stands up to examine Felicity. She looks into her eyes and feels her belly. “She’s pretty jaundiced, too. We’ll need to follow up on that.”

“Can I ask a question about me?”

She turns to look at me. “I’ve gained eleven pounds of fluid, and it’s all in my legs. And I can’t sleep. I keep trying to go to sleep between feedings, and I just can’t. I’m afraid that if this continues, it’s going to affect my milk coming in.”

“Okay, so that’s something that I’d talk with your OB about.”

Oh, wonderful, I think. Her.

“Great. She’s in Italy,” I say.

“Oh… She’s in a practice by herself?”

“Yeah.”

“Maybe the nurses there, then… But really your OB should be the one to consult about those kinds of issues.”

It seems strange to me how we’re talking about all of these issues: Felicity’s weight loss, my lack of sleep and fluid retention, and my milk production. It’s all related, but the pediatrician is responsible for addressing Felicity’s weight loss, not any issues with me. But the issues with me are causing Felicity’s weight loss. It seems to me that someone—I don’t know who—should be treating this problem holistically. This is the time and place where I need someone to help me first so that I can help Felicity. I thought maybe this doctor—my family doctor—would be able to help. After all, she’s also Felicity’s pediatrician. But perhaps there are some legal issues here to consider? Who knows.

“So because of her rapid weight loss,” the doctor explains, “she really needs to have formula as a supplement until your milk comes in.”

There it is. All the on-line breastfeeding forums have cautioned me about this: the dreaded supplementation discussion at the first visit to the pediatrician. But I gather all of their dire warnings about supplementing in the first week and throw them to the wind. I’ll do what I need to do in this moment—regardless of the shame that I know will befall me.

The doctor pulls a starter kit of formula from a cabinet and opens the box. She unscrews the cap of a premade bottle. For a moment, I cringe. But when my doctor hands it to me, I take it. I push aside all my thoughts about the most natural option being the best decision in this moment. Today, living off something synthetic is better than dying from the lack of something natural.

I nestle the nipple of the bottle between Felicity’s lips and she starts guzzling. Her eyes flip open in surprise.

“You want to give her breaks, every half ounce or so,” the doctor advises. “She needs some time for her stomach to realize how much she’s eaten. If you let her eat too quickly, it could come straight back up.”

“So… I should just take it away and check every now and then?”

“Yeah, until you get the hang of it.”

The bottle has useful measurement marks to keep track of how much Felicity has eaten. I pull the bottle away after every half of an ounce. Then, I burp her, and we resume the feeding. Once Felicity has finished the bottle, she is fast asleep in my arms.

“Thank you,” I say. “Just… um…” I shake my head, the heat of my tears stinging as they rise. “This means a lot.” I wish there were stronger words than thank you, but I’m too emotional to find them.

Author Commentary

Even as I share this excerpt, I know that there are plenty of mothers who had a similar experience at their child’s first pediatrician visit. What I write about here is hotly debated among mothers–to supplement or not to supplement?

There are plenty of women who can share an experience of their milk fully coming in after the first pediatrician’s visit–and then feeling like the doctors suggested supplementing too soon. And if they did supplement in the first days of life and suffered from low milk supply later on, they may blame themselves for not having faith in their bodies to do the job. Or they may blame the doctors for not trusting in the strength of women’s bodies.

In my case, I wouldn’t realize until six months postpartum that–while at was at that first visit to the pediatrician–my body was experiencing postpartum thyroiditis. This condition caused me to make about 10% of the amount of breast milk that my daughter needed to survive every day. But I didn’t know this. I could have chosen to say, “No, I’ll keep exclusively nursing.”

But I didn’t. Something just didn’t feel right. Maybe it was the way my daughter looked as she strained and strained to eat, as if trying to draw water from a rock.

Before becoming a mother, I was never one to really trust my intuition. I relied mostly on facts, observations, and research to make decisions. But something shifted in those first days of motherhood and I couldn’t ignore what my intuition was telling me.

We could get tangled up in this messy web of whether or not to supplement while nursing, but I think there is a much bigger question that goes undiscussed far too often when we talk about breastfeeding troubles.

Who should be responsible for intervening when a mother has trouble breastfeeding? 

Right now in the United States, the pediatrician is the first medical professional that a new mother and baby typically encounter after they are discharged from the hospital. But as you can see from the excerpt above, pediatricians don’t always frame their advice and suggestions based on the assumption that the mother and baby are still one unit. They are thinking about the baby–not the mother. But this neglects the fact that the new mother and baby are still so integrally tied to each other in those first few weeks. They still exist in symbiosis. What affects the baby affects the mother–and what affects the mother affects the baby.

After the first pediatrician visit, mothers typically shoulder the responsibility for seeking out help if they are experiencing problems with breastfeeding. They might call a lactation consultant (if their insurance covers the expense.) But lactation consultants (LC) can offer wildly different advice–which leads mothers to calling LC after LC after LC.

So here’s a broad question that I’ll just put out there for you to think about and respond as you feel fit:

What kind of support system do mothers need when they are experiencing troubles with breastfeeding? Who should be involved? And how should they help?

I look forward to hearing from you!

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