Quiz: Should You Wean for Fertility Treatments?

Welcome to the Carnival of Weaning: Weaning – Your Stories

This post was written for inclusion in the Carnival of Weaning hosted by Code Name: Mama and Aha! Parenting. Our participants have shared stories, tips, and struggles about the end of the breastfeeding relationship.

One of my most popular posts of all time was Breastfeeding Through Infertility Treatments IVF and FET which was really my own research and decision making process regarding the topic.

It is really a very difficult decision and most of the “experts” in the field are simply ill equiped to help you make this decision.

Lactivists and other breastfeeding advocates will simply tell you how important breastfeeding is. The answers I go when I asked on natural parenting forums was wait, wait, wait. Nothing is worth early weaning.

Reproductive endocrinologists and other infertility patients tend to have the opposite opinion. They say having another baby is way more important and you should wean, wean, wean. Nothing is worth jeopardizing your cycle.

Neither of these viewpoints work for a mother who is undergoing infertility treatments AND is an avid child-led breastfeeding advocate. Honestly, in my opinion you can simply NOT get a good opinion from any of the above. Only a fellow infertile would understand the needs of a cycle and only a devout breastfeeder would place the same level of importance on your breastfeeding relationship.

Please read the research on my original post so you understand the possible risks to you, your breastfeeding child, and your cycle. With that knowledge (and a good dose of thinking, talking with your partner, and prayer if you choose) take the following quiz to help you identify your feelings on key issues.

Should I Wean for Fertility Treatments?

Choose the best answer for each;

  1. My menstrual cycle
    1. has returned and been regular for at least three months with signs of ovulation (using Natural Family Planning methods)
    2. has not returned since giving birth
    3. has returned but has been sporadic or I don’t have signs of ovulation
  2. My nursling
    1. is over 12 months old
    2. is under 12 months old
  3. My nursling
    1. nurses less than 3 times a day
    2. nurses 6 times a day or more
    3. nurses 4-5 times per day
  4. My infertility diagnosis is
    1. completely male factor or female factor due to Fallopian tube blockage
    2. unknown or female factor with ovulation, luteal phase defect, or other hormonal issues
  5. I am preparing for a
    1. frozen cycle where I will only be using estrogen and progesterone
    2. fresh IVF cycle where I will use drugs to superovulate
  6. I can lie to my RE if asked if I am breastfeeding
    1. yes
    2. no
  7. If I did not wean and my cycle were to fail
    1. I would feel grateful that I still had my breastfeeding relationship with my child
    2. I would feel that I should have weaned my baby to give my cycle the best chance
  8. If I weaned my child and my cycle failed
    1. I would feel I had taken something away from my child
    2. I would feel I had done everything I could to make the cycle successful

If you answered mostly A:

You might be a good candidate to continue nursing through fertility treatments. The success of your cycle is less likely to be determined by any increased prolactin.

If you answered mostly B:

The success of your fertility treatment could be jeopordized by the increased prolactin due to nursing. And/Or your child is still highly dependent upon nursing (due to being under 12 months or nursing frequently) and weaning could be difficult or traumatic for your child. You may want to delay your treatment until your fertility returns or your child is more ready for weaning. If you do decide to nurse through treatment at this juncture be sure than you are comfortable that you have done everything you needed to give your cycle its best chance.

(the “c’s” are in the gray zone so count up your a’s and b’s and see where you stand.)

If you do decide to wean here are some tips on doing so gently use these tips to help make it a gentle transition for you and your nursling.

This is not meant as medical advice and should not be used as such. This tool is simply a way to look at some of the issues involved. Please do your research.




Thank you for visiting the Carnival of Weaning hosted by Dionna at Code Name: Mama and Dr. Laura at Aha! Parenting.

Please take time to read the submissions by the other carnival participants (and many thanks to Joni Rae of Tales of a Kitchen Witch for designing our lovely button):

(This list will be live amind updated by afternoon May 21 with all the carnival links.)

  • Is This Weaning?: A Tandem Nursing Update — Sheila at A Living Family bares all her tandem nursing hopes and fears during what feels like the beginning of the end for her toddler nursing relationship.
  • Memories of Weaning: Unique and Gentle — Cynthia at The Hippie Housewife shares her weaning experiences with her two sons, each one unique in how it happened and yet equally gentle in its approach.
  • Weaning Aversion’Gentle Mama Moon shares her experience of nursing and unplanned weaning due to pregnancy-induced ‘feeding aversion’.
  • Three Months Post-Mup: An Evolution of Thoughts On Weaning — cd at FidgetFace describes a brief look at her planned (but accelerated) weaning, as well as one mamma’s evolution on weaning (and extended nursing)
  • Weaning my Tandem Nursed Toddler — After tandem nursing for a year, Melissa at Permission to Live felt like weaning her older child would be impossible, but now she shares how gentle weaning worked for her 2 1/2 year old.
  • Every Journey Begins with One Step — As Hannabert begins the weaning process, Hannah at Hannah and Horn‘s super power is diminishing.
  • Reflections on Weaning – Love Changes Form — Amy from Presence Parenting (guest posting at Dulce de Leche) shares her experience and approach of embracing weaning as a continual process in parenting, not just breastfeeding.
  • Weaning Gently: Three Special Ideas for SuccessMudpieMama shares three ideas that help make weaning a gentle and special journey.
  • Guest Post: Carnival of Weaning — Emily shares her first weaning experience and her hopes for her second nursling in a guest post on Farmer’s Daughter.
  • 12 Tips for Gentle Weaning — Dr. Laura at Aha! Parenting describes the process of gentle weaning and gives specific tips to make weaning an organic, joyful ripening.
  • Quiz: Should You Wean for Fertility Treatments? — Paige at Baby Dust Diaries talks about the key issues in the difficult decision to wean for infertility treatments.
  • I thought about weaning… — Kym at Our Crazy Corner of the World shares her story of how she thought about weaning several times, yet it still happened on its own timeline.
  • Celebrating Weaning — Amy at Anktangle reflects on her thoughts and feelings about weaning, and she shares a quick tutorial for one of the ways she celebrated this transition with her son: through a story book with photographs!
  • Naturally Weaning Twins — Kristin at Intrepid Murmurings discusses the gradual path to weaning she has taken with her preschool-aged twins.
  • Gentle Weaning Means Knowing When to Stop — Claire at The Adventures of Lactating Girl writes about knowing when your child is not ready to wean and taking their feelings into account in the process.
  • Weaning, UnWeaning, and ReWeaning — Jennifer at True Confessions of a Real Mommy discovers non-mutal weaning doesn’t have to be the end. You can have a do-over.
  • Prelude to weaning — Lauren at Hobo Mama talks about a tough tandem nursing period and what path she would like to encourage her older nursling to take.
  • Demands of a Nursing Kind — Amy Willa at Me, Mothering, and Making it All Work shares her conflicted feelings about nursing limits and explores different ways to achieve comfort, peace, and bodily integrity as a nursing mother.
  • Breastfeeding: If there’s one thing I know for sure… — Wendy at ABCs and Garden Peas explores the question: How do you know when it’s time to wean?
  • Five, Four, Three, Two, One, Two, Three? — Zoie at TouchstoneZ discusses going from 3 nurslings down to 1 and what might happen when her twins arrive.

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Breastfeeding is a Public Health Issue?

As a non-vaxer, the term “public health issue” makes my ears perk up.  I do not believe that “public health” ever trumps “personal liberty”.  Recently though the American Academy of Pediatrics issued a new statement on breastfeeding that has some lactivists rejoicing while other moms (breastfeeding or formula feeding) are insulted at the infringement of their personal choice.

Here is the gist of the AAP recommendation read the full text here:

infant nutrition should be considered a public health issue and not only a lifestyle choice.

The wording of “lifestyle choice” seems to imply that this statement is aimed at individuals.  I can completely see why mothers would get their hackles up at another attack on how they choose to mother.  However, I do think that the statement is a positive thing and here is why:

Audience

The audience for this statement is pediatricians.  The statement goes on to say,

Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad.

To me this is the most important point.  How many of us have had our breastfeeding undermined by pediatricians that say we need to supplement or that our supply is insufficient without ever referring us to a Lactation Consultant.  Many (not all) pediatricians are very blasé about breastfeeding and even worse some hand out formula samples to exhausted, worried new mothers and just they time they need someone to encourage their breastfeeding plans.

The AAP’s statement is a strong call for pediatricians to fill their roll on the front-lines of breastfeeding support.  Hospitals already have a strong incentive to change their policies to breastfeeding-friendly ones with the Baby Friendly Initiative.  Often, a baby born in a baby-friendly hospital next meets resistance from a non-breastfeeding friendly pediatrician.  I think this recommendation will greatly improve breastfeeding support by normalizing not just breastfeeding but breastfeeding support (read: not sabotage) by doctors.

Effect of Lifestyle Choice

The AAP also has very strong statements about vaccination.  So much so that not only are 99% of pediatricians recommending vaccinations but many are rejecting families who make a different choice.  This is wrong and exactly what should NOT happen with breastfeeding v formula feeding.  The role of an AAP recommendation should be to unify the pediatric practice with the AAP’s opinion on best practices.  Currently that is vaccinating and now breastfeeding.  That does not mean nor give license to pediatricians to discriminate against families that make an alternate choice.  If you choose to not vaccinate or not breastfeed at most a pediatrician should share his opinion with you respectfully and then go about providing care to your children.

Effect of Public Health Status

The reason I am in favor of this new statement is that defining something as a public health issue brings great attention to it as well as follow-up funds!  For example, the strong stance on vaccination by the APP (and FDA and CDC) is one of the reasons that vaccines are covered by nearly all insurance plans.  The medical community deems it important ergo it is covered.

The same effect can help breastfeeding.  If it is framed as a public health issue then perhaps insurance companies will cover breastpumps (some do), lactation consultants, and galactogogues.  The exposure of the issue will improve breastfeeding support for working mothers and perhaps one day contribute to what I feel is the biggest impediment to breastfeeding – a complete lack of paid maternity leave.

Can this recommendation be abused to shame women?  Of course.  Isn’t everything?  However, WE are in charge of that.  We can decide that this is not about individual women’s choices but about the system that can and often does limit our choices (after all “choosing” to formula feed because as a waitress you know your boss won’t let you pump is NOT a choice).  We can always defend a woman’s right to choose what is best for her family.

At the same time perhaps society will put some power behind their empty words that they “care about breastfeeding”.  This is patently untrue when a woman has no access to basic support for breastfeeding.

Coping with Breastfeeding Loss

My twins are weaned.  There. I said it.

My blissful, road-block and pain free nursing experience with Aellyn was NOT repeated with my boys. Breastfeeding – even just feeding breastmilk – was an uphill battle the whole way. I used donor milk.  I pumped and pumped and pumped.  I smelled like maple syrup from all the fenugreek I was taking.  I saw lactation consultants on multiple occasions and fixed latch issues.  I tandem nursed.  I even exclusively nursed for a whole month!  I thought I had arrived.  Sadly, Boston did not grow that month at all.  He was’t getting enough.  I started supplementing with formula.

And then I went back to work.  My supply just never recovered.  Boston nursed less and less because he wanted the nourishment he got from the bottle better (a mix of pumped milk and formula).  It was just like a snowball.  Eventually I was only recreationally nursing – e.g. 99% of their nourishment was from formula. And then nothing.

Just writing this and seeing that picture makes me cry. It is heartbreaking. I would give almost anything to nurse my boys again.  Trust me I’ve tried.  Even Asher, my good nurser, just cries and cries.  He doesn’t understand anymore.  I’m honestly not coping very well but I want to write out my process so I can come to grips with this devastating loss.  Maybe it will help someone else as well.

What is Breastfeeding Loss?

Breastfeeding loss is the mourning process that happens when a nursing relationship is lost or never achieves the expectations of the mother. Maybe you never nursed and have lingering feelings about it.  Maybe your didn’t nurse as long as you wanted.  Maybe you did nurse as long as the child wanted but you weren’t ready to quit and you have unresolved emotions about it.

The problem with breastfeeding loss is that you often will not feel supported by anyone in your circle.  Formula advocates will brush it off as “no big deal” because “tons of kids get formula” making you feel that remorse over not nursing were just silly.  Some (not all) lactivists will tell you all the things you could have done which just prolongs the pain.

So what’s a mother to do?

Identify the Real Source of Your Feelings

First, you need to examine your feelings regarding the breastfeeding loss.  I think there are several layers that might be present:

[box]

  • Guilt – you feel like you didn’t do everything you could to make breastfeeding successful. You agonize over what more you could have done.  Note that other people do not make you feel guilty.  Guilt come from within.  If you think someone else is “making you feel guilty” please see “embarrassment” below.
  • Embarrassment – you feel self conscious to tell others that you’ve weaned.  You think they will think less of you.  You don’t want to be “that mom” that “gave up” on nursing.  Maybe you run a breastfeeding website and think you’ll lose your lactivist card (cough, cough).
  • Fear – you worry that your child will be one of the statistics that get diabetes, chronic ear infections, and other side effects of artificial feeding.  You worry that your kid will be the one that gets contaminated formula.  You won’t bond as much with the kid and he’ll grow up incapable of love.  Gloom.  Doom.  You’ve cursed your child for life.  ZOMG.  PANIC!
  • Nostalgia – you miss the act of nursing.  You miss the milky smiles and contented sighs.  Your heart aches to nurse just one more time.  Just one.  Nostalgia is interesting because it is not necessarily sad or happy but can be both.  Memories can make you feel warm and happy or sad depending on your perspective.
  • Anger – you feel that someone else is to blame for your lost breastfeeding relationship.  Your husband that wasn’t supportive, you job for not giving you adequate time to pump, your doctor for insisting you wean before some treatment.  Anger is externalized.  If you think you are angry at yourself you are probably feeling one of the feelings above, look closer at your anger.

[/box]

Accept Your Feelings

The key to coping with breastfeeding loss is to take those feelings and allow them to be.  Don’t add a further layer of “you’re so stupid” for feeling the things you feel.  It is ok.  Feel it.

I don’t feel guilt because I  know I did everything I could.

I feel embarrassment, which is why it took me 2 months to write this post.  I definitely have a reputation as a breastfeeding evangelist and I feel like a poser now because I’m not breastfeeding three kids in tandem.

I feel fear that I’ve short-changed my boys and not given them the best start.  My overwhelming emotion is nostalgia. Painful nostalgia.  This is what makes me cry the most.  I’m just SO SAD that it is over.

I have anger that my country has no respect for parenthood as indicated by the complete lack of maternity leave.  I had 3 months off and one of them my boys were in the hospital.  I was afforded time to pump but it was inadequate with preemie twins at only 3 months old.  I’m angry that our society says “breast is best” but doesn’t put its money where its mouth is.

Make a Plan

Next step is to take what you’ve learned about your feelings and create an implementable plan for what to do the next time you feel overwhelmed by that feeling.  Here are some ideas and I’ll use my plan as an example.

    1. My plan for feeling guilt

      • Take a moment and make a physical list of everything you did do to make breastfeeding successful.  My introduction is kind of my list.

      • If you didn’t try to breastfeed at all but feel guilt figure out what you can do to change.  Guilt is a useful emotion because it makes us uncomfortable which prompts change.  Maybe you didn’t have all the information you needed or you didn’t see an LC.  These things might not be reversible but you can decide that, in the future, you will seek more information or use more professionals with parenting help.
      • Forgive yourself.  Maybe hindsight tells you that you could of done more but you weren’t the same person then and you made the best decision you could at that moment.  Or, you didn’t.  Either way you are worthy of forgiveness.  Tomorrow is another day.[box]I don’t feel much guilt because I really feel I did everything I could.  I forgive myself for not doing more.  I did the best I could.[/box]
    2.  My plan for feeling embarrassment

      •  Remind yourself that this is about your child NOT about a contest with other mothers.  Your only responsibility as a parent is your child not being Mother of the Year according to other people.
      • If you only feel embarrassed around certain people, maybe this is telling you something about your relationship with this person.  (not always, you might just be neurotic!)  Sometimes we have friends that revel in our failures because it makes them feel better about themselves.  This is not the kind of people we need to be around.  Surround yourself with people that will love you and celebrate your successes.
      • Get it out.  Don’t make it a secret.  Embarrassment and shame hate the light.  Shine some light on it and it evaporates.[box]I’m writing this post.  Dear World, I, Paige, an avowed lactivist, have weaned my kids before 1 year.  Thank you for your support.[/box]
    3. My plan for feeling fear

      • Identify the real fears.  Don’t stay in the dark.  Read about how formula is lacking. Read about the dangers of formula.  Worry prompted by lack of knowledge is worse than just confronting the reality head on.
      • Learn how to maximize health when formula feeding.  This articlehas many suggestions although I would add a few:[box]I think it is important to really find the least dangerous way for my boys to formula feed.  [/box]
          • Don’t use soy. I really feel soy formula should only be given by prescription.  It is horrible and only needed in less than 1% of babies and yet in the US up to 50% of babies are getting soy formula.
          • Don’t use fluoridated water to make formula!  Ever.  Reconstituted formula “contains 100 to 200 times more fluoride (1,000 ppb) than is found naturally in breast milk (5-10 ppb). In fact, while breast-fed infants receive the LOWEST body burden (mg/kg/day) in the population, they receive the HIGHEST body burden if they receive fluoridated formula(source).”
          • Use organic formula if possible.  This avoids pesticides as well as genetically engineered foods.
          • Give a probiotic supplement.  For healthy gut flora.
          • Give an omega-3 supplement.  For brain development.
          • Consider hydrolyzed formula.  I don’t because it isn’t organic but if you child is having trouble with regular formula this provides milk proteins that are pre-broken down and easier to digest.
          • Practice gentle, responsive parenting.  This is good for the immune system and brain development two things that breastfed babies have a leg up on.  Practicing gentle and responsive parenting will bathe your baby in oxytocin the love hormone that breastfeeding releases.
    4. My plan for feeling nostalgia

      • Don’t avoid thinking about it.  Hold your baby and remember breastfeeding.  How it felt.  What it looked like and smelled like.  Make yourself remember the happiness you felt.  This memory is a happy memory.
      • Make a breastfeeding memory book. If you don’t have pictures, blog it.  If you don’t have a blog (gasp! lol) write it in a baby book.  What did you love about breastfeeding?  What did it feel like?  If you didn’t breastfeed write about other wonderful bonding moments with your baby.[box]I’m making a first year book on snapfish and including tons of happy nursing photos and memories.[/box]
    5. My plan for feeling anger

      • Anger can be powerful when focused!  Talk to the person who undermined you.  Let them know how you feel.  Tell them how they could have supported you.
      • If you can’t talk to the person, find another way to educate others about breastfeeding support.  Donate to a worthy breastfeeding advocacy group (like NursingFreedom.org or Best for Babes or KellyMom ).  Help organize a nurse in or write a letter to your government officials about breastfeeding.  You can see examples at NursingFreedom.org.[box] I’m not going to hide because of my embarrassment about breastfeeding loss.  I think Dionna at CodeName: Mama and I have started a wonderful thing over at NursingFreedom.org and I’m not going to give up when the going gets tough!  I’m even more energized about supporting legislation that supports nursing mothers.[/box]

Conclusion

Well I must say the few days it took me to compile this post have been cathartic for me.  I feel strongly that my continued sadness is just sullying my beautiful memories.  I overcame many obstacles to breastfeed premature twins!  I nursed for 8 months!  Yay me!!  I will celebrate my success and celebrate my beautiful children.

I hope that this post can help someone else that struggles with the outcome of their breastfeeding relationship.

What would you add?  What do you feel about breastfeeding loss?

 

In the end, it was the tornado that did it

My boys are breastfeeding!  Exclusively!  No supplementation, no (well almost) pumping and bottle feeding!

I’m so happy about this development that I feared would never be achieved.  Having preemies who had poor latch and suck along with the stress of trying to keep up my supply solely through pumping was so stressful.  Actually putting the boys to breast became recreational after the stressful work of supplying their food source with pumping and formula.  This was clearly not the way to achieve exclusive breastfeeding but it was so stressful everytime I tried.

And then a tornado hit our street.  Last Wednesday night our city’s tornado sirens went off.  We, of course, went outside to see what was up (idiots).  It wasn’t even windy or raining.  The news was saying for our area to take shelter so I went into a room with only 1 window with the kids and Pete went across the street to talk to a neighbor.  Suddenly a man came running down the sidewalk screaming “it is coming, run!”  Pete gave me a signal and I took the kids into the bathtub.  By the time Pete got there the electricity was out and the world had turned black.  The wind was whipping like crazy.

I think all the damage was done in the first 60 seconds.  I’m told it was a “burst” tornado because it only lasted like 40 seconds but it destroyed several houses – no fatalities though, thank goodness.  This one is 5 up from us:

We were in the bathtub for 20 minutes and the boys were crying.  So, I latched them both on and made shadow puppets by flashlight to keep Aellyn amused (can you say supermom?).  Our electricity was out for about 40 hours – so no pump.  I was freaking out and manually expressing into a bowl (fun).  But then this clam settled on me and I thought maybe God was giving me a kick in the pants.  So, I figured, I’m making enough for them not to STARVE, right?  They were latching great and I could feel let down.  Maybe they weren’t emptying the breast as quickly as a pump but they were nursing more often than I was pumping so my supply was fine.

Well it has been five days with nothing but boob (except I pump once so I can sleep through a feed).  Every time they cry I worry I’m starving them.  It is hard to go from measuring and timing feeds to trusting my body and the art of supply and demand again.  I’m actually glad I don’t have a dr. appt for them until the end of June so I don’t worry about weight.  They are pooing and peeing normally and still sleeping 4-5 hours at night.  I just have to trust the process.

I’m so happy not to be bottle feeding!  I have a new found respect for bottle feeding moms.  In my opinion, it is 100 times harder than breastfeeding.  Getting up at night, all the washing of bottles, mixing formula that has to be thrown away after an hour.  It is so wasteful and if you mix it with breastmilk then that is getting wasted too.  AND IT STINKS.  Like seriously.  Formula smells like festering garbage.  Their burps and farts smell even worse.  It stains everything an unnatural orange color.  Breastmilk doesn’t stain or stink when it is spit up.  A night feeding was a two hour ordeal with feeding each one (I could simultaneously bottle feed but not burp so I did one at a time), pumping, and then washing parts.  It sucked.

If a woman has chosen to bottle feed she is either uninformed about breastfeeding or she has a pretty good reason.  There isn’t anything convenient about formula!  Remembering to have your boobs on is much easier than packing a formula-fed diaper bag.  If a woman was informed, had all the good help of an LC and still chooses to formula feed then I think the physical or emotional distress must have been very high.  It is a lot of work to be taken lightly.

Anyways, I’m so excited my bumpy journey ended so well!  Here’s to 2 more years at least of boobs for my twins!

Tandem nursing twins. Asher (L) and Boston (R)