The ‘Big Latch On and Big Bottle On’
The Breastfeeding Blues & Bringing Back Balance into the ‘Breast versus Bottle’ Debate.
I have just finished nursing my toddler. My youngest two children were close together, and having just emerged from a haze of contiunous breastfeeding for the last three years, I now have a sudden surge of energy and mental clarity. But I feel a little sad about retiring from breast feeding as I really enjoyed the experience. I guess I would describe myself as a ‘lactivist’ or believer in breast feeding if it is possible, but I also believe in doing what is best for the whole family unit. I was fortunate with my three children to not experience too many difficulties nursing, and I’m thankful for this, as with my family history of allergies, breastfeeding was my preferred option. However as a disclaimer, this post is not intended to give advice or make anyone feel guilty about their infant feeding choices. After all, everyone’s situation is unique, and I am not an expert. These are merely the reflections of a mum who has breastfed her children.
I’m aware that for many mothers breastfeeding is not the natural easy process that it is made out to be. Society has really embraced the ‘breast is best’ message but this can be really difficult for mothers for whom breastfeeding doesn’t come easily. Breastfeeding can be such a lovely experience for many, but I feel for many new mothers who experience what can only be described as a ‘nursing nightmare’. Commonly there may be difficulties latching the baby, leading to a low milk supply. Which may then lead to a fractious baby who isn’t sleeping. And a tired stressed mother.
Having trouble breast feeding can be an isolating experience for a new mother. I wonder whether the ‘breast is best’ message has been promoted too much, and whether our health system puts far too much pressure on new mothers to breast feed? I feel for those who feel judged if breastfeeding just doesn’t work. The age-old breast versus bottle debate is like the topic of birth, in that it can a polarizing issue, and many have strong opinions on the topic. And I wonder whether some balance needs to be brought back into the breast versus bottle debate?
New Zealand has high rates of breastfeeding. “Breastfeeding rates in New Zealand are definitely improving. Currently 85 per cent of babies up to the age of six weeks are getting some breast milk, a 5 per cent increase over the last 10 years. That may not sound all that big but it represents a significant number of babies”(Plunket Clinical Advisor, 2012). Breastfeeding rates in NZ compare favourably with other countries. Breastfeeding is really promoted in New Zealand, and I’m in no doubt that it is the ideal way to feed a baby. However, there is a fine line between promoting something and then pressurizing someone. Obviously promoting breastfeeding is not intended to make bottle-feeding parents feel guilty. And consider that breastfeeding needs to be promoted, because if it wasn’t promoted, then the advertising tactics of formula companies would have a monopoly, and breastfeeding rates would go down. There is much misinformation and lack of information surrounding breastfeeding. But has it all gone too far? Consider that formula feeding isn’t even discussed in most antenatal classes. And I know that the textbooks say that most mothers, 95% in fact, should be able to breastfeed successfully. But there is a difference between what the text books say and what pans out in reality. And there is more to breastfeeding that the physcial ability to produce milk. Many nursing mothers are managing the demands of other children, a household and often work. I’ve known of some mothers working fulltime who have managed to exclusively breast feed, but what a herculean task this must be. If one has a high milk supply and a supportive employer and family it is probably possible, but not easy. Working mothers may face their own challenges, not to mention mothers suffering with post-natal depression, complications with childbirth or caesarean-sections, or women who lack of support from their partners or families.
Even if breast feeding does go smoothly, breast feeding is very demanding. Many mothers experience what has been termed the ‘breastfeeding blues’ or exhaustion from providing round the clock nursing. Mothers who experience difficultis breastfeeding can be more likely to develop Post-natal depression. But is this partly because of the judgment they receive in society? The relationship between postnatal depression and breastfeeding is a complex one and it is different for each mother. For some women breastfeeding can help reduce the likelihood of postnatal depression developing or the duration of the depression. For others breastfeeding may be a significant source of stress and anxiety, and it may be more beneficial for the mother to stop breastfeeding. I had a discussion with a mother (now a grandmother) who had nine children, and she believes that breast fed babies are much harder work. She said she managed nine children close together because she didn’t breast feed most of them. In my experience, I found that exclusively breast feeding a baby is a fulltime job. I was plonked on the couch for a good few months in the early days, and the housework and other hobbies had to wait. Perhaps new mothers are not prepared for the relentless nature of exclusive breastfeeding on the early months. And maybe our busy hectic lifestyles don’t help. Nor does the fact that many mothers are discharged from hospital so early if they have had a hospital birth, often before their milk has come in, and it is difficult for them to get enough rest when they are home.
And then there is the debate over whether to feed on demand or on a schedule. I fed on a flexible schedule with my first child and fed more on demand with number two and three as this is what worked for me. The baby was on the breast most of the day (or so it seemed like it at the time). And I have a sneaking suspiscion that sometimes breast fed babies are more wakeful than bottle fed babies, and I believe there is some research to support this. Like many mothers I received negative comments from people about how I fed my baby. Comments like, “You look exhausted, that’s the problem with demand feeding” or “Didn’t you just feed her an hour ago?” or “You don’t have enough milk, you better supplement with formula”. I just ignored them. Confidence can be half the battle for many breastfeeding mothers.
And well meaning midwives can sometimes be very militant about breast feeding, One midwife I know of said to a client ‘If you want to breastfeed I’ll help you, but if you bottle feed, you are on your own’. Many breastfeeding organisations promote the idea that a mother can probably breast feed and work through any issues such as latching or a low milk supply with the right help. Often there are mothers do try to breastfeed but discontinue and wean because of various problems. Often those problems might have been solvable with the right information or with more support from a lactation consultant. There are many wonderful (and free) agencies out there that can support mothers who are battling with breastfeeding such as the local ‘Breast Room.’ But I know of many mothers who have tried very very hard, persevering with breastfeeding, but sometimes at the expense of their mental health and relationships. They may have received very good support from their midwives, GP”s and lactation consultants, and may have had medical therapy such as domperidone to increase milk supply. Still however, the breastfeeding has not blossomed and consequently their baby hasn’t thrived.
Much attention has been given to mothers who want to breast feed in public and how wonderful it is that breast feeding in public is now usually accepted. However, many mothers who bottle feed feel scorned at in public too. I’ve even heard of a mother who was bottle feeding her son in a shopping centre, and a woman sneered at her and said ‘Breast is best.’ I’ve heard similar stories of mothers purchasing formula in the supermarket and encountering disparaging remarks from strangers. It’s rather astounding. I’ve seen signs in hospitals stating ‘Breastfeeding welcome.’ It sounds contraversial, but I almost wonder whether there needs to be a sign saying ‘Fabulous formula feeding mums welcome’. New Zealand has a fantastic ”Big Latch On’ community event around the country. I never got around to attending one, but it’s where breastfeeding mothers attend with their babies and all feed them together. But what about a ‘Big Bottle On’ for formula feeding mothers? A contraversial idea I know. What might be quite healing for the ‘mummy wars’ would be a ‘Big Latch On and Big Bottle On’ where all mothers of infants could get together to feed their babies, regardless of whether they feed their babies via the breast or via a bottle. Because formula feeding mothers need more support.
You are not alone if you can’t breastfeed, won’t breastfeed or need to stop breast feeding. We just don’t know what is going on behind closed doors and so often we make assumptions. Condemning attitudes never help anyone, whether it is towards a mother nursing in a public place or towards a mum who is bottle-feeding her baby. There are some sound medical reasons for bottle feeding, for example if the mother requires medication that would be very harmful to the baby (though with many medications you can continue breastfeed normally). I have another friend who bottle fed her second child because she had a prophylactic mastectomy after her first child. She discovered through genetic testing that she had the BRACA2 gene for breast and ovarian cancer that sadly took the life of her mother at a young age, and she wanted to radically reduce her chances of developing these cancers. Interestingly, she said she was far less tired bottle feeding than she was when she was breastfeeding her first child. And there are also mental health reasons for why mothers might opt for bottle feeding. I know of one mother who stopped breastfeeding her second child because she was so exhausted and she felt that she was a better mother when she switched to formula. But she felt like she had to justify to people why she wasn’t breast feeding. This is all too common. And a family member whose second baby had such severe colic that she and the baby was hospitalized several times. When her baby was finally diagnosed with a lactose intolerance and put on a special authority neocate formula at the age of nine months, she was a different child. Because even if you take dairy out of your diet, there will still be some lactose present in breast milk, around 7% I believe. So there are cases where breast is not always best.
And, if a mother is bottle-feeding a baby, how does one know whether the liquid in the bottle might be her own expressed breast milk, or formula.? Some mothers have to pump their breast milk (for various reasons; for example if the baby has a problem with sucking or latching). These women who do intend to breastfeed but end up bottle-feeding often also end up feeling very guilty for ‘their failure’. But using formula does not mean that you have failed. And aren’t we fortunate to have safe infant formulas available. Parents should be supported no matter how they choose to feed their children. Recently, the All Blacks star Piri Weepu raised controversy when he was photographed bottle-feeding his 6-month-old daughter in an anti-smoking advertisement. The footage was cut from the advertisement after complaints from a pro-breast-feeding organisation. A spokeswoman from this organisation reported that they help mothers regardless of their feeding choices. I hope that this is the case. Now that breastfeeding mothers can feed anywhere, wouldn’t it be great if formula feeding parents were also afforded the same courtesy and respect?