Pumping be gone…potential weaning ahead

When I went back to work, I partially weaned my son so that I was only nursing him first thing in the morning before I left and right before he went to bed.  I’ve been pumping right before I go to bed and mixing my milk with formula for him to drink at daycare the next day.  For the last week or so, he’s been a very fussy nurser.  More so than usual.  Sometimes it’s an outright refusal, like tonight, more often, he’ll nurse for a minute or two and then squirm off.

We had a brief period, from about 3-6 months, where he was easy to nurse.  Prior to that, nursing consisted of popping on and off the boob, screaming and snorting milk through his nose before latching again with gusto.  After that, nursing consisted of him squirming while trying to see everything but I could get around that by nursing somewhere dark and quiet and boring.  I used to look at the other moms I saw with their sweet, still, quiet infants contentedly suckling away and find my heart was full of envy as I grappled with mine.

For the last two weeks he hasn’t been interested in nursing.  Tonight, as soon as I sat down with him in the rocker in his room, he started twisting from me and screaming.  He was excited and happy to see a bottle and took a good slug of milk.  He just doesn’t seem to want it from me anymore.

I’m trying not to be an adolescent girl about this.  I’m trying not to feelrejected.  But I have to admit that I am perhaps not quite as successful in that endeavor as I would like to be.

I am not going to resist it.  I am not going to listen to kellymom.com and try to fight my way through this nursing strike or “diagnose” what might be causing it.  I’m just going to quietly stop pumping at night because I hate it.  And if my baby wants to nurse, nurse we will…and if he doesn’t, we won’t.

And I won’t waste another minute thinking about how Health Canada wants me to nurse until he’s 2 years old or beyond.  Have they met my kid?  I’d like to see one of them try to nurse him.

What the Canadian Pediatric Society actually says about breastfeeding is this:

Breast milk is the best food you can offer your new baby. The Canadian Paediatric Society recommends exclusive breastfeeding for the first 6 months of life. At 6 months, your baby will be ready for other foods (see Feeding your baby in the first year). You can continue to breastfeed until your child is 2 years of age and beyond. 

Although, the joint statement from the CPS, Health Canada and the Dieticians of Canada is a little bit more strongly worded:

Healthy term infants should be exclusively breastfed to six months of age and then continue to be breastfed with appropriate complementary feeding to two years of age and beyond.

Neither position statement actually lays out the research that led them to come to this 2 year and beyond conclusion.  I find that regrettable.  The WHO’s statement is also cleverly worded to avoid stating that there is research to support breastfeeding for two years and beyond:

Review of evidence has shown that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.

The thing is, I would cheerfully continue to nurse my infant for a lot longer…if he would only let me.  The only way I can see to salvage our breastfeeding relationship, however, would be if I were to quit my job and stay home.  I am sure that with frequent nursing and no separation of the “nursing dyad,” I could build my milk supply back up over a week or two and teach him that food comes from boobs rather than bottles.

But that’s too high a price to pay for an activity that

1) has dubious benefit in the developed world with access to clean water and high quality infant formula

and

2) doesn’t seem to be backed up by strong science or actually any evidence at all

and

3) has emotional benefits that can be accrued through substitute activities my son actually enjoys like cuddling, play-tickle wrestling, and rocking him while I sing or read books, to name just a few.

Am I missing something?  Is there some evidence for breastfeeding after 6 months, or after 12 months, that I’m unaware of?  Does anyone know where this 2 year and beyond recommendation comes from?  Is it simply an extrapolation from the knowledge that gastrointestinal disease is a leading cause of death in infants and toddlers worldwide and so extended breastfeeding is simply a way limit the amount of contaminated water ingested by the vulnerable?  It’s not like Health Canada or the WHO or the CPS actually explain their rationale for this suggestion.

Ah well, this won’t be the first time I haven’t listened to authority figures.  I sense the ending of an era, the opening of a new chapter etc etc and I will try not to let nostalgia for nursing overwhelm me.  I have wonderful memories.  I also have a wonderful son so I know that the next era cannot help but be wonderful too…in a different way.

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23 comments

  1. 2 years? What 2 years? Ack! I thought the official recommendation was to breastfeed for ONE year. Maybe U.S. kids need less breast milk? 😉
    And here I was pleased to have nursed each child for at least 12 months (2 for whom I pumped, then I quit my job) and happily gave them cow milk from the grocery store after they hit that first birthday. I didn’t completely wean till a few months later, but I would have gone nuts if I had kept nursing until they were all 24 months old. I needed sleep, exercise, and a chance to recover from everything (nutrition depletion, etc.) that motherhood does to a body.
    To use the name of your blog, I feel like a perfectly adequate mother. And my kids seem adequately healthy.
    There’s no point fighting the weaning if he’s getting good nutrition from a bottle and you did all you could (within reason). I recommend enjoying your baby and not fighting with him over something that is probably of extremely minimal added benefit by this point. He won’t be little for long.

  2. Terri C · · Reply

    You and your baby will be just fine. Enjoy him and give him an extra cuddle for me!

  3. You rebel you! My baby is formula fed but she has also become a squirmer when it comes to feeding time. She has even started to refuse to let me feed her solids, she wants to feed herself. I am not ready for this much independence in my last baby. I was hoping that she would stay little a lot longer.

  4. As far as I can tell, the two-year recommendation comes from research done in developing countries, where I think it does make sense to encourage women to breastfeed to 2. (Although, it is interesting to look at this research, because studies of extended breastfeeding in developing countries often show WORSE outcomes for breastfed toddlers, but once they adjust for income and education, outcomes start to look equivalent or better. It’s the opposite of the confounding factor problem we see in developed countries.) I’ve spent a fair bit of time looking for evidence to show a benefit of nursing beyond a year, and I can’t find it. That said, I don’t think good studies have been done. There could be benefits, but I have time believing that they’re all that significant. These decisions are really between you and your baby. I’m still nursing my 18-month-old, but not because I think every drop of “liquid gold” is making her smarter or healthier – we’re doing it because we still both enjoy the snuggles. I will say that we went through a couple of phases where I wasn’t enjoying it as much – one with biting and one with acrobatics – and I’m glad that I stuck it out. But you’re in a different situation, and you know better than anyone else what is right for you:)

    I wrote a post on the discrepancy between the 2-year recommendation and actual research, if you’re interested: http://scienceofmom.com/2011/10/27/breastfeeding-beyond-a-year-why-is-the-aafp-stretching-the-truth-about-the-benefits/

    1. Thanks! I want to keep nursing because I dervive some selfish benefit from it…but while I can lead the baby to the boob, I can’t make him drink. And if I can’t make him drink, I have to face the reality that our nursing relationship is about to come to an end and I don’t think there is anything I can do to extend it short of, as I mentioned, quitting my job!

  5. I should add that there are many communities in Canada, particularly northern and rural communities as well as many aboriginal communities that do not have a reliable clean water supply. Because of that, I generally support the recommendations of the the CPS and Health Canada regarding “extended” breastfeeding…I just don’t think they apply to an upper-middle class family living in a major urban center.

  6. I second Alice’s comment about the lack of research in developed countries. Further, even if there WERE research done in developed nations, it wouldn’t be particularly strong research (since we can’t randomize). I’ve actually been working up to a post on the whole extended breastfeeding thing, and that ridiculous statistic bandied about on Kellymom and other sites about the “natural” age of weaning being 4-7…

    Anyway, hang in there, and I hope that whatever happens, it works well for you both.

    1. Just to be clear….the CPS and Health Canada say breastfeeding *can* continue for up to 2 years and beyond. The longer the better, but weaning whenever it’s right for mom and baby. There’s no judgment on moms who wean at whatever age they choose…except, unfortunately, sometimes by other moms.

      1. The joint statement from the CPS, Health Canada and Dieticans of Canada actually uses the word, “should,” not the word, “can.” See quotes above. The CPS has a softer recommendation on their site. They use, “can.”

  7. Enjoy the extra time not spent pumping and regaining some independence for yourself – I truly ‘liked’ it when my child weaned – I was ready and she was ready and I will admit to liking it more than I even thought I would have.

  8. miriam · · Reply

    I don’t remember where I found this, but I still remember the quote: “are we our own wet nurses?” Every time I hear about women bending over backwards pumping, or fenugreeking etc, I wonder about the cost to the woman and the relationship with her child/ren and husband. Pumping was pretty easy (not at work– that was tricky and likely led to the end of my supply– even working part-time). Breastfeeding was easy after the first few weeks and I found it aesthetically pleasing (free milk– if by free you discount difficulty getting time to myself between the every 3 hour feeds and how much extra time I spent eating).
    By the same argument, I found cloth diapering aesthetically pleasing since I liked putting dirty diapers in the washing machine nicer than putting them in the garbage. And, figuring out money I made about 1$ a load above the cost of water, electricity and soap…
    By the time my daughter weaned, time pumping/ feeding was better spent PLAYING WITH MY BABY. Or bathing her. Or reading a book. Or going to the gym and losing my baby weight. Now I will have two kids, so likely I will find I’d rather play with the older child (who has been neglected somewhat by me during pregnancy) etc than mess about pumping etc.

  9. My older was a wiggle worm too. Being a first-time mom, I also bent over backwards, and as he showed less and less interest, my milk supply dwindled and dwindled. I was determined to nurse to 12 months like recommended, and here we were only at month 6. To quit trying to maintain supply by pumping felt like admitting failure, but it was one of my better decisions. My kid is fine (he’s 10 now, and plenty smart enough ha), and yours will be too.

    Cheers!

  10. […] a funny thing happened – after my post on Sunday, I got a very nice email from the Canadian Paediatric Society pointing me towards more of […]

  11. I suspect that the greatest benefits of breastfeeding are realized early on in the baby’s life, and that they start to diminish as the baby begins to take in solids (providing said solids are nutritionally appropriate). It’s incredibly common for babies to begin to refuse the breast once they have gotten used to the “easiness” of drinking from a bottle.

    I would not, however, discount the health/nutrition benefit of breast milk as coming down to the mere issue of access to clean water. Breast milk is a “real” unprocessed food, whereas formula is synthesized in a laboratory. I don’t think there is any comparison. Certainly as an adult, I know that eating unadulterated meat, fruits and vegetables is *much* better for my health than eating a Swanson Hungry Man dinner, and I doubt there’s a medical professional anywhere who would argue that point!

    All that said, breastfeeding is only the “best” option when it works for both parties. If your son is no longer enjoying it, the emotional drawbacks of forcing him to continue are definitely going to outweigh whatever health/nutrition benefits remain for him at this age. There is no need for justification or guilt when ending a breastfeeding relationship!! 🙂

    My little guy has started to wean himself as he’s become more proficient with actually eating (as opposed to licking, squishing and throwing) his solids. He’s down to about 2/3 of the amount of time he used to nurse. It’s nice to know that breastfeeding can still make up for any nutritional shortfalls, or help to nourish and comfort him when he’s sick, but realistically, we will not carry on nursing forever. And I’m totally with you on hating pumping. I gave it up a few months ago after realizing how silly it was to waste my valuable time with something I dreaded so much.

    1. I also just wanted to add that I think in the case of the breastfeeding versus formula debate, the burden of proof actually lies with those who are advocating formula; not the other way around. Breast milk is what we have evolved to produce for the nourishment of our young. It *should* be considered the default “best option” until such time as proven otherwise.

      1. I don’t think that you can focus only on the nutritional content of a fluid when trying to define what the “best option” is for infant and toddler feeding. I think an over-emphasis on the nutritional content (including things like antibodies etc) is what has caused the polarization of breast vs bottle in the first place. It’s the same as saying we should all be eating local organic meat and plants…great in theory, but just not practical for all families.

        The reality is that there are so many factors that influence a “best” feeding method that differ between families. Moms that want to or need to work. Dads that want to stay home. Medications that interfere with quality or quantity of breast milk. Maternal infectious disease. Traumatic or difficult birth experiences. Post-partum depression. A woman’s desire to control her own body. How easy or difficult it is to establish a breastfeeding relationship. Complications like mastitis, breast abscesses. Maternal major illness or hospitalization. A desire for closely spaced children when breastfeeding interrupts menses or makes them unpredictable (for ovulation tracking). An unsatisfying sex life due to hormonal changes. A workplace not conducive to pumping. Other children to care for.

        Studies show that women who have children take a financial hit – not just when on maternity leave but through the loss of seniority and lost promotion opportunities. They don’t catch up to their childless female peers. Women with children are considered less “effective,” “committed,” and less promotable than childless women or men. On top of that, women who go back to work and are known to be breastfeeding are also considered less highly than women who go back to work and are not breastfeeding. When you are faced with data like that, a few things might change your mind about the responsibility of those who draft guidelines and position statements on breastfeeding. If these agencies are going to tell women that they *should* breastfeed for two years or longer, then I think, based on the negative economic consequences, they do have a responsibility to scientifically demonstrate that there are benefits…at least until society changes to view the workplace contributions of women with children to be at the same level as those of men or childless women.

        1. When I say “best,” I am indeed exclusively referring to the fact that breast milk provides optimal nutrition for human infants. I realize (and very much respect) that there are many factors that go into deciding whether, or for how long, breastfeeding is the “best” option for any individual family. Organizations such as CPS and WHO have a mandate to be concerned with the health of the child; not with economic consequences or the progress of a mother’s career. It would be impossible for them to produce a statement that takes into account all of these various factors.

          To use your analogy of eating local, organic meats and plants — we know that these are the foods that will provide optimal health and nutrition, in the absence of other confounding factors. If finances, availability or other factors mean that a family can only eat factory-farmed, imported beef… well, it’s still infinitely better option that serving a can of Spam!

          We cannot always give our children the “best” nutrition, the “best” education, the “best” emotional support, the “best” toys, etc. We can only give them *our* best. But we still need to have commonly-accepted best practices to work towards, and that’s where these guidelines come in handy. It’s important to remember that they are only guidelines; not standards for judging 🙂

          1. My point was not that the CPS and Health Canada should be concerned with the progress of a mother’s career, but more that the current guideline has the potential to do harm. Actually they should be concerned (and probably are). Economic consequences for the family do impact the health of the child. One of the biggest determinants of our health is socioeconomic status.

            Breastmilk provides optimal nutrition for the first six months in health term infants…provided vitamin D supplementation is also given. Premature and infants with health challlenges need different feeding strategies. Sometime around six months all infants need a source of nutrients not found in sufficient quantities in breastmilk (like iron). Some infants need nutritional supplementation earlier (those prems again).

            Guidelines and recommendations should be evidence based. In the absence of evidence, the guidelines and recommendations should explicitly state that they are based on consensus expert opinion, or biologic plausibility or whatever or they should be less strongly worded so as not to be misleading…eg…”Evidence shows that breastmilk provides benefits over formula to 6 months. Breastfeeding to 2 years MAY provide health benefits over weaning to solids and whole cow’s milk but evidence is currently lacking.” It’s the “should” that gets me. That “should” is judgemental. A guideline that says mothers should breastfeed their newborns is judgemental. A guideline that says newborns derive health benefits from breastfeeding and that all mothers who are interested in breastfeeding be supported to do so, is not judgemental. Using “should” when talking about breastfeeding older children and toddlers, given the lack of evidence, is simply astounding. I have no idea how that wording made it through the consultation process.

            1. You say: “…the current guideline has the potential to do harm.”

              Exactly what kind of harm are we talking about?

              “Actually they should be concerned (and probably are). Economic consequences for the family do impact the health of the child. One of the biggest determinants of our health is socioeconomic status.”

              Are you worried that there’s going to be an epidemic of mothers quitting their jobs (or other such financially detrimental decisions) to prioritize maintaining the two-year breastfeeding relationship outlined in a simple guideline? Life is full of difficult decisions. I would like to think most women are intelligent enough to figure out which decision needs to take priority for her family.

              A guideline that says mothers “should” breastfeed their infants is not judgemental. It simply states what is optimal for the infant. It’s up to the parent to decide whether or not the recommendation works for them.

              According to various bodies of experts, infants also “should” be immediately responded to whenever they cry, “should” sleep 14-18 hours per day, “should” be placed on their backs to sleep, “should” have tummy time every day and “should” have their gums brushed twice daily. I’ll leave it to you to ponder whether or not the benefits of having guidelines and best practices to work towards outweighs the risks of potentially offending someone who can’t live up to them.

              1. A guideline using strong wording like “should” needs to be backed up by evidence. There is evidence for responding to a young infants cries, healthy infant sleep, tummy time, gum and tooth brushing. There is no evidence for breastfeeding a toddler that applies to the developed world. A guideline that demands an extraordinary action should be backed by extraordinary evidence. A guideline that demands a simple action (back to sleep for example) doesn’t need to be backed by the same level of evidence. Comparing “back to sleep” with breastfeeding your toddler, the first is a simple action with strong supportive evidence. The second may be a very difficult action that requires considerable sacrifice on the part of the mother and there is very little evidence. To me, that speaks to politicalization of the guideline. I have no problem with the breastfeeding guidelines for infants younger than 6 months.

                Mothers and their partners should be free to make the best decisions for their families, but they can’t do that if they aren’t given full information. In this case that should include the benefits of breastfeeding to two years in a way that doesn’t overstate the evidence to do so. In addition, it is time we were allowed to speak openly about the potential harms associated with extended breastfeeding without being made to feel that we are infant and toddler feeding pariahs. Economic disadvantage is one of those harms. Maybe this doesn’t matter to you now, in your youth with a supportive partner, but I see plenty of retired women in my work who are living in poverty after a lifetime of caretaking.

                1. I disagree with your continued assertion that there is “no evidence for breastfeeding a toddler that applies to the developed world.” A quick five minute Google search turned up abstracts of several studies, including some on PubMed.

                  However, getting back to my original comment (from which we’ve strayed *very* far), the burden of proof still lies with those who are advocating feeding methods other than the biological norm. The biological norm is for babies to breastfeed until they are capable of deriving all required nutrition from solid foods — a transition that takes several months.

                  Six months (approx.) is merely the point at which a baby BEGINS their transition to receiving nourishment through solids. It is not the END of breast/formula/milk feeding.

                  When presented with the choice of human breast milk, lab-created formula and milk from other mammals (e.g. cow, goat), only one of those choices is the biological norm for a human baby. Breastfeeding beyond six months is not, as you assert, an “extraordinary action.” In fact, the extraordinary action would be doing something other than what nature intended.

                  Breastfeeding beyond six months has been and continues to be done by hundreds of millions of women around the world. In Canada, most women take a year of maternity leave, and if they’ve managed to breastfeed up until the six month point, there’s absolutely nothing extraordinary, difficult or sacrificial about continuing for another six months.

                  With regard to the other “shoulds” I identified, I’m sure that as a health professional you are well aware of the controversy surrounding the “evidence” for the Back to Sleep campaign. If not, this blogger here does a pretty good job of identifying the main issues: http://www.heracliteanriver.com/?p=97

                  Also, let’s agree to remove the economic and female career progression arguments from this discussion, as they’re completely irrelevant to the original question of whether or not breastfeeding beyond six months provides ongoing nutritional/developmental/etc. benefits TO THE BABY. Let’s face it, it’s the decision to have children in the first place that has such striking economic/career ramifications on women; not whether they breastfeed for six months or 12. Unless you have some solid peer-reviewed research showing a causative relationship between extended breastfeeding and retired women living in poverty??

                  1. Send me links for the abstracts you’ve uncovered and we’ll go through your evidence.

                    Here are some great blog posts about this issue. I admit to laziness in not writing about the studies myself, but my original post is more about my feelings on this extended breastfeeding weaning issue, not meant to be a review of the literature.

                    http://goodenoughmummy.typepad.com/good_enough_mum/2011/04/extended-breastfeeding.html
                    http://scienceofmom.com/2011/10/27/breastfeeding-beyond-a-year-why-is-the-aafp-stretching-the-truth-about-the-benefits/

                    Interestingly, this debate has been going on since at least 2007:

                    http://www.aafp.org/afp/2007/0915/p765.html

                    Feeding practices are largely culturally determined. I’m not sure what you mean by biologically normal feeding.

                    Research on poverty in elderly women shows that risk is related to being unmarried (divorced or widowed) and to quote one author “a lifetime of economic subordination.” That includes homemaking and extended absences from the workforce for childrearing.

                    http://www.jstor.org/discover/10.2307/800581?uid=3739448&uid=2&uid=3737720&uid=4&sid=21100858817261
                    http://www.jstor.org/discover/10.2307/40003975?uid=3739448&uid=2&uid=3737720&uid=4&sid=21100858817261
                    http://www.actlocallywaco.org/wp-content/uploads/2011/05/reducing-poverty-amng-elderly-wmen.pdf

  12. Snorkel · · Reply

    I look at my (almost) 2 year old and I really wonder how you would breastfeed someone that large and independent. My mind boggles at extended breastfeeding.

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