Medical training taught this Philadelphia doctor about breast feeding. But the real lessons came from her twins

One of the most humbling parts of becoming a new parent was learning how difficult breastfeeding could be.

I shouldn’t have been so surprised. I had just spent the first year of my pediatric residency seeing my patients’ mothers experience the intensity of labor and delivery, the difficulty and exhaustion of the newborn period, and the unpredictable nature of becoming a first-time parent.

Still, I thought that I was well-prepared, with my knowledge and experience as a pediatrics resident, and connections to pediatrician and lactation consultant colleagues and friends.

I knew that for first-time mothers, milk can take longer to come in. I had twins, and in trying to feed them at least every two hours, and pump afterward to build up my supply, I slept at maximum one hour in-between.

Sleeping in one-hour spurts, it turns out, is a recipe for despair. So when they stopped latching well, causing more pain than I could bear, I felt helpless. I luckily got the help of a lactation consultant and the twins’ pediatrician, and things started to improve. But we had to supplement with formula from the first week onward. I felt disappointed in myself.

I wish I could go back and tell myself that I was doing more than enough for my babies, every step of the way. Now, nearly two years later, I look at who I was and what I did then in complete awe. Most days, I woke up at 5:30 a.m. to make sure I had time to eat and pump before work. I carted clean pump parts and a pump in my backpack, as I biked deserted streets at 6:15 a.m. The night resident handed off patients to me at 6:30 a.m. I saw my patients, reviewed their morning labs and vital signs, drafted notes, then pumped again before rounds started at 8 a.m. I pumped right after rounds, usually at 11:30 a.m.

Sometimes, if rounds went longer than that, I would have to interrupt and say that I had to peel off to go pump. And even though I’m a doctor training at a children’s hospital, I would be embarrassed to announce this.

In the afternoon, I’d pump again, and inevitably, would miss a call to the team phone, and end up in phone tag with our consulting specialists. I was ashamed that I was sometimes unreachable. I thought I was being selfish. I also was exhausted. I’d sign out in the evening, if I weren’t on a 24- or 28-hour shift, and once home would sanitize my hands, change my shirt, and immediately breastfeed my twins, while my husband brought me snacks and water. Soon after, I’d eat dinner, and my husband would do dishes and wash my pump parts.

Finally, we would do a dream feed (nursing and bottle feeding the babies with the lights dimmed, so that their sleep was less interrupted). Then we’d sleep and do it all over again. And no matter how hard I tried to streamline things, how much my husband did, how supportive my colleagues and program were, at the end of the day, it was a crushing load for me.

The thing that always hits me is that the struggle of the newborn period, the nonstop nature of feeding and pumping while trying to be a working mom, feels like a silent struggle. Only now do I really understand that behind a facade of calm and happiness, of sweet Instagram posts and photoshoots, lies a lot of pain, self-criticism, and doubt.

Sharing the struggle of new motherhood doesn’t make you a bad mother. But it seems more socially acceptable to share the successes. And the successes are true, and so meaningful, too. Some of my best memories are being able to nurse my children after a long workday, and feel a unique connection with them.

When I started to share my struggle with close friends and co-residents, I received empathy and lots of similar stories in return. Even if the things we struggled with were different — I bemoaned my low supply, while my friend got mastitis and clogged ducts from oversupply — having someone to talk to about this was uplifting.

Still, as a pediatrician-in-training, I worried about what my attendings and patients would say if they were privy to my raw honesty about the difficulties of breastfeeding. Was I not a good enough pediatrician if I couldn’t even achieve exclusive breastfeeding for myself?

I wrote an article about my struggle with breastfeeding that was published in the Journal of the American Medical Association (JAMA), in December 2021. I was nervous but excited to share my story with the medical community. I was surprised when I received an outpouring of emails from readers around the world.

Many were from male physicians who had watched their wives (often also physicians) struggle and felt powerless. Many were from program directors and department chairs, often within pediatrics, with whom the article resonated. I was stunned.

Now, I see that my insecurity and feeling of “failure” in my breastfeeding journey was a product of the self-criticism that reigned supreme when I became a new mother. Now, I know that struggling with breastfeeding has only made me a better advocate for my patients, and a more understanding and capable pediatrician.

Multiple times, I have helped a new mom in clinic achieve a better latch, using the skills and lingo that my lactation consultant had taught me. I’ve recommended the Philadelphia Department of Health’s Pacify app, which provided me with free, immediate virtual lactation support one Saturday night when I was struggling.

When mothers come in with partners or other family members, I coach these family members in the specific ways that they can be helpful to a breastfeeding mom, learned through the indelible ways that my husband helped me.

I suggest that even if it’s the mother who nurses, a partner or family member can be the one to unswaddle, diaper change, re-swaddle, and soothe the baby. I suggest that a partner or family member take care of washing and drying pump parts for an exhausted pumping mother. I reiterate to families, without it coming up, that it is a legal requirement for all workspaces to provide pumping space and time for their employees, and offer to write a doctors’ letter.

And I recognize that if it was so hard for me, with my resources and privilege, then I need to provide extra support for those who do not have the same access to care. In the long run, I hope to advocate for systemic and policy change to support nursing and working parents.

Vidya Viswanathan is a pediatric resident in Philadelphia. Follow her on twitter @vidyavis.