Primigravida

By Josie Glausiusz

Thanks, Mr. Mayor. Breast milk is best? Gee, I didn’t know that.

Disembodied droplets of milk surround the plump baby on New York City’s “Latch on NYC” campaign poster. “Breast Milk is best for your baby,” the poster says. Breast-feeding, as the campaign states, lowers the baby’s risk of ear infections, pneumonia, and diarrhea.

All very true. The odd thing about the poster is that there is nary a breast in sight, never mind a real woman actually breast-feeding.

As has been widely reported (see some of the best links below) come Labor Day on September 3 this year, “Latch on NYC” will enter a new phase: 27 out of 40 New York hospitals will keep infant formula locked up like medication, signing it out to new mothers only upon specific request and only after she has received a mandated pep talk about why breast is best. The campaign, in my opinion, is well-intentioned but misguided.

Take that poster, for example. It emphasizes all the benefits to the newborn, but doesn’t tell a mother why breast-feeding may be good for HER. There is some evidence, for example, that breast-feeding may lower the risk of post-partum depression (although the evidence is tenuous, in part because depressed mothers may wean their babies earlier.) Yet one of the best reasons to breast-feed is that when successful, it simply feels fantastic: nestling a baby (or in my case, two babies) in my arms, watching them nurse, was simply one of the most serene, lovely and loving feelings I have ever experienced. And there are probably sound biological reasons why this is so: prolactin, the milk-making hormone, is known to induce a sense of calm.

The problem for many mothers, however, is that they never reach this stage. Because breast-feeding, while it may be “natural” is not automatic. If that “latch” isn’t correct, nursing can be very painful. If the baby doesn’t drain the breast of milk—because the baby isn’t latched properly, or isn’t sucking well—the baby may not be satiated by breast-feeding, and will cry from hunger. If the baby doesn’t drain the breasts, they may become engorged—an excruciating experience, as I can attest. All of these are problems that can be addressed and solved, given sufficient time—but not by giving a new Mom a pep talk when she is exhausted, bewildered and in pain.

In fact, as New York’s Latch On campaign points out, ninety percent of mothers in the city start breast-feeding, but by the time the baby is two months old, the figure has dropped to 31 percent. That implies that the overwhelming majority of new mothers want to breast-feed, but don’t get the support that they need after they leave the hospital—if they have even had the attention they require from nurses in the hospital soon after giving birth. As Katie McKenzie Woodall, a New York mother of a now eight-and-a-half month-old formula-fed baby boy, says, “I had to go crying to the nurses station at 9:30 pm to get help feeding my baby; only then did they bring a pump in and actually HELP me try to feed him—all of this after getting a “tsk tsk” from the nurse because he didn’t have the proper amount of wet diapers, and as she was leaving I get, ‘That’s not good.’ The post- partum time is so scarily emotional and fragile and I already feel that we don’t care for new moms enough. But to add to that making a new mom have any added stress over how she feeds her baby is just cruel.”

Nickmom.com came up with this funny list of pros and cons.

I do believe in encouraging women to breast-feed their babies. But as I know from experience, and as I wrote in an earlier post on Primigravida, breast-feeding a newborn can be a real struggle. In my case, I succeeded in nursing my preemie twins after weeks of pumping round the clock, but I also had constant help from nurses in the neonatal intensive care unit where my babies spent the first eight weeks of their lives. The first time I tried to nurse my baby boy, a nurse spent more than an hour positioning my baby boy, encouraging me, saying “come on, come on,” as my tiny baby opened his mouth, sucked on my nipple for a second, and then fell asleep – over and over and over again. I had the strong support of my husband, my mother (who nursed me when I was a baby) my sister (who nursed all of her six children) and a wonderful lactation consultant who visited me and my babies in the hospital and at home (for a fee.) And even so, and despite my determination and my best efforts, I never succeeded in making enough milk for two babies, and I always, always, had to supplement with formula.

A government-issued ad from the 1930s – a perhaps more appropriate one with mother and breast part of the picture. (Work Projects Administration Poster Collection – Library of Congress)

Many women who give birth in New York City may be unlikely to have this degree of support. Some older new mothers may not have been breast-fed themselves as babies—American breast-feeding rates, which declined through much of the mid-20^th century, reached a record low in 1971, when only 21 percent of mothers breast-fed their infants at birth. They may never have seen their mothers, sisters or friends nurse their babies, and may have no idea how to do it. Their friends may feed them misinformation: one pregnant woman I know said that her friends told her that “nursing is really uncomfortable, but you get used to it,”—not exactly an incentive to try. They may be unable to afford the services of a lactation consultant. Or they may need to return to work soon after the birth (the U.S. is one of three countries in the world that provide no paid maternity leave) and may have no opportunities to pump at work if they do.

Encouraging new mothers to breast-feed is a worthy goal. But the 48 hours that most mothers spend in the hospital after giving birth may be too little time to establish a good breast-feeding relationship. And mothers who give birth by caesarian section—as I did—may not even begin producing breast milk until three or four days after their babies are born. New mothers need support and understanding long after they leave the hospital, and all the more so when they are up in the small hours at home, desperately trying to feed a howling, ravenous baby. They also need encouragement and comfort if they choose—for whatever reason—to feed their baby formula. As Woodall’s pediatrician told her, “do what you need to do to stay sane.” When she took his advice, she says, “you could feel the whole house take a sigh of relief.”

As for me, I breast-fed my now 19-month-old twins—one on each breast, every morning—until they were 15 months old. Truth be told, I didn’t think they really needed nursing at that point. But I loved breast-feeding, and I doubt if I would have succeeded if I hadn’t. I also don’t know what I would have done if supplemental formula hadn’t been available for my teeny-tiny twins. Wet nurses aren’t exactly thick on the ground these days.

Josie Glausiusz is a science journalist and author of “Buzz: The Intimate Bond Between Humans and Insects”

Some links for further reading: Huffington Post, The New York Post, CBS News, and Time.