WHAT happened to your butt?

No Shrinking Violet

I was the girl in the locker room who shrank into a corner and changed as quickly as possible, hoping no one would catch a glimpse of her AAAs. Even if they'd been perfect Playboy Cs, though, I still would have hidden. I grew up with two older brothers and virtually no privacy, so the We're All Girls Here philosophy of public dress and undress has always been foreign to me.

That is, it was foreign to me, until I pooped (repeatedly) on the delivery table while trying to push out my daughter, and exposed my breasts without hesitation to six-count-'em-six lactation consultants over the following month. I have almost no modesty left. The bizarre thing is that the person I seem to be confiding in most about my bodily, er, challenges, is my dad. We had a lengthy conversation today about hemorrhoids, constipation, thrush on the nipples, mastitis, and other postpartum delights. I hung up with that satisfied feeling I always get when I receive useful advice, until it occurred to me that I'd received it FROM MY DAD. Gaaah.

I wonder how many other daughters turn to their dads for ass-related advice. It's like each part of the body has its designated consultants:

"Mom, do you ever feel not so fresh?"

"Dad, do you ever get that itching, burning sensation?"

"Sis, what do you do for carpal tunnel syndrome?"

On a totally unrelated note, this made me laugh out loud. God bless The Onion.

I Feel Like Such a Boob

Reading all of the supportive comments in response to my breastfeeding posts, particularly the most recent one, has made me realize how lucky I am--lucky not only to have supportive friends who are able to put things into perspective when I am not, but lucky that I'm able to breastfeed as much as I am.

I've been able to reach a point where my daughter is about 75-85% breastfed, meaning that all of my pumping results in 4 oz. bottles that are either 3/4 milk and 1/4 formula or, on a good day, 100% milk. I still nurse her the old fashioned way in the morning and evening and give her part of a supplemental bottle afterward if she needs it. It's a cumbersome system with all of the pumping and storing and feeding and washing pump parts and bottles -- an occupation, really (gives a whole new meaning to the term boob job) -- but it works for now. I plan to take it one week at a time.

To gain some perspective on my situation, I contacted a good friend who had told me years ago about her problems breastfeeding her older son. It interested me only peripherally because I was drinking a glass of wine at the time and internally thanking my lucky stars that I wasn't pregnant.

It turns out our situations are almost identical, except she could only produce enough milk to comprise about 20% of her son's diet, which left me feeling like a boob for complaining. She took every desperate measure I did, plus one I refused to take: prescription Reglan. That stuff is scary. It increases prolactin, thereby decreasing dopamine, so its most common side effect is depression. It also carries a small risk, apparently, of side effects associated with antipsychotics: tics that don't go away even after discontinuation. My friend Mindy, a physician in Madison, WI, told me she knew of a boy on Reglan (for reasons other than milk production, duh) who developed tardive dyskinesia (google it). I don't mean to rip on women who've taken Reglan, but for me, avoiding it is a no-brainer. The idea that one should accept the risk of becoming a depressed mother just to produce "perfect" food is the very essence of wire-monkey thinking (see monkey post, below). When my friend had her second son and the very same supply problems immediately presented themselves, she started supplementing with formula weeks earlier and never looked back. She said her one regret was being so hard on herself and missing the chance to just enjoy her baby sooner. (Yes, I know, this is exactly what you've all been telling me.)

I also spoke to an acquaintance last week about her supply problems. She did everything I did to increase her milk supply, but get this: she was ready to throw in the towel after a few months of misery but her husband wouldn't let her. The sonofabitch was dead set on having an exclusively breastfed baby, so he put tremendous pressure on her to do/take/try whatever she could to produce more milk, including Reglan. Now, this woman is no wilting lily. She had her baby at the age of 41; she knows what she wants out of life. And she very nearly decided she wanted a divorce. Compared to her, I've got it soooo easy. My husband couldn't care less how much milk I produce; he just wants me to be happy. I could switch to formula tomorrow and he would probably be relieved. All of this crazy pressure I'm feeling is self-induced. Which, again, makes me feel like a boob.

Speaking of my husband, yesterday he made an observation that was profound in its simplicity. His father was raised on a dairy farm, so G knows more than the average guy about cows and milk. He said that milk supply in cows is genetic; the biggest producers are bred to create even bigger producers. And the variation is pretty wide; some cows don't produce enough to feed a calf, some produce just enough, and some produce way more. It's the Way Mores that are bred and re-bred to create cud-chewing milk factories. Farmers do what they can to increase the milk production of the less prolific cows, but there's only so much they can do. If milk production in mammals were just a matter of supply and demand, said G, farmers would rush to take advantage of that fact. They wouldn't be paying tens of thousands of dollars for champion milk producers. In other words, some animals are genetically wired to produce more milk than others. If that's true for cows, why not humans? Why am I being told again and again that I could produce gallons if only I'd try harder? That makes no sense. For believing every word of it, again, I feel like a boob.

Lastly, I feel like a boob for not investigating more thoroughly the research on breastfeeding versus formula feeding. I know how media representations of science are (mis)constructed. A study could show that breastfed babies have a 1% chance of developing asthma whereas formula-fed babies have a 2% chance, and the corresponding news article would shriek "Breastfeeding slashes asthma risk in half!" or "Formula feeding doubles asthma risk!" Both statements are technically true, but if we're talking 1% versus 2%, not 40% versus 80%, well, what's the big deal? From a public health perspective a single percent could make a big difference, but when it comes to Mommy and Daddy's Little N of 1, it doesn't matter much. And if taking pains to reduce that 2% risk to 1% renders Mommy borderline catatonic, she's lost sight of what really matters in parenting.

SO -- I think I get it now. Many thanks to all of you who've shown both cuddly love and tough love by telling me to go easy on myself and warning me not to miss the joy of this time by obsessing about stuff that really doesn't matter. I promise to stay away from The Breastapo and to avoid taking parenting advice from any person I wouldn't want as my own parent. (Sheesh, can you imagine how those cold, unforgiving, judgmental people treat their kids?)

Okay, I hear murmurs from the nursery, so I must run. Time to kiss the baby. :-)

The Breastapo

I've posted a lot about my angst over not being able to produce enough milk for my baby. Most of my misery derives from the undisguised contempt I've witnessed on the part of certain medical professionals and breastfeeding zealots toward women who claim to have an inadequate supply. I was visiting a web board on breastfeeding and found a comment that sums up their attitude:

Wow, I have never seen so many excuses for quitting breastfeeding in my life. If all of you had babies several hundred years ago, would you have just let them starve??? Only 1-3% of women cannot medically breastfeed. And to the articles comment of, "I was exhausted from feeding the baby every hour" well that is what breastfed babies do. Both of my sons nursed every hour on the hour and sometimes sooner. Nature does not set it up for 70% of the women in the US to fail at breastfeeding. It is an interesting phenomenon that the "I didnt make enough milk" excuse happens mostly in THIS country. Breasts are supply and demand, feed more, produce more...simple as that..unless you are truly one of the 1-3% that cannot do it which is HIGHLY unlikely in most cases of "I didnt make enough milk" syndrome.

This post came courtesy of "Tiff," a member of what I've come to think of as The Breastapo. The Breastapo don't just breastfeed their own babies, they demand that everyone else does too. They reduce the enormously complex process of milk production, delivery, intake, and digestion to "feed more, produce more" and scoff at any woman who meekly suggests that it wasn't that simple for her. They assume that the psychological effects of feeding every hour for months -- which would almost certainly lead to serious psychological problems due to profound sleep deprivation -- are inconsequential. They don't seem to know their history -- that hundreds of years ago people used wet nurses when they couldn't or didn't want to breastfeed -- and have almost no understanding of the cultural factors involved in nursing. They also don't seem to realize that the infant mortality rate in other countries and in this country several hundred years ago is/was frighteningly high. Women who didn't produce enough milk and who didn't have access to wet nurses probably had babies who died or were sickly until they could eat solid food.

"Tiff"'s comments about all the excuses women have for not breastfeeding in the U.S. reveal that she thinks American women are self-centered and lazy. What she completely overlooks is that American women, more than ever before, are going it alone. Most of us no longer live with our families of origin, so we don't have mothers and sisters and grandmothers in the community to prepare our meals and clean our houses while we breastfeed every hour on the hour. One of my grad students, a woman from China, was appalled that I was back in the office a few weeks after my baby was born. She said that in China, a new mother simply stays home and feeds for 6 months while her family cares for her. I told her things aren't that way in America. She said, "How do you cope??" Good question. Stress and lack of rest affect milk supply; I know that both have been major factors in my own struggle with milk production.

The irony here is that just about every member of The Breastapo I've met is female. This is yet another case of women being each other's fiercest critics. Stay-at-home-moms and working moms fight about who's raising their children correctly, when they could be banding together to demand reliable, safe, low-cost daycare from our governing bodies. Women instead of men quit their jobs to be full-time parents based on the rationale that their men's salaries are larger, instead of asking why women are paid less than men for the same work. And when it comes to breastfeeding, women sit there battling each other over the evils of formula supplementation instead of lobbying collectively for extended, paid parental leave so early parenthood would be less stressful. The problem with American culture isn't that we're self-centered and lazy, it's that we're freaking exhausted. And isolated. And, consequently, depressed and ashamed. And if we can be coerced to direct what energy we have left in battle against each other, then we have no energy to demand policy changes that would enrich our lives and those of our children. This has always been our problem in the struggle for pro-women legislation: divided we fall.

The smart woman makes her decisions based on what she knows is best for herself and her family. Unfortunately some of us take a while to figure out what that is. I think I'd better stay away from those breastfeeding boards and just keep repeating my mantra: fur monkey, fur monkey, fur monkey...

Attacked by a rabid cow! (Heaven help me, I'm turning into an edgy Anne Geddes.)

Now's the time on Sprockets when we sleep

Happy Holidays

I don't get people who are offended by the phrase "Happy Holidays." They claim it's the product of political correctness. It's not.

It's the product of laziness.

I should know. I'm one of the laziest people I've ever met. If I can kill four birds with one stone by buying a single pack of cards that will work for everyone on my holiday list, sign me up. "Happy Holidays" covers everything, even holidays -- that is, holy days -- that are holy only to the card's recipient, such as football Saturdays, TGIFs, and Crazy Hat Day at the office.

Even if I know each recipient's religion, I still can't be sure (a) whether s/he celebrates it in any meaningful way, and (b) whether it's the only religion s/he celebrates. "Happy Holidays" covers all bases. It says, "Hey, I figured you'd be celebrating something around this time. Last time we talked you were Christian but thinking about converting to Judaism for the pastry. So, you know, whatever you're celebrating, I hope you find some happiness in it."

How could anybody be offended by a wish like that?

Given that we're on the cusp of two major holidays I know of (Passover and Easter) and probably several more I've never heard of or haven't bothered to explore (I told you I was lazy), I'd like to wish you all a big, generic, heartfelt

Happy Holidays!

What's It Gonna Be? Wire or Fur?

Yesterday I was telling a friend about Harry Harlow's famous (or infamous, if you're an animal rights activist) research on primate development. I explained to her that Harlow was intrigued with love. He started the Primate Research Center at the University of Wisconsin at Madison at a time when behaviorism was in its heyday. The behaviorists maintained that there was no such thing as love, that "love" was actually conditioning: We love Mother because she gives us food. What appeared to be some transcendent state of mind and heart was, according to the behaviorists, merely attachment motivated by base physical drives such as hunger, thirst, and the need for warmth.

Harlow believed that love was something more than conditioning. He set up experiments to test the effects of removing baby monkeys from their mothers (cruel, I know). He constructed surrogate mothers of wire and fur. The wire mothers had milk; the fur mothers did not. If "love" were merely instrumental, the babies should have spent most of their time feeding at the wire monkey. Instead, they spent almost all of their time with the fur monkey, even when they were hungry. Only when the hunger became extreme did they move to the wire monkey, and then only long enough to feed. When the fur monkey had food, they never visited the wire monkey.

As I was describing this research I had something of an epiphany. I realized that this crazy treadmill I'm on -- feed, pump, pump, take herbs to boost milk supply, pump, feed, fret about not producing enough breast milk, leave the baby in the swingy chair to pump some more -- is causing me to shed my fur. People keep telling me to leave behind the pump and just nurse around the clock for a week to boost my supply, but I have a history of depression, and sleeplessness has kept me skating on the surface of it since my daughter's birth. I'm afraid to cut back on what little sleep I'm getting for fear it'll plunge me into the depths of a deep, black emptiness. And what if I have to keep nursing like that to keep up my supply? In short, I fear that going to the extremes necessary for me to give my daughter an all-milk diet will turn me into that catatonic wire monkey: The milk's there, but the love isn't.

I told my friend this and she said that's why she gave up pumping altogether. By three months she found it absurd that she was nursing her child and then setting him down to go pump when she could have been holding and loving him. My friend said to hell with it, tossed the pump, nursed until she was empty and then supplemented with formula until her child was content. A few weeks later she transitioned to formula exclusively and hasn't looked back. She knew what was needed to save her sanity and to maximize her opportunity to build a close, loving relationship with her child.

I think I'm going to have to make a choice soon. When that time comes, I know what I have to do. I choose to be the fur monkey.

Help me, Dad. For the love of God, help me.

Lady Looks Like a Dude (Part II)

Yesterday I was out with a friend who has a 3-week-old daughter. We were at the *gasp, choke* mall. In the middle of the day. With our strollers. Amid all the other moms and their strollers. As Chris Rock said in Bring the Pain, "How the %$#*! did I get here?"

I tried to quell my panic by pretending I was an anthropologist. It didn't work. I am now one of those ladies.

Fortunately my friend felt the same way, so I was not alone. We soothed ourselves with the thought that this is all temporary, that one day we will miss all of this. (We would have soothed ourselves with the pacifiers but the babies had claimed them. In truth, given a wider array of options, we would have soothed ourselves with a couple of shots of Patron washed down with beer chasers, but we're both nursing.)

So when a woman stopped to admire our daughters, I felt like I was playing a role: proud momma, smiling smugly while onlookers admire her princess.

The woman looked at my friend's daughter -- 3 weeks old, mind you; they all look genderless at that age -- and correctly identified her as an adorable girl. Then she looked at Fi and said, "And this one MUST BE A BIG BOUNCING BOY!"

I could have freaked. I could have been indignant. Instead, I felt strangely reassured that my oddness, that very quality I've always both hated and cherished in myself, was still intact. I looked like a boy as a child, and now I have a sweet little daughter who looks like a boy. It makes us just left-of-center enough to leave me feeling that I'll never become a Stepford Wife no matter how many malls I visit in the middle of the day, and that my daughter will be interesting, which is, to my mind, high praise.

But let's be honest: obviously I want people to know she's a girl. Hence that red-and-white Baby Nay confection in the picture. At least I'm not Velcro-ing bows to her head.

Yet.

Healthcare Rant

Sorry for the negativity. Chalk it up to lack of sleep. I promise I'll get positive with the next post. In the meantime, I need to blow off steam at the quality of health care in the United States. (And yeah, I realize it's far better here than in other countries around the world.)

My peeve is with how proactive the patient needs to be. Nowhere has this been clearer in my own life than with my thyroid experience. I was misdiagnosed as having an anxiety disorder for two years before I switched primary care physicians and the new one spotted and correctly identified my symptoms on the first visit: Graves' Disease. It's not curable, only treatable, so I opted for the treatment that's heavy-duty in the short term but much more easily managed in the long term: irradiation. My thyroid gland was destroyed with radioactive iodine about six years ago, rendering me permanently hypothyroid. Like a type I diabetic, I am now dependent on supplemental thyroid hormone for the rest of my life, but I'm lucky because I can take it in pill form rather than injecting it.

This means my metabolism -- which controls everything, even a person's thought patterns -- is dictated largely by the dose of synthetic thyroid hormone (thyroxine) I take. I've educated myself pretty extensively on the topic because I have this lingering fear of being incorrectly treated after the two-year misdiagnosis fiasco.

(By the way, putting a hyperthyroid person on anti-anxiety meds is not a good idea. Both hyperthyroidism and certain anti-anxiety meds have an effect whose name I can't think of now, but it's the opposite of constipation. As I told my mom, "If you think you have to fart, think again." Enough said.)

Since my thyroid odyssey began I've had several close calls medically, experiences where I was very nearly mistreated but caught the mistake and alerted my providers. Another one happened today. During pregnancy my thyroxine dose needed to be increased due to the metabolic demands of growing another person in my body. I ended up at a funky hybrid dose of 162.5 micrograms. A recent thyroid test showed that I've become borderline hyperthyroid on this dose, so I called my endocrinologist to let him know. Of course, I could only speak to the nurse, which is supposed to streamline the system by preserving the doctors' precious time but only adds another node in the communication network. I'm sure you can see where this is heading. The nurse left a return message notifying me that the doctor authorized a decrease in my thyroxine to 112.5 micrograms. This alarmed me because I was taking 125 micrograms prior to pregnancy, so dropping me even lower than that while breastfeeding (when one's metabolic demands can be as high as during pregnancy) would almost certainly render me hypothyroid. That would have dried my milk supply right up and made me feel lethargic and miserable. So I called the nurse back and explained the situation. She looked at her records and said, "Oh, I see, he wanted your dose dropped 12.5 micrograms, not dropped to 112.5 micrograms. Okay, I'll call in a scrip for 150 micrograms." Somehow there had been a miscommunication between doctor and nurse, one that resulted in improper treatment that, fortunately, I subverted by being a nosy, overinformed patient.

The thing that irks me about this is what would have happened had I been less informed, had I been one of the millions of Americans who take their physicians' word as gospel and don't double-check like I do. I would have picked up my scrip for 112.5, become hypothyroid in the space of about 6 weeks, stopped making breast milk, and not found out why until my follow-up test, scheduled 10 weeks from now.

I have to wonder how many people out there are suffering because they're being misdiagnosed and mistreated all due to miscommunication problems in the medical system. Even little kids know that the more people you put in a communication network, the greater the potential for distortion of the original message. That's why they play that telephone game, where a message goes around a circle and everyone laughs at how different it is at the end. We the patients -- no, I'll use the empowered word, clients (after all, we're paying for our treatment) -- have to educate ourselves not only to make sure we get treated to improve our health but to make sure that very treatment doesn't jeopardize what health we've got.

Grrr.

Well, the story has a happy ending for me because I caught the error and have my scrip for 150 now. But I do feel bad for anyone out there who is receiving or has received shoddy and even dangerous treatment. Caveat emptor is nowhere truer than with medical treatment.

Rant over. Next post will be frothy.

Oppressed by the Breast

Breastfeeding sucks.

(Heh heh -- I just got that.)

I'm having the hardest time with nursing. I naively thought it would either be 100% successful or would not work at all. Instead I'm stuck in the Limboland of Inadequate Supply, pumping 7x/day in the hope of being able to feed my baby the Pure Breastmilk Diet without having to defile her dainty little system with Vile Formula.

But this notion of inadequate supply is my own little fantasy, you see, because there's no such thing as an inadequate supply. EVERY woman can produce enough milk for her baby provided she tries hard enough. Such is the rhetoric of breastfeeding in the early 21st century. It's disturbingly like the weight loss rhetoric: So you say you're not producing enough milk (losing enough weight)? Just try harder. Anyone can produce enough milk (become stick-thin) with a little discipline. The implication is that you're lazy and/or ignorant if you have problems. The breastfeeding and dieting rhetorics are alike too in that everyone who's nursed successfully gives you the same simplistic advice: demand leads to supply (weight = calories in minus calories out).

A colleague pointed out to me that this rhetoric is a bourgeois White middle- to upper-class construction. Yes, research shows that breast milk is better for your kid than formula, which is why I, like so many women, was brainwashed during pregnancy that I was a Bad Mommy if I allowed so much as a drop of formula to cross my child's lips. But the advice I've been given -- stay in bed for several days and do nothing but nurse (while your maid brings you ready-made meals and your butler does the laundry, presumably) -- assumes a life of privilege, or at the very least the absence of other children in the household and the presence of a partner who brings in enough money to allow Sainted SAHMhood. I have no other children and don't intend to be a SAHM because I don't want to be. But I'm on leave now, so I could conceivably do exactly what they say. Problem is, when I tried it for 3 days, my baby was starving, cried the whole time, and lost weight. So yeah, I could build my supply by taking repeated "nursing vacations," but do I want to? Not really. It's hard watching your kid go hungry.

I've seen or consulted by phone six lactation consultants, several nurses, and one pediatrician. The first week, my poor baby lost 17 ounces, which was over 11% of her body weight. The pediatrician doesn't want more than 7% lost. So everyone told me to supplement with formula temporarily. At the 2-week appointment Fi had gained back her lost weight, so everyone was happy. They told me I could start weaning off the supplements. I did, and that's when the misery started. Poor little thing was bleating like a lamb (actually, a Muslim lamb: her hunger cry sounds like "Allah! Allah!") for food she couldn't extract from my chest. There's nothing wrong with her mouth or her latch. She knows how to suck. But multiple visits to the breastfeeding clinic at my local hospital showed that she couldn't get more than an ounce or so total with each feeding, so they recommended I continue to supplement. At the last visit she took in a paltry 1/3 ounce, so they told me she wasn't working at it because she probably already knew a supplemental bottle would come. They suggested I pump and feed expressed milk from the bottle because I can get more milk in 10 minutes of pumping than my daughter can extract in 40 minutes of feeding.

So that's what I've been doing: pumping 7x/day, taking fenugreek (don't ask), drinking plenty of fluids, etc. And I'm stuck in a holding pattern that has my daughter taking in half of her nourishment as milk and the other half as formula. Today I rented a Medela Symphony, the state-of-the-art hospital-grade pump ("sucks just like a real baby!"), to see if it can extract more milk than my perfectly respectable borrowed Medela Pump In Style. (By the way, the Pump In Style retails for about $300, the Symphony for $1300 -- hence the borrowing/renting.) I also picked up a supplemental nursing system, a laughable device that requires one to tape tiny tubes to one's breasts so one's child can get the milk/formula combo she needs while stimulating the breasts to make more milk. (Kid stimulation is supposedly better than pump stimulation.) Oh yes, and I awoke at 4:00 this morning with freakin' mastitis so I have to get some antibiotics and pump every two hours, even at night, just to keep the milk flowing so my left breast doesn't, er, explode. I've been home all day because mastitis produces flu-like symptoms.

Clearly I'm not cut out for breastfeeding. So why can't I just let it go? For the same reason, I think, that I began having problems in the first place. The first two weeks of my daughter's life were so traumatic (did you know pushing out the first post-surgical poop can actually give one a hemorrhoid? Tragically, I did not) that I was a complete wreck. I'm still a wreck, just less intensely so. I am a Type A anxiety freak stressmonger. It was only when friends and acquaintances started telling me that stress can inhibit the letdown reflex (when your brain sends the signal for the stored-up milk to be released) and reduce the milk supply that I put two and two together. I couldn't take that advice to nap when the baby naps because I couldn't nap if I heard her make even the slightest peep. It's like trying to sleep when you know an alarm is set to go off at any minute. So I've spent the past six weeks surviving on very little sleep, eating as much fiber as I can to avoid angering The Beast down below, and stressing about my inability to produce enough milk for my kid, all of which, paradoxically, make the problem worse.

I don't know where this will end. I don't know how it will resolve itself. All I can say is that I am so looking forward to the day my daughter is weaned. And this strikes me as sad, because those first few minutes of nursing, before Fi realizes she's pumping a dry well and starts to cry, are really, really nice.