Tuesday, February 14, 2012

Feeding your infant: opportunity cost of breastfeeding

Finally posting this - sorry about the delay. Hopefully Child2 will be born any day now . . .
Scenario #7: Jane MD, pumping for 3.5 months, storing for 3.5 months, formula for 5 months
** I rented a hospital grade pump, purchase equipment directly from the hospital, and personally had  an extremely abundant supply of milk**
Pump rental (40x4 months): $160
4 month supply of disposable breast pads: $20
3 nursing bras $17 x 3 = $51
Storage bags 735 for 4410 oz: $147
Formula needed for 5 months: $430
Hours spent feeding the baby for 1 year: 490 + 595 = 1085
Total: $808 for 1085 hours of work

My child never latched, despite taking all the lactation classes, seeing four lactation consultants, and helping teach mothers to breastfeed myself. First my milk supply was too low for what the baby wanted, then when it came in, it flowed too fast for him to swallow. So I pumped every day for 20-30 minutes 6-8 times a day. I had the most supportive work environment at the hospital after my 6 week maternity leave- separate pump room with hospital pump, dedicated time, on call lactation consult, ample freezer/fridge space. My boss/colleagues not only encouraged me to pump, they expected it. I was able to pump daily for 3.5 months and store 3.5 months in my freezer. One thing . . .

I could not wait to stop!

Any article you read about breastfeeding always discusses that women are failing to meet the 'goals' of recommended duration (6 months in some places, greater than a year in other places) or percentage of women breastfeeding. There is alot of discussion about the wonders of breastfeeding, its bonding potential, how the children do better in school, get more affection and so forth. (Incidentally, almost all of those correlations except less illnesses shrink to insignificant amounts when corrected for race, education, and socioeconomic status)

Truthfully, the prenatal decision to breastfeed is the best predictor for actual breastfeeding. If you went through your pregnancy not planning on breastfeeding, it's unlikely that you will decide in the hospital - no matter how much information the hospital and lactation consultants give. Equally, the first five days are the times that determine 'successful' versus 'failed' breastfeeding. So if you make it past five days, why doesn't everyone make it that 6 months to a year?

One of the major theories is when women go back to work, they return to breastfeeding-unfriendly environments. Their employers do not give them privacy/space/time, and this affects their decision to end breastfeeding. While that certainly is true, I feel this does not acknowledge the other hidden cost of breastfeeding - loss of time. Pumping is time consuming, and ideally you need to do it at least twice in an eight hour day. For the average working mom, that would be your lunch break and your morning/afternoon fifteen minute breaks. Each time the woman has to go pump, she loses productivity and breaks up her day.

Wait! It's the mom's choice, you can't claim that she is losing productivity.
Imagine you take a personal phone call during work. You talk for 20 minutes and do not do any work. What if you do that three times a day? Do you give up all your breaks for the phone calls? Do you skip lunch meetings? Do you miss networking with your colleagues during lunch? Are you unavailable while you make these phone calls? Add in that you just were 'on vacation' for two months. Moms who are returning to work want to prove they are back in the saddle when nothing breaks up that feeling like needing to pump.

We'll assume your time is worth $6/hr for minimum wage after taxes. If you just pump twice a day at work, you are down 40 minutes five times a week. If you are pumping 7 times a day, consider it 2.3 hours of time or $14 of time in the day beyond usual feeding of the baby. Consider it the price of sleep/energy/other activities you could be doing. Now this is a minimum recognizing breastfeeding as unskilled labor. Put it in real dollars by your own salary - when your job is $20 per hour.

I personally felt a sense of resentment toward breastfeeding, even though I had every possible resource and no one told me about feeling this way. Why didn't anyone tell me breastfeeding would feel like a chore and I would feel my day was disrupted?  How professional can I feel attached to a milking machine 2-3 times a day? (My fellow physicians, who delivered that year, all shared the various frustrations, shame, and helplessness they felt often during their breastfeeding experience, so I know I was certainly not alone.)

Make no mistake, I fully support breastfeeding and will be doing it with every child. I just want to give a voice to this struggle working moms feel. A mom's time is VALUABLE and there is NOTHING WRONG with feeling a sense of loss over the time you are putting into breastfeeding.

Next up: Greedy evil rich lawyers . . . or not?


  1. Good job tackling a very politicized issue. I am an L&D nurse, and while I am very pro-breastfeeding, it is a lot more complex (and a much bigger job) than people have any idea of.

  2. This should be required reading for every member of the AAP who contributed to its most recent update to the Statement on Breastfeeding & Use of Human Milk. And your brilliant analysis of the perceived "booby traps" versus the ones which REALLY affect women needs to be posted on the walls of all Baby Friendly hospitals.;)

    I blog about these very issues and actually have a book coming out this fall where I talk about the seldom discussed barriers to breastfeeding - strain on professional women being one of them. I'm thrilled to see a pediatrician talking about this, and want to thank you on behalf of struggling moms everywhere. Supporting breastfeeding (which I wholeheartedly do) does not have to mean hiding our true feelings about the toll it can take, or refusing to acknowledge that lived realities are more complicated than idealism.

  3. I can relate to this. I pumped at work for all of my children, for at least 2 years each. With my first one, a friend of mine was also pumping for her baby, and we'd pump together sometimes which made it almost fun, and certainly less lonely. I developed a technique to hold the pump on both breasts using the forearm of my left arm, so that I'd have my right hand free to answer the phone and to eat my lunch or drink something at the same time. Pumping was mostly a chore. But after work hours, that's when I could enjoy the breastfeeding relationship. That's the part I really loved and made the work of pumping totally worthwhile for me. Just being able to come home from work and breastfeed my babies, reconnecting that way, was awesome. It eased the pain for me of being separated from them and gave us this way of reconnecting that I really cherished.