Thursday, October 20, 2011

I'm OK; Nipple shields are OK

Last week, I posted about the major changes in Esther's eating life. I posted something similar on my Facebook page and got these responses:

MM: Yeah, just when you think you got the little pishers figured out, they throw you a knuckler. Hang in there!
October 3 at 9:00pm · Like

MS: Expect the surprises to keep coming along...for years! Enjoy every adventure!
October 3 at 9:40pm · Like

MMS: We drove ourselves crazy trying to figure this stuff out!
October 3 at 9:50pm · Like

MW: They tend not to get as much milk with the shield-she may start to gain more weight (and your supply will increase) now that she is off of it.
October 3 at 10:17pm · Like

Rebecca: Actually, there's no research to support that statement about shields.
October 3 at 11:55pm · Like

Rebecca: Let me rephrase, when I was bewildered as to why everyone but my doctor and lactation consultant acted like using the shield created a "less than" nursing experience, I could not find any citations to any research supporting those claims, even though I really wanted to so I could give in to peer pressure and wean her off before she was ready because of the inconvenience and because I was feeling vulnerable to the sheer weight of public opinion. All I could find was one study of less than 20 moms done with rubber shields rather than the now standard silicone ones. Luckily, this snapped me to my senses so I could stand up for my (and my doctor and lc's) decision to well-meaning but insensitive folks from that point on.
October 4 at 12:10am · Like

SR: We used a shield for a little while with Ian. Trust yourself and your little one -- listen to advice from people who know and understand *your* specific situation -- and whom you trust. Know that no matter what you will all be ok. We've got your back.
October 4 at 12:18am · Like

MW: I guess I also heard the inaccurate info about shields, Rebecca. Sounds like you are working with a good lactation consultant who can help you with any problems you might have!
October 4 at 8:41am · Like

KG: What is a nipple shield for? I had to supplement with Jack from the begginning, it took me a long time to come to terms with it. It made me feel like a failure as a woman/mother that I couldn't provide all of his nutrition like I was supposed to be able to do. What kind of formula are you using? Maybe that is why she is spitting up more.
October 4 at 10:17am · Like

I'm sure you noticed MW's response and my response to her. Normally, I'm not that confrontational, especially on Facebook. However, I thought long and hard about it before I posted that rephrase because 1) she offers lots and lots of unsolicited advice so I figured she would be able to handle a little push back and 2) I feel very passionate about the misinformation out there regarding nipple shields.

Luckily, my friend was really gracious. Based on the curiosity of other folks, I also figured I would elaborate a little bit more here.

A nipple shield is a piece of molded silicon that fits on top of a woman's nipple so that the muscles of a baby's mouth don't have to work quite so hard to mold the nipple to the shape of their own mouths. Preemies often need them and Esther needed one, too, for whatever reason. The lactation consultant in the hospital worked with us in a couple of good sessions before we went home and Esther just wasn't getting the hang of it so we started using the shield. Without it, I wouldn't have been able to feed my daughter.

However, lots of people had a reflexive response that the nipple shield was a bad thing. I often got asked, "When will you wean her off of it?"

The first few weeks of a new mom's life are incredibly vulnerable.  She's having a severe case of withdrawal since her dealer placenta is no longer pumping her full of hormones.  She's physically wounded and has usually depleted her energy reserves that are usually used for healing.  She's not sleeping very much.  The patterns of her day are totally altered and she must think about what the baby needs every time she considers doing something for herself, like going to the bathroom or showering.  The autonomic responses are all that are left to her, life breathing and having her heart pump.  All of her stress-coping mechanisms and her defense mechanisms are disabled so attacks that could normally be deflected hit hard.

One of the easiest targets is feeding this new child because it is one of only 4 needs that must be fulfilled by a mom: eating, sleeping, being cleaned and being touched.  So, any comment that feels at all like a criticism takes up an inordinate amount of space in a mom's spirit.

Being asked repeatedly when I would wean Esther from her shield felt like people were asking when I was going to really start breastfeeding her because didn't I know, breast is best?

So, when I realized that the money I spent on a second lactation consultant was wasted because she was fixated on the shield rather than on the problem I went to her with, I began searching the internet.

(As an aside, I ultimately made a rule that I could not research any parenting questions between the hours of 9:00 pm and 8:00 am on the iPad while nursing.  To much hostility out there and no filter to figure out whose solution is right for my family.)

What I ultimately found out is that there is no reason (other than inconvenience) not to nurse your baby with a shield for the entire time that you breastfeed.  However, lots of breastfeeding advocates like La Leche League disagree with that statement, both vehemently and inferentially, even though the only proof that nipple shields are bad is anecdotal at best.

Even Kellymom, which claims to be research based, cites nipple shields when discussing decreases in milk supply.

The reality is that there is no research that supports this advice.  All of it is about the old, rubber version or has a tiny sample size.  When I was talking about this with my friend who is studying to be a lactation consultant, she sent me this great article, which debunks the myths. 

The problem is that La Leche League and folks like Kellymom are the only folks out there advocating for breastfeeding and they are fundamentalists.  Fundamentalists, by definition, believe that there is one true way to do something and that all other versions are inferior to that one true way.  In the case of La Leche League, they believe that the one true way for all infants to be fed is that every meal be taken skin to skin at the mother's physical breast.  There is a hierarchy of deviations from this ideal; some are better than others but all deviations are seen as a slippery slope toward all babies being fed formula with bottles from their viewpoint.  Take a look at this document that they publish for local leaders on how to convert bottle-feeding mothers to feeding directly from the breast. It reads to me very similarly to literature advising conservative Christians to befriend folks in order to get them to say the Sinner's Prayer with paragraphs like this:
Working empathically [sic] with a woman, respecting her and her authority as the mother of the baby, we build rapport. Whether over the phone, by email, or after a meeting, when we work one-on-one with a mother so that she feels heard and respected, she may become receptive to hearing other ideas about how to handle her situation. Perhaps she isn't aware that there are means of feeding her baby other than a bottle, such as a cup or spoon, a periodontal syringe, or a supplemental nursing system at the breast. Perhaps a mother who called for help with the bottle will be moved to come to a meeting and gain a new perspective there.
This section does not encourage leaders to be empathetic to a new mother in a vulnerable state simply because it's the right thing to do.  There is an agenda to the act.  Also similar to evangelizing Christians, there is an assumption that the object of their help is ignorant of the one true way.  If they were knowledgeable, then why wouldn't they see things like we do?  Basically, formula-feeding women are the pagan babies of the Breast is Best crowd.  This condescending paternalism continues in a section a little further down:
Although teaching a baby to take a bottle isn't why we became Leaders, helping parents become sensitive to their babies' cues is a part of what we do. By helping parents with the bottle we may not only preserve breastfeeding, but also promote cooperative rather than coercive parenting. Perhaps the approaches and attitudes used here will carry forward to introducing solids, weaning and toilet training.
Clearly, if a family is feeding their baby with a bottle (even if feeding pumped breastmilk), then they won't raise their children right in other areas like toilet training.  Because feeding with interventions or formula is mutually exclusive to being sensitive to a baby's cues. (Catch the sarcasm here.)

I understand and even appreciate why La Leche folks are like this.  Societal change is generally only accomplished by extremists, the "small group" that Margaret Mead lionizes, although I disagree that they need to be thoughtful.  (Tea party, anyone?) There are plenty of studies out there showing that people who are politically active above and beyond voting are closer to the ends of the ideological spectrum than the majority of the population, which is fairly centrist.  Counteracting status quo requires force and an absolute ideal gets more folks behind it than a a diffused vision of more choices for more people.  The pendulum of public policy swings back and forth and society generally benefits from the majority of time it spends close to the middle.

This societal change is definitely necessary because corporate influences have totally sabotaged breast feeding as a valid option in a variety of ways. The Feminist Breeder describes this well in her recent post.  It is unconscionable that our society overwhelmingly thinks of breastfeeding as dirty or inconvenient or any number of other descriptors that aren't true but influence women and their children who would otherwise benefit from breastfeeding to use formula.  I love efforts like the Doula Program at the Ounce of Prevention, which helps women in poverty overcome that influence of the corporations.

Also, folks are often drawn to groups like La Leche League because in their vulnerability, it provided resources to meet their needs.  This kind of rescue can inspire an honest zealousness in well-meaning folks to help others experience the joy they have experienced.  Although leaders of the political movement may exploit this emotion in participants of the movement to ensure self-perpetuation of the organization, the individuals are simply trying to help others in the way they have been helped.  I respect that impulse.

However, I am a feminist because I believe that all women should be supported in the choices that they make and that society should be changed so that all choices are available to all people.  I believe that people are generally capable of weighing variables in a situation and choosing the best option for themselves.  If they aren't, it's because they lack information or they lack the emotional IQ to determine what is best for themselves.  Both of those can be solved without condescension or paternalism.  Maybe that's the University of Chicago-trained economist in me but I just think folks are rational actors in their own lives.

I object to the fundamentalist viewpoint when it comes to breastfeeding because it can be a major impediment to the very goal it seeks to achieve.  By setting a goal that most women cannot achieve, some - or maybe many - women will turn away from a choice that might have been right for them because they don't feel like they really belong in the community.  They are not like "those mothers" so they just won't try.  For instance, La Leche suggests that working mothers find childcare that is close enough to work that the provider can bring the child to the mother for all of his meals.


There are so many assumptions about who that mother is, I could write a whole essay on that recommendation alone.  She has a flexible job, she can afford a caregiver who only looks after her child, he and the child are physically capable of nursing, etc.  Those types of prerequisites tend to be available only to privileged upper-class folks. 

When I was able to analyse the situation and figure out why everyone was acting so weird about the shield, I could relax and even do a little education when I started to feel insecure because of someone else's mis-education from the Breast is Best advocates.

As it turns out, Esther mouth muscles just needed to get a little stronger.  At around 3 months, she batted the shield out of the way and latched on all by herself.  The latching was new since she often accidentally knocked the shield off before latching.  She stayed on for about 4 minutes but needed the shield to finish the session and then didn't want to latch that way again for another week.  I kept offering her the bare breast at the beginning of sessions and eventually she latched on sporadically for greater and greater periods of time, until the point when she protested when I offered her the shield.  We no longer need the shield at all at mealtimes.

I was fully prepared to use the shield the entire time she nursed, buying 8 shields and stashing them in the glove compartment of the car and in every bag I had, so that we would never be caught without one.  Because, with it, I could feed my daughter.  Let me repeat that.  With a shield, I could feed my daughter.  Everything else is irrelevant once that's been said.  I made the choice that I didn't want our early life together to be a struggle to get her to latch without it.  Trust me, it was ugly every time I tried.  Milk everywhere.  Both of us sticky and crying.  I am certain that the psychological damage this would do to her and to our relationship greatly outweighed any trumped up harm that breastfeeding advocates could cook up as caused by the shield.  Nipple shields are OK; you are OK. End of story.


Anonymous said...

I don't want to be overly harsh here but I read War and Peace quicker that I read this blog. Also, not wanting to be harsh, it may be that you are focusing on this topic a bit more than needed. Take me for example, I was a breast fed baby without the shield and look how I turned out. Love, the dad

PrincessMax said...

So which college class forced you to read War and Peace, Dad? Was it the Literature for Jocks 201 class you took that was right before your Climate class?

For others tuning in, my dad is actually supporting me with this comment. :-) And I am actually affirming him in his support. Perverse, I know, but families are special that way.

Not Quite What I Expected said...

Very interesting, smart, thoughtful, honest post. Thanks for sharing it.

peter andersen said...

Nice blog. Just visited Such a bizar product but it seems to work. It might be something to blog about for you? Keep it up and keep on writing. Your blog looks very 2014!