rivka

I gave Alex two bottles of organic whole milk today, and she sucked them both down. So, God willing, I've bought my last-ever can of formula.

I've been looking forward to this transition lately, and looking back at her birth and the time that followed. So breastfeeding and formula have been much on my mind, both in general and in terms of our own failure.

I still grieve the loss of our breastfeeding relationship. Not every day, and not always intensely - but reminders do still make me sad. I very much believe that breastfeeding is best for both the mother and the baby, and in our case there were health factors (a strong family history of allergies and Crohn's disease) that especially indicated the importance of breastfeeding. It's what I always imagined doing. It's what my mother did. It's what all my friends do. It is what is considered normal and desirable in my social circle. I thought we were going to breastfeed. I never imagined that we wouldn't.

Sometimes when I read about nursing, my breasts ache.

I don't feel guilty. I look back at our situation: a poor suck, very large nipples, gastric reflux disease, antibiotic-resistant mastitis. No weight gain ever from unsupplemented nursing; eventually, no weight gain even when I supplemented with pumped milk. Significantly below her birth weight at one month old. Before-and-after-nursing weight checks showing an intake of less than half an ounce. A sick and miserable baby. A sick and miserable mother. The real threat that my mastitis would require surgery. The desperate horror with which I approached the baby scale. I don't know how we could have held out any longer. Honestly, I don't know how we held out as long as we did.

My only regret is that I didn't pursue one lactation consultant's suggestion of going to a speech pathologist. At the time, it didn't even make sense; subsequently I've learned that lactation consultants know a lot more about maternal problems with breastfeeding than they do about infant problems, and that speech pathologists do actually diagnose and treat sucking problems. But I don't know. I also remember that, at the time, the process of getting a referral from my pediatrician, convincing my insurance company to accept it, making and keeping appointments, and going through unknown new therapies seemed overwhelming.

My other regret is how ashamed I felt. How pulling out a bottle in public made me want to hide. How I felt obligated to justify myself to every breastfeeding mother I encountered. How I avoided social situations where I thought I would be likely to meet lactivists. How much I still look forward to the day when Alex drinks all of her liquids from a cup, and I can get rid of the damned bottles entirely and leave this whole issue behind me.

I still feel ashamed, although my shame is now mixed with anger. I think about how hard it will be for me to seek breastfeeding support with my next baby, because it will mean exposing myself to the awful, awful things that breastfeeding advocates say about formula and the women who feed it to their babies. And I think that there has to, there has to be a better way to promote and support breastfeeding, a way that doesn't make women like me feel unworthy of being mothers at all.

There has to be.

I'm not even talking about the extreme cases - the strangers in LJ communities shrieking about how formula is child abuse, formula is as bad as cocaine; the woman on mothering.com who posted that she refuses to allow children's books into her home if they have pictures of bottles. I'm talking about discovering, just as I began to supplement with formula, that two of my LJ friends belonged to a community whose userinfo declared that every breastfeeder was a better mother than any formula-feeder. Not "making a better feeding choice" - a better mother. I'm talking about the woman who left a comment in my journal comparing making mothers feel guilty about formula feeding to making them feel guilty about not using a carseat, and who then went back and posted in her own journal about how awful it was that my friends were telling me that Alex would be okay even if I couldn't breastfeed her.

There has to be a better way to promote and support breastfeeding.

Some lactivists are unapologetic about the fact that women like me are the eggs they need to break in order to make an omelet. Others insist that of course they support women who really can't nurse. But always implicit in that support is the right of the lactivist - or anyone, really - to judge whether you tried hard enough. Always implicit in that support is the responsibility of the formula feeder to justify herself, to make her case, to - if necessary, if it looks as though she's going to be found wanting - berate herself for mistakes and admit that she was wrong.

"Of course, if a woman really can't breastfeed - like if she's had a double mastectomy - " I saw one lactivist post. Another told a story about how she learned not to judge: she and her breastfeeding friends were talking to a new acquaintance at the playground, and when this mother pulled out a bottle, everyone got quiet and looked away. The new mother explained that she was the baby's aunt; the baby's mother had died of cancer shortly after birth; the bottle held donated breastmilk. The lactivist and her friends then realized that they had rushed to judgment. Implicit in this story: if the story had been any less tragic, they would have been perfectly justified in their shunning.

"We shouldn't say that formula is second best. We should say that formula is fourth best, after nursing, pumping and bottle feeding, and using a wet nurse or a milk bank." I tried to post back here about how awful that argument made me feel, but I wasn't really able to articulate why. Since then I've seen it brought out many, many more times, and my thoughts have coalesced.

Here's the thing: I did pump. I pumped ten times a day when I first started formula feeding, and then dropped back to five or six times a day as my mastitis finally cleared. I got up in the middle of the night to pump. And the most milk I ever pumped in one day was eight ounces - about a third of what Alex consumed at that age. Using a hospital-grade pump didn't make any difference. And my milk supply dried up when Alex was four months old.

I've since found out that my situation is far from unusual. Most women can't pump enough to feed their baby pumped milk exclusively, and many of the ones who can are boosting their supply by taking a non-FDA-approved drug illegally shipped in from Canada, ~~which has severe depression as a common side effect~~. It's particularly unlikely that a woman who had nursing problems from the start, and therefore never established her milk supply, would be able to pump enough to exclusively feed her baby. Most pumpers supplement with formula - or supplement formula with small amounts of breastmilk.

A wet nurse, or milk banks: milk-bank milk is not availble without a prescription, and typically the prescription needs to specify that the baby cannot tolerate formula or has some heightened medical need for breastmilk, such as prematurity. And even then? It costs $3 an ounce. $3 an ounce. The least formula that Alex ever took, when she was exclusively bottle-fed, was 24 ounces a day. She got up to 36 ounces a day before switching over to mostly solid foods. So even if I had been able to get milk bank milk, it would have cost me $72 a day to feed my baby.

So the "formula is fourth best" argument tells women who can't breastfeed that their second- and third-best options are things which, in all likelihood, are completely impossible for them. I've since heard from other women who can't breastfeed that some lactivists include another better-than-formula option in the list: "chimpanzee or other primate milk," which, for Christ's sake, give me a fucking break! As far as I can tell, that one's just down there for extra smugness, to push formula further and further down towards the unacceptable bottom of the mothering barrel.

How do people say shit like this, and live with themselves? I found out. Here's another thing I saw endlessly quoted in lactivist circles: "guilt is a sign of awareness that you're doing the wrong thing." And its corollary: "No one can make you feel guilty unless you know you are wrong." There it is: permission to say the most godawful things imaginable to another mother, secure in the knowledge that if it hurts her, it's her own damned fault.

There has to be a better way to promote and support breastfeeding. There has to be.