Breast or bottle: your call

Breastfeeding is a much-discussed topic in our society. When we were in America for a few months, I noticed a lot of slightly obsessive talk about breastfeeding—about all the benefits of breastfeeding and how superior this natural way of feeding was. I barely heard anyone talking about the disadvantages. First of all, I want to make it clear that I’m also in favour of breastfeeding, but (and this is a major but) only within the limits that are feasible for you. I don’t think it’s right that all new mothers should be pushed or even pressured into a pattern of nipple shields, pumping, and the whole enchilada. The way that breastfeeding is often regarded as the only ‘correct’ form of feeding seems completely over the top to me.

I believe that every mother has the right to choose how she wants to feed her child. Yes, a lot of research has been done on breastfeeding and its many benefits for the baby. But there are also disadvantages, such as the stress a mother experiences if her child doesn’t get enough nutrition. Some babies don’t latch on properly, some mothers produce milk that isn’t enriched with all the normal nutrition but instead is watery, and some babies don’t drink for long enough and never get to the hindmilk. (Hindmilk is the high-fat, high-calorie breast milk your baby gets toward the end of a feed. It’s richer, thicker, and creamier than foremilk. This issue can happen if your breastfeeding doesn’t get off to a good start.) In general, people don’t speak openly about breastfeeding problems. Every mother who has just given birth wants to provide the very best for her child. In addition, the uncertainty that comes with being a new parent means that mothers can be particularly susceptible to the opinions of others, especially the women who belong to the ‘breastfeeding mafia’. I think this is a rather heavy term, so I call them the breastfeeding gurus—that sounds a bit nicer.

A pregnant client once told me that she had already decided not to breastfeed. She didn’t want any more demands on her body after giving birth and wanted her breasts to be hers and hers alone. I find this perfectly understandable. However, people in her immediate environment questioned her about it all the time: ‘Wouldn’t you like to at least try to breastfeed? It’s said to be so good for your baby.’ Once the baby was born and she was bottle feeding, complete strangers would ask her out of the blue, ‘Why aren’t you breastfeeding?’ My client was completely disconcerted by this. On the one hand, she felt guilty, and on the other hand, she wondered why people weren’t minding their own business.

 

Fiddling

I started breastfeeding right after giving birth to my oldest daughter because I felt that it was my moral duty (here we go again). I felt pressured by society, by the breastfeeding gurus. I felt as though giving my baby a bottle would mean I was failing as a mother. Why didn’t I think for a moment, What am I getting myself into? Is what’s best for the baby, also best for me? Maybe I can bottle feed as well? No, I felt I had to breastfeed. In retrospect, I don’t understand why I was so rigid about it. But when I tried to breastfeed, the drops of colostrum came out with a lot of difficulty. I literally milked my chest with a shot glass under the pump, because that way we could measure if any milk was coming out at all—three full days of ‘fiddling’! I remember this time well, our desperation mounting because our baby was losing too much weight and we were told she’d have to be admitted to hospital if she didn’t gain weight soon. Her skin was continuing to turn yellow, something that should have already disappeared, and she also became a bit drowsy. I was horrified and so anxious. When I saw that of the six drops of colostrum I had managed to squeeze out with a lot of effort and pain, at least three drops had accidentally leaked into my shirt, I couldn’t stop sobbing. I really bawled my eyes out. I was so upset that those three drops of milk went to waste, because my baby needed them so badly.

This is how I drove myself crazy. Fortunately, before I gave birth (back when I could think with a clear head), I bought a package of formula, just in case. That formula was our salvation, and I just gave it to my baby at night. I also kept on pumping during the nights. I was determined as hell. All the pumping finally paid off, because on day four after the delivery, my milk started to come in. It no longer seeped but spurted and, before I knew it, I could pump with bottles underneath the pump instead of those idiotic shot glasses. So off I went. Even though it was ‘great’ to be able to feed my child, ‘great’ was the last thing I was feeling, because I was in so much pain whenever she latched on. I know that many mothers experience this initially and then after half a minute the pain fades away; however, that wasn’t the case for me. That stinging, intensely vicious pain stayed and sometimes became even worse. What is this? I kept thinking, shocked. Do all mothers hurt so much when breastfeeding their child, or am I the chosen one forced to suffer while all the other breastfeeding mums carry on blissfully? When our midwife arrived with nipple shields, I even let myself be talked into those as well. Nipple shields can help a baby latch on better and drink more easily. I couldn’t even handle water from the shower touching my nipples, they were that sensitive. You can probably imagine that when the nipple shield came off my nipples, it hurt so much I screamed and started to cry again. Fun times.

I managed a total of three months of pumping and feeding my daughter. Three months with chest inflammation and extreme pain. Never again. With my second child, born over three years later, I bottle fed from the start. Yes, there will be people who call me selfish. Yes, there will be people who judge me and call me a bad mother. To these people I want to say, ‘Live and let live.’

My American friend was more or less forced to breastfeed by her mother-in-law. When I heard this, the hairs on the back of my neck stood on end. Unfortunately, I hear many similar stories from my clients. Mothers, or mothers-in-law, foist themselves upon these new mothers with well-intentioned advice about breastfeeding. Even with the best intentions, because they often only want to ‘help’ their daughter (or daughter-in-law), they don’t realize that their advice often has the opposite effect, and the mother in question starts to feel more insecure about her own capabilities as a mother. It seems like that was the case with my American friend. ‘Once I switched to bottle-feeding,’ she said, ‘I hid the packs of formula food from my mother-in-law. In fact, I pretended it was expressed milk.’ It was so sad to hear that she felt the need to disguise her own choices and lie about it, too. I think every mother should be free to make her own decisions without feeling the weight of the world’s opinions on her shoulders. A new mother already has so much on her plate, let her be who she is and accept her choices. Let it be.

 

Facts and fictions about breastfeeding

When I was breastfeeding, I heard from many people that breastfeeding could help with postpartum depression. A Dutch website published a study by the University of Cambridge, which had conducted research among over thirteen thousand new mothers[1]. The findings showed that breastfeeding could even halve the risk of postpartum depression, that is, if all works properly and runs smoothly. But not if you experience a lot of pain and your child does not latch on properly. In the same article, they explained that if breastfeeding does not run smoothly, this can actually make the symptoms of postpartum depression worse. Not just that, but breastfeeding problems actually doubles the chance of postpartum depression occurring. In other words, if breastfeeding goes smoothly for you, there will be loads of benefits for you and your baby. If it doesn’t go well, it can cause problems.

‘The women who did want to breastfeed, but who did not succeed, eventually appeared to have the highest risk of postpartum depression of all the groups that were included in this study,’ says researcher Maria Lacovou. Like many other mothers, I hadn’t known that. This researcher recognises that ‘it is, of course, wise to encourage women to breastfeed, because of all the benefits it has. But we must not forget to continue to pay attention to those women who are unable to breastfeed while they are so willing to do so. They have such an increased risk of postpartum depression, so it is wise for maternity nurses and other professionals to keep an eye on things.’ Maria Lacovou also states in the article that the new mother’s fear of failing in the eyes of society also contributes to her risk of mental health problems after childbirth.

 

Just a few months after giving birth, I read about the phenomenon D-MER (Dysphoric Milk Ejection Reflex), a condition that occurs in women who are breastfeeding. The symptoms involve experiencing such adverse emotions that breastfeeding becomes associated with very negative feelings. The moment the milk starts to flow freely toward the nipples, negative emotions are triggered—fear, anger, depressive feelings and restlessness—and can last for a few minutes. The good news is that the condition, which is caused by a disturbance of dopamine levels in the blood, can be treated. If you recognize these symptoms and think you may have D-MER, please check out the website d-mer.org.

 

Stop if you need to stop

If you add up all the evidence, women who aren’t feeling mentally well after giving birth shouldn’t be pushed into breastfeeding. I think nurses in maternity wards at hospitals, obstetricians, doctors, midwives, and health visitors who visit mothers at home should be specially trained to recognize all the signs of PPD. If you’re a health care professional and you suspect that the mother in front of you suffers from PPD, please advise her to do what she feels is right, not what is expected of her by society, friends, family, or anyone else with an opinion on the matter. Unlike the women who think it should be illegal to not breastfeed, I would strongly advise women who are already depressed or who are genetically more at risk of developing depression to stop breastfeeding if it isn’t going well. Don’t get me wrong; I’m definitely not against breastfeeding and, if it’s going well, I would advise you to continue with it, for all the benefits it provides you and your baby. But if you’ve been trying for a week and it’s still not working or running smoothly, please stop. Or stop even earlier, if you notice signs of D-MER or you feel complete aversion to nursing. It’s perfectly okay to stop. Really. Stop driving yourself mad. Stop pushing past your own limits. It isn’t necessary. Children grow strong and healthy when fed with formula milk. They function perfectly well, and twenty years later, no one asks your son or daughter whether or not they were breastfed. In fact, here in the Netherlands, the quality of our formula milk is so good the Chinese are importing it to China. Not too shabby.

 

The benefits of formula

Although there are many benefits to breastfeeding, formula also has a lot of pros. For example, it’s full of vitamins, meaning you don’t have to supplement your child with vitamins D and K, which is sometimes recommended for mothers who breastfeed, because of certain health risks for the baby. You have less stress about whether you’re producing enough milk and whether your baby is short of any nutrients. Above all, you know exactly how much food your child is getting, because you can monitor his formula intake easily. Of course, this is also possible if you’re pumping and giving your milk to your baby by bottle, but that does mean more work for you. During the three months I was breastfeeding, I lived the life of someone feeding twins.

Another advantage of bottle feeding is that your partner can do the night feed without you needing to pump, which gives them quality time with the baby, too. It also means that you can sleep through the night and rest up. Take a moment to let that sink in. You’ve just given birth, which has a major impact on your body and mind. You’re exhausted, hormonal, and perhaps overwhelmed. You need time to rest and absorb the momentous change in your life.

Whether you opt for breast or formula (or both), it is solely up to you and your partner to decide, no one else. I just want to reiterate that I think breastfeeding is an excellent choice, but only if you make that choice. I recommend, if possible, talking through your decision with your partner before the birth, because afterward, you’ll be a bit of a mess because of the hormones, lack of sleep, and so on, and making a rational decision is hard to do in those circumstances. You could for example say, ‘We’ll try breastfeeding for five days. If it doesn’t work by then, we can switch to formula.’ Have you already given birth? No problem, it’s never too late to switch to formula.

A client once told me that she didn’t dare stop breastfeeding. It wasn’t going very well and she was feeling like a failure. I hear this a lot in my practice. So much emphasis is put on breastfeeding, and mothers feel a great sense of failure if it doesn’t work out as they hoped. My client was pumping at work and hating it. At some point she had such a low supply of milk that after weighing the pros and cons, we agreed that she would stop. She was very happy with her decision.  something she reqally enjoyed.

 

Meet in the middle

Of course, you can also choose the middle road by combining breast and formula and giving both to your child. There is a lot of talk about ‘nipple confusion’, that babies no longer want the breast once they’ve drunk from a bottle. There are ways you can help prevent this. For example, if you give your baby a bottle (in addition to breastfeeding), you should first gently rub the bottle over his lips, so he slowly gets used to the teat. He’ll then search and latch on to the teat of the bottle. (That’s how your baby latches on to breastfeed, as well. Your child searches calmly where the nipple is located, before latching on.) In this way, your baby will not become ‘lazy’ but will automatically look for the teat.