For others, the support you get can come down to your zip code. For the past five years, I’ve been exploring the phenomenon I call “first food deserts”—neighborhoods where mothers cannot easily access the support needed to provide their babies the most healthful first food—breast milk. Think about it as you would real food. For decades, the public health message was eat well and exercise. It was a great-sounding message, but, as it turns out, it was disconnected from the reality of the lives of millions of Americans. As the USDA now documents, some 23.5 million people live in a food desert—a place where it is very hard to access fresh fruit and vegetables and therefore to eat well. Not to mention that there may be no safe place to exercise. Similarly, there are many areas of the United States where mothers struggle to find support to breastfeed. I discovered these environments in Alabama, Mississippi, and Louisiana, among other places. There is no La Leche League or other meaningful support group. Physicians’ offices display infant formula advertising. The neighborhoods are flooded with billboards for formula and early baby foods. There are no Baby-Friendly-certified hospitals anywhere in the vicinity. And the cultural invisibility runs high—people just don’t see others breastfeeding, which perpetuates the idea that breastfeeding is not the done thing. And while much effort, including the Baby-Friendly Hospital Initiative, has successfully worked to improve the hospital experience for mothers, in this country a hospital is still a two-to-three-day stay for most women. Even if a woman has a supportive experience or a good latch at the hospital, if she leaves the hospital to go home to a community that is a “desert” of support, she is still in a setup for failure. But this is the predicament most women of color find themselves in—regardless of income. That creates layers of missing support from the federal policies to the employer and local community level.
With so many structural barriers and community barriers, treating breastfeeding like a onetime decision that occurs in the hospital and then assumes autopilot commitment is shortsighted. Breastfeeding is not like choosing a job; breastfeeding is more like trying to diet. Every day is a struggle to make the right choice when the less-healthy options seem so much easier. You know how it goes: you see the brownie, you know the brownie is not good for you, you count how many minutes it will take you on the treadmill to burn it off—but you eat the brownie anyway. This everyday decision making is the real struggle of breastfeeding, and it has nothing to do with counting the benefits. The social support women need is the support to maintain the discipline and commitment required to breastfeed. This support would likely come more easily and everywhere if mothering was more properly valued.
• 5 •
Nipple-omics and the Value of Motherhood
There is no such thing as absolute value in this world. You can only estimate what a thing is worth to you.
—CHARLES DUDLEY WARNER
In The Picture of Dorian Gray, Oscar Wilde wrote, “Nowadays people know the price of everything and the value of nothing.” In our society, items are priced but value remains an abstract and often misunderstood concept. When it comes to breastfeeding, the valuations get even trickier. Our idea of value is based on what somebody is willing to pay for something, and that leaves the modern valuation of breastfeeding steeped in confusion. There is the actual cost of breastfeeding-related products and then there is the priceless value of the preventive health benefits and the monetary value of the time it takes a mother to provide it. How we value the huge time commitment for breastfeeding is directly related to the broader issue of valuing mothering in general. As a society, we talk endlessly about the importance of family, yet the time and work it takes to nurture and manage a family is utterly disregarded. Pressed for time and money, unable to find decent affordable day care, racked with guilt at falling short of the mythic supermom ideal—working and nonworking American mothers alike have it harder today than they have in decades, and they are worse off by almost every measure than many of their peers around the world. Capitalist models would tell you that when you “corner the market” on a certain product or service, then by definition your value should increase—but the exact opposite has occurred for women, who have been actually devalued by their ability to bear children and exclusively feed them. Witness the ever-persistent gender gap. Women are paid 23 percent less than men even when we are doing the exact same work as a man. So how could we be properly valued for doing work, such as birthing and breastfeeding, that men cannot do?
It is universally accepted that no one would work for free except mothers, yet no one has enough money to hire a good mom, which, in that framework, actually makes mothers priceless. This does not include Mother’s Day—when the commercial interest in celebrating mothers reaches fever pitch. Beyond that, mothering is mostly considered thankless work. In some places, it can even be a penalty. A 2008 study documented the motherhood penalty showing that the bias toward mothers, the so-called “maternal wall,” is more of a problem than the glass ceiling is for all women. The study found that when female subjects were given identical resumes, one but not the other a mother, the mother was 79 percent less likely to be hired, 100 percent less likely to be promoted, offered an average of $11,000 less in salary, and held to higher performance and punctuality standards. Mothers are under stress coping with an outdated system built around the idea that families can afford for women not to work, yet mothers are being underpaid and undermined for their secular work and their maternal work. The contradictions are complex. So are the implications. The psychological impact of generations of undervalued mothers is hard to ignore.
One is an irrational lack of confidence in our bodies. No woman actively doubts whether her uterus will eventually begin to contract after forty weeks of gestation or that, after birth, it won’t return back to size. You don’t fret that one day your kidneys will fail or your digestive system won’t work. But we consistently doubt that our breasts will perform a basic mammalian function. Lactation holds the award for being the one bodily function that we think of as precarious and likely to fail us. There isn’t much remedy to the psychological warfare against women that has turned mothers against mothers and chipped away at our self-confidence in some very basic biological functions.
In other circumstances, the impact is even more severe. I am sitting in the luxurious lobby of the Sofitel Hotel in Lafayette Square, Washington, D.C., waiting to interview a mother we’ll call Katherine. Katherine is a friend of a college friend, a highly successful attorney who moves with ease in the Beltway’s political power circles. After giving birth to her third child, the Prozac she had been taking for years just wasn’t helping like it used to, even with a higher dosage. “I just didn’t feel happy. I have a great house, great kids, great husband, and a wonderful career but I just didn’t feel satisfied on the inside,” she said. Her psychiatrist then added Ritalin. “I felt great,” she said. Ritalin is a psychostimulant, similar to an amphetamine, a class of drugs often prescribed to children with ADHD and now used more and more by moms trying to get more done. With one pop of the pill, Katherine said she felt more energetic and able to focus. “I was a better version of myself. I loved how it made me feel, like, I could do anything,” she explained, remembering how managing the nanny, rushing home to have dinner, chauffeuring the kids to soccer and dance classes, keeping track of three different activity calendars, and trying to have a “date night” just seemed “easier” with the drug. She also needed less sleep, which allowed her to stay on top of her work responsibilities, and she found keeping her weight at a size 6 was much easier with her “little helper.” It seemed like a win-win.
Except that while Ritalin does indeed make productivity soar, it does so along with your heart rate, blood pressure, and body temperature, and it causes an increased risk of stroke and heart attack. In other words, she is putting her future life at risk to deal with her current life.
At the time I met with Katherine, she was developing cravings and obsession around her pharmaceutical “helper.” She was taking almost
triple the prescribed dose, which had negative side effects. She was lying to herself and her husband about the drug. She was polishing off a one-month prescription in just eleven days. “I get another prescription in my husband’s name. If he knew, he would be so mad and disappointed,” she said, unable to look me in the eye. “He thinks I take it as prescribed, in my own name.” Katherine confided that she felt as if she was on the brink of a full-fledged addiction problem but felt trapped in the cycle of dependency and couldn’t figure out how to squeeze more time in her tightly packed schedule for therapy or treatment.
After successfully exclusively breastfeeding her first two children for six months and then pumping while back to work and supplementing occasionally with formula for the next six months, Katherine didn’t breastfeed her third child longer than two weeks because she felt she needed the Prozac at a higher dose to cope with the stress. (Zoloft and Paxil are generally considered “more safe” with breastfeeding, but those drugs didn’t work for Katherine this time, she said.) Her “failure at breastfeeding” (her words, not mine) fed more guilt, which she feels accelerated her spiral into depression.
Katherine’s experience is far too common. Instead of the blissful existence many women thought motherhood, marriage, and career would bring, they find themselves stressed out, anxious, and remarkably unhappy. To cope with the demands of modern motherhood and the quest to have it all, a woman’s must-have support list includes not only nanny, SUV, personal trainer, and housekeeper (even if once a month) but also, now, a prescription drug to help you cope with it all. Not exactly the best environment for breastfeeding.
For years, this fog of anxiety and discontent has surrounded mothers so much so that it has become normal and yet unmentionable—the modern-day “problem that has no name.” That is, until the July 2010 issue of New York magazine featured the eye-grabbing cover headline, “I Love My Children. I Hate My Life. The Misery of the American Parent,” by Jennifer Senior. The feature story, “All Joy and No Fun: Why Parents Hate Parenting,” finally said the thing no one wanted to say. At least not out loud. However, once it was uttered, it was as if someone took the lid off the pressure cooker and there was the deafening sound of a million moms screaming “Amen” in unison as someone finally put words (three pages of them) to the simmering discontent they were living out every day.
In fact, for many mothers this disappointing experience begins moments after giving birth, when they are faced with their first task of motherhood: feeding their child. The cheery breastfeeding culture and unrealistic images of peaceful breastfeeding and calm mothers sitting in meadows doesn’t always jibe with the realities of the experience. And, quite frankly, the experience is stacked against us.
Breastfeeding feels lonely. In more communal societies, breastfeeding is not a lonely activity, but in America it can be an extremely isolating experience. When not being “accommodated,” nursing mothers are hiding—behind screens and closed doors. We leave rooms. Cover our babies. At work, we express milk alone without even our babies as company—we have only a machine and hopefully a table lamp or plastic flowers for that forced homely touch. And then there’s the pump.
* * *
Imagine yourself at the superprestigious Massachusetts Institute of Technology (MIT) surrounded by tables full of small squeezable breasts, motors, flanges, screwdrivers, and pliers, with the whir of a 3-D printer buzzing in the back of the room. That’s where I am—steps from the Charles River, at the MIT Media Lab for the first-ever breast pump hackathon. The official and laudable title is “Make the Breast Pump Not Suck,” and the energy in the room is palpable. The coffee is free-flowing. The crowd, mostly young, includes husbands who’ve witnessed the experience of pumping, moms and future moms and bright-eyed engineering students who traveled from as far as New York, Connecticut, and Rhode Island looking for a new mechanical design challenge. Not to mention the $3,000 cash prize and trip for two to Silicon Valley to pitch the winning idea to investors. To add to the authenticity, there’s actually an adorable toddler running around and a nursing mom in the room. The goal of the historic two-day convening, which brought scientists, inventors, designers, engineers, entrepreneurs, parents, lactation consultants, and Silicon Valley funders to a small building in Cambridge, is to hack the hell out of a device that has not had any major improvements in over sixty years. It is a long overdue marriage of the culture of innovation and the maternal and neonatal health field that notoriously lags behind other fields in technological advancement.
Sure, we’ve made a two-ton hybrid car that revs quietly. We’ve built powerful motors that propel objects into outer space. We’ve made cell phones sleek, stylish, and superpowerful. But the breast pump still sadly resembles a mechanical milking device circa 1920. Even Wikipedia describes a breast pump as “analogous to a milking machine used in commercial dairy production.”
The first mechanical breast pump was invented by Edward Lasker, an engineer, in the 1920s. In 1956 Einer Egnell, a Swedish engineer, created the Egnell SMB breast pump, a more comfortable and effective version of the original. But, since then, little has changed about the fundamental design. Since engineers invented this thing, it seems apropos that engineers would reinvent it.
New design ideas ranged from changing the pump from a vacuum to a more comfortable compression model and integrating massaging technology from the sex-toy industry to a hands-free prototype. Others attempted to hack the experience of breastfeeding, with one group hoping to demedicalize the process by adding knitted cozies for the breast pump, making it softer and warmer for a woman’s body. Another group created MilkTrack, which uses a smart chip in the lid of supply bottles and incorporates cell phone technology to track and time stamp your milk inventory, check temperature, and track volume. I was full of hope.
But standing in that room, with the smell of creativity pulsating, it all came back to me. The trauma and the shame of my own pumping experiences. The Madonna-shaped cone-like flanges, the see-through funnels that give you the pleasure of seeing your nipples being sucked shapeless. That dreadful sound.
My first introduction to the unwelcome experience of breast pumps came in 2000 when my daughter was born. Before she was one full day old, she started running a fever and had to be put into the neonatal intensive care unit (NICU). All eight pounds of her. It was an odd sight, to have such a large baby among the other NICU babies—mostly preemies or low birth weight babies. In between visiting her isolette, I slowly rolled my IV stand and my still-sore-from-C-section self to a cold, sterile room with cinder-block walls and only a long brown table in it. Then, I hooked myself up to an industrial breast pump, boxy and bigger than a microwave, for what felt like hours, only to produce what looked like puny, insufficient droplets of milk. During those minutes, I prayed fervently, rabidly to the milk god, whatever lacto goddess of Greek or pagan origins there was or might possibly be in the expansive universe. It was traumatizing. It was like I had a great fever that could only be cooled by the sight of my milk freely flowing into the bottle becoming ounces. Meaningful ounces. The line marks, marking the milliliters on the bottle, taunted me. I desperately wanted everything about that experience to be different from how it was. I never touched a breast pump again.
That is, until my son came four years later. After nine months of exclusive breastfeeding, I had to prepare to return to work. And that meant pumping if I wanted to reach my goal of twelve months. After returning to work, I remember how I would close my office door at Fortune magazine and turn on some music in the hopes of drowning out the sound—that embarrassing, godforsaken sound—of my breast pump. It dawned on me that in all of those years since my first experience, they had only managed to put the breast pump in a cuter, more stylish tote bag—simply making it easier to carry the degrading experience.
And, while the hackathon made me excited about the long overdue marriage of innovation and breast pumping, there was definitely a twinge of sadness. Okay, more than a twinge. Why hadn’t we demanded this soon
er? Why have we accepted such a subpar experience? We have run thousands of miles and worn way too much pink to bring attention to improving breast cancer research and care. We’ve insisted that our slimming undergarments be as close to sexy as possible. But this? Why not this? We have settled on the most horrible experience when it comes to feeding our babies human milk, and we didn’t bother to fuss. This made me incredibly sad. It seemed to me that pumping had become very much like the experience of a bikini wax or a mammogram. Not pleasant, but effective. Not good, but void of regret. It was the bad we were willing to tolerate in order to be good. Good to a man. Good for our health. Or good as a mother.
My sadness confused and compelled me as it was replaced by morose unease. Because I was also among the guilty, a mother who suffered but didn’t bother to demand more. Even worse, as an advocate with a national platform, actively involved in the movement to increase breastfeeding rates, I have been focused on helping more women access breast pumps, so they could leave the house for an afternoon or return to work and still provide breast milk. I did this not remembering what happens next, the infuriating experience of trying to extract milk from your body for future consumption. Why hadn’t I remembered this before? That day, I remembered.
Pumping, as it is right now, is not the happy medium. It is not the perfect way to balance breastfeeding and work demands. It is not part of the liberation we are seeking. Pumping is often just another trap in the ongoing maze of breastfeeding torture chambers. Another element of the experience that is stacked against us. Yet more and more women are being pushed to pump, as more companies offer Ikea-like nursing rooms and more pumping perks. For example, IBM announced that it would pay for mothers to ship expressed milk back to their baby while on business trips. These perks create the dangerous illusion that breastfeeding and work are finally working, which really shouldn’t be our only end game—federal paid family leave and workplace policies giving us time to be with our children should. Instead, we settle for being shuttled into lonely rooms away from our babies and then get excited when we are given relatively low-cost perks like free milk shipment.
The Big Letdown Page 14
