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Dr. Beth Elston is a mother and a general pediatrician. She talks about her experience as a breastfeeding mother. She talks about how breastfeeding education taught to moms and health professionals often does not fit with reality and discusses the harm caused by programs like the Baby-Friendly Hospital Initiative. She shares her insights on how to best support mothers regardless of their ability or decision to breastfeed and how to respect mother’s decisions, including breastfeeding, formula-feeding or combo-feeding. She shares how her experience has changed how she supports her patients in their unique infant feeding journeys.
Mothers are taught that it’s rare not to produce enough milk to exclusively breastfeed in nearly every breastfeeding book, mommy group, and hospital breastfeeding class. The truth is we have limited studies that provide an accurate percentage of mothers who can produce enough milk for their babies for the recommended six months. Although actual rates of adequate milk production are unknown, some estimates range from 12-15 percent or more.
During my pregnancy, I began reading the Fed Is Best Foundation’s feeding educational resources and feeding plan pertaining to breastfeeding and combo feeding. I didn’t have successful breastfeeding experiences with my previous children and wanted to try one more time. I went into labor when I was 37 weeks pregnant. My labor progressed extremely quickly. By the time we got to the hospital almost an hour later, it was already too late to set up an epidural. I struggled for hours with laboring and pushing, and both my daughter and I were profoundly exhausted after delivery.
Asher was born after 46 hours of induced labor at 39 weeks, 4 days. I had sudden onset severe pre-eclampsia. In the “golden hour,” he didn’t latch. He was exhausted and a bit lethargic. After the staff took Asher for his bath, I worked with the RN and he latched really well and nursed on both sides. Towards the end he fell asleep and they had me hand express colostrumand finger feed him. His first two days at the hospital he only lost 3 ounces. I thought he was latching well but the lactation consultant who saw us before discharge said his latch was shallow. She sent us home with a shield, “just in case.” At his first pediatrician appointment at four days oldhe was down 10 ounces. The doctor gave us ready to feed bottles, encouraged supplementation and sent Asher for lab work because he was slightly jaundiced and lost too much weight. While we were at the hospital, I ended up getting readmitted because my preeclampsia never went away and had gotten much worse. I was put on a magnesium drip for 24 hours which made breastfeeding really challenging. My husband was so supportive and somehow we made it through a three day hospital stay. During that time they checked Asher’s bilirubin levels regularly. His jaundice improved and he had gained four ounces! By then my nipples were raw from his very bad latch. I started using the shield and it was a lifesaver. Asher was back up to birth weight by his two week check up. I was encouraged to wean him from the shield. That ended with many deep cracks and damage to my nipples that led to a six week bout of thrush, a bad clog, and mastitis.
The first weeks of our baby’s life are hazy, but I remember Meredith’s gasps of pain when she tried to nurse. I remember that the baby kept coming off the breast and crying and we had to get her back on. It was a constant struggle of trying to get the baby latched, having to break her latch because of the pain, then her falling asleep, unlatching, then waking up and crying. It was a seemingly endless cycle.
When we brought the baby home from the hospital, she was crying and we couldn’t get her to stop. I realized she was hungry and I gave her a bottle of formula. She drank down four ounces, stopped crying, and went to sleep. I felt relieved because I was able to make my baby happy and comfortable. I told Meredith that the baby drank 4 ounces of formula and she said that was impossible, because an infant’s stomach can only hold 5 ml, according to the nurse who taught our breastfeeding class. We both now know that is untrue.
The next day, we went to the lactation consultant at the hospital. She told us to supplement with formula, but to give no more than 5 ml at once with a syringe—no bottles. She said the baby’s stomach could only hold 5 ml (our baby was 4 days old) and we should feed her with a syringe to avoid nipple confusion. The baby sucked those 5 ml down so quickly, it was ridiculous. I knew that she needed more than 5 ml, but I didn’t feel qualified to disagree with the lactation consultant. Because she worked at the hospital, I assumed she was giving evidence-based advice. So we fed the baby 5 ml at a time with a syringe. When one syringe-full was insufficient to sate the baby, I often fed her multiple syringes at a time, even though I felt like it was wrong to do so. Continue reading →
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