Dear New Mom,

Congratulations  you're going to have a baby. Such an exciting time! Doctor or Midwife? Home or Hospital Birth? Car seat, carriage,  cradles and cribs, oh my goodness what about bibs? It's all so exciting and going to be great. But there's one thing I must tell you that you just might hate.

Much like the truth about labour which few women share, breastfeeding or moreso breastfeeding struggles are not often discussed. Breast is Best. But is it? Not always.  There are studies that support the benefits of breastfeeding; fewer serious illness, less asthma, eczema, respiratory and ear infections. But this is not to say that babies who are fed with formula will get these illnesses, be less intelligent or athletic.

Not every woman can breastfeed and the reasons are many. Yet we have a breastfeeding vision in our heads of a happy, thin beautiful, coiffed woman sitting comfortably in a rocking chair (not recommended for breastfeeding ) as her babe nestles into her breast gently suckling for routine feedings that provide optimal nourishment so the baby can sleep. For many women, this couldn't be further from the truth.

To breast feed a baby often requires a lot of ammunition and it can feel like war for many women. Those rosebud lips vs. a gigantic areola is often the first battle. The chances of a tiny baby gaining access to the heavily loaded (engorged) breasts that seem to be rapid firing spurts of white or yellow stuff are slim.

Bring on the breast pump, a workhorse promising to suck every drop of white gold from your breasts which ironically stimulates milk production. Just what you need, right? Never give up, let the next battle begin.  Pump. Pump. Pump It Off.

Your back is broken, from the body contortions you never knew in order to get that tiny tyke into the football hold,(whatever that is you say, it's not football girls play). Your nipples crack, your fever soars, diarrhea is calling at the door. Chills and spills, darn you could've sworn that cap was tight! Next time get it right! Your baby cries all day and you wonder if purple is OK. If I could just get this breastfeeding thing underway.

You're leaking from every orifice, urine, blood, breastmilk and stool. Why didn't anyone tell me this wouldn't be cool? Exhausted, depleted, sobbing and defeated, hardly fed, intrusive thoughts enter your head. What if I harm her, what if she's dead? If only I could get some sleep in my bed.

So you phone a friend and tell her your troubles. I'm thinking of bottle feeding, your head in a bubble. Your baby will get allergies, eczema and certainly won't be smart. He'll never be called up by the NHL to start. "I loved breastfeeding, we are now so close," she says. You're just anxious. Relax. We shame women for breastfeeding at a mall, we shame women for not breastfeeding at all.

When breastfeeding doesn't go well,  a woman is at greater risk for Postpartum depression especially if she is a Type A personality.

Postpartum depression is depression that may start during pregnancy or at any time up to a year after the birth of a child and it may affect a mother or father, but is more common in women. Depression is a mental illness that affects a person’s mood.

Signs of depression are:

• Feeling sad, worthless
• Guilt
• shame
• Loss of interest in activities or her baby
• Anxiety
• Physical aches and pains
• Poor concentration

A woman with PPD may believe she is not doing a good job.

New moms may also have scary thoughts about harming themselves or their baby although these thoughts are rarely acted upon. This is a serious situation and requires urgent medical care. If you believe that you or  a loved one is in danger, please call 911 or your local crisis line. Please understand that post partum depression is serious and no one is immune.

There may be something that is contributing to the shame associated with women who do not or cannot breastfeed. Many hospitals have initiated a "Baby Friendly Initiative" based upon the World Health Organization's efforts in 1991 to improve the role of maternity services to support mothers to breastfeed so as to provide what is considered the best start for babies.  The criteria for a hospital to be "baby friendly" includes breastfeeding policies, training of staff, education of pregnant women, breastfeeding demonstrations and support, rooming in and encouraging on demand breastfeeding.

The Baby Friendly Initiative restricts the use of free formula by the hospital. Many Baby

Friendly hospitals go so far as to hide formula from sight which isn't fair and may be sending the wrong message to all moms (that regardless of circumstances formula is poison) but especially to those who cannot breastfeed for one reason or another. Hiding anything is associated with shame including baby formula.

The baby friendly initiative may not be so friendly to new moms and it may be time for a review. Maybe it should be a Baby and Mother Friendly Initiative. There are many reasons a woman may need to feed her baby formula. She may choose to, her baby may be ill, she may have a medical condition and/or her baby may outright refuse. Women should never be judged for their decision on how to feed their baby by anyone. It's time we put the problem on the table and the formula in plain sight.

Breast may be best but formula is fine!

Maureen McGrath hosts the Sunday Night Sex Show on Newstalk 980 CKNW. A sought after speaker and TED speaker, she is an RN in women's health and was Head Nurse of the Maternal/Child Program at Vancouver Coastal Health in Vancouver British Columbia.  She is in clinical practice in North Vancouver, British Columbia.  Her website is backtothebedroom.ca. Follow her on twitter: @back2thebedroom

Maureen is Keynote speaker at The Birth Fair on February 25 & 26, 2017 at the Cloverdale Agriplex in Surrey, British Columbia.

Whenever we publish articles about breastfeeding, the conversations can become quite heated at times. Healthy debate is always a good thing as we know but is it helping inform us in ways that are beneficial.

In this article, Dr. Maltholtra breaks down the reasons you may or may not choose to breastfeed and why feeling pressure to defend those decisions may do more harm than good.

We all know breast is best.
If you choose to breastfeed, your baby will receive immune support that can only be provided through breast milk. You will have a unique experience to bond yourself to your little one and likely have memories that last forever. Breastfeeding allows you to save money and in most cases, be supported by your community. It is recommended to breast feed exclusively for 6 months.

But what if it doesn’t work out? What if you have complications?
Some factors that can complicate breast feeding:

– Trouble Latching – It can take some time and effort to find that sweet spot that baby likes and it is important to ask nursing or a lactation consultant to help you out if things are not going smoothly.

– Sore Nipples, cracked nipples – Until a mom gets the hang of things, she may have sore and cracked nipples. Fortunately, this is short lived and usually requires no intervention. Moisturizing can help some mothers.

– Breast engorgement – This is a sign of milk coming in and is not going to harm mom or baby. Swollen, hard, painful breasts are often sign of engorgement. Massage, relaxation and feeding itself generally manage this condition.

– Mastitis or Infection – Intense redness, heat, tenderness, and (possibly) red streaking in one or both breasts can be an indication of an infection or mastitis. A physician, breast feeding clinic or other provider should be contacted if these symptoms are experienced.

– Low milk supply – If baby is requiring more than mom can make, a visit to a local breast feeding clinic see another provider as you may require medication or other assistance.

– Plugged duct – If baby isn’t feeding well consistently, meals are being skipped (baby may be weaning), or if mom has a tight bra she can end up with a plugged duct. Breasts can be hard, red, tender, painful before feeding and better after a feeding. Massage can assist. Seeing a health care provider to rule out mastitis is recommended.

If you experience trouble breastfeeding…
If you are experiencing trouble breast feeding – let someone know. It is important to talk to someone you can trust and who will support you. If you know someone in this situation, please be empathetic to her situation. When a mom is postpartum, she is vulnerable and needs support.

Some reasons women may choose to not breast feed or may be unable to breast feed:
– Medical contraindications – Most people consider that all new mothers are healthy – they did make a baby after all. But aside from the infrequent medical contraindications to breast feeding like HIV and active herpes on the breast, many women will have common medical contraindications. Examples are autoimmune disorders which are common among young childbearing women and can require medications that are not appropriate in breast feeding. Examples of these disorders are Lupus, Rheumatoid Arthritis, and Multiple Sclerosis. With most of these diagnoses you many not know the mother has the condition and she may not want to divulge this personal information.

– Baby refusal – As all moms know, every baby is different, has a personality of their own and will have likes and dislikes. Ladies, some babies do not want to breast feed.

– Choice – Many women must return to work quickly, have never been interested in breast feeding or have other personal reasons.

Knowing the whole story may be helpful but do we need to explain?
The reason I am posting this is to remind women that you may not know the whole story and every woman should have her decision respected without having to explain it, defend it and without judgment. Many women will feel a tremendous amount of guilt and a feeling of inferiority if they are unable to breast feed or struggle with feeding and bottom line is that these feelings do not need to be solidified by others but support would always be appreciated.

What do you think? Is breast always best?
Dr. Unjali Malhotra is a Family Physician with extensive training and expertise in Women’s Health and University program development and improvement in Canada. She is the former Medical Director of Options for Sexual Health (Planned Parenthood). She is the creator and Program Director of a Women’s Health Residency training program for family practice residents at UBC and is the founder of the provincial HPV program through Options for Sexual Health. You can follow her on Twitter:@DrUMalhotra

References:

Kaneshiro N.K., National Institute of Health. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002452.htm
Breastfeeding – Caring for Kids Available at : http://www.caringforkids.cps.ca/handouts/breastfeeding
Motherrisk: Breastfeeding and Drugs. Available at: http://www.motherisk.org/women/breastfeeding.jsp
Motherrisk: Drugs in Pregnancy Available at: http://www.motherisk.org/women/drugs.jsp
Resource: La Leche League Canada : toll-free breastfeeding line for a referral to someone in your community: 1-800-665-4324