“You’re a pediatrician; you already know everything.” “Full-term babies latch easily and basically breastfeed themselves.” “I didn’t have trouble breastfeeding, so you should be fine.” I heard a lot of comments like this from friends and family when I was pregnant. However, when I became a mom, I was woefully under-prepared to answer my own questions when it came to breastfeeding. I knew I wanted to breastfeed my daughter, and exclusively of course, as I was taught, but the logistics to accomplish that were difficult to navigate and something that was not part of my excellent training in pediatrics. I had a normal, healthy pregnancy and delivered a beautiful term infant, so I thought I was all set to get this breastfeeding journey started. But my body and circumstances had something else in mind. Due to a large volume of blood loss- resulting in low blood pressure, dizziness when sitting up, and eventually a blood transfusion, as well as some latch issues, I was not able to breastfeed my daughter well in the first 24 hours. Was I now doomed to fail? The wonderful lactation consultants at the hospital where I delivered came and worked with us several times before we were discharged, but we still struggled. I was asked about using formula to supplement, especially that 2nd night when my daughter seemed insatiable, and I opted to wait it out and try pumping to supplement with expressed breastmilk instead. My years of training and practice in pediatrics did not prepare me for the experience of learning how to pump and the lingo that goes with it. So many new questions arose- what flange size do I need, what speed and strength of suction is best, what pump should I even use? I pumped 1mL of colostrum my first go around and felt defeated. Before we left the hospital, my daughter had some jaundice, and her pediatrician recommended using formula to help supplement. My pediatrician’s brain said: Think of it like a medicine to help her, but my new mom brain felt like my body was failing my daughter. Over the next few days, my daughter lost weight and was slow to gain it back. In addition to her jaundice, this meant daily visits to her pediatrician in the first week of life. I continued to breastfeed, though I had the additional complicating factor of inverted nipples, meaning I needed to use a nipple shield (basically a silicone nipple that is worn over the mom’s nipple during a feeding) to help my daughter latch more effectively. After feeding my daughter, I would pump (having found some answers to my new questions) and then feed her what I previously pumped and/or formula, and repeat every few hours. I had advised numerous moms before about doing this, but now going through it myself, I was exhausted, and stressed, and I thought about quitting. I set much smaller goals as my original goal to make it to 6 months of breastfeeding seemed untenable. I reached out to friends who shared their own difficult experiences and successes and helped me see the other side. I made a breastfeeding playlist to keep me motivated and help soothe my hungry, crying baby while I tried to manipulate the nipple shield. I relied on my husband, parents, and in-laws to take care of me while I focused on trying to feed my daughter. I utilized the lactation consultants at my daughter’s pediatrician’s office. Eventually, I saw my pump output increase and took each small victory as a motivation to keep going. I successfully dropped the formula after a few days (though if I needed to keep using it, I know my daughter would have been just fine). I successfully breastfed my daughter for over a year and was able to build quite a stash in the freezer that we could keep her on breastmilk even beyond one year. However, I would not have been able to do these things if I were not so fortunate. I was fortunate to have the financial resources to be home with my baby for 12 weeks. I was fortunate to have a mother-in-law who would cook for me, and a mother who would physically feed me while I fed my baby. I was fortunate to have the support from my workplace to be able to pump on return to work to keep up my supply and bring home milk for my baby to eat while I was away the next day. Not everyone is this country is so fortunate, and we need to do better for our working moms. My difficult breastfeeding journey has made me a better pediatrician. My advice around newborn feeding has definitely changed. I have talked to a mom struggling with breastfeeding about feeding positions and options regarding pumps with an expertise that I did not previously have. I have reassured parents that need to give their child formula that they have not failed their child. I have helped mothers come back to breastfeeding when they thought they had failed and helped others reach the decision to stop breastfeeding if they didn’t think it was working for them. I share my experiences with my patients’ parents to acknowledge that breastfeeding is difficult, more difficult than we often realize or talk about. I let them know that they are not alone in this journey, and while I may only be their doctor while they are in the hospital, I will do my best to help them meet their goals when they leave the hospital. Priya N. Jain is a pediatric hospitalist. Source
