I would like to have an honest, non- judgemental chat about breastfeeding – a topic that can evoke a lot of anxiety and judgement. I feel I can speak with some standing on this topic being a GP who sees lots of mothers and their babies but also as a mother who has breastfed and ridden the engorged, leaking rollercoaster. My own experiences have given me a deeper level of empathy for my patients and all mothers...
As a doctor, I am aware of the numerous health benefits of breastfeeding – both to mother and baby. A breastfed child has a reduced risk of being overweight or obese. The child also has a reduced risk of middle ear infections and a gut infection called necrotising enterocolitis. The rates of conditions such as childhood inflammatory bowel disease and coeliac disease are also lower in breastfed infants. The breastfeeding mother also reaps rewards; she can reduce her risk of breast and ovarian cancer and evidence also suggests that by breastfeeding, a woman can reduce her risk of heart disease in later life. Sadly, despite all the health benefits, an Australian survey in 2010 found that whilst 90% of women initiate breastfeeding, only 15% exclusively breastfeed their infant to the five-month mark.
My job as a GP is to support pregnant women/new mothers/families to make an informed decision that suits them when it comes to feeding their baby; I am not in the business of forcing my patients to do anything. So, whilst I am pro-breastfeeding given the evidence-based benefits, I am also a realist and know that for some women, and some families, it simply isn’t feasible.
Let me take you back to two years ago, and you really need to envision this moment in your mind. I was a new mum, a GP and I had my own expectations weighing heavily on my shoulders. We had a traumatic birth with an emergency C–section and the psychological scars were far more gruelling than the physical ones. I was lucky – my daughter (in the beginning at least) was great at feeding on the breast. We did it our way – she fed sitting on me in an upright position, we introduced a bottle with expressed breast milk early so that my husband could help with the feeds overnight whilst I recovered physically, and emotionally. Prior to becoming a mother, I had spouted the recommendations I had seen in some of the literature to my patients about not introducing a bottle early due to risk of nipple confusion, avoiding a dummy due to the same issues. Within several days I realised that survival was crucial; with the severe sleep deprivation, ongoing vaginal bleeding, engorged breasts, cracked nipples and constipation – I was doing what I could for both my baby and I to survive and the literature could quite frankly get stuffed.
Thankfully, though, breastfeeding worked really well for us. For a while.
We hit six months and things started to suddenly deteriorate. The wheels started to fall off and I, being a type A high achieving personality, tried everything to rebuild the very rickety and dysfunctional cart. I was taking medication to increase supply, expressing and doing all sorts of kooky positions to encourage my child to feed. I distinctly remember the moment it went too far; my husband walked into the nursery, which despite it being the middle of the day was pitch black. He found me holding our daughter in the reverse football hold (hugged into my side), standing up, swaying from side to side, loudly “shhhh-ing” (any new mother knows this sound well) tears strolling down my face, a child attached to my nipple, my whole-body jerking vigorously (like I was Shakira on steroids) whilst I delicately balanced our child around my torso. “Preez this has gone too far” was his exact response – I still remember the look of absolute shock on his face. The lactation consultant (the second one I had seen for help) agreed with my husband – it had, in fact, gone too far. The lactation consultant’s response to me was “Preeya you’re either going to drop your child or injure yourself; it’s OK to stop, you’ve done an amazing job.” The tears streamed and they continued to for two weeks as I slowly weaned.
I drowned in a thick pool of guilt for a good two months. Perhaps the only thing that saved me was a close friend of mine going through the same thing at the same time. My mother telling me that you can only do what you can do also helped – and I had done all I could. Sure, I could have expressed day in and day out and fed expressed breast milk to my child, but that wasn’t going to work for me emotionally; some mothers are able to do it and I take my hat off to them.
Women, new mothers, even partners (male or female) are flooded often with breastfeeding advice; the slogan “breast is best” was campaigned heavily years ago. Posters, midwives, friends, mother in laws, women in the café sitting next to you – everyone has an opinion on breastfeeding and there’s usually a thick smear of judgement as they serve their opinion to you. When you’re already questioning yourself and your abilities as a mother, someone else chiming in can tip the balance.
I’ll let you in on a hot tip – we mothers feel like a failure if we can’t measure up to the idyllic version of ourselves that we had envisioned. Being a mother and a GP, I better understand the 1000 expectations on a new mother – hold it together, deal with vaginal blood loss after pregnancy, seriously painful engorged breasts but also smile, widely, and respond “it’s wonderful” when people ask you how the first two weeks have been. Be sure to prepare a cooked meal and start working on losing the baby weight. Oh, and breastfeed exclusively. Of course, in the ideal world yes, we would all do this. Certainly, the guidelines (and some of them do differ) advocate for exclusive breastfeeding until six months of age (newer guidelines now actually suggested the earlier introduction of solids to supplement this around 4-6 months when the infant is ready). But not every single woman can do this. Whilst this is ideal, and the health benefits are abundant, it isn’t always feasible. Don’t forget the infant born via surrogate or who is adopted; whilst donor breast milk can work this does not necessarily work for every new family. Is the formula fed child any less loved? No. Is the formula fed child less likely to make friends at school, share toys and have a fulfilled existence? No. Some new mothers find breastfeeding a breeze, it works and continues to and, in those instances, I say go for it. Given the health benefits, breastfeeding is the ideal choice, but there is another side to the coin that isn’t necessarily wrong.
I have treated patients who stop breastfeeding within weeks or months of the birth when there are no issues, they never sought help or advice– of course, I feel a pang of “damn if only I could have intervened maybe we could have kept it all going a bit longer.” By the same token, there are mothers who try literally everything – and it still doesn’t work. Let me share two stories so you can see better where I am coming from.
One of my patients despite taking Domperidone (a medication that can help increase supply) and expressing post feeds was struggling– her infant’s weight was not increasing as it should. Despite trying all efforts and involving a lactation consultant she couldn’t produce enough breast milk to meet the infant’s demands. I remember mentioning formula top ups to her when she came in for the 5th or 6th time exhausted, and I was now quite concerned she was struggling with postnatal depression – she broke down in tears, “I didn’t think anyone would let me.” Her words have stuck with me to this day, they rang in my ears when I was in the first few months of motherhood, “let” – we don’t need to “let” a woman “do” anything; it’s her right to choose how she feeds her child and it’s our job to support her. This mother was exhausted, not tired, actually “not a single scrap of energy left” exhausted because between feeds and expressing after feeds she did not have a single moment to herself. She started topping up her breastfeeds with formula – so she used a combination of milks – and a new, calmer woman walked into my office the week later.
After having my nephew and her second child, my sister in law developed a severe bout of mastitis– she was admitted to hospital with kidney failure. I was in another state with my newborn, feeling rather helpless, but spoke to her multiple times a day. I’ll never forget her devastated phone call from her hospital bed – she was alone, my brother in law had to take their new son home because she wasn’t well enough to look after him and herself. She was absolutely broken being separated from her children and husband and to add to that, she was told she shouldn’t continue breastfeeding as the health risks to her were too great.
Some women do not have a choice when it comes to breastfeeding. Some women try everything they can and it doesn’t work. Some women need to top up the breastfeeds with formula because they can’t exclusively rely on their own supply. And I don’t think it’s fair that these mothers be made to feel adequate or like a failure.
I have heard the people, sadly some in my own profession, who do not ever advocate for any formula use even referring it to “poison.” I’ve had a patient come up from the food court under my clinic in tears; someone had commented it was “unfortunate the child wasn’t getting proper milk” the child was born via a surrogate; the mother did not have the option to breastfeed. I’ve seen my friends and patients scared to admit to people, even me, that they are topping up with formula – scared of the judgement. “Breast is best” can make mothers think if they are unable to use their breast to feed their child they must be inferior or suboptimal. Please know that as a GP I wholeheartedly advocate for breastfeeding – I try my best to support women and often involve lactation consultants (who are nurses, midwives or doctors) who are specialists in this area to help my patients – but sometimes you can try everything and the puzzle pieces still just don’t fit. And sometimes, after we have tried throwing the kitchen sink at the dead horse (yes, I’ve merged two analogies on purpose to demonstrate the energy invested), permission to stop breastfeeding, or top up with formula, can save a mother.
So, my advice is simply this. Breastfeeding has many health benefits to mother and baby and the bonding that occurs is truly magical. I remember often looking down at my daughter on my breast thinking how incredible it was that I was feeding my child. If you can do it, if it’s suitable – go for it. BUT – not everyone can do it. Breast might be best but it does not mean that everything else is wrong. I am the mother of a two-year-old, I did not breastfeed for as long as I had hoped or envisioned but my child is articulate, kind, cheeky and creative – she gives me cuddles, says “love you Mummy” whilst she pats my face and burrows her head into my neck when she is tired or upset – how I fed her had nothing to do with any of that.
Words: Dr Preeya Alexander. You can read more from Preeya over at www.thewholesomedoctor.com.au