As an obstetrician, I have counseled countless patients on the benefits of breast-feeding to both mother and baby. But I breast-fed my daughter, Safiya, for only one month, and my son, Haider, for only one week. I was a breast-feeding failure.
My struggle with breast-feeding began immediately. After as easy a pregnancy and labor as I could ask for as a first-time mom, I was excited to begin bonding with my daughter. Safiya wasn't able to get a successful latch, but I knew she would soon figure it out. I put her to my breast every two hours until she would give up and fall asleep.
But when we went home two days after Safiya's birth, she was still not nursing well, requiring me to pump breast milk and supplement with formula early on. I was a fourth-year medical student, and I had one month to study for the second of three exams required to obtain my medical license. So I decided to pump exclusively and feed my pumped milk from a bottle. I pumped every hour to help increase my supply, storing the milk pumped on the odd hours, and feeding the milk pumped on the even hours. After each feeding, I supplemented with formula. In the hours from 10 p.m. to 6 a.m., I studied between feedings, when the rest of my family was asleep. At 6 a.m., my mother-in-law, who had moved in with us to help with the baby, took Safiya and fed her stored milk and formula while I slept. At 10 a.m. I woke up and continued the cycle of pumping and feeding.
By the time I took my exam, I was exhausted and frustrated. Every minute the pump was attached to my body, Safiya was not. I could not enjoy the bonding that breast-feeding was supposed to offer and even began to resent Safiya for not being able to latch on better. I decided to stop pumping, and exclusively feed formula. While I felt relieved to live a more normal life, I continued to mourn the fact that I never experienced what it felt like to breast-feed my child.
When I became pregnant again, I was determined to succeed where I had failed before. I was a fourth-year resident in obstetrics and gynecology, and I knew so much more about breast-feeding. I was due in July, right after graduation, and would not start work until November. For four full months, my only job would be to breast-feed. I would not fall into the trap of supplementing with formula too early.
My enthusiasm crumpled soon after delivery, however, when Haider had the same difficulty as Safiya. For every hour he spent at my breast, he latched for about one to two minutes. At 3 days old, he began to show signs of dehydration, with dry lips, weight loss and no wet diapers.
I called Haider's pediatrician, who listened thoughtfully. She gently advised me that she was worried that Haider was becoming dangerously dehydrated, and that at this point, I should consider formula to be a medicine for him. We decided I would breast-feed for 20 to 30 minutes at each breast, then pump for 20 minutes at each breast and feed the pumped milk, then supplement with formula. I was to repeat this process every two hours. Sleeping did not fit into this equation. Haider did start showing signs of improvement, but feeding him occupied every moment of the day. My husband and I had to send Safiya to my mother's house because we could not manage to look after her while trying to succeed at feeding Haider. We banned visitors, mostly because I could not manage to get through an entire hour without crying.
The following day, I met with a lactation consultant. After working with us for an hour, she listed our diagnoses: retracting nipples, poor milk supply, tight frenulum, poor latch, excessive infant weight loss. I left feeling defeated. The mountain I had to climb to breast-feed seemed to get steeper and steeper. I began to despise every celebrity who posted a gorgeous picture of herself breast-feeding her child, every celebrity who called breast-feeding the most beautiful and natural thing in the world. I'm talking about you Olivia Wilde, Giselle and Angelina Jolie! Sometimes breast-feeding is neither natural nor beautiful! Sometimes it is a heartbreaking and a painful struggle.
As an obstetrician, I had recommended exclusive breast-feeding to all my patients. Yet here I was, a complete failure. Not only did I feel like a bad mother, I also felt like a bad doctor; I could not even follow my own recommendation. I was resenting Haider, just as I had resented Safiya, for not being able to breast-feed. I was angry that my body was failing me, and I was failing my child. I missed Safiya.
My pediatrician told me she would fully support me if I wanted to continue to breast-feed. Finally, she said, "I also want you to know that if you want to stop breast-feeding, it's OK."
One thing I had heard for my entire pregnancy, and my entire training as an obstetrician for that matter, was how important breast-feeding was. I almost felt like I had been brainwashed into thinking breast-feeding was absolutely the only healthful way to feed my child. This was the first time I had ever heard that it was OK not to breast-feed. So on Haider's 1-week birthday, I decided to stop.
I do still sometimes mourn not having been able to breast-feed. But formula feeding allowed me to keep my family together, nourish my children and keep my sanity. It was the right choice for my family.
I recently saw a patient who was having trouble breast-feeding. I shared my own struggles and advised strategies that might help. Finally, I told her: If you decide to stop breast-feeding, let me give you permission to do so. You are no less a mother, and your child will be just fine.
I saw this patient again several months later. She told me how much my support meant to her and how it helped her come to terms with not being able to breast-feed. I hope that as health care providers, we can find a way to create encouraging and supportive environments for breast-feeding, while also supporting women who cannot.
Maliha Sayla is an obstetrician-gynecologist at DuPage Health Specialists in Lisle, Ill.