Death Before Formula?
I've nursed three babies, and I've had low milk supply with all three.
This is a problem that supposedly doesn't actually exist. Hospital nurses, lactation consultants, and breastfeeding websites and forums all told me the same thing: "Everyone can breastfeed and everyone can make enough milk."
I didn't understand what was wrong with me. My babies would all scream at the breast or fall asleep or if they nursed successfully they would would be hungry again a few minutes later. I tried pumping, I tried medication, I tried the dreaded "supplemental nursing system," I tried nursing all day long, and nothing seemed to make any difference.
I exclusively nursed my first baby for three and a half weeks. He would suck for a few minutes, then fall asleep, then wake up screaming five or 10 minutes later, around the clock. I remember being so tired I literally fell asleep on my feet and nearly dropped him. I finally took him in for a weight check and discovered that he'd actually lost weight. He was nursing, but the milk-flow was so weak that he would fall asleep rather than have to work so hard for so little reward. I finally gave in and started supplementing, but I felt guilty and ashamed for months afterwards. I kept remembering what one of the OB nurses said to me as she discharged us from the hospital: "You can just throw all those formula samples away. They're not even fit for your dog." And there I was, giving formula to my baby and according to the rest of the world I might as well have been feeding him low-grade kibble.
A few years later I know better. I know that low milk supply affects anywhere between five and 10 percent of women who nurse. It can have medical origins: polycystic ovarian syndrome, hypothyroidism, hormonal imbalance, breast hypoplasia ... some women never find out why, but to them the problem is very clear. It's just wholly unacknowledged by the breastfeeding community. Because "anyone can breastfeed," a woman with low milk supply is seen as simply not trying hard enough.
In fact it seems to be an accepted practice among breastfeeding advocates to demonize women who choose to formula feed, and by association to also demonize those of us who didn't choose to formula feed, but had to because of circumstances that were beyond our control. There is no message out there telling us that formula is OK. Instead we are told of the many benefits of breastfeeding, which seem to include everything on the spectrum from medical to psychological. And so the implication is made: if you don't breastfeed, you are harming your baby. You are not a good mother.
It is a mother's basic instinct to protect and nurture her baby, and when the community at large is telling a mom that she is not a good mother, the emotional impact that has on her is dire indeed. Yet no one seems to consider the emotional health of women who have failed at breastfeeding, nor the secondary impact that this might have on their babies. Apparently, sending a message of guilt is seen as "healthy" for the rest of the community (I suppose it helps make moms with exclusive breastfeeding relationships feel good about their successes, and it probably does help encourage women who are having a hard time to keep going). But doesn't this tactic need to be reconsidered? Is guilt-tripping really a productive way to encourage good behavior, especially when some of those on the receiving end really don't have the ability to conform to the message?
I understand why the idea that "anyone can breastfeed" has been established among nursing advocates. Breastfeeding is hard, even under the best of circumstances. For every woman with a true supply issue, there are a handful of other women who think they have a supply issue, even though their issue could easily be solved with standard tactics like correcting latch or pumping a couple of times a day. But if these women were allowed to believe that true low supply is a real problem, they might assume they have low supply and give up before they've tried everything.
Unfortunately, where does that leave the rest of us? I remember reading a story about a young woman who had never been told that her breast reduction surgery could lead to low milk supply. Like the rest of us, she was bombarded with the message that "breast is best" and "everyone can make enough milk." She nursed her baby for several weeks, but he died of malnutrition and dehydration because she wasn't producing enough milk for him, and it had never even occurred to her that she wasn't producing enough milk. Now, I'm not excusing her. I still have a hard time understanding how she could not see that her baby was starving. But the message was loud and clear: "everyone can make enough milk, so don't worry, just nurse."
It is a message that is certainly given with the best of intentions. But I often wonder which is worse—is it worse to allow some moms to switch to formula because they believe they can't breastfeed? Or is it worse to let a few babies die because their moms believe they can? Is formula really worse than death?
It's time for breastfeeding advocates to acknowledge that breastfeeding is not right—or even possible—for all moms. Yes, breastmilk is nutritionally superior than formula and everyone should breastfeed to the extent that they are able to. For low-supply moms like me, this means nursing for as many weeks or months as we are able to, while supplementing with formula. For working moms it may mean exclusively breastfeeding until returning to work. All moms attempting to breastfeed should be given help and support by knowledgeable people. But at some point, those people should concede that true low supply is not a mythical problem. It not only exists, but it's common, and it can't always be solved simply by "nursing more." Women with persistent low supply issues should be encouraged to seek a medical diagnosis, and even in the absence of answers should be given permission to supplement or to let go of the nursing relationship without guilt. Instead of "death before formula," shouldn't the message be, "breast is best, but formula is second best?"