Michelle Duff: When breastfeeding sucks

I knew there could be the odd hiccup, but it was worth persevering. Photo / iStock
I knew there could be the odd hiccup, but it was worth persevering. Photo / iStock

There is nothing lonelier than sitting half-naked on a couch at 4am, trying to feed a newborn baby. A month ago I was saying goodbye to colleagues, accepting flowers and revelling in the anticipation of late-pregnancy. Now here I was, milk-stained pyjamas around my waist, trying for the tenth time to get my baby's tiny mouth to close around my nipple in a way that didn't cause agonising pain. You might know the lingo: all the midwives say it's about getting a good "latch," or positioning the baby in such a way that it can suck efficiently and you're both comfortable.

I had read all the breastfeeding guidelines. I had watched instructional videos. I had sat up late into the night, bleary-eyed, reading page after page of advice. Breastfeeding is possible for anyone, the articles said. It's the most natural way to feed your baby. Breast is best!

I cuddled my baby close, as the advice suggested. The pain was instant. I likened it to being cut, but maybe a friend put it better; it's like someone is trying to sandpaper your nipples off. "Ahhh," I cursed under my breath, as my husband walked in to the room.

"Are you okay?" He asked.

"No," I said, through tears. "No, I'm really not."

I never thought I'd be writing about my boobs in a weekend publication, but I also never considered I would not be able to breastfeed. Like every expectant mother, I was left in no doubt about how important it was - by my midwife, the antenatal class, the posters at the hospital, from the image of Angelina Jolie smiling beatifically in W Magazine, in the news stories and Facebook shares about the benefits of breast milk.

Oh, sure, I knew there could be the odd hiccup, but it was worth persevering. The World Health Organisation recommends babies are exclusively breastfed for the first six months of life - this means no supplementary formula, water or solid food - a target adopted by our own Government, which then recommends continuing to breastfeed alongside solid food for 12 months.

Magazine images of Angelina Jolie smiling beatifically while breastfeeding and widespread advocacy of the practice do
nothing to help mums struggling to feed their babies. Photo / W Magazine
Magazine images of Angelina Jolie smiling beatifically while breastfeeding and widespread advocacy of the practice do nothing to help mums struggling to feed their babies. Photo / W Magazine

The list of direct health benefits cited by the Health Ministry include: protection against colds, tummy bugs, infections, allergies, obesity and SIDS, with the added advantages of helping your baby to feel safe and secure, and giving the mother a chance to rest and connect with their baby. And of course, it's free.

Only, now I know it's not. Breastfeeding can, in fact, be costly. In a new book, Lactivism (how feminists and fundamentalists, hippies and yuppies, and physicians and politicians made breastfeeding big business and bad policy) and more recently a New York Times opinion piece, University of Toronto political scientist Courtney Jung outlines the reasons why. Breastfeeding, she says, has undergone a cultural shift. Ironically, in a society where wet nurses were once commonplace, breastfeeding is now an indicator of financial or professional success, and used as a means to distinguish good from bad parents. It's seen as both wholesome and hip, but "only women who have the luxury of time or job flexibility can enjoy the full health benefits," she writes. In the United States, as in New Zealand, this largely means affluent, well-educated, white women.

"As a new mother, I was surprised at how much people were invested in infant feeding, and how they felt within their rights to voice their opinions as to how I should feed my child," Jung tells me over the phone. "It was the relentless moral fervour about breastfeeding, and I just thought, how did we get to this point? Especially since the imperative to breastfeed exclusively for six months is really only possible if you are a stay-at-home mother. And then there's this false notion everyone can do it, which is completely untrue, but the insinuation is you're simply not trying hard enough, you're doing something wrong."

What's more, Jung says, the actual proven health benefits of breastfeeding are much less impressive than popular culture would have you believe.

"I assumed the science was the science, and it was out there and would show breastfeeding was critically important to infant development. I read hundreds of journal studies and I was surprised to find how much of the evidence was seen as weak and outdated."

The most recent research, published in medical journals like Pediatrics and the British Medical Journal, has found that the effects of breastfeeding are positive but "modest", and not life-defining. Jung, who spent countless hours breastfeeding both her children, said her heart sank as she read study after study.

My son was now two weeks old and I still couldn't breastfeed without pain. I was failing. Feeding my baby was my job, and I was sucking at it. At Auckland Hospital, multiple midwives and a lactation consultant (yes, this is a profession) had shown me how it should work. Some of them asked to touch my breasts; many didn't, grabbing a handful of boob and hooking my baby's mouth around it as if it were a fish.

Newborns eat a lot. Sometimes it's every 90 minutes, sometimes it's three times an hour. I came to dread each feeding. When I looked down at my son, it wasn't with the look of unconditional love you see on all the posters; it was with an "oh man, that hurts". Eventually it was too sore to feed on one side at all, so I used a breast pump to extract milk. My husband and I then took turns feeding our son with a syringe - apparently if you give a baby a bottle too early it can cause something called "nipple confusion" and they might decide never to go back to the breast. Our house looked like a scene from Trainspotting. I went to the Plunket drop-in centre to see another lactation consultant, who looked at my breast and said, encouragingly: "It doesn't look too bad. At least you still have your nipple."

Um, sorry? Women will continue to do this when their nipples are literally tearing off? "Yes, I've seen much worse than you. And bleeding is quite common. Don't worry, milk with blood in it is quite safe for the baby," she said. A young, male medical student on work experience sat there with his mouth open.

If breastfeeding comes easily, it can be relatively straightforward, if very restrictive - at least eight hours a day (and hours of the night) spent sitting down. But the only way you're going to achieve the six recommended months is if you can afford to. New Zealand's paid parental leave is 16 weeks. A working mother could, theoretically, breastfeed for six months if she lugged a breast pump to work and sat in a room for 20 minutes every three hours during her working day to pump.

That's assuming there's a space to pump. While the Employment Relations Amendment Act requires employers to provide "appropriate facilities," interpretations of this can vary greatly. A friend who went back to work when her son was 4 months old was left wondering if it was worth the stress after being forced to pump in a working studio.

"I was told I couldn't reserve the only room available for pumping (it was only room with curtains so you couldn't peer in) so sometimes I'd go there five times, at bursting point with breasts aching, but I'd have to wait. Once I got in there I'd have to put a sign up and face away from the door, knowing that anyone could walk in and find a pump up my top," she says. "Even storing the milk was an issue ... one colleague gave me a horrified, disgusted face when she heard I kept breastmilk in the work fridge (sealed in a plastic bag away from other people's food). Although my employer was supportive in allowing mums to pump, many bosses don't know what this means in a practical sense: a private room with a lock that can be booked for expressing milk. If paid maternity leave was extended to six months I would have waited to return - but the bills needed to be paid."

Mother and marketing professional Jo Payton went through "hell" breastfeeding her three children, Gracie, now 10, Ella, 8 and Finn, 6.

"In all, I fed for about three years and every time it wasn't easy. For me, giving birth was a walk in the park compared to the pain of breastfeeding, and I wish I'd been more prepared.

"I sort of thought I'd be one of those women like in a Timotei ad, breastfeeding with the wind in my hair in a paddock. But it wasn't like that at all. It was agony. I remember it like knife blades down my back, with my husband rubbing my shoulders and me crying and saying 'this is not how it's meant to be'. I felt like I wasn't trying hard enough. You sit there with everything off and milk squirting everywhere, trying to get the right latch. And it's the most isolating thing - trying to feed eight times a day with cracked and bruised and bleeding nipples."

She ended up feeding all three children with a mixture of formula and breastmilk, but wished she had known from the start that giving her child a bottle wasn't the end of the world.

"I think when you're not coping, and hurting, and there's this overwhelming pressure to keep breastfeeding, it's misinformation and it's not helpful. The mother needs to be rested and not hurting, you just have to feed your baby and it doesn't matter how. I think it was just stubborn determination that got me through."

For Jo Payton (above with niece Milly Mussett), breastfeeding Fynn and his big sisters Gracie and Ella meant months 
of painful perseverance.
For Jo Payton (above with niece Milly Mussett), breastfeeding Fynn and his big sisters Gracie and Ella meant months of painful perseverance.

For me, nothing was working. I saw another lactation consultant who told me to pump around the clock until I healed. For a month, I strapped an electric double breast pump to my chest every three hours. One summer I had worked on a dairy farm; my bedroom was now my personal milking shed.

I got mastitis, an illness not just reserved for cows. It felt like there was a small volcano in my chest. My mum flew up from Manawatu to help, since feeding was a two-person job and my husband was back at work. A midwife came round and found me surrounded by pumping paraphernalia, exhausted, with my baby asleep on my lap. "Have you been going out and meeting any other mums?" she asked.

I looked at her incredulously. "Um, no," I said. "All I'm doing is pumping and feeding, I can't go anywhere." She looked back with concern. "Do you think you have post-natal depression?"

I had health insurance, so made an appointment with a specialist to see if my son had a tongue tie. This is where the tongue is attached so tightly to the bottom of the mouth that it makes it difficult for the baby to lift it up and suck properly. The specialist said there was a slight tongue tie. He snipped it, and I paid to see yet another lactation consultant for follow-up care. I started to try and feed him from my breast again. It still hurt, but it wasn't excruciating. Going out in public, though, was terrifying. If I couldn't get him to latch right, there was a tussle while we tried again, with him crying, milk spraying everywhere, and me trying not to grimace. I got a bacterial infection from an open wound on my nipple, and another doctor prescribed me an antibiotic. "Breastmilk really is the best way to feed your baby," he said, as I gingerly did up my bra.

When my son was about 3 months old, it suddenly stopped hurting so much. Eventually it even started to become quite enjoyable. I had done it! I was breastfeeding. I deserved, as a health professional I related my story to later told me, a gold star.

But the more I thought about it, the more I thought: stuff your star. At no point had any of the multiple doctors, midwives, or lactation consultants I saw, many while I was in tears, suggested to me that there was another way. I worked out the cost; apart from three months of my son's life spent in a painful stupor, I also spent $200 on bottles, a manual breast pump, and sterilising solution; $300 on electric breast pump hire and accessories; $275 on the ear, nose and throat specialist bill that wasn't covered by insurance; $90 on the private lactation consultant; $200 on flying up my mum to help; $200 on nursing clothes; $150 seeing GPs and $100 on plastic nipple shields and various creams, ointments and gel breast pads designed to stop the pain. That's close to $1500.

The majority of women will not have as much physical trouble as I did. I couldn't find any research into how many New Zealand women encounter problems, but lactation consultants are now commonplace in hospitals nationwide. In my antenatal class of eight women, four had some kind of pain-related issue that required stopping for at least some of the time, and using a combination of breast pumps, nipple shields and supplementing with formula.

One woman, herself a healthcare worker, suffered 10 weeks of mastitis and inflamed nipples as she continued to try breastfeeding a tiny boy who was losing more and more weight. "It was mentally a huge toll, when I realised I couldn't feed my baby enough milk and he couldn't latch properly. I often ended up in tears having tried unsuccessfully to breast feed yet again and ended up with a bottle in his mouth," she says. "It was particularly difficult when fellow healthcare providers were very judgmental when they saw I was formula-feeding without understanding the path I'd come."

Despite the pressure to exclusively breastfeed, in reaching the target of six months I am in a minority. The latest Plunket figures show 17 per cent of women are exclusively breastfeeding at six months. Other figures put it at less than this - the Growing Up in New Zealand study, the country's largest study of a group of children, will follow nearly 7000 babies until they are young adults. The latest results found more than 90 per cent of mothers had stopped exclusive breastfeeding by six months, and most had stopped by four.

Study director Dr Susan Morton says the official recommendation might be unrealistic, and "set mothers up to fail".

"The policy is based on very good guidelines, but what we have found when speaking to these families is for most women it's not possible," Morton says. "If you look at the difference between the policy and the reality, it makes us question what should we be saying to mums - how can we support them to do what's best for their baby?

"If women are able to do it that's great, but what we don't want is mothers to feel like they are failing. It would be better to look at the whole environment, the mum and the baby, the stressors and their mental health. Sometimes the pressure of 'there's only one way' creates more tensions for mums at a time when they should be bonding with their new baby."

The New Zealand Breastfeeding Alliance, an advocacy group with more than 30 stakeholders, says 85 per cent of women initiate breastfeeding in hospital. But by three months, this has dropped to just over half and at six months, they put the figure at 25 per cent.

NZBA executive officer Julie Stufkens says the organisation attributes the drop in breastfeeding mums to their need to go back to work. It put in a submission to the Government to increase maternity leave to 26 weeks, with no success.

But if so many women aren't able to breastfeed to the guidelines, why aren't women given more information about mixed feeding - i.e. feeding with a combination of breast milk and formula - or formula feeding, if it works best for them and their family?

While the NZBA states it will support women in whatever they choose to do, Stufkens says the longer women can exclusively breastfeed, the better. Just one bottle of formula will change a baby's gut bacteria, making them more susceptible to infection.

Rachel Rankin decided from the start her baby would have a better start in life by being bottle-fed.
Rachel Rankin decided from the start her baby would have a better start in life by being bottle-fed.

How much of a difference does it make though? "It is significant," she says. "We're not about making people feel guilty and I understand some women can't continue. But I do think if we work to make sure women are well supported, they will breastfeed for longer."

When asked if the ministry felt it was practical to promote six months' exclusive breastfeeding as the best option when paid parental leave in New Zealand is only 16 weeks, a spokeswoman said ministries do not comment on the merits of legislation. In a written statement, the chief adviser of child and youth health, Dr Pat Tuohy, says the Ministry of Health continues to strongly support breastfeeding as a key promoter and indicator of child health. "Through our own work and through the work of the wider health sector, the ministry will continue to convey the important messages surrounding breastfeeding to women throughout New Zealand."

Despite the fact many women will be at least partially formula-feeding by the time their baby is 3 months old, mothers who do are subject to public judgement.

Palmerston North mother Rachel Rankin chose to not breastfeed for a number of reasons including that she had diabetes and wasn't confident her diet would be good enough to nutritionally sustain her baby boy. "I just thought, when I have a new baby is this something I want to be worried about? People were quite shocked about it and asked why. I think they assumed I was uneducated and didn't know the benefits of breastfeeding."

After a difficult birth, requiring another week of hospitalisation, Rankin was asked many times a day by midwives if she wanted to breastfeed. "I know they thought it would give my baby the best start in life, but I think the best start in life is Mum being comfortable and able to think she's making the right decision for her situation, whatever that is. After childbirth you're not yourself, and you're going through all these emotions, and you don't need people judging you."

Now, Rankin has her retorts ready. Recently, she was approached by a stranger who stuck her head in the pram. "Oh bubba, you have to have a bottle, is mum not breastfeeding?" she asked. Rankin replied with a straight face. "Oh no, his biological mum died giving birth."

Rankin laughs. "I just couldn't help myself. It was none of her business."

Maybe that's the point. I am still breastfeeding, and now I mostly enjoy it. It's convenient, it's warm, intimate and, after everything I went through, I still think it was worth it - for me, who could afford to perservere and who can work from home. But if you can't, or don't want to, there should be no guilt. It's your choice.

- Canvas

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