“Breastfeeding is wonderful, but it may not work out the way you envisioned. Formula is not the devil.”

As a physician, breastfeeding was highly promoted throughout my education. How could I not breastfeed my baby? Breastfeeding has many benefits, such as providing protective antibodies, causing less GI upset than formula, and decreasing the risk of SIDS. Plus, breastfed babies are smarter right? Naturally, after I found out I was having a baby, my ONLY option was breastfeeding.

There was no other option for me. I was not going to give my baby formula by any means, and I was sure all would be well. How hard could breastfeeding be? I just needed to put my breast in her mouth, and everything would be alright. Excited at this opportunity to bond with my child, I purchased my pump when I was two months pregnant and placed all sorts of breastfeeding accessories on my registry.

At 40 weeks and four days, I was induced. My labor was 8 hours, and I pushed for 15 minutes. My baby was immediately placed on my breast, and her cry was not the greatest. Something was off. She was too sleepy to latch, so she laid on me while I marveled at the life I had created. Then things immediately turned for the worst. She became less responsive, her color changed, and her breathing became shallower. The doctor quietly requested that the rapid response team be called. I knew what was going on. I had taken care of numerous critical patients to know when things were precarious.

The quick response team came and hurried to suction and oxygenate my baby. After attempting to improve her oxygen levels, my baby was transported to the NICU (neonatal intensive care unit) where she was placed on CPAP, a breathing machine that pushed oxygen into her lungs. I wept like never before, frightened for the health of my baby that I had just birthed. Per the doctors, my baby had aspirated blood and amniotic fluid into her lungs. My pregnancy went so well; why was this happening? Although I had faith in the medical team, my carnal instinct cast doubt on how my baby would fare. I spent the first several hours of her life crying, struggling to eat, and sleep.

The nurses tried to comfort me and sang praises about the NICU staff. They encouraged me to get some rest and eat while my baby was being cared for. I immediately asked for lactation and a pump the first night of my hospitalization and began pumping while my baby was in the NICU. I visited my baby at the NICU between pumping, which I did every 3 hours. Nothing came out.

I knew that this was normal, as the body creates colostrum (nutritious first form of milk made for newborns) which a pump may not be able to remove. I pumped, watched the air in the bottles, and tried to encourage myself with the medical evidence. From day 1, a Nasogastric tube (feeding tube) was placed in my baby, and the formula was immediately started. I asked if we could wait one day to see if my baby’s respiratory status would improve, allowing me to breastfeed, but the NICU doctor assured me that baby needed time on the breathing machine and needed calories to fuel her breathing. I asked him further questions about breastfeeding, and although he supported the mission, he wanted me to realize my child’s life was the priority. This is what he felt was best, and I respected his decision. I continued to pump and watched as she was fed with formula, staying by my child’s side almost every hour of the day.

On day 2, when my baby finally was removed off the machines, I asked if her feeding tube would also be removed. Her work of breathing was still increasing and eating on her own would steal her energy. The NG tube was finally removed that evening, and the nurses were ready and eager to give her formula. My milk was still not available. I asked lactation to meet me in my baby’s room, and we attempted to breastfeed my baby, but she would again not latch. I continued to try to feed her to no avail. Finally, on day 4, my baby attempted and locked for a total of 1 minute. I was encouraged and made preparations to take her home and stop formula. However, my milk was still not in. I assured myself that as soon as I got home, I would put my baby on my breast, I would begin lactating, and all would be well. Before discharge, my baby developed jaundice, and her bilirubin levels increased. I was told to feed her frequently and place her out in the light, and my doctor urged for more formula.

We were finally discharged from the hospital on day 5, and as soon as I got home, I put my baby on my breast. Unfortunately, her latching issues continued. I thought to myself, “But she latched in the hospital!” On my baby’s 7th day of life, she was able to form some kind of latch on my breast and started sucking. I was so thrilled and thought to myself, “Yes, now I can stop this formula.” I sought out some advice from breastfeeding enthusiasts in my family, and they all instructed me to stop the formula immediately since she was breastfeeding. Against my medical training, I stopped giving my baby formula around 5 pm.

From 5 pm to 3 am, my baby spent al-most all that time on my breast. She would cry after latching and go from crying to sleeping, to waking, to crying again. This behavior began to seem abnormal. By 3 am, my baby’s cry had changed to one of hunger. She cried for 30 minutes straight while pulling at my breasts, and at that moment, I decided that I needed to give the baby formula. I called lactation when the office opened, and I made an appointment. The doctor asked me if I had started to pump any milk. I explained that I had never seen a drop of colostrum or milk in the pump bottles, and I just assumed that when I placed baby on the breast, she was getting nutrition. She then watched me breastfeed while fixing my baby’s latch. She weighed the baby before and after the feed and let me know that although my baby was sucking, she was not getting any milk.

Together with lactation, the doctor tried to help me understand that my milk was not in and that I needed to continue to supplement baby formula while working on her latch. She gave me a device called a supplemental nursing system (SNS), allowing my baby to drink formula while simultaneously stimulating my breasts to make milk.

Between pumping every 3 hours and feeding my baby with the supplemental nursing system, I hardly slept. I was exhausted and discouraged. Around ten days after my baby was born, I started to pump rich, yellow milk. I would pump about 5 ml at a time for the next few days. My colostrum had finally arrived! I fed my baby this while giving her 30 ml of formula. I went back to lactation after one week with the SNS, and I attempted to breastfeed her in the office once again. The doctor weighed my baby before and after feeding and stated that the baby was still not getting any milk. Now at 14 days post-delivery, she was afraid my milk would not pick up in time to meet the needs of my child. I spent 10 minutes crying in her office.

I had done everything they told me to do. I pumped every 3 hours, I put my baby on the breast constantly, had skin-to-skin contact, but nothing was working. She let me know that our sessions would end today and to try and accept the fact that some people are just not made to breastfeed. I went to my OB/GYN, who told me the same thing. After going in for weight checks with the pediatrician, I heard the same sentiments. Can you imagine what those words did to me?

I was a mess. This honestly was not at all what I wanted to hear. Every woman should be able to breastfeed. I soon fell into a depressive state and had not quite accepted my doctors’ assessment. I spent many hours crying, calling family members who strongly disagreed with their medical opinions and told me to stop using formula. They recommended soups, leaves, and all sorts of remedies. I tried fenugreek, milkmaid tea, but my milk never appeared. Nothing seemed to help my milk supply.

I reached out to my neighbor, who had spent so much time supporting me in my transition into motherhood. She told me to try another lactation group for a second opinion. I contacted them, and they made a home call to my house. They conducted an assessment and determined that I had glandular hypoplasia. This lactation group helped me in so many ways. They told me it was okay to not pump every 3 hours at night so that I could get some sleep.

They told me it was okay to stop using the SNS if I wanted and told me not to spend these first few weeks of baby’s life dwelling on what was not in my control. They also emphasized that this situation did not make me any less of a mother. Just because I was unable to provide an adequate amount of nutrition for my baby through breast milk didn’t make me any less of a mother. God made the formula! They encouraged me just to keep putting my baby on my breast and enjoy being her mother. “Put her on the breast and give her what she needs with formula.” They provided me with a hospital-grade pump to pull every last drop of formula out of my breast.

I had two visits with this lactation group and began my journey towards acceptance. I continued to pump, and I eventually had an increase in my milk and continued to supplement with formula. Fast forward to present day, and my baby is almost one year old. She is a professional at latching and loves the breast, while also taking the formula as a supplement.

I am now at peace with my journey. One size does not fit all, especially not for a mother nursing her baby. Breastfeeding is a fantastic journey, but please realize that it is not easy, and it may not work out for you. Don’t let the stress affect your well-being. Whatever choice you make, whatever circumstances you find yourself in, people will love and support you. I spent weeks drowning in my guilt when I had to give my baby formula. Now I Look back with regret at all the hours I spent crying instead of enjoying my little gift.

Be intentional about breastfeeding if that is what you want to do but don’t blame yourself if things do not go well. Seek out professional help with lactation specialists, find professionals you are comfortable with or join a support group. These are all great resources. If I did not have support groups and lactation experts, I would have probably given up during the first week. Be easy on yourself.

Dr. Phindile Erika Chowa, MD