Mother's Milk Mailbag

"I worked as a Public Health Nurse in the county of North Dundas from 1970-1978 fulltime and then taught childbirth classes for another 11 years. Listening to Teena's & Tracy's stories, which I gather was fairly recent, just proves to me that institutions don't refer moms to outside organizations, such as La Leche League Canada.  I am so often frustrated with physicians and health units that do not recommend their patients contact us. We never pretend to take the physician's place, and we recommend that they go to their physician when needed.  We have experienced breastfeeding personally as well as have helped thousands of new parents get through rough times.  We are all volunteers and spend many hours speaking to and showing new parents, what is normal and how to correct things. It is very rewarding to see these Moms a few weeks or months later happily breastfeeding their baby and hoping to continue for many more months.  You didn't ask these women if they had contacted La Leche League or even knew about it. Most women go on the Internet, so I am surprised these women hadn't, where they could have had support."

From:  Louise Arsenault, Winchester, Ontario

"Thank you, thank you, thank you for the show on breastfeeding.  All my mom friends talk about this issue, but nobody talks about it in public months with very little for fear of being branded a bad mother.  I have two kids myself, nursed the first from birth to 18 months with very little problems.  But my second was born at 29 weeks gestation and well breastfeeding was a struggle.  I pumped and breastfed while he was in the hospital (64 days), but had to stop once he was discharged because keeping up with a 2 year old, a newborn with weak latch, plus pumping to keep supply up, plus alternating bottles/breast for extra calories as per doctors orders... well it just got overwhelming!  So I let go of the pump and hence the breastfeeding and thanked god for formula!  Of course the public health nurses have lambasted at every single vaccination appt since then, repeatedly telling me the breast is best message to the point where I just want to cry. I've also had perfect strangers come up to me while bottle-feeding my baby and "educate" me on how breast is best.  I know, I know, I know, people.  I'm doing the best I can with my circumstances.  In this day and age, very little mothers who bottle-feed take it lightly.  Bottle-feeding usually comes as a last resort, after struggle and tears on the part of the mother.  I just wish the medical community and others would acknowledge this. I am passing along the podcast."

From:  Christine Zahynacz, Calgary

"In a show that apparently was intended to promote breastfeeding, it would have been helpful to hear from an actual mother or mothers who had easily and successfully and enjoyably breastfed their babies, preferably for the 6 months of exclusive breastfeeding as recommended.  Including these voices would present a more balanced perspective than the show you aired."

From:  Mary Mckenna, Fredericton

"I love your show, it gives me insight into some of the issues that my friends and relatives who are doctors face.  I am a new father as of January, and my wife has put a lot of effort into breastfeeding exclusively. We had some difficulties early (cracked nipples, milk was a bit slow to come in), but we used donated breast milk (from my sister) and a supplementary nursing system to insure that Jasper was fed but also learned how to feed from the breast.  Two things that I think were missing from your show, and that I feel are worth you following up.  Dr. Jack Newman is a leading global authority on breastfeeding, especially with regards to helping those Moms who are having great difficulty, and he works in Toronto. His website is an amazing resource, and he replies to emails personally and promptly (both my sister and my wife emailed him about specific issues, and he sent them both links to general information and also a quick response to their specific circumstance). I think you missed out on a great opportunity by not having him on your show.  Second, the tone of the show seemed to be exclusively breast feeding or formula feeding, but that is a false dichotomy: there is no reason why formula couldn't be used until breast feeding can be established."

From:  James MacAulay

"My coworkers listened to the show yesterday with a sense of growing impatience.  Never did you address reasons why women have trouble breastfeeding.  Apart from previous surgeries, traumatic births seem to directly cause troubles breastfeeding.  I was once told by famed blogger Stephanie McPhee (yarn harlot.com) that she gave up being a lactation consultant to become a doula because the problems started during delivery.   Women are offered pain free births and caesarean sections without understanding that it increases difficulty with breastfeeding.  It makes me angry that the conversation on your show has drifted back to bottle vs. breast as a choice just like the natural vs. medicalized birth is merely a preference rather than an important health decision for both mother and infant. A few hours of discomfort (okay let's call it what it is, incredible pain) helps insure a successful breastfeeding relationship. It's all linked and the medical profession is letting women down.  I'd also like to comment that many women with supply issues successfully supplement feeding rather than abandoning breastfeeding all together as your guests did.  It sounds like they we so mad at the medical profession that they we not even going to give their babies partial benefit of nursing time with mom. You never asked them why."

From:  Jana Dempsey, Halifax

"My heart goes out to women who are unable to breastfeed.  Aside from the health benefits, the experience itself was one of the most significant in my life.  Both of these women wanted to do the best for their babies, and it's distressing to hear that they were so let down by the system.  There are 2 questions I would like to have heard someone raise in the discussion.  First, why were they having this difficulty?  Perhaps the public health nurses discussed practical factors like diet and liquid intake, but in your piece there seemed to be no attempt to address the cause, only to fix the symptom with a pill or a device.  Second, what approaches have women around the world and through the ages used to increase milk production?  We're so ready to reinvent the wheel with our technologies and inventions that we overlook traditional knowledge.  In these mothers' place, I would have appreciated medical support that brought all available resources to my aid.  That said, I thank you for your compassionate look at this dilemma."

From:  Jenny Noble, Quesnel, British Columbia
 
"As a mother who hasn't been able to produce enough breast milk for my baby (we supplement my breast milk with donated milk and formula), I listened with interest to this program. What I would have liked to hear is a real description of what support for breastfeeding looks like.  From my experience, support from health care professionals means providing far more pre and post-natal knowledge about what mothers can do to maximize their success - skin to skin contact, baby wearing, feeding on cue, laid back nursing, and many others - and providing the practical help to trouble shoot, such as helping a new mom put her baby in a sling, adjust her latch, and help her adjust to the new lifestyle that producing a milk supply requires.  Support from friends and family means taking care of cooking, cleaning and other demands, and keeping away distractions that prevent mom and baby from spending the intense time together that it takes to get feeding started right It also means telling her she's doing a great job.  Support from society means questioning our assumptions that babies should fit conveniently into our existing routines. It means expecting that new moms will be absorbed mind, heart and body with their new baby and that this is a good thing, rather than expecting them to get the baby onto a schedule and themselves out into the world as quickly as possible.

"If we actually actively supported breast feeding in our society, many more women would experience breastfeeding success. And knowing that this support is there, we should be able to extend it fully to those women who, for whatever reasons, need to feed their babies by other methods. Finally, it would have been nice to hear mention of continued breastfeeding even in those cases where a woman has only a partial supply. I have chosen to continue though my daughter doesn't get her full nourishment from me, because I know all the benefits she does get even from a partial supply. Encouraging mothers who can only partially feed their children to continue with that is another way to provide support."

From:  Kamilla Bahbahani, Kelowna

"Doctor Goldman, I have always wondered why Mother's milk was always advertised as the best natural supplement when people always expect pregnant and breast-feeding mothers to drink milk. Given that milk was only introduced in the human diet after the advent of animal domestication wouldn't the most natural Mother's Milk be water based not milk based since water is the most natural hydration form for the human body? Have there been any long-term studies that have been done comparing H2O based Milk with milk based Mother's milk? Or wouldn't the dairy industry allow it?"

From:  Alan Martin, Prince George British Columbia

"I was just sitting down to breastfeed my daughter this morning when your show came on and I listened with great interest and thought I would share my own story with you.  My experience with pre-natal classes, public health nurses, my midwife, and the doctors and nurses in the NICU (where my daughter spent the first 10 days of her life), was very different from the women you interviewed. What I was waiting for you to address was the social stigma attached to not breastfeeding! While I didn't experience pressure from (most) health care professionals I encountered, I was surprised by the social pressure to breastfeed, which started well before my daughter was born!  I went in hoping to breastfeeding exclusively, but was willing to keep an open mind. Then, when my daughter was born almost 6 weeks premature, she had to be put on a feeding tube until she was strong enough to eat on her own. Being discharged before she was, I wasn't around to feed her at night, and so she was bottle-fed formula (and then, when my milk came in sufficiently, pumped breast-milk) in the NICU. However, after six weeks of exclusively breast-feeding her, when she was strong enough to stay awake and breastfeed for longer periods of time and with more frequency, I found that my milk production was just not sufficient. On the advice of our pediatrician, I started supplementing with formula, when necessary, until I was confident I was producing enough milk (roughly until she was 4 months old). Though the practitioners I encountered were certainly pro-breastfeeding, I never felt pressured by them to breastfeed exclusively or at any cost (with the exception perhaps of the lactation consultants in the hospital, whom I can't fault because 
I was soliciting their advice on how to increase my milk production).  The worst pressure came from well-meaning acquaintances (whom I half-jokingly started to refer to as the breast-feeding nazis). These women would adamantly repeat to me "whatever you do, don't let anyone give your daughter a bottle!" If I suggested that I was open to all options, the looks of horror on their faces said it all. These women strongly felt that the breast was the ONLY way to go.

"To make matters worse, once I started experiencing a shortage of breast-milk, every time I heard "Whatever you do, don't supplement. For every bit of supplementation you provide, you lose that amount of breast-milk.  Feed more frequently, pump after every feeding, take domperidone if you have to!" I started feeling like I was somehow completely incompetent as a mother. Fortunately, I was lucky to also have a close circle of friends, several of whom had issues with breastfeeding, who told me: "if you're baby is still hungry, give her some formula. There's nothing wrong with supplementing every once in a while". And so I continued to do so. I never replaced breastfeeding with bottles or formula, but I frequently supplemented, especially later in the day when fatigue would diminish my supply. Eventually, all was well and we stopped supplementing. There has never been any "nipple confusion" and my daughter is a healthy, happy, thriving 10 month old. I am sure though, that the social pressure contributed to my stress and feelings of inadequacy as a mother when my milk supply was low. In the end, I am glad I persevered and stuck with breastfeeding, but I am in no way sorry that I also gave her formula!  For the record, I received a prescription for domperidone, but never filled it. Instead, I opted for herbal remedies and teas, which seemed to help with milk production, but certainly helped with peace of mind.  I never thought that breastfeeding would be so challenging and that feeding formula would be so offensive to some. Thank you for talking about an issue that few women discuss until well after there is a problem."

From:  Lada Darewych, Toronto

"While listening to your show I felt like I was re-living the first few days of being a new mom.  My son was born a couple of week before his due date and breastfeeding was not going well.  Everyone kept saying, "Just keep breastfeeding".  Telehealth, my doctor, nurses at the hospital and my midwife all just kept saying to continue breastfeeding and no one bothered to mention that the reason he was crying all the time is because he was starving.  On his day three check up with the midwife he had dropped too much weight and was showing signs of jaundice. I was told to take him to the hospital and as soon as we got there, they weighed him and then gave him a bottle of formula immediately. He sucked it back like a shop vac. I was stunned and horrified.  We spent the whole day and night at the hospital; he was so dehydrated they stuck him everywhere trying to draw blood.  It was awful.  It all could have been prevented if someone had advised me to top him up with a little formula.  I went on to breastfeed my son for 10 months and am currently breastfeeding my daughter who is 5 and half months. Thank you for doing a show about this topic and helping to educate new moms about the medical professions "agenda" when it comes to breastfeeding."

From:  Danielle James Stehr, Ottawa

"Thanks so much for doing the show on breastfeeding. My daughter ran into all the nonsense we heard about from your guests plus a suggestion that if she absolutely had to give her baby, who weighed almost 10 lbs., formula that she had to give it from a small pill cup. NO BOTTLES! Most of the formula simply dribbled down the baby's front. After a few days, I convinced her to keep breastfeeding but to supplement with formula in a bottle if he was still hungry.  She felt guilty about the formula but everyone was happier.  She kept breastfeeding to some extent until the baby was 15 months old.  She has just had her second baby (10lb 12oz) and right away combined breastfeeding and bottle-feeding.  Baby and mom are very happy and dad also enjoys feeding the baby.  When my daughter's first baby was about 3 months old she had to stop breastfeeding because she was ill herself and on medication.  Because the baby was used to a bottle with formula, there was no added stress about him not being able to nurse."

From:  Jennifer Duncan

"My husband and I just finished listening to your segment on breastfeeding entitled Mother's Milk Show. I myself am a new mother of eight weeks, and a nurse by profession. I grew up in family of fecund women, all of who are nurses who had no difficulty exclusively breast-feeding. My mother is a nurse, and she provided me with a great deal of literature on the virtues of breast-feeding. As a result, my expectations to breast-feed were very high.

"Much to my surprise, when my daughter was born I was unable to produce sufficient milk for her nutritional needs. We were counselled to continue to try breast-feeding using lactation aids and pumping. The regimen of pumping, breast-feeding and supplementing with a tube left me exhausted, and didn't allow me to enjoy precious time in those early weeks with my daughter.

"My experience was nearly identical to those mothers interviewed in your segment. Our health care system no longer provides new mothers with all the options in a non-biased manner. Listening to Nicole Welch from Toronto Public Health, it was clear to me the bias that many health care professionals have against formula feeding. As a health professional, I pride myself in providing my patients with all the options to make informed decisions on their health.

"With respects to breast-feeding, the pendulum has swung to far. When mothers are unable to provide breast-milk, health care provides must offer support freely and in a non-judgmental manner when woman are forced to give up breast-feeding. My own experience has altered the mindset of both my mother, and myself. While I still believe in the virtues of breast-feeding, I have an entirely new respect for the struggles that many women face when trying to breast-feed. Thank you Dr. Goldman for producing this segment."

From:  Sarah Beingessner, Waterloo, Ontario

"Thank you so much for your very balanced presentation on breastfeeding.  Having a husband with Type 1 diabetes, the pressure to breastfeed my baby was huge and I was all for it this new adventure with my first son.  It looked easy enough, but what a nightmare I headed into.  My 7 lb 3 oz baby went down to 6 lb 3oz very quickly after being born.  I was told I was doing everything right, but I knew the baby wasn't getting enough to eat. I would nurse for 45 minutes and then 45 minutes later I was at it again.  I was charting diapers, but my little boy just didn't seem to be growing.  Twice a week I went to a breastfeeding clinic where my tiny baby was weighed each week and I was encouraged to keep going despite my baby projectile vomiting almost immediately after each feeding. I was still feeding around the clock and totally exhausted.  I began to pump milk and feed my son with a bottle, but still he was only gaining an ounce or two a week while always throwing up.  My son started to have blood in his urine and we started trying to figure out what was wrong with him. My doctor retired during this time and I had a new doctor that was single and did not speak much of my language. 

"I started eating only mashed potatoes and chicken broth and my son was able to drink my milk.  My husband by this time was totally exhausted by this experience and wanted me to try formula.  I refuse to do anything that would hurt my child.  When my son was 12 weeks old we moved to another city.  Here I immediately found a breastfeeding clinic and attended it.  After the 2nd week there I was pulled aside by a health nurse and she asked how I was doing.  I was in tears as I told her my story.  She was so very compassionate and told me from all she could see that I was just one of those mom's where breast feeding and expressing breast milk was not going to work.  She encouraged me to get on the same page as my husband and try formula. 

"In one week on formula my son gained 8 ounces!  He started sleeping through the night from 7:30 PM to 7:00 AM.  No more bloody diapers and no more throw up sessions after each feeding.  I was able to get sleep and have a life back.  I could get out and take my baby on walks and shop and begin to conquer the horrible depression that I had entered during this very frustrating 14 weeks of my life.

"I am so grateful for the health nurse that gave me permission to do what was best for my son.  I am so very thankful to those people who make formula for those of us who really need it for our children.  Your show brought back a thousand memories of horribly dark days, but I am thrilled to hear a voice speaking out for balance in this entire controversy.   Love your show that brightens each Monday lunch hour!"

From:  C.C. Van Gorkom, Powell River, British Columbia

"I heard with interest your show this morning about inadequate supply of breast milk in new mothers. The same thing happened to me 25 years ago with my firstborn.  We were on a posting in Africa at the time and he was born in Kenya. Right from the beginning I did not produce enough milk for my son but I was told to give it time and let my milk come in as it takes a couple of days. But my milk never did come in to any great extent. All the books I read and various people I had spoken to all indicated that every mother produces enough milk for her children and to keep trying. I started to feel very guilty and inadequate as a mother because I knew my son was not getting enough. Some African neighbour ladies came over and gave me a special dish to help increase my milk supply but it didn't work. In fact it was the African women who told me that I was starving my baby. We bought formula as soon as we could the next time we were in a big centre and he did indeed start gaining weight. He was always a small little fellow; sometimes I have fears that maybe I stunted his growth by starving him as a newborn.  Thanks for having this show, as there really are women like me out there who for whatever reason cannot produce enough milk. We should not be made to feel guilty. I so wanted to breast feed my kids well into their babyhood but that was not to be."
 
From:  Bonnie Burns, Whitehorse, Yukon.

"It is interesting, to say the least, that the mothers' comments in today's show could be almost exactly the same for mothers who have been discouraged from breastfeeding in the past. It's almost as if we've come in a circle. Mothers who breastfed have been stigmatized and ostracized. That's just plain wrong!  There are so many misconceptions about babies and their feeding that it's frightening. Everyone needs education in why breastfeeding is important, how it should happen and what to do when it doesn't seem to work. We also need more study into why it doesn't work sometimes. No matter whether breastfeeding or formula feeding, mothers deserve better care than they are getting."

From:  Audrey Trenholme, Victoria, British Columbia

"I am currently listening to your Mother's Milk show, and it's excellent. Thank you SO MUCH for doing a show on the pressures that new moms face. My experience with the public health professionals in my community has been terrible. I have found breast-feeding to be a real challenge, and while I am certainly committed to it, the public health nurses in my town are absolutely unsupportive. What makes them so unsupportive is how totally one-minded they are about breast-feeding. I am committed to breast-feeding precisely because I know it is best for my daughter, both physically and emotionally, but the public health nurses are oblivious to the different challenges that different mothers might face - be it labour and birth complications, or undue stress, or physical or emotional barriers to a successful breast-feeding relationship - and as a result they just aggressively push the same program on everyone In my experience, I found myself having to pump in between feedings to not only increase my milk supply, but to make sure that my daughter had enough to eat, and when I shared with public health that I was supplementing my nursing with a bottle (of breast milk!) I got a lecture on how I should never, ever feed my daughter with a bottle, and I was given a ridiculous little cup that I was supposed to use to feed her my milk. They even recommended that I hand-express my milk into it, instead of using a pump. Though I had been clear that I am a single mother, and so I just didn't have the time to sit around manually expressing my milk into a silly little cup, they were totally dogmatic. It was a horrible experience, and just simply cannot be seen as a supportive resource for new mothers.  Thank you so much. This is a really important topic. I really appreciate it."

From:  Mary Butterfield, Grand Forks, British Columbia

"I listened to your show on mother's milk this morning with interest. I had the opposite experience of the women you interviewed, where I felt almost pushed by the public health nurses to introduce formula to my son. At three days old, when we went to visit the public health nurse (they no longer do house visits here in Calgary), they said that he had lost about 10% of his birth weight, and that this was higher than the normal 7-8% loss. They said that I could continue breastfeeding for that day but I had to express extra milk/colostrum (my milk hadn't come in yet) onto a spoon and feed that to him after he was finished nursing and schedule an appointment again for the next day. If he didn't gain weight by the next day, they told me I would have to start supplementing with formula. This was an extremely stressful situation, since I really didn't want to introduce formula. The next day we found that my son's weight had plateaued, and the nurse said that I could continue breastfeeding but that I needed to keep a close watch to make sure my son was gaining weight.  My milk finally came in on day 5 and my son went on to gain weight and to thrive. I am still nursing and have never used formula almost 15 months later. I have since done more research about breastfeeding and have come to understand that the more the baby sucks at the breast, the more milk production is stimulated. Therefore, introducing formula too early is counter-productive. So after listening to your show, I'm wondering at what point health nurses should suggest formula? At three days, it seemed too early, but obviously babies shouldn't be starving for 3 weeks either. Is there a happy medium?  Thanks for your show."

From:  Stephanie Westlund

"Enjoyed the show today on breastfeeding, my experience was a bit different as when I was having troubles in the hospital the nurses were very quick to offer formula rather than trained lactation consultants who might have been able to offer more guidance. However, I would agree with the fact that public health nurses are not very forthcoming with supporting formula.  I even had one ask me if I would consider hormone replacement therapy! Another common response was, " keep trying, if you really want it to work, it will" Seriously?  Needless to say the challenges were almost too much, bottles, tube feeding, finger feeding, overnight visits with lactation consultants, 16 motilium tablets per day, visits to breast feeding clinics in nearby cities... it was a very stressful time and as a new mother wracked with guilt and uncertainty. In the end I have come to a nice balance between breast and formula, but it sure would have been nice to get some more support in those early times!  Thanks again for your insights and it was great to hear from other mother's who have had the same challenges."

From:  Kelly Dinsmore, Edmonton

"Thank you, thank you, thank you for sharing Tracy and Teena's stories with us this week. As I write, I'm crying tears of frustration and sympathy, having had a strikingly similar experience to Tracy -- a history of breast reduction, a starving baby, and continued pressure to 'just keep trying.' Thankfully, I was eventually counselled to supplement breastfeeding with formula, but it took three weeks to get to that point -- a rough start in life for my son.  The pressure and judgment on parents who formula feed is relentless and ubiquitous. Even formula can labels and commercials scold parents for making a sub-par choice for their precious child. What kind of a message does this give postpartum women, or adoptive parents?  I don't question the use of public funds for breastfeeding support, and welcome social acceptance of public breastfeeding. But I sincerely hope your program has reached those for whom their militant pro-breastfeeding ideology causes them to judge and condemn parents who are doing the best they can."

From:  Kari Olson, Regina

"Bravo for tackling such an emotional and controversial subject in your show Mother's Milk. As a mother of two, I've experienced both sides of the breastfeeding spectrum and have written books dealing with these ignored aspects of breastfeeding.  My first child was born at 31 weeks and breastfeeding didn't work out so well. I ended up exclusively pumping for just over a year. This is an option that is rarely offered as an alternative to formula when a new mom has breastfeeding challenges. After my experience, I published my first book, 'Exclusively Pumping Breast Milk', and have been in contact with hundreds of women who are grieving the loss of their expected breastfeeding relationship with their baby and angry at the lack of support and information they feel they received from those around them. I encourage you to consider a follow-up story on this much- ignored alternative to formula feeding.  My second child was a much different experience and she nursed until she was just over three years old. But the emotions and challenges of the first experience with my son brought the emotions and grief back to the forefront. This has led to my second book, about to be published, called Breastfeeding, Take Two that is aimed at women who have had challenges breastfeeding their first child but who want to have a more positive experience the second time around. The book looks at the emotions surrounding breastfeeding, the societal and medical interventions that can affect breastfeeding, and provides information and advice to help women achieve their own measure of success with their next baby.

"The pressure women feel to breastfeed is not backed by the practical and knowledgeable support that women need to receive following the birth of a child Our society has bought into the 'breast is best' message, but it hasn't figured out how to support women in a manner that honours the biological nature of breastfeeding. It is this division between what our biology expects and what society supports that causes such strong emotions in women when it comes to breastfeeding.  Thank you for tackling this difficult subject. I encourage you to continue focusing on this issue and being a voice that supports women in their efforts to breastfeed by highlighting the division between biology and society."

From:  Stephanie Casemore, Napanee, Ontario

I listened to you this morning on my way to dropping my husband off at the airport. Usually, I turn down the radio so he can make business calls. Today, we both listened and had an animated conversation responding to what was said.  I am not a medical professional, just the mother of 4 who were all breastfed.  What struck me most, and I find this generally when it comes to parenting and childbirth ideologies, is the lack of common sense around many parenting issues and lack of trust that most mothers do know their own children best.  How can I get involved in organizing a milk bank for this sophisticated city of ours? Maybe we should also revive the job of wet nurse. If a couple will pay for a lactation consultant or a sleep doula, why not a wet-nurse?  Enjoy your work."

From:  Bari Zittell

"Thank you so much for doing your show on breastfeeding, in particular about women who are not able to breastfeed, even though they would desperately like to. I had my son three and a half months ago, and fully expected to breastfeed exclusively. I knew breastfeeding was best, and I knew the first 6 weeks would be challenging, but I was fully committed to doing whatever it took to breastfeed my son.  Feeding my son however did not go as planned.  My son lost weight in his second week, and we had no choice but to supplement him with formula. I was absolutely devastated, and went mad doing everything I could to increase my milk supply.  I took domperidone, I pumped up to 6 times a day, I used the supplemental feeding tubes, and I went to the osteopath.  I drove my husband and to the brink of insanity.  I could not accept giving my son formula, otherwise known as 'the devil's milk'. When my husband told me he was considering moving out because my obsession with breastfeeding had gone on for too long, I snapped back to reality. I was missing out on the most beautiful time with my son. I accepted the fact that he was a healthy and happy little boy, who was still getting breast milk, but also some formula. I accepted my failing breasts.  In terms of the public health nurse, my experience was relatively positive.  The public health nurse talked us out of giving formula in the first days, but admitted several days later that we did need to supplement. She was in touch with me constantly, and she clearly cared about my baby and I.  In Nova Scotia, breastfeeding is certainly pushed, as it should be, but for mothers like me who are unable to breastfeed exclusively, that pressure can make us feel inadequate. Public Health nurses are in an awkward situation. They want to encourage mothers to breastfeed, particularly when they are facing issues that can be overcome (such as a bad latch), but they also must recognize when a mother has insufficient milk to fully feed her baby, and suggest the alternative.  I still get overwhelmed when I hear other women's stories of their struggles with breastfeeding. Thank you again for bringing such attention to the issue."

From:  Gabrielle Gesner, Halifax, Nova Scotia

"Doctors are missing the point that it does not have to be one or the other!! I breast fed 5 children and by the 5th one I got it down to a supreme art - nursing and formula from the start - taking breaks when I needed it. Eventually when my babies were much older I was able to nurse on weekends and bottle feed during the week and my body adjusted easily.  For new mom learning to breast feed, I had my nipples tweaked by nurses, swollen and leaking breasts, sensitive nipples and soreness that at times I had to clench my teeth not to scream when baby nursed, not to mention other areas of healing as well. Add to the picture the joy combined with fatigue and stress of life never being the same again. A woman has to be DETERMINED to do it or it just won't work - physically and emotionally. I learned over the years was it didn't have to be one or the other. Formula feeding did not reduce my breast milk. My body quickly adjusted to increase or decrease in production. I was happy to breast feed because I knew I could take a break. My bottle-feeding friends and babies were happy too. And THAT'S what is really best doctors - a content, rested and happy parent provides a stable, healthy foundation for a developing child."

From :  Nancy Morrison, Fergus Ontario

"I am an avid listen and the CBC is always on in my office. So I caught your program on breastfeeding.  You should try to deal with PHD in the schools. Again they do not take well to the word no!"

From:  Gerard van den Wildenberg, Oshawa, Ontario

"Thank you so much for this episode. While both women featured where not from Toronto, this is exactly the situation my wife and I experience in Toronto. My wife was forced to have an emergency c-section and this caused problems with breastfeeding. During our 4-days in the hospital our son lost more than 10% of his body weight, and it was a constant battle with staff to feed our son formula. We tried, and tried to breastfeed, to no avail. Finally, with my wife in tears, a kindly nurse "slipped" us some formula.  I would say that the issue is not particularly with nurses and doctors, but with hospital administration and the over-zealous lactation consultants."

From:  Alex Carter, Barrie, Ontario

"If this show on breastfeeding had been the first time I listened to your show I probably would never have listened again.  I am usually a big fan of your show but I had some serious concerns with this episode.  First of all, for sure a mother who has had breast reduction surgery is definitely one who is likely to have supply issues and she didn't have good support and probably should have supplemented with formula early on but such a case is rare and an exception because of her previous surgery.  I didn't hear any mention of the fact that there are very easy and basic ways to see if a baby is getting adequate nourishment, breast milk or substitute; that is counting wet diapers and bowel movements.  My biggest concern with your show is that while you definitely promoted breastfeeding as best, you didn't mention that for most women breastfeeding is not hard or painful or even particularly difficult.  I also feel that you didn't mention that the majority of breastfeeding difficulties are easily resolved with family and professional support and that usually doesn't involve taking medications.  Far too many doctors and hospitals and nurses are not supportive of breastfeeding or properly informed on how to support mothers to fully initiate breastfeeding in a way that will successful for mother and baby.

"I don't know where those 2 mothers you interviewed live but I have never heard of a hospital that didn't have formula at the ready or a public health nurse that didn't suggest topping up with formula even when it wasn't needed.  For a matter of record, I breastfed all 5 of my kids starting in 1986 and into the early 21st century.  I was also a La Leche League Leader and as a volunteer and in my personal life I have talked to and supported 100s of women with breastfeeding. More breast milk banks would be great but really we still have a long way to go in terms of education and making breastfeeding the norm. The vast majority of women who choose not to breastfeed or who wean at a very early stage do so as a result of a lack of information and support on a personal and family level and on a larger societal level not because their baby was starving."

From:  Susanna Eve, Halifax

"I just want to say your article on breastfeeding was very interesting.  I do believe if you can breastfeed your baby, by all means do it!  There are just so many health benefits!   Now, in saying that, I can sympathize with the ladies in the article who was pretty much bullied to breastfeed I did not breastfeed my first child.  I was quite young and was not educated enough to know the difference.  So, I didn't attempt it.   I did breastfeed my second and it was very mentally draining and trying at times.  I managed to stick with it for 16.5 months, but felt I was a horrible person if I was to stop.  This is due to the stigma behind it.  I also breastfed my third child with much greater ease and did so until he was 18 months.  The other issue I had concerning the breastfeeding was that I have felt immense guilt for NOT breastfeeding my first child.  I just find the system can be far too judgemental as opposed to educational.  In reality, it is the choice of the parent and no one else.  No one should make you feel ashamed.  This is supposed to be a joyous time in your life bringing a little one into the world.  Support systems need to be in place.  Congratulations for doing your best to provide a healthy start for your baby whatever you so choose!"

From:  Nicole Burgoyne, New Glasgow, Nova Scotia

"Listening to your segment on breastfeeding, I'm struck by the difference in policy between present day, breast feed at all costs or 30 years ago when you were made to feel like you weren't doing the best for your child by breast feeding. Women need to get educated and make their own decisions regarding what is best for them and their babies. Medical authorities need to respect this.  Great show, I try not to miss it!"

From:  Angela Chartier

"I'm a registered nurse working on the labour & delivery floor. I started my career here in Toronto at a hospital lucky enough to be staffed with nurses and doctors who offer excellent feeding support, was laid off last year, and moved to Nova Scotia to continue working my passion, so I've seen the differences between large and small hospitals, lots of resources vs. limited resources, and have had some experience with women like the two mothers you interviewed for your show. I think that an overall lack of education contributes to the problem of women feeling badly for their feeding decisions. Lack of education for doctors, nurses, support staff (you'd be surprised how many mothers have had comments like "oh, your baby looks hungry!" from ward aides and kitchen staff!)--but mostly lack of education for the women themselves.

"Simply put, we don't offer enough prenatal education to girls and women from the beginning of their childbearing years, and let me tell you--trying to make up for that lack of education in a 24 hour hospital stay, with a mother who is exhausted and trying to navigate new motherhood, is difficult in the best of circumstances. Trying to further that education when issues arise is even harder. Who ultimately suffers? The mother, who doesn't receive the support she needs and is discharged at 24 hours with the "feeding well" box checked off in her care path, as if any baby is feeding "well" at 24 hours! The baby, who has an innate instinct to look for the breast, cluster feed, and cry when s/he is feeling the urgent need to protect Mom's milk supply by nursing as often as possible--usually AFTER we have already sent them home. Ultimately our society suffers as a whole in North America when a woman has a difficult experience feeding, is unsupported, and then disseminates her experience to her peers, who later come in to us using language like "I'll try to breastfeed but I'm not sure I'll be able to," and setting themselves up for failure in a very big way from the get-go.

"The experiences your two Moms had were horrible--and they underline a not-uncommon problem in our care of women and families during their childbearing years: a lack of continuous, seamless perinatal care in which healthcare team members engage in frequent and detailed dialogue with women and their partners about their knowledge, wishes, education gaps and family dynamics. Arguing with a woman who is having her 3rd baby when she wants to formula feed from the get go? Ridiculous. Her experience with her first baby should have been part of her prenatal record and well known to her care team before she entered the postpartum period. I am also shocked and deeply troubled that your first panellist's care team was so long in realizing that there was a feeding issue--4 weeks is a long time for a baby to be losing weight and a sleepy baby after the initial first couple of days is a major red flag.

"Making someone feel badly about a decision that is already made or medically necessary is a ludicrous way to provide care. An alternative? Something I offer my formula-feeding patients as an option (and we usually discuss this well before the baby is actually born, if possible) is the possibility of feeding colostrum over the first few hours or days. Even mothers who have a low milk supply, too low to breastfeed for the long-term, will usually have colostrum to offer their baby, and the benefits even of that small amount are wonderful for a new baby. I have very rarely had a mother say no to that option, especially when the discussion is prefaced by an expression of support for their long-term feeding goals."

From:  Erin Dykstra

"As a retired public health worker - health inspector - I can't help but be annoyed when one division of public health screws up as it gives all members a bad name.  I was aware that Toronto and Ontario are on a breast is best campaign and while this is indeed true it does not help the mom's and babies who have difficulty with the process and simply saying breast is best does not solve the problems.  If undernourished babies had died it would have been the parents who would be blamed not those giving the poor advice.  I do wonder what long-term health impacts could be expected when an infant is undernourished so early in life.  I was also surprised to learn that midwives would do after delivery care yet not see a problem with a baby who is loosing weight and again, didn't listen to the mom. As always, an excellent and thought provoking show - one I regularly talk to my daughter (the doctor) about!"

From:  John Bower, Regina

"Thank you for your program this morning about breastfeeding. I am a nursing doctoral student at the University of Victoria and my research to date has explored the experience of women with peri-natal depression who do not breastfeed. I have many responses to the program-most notably that the importance of the rhetoric around breastfeeding superiority needs more analysis. For, although one would be hard pressed to find a nursing leader who would condone coercive behaviour on the part of nurses there is more at play than meets the eye.  The power of the Baby Friendly movement (originating from the World Health Organization) has indeed made it difficult for nurses to justify any encouragement to consider alternate feeding choices. My research yielded many unexpected results; including the possibility that breastfeeding support, in the context of difficulties such as poor latch or lowered milk production, can be interpreted as coercive by women who are struggling with the many challenges of new motherhood. Most important, the zeal to protect breastfeeding practice (as is the mandate of the Baby Friendly Hospital Initiative) and the uncompromising promotion of breastfeeding in the face of breastfeeding challenges can trigger a depression in women who are biologically vulnerable. Language is important, and women today are surrounded by the Breast is Best rhetoric. We need to be careful about how we present infant feeding choice, so that women do not feel like they are feeding their infants in a way that is sub-standard, if in fact the tortuous road of decision-making leads them to formula.  The most important consideration is mother's well-being, and support for that will determine successful mothering more than any other factor."

From:  Joan Humphries, Victoria

"Thank you for doing a show on this topic and looking at the issue of breast feeding from a largely under represented and even ignored perspective.  I was lucky with my first child that I had a very supportive family doctor who counselled me about supplementing my feeds with formula very early on when my daughter was failing to gain weight.  I have to say that from the day that we started supplementing, breast feeding went from being stressful, anxiety filled sessions to becoming a much more fulfilling bonding experience.  I take exception to the comment by the public health nurse that if there were feeding difficulties, all feeding options would be presented to the mothers and that they would leave it up to the mothers to decide what to do.  How can that be considered due diligence if mothers are already bombarded with the message that formula feeding has so many negative outcomes?  It's like suggesting that a treatment is bad for your child "but I will leave it up to you to decide..."  I think health care providers have a responsibility to help mothers make the decision based on the bigger picture (i.e., what is best for the health of the baby and the mother).  Healthcare professionals are just that; professionals with expertise and they need to provide balanced, objective guidance at critical moments- not leave mothers on their own to make decisions in the context of a highly distressing situation with very unbalanced information about the benefits of breastfeeding vs. formula feeding."

From:  Alisa Ferdinandi, Vancouver

"I enjoyed your program aired today and hope you can steer me to a website that can help.  I just spent two weeks "vacation" with a grumpy, sleep-deprived daughter-in-law and family (there are two other children).  She is still demand feeding my 10-month-old healthy, full-term grandson every hour of the day and night, and sleeping with him instead of her husband.  The baby doesn't take much at each feeding, it's more like she's topping him up each time, and he's not very interested in the fruit and cereal she's trying to introduce him to.  Rather than be an interfering mother-in-law dispensing dated advice, are you aware of a sensible website I can pass on that will nudge her towards getting him onto a schedule, sleeping through the night in his crib, and enjoying some baby foods that will help to satisfy him.  Any advice will be most appreciated by all the family."

From:  Hazel Scott, Calgary

"What an interesting documentary about breastfeeding. My experience with breastfeeding was completely different, two of my three children were born here in Canada (my daughter was born in Switzerland) and I wanted to breastfeed under every circumstances. With my first son I gave up, after 3 month of pain, sweat and tears without any support. I wanted to breastfeed so badly, but he didn't latch on properly (that's what I think it was) and I had NO support. I couldn't even reach la Leche league. After my second son was born I wanted to breastfeed right away, so he got the colostrum. He didn't get a lot so the nurse recommended giving him formula. I literally had to fight the nurse away with the formula, which she gave him later on anyways. After I got home from the hospital I had a little bit of support from the health nurse. I had a hard time breastfeeding, it hurt and I was trying everything that I knew. Soon the nurses suggested formula. I asked my doctor to arrange an appointment in the breastfeeding clinic. It took 3 weeks to get in. That is an eternity if you can't feed your baby. With breast shield, perseverance and lots of tears I pushed through the three weeks, feeding my baby every two hours 24/7 under extreme pain. After 4 month we were a successful breastfeeding team. When I started to exercise again when he was 9 month the milk got less and less. I would have liked to breastfeed longer, but all the things I tried to increase my milk didn't work and the doctor's comment was, that it's maybe time to switch to formula. Which I did.
Both my sons were born in Edmonton and I had very little support for breastfeeding. To all the moms out there I wish them confidence and comfort with whatever choice they make. Ultimately I know all these moms want what's best for their child and sometimes that is formula.  I love your show!"

From:  Anita Godwaldt, Edmonton

"Thank you for once again bringing attention to important issues in a balanced and illuminating way.  I was recently dealing with misinformation on Facebook with regards to an article published about formula. You are so right in pointing out that woman and babies should have other options available to them." 

From:  Jane Baker, President, Alberta Association of Midwives

"Just heard this episode and had to comment. I am a psychiatrist in a teaching hospital with an interest in Women's Mental Health. I see women who are pregnant and breast-feeding who have mental illnesses. MANY of these women require medications - antipsychotics, mood stabilizers, and antidepressants in order to stay out of the psych ward and to stay well. Often these medications are not compatible with breast-feeding. The push to breast-feed puts these women in the terrible position of having to decide on their own mental wellness and breast-feeding. I talk hard to them about all the people who have grown up and done well without breast milk. Thanks so much for this topic- anything that can lessen the ubiquitous guilt mothers feel is helpful."

From:  Laura Calhoun, Winnipeg

"Recognizing that you only have a short time to explore a complex societal issue there were many important points absent from your program. Research suggests there is a small percentage of women (approximately 5%) who can truly not lactate or produce enough breast milk to feed their baby. So the question becomes why are families choosing to not exclusively breastfeed their infants when there is overwhelming evidence to support that breast-feeding is a superior feeding method? Success of breastfeeding is dependent on many factors - not just milk supply. One key component (and only one - there are many!) to a successful experience with breastfeeding is 'support' - who is there to help you in that critical postpartum period? Do you have a partner to assist or are you a single parent? Family? Health care providers? Are the people that surround you supportive and educated with regards to breastfeeding? How much preparation did you do during the prenatal period to gain a clear understanding of how difficult this task can be? Breastfeeding mothers may have to feed their infant 10-12 times in a 24-hour period. Are mothers prepared for that? There is not a lot of extra time to do much of anything else during those first few weeks. I empathize with the mothers that spoke on your program because they are left feeling like they failed. However, I can't help but think that we failed them. If our culture supported nursing mothers and created an environment that fosters their success with breastfeeding - as a society we would all reap the rewards of this gift."

From:  Kim Witges, Winnipeg

"I was saddened by the experiences of the women you interviewed today. These women have been through so much and really wanted the best for their babies. They worked and worked and worked and were let down by the health care system.  Specifcally, it seems they have both received unbelievably poor support to breastfeed.  Every important turning point they described was missed by the people who were supposed to help them.

"In the case of the mother whose baby was weighed pre and post feeding, for example (a pretty unreliable way to determine success), it does not appear that anyone asked the question of what could be done to improve the baby's ability to actually nurse at the breast.  Domperidone, for example, is not a magic bullet. It won't help much unless there is concurrent attention paid to the important part: whether baby is getting milk out of the breast at an appropriate rate or not -- whether there is a good latch.

"The support these mothers got was mechanical and medicalized in nature and not about helping them to understand how the whole thing works and what is normal. For example it is not the norm for breastfeeding to go entirely without a hitch. Many mothers need help with it, in the same way that humans need help with other natural functions in our lives. And women especially need the kind of help that respects the stress they are under when they have just given birth... not guilt and panic, but information and ideas.

"The idea that a public health official would tell a mother who has had breast surgery in the past that she should have no trouble with exclusive breastfeeding is an astounding betrayal for that mother. Most women who have had this surgery need to determine how much of a combination of breast milk and artificial milk they should use. 

"Next time you do a show on this, please contact La Leche League Canada, which is a volunteer mother-to-mother support network with accredited leaders, all of whom are women who have breastfed.  Thanks for providing these women a chance to speak out on your show, and please consider a follow-up that addresses the misinformation that is out there. We have great breastfeeding initiation rates in Canada (mostly) but poor information and poor support does nothing to help mothers continue."

From:  Louise Smith, Winnipeg

"When my wife and I first encountered the strong argument towards natural breast feeding, I did find the argument for this fairly logical and genuine.  However, I began to become a little put off by the pressure put forward at every level of the system.  Our prenatal instructor, the public health nurses, our family doctor (to much less of a degree), the nurses at the hospital etc.  Each one down the line had basically the same pitch and put forward the same pressure.  Each ended "But it is in the end your decision" - which started to sound more like a guilt trip than anything.  In the end it took a nurse - who at first we had not liked very much - sneaking a little bottle of formula to us when she realized our baby was not sleeping well and was obviously not getting enough nutrition.  Right away she began sleeping and stopped crying constantly.  After that we developed a very good balance of breast-feeding and formula, and our daughter never gave up the breast.  To this day she eats very well and has never had any weight gain/loss issues.  In fact she has been one of the healthiest babies our doctor has dealt with.  I am very grateful to the nurse who obviously felt somewhat insecure recommending the formula in the first place.  She actually implied that she preferred we not mention that she had been involved in our decision to use formula.  After seeing the problems many of our friends have been dealing with in this area, I think a healthy balance of breastfeeding and formula may be the best course for more families that are being steered away from it.  In the end it IS the choice of each individual family to decide.  I think the options should be presented in a much better way to insure that pressure from individuals in the system is not overpowering a family's right to make a truly informed choice."
 
From:  Mike Brittain, Rockland Ontario

"The program on breast feeding presented a false dichotomy.  Formula and breastfeeding are not mutually exclusive, then can be given together.  My wife too cannot produce enough milk and we were starving our first child.  Luckily we were but in contact with a breast feeding doctor that first collected the data to prove how much the baby was receiving (weighing baby, diapers, etc) and guiding us to supplement the baby with formula while continuing to breast feed.  In reality there is a total lack of data and research in the field. Public health nurses need more education to do an thorough physical exam, collect the appropriate data and not perpetuate this misconception that giving formula excludes breast feeding."

From:  Donald Clarke, Almonte, Ontario

"Listening to the two women commenting on the stress that they encountered with public health nurses took me back 16 years.  Having medical issues and not being able to make enough breast milk resulted in my having "starved" my child for three weeks at the request of our health unit nurse. My doctor told me to supplement - an option not supplied by the health unit. New mothers need all the available advice they can get and not be made to feel inadequate because they are unable to breastfeed. It's not something they may have control over. Having twins 2 years later I was prepared and was able to use a breast pump (another option not recommended) for the first 2 months and then wean my babies to formula.  It disturbs me that things haven't changed over this time period.  Thank you for this show."
 
From:  Rhonda Bateman, Sault Ste. Marie, Ontario

"I was looking forward to this show. I am a mother of a 16-month old, who I still breastfeed. I was one of the lucky new moms, in that I had an uncomplicated, un-medicated birth. Also, my baby latched on right away and I had an ABUNDANT oversupply of milk. Had there been a milk bank in Ottawa, I would have happily donated to it. I am hopeful that more banks will reopen across Canada -- THAT will be a sign of public health progress.  On a more sombre note, I would like to say that I'm so sorry the two mothers on your program had such a difficult time with breastfeeding and with the members of the healthcare community who were supposed to help them. In my circle of friends, many have encountered the opposite problem: their babies were given formula, much to their dismay, and without any strong explanation. Most of them also had traumatic births for one reason or another. I don't know if there is a provable connection here, but, it may be an interesting topic for a future program."

From:  Laura Nerenberg, Ottawa

"I have always found your show interesting and enlightening. I appreciate everything I learn from your show, and it always makes me think. I don't always agree with you, and I sometimes think of writing to you, but this is my first time.  Thank you, thank you, thank, for your program about women who have trouble breastfeeding. My children are now in their early 20's, so I did not run up against the institutional insistence on breast-feeding. However, there was a very strong stigma against bottle-feeding amongst my social circle, and I was part of it.  I had a midwife and was determined to breastfeed my daughter.  As it turned out, though, here in Newfoundland and Labrador, all children had to be delivered in a hospital in those days, and due to a long and fruitless labour, I was given a caesarean section, which in concert with a previous discectomy and weight gain, left me with almost constant back spasms. For 4 months I determinedly breastfed my baby.   I was not nearly so bad off as your two interviewees, as my daughter did gain weight. But I was breastfeeding her ALL the time. She rarely slept, and then only from exhaustion. She cried from hunger all the time. We were latched together about 14 hours a day.  When I finally caved-in and gave her a bottle at age 4 months, it was the first time she had had  a contented sleep in her life.  In retrospect, I wish I had not been so stubborn."

From:  Kerry Cornell St. John's