Breastfeeding Dialectics

While I was pregnant with our son, idealistic visions of my exclusive breastfeeding experience were forming in my mind as he was developing in my body. After careful research, I concluded a year of breastfeeding seemed ideal, as a minimum of six months was recommended. I imagined feeding our son, sitting with him cradled in my arms, skin on skin, and rocking him to sleep peacefully while catching up on some medical journals during my seven-week maternity leave.

The reality was definitely far from that fantasy.

When he was born, the first challenge presented immediately when I couldn’t breastfeed him. In the hospital, lactation consultants came in during their shifts and tried to get him to “latch,” but it was painful for me. After a few days, my skin red and bruised, the lactation consultants appeared perplexed as to why this was happening. They brought various plastic devices to help me. “Maybe your nipples are too flat,” one hypothesized. Or, “Maybe you’re holding him wrong, no, hold him more like a football, yeah,” another cheered. And while my lack of football expertise and anatomical contributors were possible factors, eventually we realized the problem was a scar I had on my chest from a childhood fall. After a few days, our son was crying more intensely when the milk wasn’t available for him. I asked the maternity nurse if I could have a bottle and some formula but she declined, stating he would get confused and not want to feed from my breast as a result. “Breast is best,” she said, knowingly.  

In my postpartum haze, I Googled various topics about formula and bottle feeding. What the nurse said was well documented as “nipple confusion.” Sources agreed that if I used a bottle, he would then reject my breast and I would be depriving him of the benefits of breastfeeding – all the nutrients and antibodies that would help him grow and build his immune system. According to various internet sources, feeding your baby formula can cause all kinds of health hazards, from eczema, allergies, asthma, diabetes, and even cancer later in life! One source even claimed a single drop of formula could alter the intestinal flora, forever predisposing the baby to a host of terrible medical conditions. Not yet out of the hospital, I was already failing the first task of motherhood.

A few days later, we sought the assistance of a lactation consultant. She said that, as a lactation consultant, her job is to help women breastfeed, but she was concerned about my skin wound and hungry baby. She supported me by teaching me how to pump my milk, feeding it to him from a bottle, then laying him on my skin, to simulate the experience of breastfeeding. This seemed to work. My husband supported this effort by feeding him bottles of pumped milk. Despite pumping every couple of hours, I wasn’t making as much milk as he wanted to drink. We tried the extensively hydrolyzed formula recommended to us and which, though quite expensive, was theoretically less likely to trigger allergies.  We marveled at the cost, as well as the time it took to boil a pot full of bottles every night. Pumping was time consuming, along with changing diapers and clothing and managing naps, there was not much time remaining in the day.  In addition to constant pumping, I took herbal supplements and teas to increase my milk supply. When I returned from maternity leave after seven weeks, medical journals untouched, my colleagues all wanted to know how my “vacation” was. It was a lot of things, but certainly not a vacation. I was exhausted and ashamed to admit my failure at the first and most important task of motherhood: feeding my baby. “Breast is best,” jingled in my head.

What shocked me most was how people found themselves entitled to comment on my formula and bottle feeding – even on my body. On one occasion, a woman I had just met asked me what was in the bottle I was feeding our son. When I said formula, she asked, “Why not breastmilk?” “I can’t make enough,” I replied, and she responded with “I think you can buy that.” As though I could just stop being so lazy and pick up some breastmilk at the local grocery store. Numerous people asked why I wasn’t exclusively breastfeeding. People asked me why I needed to pump when my baby was with me and I felt embarrassed since the issue was private for me. I observed disapproving stares in public as I pulled out my bottle or can of Similac.

I was able to pump for almost five months despite a long commute and the challenges of a new job. Eventually, it became too much and I used up my frozen supply, just shy of six months. To me, it had been an ordeal, but I came close to my goal of minimum six months of breastfeeding. Although it didn’t go smoothly, I was relatively satisfied, yet somewhat shaken and shocked at how an experience that seemed like it would be so natural was so difficult.

Looking back now, I remember my postpartum months on both occasions: dropping hormones, sleepless nights, isolation, the constant demands of a crying newborn – states of high stress. When stressed, the way we process what’s going on around us changes. Our thinking can become distorted, orientated toward the irrational as we lose our capacity to negotiate between our feeling states and rational ideas. We can also become more vulnerable to inflexibility, retreating into absolutist positions as a protective mechanism. Why does the mind do this? Having numerous possible and conflicting truths that one can’t resolve creates uncertainty, which leads to more stress, so our mind seeks to avoid that scenario. In stressful times, the mind desires understanding in certain terms so as to simplify, figure out what is “right,” to resolve the conflict and act, all to mitigate our stress. While that works well for survival, mental inflexibility makes it harder to resolve more complex or nuanced challenges.

In the 1990s, Marsha Linehan, an American psychologist, developed Dialectical Behavioral Therapy (DBT), a type of psychotherapy aimed at helping those who struggle with intense emotions and inflexible thinking. We can trace the concept of the dialectic as a debate as far back as ancient philosophy and the Middle Ages. In the 18th century, the German philosopher Hegel coined the term “dialectal thinking” to describe a process for overcoming inherent contradictions between two differing points of view and synthesizing them into one. It can be hard accepting the reality that many situations in life contain multiple truths. With children, we are biologically driven to think, feel and behave in a way that serves the little person we are raising, yet these drives can sometimes be in conflict with our own selves or even with rational ideas and facts. To further complicate child rearing, sometimes our truths can be different than the truths held by our partners, friends or family. Holding multiple truths in our minds is a common and necessary part of parenting. Looking back, it may have been more useful to offer a DBT skills group on the maternity unit instead of endless lactation consultations.

Fortunately, in the eight years between my two children, the landscape of baby feeding shifted. The motto changed along the way from “breast is best” to “a fed baby is the best baby.” When we had our daughter, I had several high-risk pregnancy conditions and a challenging birth. This time I managed a longer maternity leave of three months and wireless pumps had infiltrated the market, all of which led me to hope I would have more success. Despite constant pumping, I was barely making an ounce of breastmilk a few times a day. Alone at home, pumping made it hard to hold my daughter. If I had the pump on and she woke up crying, I couldn’t snuggle her with the plastic attachments in the way. I was spending more time pumping and less time holding her than I wanted. I started wondering what was more important – her getting this tiny amount of breastmilk or her getting the most physical touch and affection that would help her feel close to me?

When our daughter was about five weeks old, I was pumping in my rocking chair at 2 o’clock in the morning when she started crying, stirring with awareness that she was hungry and wanting to be held. My fears about her not having breastmilk were contending with my concerns about not holding her, and I was stressed. Eventually I was able to resolve my feeding dilemma by using a DBT practice called “wise mind.” Wise mind is based on the idea that people have three states of mind in any given situation: rational, emotional and wise. The rational part of your mind is driven by logic, whereas the emotional part of your mind is motivated by feelings. These two ways of thinking can come together, forming a wise portion of your mind, the space where our emotional and rational minds overlap. Some describe it as the middle ground.

Wise mind practice can be used for a variety of conflicts and it’s easy to do. Start by making a table (see below) and writing in the box to the right of “emotional mind” everything you feel about the situation. Then try to fill in the box next to “rational mind” with what you rationally know. Then, see if you can synthesize those two positions into a compromise in the “wise mind” box in a way that respects your feelings but also honors your rational thought process. Ideally such a synthesis should help you move closer to a healthy solution for your conflict. Here is my breastfeeding example:

That night, I decided to give up pumping. Picking up my daughter and holding her close, I set off to the kitchen to mix up some formula. Feeding her in the rocker she happily dozed off, snuggling up to me. From that night forward, I had more sleep and eventually worked my way out of my sadness that I wasn’t able to breastfeed her.

Breastfeeding is a great way to feed your baby – good for them, healthy, helps formulate attachments and makes financial sense, too. If it works out, that’s great. Of course, I wished it had worked out for me. When it doesn’t work, or if someone choses for themselves and their family not to breastfeed, please consider it their own personal choice to be respected.