If you didn’t immediately realize it from the title, this is going to be a (very long!) post about breastfeeding. I’m writing it mainly to share my thoughts and my experience with Emma and have it recorded for my own future reference — so you can choose to read or skip this one as you see fit!
I read this New York Times article earlier today discussing whether hospitals should be banned from giving out samples of infant formula because it interferes with breastfeeding. I have VERY mixed feelings about this. I recognize that it’s a very effective form of marketing for the formula manufacturers. Do the samples matter? Absolutely. When we realized we needed to supplement with formula, we grabbed the first sample we came across — and since we weren’t able to return to exclusively breastfeeding, we’ve now bought several tubs of that brand. They gave me samples and coupons, and I’m now giving them my money.
(Interestingly, I did not receive any formula samples from my hospital. I’m not sure if they were banned at my hospital, as discussed in the article, or if they didn’t give me any because I had communicated my plan to breastfeed exclusively. But I was given one unsolicited sample pack from my OB, and received several, also unsolicited, samples and coupons by mail.)
So yes, by using the samples we certainly fell smack into the marketing strategy. But when we needed to use formula within the first week of Emma’s life, I have to say that it was REALLY NICE that we already had those samples, and that no one had to run out to the store and try to make sense of what we really needed in those early days when we were already overwhelmed by everything.
Yes, breastfeeding is best. But I’m also not sure it’s fair to say that getting samples has a negative effect on breastfeeding attempts. Perhaps it does for some women, but it didn’t for me. I was 100% dedicated to breastfeeding and was — and still kind of am — very upset that I wasn’t able to exclusively breastfeed Emma. Yet I appreciated the formula samples and coupons I got and continue to get. If we hadn’t needed them, I wouldn’t have used them. Pretty simple.
If anything, I was pleasantly surprised to discover that all of the literature that came with the formula samples talked about breastfeeding, encouraged breastfeeding, and even gave tips on how to deal with common breastfeeding issues. The formula companies are pushing their product, yes, but that doesn’t seem any different than what the drug companies do. I never once felt like I was being pressured to use it if I didn’t need it.
Anyway. On to my personal experience…
I always planned to breastfeed Emma. From conversations with friends who’d already had children, I feel like my expectations were realistic. I didn’t expect breastfeeding to be easy, but I did expect us to get the hang of it eventually after some fits and starts — after some soreness and discomfort. I admit there was a part of me that though easy pregnancy = easy breastfeeding! Still, I was prepared for it to be hard at first.
What I WASN’T prepared for was the idea that I might not produce enough milk for my baby. I mean, the lady who taught our birth and childcare class flat out said: “A lot of women THINK they have a supply issue, but it’s very rare to ACTUALLY have a supply issue.” I read the same thing in passing in several places online.
Emma was born on a Monday morning. For the first 3 days, Emma seemed to be getting plenty of food but left me blistered and scabbed. I have a pretty high pain tolerance, but it just got worse and worse. I would wince each time she latched on. Still, I stuck with it. We saw the hospital’s lactation consultant on the day Emma was born, but our efforts to get ahold of her the next day were fruitless. We finally saw her again on the day we took Emma home. She gave me a nipple shield and showed me how to use it so that I could continue breastfeeding while letting things heal. She also showed us how to set things up for a couple different breastfeeding positions. I left the hospital on Wednesday afternoon feeling really confident.
My milk came in later that day. For the next three days, I continued to nurse Emma using the nipple shield but didn’t get much relief from the engorgement. On Friday, I tried nursing once without the shield and felt a significant difference in my breast. She had obviously gotten more milk during that session than before — but it was so painful. I tried again without the nipple shield once on Saturday with the same result. But I went back to the shield, because the lactation consultants continued to advise me to use it and because it alleviated the pain.
Lesson Learned #1: Use the nipple shield as little as possible!
For the first week, I was also alternating sides — nursing on the left for one feeding, and the right on the next. I figured it would give each side a bit of a longer break, in hopes of easing the pain. I’m pretty certain I told the lactation consultants I was doing this when they asked, but they didn’t say anything and in retrospect, this means each breast was going 5-6 hours between feedings, which certainly did nothing to help establish my supply.
Lesson Learned #2: Nurse from both sides at each session! (I would have known this if I’d read a little more beforehand. I regret not doing more reading on my own about breastfeeding before Emma was born.)
On Friday, Emma weighed in at 5 lbs 12 oz at her pediatrician’s appointment — down 9 ounces since birth, and down an additional 2 ounces since she’d left the hospital. On Saturday, our pediatrician told us to start supplementing with 0.5 oz formula per feeding due to the bilirubin levels they measured from a blood draw the day before. I was bummed, but of course concern over Emma’s jaundice outweighed any disappointment and we started giving her the half ounce each feeding using a small syringe so that she didn’t get the dreaded “nipple confusion.”
On Sunday, I got a breast pump and began using it a couple times each day. I don’t remember exactly why I started using it so quickly — probably to get the hang of how it worked, and possibly because I was worried that Emma wasn’t getting enough milk from me.
On Tuesday, when Emma was 8 days old, I went to the hospital’s nursing mom’s group for the first time, where I was able to weigh Emma, feed her, and then weigh her again to get a fairly accurate measurement of exactly how much she was getting from me. I was still using the nipple shield. Emma ate 4 mL from the left side and 8 mL from the right side. There are 30 mL in an ounce — she got less than 0.5 ounces over an entire nursing session! The lactation consultants saw that and said yes, I needed to supplement, and needed to supplement with even more than 0.5 ounces per feeding. They also told me I needed to start feeding from both sides (the first time they told me this) and recommended that I pump as much as possible. Feeding sessions grew to last an hour as I nursed from both sides and then pumped.
Lesson Learned #3: Start pumping early to help establish milk supply.
On Thursday, when Emma was 10 days old, I went to mom’s group again where Emma ate a whopping 2 mL from the left side, again through the nipple shield — which the lactation consultants told me to keep using even after discussing how I felt like she got a lot more without it. They gave me a supplemental feeding system that involved a bottle of formula and a tiny tube that ran underneath the nipple shield. Emma could get formula through that while still feeling like she was breastfeeding. And nursing sessions grew to last more than an hour as I used the supplemental system on each side following by pumping. I was getting somewhere between 0.6 and 0.8 ounces total per pumping session. It was downright depressing.
By Monday, when Emma was 2 weeks old, I couldn’t maintain it any longer. She was feeding every 3 hours, and each session lasted more than an hour. There was hardly any time for me to get any sleep. At my wit’s end, I began using a bottle for the first time and replacing some nursing sessions with pumping-only to save time and get a bit more sleep. Emma was eating at a ratio of about 80/20 formula/milk. The next day at mom’s group, with the lactation consultants still encouraging me to use the nipple shield, Emma ate 2 mL from the left and 8 mL from the right.
ARGH.
At mom’s group the following week, when Emma was 3 weeks old, I finally listened to my gut and nursed her without the nipple shield. She ate 12 mL from the left and a whopping 34 mL from the right! It still wasn’t enough to quit using formula, but I had been right all along about the constraining effect of the nipple shield.
Lesson Learned #4: Listen to my instincts. The lactation consultants are smart, but they don’t know my specific baby and they’re not always right.
But Emma was still causing injury. Rather than continue with the shield, I decided to start a combination of pumping, bottle feeding and nursing, since she didn’t seem to be confused at all by going between a bottle and the breast. After trying a combination of several things aimed at increasing my milk supply — pumping 8 times a day, taking herbal supplements, eating oatmeal, staying hydrated — I was getting somewhere between 1.5 and 2 ounces total per pumping session. It still wasn’t enough for Emma to go off formula, but at least the ratio of formula/milk had risen to about 50/50.
I continued nursing Emma without the shield once or twice a day to ensure that she didn’t “forget” how to nurse while also preventing too much injury to my chest, and I remained optimistic for several weeks that I could increase my supply enough to go back to feeding Emma exclusively with breast milk. But it never happened. I maxed out in mid-September at around 12 ounces per day, nowhere near the 32-34 ounces she was eating on a daily basis at that point. Shortly after that, I stopped nursing and went to just pumping.
These days, she’s entirely bottle-fed and eats 28-30 ounces per 24 hours. I’m still pumping, so breast milk makes up 8-10 ounces of that, but the rest is formula, somewhere around a 65/35 ratio of formula/milk. If I think about it too much, I’m still upset that breastfeeding didn’t work out. I wonder whether I would have had a supply issue if I hadn’t used the nipple shield, or if I had fed from both breasts each time, or if I had pumped earlier — hence my “lessons learned” about things to do differently next time.
It’s hard to accept that I wasn’t able to properly feed my baby, and that I may have caused the problem by not doing things “right” early on, but I have to remind myself that it is what it is. And frankly, I jumped through so many hoops trying to increase my supply throughout August and the first half of September that it seems like if I was able to produce more, I would have. I know the first week is crucial, but it’s hard for me to believe that the mistakes I may have made in the first week destroyed my chances forever. It will be very interesting to see whether things are different next time.
Lesson Learned #5: Don’t freak out if we have to use formula with the next baby.
I’m proud of myself for sticking with it long enough to provide Emma with some amount of breast milk for her first 3 months, but when I go back to work in two weeks, Emma will transition to 100% formula fed. I know from talking to several friends that pumping at work is difficult, and I just can’t justify continuing to pump when I get so little milk. I have high hopes of a successful breastfeeding experience if/when we have a second child but at the end of the day, Emma is healthy and thriving, and we have formula to thank for that.
Jennifer says
Love this! I agree with you 110% on one and 2. We used a shield for a while when I had thrush, and I would stay engorged on that side. On the flip side, I was finally able to heal a little. Breast trauma early on when you’re nursing every couple of hours is a huge problem – so hard to heal from!
Believe it or not I also didn’t know you needed to nurse from both sides. Isla always acted full after one side, but I think not nursing on bot h sides is the main reason she hadn’t gained weight after 2 weeks. When I started nursing both sides, she gained like crazy for a couple weeks – basically catching up for the first two weeks.
I wish somehow I could have shared this more effectively with you since we both had to learn the same lessons independently.
We tried to see a LC in the hospital and never did get to see one when we were actually nursing. very frustrating! You always hear about these wonderful LCs, but you really need them in the first 48 hours ,and if there not around, it’s not very helpful.
I’d also planned to go to formula after 12 weeks when I went back to work. obviously that didn’t happen, but I wouldn’t want to spend an extra hour pumping at work that I could spend at home with my baby.
saroy says
Yeah, that’s another aspect of pumping at work that I didn’t even mention — the fact that unless I could figure out a way to work while holed up pumping for an hour a day, I’d have to stay at work an hour longer. Which, as you said, would take away from time I could be at home with Emma.
Jennifer says
I love that picture by the way.
SarahM says
I’m sorry you had such a frustrating experience with breastfeeding. A lesson I learned has been that not all LC are the experts you’d hope for. Some have gone through a lot of training and others haven’t. From reading over your experience it seems like the health care providers you were working with dropped the ball quite a bit!
saroy says
The LCs were very attentive and nice, so it wasn’t my intention to place any blame. They were always responsive, with the exception of my second day in the hospital (which was a Tuesday, so I later realized they were all over at the mom’s group).
I think they were all very well trained. I just think it’s more like I said — they don’t know my specific baby, and they didn’t see us every nursing session. I wish I’d been more confident to not follow their instructions to the letter when I had a gut feeling I needed to do something differently.
Mom says
Well said!! I’m proud of you and your efforts and Emma has certainly benefitted from your efforts!
becca says
I think you did all the right things, from the outside looking in at many women and how frustrating this is.
I find that NYT article angering. It is very paternalistic to attempt to take women’s choices away in order to force them to do one thing or another. Some women still don’t get 3 months of leave (FMLA only covers women that work at >50 people companies, and doesn’t require pay), women have to go back to work, long hours, some states don’t protect their right to have breaks to pump or breast feed, and they have to work to pay rent, etc. The point is for some women breastfeeding is still a luxury. And even for those that have the luxury, what you’ve pointed out is that it doesn’t always work out. Hospitals shouldn’t be trying to force women’s hands in this.
saroy says
I was more focused on the to-give or not-to-give samples debate and didn’t even consider that aspect of the issue, but I think you’re right when you say breastfeeding is a luxury for many women.
Jose’s mom, for example, breastfed for about a month and then switched to formula because working was a financial necessity, and she was in a job where she couldn’t pump. (Not to mention that while I don’t have any info on this, I would guess that personal, portable breast pumps were not exactly prevalent or affordable 30 years ago.)
So yep, I totally agree with you. I’m ok with hospitals encouraging breastfeeding, but not with trying to force it.
becca says
I mean seriously the same politicians that say the state shouldn’t step in and protect the rights of nursing mothers (or the rights of parents to stay home at first) and make it easier for women to nurse are the same politicians that try to ban free formula in order to force women to do it. Its really appalling if you think about it from a political perspective.
Nujoud says
I know you had problems with feeding, but you should know that even for mom sthat do get to exclusively breastfeed, its no walk in the park for most. I had massive and I do mean MASSIVE pain from cracked nipples that lasted at least 2-3 weeks per nipple early on. But I’ll be honest, I’m surprised at your lactation consultants advice to use the sheild so much since I was always told to just nurse through it.
saroy says
Oh, after talking to many friends and hearing the same thing, I was definitely prepared for it to be difficult and really painful. I didn’t think to question the nipple shield until a couple weeks had passed, since it stopped the bleeding (literally) and the LCs repeatedly told me it wouldn’t affect how much milk Emma drank (which I finally realized wasn’t true).
Anyway. I do feel like I was geared up for it to be really hard for at least the first few weeks. But I was completely unprepared for the supply issue, and it really caught me off guard. I feel like pain would’ve been easier to deal with, since it would’ve eventually gone away! The supply issue never fixed itself despite a solid month of effort, which was been really depressing.
Like I said, it’ll be interesting to see if I experience a supply issue again next time around since I’ll do things differently at the beginning. I go back and forth on how much effect I think using the shield had on my supply.
Erin S. says
Sarah I think you have done an amazing job with your efforts to breastfeed Emma! She will be a healthy girl no matter what, so try not to beat yourself up. That being said, I understand your feelings a little bit since I can’t keep up with Keagan’s need’s anymore. We’re about to start supplementing this week, so I’ll be coming to you with formula questions.
Also, I love that pic of you and Emma. You look tired but so happy and beautiful
Can’t wait to have you back at work!