More than Breastmilk

Breastfeeding stories of challenge and triumph Katie Madden RN, IBCLC

www.BalancedBreastfeeding.com

The material provided in this e-book is an information resource only and is not to be used or relied upon for any diagnostic or treatment purposes. The information is intended to be educational; it does not create any patient-physician relationship and should not be used as a substitute for professional diagnosis and treatment. Please consult your healthcare provider before making any healthcare decisions for you or your child or for guidance about any specific medical conditions. Katie Madden expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information provided in this e-book.

Table of Contents

How Breastfeeding Ended My Body War: Katie’s Story by Katie Madden………………………………………………………………………….…… 1 You Grew Them; Be Nice to Them: Make Peace with Your Boobs by Katie Madden……………………………………………………………………………… 2 It’s Not Exclusive: Margaret’s Story by Margaret Kite………………………………………………………………………….…… 3 What Happened Here? “Exclusive” Happened: A Response to Margaret’s Story by Katie Madden……………………………………………………………………………… 5 The “F” Word: Formula by Katie Madden……………………………………………………………………………… 6 Succeeding Together: Jenny’s Journey by Jenny Godowsky……………………………………………………………………….…. 8 A Response to Jenny’s Journey by Katie Madden………………………………………………………..…………………..... 10 Stay Right Here. Right Now. by Katie Madden…………………………………………………………………………….… 11 Nursing Versus Breastfeeding: An Exclusive Pumper’s Story (So Far) by Cana Hartman…………………………………………………………………………..… 12 A Response to Cana’s Story by Katie Madden…………………………………………………………………..…….…… 15 A Clash of Two Worlds: Megan’s Working and Pumping Story by Megan Pinand……………………………………………………….……………………. 16 It Isn’t About the Bottle; It Is About the Bottle-Feeder by Katie Madden……………………………………………………………….…..………… 18 Feed Your Baby, Not Your Freezer by Katie Madden…..……………………………………………………………….………… 19 “Postlactum Depression”: When Baby Weans Before You Are Ready by Aurora Phillips ……………………………………………………………..…….……… 20 Don’t Rush It by Katie Madden………………………………………………………………..…………… 22 Holes in the Plan: Learning to Trust Myself as a Mother by Kasey Stacey…………………………………………………………………..………… 24 A Response to Kasey’s Story by Katie Madden…………………………………………………………………..………… 28

How Breastfeeding Ended My Body War: Katie’s Story by Katie Madden

When I was 13, I saved my money to order TBRS from a catalog. TBRS. Total Body Reshaping System. At 13, I was already sure my body needed to be totally reshaped, starting with my boobs (because I had none). Over the next 10 years, I raged against my body. I hated it, wished it were different. I dieted, binged, over-exercised. But mostly I was just mean to it. I said a lot of nasty things to it that I wouldn’t say to my worst enemy. When I was 21, I was at the height of my body hatred. I was in nursing school and had gained the inevitable freshman 15… okay, by that time it was the junior 30. On one particularly dark and lonely night in my Baltimore apartment, I painted a life-sized mural of myself naked. My body was misshapen and ugly in my depiction. There was no head, only clouds. This remains in my memory the illustration of my body hatred of my teens and early twenties. When I was 23, I became pregnant with my one and only child, Lucy. Almost immediately, my relationship with my body changed. I was planning a birth center birth and wanted and needed so deeply to have a natural birth and a long, easy breastfeeding relationship that I decided it was time to have a “come to Jesus” with my body. It was time for us to confront our differences, set them aside, and move forward. So, I said to my body, “Body, I know I have been shitty to you for ten years. I have thought and said horrible things about you, I have abused you, fed you poorly, and sometimes not fed you at all. I’m so sorry, body. But, believe me when I tell that I have changed. You have grown this amazing baby living inside of me. Thank you for her. I need to ask you for a really huge favor. I don’t deserve this favor because I am such a crappy friend, but I have to ask. Please birth this baby for me. Please let me have my baby naturally and please let me breastfeed her. If you do that for me, I promise I will never mistreat you again. I will love you no matter what size you are. I will feed you well and exercise you as best as I can. If you do this for me, I promise I will never say mean things about you again.” And my body obliged. It birthed my 8-pound, 14-ounce baby after 15 hours of labor. On July 16, 2006, I reached down and accepted my body’s gift to me: a fat, wet, wide-eyed Lucy, hot on my chest. I waived my white flag and retreated from my body war. I was humbled. I thanked my body that day. Together we nourished Lucy for almost three years, enjoying an easy breastfeeding relationship. Since then, I swear I haven’t said one mean thing about my body. We have gained weight and lost weight, eaten well and eaten poorly, been fit and been out of shape. But we have been best friends. You are so much more than a size or a shape; you are revelation. Thank you, body.

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1 You Grew Them; Be Nice to Them: Make Peace with Your Boobs by Katie Madden

Before you got pregnant, how did you feel about your boobs? I was obsessed with my boobs. Ironically, I have been a little boob-obsessed my whole life. When I was in middle school, I tortured myself daily, wondering when my boobs would grow. I prayed for my period because I thought getting a period meant getting boobs (it didn’t). I had one dirty little training bra that I refused to let my mom wash because I only had one and I refused to take it off. In high school, I had nice little B cups, but my nipples pointed down and I was ashamed of that. They weren’t perky like the boobs I saw…well, in porno. In college I gained the freshman 15, which turned into the junior 30, and my boobs came in full force. Always looking down at the ground. But, I could hitch them up and put them on display. They were a wonderful distraction from my soft tummy and they earned me a lot of attention. But I still hated them. I hated my body. I hated myself. I had major body image issues from ages 13-23. I was obsessed. I was really mean to me. When I got pregnant, I had all of my eggs in one basket: I would birth at The Birth Center with no drugs. I would breastfeed. This is it. I was giving my body one chance to redeem itself. And it pulled through. Me and my body, we called a truce and I haven’t looked back. But I was lucky. Really lucky. What if something had gone wrong? What if I hadn’t been able to deliver at The Birth Center? What if I didn’t make enough milk or Lucy hadn’t latched on? Where would I be? It would have been bad. I guarantee you. Some of you are in that exact place. Your body let you down. Again. After years of trying to get pregnant, carrying baby to full term, delivering naturally, you struggled to breastfeed. Figures, you said, my body has never been able to do anything right. After years of hating the odd shape of your breasts, wondering why your areola are so big, wondering why one breast is so much smaller than the other, you struggled to breastfeed. Figures, you said, They were always ugly and worthless. After a long labor without an epidural, your birth ended in a C-section and you struggled to breastfeed. Figures, you said, Nothing about my birth went right. Why would breastfeeding be any different? But to all of you who have heard this voice in your head confirming what you always “knew” to be true of your breasts and your body, I ask you this: If your child is dyslexic and he comes home with a C on his math test, do you say to him, Figures. Your brain never worked right anyway. Why would he ever strive for better? If your child doesn’t get into the college of his choice, would you say, Figures. You have never been worth much and now this just proves it. How could he recover from that? If your child falls at the playground and skins her knee, would you say to her, Figures. You fall every time we come here and you will fall every time you ever go to a playground. Why should she ever go to a playground again? I hope this hurts your heart to read. It hurts my heart to write. You would need to be mean and evil and hateful to say this to your child. Someone you grew. Someone for whom you are responsible for nurturing. If your child is dyslexic and comes home with a C on his test, you love him and praise him for his successes and ensure him that he is capable of this and so much more.

2 If your child doesn’t get into college of his choice, you love him and tell him that although this feels devastating in this moment, there is so much more life to live. There is so much more to life than what we have planned. If your child falls at the playground and skins her knee, you love her. You pick her up and kiss her on the head and tell her that her body is strong and beautiful. You tell her than she will trip and fall, but she must always get back up and trust that her body will carry her wherever she wants to go. If your body finally conceived and birthed a baby and is now struggling to produce enough milk, you love your body and praise if for its successes and ensure it that it is capable of this and so much more. If you have never liked your breasts and you are trying really hard to breastfeed, but you have had set back after set back, love your breasts. Tell them that they are beautiful and bountiful. Praise them for the milk that they make. Thank them for the emotional bond they have allowed you to have with your baby. Tell them that no matter what happens in life, the three of you are in this together, so no matter what the setback, you will carry them wherever you go. v v v v v v v v v v v v v v v v v v v v v v v v

It’s Not Exclusive: Margaret’s Story by Margaret Kite

I thought it would be “natural.” Maybe painful or uncomfortable at first, maybe inconvenient at times, but I never doubted that it would work. I never doubted that I would breastfeed my baby. I wouldn’t be one of those moms who quit because it was hard. I would do it because that’s what was best for my baby—it says so everywhere. He was breech and I was made to have a C- section, so already things weren’t going according to plan. But, he was perfect, and that’s all that truly matters. He was born weighing 8 pounds, 15 ounces; the staff in the operating room said, “It’s a boy, and he’s BIG!” Donovan latched in the recovery room, and off we went on our breastfeeding journey together. I exclusively breastfed him in the hospital, and it hurt. It hurt a lot. Two different lactation consultants came in to see and both said they saw nothing wrong and we were all okay. I just kept going. I am not one of the moms who quits when it hurts, I told myself. After four foggy days and three long nights, we were set to be discharged. That’s when they found he was jaundiced. But not too much, they said, to leave. And he’d lost weight, but not too much, they said. And he hadn’t had any poopy diapers, but he would, they said. So home we went. With a baby who was slightly jaundiced, who’d lost slightly more weight than he should have, and who wasn’t having the output he should. It didn’t take long for Donovan to tell me himself that they were wrong. He did need something else. I called the pediatrician helpline and spoke to a nurse who told me to supplement. That night, we ran out for formula and found a bottle, and our baby ate. He stopped crying. We took him to the on-call pediatrician at A.I. the next day. He was down to 7 pounds, 11 ounces. He said that we had to supplement. I asked if it would harm our chance to breastfeed. He said I didn’t have a choice. My baby was hungry. I had to feed him. So I did.

3 Donovan loved the bottles. But as much as he loved the bottles, he hated my boobs. I was heartbroken. He would scream and thrash his arms and turn his head back and forth when I tried to nurse him. I knew why and I couldn’t blame him. There wasn’t milk there. I thought I was just waiting for it to “come in.” But a week passed, ten days passed, and I waited. I pumped around the clock—ten to twelve times a day. Everyone said to just keep putting the baby to the breast, so I did, but he screamed and cried. It was torture for both of us. When I pumped I got a quarter ounce to a half ounce total. So I tried everything I had read. I used heating packs before pumping. I drank loads of water. I ate oatmeal. I made lactation cookies and on and on. You name it, I tried it. I went to see Katie when Donovan was 14 days old. My milk had never really come in. We suspect it was because I had severe edema after the C-section, that my body was confused. In any case, Katie and I made a plan. We would try to increase my milk production, keep pumping, and wait to reintroduce the breast to Donovan when there was something there for him to eat. I felt like a weight was lifted off my shoulders. I didn’t have to try to force my son to nurse. I had a plan. I could go on. One day at a time. At our next visit with Katie, we moved from not nursing at all, to latching with a shield, which was wonderful, but, devastatingly, he didn’t transfer anything. That moment was when I thought it was all over. So what if my milk came in, I thought, my baby can’t get it from me to him. But I told Katie that I wanted to keep trying. I kept taking my supplements and pumping, and at our next visit, Donovan latched without a shield and took in half an ounce, and then finally an ounce and a half. I felt like we’d arrived. I had some milk, and my baby could drink it. He was six weeks old. It took us six whole weeks to get to this place that really felt like breastfeeding. I wouldn’t have made it to that place without Katie’s support and guidance. Knowing I had someone on my side who had experience with more babies than I could imagine made me more confident. Having a plan made the weeks seem more manageable. Having appointments where I could express how I was feeling to someone who would understand and not judge made all the difference. It’s been a month since then. Donovan is 11 weeks old and we’re doing it. We’re breastfeeding. No, it’s not exclusive. I hate that word. I still don’t have enough milk, although now sometimes I can get as much as three ounces when I pump in the morning, which is six to 12 times what I was making at first. So, Donovan gets the combo platter. He gets mommy’s milk and formula. I live by the advertising slogan “every ounce counts” because I see every ounce I make for my boy as a victory for us. I explain it that he gets his meals from the bottle and snacks from me. But every morning, his first meal is all breastfeeding. I just have more milk then. I pick up my smiley boy from the crib and change him, nurse him, snuggle him, and lay him back down. It’s early and we’re groggy, but it’s our special time. I cannot “exclusively” breastfeed. I have no milk in the deep freezer I bought before he was born. I haven’t used any of the storage bags I was given from my registry. It hasn’t gone at all like I imagined or planned, but we have finally gotten to a place of peace. I am a breastfeeding mom and I give my son what he needs always— whether from me or from a bottle. I am proud of our journey because it was hard and we stuck it out together, me and my son.

4 What Happened Here? “Exclusive” Happened: A Response to Margaret’s Story by Katie Madden

It seems to be the buzzword lately. EXCLUSIVE= SUCCESS?? Bullshit. WELL-FED BABY, BALANCED MOTHER = SUCCESS That is the first problem with what is going on in the breastfeeding culture right now. Hospitals are seeking exclusivity upon discharge. That means that they take a “breastfeeding is natural” and “things will get better” approach to breastfeeding, which, in my opinion, is plain stupid and dangerous. After all, even if Margaret wanted to call up and tell those nurses and doctors that they were wrong, that it didn’t get better, it got worse, who would she call? So, here is what happened to Margaret. Her milk was delayed in coming in. Donovan wasn’t getting enough to eat at the breast in the first few days of his life. He wasn’t putting out adequate diapers, he was losing too much weight too fast, and he was getting jaundice. But, for the sake of exclusivity, Margaret was not told to supplement. She was just sent home. In the meantime, Donovan was getting frantic. He wasn’t getting enough to eat and he knew it. Every time he thought he found food, he would latch onto the breast then quickly pop off because, to him, it wasn’t food. He started showing over-active rooting signs and crying inconsolably. Margaret did the right thing by feeding him formula when the pediatric nurse told her to. Only, at that point, Donovan was so frantic and so desperate for food, he would only accept the bottle. He had learned (smart cookie) that the boob was a pacifier and the bottle was food. Now, Margaret was the one flailing. She called everyone she could think of, begging for help with her breastfeeding relationship. And do you know what she got? A whole lot of “nurse more,” “pump more,” “eat lactation cookies.” Not one person said to her, “Margaret, you and Donovan are individuals with unique needs and circumstances. Let’s meet in person so I can get to know you and your baby.” I am not implying that if Margaret had come into my office earlier I could have saved her milk supply. I truly think Margaret had an abnormal response to her C-section that caused such extreme edema that it told her body to not make much milk. However, what keeps me up at night is the two weeks Margaret spent torturing herself and torturing Donovan by putting him to the breast over and over again so he could scream and she could cry about him screaming. She did that because that is what “breastfeeding mothers are supposed to do.” But Margaret isn’t “a breastfeeding mother.” She is Margaret who breastfeeds. Donovan isn’t “a breastfed baby.” He is Donovan who breastfeeds and bottle-feeds. Here is what I think needs to happen in order to make a more humane, kind breastfeeding environment for new mothers and babies. 1. Mothers need to develop a trusting relationship with a Lactation Consultant before the baby arrives. That LC should acknowledge that a mother is an individual, not a set of milk making boobies. The LC should know the mother’s medical history, her support network, and her unique life circumstances. She should also learn the mother’s unique personality traits and anticipate how she will respond to any breastfeeding hiccups. (For instance, Margaret is dedicated, selfless, and, well, stubborn. This served her very well when it came to breastfeeding Donovan). It should also be said that this LC shouldn’t be a psycho boob nazi who thinks that it is exclusive breastmilk or bust. Those ladies tend to be pretty weird and abrasive. Just sayin’.

5 2. Mothers need early and direct access to that Lactation Consultant whom they trust. The nurses and lactation consultants in the hospital do their job, but there is no continuity of care after a mom is discharged from the hospital. It stands to argue that they don’t even know how much they hurt Margaret and Donovan by sending them home that way and there is no way of telling them. 3. Mothers need continued support from that Lactation Consultant and other mothers for the duration of breastfeeding. Not just the first week, not just the first six weeks. All the way to weaning. Because breastfeeding is constantly changing and evolving, a mom needs to know how to change and evolve, too. 4. Mothers need a supportive, non-judgmental space to grieve what was lost. Loss of the ideal—whether it is birth or breastfeeding or both—is a real, traumatic emotion. Grieving that loss is a critical part of moving forward and being the best mother she can be. 5. Lastly, mothers need to know that formula is fine. It is more than fine. It is a gift. Formula fed Margaret’s baby when he didn’t have enough to eat. Formula taught him to trust the world again. Eventually, formula helped teach Donovan that the breast is a lovely complement to his bottles. Formula saved Margaret’s breastfeeding relationship as I have seen it save many, many, many other breastfeeding relationships. I agree with Margaret. I hate the word exclusive. The word exclusive does a really great job of taking an amazing breastfeeding journey, like Margaret’s, and boiling it down to “not enough.” I say we start worrying more about a mother’s experience of breastfeeding and less about whether or not a baby is exclusively eating breastmilk. v v v v v v v v v v v v v v v v v v v v v v v v

The “F” Word: Formula by Katie Madden

The “F” word is not a dirty word. Formula. There I said it. Formula companies are genius marketers. They are unethical, sleazy, creepy stalkers, but they make a high quality product that we are lucky to have easy, affordable access to. Let’s start with the fact that formula is a perfectly acceptable substitute for the optimal infant food, breastmilk. Just like injectable insulin is a suitable substitute for natural insulin. Just like Pitocin is a suitable substitute for oxytocin (the hormone that makes contractions). If you need a synthetic hormone, drug, or food, then by all means, take it! Formula is a choice. Basically, I see formula four ways: • Formula is a choice. • Formula is a medication or a dietary supplement (like a vitamin). • Formula is a gateway drug. • Formula is not failure. 1. Formula is a choice. Thanks to the feminist movement, modern medicine, and big business, every woman has the choice to breastfeed or bottle-feed. How liberating. I am not being sarcastic here. It is liberating to know that you can still be a mother even if you don’t want to breastfeed. If it weren’t for formula, your choices would be to A) have a baby and breastfeed, B) have a baby and let it starve to death, or C) have a baby and find/pay somebody else to breastfeed him. But, it you choose formula, then own that choice. I am not speaking to the audience that chooses formula feeding. I am not passing judgment on non-breastfeeders; they just aren’t “my

6 peeps.” As with any choice you make, it is your choice and you should own that choice. Don’t ever let anyone make you feel bad for a choice that you made. 2. Formula is a medication or dietary supplement (like a vitamin). My hybrid-feeding mamas are the ones who try like hell to breastfeed and just don’t make enough, damnit. It is a real thing and anyone who tries thinks that “everyone can breastfeed” or that “if you aren’t making enough milk, you aren’t trying hard enough” can meet me in the back alley after school so we can fight. (Carolyn, Beth, Michelle, Brittany, Gretchen, Colleen, Megan, and about two hundred more women have got my back.) A lot of these mamas’ hearts break in two when they need to start adding formula to their babies’ diets. They feel like it is a sign of failure. Like one drop of formula counteracts the other 20 ounces of breastmilk. But what if we regard formula as a medication like Pitocin or Insulin? What if we consider the fact that if a mom’s breastmilk isn’t quite enough, then we just need to give baby a little booster, a nutritional supplement, a vitamin or a medicine? Maybe if we start regarding formula as a vitamin rather than a food, it won’t feel quite so much like rat poison. (Disclaimer: do not feed your baby rat poison.) 3. Formula is a gateway drug. Now, if we are going to call formula a medicine or vitamin, I am also going to make the argument that formula is a gateway drug. No, I don’t mean that if your baby drinks formula he’ll be sure to be snorting cocaine by seven and a half months. I am saying that a mom who feeds formula in addition to breastfeeding can easily lose more of her milk supply as she feeds more and more formula. It is a lie that you can breastfeed and formula feed without it having an effect on breastfeeding. You can breastfeed and formula feed and pump and it won’t have an effect, but that just sounds like a whole freaking lot of work! So, if you are breastfeeding and offering formula supplements, you have to watch your supply and your baby’s formula intake more closely. Breastmilk is a limited resource; formula is not. So, anytime you are instructed to “just give the baby a little formula,” you must also pump. If you are messing with formula at all, you should be doing so with an IBCLC in your corner. It can be complicated and risky to your nursing relationship. 4. Formula is not failure. I feel the need to restate this fact about 500 times. Formula is not failure!! Formula can help get a breastfeeding relationship over a hump. It can help a baby regain her birth weight and keep her out of the danger zone. Breastfeeding is a marathon, not a sprint. Sometimes, formula is needed in the first leg of the race so that you can cross the finish line. I get that you want to “exclusively breastfeed,” but if you had a choice between no breastfeeding and breastfeeding with a few doses of formula, which would you choose? And, truly, isn’t success a baby that is alive and healthy? And isn’t success being able to have a breastfeeding relationship? Then let’s put this formula failure nonsense to bed. P.S. I still think formula companies are sleazy dirt bags…just for the record.

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7 Succeeding Together: Jenny’s Journey by Jenny Godowsky

Independent, stubborn, adorable, loving, smart, funny, breathtaking. These are all words I would use to describe my daughter Aria. I know all this about her and she is only 16 weeks old. In fact, these characteristics have been present for many weeks now, and I have become aware of them largely through our breastfeeding relationship. Aria was born eight days early at The Birth Center on November 22, 2013 after a very quick but intense seven-hour labor and ten minutes of pushing. At 6.9 pounds, she was small but beautiful and healthy. The nurse and midwife remarked at how quickly she “pinked up” and how her lips were bright red when she first appeared. Immediately after she came out, Aria was placed on my chest. As I stared awestruck at my daughter, I waited for her to wiggle up to my breast, start rooting, and latch. I had learned to look for these signs and even watched a video of a newborn displaying them in Katie’s breastfeeding class. So there I lay, waiting for this incredible instinctual performance to begin. Aria had other plans. She wanted to sleep. And sleep. And sleep some more. The nurse decided that, because Aria was on the smaller side and so sleepy, she would check Aria’s blood sugar. It was 34 and needed to be 40 to be considered in the safe zone. The nurse worked with me to help Aria to latch, which she refused to do, even with a nipple shield. Eventually the nurse said they would need to give her formula through a little syringe to help stabilize her blood sugar. My head was spinning. I was exhausted from labor and filled with surging new hormones. At this point, I managed to remember what Katie had said in class: “Feed your baby, protect your supply.” I agreed, knowing my baby needed to eat. Her blood sugar was tested again and was fine, but dipped on the following test. Protocol required that the nurse call my pediatrician to see what they advised. The possible outcomes were 1) We stay longer at The Birth Center and monitor Aria’s blood sugar; 2) We go to the hospital and admit her to the NICU for observation. My immediate goal changed from breastfeeding Aria to keeping her out of the hospital at all costs. Thank goodness the pediatrician chose option #1 even though she said that if Aria had been born in the hospital she would already be in the NICU for observation. We had to stay an additional three hours to make sure that Aria’s blood sugar stabilized. It did and we arrived home around 10:30 pm. The next morning, we met with the pediatrician on-call, who said Aria looked great and that she was not worried about her blood sugar. I was so relieved, but I still couldn’t breastfeed my baby. The next week was a total blur. For the first few days, every two hours I would wake Aria, hand express colostrum into a plastic spoon, and feed it to her. Then my husband Dean and I would feed her formula through the syringe. Aria was born on a Friday and the following Monday I had an appointment with Katie. We were able to get Aria to latch with the nipple shield but, of course, she didn’t want to do it at home. My milk was coming in, so our plan changed to pumping and bottle- feeding Aria every two hours, around the clock. This continued for the next five days. By the time I woke Aria, tried to get her to latch, fed her a bottle, pumped, and washed everything, I had about a half an hour of “sleep” before waking to do it all again.

8 After Aria’s one-week appointment with the pediatrician, I came home determined to get her to latch. She was gaining her weight back, so I felt I could relax a little. I finally had a successful nursing session. After that day I no longer needed to pump and bottle-feed. I saw Katie twice more, and each time we changed our plan to fit Aria’s and my needs. I continued to use the nipple shield as well as every trick in the book to keep Aria awake while nursing. Even stripping her down to only a diaper and putting ice packs on her didn’t make her stay awake. While I acknowledged the importance of the shield and was glad to have it, I hated it. It drove me crazy. I was always dropping it or losing it. One even went through the wash! At one appointment I said I couldn’t wait to get off of the shield. Katie made me stop and realize how far we’d both come in such a short time. This is something I’m not good at doing and am continuing to work on. On Christmas Day, Aria latched without the shield and we’ve been successfully nursing ever since. Now don’t get me wrong, by “successful,” I do not mean perfect. I had to change my definition of success. It has not been without its ups and downs. As Aria grows and changes, I grow and change with her. We learn together. Our breastfeeding journey has been one of the hardest, most emotional, scariest, and most rewarding experiences of my life. Looking back on it, the beginning was traumatic. I don’t think I fully realized at the time how terrifying it felt to not be able to nurse. I had to survive, and allowing myself to feel everything would have prevented me from moving forward. This was something I was familiar with. At 16, I was diagnosed with clinical depression and have been on numerous medications over the years to manage the depression as well as anxiety. A year ago, after trying to come off of my medication to see if I would be able to handle a medication-free pregnancy when the time came, I crashed big time and ended up with a new diagnoses: OCD. Looking back, this was not surprising. I have always been a perfectionist with a tendency towards “all or nothing,” “black and white” thinking. With the help of a wonderful therapist and increased dose of medication, I felt better than I could remember. I also knew I could not go through pregnancy without medication. Thank goodness I had this experience before becoming pregnant, as it helped me learn the skills necessary to cope when Aria was born. Here’s what breastfeeding has taught me: • Surrender your control. I could be a full-on perfectionist working 24/7 trying everything under the sun to get Aria to latch. If she didn’t want to do it, it didn’t matter. I had to realize that I’m dealing with another little human being and can only control my side of the equation. I had to surrender my perfectionist ideals and embrace the fact that Aria’s inability to latch from the very beginning was not a reflection of me as a mother. This was hard. During those early days I felt like a failure. My first task as Aria’s mom was to feed her and I couldn’t do it. WRONG. I did feed my daughter and I did keep her alive. It wasn’t the way I envisioned, but it worked. I suspect this is what much of parenting will be like! • Mindfulness is key. When you’re in the heat of the moment, it is so hard to see the light at the end of the tunnel. Five minutes of poor latching = “my baby’s never ever going to breastfeed!” While working on breastfeeding Aria, I learned to stay in the present moment and focus only on the current nursing session, just as while in labor I focused only on the current contraction. Now when I nurse, I try to remember to

9 take at least a few minutes to stop thinking of everything I have to get done, I put down the phone, and I stare at my daughter. Breathe in every aspect of the beautiful moment and treasure it, for it will pass all too quickly. • What works for you and your baby is what is best for you and your baby. It doesn’t matter what the books say, what the doctor says, or what your brain tries to trick you into thinking. Our minds can simultaneously be our most powerful weapon and our worst enemy. If you feel comfortable and your child is healthy, then you are successful. A sense of humor doesn’t hurt either! • Trust yourself and your baby. As most breastfeeding mothers do, I often wonder, “is she getting enough to eat?” Well, I’m certainly changing enough diapers, so if something’s coming out, something must be going in! Aria will let me know if something’s wrong, and I, as her mother will notice. • Love your body. Whatever body issues you may have, give your body the respect it deserves. This does not mean liking it every moment, but acknowledging its strengths. I not only grew and birthed my baby, but I continue to keep her alive and thriving. Our breastfeeding journey has empowered me. It has given me a newfound sense of confidence that I didn’t have before and that I know will help me with all aspects of parenting. Instead of viewing struggles as problems, I strive to think of them as new challenges. In the beginning, breastfeeding success meant getting Aria to latch. Now success is teaching her to unlatch before she swivels her head 180 degrees to look at the latest distraction. When I get caught up in worrying if I’m doing a good enough job, I try to remember what I’ve accomplished. I left The Birth Center with a six- pound little girl whom I couldn’t breastfeed. I now have a thriving 13-pound bundle of joy who, in her 16 weeks, has taught me more about life and love and my true self than I’ve learned in the past 32 years. I can’t wait to find out what she’s going to teach me next.

A Response to Jenny’s Journey by Katie Madden

Jenny came to breastfeeding support group practically every Friday from when Aria was two weeks old until she graduated to big babies group at 16 weeks. Each week, Jenny told her story. She relived in great detail the first few days of Aria’s life. For many, many weeks, Jenny could not move past the fact that Aria needed to have formula in the first days of her life, even though it was medically necessary. Each week, Jenny owned her story of depression and anxiety. She has no shame about the fact that she takes medication to manage her brain; she wants to make sure no one else has shame either. Each week, Jenny made progress. The first week, she was successfully nursing with the nipple shield, but she still wasn’t happy because she was using the shield. A few weeks later, she reported that Aria nursed a few times a day without the nipple shield, but she wasn’t happy because it wasn’t one hundred percent of the time. After Christmas break, Jenny was thrilled to announce that she and Aria were shield free, but frustrated to report that Aria was exceptionally gassy and fussy and she didn’t know why. Now, I am not trying to make Jenny out to be a complainer or overly negative. Quite the contrary. Jenny loves Aria fiercely and is absolutely smitten with her. Jenny works very hard and expects nothing less than perfection from herself. When Aria didn’t latch or didn’t get off the shield or didn’t stop crying for hours, Jenny saw that as a reflection upon herself. Jenny saw that as not being a “good enough mother.”

10 But, when Aria was about 12 weeks old, something changed. Perhaps it was sudden, or perhaps it was gradual, but something inside of Jenny clicked. She got it. After weeks and weeks of struggling to find peace with her breastfeeding journey and find balance in mothering, Jenny got it. She came to support group and she proclaimed the lessons breastfeeding had taught her. There was an electricity in the room as she was talking. I had goose bumps and tears in my eyes. I had watched Jenny blossom into a confident mother right before my eyes and it was awe-inspiring. Do you get it? These are the lessons your baby will teach you if you let her: • Surrender your control. • Mindfulness is key. • What works for you and your baby is what is best for you and your baby. • Trust yourself and your baby. • Love your body. v v v v v v v v v v v v v v v v v v v v v v v v

Stay Right Here. Right Now. by Katie Madden

As most of you may know, I have a daughter, Lucy, who is seven and a half. She is cute, hilarious, smart, kind, considerate…stubborn, bossy, and persuasive. She reminds me a lot of her mother. As Lucy’s mother, I feel the following emotions five to 125 times per day: guilt, anxiety, self- loathing, self-judgment, failure. Just last night I was sitting in Lucy’s room as she was falling asleep (a once a week treat when she isn’t being the boss of me) and my mind was reeling over all the things I am doing wrong. Lucy watches too much T.V. She should be taking piano lessons. Her handwriting is really bad. I should take her to visit her great-grandmother before she dies. I think she has a cavity because I don’t make her floss her teeth. I should stop trying to grow out her bangs… I am a SHITTY MOTHER!! Then, I took a deep breath and listened. Lucy had fallen asleep and I walked over and looked at her sleeping (I love my kid so much when she is asleep). In that present moment, with her lying there in a nice warm bed, dinner in her belly, teethed brushed, mommy’s kisses on her cheeks, I was an awesome mother. Our brains love to solve problems. We aren’t content to just be okay with how things are. That’s boring. We need to always be searching for something more. I often remind myself to stop problem solving and focus on what is good. It brings me back to the present moment where nothing is really wrong; where all is right. I observe, take note, and become curious about what is happening, but I don’t try to pass judgment or to fix it right away. I see this everyday, multiple times a day, when I am helping mothers learn to breastfeed. If a woman is feeling anxious, guilty, or like a failure while she is breastfeeding, chances are she isn’t allowing herself to be present in the current breastfeeding session. Rather, she is entering a past or future breastfeeding session. Here are two examples that I almost guarantee you will be able to relate to: Example #1: Baby is fussy at the breast Entering the past: I must have eaten something wrong. Oh no. I am going to have to stop eating ice cream. I love ice cream! I don’t want to stop eating ice cream. But, if I don’t stop eating ice

11 cream and my baby is fussy, I will feel like a terrible mother! I am a terrible mother for eating something that is making my baby fussy even though I have no idea what food item that may be! Entering the future: I don’t make enough milk. I will never make enough milk. I will fail at breastfeeding. I think my baby is self-weaning. Staying in the present: Hmm. That’ weird. She’s being fussy. I wonder what her problem is.,, Ppppffffft. Oh, she had to fart. Now she is better. Example #2: Baby is looking to nurse 45 minutes after the last feeding: Entering the past: She must have not had a big enough feeding last time. I don’t even know what a good feeding is! I thought that was a good feeding, but it wasn’t! I’m starving my baby! Entering the future: Oh my God. She has to nurse again?! How will I ever go back to work if she nurses every 45 minutes? How will I ever have a life again? How will I ever get my hair done? I am so selfish for wanting to leave my baby and get my hair done. I am a terrible mother. Staying in the present: Hmmm. Weird. She wants to nurse again. I am going to grab a glass of water and enjoy this time as an opportunity to watch another episode of Orange is the New Black. Here’s a little peek into the head of Katie Madden, the IBCLC: When I am listening to a mother tell me about her breastfeeding situation, I don’t problem solve at first. I listen and ask questions and listen more. I observe an entire breastfeeding session. I take some measurements. I ask more questions. Only once I feel like I have all of the information do I begin to problem solve. I would never try to problem solve based on one behavior at one breastfeeding session. Neither should you. So, are you feeling shameful, blameful, or guilty? You are most likely in the past or future. Return to the present. Whenever you leave the present moment, you may feel like a terrible mother. In the present moment, you are everything your baby needs. In the present moment, you are the perfect mother. v v v v v v v v v v v v v v v v v v v v v v v v

Nursing Versus Breastfeeding: An Exclusive Pumper’s Story (So Far) by Cana Hartman

The story begins before my son was born. I took just about every class offered by The Birth Center and studied and practiced HypnoBabies to prepare for his birth, and so I felt confident and prepared. I did not, however, feel as confident or prepared to breastfeed. My sister and sister-in-law both had recently had frustrating experiences trying to breastfeed, and both ended up giving formula in bottles. The breastfeeding class helped with the basics, but I was still having anxiety knowing I had flat nipples and hearing other people’s issues in the back of my head: inverted nipples, food allergies, reflux, etc. I made an appointment with Katie Madden, and unloaded all my fears to her. We talked through them, and made a plan. She also set me up with nipple shields. I then felt good to go. After Jackson was born, he was put on my chest, and I whipped out my trusty nipple shield. He squirmed up my front and kind of licked at my breast, then fell asleep. We were off to the races. The first few days at home are kind of a blur. I know that he was wetting his diaper the appropriate number of times, and his poop changed from tar to seeds, but I remember thinking his latch was not great, so I hand expressed into a spoon after every feeding (as I had seen at breastfeeding class), and spoon- fed him as much as possible. I believe it was day four when my milk came in. My boobs were feeling tingly and within an hour I was crying because they were so hot and painful. I called my mother-in-law and begged her to run out and buy me a pump. She asked what kind and I, feeling tired and out of control of my body, couldn’t even talk to her about it. “I don’t care…just hurry!” She brought me the

12 Medela hand pump. What a life saver; pumping felt great. I think I got around four ounces, and Jackson killed it. I was happy that he took a bottle so easily, but what I didn’t know was that moment ended my nursing relationship with my son. It was like a light switch was flipped in his head. He started refusing to latch and would scream until I gave him a bottle. I started attending the breastfeeding support group at The Birth Center, and made an appointment to see Katie. I was very nervous going to group the first time, thinking everyone would be sitting around smoothly nursing their babies, and I would have to whip out a bottle. I felt ashamed. Fortunately, I found the group to be completely non- judgmental, and was relieved to hear that I was not the only one having difficulties. At a one-on-one appointment, Katie gave me some tricks to try with Jackson, and patiently sat through him screaming in her office for at least an hour and a half before he finally gave in and latched. We got home and I kept my nipple in his face for the rest of the day. I look back and treasure that day, and the few other times he successfully nursed. I am so glad to have those memories. For three and a half months, that’s 17 weeks, 119 days, about three times a day, so that’s around 357 times, I “practiced” nursing Jackson. He latched about four times, licked my breast and laughed around 20 times, and the other 333 times he screamed in my face. As he got older, the screaming got worse, and was accompanied by squirming away and hitting. But I was determined not to be “beat” by an infant, and hung on for dear life to stories I heard in group of 4 month olds “getting it”. During that time, I was pumping five to eight times a day and feeding Jackson his beloved bottles. I used the hand pump for about three months, until my insurance company conceded to cover the expense of an electric pump. Now I use the electric pump at home and the hand pump when we are out and about. Here are some of the “tricks” I tried during our practice nursing sessions: • Bait and switch: give baby a bottle and once he starts sucking, quickly switch out for the nipple • Sneak attack: creep up on baby in the dark and put your nipple in his mouth hoping he will start sucking in his sleep • Lesser of two evils: give baby a bottle of formula (which he hates the taste of) and then offer a delicious breast • Switch-a-roo: similar to the bait and switch, but with the pacifier • Under the arm: start by giving baby a bottle right next to your breast, under your arm, and slowly move his mouth from the bottle to the nipple • Bottle top: use the bottle’s nipple in place of a nipple shield • Two at once: try getting a bottle and a nipple in baby’s mouth at the same time • Bath time (my favorite): sit in the tub with baby, skin to skin, and get so relaxed and use baby’s natural rooting reflex to get a latch • The dangle: “tea bag” baby with the breast, kneeling over him • Nurse-in: lay in bed with baby, lots of skin to skin time, all morning and afternoon, offering the breast often • Get used to it kid: hold your nipple next to baby’s face as he takes a bottle

13 • The fire hose: spray milk into baby’s mouth as he hollers at you and massage his throat to encourage him to swallow (like a puppy) • The stand-off: who can hold out longer? Mommy or baby? There were many other strategies tried. I kept thinking if I found the right trick, I could flip the switch in Jackson’s head back from bottle mode. I was determined, but there were some tough days. I left one breastfeeding group feeling angry that mothers were crying that their babies would nurse and nurse all day. I grew resentful that those having supply issues could supplement nutrition, but I could not supplement that closeness with my baby. In retrospect, I think I was having my first PMS since getting pregnant. Once I got my period, I was able to step back and appreciate having such an easy time pumping, having an ample supply, and a baby who loves taking any bottle from anyone, anywhere, at any given moment. I am fortunate to be able to work from home, so Jackson and I are very close (my husband calls him my symbiotic baby because we are so connected). I have the advantage of freedom that comes with bottle feeding; not worrying about a latch in a distracting place, no worries for a baby sitter, my husband can get up with Jackson in the night just the same as I can. Additionally, my husband has a great feeding bond with Jackson. And, I have to give mad props to the guy for being so supportive throughout this journey. He would sit next to me on the sofa, rub my back, and say encouraging words as our son screamed at my breast. I could complain about having to disappear every three hours or so to pump in private because it is definitely not socially acceptable to pump in front of people, but really I have it down to a science now, and it only takes five to ten minutes. One time, though, I was parked in the back of a parking lot, pumping with the hand pump, and a quite pregnant woman waddled up, I guess to see me nursing my baby. When she saw that he was sleeping in his car seat and I was pumping, she gave me a dirty, confused look, and literally mouthed “ewww.” I just had to laugh to myself, knowing that soon she would have a baby of her own and discover that you do what you have to do, even if it means hand expressing while standing on your head; at least, that’s how I feel. Throughout this whole time, Jackson has been thriving (he is over 18 pounds at three and a half months old, rolling, starting to sit up, and has gotten two teeth already), and fortunately I have had no issues with supply. I have always had enough to freeze at least five ounces a day. That momentarily dipped (to a level where I was still comfortably feeding Jackson all he wanted but not banking any) when I was ovulating. So, I drank a ton of mothers’ milk tea and ended up engorged at 3:00 am, baby sleeping but me awake and pumping. At least I know it works, if I ever need it. After finally feeling like I had exhausted every trick in the book, and using up every ounce of patience with “practicing” that I could scrounge up, I have finally come to peace that I have done everything possible to nurse my baby. It brings me tremendous comfort that Katie once told me that there is breastfeeding… and there is nursing. I have not been successful with nursing, but I am breastfeeding! And I now feel at peace with that! I was pleasantly surprised to find many other mamas online who are also exclusively pumping (for a variety of reasons). They call it EPing. After one last meeting with Katie, doing an eight-hour stand-off with Jackson and then staying up way too late going on different Facebook groups and reading articles about EPing, I can now say that I am now a PROUD PUMPING MAMA!

14 A Response to Cana’s Story by Katie Madden

Each week, Cana came to breastfeeding support group. Each week, she told her story. How Jackson latched for just a few days in the beginning. How he got a bottle once and never came back to the breast. How she tried everyday to coax Jackson back to the breast. How most of the time, he screamed at her as though she were putting soap in his mouth rather than a nipple. Some weeks, Cana was upbeat and hopeful. “This week, Jackson let me put the nipple in his mouth and he didn’t scream,” Cana shared once. “Now Jackson will laugh when I put the nipple in his mouth!” Other weeks, Cana would be teary-eyed, feeling defeated, resentful, and angry. Nevertheless, every week Cana came. She called group her sanity. The fellow mamas were always impressed by Cana, as was I. At some point, I shared my perspective with Cana and the group about nursing versus breastfeeding. Aren’t they the same thing? Well, technically, yes, but I like to think about it this way: When you nurse your baby, you are feeding her right from your breast. She snuggles in close. The skin of her mouth and her face is right up against your skin. As she gets older, she may pat or stroke your breast, bury her head deep into your breast, or wrap her arms around your breast in a big boob hug. Regardless of how much milk is coming out of your breast, if your baby is suckling, you are nursing. I often explain this analogy to mothers who have a low milk supply and need to supplement with a bottle after breastfeeding. In no way does supplementing lessen your nursing relationship. Those mothers have a nursing relationship and a partial breastfeeding relationship. Breastfeeding, however, is providing breastmilk for your baby either directly from your breast or via bottle. Some mothers do this when they are separated from their infants while at work. Some mothers choose to pump and bottle feed for personal reasons. Some mothers are forced to exclusively pump because their babies are very hardheaded and stubborn (like Jackson). What a gift it is to be able to breastfeed and nurse your baby. If you are reading this and you are able to latch your baby directly on to your breast and provide her with one hundred percent of her daily nutritional needs, stop, take a deep breath and have gratitude for this gift. Some women get to nurse and some get to breastfeed, but you get to have it all. I have known a handful of “EPers” (Exclusive Pumpers) in my career. These mothers have a few things in common: they have a fierce dedication to breastfeeding, their hearts yearn for a nursing relationship, and their hearts break each and every time they attempt and fail. They are grateful for the milk they are able to make and express and angry that they have to take so many extra steps to get it into their babies. In turn, of course, I have known a number of the EPers’ babies, but none tops Jackson. Cana and I met one last time before she decided to stop trying to latch Jackson. Cana had reached the end of her rope (after three and a half months of trying, imagine that!) and we needed one last face-off before we threw in the towel. Cana brought Jackson to my office hungry and we spent 90 minutes together as Jackson got hungrier and hungrier. I pulled out all my tricks. I had plenty of patience, as did Cana, as Jackson cried and cried and cried… finally, I surrendered. Cana surrendered. Jackson had won. I love him for being so damn adorable and so damn stubborn. Jackson is one of my favorite babies (okay, I know I say that about all the babies, but he will always hold a very special place in my heart.) Why? 1) He is a super duper fat breastfed baby and I have a thing for fatty babies. 2) He is a very, very happy-go-lucky boy (unless Cana put her nipple in the general proximity of his face). 3) He beat me. People like to call me the “Boobie Whisperer” or a miracle worker. But, the truth is, I don’t have magical powers and I can’t make babies do anything they don’t want to do. But I can help mothers accept what is. For Cana, that meant letting go of her

15 attempts at being a nursing mother and embracing her role as a breastfeeder. Cana discovered a whole new world of EPing and found community amongst them. Most importantly, and I will say this again and again, each and every baby is a person. Some babies have much stronger personalities than others and to deny this is to ignore your baby’s uniqueness. You have the opportunity to learn so much from your child by breastfeeding. He will teach you lessons about how to be his mother that you apply for decades to come. So, ask yourself, “What is my baby trying to tell me about who he is and what he needs?” In Jackson’s case, he was saying, “No thanks, Mom. I don’t like it straight from the tap. I know you had different plans, but this is the way it is going to be whether you like it or not. Look on the bright side…I am an awesome kid!”

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A Clash of Two Worlds: Megan’s Working and Pumping Story by Megan Pinand

I can describe working and pumping in only one way: a clash of two worlds. I didn’t realize how intertwined work life and family life could be until I pulled out my boobs in a small room next to the visitor’s office and connected with my baby during my work day. At first it was scary, but now it is routine and I consider it a wonderful break. Because it’s not about the milk. To me it is spending a half hour with my little baby. I look at pictures and videos, imagine him, breathe, and can feel him close to me. I also relax, forget about whatever is going on at work, and check in with myself. It’s actually the best part of the day! At first I felt very daunted by having to pump during work although I was committed to doing it. I stepped back into my working mama shoes with my first priority being pumping. I was afraid of my milk supply decreasing and I knew there would be scheduling conflicts. But I figured it out. As moms we think of the worst and the scariest of all scenarios, and then we figure out ways to make it work and do the best we can do for our babies. We are stronger than we think! So here are the specifics about me and how I work things out being a Pumpin’ Mama: I am a Financial Analyst at Barclays bank in Wilmington. I work 40 hours a week and commute about two hours per day depending on whether I pick up and drop off or not. My baby boy and three- year-old daughter are in full time daycare (ten hours a day) since my husband also works outside the home. I pump at 9:00 am, 1:00 pm, and 4:30 pm. The last pumping session is in the car on the way home. Baby boy gets three- to four-ounce bottles at school and I pump exactly that. When I first returned back, he was eating less during the day, but after a few weeks he started getting a little hungrier, so I increased my supply a bit by taking fenugreek supplements and drinking Mother’s Milk tea. Worked like a charm! My job usually would entail lots of meetings and longer hours than I’m working now, but my boss is being pretty easy on me since I’ve been back. I had a conversation with her before I returned that I would need to shorten my hours a bit (I work from 8:30-4:30 and skip lunch; before I was working until 5:30). I will continue this until I’m ready to “lean back in,” but for now, and at least until I’m done nursing, this is the flexibility I need. I also have the opportunity to work from home one to two

16 times per week, when I can. I usually take advantage of this one time per week, but I’d like to work up to two. This is wonderful because I can skip the commute, keep pumping while working, and can visit baby boy at daycare for a half hour, and I really treasure this time. With an older child, it is rare to have one-on-one time except during those middle of the night feedings! I have definitely taken a step back in my career and would be “leaning in” much more than I am now if I did not have a baby. I actually prefer it that way because I’m maximizing the time I have with my kids while earning a good salary at a job that I really like (not love, unfortunately, but I do like it). The Megan ten years ago would be very shocked that I am happy with a step back, but really, that Megan didn’t know what she was in for when motherhood took over. Some things I came across that surprised me when I returned back: 1. Most guys (even dads!) are really, really are uncomfortable when you talk about your boobs being a food source. I work with a lot of men, and sometimes have to explain where I’m going if I leave a meeting or have scheduling issues. Making jokes like “oh, just going to go pump my boobs” really isn’t funny! Whoops! Learned that lesson quickly! 2. There are a lot of women (even moms!) who don’t get it either. My boss was one of them. She had no desire to breastfeed, her nurse told her she had flat nipples, and she wanted her husband to get involved with feeding. Perfectly reasonable choice in my opinion and I can relate. My first daughter was formula fed, although I did not choose it to be this way, but that’s the subject for a different story. When she asked what my pump was as it was sitting on my desk, and I explained, she said, “LIKE A COW?!?!?!” It was honestly like she had never seen or heard of a breast pump before. I was shocked, quietly ended the conversation, and cried on my way home. How could she be so ignorant? Doesn’t she realize what a sensitive subject this is? How could someone compare a new mom to a cow? WOW! I actually wound up pulling myself together and talking to her about it the next day. I explained how important nursing is to me, how committed I am, and that I need her support. I pat myself on the back for this because the next pumpin’ mama who works for her definitely won’t have this issue. It has helped our relationship and she lets me have lots of freedom to pump when I need to and get home for my baby. 3. The pang in your boobs or leaking will come at the most inconvenient time. And it will throw. you. off. your. game. If it happens in meetings or conversations I cannot focus on anything else except going to pump. This is a serious one, because coming back to work I was already way off my game, and this was just the icing on the cake! I’m still getting used to this. I’ll be back on my game some day I’m sure. I hope. 4. People see me in a different light. I am considered “that mom who uses the mother’s room.” This started while I was pregnant. Then I was “that pregnant girl.” Although this took me by surprise, the truth is I wouldn’t want to be seen in any other light because this is me. The one who walks around with the black pumping bag, the one who works hard to leave on time for her kids, and the one who balances it all. I’m so proud to be seen in this light, because there was a chance I couldn’t do this. Although there are really hard days, busy days, when I’m tired and I feel like I just need a nap, above all I’m so proud. I’ve come a long way in what I consider the hardest part of motherhood yet. To me, the clash of two worlds that pumping at work is can be a little overwhelming, but at its core, it is a way to connect with my baby and do something truly amazing each and every day. It is absolutely worth the time, the effort, and the tears. I am surprised that I like it and hope it continues as long as my baby needs it to.

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17 It Isn’t About the Bottle; It Is About the Bottle-Feeder by Katie Madden

There are a ton of bottles out there claiming to be the best for the breastfed baby. Tommee Tippee “encourages your baby’s natural feeding action, ‘just like mom.’” Avent Natural Bottle claims, “the nipple features an innovative petal design for natural latch on similar to the breast, making it easy for your baby to combine breast and bottle-feeding.” The Joovy Boob Baby Bottle says, “the large diameter base and nipple length assist your baby in properly ‘latching’ onto the bottle.” The list goes on and on. So, which bottle is best? Well, it doesn’t really matter. I say start with the bottles in your house and make sure it is a slow flow nipple. What is important is how you feed the baby a bottle. When babies breastfeed, they have both drinking time and sucking time. Meaning, they do in fact “use you as a pacifier” (gasp!). This is a really healthy way for them to eat. The pacifier sucking, or non-nutritive sucking, gives them time to digest their food and let their brain catch up with their belly. This is kind of like setting down your fork during dinner to take a sip of water or to talk with your husband. In most circumstances (over-producers aside) breastfeeding takes at least 20 minutes. Coincidentally, it takes our brains about 20 minutes to register that we are full. Bottle-feeding, however, doesn’t work quite the same. When a breastfed baby gets onto a bottle, he takes his super power breastfeeding suck and guzzles the bottle. It isn’t uncommon for a breastfed baby to finish a bottle in fewer than five minutes and still look hungry. The problem with bottle guzzling is that the baby has had no opportunity to have non- nutritive sucking time during which to allow his brain to catch up with his belly. He will therefore still think he is hungry and overeat himself. Sound familiar? It is just like when you miss lunch and by dinner you are starving so you eat an entire plate of spaghetti and meatballs in five minutes. Fifteen minutes later you realize, “Oh man. I ate too much.” Right? So, here are some ways to slow your bottle-fed baby down. This is a really, really, really important concept to understand when you are back to work. I have lots of cool videos available in the Pumpin’ Mama’s Blueprint Program. Paced bottle-feeding: 1. Sit baby upright in your arms, not laying flat on his back. Can you drink easily while lying down? 2. Keep the bottle as horizontal as possible without letting air get into the nipple. If baby is lying flat on his back and the bottle is perpendicular to his mouth, gravity will make the milk flow into baby’s mouth much, much faster. 3. Tickle baby’s mouth with the bottle and wait for baby to open wide and latch himself onto the bottle. Don’t wiggle the bottle into baby’s mouth. 4. Watch baby closely. If he slows down or stops sucking, take the bottle out of his mouth or tip the milk back out of the nipple. What’s happening here is that baby needs a break, but the milk continues to drip into the back of his throat, so he must

18 reflexively starts swallowing again. Also, a lot of people have the tendency to wiggle the bottle to prompt the baby to start sucking again, which interrupts the baby’s rest period. 5. Stop baby every half ounce to one ounce to burp. If he gets really upset at this, try giving him a pacifier to suck intermittently and while burping. 6. Try to stretch the feeding to 15 minutes or longer. If you can’t stretch it that long, make sure you wait at least that long to decide whether or not that bottle was “enough.” Use the pacifier and other soothing techniques to hold him off for those 15-20 minutes. Sometimes, when a baby is really set in his bottle guzzling ways, he can get really mad when you start pacing his feedings. Just be patient with him and keep doing it. Soon, he will learn that the milk isn’t going anywhere and he will start to allow paced bottle-feeding.

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Feed Your Baby, Not Your Freezer by Katie Madden

Before you go back to work, you should be sure to have three daycare days worth of milk in your freezer to act as a cushion. Once you start working, you will be pumping for your baby, not for your freezer. So, let’s say your baby eats 12 ounces of milk every day at daycare (expect him to eat about one ounce to one and a half ounces for every hour he is at daycare). On Sunday night, you will take 12 ounces from your freezer stash to defrost for Monday. On Monday, whatever milk you pump you will send to daycare for your baby to drink on Tuesday. Tuesday’s milk is for Wednesday, Wednesday’s milk is for Thursday, Thursday’s milk is for Friday. Whatever you pump on Friday should go back in the freezer. The trick? Whatever you put back in the freezer on Friday night should be equivalent to what you took out the Sunday prior (in this example, 12 ounces). If you come up short, you should do some extra pumping over the weekend to make up the difference. Fresh milk is preferable to frozen milk, so it doesn’t make sense to freeze fresh milk and defrost frozen milk. Use whatever fresh milk you have first!

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19 “Postlactum Depression”: When Baby Weans Before You Are Ready by Aurora Phillips

In the months before my son was born, I knew only three things to be true about my upcoming breastfeeding experience: 1) I would breastfeed. 2) I would go back to work at six weeks and it would be “totally fine.” 3) I would stop breastfeeding when he “could ask for it”…because that’s weird. Three years later, I laugh at that list because only one of them was true, and even that was a close one. After transferring to The Birth Center late (30 weeks), my son, Carlos, was born in June 2010 in the Yellow Room. Though I didn’t know it at the time, I was incredibly lucky to have Katie in the room that day because the first thing I “knew” was about to be tested. Like all TBC nurses do, Katie helped me through my first couple nursing sessions with my newborn before I left for home. As I told her, it didn’t feel good, but it didn’t really hurt either. Of course, I’d just given birth to a nine-pound, seven-ounce baby, so things were relative. The first few days home were a blur. My mom and my sister were there 24 hours a day and both were supporting my nursing, but my family also believes a sleeping baby should be left to sleep, so there were a few too many missed feedings. My mom also kept telling me the pain would go away once my nipples got used to it, which I assumed meant “toughen up, kiddo.” By the time Colleen and Justine came for a home visit, Carlos was jaundiced and had lost “too much” weight. They warned that he’d need blood tests for the jaundice and prepared me for the pediatrician’s likely reaction to his weight loss. By then, the nursing I was doing was very painful and though Colleen’s advice was helpful, my nipples had already taken a beating and I just couldn’t maintain any peace of mind once they’d gone. Thankfully, I felt like I had a relationship with Katie because we spent so much time together during my labor, delivery, and recovery, so I finally reached out to her. With her help, I finally got Carlos up to his birth weight at three weeks, but not before Katie nicknamed him “The Barracuda” because I went two weeks feeding him every two hours around the clock, no exceptions. It was a very close call, with many nights of crying from the pain and crying from the secret thoughts in my head. “What kind of mother doesn’t want to feed their baby?” I said, but it was the truth; I didn’t want to feed him. It just hurt so bad. Then, three weeks later, the second thing I “knew” would come under fire. We were approaching the time I was supposed to go back to work and there was a lot of talk in my house about whether or not that would really happen. However, given other circumstances in our family, it was determined I had no choice but to go back to work for now. So I did. With pump in tow, and a plan to have Carlos brought to me for my lunch hour to breastfeed and snuggle, I returned to work with a heavy heart. This was the first step in the weaning process and how I reacted would foreshadow the true end to our breastfeeding journey. It was hard to pump at work; I just wasn’t making enough milk. There were a lot of demands on my time and my brain and it interfered with not only the pumping routine but also my emotional health. Every day that I was away from him, I was more and more depressed. I was sure my waning milk supply was because I was away from him and that just fed the sick feeling I had about leaving him every day. So much for being “totally fine.” There were many peaks, and my fair share of valleys, in my breastfeeding journey. Whether I was breastfeeding or not, I would have had to go back to work at six weeks. I was lucky to have the extra special nursing time with my son when I got home. Sure, I cried during many of our nursing sessions, promising him I would love him with all of my heart and apologizing for having to leave him,

20 but at least we had that time together. And yes, he comfort nursed a lot at night to make up for the time we were apart, and that meant many sleepless nights, but I didn’t really care. I need that time with him as much as he did. And, at six months, when my husband had to have spinal surgery, the stress of our life nearly assassinated our breastfeeding. My supply plummeted and we used up my entire back stock. But Carlos and I fought through it and were still happily nursing at his first birthday. The second step in the weaning process was all my idea: no more pumping at work! After 46 weeks of pumping three to five times a day, I was beyond over it. Breastfeeding was as easy as breathing by that point, so I decided we could just nurse while we were together and not nurse when we were apart. It was a terrific plan and I was walking on nursing-relationship-sunshine, especially when, at 15 months, I finally decided to leave my job to spend more time with Carlos. Unfortunately, I had signed up to do a three-day breast cancer walk and I was starting to freak out about what would happen while I was away from him. I had resigned myself to pumping while I was away. I hoped my husband would bring my son to me each night but he thought that would be too stressful on Carlos. Instead, the plan was for someone to come each night and retrieve the milk I pumped to bring to him the next day. It seemed like a great plan until the first day at lunch when I tried to pump, and there was nothing there. I thought maybe it was because it was the middle of the day and I didn’t usually nurse until late afternoon. But when I got back from that day’s walking, and tried to nurse again, there was still nothing. The grief and panic hit me like a freight train. I was sure that the emotion of the day, coupled with the absence of my son, had killed my supply in an instant. I continued my pumping attempts for the duration of the event but never pumped more than half an ounce at a time and never bothered to have anyone come retrieve it. I was beyond depressed about it, but some nurses who were working the event tried to assure me my supply couldn’t go away that fast and that I’d still likely be able to nurse when I got home. Well, they were right, but not in a way that helped me. I did nurse Carlos for another week or so after the walk, but it was a rapid descent into being weaned. Simply, I was devastated. I reached out to Katie, who confirmed what the nurses had said about my supply. I’m sure she tried to make me feel better in a dozen different ways, but all I remember is her telling me my milk had probably been waning for a while and the nursing we’d been doing was probably more about emotional connection and less about physical nourishment. That translated to “you failed at this and didn’t even notice” in my head. I did a quick spiral into a dark place before asking Katie for help with what I had dubbed “postlactum depression.” It’s been 20 months since I stopped nursing my then 16-month-old son. In many ways, I am still not over it. I’m actually teary eyed as I write these last sentences. I’m not sure why it makes me so sad. At the most basic level, I was simply not ready. Not ready to let him go, not ready to accept him growing up, not ready for the next phase. I had just come home to be with my “baby” and all of the sudden I felt like he didn’t need me anymore. Even though we are incredibly close, I still miss those nights snuggled up together nursing in bed. When he was born, it had healed me of decades worth of heartbreak. But when I finally realized our nursing relationship was over, it was a worse heartbreak than I’d ever felt before. And today, as I nurse my new baby, I wonder how many of my “difficulties” nursing my daughter (aka somewhat irrational fears) are really just symptoms of my PTWD (post traumatic weaning disorder…yeah, I made that one up, too). I wonder if I will taint my nursing relationship with my daughter if I don’t get over how it all ended with my son. Though I’m still working on remembering that time with less anguish and sorrow, I have found some perspective. I am

21 grateful for the 16 months we had together in that phase of our relationship. And, while it hurt the most of all at the time, I am now most grateful for those last weeks of our nursing time together. I know he was humoring me and I appreciate that, because I needed it. v v v v v v v v v v v v v v v v v v v v v v v v

Don’t Rush It by Katie Madden

Have you ever caught yourself thinking, “I can’t wait until she can just_____.” Most of us have. I can’t wait until she smiles at me. I can’t wait until he starts eating solid food. I can’t wait until he sleeps through the night. Have you ever caught yourself thinking, “I can’t believe she is ______already.” I can’t believe she is smiling already. I can’t believe it is time to start solids! I can’t believe it is time to wean… As mothers, we are caught on a daily basis dreaming of what our child will be like in the future and wishing for things to get just a little easier. Simultaneously, we are also mourning the loss of our babies. They grow too fast. Do you look back and feel satisfied that you soaked up every moment of every stage, or do you long to go back to that time and pay closer attention? Based upon my recent “Girls’ Weekend” with Lucy, I have come up with a few ways to prevent rushing your time away. Wait. Before I go on, I want to clear something up. At Big Babies Group, it was brought to my attention that I seem to have my shit together. I know it seems like I know what I am doing because I have a blog and I know how to help women breastfeed, but the truth is, I am only a few steps ahead of you in this mothering game. I have no clue what I am doing with my seven-and-a-half-year-old and you better believe I am terrified and clueless about what comes next. My house is usually a mess, I drink too much coffee, I work way too much. I go through phases of eating well and exercising and phases of eating way too much ice cream on a constant basis. But, I forgive myself and I strive to be better everyday. I am human; I am flawed. Okay, now that we have that out of the way, read this advice and don’t think, “Why is Katie such a perfect mother?!” Rather, think, “I should try that.” 1. Put it away. Your phone, your iPad and your camera. Are you reading this blog while you are nursing? As your baby plays on the floor? As your husband sits next to you on his phone? When your baby is a newborn and you spend 12-16 hours a day breastfeeding, it is common for you to spend a lot of time on devices. Nursing can get really boring sometimes, so it is expected that you will rely on technology to get you through. But, make sure you know when to put it down. Make sure you look at your baby while she is nursing, especially if she is looking at you. Are you remembering to memorize the dimples on her knuckles? When is the last time your traced the swirl in his hair at the crown of his head? Have you let her fall asleep on your breast today, then just stared at her as that line of milk dribbles out of corner of her mouth? Once your baby starts crawling and walking, these snuggly moments become fewer and fewer. He will be way to busy to stay and snuggle after nursing. So hold him a few moments longer before you lay him down in bed.

22 2. Brag. A lot. Before you are on to the next thing, make sure you have properly acknowledged how awesome you are. Share this with everyone. One of my favorite things about the Pumpin’ Mama’s Private Facebook group and the Weaning Gracefully Facebook group is that it is a place where bragging is encouraged. Nowhere else will you get 20 likes for successfully pulling off a pumping session at a formal gala, for going eight hours overnight without breastfeeding, or for pumping four ounces after struggling for two weeks with a drop in milk supply. Here’s a brag from the Balanced Breastfeeding Facebook Page:

23 What do you have to brag about? You survived the first two weeks of your baby’s life! You survived the first six weeks of your baby’s life! You are breastfeeding! You are working and pumping! You nursed in public! You are nursing a toddler! You night weaned! You weaned completely with grace. Find someone to brag to. And do it often. (Me personally, I call my mom because the only thing she loves to hear about more than my successes is Lucy’s successes!) 3. Take it all in. Just breathe it in. Take a mental inventory of what is happening at any given moment. Use all five senses and really savor the moment. Don’t wish for tomorrow, don’t long for yesterday. Just relish in today. See? Not profound, just profoundly important. v v v v v v v v v v v v v v v v v v v v v v v v

Holes in the Plan: Learning to Trust Myself as a Mother by Kasey Stacey

My breastfeeding story is a story with a long, winding plot. It’s a story with some intense internal conflict and self-discovery. Mostly, though, my breastfeeding story is a story of relationships—with my son, of course, but also with my husband, with myself, with a kickass lactation consultant, with a group of supportive women, and, begrudgingly, with my breast pump. From well before I was married or pregnant, I had known that I would breastfeed my children. It is what the women in my community do, it is the best source of food for a baby, it is the ideal way to initiate bonding between mother and child, and it is what my breasts were made for. It was simple and clear and it would be easy. I would breastfeed my children just as all my friends and acquaintances do. I took Katie’s prenatal breastfeeding class at The Birth Center, but other than that, I didn’t do anything to prepare to breastfeed. Reproductively speaking, my body had always done exactly what it was supposed to do. I had no difficulties getting pregnant, I had a low-risk, relatively easy pregnancy, and I had wonderful natural birth more or less according to my birth plan. I’ve always seen breastfeeding as a natural extension of having a baby, so I assumed that I’d be able to nurse my baby right after birth with no problem. After he was born, Vincent was really sleepy. I hadn’t slept much in the days preceding my labor, so I was exhausted, too. Vincent didn’t latch right away, so we decided to let my husband hold him skin-to-skin while the midwife stitched me up from the birth. We tried intermittently during the post-partum stay at The Birth Center to get Vincent to nurse, but he kept falling asleep at my breast. I was too tired to push the issue, and I thought that he and I would both be more interested in the process after we got some much needed rest. Peggy, the post-partum nurse, tried to help Vincent to latch on, but he had his own agenda. My husband and I took Vincent home after a few pathetic half- latches, hoping that he’d fare better once we were settled in. Those first days at home are a bit of a blur now, but they were filled with failed attempts to get my son to nurse followed by my husband helping me to hand express whatever colostrum we could get and spoon-feeding Vincent. Every three hours, we would try again, and after a while I began to add a pumping session after hand expressing because I wanted to be sure that my milk would come

24 in. Peggy came to do our home visit a couple days after delivery, so we once again worked on Vincent’s latch, but we were largely unsuccessful. Peggy assured me that she’d get into contact with Katie and that we would figure out and fix the problem. I called the midwives to check in each day after delivery, and they said that they’d e-mail Katie on my behalf, as well. In desperation, I also sent Katie what would be the first of many ranting, frustrated, scared e-mails, begging for help with breastfeeding. Meanwhile, my husband had arranged an appointment for me with the lactation consultant at our son’s pediatrician’s office. As it turns out, Katie was violently ill the weekend my son was born. (She likes to tell the story of how she dragged herself out bed, shoving her face full of Immodium, to take her IBCLC recertification exam that weekend.) She responded to my e-mail a couple days later and we set up an appointment to “put breastfeeding back together.” I can’t express the relief and reassurance I felt when Katie responded to my e-mail. I had been devastated, convinced that I had ruined my chances at breastfeeding because when my milk transitioned from colostrum, I had started bottle-feeding Vincent what I pumped. Katie gave me confidence that we’d be able to save the nursing relationship that I so desperately wanted and had previously thought I’d have no problem developing with my son. When I met with Katie, Vincent had finally latched, albeit with a nipple shield. I had met with the other lactation consultant, and she instructed me to do my best to nurse Vincent without the shield, but I was hesitant. I had an abundance of milk and Vincent was eating like a champ. I felt that Vincent and I had finally made progress with nursing and she wanted me to start from scratch. I was five days post-partum, more exhausted than I have ever been in my life, and I just wanted to continue successfully feeding my son. I was starting to develop some nipple pain, but whatever. My son was nursing and life was getting better. I’m so, so glad that I didn’t cancel my appointment with Katie. Although Katie also encouraged me to ditch the nipple shield, her approach was entirely different. Katie explained that the nipple shield being too small was causing the pain that had developed; unfortunately, I was using the biggest nipple shield available, so the pain wouldn’t get better as long as I was using the shield. However, Katie let it be my choice to wean from the shield. I felt that we were coming up with a breastfeeding plan together. Katie also noticed that Vincent was taking a rather shallow latch, so she gave me some tips for getting him to take a wider, deeper latch that would be more comfortable for me. At the end of our appointment, Katie encouraged me to attend the Friday breastfeeding support group at The Birth Center and above all else, this may have been the best advice that Katie has ever given to me. The group has been my source of solace and comfort when breastfeeding has gotten really difficult as well as my source of camaraderie and friendship when breastfeeding is going really well. I almost didn’t go back after my first support group. Breastfeeding was going well and I felt terribly out of place. All these women had real problems, but at two weeks post-partum, I felt that I had gotten the hang of breastfeeding. My son was gaining weight beautifully, and although I had some nipple pain, it wasn’t anything that I couldn’t handle. I didn’t have breastfeeding problems and I didn’t think I needed support. Most of the other women in the room that week were dealing with low supply issues, and I was making enough milk for twins. I had no idea that low milk supply was such a prevalent problem. It was after this group that my paranoia about my own milk supply began. If all of these women struggled to make enough milk for their babies, could that happen to me? What if I woke up one morning and my milk had suddenly dried up? I feared that everything I had dreamed of for nurturing and nourishing my son for at least the first year of his life could suddenly be taken from me. I knew then and I know now that the fear is irrational, but I still can’t quite shake it. I kept going to support group because I like being at The Birth Center. My life changed irrevocably when I delivered my son there, and I didn’t want to let go of that experience and the people who were a part of it. After a couple weeks, though, breastfeeding had suddenly gotten really

25 difficult and I found myself needing Katie’s support and the support of the other women in the room. Even if no one else was experiencing my particular issue, they had had struggles, too. When I saw women with older babies, women who had overcome any number of problems and who really had gotten the hang of breastfeeding, I felt relief. There was clarity and enjoyment and peace of mind on the other side of this hardship. A bit of nipple soreness turned into excruciating pain. At three weeks post-partum, I had intense vasospasms. By week four, I thought my son was trying to chew my nipples off. I was sitting in the upper room at The Birth Center at new moms’ group one Wednesday when Katie came into the room to microwave her coffee. She casually asked how I was doing and I could only shake my head “no.” “I have holes on the sides of my nipples. Holes. I just don’t even know,” I told her. Katie looked at them and asked me to schedule an appointment with her. The damage was bad, she concluded, but I could overcome it. She gave me breast shells to wear around the house between nursing sessions, which would allow air to get to the nipples to speed the healing process. This would make the vasospasms worse, but vasospasms were now the least of my concerns. Weeks passed and my nipples were only getting worse. Every time they’d begin to heal, Vincent would pull the wounds back open again when he nursed. His latch was still terribly shallow and he acted like a puppy playing tug-of-war with my nipples as he nursed. Katie had suggested pumping for a little while to give my nipples a rest, but no part of me was interested in that. Despite the pain, I loved breastfeeding. I loved spending that time with my son, providing for his needs, and being his source of comfort. The thought of not having that relationship with Vincent, even if only for a short time, was heartbreaking. Also, I’m extremely lazy. As I told Katie, it’s way easier to breastfeed than to pump. I’d much rather clench my teeth and suffer through each nursing session than deal with an endless cycle of pumping, washing and sanitizing pump parts, feeding the baby pumped milk, washing and sanitizing bottles… No thanks. I remember the night I decided to follow Katie’s suggestion to pump, when my son was about seven weeks old. Vincent’s latch was more painful than ever, and for the first time, I cried out in pain. I sent Katie another of my crazy-lady 1:00 am e-mails asking her to help me come up with a pumping plan. I would pump some and nurse some, to see if those longer stretches without Vincent tearing up my nipples would allow healing to begin. This way, Vincent and I would still get to maintain our nursing relationship. It didn’t work. Despite the longer stretches between nursing sessions, the holes on my nipples were still getting wider and deeper. I was at moms’ group again when my right nipple bled for the first time. I knocked on Katie’s office door to show her the damage and we quickly came up with a plan. I would cease nursing on the right side altogether, pumping instead. I would nurse Vincent on the left and bottle-feed when I would have normally fed him on the right breast. Once the right side was healed, I would reverse the plan, feeding on the right and pumping on the left. I thought that it would take maybe a week to heal each nipple, but no. The hole on the right side was deep and since it had to heal from the inside out, it took a while to completely scar over. Meanwhile, the left side was still getting worse. Desperate to heal and feeling defeated, I decided to primarily pump both sides. I would nurse only twice a day, just so that Vincent remembered how to eat from my breasts. I pumped both sides eight times a day, including in the middle of the night. My son was sleeping through the night, but I was setting alarms and getting out of bed to pump. Paranoid about my milk supply, I would pump until my milk stopped flowing and then let the pump run for an additional five minutes in order to stimulate a second let-down. I was miserable. I wasn’t getting much sleep; it was like the first two weeks post-partum all over again. I was spending four hours each day hooked up to my pump and then additional time washing and sanitizing the parts. Since we were barely nursing, I felt disconnected from my son. I had

26 rather suddenly taken away his primary source of comfort, and he began having periods of fussiness and I didn’t know how to soothe him. I was devastated and exhausted and I wasn’t sure if this was ever going to end. My nipples were finally healing, but much more slowly than I had anticipated. I hated that damned pump. It took over my life. I couldn’t leave my home without worrying about when I’d have to pump next, how I’d manage to pump in some strange location, how many bottles to bring, and how long it would be until the pumped milk spoiled. I certainly couldn’t go out without bringing my husband, my mom, or my sister with me so that someone could hold the baby while I pumped. My days were structured around pumping and washing and agonizing over quantities of milk. I wanted to crawl into a dark hole and, if not die, at least get a solid stretch of sleep before reemerging. But I’m grateful for my pump. I love my pump. I am fortunate to have a high quality double electric pump. Twice now, the pump has saved my ability to breastfeed my son, and for that, I am thankful. While working through the nipple pain, Katie and I tried to figure out the cause of the trauma. Katie’s theory was that I had a ton of milk, causing Vincent to take a shallow latch in order to regulate the amount of milk he was getting when he nursed. Additionally, I had had flat nipples with adhesions, so early on, Vincent had pulled out my nipples and they had sort of split on the sides, causing the holes to develop. Because his latch was so shallow, the tears could never heal; nursing was causing constant friction on the site of the trauma. The new goal, then, was to teach Vincent to take more of my breast when he latched so that I wouldn’t have a resurgence of damage after the original wounds had healed. I tried, but he wouldn’t do it. When Vincent was nine weeks old, Katie asked to check the anatomy of Vincent’s mouth again. She had checked it at our first appointment because when he was born, the midwife said that he had a posterior tongue-tie—very slight, nothing to worry about, we all thought. At support group that week, one of the other moms also happened to be a speech-language pathologist who worked with babies in the NICU who had trouble latching. After Katie examined Vincent’s mouth, she asked this woman to take a look. The SLP found that Vincent had little lateral motion of his tongue due to the posterior tie. Katie referred me to a pediatric otolaryngologist, so I took Vincent to have his tongue-tie evaluated early the following week. When I reported that Vincent tended to tuck in his upper lip when he latched, the ENT recommended not only a frenotomy of the tongue, but also of the upper lip. He couldn’t promise that these procedures would fix breastfeeding, but it would at least give Vincent the proper anatomy to do what we had tried to make him do all along. A few weeks after the frenotomies, I begged Katie to tell me that I could wean myself from the pump. I was pretty well healed on both sides, Vincent had the ability to latch better, and I needed some normality in my life. Once I offered Vincent the breast more often, he decided that he was done with bottles, so we have returned to our former nursing relationship. For the first time, nursing is comfortable more often than it is uncomfortable. I can’t say that we won’t have more hiccups in the future, but I’m feeling pretty good about breastfeeding these days. Katie has been a Godsend. I was determined to make breastfeeding work, but without Katie, I don’t know how I would have been able to do that. Katie’s ability to evaluate my situation and help me to make plans to improve it has been invaluable. One thing I value most about Katie, though, is that

27 she doesn’t demand. She doesn’t come up with plans and insist that they are followed. Katie listens, draws on her experience to assess, and makes suggestions. Every path that I have taken on this breastfeeding journey has been my decision. Katie is part friend, part mentor, and part therapist, and I am blessed to have her in my life. I think I’ll continue to send her e-mails at one o’clock in the morning just to say, “Hey. Everything’s going great. Thank you.” My breastfeeding story wouldn’t be complete without mentioning my husband, Mike. At support group, we occasionally talk about how husbands don’t always “get” breastfeeding. They’re supportive, but they sometimes say things that are inadvertently more hurtful than helpful. And how can we expect them to “get” it? Breastfeeding is something that fathers will never do. I’m fortunate, though. My husband is not only supportive of breastfeeding because it’s good for the baby, but he understands how important breastfeeding is to me. In those first few days, he fought for my ability to breastfeed when I was too out of sorts to do it myself. He scheduled and drove me to appointments, he hand expressed my colostrum, and he made sure that both the baby and I were awake to nurse every three hours. He sympathizes with how difficult pumping is, he empathizes in my hatred of the pump, and he values the relationship that I’m able to develop with our son. He celebrates my breastfeeding victories and he struggles when I encounter challenges. He recently asked me if breastfeeding still hurts. I saw the glint in his eye when I told him that it doesn’t really. I love that he can be excited for me, even though he can’t directly experience breastfeeding. As I continue to breastfeed instead of pump, I can no longer see how much milk I’m making, so I’m learning to trust my body; I grew this baby and I have the ability to make plenty of milk to feed him. I’m blessed to be able to do so and while I never want to take it for granted, I know that I need to let go of my irrational fears. I’m growing into my role as a mother, and breastfeeding has been a vital part of that growth. I’ve never known a love like the love I feel for my son. I love the connection that we have. I love when he stares into my eyes while he’s eating, when he looks up at me and smiles. I love when he’s nursing and he wraps his little arms around my breasts, almost as if he’s guarding them. I love when he falls asleep at the breast; in my arms, he feels safe and comfortable. I will be so sad when the inevitable day comes that Vincent weans. Through breastfeeding, I’m learning the true meaning of sacrifice. Motherhood requires complete self-sacrifice. During pregnancy I sacrificed my body to grow my son in my womb and now I sacrifice my body to feed him. As he grows, he’ll need my physical sacrifices less and less, but his needs and well-being will always come ahead of my own. Love is sacrificial, breastfeeding is sacrificial, and I am so thankful that I’ve been able to begin my journey through motherhood by nursing my son.

A Response to Kasey’s Story by Katie Madden

Kasey is right. Breastfeeding is sacrificial. Breastfeeding means being willing to give of yourself completely to another person whom you have just met, but you feel like you have know all your life. Here’s what I know about Kasey. Kasey is one of the most stubborn, determined, and selfless women I have not only worked with, but known. I have seen some seriously jacked up nipples in my ten years of helping women breastfeed, but Kasey’s rank in the top five. They were bad. There are a

28 few specific memories I have of Kasey that I will never forget; memories that will forever remind me that when a woman gives her one hundred percent to breastfeeding, I give my hundred percent, too. 1. Kasey has always loved breastfeeding. At support group, I often ask the question, “Who loves breastfeeding?” to prove the point that very few women with babies younger than 12 weeks love breastfeeding. Some hate it, some endure it, some like it sometimes. But, oftentimes, it isn’t until 10-12 weeks that a woman falls in love with breastfeeding. So, I asked this question of the group and Kasey was one of three women in a room of more than 20 who raised her hand. Now, I can’t remember what horrific stage of breastfeeding she was in, but Kasey was at some point of enduring the pain of what she calls “holes” in her nipples. They were like canker sores, one on each nipple. But, despite that pain, she never stopped loving breastfeeding. 2. Kasey always told me the truth about what she was and was not willing to do. Kasey knows herself really well and she owns who she is. She let me know she is lazy and wasn’t all that interested in pumping to heal her nipple canker sores. Eventually, the pain got so bad that she had no other choice. The fact that she had told me that she was “lazy” (I beg to differ, by the way), helped me to really empathize with her as she struggled through pumping and bottle-feeding. We were able to tweak breastfeeding plans together nearly weekly because she would tell me what was working and what wasn’t. She was transparent and honest, not a martyr following instructions simply because I told her to. 3. Kasey is forgiving and understanding of the process. I practically sat up in bed one night and realized Vinny had a posterior tongue-tie and possible upper lip tie. I thought about Kasey’s nipples a lot. That sounds really weird, but cases like hers haunt me until they are solved. I believe deep down in my soul that severe nipple pain and trauma is never normal in breastfeeding. Kasey had been pumping for weeks at this point and the time was approaching that we would re-introduce Vinny to the breast and I was petrified that the wounds would just reopen. Sure, my adhesions theory made sense, but it wasn’t enough for me. There had to be another reason why Kasey’s nipples were so badly damaged. So, the next day, I looked at Vinny’s mouth again. Posterior tongue-ties are tricky, as are upper lip ties. It has been only in the past few months that I have found a physician I really trusted to refer these cases to. As a nurse first, I will admit I am apprehensive to refer a baby to have a release of a posterior tongue-tie or upper lip tie without a compelling reason. It is a relatively new elective procedure and although there is little risk involved, it can be upsetting to mom and baby. It isn’t a quick fix and often the breastfeeding issue is multifaceted. I missed Vinny’s tongue-tie. I waited too long. I am frustrated knowing that if I had acted just a little sooner, I could have saved Kasey even a little of the pain and trauma she endured. Maybe. Maybe not, since there were other factors at work, but I am not ashamed to say I made a mistake. I am not too proud. Every mama and baby teaches me something new about breastfeeding and about myself. Over the past few months, thanks to Kasey’s case and a few other key cases, I am much quicker to refer a baby to have his mouth evaluated if I suspect there is limited range of motion in his tongue or upper lip. The results have been really great. So, although Kasey endured way too many weeks of discomfort, she has paved the way for so many of the mothers I will see in the future.

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29 About the Author

I’m Katie Madden RN, BSN, IBCLC & founder of Balanced Breastfeeding.

I teach new mothers to breastfeed with confidence so they can enjoy their nursing relationship without pain, exhaustion, or fear. I have almost ten years of experience helping women learn to be mothers through breastfeeding. It is my passion and my gift. I have a knack for making breastfeeding work and building a mother’s confidence. I believe that breastfeeding is about balance. There is no one right or wrong way to breastfeed your baby. It is my job to help you meet your breastfeeding goals. I have the privilege of providing private in-person consultations at The Birth Center in Wilmington, Delaware, where I also teach breastfeeding classes and lead a number of free breastfeeding support groups throughout the month. I was born and raised in Maryland but currently reside with my husband and eight-year-old daughter in Pennsylvania. I was given the gift of breastfeeding my daughter Lucy for almost three years. This experience changed how I care for women and how I care for myself. It was life altering and powerful; everyone should have the opportunity to experience it. Balanced Breastfeeding was born out of my desire to reach more women all over the world. The Internet is an overwhelming and often misleading place for a breastfeeding mother. Balanced Breastfeeding gives you a place to learn simple, implementable lessons about breastfeeding in a way that is not overwhelming while building a community with like minded women, all under the guidance of a skilled, seasoned Board Certified Lactation Consultant—me!

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