First Person: The Pump
Parent Corner: Guilt-Free Feeding
Interview: Sarah Tyack RN, BSW, IBCLC

" "Nourish" is a very rich word because it has a kind of literal and metaphorical sense to it. We literally nourish ourselves with food. But we nourish our spirit, we nourish our culture, we nourish our community. You can feed yourself in many, many different ways."
--Michael Pollan

This month, our focus is on feeding your child, whether that's via breastfeeding, pumping, formula feeding, or any combination of those methods. The issue of feeding can be such a lightning rod for new parents (and their families and even complete strangers), and it can be a source of pride, accomplishment, guilt, shame, and fear for parents. In this newsletter we take a look at one mom's story of her very personal relationship to her breast pump and how her breastfeeding trials were tied to her perinatal mood disorder. We have some sane words about guilt-free feeding, just for parents. And we have a great interview with Sarah Tyack, a lactation consultant with years of experience.

We welcome feedback about our newsletters. Let us know what resonated with you or what you'd like to see more of. 

The Pump 

"No milk, no milk, no milk," my breast pump would chant at me mockingly. Nightmares of it chasing me, growling its pump and wheeze repetitive mechanical noise. My relationship with the pump began when my son was four days old. I call it a relationship, because by the time my baby was six months old, my boobs had clocked over 200 hours of quality time with this machine. At four days old, his weight had dropped 18% and my milk hadn't come in yet, so my doula came to the house and helped
me set up this awkward contraption of tubes and funnels to try to help get things flowing. All of three teeny tiny drops of milk dribbled out and my doula assured me that eventually there would be a fountain of spray bursting forth soon enough. Little did I know, that would never really happen and this would be the beginning of what I call the Nightmare Merry-Go-Round.

Fast forward three weeks, this is the Merry-Go-Round:

1. Nurse baby on one boob for 20 minutes, nurse baby on other boob for 20 minutes, because you're told your baby is a slow, lackadaisical eater with a weak suck (what a compliment!).

2. Load up a measly 10mL of previously expressed breastmilk into the Supplemental Nursing System (SNS, aka Shitty Nightmare System).

3. Prepare and add an additional ounce of formula and hope it won't lower his IQ and make him obese.

4. Latch baby and try 27 times unsuccessfully to slide a tiny tube into baby's mouth at the nipple to supplement nursing, because your boobs won't do this one job and produce enough milk.

5. Throw SNS across the room and cry and try to pull it together so you don't emotionally scar the baby for life.

6. Try again and hold your breath while baby sucks down half the supplement from the SNS at the boob hoping he won't fall off the latch or push the tube out of his mouth or the tube won't get pinched and stop flowing, AGAIN.

7. Repeat on the other side, feeling like the SNS is an intruder like "the other woman" in your intimacy bed of mother and baby.

8. Burp baby, which somehow feels like it takes forever because you've already been at this nonsense for over an hour now.

9. Put baby down and spend 15 minutes pumping while he lies in his bouncy chair looking lonely or while someone else gets his peaceful post-fed slumber snuggles and your arms ache for him.

10. Put the measly 10mL of expressed gold in the fridge and feel defeated.

11. Then wash all the pump parts while cursing them.

This all takes 2 hours. Only one hour till you get to do it all over again! All day, every day, for six months. Two hours of work to feed the baby, one hour to eat, pee, hydrate, rest. Repeat. In addition to that: Go on a lactation-cookie-only diet for three days, eat only galactagogue foods, ingest every herb under the sun in massive quantities, drink gallons of medicinal strength Mother's Milk tea, stop wearing clothes altogether so all you do is skin-to-skin, and do a rain dance in a futile attempt to call on the lactation gods to up your supply already. It. Was. Hell.

So why didn't I just give it up already, you ask? That is an excellent question, one with which I tortured myself to no end at the time. I was so fixated on desperately trying to increase my supply and breastfeed that I drove myself to the brink of insanity. If you relate to any of this so far, please please please read That blog was my main source of support when no one understood why I couldn't just give it up already. In my defense, I didn't realize, until I had to put the
pump down and back away six months later, that I had a severe case of perinatal depression and anxiety that significantly contributed to my obsessive-compulsive relationship with this pump. You would've had
to pry my dead cold hands off that pump if it wasn't for my baby finally refusing to nurse anymore at six months old.

In my very progressive Seattle area community, my friends offered support by encouraging me to reject the "breast is best" pressure and do what's right for me and my family. But I didn't receive it as support; rather I felt more isolated and alone, because no one understood why I wouldn't give it up, not even me. It took me over a year to finally understand that the reason I desperately wanted to nurse my baby so badly was because it was literally the only time I felt connected and bonded to him. I didn't care about society's potential judgment if I were to switch to full-time formula. I just wanted to feel attached to my baby.

You're feeding the baby, that's what matters, right? What matters is that baby and mom are healthy. Baby was healthy, I was very ill. I was suffering with a perinatal mood disorder that was so bad that my only hits of oxytocin and serotonin were happening during breastfeeding. I thought I was some kind of monster and a terrible mom and didn't deserve this beautiful baby, because for the first entire year I never felt those lovey-dovey feelings when I looked at him, except when I was nursing, then I felt calm and loving while gazing at him. I thought, how selfish and immature am I for enjoying nursing more than I enjoy my actual baby. But there was a physiological explanation for that lack of emotion: it was
the perinatal mood disorder robbing me of the joy of having a baby.

I didn't realize I had perinatal depression and anxiety until he stopped nursing at six months old. Breastfeeding had died a long slow painful death, him gradually rejecting the breast more and more in favor of the free flowing bottle, until he officially would no longer nurse anymore at all; that day just happened to fall on my birthday, of all days. And that night out with my girlfriends all I could hear was how my lactating friend couldn't drink because she had to nurse her baby. And I was dying inside.

Then it occurred to me--you know, it's often sad when you stop nursing, but I don't think it's supposed to make you suicidal. So that's when I got help and started to climb out of the pit of the depression. I learned that some women's bodies are extra sensitive to the constant fluctuation of
hormones during lactation and that alone can cause a physiological chemical imbalance that can induce perinatal depression and anxiety. I learned that the same chemicals and hormones that affect mood also
affect lactation, so sometimes when women with low supply issues get treatment for a perinatal mood disorder, their milk supply goes up as a byproduct of the chemical/hormonal stabilization. Until they create a lab test to definitively prove I really did have Insufficient Glandular Tissue, I believe in my heart of hearts that was the core reason my supply never went up despite my dutiful laundry list of efforts.

The Pump and I have been broken up for exactly one year now. The day I returned it to the hospital I was renting it from was bittersweet. I wanted to feel free, but instead I felt defeated. We fought long and hard, my baby and I, and it was over. It was only a six-month relationship, but it was an
abusive one, and the Merry-Go-Round memories still haunt me, especially as I consider having a second baby. Did my body fail me? What's wrong with me? Why me? Am I less of a woman, because I couldn't do this? Therapy is helping me work through the questions of grief.

So, momma, if you are reading this and can relate to this pain ... know that this pain is a symptom of this vicious illness. It is not you. You are not a bad mom. This is a chemical cloud that has invaded your mind and heart. And it will pass. Go to therapy. If it doesn't help, add meds to it, and/or switch therapists. Don't wait like I did. You deserve to not suffer. One day you will come out on the other side and this will all be a bad memory. It may be in a month or a year, but the sun will shine again. I don't know when, but I promise you it will. You are not alone. You are a warrior mom. Keep fighting.

And if you are a loved one of a momma that you believe is obsessively pumping, give her grace and encourage her to get support. Before I found myself in that hell, I judged a girlfriend so harshly for what I ignorantly thought was self-inflicted torture. A wise therapist once said, people have a very good reason for being the way they are. We just may not know or understand what's really going on underneath it all.

Kaela Koepke is a stay-at-home mom of one bright shining two-year-old and lives near Seattle, WA. Her pre-mom career was a mental health therapist and chemical dependency counselor. She unashamedly says, "Yes, counselors get PMADs, too. It is an illness that does not discriminate."

Guilt-Free Feeding
Is there a topic more loaded for new parents than how and with what to feed their babies? Most of us know that breastmilk is the healthiest food we can feed our babies. We also know this doesn't necessarily take into consideration real life challenges (physical, emotional, situational) and how DIFFERENT every family is. Sometimes, no matter how hard you try or how much you want it, breastfeeding just doesn't work out. Pumping can be a good alternative for some, but for others pumping is a nightmare.  There are several variations for feeding a baby--exclusively breastfeeding, exclusively pumping, breastfeeding and pumping, exclusively formula feeding, a breastmilk and formula combo. How you feed your baby should not only be healthy for your baby, but healthy for you, too!
New parents want what is best for their babies and sometimes what is best is to let go of what is causing emotional distress, pain, disappointment, feelings of inadequacy, and on and on. Formula is a good alternative when breastfeeding and/or pumping is not working, either for physical reasons or emotional reasons (BOTH are valid!). There is no reason to feel guilty about a decision that will positively impact your mental health (like how we always tell you to find ways to get more sleep and take care of yourself).  If feeding your baby is causing you stress and guilt, think of these questions: Are you holding your baby? Comforting your baby? Loving your baby? Listening to your baby's cues? Yes, yes, yes, and yes? Then you are nourishing your baby regardless of how and what you are feeding your baby!
To the mamas who are breastfeeding, the mamas who fought the good fight and decided the best option for their families was to stop breastfeeding and/or pumping, the mamas who decided formula was best for their families from the beginning, and every other mama just trying to do what is best for her baby and herself--YOU ARE ALL DOING A GOOD JOB!!!
Here are some resources for you to check out when you need a reminder of how awesome you are that you are nourishing your baby the way you need to:

Sarah Tyack RN, BSW, IBCLC
Sarah Tyack is a registered nurse and internationally board certified lactation consultant in Seattle and the Eastside. She has over 20 years of experience working with new moms and their babies. We had the opportunity to interview Sarah regarding her experience and expertise. 
What are the most common breastfeeding issues that come up in the population with whom you work?
The most common issues are low supply and sore nipples. The reasons for both of these issues can be complicated but it ' s often from not getting the proper support in a timely manner.
What percentage of the women with whom you work are also experiencing a perinatal mood and/or anxiety disorder?
A large percentage. I ' d say 75% of my clients have some sort of PMAD. I do a lot of emotional work with my clients.   My clients are used to situations where B comes after A and C comes after B and if B doesn ' t come after A, they know exactly what to do to make that happen. So when they have a baby and B isn ' t   coming after A, they think there ' s a problem that needs to be fixed. So they   search the internet to figure out how to fix these  " problems. The internet can be so undermining to new moms. There ' s something to support any position you take about anything so therefore you ' re always wrong. I really try and get my clients to learn how to read their baby ' s needs and get off the internet.  
In your experience, is there a connection between perinatal mood and anxiety disorders and breastfeeding? 
Absolutely! In my experience, there ' s a strong connection between breastfeeding difficulties and perinatal mood disorders. I work with a lot of professional women who are used to feeling   competent and knowing exactly how to achieve a goal. Having a baby and having breastfeeding   challenges is very disarming for these women. It may be the first time in her life she doesn ' t feel competent. Almost all my clients say,  " I feel like a failure. I can ' t even feed my baby."  
What are the most common worries or fears of pregnant women regarding feeding? 
Unless someone personally knows someone who has had breastfeeding   challenges, I don ' t think most pregnant women think about it. They ' re very focused on the birth and think they can just figure out how to breastfeed on the internet.   
Are there common "myths" or misconceptions about breastfeeding that you hear regularly?  
Moms are often surprised at how difficult it can be. They think it should be   easy and   instinctual and when it ' s not, they feel like a failure. Other myth: Breastfeeding is supposed to hurt. If it hurts, it ' s time to see a lactation   consultant.  
In your opinion, what are the most important things for pregnant women to know about feeding in the first several weeks postpartum?
When I   teach   prenatal breastfeeding classes, I focus on what to expect in the first 24 hours, the first few days, and the first few weeks. In the first 24 hours, babies only eat an equivalent of a half a   teaspoon of colostrum a few times. The next 48 hours, they should be eating every couple of hours. What goes in, comes out. This is why we ' re so focused on pees   and poops. This is how you know if your baby is getting enough. Until the baby is back up to birth weight, moms should only go one 4 hour stretch in 24 hours without feeding. We expect babies to be back up to birth weight in 2 weeks, though most babies are there sooner. Once the baby is back to birth weight, I tell moms to nurse on demand. They don ' t need to look at the clock anymore. They just need to look at their baby.  
When would you recommend contacting a lactation consultant and what are the reasons somebody might contact a lactation consultant? 
The majority of calls I get are from moms with sore nipples or a baby ' s   inadequate   weight gain. I love it when moms contact me while they ' re pregnant. When I work with someone in the first few days, we ' re able to nip problems in the bud. I recommend that every mom have an appointment with a lactation consultant. Since a lot of moms think this should be easy, they ' re sometimes embarrassed to call or they wait until they ' re so miserable with sore nipples or their baby isn ' t gaining weight. Moms are often crying when they call me or are crying at our appointment.  
What should a woman be looking for when searching for a lactation consultant/what questions should a woman ask before hiring a lactation consultant?
My clients often find me by looking at my reviews and my website online. Make sure this person has great, genuine and authentic reviews. Ask about the lactation consultant ' s experience level, ask how long the appointment is, ask what is typically done in the appointment, ask about follow-up support.  
Are there other resources available for women with feeding challenges in the community?
A personal in-home   appointment with a good lactation consultant is really the best kind of   resource. There are some support groups focusing on breastfeeding and other support groups focusing on emotional issues that can present themselves as a result of feeding   challenges.  
Any final things to consider relating to feeding and maternal mental health?
I often see moms who were given a very complicated and unsustainable plan. I always ask what her goals are and then we set out to try and achieve HER goals, not mine. Moms often forget they have common sense.   Common sense goes a long way! I find myself telling my clients that this is a process and there isn ' t always a quick fix. It ' s important to be   patient and have some self-compassion. I ' m always assessing a mom ' s mental health and so I don ' t use a cookie-cutter plan for every mom.  
Sarah has a private practice as a lactation consultant and has an excellent understanding of some of the most common and not-so-common challenges new moms encounter. She's worked in many specialties as a registered nurse. She also volunteers as a court-appointed special advocate for kids. These varied experiences have helped Sarah look at situations with a holistic approach. For more information about Sarah and her services, please visit her website at  
  • University of Washington is conducting a new study and recruiting for an upcoming mindfulness-based childbirth education program for pregnant women who have experienced sexual assault or abuse. Women receive weekly childbirth education sessions as well as individual mindfulness coaching, and the program is free of charge. The next groups starts August 11, on the UW campus. Click HERE for more information.
  • The Day Program at Swedish's Center for Perinatal Bonding and Support, a brand new program at Swedish First Hill, is now open. In addition to outpatient psychotherapy and reproductive psychiatry services, there is now an intensive outpatient program for pregnant and postpartum women with perinatal mood and anxiety disorders. The program will run from 9 am to 3 pmMonday through Thursday, and patients will stay an average of 2-3 weeks in the program. The Day Program will be primarily group focused, and babies under 6 months of age are encouraged to attend with mom for attachment and support in the transition to motherhood. The hope is that this will meet a need for moms who need more support than outpatient services but do not meet inpatient requirements, as well as transition patients from inpatient services back into outpatient services. N ew patients are being accepted at this time. Please call 206-320-7288 for additional information or to refer patients directly to The Day Program. M ore information is at:
  • Red Thread:  Story Circle exploring Traumatic Birth Memory War Theater invites you to participate in a half day of story sharing and exploration around traumatic birth . We are inviting a small group of women who have experienced a traumatic birth to attend this half-day workshop. Theater artist Tikka Sears facilitates the workshop with support from psychologist Leslie Butterfield.  This workshop is FREE. Please register online for the workshop and answer a few questions about your experience and why you would like to participate. Please register only if you are certain that you can attend as space is very limited. Workshop location and logistics will be sent after registration takes place. The deadline to register is  August 2, 2016 For more information, go to  or email
Are you a provider who works in perinatal mental health or a complementary service, such as massage therapy, acupuncture, or postpartum doula work? We are looking to add resources to our internal referral list for families seeking help.  To apply for our provider list, please complete our  provider application  and we will contact with you more information. Questions? Contact . Please share with a provider you know who works with pregnant and parenting families.  
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Perinatal Support Washington (formerly Postpartum Support International of Washington)