Why I Didn't Breastfeed My First Baby

My oldest son is 7. He was mostly formula-fed from birth, and completely formula-fed from about 7 weeks of age.

Given the person I am now, the breastfeeding advocate and educator, who has successfully breastfed three subsequent children, sometimes I look back and can't quite believe he wasn't breastfed. But his birth and my experience with him is what made me so passionate about birth and breastfeeding in the first place.

But why wasn't he breastfed?

Was it awareness, or lack thereof?
I don't think so. I was aware of the benefits of breastfeeding. I intended to breastfeed him. In fact, here's an excerpt from a LiveJournal entry I wrote when I was about eight months pregnant: 

The doctor asked if we'd taken any classes, which we have. She said, "Oh good, so you're prepared." Haha! Yes! I feel so prepared! Ok, I know the basics, and sort of what to expect. But prepared? I don't think you can ever really be prepared for your first childbirth. I mean, ok, the nursery is almost ready, he'll have clothes to wear and a place to sleep and something to eat (boobies!), but seriously. Prepared? I keep trying to remember the signs of labor and thinking how this class we took has a doozy of a final exam!

Then, about a week before the baby was born:

I went ahead and ordered a dual electric breast pump...Still cheaper than formula in the long run, and I hope that I will be able to give him breastmilk for as long as possible. 

So I was definitely "aware" of breastfeeding, of the benefits, that I wanted to breastfeed. I had made that decision and was planning ahead.

Was it education, or lack thereof?
This was part of it. And I think one of the big problems was, I didn't know I needed to be educated. I bought a couple of breastfeeding books, but I didn't read them. I didn't take a class, didn't attend any LLL meetings, didn't talk to other breastfeeding mothers about their experiences. Indeed, as the birth story I wrote just a couple of weeks after he was born shows, I didn't know what I didn't know:

They brought the baby to me and helped me latch him. He knew what to do, but I was still pretty out of it. I also have the timeline here a bit befuddled, because of what ensued. I know they needed to check his blood sugars because of his size, and asked us if it would be ok to give him some formula if he needed it, and if so, what kind. We said it was ok, but we didn't know anything about formulas, so just go ahead and give him whatever they thought was good. They suggested Enfamil with Lipil. Sure, why not.

If I had done any reading or taken a class, I would probably have known that he likely didn't need to be given formula, or we would have at least known to ask more questions. As it turned out, his blood sugars were fine, but I soon went into shock due to blood loss from the delivery. The nurses told me that because I'd lost so much blood, I wouldn't be able to make milk:

I didn't get a chance to try nursing again. I needed to rebuild my blood supply before I could even think about making milk.

I was stuck in bed for all of Sunday and Monday. They came and checked my bleeding periodically, gave me IV pain meds, brought me food. They brought the baby in on Monday for me to try nursing again, but I was pretty weak and sore. They were giving him formula, which was fine. With his size, he needed to eat, and I didn't have food for him. 

What no one told me, apparently, was that in order to make milk, I needed to nurse the baby. Even if my milk supply increase was delayed, I still needed to be nursing him and/or pumping to set up prolactin receptors and to encourage milk production. Even if he had to be supplemented with formula, that didn't mean I shouldn't nurse him. The colostrum would benefit him, too. I do recall that they fed him whatever colostrum I pumped, but it wasn't much.

Was it willpower?
Yes. I'm sure a big part of the problem was willpower. Now, I went through a traumatic birth, and I got off to a bit of a rocky start, but that alone didn't make breastfeeding impossible. The bigger problem in this story is that I didn't know how much hard work it takes in the beginning, especially when there's a rocky start, to breastfeed. I didn't know that if I stuck with it, it would get better and easier and really feel worthwhile, and so I didn't try.

Was it support, or lack thereof?
Yes and no. The support in the hospital was variable, as evidenced by some of the quotes above. Then there was this:

[On Tuesday, the lactation consultant] showed me how to use the pump and said I'd need to pump for 15-20 minutes every 2-3 hours to stimulate milk flow and establish a supply. She also suggested I rent a hospital-grade pump, because the one I'd bought would burn out if I used it that often. I think I pumped twice that day. With all the people in and out and all the activity, and my general weakness, pumping seemed like just that much more hassle, that much more of an energy drain.

Wednesday was better, and I did pretty well with pumping. A different lactation consultant came to see me and helped me breastfeed the baby. I tried the football hold, because of my sore abdomen, and the cross-cradle, which I found more comfortable. They told me I should breastfeed for 10 minutes per side and then pump for 10 more minutes.

This information is only sort of correct, and she didn't say the most basic thing, which is, "You have to nurse the baby to make milk, and here's why." She didn't say, "The best thing you can do to bring in your milk is to nurse the baby." She didn't say, "Spend time skin-to-skin with your baby and nurse on demand." She didn't say, "Watch the baby, not the clock." Etc. And no one, again, told me that it was hard work and perseverance that would matter the most. Everyone said it was fine to supplement with formula, and no one, not even me, fought for me to breastfeed.

On the other hand, my mom wanted me to breastfeed. She wanted me to so badly. But she didn't know how to support me, and I didn't know I needed support or how that support should look. A friend tried to help; she even offered to nurse the baby for me to show me how it works! She offered me the contact information for a local La Leche League leader. She knew I needed support, and she knew how to give it, but I didn't know how to take it, or that I should, and I was convinced that I should do what I was told by the hospital, not knowing, as many women don't, that the nurses at the hospital maybe weren't the be-all and end-all of breastfeeding information.

How did I feel about "failing" to breastfeed?
Well, there's this, from about 3 weeks postpartum:

I know these are questions best put to a lactation consultant, but I really want a more unbiased analysis. I want a totally practically-minded opinion, and I feel like an LC would push me to try breastfeeding, when I find it so discouraging. It's the lactation consultants who first told me to pump 8 times a day, and I didn't manage to do that and it just made me feel bad. I know that's what I'd need to do to boost my supply, but it's really hard. I don't know whom to turn to or whom to ask, and it's very upsetting. Breastfeeding is the one thing only I can do for my son, and I'm not even sure I want to do it. I know I'm not alone. I know there are other mothers out there who tried to breastfeed and just didn't want to. But I never thought I'd be one of them. I never thought I'd find it so difficult or, frankly, unpleasant.

I mean, anyone can mix some formula in a bottle and put it in his mouth. Many people have over the last 3 weeks, although it's his father who does it most often. But only I can produce breastmilk for him.

"I don't know whom to turn to or whom to ask...Breastfeeding is the one thing only I can do for my son..." I was so torn, and confused, and I didn't have the information I needed. I didn't want someone who would "push" me to breastfeed, and I thought all lactation consultants would be like the ones I saw in the hospital, who I didn't find to be helpful and I did find to be pushy. But that was exactly what I needed, someone who would "push" me to breastfeed. I didn't realize, you either breastfeed or you don't, and I certainly could have. (In that same post, I lamented that I "only" pumped 2 to 3 ounces in a sitting, having no idea that's actually quite good!)

And there's this, from one month postpartum:

I've been crying a lot. I think one reason is that I feel bad about having to give up on breastfeeding. I know I had so many extenuating circumstances that it would have taken a rather heroic effort to really get in there and exclusively breastfeed, but knowing the reasons doesn't make me less frustrated that things aren't working out the way I'd hoped they would.

And this:

A couple of women I know have recommended an LC in the neighborhood. Maybe I should talk to her. I don't know. I just want to feel better. I want to feel like I've resolved this for myself, and right now I obviously don't. If I try and fail, will I feel worse, or will I at least be able to say I tried? If I try and succeed, will I find the joy in it that I am hoping to find, or will I just get discouraged again? 

And then at six weeks, I thought I might try to relactate:

[I tried putting him to breast...] And even more exciting, milk came out! I thought my milk was dried up, but he got some out. Not very much, but enough that he was willing to keep sucking. So I let him. (Ow) 10 minutes on each side, he sucked. And milk came out on both sides. I let him keep going until it got too painful and he got too squirmy. I think he got a little frustrated when he wasn't the least bit satisfied after 20 minutes of sucking. I would be too, hehe.

Then we gave him a bottle of formula and he gobbled down 6 ounces, so I know he hardly got anything from me. But I wasn't so much interested in volume as ability. That was pretty exciting. My nipples are still sore this morning from it, but it felt really good emotionally.

I was not successful, but it's clear that I wanted to try, and I gave it a go. I even finally contacted the La Leche League leader that I should have spoken to in that first week! If my birth had gone more smoothly, I probably would have breastfed. I can't change the craziness that was my oldest son's first six weeks of life, but I think the lessons of what I went through can give us all some perspective on what other women might actually need, and how we can provide that.

What can we learn from my experiences?
I think we need to give most women, especially middle class, educated women, enough credit to assume they know about breastfeeding. It's not a lack of awareness that causes women not to meet their breastfeeding goals. After all, something like 90% of women state an intention to breastfeed upon giving birth, yet less than a third of them are still breastfeeding at six months postpartum, and not even half are still exclusively breastfeeding at six weeks. Something goes wrong in those first few days postpartum and in the early weeks.

I think the biggest factor in improving breastfeeding rates and success is education, followed closely by support. Education and support work hand-in-hand. First, we educate women not about why they should breastfeed (or not just about why), but about how breastfeeding works and what they can expect. Second, we educate women about finding and/or building a support network, to have phone numbers on hand they can call, websites to visit, books to read, to let them know that they can and should ask for help, that they don't have to - and shouldn't have to - go it alone, and that there's no shame in having a little trouble at the beginning. Third, we provide that support network, with continuity prenatally, at birth, and in the weeks following the birth. Whether they join a La Leche League meeting, are friends with an experienced breastfeeding mother, or get all their help online from blogs and Facebook, women and their partners need to know (a) they probably will need help; (b) it's okay to ask for help; and (c) where that help can be found.

It's amazing that I documented my experiences with such detail in the moment. It's hard to look back seven years through the lens of who I've become and remember what I was feeling at the time. Because I wrote it all down at the time, it's all out there, raw and visceral, and I can see right there what I knew, what I had, and what was missing. Filling in those missing pieces for other women can make a huge difference in their lives and the lives of their children.

***

To read the full account of my oldest's birth, see the four-part story starting here. 

For a quick-start guide to breastfeeding that answers many of the most common questions new mothers have, check out my e-book, The Jessica on Babies Breastfeeding FAQ, available for Kindle from Amazon.

Pumping Tips for Stay-at-Home Moms

With my second and third babies, I intended to pump milk and build a freezer stash so that the baby could have a bottle once in a while if my husband and I went out. What I found was there's not much time or motivation to pump when you're with your baby 24/7, since preparing a bottle is more trouble than just putting baby to breast, and when exactly are you supposed to pump when you have to feed your baby every couple of hours?

I actually did manage to fill a few freezer bags with pumped milk with my second, which I ended up donating because we had so few opportunities to actually give the baby a bottle. My husband worked long hours, we didn't have a budget for hiring a babysitter and going out often, and the few times we did go out, the baby wouldn't take the bottle anyway!

With my third, I resolved to pump for donation and, again, so we could leave him with a sitter, and that time I found even less opportunity and motivation to pump and ended up not putting much aside. He did get some bottles of expressed milk as a newborn, but after a few months, he, too, no longer took a bottle.

So, this time, I vowed I would find a way. One of the biggest difficulties many women have with breastfeeding is the feeling of being "tied" to the baby. You can never go out without the baby because you have to feed him. It's frustrating. Pumping and storing milk toward this eventuality can help. I bought myself a Hygeia EnJoye double electric pump, revived my hand expression techniques, and promised myself and my baby that I would find one time a day to pump and that he would get bottles often enough that we could leave him with a sitter and go out.

Now, obviously the situation is different if you work outside the home and are away from your baby on a regular basis. In that case, the baby is receiving bottles almost every day, and you're pumping instead of feeding during the time you're away from baby. That's not to say it's easy! Just different.

Here are tips for pumping/expressing milk when you stay at home with baby!

• Pick a time of day when you're pretty sure you'll be able to take 15 to 20 minutes to express milk on a nearly daily basis. Many women have more luck pumping first thing in the morning, so if that's an option, it may be a good choice. I tend to pump in the afternoon, but that's just easier for me because we're not rushing to get out the door.
• You may not need a fancy electric pump if you're only pumping once a day. Hand expression can be very effective for many women (myself included). You may also want to try a manual pump, which generally run $30 to $50, rather than a pricey electric pump. Check out my video on hand expression (NSFW) if you're not sure how to do it.

• You can start pumping as soon as your baby is born, if you want, but wait to introduce the bottle until breastfeeding is established, usually around 3 to 4 weeks of age.
• Give the baby a bottle at least every other day or so. This is the mistake we made with both baby #2 and baby #3: If you don't keep giving a bottle, the baby will forget how to use it or will simply refuse to take it, preferring your breast (understandably so). Have someone else give a bottle when the opportunity arises. I had my 7-year-old feed the baby one evening while I made dinner, for example. Baby may not take a bottle from mom but might from someone else. I did manage to give him a bottle myself the other night, but it sure felt weird to me!

• If you have trouble producing for the pump, or you have trouble finding a time between feedings to pump, you can try pumping while you nurse. Latch baby on one side and use the pump on the other side simultaneously. I find this to be extremely effective. Your baby will achieve the letdown for you, and you don't have to keep baby waiting to eat while you pump! It's a win-win. It is, admittedly, somewhat awkward, though, and it may take a few tries to get the hang of it. You can also use this method to help your body "learn" to respond to the pump if you're having difficulty getting letdown for the pump alone, and you can use it to help increase your supply if you're having supply problems.

• Massage and do breast compressions while you pump. If you are pumping just one side, or you have a hands-free pumping bra (highly recommended if you're double-pumping), use a free hand to compress and massage the breast while you pump. Find the full ducts and put pressure there to push the milk forward. This can greatly increase the amount you extract. I find using a combination of pumping and hand expression yields the highest volume in the shortest time for me. Milk removal is the trigger for milk production, so the more you remove, the more you'll produce!
• Remember that your supply will adjust to the demand. You can pump extra and have enough to feed your baby, but only if you pump consistently to tell your body you need that extra milk.
• At first, you may find it difficult to express a large volume of milk. Pump as much as you can, then keep pumping for a few minutes after you've "run dry" to let your body know you want it to make more milk. You should find your milk volume increasing if you pump daily. Be sure you are hydrated!

Milk Donation

If you find you are expressing considerably more milk than you need, even after giving a bottle every couple of days, you can use that excess milk to help another baby in need, either by donating through the Human Milk Banking Association of North America (HMBANA), which provides donor milk to babies in the NICU, or through a private milk sharing arrangement. You can find local-to-you mothers in need of donor milk by visiting Eats on Feets, Human Milk 4 Human Babies, or Milkshare.

Private, mother-to-mother milk sharing is controversial and not regulated or endorsed by the FDA, but it is legal and completely up to you and your milk recipient whether you want to enter into such an arrangement. Milk donors typically do not charge recipients for their milk but may ask the recipient to cover costs such as storage bags and shipping (if applicable). Milk donation is totally voluntary. Some recipients may ask that you be screened for diseases that can be transmitted through breast milk (a simple blood test). As a donor, you are doing a great favor to a baby and mother in need, but you also have a responsibility to ensure that your milk is safe for another baby to drink, meaning you should use best practices in expressing and storing your milk to ensure it is not contaminated or soured.

Guest Post: Baby N's Birth from His Father's Point of View

Today's special guest post is from my husband! He wants to tell our kids' birth stories from his point of view. Often the man's role in and feelings about birth are underplayed or downplayed, and in a series of articles, my husband will explore his own impressions and experiences during the births of our sons. So, to celebrate 100 likes on the Facebook page, here is his perspective on N's birth! 

(Notice his challenge at the end. To continue the series and hear about S's birth, let's keep pushing forward to 200 likes! Share the blog with your friends, and if you haven't done so, please like the Facebook page!)

***

I've been wanting to tell the birth stories of our 4 kids from my perspective, the husband’s. I've had this idea for a while, but it’s hard to find the time to write it. You read many stories from women about their birth experience, but I can’t say I read many from the father’s point of view. So, I’m not expecting many men to read mine. But who knows? Maybe I am the strange one.

Each one of my kids' births was very different, an amazing experience by itself. Some were more exciting for me, others not as much. This is simply meant to put down in writing what I experienced and how I felt during those times. Take it as you will.

Baby N

First child! I was an exemplary husband, or so I thought. I went to all the birthing classes, went to the tour of the hospital. I don’t think I missed a single OB/GYN appointment. I knew a lot about what was going to happen; well, I thought I knew. I mean, reality… well, I think most of us know how that is.

When the day came and we went to the hospital, we figured we would take along my wife’s mother. It would be a great experience and be helpful. I am very thankful for my mother-in-law for all her help, but this made for some awkward moments and made it difficult to talk to my wife in private. I was very nervous, but I thought I knew it all. We were joking about not taking an epidural, about why you would suffer pain when you do not have to. I was very casual about it; hell, at some point we ordered pizza to the delivery room. She pushed for a long time. It was nice for me at that time, I got really involved. The nurse had me help. I felt it was great. I got to hold a leg up, and look at the entrance to see if someone is coming out. I don’t think I thought too much about her pain and how she was feeling in all of this. At the time I thought I was great; today, I realize I was rather inconsiderate.

When the doctors “finally” offered a c-section, I was happy. Great, they will take him out, he won’t have a squishy head, and my wife parts will remain intact. Yes, men think about that. Well, some of them. Got all scrubbed up, the nurse asked me if I had a camera. I thought that was funny. I went in to the OR to find my wife lying in a crucified position (thankfully, my mother-in-law was not invited to this occasion). It was still all cool. I sat by her head, trying to make my usual silly jokes. I was in a huge adrenaline rush. Everything was happening pretty quickly. Pretty soon I got to hold the baby. I got to hold him first. Well, she couldn’t, being that she was crucified to an operating table and half numb. Looking at him, hearing his cry… the newborn cry is great. It hits me in a soft place every time. But the first one, it was amazing.

Then they took him away to the nursery and took us to another room to recover. Apparently she lost a lot of blood. I did not realize it then, not even when they sent a specialized trauma nurse to see her. I think it is a good thing I was high on adrenaline, or I would have freaked out. That one took a long time to settle.

At the stay at the hospital, for the next five days, I was also being great. I came by, fed the baby, and changed him. I was rather happy she did not breast feed. I got to play with my new baby a lot. This continued after she got home. They sent us home with a bili light machine, to treat his jaundice. Still, I was being cool, letting her sleep and rest while I took care of him. Every day I would change him, feed him, and wash him. All she needed to do was rest. I was supportive of her attempt to breast feed, but when she couldn’t, I was not upset. I get to keep playing with him, feeding, feeling so helpful. What a great husband I was being. This continued for about 3 months, until we moved to California, where I suddenly had to work more, and leave her alone with him.

Only much later, as she was getting ready to have Baby S, did I realize how bad I was at the time. I distanced her from her baby. I felt I was being helpful. She felt I was being helpful. But, that was not the right way to do things. I pushed what I wanted, and at the same time thought to myself, “Why is so distant from him?” There are ways to be helpful, but I do not think this was the right one. Now, I know I was being selfish. I did not see how she was unhappy, how this had made her feel.

It took me a while to change my way of thinking, and see how important it is to her. I can’t say I quite understand it yet. But, with Baby S, things were different.

That’s the first story. I think this post has gone long enough, so I challenge you to help the Facebook page get 200 likes to hear so I can tell you what comes next! 

I will say this to any men out there who are about to have a baby: It is indeed a lot about her, and not because she carries all the burden of the pain, pregnancy, delivery, etc. It is because, in the end, I do think the outcome will affect her a lot more. So, get involved, but also remember that the best help you can give is to push her to achieve what she wants. To quote Coupling, “Ask her three times” if she’s sure. But when you do ask her, make sure you mean it.

Formula "Goody" Bags

I've written before about doctors and hospitals giving out bags supplied by formula manufacturers, specifically here and here. It is a common marketing technique for formula companies - especially Enfamil, Similac, and Nestle/Gerber - to provide "gift bags," samples, and coupons to OB offices, pediatricians, and hospitals to be given out to expectant and new parents. In exchange for the doctors' and hospitals' assistance with marketing their formula, the company supplies free formula to these providers. Their idea is that if you send a new mom home with some free formula and some nice "gifts," she will be more likely to choose your brand if she decides to use formula, and she will be more likely to try using formula if she has some on hand already.

Samples may be anything from a small can of powdered formula, to a few ready-to-feed bottles, to coupons for free or discounted formula at the store. Often, the company will take things one step further and give out diaper bags, insulated bags, ice packs, and other useful items, along with booklets of information about infant feeding.

Research has shown that new parents who have formula samples at home, especially those that they received from their doctor or hospital, are more likely to supplement unnecessarily and are less likely to be exclusively breastfeeding at six weeks than those who do not have formula readily available. Formula samples directly sabotage breastfeeding. (See the above-linked posts for why and how this happens.)

In all honesty, in all three of my previous pregnancies, I did not receive formula "freebies" from my OB or pediatrician. Since my first baby was receiving formula from day one anyway, I did receive samples from the hospital and pediatrician, and I don't know what I would have gotten had I been breastfeeding. With my second and third, formula samples were not offered, and I was exclusively breastfeeding. I did receive some samples and coupons in the mail from joining mailing lists, but I did not receive any from any of my medical providers.

Today, though, I had my third visit with my new OB. After the appointment, I spoke with the billing office about what our financial obligations would be, based on my insurance coverage. After signing the payment contract, I was handed two gifts, one with Similac branding and one from Enfamil. I was excited, because never having received formula goody bags before, I didn't really know what they might be like. Also, it was entirely possible some of the stuff might be useful (ice packs are ice packs, after all), and I was curious to see what I was given. The Similac bag was a nice shoulder bag, while the Enfamil packaging was not in and of itself useful.

I know I personally won't be swayed by the formula marketing, since I have successfully exclusively breastfed two kids already and am extremely confident about breastfeeding this next little guy. I'm not worried that having some formula samples in my house will cause me any problems. I have a purely academic interest in what these bags contain and how their contents might be perceived by a mother less gung-ho than I am about breastfeeding.

I was not disappointed.

I'll start with the Enfamil package. It was a small, cloth bag fastened with Velcro. The label said it is a "birthing and beyond kit" and informed me that it contained ready-to-use formula. Inside were four "Nursette" bottles - two Newborn and two Gentlease - and one bottle nipple. Also included were a booklet on caring for my newborn, a book of coupons for various Enfamil products, informational cards about each type of included formula, and a postcard telling me that I could download the American Academy of Pediatrics' New Mother's Breastfeeding Essentials ebook from Enfamil's website.

The booklet, called "Your new baby - a detailed guide to your newborn's nutrition and well-being" contains a selection of generic advice regarding newborn care, milestones, and development, including a section on breastfeeding. This section is brief, not detailed, and is not complete enough to truly be helpful. They also find ways to advertise other Enfamil products such as their Vitamin D supplement, with a page on why supplementing with Vitamin D is important. The breastfeeding section is immediately followed by a section entitled "supplementing & formula-feeding," with the headline on the first page, "Going back to work - or just ready for a change." They then briefly discuss reasons why a mother might choose to supplement with formula, none of which are situations in which supplementation with formula is medically necessary: "milk was delayed coming in," "going back to work," "didn't feel like baby was getting enough," "mom or baby got sick," "baby had trouble latching or sucking," "pumping was too uncomfortable or inconvenient." This is followed by tips for bottle-feeding and preparing formula. The booklet also directs you to an 800 number or the Enfamil website for "live help."

I'll discuss all of this after we look at Similac's bag.

First of all, Similac's gifts were much more impressive. It starts with a quilted, messenger-sized shoulder bag which could be used for just about anything. It is simply black, with no Similac branding except for the large, removable label hanging from the strap. The bag is called a "Breastfeeding Supplementation Kit". In the bag were a sample-sized can of Similac powdered formula, a black cooler bag sized just about right for two bottles, with two Similac-branded ice packs inside, a Similac-branded booklet called "The Art of Feeding", a chart for how long breastmilk can be stored and instructions for use of the cooler bag, and a pile of coupons for everything from diapers to Disney movies. Surprisingly, none of the coupons were for Similac itself.

The "Art of Feeding" booklet starts out by recommending that mothers take Similac's prenatal vitamin during their pregnancy to aid their babies' development. It then discusses the nutrients a baby needs in its first few days and weeks of life and gives a quick overview of a sample diet for a breastfeeding mother. Next is a several-page guide to breastfeeding, including rough descriptions of the four most popular breastfeeding positions, tips for latching, an overview of newborn feeding habits, and what to look for when it comes to baby's diapers and weight gain. There is a brief FAQ, and then they recommend contacting their "feeding experts" at a toll-free number if you have further questions. The rest of the booklet contains advice about how to wean to formula, how to choose which type of formula to use (of course, Similac offers a wide range of options), how to choose a bottle and nipple (Similac has those products, too!), how to prepare, store, and use formula, and an overview of all of Similac's products.

The first thing I want to draw your attention to is the absurdity of a formula company - any formula company - offering advice on breastfeeding. Take any of this advice with a grain of salt. While none of what they say in either booklet is precisely "wrong," it's also not the kind of detailed help a struggling new mother might need, and some of it is misleading or incomplete. By including this information, these companies are trying to look like they're being breastfeeding-friendly, while simultaneously giving new parents the "permission" they need to supplement or switch to formula rather than try to solve any breastfeeding problems they encounter. By "allowing" a mother to use formula in addition to (or instead of) breastmilk, they are presenting her with a guilt-free "get out of breastfeeding" card. And they offer no real advice about how to know when you actually need to supplement, how to avoid the need to supplement, or how to realistically combine formula and breastfeeding in a way that will not further harm your breastmilk supply. They also do a fine job of explaining why their products are "almost as good as," or "the next best thing to" mom's own milk, and they show a range of products to meet any baby's needs.

Why does all this matter?

Well, let's look at where I got these bags. Who gave them to me? My doctor. By giving me these bags, my doctor is implicitly endorsing my use of formula. She has not given me any information on breastfeeding, has not discussed my choice of feeding method, and has not asked if I need any help making such a decision. I'm seven weeks from my due date. Maybe I'm still on the fence about how I want to feed my new baby. Maybe I haven't even really given it much thought. Maybe I'm being bombarded from all sides by the internet, my family, and my friends about how I "should" do this or I "can't" do that. Maybe I don't trust my breasts and my body. Maybe I don't really "get" how breastfeeding works. Maybe I think it's "gross." Or maybe I have body issues due to psychological problems or sexual abuse and the thought of anyone touching my breasts, even a baby, is nauseating or panic-inducing. I now have a ready-made solution: my doctor gave me formula samples. If I have any doubts about breastfeeding, I now know that my doctor thinks giving me some formula "in advance," "just in case," is a good idea. And if my doctor thinks it's a good idea, who am I to question?

Now, granted, this is my fourth baby, and I've made it pretty darn clear with my doctor, in the short time we've known each other, that I know exactly what I'm talking about and that I have a very clear idea of what I'm going to be doing. So it may be that she sensed I don't need her advice. I don't know how she might be with a first-time mother, or even a second- or third-time mother who is considering breastfeeding for the first time. I may actually ask her at our next appointment if they do provide any prenatal breastfeeding support or advice. One thing I am comforted by is that I got two different brands' bags, so the office is not endorsing one over the other, and they just sort of threw them at me with a, "Oh, yeah, you can have these if you want" attitude. But I wasn't exactly discouraged from taking them, either. And the way it's presented, "Oh, and we have some goody bags for you, too!" makes it sound so exciting and exclusive! Of course I'd want a goody bag!

I'm very interested to see what, if anything, I get from the hospital, if this is what I got from the OB!

Breastfeeding simply can't compete with the formula marketing scheme. Sure, I could get a bag from Medela or Hygeia or Avent or Lansinoh with various breastfeeding accessories such as breast pads, lanolin, and freezer packs. But these companies simply don't have the market share that the formula companies do, and they don't have as vested an interest in gaining you as a customer. You'll never, ever spend as much money on breastfeeding as you would if you buy formula. You just won't. It's not worth it for their bottom line to give out freebies like it is for the formula companies. That leaves doctors and hospitals and midwives and bloggers and lactation consultants to do the leg work of educating the public about breastfeeding.

What it comes down to for me, with this blog and in my life, is this: I don't have any say in what you choose to do, how you choose to give birth, how you choose to feed your baby, or any other of the myriad choices you'll be making as a parent. But, I do care that you make those decisions based on good, solid, evidenced-based information, which is what I try to provide you with here on my blog and if you ask me advice in person or through my social media outlets. There is no disputing the fact that formula is inferior to breastfeeding. There is a time and a place for the use of formula, and I can even give you advice on how and when to use it in a way that won't sabotage your breastfeeding relationship, if you need such help. I hope - I really, really hope - that you won't turn to Similac or Enfamil or Nestle to tell you how to "successfully" supplement your breastfed baby with formula and think that the information they give you is truly accurate.

I know that these formula samples can be genuinely helpful in certain cases when short-term supplementation is necessary. But I also think there are ways to provide such samples to the mothers that need them, without essentially spamming every pregnant mother with something she probably won't need.

As for me, I'm going to keep my bags to use as an educational tool when I finally start teaching my own breastfeeding classes. Raising awareness of exactly what you're getting when your doctor hands you a "goody bag" is a necessary step toward improving breastfeeding rates and successes.

Did you receive formula goody bags from your OB, hospital, or pediatrician? What types of products did you get? How did you feel about receiving these freebies? Did you use any of the products?

So, Which is Easier, Breast-Feeding or Formula-Feeding?

All right! Now that vacations out of the way and I can get back to a more regular blogging schedule, let's talk about that breastfeeding survey! I asked you to fill out a short, 10-question survey about your own exposure to infant feeding and your feelings about which is easier. I was actually fairly surprised by the results, and I think you might be as well.

I received 26 responses, not including my own. If you'd like to respond and haven't yet, I'll leave the survey up for a little while longer. I can revisit it in a few months and see if a greater number of responses alters or reinforces my conclusions.

The first two questions asked whether, in your experience or observation, breastfeeding and formula feeding are "very difficult, difficult, manageable, or easy." The majority of you answered, for both questions, "manageable," which was surprising to me. The second most popular answer for both questions was "easy." Overall, it seems infant feeding in general, be it by breast or bottle, is not considered a great challenge. Many responders felt the need to clarify or justify their responses by adding comments that different variables may affect their feelings, such as whether they work outside the home (making breastfeeding more difficult), or by stating that even if they thought breastfeeding was difficult, it's still worth doing. Two responders who felt formula feeding was difficult commented that it was because of all the bottle-washing.

And what do I think? I think formula feeding is very easy, if you have a baby who tolerates regular formula. I also think breastfeeding is easy, but there is a greater learning curve. I also think breastfeeding is not easy for everyone, for various reasons ranging from a physical problem with creating enough milk, to emotional difficulties, to a baby with physical or medical problems. All-in-all, having done both, I am going to come out and admit that formula feeding is easier in many ways but that I prefer breastfeeding on the whole.

The third question asked if you know how to properly prepare formula. I asked this because I think most people think they know how, but they may not be aware of the official guidelines to prevent bacterial contamination. The majority of you say that you do know how to prepare a bottle of formula properly. Certainly, preparing a bottle is not rocket science, but I was curious to see how confident we all were about our bottle-preparing skills. For the record, I knew the basics (how to measure, how to sterilize/sanitize bottles and nipples, how to warm the bottle). Some health authorities recommend boiling the water prior to use and not allowing it to cool below 70 degrees Celsius before mixing it with the formula powder. It is important to note that powdered formula is not sterile and is not safe for use with very young babies or babies with immune system compromise. Ready-to-use formula is sterile (but also considerably more expensive).

To contrast this, I then asked whether you know what a proper latch should look like when breastfeeding. Most of you say you do know, which is encouraging. The important thing to remember about your baby's latch is that it should feel right. However, if you're looking from the outside, your baby's lips should be flared outwards. The nipple should fall far back in the baby's mouth, so that a good section of the areola is in the baby's mouth as well. Many lactation consultants will advise you to try for an "asymmetrical" latch, meaning that the baby's lower jaw is closer to your chest than his upper jaw. The baby's chin should not be tucked into his chest, and his ear, shoulder, and hips should be in a straight line - his body should not be twisted, and he should not have to turn his head or strain to reach the nipple.

It really got interesting after this. The next four questions asked you specifically about your exposure to formula and breastfeeding aside from your own baby (if you have one). While most of you had often seen babies being fed from bottles, only about a quarter of you had seen babies breastfeeding on a regular basis. Several of you had seen bottles being prepared, and a third of you had prepared bottles for other people's babies. I was not surprised to find that there was far more exposure to bottle feeding than breastfeeding. Certainly the bottle is a pervasive symbol of babies and baby care in the Western world, especially the United States.

Finally, I asked you to decide which is easier, breastfeeding or formula feeding. The majority of you said breastfeeding is easier. Many who said that formula feeding is easier felt the need, again, to modify their responses by adding a comment that they still believe breastfeeding is better, even if formula feeding is easier.

What's interesting to me is that there was a definite reluctance to classify breastfeeding as difficult. I assume most of the respondents are breastfeeding advocates, experienced breastfeeding mothers (or their partners), or favor breastfeeding over formula feeding with their own children. If we say that breastfeeding is not easy, we may increase reluctance in giving it a try, especially among those who are specifically wondering which is really easier. Those who said formula feeding is difficult generally mentioned bottle-washing as a major turn-off. Those who wanted to comment as to what they found difficult about breastfeeding tended to allude to the difficulties associated with pumping and being "tied" to your baby.

I think this reveals a few basic issues in the "breastfeeding versus formula feeding wars." (By the way, the majority of you were not aware of this issue before becoming pregnant with your own baby.) The first is that there is still not enough general exposure to breastfeeding in everyday life. We need to see more breastfeeding in public, on TV, within our own families. Because of the strong formula/bottle-feeding culture in the United States and other Western countries, many children grow up never seeing a baby breastfeeding. Reinforcing this is baby dolls with bottles, the bottle as a symbol of "baby" in baby shower decorations, congratulatory greeting cards, baby birth announcements, and so on.

The second is that there is a perception that in deciding which feeding method to use, it matters which is "easier." I've written a couple of posts on this topic (for example, here and here). Many aspects of child-rearing are neither easy nor fun, while others are incredibly rewarding. What's important is not whether one is "easier" than the other, but which one is more beneficial to mother and child.

So is breastfeeding easier than formula feeding? In all honesty, no. It isn't. But both have their challenges, and the question is whether breastfeeding is overall more beneficial to mother and baby than formula feeding. And to that, I can say unequivocally, YES, it is.

It's Your Turn, Take 2! Your Breastfeeding and Formula-Feeding Experiences

Let's make this easier. I haven't had a very enthusiastic response to my little survey, posted Wednesday. I've made a web-based survey for you to fill in instead, rather than having to answer in a comment or email. Responses will be anonymous, and you can feel free to comment on any question to clarify or enhance your response. Enjoy!

Click here to take the survey!

It's Your Turn! Which Is Easier, Breastfeeding or Formula-Feeding?

I want to try something different with this post. I get a lot of hits on my blog for people looking for "is breastfeeding easier than formula?" and related searches. They mostly land on this post. I've also written a few others, like this one, and this one, that touch on that topic. Because this seems to be a popular question, I want to put it to my readers to help me answer it. In the comments, or in an email to jessicaonbabies (at) gmail (dot) com, or as a comment on this post on the Facebook page, answer the following questions as honestly as you can, either from your own experience or the experiences of friends and relatives. You can keep it anonymous if you want to, and feel free to expand on your answers if you want to be more specific. I'm interested to see what the general trends are. I'll follow up on this post in a week or two with a compilation of your responses and my reaction, as well as my own answers!

1. In your experience, or the experiences of people around you, do you see breastfeeding as:
a. Very difficult
b. Difficult
c. Manageable
d. Easy

2. In your experience, or the experiences of people around you, do you see formula feeding as:
a. Very difficult
b. Difficult
c. Manageable
d. Easy

3. Do you know how to properly prepare a bottle of formula?
a. Definitely
b. I think so
c. Not sure
d. No

4. Do you know what a proper latch looks like when breastfeeding?
a. Definitely
b. I think so
c. Not sure
d. No

5. Before you had a baby of your own, did you ever see someone breastfeeding a baby? (Including on TV)
a. Never
b. Once or twice
c. Occasionally
d. Often

6. Before you had a baby of your own, did you ever see someone giving a baby a bottle (regardless of what was in it)? (Including on TV)
a. Never
b. Once or twice
c. Occasionally
d. Often

7. Before you had a baby of your own, did you ever see someone prepare a bottle of formula? (Including on TV)
a. Never
b. Once or twice
c. Occasionally
d. Often

8. Before you had a baby of your own, did you personally ever prepare a bottle of formula for a baby?
a. Yes
b. No

9. Before you were pregnant, were you aware of the breastfeeding versus formula "wars"?
a. Yes
b. No

10. In your opinion, which is "easier," overall?
a. Breastfeeding
b. Formula-feeding

How Dad Can Bond with Baby

"I plan to pump and make bottles once in a while so his dad can feed him and bond with him, too."
"We do formula at night so Daddy can take the night feedings. He needs that bonding time."
"If I breastfeed exclusively, then how will his dad bond with him?"
"I want to make sure my husband has a chance to bond with my baby, too, so I think he should handle some of the feedings."

I hear or read comments like these often, usually couched as arguments against exclusive breastfeeding, and what it comes down to is the concern that if Dad doesn't feed the baby sometimes, if Mom is "hogging" the baby by breastfeeding all the time, then Dad won't get to bond with his baby.

Why is feeding so closely associated with bonding? Why is there this notion that the only way to bond with a baby is by feeding?

Part of the issue is that we breastfeeding advocates often tout the "bonding" aspect of breastfeeding as one of the major benefits. Nursing a baby activates love and attachment hormones in the mother (oxytocin and prolactin) that encourage the mother to protect and care for her child. Coupled with this are the warm feelings that the cuddling and eye contact associated with feeding provoke.

But there must be ways to bond with a baby aside from nursing! After all, parents who bottle-feed become attached to and bonded with their babies without nursing them. Parents who take in older children who no longer need bottles or breastfeeding bond with and love their adoptive children. What about stepparents who come into children's lives after infancy and become very well bonded with them?

While nursing, and feeding in general, definitely promotes that bond, not nursing or feeding doesn't prevent bonding.

While the mother may be the only one who can nurse a new baby, dads can certainly bond with their babies in other ways.

If we want to keep talking about feeding = bonding, then, once breastfeeding and supply are well established (at around four to six weeks), mom can start pumping so that Dad can give the baby a bottle. Indeed, if Mom is returning to work, she'll need to pump and have someone feed the baby from a bottle anyway, and it's a good idea to get baby used to taking a bottle of pumped milk before he has to be separated from Mom for any length of time. However, I do not recommend having Dad give a bottle at night in the early weeks, especially if there is any concern about milk supply, because late-night and early-morning feedings are essential for establishing supply and stimulating milk production. If he does give a bottle at night, then Mom should wake up and pump at around the same time that Dad is giving a bottle, at least for the first several weeks.

Continuing on the feeding = bonding track, once baby starts taking solid foods (around six months of age), Dad can feed baby! That first introduction to solid foods is usually fun and hilarious, watching baby's expression as he experiences a new texture and flavor, trying out the spoon for the first time. Of course, this has to wait until the baby is old enough for solids, but it can certainly be an enjoyable bonding=feeding time for Dad.

Moving on from feeding, how about bathing baby? My husband was the expert baby-bath giver for our oldest. Baths are fun and relaxing for baby and parents alike, and the skin-to-skin contact of Dad's hand as he washes the baby is healthy and also stimulates bonding and love. Dad can also massage baby before bed (Google "infant massage" for techniques).

Dad can diaper and dress baby. Before our oldest was born, we scoffed at the idea that diapering the baby would be a time of bonding. Who wants to change a poopy diaper? It's just a chore that has to be done. But we both soon found out that, while not exactly "fun" in the "enjoyment" sense of the word, changing a diaper can be much more than just changing a diaper, especially when it comes with tickles of the armpits, raspberries on the tummy, and stroking those adorable baby feet. Anything to entice a smile!

Dad can soothe the baby. Especially in those early days and weeks, when the baby may be fussy in the evenings and need help calming down, Dad can absolutely hold and cuddle the unhappy baby. He can hold the baby skin-to-skin against his chest, which will help the baby regulate his breathing and heart rate and keep him warm. He can swaddle, bounce, shush, or sing to the baby. Often, I've seen the magic of Dad's big, warm hands comfort a baby with gas or other tummy troubles, and Dad's deeper voice is calming and relaxing for the baby.

Dad can wear the baby. When baby needs to be carried, Dad can strap him on just as easily as Mom. Wearing a baby in a wrap or front-carrier is beneficial for both baby and parent!

Dad can sleep with the baby. While I know that not all married couples share a bed, it is pretty common. If Mom is co-sleeping, then so is Dad! Dad can cuddle his sleeping baby, gaze at the sweet sleeping face, and help quiet him during night wakings. And even if they don't co-sleep, what cuter picture is there than of baby asleep against Daddy's chest for a cozy nap?

The essential piece to bonding with your baby is not the feeding, it's taking care of your baby in general. Any way that you care for a baby will encourage a bond. The only way to ensure that Dad does not bond with his baby is for him not to participate in the day-to-day needs of his baby. The above ideas are just a few of the myriad ways fathers contribute to the well-being and care of their babies.

Breastfeed Just Once, and Then Decide

I stumbled across a rather polarizing article on why a particular author decided even before giving birth that she wasn't going to breastfeed. I'm not going to link to it, because I found it offensive and simply argumentative, but it can be found on the Mommyish site, if you care to go hunt it down. The problem I had with her article was that all of her reasons for not wanting to breastfeed were uninformed nonsense. She clearly wrote the article just to antagonize and not to convince or even to simply state her position.

Look, I said this in my very first paragraph of my very first post here: "I don't so much care what you choose to do. I just care that you make an informed choice." And I hope that you feel my posts since then have held to that basic philosophy. So if you give birth having already decided that you just don't want to breastfeed, then you don't have to defend yourself. Simply saying, "I just don't want to" is perfectly fine.

But it got me thinking. How can you decide even before giving birth that you just don't want to? I understand if there are underlying issues, such as previous sexual abuse, body image issues, or emotional or health issues that make breastfeeding difficult or insurmountable. Those are reasons far beyond, "I just don't want to." I'm talking about perfectly healthy women who have had healthy pregnancies and healthy birth scenarios who immediately request formula to feed their babies. How do you know you just don't want to? What turns you off so much about it?

For those women, I have a proposal. Breastfeed once. Just once. As soon as the baby's born, the best place for her to be is on your chest, skin-to-skin. Why not give the baby that one dose of colostrum? Nurse for 20 minutes, an hour, just once, while they clean you and the baby up and get you ready to go to the maternity ward. After that, do what you want, but why not give it a try at least? It certainly wouldn't do any harm, and you might be surprised by how it feels. Maybe try it once more when the baby wakes up. And then switch to bottles. After all, those first few breastfeeds help you out almost as much as the baby, by helping your uterus contract, which will help prevent hemorrhage and help you regain your shape.

I'm not going to try to convince you to continue nursing. I'm not even trying to convince you to nurse that one time. I'm just asking, why not? The thing about breastfeeding is, it's almost impossible to change your mind later if you choose not to breastfeed. But you can always change your mind and stop breastfeeding once you've started. Every drop of colostrum and every drop of breastmilk your baby gets makes a difference in her health and in yours. More is better than some, but some is better than none, after all.

Feel free to ignore me. I'm not pushing anything on anyone. I'm just making a suggestion. You might ask my opinion on a car seat or where the baby should sleep or how he should be dressed for this weather. You might ask me whether I swaddled or if I used a pacifier or which pediatrician I like. You might ask me which hospital I delivered at and why. You might ask what stroller I use, whether I let my cats near the baby, and if I took any medications during pregnancy. And, you might ask my opinion on whether you should breastfeed or not. If you're dead-set against breastfeeding, then don't breastfeed. There are plenty of other decisions you have to make about your child, stretching into the long years ahead. If the idea of breastfeeding is just too overwhelming, or you don't want your breasts to belong to someone else for the next year or two, or you just generally find breastfeeding "icky," or you're afraid you'll get sexually aroused by nursing, or you're uncomfortable bearing your breasts, or you have sensitive nipples and you're afraid it'll hurt, or you think breastfeeding will make your boobs saggy, or you want to be able to hand off baby to someone else to feed, or you just don't want to, then don't breastfeed. I'm no one special, that you should listen to me more than anyone else, more than yourself. In the end, you're the mommy, and it's your baby, and you get to choose.

But, just a friendly suggestion, breastfeed once. All of your worries or fears or just not wanting to aside, one feed, one time, the first time will not change anything. If it hurts, then stop. If you get aroused (highly unlikely right after giving birth, I'd think!) and you don't like it, then stop. If you want someone else to feed the baby, then stop (or, you can pump and let someone else give the expressed milk - just a suggestion!). One breastfeed isn't going to make your boobs any saggier than pregnancy already has (although it's a myth that nursing makes your breasts saggy - it's pregnancy, gravity, and age that do that). And having just given birth, your breasts and all the rest of you are going to be bared anyway, so what difference does it make?

Breastfeed just that one time, and then decide. You can always choose not to breastfeed, any time from day one until day 730, but once you've passed the first few days without breastfeeding, it's going to be mighty difficult to choose to breastfeed.

The most important thing, though, is that you love your child, that you make the decisions that you think are best, and that those decisions are informed decisions.

Happy Breastfeeding Awareness Month!

About Those Formula Freebies and Mayor Bloomberg...

By now, just about every breastfeeding blog I read has made some kind of commentary or another on New York City Mayor Bloomberg's new program for breastfeeding promotion in NYC hospitals. Part of the Latch-On NYC initiative, this voluntary program requires that participating hospitals lock up formula, not routinely give out formula samples and formula-branded paraphernalia to new parents, prohibit the display of formula promotional materials in the hospital, and conform to the New York State hospital regulation that exclusively breastfed babies not be given formula supplementation unless medically indicated. The program is expected to raise breastfeeding rates in participating hospitals because research shows that women who are given formula samples by their doctors or in the hospital are 3.5 times more likely to be supplementing with formula by two weeks of age. If formula is kept under wraps, and new mothers receive education about breastfeeding before their babies are given any formula, the thinking goes, breastfeeding rates will rise and the overall health of the population will improve. Hand-in-hand with this is news of an AAP resolution that pediatricians should not routinely hand out free formula samples to patients, for the same reasons.

I have been reading every blog post I've been linked to, taking in almost every comment on all the major breastfeeding and parenting blogs I frequent, and I still don't quite know how I feel about this initiative. It sounds like they're basically trying to get NYC hospitals to conform to the Baby Friendly Hospital Initiative standards without going through the BFHI certification process. I gave birth to GI in a Baby-Friendly hospital, and I felt that the breastfeeding support there was excellent. Of course, I went in intending to breastfeed. If I had gone in less certain, uneducated, or sure I wanted to use formula, I'm not sure how I would have felt. I didn't need or want to ask for formula, so I don't know what kind of "lecture" or "education" I would have gotten had I made the request. I didn't have any problem nursing or producing milk, so I don't know how I would have been treated had I genuinely felt my baby was starving and needed formula supplementation. Because I've been lucky enough to be able to nurse with relatively few problems, and because I'm extremely pro-breastfeeding, well educated about breastfeeding (I literally wrote a book on it), and because I wasn't going to let anything or anyone stand in my way of breastfeeding, I didn't need to think about "the other side."

I often wonder whether I would have been able to breastfeed NJ had I given birth to him in a hospital like the one where I had SB and GI. Rather than jumping straight to formula when there was the slightest hint of a problem, if they had been more supportive of breastfeeding and, more importantly, had been more supportive specifically of me in my situation, would I have left the hospital breastfeeding instead of with an extra case of formula? It's very hard to say. My husband and I were discussing this last night (in the context of the above-mentioned controversy). His perspective and memories of those early days are different from mine, but we both remember that the lactation consultants who visited me were quite unhelpful. While it may have been true that many women who experience postpartum hemorrhage have difficulty with their milk supply, and while it may have been true that pumping often would help bring in my milk, what I really needed was to spend lots of time skin-to-skin with NJ, nurse him on demand, and be forced to care for him. Yes, I was weak. Yes, I had lost a lot of blood. Yes, I was in pain. But NJ was healthy and strong, had a great latch, and, with a little help, I probably could have initiated breastfeeding while in the hospital and breastfed him several times a day during that four-day stay rather than allowing the nursery nurses, my husband, my mom, and my visitors to feed him for me. It's probable that he would have needed a few bottles (or to be fed via syringe, perhaps?) on the first day when I was fairly down-and-out from blood loss, but on the second day? The third? Through the night? I do remember some good practices, such as telling me to save whatever I did pump and that they could give him that in a bottle instead of formula. They did provide me with a pump and show me how to use it. They did have lactation consultants come every day. But I constantly feel, looking back, that the advice the LCs gave me was, while not necessarily wrong, unhelpful or misleading. If you straight out tell a woman she won't have enough milk, why should she even bother to try? And if you don't tell her or her husband that formula is not, in fact, equal to breastmilk, then why shouldn't she just go straight to formula to begin with?

What's missing in all of this, to me, is that education prenatally is vitally important. The decision to breastfeed can't necessarily be made in the postpartum haze. The desire to stick with it is lowest when in the throes of newborn nursing, and the temptation to use that free formula is highest at the most critical period in the breastfeeding relationship. I know this. I've lived it. You need to walk into that hospital determined to breastfeed. You need a supportive hospital staff, from the OB or midwife to the delivery nurse to the postpartum nurses. You need lactation consultants on hand 24/7 (not just during business hours!). You need good, solid breastfeeding information. And you need to know that you are going to be respected for whatever choices you make.

The loudest complaints against this program seem to be from two basic viewpoints. One is the women who never wanted to breastfeed and don't liked feeling "shamed" or "guilted" by the hospital for their choice. The other is the women who desperately wanted to breastfeed but, for whatever reason, needed to supplement with formula in the early days and struggled long and hard with the decision. Both feel that formula samples are helpful, especially those that only needed a can or two of supplements before being able to go on to exclusively breastfeed. Both feel that being lectured or educated by hospital staff before someone will go get them a bottle for their starving babies is shaming and unfair.

The thing is, I agree with them, too. If my baby is starving because I can't produce enough colostrum or milk to satisfy him (please note that this is rare), then I need to be able to give him something else. If the hospital staff balk at giving me a bottle of formula to feed him, and I have to sign a form or justify my request every time my baby gets hungry, it's going to make me feel even worse and more inadequate. Support doesn't mean just patting a woman on the back and telling her she's doing a good job breastfeeding. Support means sitting down with a woman and figuring out what she wants, what her goals are, and then helping her get there. A good IBCLC knows this, and a good IBCLC will know when formula supplementation is necessary and how best to introduce, use, and wean off of those supplements, if possible. Having a nurse who's had a little bit of lactation training come in and tell you once again that formula isn't as good as breastmilk, and maybe you should have another go at feeding from the breast before you give a bottle, is only going to make a frustrated mother more flustered and upset. We need a balance.

I'm in favor of locking up the formula, but I'm also in favor of giving it to any mother who asks for it. I'm in favor of banning the gift bags and the formula-branded handouts, but I'm also in favor of giving unbranded formula to mothers who need it (in the hospital). I'm in favor of good breastfeeding support and information, but I'm also in favor of education in the proper preparation and use of formula, if a mother chooses to use it. I'm in favor of pediatricians having formula samples on hand to help out mothers who need it, but I'm also in favor of pediatric offices having lactation consultants on staff to help mothers who are struggling. Balance.

We need a more comprehensive solution. While restricting access to free formula will increase breastfeeding rates among those who are on the fence (that's been proven), it will not help those women who truly need it or who adamantly refuse to breastfeed. We need information and education throughout women's lives, and especially during pregnancy, to help them learn about breastfeeding before there's a squalling baby in their arms. We need postpartum support, especially for those women who are going back to work. We need support for pumping in the workplace. We need better, longer maternity leave. We need a cultural shift.

If there is one thing I know, unquestionably, it's that the more babies who are breastfed, the better. Banning formula freebies in hospitals and pediatric offices is a step in the right direction, but it's not the only step.

Kids Need to See Women Breastfeeding

The other day, we were at a community barbecue at the Rabbi's house. I wandered into the living room of the house, where several of my friends were sitting around and chatting. One friend said she was sorry, but she thinks she made a faux pas. I couldn't imagine what she could have done. She explained that NJ had come in while one of the other mothers was preparing a bottle of formula for her daughter. (Not that she needs an excuse for this, but her daughter is 2.5, autistic, and has feeding issues, so she takes a bottle of formula to supplement her food intake.) He said something along the lines of, "I didn't have that when I was a baby!", to which my friend replied that he had. He argued, and she wasn't going to push the issue, so she just said, "Okay."

I shrugged and said, "No big deal. He doesn't know that he was formula fed." It's not that it's a big secret or anything. It just hasn't come up as a topic of conversation. He watches me nurse GI, and I think he has a vague awareness of my having nursed SB, and he's seen several of my friends nurse their babies, and he has always just assumed that (a) that's how you feed a baby, and (b) that's how he was fed. I call him my little five-year-old lactation consultant because he's very interested in breastfeeding and knows that it's the best choice for a baby. I haven't made a big deal of it, just exposed him to it by feeding his brothers. It has imprinted as "normal" on his brain, and I hope he carries that image with him into fatherhood so that he can be an awesomely supportive husband when his wife (G-d willing) has a baby (G-d willing).

I told my friend not to worry about it and that, if he asked me, I would talk to him about it. Apparently the whole episode didn't make much of an impression on him, because he hasn't mentioned it. It does make me wonder if I should sit him down and have "a talk" about it with him, but I mostly feel that it just isn't that important. At some point, it will come up in conversation, or he'll ask, and I'll explain that when he was born, Mommy wasn't as well-informed as she is now, and she was also very sick, and it was very hard for her to nurse him, so he got bottles of formula instead because he had to eat something. I'll tell him that we don't need to judge other mothers for how they feed their babies. (I wouldn't want to deal with the embarrassment of having him say something rude to a mother giving her baby a bottle! And he's the type who would say something, too, if it occurred to him.). I'll just say that some mothers decide to feed their babies formula from a bottle instead of nursing them for whatever reason, and that's their choice to make.

I'm glad that my sons are growing up exposed to women nursing. I think the image of a baby drinking from a bottle is so ingrained in our society that many girls (and boys) grow up thinking that's the only way to feed a baby. I know that when I had NJ, I didn't even really know what breastfeeding should "look like," or how it worked. I didn't know much about bottles, either, granted, but I think if I had grown up with more exposure to breastfeeding women, the idea of breastfeeding might have come more naturally to me. I didn't wrestle with the decision to breastfeed - I had intended to, before the circumstances of NJ's birth led me down a different path - but I didn't educate myself, and that was the mistake.

I think growing up knowing that babies are fed from the breast will serve more than one purpose. First, it will make breastfeeding normal, and that means that when they have their own babies, these children will think first of breastfeeding rather than bottles. Second, they will know how breastfeeding looks. How to hold the baby will come more naturally, because they'll have seen it live. They'll know how it should sound, and what the baby needs to be doing. They might even have talked to someone about how it feels or what problems she might have had. Certainly, they or their wives will need help and support from friends and relatives and medical providers and society as a whole in order to start and maintain a successful breastfeeding relationship, but they'll be motivated to breastfeed and motivated to seek out such support, knowing that their breasts were designed to feed their babies.

Growing up seeing breastfeeding as a regular and normal thing will also decrease the "breastfeeding in public" debate. If breastfeeding is just another thing you see every day, then it is no longer sensational or controversial, so there will be no need for debate. Feeding a baby is feeding a baby. It's not sexual or indecent or offensive. And if a baby suckling from a breast is as ordinary a sight as a child eating french fries, women will feel more confident in starting and continuing to breastfeed because it won't seem weird or unusual or "out there" or uncomfortable.

So, to my little five-year-old lactation consultant, my son who is so concerned for the welfare of babies, thank you for already being so supportive of breastfeeding. Thank you for showing that a child can process the idea of breastfeeding as normal, take it in stride, and establish a vision of baby feeding that will encourage him to champion breastfeeding for his own babies one day. Kids are not offended or put off by breastfeeding. It's kids who will become the next generation of breastfeeding supporters because they have been exposed to it as children and don't find it exceptional at all. And that's what we want.

And, if my son asks me how he was fed as a baby, he will also get to learn that sometimes we do need to use formula, and we don't think less of a mother just because she isn't breastfeeding. Maybe the next generation of "Mommy wars" won't include a breastmilk-versus-formula category at all.