We’re very pleased to share an interview with Stephanie Casemore, author of Breastfeeding, Take Two: Successful Breastfeeding the Second Time Around.* This book is written for mothers who had a difficult breastfeeding experience with a first baby and are looking ahead to a new breastfeeding experience with a new baby.
What were your breastfeeding experiences like with your first and second babies?
My breastfeeding experiences were vastly different and yet they are closely connected. The birth experience played largely into each as well.
My first baby, my son, was born at 31 weeks gestation after I developed pre-eclampsia and was hospitalized at 30 weeks. His birth was an induction and was a very clinical experience. I was separated from him immediately and didn’t get to see him for another sixteen hours. I began using a breast pump soon after delivery to initiate my milk supply and am thankful for the good advice I received from the hospital staff about pumping.
I started breastfeeding attempts a week or so after my son was born, but soon breastfeeding too became very clinical with pre and post weights being expected and a nipple shield introduced. After five weeks in the NICU, two of those with me living in a care-by-parent unit caring for my son 24 hours a day, I finally introduced a bottle in order to be allowed to bring my son home (he had to be taking all his feeds by mouth). Breastfeeding was getting no easier and in fact my son had now started to cry and flail at the breast and, soon after he arrived home, started to projectile vomit. I was stressed, overwhelmed, and lost.
Life became a cycle of attempted (and often rejected) breastfeeding, bottle feeding expressed milk, and then pumping. Shortly after he reached his due date, I decided that I would continue to pump exclusively and feed my milk by bottle. I had asked many people for advice and help, but it never helped. I was told by two different professionals that it was okay to just feed formula, but that wasn’t what I wanted, and not the advice I needed. After five months of asking for help and seeing multiple medical professionals, I finally was told to try an over the counter medication for reflux and my son’s feeding behaviour changed overnight. Had I got that information and help months earlier, would I have been able to breastfeed my son? I’ll never know. By that point I was well into the routine of exclusively pumping—and continued pumping for a year—and my son was receiving all breast milk with no supplementation needed. But the lost breastfeeding relationship was difficult to accept.
Three years later I became pregnant with my second child, my daughter. When I first found out I was pregnant, my first thought was about breastfeeding: would I be able to breastfeed this child?
I had a great deal more information than I had with my first and knew going in that the birth experience affected initial breastfeeding, so I did everything I could to protect that early breastfeeding experience with my daughter. It wasn’t always easy, but I was determined. My daughter was born at about 37 weeks and her birth was quick and normal. She nursed within the first half hour following her birth and I kept her with me—in my bed most of the time—while we were in the hospital. She gained weight well and was above her birth weight by six days of age.
By all accounts, things were going well. But I didn’t believe it.
I kept waiting for something to go wrong.
The emotions and fears and worries of my experience with my son started to pop up and it was difficult to separate the two experiences. Any time my daughter cried inconsolably, any time she didn’t nurse well, or any time I became a bit engorged, I worried that breastfeeding wasn’t going to work out. I had to learn to trust my abilities, my body, and my baby. My daughter and I had some ups and downs, but we persisted and just kept going. I was amazed when we hit six months and thought a year seemed a long way off. Once we hit one year, I couldn’t imagine stopping. Breastfeeding became an easy way to mother and an easy way to connect with my daughter when she needed closeness. She self-weaned when she was three years and two months old after declaring she didn’t “need” to nurse any more. It was a bittersweet moment.
You write that there is no such thing as ‘breastfeeding failure.’ How do you instead view difficult breastfeeding experiences?
Our world is consumed with the idea of evaluation and measurement. Everything—even breastfeeding—seems to be evaluated and held to certain standards. But the concepts of “success” and “failure” when it comes to breastfeeding, which is at its core a relationship, are arbitrary measurements.
What constitutes “failure” when it comes to breastfeeding? And who determines what failure looks like?
There are certain guidelines in place, but even those are arbitrary and often adjusted. Success might look very different for a mother of a preemie or a mother of twins or a teen mother or a mother who must return to work full-time shortly after the birth of her child. Failure then too, is very hard to define. For these reasons, I would much prefer to look at breastfeeding in terms of simply “did” or “did not”.
Failure is also a perspective. Thomas Edison is quoted as saying “I have not failed. I’ve just found 10,000 ways that won’t work.” Everything for him was a learning experience, and I think for women, breastfeeding—regardless of whether they “failed” or not—can be a learning experience. It’s all in the perspective of how you look at your experience. With my son, I did feel as though I failed him for a very long time, but then I realized that my experience strengthened me in many ways and in the end has been a very positive thing. Do I wish I had been able to breastfeed him? Of course. But that is a feeling of regret, no longer a belief that I failed.
Difficult breastfeeding experiences are more a reflection of our society’s failure than a mother’s failure. Mothers, by and large, do everything they can to breastfeed their babies. Yet when accurate information and meaningful support isn’t accessible for every mother, mothers are going to do what they need to do in those circumstances to feed their children. I find no failure in that.
You say that what is often characterized as guilt over an unsuccessful breastfeeding experience is actually more accurately described as grief. What’s the difference, and what does it mean for a mom contemplating another breastfeeding experience?
Guilt is an emotion that is felt when you do something you know you shouldn’t do or you don’t do something you know you should do. Almost every mother I’ve communicated with over the last several years did everything they could to breastfeed. “Everything” though is largely influenced by the information and support that they have access to.
So, if you were given poor advice to supplement with formula in the hospital and this negatively affected your milk supply and led to early weaning, should you feel guilty? In my opinion, no. Anger at the inaccurate information and lack of support is likely appropriate, but when a mother has tried to access information and support and that information and support has been faulty, lacking, or led to difficulties, guilt is misplaced. Many moms will say they feel guilty or that they “failed” at breastfeeding and while they may name the emotion as “guilt” I think grief is more often what is felt.
Our society often doesn’t recognize breastfeeding as a meaningful relationship, but it is—and it’s a biologically-expected relationship for both mom and baby. When breastfeeding doesn’t work out, there is a loss and that loss is often felt as grief. Just as with any other loss in life, we need to work through the grief.
If you push it to the periphery and don’t work through it, as often happens with a new mother who must “get on” with life and family and the care of her new baby, the grief remains, often to resurface with the expected arrival of a new baby and another opportunity to breastfeed. Working through the grief and loss of the first experience will help a woman move into a second breastfeeding relationship. Understanding breastfeeding as a relationship, more than merely a means to feed a baby, will lead to a better understanding of the loss that is felt when breastfeeding ends sooner than desired, and this recognition of the loss will help a woman recognize the grief that she may be feeling.
Can you list a few things moms can do to process a difficult prior breastfeeding experience, in preparation for a new nursing experience?
There are many things that can be helpful to process a difficult past breastfeeding experience. I’ll list some of these things below.
1. Acknowledge emotions that are still lingering from your first experience. Chances are as you move into your pregnancy many of these will start to surface on their own, and, over the first few weeks of your new baby’s life, you will likely have a surge of feelings that relate more to your past experience than the present.
2. Recognize everything you did do for your first baby and that breastfeeding relationship. It is more common for us to look at what we do wrong than what we do right. Chances are your baby is now a healthy, happy infant or toddler and that means you did something right! Give yourself credit where it is due. Not one of us is a perfect mother, but we all love our children.
3. Flip your thinking. Rather than seeing your experience as a negative, look at it as a positive. I think in most cases a challenging experience helps us to grow and learn, and become stronger and more committed. It might not have been the experience you wanted, but it was the experience you got, so accept it and consider how it made you better.
4. Talk about your experience. Find support from others who understand how emotional breastfeeding—and not breastfeeding—is and share your story. As you share, you will be working through the lingering emotions and preparing yourself for a breastfeeding relationship with your next baby.
5. Forgive. Part of processing the past experience is the need to forgive. Do you blame yourself? Do you blame others? At the risk of sounding like a twelve step program, it is important to forgive in order to move on.
6. Educate yourself. We can’t change our past, but we can grow from it. Learn about normal birth and breastfeeding and empower yourself. Figure out what you’ll do differently the next time around and use your past experience, as Edison did, to figure out what didn’t work and to make a plan for the next opportunity.
*We were provided with a review copy of this book.