A Few Breastfeeding Surprises

Yesterday, I was nursing Greta and just enjoying the closeness and the sweetness of the moment. I don't always enjoy nursing, and so when I have those moments when it can be just calm and lovely and sweet, I cherish them.

It also reminded me that I'd been wanting to post about some things that surprised me about breastfeeding -- things I didn't know, or wish someone had told me ahead of time. So here are some things that I've been surprised by with my breastfeeding journey.

First of all, every woman is different and every woman's experience with breastfeeding is different. This seems like it should be obvious -- since it is drilled into us that each pregnancy and birth is different. But it feels even more true for breastfeeding. For example, the biggest myth that I heard about breastfeeding was that If it hurts, you're doing it wrong. Nope. Breastfeeding can hurt no matter how good the baby's latch is. Greta didn't have a perfect latch, but even when the nurses and lactation consultants told me that it looked great, I was still in a ton of pain. There's no need to keep trying to get a better latch just because it hurts. If the latch is deemed "correct," and it still hurts, the mom shouldn't have to beat herself up with trying to get a better latch -- she can either find ways to manage the pain as it is, or she can choose an alternative method of feeding, but it just doesn't make any sense to make her feel like she's doing something wrong. It still hurts to breastfeed most days, but my baby seems to be getting food and my supply doesn't seem to be dropping.

Speaking of supply drops, I wish that someone had told me that all the "rules" for breastfeeding are actually quite individualized. I broke many of the rules and didn't suffer the ill consequences that I'd been told to expect. I understand that the rules are there to prevent problems -- even if those problems are rare -- but I think I would have appreciated some advice on how to navigate which rules to follow and which to not. I don't think I could have gotten through the first few weeks of breastfeeding without having broken the rules.

Arden's List of Broken Rules
1. Any amount of formula can ruin your chances of breastfeeding success. We gave Greta formula the first night home from the hospital, when she was inconsolable, had been dropping weight, and my milk hadn't come in yet. Later that week when we were having so many problems with failed feeding attempts, a half-ounce of formula at the start of each feed to calm her down and get her ready to nurse was our saving grace. Still later, when I was desperate to get out of the house with my baby, having a bottle of water and some pre-measured formula in the diaper bag was a great relief and required much less planning than prepping some milk or attempting to breastfeed in public. Honestly, as weird as it sounds, formula has kept me breastfeeding. I can't remember the last time that she got formula -- it was probably a month ago or more -- but having it available is hugely beneficial from a psychological perspective.
2. You should never use a nipple shield, or should wean yourself and your baby off of it as soon as possible. I don't know if this is true, but I do know that I still use a nipple shield and have no particular desire to try to wean us off of it. I am considering trying to do that this month, since I am on break from school and will be nursing more frequently, but I just don't see a strong reason to do it. Maybe my supply would  have been better if I hadn't used it, but I think my nipples get plenty of stimulation even with the shield on. So the other main reason is for my own convenience, and, at least so far, that's just not a good enough reason for me.
3. You should wait to introduce a bottle. I've heard the exact opposite from most other moms. In fact, I can't think of anyone I know who regrets introducing a bottle early on, but I can think of several parents who have told me that their baby refused the bottle when they weren't introduced to it until later. I will say, though, that I think it helped that we used the Breastflow bottles (that require the compression and suction in order to work), so that Greta didn't get too used to drinking her milk quickly.
4. You should nurse whenever possible, and never pump unless you physically cannot be with your baby (for work, etc). I pump every morning even though my baby might be sleeping just upstairs, or even receiving a bottle of breastmilk just a few feet away. I always feel the need to justify the fact that we do this, but to be honest, it's just better. First of all, nursing is a miserable experience when you're already really tired. I know a lot of people say that you can just nurse while sleeping in the side-lying position, but I'm totally uncomfortable with the idea of being asleep while nursing. I struggle enough with worrying that my baby's airways aren't clear when she's pressed against my breast -- I don't need the additional worry of being unconscious for that time. Second, because she sleeps (mostly) through the night, it feels silly to let all that extra milk go to waste by just nursing and reducing my supply. By having trained my body to get used to a pump session in the mornings, I can usually get two full meals of milk pumped, even though she only drinks one at around that time of day. Third, if I had to wake up (and wake her up) early enough that I could get in a full breastfeeding session before needing to leave for work, I'd have to set my alarm for 3:30am. I feel totally justified in breaking the nursing-only rule for those three reasons, even if it means that my baby only gets 2 nursing sessions a day with me on workdays. Even beyond breaking that rule for my morning pump sessions, though, I have to say that I would have gone insane if I hadn't been able to miss a feeding here and there and pump instead. Even in those first few weeks, it was wonderful to go out for a little break and have someone else give her a bottle for her next feeding.
5. You have to vary your feeding positions. Watch -- as soon as I post this, I'm going to come down with plugged ducts and mastitis, but the truth is that I nurse in the exact same position everytime. I can't even remember the last time that we used the football hold, and I've never tried the side-lying position since the hospital. I think that pumping might help with this -- since the pump only has one way of draining the breast too, either my breasts just adjust how they produce the milk, or maybe the pump just does a better job of extracting the milk evenly, even if it's not as efficient as a baby. Or maybe I'm just lucky.

So those are my broken rules. I might be forgetting some, but basically my motto is that breastfeeding is all about getting the milk into the baby by any means necessary. Maybe, if I had been another woman, breaking even just one of these rules would have immediately reduced my supply and ended my breastfeeding experience early and completely. But I think it was worth the risk for me, since I know I wouldn't have lasted very long if I hadn't bent some of these rules.

Now onto the rest of the things I wish I had known about breastfeeding.

Nursing takes much more time than I had expected. When Greta was first born, we'd basically wake her up, change her diaper, nurse, burp, nurse and then put her back down to sleep. When we looked at the clock after putting her back down to sleep, we'd have only about an hour and a half or so before the next cycle would need to start again. And that was on a good cycle. Sometimes it was as little as 30 minutes before nursing would start again. And that was adhering to the 3 hour rule -- imagine how infuriating it was to hear home health nurses and lactation consultants say, "Well, it's every 2-3 hours, so every 3 hours is the minimum, but you should be aiming for more frequent feedings . . ." If we'd nursed every 2 hours, she would never have gotten any sleep! Even now, nursing still takes at least 40 min to an hour each time -- and can still easily take as long as an hour and half.

If I don't have help, it takes even longer. If I can't get ready and settled for nursing while someone else changes her diaper . . . if I have to get up and hunt around for a burp cloth when I forget to bring one over before we get started . . . if I have to prep a beverage or a snack for myself ahead of time, instead of letting someone else do that after I already have her latched on . . . it can take so much longer.

Pumping takes more time than I'd expected too. I spend about 2 hours a day hooked up to a pump and expressing milk, but pumping is more time consuming than that. I remember watching a "how-to" video for a pump before I got pregnant. I was nervous about pumping, and the video made it seem like SO much work -- setting up the pump, washing all the materials, etc. But little did I know, it would feel even more time consuming than that. Maybe I make things needlessly complicated, but I always sit down with a big glass of ice water every time I pump. And for my morning pump session when I've just woken up, I want a snack to be handy, because the worst thing in the world is getting hooked up to a pump and being unable to think about anything except how much you wish you'd gotten a snack. Actually, the worst thing is being unable to think about anything except how much you wish you'd gone to the bathroom. So add that to the pre-pumping to-do list. I also use a heating pad to help with the letdown, so that takes time to heat up. And putting on the hands-free bustier thing and checking to make sure everything is attached correctly takes time too. Add it all up, and I can easily spend 15 minutes preparing for a 20 minute pumping session. Obviously, when I'm at work, I don't have that kind of luxury, though, which may explain why my output is so much lower.

Planning around one's breasts is a huge hassle. It's hard enough to plan around your baby's feeding schedule, but planning around your breasts is a whole other headache. Last Sunday, I marched in the Twin Cities Pride parade. As much as I wanted to bring Greta to the big event, it wasn't practical to bring the baby, the breastfeeding pillow, etc and finding a comfortable place to nurse would have been extremely difficult because of the crowds. So marching in the parade meant leaving the baby at home and taking a bus downtown, marching in the parade, and taking the bus back. With crowds and variable bus schedules (the bus I took ended up being over 25 minutes late), I was pretty anxious about how long I was going to be away from both pump and baby. She had plenty of milk in the fridge, but my breasts were going to be in agony if I was unavoidably delayed. I ended up packing my handpump in my purse, even though I don't know where I would have pumped (under a shady tree in Loring Park?) if I had needed to use it. Thankfully I was able to get home fast enough that I was uncomfortable, but able to manage.

It isn't free. Everyone always talks about how breastfeeding is so great because it's free. It's less than formula, but it isn't free. It might be free if I stayed at home all day, and never put on clothes, but that's really about it. The moment that I step outside of the house, the breastfeeding costs start adding up. There is the expense of the nursing tanks and bras (estimate: $250 for 4 bras and about 7 tanks -- purchased mostly at Target, with a few items from Motherhood) and the breast pads to prevent the leakage (about $6 per month for the generic disposable ones or, if you wash them every week, you can buy re-usable ones for about $20, but they don't stay in place as well in my experience) in order to just put on nursing-friendly clothes and get outside the house. And that's not including nursing-friendly tops (it assumes that you wear a regular shirt over a nursing tank or bra, which may mean exposing your belly everytime you nurse . . .) if you add in a few nursing-friendly shirts and dresses, your wardrobe can get much more pricey. Since it is summer now, I'm totally coveting a nursing summer dress, since I can't wear any of my normal dresses anymore.

If you go to work at all, then there's a whole other set of expenses. There's the pump itself (which might be covered by insurance, if you're lucky like me, but might cost up to $300 if a woman's insurance doesn't pay for it). Then there are the bottles and accessories. There are some that come with the pump, but we bought extras because I was so stressed by the limited time for pumping at work and didn't want to fuss with washing bottles at work. So the accessory kits were $24 each and we bought two. And if you're working and pumping, you often need storage bags, unless you have enough pump bottles for all your milk and don't plan on freezing any. Greta gets mostly fresh milk and I use the bags only for freezing, so we only go through about 10 bags a week and they cost about $8 for 50. Oh, and the handpump, which comes in handy for Gay Pride parades and car trips, costs $30 and wasn't covered by insurance (at least, not if I also wanted the double electric pump that I need for work). And if you're pumping and giving the baby bottles, you still have to pay for those bottles (I'm guessing around $30 total for the year, since we wash them frequently). And drying racks are expensive too -- and we bought two because the first one we bought didn't have a high enough capacity (so about $25 for the two of them, although if we'd just bought the high capacity one to start, it would have been $13).

Then there are the personal comfort expenses. You might need them, you might not. I still use a breastfeeding pillow and a nipple shield. And we have lost a few nipple shields and feel more comfortable when we have more than one in the house, so we've probably bought about 5 of them total -- and they cost about $9 each. And if you need/like nipple cream, that costs money too. We received all our nipple cream as gifts, but the ones that I used would have cost $10 each if we had purchased them ourselves. My breastfeeding pillow and extra cover cost about $40. We already had a cheap stool, but nursing stools run about $35-40.

I'm probably forgetting some more expenses, but you get the general point. And it's not including the opportunity cost of the lost time. I haven't been back to work at the Science Museum since Greta was born, for example, because I'd end up spending about a quarter of my usual shift time pumping. My salaried job doesn't dock me for my pump breaks, but some women have to take their pump breaks unpaid at their regular jobs.

So for a year of breastfeeding, I expect to spend at least $600 (and remember I didn't have to pay for my big pump). Cheaper than formula? You betcha -- especially since most of those items can be re-used for a second child. Free? Not unless you regularly throw away $600.

Nursing is exhausting. There's the physical act of holding yourself in place (often in an uncomfortable position) for the amount of time that your baby nurses, and then there's the calorie burn associated with nursing, and then there's the hormones which can make you nod off even if you were alert when you started nursing. And then there's the tiring factor of how long it takes to nurse and how little time you have for everything else. It's just plain tiring to nurse. And most of that exhaustion goes for pumping too.

So all in all, breastfeeding is a lot more work than I'd expected. It drives me a little crazy when I hear people talk about how breastfeeding is, "simple, convenient and free!" because for most women -- at least those who like to put on clothes or leave their homes or have to work -- it just isn't. What drives me super-insane is when I read reports that try to answer the question of "Why don't women breastfeed longer?" and the answer seems to be coming back to the "stigma of breastfeeding" or "misinformation in hospitals," when the fact is, it's just an awful lot of work -- especially for someone who was just pregnant for 9 months and recently popped out a baby. And it's especially hard when the "gold standard" is such a lofty goal. Exclusive breastfeeding is ideal, but I already know that I can't win that badge because of the formula that we've given Greta. I'd be lying if I said there weren't days when I think about quitting simply because I know that I can't consider Greta and myself to be part of the CDC's Healthy People 2020 46.2% goal for exclusive breastfeeding during the first 3 months. I know that the CDC isn't disappointed with me as a person, but it's hard not to take these things personally.  I wish there were some kind of middle-ground goal or recommendation for people who fall short of the exclusive breastfeeding ideal. For example, they have "first 3 months" and "first 6 months" exclusive breastfeeding goals, but if Greta's exclusively breastfed for months 3-6, does that count for anything? Does anyone study babies who were given formula? It feels like all the comparisons are made between "formula fed" and "exclusively breastfed" babies -- with parents keeping careful track of how much their babies eat and how much weight they gain, etc, one would think that they'd have a way to compare gradations of breastfeeding -- for example, similarly-sized babies who consume only breastmilk versus babies who (on average) consume x ounces of formula a week and the rest is breastmilk.

But breastfeeding isn't a science. It's an art. And it's an art that often masquerades as a science, which is the most frustrating form of art. Which is why in no situations is breastfeeding more confusing than when it is being described as birth control.

I have a pretty firm goal of not getting pregnant again for awhile. When Ben and I were researching birth control methods and back-up birth control methods, we looked into the LAM method. LAM, when used correctly and consistently, is considered one of the most effective methods of birth control. Unfortunately, unlike the progestin-only birth control pill that I take everyday, the "rules" for effective use of LAM are spotty at best. In searching for information, I found so much conflicting information -- even among reports intended for healthcare providers who were to educate women about LAM. It was very frustrating how often I found the advice that LAM would only work if a woman "doesn't go too long between feedings at night." What's "too long" mean? Are you really going to tell a new mother that she should doubt any amount of extra sleep that her baby starts to give her? Can we please just agree on a number of hours? On the Association of Reproductive Health Professionals website, I found a number -- 6 hours. But the fact that so many resources did not cite this exact number of hours makes me trust it less. That website also highlighted the conflicting information about pumping. In their video, the nice lady explains exclusive breastfeeding as "that means no formula or other baby foods." Yet, in the text of their website, a parenthetical comment also cheerfully reminds us, "(no pumping!)"

I can forgive a birth control method for having a limited scope in general, but if you nix pumping, you're talking about a very exclusive group of women that this can appeal to. Other sources say that pumping is perfectly fine (without even any restrictions on the number of times a day that women can pump vs. nurse), while still others say that even a pacifier is unacceptable, since the breast must be used for all of baby's suckling needs. Once again, the lack of any information about the relative effectiveness in the middle ground means that either women are trusting LAM to be effective for them when it is not, or they are stressing about reaching a perfect ideal when they shouldn't have to.

Of course, the video makes it seem as though this is the most stress-free birth control out there. It's touted as "safe, simple, and convenient." I will give them "safe." Simple? Convenient? Let's remember that we are talking about breastfeeding as a birth control method here. What are we comparing breastfeeding to? A shot every three months. A pill once a day. An intrauterine device that doesn't require any special attention once placed except an occasional check. To be honest, in comparison to the alternatives, I can't imagine a less convenient method of birth control than exclusive breastfeeding -- particularly if you weren't already feeding your baby mama's milk and therefore had the full range of options open to you. And simple? If I miss a mini-pill, I know exactly what to do and for how many hours I need to use back-up birth control. If a woman's baby finally sleeps through the night and she finds that she's gone longer than 6 hours between feedings, what's she supposed to do? There's no information on what happens if you don't follow one of the LAM rules -- just that anything less than exclusive nursing makes the method "less effective."

The happy woman in the video also excitedly tells us, "There's nothing to buy!" I'm willing to invest in nursing bras, nipple cream, breast pads, nipple shields, etc because I want to breastfeed my child. But again, as a birth control method, it's definitely more expensive than my free birth control pills. (Even if I weren't insured, they'd be less than $50 per year . . . remember that LAM only works for the first 6 months even if you continue to breastfeed past that.)

Don't get me wrong, I think it's pretty cool that our body "knows" not to get pregnant while we're exclusively feeding a baby. I think that the science of the human body is awesome and I'd guess that breastfeeding alone probably prevents pregnancy for most women -- even if they aren't  following every single LAM rule. But even if it's one of the most effective methods of birth control, it just doesn't seem reliable if the folks in the medical arena can't even agree on what the rules of use are. If every rule that I've seen is true (no pumping, no pacifiers, no sleeping . . .) and if women are expected to follow them all, then this is a method of birth control that could only be utilized by the most elite of exclusive breastfeeders. And since you're not even supposed to have sex for the first six weeks after delivery, it's an awful lot of stress for only 4.5 months of birth control. I'd prefer to keep my pumping (and, therefore, my job), my emergency formula stash, my 7-10 hour nightime break between feedings, and my baby's pacifier . . . and take a pill.

Okay, I've been writing this post in little pieces for the last week, so it's incredibly long and I probably should edit it down. But instead, I'm just going to post it because my baby is about to wake up. So, to sum up, breastfeeding is awesome and I'm going to keep doing it, but I wish people talked more about the downsides instead of leaving them as fun "surprises" for after you've birthed a baby.