Wellness & Education

Wellness & Education

So you've decided to breastfeed...

From the moment you pee on that stick for confirmation (or often even well before), your breasts loudly announce your pregnancy. First, they’re tender. Then, they’re bigger AND tender. Then, they’re changing color and getting strange bumps they didn’t have before. Then, as you near the finish line, they start to ooze or leak. There is no escaping the fact that the pregnancy hormones are preparing your body not just to create and birth another person but also to biologically feed that little person. If all of this is a normal, natural process, why is it so DIFFICULT for some of us to breastfeed? Our bodies make milk without our consent, just as our babies grow without our consciously consenting to the development of tiny kidneys. If we are programmed to do this, shouldn’t it be as easy to grow and nourish our babies OUTSIDE our bodies as it is when they are IN?

Overcoming the Social Challenges of BreastfeedingEven aside from the woes of the first few days (ok, maybe weeks) of sore nipplesengorgement and an occasional plugged duct, mothers preparing to feed their newborns have more persistent, pervasive and insidious battles when we make the choice to use our breasts for their primary biological purpose. If it were simply pain, we would gladly endure. Having already suffered through months of aching backs, episodes of vomiting, swollen feet, exhaustion and the occasional unexpected leakage of urine—surely no one can argue that we mothers aren’t willing to endure discomfort for the well-being of our offspring. Our midwives, obstetricians, pediatricians, mothering websites, what-to-expect pages and Bump apps all tell us that breast milk is the best food for our babies. We know breast is best. And yet so many of us give up, sometimes without much fight.

First, there’s the advertising.

Thank you, Enfamil, for reminding us we might not be able to breastfeed our babies. Thank you, Similac, for sending us a can of something we can’t bear to waste. We will put that on our pantry shelf just in case. Thank you, parenting magazines and pregnancy-related websites for accepting the generous funds offered by formula companies to promote their products in your banners and sidebars so that these products remain eternally in our periphery, reminding us they are there to save us, if breastfeeding doesn’t quite work out. Don’t get me wrong – formula can be, quite literally, lifesaving when required. But if you’ve decided to breastfeed, throw out the free sample. Or donate it, if you can’t stand to waste it. If it is on your shelf, you will use it, and sometimes before you have to. Committing to breastfeeding means being prepared to provide breast milk for your baby exclusively (unless medically indicated) for the first six weeks. If, during those six weeks, your doctor tells you to give your baby formula, go and get some. But, anticipating problems by hanging onto free formula is like filling your pantry with Girl Scout cookies in anticipation of failing at your strict Paleo Diet. 

Then there’s the ‘helpful’ feedback.

Cue the lifelong unsolicited parenting advice that starts with the announcement of your pregnancy and ends, well, never. Well-meaning relatives may have a negative response to breastfeeding: “women didn’t do that when I had your mother, and she seems just fine.” And friends have their own input, loaded with emotion and righteousness from their experiences: “I wanted to breastfeed, but my milk didn’t come in,” “My son was allergic to my milk,” “I was starving my daughter to death and didn’t notice,” “Thank god someone gave my baby formula—I didn’t know what I was doing.” 

If you choose to breastfeed your baby, make it clear from the start, and set firm boundaries with friends, relatives and co-workers regarding the input you welcome and find helpful. Choosing how to feed your baby is one of the first major parenting decisions you will make, and it will not be the last. Nor will it be the last decision that receives cheers or jeers from the peanut gallery. Establishing clear boundaries around your choice is important and can be as simple as stating, “I have chosen to breastfeed my baby, and I would find it helpful if you would support my choice.” You can choose to offer an articulate argument on why you want to feed your baby, or you can simply stand firm in your choice. In any event, establishing clear boundaries with your well-meaning loved ones sets the stage for unsolicited and often unhelpful advice you will receive when the time comes to choose a method for potty-training, to select a preschool or to allow your child to date. Make your decision about how you will feed your baby about what is best for you and your baby, not about what makes others feel inadequate or uncomfortable. 

And the bedroom...

Before there was baby, there was the business that brought you your baby. Now that there’s baby, someone else is occupying the space in your arms, and the breasts that may once have been a focus of your sexual relationship are now what’s for dinner. Before there was baby, your breasts were erotic and only occasionally tender. Now that there’s baby, your breasts are swollen, sore, cracking, leaking, and constantly at the whim of another person. You’ve traded in your red lace demi for a less sexy, very supportive thick-strapped nursing bra with its absurd latches and flaps. Partners can often feel neglected simply as a result of the distraction caused by the arrival of a new baby. As you return to physical intimacy, it is important to be open about the new role assumed by your breasts and the impact this has on your sex life. After having your breasts handled all day by your nursing newborn, you might feel less aroused (maybe even irritated) at having them handled while the baby is sleeping and your partner is initiating sex. It is important to communicate this to your partner and to both be able to keep a sense of humor about the milk that might leak from your nipples when you orgasm or the nursing pads you had to tuck inside your sexy bra. 

And the daily pumping juggle.

Breastfeeding for the recommended year requires that many moms figure out how to continue making milk after they have returned to work and left their babies in someone else’s care, generally to eat from bottles (sometimes of supplemental formula and sometimes of pumped breast milk) while we are apart. In our society, paid maternity leave is limited and laws protecting a mother’s right to the time and space to pump are only now emerging. Breast pumps are strange things that are very expensive. But your insurance will pay for one—ask your provider for a prescription. The Affordable Care Act mandated insurance coverage of this medical device to balance families’ needs to have moms return to work and babies’ needs for continued breast milk. In the state of Oregon, employers are required by law to provide employees with accommodations that are not bathroom stalls and the time (30 minutes for every four-hour period worked) to pump sufficiently to maintain their milk supplies after returning to work. Make sure you let your employer know in writing of your intent to express milk when you return from maternity leave in order to have this need accommodated—and make sure you are able to prioritize pumping as you would a scheduled meeting. Ask that your pump break be integrated into your Outlook calendar and that a sign be created for the designated pumping area that alerts your co-workers of your need for privacy to avoid the awkward situation of your manager walking in on you pumping during lunch. 

Finally, make sure you practice pumping before you return to work so that you are familiar with all the pieces and their connections and can assemble, dissemble, clean and store the pump parts without difficulty. This will make it easier for you to juggle eating and pumping during the same time period and allow you to feel less pressured and stressed during your pumping episodes. 

And, sometimes, mamas need some help.

Most of us live in nuclear households isolated from other women who have had successful breastfeeding experiences who might be able to offer advice and tips on how to improve the breastfeeding experience or normalize our concerns. In addition to all of the pressures that exist outside of biology, we are often set adrift when we are discharged from the hospital and find ourselves, days into sleeplessness and leaking boobs and a baby who won’t stop screaming long enough to latch on, exasperatedly scouring Dr. Google for answers or digging for the number of the lactation consultant who popped by just as soon as we had stepped into the first post-delivery hot shower. Even our pediatricians and obstetricians have limited breastfeeding education and the resources available to provide us with assistance in our moments of milky crisis are limited. All of this while the formula can sings to us from the pantry shelf and bottles beg to be filled and handed to our partners so we can run to the store for a moment of silence alone in the bread aisle. 

Remember that help IS available. Make sure you seek that help before it is too late. Set up a lactation evaluation for three days after your baby’s delivery. You can always cancel the appointment, but you’ll have it if you need it. Visit La Leche League for helpful tips and answers to your questions. Add their local Oregon chapter numbers to your contacts and send an email to a leader asking them what availability they have to provide support. Establish your network of helpful lactation resources long before your baby is delivered. Attend a lactation class before you are struggling with a real baby with real-time demands so that you familiarize yourself with the process and have the opportunity to meet educators, clinicians and other moms who can help you along the way. If you need a breather from the constant demand from your breastfeeding baby, your partner can certainly provide a bottle while you take a break. Just remember to not skip feedings: that is, make sure you pump if the baby doesn’t nurse to maintain the delicate supply-and-demand system your body uses to know how much milk to generate. 

For those moms who have had successful breastfeeding experiences: congratulations! Please, make a point of sharing your SUCCESS with your friends. Please, dissipate the negativity about breastfeeding that bombards so many women during pregnancy. For those moms who have struggled: be gentle with yourselves. What an incredibly exhausting, isolating battle it can be to fight all the social barriers to breastfeeding we face. For those moms who want to breastfeed: ask for help! Recognize early the people who may not provide support and seek out those who will. Involve your partner. 

As you navigate the potential struggles that come with the decision to commit to breastfeeding your baby, remember that the ultimate goal is two fold: 1) to form the foundation for a fulfilling lifelong connection with your child, and 2) to nourish this tiny person. What this looks like for you will not necessarily match what this looks like for anyone else—your relationship to your child and all facets of your parenting experience are distinctly unique. Be gentle with yourself, and with your child, as this experience unfolds. 

Research clearly demonstrates that breastfeeding IS best. We want to help you be successful - ask your provider for referrals and helpful resources. It is our job as medical providers to help you and your baby navigate the complicated path of obstacles to a satisfying nursing experience. 

Morghan B. Milagrosa, CNM, WHNP-BC, MSN - Tualatin, Oregon Certified Nurse-MidwifeMorghan Milagrosa is a Certified Nurse-Midwife in the Tualatin office of Women’s Healthcare Associates, LLC near Portland, Oregon. She attended Swarthmore College for her bachelor's degree and the University of Pennsylvania School of Nursing for her master's in nurse-midwifery. Morghan describes her three children as her "life’s greatest teachers," and motherhood as "an incredibly beautiful mess of unexpected tears and surprising delights." Read more about her and schedule an appointment >

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