Things I didn’t know about breastfeeding – part 2: Maternal Health Risks of Formula Feeding

Most people are at least vaguely aware of many of the health risks for babies and children associated with formula feeding. 90 % of mothers today disregard current recommendations and choose not to breastfeed, or to start feeding formula within the first few days or weeks. The risks of formula feeding for babies are numerous. Increased rates of childhood obesity, increased incidence of asthma, ear infections, severe lower respiratory infections, SIDS, type 1 and 2 diabetes, lymphoma, crohns disease, childhood leukemia, necrotizing enterocolitis are just some of the health problems formula fed infants are at increased risk for.  Along with numerous health benefits, even better brain development is linked with full term breastfeeding. Still, the benefits to the health of the mother are often overlooked or disregarded.

Lactation is a continuation of the physiologic process started with conception and pregnancy, and choosing not to bother with it increases many short and long-term health risks problems for moms.  Health care professionals rarely emphasize these risks in prenatal or pediatric care.  I see multiple posters on the walls promoting vaccination at the pediatricians office, and not a single one promoting breastfeeding. Formula feeding infants after giving birth puts women at higher risk for not only breast cancer, but ovarian cancer, diabetes, cardiovascular disease, post-partum depression, obesity,  and many other serious health conditions.

Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths.  Formula feeding results in 911 preventable infant deaths, and $13,ooo,ooo,ooo.oo per year in health care costs. Suboptimal breastfeeding costs us another $17.4 billion a year, resulting from premature deaths and direct preventable medical costs for mothers (the preventable deaths in moms are primarily caused by breast cancer and hypertension) . I always feel that i need to write these numbers out to  fully absorb them and all their zeros : $17,400,000,000.00  each year could be saved if women would only breast feed their babies for a few months. 

The mechanisms behind many of the increased disease risks are still not entirely clear, and more research is definitely needed.  Researchers think that by not breastfeeding, and not participating in a process that the body prepares for during pregnancy, many crucial systems can go out of whack. And the effects for mothers can last for decades, long after nursing children are grown.

Immediately after birth, the detachment of the placenta and suckling of the baby causes oxytocin to be released from the mother’s pituitary gland. This hormonal process signals the breasts to release milk to the baby, and simultaneously contracts the uterus. Women who have had multiple children often experience more discomfort with this postpartum cramping with each consecutive child. (my own memory of these is that they were worse than the labor cramps after my second child, I had no pain medication during labor, but needed to alternate ibuprophen and acetominophen in the first days following that birth. )  The resulting contractions prevent postpartum hemorrhage and rapidly shrink the uterus back to its original size. It hurts,but serves a purpose. This cramping over the first couple of days postpartum is the one time that the statement “nursing should never hurt” does not apply.

Formula feeding dramatically increases the risk of breast cancer for mothers, yet we almost never see any mention of this in main stream media promotions of breast cancer awareness, which often claim to be engaged in a “race for the cure”.   In more than one state in recent years, I have seen entire newspapers printed on pink paper during breast cancer awareness month, yet not a single word anywhere in the pages mentioned breastfeeding. Most of the info dispersed broadly proclaims “early detection saving lives” with routine mammograms rabidly promoted.  One of the largest and most meticulous studies of mammography ever conducted, involving 90,000 women and lasting a quarter-century, found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. The mammograms’ only discernible impact was to elevate the diagnosis rate by 22%, or “overdiagnose” patients who were suffering from nonlethal forms of cancer and therefore could have avoided surgeries, chemotherapy and radiation treatments.  What this means is, up to one third of all diagnosed breast cancers, or 50,000 to 70,000 cases a year are being treated that would not ever progress. What this means is, thousands of women each year undergo drastic treatment for tumors that might never have affected their health.  For each woman’s life saved by a mammogram, 10 other women will undergo dramatic and unnecessary surgeries.

Breastfeeding on the other hand IS well known to be a highly effective preventative factor with breast cancer, yet no one ever wants to talk about it.  There is no argument;  studies from the US, the UK, China, Japan, New Zealand and Mexico… from scientisits all over the world, in fact over 50 well documented controlled scientific studies have now shown that women who breastfeed their children clearly have reduced risk of developing breast cancer,  and that the longer women breastfeed, the more additional protection they accumulate against breast cancer.  The lack of any, or short duration of breastfeeding in developed countries, including the USA,  is a MAJOR contributing factor in the high incidence of breast cancer in these countries.  Every time i see a pink ribbon twirling in the breeze, I wonder why this is not ever talked about in the mass media awareness campaigns.

So what does it mean that there is “significantly increased” risk of breast cancer caused by formula feeding? For every 12 months a woman breastfeeds, her risk of breast cancer drops 4.3 percent, plus there is an additional 7 % decrease in risk with each child a woman breastfeeds.!!   Its really a huge preventative effect.  a 2010 Journal of Perinatology paper. For women who have a family history of breast cancer, breastfeeding also decreased their risk of getting it, according to an analysis of data from more than 60,000 women led by Stuebe, published August 2009 in the Archives of Internal Medicine. Whereas the potent drug Tamoxifen can reduce risk for those with a mother or sister who had breast cancer by about half, moms who had breastfed at all had about 60 percent less risk, a very significant statistic. Women who lactate for a total of two or more years reduce their chances of developing breast cancer by 24 percent. Its true that breastfeeding cant generally help those women who choose not to reproduce, but more than 80 % of women in the US do.  One other glaringly important factor is that along with preventing maternal breast cancer, breastfeeding your daughter also protects her many years in to the future from developing breast cancer.  Women who were formula-fed as infants have 33 % higher rates of breast cancer as adults, according to a 1994 study by J. Freudenheim et al.,  : “Exposure to breast milk in infancy and the risk of breast cancer”. Epidemiology 5:324-331

To move toward improved breastfeeding numbers, one subtle but fundamental adjustment that must happen in both the research and academic circles and popular opinion is a shift in how we view the act of breastfeeding:  from the comparative experimental group to the biological norm.  When viewing disease risk using breastfeeding as the biological norm that it is, you see that the percentage of “increased risk from formula feeding” is in fact a much greater percentage than the comparative percentage of “decreased risk  for those who choose to breastfeed”.  We see this type of misleading phrasing so often in relation to feeding choices that many bristle to hear the same conclusions  more accurately conveyed using the correct biologic norm,  human babies getting human milk.   (to phrase it as “decereased risk” minimizes the numbers, when you flip it, for example, reduction of risk by 50 % in 100 women translates to an increased risk of 100 % to go from 50 to 100.)  This way, its clear that breast feeding is not just “best”  or “ideal” or “optimal”—it is simply the biological norm. When assessed as the norm, breastfeeding should not be discussed as conferring  benefits as much as formula feeding must be viewed as dramatically increasing risks. This doesn’t mean in any way that we should discard all the good research we have that uses formula feeding as the norm and speaks or relates evidence of “decreased risk” associated with breastfeeding, we just need to be constantly aware of how this language flips the #s upside down.

Breastfeeding reduces the risk of ovarian cancer.When compared with women who had breastfed for at least 18 months, mothers who never breastfed had a 1.5-fold increased risk of developing ovarian cancer. For each month a woman breastfeeds, her relative risk of developing ovarian cancer is reduced by 2 %.

Breastfeeding decreases a mother’s risk of developing endometrial cancer. Studies show a decreased risk of endometrial cancer with breastfeeding that is directly proportional to the duration of lactation. (longer duration of breastfeeding= less risk) 

Breastfeeding protects mothers from later development of diabetes. 240,000 women enrolled in the Nurses’ Health Study since 1976, and 150,000 women who had children reported their lifetime duration of breastfeeding. Approximately 75 percent of the entire group reported ever breastfeeding their babies.

The results of the study have clearly demonstrated that breastfeeding protects women from later development of diabetes. For each year that a mother breastfed, she reduced her risk of developing type 2 diabetes by 15 percent. This was independent of other risk factors for diabetes including body mass index, diet, exercise, and smoking. The most interesting and convincing finding in this study was the reduction in risk of acquiring diabetes related to the length and intensity of breastfeeding. Longer continuation of breastfeeding per pregnancy/child conferred  a greater benefit. One year of lactation with one child resulted in a 44 percent reduction in risk , compared with a 24 percent reduction in risk for a woman who breastfed different children for shorter durations adding up to a total of one year.

Non-breastfeeding women have a four times greater chance of developing osteoporosis than breastfeeding women,  and are more likely to suffer from hip fractures in the post-menopausal years. During the postpartum months, physiologic changes happen that favor lactation, and calcium will be found and utilized by the mothers body, and a mother may experience decreases of bone mineral. A nursing mom’s bone mineral density may be reduced by 3-9 % percent while she is nursing, but  this is all gained back, and bone mineral density may actually increase to higher than  her pre-pregnancy levels when the baby is weaned from the breast. This is not dependant on additional calcium supplementation in the mother’s diet. Estrogen levels increase during weaning.   Similarly, bone mineralization increases in adolescent girls  as their estrogen levels increase.  Breastfeeding protects against osteoporosis.

A large percentage of mothers, (both breast feeding and formula feeding) have been found to be anemic.  Formula-feeding mothers typically get their periods back within six to eight weeks, while exclusively breastfeeding mothers often don’t bleed for several months or more. This conserves iron in the mother’s body,  and further, it often contributes to a natural spacing of pregnancies. The WHO recommends a minimum of 24 months after a live birth before attempting another pregnancy, to reduce the risk of adverse maternal, perinatal, and infant outcomes.  (more space between = overall healthier moms and babies) Far less iron is required in milk production than the amount lost from menstrual bleeding. The net effect is an increased risk of anemia in formula-feeding mothers as compared with a reduced risk for those breastfeeding. The longer the mother nurses and keeps her periods at bay, the stronger this effect . Alternatively, exclusive breastfeeding may be a marker of high socioeconomic status, better diet quality, or compliance with vitamin/mineral supplement use. (anecdotally, my bleeding returned at 6 weeks even while 100% exclusive, on demand breastfeeding. my friend calls this being a “Fertile Myrtle)

Formula feeding moms are fatter. Breastfeeding mothers showed significantly larger reductions in hip circumference and more fat loss by one month postpartum when compared with formula-feeding moms. Breastfeeding mothers tend to have an earlier return to their pre-pregnant weight. Those who had children and had not breastfed had 28 percent more visceral fat than those who had consistently breastfed. University of Pittsburgh’s Department of Epidemiology, found that women who had not breastfed had an average of about seven and a half additional centimeters of fat around their waists.  Its also interesting to note that human milk from moms who have been lactating for more than 1 year have significantly increased fat and energy contents, compared with milk from moms nursing for shorter periods of time.  Anyone who has nursed a toddler can tell you why the milk moms make for older kids has more energy in it.  These longer duration nursing moms are so few and far between here in the US that we must look to studies conducted in other countries for the most up to date evidence related to “extended ” or ” full term” breastfeeding. It would seem logical that if the milk is fattier,  that more fat is dripping off of mom.  Unless moms dramatically  increase their own caloric intake, they’ll lose even more weight the longer they breastfeed.

Most health agencies recommend that when biologically possible and safe women breastfeed infants exclusively for the first six months with the option of introducing complementary foods in addition to breast milk through 12 months. Almost three quarters of women start out with intentions of breastfeeding their infants , but by six months, only 42 % are giving their babies any breast milk at all, and only 12 percent are still  exclusively feeding their babies breast milk at that point. Those who had children and formula fed had 28 percent more visceral fat than those who had consistently breastfed. University of Pittsburgh’s Department of Epidemiology, found that women who had not breastfed had an average of about seven and a half additional centimeters of fat around their waists.

Recent research has shown aortic calcification, a risk factor for stroke, heart attack and other cardiovascular complications, was “significantly more likely” to be found in mothers who had not breastfed than in those who had for at least three months—even after adjusting for lifestyle, family history, socioeconomic status, BMI and other health issues, according to a study led by Schwarz that was published in January 2010 in Obstetrics & Gynecology. Better long-term heart health for breastfeeding mothers might stem in part from blood pressure, which was “significantly higher” in mothers who had not breastfed than in those who had.  Risks for cardiovascular disease in lactating versus non-lactating mothers seem to be firm regardless of BMI, which is usually a factor for both conditions. This finding “indicates that lactation does more than simply reduce a woman’s fat stores,” Schwarz and her colleagues wrote in their May 2009 paper. They proposed that hormonal stimulation is likely playing a substantial role.

Women who formula feed are at greater risk for postpartum depression.  Studies show that formula-feeding mothers show more postpartum anxiety and depression than do breastfeeding mothers. The emotional health of the mother may be enhanced by the relationship she develops with her infant during breastfeeding, resulting in fewer feelings of anxiety and a stronger sense of connection with her baby. A woman’s ability to produce 100% complete nourishment for her child’s needs can produce a unique sense of confidence. Psychological researchers have pointed out that the bond of a nursing mother and child is stronger than any other human contact. Holding the child to her breast provides most mothers with a more powerful psychological experience than carrying the fetus inside her uterus. The relationship between mother and child is rooted in the interactions of breastfeeding, and breastfeeding is protective of maternal mood.

These feelings in the early days , weeks and months postpartum establishes the health and psychological foundation for years to come.  The neurotransmitter oxytocin, which is released during nursing, helps women get to that “blissed-out state” many women have while breastfeeding.  This relaxed state of mind can help women cope with all the new stresses of being a new mom.” Simply getting the body in the habit of releasing this hormone by frequent nursing can pay off long after weaning. “Moms who breastfeed over long times get really good at releasing oxytocin” at other times, which activates the parasympathetic nervous system and can help alleviate stress later in life. 

Although many studies try to control for lifestyle, women who breastfeed are more likely to engage in other healthy behaviors,  and these are challenging to fully take into account. According to by Elanor Schwarz,  an assistant professor of medicine, obstetrics, gynecology and reproductive sciences at the University of Pittsburgh, there also might be a sort of long-term feedback loop, in which women who were breastfed as infants would be more likely to breastfeed their own children, thus benefiting from both their own early breast milk diet and the effects of lactating themselves.

These results of all these studies show something repetitively similar and undeniable: there are substantial increased health risks for women who choose formula feeding. The longer a woman breastfeeds her child, and the longer the time she exclusively breastfeeds, the greater the overall benefit to her health. We know well of the tremendous risks of formula feeding infants, including detriment to both health and intellect that extend far into the child’s future, even as an adult.

Formula feeding not only jeopardizes a child’s health, but a mother’s health too, increasing her risk for numerous serious, life-threatening diseases. The message from all of these studies should encourage all women to breastfeed for as long as practicable, and should convince medical providers to encourage exclusive breastfeeding for the first six months of life and extended breastfeeding whenever possible.

Thrush

It has been five years  since O was born.  I’m listening to him playing in the other room, laughing with his older sister J. I feel happy today, I’m very thankful and lucky to have a solid partner and healthy kids.  We don’t have tons of money but we have what we need, and more advantages than many.  Its good to have this perspective, I feel calm and well, unfortunately not how I have always felt.

I have wanted to revisit the experience of my son’s first year in writing for a while- to share with others- to hopefully educate and prevent this from happening to some other mom out there. I did not feel happy and lucky and thankful four years ago, while we struggled through and eventually won a horrific battle with a very small organism called thrush.   It has taken all this time  for me to sit down and write this- partly because of the fullness of a colorful life with busy young ones-  but mainly because I well up with anger even now  (though finally less so) thinking back on this loss of such a large chunk of O’s first year, and then dreading that other mamas out there have gone through, are experiencing right now, and will encounter this kind of bullshit in the future.

O was “born in the craft room” (as he now tells people proudly) of our home on a pleasant late august day four years ago.  He came about three weeks+ after his official EDC, and would likely have been induced in a hospital-birth because  he was so “late”.  He was 8 and a half  pounds , just like his big sister had been, and though his hands were a bit blue he was healthy and strong.   He  started rooting around to nurse before i had even pushed the placenta out!  He was dark and dusky, and we joked that he looked like montezuma or some ancient mayan king.  Today he’s a cheerful blue eyed blondie and looks like a totally different kid than he did when he was born.

When he was about three weeks old, one morning he had a sudden red, angry diaper rash.  My daughter, born almost exactly three years earlier, had never really had any diaper rashes, so it was a new phenomenon to me.  we tried some cream and aired him out with no diaper and I looked up stuff in my many “dr. mom” type books about diaper rash.   We also noticed that he had some white spots inside his mouth that didn’t look like anything I remembered from when Julia was a tiny thing. I immediately was on the phone with our doctors office, who advised me that we couldn’t get in for several days to see the health care provider we know and trust,  but that they could get me an appointment with the local nurse midwife at the women’s health center, the next day.  I didn’t want to wait.

So -not being able to get an appointment with our preferred P.A. for many days, off we went to the local walk in clinic, (sadly, this is where i find myself turning more and more for our health care (even though they blatantly overcharge us), mainly because of the fact that I can get in to see someone (who usually seems new to the english language) when i feel that i need to get myself or the kids in to be seen by someone immediately, not many days later.   They are even open on saturdays.  With no insurance,  I’ve  spent tons of money on “well child check ups” but when there is an actual illness or injury (usually on a friday night of a three day holiday weekend) I get an answer machine that tells me to go to the emergency room.  I wonder about  the claims that  the uninsured present an unfair burden to our ERs.   What ever happened to the days of the doctor with his little doctor bag who would come to your home?  I remember my mom being able to get a call back from my childhood pediatrician at any time of the day or night.  She may have used this service twice in twenty years.

The midwives give you their home #s, cell #s, and a pager #.  My midwives provided a highest quality of care that we sought, where they did come to our home, spent at least  an hour or more at each visit assessing the health of our whole family, and gave us lots of ways to contact them immediately.  For me, its not so much that I need to get a hold of them, its more knowing that I CAN.  I was always a very  healthy individual, not requiring much medical care until my pregnancies, except a few rounds of antibiotics throughout my childhood.  I believe I was at a disadvantage in not knowing how to deal with the modern “medical care model”.  The friendly nurse at the walk in clinic seemed untroubled by the spots in his mouth, suggested dipping him in some water with a bit of vinegar mixed in, and continuing the airing out of his bottom as we had been.  She said that a little bit of yeast is not usually something to worry about  unless it was bothering him or  “interfering with his feeding”.

We went home, I read up on thrush, started being very careful about avoiding sugar, switched him over to paper diapers,  rinsed him after every change with the vinegar water solution, and aired him out as best we could. I read that sunning the baby  was a good way to combat yeast.   It was rainy and dark all that fall, but , over the next  week or so , with careful attention,  his stubborn rash completely cleared up,  and the spots in his mouth also disappeared.   He started growing and changing, his dark hair fell out in clumps and a new white blonde duck fuzz grew in. He was robust and alert, almost too alert.

Over those weeks I was so tired . O wasn’t like my daughter had been.  She was a very “easy baby” who fell smoothly  into our routines and slept through the night when she was just a couple of months old.  She was a serious and efficient nursling and set her own schedule of around every three or four hours.  We used to call her a “soldier nurser” because she was so serious about it.  O at first nursed continually, about every ten minutes at first, then after a few weeks every hour and the longest stretch he would sleep for  was about 2 hours at a time until he was over 2 years old.   In general he was a fussy cranky puking thing for the first six months -or longer- right up until he started cruising and walking. J almost never threw up.  Often O would vomit up his whole nursing,  and then would be hungry again immediately, so this continual suckling meant i was producing about enough milk for octuplets.  I had to sleep on towels for almost a year because of the fountains of milk that I produced.

Thinking back I can see numerous factors that gave the yeast an advantage, beyond always being soggy and hardly sleeping, there was additional situational stress. We had moved our whole lives and my business (including greenhouses etc) across the road in the last weeks of my pregnancy.  When Julia and I took a bath the first night in our new house,  we realized immediately that the greenish colored water from the hundred and thirty year old hand dug shallow well wasn’t going to work for us.  So we immediately had a new well drilled ,  and all that autumn we crossed a moat around the house from the torrential rain  which began just as my husband finished up digging the trenches with a backhoe to put in the water lines.  It seemed as if it only rained drizzled or  sleeted for all of that october  and november.  On Halloween weekend,  while we were away visiting family we had an unbelievable windstorm which blew the power poles over across the bridge coming on to the island.   one  of the greenhouses we had moved but hadn’t gotten properly secured yet flew up into and wrapped around a tree and was a total loss.

We attended several weddings,  driving and staying several hours away in the early weeks following O’s birth. One, my sister-in-law’s,  when O was just a week old.  I thought i didn’t need any help, I was confident I had it all under control.    This was the second time around.  Shouldn’t it be easier the second time around?  I remember going to the grocery store -maybe five days after O was born- when i should have been staying put at home.  Accidentally bumping the kiddie cart into an old lady in the bakery aisle, my shaky apology was met without acceptance and  only a nasty scowl from her.  Hot tears streamed down as i struggled to keep the three year old and newborn quiet and get through the necessary grocery shopping. After O was born, My husband went back to work after just three days. With J his boss gave him a couple of weeks off. My mom was here helping for a few days , but she had been hanging around waiting for him to be born for weeks, and had to go back home a few hours away to work. When I look back now its easy to see the difficulties of the whole situation, to see how stressed and tired and compromised my system must have been, and accept mistakes I made which contributed to the whole ordeal.  I should have been smarter and asked for help, should have stayed down and not been trying to be a supermom.  Though this is all clear to me, it is not clear to me the motivations of those who would not help me after I wound up with an intraductal yeast infection.

Around the time of the second wedding we went out of town for, when O was three weeks old, I started to know something really was not right. Though Owens symptoms had cleared,  and he was strong, thriving and nursing happily; I had started to become more uncomfortable and itchy around my nipples.  The itchy skin started to flake away and reveal a raw ring of a rash.

I had read about  yeast or Thrush as it is commonly called when associated with a baby.  I started looking up more and more and eventually determined that this was likely what was going on with me.  Itching, redness, flaking, rawness, and the previous presentation of the white spots in O’s mouth and the angry rash on his bottom.  I asked my midwife for help and she offered lots of suggestions similar to the yeast combatant regimens I had found on line and in books.  Hygiene, dietary changes,  air and sun,   rest etc.

It is important to understand that though they are arguably more knowledgeable about pregnancy and birth than OB’s, (statistically home-births have much better outcomes than hospitals), home-birth midwives do not have the privileges to prescribe most medications .  They can carry some limited life saving medications and oxygen, but  are quite limited as far as what they can realistically do to help in exactly this kind of situation. To me this presents one of the only real downsides to choosing home birth, a later lack of access to the modern system, both from the realities of these legal limitations,  and due to the attitudes of those entwined with the business of medicine towards those like me who choose this less invasive approach for caring for their families.  There were several times I felt the distinct implication -from bogus advice we were given and the comments from different nurses, CNM and PA s – that since we had chosen a home-birth we therefore didn’t deserve the benefits of  prescription medicines.   From some it seemed there was the assumption that since we chose home birth, we must not believe in anything except herbs and witchcraft.  There are currently many states expanding the list of drugs CPMs may carry and dispense.  I hope Maine will follow.

During this time and in the months afterward, i talked to lots of women who divulged to me their own chronic yeast issues. I had only experienced a brief yeast infection earlier in life, in college from drinking too much yeasty  beer (i believe).  Even with this limited knowledge of yeast from my own experience, its not hard to recognize that itching feeling once you’ve experienced it even once.

So, while visiting my mom in southern maine that October, she convinced me to go see another doctor since this issue just was not clearing up.  We called the local La Leche leader listed in the phonebook who gave us the name of a “breastfeeding friendly” doctor in the area. Before this, I had no idea about categorizing doctors as to who were “friendly” or “unfriendly” towards breastfeeding.  Unfortunately , this lead didn’t pan out, as she was not accepting any new patients.   So they directed us to an Urgent Care facility associated with  the local hospital.  Again, this is a walk-in facility.

It was a very nice new and very expensive looking facility with a lovely fireplace, and it seemed cozy and safe.   The male intake nurse was abrupt and snotty with me, after hearing that the baby was born at home asked me,  “so why are you here, why cant you just have your midwife prescribe something?”  i hadn’t realized until this moment that having chosen home birth would mean for some that i now didn’t deserve care when i needed it.  So they stuck us off in an exam room with lots of machines, and they made us wait around in there for about 45-55 minutes,  until an officious doctor briskly entered the fancy exam room,  and seeming annoyed,  asked if i had fed the baby.  Well, after 45 minutes in a room with nothing to distract O, obviously he had nursed. No one had said not to.  So, acting put out, and throwing up his hands, he said not to feed the baby, and left us again, to reappear another 35 minutes later.  He roughly pulled O’s mouth open and looked  quickly into it.  Then put a big wooden tongue depressor roughly into his tiny mouth-  which made the baby scream, and then,  apparently determining something which he wasn’t going to waste his time discussing with me,  he quickly wrote out a prescription  for O for Nystatin, a common anti-fungal drug.  (later i read that Nystatin is only effective against yeast 40 % of the time) Then he left the room!  I was apparently finished being honored with his presence.   I asked the male nurse to please ask him how to apply this liquid, and what i was to do about the painful rash on my breasts, at which point  he went and got dr. to come back. I asked him how i should be treating myself, and tried to show him the rash but as i started to rearrange the crying baby and lift my shirt to show him  he turned away and held up his hand to block his view in an offended way,  as if I was flashing him.  He asked “have you been admitted?”.   I didn’t really know how to respond to that ,  since i thought  since i had been waiting around for two hours to get some medical care here, that we had probably been admitted way back at the beginning with the snotty nurse.?     I asked again what i should be doing to treat the rash on my breasts, asked if i should use some monistat cream or something else on my breasts and he said “just do whatever it says on the box.”  and then “is that all?” and then he left again.  I left in tears.  Of course there are no directions for breast yeast on a box for vaginal yeast cream.  Finally it became clear to me that I wasn’t  going to get any help here from these people, so, I left, asked the receptionists “where do i pay” and they just laughed nervously and said i would be getting a bill in the mail. I did not pay that bill after speaking to some idiot who worked for the york hospital quality control dept. who cleared my bill and wrote a nice letter stating that he was quite sure i had received “only  the most appropriate care”  from their top of the line facility with its infallible doctors. When i began to ask the busy lady pharmacist if she had any other advice for me she stated that “I’ve spoken to Dr.  on the phone and he told me that he has answered all of your questions about this medication.”   then she thrust the bag at me and turned to the next person in line.  I only later thought of how screwed up it was that this guy couldn’t give me the time of day but had enough free time to call this pharmacist up and direct her not to answer any of my questions??

So, we started using the nystatin as the directions said , every 3 hours coating the entire inside of Os mouth with it.  I spent hours reading about yeast,  and did everything i could figure out to do that might help get rid of it. I began more strictly eliminating things from my diet which could possibly feed or aggravate the yeast: stopped eating anything sweet, anything that was a simple carbohydrate, anything with gluten, starches, fruits, dairy, and anything which had yeast in it , anything that ever used to contain yeast or could ever become yeast .  I swore off yeasted bread and made these crackery type of nutty flatbreads that my vegan college friends would have  been proud of.   I was down to eating seeds nuts and twigs basically, and I wasn’t positive that any of this was really helping things, but I noticed a direct connection when i ate something at all  sugary the itching would flare right up.  It wasn’t easy to get enough calories especially while nursing ravenous baby O.  The pounds dropped  off. I  fit into jeans again that had not fit me since college.

We continued to have lots of rain and little sun that fall.  The maples  all had a blight;  dark rings mottled the leaves and dulled the fall colors.   The itchy ring around my nipples had become so painful that it hurt to have anything (including cloth) touching it, so i spent most of my time during those months hanging out topless around  the house.  It was depressing.   My mother in law mast have been horrified when i came down to the dinner table one night topless while she was visiting.   I hoped everyone around me could understand  how excruciating it was for anything at all to touch the raw area.   To be clear- I  can tolerate pain,  I had 2 eight and a half pound babies without any pain medications.  This yeast was something worse than just pain, and endless itch  like hundreds of inflamed mosquito bites on my erectile tissue.

Grasping for any relief, I sought out  plenty of other less-than-modern medicines.  I started taking expensive pro-biotics to boost the good yeast fighting bacteria in my body. I obtained and drank tea made from the bark of a fungus resistant south american rainforest tree.  I used something called gentian violet , which dyes everything it touches a vivid purple, then gold.  Nothing seemed to help very much. The itchy nightmare continued.

Again i tried to get in to see my regular doctor but was told that the nurse midwife was still the only one available.  Desperate at this point, I decided maybe I was wrong about her and should give her another try.  After all, we had paid her over three grand a few years back for about an hour of her time (when we transported from home and had a quick and rather uneventful birth at the hospital,  due to meconium in the amniotic fluid).

I went to her armed with a bunch of printed out info i had found online about thrush, some of which outlined the safety and usefulness of fluconazole, (a systemic anti-fungal),  when dealing with hard to treat yeast  infections.  She was hesitant to prescribe it, but eventually gave me a script for just ONE pill of it, plus 2 more bottles of the sticky fructose nystatin (we went through a total of 4 fifty dollars bottles of this useless syrup) , telling me to also go ahead and apply the nystatin to myself. If you can,  imagine trying to put watery maple syrup on your boobs. Then imagine trying to go to the grocery store this way.   Nystatin in this suspended liquid form has the consistency of watery maple syrup, and is actually sticky because it is apparently suspended in fructose (sugar!). I did more research and I discovered that i was  one of the 60% of people for whom nystatin is totally ineffective. I now think using it was just adding SUGAR to the problem, which most people know  feeds yeast, actually making our problem worse.

About  24 hours after taking the one pill of fluconazole (which was more than thirty dollars)  I saw noticeable improvement.  Finally! The rash looked less angry than it had in a month.  and I was thrilled, but when i spoke with the midwife on the phone a few days later, she would not give me a prescription for any more of it , stating that one pill ought to have been enough to clear up the infection. (apparently, i later read,  this one pill is a correct dose for a vaginal yeast infection, while ductal candida can take five weeks or more to clear with a high daily dosage.)  She then told me what i should do was to go out to the grocery store and buy some cabbage, boil it up and apply it to my breasts.  So, even though i hadn’t read this as a cure for yeast anywhere,    i was so desperate for some relief,  that i covered up my sticky purple boobs,  buckled the kids into the car and went out and bought cabbage and did exactly what she advised.  The rash flared back up in a day or so.  Cabbage never is mentioned in anything i’ve ever read about yeast. Again I had the distinct impression that this lady thought I did not deserve appropriate medicine.  I will never be able to understand why she did not direct me to a lactation professional, but instead gave me negligently improper advice.

Realizing eventually that she wasn’t going to help me, i tried again in the town across the bridge.  Determined to get the help i sought,  one morning I drove all over the  town from office to office;  first to a low income health center who said they only really provide free birth control and pregnancy testing-  they sent me to another women’s health center where they only do prenatal  care and births- and they sent me to a family practice over on the other side of town.  Finally late in the morning, i got in there to speak to an official lactation consultant lady.  She was kind and gentle and supportive and took one look at my raw boobs and determined that yes, it definitely looked and sounded like a yeast problem to her. She gave me a two week prescription for the fluconazole. (costing over 300 dollars at the local family owned pharmacy,  only to later learn that I was being obscenely overcharged; while out of town weeks later i got the same prescription refilled for around twenty dollars! ! )

Almost immediately,  it started to work! Again, after just a day or so i started to see vast  improvement. I was so thrilled.   The rash was steadily getting better, but at the end of two weeks was still not completely gone, there was a small spot of it left.  I called and was told that the lactation consultant was out on sick leave recovering from surgery and that there was no one else at their facility who would now help me.  Apparently in all of the hospital system of providers, they only have (had) that one lady on payroll who is qualified to give any advice on breastfeeding issues, and she  really was only  supposed to be treating O, not me, as we were not seen as a mother-baby dyad.  They told me they were a “pediatricians office, and we only treat children here”.  They could offer me no leads as to who might be able to help me. It seemed totally ridiculous to me that no one was qualified to help a nursing mom and baby, nor could they direct me to someone who was qualified.

After a couple of days of my stopping taking the systemic anti-fungal , the rash came back again,  angrier than ever. I started to think that  maybe it wasn’t as painful, but I really had developed some scar- tissue around the areola by this point , which has less sensation. At some point I began to have random hot shooting pains searing deep into my breast tissue.  I looked at the bottle of gentian violet, the only other thing that had seemed to help a bit, but just  couldn’t bring myself to look at the baby with a purple mouth anymore.

So, I  got on the phone to another hospital about an hour away from us, and thankfully I got a hold of a  lactation consultant up there who had good and up to date information. She wound up mailing me a large packet with all sorts of useful information about yeast and up to date info about the usefulness and safety of fluconazole in treating persistent yeast for ductal candida, even how it was safe and useful in premature babies. Interestingly, her info suggested an even higher dosage for a longer duration than i had been previously given was totally safe.  It was described how it would be about as dangerous as taking tylenol.    Unfortunately, due to some technicality of the grant which paid her, she herself was only able to treat maternity patients of that particular hospital, and also couldn’t prescribe anything and told me to see my “regular physician”.

So once again i tried  to get in to see my regular doctor lady, and once again was  directed to the midwife at the women’s health center. I told the secretary that  there was no way that i wanted to see her again since she had already treated  me inappropriately once with this ordeal!  So she got me an appointment with a new unknown-to-me young physicians assistant,  at yet a different doctors office in town.  She was quite friendly and acted sort of sympathetic at first, but in the end was thoroughly unhelpful.  I went in armed with all the printed info from the lactation consultant,  and I tried to quickly express to her what the situation had been over the past many months, but  the reality is our version of modern medicine allows only five minutes or so with the “health care professional” and with both kids climbing on me in her exam room i’m sure she wanted to get rid of us as fast as she could.  She refused to prescribe any more fluconazole for me, unless i would consent to expensive liver tests.  She claimed it was a very dangerous drug for my liver.   She then told me what she thought i needed to do was to go out and buy some Dial soap, and then wash my breasts every time after nursing with the soap, saying that  “perhaps its a hygiene issue”.  I looked at her stunned – since i had just gotten done describing to her how i was changing sheets and towels daily, boiling my bras and bleaching everything in sight.

As we were walking out she added an encouraging, “I like your nice family” and “some women just find that they aren’t able to breastfeed”.

Really?

A woman like me, who already has successfully nursed her first child for a couple of years with no problems whatsoever?

Are you fucking kidding me?

She also told me that she treats many women who have persistent lifelong yeast problems.   No wonder,  if this is the kind of advice they are getting!!

I left feeling totally helpless and depressed.  Again, like a fool, i went out and bought the dial soap and obediently did as she had told me to do.  Unfortunately for me, I’ve always been quite allergic to most soaps,  and apparently Dial is a rather irritating one if you have this soap allergy, so of course,  I promptly broke out in a contact dermatitis rash all over my body and face.

I again tried for an appointment with my “regular” doctor, and this time impatiently waited the week or ten days to get in for an appointment with her.  She was very sympathetic. Apparently, she actually had nursed her own babies too. I realized  suddenly that she was a “breastfeeding friendly doctor”.  She took the written information i had brought and took it into another room to photocopy it!  She acted as baffled as i had been as to why no one was willing to treat me appropriately.   She gave me an unlimited prescription for the fluconazole and said what i had been wanting to hear all those months, which was  “we’ll do whatever we can do for you to be able to nurse your baby”. RIGHT ON.

She gave me multiple refills and After about  three months of taking a high dosage each day, i went a couple of weeks finally with no sign of itching, pain, or other irritation and I was able to stop taking  the fluconazole and the rash did not ever return.    O continued to nurse happily until he was almost three years old.  Neither of us have had any liver problems or any side effects to date from taking the fluconazole for those few months.

The WHO (world health organization recommends a minimum of TWO FULL YEARS of breastfeeding for optimum health of children.

In the USA only one out of ten babies is being nursed at the age of six months. Many never get to at all.  They cant even locate enough kids nursed beyond six months in the USA to compile any statistics about these longer nursing kids, so almost all research on this is conducted in other countries.  This is one area where all the research agrees that formula feeding is a far inferior fourth choice substitute for human milk.  It produces sicklier , less intelligent humans.

I did not feel that the importance of breastfeeding was very understood by most of the doctors i saw. They didn’t say it, but i got the idea from their other  words and actions- a  few of them anyway- that  they didn’t really get the idea, that they really didn’t get why I wouldn’t just put the kid on bottle.

Who cares? whats the difference? No one breastfeeds these days anyway.

I have been present for most of the moments of the development of my bright and healthy daughter and son, and when comparing that to the slow dullness and delayed speech, behavior, potty training, etc. of some bottle-fed babies we knew,  it makes a sad comment on what we value in our culture.  My husband says the only legitimate reason i can see for not breastfeeding is if the mother has died.    I know that my criticisms of the big picture in relation to this whole issue get twisted and taken as personal attacks and judgements by some of my friends and acquaintances.  I love all of the kids we know, those lucky enough to have had their mamas milk, and the ones not fortunate enough to have gotten any mama milk. I’m pro choice, but deep down i feel that if you make the choice to have children, from that point on you have a responsibility to give them the best whenever you can.  Its why we make laws to protect children, like seatbelt laws and no smoking laws.  While i would not go so far as that supermodel who wanted to  make it the law that moms should nurse, i do want to see big changes through education and our pregnancy and birth care, and our laws, not by mandating but by encouraging.  A mother can get a tax write-off for paying someone else to watch her babies, but no credit to be with them herself.  Until we see the value and productivity of parenting accepted as a valid occupation, we are lost.

My opinions have changed somewhat about other women i  know and don’t know who have unfortunately not managed to choose to breastfeed.  I used to really hold the judgement that a woman who didn’t nurse was choosing not to love that child enough to sacrifice just some brief months of her freedom to give him/her the best start.  If Owen had been my first born and i didn’t know that it wasn’t just normal to be in that kind of pain, i would have most likely given up from the discomfort of the intraductal yeast infection.  I hope other women- first time moms-  are not being denied appropriate care like this, but I know in my heart they often are.

I see in the newspaper that the particular nurse midwife who prescribed me cabbage leaves spends some of her time in africa and other third world places promoting health care for women.  I cant help but wonder how might her time be better spent learning how to take better care of the people in her own community.

I often see the little boy of the doctor who told me to wash with dial soap at story hour with his babysitter.  She says she watches him often since Dr  works long shifts at the hospital ER now.  I’m guessing she herself likely has “not been able to breastfeed”  her boy.   He does not sit still or pay attention at all to the story hour lady; instead he runs about and acts like she’s just a TV set thats on in the corner of the room.  My son loves the story hour. He sits rapt and he knows all the words and tunes to the songs and hand movements by heart. I know I don’t make four thousand dollars an hour,  but I’m making the best little humans I possibly can.

What can be changed so that women are encouraged to breastfeed ? Or, at the very least, how can we  change things so that women can get appropriate care when they seek it if they encounter infections or other difficulties,  as we did?  If a woman who has already had 100% success nursing her first child can be told that “some women just aren’t able to nurse” ,  or made to wait for hours and then not examined and treated like an exhibitionist , or told that cabbage or harsh soap are appropriate treatments for a persistent internal infection…  ?  What can be done to correct this ignorance? Currently, in their training, Pediatricians and Obstetricians receive only three hours total of breastfeeding education.

Routine interventions and medications administered in the hospital setting during birth and immediately afterwards  can help to sabotage the breastfeeding relationship. It is not uncommon for nurses to tell a new mother that her baby will starve because she obviously doesnt have enough milk .  Women are told this in the first days postpartum, unravelling their confidence before their milk has had a chance to come in!

I bristled at the subtitle of  recent La Leche book , something about how the organization has successfully “changed the world by teaching all that babies were born to be breastfed”  What a joke.  La Leche volunteers aren’t allowed anywhere near maternity wards, yet “breastfeeding gift bags”  are still regularly handed out with formula samples and formula and bottle feeding product coupons. A doctor friend of mine divulges that the majority of women who birth in hospital already have their minds completely made up,  and never consider breastfeeding at all.  They just want her to say they were not successful from hour 1 and get her to bring them a bottle.   She and her doctor friends see it as mainly a waste of time trying to discuss with them.  here is an excerpt of her discussion about it:

“…so tonight I was reading notes on this baby whom I took care of late Saturday night and Dad was calling me TUEsday night flustered bc baby not taking bottle …and called me again at 5:00 am next day flustered…and I mentioned nursing, going back to nursing,,,,surely her milk WAS in by now try again etc and I was getting no where fast…anyways I happen to read the MD note from…MOnday? OR sunday…anyways it was this very thoughtful note ( written by a man) who really spent a lot of time encouraging nursing and telling her it was the best thing to do, and that she had really given it almost zero effort ( like she put him to breast once and he did not latch on, OK…but for that matter he did not take bottle either very readily)….anyways he put time into almost begging her to consider and reconsider,,,and then he left room and spoke with the RNs to keep encouraging her…. And despite everything HE said she kept lookign at him saying well, she wanted to him to eat..RIGHT NOW…she needed to see him eat, and he kept sayign in first few days of life it is normal for only colostrum to be there and milk takes few days to come in etc etc. TO no avail. SO this illustrates our point from earlier in the week…she said pre birth that she wanted to nurse…she was offered nusring and help and MD saying being a cheerleader ( and a MAN at that)….and clearly she was NOT going to give this any effort…. on the street she will say ” He did not latch on…he was sleepy…he was not a good eater….he was fussy” and someplace in there she will say WELL THE NURSE GAVE ME formula and DOC SAID IT WAS OK………. the nurse called later and said ” MOm is demanding formual , I need an order to give ti to her and he said OK ( bc if we ever said NO you cannot feed your kid” we’d get in trouble….(in the end)What can we do about this?…”

I suggested to her that as a start, women could be made to sign a release in hospital similar to forms required when declining vaccines, which states clearly that they understand that the percentages of many serious illnesses will dramatically increase for the child should they opt not to breastfeed, also doubling or tripling their own risk of breast cancer etc., that the child’s IQ will be lower, etc. basically list some of the most striking differences/risks we know to be true.    I believe we need to start viewing the bottle as an accessory to child abuse and neglect.

All three women I know who had babies earlier this month were delivered by “emergency c-section”.  Three weeks in, only one of them has successfully established breastfeeding.