When I meet people for the first time and tell them that I’m a doula, Lamaze educator, lactation counselor, and car seat technician, it’s interesting how they react. Some people respond by telling me all sorts of things. I end up being told birth stories, completely unprompted, or they tell me about a friend who is also a doula, or they tell me what their breastfeeding journey was like. Sometimes, there’s an air of defensiveness to their confessions. And I get it– I really do. Breastfeeding isn’t the most cut and dry thing to wrap our arms around.
1) We have no good way to tell how much milk a mom is making- If a mom pumps milk, we assume that the pump, which is this expensive machine that’s supposed to be really good at getting milk out of human mammals, is going to do so efficiently and is a good way to determine if a mom has supply issues or not. Yeah, that’s not the case. Not everyone responds well to pumping, especially in the first week or so, and if you use pumping to see if a mom is making enough milk, there’s a good chance that her pumping output is going to be disappointingly low. Ignorant providers use this as proof that a mom’s body is broken and can’t produce enough milk. Oh, and by the way….those pumps are having major quality issues and breaking all the time.
2) Since there’s no gauge on the side of the breast, we have to guess how much milk a baby is taking in- There’s an elaborate method of weighing a baby before and after a feeding to estimate how many ounces of milk a baby took in, but that’s still not bullet proof. It’s not an uncommon impulse to have so little confidence in the breastfeeding process that providers will make mothers bottle feed babies just to verify input. Even when bottle feeding pumped human milk, the message is strong–you can’t be trusted, your body can’t be trusted, and only the bottle can be trusted.
3) The nutritional content isn’t static, so it’s really hard to know what the caloric content is- The more we understand breastfeeding and the production of breast milk, it’s become startlingly clear that the milk a mom makes for her baby changes hour by hour, day by day, month by month. It changes depending on which child you’re feeding. If you have a preemie, we’ve just realized your milk is really a lot more calorically dense than we ever thought. We do know that on average, breast milk is a lot more calorically dense than formula, so it does take a higher volume of formula to approach the nutritional needs of a baby. At least, though, health care providers know exactly what is in it, unlike breastmilk, which changes if baby is getting sick, or needs more calories, or based on the time of the day.
4) It’s really hard to trust that you’re breastfeeding the baby as much as you say you are- When we talk about breastfeeding, we tell moms to watch for cues. We call them hunger cues, but babies also cue out of thirst. News flash– babies are human and get thirsty, even when they aren’t hungry. Expecting a baby to get hungry and thirsty on a set, quantifiable schedule is about as crazy as expecting you to only be thirsty every 3 hours. So with breastfeeding, every time you sit down to nurse baby can be different in length and frequency, which is maddeningly hard to plan out and account for.
5) Only a few people are qualified to help you- Breastfeeding has a learning curve. It’s not easy for most moms and babies at first, but if they can make it past the 2-3 week mark, it usually gets much easier. However, getting past that hump can be really, really %@$*!#* hard. If you had a baby 100 or 200 years ago, by the time you had your own kids you would have watched lots and lots of babies be breastfed, and most women knew enough about breastfeeding that they could help each other. Now, we not only have so few people (including medical professionals) that are appropriately and accurately trained to help with breastfeeding, but we wall them off and only make them available during banking hours. It can take a lot of dedication, perseverance, and tenacity to get through the early breastfeeding struggles, but there’s a huge role that luck plays. If you find the right lactation specialist, you’re good. If you have a bunch of lactation specialists who don’t really care…you’re probably screwed.
6) Your mom didn’t breastfeed, and her mom didn’t either- Breastfeeding rates have risen since the 1950s, when only about 5% of moms ever breastfed their babies, but the 6 week breastfeeding rates in the US are still pretty low. Initiation rates are high, but almost 70% of moms give up breastfeeding before they initially planned to. There are a lot of moms out there who had bad breastfeeding experiences. This makes breastfeeding seem impossible; more tragically, it can unintentionally undermine a mom’s desires for feeding if she’s hearing from others that it’s just not important. And this one is the trickiest thing about breastfeeding. We know there’s a sociological component to breastfeeding. The barriers aren’t just biological. The biological barriers can be real, but we still struggle to have good, healthy conversations about breastfeeding within the larger construct of motherhood.
As is the case with most medicine, we’re realizing more an more that there’s a whole hell of a lot of nuance with breastfeeding that we have to get used to. Pumping and bottle feeding human milk can seem like a good solution, but most people who suggest it completely ignore how draining the process of pumping for every feeding or after every feeding becomes. They suggest pumping and make it seem that it’s as easy as brushing your teeth. Constant pumping sucks. I don’t have anything super simple to offer as a solution to any of these things, other than education. Humans are mammals. We are mammals with young that need fed. Rather than think that the process is broken, I’d posit that breastfeeding usually works– but we are the ones who are making it not work with our bad information, lack of trust, and unrealistic expectations.
*I decided to couch it in these terms. It’s kind of tongue in cheek.