Failure to Thrive: When the System Fails the Mother
by Jo Maselli
I still have a screenshot of my son’s growth chart from the day we were sent for an emergency consultation with a pediatric nutrition specialist because he had developed failure to thrive (FTT, a term healthcare professionals use to describe when a child is not gaining weight at the expected rate). My son dropped over 80 percentile points in his first five weeks of life.
We were advised to begin bottle feeding with a strict pumping regimen, to supplement with formula whatever was needed to meet minimal daily intake goals, and to come back in a week for a weight check and a consultation with an International Board Certified Lactation Consultant (IBCLC) and a prominent local pediatrician who specializes in infant feeding and lactation.
We had been attending regular weight checks every few days, my husband carrying the baby and my tiny mother practically carrying me across planes of ice because I had not yet healed enough from my cesarean to walk safely to our car. Every trip up and down the stairs to our second floor flat was agony.
I was also in the early stages of what I would later realize was severe postpartum depression, which I desperately hid from everyone, because I was convinced they would take my baby away from me if they knew. Seeing him rapidly weaken, shrink, and deteriorate before my eyes despite my best efforts at exclusively breastfeeding only deepened my fear and the depression.
Most mothers remember the difficulty of bringing their first baby home and can recall the helplessness one feels before they learn how to interpret their newborns’ cries. But few understand what it is like to be immersed in that sound 24/7 for weeks on end, knowing it is happening because your baby is starving, and not knowing what you are “allowed” to do about it. My son began “cluster-feeding” non-stop (i.e. 16 hours a day) at five days old, and it never ended. This meant nursing 10-45 minutes each hour, for eight hour stretches at a time for weeks on end. And the times in between he was still feeding every two hours. None of us were sleeping.
Most mothers remember the difficulty of bringing their first baby home and can recall the helplessness one feels before they learn how to interpret their newborns’ cries. But few understand what it is like to be immersed in that sound 24/7 for weeks on end . . .
My husband and mother decided to use a pacifier, against my wishes, so that my son and I could get some sleep. They could see what I could not at the time: my mental and physical health had been completely and totally destroyed by my interpretation of “breast is best,” and my belief that I had to do anything in my power, at whatever cost, to ensure a “successful” breastfeeding relationship. I truly believed that if I made any more “mistakes” (according to the La Leche League books I had dutifully studied, this included the induction, cesarean , and small amounts of formula I had allowed in hospital), it would be my fault for failing at exclusive breastfeeding, at bonding with my baby, and at motherhood in general.
I came to pregnancy quite neutral on most motherhood issues, but quickly became very enamored by the natural motherhood movement which is prevalent in my (mostly white, affluent) community. I bought into it wholesale, without questioning the levels of support and privilege involved — everything from being able to ensure round-the-clock support from paid help or family members that did not need to work, to the presumption of a fully functional and typical reproductive system, and access to the insurance and personal funds needed to pay for all the tools, supplements, and consultations required. This means that, as a middle class breadwinning teacher about to be stretched thin by living on EI (Canadian employment benefits) for a year, and with underlying (but as yet undiscovered) hormonal and autoimmune disorders, I was perfectly set up for failure.
In a prenatal breastfeeding class led by a prominent and well-respected local IBCLC, we were told to essentially ignore any members of our support system who had not exclusively breastfed, including our own mothers. This IBCLC also made extremely offensive comments speculating about the connection between children being weaned onto bottles to attend childcare “early” (i.e. before our generous year-long Canadian maternity leave was up) and incidences of psychopathic violence such as mass shootings, even after being informed that some of the participants could not afford to take a full leave. The IBCLC whom she referred me to was no better, telling me, “Whatever you do, DO NOT give him formula,” even after witnessing evidence of failure to thrive and dehydration and being told that her suggested interventions were not working.
In those agonizing early months, I convinced myself that because I was unable to sustain natural labor, to birth my child myself, or to feed my child from my breast, that I did not deserve to be a mother. Furthermore, I believed that because I had made all the “wrong” decisions in terms of birthing (some go so far as to blame mothers simply for birthing at a hospital, when I knew in my gut this is what we needed), I felt like I was ill-equipped to be able to recognize and take care of my child’s needs. At times I questioned whether or not my baby would be better off without me. The few moments I was not feeding were spent desperately fighting for survival against my darkest thoughts. Time I should have spent sleeping or eating was spent silently weeping in my bed, trying not to let anyone catch me.
At six weeks, as I learned more about the extraordinary measures some low-supply moms take to try to maximize supply (while still requiring supplementation), knowing I did not have the energy or resources to sustain them, I felt an even bigger sense of failure; this time not a physical failure, but a failure of temperament for not being selfless enough, resilient enough, or motherly enough to sustain a year of 12+ removals a day at 45 minutes apiece, to persevere with the SNS (supplemental nursing system), to commit to the physical therapy needed for a tongue-tie clipping, to change my diet, etc. Essentially, I wanted to be able to sleep, eat, and leave the house — all things that an extreme approach would not allow me to do, and all things I desperately needed to heal my body and mind.
Like many low-supply moms, I got lots of terrible advice and a little good advice. The terrible advice was mostly standard advice that probably works for able-bodied dyads, and as I heal from my trauma, I’ve begun to let go of my resentment for those people who gave me such advice — dangerous as it was for us — since I’ve now come to understand that for the typical dyad, this advice may be all that is needed. Looking back, I cherish the advice that I received by those who took the time to get to know me and my son, carefully observe our situation, and thoughtfully, compassionately counsel me to make my own decisions by giving me permission to make my own wellbeing a priority.
What I needed most, early on, included careful screening for PPD, PTSD, hormonal and endocrine disorders, and insufficient glandular tissue (IGT) prior to suggesting interventions, including those aimed at exclusively breastfeeding, low supply, or exclusive pumping (which is what I did for four months, despite it driving me to the brink of madness). I also needed a comprehensive understanding of the possible side effects of domperidone, often prescribed to increase prolactin levels, which caused me to develop a temporary liver disease and may have worsened the intensity and duration of my PPD. I can’t help but wonder, if I had been “allowed” to continue supplementing with formula from day one, would I have been able to maintain some level of nursing for a longer duration of time?
Getting off the pump and back on the breast is hard for most FTT moms due to the trauma of FTT. For someone who, according to evidence from pumps, weighted feeds, and my son’s weight loss, was only producing a quarter of the milk he needed, I needed someone to counsel me in adapting my goals and expectations, to redefine sufficiency on my own terms, and to offer me more personalized options. I needed someone to believe what was happening to my son and I, and suggest interventions that supported both of our wellbeing equally. I needed mentally health early intervention that was geared towards women like me, who are essentially supplementing formula with breast milk, and not the other way around. I needed to be seen as a person with needs, not a milk carton on a shelf that just needed to be opened properly.
What I hope will come from stories like mine is an understanding amongst IBCLCs, doulas, midwives, and doctors that women deserve more than black-and-white approaches to birthing and breastfeeding. This idea that there are experts who know better than the mother about her own body and her own child is one that female-led birthing support communities are supposed to fight against. And yet, these are the very people who gaslit me the worst before, during, and after my traumatic birth and feeding journeys. Telling me my body shouldn’t need an induction, a cesarean, or formula. That I was “made to do this,” which I think is a statement that is meant to empower able-bodied women, but can be harmful for those of us living with disabled endocrine systems — often the result of deeper issues, like trauma, chronic stress, and mental illness.
We would never imagine telling someone who needs glasses that they are simply not trying hard enough to achieve 20/20 vision, or that they were simply uninformed about how to see, that they just didn’t receive enough vision support, that they just need to change their diet, that they are just too anxious about needing to see, or that visual impairment is an imagined condition created by the people who make and sell glasses. It is as absurd to suggest that all female reproductive organs function at optimal levels as it is to suggest all human eyes have 20/20 vision; the evidence to the contrary is clear.
A woman cannot experience an empowering matrescence without her inherent wisdom, intuition, personhood, and autonomy being fully honored by those who are there to support her in the birthing of herself and of her child. For me, ironically, this came from the doctors and nurses who helped me feel empowered during my cesarean, and who assured me it was ok to combo feed or exclusively formula feed if it helped me heal and bond with my baby. Not from those who pushed a one-sided, aspirational approach to what “natural” motherhood “should” look like. This is why I want my story to be heard. We need to usher in an era of more inclusive, nuanced, individual, needs-based, collaborative care — one rooted firmly in the idea of female bodily autonomy — if we are to properly serve and save all types of mothers.
Jo is a high school Drama & English teacher in Toronto, Canada. She is the mother of a healthy & highly active two-year-old, and she is currently recovering from PPD. Jo participated in the NSFMG Talking Circles program, where she began to rediscover and her voice, and the power of storytelling. Her low supply story was initially shared on Instagram at @lowsupplymom .