Mommy wars: battle of baby feeding

When Lydia was several weeks old, I sat uncomfortably in my former pediatrician's office awaiting the lactation consultant on staff. Ever since my milk supply had come in, Lydia had increasingly been having problems nursing, and I called the doctor out of concern that she was not eating enough. Her weight check confirmed she wasn't gaining weight. When the lactation consultant came in, she asked me to nurse Lydia so she could see what was going on with us. I felt nervous allowing someone else to see that my breast feeding relationship with Lydia was anything but "natural" and "a beautiful bonding experience," like all my books had led me to believe it would be. Lydia would try to eat and within minutes be screaming and writhing, as if in pain. I would keep trying, only to have her often refuse to eat, and both of us in tears by the end of our feeding sessions.

The lactation consultant watched Lydia scream and arch her back as if in agony within minutes. She frowned. The latch looked fine, she said. "Well, why don't we try a bottle of formula?" I cringed, but I consented. I watched the nurse prepare a bottle, and as she gave it to Lydia, I sat next to her quietly shedding tears. She said because Lydia took the bottle so well, she probably had GERD (or commonly known as acid-reflux), which would make feeding in a reclined breast feeding position painful. She gave me a prescription for GERD medication, advised that I try to feed her in an upright position and/or express milk and bottle feed Lydia, and sent me on my way. I called my husband and my mother, who both knew my feeding struggles intimately, and tried to tell them the diagnosis. But every time I got to the part of the story about giving Lydia a bottle, I started crying so hard that I was unintelligible. I felt like a complete failure as a mother because I could not do what I had always been told was the most "natural" thing in the world.

Because of those feelings of failure, I wasn't ready to give up on breast feeding. Rather than spending quality time with Lydia in a relaxed way in those early weeks, every time she got hungry, I'd attempt to contort our bodies so I could breast feed her in an upright position somehow, fail within a few minutes, hook my breasts up to a machine, pump milk, and then give her a bottle. While I would pump milk, I could not hold Lydia - she would cry, hungry and wanting to be held. Since she was hungry every two hours, it felt like all I did 24-7 was attempt to breast feed, pump milk, or give her a bottle. I went to the weekly meeting of La Leche League hoping to find support, only to find all the other moms happily breast feeding at the meeting and discussing the importance of it while I silently hoped and prayed Lydia would not get hungry while I was there. I dreaded having to take out my bottle of expressed milk and feed her the "unnatural" way in a room full of breast feeding advocates. I called yet another lactation consultant; this was probably the fifth lactation consultant that I would have seen by that point, and I decided this was my last ditch effort.  I was sick of spending every minute of the day fighting the battle to breast feed, which I believed by that point had taken a negative toll on my relationship with Lydia. However, I had heard wonderful things about this consultant (she heads the Breast Feeding Center of Ann Arbor), so I figured why not just hear what she had to say.

Unlike with previous lactation consultants, she actually examined Lydia. She said her mouth was very small. I told her about the GERD diagnosis, and she expressed skepticism. If the medication hadn't already helped, she said, it was unlikely Lydia had GERD. I frowned. She then watched me feed her, and as soon as Lydia began to writhe and scream, she said, "She's choking on your milk. Her mouth is very small and she probably has a sensitive gag reflex. Let's just try feeding her with a nipple shield." I had never even heard of a nipple shield, but was at the point where I would have tried anything. Lo and behold, Lydia then nursed for 40 minutes straight. It was as if she was a different baby, and I wanted to weep from joy and exhaustion.

In the following weeks, I continued to feed Lydia with a nipple shield, and went to a support group hosted at the Breast Feeding Center of Ann Arbor for mothers with breast feeding challenges. We sat in a circle and shared our struggles - failure to latch, low milk supply, etc. Women wept, babies cried, and lactation consultants offered help. It was very therapeutic and I am grateful for those women who helped me to feel I was not a failure because I had problems feeding my child in the so-called "natural" way.

By the time I had Anna, I was already a wounded soldier in the breast feeding battle. I was extremely anxious about breast feeding her, and breathed a sigh of relief when she seemed to be doing great at first. Then my milk supply came in, and a new battle began. The symptoms were very similar to Lydia's, but this time I'd learned the weapons of war. I immediately called in the cavalry (the lactation consultant who'd been such a savior in Lydia's case), but this time there was no easy solution. Anna scoffed at the nipple shield, but she wouldn't let the discomfort stop her from getting enough to eat. She choked, she writhed, she refused to nurse from my left breast, but she was determined to get enough milk to survive and gain weight. My lactation consultant basically told me she was getting enough nourishment, but had trouble with the "swallow, suck, breathe" coordination. She gave me some good ideas for how to make her more comfortable and encourage her to nurse from the left breast. (To this day she will only nurse on the left breast if I put her in one specific position.) I attempt to make it as much of a bonding experience as I can, but we've had to find other ways to bond together.

Image from Topinambour

All of this has led me to reflect - why was so much of my self-worth coming from my ability to breast feed Lydia? Why did I turn into a blubbering mess when a nurse gave my daughter a bottle of formula? Why was I willing to spend all my waking hours attempting to get Lydia to drink breast milk? Why did I think I was a failure as a mother if I failed at breast feeding?

The current most popular parenting philosophy, attachment parenting, places breast feeding at the top of the list of best practices for raising a healthy, happy child. Dr. Sears - the attachment parenting guru - has a whole section in his book and on his website about why breast is best, and the information he gives on possible challenges makes it sounds like you can just easily overcome breast feeding problems like mine. Public health officials take the same stance. Advertisements by the Michigan government adorned buses in Ann Arbor when I was a new mother to Lydia, encouraging mothers to both lose the baby weight and breast feed with the slogan: "Slim faster. Breastfeeding burns calories." New York City subway ads make it clear that formula is inferior for the health of infants. Article after article in the news told me that the science was clearly on the side of breast feeding. Thanks to the attachment parenting craze, public health agencies, and the media, when I registered for baby items, I never thought twice about registering for a breast feeding pillow and other breast feeding-related items. I made no room for myself to fail, because breast feeding was clearly what "good" moms do. I recently read a book entitled, "Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn't," which I heard about from a Facebook post by another mother who struggled with breast feeding. As the author Barston (2012, p. 3) put it, "For many women of my generation, social class, and educational level, breastfeeding is seen not as a choice but as a given."

The author herself tried and failed to breast feed her son after suffering "latching problems, an undiagnosed tongue tie, nerve damage in one breast, severe and sudden postpartum depression, a traumatic birth, jaundice, and a milk/soy protein intolerance which didn’t get better despite an elimination diet." She wrote the book for mothers who try and fail to breast feed, and feel shame and self-condemnation as a result. She explores the history of the lactivism movement, the science behind breast feeding advocacy, the societal judgments made about bottle feeding mothers, and the challenges that many women (herself included) face when they fail to breast feed. She argues that the new defining battle in the mommy wars is not the issue of mothers' work, but rather how mothers feed their children. She discusses the science often cited by breast feeding advocates, which is largely based on population studies with lots of confounding variables. Even if breast feeding is associated with slightly better health outcomes for babies, the benefits are typically marginal; Barston contends these benefits should be weighed against the costs for individual moms and their infants. As Barston puts it, "[b]reastfeeding is usually a beautiful, mutually beneficial act between mother and child. But breastfeeding isn't necessarily the right choice for every mother and every child, whether it is for medical reasons, psychological reasons, professional reasons, or a myriad of other reasons that are, frankly, nobody's business. Under certain circumstances, breastfeeding becomes a painful, emotionally fraught, conflicted act" (p. 4). She concludes the book urging breast feeding advocates to quit focusing on the detriments of formula, and instead find better ways to support women who want to choose to breast feed. I know in my own personal experience, it was shocking how many lactation consultants actually had no clue how to help me, and baby books were completely useless for women suffering real challenges to breast feeding. My pediatrician admitted to me that in all her training and residency, she received 30 minutes of training about breast feeding. Who are women supposed to turn to if pediatricians and most lactation consultants have no clue how to solve breast feeding challenges?

As I was driving home for lunch one day (ironically to breast feed Anna), I heard a story on NPR by an science journalist - Florence Williams - whose major interest was the environmental toxins in breasts. Her book, Breasts: A Natural and Unnatural History, was an emotional roller coaster for me to read as a breast feeding mom. Williams had breast fed her two children, and became interested in investigating breasts after she sent her breast milk to be tested for various environmental toxins and was disturbed by what she found. She asks: "[h]as all the ruckus - all the maternal guilt, the physical and metal introspection, the madre-a-madre name calling, the battles with the medical establishment - been worth it? Is milk, au naturel, really so superior to formula that we must make each other feel bad about our failures and choices?" Williams asserts that the "honest answer to this question is yes and no." (p. 169) She details the emerging immunobiological research, which has identified several unique components in breast milk (e.g. oligosccharides, lactoferrin, etc.) that have such amazing immunity-boosting properties that researchers hope to use to them fight cancer and HIV. The emerging research on breast milk components and their capacity to heal and protect is amazing, but paradoxically, research is also finding new components in breast milk that are potentially extremely harmful. "DDT, PCBs, trichloroethylene, perchlorate, dibenzofurans, mercury, lead, benzene, arsenic. When we nurse our babies, we feed them not only the fats and sugars that fire their immune systems, cellular metabolisms and cerebral synapses. We also feed them, in albeit miniscule amounts, paint thinners, dry-cleaning fluids, wood preservatives, toilet deodorizers, cosmetic additives, gasoline by-products, rocket fuel, termite poisons, fungicides, and flame-retardants." (Williams 2012, p. 198) It turns out that breasts accumulate more toxins than other organs, process them differently, and - thanks to biomagnification - pass them off extremely efficiently to nursing babies. Williams is careful to note that breast milk is just one way that children ingest these toxins - they pass through mothers' placentas, and formula-fed children catch up to the alarming levels of toxicity of breast-fed children by mid-childhood. However, when I read Williams's review of the research on toxins in breast milk, I couldn't help but feel more ambivalent than ever about breast feeding. I thought, "So I've been killing myself to breast feed, thinking this is the best thing for my children, when in fact I might be harming them with poisons in my breast milk?"

Before I had kids, I thought any woman who read the news and parenting books should know that breast feeding is the "right" choice. Bottle feeding and formula feeding moms were just amommymous to me - I was ready to make unfair generalizations about and look down upon their choices. Now that I'm a wounded warrior, I know that like all the choices parents make in caring for their children, there is rarely a one-size-fits all answer. I now am quick to tell friends who are expecting to come to me if they have breast feeding problems, because I know personally the self-condemnation and lack of support out there for mothers who struggle to feed their infants "naturally." I see that there is no one "natural" way to feed one's child, but rather that infant feeding is just one dimension of parenthood that can be done lovingly in a multitude of ways. While I am certainly not anti-breast feeding, I would now assert that there is no one "right" or "natural" way for mothers to feed their infants. And rather than seeing the challenges I've had as a curse, I've come to see them as a blessing in teaching me humility about having any dogmatic views on parenthood choices.

Childbirth - Where's my Dr. Huxtable?

Like so many other parenting choices, discussions about childbirth can be divisive. Natural childbirth vs. childbirth assisted by pain medication, hospital birth vs. home birth, obstetrician vs. midwife, when and whether to induce, and when to perform a c-section. In the case of childbirth, I believe it's definitely a "mommy" issue; the mother carrying the baby feels more ownership over birth choices than her partner, since she is birthing the baby. Adding to the sensitivity of the conversation, childbirth often doesn't go how parents would like - as with so many things in life, many factors in labor are beyond our control.

Steering clear of the divisive issues above (I'll leave those issues to documentaries like "The Business of Being Born" and "Pregnant in America"), what struck me when I was preparing for childbirth was how difficult it is to not have an anonymous birth experience where you can really only count on your partner to be there. I had dreams of having a warm relationship with my midwife through the pregnancy, which would lay the foundation for good communication and a positive experience when labor took place. We'd be that inexperienced couple, like so many of Dr. Huxtable's patients, who would be guided and cared for from pregnancy to baby's first breath. But I quickly discovered that there would be no Dr. Huxtable. That model of caring for mothers appears to be on the way out in the US healthcare system.

I am blessed to have health insurance - our family's coverage is through an HMO. When I was shopping around for a midwife, I discovered that I couldn't find a single sole practitioner midwife or obstetrician covered by our insurance. The only way we could have guaranteed to have a sole provider was to seek out a solo practicing midwife not covered by our insurance and do a home birth. While some might have the financial resources and the desire for that, we did not.

Childbirth wasn't always so amommymous in the United States. The data on obstetrician practice reveals solo practice is increasingly rare. According to research by the American Congress of Obstetricians and Gynecologists (ACOG), obstetricians are increasingly practicing in groups: the percentage of obstetricians practicing solo has decreased from 33% in 1991, to 23% in 2003, to only 19% in 2012. The causes are complex, including (though I am sure not limited to) decreasing affordability and availability of liability insurance, health care reform, higher salaries in hospital jobs, health insurance companies looking to cut costs, and the difficult lifestyle for solo practitioners who are on call 24-7. While I could not find similar data on midwife practice trends in the US, in her amazing memoir - "Baby Catcher: Chronicles of a Modern Midwife" - Peggy Vincent shares her life story as an American midwife, including dozens of memorable birth stories. Part of her tale includes the details of how her decades-long career as a solo practicing midwife came to an end when she got caught up in litigation over a woman's childbirth who was not even her client. In her view, sole practice midwifery was nearly impossible at the end of her career in the 1990s due to the lack of availability of liability insurance.

In my case, my health insurance only covered obstetricians and midwives in group practices. I selected the smallest practice I could find - it had two obstetricians and two midwives - and selected one of the midwives as my primary caregiver for my first pregnancy. She is amazing, and I felt very secure in her care. However, I did not develop the same good patient-doctor relationship with everyone in the practice, and as Lydia's due date approached, I felt nervous wondering who would attend our birth and whether she would be able to support me.

In the context of these systemic challenges facing women who are seeking a consistent caregiver during both pregnancy and birth, I have my individual issues. I'm not a person who welcomes new experiences without trepidation. I had never experienced childbirth before, and I didn't know what it was going to be like or how I was going to successfully navigate it, which made me crazy. The images in the media are ridiculous (though often hilarious) - the woman always turns into a raving lunatic. I read several books on childbirth, and we took a birthing class. However, I felt like no matter how many books Jeff and I read on the subject, we remained clueless about what labor was actually like. In fact, the more information I got from books and our class, the more nervous I felt.

As with so many life experiences, knowing about something is not the same as knowing something. Having taken French since sixth grade, I knew quite a bit about La Tour Eiffel. I had seen many pictures and read dozens of textbook descriptions, so I anticipated I wasn't going to be very impressed by her. But I still remember the feeling of having my breath taken away when I first saw her in person - what a beautiful man-made wonder. Childbirth is like that - knowing about it is quite different from experiencing it.

After leaving one of our childbirth classes in which they showed footage of women in labor, about a month and a half before Lydia was due, I told Jeff I thought we should consider hiring a doula. I had never heard of a doula before I was pregnant with Lydia. We did not have any friends or family who had hired one. I believe I first heard the term "doula" in my prenatal yoga class, which included a sharing time before the workout began. Several women mentioned their relationships with their doulas, and I was intrigued. DONA International gives a good definition: "The word 'doula' comes from the ancient Greek meaning 'a woman who serves' and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period." (For those interested, the "More Business of Being Born" documentary series has an informative episode devoted to the subject of doulas.) The idea of having a relationship with someone during our pregnancy who would attend our birth to support us sounded like the best solution for making birth less "amommymous."

Our doula, Cara, talking me through a contraction.

Based on the recommendation of a friend in my prenatal yoga class who had already given birth with a doula, we hired our first doula in my seventh month of pregnancy with Lydia. We met with her several times before the birth to go over our wishes and anxieties, and we felt more secure knowing she would be there when labor began. Ironically enough, our doula got ill when we went in to labor, and a back-up doula who we had not met before attended Lydia's birth. She was outstanding, and it was neat to have two doulas visit and care for us postpartum. Our experience having a doula during Lydia's birth was so wonderful that we wanted to have our first doula at Anna's birth, as well, but she had just made a career change. She shared a recommendation, and we hired an equally amazing doula (Cara Genesio) to attend our second birth. Jeff and I both felt that support of our doulas helped us immensely. They provided information, alleviated our worries about birth, massaged me during labor, relieved Jeff physically when he was tired, held my hand, provided encouragement, made sure I was hydrating, and intervened at key moments to advocate for us.

One really wonderful thing about the doula profession (in our local area at least) is that many doulas offer their services on a sliding scale and/or for free for families that qualify based on income. I know I worried about affordability when I was still a graduate student as we were planning for Lydia's birth, so I was amazed at how many doulas strive to support mothers of all socioeconomic levels.

While I never did find a Dr. Huxtable for our girls' births, I am grateful for doulas, who I believe have filled a real void in modern American childbirth culture. They are making lots of mothers like me feel that their birth experiences are anything but amommymous.

Pregnancy Loss

This is a really challenging post for me to write, since I have not shared much about my pregnancy loss with people. I'll start by admitting I dislike the term "miscarriage." I want to use this venue not to share the details of my pregnancy loss, but rather to explore the way my personal feelings and my social context collided. It seemed to me like American language and social norms did a poor job making meaning of what I experienced emotionally and physically.

As I started to write this post, being the nerd that I am, I did some research on the etymology of the term miscarriage, which was actually very cathartic for me. I found several interesting articles on the subject (see references at the end of the post, if interested). While I don't necessarily agree with the views of the articles' authors, I found them really insightful for giving me a historical perspective on the value-laden language surrounding what I experienced, and why American society seems to do such a poor job with accommodating women's reactions to pregnancy loss.

Why do I dislike the word miscarriage? For one, the word itself implied it was just my body's failure to carry the baby. In her analysis, Jutel (2006, p. 427) puts it this way: "Miscarriage implies the failure of the mother/womb to protect the dependent fetus, while stillbirth conveys the autonomy of existence and the innocence of the mother in the infant death." So when I would use the word miscarriage to describe my loss, I had a very negative emotional response to it as the word came out of my mouth. By my medical caregivers, I was urged to think of the loss as a sad blessing. My midwife encouraged me to come in for an ultrasound after the bleeding began to be sure that what I was experiencing was a miscarriage. I looked at the ultrasound footage, as my midwife explained that what she saw was just some small remaining pieces of tissue. I do not recall her exact words, but while she was very nurturing, she essentially said that a miscarriage was "nature's way" of ending a pregnancy that was not healthy. Nature's way. Survival of the fittest. So I should count myself blessed that this baby didn't go to term - something was wrong with him or her. Indeed, to watch one's child suffer and lose that child is the most horrifying, unfair loss imaginable to me. I have seen people lose their children, and pregnancy loss is not the same. Yet, it still seemed to me that the use of the words "miscarriage" and "nature's way" were inadequate for what I felt as a real loss. What I felt emotionally was joy turned to sorrow, and grief for dreams of a child that were now just shadows.

I also resented that my loss was a political issue. Reagan's (2003) article does a nice job of detailing how miscarriage has been co-opted by multiple political movements in the United States throughout the 20th century. I didn't realize that some might conclude I'm making a political statement of my own by preferring the term "pregnancy loss" to "miscarriage." Reagan argues that the movement to use the term pregnancy loss rather than miscarriage draws on both the pro-life and feminist movements to comprehend and define miscarriage, female emotion, and motherhood. According to her historical analysis, only since the 1980s have women have been encouraged to speak more openly about their grief following miscarriage, which she attributes to the success of the women's health and pregnancy loss movements. Reagan's article is fascinating in its exploration of the political history behind how miscarriage is understood, but she lost me was when she interprets the offering of grief ceremonies to mothers who have experienced pregnancy loss as anti-feminist, and "requiring that she grieve and join the political project of making the fetus into a person." (p. 368) I personally feel offended by the idea that to want to grieve my loss meant that I was making any political statement, or that I am anti-feminist if I thought of the fetus inside of me as a person.

Photo by jpellegen

Jutel (2006) notes that not all cultures use viability or gestational age in their assessment of personhood. She points out that the Maori culture uses the same word for fetus, baby, and child. Another culture that I'm familiar with is Japanese culture, having lived there for four years and studied the language for much of my adult life. There are temple rituals and services to memorialize pregnancy loss (mizuko kuyo), whether due to miscarriage, stillbirth or abortion. Many temples regularly hold mizuko services where women and men can come to worship. According to interviews with women who attend mizuko services, their emotional and spiritual reasons for attending range from sin atonement to ancestral respect. While women each have their own personal reasons for practicing mizuko kuyo, its very existence in Japanese society provides a cultural space for those who have experienced any kind of pregnancy loss to grieve and be comforted. Feminist critiques have taken a normatively negative view of mizuko kuyo, seeing the temples as exploiting women's guilt and grief. According to that perspective, the entire temple culture in Japan should be seen as exploitive, as worshippers pay for blessings on or atonement for a variety of life experiences, ranging from passing exams to pregnancy loss. According to my spiritual worldview, "Blessed are those who mourn, for they will be comforted" (Matthew 5: 4). In other words, it's hard to receive comfort if one does not mourn. While I don't believe I personally can pay a price for atonement or blessing, I really wish we had something like mizuko kuyo in American culture - a non-politicized space to mourn and receive comfort. Some good friends who knew about our pregnancy and its loss brought us flowers and a meal as soon as they heard and visited with us. That meant so much to me, and I think that's because flowers and visitation represent something in our society. They represent an attempt to comfort someone who is grieving.

Part of the reason we have no cultural space for grieving a miscarriage is political, but part of it is a social custom that has existed despite the ebb and flow of social movements around women's rights and reproduction. That is the custom of silence about pregnancy until the first trimester (at least) is over. We don't share in case "something happens." Regardless of the fact that Reagan's analysis of media representations finds women are speaking out more about "miscarriage" since the 1980s, the norm of silence has not broken. Most women still do stay silent about it, or share in private with only their closest confidants. I myself followed this custom, and only shared our pregnancies early on with parents and a handful of friends. But that custom of silence during early pregnancy implies an expectation of silence if "something happens." I know I felt (whether it's true or not) that because of the norm of silence, people didn't want to hear about it. I didn't even want to take too much time off of work - despite the fact that I was enduring a very painful physical experience on top of my emotional pain - in case people thought something was "really wrong." I took a couple of sick days, and when I went in still suffering, some of my coworkers kindly asked me if I was feeling better. I forget what I said... I tried not to be dishonest, while also still not sharing. I think something like I was "taking it easy." And I tried not to burst into spontaneous tears for the next couple of weeks at the office. The whole custom of silence makes women's experiences of pregnancy loss largely anonymous.

Jutel ultimately concludes that women should have the agency to choose the language that best explains the meaning they make of their pregnancy loss experiences. "Bringing the discussion back to the woman allows her the opportunity to acknowledge 'losing the baby,' if this is how she interprets the experience." (p. 433) Given the contested nature of American language surrounding what is growing inside a woman's pregnant body - fetus, baby, child - and what happens when a healthy child is not the result of a pregnancy - miscarriage, stillbirth, abortion - I feel like I can't even choose the language I'd like to explain my experience and subsequent grief. The custom of silence and lack of language and cultural norms for mourning made me feel like I was forced to choke down my grief. Like being amommymous, it's an empty feeling. But a woman who has suffered pregnancy loss isn't amommymous. She can't even claim to be a "mommy," since - according to our culture - she never had a "child."

What I can say is that while Jeff and I did grieve mostly alone, I could always turn to God for comfort. I believe God loves me, and that though this was "nature's way," it wasn't His way. (A good book on my theology of suffering is "Is God to Blame?".) I often sought time alone for myself to cry and listen to a song with the following refrain:

"This is what it means to be held,
how it feels when the sacred is torn from your life
and you survive.

This is what it is to be loved and to know
that the promise was that when everything fell
we'd be held." (from Held by Natalie Grant)

References

Jutel, A. 2006. "What's in a Name? death before birth." Perspectives in Biology and Medicine, 49(3): 425-34.

Regean, L.J. 2003. "From Hazard to Blessing to Tragedy: Representations of miscarriage in twentieth-century America. Feminist Studies: FS, 29(2): 356-78.