Boobs are complicated

I’m pretty sure that this is a statement that everyone will agree with to some extent or another, but in this particular instance I am referring to their function as centres of milk production. Woo!

Now, I have a rare connective tissue disorder, and when I was born I had a cleft soft palate towards the back of the roof of my mouth, which meant that I was unable to form the vacuum necessary to suck.

You can probably see where this is going: not being able to suck meant that breastfeeding was completely out of the question for my mum, but it also meant that bottle feeding was a challenge – using bottles and straws still requires suction! I spent several days in a neonatal care unit being fed through a tube, and in the end my parents used special bottles to help painstakingly dribble formula down my throat until I was big enough for the doctor to perform the surgery that would close the gap in my tiny, tiny mouth.

There is a 50% chance that any child of mine will be born with the same genetic condition. When I was pregnant with my daughter, and before The Virus became the predominant stressor du jour, it was something I would routinely ask my doctor any time he was checking her via ultrasound: does her mouth look okay? Logically I knew that it would be very hard to tell, but if we could somehow know in advance whether or not her lips or palate hadn’t formed conventionally it would help me get organised with ordering special bottles, mentally prepare to try exclusively pumping breast milk, all of that. And every time, my doctor would say, “hmm, yeah, it looks okay.”

My overwhelming relief when she was born with the standard number of holes in her mouth! This beautiful, tiny, wrinkled shrimp of a human seemed not to have inherited my medical issues! Of course, there are other aspects: she could still experience severe short-sightedness and retinal detachment; she could have joint problems that plague her into adulthood. BUT! The first hurdle was cleared.

I wasn’t confident that I would be able to breastfeed her. My mother hadn’t been able to, one of my best friends had severe supply difficulties, and at the time I only knew two other people who’d had babies recently whose babies still nursed vs drinking formula – everyone else had either not been able to, or decided to stop pretty early on. It seemed like a huge challenge. I was also concerned about how stress impacted things: oxytocin is the magical hormone, right? What if I wasn’t relaxed and happy enough for my milk flow to be successful? What if worrying about exactly this issue caused me to under-lactate? What if my fears about The Virus also got in the way? Ooh, so very many things to worry about.

I had written on my birth plan that I hoped to breastfeed, and my hospital had a lactation consultant, so they were fully ready to support us. At first, they gave me advice on how to check her latch was good (I had also actually watched this video a couple of times while I was still pregnant, which I think is a fantastic resource) and told me to wake her up at least every three hours and feed her “for at least 5 minutes on each side”. But they don’t warn you about how babies just fall asleep! All the time! Mid-feed! They just… stop! And you poke them (gently) and tickle them and blow on them and call to them but they just keep sleeping! Babies are biologically programmed to fall asleep on the breast and that can’t be helped, but when your child is a little jaundiced preemie it is (I was informed) even more necessary to wake them up and make absolutely sure they feed.

I tried my best, and I thought she started out okay, despite the whole routinely falling asleep thing. I was absolutely besotted, high on the exhilaration of having suddenly yet successfully given birth to my tiny human, and feeling like I was actually going to make a success of this whole thing.

And then the third day came. During the morning visit, the midwife told me, “You get a meeting with the lactation consultant today! Can you both come down to the second floor at 9 o’clock?”

So I did. There, they measured my daughter’s weight before and after feeding, and found that she’d only drunk enough to gain 3g weight. The lactation consultant then milked me(!), and got out a significant amount more – very painful for my already-raw nipples, exactly like stabbing little needles into each duct, but that’s just part of the fun I guess. “So,” she said, “it’s not that you’re not producing milk! It’s just that she’s so small and not very good at drawing it out yet.”

When we got back to my room, my midwife came in and said, “While all babies lose weight after birth, your baby is losing weight at a slightly faster rate than we would like. Not dangerously so! But we want to make sure she thrives, so what do you think about supplementing the end of her feeds with a little formula?”

Well, of course I’m not going to say no to making sure my 2700g (just under 6lbs) newborn is getting enough food to grow! And now, with the clarity of hindsight, this was a perfectly sensible thing to say and do. But it marked the first blow to my self confidence regarding breastfeeding. And, with that same clear hindsight:

• my body was producing enough milk for her, even though she wasn’t yet entirely effective at extracting it
• I should actually have fed her for longer per session, which was not the advice I received
• being able to breastfeed was actually a lot more important to me than I had anticipated
• if I had been advised to pump milk and given my baby the expressed milk in addition to her regular feeds (rather than formula), this would have helped my mental state enormously.

The nurses and midwives were by no means dissuading me from continuing to breastfeed. In fact, one of the nurses borrowed a textbook from a friend who was studying to be a midwife, and she and I sat down together and went through the section on the early days of breastfeeding.

But while I was beginning to lose confidence in myself and my ability to be a successful parent, time marched ever onwards and before too long we were on the way home.

Now, I may have mentioned this once or twice before, but my husband is a scientist. He loves quantifiable data, but sadly when you’re breastfeeding and want to know exactly how much your baby is drinking, short of buying a baby-weighing scale (which in retrospect I wish we had), that data is a bit thin on the ground. You can’t judge it by how much milk gets pumped using a manual or electronic pump either, since a baby is generally far more effective at obtaining milk than even the best pumps. So my daughter was feeding… and feeding… and feeding, but she was also doing what babies do, which is grow, and grow, and grow – and as they grow, naturally they need more food to sustain that development. The photo of the book just above includes a part that says, ‘For a period at 2, 3, and 6 weeks after birth, and again at 3 months, a baby may seem like they want to drink all the time, even after they’ve just been fed’ and this particular sentence is probably the one that I most wish I had gone back and read again, because those were the exact times when I really, really felt the worst, and like I was failing the hardest.

“She’s still hungry!” my husband would say at 2-3 weeks, shoving his clean finger in her mouth and getting the automatic sucking reaction.

“She sucks automatically when you put something in her mouth like that!” I snapped back.

“I’ll give her some milk,” he said.

“But she’s just this second fed!”

And my husband again, “Look! She’s drinking the milk! She was obviously hungry. We should increase the amount of formula she has.”

“No! It’s much easier to overfeed a baby on formula, if we give her too much her stomach won’t be able to take it and she’ll be sick. We should let her breastfeed as much as she wants and then my body will adjust and be able to provide accordingly.”

“But it’s hard for you right now. I’m not saying you should stop breastfeeding, but it’s clearly not enough at the moment.”

“But if we increase the amount of formula she has then she won’t need so much milk from me, and my supply won’t increase properly… Please don’t give her more formula…”

“But she drank all this today! She isn’t getting enough just from you. You only got 30ml from pumping this afternoon*, you’re not producing enough.”

*this is a perfectly reasonable amount for one session while also breastfeeding

“And the other night she threw up massively in her bed! She nearly choked! Don’t give her so much!”

“That was bad, yes. But babies throw up! Giving her plenty means she’ll sleep better!”

And so on and on this went. Before we go much further, I do want to reiterate that my husband’s priority is and has always been making sure that our baby grew healthily while also trying to support me, and to him, giving her formula (thereby taking some pressure off me) was the best, most logical way to do it. We just didn’t agree on what constituted “the best way”. Another week would go by and I would cry at how my body wasn’t doing enough* and how I wasn’t being given the chance to improve, but… what if my husband was right, and if she wasn’t getting enough food? Then it would be my fault that she was starving. Was I a bad mother? Was I completely useless? I couldn’t get pregnant naturally and now I couldn’t breastfeed properly either, what a complete failure of a human… why did I even exist…

* it was doing just fine

BUT breast milk is famously best for babies, breast milk will help her fight off germs and things while she’s so small and (as a preemie, extra-)vulnerable, and there’s this bloody virus to consider too so I should keep trying, if I try a little harder it’ll get easier, I want to keep trying, I want to be able to protect her and keep her healthy, I don’t want to give up, I don’t want to…

And she wanted to feed all the time, constantly, constantly feeding. I was stuck in the armchair all day, every day – she fed and fell asleep, and if I tried to move she would wake and want to feed. I think anyone who breastfeeds will relate to this, but I honestly wasn’t mentally prepared for it! It wasn’t included on any of the ‘things you should know before having a baby’ blogs, books or websites – they talked about how the postpartum recovery period would be hard, how you wouldn’t have any sleep, but they never mentioned just how much you would be stuck. My butt hurt from sitting down all the time, my shoulders and back were agony from constantly feeding her (even with supportive cushions). I felt myself getting weaker, and weaker – giving birth had been one thing, but I felt infinitely worse because of this constant inactivity. This turned into another week, and another, until I couldn’t take it any more, called my parents via FaceTime, and sobbed.

“You absolutely have to do what is right for you,” they said. “While the science may back breastfeeding, you know formula-fed babies do just fine. Your mental health is necessary for her health and development. And it doesn’t have to be all or nothing! What about just supplementing with formula at night, and exclusively breastfeed during the day?”

It was a good idea, and I put it to my husband, who also thought it was worth a shot. But before that happened, we – at last! – had a visit from the city hall midwife. It was officially a one-month checkup but, as with everything, “because of covid” she ended up coming at 6 weeks instead.

“Let’s weigh her now, while she’s sleeping,” she said, and put our daughter in the little sling she used to weigh infants.

“…Oh, wow.”

She had gained about 50g a day/350g a week since leaving the hospital, or 40g a day/280g a week if you counted from her birth weight. No matter how you calculated it, she was growing 100% totally and utterly FINE. I had absolutely zero reason to worry. None whatsoever.

“Whoa,” we all said. “That’s… a lot.”

“You’re doing really well!” said the midwife. “You don’t need to wake her up in the night to feed any more, let her sleep as long as she wants.”

“What about formula?”

“Entirely up to you. You can supplement if you want to, if it makes life easier, but it’s entirely your choice. She’s growing so well, there’s clearly not an issue on that front!”

Ohhh, the enormous weight that meeting took off my shoulders! It would ultimately take us a little longer to drop the evening bottle as I still didn’t really have confidence that she’d sleep well from breast milk alone, but eventually we pushed through.

Her first tooth came through the day she turned six months old, and that was a whole different type of challenge. Fresh teeth are so sharp! So very sharp! Unbelievably sharp! And she wasn’t used to having sharp things in her mouth yet, so it took a little while for her to stop accidentally biting me (ow) (ow) (no, really, ow). And then when she got her legs, she wanted to stand up all the time – yes, while breastfeeding – and do all manner of bizarre gymnastics at the same time as being attached to my chest. Please let go before flinging yourself backwards, child. Please.

But it is so, so convenient! I can imagine it being even more so if we existed in pre-covid times. Not having to worry about sterilised bottles or warm water on the rare occasion we leave the house! Not having to buy expensive formula! Knowing that my body modifies the milk depending on the time of year and her physical condition! Any time she wants milk for comfort or reassurance, I’m right here. And now she’s older and beyond the physical need for breast milk – all her nutrition comes from food now, after all – being able to cuddle up in the armchair first thing in the morning or last thing at night and have our relaxing time together is something I really cherish.

The timing of this post is funny, in a way, because I had already started writing it when I went back to our fertility clinic for a health check just last week, and while I was there I had a brief chat with my doctor about the possibility of trying to do another round of IVF.

“The thing is,” she said, “if you do want to start IVF again, you need to have stopped breastfeeding altogether. And yes, you’re right, we know covid vaccine antibodies get passed along through breast milk, but what we don’t know is how much an actual effect they have, nor do we know how long they will continue to be transferred, especially given that the vaccine’s effectiveness drops over time. It’s hard to say.”

“And of course, after 35 it becomes that much more difficult to have a successful pregnancy, right,” I nodded.

“Right, so that’s another factor to consider. I know it’s a tough decision to make.”

‘Tough decision’ is right. I never imagined that we’d get this far – that I’d get this far – but now that we’re here I don’t know that I’m ready for our breastfeeding journey to end. You hear of some kids just one day suddenly deciding they’ve had enough and that the world is too exciting a place to be stuck to a boob…! but my daughter isn’t there yet, so I guess I’ve got a lot more thinking to do…

I know this is a very niche topic and of negligible interest to the majority of people who follow this blog, so if you made it this far I am hugely appreciative! Thank you so much 🥰