Breastfeeding: breast is best except when it's not OR Chest Feeding: chest is best except when it's not!

Author's note: I identify as female and I'm writing this blog post from my own personal experience. I am choosing not to refer to breastfeeding as chest feeding throughout the entire article as that would not reflect how I personally identify. Please do not mistake this choice as exclusion. While reading this article please exchange breastfeeding for chest feeding and mother for birthing person if that better aligns with how you identify.

If you know me or are familiar with my blog, then you know that my road to becoming a doula was paved with my own lack of education. ( https://www.resolutionparent.com/new-blog/2020/3/25/five-things-i-wish-id-known-before-i-gave-birth ) When I was expecting my first child I had set my sights on breastfeeding and following that journey for as long as I possibly could. I don't remember setting a specific timeline for myself as a goal but I do remember being/feeling adamant about exclusively breastfeeding. At the time I thought that as a natural way for an infant to be fed and nurtured I would instinctively know how to accomplish this task. Boy was I wrong!

I'd like to start off by pointing out that it's a 7-year credentialing process to become an international board certified lactation consultant (IBCLC). That's almost the same amount of time it takes to become an MD. That's how long it takes to learn the wealth of knowledge surrounding the topic of breastfeeding. So yeah, boy was I wrong.

Now that I know better let's get back to my idea that breastfeeding is best, except when it's not! I personally fall into both of those categories.

I will never cease to be amazed at how the human body is not only capable of generating milk for a newborn, it's capable of changing nutrient density and consistency and fat content and quantity etcetera based on the current needs of that newborn. It is nothing short of miraculous. My miraculous body was so good at taking the cues that it was being given that I ended up with enough milk to feed triplets instead of the single born baby that I had. Some people might read this and think what's the problem, I barely have enough milk to feed one baby and you had enough to feed three. That's exactly the problem. The quantity I was producing was way out of whack with the demand. I had unknowingly put myself into a danger zone by over pumping and being uneducated about this miraculous thing called breastfeeding. I went from a point of having an oversupply of milk to a hospitalization as a result of a complication from an infection that arose from said oversupply of milk. Not fun! So how did I get here, how did this happen?

It starts with flat nipples, incorrect flange sizes on a breast pump, a shallow latch, and an excruciatingly high tolerance for pain. It ends with a 2-year successful breastfeeding journey that still brings me joy to this day. So let's talk about the in-between.

Nipples and areola come in all different shapes and sizes. I never knew that before! We can blame that on my seriously inadequate reproductive health education but that's a topic for another day. What I learned about my nipples was that they are technically flat. This means that a deep latch is a little bit harder to achieve and requires a little more finesse. There are many helpful breastfeeding positions and tools available to make breastfeeding with flat nipples easier. A nipple shield is one such tool. It's a silicone triangular shaped "attachment" that you place on your areola and nipple to provide more surface area for the newborn to latch onto. These tools while extremely helpful also need to be sized appropriately. At the time I was also told that pumping for a few minutes prior to attempting to latch my newborn could help draw out the flat nipples. Again, pumping parts also come in different sizes. Using the wrong size flange for my body resulted in major tissue damage to both of my areola. The shallow latch my son was using further lead to major nipple damage and frustration on his part at not being successful at extracting sufficient milk. Now let's go back to the part about me having enough milk for three babies instead of one. Bottom line, I was over pumping. I had been told to pump after each feeding for a few minutes. I didn't know to question this. I didn't know that doing this would signal to my body to produce more milk. I didn't know that the pump parts I was using were the wrong size for my body. There was a lot I didn't know. The one baby that I had was inefficiently extracting milk, damaging my nipple tissue, and the unnecessary pumping was damaging my areola. It was a perfect storm for infection.

The infection felt like my breasts were on fire and rock solid. That came with 104° fever and a trip to the emergency room. While waiting in the emergency room I tried to manually express milk so that I could provide myself some relief. I was not very successful with this technique. I was in so much pain. I was in so much pain that when the surgeon finally came to perform a procedure to remove what had been diagnosed as an abscess in my breast I wasn't able to ask any questions. I wasn't able to think. I was only focused on relief. The surgical aspiration of the abscess was guided via ultrasound. The needle was inserted into my areola near my nipple. I never should have let that happen. I didn't know any better. I have a permanent reminder on my body of that. The ultrasound guided aspiration should have indicated the insertion of the needle in my breast tissue instead. Not only would this have been less damaging it also would have been less painful. The pain was unbearable. I say this as someone who describes giving birth as feeling like your body is being ripped in half and doing that unmedicated. The pain was so unbearable that I was given morphine, a lot of it. When the procedure was finished the abscess was clear and I was left with instructions for moving forward which included bottle feeding my newborn and two different kinds of antibiotics. I could see the blood in my milk when I pumped and subsequently dumped it. I cried when I had to do that even knowing that it looked absolutely disgusting and I would never want to drink it. I cried a lot.

I began a new journey of formula feeding and bottle feeding. I was extremely discouraged. I was angry. I felt shame. I felt guilt. I felt doubt. I felt disappointed. I felt like a failure. I was so set on exclusively breastfeeding I couldn't see this pause as time and space for my body to heal. I couldn't accept that my son would be formula fed and bottle fed for the rest of his infancy. I had a plan and I had a goal of exclusively breastfeeding my son and I was determined to make that the ending of our story. The pause lasted about 3 weeks and then, while working with an IBCLC, I was able to get my son back on my breast with a deep enough latch and the appropriate amount of milk. The IBCLC taught me many different nursing positions that would help achieve the deeper latch my son and I needed to continue to be successful. She measured my areola and sized me appropriately for a nipple shield and flanges. Shocker, one side was larger than the other. She taught me how to look and listen for cues that my son was doing nutritive sucking and when he switched to non-nutritive sucking. I learned how the composition of my milk changed regularly based on my baby's developmental needs. I was amazed! Why hadn't I done this before I had my son, I thought shamefully. I could have saved myself so much pain and suffering. Learning from my past, I would eventually use those lessons to become a postpartum doula.

As a postpartum doula I encourage all of my clients to meet with an IBCLC before they give birth if they plan on breastfeeding. As a postpartum doula I encourage all of my clients that are not planning on breastfeeding to meet with an IBCLC as well. The human body begins the lactation process during the pregnancy. There are steps and measures that need to be taken to safely eliminate lactation. Working with an IBCLC is the safest way to accomplish this.

As an ardent supporter of breastfeeding I completely recognize when breastfeeding becomes challenging to the point that the health of the mother is suffering. In these scenarios I work very diligently to support the mother through her decision-making process. Sometimes people choose to continue breastfeeding and set small goals for themselves on a daily basis that allow them to feel successful. Other times people choose to stop breastfeeding and need support working through the grief that comes along with that decision as well. Breastfeeding while natural, is not easy. It definitely supports oxytocin production which is the love feel good hormone. And that's a major plus. But it's also physically exhausting. It can also feel isolating, demanding, and unsustainable. When I meet with someone that's in the throes of feeling isolated and exhausted, I listen. Sometimes that person is looking for validation to quit, which is not a word I would attach to the experience. Sometimes that person is looking for a grief partner to mourn the loss of the breastfeeding relationship. Sometimes that person is looking for someone to celebrate with them at having accomplished something they never thought they would.

For me the reminders of the extreme emotions I experienced on my own personal journey allow me to believe that the health of the mother both physically and mentally is tantamount. What's essential is that baby get fed. How baby gets fed is interdependent on how the mother feels. When the mother feels that breast is best she is right. When the mother feels that breast is not best she is right. Matrescence, a term coined my Dana Raphael, Ph.D. in 1973 (and a class at Teachers College Columbia University) is the process or experience of becoming a mother. Leaning in to your intuition and trusting yourself, knowing that what's best for you is ultimately what's best for your baby will allow for the journey to thrive and not just survive. I want to see and experience and guide and help everyone to thrive on this journey. That's why I believe breast is best, except when it's not!

Thanks for taking the time to read my post. Until next time.

With warmth, love, and kindness,

Raquel

P.S. If you are looking to work with an IBCLC here are two of my recommendations:

Sarah Siebold https://www.immala.com

Yana Katzap-Nackman https://headfirstdoulas.net