Family Medicine Vital Signs

There was never any question in my mind that I would breastfeed my children.  Not only did it seem to be logically the most natural and nutritive way to feed them, I looked forward to experiencing the profound bonding experience that was promised, the deep satisfaction of knowing that my body produced everything my baby needed to stay alive.  My formal medical education on the subject, which was limited to a single lecture by a devout breastfeeding enthusiast, only pushed me farther into my resolve.   When I found out, at 9 weeks into my pregnancy, that I was carrying not one, but two babies, I dug my heels in harder.  “I have two breasts!”  “Breastfeeding is about supply and demand!”  I knew that some women struggled with breastfeeding, but I would not be one of those women.

 

When my water broke at just shy of 36 weeks and I underwent cesarean section for breech presentation, I was unwavering in my commitment. I met the in-house lactation consultant before my surgery, my daughters were placed on my chest in the recovery room to nurse within an hour of their birth.  On our first night in the hospital, however, both my daughters began to experience episodes of apnea, typical of premature babies.  They were moved to the NICU for continuous monitoring, with a promise from the nursing staff that they would be brought back to my room for feedings.

 

The nurses dutifully wheeled my tiny babies with what seemed like an endlessly increasing entourage of medical accessories to my room every 2-3 hours.  First a sensor placed on their little feet to measure oxygen saturation and monitor for episodes of apnea, then a tiny IV to stabilize their blood sugars, and finally, two nasogastric tubes because my babies were not getting enough to eat.

 

I was crushed.  My husband began to make runs to and from the local milk bank where we would eventually spend over $1000 in donor breast milk.  I set alarms for every three hours and went to the NICU to try to nurse my girls. I pumped every three hours, two hours and then every hour for days.  The lactation consultant taught me how to express milk by smashing my breasts against the pump flanges.  My hands ached from squeezing, my back ached from slouching, and my heart ached with the looming sense of unavoidable failure.

 

Finally, after my husband and I had been boarding in the hospital for over a week the lactation consultant sat us down, reassured us that we were doing everything properly and then told us, “You know you don’t have to do this, right?”  I think back to that conversation now and recall how we expressed our appreciation for her support but explained that I needed to continue trying to make sure that I could say that I had done everything possible.

 

What will make me sad forever is the weeks that followed.  I truly missed out on the first 6 weeks of my daughters’ lives because of the pressure I put on myself to breastfeed.  While my mother and husband were caring for my daughters, I was alone in a bedroom crushing my breasts for 45 minutes at a time just to provide the greatest percentage of breast milk possible.  When they started gaining weight and then sleeping longer at night, I still set alarms to pump every two hours.  I was exhausted, lonely and incredibly sad.  Instead of holding my babies, I was holding my breast to a pump.

 

Several weeks ago, a lactation consultant spoke to our residency program about “Maternal-Infant Health.”  Unsurprisingly, the vast majority of the lecture was devoted to singing the praises about breastfeeding.  I watched with frustration as my classmates—the majority of whom are not parents—nodded in agreement with the familiar claims of superiority.  They didn’t question the validity of the statistics; they didn’t ask about the number needed to treat in studies claiming that exclusive breastfeeding prevents upper respiratory infection and diarrheal illness; they didn’t analyze the cost-benefit ratio of lost hours of work or sleep on maternal psyche.   Why would they? To someone who has never witnessed a true breastfeeding struggle, it is an obvious choice.

 

The lecturer concluded with a plea that we, as primary care physicians, not underestimate our influence in a mother’s decision to pursue exclusive breastfeeding.  She isn’t wrong.  My turning point came at my daughters’ two month well baby check when we were finally able to see our chosen pediatrician.  When she asked how we were feeding the girls and I replied that I was pumping and supplementing with formula because I just couldn’t make enough for two babies, her face changed into an expression of sincere empathy.

 

“You probably feel like you’ve already failed as a parent, but you haven’t.  I know because I felt the same way.  You are feeding your babies and you are doing a great job.  They are growing just as they should.  You know they are going to be just fine, right?”

 

I will never forget that appointment.  My relationship with my daughters, my body and my doctor changed that day.  I began to focus on the myriad opportunities I am afforded every day to help my daughters be healthy and successful, only a handful of which involve food in any form.  I continued to pump, but prioritized my mental health, my sleep and my relationships with my daughters and my husband over my pumping log.  Today, my daughters are happy, smart, healthy toddlers with fantastic immune systems who love to eat everything from roasted vegetables to Thai curry.

 

I am sharing my story as a background to my own entreaty of my colleagues who take care of new mothers and babies.  Please, take the time to educate yourself on the full scope of breastfeeding research.  Be analytical and diligent in recognizing bias and confounding.  Do not accept the enthusiastic pop statistics at face value because it is easy. Above all, help me to shift our mission as healthcare providers from encouraging new mothers to breastfeed to encouraging new mothers, period.  New parenthood is one of the rawest, most uncertain and vulnerable stages of life for many.  Go ahead and have the breastfeeding conversation with your patient—but listen more than you talk, validate whatever experience your patient is having and most importantly, make sure your patient feels supported before she leaves.  Your patient-physician relationship and clearly expressed dedication to help a family through these difficult early stages regardless of feeding choice will do worlds more for a child’s long-term health than a few ounces of breast milk.

Rachel Goossen, MD is an Intern Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.