The Milk Bar Is Empty

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The Milk Bar is Empty

By Sara Graefe

I first made my choice – no, my commitment – to breastfeed back when I was seventeen. And no, I wasn’t pregnant, just fiercely passionate about social justice issues. I hung out with the artsy-political crowd, went to protest marches and, in my senior year, took a World Issues course. My graduating assignment: a special project on the Nestle Baby Formula Scandal. What I discovered blew my world open. How could it be that Nestle, the company that makes the chocolate milk powder I associated with the comfort and warmth of my childhood – how could this same Nestle be killing babies in the third world with its unethical marketing and distribution of baby formula?

I saw the issue as black and white: breastfeeding = good, formula = bad. My all-or-nothing adolescent brain couldn’t wrap itself around any possible shades of grey. My classmates, meanwhile, were more interested in the pending lunch bell than my impassioned speech (read: rant) on the disastrous effects of formula feeding in poor, developing countries with no clean water supply or the means to sterilize baby bottles. A couple of guys at the back snickered uncomfortably every time I mentioned the word “breasts.” But I got an A+ on the project and my teacher suggested I get involved with the local chapter of the La Leche League. I started boycotting Nestle products, a bit of a sacrifice because Kit Kat was my favourite chocolate bar. And there was no question that when the time came, I would breastfeed my own baby.

Flash forward twenty years: it’s the middle of the night, almost three days after the birth of my son. We should all be home by now, my partner, my newborn and I, but instead we’re still in the stark, cold hospital room, awake and on our feet. Well, my spouse is on her feet, anyway. I’m sitting up in bed, fighting sleep, clutching my newborn to my breast in the cradle position, trying to get him to latch to the feeding tube, a tiny straw no wider in diameter than a headphone wire that’s taped over the tip of my raw, overworked nipple.

Amanda stands at my shoulder, bleary-eyed, painstakingly submerging the other end of the tube into a medicine cup filled with donated breast milk from the hospital bank. Hers is a delicate task, a test of her fine motor skills. The tiny parts are hard to grasp, she has to get the angle just right for the milk to flow and she can’t let her fingers come in contact with the milk itself for fear of contamination. Her hands shake from lack of sleep, but the donated milk is such a precious commodity that we can’t afford to spill a drop.

Meanwhile, at my breast, Aidan is fussing from hunger and won’t latch to the hard, plastic tube – even though he had a perfect latch before, when it was just my nipple.

We were supposed to be discharged yesterday, but Aidan has lost more than a third of his birth weight and is failing to thrive. Hard to believe this pale, gaunt little baby was the pink, vigorous infant who greeted us a few days earlier, a healthy 7 pounds 3 ounces with high Apgar scores. Almost three days post C-section and my milk is nowhere in sight. We’ve gone from “feed on demand” to scheduled feeds every two hours, waking Aidan and ourselves if necessary, supplementing with the donated milk until my own supply comes in.

I finally get Aidan’s mouth around both the tube and my nipple. After a few false starts, we gradually coax down about half the serving. Suddenly, the tube pops out of Aidan’s mouth, the hard plastic poking into his tiny nostril and spraying milk up his nose. He splutters and coughs, almost choking, then starts bawling uncontrollably.

“Oh my God, I almost killed him,” I cry, yanking away the offending tube.

Try as I can to comfort him, he steadfastly refuses to latch back on – and really, who can blame him? But we’re desperate at this point – we’ve got to get the requisite number of cc’s into him each feed. It’s not a question of giving up and trying again later. His little life hangs in the balance.

Amanda can’t take it anymore. “Let me try,” she says. Reluctantly, I hand Aidan over to his other mom. It’s like conceding defeat – less than 72 hours in and I already feel like a total and utter failure in the motherhood department. She takes him over to the armchair in the corner and attempts feed him the rest straight from the medicine cup so I can get a head start on pumping – twenty minutes on each side with the hospital breast pump, an ancient, massive warhorse that looks and sounds like a milking machine for cattle. It’s an exercise in futility. A few beads of moisture form around the inside of the clear plastic receptacle, but nothing – not a single drop – is being expressed from my breast.

I swallow back tears – how can my body let me down at a time like this? I blame my small, mismatched breasts, even though my midwives have assured me that shape and size have nothing to do with it. More likely the surgery has confused my body – I missed out on that surge of hormones that comes with natural labour. I choke up again and this time can’t hold back the tears. I just let them flow silently and keep pumping, because I’ve been promised that this – along with Aidan continuing to suckle my nipple during supplementation – will help kick start my milk production.

I glance over at my little family through misty eyes. Amanda’s still struggling with the cup but finally gets Aidan to take a few small laps with his tongue, like a tiny kitten. If we’re lucky, we’ll be able to catch a few minutes of sleep before the feeding cycle starts all over again.

And yes, there are easier alternatives available to us in this moment – namely, bottle-feeding Aidan with formula. But I am still determined to nurse Aidan, in spite of this initial setback, and have been warned against introducing an artificial nipple. And formula? Over my dead body. “Breast is best” has been my mantra since I was seventeen, after all.

I have always held fast to my convictions. I pride myself with being a principled person, someone who acts consciously and with integrity. I have an innate stick-to-it-ness that helps me persevere even when the going gets tough. Stubborn, Amanda would say, blaming my bullish Taurus nature.What I don’t fully realize yet is that motherhood isn’t as black and white as my teenaged self imagined. That it’s all about flexibility and shifting expectations – about wanting the very best for your child, certainly, but also being able to live in those grey areas, to compromise, adapt and, in some cases, let go completely.

I don’t realize this yet because I’m still utterly crushed from having to forego the natural home birth I’d so badly wanted for a scheduled C-section at 39 weeks (my son was breech and wouldn’t turn, no matter what we tried). Home birth = good, hospital birth = bad, surgical birth = unthinkable. I don’t yet see that this is but the first of many instances where I will be challenged to let go of some lofty, preconceived notion about what motherhood should look like and, instead, let my son take the lead.

I still naively believe that if I want to breastfeed, I will breastfeed, come hell or high water. That simply by virtue of wanting it badly enough and working at it, it will happen. And given the known benefits of breastmilk, why would I offer my newborn any less? Sure, it might be hard at first, but the books and well-meaning professionals that surround me keep assuring me that if I just stick to it, my milk will come in. Breastfeeding is the most natural thing in the world, they keep reminding me. My teenaged self knows this to be true. My body created this beautiful, healthy baby – why wouldn’t it also create the nourishment to keep Aidan alive? Although many women encounter challenges along the way, only a negligible percentage truly cannot breastfeed due to underlying medical conditions. Not once does anyone suggest that I may be one of those very few.

Early the next morning, we’re roused from our slumber by the new day nurse and wait with baited breath as she weighs Aidan. He’s maintained his weight – a small victory – but hasn’t gained nearly enough.Swallowing our discouragement, we rally ourselves for the next feed. Just then, the nurse takes in our feeding paraphernalia drying on paper towels next to the small sink in the corner. She admonishes us for cleaning the gear in the same sink we use to wash our hands and brush our teeth, the only sink we have access to. She lectures us for air-drying without a sterile cloth, and for not replacing the tube each time, even though we’ve only been provided with one – didn’t we know the tiny water droplets are a breeding ground for infection?

We find out later that we’ve been written up for our “poor hygiene.” This hits Amanda particularly hard – as a social worker, she’s sometimes called upon to assess families at risk. It’s unfathomable that we’re suddenly the ones being flagged. The nursing staff had been so warm and friendly with us the first few days post-op. But as soon as Aidan’s weight plummeted, there was a noticeable shift – every move we made was suddenly met with such scrutiny. What were we doing wrong? Why was our baby not thriving?

By the time our midwife arrives for her daily check-in, I can barely hold it together. How can my milk possibly come in here, with the lack of sleep and lack of privacy, the pressure to perform, and now the judgements from the nurses? Allison reassures me that she’ll get me home as soon as possible. Aidan just needs to gain more weight before he can be discharged. Besides, we only have access to the milk bank while I’m still in hospital.

Allison examines my breasts, a bit disconcerted that I’m not experiencing any warmth or sensation of letdown. I swallow hard, and ask her the question I’ve been too scared to put into words: is it possible that I’m one of those women who simply can’t breastfeed?

Allison considers for a moment. “I like to think it’s possible for every woman, under the right circumstances and with the right support, to breastfeed,” she says, carefully.

Two days later, we’re finally discharged, sent home with a rental pump and our final ration from the milk bank – enough to last twenty four hours. I’m ultra-aware of the ticking time clock, but relieved to be home. Surely my milk will arrive within a day, once I settle in and unwind.

We continue Aidan’s feeding regime – the tube/cup/pumping combo – through the first night and into the wee hours of the morning. We’ve graduated to feeding him every three hours, but the extra sleep still isn’t enough. As the sun comes up, Amanda tearfully announces that she can’t sustain this. She’s been doing everything else around the house and has to go back to work in two days. She won’t be able to function unless she catches up on some sleep. If I want to keep trying, that’s my choice, but I’ll have to figure out a way to do the tube feeds on my own.

That’s physically impossible, I counter – I’m not an octopus. And who’s going to settle Aidan while I pump? I can’t believe she’s abandoning me at a time like this.

We’re barely talking to one another by the time Allison arrives a few hours later for her first home visit. She diplomatically listens to ourconcerns, then recommends a Supplemental Nursing System, or SNS for short – an inverted, plastic bottle that the nursing mom wears around her neck on a string, and nestles between her breasts. Two separate feeding tubes run down from a specially designed air vent, one for each breast, and are taped to the tip of each nipple. Essentially, it’s the Cadillac of tube feeding and cuts out the middle man – Amanda standing at my shoulder, holding the tube in the cup – so I can nurse Aidan by myself.

The other, more pressing issue is, we’re running low on donor breast milk. Allison asks us about our back-up plan. We’re in total denial – we don’t have one. She calmly suggests Amanda pick up some baby formula while she’s out at the medical pharmacy, buying the SNS.

“Formula?” I croak. The moment I’ve been working so hard to avoid is staring me right in the face.

We don’t really have any other options at this point, Allison reminds me. We need to ensure a smooth transition for Aidan once the donor milk runs out. He can’t go hungry.

I’ve been so anti-formula that I don’t really know the first thing about it. Which brand to buy? How to prepare it? We ask Allison for guidance, but she blushingly admits that as a breastfeeding advocate, she doesn’t know much about formula either.

“Wait,” Amanda remembers. The provincial child welfare ministry where she works recommends Nestle Good Start as the formula of choice for its foster families. If it’s good enough for BC’s most vulnerable, special needs infants, then surely it’s good enough for our son.

“Nestle?” I bristle. But what else is available? I know from my boycott days that all the other big brands are equally guilty of dubious practices in the Third World, and this is not the time to be researching more ethical options. It’s amazing how quickly you can let go of even your strongest convictions when you’re seriously sleep deprived and your baby’s at risk of starving.

In the late 60s, my mom was considered “difficult” because she insisted on breastfeeding at a time when formula feeding was the norm. The nurses made her feel like a huge inconvenience every time they carted me down from the nursery to feed naturally at her breast, throwing off the rigid hospital schedule where bottle-feeds occurred like clockwork, every four hours on the hour.

Almost forty years later and the tables have turned completely: “Are you planning to breastfeed?” I was asked countless times in the myriad of pre-natal appointments. My firm “yes, of course” was always met with clucks of approval, positive reinforcement for my good intentions. Later, when my milk didn’t come in, I was praised by my midwives and hospital staff alike for my heroic efforts and unwavering commitment. The hospital lactation consultant jumped up and down like a cheerleader as she watched me finally express a smattering of tiny white droplets with the electronic pump. “See? It’s coming! You’re doing great!” As the next five weeks go by, I am applauded by my health providers for stubbornly sticking to it, even long after it is reasonable or sane for me to do so.

Amanda finally puts her foot down. She says aloud what no one else has dared to utter: “I don’t think your milk’s ever coming in.” Her words just hang there, leaden, in the living room, as I feed Aidan with the SNS in the armchair. She hovers over us, an intrusion into our cosy bubble: “If it was coming, it would’ve come in a long time ago.” She wants us to switch to bottles so that the feeds go faster, so we can tag-team feeding, so I can get some much-needed sleep. But all I can hear is that she’s giving up on me and, by extension, giving up on our son.

I feel a surge of rage. My mother’s sitting there, on the couch, looking up at us from her book. I don’t know what’s worse, Amanda pulling the rug out from under me, or that we’re having this argument in front of my mom, who’s flown half-way across the country to help – cooking us healthy meals, keeping me hydrated, cuddling Aidan while I pump, doing her part to get the milk flowing. Not wanting to make a scene, I blink back tears,take Aidan and leave the room. I head upstairs to our bedroom and sit in the gliding rocker we’d bought specifically for breastfeeding, an irony that’s not lost on me in this moment. I hold Aidan close, rocking him as he finishes his tube-feed at my breast, crying quietly to myself.

Still, I can’t fight the nagging feeling that she’s right. That I’m not physically able to breastfeed Aidan, as much as I want to – and if that’s the case, what’s it going to take for me to let go? The thought of not being able to provide for my son in this fundamental way is unbearable. It goes deeper than my teenaged ideology – it’s primal: without formula or a wet nurse, my baby will die.

Downstairs, I find out later, my mom’s telling Amanda that I’ve always been stubborn like this, ever since I was a little girl. “It’s no use talking to her,” she says. “Once she’s got her mind made up, that’s it. She’ll have to figure out for herself that bottle-feeding Aidan isn’t the end of the world.”

Unable to deal with the looming truth, I keep feeding Aidan with the SNS. But I’m losing steam. I start taking a reprieve from pumping at night, so I can get more sleep. Then I start scaling back in the day. I just want to hang out with Aidan and enjoy my baby, rather than being on the constant feeding-pumping-sterilizing treadmill.