Thank you for writing this and for all of your nuanced and thoughtful work on this topic.
Breastfeeding was probably at the level of traumatizing for me, and undoubtedly what led to PPD with my first child. Even seeing "breastfeeding" in a headline, even for work as compassionate as yours, causes me to pause and wonder if I have the stamina to read on. Like you say in your post, I think "breastfeeding" is a trigger word for me now.
Feeding decisions/breastfeeding challenges belongs in the CENTER of the new-mom stressor map alongside sleep deprivation. Babies exclusively eat, sleep, and poop for several weeks. A woman's entire mind and body is in service of this for a very intense period of time. And the fact that feeding mechanisms and decisions are at the heart of all of this, and the way we talk about it has been so exclusively been focused on the baby and not the mom, means that feeding to me goes smack dab in the center of a map of stressors for the first few months in my view.
My baby was excessively sleepy and had a very hard time waking to eat (we put ice cubes on her belly, played "turn down for what" in her ear - our pediatrician friend came over and said he wouldn't have believed it until he saw it) and she was born on the larger side and genuinely didn't seem to want to eat. I triple-fed her for one month. Triple feeding, in my experience, which is more common than I realized (SHOCKINGLY), means feeding, pumping, feeding baby through a syringe, and repeating this 90-minute process every 2 hours in the first few weeks. I remember thinking (while I still had brain function): what am I going to do with this 20-minute chunk of freedom? Eat? Get off the couch? Poop? Shower? Sleep? My life was live in increments of 90 minutes of pain and plastic tubes and switching positions and resenting the baby, and 30 minutes "to myself." I wept several times a day. The lactation consultants and home visitors all normalized this, saying "breastfeeding takes a little while to get used to" and "you're doing well" and "you have to keep going until she gains more weight." No one validated that triple feeding was CRAZY and next to impossible and should only be an extremely short-term tactic - it was just a price to pay to get breastfeeding established. One day I felt my mental health slip so low that I called it. My doctor helped, she said "it sounds like you're just done." But it felt like I was FAILING in the most enormous way, and every single thing I read about women loving breastfeeding or the wonders of breastmilk just make me fill with rage and sadness.
I hear of other moms who triple fed for as long or longer, or I hear of moms pumping for a year, and I feel so wholly inadequate. I experienced this as pure torture that just made me resent my baby - what's wrong with me when other people are normalizing this? I saved every. single. article. on the internet about feeling okay quitting breastfeeding/using formula, for which there were SO few in 2019. I must have spent a hundred hours just looking for anyone to tell me that that level of commitment was NOT worth it. That my mental health was worth it.
Thank you, Molly, for being that voice. There are a few more now. And the fact that studies are moving a little more into that direction around BFing and mental health is promising, but I just think about all the suffering moms out there who feel like they are failing out the gate when it isn't working. And carry that with them for a long time, even though their own choices to switch to formula proves they made the right call. We still have to change the narrative. And center the mother in the discussion. That's what ultimately convinced me to stop: healthy mom = healthy baby. Full stop.
Katherine! Thank you for reading (apologies for the trigger subject line) and thank you so much for sharing this. You captured it so beautifully and I got goosebumps reading your comment.
Triple feeding sounds crazy and crazy making and should never be "the price to pay to get breastfeeding established" if it compromises your own health. This is one of the call outs from the conversation with Andrea too -- the need for nuanced language and supportive options that recognize individual needs.
That social narrative behind the available reading for you in 2019 on "women loving breastfeeding or the wonders of breastmilk" is shifting but everyone needs to remember how their own journey (easy or difficult) is only a sample size of one and should not be projected as the expectation for everyone. That's another thing that drives me bananas. It's subtle but so insidious in how it affects individual perception of the challenges (as you point out!)
Thank you for introducing this topic. Having followed the medical literature on benefits of breastfeeding over the last forty years, and followed the posts of social media greats like Scary Mommy, and having read the influential work of Emily Oster, it is no wonder that mothers are still confused and we are all still struggling with this topic. We know that difficulty breastfeeding is highly correlated with postpartum depression. No hormonal cause-and-effect has been delineated, but there is work being done to investigate this. We also know that inadequate support is a crucial factor in breastfeeding failure. Moreover, many pediatricians are inadequately trained to support problematic lactation. This is changing, but formula remains an easy out. Yes, fed and adequate growth is best, but we have far to go to assess the cultural, community, and familial factors that influence mothers’ behaviors. PPD is the most common complication of childbirth and depressed mothers rarely BF successfully. We have much left to learn!
We absolutely have much left to learn! Even the medical literature is incomplete and, while I appreciate Emily Oster's perspective, when you are dealing with an underfunded and under-researched topic, it tends to end with "confusing" and conflicting information when you revolve advice around the strength of the data.
My stance will always be the middle ground with solutions that go far beyond the pressure on mom to decide. Start from the risk-risk profile -- the risk of challenges impacting maternal health (we need more data) and the risk of not providing breast milk to an infant (we need more data). Both sides of the equation are equally important but we tend to skew towards baby. Accept that breast milk is the best option... but not if mom gets sick struggling to provide it. Yes, formula can be an "easy out"... in both a negative and positive way. And I still think the most critical thing here is not to aim towards influencing mothers' behaviors but making sure they have every bit of support (personal and structural) they need to make true choices around breastfeeding. That is what is currently missing (in my opinion).
One of my favorite insights from the conversation with Andrea was that she has no intention of pushing her breastfeeding journey as far as she did but when she had the support to make true choices along the way, she was able to keep it up without even realizing.
Molly, I totally agree with you. I do not want to underplay the importance of maternal mental health. No one should get sick trying and failing to breastfeed, or feeling guilty if they cannot. We are doing such a bad job of stressing the importance of healthy matrescence. It tends to get lost in the “support the baby with breastmilk” (at all costs). Our messages should not be mutually exclusive, not either/or but both/and. Term babies will always do fine when formula fed. For premature infants it is a different story. Thank goodness the CDC has a great interest in the epidemiology of breastfeeding, not only as a means of preventing asthma, diabetes, and obesity, but also a tool for SIDS prevention. Hopefully the studies will keep coming and our support for mothers postpartum will improve!
Absolutely! And, yes, the research on benefits of breast milk for premature infants is one area where there are very clear (and important) benefits.
We just need to make sure that those mothers have extra support and extra resources to support breastfeeding without the additional pressure. I loved this part of the discussion with Andrea where she brought up exactly this -- how important the exact words are when it comes to supporting NICU moms -- walking the line of knowing how valuable breast milk is without the language (and pressure) itself being an additional source of stress at a time when these mothers are already in one of the most stressful moments of their lives.
Thank you for writing this and for all of your nuanced and thoughtful work on this topic.
Breastfeeding was probably at the level of traumatizing for me, and undoubtedly what led to PPD with my first child. Even seeing "breastfeeding" in a headline, even for work as compassionate as yours, causes me to pause and wonder if I have the stamina to read on. Like you say in your post, I think "breastfeeding" is a trigger word for me now.
Feeding decisions/breastfeeding challenges belongs in the CENTER of the new-mom stressor map alongside sleep deprivation. Babies exclusively eat, sleep, and poop for several weeks. A woman's entire mind and body is in service of this for a very intense period of time. And the fact that feeding mechanisms and decisions are at the heart of all of this, and the way we talk about it has been so exclusively been focused on the baby and not the mom, means that feeding to me goes smack dab in the center of a map of stressors for the first few months in my view.
My baby was excessively sleepy and had a very hard time waking to eat (we put ice cubes on her belly, played "turn down for what" in her ear - our pediatrician friend came over and said he wouldn't have believed it until he saw it) and she was born on the larger side and genuinely didn't seem to want to eat. I triple-fed her for one month. Triple feeding, in my experience, which is more common than I realized (SHOCKINGLY), means feeding, pumping, feeding baby through a syringe, and repeating this 90-minute process every 2 hours in the first few weeks. I remember thinking (while I still had brain function): what am I going to do with this 20-minute chunk of freedom? Eat? Get off the couch? Poop? Shower? Sleep? My life was live in increments of 90 minutes of pain and plastic tubes and switching positions and resenting the baby, and 30 minutes "to myself." I wept several times a day. The lactation consultants and home visitors all normalized this, saying "breastfeeding takes a little while to get used to" and "you're doing well" and "you have to keep going until she gains more weight." No one validated that triple feeding was CRAZY and next to impossible and should only be an extremely short-term tactic - it was just a price to pay to get breastfeeding established. One day I felt my mental health slip so low that I called it. My doctor helped, she said "it sounds like you're just done." But it felt like I was FAILING in the most enormous way, and every single thing I read about women loving breastfeeding or the wonders of breastmilk just make me fill with rage and sadness.
I hear of other moms who triple fed for as long or longer, or I hear of moms pumping for a year, and I feel so wholly inadequate. I experienced this as pure torture that just made me resent my baby - what's wrong with me when other people are normalizing this? I saved every. single. article. on the internet about feeling okay quitting breastfeeding/using formula, for which there were SO few in 2019. I must have spent a hundred hours just looking for anyone to tell me that that level of commitment was NOT worth it. That my mental health was worth it.
Thank you, Molly, for being that voice. There are a few more now. And the fact that studies are moving a little more into that direction around BFing and mental health is promising, but I just think about all the suffering moms out there who feel like they are failing out the gate when it isn't working. And carry that with them for a long time, even though their own choices to switch to formula proves they made the right call. We still have to change the narrative. And center the mother in the discussion. That's what ultimately convinced me to stop: healthy mom = healthy baby. Full stop.
Katherine! Thank you for reading (apologies for the trigger subject line) and thank you so much for sharing this. You captured it so beautifully and I got goosebumps reading your comment.
Triple feeding sounds crazy and crazy making and should never be "the price to pay to get breastfeeding established" if it compromises your own health. This is one of the call outs from the conversation with Andrea too -- the need for nuanced language and supportive options that recognize individual needs.
That social narrative behind the available reading for you in 2019 on "women loving breastfeeding or the wonders of breastmilk" is shifting but everyone needs to remember how their own journey (easy or difficult) is only a sample size of one and should not be projected as the expectation for everyone. That's another thing that drives me bananas. It's subtle but so insidious in how it affects individual perception of the challenges (as you point out!)
💯 "change the narrative. And center the mother" 💯
Thank you for introducing this topic. Having followed the medical literature on benefits of breastfeeding over the last forty years, and followed the posts of social media greats like Scary Mommy, and having read the influential work of Emily Oster, it is no wonder that mothers are still confused and we are all still struggling with this topic. We know that difficulty breastfeeding is highly correlated with postpartum depression. No hormonal cause-and-effect has been delineated, but there is work being done to investigate this. We also know that inadequate support is a crucial factor in breastfeeding failure. Moreover, many pediatricians are inadequately trained to support problematic lactation. This is changing, but formula remains an easy out. Yes, fed and adequate growth is best, but we have far to go to assess the cultural, community, and familial factors that influence mothers’ behaviors. PPD is the most common complication of childbirth and depressed mothers rarely BF successfully. We have much left to learn!
We absolutely have much left to learn! Even the medical literature is incomplete and, while I appreciate Emily Oster's perspective, when you are dealing with an underfunded and under-researched topic, it tends to end with "confusing" and conflicting information when you revolve advice around the strength of the data.
My stance will always be the middle ground with solutions that go far beyond the pressure on mom to decide. Start from the risk-risk profile -- the risk of challenges impacting maternal health (we need more data) and the risk of not providing breast milk to an infant (we need more data). Both sides of the equation are equally important but we tend to skew towards baby. Accept that breast milk is the best option... but not if mom gets sick struggling to provide it. Yes, formula can be an "easy out"... in both a negative and positive way. And I still think the most critical thing here is not to aim towards influencing mothers' behaviors but making sure they have every bit of support (personal and structural) they need to make true choices around breastfeeding. That is what is currently missing (in my opinion).
One of my favorite insights from the conversation with Andrea was that she has no intention of pushing her breastfeeding journey as far as she did but when she had the support to make true choices along the way, she was able to keep it up without even realizing.
Molly, I totally agree with you. I do not want to underplay the importance of maternal mental health. No one should get sick trying and failing to breastfeed, or feeling guilty if they cannot. We are doing such a bad job of stressing the importance of healthy matrescence. It tends to get lost in the “support the baby with breastmilk” (at all costs). Our messages should not be mutually exclusive, not either/or but both/and. Term babies will always do fine when formula fed. For premature infants it is a different story. Thank goodness the CDC has a great interest in the epidemiology of breastfeeding, not only as a means of preventing asthma, diabetes, and obesity, but also a tool for SIDS prevention. Hopefully the studies will keep coming and our support for mothers postpartum will improve!
Absolutely! And, yes, the research on benefits of breast milk for premature infants is one area where there are very clear (and important) benefits.
We just need to make sure that those mothers have extra support and extra resources to support breastfeeding without the additional pressure. I loved this part of the discussion with Andrea where she brought up exactly this -- how important the exact words are when it comes to supporting NICU moms -- walking the line of knowing how valuable breast milk is without the language (and pressure) itself being an additional source of stress at a time when these mothers are already in one of the most stressful moments of their lives.