The eight new moms were all doing well with nursing their infants.
Still, they had come to the breastfeeding support meeting in West Philadelphia on this October morning, babies in tow, because it was a place to gain knowledge — and a chance to be honest.
"You think breastfeeding is going to be this magical thing," said Lara Kalin of Manayunk, patting her 7-week-old daughter in a baby carrier on her chest. "But she's learning and I'm learning. It's a working relationship."
Lauren Hansen-Flaschen of West Philadelphia cradled 6-week-old Lucas and chimed in. "I remember people saying you'll have this euphoric experience. I'm like, 'When is that?' "
The confessions were familiar to nurse Patty Siegrist, a certified lactation specialist who leads the bi-weekly group at Studio 34, a yoga and healing arts center.
"Not to be a Debby Downer, but when I teach my breastfeeding classes, I say the first three months of breastfeeding are the hardest thing you will ever do," said Siegrist, who works for Lifecycle WomanCare (formerly the Birth Center) in Bryn Mawr. "It's the longest shortest period of your life. Some days will seem 55 hours long."
Breastfeeding is nature's way, and the well-documented benefits include building the baby's immune system, reducing maternal breast and ovarian cancer risks, and enhancing mother-infant bonding. A recent report suggests that as little as two months of breastfeeding can even reduce the risk of sudden infant death. But for many women, being a physical food dispenser is often an uncomfortable, stressful, embarrassing job that can be hampered by everything from sore, cracked nipples to the lack of places for working women to pump their breast milk.
Many experts now say the best way to encourage women to persist is to be realistic. Diane L. Spatz, a nurse researcher and lactation program director at Children's Hospital of Philadelphia, even believes the World Health Organization and other authorities should stop using the word successful when promoting breastfeeding.
"The opposite of 'success' is failure," she wrote recently in the American Journal of Maternal/Child Nursing. "For any new mother, breastfeeding may not come intuitively or naturally and it may require a lot of work. …We need to help mothers set realistic goals and provide education, support and care to reach those goals."
Getting through the first days
The American Academy of Pediatrics and other groups recommend exclusive breastfeeding — no commercial baby formula — for about the first six months.
That's fine in best-case scenarios. The thick, immune-rich pre-milk, or colostrum, transitions to thinner, whiter, more abundant milk over the first three to five days. The full milk supply comes in by about day 10, as the baby's stomach and appetite grow.
In many cases, however, the early milk supply is skimpy, even when the breasts are normal, so formula supplementation becomes necessary. The critical early days also may be disrupted by illness.
Heath Williams of Bella Vista, for example, had a 42-hour labor and a forceps delivery. Her newborn son went to intensive care. Four days later, she developed postpartum high blood pressure and required intravenous medication.
Even though she "felt like crap," she managed to maintain her milk supply by using a breast pump, so Ivan got her nourishment, if not her breast, from the start.
"Now, he's great," Williams said of her 5-week-old son. "And breastfeeding has gone pretty well."
Siegrist, 67, whose four children are adults, was unable to produce enough milk to nurse them for reasons that weren't clear. Her deep frustration led her to train to be a lactation consultant. In 1996, she went through the profession's certification process, which requires continuing education and testing.
"All four of my kids were losing weight," she recalled of those difficult days. "I became a lactation specialist so I could help other women do what I couldn't do."
Delayed onset of lactation, defined as more than 72 hours after birth, is surprisingly common, with some studies finding it affects a quarter or more of women. Women who get pain medication during labor — as about 80 percent do in this country — are two to three times more likely to have a delay than those who tough out the delivery, according to a study by the U.S. Centers for Disease Control and Prevention.
Obesity also increases the chance that milk production will lag, Spatz and other researchers have found. The biological reasons aren't clear but may have to do with insulin resistance or a decrease in prolactin, the main hormone needed for lactation.
"But just because a mom has a delay, that doesn't mean she can't establish a normal milk supply and be a long-term breastfeeder," Spatz said. "She may need a hospital-grade breast pump. And she needs skin-to-skin contact with the baby to increase prolactin."
About 4 percent of babies are born with another potential problem: a "tongue tie," or ankyloglossia, in which the membrane connecting the tongue to the floor of the mouth is too short or extends too far. This can interfere with sucking and swallowing, and sometimes needs surgical treatment.
"I check every baby I see for a tongue tie," Siegrist said.
Even when all goes smoothly, questions come up, especially as moms build a storehouse of milk so they can share feedings with partners or babysitters. Tess Zwizanski of South Philly said 5-week-old Zelda was thriving, "but I just started pumping and it's overwhelming." The group offered wisdom about the optimal time of day to pump, a gizmo called the Haakaa (used to collect milk on one side while feeding on the other), milk shelf life, and freezer storage.
As the meeting wound down, Siegrist shared an affirming anecdote.
"I remember one mom who I thought: 'She's not going to make it. She's going to quit trying to breastfeed.' I was wrong," Siegrist said. "She called me four months later and thanked me for being part of her breastfeeding journey. It took her 17 weeks to get to full milk production, but she did it."