How Formula and Fear Ended My First Breastfeeding Journey

The year was 1997, and I entered the hospital where I was planning to birth my first baby. I had read all the books, taken the classes and prepared to the best of my ability for my impending birth. My rolling luggage contained all the supplies recommended by the Lamaze teacher and close friends. I had a well-thought out Birth Plan. In all honesty, my entire plan consisted of avoiding medications and birthing a baby. I assumed that the hospital staff would fill in any blanks I had forgotten to complete. My "water broke" at home, so the hospital policy stressed the importance of remaining in bed to avoid "severe infection." Since we had not discussed this in prenatal classes, I deferred to the attending nurse.

The contractions were as regular as the hands on a clock, which caused the staff to predict a "fast labor." The nurse approached me and explained that the labor could and should be hastened, so I could deliver my baby before the day was out. I excitedly agreed--not comprehending that I was consenting to Pitocin administration. Almost immediately, I was consumed with incredible pain and fear. My body was reacting in a way that seemed uncontrolled or understood by my mind. I was still trying to focus, but was not as successful as I had been the previous hours.

Again, I was approached with an option of "lessening the pain" and "taking the edge off." The nurse offered a visit from the anesthesiologist who would happily provide the epidural--resulting in a "pain free birth." I declined, not because I did not want the relief, but because I had predetermined my pain management goals.

A few hours of intense labor and my son joined us earth-side. I was holding my perfect little baby and, for a time, everything was well in my world. I cuddled and stared in awe until we slept. I felt completely as ease while my baby and I synchronized our breaths and adjusted to our surroundings.

The shattering news was delivered only a few, short hours later. A new nurse (who replaced my kind, supportive day nurse) brought the discovery to my attention. She entered my room and abruptly stated that my son was jaundiced! I looked at her in confusion because we had not discussed this diagnosis in my prenatal classes. I asked if he would be all right. She said that his numbers were at eleven and he needed formula. She also stated that since my seven pound baby was very large, formula was a necessity. I reluctantly explained that I desired to breastfeed. Her quick, rehearsed response was, "Do you want this baby to live, or do you want to breastfeed?" What a terrifying question to be presented with just hours postpartum. What is jaundice? Why is my baby's weight an issue? There were no explanations, just fear and accusations. I immediately consented to formula--considering the alternative that was provided.   I was extremely vigilant in offering a bottle, along with breastmilk for every feed, until I left the hospital. The following day, I was applauded for my baby's progress, which the nurse attributed to the formula. She discharged me with several containers of formula and admonished me to continue feeding formula to safeguard against tragic results.

I took my bundle of joy and bundle of formula and left the hospital. I religiously offered a bottle of formula several times a day to prevent whatever condition would develop without it. I was too afraid of putting my baby at risk to exclusively breastfeed. I never spoke of my breastfeeding journey with friends. I was too embarrassed about them knowing I almost put my baby's life in danger by my "selfish" desire to breastfeed.

My six week check up resulted in more congratulatory remarks about my baby's development. When asked about feeding, I responded with a pro-formula remark since I understood there was a "danger" associated with exclusive breastfeeding. My schedule of formula feeding was positively reinforced and I conceded that my pediatrician was favorable of formula feeding.

At six weeks, when my baby experienced "frequency days," I was convinced that my milk was insufficient to satisfy my baby. I increased the amount of formula, not realizing that in doing so, I was signaling my body to actually slow milk production. By now the free samples had disappeared and I was investing hundreds of dollars into a breastmilk substitute. I read all the propaganda and purchased the most attractive cans that touted a closeness to breastmilk. Once again, my ignorance won out. I invested in a product that was trying its best to mimic the fluid I had in abundance.



My breastfeeding journey ended so much sooner than I desired. I had a personal goal of nourishing my outside of the womb just as I had for nine months. No one questioned how my body could grow a baby for forty weeks. No one questioned if I was providing adequate nutrition in utero. No one questioned how my body sustained life, but outside of the womb, apparently, my body failed miserably at the task. I questioned everything about my parenting choices. I felt like a failure because I was pronounced a failure. Perception is reality.

My second child made her debut twenty-two months later--at a Baby Friendly designated hospital. My labor plan was supported and within a few hours, I held my daughter skin-to-skin and was breastfeeding. I was prepared to defend my choice this time. I had researched the AAP jaundice guidelines and realized that jaundice was a common condition due to extra red blood cells and I understood what numbers would constitute a legitimate concern. I was ready to confront the fear--but the fear never came. I also anticipated being judged for "giving only breastmilk" to my large baby. After all, she was about the same size as her brother at birth. The judgement never came. My little girl was weighed, her diapers were counted and I was encouraged to "keep up the good work." The following day, an IBCLC visited me to ask how breastfeeding felt and if I was experiencing any pain. She requested that I allow her to observe a feeding session. My little girl latched, sucked and fed for several minutes. The session was used to educate me on signs of milk transfer and recognizing swallows.

The following day, I left the hospital with my bundle of joy and bundle of confidence. I was equipped with knowledge and confidence. I knew my body was capable of nourishing my baby. I knew I could provide milk for my offspring just as every mammal does. I was not going to be bullied or scared into making a choice that I did not agree with. I was older, bolder and more educated.

The combination of advocating for myself and a hospital that supported breastfeeding made my dreams a reality. Breastfeeding continued until her first birthday--and a breastfeeding advocate was born.

My third child presented some feeding challenges. We worked through issues with an IBCLC and each problem I encountered was resolved with a solution that allowed me to continue my breastfeeding relationship. When the issue of jaundice surfaced this time, I supplemented for twenty-four hours with my own expressed breastmilk. I was surprised that this little girl trumped her brother in size. Her birth weight prompted the nurse to advice breastfeeding "every chance I got." A quote that was not followed up with any severe warnings or fear mongering. My hospital stay consisted of small snacks, skin-to-skin holds and frequent feeding. My baby and I were only separated when I showered (at which time she transferred from my chest to her father's). I could not help but contrast this scenario with my first birth. I wondered what that event would have looked like had I been knowledgeable and supported.

Yes, hindsight it 50-50, but I hope foresight can be as well. We have come a long way in our birth and breastfeeding practices. The Baby Friendly Hospital Initiative has laid some great ground-work and provided a foundation for providing in-hospital breastfeeding support. The initiatives, protocols, policies--all aided by skilled and educated health professionals are helping to bring instinct and the biological norms back into the highly medicated and routinely intrusive process of hospital birth.

For those who find themselves where I was as a first-time mom, let me offer you the information and support I so desperately needed. First, you need to know you are amazing. You are, after all, capable of making a person! Your body is a super-factory that is able to create the most intricate life form known. Simultaneously, your body is preparing the perfect nourishment for its creation. What a spectacular system you are equipped with.

Secondly, know that you will face adversaries in your quest to breastfeed. There are people who have made a point to question your ability. I am both saddened and angered that instead of celebrating the power and strength of a woman, some choose to undermine and minimize the uniqueness of our gender. I suppose there are many reasons for the skepticism. Some sabotage breastfeeding for a profit, some out of ignorance and a few from habit. Old wives' tales are difficult to shake.

Here are a few reassuring points you need to commit to memory.

1. Your baby is not born "starving." Although food is often withheld from the laboring woman, the baby's access to nourishment is not interrupted in the womb.
2. Baby's are not born with an "empty" stomach. There is research on how much fluid a baby's empty stomach can hold and malicious people are using that information to question a woman's ability to satisfy her newborn. Remember, baby's gauge is not on "empty" at birth.
3. Mammals have milk for their offspring and instinctively nurse. Visit any zoo, wild animal park, pet store, etc. and ask to see the resident "lactation consultant." You will be met with blank stares and confusion. Mammals have been feeding their newborns for generations.
4. Babies have very tiny tummies. They are born with a desire to suck and suck they will. The more frequently the better. Because the suck reflex exists, if a baby is placed on the breast, he will often begin feeding spontaneously. The baby that is fed frequently, will be satisfied and signal (through hormones and biology) for the mother's breasts to make more milk. 
5. Moms have thick, rich milk the first few days that is full of protective factors and concentrated nutrients. This milk also has a mild laxative effect that encourages the expelling of meconium and reduces the risk of jaundice.
6. Since babies have tiny tummies and moms have small amounts of colostrum, the baby can eat constantly and not get overfed.  In fact, when the baby is satisfied, the suck will change from active eating to pacifying--another way a newborn instinctively stops himself from eating to the point of discomfort. 
7. The best way to make milk is by removing milk. Early, frequent feeds is the key. If a mom and baby are separated at birth, mom should remove milk manually or with a pump within six hours of delivery.
8. For full-term, healthy newborns, breastmilk intake is not measured. It is preferred to allow mom and baby and partner time to recover and bond. Measuring intake is not necessary since there are more favorable ways to ensure milk transfer.
9. Babies should have one wet diaper for every twenty-four hours of life until around day six, when they will begin having 8-10 wet diapers daily. 
10. Initial weight loss is common. Babies should return to birth weight by two weeks of age. It is important to get a good weight at discharge or the first week of life to make certain baby is gaining weight. 

Christy Jo Hendricks, IBCLC, invented the Lactation Lanyard to remind mothers that their milk supply is the standard for feeding, NOT the formula bottles.

The first few days after delivery is mostly about bonding, recovery and feeding. Most women who can birth can also breastfeed. It is the way a mammals body works. There are conditions (like the ones I had after delivering my third child) that require intervention and support.

Warning signs can include:

• No, or little diaper output
• Discontent, inconsolable infant
• Continued weight loss
• Signs of dehydration
• High billirubin
• Constant feeding without satisfaction

The breastfeeding mother may show warning signs:

• Little or no change in her breasts during pregnancy
• Breasts that do not feel softer after a feeding
• Pain while breastfeeding
• Diagnosis of retained placenta

The above is not an exhaustive list nor is it a list of reasons to abandon the breastfeeding path. These are, however, a few reasons to involve an IBCLC in your journey. Occasionally, temporary supplementation is necessary or even long-term supplementation, but a lactation professional can advise you on how much more milk is needed and what kind of supplementation is available.

Data shows that most moms want to breastfeed. Who are we to downplay their desires. We should do all we can to support the goals of women in our society, who, after all, are creating society. To effortlessly dismiss a woman's goal of providing human milk to her newborn or to sabotage her goals with fear and false information is disgraceful.

I have spoken with many women who feel robbed of the breastfeeding experience and others that are angry that they did not have the support or education that would have resolved their issues. The groups that are preying on these women to gain followers or instigate more anger and resentment are indeed deplorable. I hope we can see our government, communities, families, health agencies and medical professionals working to support breastfeeding and empower moms rather than stripping them of their goals and power.

When Natural Disasters Strike, Breastfeeding Matters

Earthquakes, floods, tornadoes, fires. Recent years have seen their share of natural disasters and emergencies which will only continue to occur with the passing of time. Even now, a State of Emergency has been declared for Hurricane Matthew, and heightened seismic activity at the Salton Sea has prompted scientists to warn of the elevated risk for “The Big One” at San Andreas fault.

Disasters and emergencies, while incredibly devastating, invoke a sense of camaraderie as people from all walks of life and differing backgrounds join together to help; to donate. While the intention is good, the protocol of infant feeding during natural disasters in particular needs dire improvement. This problem springboards from the lack of education on the importance of breastfeeding as a whole.

Residents wait in line at the Superdome for shelter
during Hurricane Katrina. Image source: chron.com

Major health and aid agencies have come to a general consensus on how infant feeding issues should be addressed during disasters. They agree that the use of formula should only occur when mothers have weaned and relactation is not possible, or when the baby has lost its mother and wet nursing is not an option. They agree that ongoing support and assistance is necessary in such a case to limit the risks associated with artificial feeding, and that the distribution of breastmilk substitutes should be tightly controlled, carefully monitored and only provided to babies with a clear need.  

UNICEF, WHO, and the International Red Cross are active in alerting non-government organizations of the need to support breastfeeding and to be extremely careful in the distribution of breastmilk substitutes. Despite their efforts, and despite these guidelines, infant formula and bottles continue to be distributed unnecessarily during disaster situations.

During emergency situations, the cleanest, safest food is human milk.

Myth: Mothers who are under stress cannot breastfeed. Fact: Mothers will continue to lactate in times of stress but will need adequate support.

Myth: If a mother is malnourished, she either cannot breastfeed or the milk she produces is poor quality. Fact: Malnourished mothers or mothers with illnesses CAN provide healthy and safe milk for their babies.

The Problem with Formula Donations During Emergencies

One of the biggest tragedies during Hurricane Katrina was that almost no breastfeeding mothers were found. One-third of Louisiana’s population was displaced, which was about 1,300,000 people, and more than 100,000 evacuees remained in shelters more than one month later.

The distribution of formula and bottles by aid workers during this time disregarded the importance of clean water and utensils to make feeding infants possible and safe, and the more time that passed, the higher the risks for infant mortality continued to climb.

According to the American Academy of Pediatrics, in any given emergency, clean drinking water and a sterile environment may be inaccessible. Even in a potentially less catastrophic emergency, such as being trapped in gridlock for several hours, access to water to make formula as well as the ability to clean and sterilize bottles or feeding utensils is not possible. Infants need to be fed every 2 to 3 hours. When disaster strikes, reality hits, and panic can ensue.

The WHO states that artificially fed babies have a 1300 percent increased risk of death from diarrhoeal disease as compared to babies that are breastfed. The WHO adds that babies who are artificially fed are inherently more vulnerable to disease because they do not receive the disease-fighting antibodies that are in breastmilk.

“In past emergencies, 12–75% of all babies have died, so any factor that increases disease transmission and reduces the ability of babies to withstand disease may well result in their death.” - World Health Organization

At the time of Hurricane Katrina, information was not readily available to support optimal infant nutrition; rescue workers were not trained in breastfeeding support and management. Overall, the distribution of formula discouraged breastfeeding, decreased mothers’ confidence, and increased the risk of infection, illness, and death.

The Clear Advantages of Breastfeeding During an Emergency Provides comfort and relieves maternal anxiety Protects against infectious diseases Readily available Nutritionally perfect Perfect temperature Fights Illness

The Disadvantages of Formula-Feeding During an Emergency It may not be readily available May become contaminated Water mixed with powdered formula may be contaminated There may be no means of refrigeration to preserve it There may be no method to sterilize feeding utensils

While some strides have been made to educate about the importance of breastfeeding during disasters, the lack of normalcy is still present in our society and more efforts should be made to instill it in mothers, aid workers, and government agencies collectively. Milksharing or local donations of expressed milk should be a mainstream option to feed infants in dire cases.

Future natural disasters are inevitable and will continue to have a devastating effect on the economy and well-being of families. Protecting, promoting, and supporting breastfeeding during these natural disasters will help prevent long-term health and developmental problems that may occur as a result of alternative feeding methods. Encouraging breastfeeding will also lessen the economic blow, as the overall cost of the disaster is significantly reduced for both the families and societies affected. It is an investment that will pay for itself in more ways than one, several times over.

Contributing author: Samantha Johnson is a freelance writer, blogger, wife, and breastfeeding mom. Her Bachelor of Arts degree in journalism from California Baptist University has led to more than six years of full-time writing experience and countless exciting opportunities. Aside from writing, her passions include drawing, painting, iced coffee, reaching her goals, balancing life's priorities, and encouraging others. You can visit her blog at unlazylike.wordpress.com.

Teaching Breastfeeding through Simple Analogies

We have to realize how vague our breastfeeding descriptions are to those who are unfamiliar with "normal breastfeeding behavior." Statements like, "babies breastfeed often" or "expect baby to wake frequently" can be misinterpreted based on the mom's expectations and definitions of the terms. The more specific lactation educators and consultants can be, the more successful moms will be. I try to use one of the "7 Laws of the Teacher": Teach from the Known to the Unknown.

Analogies can bring education to the forefront and help new parents relate to breastfeeding in a tangible way. I have shared these analogies or "advertisements" over the past year, but thought I would gather a few of them up and share them in one blog. I hope these analogies help others to educate on breastfeeding and convey the message that breastfeeding is the standard infant feeding practice.

I often describe breastfeeding anatomy and philology with house-hold items moms are familiar with. They may not have studied pictures of Dr. Coopers's Anatomy of the Breast, or read Dr. Hartman's research on the Mammary gland, but they have handled a bottle of glue.

Different posters convey the same message.  Having a variety of presentations can help reach the visual or auditory learner.  Some people like a quick, easy-to-read visual, while others prefer more detail. Advertisers state that a message must be seen at least ten times by an individual before it is "recognized." I think many educators can relate to this statistic.  I often feel like I am saying the same thing over and over again.

Unfortunately, some moms have been told that something is "wrong" with their breasts.  It is easy to blame a vulnerable, hormonal postpartum mom for difficult latch issues.  I like to remind moms that the baby doesn't come out of the womb, look at her breasts and announce, "those aren't like the ones I've seen in magazines." Babies have no basis for comparison.  There is a huge variation of nipples across the land and this could be a problem if babies were meant to "nipple" feed, fortunately for all the nipple challenged mommies out there, babies "breast" feed. I tell moms that nipples are like snowflakes--there are no two exactly alike. 

Anatomy concerns span from nipple formation to breast size. This is an easy description of "cup" size that everyone can relate to. 

Once moms gain the confidence that they will have what it takes to breastfeed, the next obstacle is milk supply. If I had a nickle for every time I heard the statement, "your milk hasn't come in," I would be a millionaire. 

I remind mothers that even though their meals were withheld from them, the baby had a steady supply of nutrient.  I sometimes joke that if they had been at the Home Town Buffet all day, they wouldn't be hungry right away either.  I encourage them to practice skin-to-skin, nuzzling, cuddling and offering the breast; but not be be discouraged if the baby is not ferociously hungry or "crawling to the breast right away.  In fact, the Breast Crawl has been documented to take up to 90 minutes to spontaneously occur. 

I invented the Lactation Lanyards as teaching tools to help with bedside education.  Seeing a formula bottle gives the impression that the baby should consume the amount in the container.  It is empowering to show a mom an accurate size of the newborn's stomach capacity.  The Lactation Lanyards are available from the Birthing, Bonding and Breastfeeding Store. 

Once a mom understands that her body is not only capable of growing her baby, it is also capable of 

nurturing her baby, the next obstacle is often overcoming any difficulties.  Prevention is key.  The first preventative step is not giving into the recommendation to bottle feed, or offer "just one bottle."

What about the accurately diagnosed "insufficient mammary tissue" or complications from breast surgery. What are those moms to do?  We have set the options as "breast or bottle" rather than "breast AND bottle." Some is still better than none, and this analogy points to that truth. 

I have many other posters and reminders about breastfeeding and breast milk.  I am working on my 2014 analogies.  Feel free to share misconceptions that frustrate you in the lactation field.  I may be able to make a visual to correct the erroneous advice. I hope you will join me on my Facebook Page: Birthing, Bonding and Breastfeeding and share some of the evidence-based information we post with others. Some of the posters are available for framing from the BBB Store. 

Happy New Year and let's work together to tackle myths and fears in 2014!