Why I'm over and done with breastfeeding #It worked for me#babies#breastfeeding#breastfeeding challenges April 13 | Guest post by Summer Pierre I've had some struggles with breastfeeding in the four months since my son was born. One of those struggles was just grappling with the SHOCK that it could be so hard. I am still grappling with that shock –- as it has been renewed again and again over the last 3 months with each twist and turn I've had to manage. The newest shock is that I'm throwing in the towel, that it actually never worked for us and won't. This is perhaps the most painful shock of all. I wrote a post about this issue after things had gone to utter shit and I visited with a lactation consultant. I was very hopeful then, clinging to my little plan with my knuckles going white. I was bound and DETERMINED to get this BALL ROLLING, dagnabbit. Give me a plan and I am ready for the fight! Friends and acquaintances came forward with their stories of breastfeeding triumphs over tragedies. I got some wonderful e-mails from some of you with your own stories of feedings gone wrong and right. My fragile spirit rose timidly. So we went ahead, trying to get my milk supply up and to fix Gus' supposed sucking issue so I could get rid of the nipple shield. Little did I know, that at that moment things were as good as they ever were going to be and the only thing that was going to REALLY change was my attitude. I'm glad no one told me this bit of information. I would have been a basket case. Sure, with night and day pumping, and herbs and oatmeal my milk supply eventually rose…for a time. Then it dropped again for no apparent reason so I had to go back to supplementing and pumping and pumping some more. I was panicked about the supplementing and would hate to give Gus any formula, freaking out every time I had to make him a bottle. I Googled (read: BAD IDEA) breastfeeding stories and testimonies about milk supply, about how it is very rare to not have enough milk while I pumped away night and day. Then just like that, my milk supply would still drop on its own for no reason. Gus also never NEVER wanted to nurse without the shield. We'd try, he'd sometimes latch on feed for about two minutes until he realized what he was doing and he'd suddenly wake up, INSULTED, like I'd just fed him a HORRIBLE IMPOSTER and it was OBVIOUS that I didn't love him at all, otherwise I wouldn't be putting THIS thing in his mouth. So back with the nipple shield, or what I like to call, the HATEFUL thing. At the lactation consultant's suggestion, I took Gus to see a craniosacral therapist. The therapist took one look at Gus and said in his very even-tempered calm craniosacral way, "I think you're the one who needs the therapy." He was right, of course. I was ragged with stress over how this was still not working. So I went. Nothing improved. The pediatrician did not agree with the lactation consultant on her belief that Gus had a sucking problem. So it was me again. And nothing improved. After a tearful conversation with the lactation consultant (AGAIN) she gently asked, "Well, do you LIKE nursing?" WHAT? HUH? What kind of crazy question is that? The thought had never even occurred to me. "Sometimes," I answered, "when it works." Related Post Pumping and bottle-feeding saved us Breastfeeding is awesome, but we sucked at it. Here's how we got past that. "Well, why don't you just feed him when it works?" So that's what I did, but it still required that I pump at least 3-4 times a day and sometimes my milk would drop anyway, but for about 2 weeks, it was okay. Except for the mastitis. That hurt like hell. And also the breast that produced milk, when it uh, FELT like it, no matter if I pumped the hell out of it. Sometimes it eked out milk, sometimes it just sputtered. At its best, it was about 50/50 with the formula, but I thought, I'll take what I can get. Only, there was just one more problem: The raging migraines that were starting to show up 3 times a week. At first I didn't equate them with the milk supply, but I started to notice that when I started a new dose of herbs and my milk supply went up, I'd be debilitated with violent migraines, the kind I used to get while on birth control pills. And you know what happened when I had migraines? I had to take medication, so it meant I had to PUMP and DUMP. And after 4 straight days of this, with Gus barely able to feed, he decided to tell my boob and its INFERNAL SHIELD to take a hike. He started to react as if I was offering a HOT POKER to his face instead of food. Last week I had an appointment with my midwives, but for 3 days before I went off the herbs and I was curiously migraine free. So I asked the midwives if this could at all be a possibility, because these are HERBS right? Nature's medicine! It turns out that YES it is a total possibility, because they aren't just tinkering with my supply, but my hormones–so there you have it. So last weekend I started the slow process of weaning myself from breastfeeding and I am just going to say it, it's been very very sad. I had wanted in my heart of lowered expectations to make it to at least 6 months, but I can't even do that. I need to be healthy and happy for Gus, instead of forcing my supply on myself and him. Having come from a breastfeeding culture, THE HIPPIES, I never in a million years thought this is the way it would go. Also, as a result of being around people that have never had ongoing supply problems, I haven't had a lot of empathy. It's been a lot of HOW IS THAT EVEN POSSIBLE? It's possible, OKAY? And while I'm on the subject I'd like to say to all the "experts" who write crap on web pages and in books about how RARE it is not to have enough milk, SHUT THE HELL UP. Tell that to the women in THIS video. Tell that to the woman who told me she got into a CAR ACCIDENT because she fell asleep at the wheel because she had been pumping throughout the night to get her supply up. Tell that to the other woman who told me about sitting at a support group at the La Leche League, with a ROOM full of low milk suppliers, where a woman bragged that her two month old had finally started gaining weight and was SEVEN POUNDS. A TWO MONTH OLD. (Even the La Leche League leader a.k.a lactivist was like, "Lady, it's time to give your baby some FRICKN FORMULA!"). It's weird, in a society that doesn't supposedly support breastfeeding, I haven't felt a lot of support around not breastfeeding or knowledge about why women don't breastfeed (thank you to those who have reached out their non breastfeeding selves to me!). It's been a real eye opener –- another in the long list that is under the title MOTHERHOOD. Now, if you'll excuse me, I have to go feed my healthy, thriving son. Reporter Name * Reporter Email * Original text Enter the original text here. Edited text* Enter your suggested copyedit here. Notes You can add a note for the editor here. * Required information. Fix Typo Guest post written by Summer Pierre Summer Pierre is an artist and writer living in Brooklyn, NY. You may remember her for giving birth in a cab. http://summerpierre.com PREVIOUS Sexy Norwegian DILF rocks the sling NEXT What I learned from our first camping trip with a baby Show/Hide comments [ 81 ] I'm so glad you've shared this story. It is NOT easy for so many women and those who do have an easy or at least relatively easy time should be compassionate and understanding. Never judgmental. 2 agree Reply Good for you for doing what is best to keep yourself sane. Low supply due to PCOS and breast hypoplasia here. I still nursed for two years, supplemented with formula till the first birthday, ended up with a great kid and a passionate, raging hatred for La Leche League and other 'lactavists' who deny the truth that some women just can't produce enough milk on their own even with herculean efforts (if you're involved with LLL and reading this, rest assured that I have no beef with you unless you have told a woman that it's "almost impossible" for someone to fail to produce enough milk for her child or that she's "just not trying hard enough" or doesn't "want it enough"). There's a reason that women have been nursing the babies of others for hundreds of years, and that's because some women (the ones who got to be the wet nurses) produce more than enough and some of us barely produce anything at all. This isn't new. 4 agree Reply This comment totally brought something new to my eyes — I always thought wet nurses were for the rich as a "convenience" thing, but your observation now makes me think maybe rich people could afford wet nurses when the mom didn't have enough milk, and that the poor babies just died. Maybe it's true that some women don't produce enough milk. Thanks for your insight. I do try not judge, but you're right, it's hard to understand how it's even possible not to breastfeed when I personally only had a few small problems at the beginning that were easily fixed and when many of the moms I know had zero problems (I was even jealous of them!). Just like co-sleeping or not, attachment parenting or not, working or not, no one is a complete hippie, complete yuppie, complete techno-mom. Everyone has to find balance somehow. I work and pump and get mad when someone gives the baby a bottle when they know I'll be home in ten minutes and could just breastfeed. I do EC part-time and feel guilty when I need get stuff done and don't want to pay attention at that particular moment. I never planned on bed-sharing but then discovered how to nurse on my side and loved the extra sleep. I plan to do BLW but you never know if it'll work or not. 1 agrees Reply I totally feel your pain. With both of my children, I started out with an abundance of milk… So much that I would literally spray all over the bathroom walls when getting out of the shower. (Inconvenient, to say the least.) However, about two months in, both times, my milk supply declined dramatically. I went from pumping 6-8 ounces to barely getting one. My first child also refused to nurse without a shield. With both of my children, I ended up throwing in the towel when they were about 4 months old. The milk just stopped altogether. I don't regret it though… Both of my kids are healthy and strong (and intellectually gifted!)… So giving them formula during their infancy had no negative effect whatsoever. I couldn't ask for healthier, happier children…and self. 🙂 2 agree Reply Yes! 1 agrees Reply I think this (US) culture is very polarized on many issues and breastfeeding vs formula is no exception. When I am around many mothers who breastfeed they often slam women who formula feed, when I am around women who formula feed and they find out I breastfeed, they become so very defensive and abrasive (no idea what they talk about with only formula using moms.) There seems to be no middle ground. In my opinion the choice of how to feed your child is an intensely personal one and really no one else's business. As for some people saying only a small percentage of women not able to breastfeed, I do not know the stastics. All that matters is that you fall into that percentage right? I know I'm on the opposite end of the supply spectrum, had I been born in the past I'd probably be a wet nurse with how much I produce! (I breastfeed my baby, my toddler and pump and extra 4 to 8 oz a day for freezing and still get engorged.) However for ever one woman I know like me, I know 10 who struggle. They can't all be the lazy bums that so many lactivists paint them to be. I think you have done all you can do, if not much more! As a long sufferer of migraines I know how hard it is to be remotely human (much less a mom!) with a migraine. It is unlikely that your child is going to remember if you breastfed him but he is going to remember if you were fully there for him with all your loving support. If you need to formula feed to give him all that support, so be it! And I'm with Shannan, if the people you surround yourself with are negative, run from them – FAST! Being a mom is already hard enough with that strain. 1 agrees Reply With my son I had to use a shield (flat nipples apparently? Who know? Not I!) and then he refused to nurse without it, and I also supplemented with formula with him until he decided at 7 months he didn't want the boob anymore. It was a sad day. But we got over it (as in I got over it.) As long as we feed our babies and they are healthy and grow, isn't that what's important? 1 agrees Reply I had problems such as this with my first son. I gave up after 2 months. I have never felt guilty about bottlefeeding, supplemental or full. Because it's about providing my child with whatever they needs by any means possible. But I will say this.. sounds like this is a first time child? perhaps the next time around will be a little easier.. and the time after that.. easier still.. depends on how many children you want. If you do have more, you may find it easier. If you don't have more, take solace in the fact that you have done what's right for you, and provided for your son's needs now. And society be damned. I've known too many breastfeeding moms with problems and guilt about supplementing and bottles. I emphatically tell them to stop! No one else matters but her and her child and meeting those needs. Even one day of breastmilk and it's antibodies is better than no days at all.. it's all icing on the cake of providing. Now that you've made your decision, you can enjoy your feeding time with your son, no stress! -Carolyn 1 agrees Reply if it doesn't work, it doesnt work. i'm battling through my own bfing problems. no one should feel bad about choosing to give their baby formula 🙁 your a supermom for doing all that you did 1 agrees Reply I feel so bad you haven't had more support! I was on the flip side in a way. The women in my immediate family never breastfed and always seemed to push the idea I wanted to away, so when I started having difficulty, it was just a constant barrage of 'give up'. I commend you on trying so hard! You put in ten times the effort of those who have it easy, and you can brag about that!! 1 agrees Reply I'm right there with you! The women in my family never breastfed either, so I was constantly barraged with "I think she's still hungry", "How do you know she's getting enough?" day in and day out! As if I didn't have those thoughts myself, their "concern" really wore me down at times. I stuck with it and kept reminding myself that I have to trust my body and my baby to know what they're doing. Reply The difficulty of breastfeeding is the big, dirty secret of motherhood! Some people take to it right away, but with my first I was torn up and bleeding for 4 months. (And here's where people will usually offer such helpful advice as 'did you see a lactation consultant?' or 'he must have been latched on wrong', etc,… because I have must be living under a rock with no idea what I was doing if it was not going well.) I wish I had stopped trying to breastfeed sooner. It totally impeded my relationship with my baby. I spent all day dreading his next feeding. Now with my second son, it hurt like hell for the first 6 weeks but my milk came in strong and everything worked out from there. I'm sorry you went through this but it is totally something people don't talk about enough. Everyone wanted to freak us out about labor and lack of sleep, too, but nobody ever told me breastfeeding might hurt like hell and leave me worried all day long about whether or not my baby was actually eating anything. Maybe some moms forget about the pain and worry of breastfeeding because it eventually works out (for some) and they choose to recall the sweet snuggly time with their little ones. Good for you for taking care of yourself! 1 agrees Reply I have a Gus, too (also 4 months!) and I'm right about where you are. I'm getting really tired of listening to my family and friends gleefully tell me about how milk literally pours out because their shirts were ALWAYS SOAKED and how it's a wonder that my supply is so low. My Gus was born @ 10 pounds and was admitted to the neonatal intensive care unit for low blood sugar. I had no choice but to supplement my measly colostrum with formula right from the get-go. The lactation consultants were a joke at my hospital. One told me not to bother pumping while he was in the NICU. I had a friend smugly tell me that she breastfed almost exclusively for a YEAR. And just to add insult to injury, there are tons of billboards all around our city proclaiming "We breastfeed! And so should YOU!" Like it's SO FREAKING EASY. 1 agrees Reply I can't believe they told you not to pump while he was in the NICU!!! We were in the NICU, too, and for all the issues we had with unhelpful nurses who were really discouraging about BFing in the NICU, the lactation consultants were good about telling me how often I would need to pump to keep my supply. I really can't understand how they could tell you that!? Reply The LC's were (and I say this with as much emphasis as I can muster) RIDICULOUS. I was in the postpartum room for 2 days and I had 2 LC's drop in. And again, let me emphasize DROP IN–like, didn't even bother to sit down, threw a business card at me and determined that because Gus had a good latch, that I would be fine. BOTH OF 'EM! I asked about renting a pump after I got discharged (Gus would be in NICU for several days after) to keep my supply up and was told by Lactation-Consultant-From-Hell that "Oh no, don't bother to rent one, he'll just be out in a few days, right? You'll be fine!" I mean, I know they're probably pressed for time BUT SERIOUSLY. Water under the bridge now, because now I have a big, happy, healthy (mostly) formula-fed baby! 1 agrees Reply 🙁 I feel your pain, it's better to enjoy these moments than not, and if that means to quit breastfeeding, then by all means quit. I had low supply with my first child, and quit after three months. With my second child I took a lot of Fenugreek and quit pumping, this seemed to work for me, but everyone's body is different. The time with your baby, enjoying all the firsts, is so much more important than what is in his bottle. 1 agrees Reply Oh wow, your story is so similar to mine! After about 3 months of breastfeeding, my supply significantly dropped. My daughter would cry every time I fed her because my breasts would run out of milk. I would then have to make a bottle with a screaming baby in my arms and then after she ate, I would pump so that I could try to build my supply up. And on top of it, I also had mastitis and couldn't feed her from one breast. After a month of that, I threw in the towel too. I did not want to make my daughter cry when I knew she could be satisfied with a bottle. I have had some regret about giving it up (even though I rationally know it was the best choice) but hearing stories like yours makes me feel better and not so inferior. Thank you so much for sharing! 2 agree Reply You sound like you have tried everything in your power to do what is best for your kiddo. Nobody can fault you for that. NOBODY. My son started self-weaning at 7 months and was completely done by 9. I tried everything you did; pumping non-stop, taking supplements, yadda yadda but he was just not interested. He acted like I was trying to kill him whenever I tried to encourage him to nurse. Many people told me it was just a nursing strike and babies don't self-wean before a year. Well, my son was the exception. I think the issue many women have with formula feeders are the ones who barely give it a shot (or no shot at all) before switching to formula. But you fought like a champ and I applaud you for that. You do whatever it takes to keep your sanity. Good on ya mama! 2 agree Reply My daughter self weaned at 7 months. 1 agrees Reply this is *so profoundly* similar to what i went through, and continued to put myself through the exclusive pumping for 19 months (with decreasing frequency and increasing supplementation with cow's milk once she old enough). i also pumped milk full of blood a few times, and had migraines, and while the slow decrease was going on, would have horrifying periods 3x in the course of 6 weeks and excruciating ovary pain that was totally palpable but showed nothing on an ultrasound for months. the part that really got to me was her reaction, like you describe, as if i were shoving an instrument of torture forcibly in her face rather than offering her sustenance. when i walked out of our birth class after the one focused on breastfeeding i burst into tears, i guess i had some intuition about what we were really in for, on some level. 1 agrees Reply also: i SO LOVE your illustration!!!! 2 agree Reply Wow, you really gave it your all. That is something not everyone even has the mental willpower to attempt! I have a pretty low supply (I never leak, I'm never engorged, and other things), and I don't respond to the pump at all. At night when my supply is down, I give a bottle of formula to my 3 month old. SO WHAT. What I'm doing is exactly perfect for us. He's alert, meeting milestones early, and has a cute layer of chub-chub he wouldn't have without his supplement. 1 agrees Reply Cierra, my daughter self-weaned at 7 months. I didn't kill myself over trying to get her back on the breast (since I had planned on weaning around the 9 month mark anyway) — so after a 4 days of engorged breasts and a child who literally could not be less interested in sticking my boob in her mouth – I went through my frozen stash and then moved on to formula. Interestingly, the weaning coincided with her sleeping through the night for the first time ever. So you know — child sleeping 12 hours but not breastfeeding vs. child waking every 4 hours? Hmmm. Tough decision….. (er, not really) 1 agrees Reply Wow. Maybe it's where I'm at in the country but everyone asked me through both my pregnancies about breastfeeding. I'm fairly certain some of them actually examined physically my breasts while doing it, and I'm not making that up. I had a reverse experience. I was fairly ambivalent about it and not committed to it at all. In fact, maybe mildly hostile. Clearly I could see the medical benefits, but also felt OK with bottle feeding despite my earth-mother-mother and her protestations about her radical late 60s nursing of my brother and I. I made an agreement with myself: 4 weeks before I quit, hell or high water, then I'm done. I figured I'd devoted much longer times than 4 weeks that to ridiculous, pathetic, painful, futile pursuits (like….JERKS I dated). I did have a rough start with my first baby. I got mastitis. But after probably 14 days, we smoothed out and I really loved it. I nursed the second one for two years, shocking everyone including myself. Of course, the second one was much easier since one of us knew what we were doing. Give yourself a break. You did a great, amazing job to stick with it as long as you did in the circumstances. My close girlfriend has struggled horribly with breastfeeding after each of her two IVF babies were born. She worked 80 times as hard as me for a fraction of the reward. The second time though, she was able to give herself a break and quit early. We all need to be more gentle with each other. 1 agrees Reply I'm KelliK's "close girlfriend" and Summer, I can so empathize with you. These first few months are so very precious and go by so quickly it's just amazing. And having spent them trying to sort out why my own body failed me so miserably was a mistake that I was simply compelled to make. As so many others mention, the politics surrounding breastfeeding are completely polarizing and I got wrapped up tightly in them. Convinced by the lactavists and beaten down by the "breast is best" campaign, I refused to formula feed my first son and caved to the pressure of "waiting it out". He was hospitalized at 5 days old with an astoundingly high bilirubin and had lost over 20% of his birth weight. I spent far too much time, emotion and energy trying to give my him 5 or 10% of his nutrition from breastmilk and then supplementing with formula until he weaned himself at 7 months and my biggest regret is that I'll never have that time back to be able to correct (what I perceive now to be) my selfishness and stubbornness and simply enjoy the precious gift that was entrusted to my care. Reply i should also mention that I was much more prepared for my 2nd son; starting on herbs at 35 weeks of pregnancy The good news is that I had already suffered a huge loss and it was much easier for me to face the subsequent loss head-on. Baby #2 never really liked bfeeding and after 3 months decided that he'd prefer the bottle and after a couple of fights with him acting like the devil himself was being shoved down his throat, I gave up. The difference is, I never looked back. That is not to say that I don't still have days that the tears come for the loss of what I wished for. But even those days are getting farther apart and the tears dry up much faster. I have 2 beautiful, perfect, healthy, thriving boys and not a soul can tell how they were fed as infants. Nor is it anyone's business but my own. I'd say to anyone who's suffering with this: Give your beautiful child a squeeze and hang in there. Better days are coming. 1 agrees Reply Ugh. I hate that women/mothers are made to feel like there is a right and wrong side of the breastfeeding/formula issue, like being a mother isn't hard enough as it is. I EBF'd my daughter until 6 months, and weaned her at 13 months, so when new mama friends ask me for advice and share their struggles with me, they are always surprised when I tell them if it's making them miserable and it's not working, then just go to formula–it's what I would've done, and if I worked? Forget it–I hated pumping so much that if i were working, that would've been the end of BFing for me. Either way, your baby is being nourished and cared for. (And BFing is not the panacea it's made out to be. I have at least one friend who reported having PPD while BFing, which went away when she stopped BFing. It's probably more common than we think.) And the next time someone gives you shit about being stronger or whatever, I suggest you ask them when's the last time they gave BIRTH in a damn cab. 1 agrees Reply You did a good job, mama. I know the pain and sadness of weaning before you're ready. But I promise, the rawness of it will diminish. Your baby boy will thrive. And you will be glad that you made the choice to do what was best for BOTH of you. 1 agrees Reply My little girl is 4 months old and I did not breastfeed. I had a couple different reason but the main reason is migraines. I am on daily meds that I stopped taking to get pregnant and of course stay off while I was pregnant. I knew if I was going to be a good mother I would have to go back on those meds or I would not be able to function. I was lucky to have just one or two migraines while pregnant. I heard it could go either way , some women gets ton some get none. After I had her within the first week I had 3 migraines I knew I was making the right decision to get back on my meds and not breastfeed. 1 agrees Reply There is no shame in not breastfeeding. There is no shame in breastfeeding. How you feed your child is not what makes you a good mother. Doing what's best for your baby is. Very few people accept awards and thank their mothers for breast feeding. They thank their mothers for their support and love. Sounds like you've got that in spades. 7 agree Reply Summer, I am so sorry to hear what a horrible time you've had and my heart goes out to you and your sweet Gus. I had a similar frustrating eight weeks of trying EVERYTHING – constant visits to three different LCs, herbs, pumping 8x a day on that damned hospital grade pump, getting mastitis, getting thrush from the antibiotics, exhausting myself, and watching my beautiful, precious, lethargic, struggling daughter slowly try to regain her birthweight. I filled out feeding charts and counted wet diapers every day and prayed I'd get the 25 ounces into her one way or another, and every time she gained those fucking numbers went up and there were more ounces to coax into her. I fought so hard and my supply never rose or stabilized and my daughter never had any success nursing – something I thought would be so "natural" was the hardest and most grueling work of my life. And yes, I heard from every single woman who had a huge milk supply or an effortless time, and just wanted to die from being so tired and so sick of the struggle. We used formula, and honestly the worst part of the whole thing was the UNBELIEVABLE amount of shit other people gave me. I watched my daughter grow – gain those precious ounces and then pounds (!!) and her eyes got brighter and she turned into herself, the sweetest transformation of my life. And meanwhile, I got so many glares, strangers telling me she would never truly love me or bond with me because I "only" bottle-fed her, and nasty comments. The first time anyone ever smiled at me feeding her in public was when I fed her solid food for the first time at a cafe at nearly eight months – it was like someone turned the lights and heat on in the dark, cold room I'd been stuck in and other people suddenly weren't assholes anymore. Your last sentence made me cry. Thanks for this whole honest, fantastic post. I hope your next three months with Gus are as joyful and easy as the first three were hard and frustrating, and it only gets easier and easier from there. 1 agrees Reply Now I've got tears in my eyes! Thanks, Susan! xo Summer 2 agree Reply I was bound and determined to breastfeed my first daughter. Well, she did not have that same conviction. As a matter of fact, she hated it. She would fight against my breast or just didn't have any interest at all. I could only nurse from one side due to an inverted nipple, so I had low supply in the first place and swapping back and forth from breastmilk to formula seemed to upset her stomach horribly. Then the mastitis kicked in. I literally counted down the days until the 3 months that I had promised myself that I would try nursing were up and then happily gave up breastfeeding. We were both much happier and still had (and continue to have) a healthy, loving relationship…(cont) 1 agrees Reply (..cont) I had my second child 3 years later and it was a completely different scenario. I was still only producing milk from 1 breast, but she took it with no problems and I was able to keep my milk supply up with no issues what so ever without even pumping or anything unless she was away from me for an extended period of time. There was no need to even supplement, as she refused to take formula of any type or even pumped milk from a bottle. Reagan happily nursed until I finally weaned her at 13 months, when she went straight to regular dairy milk. I am expecting my 3rd child this summer and am not sure what to expect. She might be a natural nurser like Reagan, or a reluctant one like Tressie. Either way, I have decided to let my child choose what is best for them and we will go from there. There is no reason to be ashamed over not breastfeeding. As long as your child is healthy and happy, that is all that matters. Thank you so much for sharing your story. 1 agrees Reply I can definitely relate to some of this story. My daughter started boycotting the boob at 3 months old. We had struggled for a month or more, nipple shield, then weaning off the nipple shield, pain, then realized we had a bad latch and my daughter didn't like to open her mouth wide enough. We finally got it right, and I loved it! Then I went back to work and she started getting a bottle. She realized eating could be easier, and decided no more boob for her. She would bounce off the boob like she was repulsed by it. I cried so much, felt totally inadequate: I mean, how many moms can't feed their babies? 2 agree Reply Amen. My son only learned to latch properly on the right side. I went through about 3 weeks of hell trying to get him to latch onto lefty correctly, but he never got it and I ended up with a bleeding nipple. So then came the joy of pumping one side while feeding exclusively on the other. Of course, that wasn't inconvenient at all (rolls eyes). I, of course, felt guilty for pretty much hating breastfeeding. Probably didn't help that my hubby really really wanted me to breastfeed for as long as possible. But, when my babe hit 4 months, we quit. Cold turkey, which wasn't really that hard because by then my milk supply had gone down so much it didn't really matter. Breastfeeding was the most emotionally draining thing I have ever done. I felt like such a failure. But once we quit, my relationship with my baby blossomed. It was one of the best decisions I ever made. I want to try it with the next baby, but if it doesn't work after a couple weeks, I'm going to switch to formula for my own sanity. Babies need a happy mom too. 1 agrees Reply One of the things that amazes me with this story and the stories in the comment section is that no one has mentioned breastmilk banks or having a friend offer to share some of their abundance. I understand that the banks are rare and that for many people it may seem creepy to offer some pumped breastmilk to a friend, but there are no health or safety reasons that breastmilk can't be shared. I understand that formula is a good option, but it seems like a lot of mothers would prefer to feed their child breastmilk, and there are some health benefits associated with breastmilk. Maybe getting it from someone else should become more of an option, though this would have to involve removing any stigma that may make a woman feel badly about her milk production. It seems to me that finding ways to make life easier for a friend or stranger is far preferable to making things harder by adding pressure. Reply Heather, A friend of mine did offer me her "extra" breastmilk and made it very hard for me to gracefully say no – she meant well but was very pushy, thinking it was such a great solution to my feeding problems. I really didn't want it and it was very humiliating to be put in the position of pity, and unscreened bodily fluids aren't very safe either, if you have any reservations about that. I think screened, professional milk banks are a great idea for young babies, or mothers who are comfortable with the offer. Nearly every mother I know who breastfed and had a good supply had this kind of Mother Earth-like urge to share the abundance (must be nice!) and that's great, when it goes through a bank or is mutually comfortable… but when I fought my hardest for a few meager ounces and breastfeeding was a hard experience, formula was easier and a TON more comfortable than being put on the spot with a friend's pity. I was crying by the end of the conversation, feeling so diminished as a mom, and it damaged our friendship. I'm sure other people feel differently, but that was my experience as a new mom with supply issues. 2 agree Reply Not to mention, milk banks charge about 3-4$ per OUNCE of milk. That could add up to 60 $ a day to feed your child, not to mention some women would have to drive great distances to get to the closest milk bank, there just arent many in the US. 1 agrees Reply Actually Heather, as Susan said, there ARE health risks associated with unscreened breast milk. I don't want to have to ask a friend, when was your last STI test and did you get an HIV test with it? I'm not judging people who have contracted STIs or HIV but some are passable through breast milk (HIV included). Also, some women don't have female friends/relatives. 2 agree Reply It is my understanding that milk banks, because of the limited supply, should be for special circumstances, like wanting to give an adoptive child breastmilk or for babies who can't tolerate formula and their mothers can't BF for whatever reason. Also, a lot of the benefit of breastfeeding comes from the bond and the intimacy, which can be achieved even when bottle-feeding 1 agrees Reply My understanding is that milk banks will reserve the milk for babies who really need it, but beyond that will willingly dispense to anyone with a doctor's prescription. Insurance may not cover it, though, and yes, the processing the milk banks do makes it expensive, so that is a serious barrier. They do, however, ship the milk so it's not necessary to drive to pick it up. Because of that cost barrier, I know women who have felt comfortable with accepting breastmilk from others, and they have often offered to pay for the donor mothers to be screened for the few (but sometimes serious, like HIV) diseases that are transmissible via breastmilk. I think the emphasis, though, is that they felt comfortable accepting it, and generally actively solicited it – not had it pushed on them by the donors. That does sound like a horrible experience. 1 agrees Reply Thanks so so much for your responses. I had no idea it was so complicated. This is one of my favourite things about this site – people are so willing to politely inform you when you're misinformed – I was aware that screening for things like HIV is necessarily, but are there any other health issues that I'm missing? I imagine it would take a very specific kind of friendship and serous screening to make something like this work. It's most definitely not an option for everyone. I had no idea that breast milk banks charged for their services (this may sound really naive, but I'm not a mom and I'm from Canada so I really don't know what this type of service would cost here or elsewhere). Susan – I am so sorry that was your experience with your friend(s). Sometimes people who try to be overly "helpful" are worse than people being judgmental. Thanks for responding – I really appreciate it. Next time, I'll so some more homework before posting. 1 agrees Reply If you have another baby– try breastfeeding again!– for all 6 kids I've had, breastfeeding has been a different experience with each kid . Some it was rocky and some it went smooth as glass… Reply Summer – thanks for such an honest, brave and obviously painful post. My personal philosophy is that happy moms = happy babes. If anyone ever gives you guff about not breastfeeding (why people would do this is totally beyond me!), I say give 'em hell! 1 agrees Reply great lil' article, thanks! i haven't even given birth yet, and i feel pressured by the lactivists and anti-C-section people. i read all this dire stuff about how society doesn't give enough support for breastfeeding ,and western medicine will force a cesarian on you. what i see in my social circles is undue pressure to conform to what happens to work for some women. hey, if your infant latches right on and the whole thing works great, good for you! if you don't need a C section, that must be nice! (every woman in my family for three generations has had to deliver via C section, does that mean they all missed the "real" birth experience? are all their kids, me and my cousins, terrible people?) so, nicely done. do what you can do, the best you can, with your given circumstances. your kid'll be happier that way in the long run! 1 agrees Reply I had some really interesting conversations with my mom about breastfeeding dogma — she helped me see how, given what they were up against back in the '70s, the Le Leche League-style BREAST IS BEST stridency was really important. When you're trying to turn around a cultural trend, a little dogma and hardcore activism goes a long way. But now that breastfeeding is much more the norm, that dogmatic attitude can actually be damaging. It really helped me to understand some of the strident "lactivism" once I had the larger historical/cultural context in mind… Also, even as a breastfeeding mother, I gotta say that having a can of formula in the kitchen cabinet did wonders for my sanity. Even though we haven't had to use it yet, just knowing that it's there helps lighten the mental burden of "omg, my body is responsible for nourishing my son." 1 agrees Reply I have definitely seen that as the history that has lead to this point. There's needs to be a new approach with a line between being super supportive of breastfeeding and setting women up for a personal tragedy, or giving unrealistic expectations. When you read the La Leche League breastfeeding information and often in their classes, its easy to get a soft-focus mental image of you and your baby sitting in a room with in with him suckling contentedly as you gaze down at him in utter peace. I can see the difficulty in getting women on board with breastfeeding if they picture what most women look like for the first few weeks of exasperated, one-step-forward-two-backward learning, but just like labor books that underplay labor pain, I think they are doing an injustice to the experience of many, many women. 2 agree Reply Also, don't forget that you can breastfeed all you want and still end up with a sickly kid – like me! My mom never used formula, and I'm still a complete medical wreck. 🙂 1 agrees Reply Fantastic! I bf my munchkin for 19 months before she self weaned, but have friends who have had (and are having) many varied problems, and the option that no-one ever mentions is choosing to be happy and (relatively) stress free and using formula! its as if bfing is taboo in mainstream society, but stopping bfing is just as taboo within some circles! The most important thing about being a mum is to trust yourself, your intuition, and your ability to make the best decision available to you. Reply DUDE! I, like many others who have commented, went through a similar herculean effort to breastfeed my son- round the clock hospital-grade pumping, taking 20+ pills (herbs and domperidone) a day, nipple shield, finger feeding, home visits from the lc. We made it three months! When I first realized I was going to have to supplement (a few days after he was born), I felt like someone close to me had died. I grieved for a while. The funny thing was I was really prepared, open and ready-for-anything when it came to giving birth, but that breastfeeding would be sooooo hard for me NEVER EVER crossed my mind for a second. When it happened like it did, it was a huge blow. Reply Thanks for sharing your story, Summer. As an adoptive mama, I sometimes feel guilty that I never attempted the adoptive breastfeeding protocol, even though it would have been an actively bad decision for me, my kid, and my family. I know that, and yet I STILL FEEL BAD ABOUT IT. Mother guilt, mother shame–I hate it, and I especially hate that we do it to each other. Big hugs to you. 1 agrees Reply I was an exclusive pumper for 11 months. In the beginning, I pumped 12 times a day for the first 4-5 months and then pumping every five hours till at about 10 months I stopped producing enough milk. I took the fenugreek, I drank the mothers milk tea, those last few weeks I ate oatmeal twice a day until I accepted defeat and gave her the formula a month later. But seriously when I would make up with a few of my still nursing mommy friends (one of them ironically a member of LLC) they actually tried to tell me that I should have – in their words- "kept up the fight" and my milk would have come back. To that I said, "Whatever – my baby is healthy and I gave her 11 months of breast milk and seriously there are more important things to worry about in the big scheme of things" I don't talk to a few of those mommy friends anymore and that is cool with me. If the people you surround yourself are negative, run from them – FAST. As a mom, I already have enough guilt, I dont need anyone adding to the fire. 1 agrees Reply diversity needs to be embraced – what works for me may not work for someone else … what my friend swears was the only way for her, might be totally unsuitable for my circumstances – we need to understand that in parenthood and in life nothing is black and white – wish there were books that said this .. they all seem to shout there is the only way … find your own path and be kind to those who choose a different one. Reply Good for you for making the best choice for your baby. Not all moms can breastfeed. That is why there is formula. I think some women can forget that, and think that formula was invented as some sort of evil plot to kill babies. (Not minimizing the ways in which it has been used for profit over the best interest of babies, but still.) As an adoptive mother feeding my daughter formula was always expected and still I felt guilty about it. But when I saw how fast and how well she has grown I got over it. Feeling bad didn't change what I had to offer to her for food, and she certainly doesn't seem to suffer for it. 1 agrees Reply There is so much debate about this. My opinion is that your baby is small for such a short time. If the herculean efforts to breastfeed are interrupting your enjoyment of your precious, sweet smelling bundle of love, then for the love of god, don't breastfeed. Save the mommy guilt for really, really important things…like potty training. 1 agrees Reply Thanks for your story! You did an amazing job with your breastfeeding and no one should feel guilty about doing what is best for their child! Reply Great article! I am as much of a lactivist as anyone can be, but I recognize that there ARE mothers out there that literally do everything humanly possible to make it work and it still doesn't work out. Thank goodness we have formula to feed our babies. I've come to the conclusion that society just doesn't support mothers/women/families in general. Whatever decisions mothers make, we face criticism. Breastfeeding over X months? That's gross! Formula-feeding? Neglect! Crying it out? You're cruel! Co-sleeping? You'll spoil your baby!!! Going back to work? Your kids will turn out bad! Staying home? Your kids will turn out bad! 1 agrees Reply Seriously, sometimes it seems like there's just no way to win! Damned if you do, damned if you don't…The only thing you can do is your best and try and ignore all the noise and judgemental BS out there. 1 agrees Reply I breastfed both of my boys for about 6 weeks; both of them were supplemented with formula right off the bat. My first son never latched at all, and everything was given to him in a bottle. (This made staged sleep MUCH easier for his dad and I.) My second son latched so hard that he cracked & bled me immediately after birth. I pumped for him, too, when I realized that I was in excruciating pain while trying to feed him without the bottle. My supply was tolerable at best. I produced better for my 2nd than for my 1st, but then I was trying to juggle feeding schedules plus pumping schedules plus a toddler plus healing from my tubal plus sleep. Taking the pumping schedules out of the equation (the only thing that was removable from that list) created a Mommy who wasn't on the brink of tears most of the day, and who could enjoy her kids. Breastfeeding isn't for everyone, and sometimes the best decision you can make for your child is the one that keeps you sane. Mommies know what is best for them and for their children. Do what you know to be right, and everyone else be damned. 1 agrees Reply I loved this post! I am ALL for breastfeeding and agree that breast is best. But I am SO SICK AND TIRED of militant breastfeeding is the only way types. They are the reason that women feel guilty when they supplement and they are the reason that, when women find themselves struggling with breastfeeding, they get so stressed out. Breastfeeding is a complex thing and in order to have a good milk let down, a women has to be relaxed so her brain can secrete the right hormones to let it all happen. It is very hard to relax when a women is stressing out because she thinks that if she can't feed then her baby will either starve or be physically and emotionally stunted for life by formula. That is why we must rise against the crazy militants and promote breastfeeding as best but formula as a perfectly healthy option. I think that when we de-stimatise formula, there will be a lot less stressed women and a lot more successful breastfeeders. 1 agrees Reply AMEN!! My son is 4 and I still get people that GAWF at me when I mention that I didn't breastfeed. Believe me, I tried…but threw in the towel when pumping day and night got one ounce. ONE OUNCE!! 1 agrees Reply I went through this with my first born, and with my second on the way I am planning on trying again. With my first, my milk came in slowly and then BAM suddenly there it was, only it didnt want to come out. The pain was horrible. I would pump and get nothing, my daughter was losing weight and frustrated, I was frustrated, when the milk decided to come I was soaking pads left and right and STILL she was losing weight…and then my (Now ex)-husband said, lets give her a bottle. I was mortified…and also relieved. She gained weight and I felt sad, but it was better for her. Still I am planning on trying again…we will see! 1 agrees Reply So this is my first comment… and I just wanted to tell you that you made me cry, Mama. I have been carrying that "shame" of not being able to breastfeed my son for 8 YEARS. I also worked with lactation consultants… and tried the herbs… and pumping… and after two weeks one of my nipples had no skin left on it where Sebastian had been trying so hard to get milk. I can't even begin to count the number of nasty comments I got about how I never tried hard enough or screwed my son out of a good start. I tried.so.hard and cried so many nights because I just couldn't get it to work. Thank you for writing this… 1 agrees Reply Wow. I love stumbling across raw stories that tell it like it is. No, not everyone can breastfeed. I have a ton of admiration for how hard you tried to make it work. If i had been in your boots I would have done the same thing. No one should judge anyone for not being able to breastfeed or any life circumstances around why someone just doesn't. I write at Breastfeeding Moms Unite! and like the title suggests I'm all about just that. Having moms of all different breastfeeding backgrounds unite and support each other. Thank you for your story. 1 agrees Reply That is really frightening about the 2 month old at 7lbs. I've seen it too… I am a strong believer that this low-supply problem is a much bigger deal than we've been told. I know the argument against it is that "how could the human race have survived if so many women were legitimately unable to breastfeed?" But here's the thing – there have always been wet nurses, or other women in cultures where it's "normal" to feed another's baby – ie, there's always been some sort of breastfeeding "alternative". And if you look back in history, the infant mortality rate was also wayyy higher than it is in modern times, and we can't really know how much of THAT was due to insufficient supply, right? Anyway – I want you to know that you are NOT alone. There's a few women who frequent my blog (the Fearless Formula Feeder) who've also had low supply. It sucks balls. You did your best and your baby will thrive on formula, as I'm sure you already know. And thanks for having the bravery to put this out there in the blogosphere! 1 agrees Reply I agree completely – googling "low supply" only to be told it "never" happens makes me feel like a huge freak – because it DOES happen. http://coleemmett.blogspot.com/2010/04/if-at-firs… 5 agree Reply Thank you for posting your story. I had almost an identical experience – I even started taking prescription medicine to try to increase my milk supply. I was spending 1 hour out of every two trying to nurse and pumping and my son and I were both miserable. I finally realized that my mental health was more important to my son than breast milk and quit after two months. But it was so sad and hard and I felt horrible every time I would take out his bottle and get judgmental looks from mothers who did not know my situation. After several months I read the article "The case against Breastfeeding" that was published in, I think, the Washington Post? Anyways, I felt much better when I learned the science is not the slam dunk they claim in terms of the benefits of breastfeeding in comparison with formula. Obviously, breastfeeding is the way nature intended, but for well-educated, financially stable moms who are giving their children all the best resources possible, breastfeeding does not make a difference. Thanks for having the courage to post this! 1 agrees Reply I think this is basically the only story I ever read about breastfeeding. Doesn't it ever work for anybody? You guys are freaking me out here. 1 agrees Reply Yes, it does work out for some people, some even easily. For me it didn't truly work out until about 2.5 months. Before giving birth it all seemed so clear, watched the 4 breastfeeding videos my birth center required, knew I could just call a LC if anything went wrong. Sure. It was a long story of bloody scabbed nipples, finger feeding, pumping day/night, a billion different bottles, a hellish ride with a nipple shield, but finally she got it. She's now been latching like a champ for a month- and when it does work well it's a lot more convenient than any other method. But I went through it all alone, because I was afraid of what people would say, and that's BS (on my part and theirs). For anyone else who's had to resort to a nipple shield and had people tell them there's no going back to the nipple after that, baby and I disagree! Sure breast is best, but here we are, a bunch of quite intelligent formula raised survivors! 4 agree Reply Hey, thank you for sharing this story. You managed to be touching and to make me snort out loud – twice. I'm about 6 months along in my first pregnancy and I know I'll be getting a little anxious about bfing as the due date gets closer and closer . . . I think I'll be able to be a bit gentler with myself if that doesn't all go "according to plan" thanks to all the wonderful comments shared by the women here. Didn't someone once say something about "best laid plans" anyway . . . ?? 3 agree Reply Great post! So far, I've had it easy – easy conceptions, easy pregnancies, easy births, easy BFing (OK, except for the one miscarriage and the 10 seconds or so when #2 got stuck and the doc had to go in with 2 hands. I could live without a repeat of THAT for a lifetime or two). But I have had so MANY friends and aquaintances who have NOT had it easy, I've avoided (I hope) the it-was-easy-for-me-so-it's-always-easy attitude. I've seen a lot of it and I do understand it (I know I'm not great at social niceties or heck, basic grammar when in the just-post-baby haze), but I still want to smack the mommy-judges upside the head. I'm one of the eldest of 8 kids, I'm planning on having at least one or two more, and all I can say is – find the joy, dump the guilt, whenever and wherever you can. What works for you, works. What doesn't, doesn't. People have been looking for what works for millenia, and look how many different solutions we've come up with! We'd all be much saner if we could focus on what we do that works, instead of what we do that doesn't, or that by all experts 'shouldn't' but actually does. Mommies for the Promotion of Maternal Sanity! And on that note, I'm going to bed ;> 3 agree Reply Thank you for this post conveying your frustrations. I had dreams of a blissful pregnancy, a dula assisted birth, and a happy fat breastfeeder. But when I gave birth to my son at 25 weeks all those plans went down the drain. Now at 90 days in the NICU pumping 6-8 times a day (and so so sick of people asking me if I am pumping enough) I still only get enough milk for one of my sons daily feedings, with the help of Reglan-twice. Its at the point now that I just want to enjoy the time I have with my son when I can be with him in the NICU and cut myself some slack. Plans are for suckers! 2 agree Reply We have pretty much the exact same breastfeeding story. Sorry you had to go through it all too…but at least we both have healthy thriving children! Even if they are formula fed. 🙂 2 agree Reply I too had migraine issues with the herbs. I didn't realize I had low supply until I had to introduce formula for a medical reason. And then I realized I had been starving my son because of the Breast is Best propaganda. No, a healthy, thriving child is best. And that is completely possible with formula! 1 agrees Reply Whoever says our society does not support breastfeeding was never around any of the people I was. I felt harassed when I DECIDED not to breast feed any longer 🙁 Like I was a horrible mother, depriving my child. I had the opposite problem. My son would eat for five minutes, sleep for 20, eat five, sleep twenty. By the time two months rolled around I was so sleep deprived I was suffering constant headaches, vomiting, and horrible depression. Besides, I was producing so much milk I went from an F cup to JJ. Uh… that's 5 sizes an excruciating pain. I felt like I was constantly pumping because, since he fed for such a short time, I still had to pump after! I had to make a decision: Would putting my baby on formula make me a better mom? I could be more attentive, focused, and not so sick & down. So yes, it did. The funny part? My son had breast milk just shy of 11 months, despite having only been fed au natural for 4 months. Even the NICU babies, and my own friend's [who wasn't able to produce her own milk] preemie were able to benefit. Yes, there was THAT much milk. The downside to that was, stopping was painful, both physically & emotionally. We all stop breastfeeding for different reasons. No one should judge another woman for their decisions. As moms, we need to support one another because… well, who else understands? 1 agrees Reply This is a really awesome article for me to read, just to prepare. It is likely that our baby will get milk from its birth/other-mother, early on — 1-3 months' worth or so. And we've been offered another, very loving source. I want to try to breast-feed. This means getting a pump and using it every three hours, and if I eventually make milk, freezing it, from January on. It might mean taking hormones. The ones endocrinologists use for lactation are basically those in birth control pills, which give me migraines, so I might not be able to do this. If herbs can also cause migraines, well, I'm screwed. So you know what? I'm going to be realistic. Between me, the biomom, and our gifted breast milk, we will do our damnedest to do right by our baby with the best food possible. At some point we might have to go to formula and/or cow's milk. And you know what? That'll be okay, too. I am granola-crunchy in so many ways, babywise. I also have to be realistic for our situation. 2 agree Reply I didn't have any trouble breastfeeding – my daughter could latch right away, my supply was good, etc. But I HATED it. I hated being sleep deprived and covered in milk all the time and always, always having someone touch me. I never felt that magical rush of love we're supposed to get from nursing; I felt like we bonded far, far better when she WASN'T nursing because I didn't resent her then. I made it 3 weeks of exclusively nursing and then started supplementing, and the first time my husband gave the baby a bottle I sobbed facedown on the kitchen floor because I felt defective. I was prepared for nursing to be hard; I was not prepared to hate it because NONE of the pro-BF literature mentions that possibility. I spent a good two years feeling like I had failed my daughter in the most profound way because I was so invested in the BF party line. We did about 50/50 nursing and formula until my daughter started doing the "you are killing me" reaction to nursing at three months; then I pumped for three more months and then gave up. I felt betrayed by lactivism, and after those two years of guilt I started to feel really, really angry. I understand the need to support new nursing mothers, I do. But I refuse to accept that supporting them should come at the expense of telling them the full truth. What I tell women who ask me about BFing is, "There's a pretty steep learning curve; not everyone can do it; you may love it; you may hate it; it's ok to stop when you want to stop. And it's not anyone's business but yours how you feed your baby." My daughter is 4 now and this is still a really emotional topic for me. 4 agree Reply This may be this blog's best blog I have ever seen 1 agrees Reply I am just now reading this article, as I am in the throes of breastfeeding my 6 week old. I have had the opposite problem- oversupply and an overactive letdown that makes every feeding akin to a game of roulette: will my baby scream and arch away because the milk is choking him? Or will this be a calm, uneventful feeding, fulfilling for both of us? It's really hard to have to face this numerous times a day, every. damn. day. When it doesn't go so well, it's frustrating for him, I'm sure, but also really frustrating for me. NO ONE EVERY SAID THAT BREASTFEEDING WAS HARD. But shit, it's WAYYY harder than I ever imagined, and it's only been 6 weeks. 2 agree Reply I would just like to say Thank You for sharing your story. Mine is a similar story. I'm begining to let my milk dry up now, after working with a lacation nurse, who also put me on herbal supplements, had me breastfeed with the hated nipple sheild, because he would not latch without it, then supplement a feeding with formula, then pump, to try to pick up my milk supply. With him on a 2-3 hour feeding schedule, I felt like all I could do was the regimen. I was exhausted, and I was stressed, and although I tried my best to not let my son feel it, I'm sure he did. Even with the nipple sheild he had a shallow latch, and was causing alot of nipple damage, and it was so painful I would have tears streaming down my face as he nursed. The lacation nurse told me that this may not get better until he was 3 months old! I decided to exclusivly pump and give him expressed breast milk and formula, but like you, my supply was inconsistant. I've finally decided, I'm done, but am still stuggling with the guilt of that decision. Searching the internet for some support in this decision, (which there is not alot of), I found your article, and made me feel alot better. So Thank You again 2 agree Reply Join the conversation Cancel Reply Your email address will not be published. Required fields are marked *Comment No-drama comment policy Part of what makes the Offbeat Empire different is our commitment to civil, constructive commenting. Make sure you're familiar with our no-drama comment policy.