Showing posts with label breastfeeding. Show all posts
Showing posts with label breastfeeding. Show all posts

Monday, February 29, 2016

Because I Hated Every Second of Breastfeeding

Genmedmom here.

There have been many times when I have struggled to empathize with the patient. There are certain healthcare issues, and certain patients, that I have found consistently frustrating over the years.

I've written about this, and been pretty well chastised by readers. I don't mind, because I know that 99% of physicians have their kryptonite issues, and just don't talk about it. I'll take the heat for being honest.

My kryptonite issue has been obesity. I admit, that for many a patient encounter, I've sat there and counseled (for the millionth time) on diet, and exercise, and priorities, and wondered to myself: Why can't you do this? Why can't you just lose weight?

I know that sounds terrible. Heck, it IS terrible. My bias is based on my own experience: I gained sixty pounds in my first pregnancy, and fifty in my second. The weight didn't come off postpartum, and I found myself obese. BMI 30. I dedicated what precious little time I had as a working mom to eating healthy and exercising, and I lost it all. It took two years. It was hard. There were ups and downs. I've written endlessly about it here, and here, and here....

Of course I know that it is totally and utterly unfair to think "Well, if I could do it, why can't you?" but truth is, that's a pretty natural way to think, and many of us think like that.

So I've been making a conscientious effort to do better, to let go of the bias, and the frustration, and meet people where they are, no matter what the medical issue is.

But it was only when I was sitting with a lovely young patient of mine who was upset, grieving, actually, that she had been unable to breastfeed her infant, that I had a real breakthrough.

This poor woman had had a complicated pregnancy and delivery. Nothing had gone the way she had planned. But she held on and held it together, because she knew that if her baby survived, she would do everything right. She would take THE BEST care of this baby. She was determined to breastfeed for a full year. It had never occurred to her that that might not happen.

There were problems with the latch, with the milk supply, with pain, with baby's growth. Still, she was determined. She got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera... for weeks.

But one day when she had spent an hour and a half with the industrial-grade pump and got only about a teaspoon of breastmilk, with her nipples raw and bleeding, with her infant screaming, starving, with the pediatrician's concerns about his growth, with her consultants saying "Just push through! Keep trying!" for the gazillionth time but without any other real suggestions, and without any progress, she broke down.

She gave up.

So the baby got formula. And did fine. And grew. And she thought this burden was lifted from her.

Until the judgments came.

She was part of a social circle that especially valued breastfeeding. Friends and family would comment, say, "Don't you know breast milk is best?" or "Well, if you had only tried X, I bet it would have worked" or "If you had only HUNG ON a little bit longer" or "Those doctors pushed you towards formula, those doctors always push the formula, you shouldn't have listened" et cetera, et cetera.

It got to the point that she hid bottles and formula, or avoided socializing altogether. She felt like a freak, a failure. She worried what awful consequences there might be for her baby. She waited for some severe illness to befell her son, and for someone to blame it on her.

Oh, my heart went out to her.

Flashback. I was pregnant with Babyboy (now five and a half years old). I had a three-page birth plan outlining my natural vaginal delivery. I had a doula. I had Ina May's books on childbirth and Nancy Mohrbacher's books on breastfeeding. I had secured a highly-rated lactation consultant and booked a consult with her BEFORE the baby was born. I bought Medela breastmilk bags and a plastic organizer for the freezer. I arranged a breastfeeding room in my office.

But there were complications. The delivery- that's a story for another day. Emergency C-section for deep transverse arrest. Bradycardia. Meconium. Mayhem. I was discharged with a hematocrit of 22.

Babyboy was fine, but I grieved the loss of my dream birth. I was determined to get breastfeeding right: I wanted to breastfeed for a full year.

But. There were problems with the latch, with the milk supply, with pain, with baby's growth. I was still determined. I got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera.

Miraculously, I was able to breastfeed for a full three months.

But, I hated every single second of it.

When it got close to feeding time, I would inwardly cringe. With his latch, I would outwardly gasp, and clench my teeth in pain. The doula and the lactation consultants gave up on me. It was a nurse practitioner at Babyboy's pediatrician's office who suggested APNO (All-purpose-nipple-ointment), and it was an OB/GYN who prescribed it for me. The APNO cream helped a bit, and it got me through the three months, though nothing really helped.

Inevitably, what would come to mind with EVERY feeding were images:

Of glass-shard covered twine being pulled out of my breasts through my nipples.

Of someone pouring acid over my areolae.

Of my baby with little piranha teeth and malevolent intentions.

Oh, I hated it, and I hated myself for hating it. Wasn't breastfeeding supposed to be this wonderful bonding experience? I would rock and cry, literally cry, while stroking my baby's forehead and begging forgiveness, because I could not WAIT for this to be over.

So when it came time to go back to work, I started on a combined oral contraceptive and took Benadryl, and let that milk supply dry right up. Worked like a charm. I was done. It was such a relief.

When I told my colleagues I would not be needing that breastfeeding room, I got some eyebrow raises, but no one questioned. Many of them had made similar decisions for different reasons.

Most of my friends were understanding (very different social circle from my patient-mom) and for that I was very grateful. As a matter of fact, people came out of the woodwork with their own breastfeeding difficulty stories. I was not only NOT the only person who had struggled, I was not the only person who hadn't enjoyed it, and I was not the only person who had guilt about that.

Yes, there were a few "judgy" moments. People I didn't know well, and luckily didn't give a rat's ass about. A lady at book club gathering, a friend of a friend.

But my patient, my poor patient. Her "support network" was annihilating her. I was outraged on her behalf. I wanted to reassure her.

So I shared my own story with her, and we discussed ways to manage the hurtful comments and avoid the negative people.

For doctors, sharing our own stories and feelings about medical issues with patients is a tricky thing. Sometimes it's appropriate, sometimes it's not, and sometimes it's a mixed bag. In this case, the patient expressed relief and gratitude. She had been initially expecting me to judge her, too, she said. She was so glad to have found validation, reassurance and open discussion instead.

That's when I had my breakthrough: The patient had been expecting me to judge her, and had instead found validation and reassurance.

Wow. THAT is what I need to bring to EVERY patient encounter. Validation, reassurance, open discussion. Because that is what I would want for me, as well. It's what I want to be able to provide for everyone, especially my patients.

Monday, June 24, 2013

Pump hero

I needed to meet with a team to grade their students and had set up a time to meet them in their team room. This is one of the best team rooms we have in the hospital. It's spacious, with a wall of computer stations on either side, and windows lining the opposite wall from the door, filling the room with natural light. When I'm bringing the third-year students around to their team rooms after orientation, I always deliver this team's students last since it's kind of like closing the curtain between first class and coach.

I walked into the room and saw a medicine intern with her back to me, working at her computer. At the other wall, the senior resident was reading some papers before him. They greeted me as I sat down with my folders and took out my forms for grading.

"I hope you don't mind, but I'll be pumping while we do this." In the sudden quiet, I heard the telltale rhythmic sounds that I knew so well. She was pumping. Right there. In the team room. I didn't notice earlier, but she apparently had a hands-free set-up going, and was typing away, doing her notes. I glanced back at the senior resident, nonplussed. This was routine business.

I was filled Admiration. So impressed.

"I think it is so awesome that you pump in the team room!" (Could I have?)

"I've lost all modesty after 9 months," she said with a smile.

We graded. She finished pumping, cleaned up, stored the milk, and I could not stop smiling.

Saturday, May 11, 2013

The Last Bu-bu

WE DID IT!!!  When I started breast feeding I was determined and optimistic!  But, as I persisted I got discouraged more times than I could remember.  There were latching problems, cracked nipples, thrush and the pumping!  PUMPING SUCKS!!!!  I celebrated when we hit the one year mark and I stopped pumping.  My plan was to allow my baby girl to self wean.  Well, she wasn't interested.  I stopped pumping but kept making LOTS of milk, so we persisted with morning and nighttime feeds.  When my baby girl was a year and a half I left the lab and went back to surgical residency hours.  My initial stint on transplant kept me at work around the clock and I felt for sure that my milk would dry up.  Miraculously it didn't and "bu-bu" time became a special time with me and my baby girl in the midst of all the chaos.  Well, the time has finally come.  Baby girl is losing interest, I've basically stopped making milk and my baby girl is a smart, amazing, beautiful big toddler now.  She hasn't had bu-bu in a week.  I put her to sleep by telling her princess stories or stories about my "doc-tur house" while she lays her head on my chest.  I'm a bit sad our "bu-bu" time is over but amazing grateful for the two and a half years we had of this amazing connection.  I'm incredibly proud of our accomplishment that survived even the insanity of residency and as always I am crazy in love with my beautiful child.  I can't wait for all the new memories we will make together.

Now off to pick some strawberries!  Happy Saturday!

Friday, May 11, 2012

A tired American - an angry rant

Ok, so this is risky, and I’m likely to attract plenty of debate but here I go.

First, why am I writing about this?  Because I took an oath to be a healer.  To me this means tolerance, justice, acceptance in order to achieve a greater good, in order to promote a healthy society.  So, I am just a little irritated today as I look at my country which appears to be at odds with itself.  My anger started while listening to NPR on the drive to work this morning and hearing about all of the discussion resulting from the TIME magazine cover of a model-like mom breastfeeding her three year old standing on a chair.  Criticisms flying everywhere about extended breastfeeding and self-important moms. There is the typical sexualization of breastfeeding with lots of reference to the attractiveness of the mom on the cover, and the usual “if they can ask for it” type comments.  (side note: newborns ask for it too - its called crying!!)  So funny, that anyone who decides to formula feed their infant gets nearly stoned for not going the “breast is best” route.  Then we flip it around and hate on the moms who keep breastfeeding.  I realize I’m using the proverbial “we.”  If this doesn’t apply to “you,” then feel free to ignore.  But for all the rest of us: Lets STOP THIS!  Mothers are always criticizing mothers - breastfeed or not breastfeed, work or stay at home, work a lot or a little, nanny or daycare or grandma, etc, etc.  Even Fizzy’s post last week, illustrated how quickly we jump to judgement.  As clinicians we do know the literature and the evidence, but the first step in being able to do no harm is gaining the TRUST and RESPECT of our patients, and in order to do this there needs to be more tolerance and listening.

Anyway, I’m just all revved up.  I live in the Amendment 1 state.  Justice, tolerance.  I won’t say anymore than that.  Our political system is full of polar opposites, butting heads and refusing to compromise.  We’re arguing over reproductive rights of women... AGAIN!  WHAT IS GOING ON!!!

Can’t we all just get along?

Tuesday, April 3, 2012

When breastmilk isn't best

That's right, I said it. Breastmilk isn't always best.

I always considered myself to have a very healthy attitude about breastfeeding. I set a goal for myself to do it for a year, but was willing to occasionally supplement with formula. And when women tell me they want to breastfeed, I try to offer practical tips, including telling them not to stress if it doesn't work out.

But recently, I've realized that my attitude about breastfeeding is far from healthy.

Ways you know you have an unhealthy breastmilk obsession:

--You have passed up a chance to do something actually enjoyable in order to pump

--Your baby is 6+ months and you are still pumping

--...even though it means you leave work later and see your baby less

--Your freezer contains more milk than food

--You have fed your baby breastmilk that might have been going stale instead of fresh formula

--You make breastmilk bottles with less milk than you think your baby will drink so none of it will get "wasted"

--You feel sad/angry when the baby doesn't drink all the milk in a bottle because it is "wasted"

--You have given up sleep to pump

--You have given up sleep to keep your baby from getting a single bottle of formula

--You think formula smells bad

--When your baby does get formula, you feel guilty

--Even though you pretend not to, you secretly judge other women who don't breastfeed for at least a full year

Is this healthy? Is it necessarily in my baby's best interests? I'd say it's often very clearly against my baby's interests, actually.

The way I finally realized this might be a problem was that recently I had an issue with my pump equipment. I found some old crud on the... yellow thing the milk filters through (OK, I don't know what any of the equipment is called). I washed it daily but apparently didn't completely dismantle it properly. I worried that all the milk I had pumped was tainted. Two months worth, about 300 ounces. And I started to panic.

I started to plan: No more skipping pumping sessions. Maybe start pumping again on weekends. Somehow I had to replenish all that lost milk.

That's when I realized that I was being completely ridiculous. My baby is almost a year old and the winter is over... so what if she got a couple of months of formula? Would that really be so harmful? Would it be harmful AT ALL? In fact, might it even be better to give fresh pumped milk and formula, rather than all frozen milk?

(By the way, the above is a great reason never to use donated breast milk that isn't well screened.)

Anyway, I emailed my pediatrician's office and they said I didn't have to throw out all that milk. But part of me still thinks I should, just to cut the chains (and be safe). I haven't decided yet, but I've decided I'll be okay with it either way.

Thursday, June 5, 2008


Today was one of those insanely busy days, the kind that I had never come close to encountering prior to having my first child. On top of my regular clinical duties, I had additional responsibilities that had been "saved" for me since I couldn't do them while (inconveniently) out on maternity leave. The end result was that I ran around like a headless chicken trying to round with my housestaff, see consults, see clinic patients, fit in two pumping sessions, and deal with some seriously crazy patient scenarios, straight out of Grey's Anatomy.

Today, multi-tasking was the only way I could survive. I seriously had almost no time to sit still, I barely ate lunch (two hours after I initially heated it in the microwave), and always, always took the stairs.

My most peaceful moments were, coincidentally, while pumping. At least then I had no choice but sit in my office and internet surf or read my email (probably against OSHA regulations to walk around the corridors while pumping).

Of course, during my second pumping session, I actually paged the resident I was working with on consults to discuss our patients, you know, seriously multi-tasking. I made no excuses for the background whirring noise. "I'm pumping," I announced unceremoniously at the beginning. There was no time to be modest.

(I knew she was a mother; I certainly wouldn't have said this if she were a man.)

She chuckled. "I've so been there."

Which is why I love working with housestaff who are mothers themselves. There's an unspoken understanding.

They get it.

Monday, June 2, 2008

Herbal Suspect

I first learned about the potential dangers of taking herbal supplements in medical school. The point was driven home by a patient with rhabdomyolysis. Another with acute liver toxicity. Many an attending warned us to ask about supplements or instilled the fear that anything could make it's way into an herbal pill, and thus their usage should be actively discouraged.

I frowned at the lack of strong evidence supporting their usage. I have to admit that I grouped those who used herbs (and usually it was multiple offenses) as a little bit out there. You know, a crunchier sort, not grounded in science or rigor.

My mother, as luck would have it, would fall into that group. She is all about the holistic and the natural. Her evidence has always been in the form of testimonials and N=1 logic. A friend cures constipation with mega doses of Vitamin C? She's on it. Her cousin's babysitter ate flaxseed once and had more energy? Done. A friend of a friend of a friend of a friend (who is wife to a physician!!!!) swears by walking on her hands to cure the hiccups? She asks for how long. I've often wondered how half my genes are from her.

I, on the other hand, harbor a healthy fear of supplements, with herbs topping the list. They frighten me because they can very well be biologically active in non-perfectly-elucidated ways. Perhaps it's the complete lack of control in terms of production, dosing, effect, and potency that scare the OCD scientist inside me. Then, there's the fear of hidden toxicity. Who knows what could happen? A couple of years ago, I would have never thought I would ever try taking herbal supplements. No way.

Yet, when I started stressing about returning to work and pumping enough to keep my newborn son fed exclusively on breastmilk a few months ago, I read with interest about fenugreek and Mother's Milk Tea. Really? Increase milk production? Mine more liquid gold with every pump? Of course, I didn't look into possible negative side effects at all; I didn't even care. If it meant being able to nurse longer, I would consider trying it. Fear of the unknown and the unaccounted for never entered the equation.

I decided to try Mother's Milk Tea. The ingredients include fennel seed, anise seed, coriander seed, spearmint leaf, lemongrass leaf, lemon verbena leaf, althea root, blessed thistle herb, and fenugreek seed. Listing out those ingredients makes me feel like a witch mixing a potion in a cauldron in my backyard.

I drank my first cup excitedly, thinking about how much more milk I'd produce that day. It tasted slightly bitter and medicinal, certainly nothing I would voluntarily choose to drink if given the option. Over the next few days, I diligently brewed my herbal concotion and did notice an increase in how much I pumped if I drank two or more cups a day. Maybe.

So, now, it's been a little over the month, and I have often wondered aloud why Costco doesn't carry Mother's Milk Tea by the crateload. For my child, I've recklessly turned from a science-based pragmatist into a herbal-tea-chugging junkie who's just looking for her next fix.

Which makes me think about how much motherhood (and the compulsiveness to be a "good mother") has changed me.

Also, if I grow a third eye, you'll know why.