Our Bodies, Ourselves (96 page)

If you have had breast surgery, successful breastfeeding may still be possible. Breast reduction surgery or a lumpectomy (breast cancer treatment) can sometimes cause problems with milk supply. Breast augmentation surgery is usually less problematic. If you have had a mastectomy (breast removed), you can probably still nurse with the milk produced by the remaining breast. Inform your health care providers about your surgery, and be sure to monitor your baby's weight carefully. Even if you do not have sufficient glandular tissue to produce a full milk supply, you can usually breastfeed if you choose to and supplement with formula or donor milk.

Adoptive mothers may also wish to breastfeed, and in some cases it may be possible to create a
milk supply even without giving birth. Putting the baby to the breast frequently can sometimes help stimulate the nipple and affect hormone levels that control milk supply. Using a quality double electric pump might also help to build your milk supply. A supplemental nursing system (SNS) can be used to allow adopted babies to drink their infant formula at the mother's breast while simultaneously stimulating the mother's milk supply. Some women who are expecting an adopted child prepare for possible breastfeeding by beginning a pumping regimen in advance of the baby's arrival or taking prescribed medications that stimulate milk production. It's a good idea to make enjoyment of the nursing relationship the main goal and to regard milk supply as a bonus rather than a necessity, as the amount of milk produced is generally small.

Many mothers breastfeed their babies wherever they are. In most parts of the world, it is common to see women breastfeeding on the bus or in a park. But in the United States and some other Western countries, cultural taboos and the sexualization of the female breast sometimes make us feel uncomfortable about nursing in public.

Nursing wherever we are makes it easier to go out with the baby without advanced planning. If you nurse only at home or in private places, you may feel constrained and wean earlier than mothers who feel comfortable nursing in public. Part of becoming more relaxed about public nursing is trying it out and experimenting. Specially designed nursing clothes now make it easier to breastfeed discreetly (if discretion is your goal). You can also try nursing in front of a mirror, just to see what others see. In addition, certain baby carriers (e.g., slings) and nursing covers can provide privacy for you and your nursing child.

I went to a La Leche League meeting when my daughter was just a few weeks old. It was one of the first times I left the house after giving birth, and it was the first time I nursed in front of people I didn't know. I was so comfortable because I was around other nursing mothers and it gave me so much confidence. I have now breastfed two kids for a total of five years and can't even begin to count the number of public places we've nursed
.

Women in the United States have a constitutional right to breastfeed in public, and almost all states now have laws that specifically address public breastfeeding as a legal right. A growing number of mothers identify as lactivists—lactation activists—and advocate for the legal right to breastfeed in public. Many mothers' groups have formed to make our culture more
accepting for breastfeeding mothers and babies. Some have filed lawsuits against public facilities where women have been asked to stop nursing and have participated in public nurse-in protests against coffee shops and restaurant chains that have asked nursing mothers to leave or cover up.

Returning to work after your baby is born doesn't mean you have to stop breastfeeding. Unless you work at home, work for only short periods of time, or have on-site day care in your workplace and can take breaks to breastfeed your baby, you will likely need to express (pump) your breast milk, refrigerate it, and then have your partner or a caregiver feed your milk to your baby. Many mothers have continued breastfeeding for months—even years—after returning to work.

A good-quality breast pump will make it easier to continue breastfeeding. When you return to work, breastfeed your child before leaving home each day and try to take two or three pumping breaks during an eight-hour workday. When you are reunited with your child after work, nurse frequently to maintain your milk supply.

As a working mother, I always nursed my baby after waking in the morning and then pumped the remaining milk for her first bottle of the day. I also woke her before I went to sleep at night or pumped before going to bed in an effort to build my supply and decrease the amount of milk I had to pump at work. I also found that co-sleeping and night nursing was a beneficial way for us to bond, despite my extended daily absences, and it also helped build my milk supply
.

The 2010 health care reform legislation requires companies with more than fifty employees to provide a lactation room and unpaid break time for breastfeeding mothers. Individual states and employers may have additional protections. If you are planning to pump after returning to work, explain your plans to your supervisor or human resources department prior to your maternity leave, so that your employer has the opportunity to make the necessary arrangements for you. Many employers are eager to retain their employees and may be able to help you work out a plan to take pumping breaks.

Unfortunately, many workplaces and jobs have not yet made the appropriate changes to support breastfeeding women. Mothers who are paid hourly to work in fast-food restaurants, in stores, or on assembly lines—disproportionately African American and Hispanic—are often not provided with lactation rooms or paid pumping breaks. Women who work in salaried positions are more likely to have such benefits. This division establishes a group of women who can afford to breastfeed beyond the first weeks and another group who often cannot.

I felt like I was cut loose from the system way before I was ready. I was discharged before my milk had even come in. Some of the people who trained me at the hospital had not even nursed themselves. I felt like each individual tried her best, but it never came together for me. He never latched correctly. I never produced much milk. After a few days, it felt like time was ticking away and my baby wasn't getting enough to eat. When I finally made the decision to say, “I'm done with this. We're going to give you some formula,” it was a huge relief. I felt like I could finally start trying to enjoy this new life
.

In the not-so-distant past, many nursing mothers felt as though they were singled out for choosing to breastfeed. Now that health care
providers and government officials are touting the benefits of breast milk, many formula-feeding mothers now feel that we are judged each time we feed our babies from a bottle.

Many of us who want to breastfeed but can't for medical reasons, or who lack the support we needed to get off to the right start, feel deeply disappointed that our bodies are not doing what we think they are “supposed” to do. These feelings may be similar to the grief and sense of loss some of us feel when labor and delivery did not go as we hoped.

There was always an assumption that I was going to breastfeed, and every time I pulled out the bottle, I always felt like I had to explain myself. People assume that everyone can nurse their babies. But not everyone can. I don't want to be judged for that
.

Infant formula is sold under different brand names and can be purchased in most large grocery stores and drugstores. Typically, there are only minor differences between standard formulas made by different companies, despite some of their advertising claims. Unless your infant has a health problem, you may feed her or him any of the commercially available formulas.

All formula is made from either modified cow's milk or soy products, with additional nutrients added. (Because soy milk and cow's milk are not appropriate foods for human newborns, they are altered when used in formula to make them safer for babies.) Some formulas are modified to feed babies with special needs, such as premature babies or infants sensitive or allergic to cow's-milk protein. Allergy symptoms may include eczema or skin rash, abdominal pain or cramps, and vomiting or diarrhea. Soy formula gained popularity in the 1990s because of concerns about allergies to cow's milk protein. But babies can be intolerant of soy protein as well, and there are no known advantages of soy formula over other formula, except for kosher and/ or vegan families that want a formula without cow's milk or babies who cannot tolerate cow's milk—based formula.
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If your family has a sensitivity to cow's milk or soy products, consult with your baby's care provider to choose the formula that is best tolerated.

Recently, formula companies have begun adding omega-3 fatty acids to formula. The companies claim that these fats (which are present in human milk) will increase visual development and intelligence in children who consume them, compared to babies who consume formula without these fats. However, the most recent research does not appear to support this. The same companies that market formula are now marketing the fats for use by pregnant and nursing women, with little evidence that using them has positive effects on the baby. Pregnant and nursing women and their babies can benefit from a diet rich in omega-3 fatty acids.

As new mothers, we face changes in our relationships, sexual health, and emotional well-being. Meeting the challenges of new motherhood is easiest when we are able to attend to our own health and well-being, communicate openly and honestly with our partners and other loved ones, and get support from the people around us.

Unfortunately, these things aren't always under our control. Our partners, other family members, and employers may expect us to bounce back from birth after just a few weeks. Whereas in other countries, new mothers can easily and freely access community-based or even home-based health care and support, in the United States, postpartum care is fragmented
and often inadequate. For more information, see
“Being a Mother Today.”

Our bodies change dramatically during pregnancy and childbirth and continue to change postpartum. Our culture emphasizes the need to lose the baby weight and get our bodies back—as if it were possible or desirable for pregnancy and childbirth to leave our bodies entirely as they were before. These attitudes devalue the fact that our bodies have done the incredible feat of growing a whole other human being. Even when we are in awe of our bodies, our shape and appearance after giving birth can be difficult to get used to.

My body now is a lot different than before I had my son. But it is also a body that has served a purpose. I look at my belly, a little looser than before, and remind myself that it carried him while he grew. I look at my breasts, lower and less full than before, and remind myself that they nourished my tiny premature baby into a rough-and-tumble toddler.
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The postpartum months are not a time to diet. A healthy, well-balanced diet with plenty of protein, calcium, and fiber is important for postpartum recovery. Extra calories are needed to support breastfeeding. Opt for easy meals, frequent snacks, and fresh, healthy foods. Ease back into exercise slowly, beginning with light walks and abdominal exercises.

Pregnancy and new motherhood can sometimes trigger eating and exercise disorders, especially in women who have struggled with those disorders previously. If you find yourself turning to unhealthy behaviors as a way of coping with the emotions and challenges of new motherhood, seek help from a qualified counselor or health care professional.

After recovering from childbirth, some of us experience increased sexual desire. Many new moms, however, feel less interested in sex, at least for a while. Some women forgo sexual activity entirely during the postpartum period and focus instead on bonding as a family. Others of us miss being as sexual as we were before.

Often a woman and her partner experience mismatched levels of desire:

All that first year, our old forms of go-to-it sexuality were just too much. I was too tired and I'd fall asleep in the first five minutes, leaving Jack frustrated, even angry. Other times I've have the nursing and holding of the baby on my mind and intercourse seemed rough and crude. Also, I think that by the end of the day I had had a lot of skin-to-skin rubbing and touching and didn't feel sexually hungry at all. But Jack hadn't had much at all. The unevenness was driving us nuts
.

How we feel sexually is affected by many factors, from our physical recovery to the strength of our relationship. Many of us need time to adjust to our new role of mother. Sleep deprivation and shifts in hormone levels can decrease our sexual desire. Our emotions are also key ingredients in how we respond sexually. Depression (and some of the drugs used to treat it) can negatively affect libido (see
“Postpartum Mood Disorders,”
). In addition, feeling insecure about our bodies can affect our sexuality; those of us with poor body image are often less interested in being sexual.