Sunday, 11 September 2016

Five Grief Stages of Breastfeeding Cessation

Although things were going surprisingly well, I attended a breastfeeding support group when Kate was only four days old. I think I needed validation that we were doing things right, or I wanted to know what to do if things stopped going well, but mostly, after being holed up in a hospital room for three days, I just wanted to get out of the house. There was another mother whose baby was only a few days older than Kate. She only shared a few details of her birth event, but I knew it was not exactly what she was expecting. I got the sense that she wanted to do an all natural, possibly a home birth, but ended up with a C/section and her baby needed to be in the NBICU for a few hours after birth. Her recovery had been hard and she was still in a lot of pain. Breastfeeding was quite challenging. Her baby wasn't latching well, they were trying SNS, nipple shields, everything. She was pumping, but producing very little. It seemed to be another layer of disappointment for her.        
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              About two months later, I started attending the New Parents group and I ran into her again. She was talking with the nurse who led our classes about her breastfeeding struggles. While I was trying not to eavesdrop, I couldn't help catch a bit of their conversation. The nurse was gently suggesting that maybe it was time to move on from breastfeeding, and she offered some suggestions to help her with this transition. I was glad I overheard her, as her words helped me when I had to stop nursing and pumping. Here's the advice she gave adapted into the Five Grief Stages of Breastfeeding Cessation.

1. Appreciation
Be thankful for the time you spent breastfeeding your baby; no matter how long or short it was. There are many women who want to breastfeed, but aren't able to do so. 5-10% of new mothers will not produce enough milk to nourish their newborns. Some women have had prior breast surgeries including cancer treatment that prohibits nursing. Women with infections such as HIV are restricted from breastfeeding.  Schitzophrenic mothers have to forgo breastfeeding due to their psych medications, which prevent them from decompensating. Some babies don't latch well. Frenulums may be tight, or a cleft palate may be present. Adoptive mothers or women whose babies are delivered by a surrogate may not have the opportunity to breastfeed. As paid maternity leave is not guaranteed in the United States, some women must return to work as soon as six weeks after their baby was born, sometimes even sooner. Some women may not respond well to a pump and will lose their milk supply. Despite laws to protect a woman's right to breastfeed in the workplace; sometimes it's simply not feasible. Only a small percentage of women in the United States continue breastfeeding to their baby's one year mark. Don't whine about only nursing for 11 months.

2. Acknowledgement
"Feeding your baby is the most important thing" the nurse said, "How you feed your baby and what you feed your baby are just details." I've often reminded my patients that formula fed babies turn out very well. My Husband wasn't breastfed and he has a PhD in computational chemistry. I had to follow my cues from Kate. She was just as satisfied by her bottle of formula as she was with a bottle of breast milk. As long as I was available to cuddle and snuggle with her, she wasn't bothered by the fact that we weren't nursing. It may have been the development of two more teeth, but she seemed to advance her self feeding and really moved away from purees and started eating more solid foods. I've often noted that other animals in nauture breastfeed for a very short duration. Although other species are much more mature and developmentally advanced than humans; their mammas know that their babies survival is dependant on their ability to hunt and feed themselves. As Kate could now walk, grab things with her hands and bring it to her mouth and chew; she was ready to move on. It was time for me to be ready too.

3. Anticipation
"What are some of the things you can feel excited about doing after breastfeeding?" the nurse asked. For me, it was some of the little things. I could wear what I wanted, when ever I wanted. I no longer needed to live in my nursing tanks. I could wear a dress out in public without worrying about flashing my bits if she needed to nurse. I could sleep through the night without feeling guilty that I didn't wake up to pump. We no longer needed to spend 45 minutes each night washing my five sets of pump parts and packing my pump bag. No more worrying about forgetting my pump bag at home, which happened on three occasions. The first time Husband had to drop off my bag, he was very sweet and even brought me a coffee. The third time, he was really pissed and became more angry when he got stuck in traffic on his way home and was late for a Web-Ex conference.

The first time I went to work deliberately leaving the pump bag at home, my shoulder felt so much lighter, and it wasn't just because of the weight of the bag during my climb up two flights of stairs from the parking garage to the office entrance. I didn't have to worry about trying to fit in a morning pumping session in between patients. I no longer had to miss lunchtime interviews with prospective candidates because I needed to pump. I wouldn't have to strip down and hope that everyone would respect the 'do not enter' sign on the lockless door to the quiet room. Oh, I'm sure I flashed the window washers, some construction workers and various flight paramedics (the room I used overlooks the helipad landing).

Mostly I felt a weight lifted from being relieved of the pressure of pumping. I didn't have to worry about how many ounces I would produce; fear I might spill some or forget to refridgerate or leave the milk at work (which miraculously, never happened) While I appreciated that he was involved; it would bug me when Husband would ask me how much I pumped and then would do the math to let me know how much I needed to fill her day care bottles each day and possibly have some left over for the freezer. While he never said anything to put pressure on me, I resented feeling like I had to meet my quota. While fortunately, I haven't had any occasion to use it, but the next time I get a cold; I am so taking pseudophederine!

4. Celebration
The nurse suggested doing something that she couldn't do before as a way of celebrating the end of breastfeeding. Perhaps going out for Mexican food and having a margarita. As I had often consumed alcohol and followed the one hour rule, I had something else in mind. I went out and got botox injections. My previous session was about a month before Kate's embryo transfer. "We're not actively trying, but we're not preventing anything. We're open to the idea." I told the anestetician who asked if I were planning a pregnancy, just because it was fun to say. It was even funnier as I had started my lupron injections that morning. This time, I knew that I could take advantage of their complimentary re-tocuh after two weeks.

5. Commeration
The nurse's final piece of advice to the new mother was to purchase a special necklace that would allow her to reflect on her breastfeeding memories when she looked at it. While I haven't ordered it yet, there is a woman who can make a necklace with a drop of your breastmilk. I completed my final pumping session on the night of my botox injections so I would have some for this purpose.

About a month later, I discovered there is a sixth stage of grief. I was getting dressed for the gym and for the first time post-pregnancy, I realised that my breasts now looked the same as they did pre-pregnancy. My immedicate response was to be thankful that they did return to my previous state without any stretch marks, enlargened areolas or deflated looking skin (or at least it hasn't taken affect, yet) When I arrived at the gym, I saw a 28 week pregnant woman with her perky cleavage just bursting out of her top, reminding me what I no longer had. I commiserated with a friend who is a fellow A-cup. "Sorry Jane, somethings just aren't meant to last."