I breastfed my son exclusively for 6 weeks. He cried all the time. Diapers were dry when they shouldn't have been. Test weighing before and after feeds indicated he was at most getting 50cc per feed, and his birth weight was over 4 kg [9 lbs]. Finally, in desperation, I gave him a bottle. He gulped down 250 cc in a flash, burped, went to sleep for 4 hours. Peed. Carried on with breast and bottle, when I finally decided to discontinue breastfeeding, didn't have a minute's discomfort from engorged breasts. The lesson learned, in spite of being at times a lactation counselor, was that I simply made very little milk.
With my daughter, two years later, I developed a raging fever and mastitis in both breasts a week after giving birth to her, which required antibiotics, and then I got mild pneumonia. From the age of two weeks she was entirely bottlefed.
With #3, second daughter, I began by both breastfeeding and bottlefeeding supplement after the breast. She was happy; I was happy. The nursing went a lot better, although, judging by the amount of formula she drank, she wasn't getting a great deal from me. I figured she was getting my antibodies which was the main thing.
Yes, yes, I know that the plural of anecdote isn't data. But the point I'm trying to make is that flexibility is very important, and that babies can indeed suffer when the Lactation Nazis coerce women into using only one feeding method.
The other day I unearthed, when going through my memorabilia in search of some documents proving I exist, the card my mother got from the hospital with the instructions for making up my formula in 1946. In those days one used cow's milk, water, and sugar in carefully measured amounts and made up a day's supply at a time, put it into glass bottles and sterilized the lot before refrigerating it. It was a finicky and time-consuming process, and my mother, at least, was in a constant state of anxiety that she'd not done it correctly. Obviously, I survived, as did literally millions of other children so fed. At the time, it was the "modern" way for a modern mother to feed her child. Dr. Spock goes into considerable detail about bottle feeding but offers no advice for nursing mothers in his 1946 edition of his famous childcare book.
All that has long changed. For one thing, cow's milk, or indeed, whole milk of any kind isn't used any more. The basic objection was that the type of fat [not the amount] in cows' milk was not easy for a baby's gut to digest. Since the milk substitutes these days are virtually vegetarian in origin, and the type of fat is as close to that of human milk as can be synthesized, that problem is gone. So is the problem of "milk allergy" [lactose intolerance, usually]. Recently, studies have shown, in Israel anyway, that breast milk is very often deficient in Vitamins D and B12; modern formulas are all rich in vitamins and trace elements. In fact, there is only one area where a modern milk substitute falls short: it does not have maternal antibodies against certain diseases, mostly minor [ear infections are less in breastfed babies than in exclusively bottle fed babies]. Moreover, babies begin to develop their own resistance quite early.
A lot used to be made of the fact that breast milk is "always at the right temperature" and there isn't any fussing with bottles and synthetic nipples. Studies have shown that babies can drink either expressed breast milk or formula directly from the fridge with no ill effect; by the time it has reached the stomach, it is warm. No one sterilizes bottles any more, either, but makes up the formula in a clean bottle just before feeding [prefilled disposable bottles are sterilized, of course], using boiled water. That negates the "fuss factor" that my mother went through. Human nipples are often not really conducive for inexperienced babies to suck on. While, except in some prematures, all babies have a sucking reflex, it is indiscriminate, and many babies have a lot of trouble latching on. Bottle nipples are better designed as milk delivery devices.
Fathers cannot breast feed, period. So being rigid about exclusive breastfeeding cuts him right out of the equation. "Let him bathe the baby" I was advised at one point in my midwifery training. New dads are unlikely to feel that coping with a squirming, slippery, wet infant is as pleasurable a feeling as giving their offspring a bottle -- deep down inside, many men are Yiddishe Mommas. And some women definitely use nursing as a tool to avoid intimacy with their husbands, for a variety of reasons. It is very tiring; a breastfed baby rarely goes as much as three hours between feedings, day and night. I know I felt as if my children were literally sucking the marrow out of my bones.
Back in my British days, the Ward Sister would visit each new mother. Cambridge is in a largely agricultural area, and many of the new mothers were school leavers by the age of 16 and found the medical staff rather intimidating. Sister would ask, in her poshest accent, "Are you going to feed the baby yourself, or are you going to...[slight pause for effect here] artificially feed the baby?' It was a very brave young woman who asked for a bottle after that, but when the district midwife made her home visits after discharge, she almost inevitably found bottles of Cow & Gate, the British equivalent of Similac, in use. All the coercive methods in the world will not increase compliance with breastfeeding, and in fact, provoke the opposite response from sheer annoyance.
Dr. Amy Tuteur has pointed out that a woman who wants to bottlefeed has made that decision before she ever asks for a bottle. But there are some things that could be done which might make some women give nursing more of a chance. Increase, for example, hospital stays beyond two nights. The milk comes in only on the third day normally, and while colostrum is adequate for the baby's nutritional needs, many newborns are  not hungry initially, and  the mother really has little or nothing to give. But she's discharged before she and the baby have a good nursing experience in hospital -- and in fact, is discharged just when she comes down off her cloud with a bump and has "third day baby blues". There she is, at home, alone, feeling crummy with a baby who won't stop screaming -- which leads to the next thing a new mother needs: home visits by professional midwives during the first two weeks. [This is legally required in the UK]. Not just to assist with nursing, but with other postpartum issues. A mother who is exhausted, and in pain from stitches or hemorrhoids can actually have less milk. She certainly has less patience with a cranky infant.
If one wants a mother to continue nursing after the first weeks, or the first couple of months, maternity leave must be extended and a mother not penalized by losing a substantial amount of income. Most women aren't working for the love of the job but because their financial input is essential these days. No amount of legislation decreeing that there should be better conditions on the job for women who need to pump will encourage women to do so if they are needed at their desks constantly -- and that's a staffing issue. It can take half an hour, every three hours, for a woman to empty her breasts, which means a lot of time away from her desk. If she has to use an unsanitary bathroom, or miss lunch, or has no place to refrigerate the expressed milk, or knows she is placing an additional burden on her non-nursing co-workers, she'll change to a bottle pretty quickly. Many employers make it clear they regard a nursing mother as a nuisance, particularly in lower-paid service jobs.
Instead of lecturing and intimidating women, nurses and midwives need to be supportive no matter what the mother's choice. It isn't an issue of success or failure. For me that has always been the bottom line. No mother really wants to be a "bad" mother; it isn't a clearcut issue. If a woman tells me she is undecided, I may try to sway her toward giving nursing a chance, but if she has objections to the whole business, I'm not going to push it. She will fail, unless the incentive comes from her. It's not my place to lay an unjustified guilt trip on her.
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