“And we won’t worry, we won’t shed no tears we’ll find a way cast away the fears forever yea”.. (Dr Amrita Narayanan (Chennai | Feb 2011)
In the beginning
When the labor pains start it is dawn or perhaps a little earlier. I wake Parag and we slow dance a little together: he holds my belly and I sing: “Can I just ask for one moon dance with you, my love”. We have walked a long road for this moment. We moved from the United States to India just a few months ago. We’d tried long and hard to find a midwife for a home birth but none of them had been available. Travel weary from our immigration we’d decided not to brave the trip to the birth center in Goa but to stay at my parents place in Chennai and bring all our wisdom, childbirth classes and years of yoga and ayurveda practice to the clinic where we would have our birth.
Over 24 hours later
We had been so unprepared for a cesarean section that we hadn’t even run through the protocol with the doctor. I’d known every detail about the stages of labor and the positions to assume, the oils with which to anoint myself, the herbs I’d been taking in preparation for months. Everything but the c-section protocol. I knew my body but not the medical system. When they wheeled me into the operating room the only words they kept repeating echoed in my head: “we can’t wait, there was meconium in the fluids”. Parag and I are both crying: we had toiled through over thirty hours of labor with no pain medication only to have the plug pulled on us—or so it felt—with the doctor’s mandate that we get the baby out instead of allow her to continue her journey. So when they refused Parag entry to the room of his own daughter’s birth, when they didn’t tell me it was a boy or girl until I asked, when they whisked away my daughter for observation rather than give her to me in the first minutes of birth, we endured the losses as best as we could without an iota of protest. I finally held my baby girl in my arms several hours after her birth and even then my joy was truncated: the doctors denied me the right to feed her.
We lost our sense of “our baby” that day. That day the institution owned her and lent her out to us on a supervised loan--like a rare book. A draconian nurse closely watched the “visit” of my baby girl to my room. The only symptom that our baby had was a tachypnea—rapid breathing—not uncommon in infants who had a long labor and typically abating after 2-3 days. Yet the doctors decided that it was better not to allow me to feed her “just in case and to be absolutely safe.” Instead she was given IV fluids and kept in an incubator. I know today that it would have been much better for her to be near her mother’s skin and feeding as much as she could but in the moment of pain, exhaustion and disappointment that was our birth experience we were completely shorn of our sense of agency. We did not think for ourselves. We listened and obeyed with rage but we were not able to assert ourselves.
We did have one subversive moment that I recall with pride. On that first visit when the nurse’s back was turned for a moment I allowed Ranya to get at my breast—the word choice is purposeful, this little girl was going for her milk from the get-go—and she managed to get a few drops of milk.
The doctor enters our room furious. “You fed the baby, you should not have fed the baby. She has thrown up”. I tell her flatly that my baby did not throw up because of the milk. I am getting my energy back and I look her in the face and say: “maybe she threw up because you pumped her full of antibiotics”.
The power ultimately is hers because we gave ours away by coming into the clinic rather than having a home birth it seems. We are denied the right to have visits in our room because of the “risk” that we might feed Ranya-ru—yes we gave her a name amidst all this—again.
After several hours of strategizing and a few arguments with a couple of different doctors—the pediatrician as well as my own Ob—we agree that we can have four visits per day to Miss Ranya or little Ru as we are now calling her—who is kept in the “baby room” for observation.
I cannot do the visits to the baby room tonight. The walk is too long and too painful on my wrecked cut-up body but more than that the emotional wound of holding my baby standing up in the room, the ignominy and pain of being prevented from feeding her, is overwhelming. Parag goes instead, he holds her and sings to her, the nurse tells him that Ranya-ru is very sweet tempered and hardly cries
Till today Parag and I recall the first night we were all allowed to sleep together as a family as one of the best sleeps of our life. Little Ranya is adorable, painting-pretty, intelligent and our hearts are so full we even thank the doctors as we leave the next day, our fury at the birth experience somewhat quelled by the joy of holding our baby girl in our arms.
Day five, the days that followed, and my introduction to the sisterhood of the powdered milk
Then you stop and think a little, are you the victim of the system?
Any day now, they’re going to let you down,
Remember Jah will be there, to see you through.
Today when I think about what happened next, these lines from a Bob Marley’s song echo in my head. Conspiracy theories have a certain allure because they lay the blame outside. Call me paranoid, but I like them because they are doorways to the unconsciousness. Even though the blame is laid outside, the conspiracy theories we believe in tell us about who we are inside: though we are conspired against from without, the vulnerability comes from within.
The rest of this story is about milk, breast-milk to be precise and the conspiracy that exists against breastfeeding. It’s personal and yet it’s also about society. I am going to tell you about how, despite being consciously philosophically strongly in favor of breast feeding, a series of circumstances and key players drew out my unconscious (till then hidden) feeling that my own breast milk was inadequate or insufficient for my baby and that I should revert to “Formula” milk powder instead.
Two days after my discharge from the nursing home. I was back in a room full of nurses. My baby had been screaming and crying at my breast, and I’d brought her in to ask for help. I was tense and worried and had been up all night and when the nurse put a manual pump to my breast it did not yield much milk. Within minutes of the low yield pump the on-call pediatric doctor had been contacted. Six pairs of eyes watched my dismayed face as she announced: “your baby is not satisfied by your feeding, you will need to supplement with Naan brand infant formula”. I was incredulous. Just days ago my breasts had been painfully engorged and now I was being told I did not have enough milk. Six pairs of eyes watched as the head nurse demonstrated how to mix and feed Naan brand infant formula. Thirty spoonfuls or so and little Ranya spat out a little of the white liquid. “That how babies show they are satisfied,” said the head nurse authoritatively. Rule number one of the sisterhood of the powdered milk: babies will always behave in a reliable and predictable manner.
Nobody mentioned that using formula would set my milk supply lower. Nor did I think of this, so flooded was I with humiliation, shame, and exhaustion. I didn’t feel like I had another fight left in me though I longed to breastfeed. I turned my face to look at Parag when the nurses left, tears in my eyes. “I don’t believe them,” he said. “Lets use the formula today for the next feed while you get some rest and then we’ll try again. I know you have milk”.
Within days I was back to breastfeeding and supplementing with expressed breast milk because Ranya still seemed hungry after the feed. She never did do the satisfied spitting up that the nurse had indicated but over a month later as our eyes met over the plastic bottle that was brimming over with over 6 ounces of expressed milk Parag and I both knew it was true, I did have milk.
One Month Later: the plot thickens
Ranya was not nursing well and we were having to administer expressed milk in a bottle feeder even after she spent over thirty minutes at my breast, in addition she often pulled on and off my breast as though she had not got a good latch even though numerous people including our breastfeeding consultant—who was long distance in Bombay—and the hospital nurses said that the latch seemed fine.
Having suffered the hospital route we were determined not to use any more allopathic medication for what looked like stomach acidity that was causing the frequent crying in baby Ranya. We consulted an ayurvedic physician—one with whom I wanted to have my birth but who was not available to tend my labor—who recommended a digestive aid that is given to babies—Rajyanyadi powder. Ayurveda works slowly however and it was almost two months before we saw a clear improvement—in the meantime various diagnoses such as thrush and GERD were thrown out from the side of western diagnostics. However when we had no luck with off the counter or prescription carmicides we decides to wait it out and let the Ayurvedic treatment take effect.
I cannot emphasize the stress to our family unit during this time. Ranya cried constantly and loudly day and night partly from her stomach pain and partly from not being able to feed effectively. Sleepless nights, common for most newborn parents, took on a whole another meaning for us. I was constantly haunted by my infant’s obvious distress and family members constant enquiries as to whether she was getting enough food. When an early weight check suggested she was on the lower end of the continuum our pediatrician—whom we had not had the energy to change—expressed some skepticism about whether I had enough milk to breastfeed. Do you have enough milk for at least twenty minutes of feed? Are your breasts feeling heavy before each feed? Rule number two of the sisterhood of the powdered milk: most likely a mother does not have enough milk so doctor’s must assess for signs and symptoms of inadequate milk.
I completely panicked. I doubled my efforts to express milk, pumping into the day and night and breastfeeding and then providing expressed milk first through a spoon and as Ranya’s needs grew, through a special needs feeder. All the while Parag and I became more and more stressed. Hell bent on this goal of breastfeeding, we were unable to enjoy our little daughter.
I became terrified of her appetite. All her cries no matter the cause struck fear in my heart that they were a cry for food that I felt unable to answer. During this time Parag’s mother suddenly passed away and the house was flooded with relatives during which time many women assured me that Ranya-ru’s crying was most likely because I did not have enough milk. Rule number three of the sisterhood of the powdered milk: every cry of the baby that occurs less than two hours apart is a sign that the mother does not have enough milk.
During this time I was sustained by brief moments of light. In those moments, either in Parags arms, while holding my baby girl or rarely alone, I felt connected to what Marley would call Jah, to a force that would see me through this. Other times I was miserable, bereft, angry, exhausted and badly wanting to quit. The strong arms of Parag, his parents and mine, the homes that held us and fed us during this time held me up towards my own goal when I myself could no longer continue.
Two months: Mumbai bound
At two months we were feeding a combination of expressed and direct breast milk but I still had the feeling that something was terribly wrong and could not understand why our little one always seemed so hungry. Despite the protests of my mother with whom I was staying at the time—she felt that our baby was too young to travel—Parag and I decided to make the journey to Bombay to see our till now long-distance lactation consultant Yasmin.
We’d gone armed with two four-ounce bottles of expressed milk that I’d woken up twice in the middle of the night to pump. When I remember that flight from Chennai to Bombay and the level of tension I felt during the flight I can say that I while my conscious fear was of not having enough milk and of having to publicly breastfeed a baby with latching problems my unconscious fear that quickly emerged was of being inadequate myself, of not being able to cope and of failing: failing my baby to provide the nutrition she needed and failing myself as a mother. And this is where the conspiracy meets unconsciousness: if we have these flotsams of low self esteem in us they act as receptors to the popular paradigms of patriarchy. My own fears had made me vulnerable to the sisterhood of the powdered milk and there was nothing I could do about it except now that unconscious fears had been made conscious to tackle them head on through the metaphor of milk supply.
A day after arriving in Bombay we met with Yasmin. She had been my lifeline during the early days and I was so happy to see her. However the first meeting we had with her was a disaster. First, I’d arrived there with a “just in case” bottle of formula (which in fact we had not used at all in over a month). When Yasmin expressed surprise about me bringing formula instead of expressed breast milk I felt immediately ashamed and defensive. Ranya reacted by becoming very fussy and agitated. Then, looking at the way Ranya drank milk and hearing that I supplemented each breast feed with expressed breast milk to the tune of 3 ounces Yasmin declared that Ranya couldn’t possibly be getting enough during her breastfeeds. I was so vulnerable at this point that all I heard was “not enough”.
When I returned home that evening I could not express any milk at all and I had to supplement with formula for the first time since Day 5 and 6. For the next few days it was tough to express milk and I was in a panic. I remembered my own mother’s story that her breast milk had stopped overnight and though Yasmin assured me that this was impossible, I was convinced that the same fate had come upon me. When I talked to my mother she agreed that this is what had probably happened and she suggested I come home to Chennai where there was a chance I could revive and perhaps get my milk back. But Parag insisted we stay in Mumbai and keep trying.
Then two things happened. First another Yasmin recommended Cranio Sacral Therapy (CST), a relaxation therapy that was known to help breast-feeding mothers, particularly those who’d been separated from their babies during birth. We were introduced to Zia, a CST practitioner whose beauty and confidence were instantly calming. Second Yasmin suggested a breast-shield, a plastic device that would help Ranya latch better. The breast-sheild was instantly helpful and her crying dropped about 50 percent overnight.
CST feels a bit like healing: like a massage to the body’s energy. I enjoyed the relaxing vibe of my healer and found myself brimming with milk after the first session. This time the Bob Marley song in my head was about how conspiracy is conquered by love “And we won’t worry, we won’t shed no tears we’ll find a way cast away the fears forever yea”
3 Months: cured but not yet healed
It had become completely clear that milk supply was not an issue and yet I needed constant reassurance on this score. This I attribute to the conspiracy and to my vulnerability: every time someone suggested I might have inadequate milk—be it a relative or a stranger who doubted the power of breast-feeding—I felt a strange panic arise in my breast. Thus, even though we were completely feeding little Ranya breast milk, I felt cured but not healed. I was haunted by the fear that I was going to loose my milk at any time and my body felt still in the emergency mode. Every time Ranya had a poor feed I would be terrified that this would affect my milk supply. Though we were not using formula I felt I was still relating to the formula. This means almost daily I would have the thought “oh good thing I did not use formula today” or “it has been one week of no formula” or mentally calculating and recalculating “well in the past three months I gave 10 formula feeds”, or was it eleven, let me see again”. Long and short was that formula was prominent in my thoughts even when I wasn’t using it.
I began to realize that only if I could trust completely my own ability to breastfeed and Ranya’s ability to receive nourishment at my breast that I would be truly healed. As long as I had the attitude that I had somehow escaped the enemy (formula) I was still giving the powdered milk much more importance than I wanted. In addition, by continuing to fear that I would lose my milk supply suddenly, I was in fact suffering an ongoing trauma: that of being told I had inadequate milk--as had happened several months ago at the nursing home—except this time it was me who was allowing the ongoing violation. I knew that if I did not find a sense of home with my feeding and with my milk, the voices of the pediatrician and nurses from the early days would still echo in my head.
I had to conqueror the inner fears, the Duppys as Bob Marley might say, of being replaced by a powder that was priced at $3 for a kilogram. I believe these fears were still at large for two reasons: First my own inner sense of inadequacy that had been brought to the fore by a difficult birth and unsupportive doctors who believed in formula over breastfeeding. Second my own infant trauma of being switched from breast to formula at three months because my own mother’s milk “went away” overnight had become a trans-generational trauma where my mother’s fear about milk that could magically disappear overnight was still at large in my own psyche.
It took a lot to get to take back my power. It took pushing through some very fussy feeds where it might have been a lot easier to mix powder and water—just even for that one feed. It took re-training my mind to step away from constant measurement and to trust in the flow of milk, to feel milk in abundance instead of milk by the ounce. It took suffering through the anguishing worry that my daughter may not have been getting enough to eat and that it might have been my own stubborn fault that this was the case. It took being on tenterhooks every time there was a weight check. And it took all this over and over again but I slowly began to see signs of change such that when I went back to Chennai and visited the pediatrician who had been there at Ranya-ru’s delivery I earned a compliment from her: “you are such a confident mother”. Emboldened I asked: “in hindsight, knowing all that you know now, would you still have recommended the 3-day separation that you insisted upon when she was born”. She paused and then said slowly: “perhaps not. I just wanted to be on the safe side”.
I was grateful for the acknowledgement though perhaps in an enraged sort of a way. To contemplate the possibility that our suffering might have been unnecessary was both affirming and numbing at the same time. I demurred to my gratitude: I was too tired for rage and too relieved that I’d come though the worst.
5 Months: the triumph of the invisible
At the beginning of Ranya’s fifth month we found ourselves in Ahmedabad where Parag had a new job. We were still feeling that “stranger in a strange land” feeling where the newness of the India that we previously “knew” was hitting us hard. The summer was blazing hot. We had no friends in the area and were completely dependent on each other for support. Locally that is. In Bombay and Chennai we still had our parents and Yasmin, both of whom continued to be of incredible support to us. I make the comment about the weather, about our immigration stress and about the absence of friends because I think all these are important factors in breastfeeding. In a patriarchal social climate where there is very little support for breast feeding every little bit of support you can get counts—whether it is from a balmy day or a good friend. So perhaps you will understand when I tell you that I seriously considered formula once again.
It happened one of those hot days when we went to see a new pediatrician. Dr. Vyas came recommended as “breast feeding friendly”. At this time, although Ranya-ru was indeed breastfeeding (with the nipple shield) I was still not fully trusting of the process. I was ashamed of using the breast shield in front of people and found breast feeding outside the home impossible. I was also terrified that she was not gaining enough weight.
When Dr. Vyas’s nurse weighed Ranya as his office my heart was in my stomach. Sure enough Ru’s weight had changed very little from the last weighing. I was terrified that I was not providing her with enough, somehow starving my own baby. Dr Vyas responded to my fears by suggesting I start solids four times a day as soon as possible. When I called my mother, before I could even tell her what had happened, she told me that she had serious misgivings about my decision to breast-feed without adding the supplement of expressed milk. “Your baby is growing and will need tons of nourishment” she said. I myself had read and heard from Yasmin that the truth was that my baby took in no more milk at five months than she had at two but it was hard to ignore my mother’s words and the implication: that I could not meet my baby’s needs via breast-feeding.
Materialist is the word that comes to mind when I think about this: the world is a lot more comfortable with materially visible and measurable food than with breast-feeding. Materially visible food spreads the sphere of influence and control to a larger community and while it may allow the mother a break, it also breaks the exclusivity of the mother-child relationship. I began to wonder if this mother-child feeding relationship was threatening for some people. What I know for sure is that breastfeeding past 3-4 months is not supported even by doctors and people who support it in the beginning. In my anxiety, I tried a watered down version of the doctor’s suggestion and gave Ranya a little mashed up chikoo two days in a row. I gave up on the third morning when Ranya was screaming and crying as she pushed out a huge (for her) stool. I went back to worrying and exclusive breast-feeding. Parag took the strong stance that we were not going to weigh Ranya again, something our Ayurvedic physician had recommended a long time ago.
I think it was this decision, this taking a stance that was spearheaded by Parag and followed by me that was the turning point. If you want to conquer your fears you have to risk everything. I had to take the risk that perhaps my head was right to understand that it was my heart that was true. My head said Ranya was not gaining adequately. My head trusted the numbers. My heart trusted my lover and my own squashed breast-feeding instincts. Ten days later as she was feeding Ranya ripped off the breast shields and continued feeding. Amazing amazing experience. The breast shield had made lying down and feeding impossible (slipped off especially at night) and was cumbersome to fit on and keep clean. Ranya’s decision to progress to naked breast, live and direct, was a huge relief.
Six Months: birth of a mother
I continued to worry a bit about weight for a while but you’d be amazed at how much it helps to avoid weighing your baby! Over time I started to get my sanity back as my sleep improved—I slept with Ranya beside me and night-time feedings got easier and easier. And slowly, I don’t know how exactly, I started to feel more and more confident about my breast-feeding.
We slowly introduced solids again at six months—a little rice kanji—and Ranya was interested in trying them but mostly for the taste: breast milk was still clearly her primary nutritional source.
One more hurdle: it was hard at this point to cope with the success of breastfeeding. The consequences of successful breastfeeding is that your baby needs you a lot. Mine certainly couldn’t manage without me for more than an hour and a half or two at this point and this put a huge damper on my grand plans for getting back to work. I’d been working at a hospital as a doctoral level clinical psychologist and had earlier planned to start seeing hourly patients at a local clinic but realized that if I wanted to continue breast feeding this was going to be very hard.
As luck would have it my daughter’s needs for me to be at home, gelled with my own crystallizing. My pregnancy had germinated an old dream for me: I had begun to write again and nurture the hope of publishing my work. Deeply satisfied with being a breast feeding mother, I decided to revise my plans to be a full time clinical psychologist for a while and to stay home and write. This allows me to nurture my own dreams as well as be there for Ranya. I keep in touch with my field by teaching a few hours a week and seeing patients a couple of times a week but I restrict myself to only those patients whom I can see at home thus cutting out my commute time. Since we did not choose to have a nanny I only work when Ranya-ru was sleeping or when Parag was available to take care of her. This a time when I firsthand understood what it meant to put foundations underneath my castles in the air and become comfortable with a pace that is slow as molasses but yet deeply satisfying.
This was another turning point. When I realized how much work it was taking to fuel my visions, I began to allow myself credit for what I was doing both as a mother and as a psychologist-writer. There is no faith like your own and my ability to see myself clearly as such doubled my confidence. For the first time I feel I am living the feminist and non-materialist credo that I espouse, meaning that I give myself as much credit for the work of motherhood as for the material that I produce, also that I receive as much reward from Ranya’s growth as I do from my other work outputs. While previously if Ru was having a fussy day or night I would resent this tremendously as it would eat into my other plans for the day, however now that I consider her to be my “plan for the day” (so to speak) I’m able to integrate my work and Ranya with much more joy and satisfaction and less resentment.
Nine months (and milk-ily ever after)
Two weeks before Ranya-ru’s nine month birthday I was about to board a flight again, this time armed with only my own breasts. I flew trans-continental to the United States with my baby and had a smooth flight accompanied by tons of breast feeding and sleep for both of us. So when I reached my brother’s house in New York city, imbued by my strange new sense of confidence, I popped her on his bathroom scales and finally the numbers lined up: at nine months Ranya-ru had tripled her birth weight.
Today I still wear my confidence shyly at times, though I can be a bear if I need to. In recalling all that happened I still sorrow that there were so many women, “the sisterhood of the powdered milk”, who discouraged me from breast feeding. Professionally I learned firsthand about the concept of womb-envy or breast envy—that patriarchal forces fear a women’s power to breast-feed. Personally and politically I learned that many women who were raised under that patriarchy, reinforce the idea to new mothers that “not enough milk” is a reality and that powdered milk is an answer to this problem. I’d also learned what I’d always suspected, that the healthcare system is run from a patriarchal basis, meaning that it values man over nature and that doctors, both men and women, trust their protocols, their pharmaceuticals and their instrumentation far more than they trust nature’s process and mothers’ instincts. As a human I learned about the “it takes a village” cliché firsthand—for we could not have successfully breastfed without the numerous source of physical, emotional and financial support from both families and from Yasmin and Zia.
In my experience and in hearing the stories of those of my peers who gave up on breast feeding and those who didn’t, the primary reality that gets in the way of breast-feeding is not lack of milk but lack of support both social and personal. A close second comes a woman’s own feeling that she is not enough and so by derivative the milk must not be enough either. To process these two realities is a tremendous journey, a journey of subversion of social order and surmounting of individual shadows requiring huge support but the results are well worth it. For milk I still maintain is not only liquid nourishment, it is flesh and fluid communication between mother and child. When I see how close Ranya and I have become, how deeply in tune we are I think of breast milk as a metaphor for a common source that keeps us both connected. As Ranya nears one and the topic of weaning comes up I am proud to say that Parag and I feel confident and ready to plunge into it as a process not as a goal. Weaning won’t be something we do because its time according to a book or to someone else, it won’t be something that happens because there is not enough milk, it won’t be something that is decided by me or Parag or Ranya-ru alone: it will be a relational process that will unfold in the space and tenderness that lies between us.
Email note written to Yasmin on Nov 1, 2011
Yes in a way Yasmin you are my mother. You pushed me to open more and grow more. I was so angry with you when we had the "disaster" meeting but actually what I realized later was that my anger was against my own mother who shut down her body due to anger at her mother in law and her circumstances and stopped breast feeding me when I was 3 months old. And you called my attention to how I was imitating my mother unconsciously. And I was. But how to be better than your mother without feeling guilty? In month 9 and 10 of my nursing I felt an immense guilt because I had nursed longer than anyone else in my family and I could not come to terms with this at first. In the end I was able to move away from the competition model of thinking about things and I could just accept that I was nursing--not longer or better than anyone but just right for myself and our family--for this also you were a role model in the way that you shared information about your own daughter without a sense of competition or comparison.
There is so much more Yasmin. Truly I feel this could be a very long article and I had the thought of contributing it to a Psychoanalytical Journal because it is a true example of a concept we call "intersubjectivity"--where one person's inner self communicates with another as happened between us through your dream that you were then able to communicate to me. Even though I could not speak with you about it at the time due to my complex feelings of "overtaking" my own mother and a peculiar sense of dedication to being just like my own mother and her sister (who did almost solely EBM rather than nursing because in the end it was too hard for her not to know exactly how much milk was being taken in).
You must realize the depth of our gratitude to you and your role in our life, not just for Ranya's breast feeding but also for my growth as a mother, as a woman, and as a human being. I continue to grow in love for you as we communicate ongoing. ~ Dr Amrita Narayanan (2012)