Imagine a River of Milk
I bring my five-week-old into the doctor’s office. The nurse puts him on the scale, naked and cold. He starts and splays his arms out, wriggling. I see the numbers on the screen and flinch. Since he has been born, I’ve been putting him to my breast constantly, even though it hurts. My shirts are stained with lanolin and nipple cream and milk. But the numbers don’t lie: he has only lost weight. The doctor says, “Do you think he’s at the bottom of the weight loss?” I’m not sure exactly what he means. I don’t know if he’s at the bottom of anything. I think this man is supposed to be the doctor, is supposed to know if there’s a reason to be concerned. If he isn’t, then my baby must be okay.
I tell myself this, but in my gut, I don’t believe the baby is okay. I think of the way my baby wants to nurse constantly, for long duration, and still wants to suck his hands—he is hard to satisfy. I think of the reddish-orange spots in his diaper—called brick dust, which is normal for a day or two—but I wonder if it has gone on too long. Is it signaling dehydration? Friends have come over and delivered meals and assured me that it’s normal for newborns to nurse for a long time, to be fussy. I read that I should hear my baby swallowing when he nurses. I’m not sure if I hear it. What does a newborn’s swallow sound like?
On the way home from the doctor’s office, my husband and I stop at Trader Joe’s. I stay in the car with the baby. I’m acting calm, like nothing is wrong, but inwardly I’m beginning to panic. I call my midwife at the birth center where we had our baby. I tell her about the weight loss, the numbers on the scale, and she tells me to come there right away. When my husband gets back to the car, I tell him we have to go to the birth center. “Right now,” I say. He is a little confused, but obliges.
We pull in and my midwife watches me breastfeed, checks the latch. She says it looks okay. She checks his tongue, but it doesn’t look like tongue-tie. After I feed him, she offers a bottle and he scarfs it right down. She looks at me, a little concerned, and says, “He was hungry.” Soon after the bottle he is sleeping more peacefully than I’ve seen in weeks. She recommends supplementing—an ounce or two of formula after each feeding to make sure he’s getting enough milk while we try to problem solve and figure out what’s going on.
The tricky thing is that I am committed to breastfeeding, and I know supplementing will damage my supply—what the baby takes tells the body how much milk to make. It’s a delicate balance of supply and demand, with the baby dictating the terms. Supplementing can start a vicious cycle where it’s hard to make enough milk; this is why midwives and lactation consultants are often hesitant to recommend it. Conversely, though, a baby who is not getting enough milk may be too tired to nurse well, which will then send the body incorrect signals for the amount of milk needed. It’s a lose-lose situation.
I begin wondering what options parents had before formula. If a mother couldn’t make enough milk, the primary solution was a wet nurse. Maybe the nurse was a friend, or maybe hired help. I learned that in France, during the Renaissance, many women hired wet nurses. In fact, it was so common that the French government passed a law saying that a woman with a baby younger than nine months could not be a wet nurse. Too often, women would abandon their newborns on the church steps in order to secure gainful employment.1
A few days we begin supplementing, I make an appointment at the hospital to see a lactation consultant. She gives me a flat, stiff C-shaped pillow to put my son on while he nurses. She places him on her tiny scale before and after he feeds off of each breast to see exactly how much milk is sitting in his stomach. She confirms my suspicion: my body is simply not making enough milk for my baby. I feel both a sense of sadness and relief at this. On the one hand, knowing the problem will allow me to work toward a solution. On the other hand, I had tried so hard to do everything “right”—a drug-free childbirth, all the classes, lactation support—and yet things were still spinning out of control.
The lactation consultant outlines a plan. The main thing is to send the body signals to produce more milk. This means that after I feed the baby, I need to pump for five to ten minutes to make sure my body gets the message: produce more. If I really want to be serious about this, I should also wake up in the night and pump if the baby manages to get a good stretch of sleep in.
My insurance will cover the price of a hospital-grade rental pump. It’s a large, industrial-looking tan box with a motor that hisses and wheezes. I attach all of the hoses, the breast flanges reminding me of the French horn I played in middle school. I pump my empty breasts after every feeding, adjusting the dials and ratcheting up the suction until I can feel a tug that’s a bit uncomfortable but not painful. While I’m doing this, my husband gives the baby his bottle of formula to supplement. I record when my son ate, for how long, how much he took from a bottle afterward, and how much I was able to pump (if anything). On top of this routine, I take four capsules, three times a day, of both blessed thistle and fenugreek. Fenugreek is one of the main ingredients in imitation maple syrup, and at this dose, my urine, my sweat, and my clothes all smell like maple syrup.
Over the next few weeks, my research brain goes into overdrive. I google every related phrase combination I can think of: “low milk supply,” “breastfeeding;” or “newborn,” “latch,” “galactologues,” and “more milk production.” I read whole books about increasing milk supply. I often read while I’m nursing. I read about women dragging their IV stands down the hospital hallways after a C-section to breastfeed their babies. I read about nasogastric tubes that run expressed breast milk into a premature baby’s gut when they are born before the sucking reflex is fully developed, and I read about adoptive moms taking hormones and supplements, then pumping, like me, to teach their bodies to produce milk. I’m astounded by the numbe of products I can buy to help me breastfeed more effectively: pumps, bottles of herbs, My Brestfriend nursing pillow, a Boppy nursing pillow, Organic Mother’s Milk Tea, Mother’s Milk capsules—there’s even a prescription medication that can cause an increase in milk. But it can also cause severe depression, so I decide to steer clear.
I learn that the earliest writings about breastfeeding come from Egypt around 1550 BC, when the advice for new mothers struggling with milk supply was to “warm the bones of a swordfish in oil and rub her back with it.” Or “let the woman sit cross legged and eat fragrant bread of soused durra, while rubbing the parts with the poppy plant.”2 Not exactly practical—what is “soused durra?” I google again (some kind of grain).
I find myself jealous of other parents for whom breastfeeding comes so naturally. My mother-in-law remarks that her daughter had so much milk, she had to work to dry some up. After her last baby, she sat in a recliner with her breasts covered in cabbage leaves for days. When I go back to work, my coworker pumps bottles full of extra milk, leaves them in the fridge. I feel a desire to take the bottles, although I don’t know what I want to do with them. Feed them to my baby? Dump them down the drain out of rage?
The book I’m reading says that I must “connect my brain and my body.” Things like stress, fatigue, pain, and anxiety about pain are all things that can impede letdown. I need to imagine rivers of milk, fountains of milk. The key is to just relax. To rest and relax; exactly the things I cannot do. Everyone tells me I’m putting too much pressure on myself, but I don’t know how not to. In an online forum, I try not to let a La Leche League Leader’s comment get under my skin: “Remember breast milk is one of the purest substances on earth, while formula is made from the cheapest oils available.” Even the canister of formula says, “Breast milk is the best food for babies.” Every time I try to take the pressure off of myself, to relax and tell myself I’m doing okay, I can’t shake the feeling that my baby will be sickly, obese, or stupid if I do not Exclusively Breast Feed, or, EBF, the ever-present acronym on all the websites and forums I read.
My husband reminds me that he was formula fed, and he turned out fine. I know he wants to support me; I also know he’s not sure exactly how to do that. One night he finds me in the living room after staying up late to get in another pumping session. I had spilled the one ounce of milk I had managed to pump and was sitting on the floor crying. “Maybe you should just stop, Rebekah. Go to bed,” he says, gently. I cry harder. I know he’s right, that he’s trying to be helpful and let me off the hook, but the hook is one that I have created in my own mind. I had unwittingly assumed that breastfeeding would come easily, naturally. I had chosen to start my journey into motherhood on a certain path—freestanding birth center, midwife, as little intervention as possible. On this path, breastfeeding was the assumed method of feeding, and I thought that by identifying as a certain kind of parent, I could control the outcome.
People say things about my son like, “Enjoy these days, I bet he’s growing like a weed,” but he isn’t, actually. The only thing that’s growing is a zygote of mother-guilt in my brain. The short-term memory can only hold seven plus or minus two facts at a time. Which explains why I can’t keep anything in my head except when the baby ate and how many ounces he took from the bottle, and did he spit up, and was that too much, and is he still hungry? When my husband asks me to grab something while I’m up, I forget what he has asked by the time I get to the kitchen.
I mention to my husband that most progressive cities across the US have human milk banks. Nursing people can donate extra breast milk to these banks for babies whose parents want to feed them breast milk but can’t. He is a little freaked out by the idea, but then remembers that when he lived in Peru, women would often pass around babies and toddlers to suckle on whoever’s breast was available. Feeding your baby someone else’s milk is a much more common practice in developing countries, and one that’s sometimes necessary. Historically, in the absence of a mother’s milk, formula, or the ability to provide a wet nurse, many babies simply died.
Even today with breast pumps and formula, missing a feeding is not convenient—a nursing parent has to find a way to pump approximately every four hours, or else risk damaging their supply, becoming uncomfortable, and/or leaking. I find myself often choosing outfits based on the stretchiness of the neckline and making commitments around the baby’s feeding schedule or how much human milk I have in the freezer. Nursing today still feels like a tightrope walk between parental autonomy and the desire to nurture and do what’s best for your child.
Over the years, breastfeeding has fallen in and out of favor, reaching its lowest point in the United States in the 1970s, when only about twenty percent of new mothers nursed their newborns. My mother breastfed in the 1980s, when rates were climbing, but still closer to fifty to sixty percent.3 By the time I had my first child, breastfeeding was making a major comeback and the national average of babies who nursed hovered at around seventy-nine percent.4 In fact, all of my friends who had children had nursed them. At my baby shower, they gifted me with nursing pads, nipple balm, breast milk storage bags, and nursing covers with clever names like “the hooter hider.” No one wants to tell the pregnant person in the room about their traumatic birth, their difficult journey with breastfeeding, or postpartum depression. As a result, these struggles felt like real possibilities for other new mothers, but not for not me.
In seventeenth-century in England, the wealthy didn’t breastfeed because it “spoilt the figure,” was “noisome to one’s clothes,” and “interfered with gadding about.”5 In the 1970s and 80s mothers were encouraged to formula feed—at that time, formula was considered the best option for babies.6 Today, in the United States, breastfeeding is typically a practice reserved for more affluent parents who can afford to stay at home with their babies or pay for expensive pumps to use in a private space. Breastfeeding rates in the United States rise with maternal age, education, and income.7 Pediatricians recommend breastfeeding for a year (and breastfeeding exclusively for six months), but since most women receive no paid maternity leave and only twelve weeks, unpaid, are covered by the Family Medical Leave Act, the United States suffers from what is called a human milk gap.8 This occurs when the period of time during which most employers support a breastfeeding parent’s efforts does not line up with the medically recommended duration. Single parents and people struggling to make ends meet wind up bearing the brunt of this lack of support, causing breastfeeding rates to drop dramatically in poorer families as compared to their upper and middle-class counterparts. A parent’s right to choose how to feed their own baby exists for only some people. That I can afford to experience this struggle at all proves my privilege.
In the past, people believed in the magical qualities of breast milk long before there were studies to back it up. As a society, we may be less superstitious these days, but I knew that breast milk was linked to better baby health and higher IQs (although the research on this is muddied because the supports that allow a mother to breastfeed are also the same supports that promote better infant health overall). When wet nurses were in fashion, some believed that the characteristics and qualities of the wet nurse would be imbued into the baby through the human milk. Mary Wollstonecraft, in her “Vindication of the Rights of Women,” argued that a mother who “neither suckles nor educates her children, scarcely deserves the name of a wife, and has no right to that of a citizen.”9 Even when breastfeeding your own children wasn’t popular, there still seemed to be an understanding that there was something important and mysterious to it.
Today we know that breast milk does have almost magical properties. The baby’s saliva is absorbed by the breast tissue and tells the nursing parent’s body what kind of milk to make. If the baby is sick or going through a growth spurt, the composition of fats and antibodies in the milk changes. Babies who receive breast milk are also given antibodies for all of the diseases that the parent’s body has fought off. In this way, breastfeeding serves as a protection spell. It is also mildly anti-fungal and anti-bacterial. Supposedly, though I never tried it, if you squirt a little breast milk into the eye of a baby with conjunctivitis, it will cure the infection. Breastfeeding is also crucial to the baby’s microbiome, populating it with all sorts of helpful bacteria to keep the baby healthy.10
Along with these medicinal properties, we now have the science to confirm the emotional benefits of breastfeeding. When a mother breastfeeds, her body releases oxytocin which produces feelings of bonding, intimacy, and relaxation.11 While I do feel a strong bond and connection to my new son, I don’t feel a rush of calm when my milk lets down. In fact, I don’t have much of a sensation of the “tingling” that my midwife describes at all. Knowing I have to put my baby to my breast fills me with anxiety. I’m unsure if I am doing it correctly, and it hurts. I worry my way through the feedings.
With all of this knowledge, I feel trapped, not empowered. Perhaps if I knew less about breastfeeding, I would not feel guilty for feeding my baby formula. Perhaps I would be able to enjoy letting my husband share the load of feeding a newborn. Perhaps I could make peace with my situation and just go to sleep.
Ultimately every parent has to make their own decision about what kind of feeding practice will work in their life and the life of their baby. For me, as a well-educated cis woman with a spouse and, at the time my first son was born, a job where I could take my baby with me, choosing not to breastfeed didn’t feel like option. Though I know plenty of wonderful parents who formula-fed their babies, and though I know formula has saved the lives of countless babies, in my head, throwing in the towel on breastfeeding meant contaminating my baby and myself, taking a C on the first test of good motherhood. If breastfeeding is the best for my child, why do something less, I myopically thought. Exclusively breastfeeding was the gold star on the sticker chart of motherhood, in my mind—never mind the fact that my efforts filled me with anxiety and feelings of inadequacy.
The problem, which I didn’t realize in those early months, is that this tension never goes away. There are endless tests, endless comparisons, and there is no way to win in the game of perfect motherhood. Hold onto perfection too tightly and you wind up in the grocery store aisle having a panic attack over non-organic crackers.
Now, several years later, while I’m proud of my efforts in retrospect, I know I would be gentler on a friend experiencing the same situation than I was on myself. It may have added more stress than it did anything else, but I did stick with it. Eventually, my son’s supplements became his first solid foods, and we were able to eliminate formula.
When I went to the hospital to return the pump I had rented, I wasn’t sure exactly what parts to turn in—what pieces they sterilized and reused and what would be discarded. When I arrived with tubing and bottles that had touched my milk, the receptionist looked disgusted and said, “We don’t want that back.” I felt my eyes welling up, wanting to scream at her. She had no idea how precious my own milk was to me.
My immediate strong reaction toward the woman at the desk took me by surprise. After I finished returning the pump, I sat in the car and cried for a few minutes before driving home. It was gray and drizzling, the beginning of winter. I was crying tears of anger, but also of relief that this part of the journey was over. I realized that all I wanted in that moment was for the receptionist—or someone, anyone—to understand how hard I had worked simply to feed my child. It’s impossible for me now to untangle which actions and motivations were for my baby and which were for me, to live up to the ideal image of motherhood I held in my mind. Even so, leaving the pump behind and driving home that day felt like a literal unburdening. I finally believed I had done everything I could, and that it was enough.
Rumpus original art by Lea Wells.
1. Stevens, Emily E. “A History of Infant Feeding.” The Journal of Perinatal Education v.18(2), Spring 2009. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/↩
3. Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. 3, Who Breastfeeds in the United States? Available from: https://www.ncbi.nlm.nih.gov/books/NBK235588/↩
4. Results: Breastfeeding Rates: National Immunization Survey (NIS): Breastfeeding Among U.S. Children Born 2009–2016, CDC National Immunization Survey. CDC. Available from: 2019. https://www.cdc.gov/breastfeeding/data/nis_data/results.html↩
5. Stevens, Emily E. “A History of Infant Feeding.” The Journal of Perinatal Education v.18(2), Spring 2009. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/↩
6. Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. 3, Who Breastfeeds in the United States? Available from: https://www.ncbi.nlm.nih.gov/books/NBK235588/↩
7. Kukla, Rebecca. “Ethics And Ideology In Breastfeeding Advocacy Campaigns.” Hypatia 21.2 (2006): 157-180. Women’s Studies International. Web. 28 Nov. 2014.↩
9. Lepore, Jill. “Baby Food.” January, 2009. The New Yorker. Available from: http://www.newyorker.com/magazine/2009/01/19/baby-food↩
10. Garbes, Angela, “The More I Learn About Breast Milk, The More Amazed I Am.” August, 2015. The Stranger. Available from: https://www.thestranger.com/features/feature/2015/08/26/22755273/the-more-i-learn-about-breast-milk-the-more-amazed-i-am↩
11. West, Diana and Lisa Marasco. The Breastfeeding Mother’s Guide to Making More Milk. McGraw-Hill, New York. 2008.↩