The Comfort of Numbers
Often you will hear a new mother say of bottle-feeding: “I like the fact that I know how much my baby is eating.” And indeed it is true. When using a bottle to feed a baby, whether it be formula or breast milk in the bottle, you have the peace of mind of knowing your baby is getting a certain amount of food. In fact, this is often one of the positives formula companies offer when comparing the benefits of breastfeeding and formula feeding. However, this reliance on numbers—the comfort one feels knowing how much a baby is eating and the comfort a woman can feel knowing just how much milk she is producing—can also serve to make it more difficult to transition to exclusive breastfeeding.
When my son was born nine weeks premature, he began a five-week stay in the neonatal intensive care unit (NICU) and his hospital stay was centred around numbers—numbers dealing with, of course, his weight, but particularly numbers dealing with his feeding. The very first things we were usually told on our daily visits to the NICU were how much milk our son was now receiving through his nasogastric tube (NG tube) and how much weight he had gained. His feeding schedule was also always reported to us as a sign that he was getting stronger and able to eat more at longer intervals: q2 and then q3 and then home!
When I started attempting to breastfeed, numbers were never far from me. After only a couple of attempts, the nurse had me start pre and post weights to quantify just how much my son was taking at the breast and determine how much more he needed through his NG tube. For the two weeks prior to his release, I stayed at the hospital with my son and focused on establishing a successful breastfeeding relationship. Prior to every feed I would weigh him and record the numbers. After every feed I would weigh him and record the numbers. Throughout this time I was also religiously recording the volume of each pumping session to determine just how my milk supply was doing. I was keeping records as a means to prove to myself, and to others, that things were going as they should be, or that things were not working out as well as hoped. I became a slave to these records.
Mothers of full-term babies are not immune to this numbers game. So many mothers are urged to supplement with a bottle soon after the birth of their baby. The suggestion is usually presented as a baby’s need for food since a mother’s milk may not yet have come in. When the normal breastfeeding pattern of a newborn is to nurse frequently but for short periods of time, it is easy to be lead to believe that you do not have the milk necessary to satisfy your baby. And when you see your baby take a couple ounces by bottle and can quantify your baby’s intake and know that you are providing food, it is easy to become misguided and start to question your ability to provide sufficient breast milk for your baby. However, your baby, in its instinctual wisdom, knows best, and, indeed, this frequent nursing is the best thing to establish a strong supply of breast milk.
Of course supplementation with formula means that a baby is not stimulating the breast as frequently, a mother is not removing as much milk as possible, and a mother’s milk supply may very well start to diminish. This can lead to an unhappy baby who is not being satisfied at the breast since milk production has declined. A baby may start to balk at the breast, refuse the breast, fuss at the breast, fall asleep at the breast, and any other number of reactions. Of course a mother, wanting only to see her new baby satisfied, turns to the bottle feeling relieved knowing her baby is eating sufficient amounts.
Supplementation soon after birth is, of course, not the only reason a baby may be bottle-fed. Difficulties establishing breastfeeding can also force a mother to use a bottle to supplement breastfeeding attempts. In this situation as well, there is comfort knowing that even though you continue to work at establishing a successful breastfeeding relationship, you are able to ensure your baby is eating well. And indeed sometimes the reduced stress involved with bottle-feeding (as opposed to the screaming and thrashing and kicking and crying—of both mother and baby—that can come with difficulties breastfeeding) can make the bottle a refuge and a comfortable shelter from the stress and anxiety surrounding the attempts to nourish your baby at the breast.
The problem with the numbers that naturally come with bottle-feeding and expressing breast milk is that they become a comfort and a means of control. When breastfeeding, you have no numbers other than the frequency and length of time your baby is feeding. You have no idea how much your baby is receiving. Your only indication is the assurance that your baby is growing and gaining weight. But when bottle-feeding and expressing milk, you have the ability to monitor your baby’s intake and your output. You can see your milk in front of you, lined up in the fridge or packed into the freezer. It is tangible. To switch from pumping your breast milk and feeding it with a bottle to exclusively breastfeeding requires a large leap of faith and a belief that your baby knows how to regulate your supply and will nurse efficiently at the breast, and a belief that your body will continue to produce milk. This leap of faith is a major obstacle that prevents many mothers from transitioning their babies to exclusive breastfeeding after they have been exclusively pumping or using formula supplementation in addition to nursing.
Now there are of course situations in which a baby just does not get the hang of breastfeeding or isn’t physically capable of breastfeeding, but there are also many situations in which a baby will latch but perhaps does not nurse consistently every time. In these situations, there is often an opportunity to place your trust in your baby and roll the dice, so to speak. And it is a roll of the dice in some respects. To switch to exclusive breastfeeding means that you will no longer be pumping, and pumping has likely been the one thing over which you have had some degree of control. To switch to exclusive breastfeeding means that you will not be scheduling when your baby feeds or when you empty your breasts, but you will instead need to allow your baby to nurse on request. To switch to exclusive breastfeeding means that you will not have the comfort of your daily record of pumping volumes or your baby’s daily intake; you will need to believe that things are as they need to be. And even if you do manage to put your faith in your baby’s ability, there is no guarantee things will work out. Your baby might just not be able to transfer enough milk; he might continue to be fussy at the breast even when allowed to nurse as often as desired; you might feel as though your supply is starting to diminish if your baby is not nursing well; and you might find that the stress of trying to transition over to exclusive breastfeeding is just too much to bear and that you would rather have your baby content and the stress of breastfeeding removed from your life.
But you may just find that your baby does know what he is doing and that you do establish a successful breastfeeding relationship. And in the opinion of many, this would be a wonderful thing. It is a risk in some ways and frightening in some ways, and, in the end, the decision to take the plunge and attempt to transition to exclusive breastfeeding is in your hands.
When I was in the early months of exclusively pumping, I had to struggle with many of these issues. Once my son was home from the hospital, I became obsessed with the numbers. I had built such a reliance in the hospital on the pre and post weights to determine how my son was feeding, I had no knowledge of how to tell if he was breastfeeding well or not. I did, however, know how much milk he took from his bottle. I always knew exactly how much I was pumping. I had a written record to prove my success.
There was a brief window of time, when I look back, during which I may have been able to transition to breastfeeding exclusively. But the fear of the unknown and the loss of control I felt at not having those daily numbers in front of me held me back. I worried that I would lose my supply if I stopped pumping for a few days and relied only on my son to maintain my supply (naïve perhaps, but the fear was very real for me at that point). I worried that if breastfeeding didn’t work out, I would not go back to pumping and my son would instead have to be fed formula. I felt it better that he received breast milk, regardless of how it was delivered, than receive formula. This, of course, is not the only reason I continued to exclusively pump, but it certainly did factor into my decision not to jump in with both feet—if only for a day or two—and see if my son could exclusively breastfeed.
When I weaned, I gathered the notebooks in which I had recorded all my pumping sessions (yes, I had more than one notebook), and I started to calculate the quantity of breast milk I had expressed and the amount of time I spent expressing breast milk over that year. In total, I had pumped approximately 389 litres of milk and spent approximately one entire month expressing that milk. Those numbers were, and still are, staggering to me. Those numbers, in many ways, encapsulate the year I exclusively pumped. And yet, they were a burden to me. They were a reminder of my inability to breastfeed and a symbol of my obsession to provide breast milk for my son. I am immensely proud of myself for pumping when breastfeeding did not turn out as expected, and I feel even more strongly now that breast milk is the absolute best way to nourish an infant and that exclusively pumping should be presented to all mothers who are unable to breastfeed as a viable alternative to formula. But I also recognize how my actions were driven by a need within me to “do this right”, and in some way, make up for the loss of a breastfeeding relationship with my son. The numbers in my notebooks were a means of controlling my experience and a way to cope with the loss of what I had expected to experience.
Six months after I weaned, I threw those notebooks away. In some ways, I wish I hadn’t even kept them at all. But when I did throw them away, I also threw away all the grief and guilt and sadness I felt over not being able to breastfeed my son—although I still hang on to a little bit of regret. The numbers in those notebooks meant nothing. What was meaningful was the love and dedication that allowed me to fill those notebooks. It didn’t matter that breastfeeding had not worked out as expected but that I did what I needed to do for my son given the situation that was handed to us.
(Also published in Breastfeeding, Take Two: Successful Breastfeeding the Second Time Around)