Executive Summary

I had a thought today that I would like to know the answer to. With so much publicized research being done on the properties of breast milk (antimicrobial, stem cell properties, brain development and so on), where is the research into real lactation problems? Where is the safe approved drug to increase milk supply (Metclopramide isn’t really ‘safe’ and Domperidone isn’t really ‘approved’), where are the actual diagnoses for supply problems? Maybe companies would rather head toward synthesizing the properties of breast milk rather than helping to fix bodies to produce it. After all it’s only several hundred thousand women a year, and formula does exist (my tongue is so far into my cheek it might poke through…)

I don’t know. I suspect there is not a satisfactory answer.

So I leave you with this. A short guide to various posts that are intended to be helpful.

I need help:

How to interview a Lactation Consultant

11 things a Lactation Consultant should know how to do (IMO).

Do I need help?

I find my tongue tie resources out of date, though you can see my experience here. For better information I would urge joining this Facebook group. They maintain lists of providers and are fairly knowledgeable about what is to be expected. If a provider is not on their list people can often recommend local alternatives (for instance I know of at least 4 laser tongue tie release places in New Zealand now, but none has made the general list. Do see the New Zealand Tongue Tie resources page instead.)

I need to combination feed-how do I do this?

The big fat Combo feeding FAQ

Walking the line

Benefits of

With low supply

SNS tutorial

Nipple confusion

Managing long term

Formula

Solids

Weaning

Body Image

What is causing this?

Able

Potential causes

Birth complications

Rare vs Undiagnosed

My most popular post

Making Milk beads

And the rest of my life.

I think I no longer feel bad, because it isn’t something I did wrong. It’s purely a medical issue.  A medical issue that some people would have me believe is my fault. A medical issue I cannot get satisfactory treatment for and that is largely undiagnosed. That makes me mad.

I lie. I still feel bad and somewhat inadequate, but I no longer feel guilt. I do wonder how much of my feeling bad is a normal level for someone suddenly faced with a non-life threatening failure of a body part. Somehow I can’t imagine people feel a mix of loss of gender identity and self loathing after losing a kidney or having a splenectomy. Or losing a finger or a limb. I’m sure there are other mixed feelings but I wonder how often self hatred/loathing/failure is a part of that.

Not trying hard enough

Not trying hard enough is a phrase that has haunted me most of my life. For a long time it’s been applied vaguely at me in regards to weight loss. Despite my counting calories, and measuring or weighing most everything I eat and seeing no results. I bought into the idea that I must be doing something wrong and that I wasn’t trying hard enough. Now that I’ve finally (finally!) been diagnosed with PCOS I can give myself a little bit less of a hard time.

When breastfeeding went wrong and people actually said to me that I needed to work harder and that I wasn’t trying hard enough (also see: lazy, uneducated, and so on) I again bought into the idea that I wasn’t trying hard enough and it ate me up inside. I mean so many people were saying (mostly without knowing the specifics) that there must be something I was doing wrong.

Thing is, in a normal situation these things are not rocket science. They are simply not that hard. When you aren’t in a normal situation though, all bets are off. There are lots of variations on not normal, so be cool and give support.

This time around has been a really different experience for a lot of reasons. If I had more time I could write guides about horrible sleepy fussy babies with oral particular-ness and how much more this low supply gig sucks when you also have a toddler.  Most importantly though I know this time I am totally awesome and actually pretty damn hardcore for being able to do this.

I ran into some internet comments the other day espousing the same old tired bullshit that low supply is ultra rare and that people who say they have it are all a big bunch of lazy liars and blah blah blah. It made me a bit weepy because I’d forgotten how many of that type of ‘lactivist’ there still are. Here I’d been thinking that recent media exposure on the prevalence of breastfeeding issues had somewhat changed the landscape in the past two years. Ha, I say. Ha.

Someone else in the same stream of comments said something along the lines of ‘Well 99% of pancreases work so diabetes is ultra rare and you only think you have it’. Someone else countered with ‘Don’t eat 50 donuts a day and expect your pancreas to work’. I then thought, if anyone told a type 1 diabetic that eating donuts caused their disease they would just be convinced that person was a moron. Put it all in perspective for me. Anyone who ever thinks I didn’t or I’m not trying hard enough I can automatically dismiss as a moron.

Phew.

How to interview a lactation professional.

I’ve thought about this some, but then it came up in the comments for another post. A few of my posts reflect ideas I’ve had on this topic, so I’m going to expand on those as well as adding some new thoughts.

This should probably be broken into two groups: Prospective mothers (expecting), and/or those requiring generalist help and current mothers who have experienced a problem.

Let’s cover expectant mothers first.

If you are expecting your first baby, or your first baby you wish to breastfeed, you want to make sure you have an adequate amount of support. You should be focusing first on what resources are available to you.  This means checking with your hospital, your birth care provider, your pediatrician (if you are in the US for example), your local LLL chapter as well as seeing what private lactation professionals there are in your area. You should focus on how to access the services and what the cost will be to you. Having knowledge of where to find these resources is just as important as a birth plan, and for much the same reasons. The goal is to educate yourself to make informed choices. In addition, trying to find a lactation professional when you are desperate for help does not allow you to make informed choices. Try not to wait until you are desperate.

General questions to ask:

  • What are your qualifications? Here is a lovely guide I found on what all the titles mean.
  • How long in practice?
  • Is there any particular area you have additional expertise or interest in? (If you’ve got low supply and you are talking to a IBCLC specializing in oversupply she might not have the resources to give you the best help. If you are surveying what is available in your area then this is information worthy of noting down.)
  • What are your working hours? Do you work out of any hospitals or clinics?
  • What are your fees? What are your followup policies?
  • What breastfeeding challenges have you seen, treated, or overcome yourself?
  • Do many of your clients meet their breastfeeding goals?
  • If I experience a problem outside your area of expertise do you feel you have relevant resources to refer me elsewhere? What would you consider outside your area of expertise?
  • If I experience problems it will likely be a very emotionally turbulent time for me. Have you had experience supporting decision making and coming to a consensus about ways to resolve the problem (your provider should be willing to have a back and forth with you and if you decide that enough is enough support you in that as I refer to in this post).
  • What kinds of issues have been most difficult for you to help mothers and babies with and why? (as in, do they find the mother’s determination lacking, are surgical referrals difficult to get, etc. This is should act as a sounding board for their typical experience, if they have professional peeves as well as how understanding they may be to your situation)
  • How do you generally balance a mother’s well being with her initial desire to breastfeed? How do you manage situations that do not meet expectations and goals?

I also think that pursuant to this list, some of the general things you should ask a lactation professional if they have experience in are:

  • Do you have experience identifying lip and tongue ties, including posterior ties as well as other oral abnormalities like bubble palate? Are you confident identifying these types of abnormalities?
  • Do you have experience identifying a breast with  insufficient glandular tissue?
  • If you are a first time mother at risk for breastfeeding difficulties (PCOS, diabetes gestational or otherwise, history of thyroid disorders, lack of breast changes) you should certainly mention that. An appropriate response to my view would be a physical examination of the breasts as well as a wait and see with potential aggressive treatment if desired. Go the other way if you are told that any of those things will not matter.

Now for mothers who have previously experienced issues or are currently experiencing issues.

You’ll want any of the above that seem relevant as well as the following.

Specific questions:

Most of these are fairly situational so choose or adapt any that seem appropriate to you.

  • My issue last time was X. Will you help me explore solutions for that? How will you do that?

I’ve found some sounding board questions quite helpful to see how much recent research has been kept up with. You might ask if they know about the link between PCOS and breastfeeding issues, thyroid problems and breastfeeding difficulties, or even a more general tricksy question-what medical factors are you aware of that influence milk production in the mother and milk extraction or digestion in the baby?

  • What are your guidelines for supplementation in the infant.?

This is a personal preference one. The answers may range from over 7-10% weight loss, to watch the baby. I’d be wary if they say that supplementation is almost never necessary. If they say that I’d follow up with askance for some clarification i.e. in general or among your clients? What techniques do you use then for managing babies with milk extraction issues or mothers with milk production or ejection issues?

  • If supplementation becomes necessary which methods will you support me with? Are there any you will not support?

If you used donor milk last time and plan to should it become necessary again you’ll want a professional that supports you in that. If you used formula and prefer that, again, support. If you want to use bottles, you’ll want support in managing that, if you don’t you’ll want tips on other feeding methods.

  • As my issue was X last time can you give me some realistic expectations on what management of this issue will look like on a daily basis and what difficulties I am likely to face?

If they tell you you’ll need to pump 15 times a day as well as do some other things and this does not seem sustainable to you because of other children then bring that up. Discussion about an action plan is key.

  • Make sure to mention things you did or tried previously and whether or not you feel they worked as well as whether you’d be willing to do them again.

For instance, I tried domperidone and it inhibited my letdown reflex, and I am open to supplementing via SNS if it can be demonstrated to me that an oral abnormality is not the issue etc. You don’t need the frustration of reinventing the wheel and to avoid that the LC will need as much information as you can give her.

Warning signs:
  • Being told to wait and see or being told that every baby is different when you’ve experienced issues previously. Wait and see is a reasonable approach for some things but not if you want to be proactive. With some things it’s important to act quickly.
  • Your LC should never touch your breasts without permission.
provide support and encouragement to enable mothers
to successfully meet their breastfeeding goals

So if your goal is to breastfeed for 2 months then move to combination feeding for the next year she should be able to give you strategies on how to do that. She should also be supportive of your goals and willing to have an open and non-judgmental conversation with you. If your goal is to exclusively breastfeed with contraindicating issues she may (unpopularly) explain that that may not be possible, but give you long term management tips.

Note: there are a range of breastfeeding topics I do not have much experience with. Issues like oversupply, feeding multiples, flat or inverted nipples, breast size issues, prematurity in the infant, allergies in the infant, and reflux as well as others so I can’t give examples of more specific questions relating to those issues. However I can say that if any of your concerns are brushed off without explanation that is cause for alarm.
Overall you want to be having a conversation. Figuring out if this is the right person to help you if and when you need help.

Becoming a pariah: Breastfeeding’s underclass

I was a member, as previously mentioned, of a large parenting forum. I had a journal there which I started shortly after my baby was born. In that journal I documented our ups and downs with our breastfeeding issues. I’m considering how best to showcase those posts, often very raw and unhappy, on this blog. Anyhow, I titled my journal our journey with low supply as I thought that was our issue for 8-9 months. I keep digressing, but the main topic was about our struggle with low supply.

First off it made me hugely unpopular because the noisy breastfeeding advocates exclaimed that low supply was so rare and here someone was living with it, struggling with it, being public about those struggles and emotions, and apparently most aggravating, finding a way to keep breastfeeding despite it. Somehow being a successful combination feeder was a huge insult. I guess it’s easier if people fall into the breast feeder or formula feeder camps. It seems that once someone has fully gone over to not breastfeeding and they say that they did because of low supply it’s easier for those vocal people to tut and say that that wasn’t the issue. Far more difficult for them to do so to someone who has kept breastfeeding and has not managed to increase supply. Anyhow, as long as I didn’t argue the party line (all women can breastfeed; try harder!) too much I mostly got left alone; ignored even. But until I changed the title of my journal to something more general, at least three separate people came into my journal for the purpose of arguing with me about how I was wrong. I was told that if I’d been better educated, if I hadn’t doubted my abilities I would have seen that I was wrong about having low supply and I would have been a successful breast feeder. Now, at the time I tried to be nice and civil. After all they weren’t quite that blunt (ok, one person did tell me that if I’d believed I could breastfeed I would have been able to do it). People hardly talked to me in there as it was. I was trying to be sociable. But it got to me. I spent so much of that time plagued with extra doubt because of the things people were saying to me. By openly labeling myself a low supply mom, I publicly invited scorn from those breastfeeding advocates indoctrinated in the belief that 99% of women can breastfeed. One of the most hostile to me now has a blog herself (possibly one of the more hostile pro-breastfeeding blogs I’ve ever seen, not that I go looking) and is very much a ‘I did it why can’t you’ type.  I gave her latching advice and other support and she threw it in my face because after she ‘educated’ herself she decided my low supply wasn’t ‘real’.

I continued to offer advice and support to women who were also experiencing similar issues. During this time I noticed an upsetting trend. I am a member of other open breastfeeding support and information sites and networks and I saw it there as well. It was acceptable to treat women with breastfeeding issues as second class breast feeders. Talking about what problems looked like was ‘not ok’, ‘scaring women’ and the like. Those who had issues were dismissed as uneducated and failed by the system, those who succeeded were hailed with a ‘job well done’. This further glossed over what symptoms of breastfeeding issues look like. Who needs breastfeeding information and advice most? Those with issues, yet these areas are frequently dominated by passionate women with breastfeeding as their cause. Those who had issues, with pertinent advice to give, are most often relegated to the back seat while those who have overcome, or did it without too much fuss, become the first line of offense for those looking for help. The feelgood message is all very well and good, but it’s not appropriate for anyone with an issue beyond ignorance. So yes, know what a normal newborn feeding pattern is like, but also know when things are verging on abnormal and do not apply the protocols for ‘normal’ to that.

I know this is overflow from the dispelling breastfeeding myths movement. Dispelling myths is all well and good since our cultures need to relearn what normal breastfeeding looks like, but preventing knowledge of what problems look like to keep from ‘scaring’ someone hurts us all. No wonder when breastfeeding fails women feel so lost. They don’t know why or how things went wrong. There’s rarely any closure. On top of  not being able to access adequate help that is able to competently discuss the issues and come to a satisfactory resolution, you have these freaking mommy wars pushing that it was all about toughing it out. Advocates pushing that it’s all about the mother’s ability to stick with it and it becomes a spiral of what-if and if-only long after the fact.

I spent a long time feeling really bitter about how I couldn’t get any meaningful advice. Then I realized, those who had it to give had long since distanced themselves from those who only had platitudes because the self proclaimed bearers of breastfeeding wisdom feel continually justified and vindicated in what they are telling people (most of which is more or less true and nonetheless helpful and reassuring to those who are simply ignorant of what normal newborn behavior looks like), while those who have advice to give on problematic matters get shot down, belittled, accused of scaring or misleading women and other negative things. So they, though they may crave the providing of proper information and support, slowly withdraw because frankly it’s a demoralizing atmosphere. Like me. So now I’m part of the problem. At least I’m preserving my sanity.

Regret for information not had, and tears shed for the wrong reasons, are most bitter indeed.

Lactivism vs Feminism

I wandered into a discussion the other day about whether or not lactivists want to ban formula completely. I actually wrote this post last week, but have been putting finishing touches on it and autoscheduled it for later.

Anyhow, some of the anti-formula commenters involved in the discussion (I don’t consider being pro breastfeeding the only requirement for being a lactivist) said that no, they didn’t want to ban it completely, but they wanted it to be prescription only. I backed away before I started picking fights because I’m being a coward. But that just made me feel sick. (Not the prescription only bit, that’s old news, the banning it bit. Also, you may have had to be there.) How has lactivism come to supersede feminism? First off, some of the problems with that are that it punishes women for needing to formula feed without adding anything to help women. It assumes that formula being available causes formula feeding. Long before we had commercial infant formulas people would feed babies anything white in lieu of breast milk, so chalk dust and water for instance. Oh and then there was pap. Bread, water and flour. I’ve even seen reference to pap containing ground walnut shells. I am not kidding. Not that long ago condensed milk was given to babies. Even now there are people who dilute formula or give infants skim milk to save money. I don’t think formula is that great, but it’s pretty darn good compared to what used to be available. Sure it would be grand if there were milk banks for everyone and it was free, or cheap, and screened, but there aren’t.  So stop holding up the what if and focus on the what is.

I wish everyone wanted to and was able to breastfeed, but, fact is they don’t or can’t. Punishing formula is not the answer. Besides the fact that it’s inanimate and you can’t hurt it, limiting it hurts women. Limiting formula availability does not guarantee more available care for breastfeeding. More available care for breastfeeding does limit formula use though. Sure, they have a connection, but there are many other factors at play, foremost the education of health care providers. You know what? I fully support the Baby Friendly Hospital Initiative for promotion of breastfeeding. When properly applied. Properly applied it doesn’t limit it, it just makes it not free. Having it not be freely available in the hospital setting does more to protect women’s breastfeeding goals from poorly trained health care providers, than it limits any choices. If you know you want to formula feed, you bring it in. If you have serious issues while you are there they do provide it for you. If you don’t know before you go, then you aren’t actually in the hospital that long. I both gave birth and did my post birth recovery in BFHI centres (two separate places), and they provided water and washing supplies for formula preparation and bottle cleaning, they just didn’t provide the formula. I realize there can be issues with BFHI staff, but I’m just going to have to come down on the side of women who want to breastfeed on personal principle. I guess I’d rather have untrained health care providers being snotty than sabotaging biology.

Popular voices of the lactivist movement have little regard for the feminist movement. Erroneous lactivism wants women to have jobs that are suitable for breastfeeding, if they have jobs at all. So what about women who travel, who work unpredictable schedules on call or similar, and women who work in the field, away from spaces and facilities to pump? Are these jobs no longer suitable as women’s work? Because of breastfeeding is there again such a thing as women’s work? Is that what lactivism is currently telling us? Even women who just don’t pump well get the short end of this stick, being lesser in lactivist eyes for simply working outside the home.

I don’t like to consider myself a feminist because I don’t like associating with other self described feminists. Oddly enough those were the people that gave me the most flack when I became my households primary earner in a male dominated field. I’m certainly a postmodern feminist. I enjoy the benefits I would not have had historically, but find little issue with my modern life. I don’t like to think of myself as a lactivist either, because of the company that I’d be keeping. I certainly do have issues with breastfeeding support and education as well as access to services. I just can’t get on that bandwagon with many of those that consider themselves lactivists. In both cases, for me, its about walking the walk without talking the talk.

The ideas behind, and in truth, real lactivism is no more ‘breastfeed or else’ any more than real feminism is about the superiority of women and putting y’s in words. With both there are hangers-on to the cause that miss the point and push a different agenda. Lactivism is about breaking down barriers to women breastfeeding. Feminism is about women being equal people. The image of lactivism is now tainted by unyielding group-think much the way the image of feminism has been tainted by bra burners.

I guess that’s my new comeback for the anti-formula crowd (I’m making an effort to use the word lactivist properly, for those trying to inform and break down social barriers). Oh, so you aren’t a feminist then?