If I See One More #BreastIsBest Photo on My Facebook Feed I’m Going to Scream

To all exclusively pumping moms out there, you rock! Reposting from my personal blog. I wrote this back in December 2015:

My pump and trusty pumping log
My pump and trusty pumping log

Six weeks on and we’ve kind of settled into a routine with Squishy.

Being a first-time mum is tough. I don’t think I can adequately describe how challenging the first weeks are. You’re expected to care for a tiny person fully dependent on you to survive (the pressure!) while juggling sleep deprivation (which actually led to me having a few scary-as-hell sleep paralysis episodes) and everywhere-all-over kind of body ache (back, bum, name it). Being a new parent is rewarding, but man is it exhausting.

As if being a new mum wasn’t stressful enough, I also got a rude introduction early on to a Mummy Wars topic favorite: Breast vs. Bottle. (Frankly I think the concept of warring mummies is silly and debatable. For the sake of this post though, I’ll assume that it exists. Onward.)

*

Before giving birth I was firmly in the Breast camp. I read the initial chapters of “Caring for Your Baby and Young Child,” a bulky doorstop of a book authored by the American Academy Of Pediatrics which my sister gave me (she’s a developmental pediatrician). AAP’s policy is clear: it recommends exclusive breastfeeding for the first six months, to be continued as long as both mother and baby want to. “Unquestionably, breast milk is far superior to any formula designed for babies,” it declares on its website. (1) Singapore’s Health Promotion Board echoes this sentiment: “Without a doubt, breast milk is the ideal and most natural food for your baby.” (2) Failure to breastfeed is supposed to be associated with elevated risk of obesity, diabetes, gastrointestinal infections, eczema or asthma, and SIDS among others. Breastfeeding is also associated with higher IQ. (3)

(Numbers refer to my sources and footnotes, which are at the end of this lengthy post.)

Okay then, roger that. While pregnant with Squishy I dutifully familiarized myself with latching techniques and breastfeeding positions on babycenter.com (a handy source for urgent pregnancy/baby/breastfeeding questions — everything I’ve thought of asking, another paranoid parent has asked before). I read the breastfeeding chapter in my copy of ‘What to Expect When You’re Expecting’, along with the relevant FAQs. I binge-watched baby breast crawl videos on YouTube.

I had a mental picture in my head of how Squishy and I would first meet. We’d have skin-to-skin contact. I’d breastfeed him within an hour of his birth (the books say colostrum is his first vaccine!). For some reason all this mental imagery was always in picture-perfect soft focus.

What actually happened:

  1. I found out I have flat nipples, which apparently makes breastfeeding thrice as challenging. (A potential problem I forgot to consider in all my pre-reading, and one which most breastfeeding articles just gloss over. Or address in chirpy language with little practical use, e.g. “Don’t give up!”)
  2. Squishy just. Wouldn’t. Latch. He’d then cry and scream because he was hungry, making feeding him difficult, which in turn made him hungrier.

I was determined to feed Squishy breastmilk and borrowed the maternity ward’s Medela Lactina breast pump, but colostrum being what it is most of it stuck to the pump flange. I was visited by two different lactation consultants who tried to teach us to latch, with varying degrees of success. One suggested nipple shields. By hand expressing I was able to feed Squishy very small amounts via syringe. Still, he was having trouble sucking and my breasts certainly weren’t helping him learn.

A procession of nurses also tried to help us latch; there was a gem of a nurse who was very encouraging and gentle but most of them ended up putting me off latching/hand expression* by being rough. One of them even had the cheek to tell me she was used to “normal” breasts, which on hindsight was highly inconsiderate — I was already feeling like such a failure even after trying and trying and trying. To be told my body was deficient in some way compounded the deep frustration and helplessness I felt. I kept quiet though.

So there I was, my newborn baby fitfully sleeping in the bassinet next to my bed, frantically researching how to deal with nipple problems while watching the hospital TV’s ‘How to Breastfeed’ video on loop. I hated the woman on TV for having perfect breastfeeding boobs. I could see Squishy rooting and I knew he was still hungry, knew that after they took him away to the nursery to be cared for while Hubby and I were supposed to sleep, he would wake up screaming to be fed. I felt actual pain. I couldn’t seem to give him what he needed. For me, there was hardly any sleep.

I was absolutely stressed out. Things came to a head when we returned to the hospital five days later for a checkup with both Squishy’s pediatrician and my OB. We visited the pediatrician first. He told us that Squishy had lost more weight than expected. Maybe it was time to consider supplementing with formula, he said.

I was crushed. Based on everything I had read giving babies formula — even if it was just to supplement and not to replace — was the worst thing you could do. Like feeding him formula made you a bad mother.

I certainly felt like one when I visited my OB’s office, our next stop that day. My OB asked me if I was sleeping (no, I wasn’t). Get some rest, she said. You’ll burn out. And that won’t help you or your baby. Then she gave me a good talking-to.

It may be hard to believe, my OB said, but there was a time when popular opinion worldwide was in favor of formula. Not the other way around. My OB was 100% formula-fed, because the marketing spiel in Singapore in those days was that formula made your kids smarter (Singaporeans, being kiasueagerly listened). “I didn’t turn out too bad!” she laughed. By then I was bawling in her office — I was both frustrated with myself (for not being able to do something that was supposed to come naturally, for fuck’s sake) and annoyed (feeding Squishy formula was not the end of the world so I should stop being so dramatic).

The Hubby, who was (and still is) extremely supportive of my decision to breastfeed, gently reminded me to be logical. Our first priority was to get Squishy to a healthy weight. We’d continue to practice latching everyday, but I shouldn’t force Squishy to breastfeed at the source to the point where he wasn’t getting enough to eat. “Proper nutrition – especially during the first three years – is crucial for a child’s mental and physical development.” (4) Actually Hubby himself was formula-fed, mainly because my mother-in-law worked outside Manila and only saw him on weekends. Mom shared that even I was fed a mix of formula and breastmilk.** She was also working at that time, plus my older sister and I were hardly a year apart, so she had two young babies to care for and it was difficult to sustain exclusive breastfeeding. I planned to pump in between our latching sessions so I could keep my milk supply up. Overall, what Squishy’s pediatrician was suggesting wasn’t that bad.

But it still took me a while to process this. I was crying at the drop of a hat at really random shit, in really random places. To add to the stress was a degree of societal pressure. This year plenty of my Facebook friends became new/repeat mums. My newsfeed was a steady stream of photos or status posts hashtagged #BreastIsBest or #ExclusivelyBreastfed or (and this, to me, rankled the most) #LiquidGold. I didn’t see any that were hastagged #FormulaFed, #BottleIsTheBomb #HesMixedFedAndLovingIt or similar. Exclusive breastfeeding was like some perverse status symbol among millennial mums.

After a particularly stressful latching session with Squishy, my Mom gave me The Talk which helped the most in me getting my act together (and finally snapping out of my post baby blues).

Squishy is Squishy. What works for him may not be what works for other babies. It may not even be what works for his future siblings. Squishy and I needed to discover each other’s individual style, personality, temperament. I needed to trust my motherly instincts in raising him. I needed to focus on what was important. Squishy was born healthy. Ten fingers, ten toes. Some parents would give anything to have my “problem.” (Natalie Morgan’s heartbreaking post on her daughter Eleanor comes to mind.) Me being stressed probably had a bigger effect on Squishy than the addition of formula to his diet. The right thing to do was to adopt an attitude of gratitude. There was much to be thankful for.

That hit home. Of course. I was completely missing the point. Instead of enjoying these first weeks with my beautiful baby boy I was caught up in my own hang-ups of having him breastfeed at source. Adamant that he conform to my mental picture of how things “should” be.

Which is why I found some commenters on a Facebook “breastfeeding support” group I was recommended to join highly irritating.

The original poster was depressed, asking for advice because she was having difficulty breastfeeding — to the point where her baby was clearly not gaining enough weight. She seemed to be on the verge of considering formula feeding to help her baby’s weight catch up. Commenters to her post criticized her soundly for this decision.

What baffled me was this mum thought it better to muck around on Facebook seeking advice from random non-medically trained strangers instead of consulting the child’s pediatrician. It annoyed me that some people were blindly, fanatically pro-breastmilk without question.

*

Reading the group’s posts also inspired me to do my own research on the benefits of breastfeeding. I’ve read the headlines. But I wanted to dig deeper and read the actual studies that underpinned them.

What I found out was that breastfeeding benefits are not as clear-cut as the headlines make it out to be.

The problem with breastfeeding studies was that most suffered from selection bias. When one considers that mothers who breastfeed tend to be wealthier and better-educated (5), it becomes difficult to separate the benefits brought about by breastfeeding alone vs. those that are due to the circumstances the child grew up in.

An experimental study attempted to remedy this by studying siblings thus controlling, to some degree, for selection bias. The researchers examined commonly cited breastfeeding benefits (like those I listed above) and found that within a family the “benefits” associated with breastfeeding disappeared — except for a “causal connection” between breastfeeding and intelligence. (3) (The observed gain is 3.2 points in IQ for full-term babies over 6lbs. Great but hardly earth-shattering.) In another oft-cited randomized study on breastfeeding and effects on childhood obesity in Belarus, researchers found “no effect of prolonged and exclusive breastfeeding on height, adiposity, or blood pressure in Belarusian early school-age children.” (6)

Dr. Kramer of the Belarus study also had this to say:

“If breast-feeding had a potent effect on preventing obesity, would we be living the obesity epidemic at the same time as we have witnessed a renaissance in breastfeeding? When parents started putting their babies on their backs to sleep, the SIDS rate went down; when people stopped smoking, lung cancer rates went down; when people started using seatbelts, deaths from automobile accidents went down. No one ever said that breastfeeding is the ‘‘cure-all’’ preventive measure for obesity. But if it were having a potent effect, would we have seen the epidemic we are witnessing now? Another way of rephrasing that is, whether or not breast-feeding has a small effect in any country, countries such as ours that are experiencing this epidemic have to come up with better ways of controlling it.”

*

So where does all this leave Squishy and me?

At the end of the day, I stuck with the decision to feed Squishy breastmilk. I think this has more to do with emotion than anything else: I cherish the thought of making milk to nourish my baby; I could do it. My body was made to do it. So I did.

I did more research and came across mums who exclusively pumped. After I made peace with myself and my body re: latching, I focused on getting my milk supply up by sticking to a pumping schedule (Initially, I pumped 10x, dropped it to 8x, and am now down to 7x a day. I figured 7x a day is probably the schedule that would work best when I return to work). [Update: I’m now down to 4x pumps a day. Surprisingly my supply has balanced out, and despite this he remains 100% breastfed.]

I took a leaf out of both Western and Philippine alternative medicine and drank fenugreek and malunggay (moringa) supplements. I kept a pumping log, meticulously recording how much Squishy ate and how much I pumped.

I stopped supplementing with formula by Day 11, a mere six days out of the hospital. At my peak so far, I’ve pumped 1.2L of breastmilk a day, and now comfortably pump between 800mL to 1L. I have a 3-day backlog of milk in the fridge. At our last visit to the pediatrician a few days ago, Squishy weighed in at 5.2kg, a healthy weight for a 1.5-month old baby.

Squishy and I are still able to bond during his feedings; I love kissing the top of his head and rubbing his little feet while he feeds from his bottle. Better yet, Squishy also has an opportunity to bond closely with his daddy, his lola, and other caregivers around the home. I don’t need to be awake while he feeds and could grab some rest if needed.

So, Breast vs. Bottle?

We chose Breast in Bottle. Ha! Happy bub, happy mum.

For more on exclusive pumping, I found Kelly Mom and Exclusively Pumping Mamas to be helpful sources. I use a Medela Swing Maxi pump and Dr. Brown bottles (switching from Medela Calma bottles, which gave Squishy too much gas).

*

My point with this long post is not to campaign for any particular form of feeding your child. My Mom put it best when she said #LessStressIsBest (hashtag mine).

Breastmilk is still the ideal food for your baby. But people have got to acknowledge that while some mums will find breastfeeding at source to be most convenient; others will prefer to bottle/formula-feed for various reasons. Another group of mums, like me, choose to bottle-feed pumped breastmilk due to physical constraints or other reasons. Yet another group would mix it up.

Frankly, it does NOT matter. Whatever works for you and baby, mummies and/or daddies.

So parents, friends, random relatives and yes, even healthcare professionals, next time you see a mummy with a bottle go easy on the judgments, yes? Like that Similac Mummy Wars advert says, at the end of the day we’re parents first. All we want is to feed our children.

***

Footnotes:

(1) Quote is from Jane Morton, MD, FAAP. http://www2.aap.org/breastfeeding/policyonbreastfeedinganduseofhumanmilk.html

(2) http://www.hpb.gov.sg/HOPPortal/health-article/5498

(3) “Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias.” Eirik Evenhouse and Siobhan Reilly. December 2005. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361236/

(4) http://www.babycenter.com/0_failure-to-gain-weight-in-babies_1621.bc

(5) “Breast-feeding Benefits Appear to be Overstated, According to Study of Siblings.” February 25, 2014. http://researchnews.osu.edu/archive/sibbreast.htm

(6) “A randomized breast-feeding promotion intervention did not reduce child obesity in Belarus.” MS Kramer et al. February 2009. http://www.ncbi.nlm.nih.gov/pubmed/19106322

* Side note on hand expression: A third lactation consultant, whom we visited a week after I gave birth, gave me a tip on how to hand-express effectively by showing me this video from the Stanford Newborn Nursery. It was very different from the nurses’ so-called “techniques.” With hand expression, all you have to remember is: “Press, Compress, Relax.”)

** Another side note. Both Hubby and me didn’t turn out too bad. We both graduated at the top of our high school class, finished top for our board exams (he’s way better at numbers than me though). We’re of average weight (pre-Christmas Noche Buena dinner, hoho), both of us have decent jobs, and we’re okay socially (I think. Ha!). Obviously, this is anecdotal evidence from a sample size of two. But I challenge anyone to visit a Primary 6 class and identify those who were exclusively breastfed from those who weren’t. Come on. I dare you. I double dare you.

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