I cringe every time someone asks me, innocently, “are you breastfeeding?”
Like many others, I had no idea that breastfeeding is such a contentious topic until I became a new mom. Somehow, lots of people who aren’t the mother & baby insist on pressing their opinions about an issue that is really none of their business.
The passersby on the streets who stare overly long at a mother breastfeeding in public then declare discomfort and demand said mother to cover up; the judgmental medical staff who question a mother’s capacity if said mother chooses not to breastfeed; and even fellow mothers who feel a sense of superiority if they are more successful on their breastfeeding journey.
Why is breastfeeding versus formula feeding so widely debated when it simply boils down to a method for keeping your baby alive?
Why does a mother get judged based on her ability to breastfeed, or her decision not to?
If I had to pick one thing that has been the most difficult throughout this pregnancy and birthing journey, it wouldn’t be labour – it would be breastfeeding. Mind you, I had a rough labour. Epidural, forceps, third degree tearing… yuck. Long story short, Baby Y was exclusively formula-fed for the first couple of weeks. She slowly transitioned to become exclusively breast-fed only at three months old. Not going to lie – getting there was excruciatingly hard physically and mentally, for both baby and myself.
I always knew that I wanted to breastfeed exclusively. Full disclosure – my siblings and I were almost exclusively formula-fed. Back in the day, my mom had a very short eight-week maternity leave, which made breastfeeding unsustainable. Formula feeding was all the rage too, so it seemed like the better option. We all grew up to be fantastic adults, if I may say so myself, anecdotally debunking the whole “formula is poison and makes you stupid” argument by lots of extreme breastfeeding advocates. My mom is not any less of a mother for formula feeding us.
There are many reasons why I wanted to breastfeed exclusively, but it really boils down to breastfeeding being free and convenient. However, I was absolutely clueless that something so natural could be so, so difficult.. The days when breastfeeding did not go well were dark. I sobbed a lot uncontrollably, and constantly questioned my self-worth as a mother. Although I just accomplished the incredible feat of birthing a baby, my self-esteem plummeted. My ability to connect with my baby suffered, as each time I offered up a bottle of formula, I felt guilty as hell. On top of that, it was the worst feeling in the world when my supply was insufficient to meet my baby’s demand. I was not enough for my baby.
Looking back at my breastfeeding journey made me realize that there were so many things I could have done, or others could have done, to make my journey a much less bumpy ride.
Lesson #1 – Take a breastfeeding class before baby arrives
During pregnancy, I had heard that breastfeeding might be a challenge. In preparation, I watched a handful of YouTube videos and read one book. Ha, I thought I was so ready. I mean, I knew the difference between colostrum, foremilk, and hindmilk. Baby goes to breast and drinks. What else was there to know?
What I didn’t know about were the nightmares of breastfeeding – leaky breasts when your baby cries, or when any other baby cry for that matter; sore, and maybe bleeding nipples from an incorrect latch; sore, and maybe rock hard painful breasts when engorged with milk; or sore, and maybe inflamed / infected / rock hard lump in your breast that is a blocked milk duct that literally sends shivers down your spine when the result is mastitis a.k.a. a breastfeeding mother’s worst nightmare.
A breastfeeding class before Baby Y’s arrival would have saved us a lot of the stress we experienced over the next few months after her birth. Once Baby Y was born, the medical team plopped her on my chest and within thirty minutes, I was told to breastfeed her. When breastfeeding did not go as planned, we were told to try out every feeding method in the books (cup feeding, syringe feeding, the SNS system). Nothing worked, each feeding session took almost two hours and we suffered in a thick haze of sleep deprivation and tears (from us, mostly). We knew so little about feeding a baby – ie. that it wasn’t as simple as baby to breast – that we were blindsided by the hurdles we faced.
Yes, a breastfeeding class, or a class about feeding a baby/issues you might encounter would have been very helpful.
Lesson #2 – Breastfeeding, if done right, should not be painful
The first time the midwife latched Baby Y onto my breast, OOOWWWW, it hurt.
“Yes, it’s supposed to hurt, just bear with it”, I was told.
No. Breastfeeding, if done right, should not hurt. It might be uncomfortable the first couple of times as your nipples get used to it, but it should be relatively painless. The baby should not be chomping down on the nipples, but on the areola (dark area around the nipples). Turns out, my breastfeeding experience was quite painful because Baby Y had a severe tongue and lip tie. As much as I really enjoyed having midwives as my primary caregiver for pregnancy, the support they provided for breastfeeding was admittedly subpar.
My primary midwife examined the tongue and lip tie right after Baby Y’s birth, but did not suggest clipping it. She said some babies grow out of it, and it may not impact breastfeeding. I have learned that generally, tongue & lip ties do largely impact breastfeeding as it results in a poor latch at the breast. This results in excruciating pain (imagine a piranha chomping down on you eight hours each day) for mom, and inefficient drinking for baby. This means baby will not get the nutrients they need despite enormous effort. Surprisingly, lots of medical staff lack knowledge about this. If you’re in the same situation, it’s best to consult a lactation consultant/pediatrician combo. For newborns, snipping the tongue/lip tie is a quick procedure and relatively painless. It will become more painful as baby grows and nerve endings around the area increase.
It was only after persistent request that our back-up midwife offered to provide a referral to get the tongue tie clipped. We had an appointment scheduled on Day Four. More on that story later.
As Baby Y could not extract breastmilk effectively due to her tongue/lip tie, and she was born with quite high levels of jaundice, the midwife pressured us to feed her lots of formula to ensure that her jaundice goes away, since their job is to ensure that baby thrives. My breastfeeding goals were secondary, and in other words, not important to them. While I was very grateful for their superb care of my baby, how I wished that they had better breastfeeding support! Every once of formula given to Baby Y in the first early days drastically hurt my breastmilk supply.
Lesson #3 – Just one session of hands-on help is better than watching hours of video
A few hours after birth, since Baby Y couldn’t effectively extract the colostrum (thick yellow liquid gold that can sustain baby for the first couple of days), the Grand River hospital staff told me to hand express the colostrum and feed it to her in a spoon. “How?” I asked. “Watch this video on the hospital room TV”, they told me.
I watched the video, then tried hand expressing. When they checked back and I told them I seemed to be getting nothing, so they said – “Okay, just feed her this cup of formula”.
Day One. Within a few hours of birth, we were handed a cup of formula. So much for being a “Baby-friendly” hospital, Grand River. They could have hand expressed FOR me, or gotten me to demonstrate, to ensure that I was doing it right. There is only so much YouTube University can teach. A video cannot teach as effectively as real, hands-on help. For a hospital that is supposed to be a world-class advocate for breastfeeding, they gave up way too easily.
Ultimately, fed is best, but if a hospital staff offers formula to your baby without first assisting with hand expressing colostrum in the first few days, try to get help hand expressing first before throwing in the towel. Read this – most mothers do have enough colostrum. Supplementing so early on could have devastating effects on success with exclusive breastfeeding.
We did ultimately get some great hands-on help with the hospital lactation consultant. We were back at the hospital’s outpatient clinic a few days after we got home, to get Baby Y’s jaundice level checked. The lactation consultant was fabulous in helping us adjust the latch. However, the one thing I did not appreciate was her judgmental tone when this conversation happened:
Lactation Consultant: Are you breastfeeding?
Me: Uhm, kind of. We are also supplementing with formula.
Lactation Consultant, stares at me with raised eyebrows: Why?
Me, shuffles uncomfortably: Uhm, she has a tongue tie.
Lactation Consultant: Okaaaay. You ARE going to try to breastfeed exclusively right?
Me: Uhm, yea, once her tongue tie gets released.
A mother really does not need anymore judgments as she is her harshest judge.
Lesson #4 – A whole lot of mediocre treatment is still inferior to a little world-class help
If you need breastfeeding support, a lactation consultant/pediatrician combo should be your go-to. Not a midwife, or OB. There is also a huge difference between a mediocre lactation consultant/pediatrician combo versus a world-class one.
Baby Y’s tongue tie was so severe that it was still tied after four clippings. Four. Four times, she was pinned down on a table by two or more people, who shoved sharp instruments into her mouth, then snip-snipped with bleeding and lots of crying. It was as traumatizing as it sounds. I’ve always wondered if she could have avoided the terrifying multiple procedures, had we gone to the right people from the beginning.
In the KW region, there are very limited options to have your baby’s tongue/lip ties snipped. It is odd, but the hospital does not include this procedure as part of their routine newborn check. You have to be referred to a pediatrician, and it could take days before the tongue/lip ties get resolved. The precious first couple of days were wasted. I was referred to New Vision Family Health Network and Cambridge Breastfeeding and Pediatric Clinic. Based on our experience, I would NOT recommend either of them.
The New Vision doctor has no experience with lip ties, and barely knew how to deal with tongue ties. Case in point – he was the first to snip Baby Y’s tongue tie… or so we thought. Turns out, he barely scratched the surface of the tongue tie. I was still experiencing breastfeeding pain weeks after the procedure was done, and Baby Y was not getting the breast milk she needed, due to ineffective nursing. We had to bring Baby Y to the Cambridge clinic.
The Cambridge clinic seemed like THE place in the KW region to get tongue ties snipped. Apparently the pediatrician snips more than ten a day. Baby Y had her tongue tie snipped a grand total of three times at this clinic. On our first visit, Tara, the lactation consultant, did a pre and post feed weighing to determine how much breast milk Baby Y was transferring. This exercise really only provided information about how much baby is drinking at that particular moment, not at every single feeding in a day. Essentially, the pre/post feed weighing method is quite useless unless you are doing it for every single feed during a 24 hour period to figure out how much your baby is drinking. You cannot just extrapolate and assume baby drinks at the same rate and takes in the same amount every single time!
“Looks like your baby transferred about two ounces. You don’t have a milk supply problem”, she said, “You should really stop the formula supplementation. It is bad for you and bad for the baby.”
For a mother who was already struggling with the guilt of supplementing with formula, that judgmental statement really did not help. Also, what Tara had failed to ask was how much formula we were supplementing. At that point (week 4), we were supplementing pretty much 80% of Baby’s milk. In the moment, I was so happy to have someone validate my milk supply that I failed to question whether it was wise to so abruptly remove 80% of Baby’s food source.
We went home and did a full week of no supplementation. One full week, cutting out 80% of the food Baby Y was having. I was so desperate to make breastfeeding work that I ended up starving my baby. When we weighed her at the midwife clinic a week later, no surprises, Baby Y had lost a bunch of weight. The midwife immediately got us back to supplementing 3-4 ounces per feeding. We were heartbroken and confused. How did this happen? We were following instructions from a certified lactation consultant, and the pediatrician!
We made another appointment back at the Cambridge Clinic. I was almost in tears when I told them that we stopped supplementing per their instructions, and Baby Y’s weight had dropped drastically.
“Oh. Hmm, okay then, continue supplementing and see what happens.”
Excuse me? Wasn’t that a little casual? Shouldn’t you have gathered more information before inappropriately advising us to stop supplementing? From that day, I learned that while you should trust your healthcare providers, you should not trust them blindly. And also, pick your healthcare providers cautiously.
We were still facing numerous issues despite the many visits to get Baby Y’s tongue tie clipped – her tongue tie was yet to be fully released, she has streaks of blood in her poop (which two doctors we saw brushed it off as dairy allergy, though cutting out dairy did nothing to improve the situation), and was still constantly waking up numerous times at night to nurse. Was she not getting enough milk still?
As I was at the end of my rope, I decided to attend the YMCA breastfeeding buddies support group. They meet every Monday morning. A fellow mom recommended that I make an appointment at the Dr. Jack Newman clinic. Yes, you read it right, the world-class famous breastfeeding authority Dr. Jack Newman. He sees patients! I had no idea. I mean, Jack Newman is a known celebrity in the breastfeeding world. How could I possibly be able to consult with him?
The Newman clinic also has an email service that is answered by Dr. Newman himself. I recommend emailing Dr. Newman before making an appointment. Also, since there are several pediatricians on staff at Dr. Newman’s clinic, my tip is to request for Dr. Newman when making your appointment – they seem pretty accommodating with my request. No offense to the other pediatricians, but if I’m going to drive two hours to North York, it has got to be for the one and only Dr. Newman (some serious fan-girling here)!
The downside is that you’ll have to fork out ~$80 for the lactation consultant as they are not covered by OHIP, unlike the Cambridge clinic. The lactation consultant we dealt with at Dr. Newman’s clinic was Stephanie Carrabin. I highly recommend her to any mother who doesn’t mind paying for a quality lactation consultant. She listened, instead of just talking at us. She made no assumptions. She provided good advice and most importantly, she did not judge us when we mentioned supplementing.
Lesson #5 – With sufficient stimulation, your breasts can produce enough milk to feed your entire neighborhood
With insufficient stimulation, even if your body is capable of producing milk, there will not be enough milk for your baby because your body doesn’t know it needs to feed one.
In the early days, the midwife lent us a breast pump. She had told me not to buy one because it is not required. I would actually recommend all mothers buy a breast pump – you’ll never know when you might need it. Even if you are exclusively breastfeeding, there might be the odd time you will want to pump so that someone else could feed baby. The midwife said my milk would come in around the third or fourth day, so I could just extract the milk via pump, if Baby couldn’t latch properly. What she did not mention was, if I didn’t pump religiously while Baby Y wasn’t nursing, and didn’t hand express efficiently, the milk would NOT come in. This is where I really wish I had educated myself more. I had thought breast milk would just magically appear. However, my brain and body were not getting the stimulation they needed, to know that there was a baby waiting to be fed. I waited and waited, milk never came on the third or fourth day. It took almost two weeks for any resemblance of milk to “come in”. Due to insufficient stimulation, my milk supply, when it came in, was far from the demand required.
In an attempt to salvage breastfeeding for me, the midwife told me to do the following at each feeding (feeding cycles were every three hours):
1) Nurse Baby on one breast for ten minutes
2) Top up with formula until baby is satisfied
3) Pump for 15-20 more minutes to stimulate breasts to make more milk
This sounded like a grand plan… except, how could I make my baby nurse for ten minutes? At that time, Baby Y took at least thirty minutes on each side while nursing very inefficiently. If I unlatched her too soon, she wouldn’t get much hind milk. If I didn’t unlatch her, she would end up on the breast for over an hour. Then, we formula fed. This took us to almost two hours of feeding. Baby then went down for her nap, while I continued the routine, and pumped for 20 minutes. I then had a few precious spare minutes to eat/use the bathroom/rest and before I knew it, the cycle was repeated again and again all day long through the night.
I was getting ZERO rest, which of course, negatively impacted my milk supply.
By week three, I was on the verge of giving up. I was barely getting four hours of sleep a day, each feeding session was just an emotional roller coaster of stress and anxiety, and my milk supply was seeing very small improvement. For every bottle the baby takes, you also have to teach your body to make that through pumping. It was such an uphill struggle to keep up.
Unfortunately, breast feeding is really a game of more demand more supply. I finally settled into a routine of:
1) Nurse Baby on both breasts until she is no longer drinking (whether it is 10 minutes or an hour).
2) Top up with formula if baby is not satisfied (not all feeds need supplementing, so we had to really watch Baby Y to determine if she was still hungry). Try to get someone else to do this step (ie. my Mom, who was helping out, or husband)
3) Pump for 15 more minutes (I used the Ameda Purely Yours Double Electric Breast Pump) to stimulate breasts to make more milk, continue pumping even if nothing is coming out.
It was still as time consuming as ever, but rather than trying to time Baby’s nursing session, I just tried to relax and let her nurse for as long as she wanted. It was quite ridiculous as my days were spent sitting on my couch nursing all day long. However, it does get better as baby grows and become stronger. Now, she nurses for about ten minutes on each side and voila! Done!
Lesson #6 – Your breastfeeding journey will get better. If it doesn’t, there is always formula. As long as your baby is thriving and well-fed, you are a fantastic mother.
For more than two months, I resented breastfeeding. Each time I had to provide a bottle of formula, I felt like an absolute failure. Why was my body able to create such a beautiful baby but unable to sustain her? I started avoiding direct latching Baby, and preferred pumping then asking my husband/parents to feed Baby Y with a bottle. Each feeding time was so emotionally painful whenever I didn’t yield enough through pumping and we had to supplement with formula. I felt increasingly less adequate at each feeding. It was so draining.
Finally, I decided I didn’t want to let breastfeeding ruin my entire motherhood experience. I knew that the first year goes by fast, and I wanted to enjoy the very limited time off with my baby. It is okay if I don’t yield enough breastmilk to have Baby Y exclusively breastfed. A little is better than none. I started accepting that supplementing is honestly not the end of the world. I have a healthy and happy baby. That was all that matters. At that point (1.5 month mark), we were probably doing 50/50 formula versus breastmilk.
I think that was the turning point of my journey. Not stressing out over my breastmilk supply really helped. I was generally happier and more relaxed. I slept better. I ate better. Slowly, my supply increased. I was doing a routine of pumping and feeding through the bottle so that I could see the yield. I ensure that I directly latched Baby Y a couple of times a day so that she would not forget how to breastfeed. She was still a really slow nurser, taking more than an hour each time. For the other times, pumping then bottle feeding was a lot more efficient. Breastfeeding experts always say that the pump will never extract milk as well as your baby, but in my case, I think the pump was better due to Baby Y’s tongue tie – much more efficient. The pump output did not impact my mood as much, and I had just accepted that supplementing was part of our feeding routine.
Then, one day around ten weeks, we noticed some blood in Baby Y’s poop and her entire body was covered in rashes. We started panicking and after some googling, concluded that she must be allergic to something in the breastmilk, because Doctor Google is obviously correct. While waiting for our appointment with the family doctor, we pulled a classic-first-time-parents-overreacting move – we stopped breastfeeding for an entire day and just fed her formula to see if her rashes would clear up.
Luckily it was a weekend, so my husband did feeding duty all day long while I still consistently pumped at each feeding to ensure that my supply did not get negatively impacted. What this exercise showed me was that…
… my supply had actually caught up with what Baby Y needed.
Oh my god. 80 days – that was how long it took to get the supply to equal to the demand.
Anyway, her rashes were just eczema, nothing to do with the breastmilk, teehee.
Still traumatized from the last time I exclusively breastfed Baby Y and her weight drastically dropped, I was terrified at the thought of doing it again, despite the pump output clearly showing that I have sufficient milk for her. So, I dropped by at the YMCA breastfeeding buddies session on Monday morning, at the Roger street location. After detailing the horrific breastfeeding nightmares for the past 80+days, I burst into tears. I am not sure which part of this whole journey was more painful – the thought that I could not feed my baby, the many tongue-tie releasing procedures my baby had to endure, or the extreme exhaustion from the feeding/pumping rinse & repeat. Talking to the ladies at that session was extremely freeing. That night, I finally coughed up the courage to try exclusively nursing Baby Y and stop supplementing.
Three months later today, we are still going strong. So strong that Baby Y now rejects the bottle and any other way of drinking! I guess I can’t really complain.
Lessons I learned from Dr. Jack Newman’s Team
Blood in stool does not necessarily mean a dairy or soy allergy.
Many pediatricians readily diagnose milk protein allergy as the cause of blood in poop, then ask the breastfeeding mother to cut out these foods. Cutting out dairy and soy is no joke – helloooo, we’re a Japanese/Chinese household. Our diet is literally based on soy. Despite following the pediatrician’s order to cut out dairy and soy, there was no improvement to the blood in poop situation. Dr. Newman suggested that it could be due to a decrease in milk supply, which causes irritation of the lining of the gut and as a result, blood in the stool. We followed his instructions to work at increasing milk supply, and I’m happy to report that blood is gone!
Snipping the tongue tie may not be the solution.
When we saw Dr. Newman, Baby Y already had four tongue tie releases, yet the tie has not been fully taken care of. Although the main purposes of the Dr. Newman visit was to have him snip the darn tongue tie once and for all, Dr. Newman suggested that we hold off on it. Baby Y was turning four months then, and the tongue tie procedure might be not as painless as it was when she was a newborn. Hence, to solve the issue of potentially getting less milk than she needs at the breast, a suggestion was made to start solids. Baby Y enjoys exploring the different foods. We definitely enjoy feedings solids more than seeing our baby pinned down on a table and getting another tongue tie snipping.
Always have some potatoes on hand
I keep getting annoying blocked milk ducts. Stephanie, the IBCLC we saw, gave me a handout which had an interesting idea – use potatoes to help relieve the blocked ducts. Huh? I know! Weird! However, I’ve just tried it on a particular stubborn set of blocked ducts and you know what, it works.
So, there you go. Lessons I learned from exclusively formula feeding to exclusively breastfeeding… but honestly, nobody cares other than us mothers who put so much pressure on ourselves. As long as our babies are fed and happy, who cares! Baby Y is happily chomping down on solids now and the breast milk versus formula struggles seem like such a distant memory. We have now moved onto the controversy of traditional weaning with purees versus baby led weaning. Ah, that’s a topic for another day.