The System Fails

I met a new mother of a nine day old baby girl in the elevator at the ped's office the other day (Naomi's diagnosis: strep throat. Prescription: two daily doses of PINK MEDICINE MAKES ME SICK I DON'T WANT IT NONONONONO!!!). I made some polite conversation, she asked about my sling (I was wearing this one in navy blue, tummy to tummy position), we yada yada'd down to the lobby.

I thought of my co-LLL leader, who makes a point to ask every new mother she meets, "so, how's breastfeeding going?" I understand why she does this, even though it seem unneccesarily nosy to me. She wants breastfeeding to be seen as the norm, something everyone does, the expected run of the mill thing, and this is her way of promoting her view. She can always back up the question with good help, but it seems to me to be a dangerous way to open a conversation with a postpartum woman.

I thought of asking this new mom that question, and I scanned her belongings for signs of bottles. Not seeing anything conclusive, I decided anyway to steer clear of the feeding question. Dancing around landmines is not my style.

It's a damn good thing I didn't ask. In the way mothers have of cramming a whole lot of information in only a few minutes of conversation, she volunteered her breastfeeding story. And it was a bad one.

She'd had a breast reduction. During her pregnancy she "really wanted to breastfeed" but was concerned about whether or not she'd have enough milk. She mentioned this concern to every medical professional she worked with during her pregnancy, and they brushed off her concerns. Nobody discussed with her the type of surgery that results in the most damage, nobody asked what type of reduction surgury she had. Even the lactation consultant she saw immediately postpartum told her that she had nothing to worry about because her baby was pooping just fine. It wasn't until her baby was nearly a week old and losing too much weight that she found out that 1. she would most likely have serious breastfeeding problems and 2. She'd need a pump immediately.

Nobody told her where she might find more information. (I told her to get a copy of Defining Your Own Success as soon as she could. She never know such a book existed). Maybe they thought she wasn't really serious, who would seriously entertain the idea of breastfeeding after a reduction?

She got tearful about how her baby lost so much weight, how she lost those first few days which can make or break your breastfeeding chances to try and make it work. She knew her chances of breastfeeding were small and it was breaking her heart. Her voice cracked when she told me about what an awful failure she felt like, being unable to provide her baby with this basic food.

My heart broke for her, and I helped her as much as I could in the moment I had. I told her she could probably partially breastfeed, but it would be a difficult uphill battle. I told her that if she has another child she might be able to breastfeed fully because new milk-producing cells are created with every pregnancy. Most important, I said, don't go down that path of guilting yourself over what your baby happens to be eating.

The lactivist in me was in a rage. I lost count of how many people failed this woman with their lack of accurate information about breastfeeding. Sure, the information was out there if she were to go digging for it. But why should she have to go digging? Why didn't her OB talk to her about this? Why not the pediatricians she interviewed? They wouldn't have to be experts on BFAR, just knowlegable enough to recommend one book or one website.

She did exactly what most people do when confronted with a question about their bodies: she asked the people who are supposed to know the answers: her medical professionals. They failed her, and she's the one who pays the price with this awful postpartum experience.

I wonder how much of this professional disinterest in breastfeeding education is because people don't see it as a significant loss. There is very little respect for the women who grieves the loss of the breastfeeding relationship, because, after all, formula is just fine. Wipe your tears and enjoy your baby, direct your anger at those boob nazis who want you to believe that breastfeeding is important, that you suffered a loss when lactation failed. THEY are the problem, they want to make you feel bad, forget about the system that failed you.

Lactation failure is a loss. We are mammals, breastfeeding is a central feature of the parent child relationship. And it's a loss that occurs when we are most vulnerable. Sometimes the only way to deal with the loss is to downplay the importance of it.

The last thing she said to me was that she was going to get the book and give breastfeeding her best shot. She looked hopeful; she was happy to have finally found someone who gave her real information. If it were me? I might cut my losses and switch to bottles, and skip the Lact-Aid and pumping rigamarole. But what I would do is immaterial. She needs information, not an editorial. A book recommendation, a website with forums to ask questions, and the email of the only BFAR mom I know.

Shame on those ignorant medical professionals whose personal biases prevented them from helping a woman mother the way she wanted to. Shame on those people who took the choice out of her hands.

Comments

[Jaimie]

I was deeply touched a few months ago by Peggy O'Mara's description of the mother whose heart breaks when breastfeeding doesn't work out for her, and your post similarly touched me. It makes me so angry, and so sad, that this happens - that we've lost generations of knowledge, that the medical community displays such apathy, that the formula industry marketing machine has so defined the parameters within which a new breastfeeding mom is forced to operate. Luckily, the breastfeeding movement is gaining momentum and becoming more vocal... unfortunately, the very women who the breastfeeding movement is designed to empower - those who could not breastfeed themselves - often feel targeted in these efforts. With more thoughtful people such as yourself to serve as advocates, perhaps we can someday find a gentler and more effective message that will unite mothers instead of creating deep, painful divisions. Because we'll only see changes in the medical community when we demand them, and we can't demand them - not as a whole, not as a force that is impossible to ignore - until we have all moms on board. I recognize my own failures in this - a tendency to immediately disbelieve the "I couldn't because..." statements, even if this reaction isn't spoken - and will remember this post in the future, in my efforts to realign my thinking to better serve a long-term objective rather than overzealous promotion of breastfeeding at all costs.

[Kelly]

I lost my very much wanted BF relationship with my firstborn due to bad advice and poor support. My son is 13 months old and not a day goes by when I don't think about it. Your response to this woman was right on target! It is hearing from LLL leaders like yourself that encourages me. For hypothetical baby no. 2, I plan to seek out LLL early!

[Ally]

My best friend tried to bf both her babies after a breast reduction. The first, she tried so hard he was darn near failure to thrive before she finally started supplementing. The second, she supplemented from the start. But I know she never pumped or did anything but put the baby to breast, and I know she was told that chances were she wouldn't be able to bf the second.

To this day, she mourns that loss. I remember how happy she was to have me nurse my son at her house (and still is). She said this a lot - "there's been a lot of sad and frustrating nursing in this house, it's nice to have happy, successful nursing here instead."

[nate]

Thank you so much for your advice to that woman. The BFAR site will hopefully lead her to the BFAR yahoo group, which was my lifeline. And I didn't even find it until dd was 3 months old & I was back at work. Medical professionals are horribly uninformed about BFAR, as are many of the LCs out there (it was the independant LCs in town who I found knew the most, not the ones employed by the hospital--who were okay, and reassuring, but not all that knowledgeable. If you have any way of getting in touch with that woman, give her my email address. And thank you again.

Oh, and my dd was on some evil (to her) pink antibiotic last spring--finally one of the pharmacists (when I called them in tears b/c she was refusing it) suggested mixing it with applesauce, and THAT went down fine.

[running2ks]

First off, anytime a woman's questions and concerns are blown off--I get furious. I feel for that poor woman!

I remember when I was on purple pills and the doctor said I should just "not nurse" when I questioned her about the safety of them. I left that doctor and found homeopathic alternatives.

Why should we be out there alone?

I am so glad you are educating and helping people.

[Moxie]

This story breaks my heart, as does every story of a women sunk because of bad information and no support who then feels the failure as her own.

This is the reason I ask every new mother I see how it's going. Even if all I can offer them is sympathy on how hard it all is, I just can't let them go around thinking it's easy for everyone else and hard for them. FWIW, I usually say something like "It's so hard to get everything going right, isn't it?" It's a clear opening to talk about nursing, but not necessarily.

You're a good woman.

[Lilian]

I TOTALLY understand and agree wholeheartedly, that's why I want to become a LLL leader, so I can try to help somehow.

My experience was very similar, I didn't have a breast reduction, but my baby had severe jaundice and was too lethargic to nurse, he was even getting dehydrated.

The pediatrician advised us to supplement "finger-feeding" formula with a syringe. He stopped breastfeeding, with nipple confusion. I pumped for a whole month (thank God I was able to pump enough so he didn't need any formula), and thanks to the use of Medela's SNS (supplemental nursing system), which we saw on Dr Sear's _The Baby Book_ he was finally able to learn how to latch on, at 1 month 3 days, and he nurses until today :)

Most of my close friends haven't succeeded, though, and it breaks my heart every single day to think of them!!! (one of my best friends had had a breast reduction and was able breastfed her second child for 4 months OK even though it didn't work out for the first one).

[J]

As a bfar mom, that story just kills me. The most common scenario is that LCs, OBs, and Peds hear "breast reduction" and immediately tell the expecting woman that she can't breastfeed. Here is the opposite situation, and yet the end result is the same--total failure of the system to support the breastfeeding mother during those critical first weeks when help can mean the difference between breastfeeding and not.

There's so little information out there, and some misinformation, that just by having the information from that site and Diane West's book I ended up being more informed than ANYONE I came into contact with during those first few weeks after my baby was born (LCs, LLL, OB, Ped). I ended up being the one to propose pumping to increase my supply, taking fenugreek, trying the SNS if it turned out I needed to supplement, etc. My OB and Ped were receptive to those things, but it certainly didn't come from them, and if I hadn't suggested them (if I hadn't known about them) I probably wouldn't have been able to breastfeed my daughter.

Kateri, for future reference, you can always give out my email address to bfarring moms. And my story is on the bfar website:

"Jen's story":
http://www.bfar.org/stories.shtml

[bitemycookie]

hi. i found you by way of afrindiemum. i am a bfar mom. i had my first breast redux at 18 and a second one several years later. both times both surgeons told me that they would be leaving my milk ducts in tact and that they would both be surprised to hear that i couldn't breastfeed when the time came.

when i checked into the hospital for delivery, i casually mentioned my reductions to the nurse. as soon as i was wheeled into the recovery room there was a pump waiting for me just in case there was a problem. there was also a brilliant, kind and encouraging lac nurse on stand by who visited with me nearly daily for the first month of foo's life. we had major latching issues which resulted in me finally resorting to pumping and bottling. i have used every massage technique, breastfeeding apparatus, syringe (fingerfeeding), nipple shield, tincture (and finally domperidone)and boob buddy you can imagine to create and deliver my home-made milk to my baby. my lactation consultant said she had never seen another mother so committed to making it happen. most of her clients didn't need her anymore after a few visits. i saw her every week for 4 months.

and after four exhausting months we switched to formula, and it has been a fine second choice, but the hospital certainly never pushed it on us.

just wanted to share my little experience and mention that there are surgeons, hospitals, and other medical professionals out there that do warn women of the risks of reduction and will do everything in their power not to jeopardize nursing in the future.

this woman's story is a heartbreak and she is lucky to have met you at the very moment that she did. hopefully the resources to which you directed her will help her get through this hideously hormonal time and just be with and bond with her baby.

sometimes i think i was so focused on the milking that i forgot that was bonding to be done and instead i just cried, naked from the waist up with a wrinkly, helpless baby in my arms wondering why one of the most natural things in the world had to be so painful and hard to do.

gosh, that got long fast. anyway, i hope this is not an unwelcome comment, but this subject is near and dear.

[Margot]

I'm so glad you didn't ask that woman how the breastfeeding is going. I think people are often very intrusive with women who are pregnant and new mums. I don't know why they feel so entitled to ask such personal questions of people they don't even know.

It IS personal to ask other people about stuff involving their breasts. Its like if people felt entitled to go up to women they don't know and ask them what colour knickers they're wearing.

As you found, if a woman wants to tell someone about her experiences, she will.

I had a breastfeeding disaster. A supply problem that never resolved, despite pumping 12 times a day, swallowing fenugreek and blessed thistle by the boxful, even trying domperidome, etc etc. I finally settled for partial breastfeeding with formula. Even pumping that many times a day (and direct breastfeeding as well), I only got about 5 oz the whole day. And there was hardly any information available about how to combine formula and breastfeeding in ways that don't lead to the baby just going for the bottle every time.

And my experience was that nobody in the breastfeeding field could really help me. I got so tired of being offered the same pieces of advice over and over, none of which made any difference, and always with the implication that somehow I JUST WASN'T TRYING HARD ENOUGH.

Well, I was. I was quite traumatised by the whole experience, and really struggling with depression and a deep sense of failure. And in all honesty, I often felt that if one more person asked me about breastfeeding, I would spit in their eye!

Margot