From the Formula Archives

The following post is really the impetus for this entire blog.  In the midst of everything going on after Little A was born, I kept thinking to myself, “I need to write about this.”  I figured I needed distance from the experience, however, so I wrote about other things instead.  I kept waiting for the right time to talk about it.  And then I realized that I will never really have “distance” from this experience.  It will always be with me.   Sometimes you just have to jump with both feet.  

So here goes.

Part I: Pour Water

I formula feed my baby.  

Let me begin by stating that I got the public service announcement.  I know breastfeeding is best for my baby.  Message received.  And let me be clear about my goals in writing about my experiences here.  I am not advocating for formula feeding over breastfeeding.  If breastfeeding had worked for me, I wouldn’t be writing this.  In some ways, that is unfortunate because I feel my struggles have granted me clarity on an alternative albeit controversial viewpoint regarding this topic.  My hope is to bring some balance to the discussion of a women’s issue that—in the grand tradition of most women’s issues—has become more of a public than private domain.    

Before Little A was born, I bought The Nursing Mother’s Companion.  I conducted Internet research for two months before I ordered my breast pump.  I stocked my closet with lanolin ointment, nursing bras, nursing bra pads, breast milk storage bags, a nursing pillow, and a nursing apron.  I read about breastfeeding online and then asked my friends informed questions.  My husband and I even paid for and attended a breastfeeding class.  My point here is that I invested heavily in my plan to breastfeed and had every intention of making it work.  

I knew it was going to be difficult.  And painful.  Really painful.  I had read posts from moms on message boards about sore nipples, chapped nipples, bleeding nipples, leaky nipples, infected nipples, etc.  I even read an article about a woman whose left nipple fell off.  No joke.  I’d read enough to know that this “natural” process takes a lot more work than the average person would suspect.  But I had also read about all of the benefits of breast milk: live antibodies for a stronger immune system, lowered risk of childhood obesity, lower risk of allergies, a higher IQ…you get the picture.  My baby could have all of these things from something that I could make for free!  Sign me up.  I could see myself already, a Mona Lisa smile on my face while my breasts martyred themselves to the cause. My little one would partake of this magical elixir, probably while snuggled inside one of those stylish baby slings.  Other women would look at me breastfeeding my baby while scoping out the produce at the farmer’s market and admire my earthiness.

The nurses who taught our breastfeeding class were adorably militant, although my husband and I felt they spent seventy-five percent of the time preaching to the choir about the benefits of breastfeeding.  I mean, isn’t that why we were all there?  We had read up on all of the reasons why we should breastfeed; we were looking for a set of instructions.  Towards the end of the night, each couple did spend a few minutes holding a creepy baby doll and practicing the breastfeeding staples: the cradle, football, cross-body and side holds.  We got a thumbs-up from the instructor.  We watched a video that looked at least two decades old featuring women with feathered hair-dos and big bangs wearing dresses like doilies and breastfeeding sleepy cherubs.  They certainly didn’t look like their nipples were bleeding and about to fall off.  In fact, I distinctly recall one woman donning the same expression I wear after a nice glass of Two-Buck Chuck.  I was ready.

Part II: Add Powder

Fast-forward to August 10th, 2013:  the day Little A was born.  This was the most miraculous day in our lives.  When the nurses laid Little A against my chest, skin to skin, the world as I knew it did not extend beyond our two bodies breathing together, learning each other.  I was anxious to get this breastfeeding thing underway, as research shows that mothers who introduce the breast within the first thirty minutes are usually more successful in the long run.  I tried to get Little A latched on, and that’s when things got less like that video and a lot more complicated.   

A lactation consultant named Vera was quick to inform me that I had two things working against me:  1.) my nipples were not “breastfeeding friendly” (she really had a way with euphemisms) and 2.) Little A was not latching properly.  Apparently, moms aren’t the only ones with a learning curve in this business. It turns out that sometimes babies have to be taught how to breastfeed, too.  What this looked like to the general observer was an unfortunate looping reel of me and Z (my husband) analyzing a diagram from my book and trying to properly maneuver my breast into a baby’s mouth only to have her begin screaming and crying.  “Not to worry,” Vera assured us.  Well that was a relief.  She brought me a floppy plastic disc with holes punctured through the center, informed me it was a nipple shield, and demonstrated how to use it.  

Throughout the night and into the next day, I did everything Vera had taught me.  It seemed to be working to some extent: I was in pain.  It felt like someone had punctured a small hole in my nipple, inserted a thin, hot straw, and proceeded to suck my blood through it.  Not pleasant, but compared to giving birth, bearable.  The trouble was, it really didn’t look like anything was actually coming out.  If I squeezed my nipple, nothing happened. And the baby still seemed incredibly frustrated at feeding time.  She would look like she was starting to feed and then suddenly turn her face away, cry, and push herself off my chest.  We were concerned.

“She’s much more efficient at getting that milk than you,” Vera reassured me on her next visit.  She went on to explain that all I had for the moment was colostrum, a very nutrient-rich substance that precedes the actual breast milk which would “show up in a day or two.”  Since Little A’s time at the breast seemed especially fraught with anxiety, and my evidence of milk production seemed especially dismal, she recommended we supplement with thimbleful quantities of formula from a syringe with a teensy little hose attached to the end.  We would run the hose up alongside the nipple shield while Little A breastfed (or “breastfed,” as it began to feel) to sort of trick her into thinking she was getting the milk from me.  Our hope was that this would acclimate her to the nipple shield and keep her satiated until my milk came in.  Feeding Little A in this manner was a balancing act that required four hands.  I wasn’t going to pull it off while strolling around a farmer’s market with my baby in a sling, and I certainly wasn’t going to pull it off on my own.  Since Z was returning to work in two weeks, I knew I had two weeks to teach Little A to breastfeed from breasts that were still, for all purposes, empty.

Five days after Little A was born and two days after we left the hospital, we visited our pediatrician.  My milk still hadn’t come in.  The weight check confirmed what was already obvious to us: she wasn't getting enough to eat. Little A had lost between twelve and thirteen percent of her birth weight (the upper threshold of acceptable weight loss is ten percent).  The doctor sympathetically broke the news that we were starving our baby, as we were obviously sleep-deprived.  Little A had been waking up to feed every forty minutes to an hour for the past few nights.  The trouble was, we were following Vera’s original directions for supplementing her diet with formula, when it was becoming apparent that the formula was all she was actually getting.  

The pediatrician handed me three bags filled with different formula samples, told me to increase the amount I was giving Little A until my milk came in, and encouraged me to make an outpatient appointment with a lactation specialist.  He may as well have handed me a container of lighter fluid and told me to feed it to my baby.  Everything I had learned about breastfeeding served to make formula its direct antithesis in my mind.  Formula, I was certain, would make Little A obese, sickly, and dumb.  I broke down in his office and cried.  “I feel like I’m feeding her liquid Happy Meals,” I blubbered. No amount of reassurances to the contrary made me feel any better. How I felt about it didn't matter, however. This baby needed to eat.

Sifting through the numerous formula samples when we returned home, I realized that I had received an abstinence-only education in feeding my baby.  So fervent is the campaign to get women to breastfeed—and I am not at all disparaging this effort—that it seems the medical industry has decided that if women are simply uninformed about other options or shamed for considering them, they simply won’t.  The trouble is, that tactic doesn’t work for the mother who isn’t physically able to breastfeed, or who adopted a child, or who chooses not to breastfeed for personal or career reasons.  

I had attended fifteen plus hours of new parenting courses at the hospital on everything from new baby care to giving birth, and none of those classes had offered any advice on making informed choices when it came to choosing a formula.  In New York, Mayor Bloomberg went so far as asking hospitals to lock up formula samples and not offer them to new mothers unless they requested them, turning a legitimate alternative food source into some kind of baby methadone.   The books and the Internet, when scoured for advice on supplementing with formula, usually began by warning mothers that they probably didn’t need to supplement with formula, that their fears were unwarranted, that—as Vera had told me—there was more milk in there than I thought.  They went on to say supplementing would likely reduce my impending milk supply.  It felt like the entire system was set up in such a way that my own common sense was pitted against me like a breastfeeding saboteur.   

It’s strange that with every other aspect of my pregnancy, every responsible source for medical advice recognized that each woman and her pregnancy is different.  When discussing infertility, no one proposed that a woman wasn’t trying hard enough.  Everyone seemed to be in agreement that some women’s bodies are not capable of bearing children even though they were biologically designed to do so.  When it came to breastfeeding, however, the party line was always the same: If you think you aren’t producing enough milk, you are either paranoid or doing something wrong.  

Six days after Little A was born, my milk still hadn’t come in.  Little A, my husband, and I met with our lactation consultant at the hospital’s outpatient clinic.  I won’t go into the details here, as it was really just more of the same information:  Hang in there; keep trying; she’s getting a little something; don’t jeopardize your chances of making this work.  With that encouragement under my belt, I renewed my efforts with intensive vigor.  Following the consultant’s advice, I went through the motions of breastfeeding right before I thought Little A would get hungry in order to reinforce the practice, then I would follow that with “breastfeeding” with the syringe, and then I would use the breast pump to help stimulate milk production.  It was an hour and a half-long process that, when it was over, began again in a half an hour.  My husband and I knew it wasn’t sustainable in the long run—unless I vowed to never get up from the couch again—but we looked at it as temporary insanity in order to achieve our goal.  

Eight days after my baby was born, I got some milk.  Enough that if I combined everything I had pumped in an eighteen hour period (Little A still couldn’t or wouldn’t latch on), I had between three and four ounces, or one, tiny feeding.  No matter what I did—”breastfeeding” with the syringe and hose and nipple shield, increased pumping, Mother’s Milk tea, eating oatmeal—that amount never increased.  Still, we soldiered on.  

It is difficult to capture in words what it feels like to have your baby, a child of your own flesh, collapse into a fit of despair every time you try to feed her from the breast.  Little A just found it so difficult to latch on properly, and she hated the nipple shield so much, that she had to be near starving to put up with it.  It was hard at times not to take it personally that this tiny little person was utterly rejecting me in this fashion.  Breastfeeding sessions often dribbled off into tears for both of us and then capitulation when we reverted to a bottle.  This was not the portrait of motherhood I had painted in my mind.

When my husband had to return to work, I gave up on trying to feed Little A directly from the breast.  It was impossible to get her positioned correctly, get the nipple shield in place, manage the syringe, and ensure she didn’t swallow the little hose all at the same time.  Without the syringe, hose, and nipple shield, Little A would simply scream until she got a bottle.  With all of that apparatus, there was no way I could ever feed her away from home like so many other mothers I had seen chatting in parks with aprons draped gracefully over breastfeeding infants.  Z and I agreed that the breast milk itself—not the delivery system—was most important.  Every drop that I pumped was precious, and I would store it in a special bottle in my refrigerator for Little A’s three o’clock in the morning feeding.  No one else was allowed to give her that bottle.  A part of me looked forward to getting up in the middle of the night, holding my baby in my arms, rocking in the darkness, feeding her something from me.  It was the closest I could get to breastfeeding, and it was incredibly special to me.  

Part III: Shake

Exactly one month after Little A was born, what little milk I had completely disappeared.  It was weird.  It felt like closure to a month of grieving.  

“Grieving what?” my friends would ask me.  Sometimes it is difficult for people to understand why my inability to breastfeed was so painful to me.  Some women joked that I just dodged a huge bullet.  “What are you grieving?  Bleeding nipples and mastitis?”  Yes.  Yes, I am grieving that I missed this experience so many mothers get to have.  I miss its messes and its pain and its sacrifice.  I am grieving that right out of the gate, I wasn’t able to give my baby the absolute best start possible.  I constantly blame myself for not working at it hard enough.  For a month, I cried at least once almost every single day.   

Other friends seemed suspicious and asked enough questions about what I had tried before “giving up” that it was clear to me that they felt my lack of success was due to a lack of effort.

It took a long time before giving Little A a bottle didn’t feel akin to handing her a pack of cigarettes and telling her to light up.  “You were a formula-fed baby and you turned out fine,” my mother would repeatedly point out.  “So were 80% of your friends,” she would add.  True.  My generation (I was born in 1978) was the tail-end of one of the most formula-fed generations ever.  But maybe I could have gone to Julliard had you breastfed me, I thought.  Ha ha.  It wasn’t a serious thought, but really, how can anyone say you didn’t miss out on something when you don’t have an alternative outcome for comparison?  I will always just have to believe that my inability to work on something with the kind of tenacity a Julliard student exhibits has nothing to do with what I ate as an infant.  If I want to find a way to blame my parents for my mediocrity, I will have to blame something other than diet.

As time has passed and we have watched Little A grow and thrive, my fears that she will not develop comparably to her breastfed peers have diminished.  Okay, it still bothers me that I couldn’t feed Little A in the midst of an apocalypse.  Hopefully we won’t have one of those until she is on a completely solid food diet and on equal dietary ground with those other babies.  Then we’ll see how she fares with a crossbow.  

So why am I writing this now?  I guess I wanted to appeal to a few different audiences.  I feel that in some ways, breastfeeding has become a kind of status marker between mothers.  There is an unspoken competitiveness inherent in it related to whether or not one “chose” to breastfeed and if so, for how long.  Not breastfeeding your baby somehow screams to society one of two things: 1.) that you are not educated on the benefits of breastfeeding or 2.) you don’t care about doing what’s best for your baby.  I am not just imagining this due to my own guilt.  I have had multiple strangers ask me in parking lots, grocery stores, etc. if I am nursing.  One acquaintance, upon seeing Little A for the very first time, chose “How is breastfeeding going?” as her opening question.  Not “What do you think of motherhood?”—which entails far more than breastfeeding, or “How is your baby doing?”  

The stigma of formula feeding has even driven me to try hiding how I am feeding Little A.  I apologize to those friends who visited my home and later posted pictures on Facebook of me bottle feeding Little A only to discover I untagged myself in those photos and hid them from my timeline.  I apologize to my husband for insisting when we were at a party that he mix a bottle of formula in another room in order to make it seem as if he just casually went to retrieve a bottle of breast milk I had stored in a cooler.  I will admit that I have scoped out the formula aisle of Target to make sure the coast is clear before grabbing a container of formula and—on particularly sensitive days—waited in a longer check-out line simply because the cashier was male and therefore (in my mind) less judgmental.

Baby care books and websites almost always address formula feeding by saying “For mothers who choose to formula feed…”  Choose?  I wouldn’t say that’s how it went for me.  That wording stings.  On the other hand, what if it is a mother’s choice?  What if, due to her career, psychological condition, tolerance for pain, or any other reason, a woman decides to use formula instead of breastfeed?  What business is that of anyone else?  Meat is a “natural” part of the human diet, but vegetarians don’t face public castigation when they bypass the meat department at the local grocery store and buy tofu (a manufactured substitute) instead--even with all of the controversy surrounding soy.  It’s a rare woman who doesn’t know that breastfeeding is the best way to feed a baby--and if there is one, the outside of every formula can on the market will educate her that “breastfeeding is best” via a government-mandated statement.  

Thus, I have some appeals for any and all who are reading:

To Women Struggling with Breastfeeding: If, like me, you are unable to make breastfeeding work, remember that formula—while it will never be breast milk—is a darned good approximation.  If you find yourself breaking down in tears every time you mix a bottle, wondering if your child’s IQ is going to be lower as a result, stop for a moment and really think about that.  It’s a big leap to link someone’s intelligence to his or her diet as an infant.  It’s difficult to control that research for other factors that probably have a bigger impact on children’s health, well-being, and educational success: parenting and access to quality health care.  It is reasonable to assume that parents who conduct all of the research into breastfeeding and commit to it also make a number of other intelligent parenting choices on a daily basis—all of which ultimately play into that child’s intellectual development.  How can we really determine what, if any, impact breast milk had on that?  If ten years from now I attributed Little A’s social development, lack of disease, and high test scores to which brand of formula I chose, people would think I was nuts.  If I were breastfeeding, however, some of those same people wouldn’t even blink at the idea of correlating breast milk with all of those things.  As Joan Wolf, author of Is Breast Best? points out, “correlation does not equal causation.”  

I’m just saying that it’s okay to embrace a healthy spoonful of skepticism anytime a food starts sounding like something concocted at Hogwarts Academy.  

To Women Everywhere: So many things concerning us—be they personal choices or biological experiences—have become public property.  Let’s not use whether or not a woman is breastfeeding as a value judgment on her parenting or character.  One abc news report discusses a nationwide survey in which 36,000 women were surveyed about breastfeeding versus formula feeding.  Of the mothers who identified as breast feeders, 66% said they “felt sorry for formula-fed babies,” and 33% said they thought formula feeding mothers were “selfish and lazy.”   There is no need to feel sorry for anyone.  We have decades of evidence to show that those formula-fed babies turn out just fine.  Remember that being a mother is a lifelong job, and in the big scheme of things, breastfeeding is just one small aspect of that.  

To the Medical Industry:  We should continue the “breast is best” campaign.  It is a fact that breast milk is the best sustenance for babies, and women should be educated about this when they have children.  Just as abstinence-only education does not work with our nation’s teenagers, however, so it does not work when educating mothers about feeding their babies.  Not educating mothers on alternative options does not fix what is broken or force a woman who does not choose to breastfeed into doing so.  In addition, those who are charged with educating women about the benefits of breast milk should use caution in how they portray the research.  I later found that some things described as absolute benefits to breastfeeding were overstated or not actually proven.   In the event of breastfeeding failure, this can truly be damaging to mothers.  

I mentioned earlier that I took a breastfeeding class while pregnant.  I remember a woman asking the instructors what her best options for formula were if she was unable to produce enough milk.  Instead of providing useful information on how to select infant formula, the instructors brushed off the question by telling  the woman that as long as she was dedicated to the task, the likelihood of that happening was slim to none.  

Finding myself in that exact scenario months later despite my dedication, I remember wishing that I had been given guidance on choosing a formula.  It felt like books, websites, and doctors sort of lumped all formulas together as “pretty much the same thing.”  One even compared the different varieties (milk-based, soy, and hydrolyzed) to different varieties of Coke, to which I couldn’t help but take offense on several grounds.  Most importantly, they’re not the same.  It took us months to find one that agreed with Little A’s stomach, and I called her pediatrician several times for help understanding the differences in the ingredients.  We had never been educated on what was and was not normal for formula-fed babies.  Even properly feeding a baby with a bottle was foreign to me.  No one had ever taught us how to select the best bottle or how to minimize swallowing air or how to know if the nipple flow was appropriate.  We had to figure it all out on our own.  That made me feel like the medical industry’s concern over the well-being of my baby’s diet ended when I was unable to breastfeed.  Apparently I am not alone in this dilemma, as a report from The Telegraph in the UK strongly urges the medical industry to better educate formula-feeding mothers.

One stroke of luck I had in all of this was that my daughter’s pediatrician completely understood the pressure I felt to breastfeed despite biological difficulty.  His own wife--also a doctor--was unable to breastfeed their daughter beyond three weeks.  Having a sympathetic ear from a medical professional, someone who encouraged me to give it my best shot but also let me know that I could still be a fantastic mother and raise a successful, thriving daughter no matter which way I chose to feed her, played an invaluable role in helping me cope with this experience.  It is important for medical professionals who work closely with mothers to recognize when the stress from breastfeeding is outweighing its benefits due to the deteriorating well-being of the mother.  

Part IV: Serve

I didn’t intend for there to be a Part IV to this, but I am compelled to close with a memory.  It was three in the morning, and Little A and I were sitting in the dark on my living room sofa.  I was giving her that one bottle of breast milk I had collected from all of my pumpings throughout the day and night.  Halfway through her bottle, she was lightly dozing, only occasionally sucking and exhaling her soft, high baby sighs.  She looked like blown glass: delicate, beautiful.  I decided to try breastfeeding her without the gadgets, the nipple shield, the extra hands.  I hoped she was tired and full enough that she wouldn’t get upset that I didn’t have much to offer or that it didn’t feel right to her.  And it worked.  For forty minutes, we sat in the dark, and I felt what it was like to breastfeed, to have everything work.  And then she woke up, cried, and finished her bottle.  I knew I had soothed her more than fed her during those forty minutes, but I didn’t care.  I felt that even if things didn’t work out, even if she never latched well on me again, even if I never had enough to feed her without supplementing, for that one night, I had done it.  I knew what it felt like to breastfeed my baby.  

And that will always belong to us.