Marisa Ward interviewed by Denae Heartfield DH: The first thing we wanted to know was: what did you hear or experience before birth that influenced your decision to breastfeed? MW: The very first time I ever thought about it was in undergrad. I was a psych major, and I had taken a course from one of my psychology professors. It was developmental psychology or something, I don t remember the course, but what stands out in my mind to this day was a specific lecture or series of that she [my professor] gave that was on bonding, breastfeeding, and birth, and how those three things work together from the beginning of life, or the birthing process. And, she talked about all the benefits, and how things that happen during birth foster breastfeeding, things about breastfeeding that encourage bonding, and how it all works together for the good of the baby and the good of the mom and all of that. From then, since I was 19 or 20 years old when I heard that lecture, I knew that s what I need to do. Then, I m a Nurse Practitioner, specifically a women s health nurse practitioner, so I m familiar with, I know all about the benefits of breastfeeding already, just from a professional standpoint. And I encourage it with all of my patients. So, I knew before I got pregnant that I was going to breastfeed, that was set in stone, that s what s going to happen. It wasn t a question at all beforehand. DH: That s awesome. If you feel comfortable sharing about your birth experience, we d love to hear that, especially how, after giving birth, it influenced your early breastfeeding. MW: My birth experience was nothing that I wanted it to be. I had planned for laboring at home and having a vaginal birth. I ended up with my water breaking at home, and I didn t recognize it for what it was until the next day. So, I had gone to work and everything, I m having these contractions, nothing too severe, but I m at work, having contractions, leaking amniotic fluid. Finally, I m like, this isn t normal. It took me a while to accept that that s what had happened. Then, I reported to the hospital, they took me to L and D [Labor and Delivery], they hooked me up to the monitors, determined that yes, indeed, my water had broken. They were noticing on the monitors that his [my son s] heart rate was dropping every time I would have a contraction. So, they send me in to have a C-section, because they were concerned that it wouldn t go well if I had a vaginal birth. I was 35 weeks and six days, almost 36 weeks, had a C- section, he came out. From when I got to the hospital, to when they finally had me on the operating room table, it took maybe two hours and I had like three panic attacks in that period of time, just because, this was not at all, how it was supposed to go. I had done everything right: exercise, eat well, take prenatal vitamins, everything. The change in plans and how fast everything was going really took me by surprise. Then when my son was born, he was born four pounds, 5.8 ounces, so he was very small, much smaller than he should have been, for a 36-week old baby. I was not able to hold him. They didn t let me hold him skin to skin for some time. They showed me the baby, brought him up to my end of the surgical table so I could see him, and then took him to the NICU. Because, with him being so small, they were concerned that he might have issues breathing. Then, I was wheeled back to my room. I don t even remember, I was on so many drugs from the surgery. I don t recall exactly what happened. There were phone conversations that I had with people that I don t even remember having them. But, I do know that I was adamant about breastfeeding. He was in the NICU for two days and they were giving him formula because I wasn t producing yet. It was 35 weeks and six days, my body wasn t really thinking about having to 1
breastfeed just yet. But, I knew what I wanted, and I knew that s what I was going to do. Looking back, I was really, really determined to breastfeed. I don t remember where I got this information from, it may have been a friend, or maybe I looked it up online, but I came by the information that fenugreek can help promote lactation, help promote milk supply. So, I sent my husband out to the store to come back with some fenugreek, fenugreek capsules. I was taking like three capsules three times a day, or something like that, and eventually my milk did come in, so I solved that problem. The second issue was getting him to latch on. I don t know if it was me or him because he was so little, but I never did get him to latch on very well in the hospital. The hospital was really good at providing a pump, so I had a really nice, hospital-grade pump. After a day or two, I was pumping milk and providing milk to the NICU for him. But, I had a hard time getting him to latch on. The hospital did have a lactation specialist or a lactation nurse, I forget the name. I did not see her at all. I asked for her, but I did not see her, but thankfully, the nurses in the postpartum unit were very, extremely helpful. They helped try to get him to latch on, gave me tips, had me go over to NICU and try to hold him, try to get him to nurse. I received really good nursing care from them. Thankfully, he was in the NICU, but he didn t have any breathing problems, he didn t have any issues feeding or anything. He was just really little. I think the fact that I had already made my decision, made up my mind that I was going to breastfeed, and the fact that I was so determined, really helped a lot, helped to make that happen, because, there were several barriers in place. And, if I didn t know about fenugreek, I probably wouldn t have been able to breastfeed, or if I wasn t aware that the hospital has pumps and that the more you pump, the more you make, I wouldn t have continued trying to pump and encouraging that milk production. DH: You spoke a little bit about your experience at the hospital. You said that you received great nursing care, didn t really get to see the lactation consultant. Would you say that the nurses were really behind you, did you feel like you were supported in wanting to breastfeed at the hospital? MW: Yes, I was. DH: Great. So, what was your experience like after you got home? MW: Well, after I got home, things were a little different. It took him, I think, maybe four, five, six weeks before he really got the hang of nursing. I didn t have the best support at home. My mother, my husband, they were all concerned that he wasn t getting enough to eat. They were also concerned that I wasn t getting enough sleep, because he was getting up every two hours. And, with nursing, it s not something you can really pass off to your husband because he s not lactating. So, I would get from my mom, Oh, he s not eating enough, maybe you should supplement with formula. Just give him a little bit of formula. Are you sure he s getting enough? From my husband I would get, You know, how about we just give him some formula? Give him a bottle or something, so that way you can sleep, and I ll feed him. Their concerns were all rooted from wanting to help, from concern, but I knew that the more I nursed, the more milk I would produce. And I knew that if I supplemented with formula that would be less nursing, and so, I won t produce as much milk. So, once again, I think my own background really helped with that. Because, it is so much easier. It s so much easier to go with the formula. Especially since, I can t tell you how many coupons and free samples of formula that I had and gave away, from the hospital or the mail. 2
Just tons of formula that I just wasn t going to use. But, if I were someone else, then it would be really tempting to just put a nipple on that little bottle and give it to him so I could go back to sleep. And then, I remember one day. You know, after you have a baby, your hormones are just all over the place. And, you really are crazy. I didn t realize this until it happened to me, but you are literally insane. So, I had sat on the couch to nurse him and because his latch was still a little off, it would hurt sometimes when he latched on. And that day, it just hurt, and I just started crying. I was like, Why does it still hurt? Why does it hurt to feed my baby? And, I think the problem was a little bit of thrush, which was adding a further complication to that. But, I did take advantage of my local La Leche League chapter and went on their website. If you go on the La Leche League website and then find your local chapter, they have a list of women who you can call, for free, and they can help you out over the phone. You just call and then talk to them. So, I found a person who I could call, and I called her up and I explained the problems to her. She offered good tips, and advice and support, basically saying, Hang in there, keep going. Then finally, after 6 to 8 weeks of it being uncomfortable, we finally got the hang of things. I m not afraid to say that nursing my child was one of the most difficult things that I have had to master and accomplish. I worked hard at it, looking up stuff on the internet, going on forums, talking to experts. I have friends who are labor and delivery nurses; I have friends who are nurse midwives. I took advantage of every single resource that I had at my disposal to make it happen, just because I knew it was the right thing to do. And it was really the most rewarding experience of my life, nursing my baby. I m so glad that I persevered and insisted on doing it. DH: That s awesome. So, you talked a little bit about your experience with your family and the things you found helpful, as far as resources. What do you think you wish you would have, that you would have found helpful? MW: What do I wish that I would have had? I don t think there is anything that I wish I would have had, other than someone there in person to help me and reassure me that I m doing it right or help me with his positioning, help me in those days right after coming home from the hospital. That would have been nice, because I didn t have anyone. My mother, she was there for a few days, she nursed me, but that was 30-something years ago, and she only nursed me for six to eight weeks, or something like that. I had friends on the phone and was looking at things online, but it would have been helpful to have someone in person. Maybe an at-home doula or something like that, that would have been helpful. DH: What was your experience like in the community? MW: I didn t have too many interactions in the community. My son was born in September, and I live in Missouri, and that year it got cold pretty quickly. I wasn t out and about much at all, except for church. Everyone at church was so supportive. They even have a place they call the cry room, where it has speakers so you could still hear the service, but you can go in there if your baby starts crying, they need a change of diaper, they need to nurse or something, you need a quiet space. They provide a little space for that. I go to a pretty small church, and we have nurses and public health servants. So, everyone s pretty aware, pretty down with breastfeeding. I didn t get any negative feedback from that. The few times I did go out to the mall or to a store, I never felt comfortable nursing out in the open. Not because of any kind of perceived hostility from the community, but just because I had been home all winter. To me, nursing was something private. It was a private moment between me and my baby. Quiet time, he s nursing, I m looking at him, and he s looking at me. I just didn t feel comfortable doing it with people 3
walking by. I just didn t want to do that. So, if I was ever out at a store or something and he had to nurse, I would just go to the fitting room. I d go into the fitting room and nurse over there. I wouldn t go in a bathroom, that s disgusting. The mall here, they also have a little nursing room. It has a rocking chair and a changing table. I was impressed by that. DH: That is impressive, very mother-baby friendly. What was your experience like with healthcare providers? MW: I didn t have too much of an experience with them. I did get sick a few times and needed antibiotics. And, I would always make a point of asking the doctor or nurse practitioner to make sure the medication was safe while breastfeeding. Will it pass into the breastmilk? Will I need to pump and dump? I didn t get much help his pediatrician, just not much help at all. Like I said, he got thrush, and he was treated for that, and I needed something to treat my nipples, which were cracked and sore. I spoke to my OB/GYN, and she offered fluconazole, which is a pill treatment, and I wanted what s called allpurpose nipple ointment, which is a compounded ointment that has anti-fungal and anti-bacterial stuff in it. So, I ended up having a friend prescribe it to me, which I didn t like doing and felt guilty about. But, I needed it, so I asked. So, not a lot of help from health providers. DH: What do you think you would have found helpful from the healthcare providers? MW: Information and things about preventing thrush, preventing problems; advice on how often I need to breastfeed to maintain milk supply; things I could do to maintain or promote milk supply; maybe advice on how often he should be nursing; reassuring me that he is getting enough and my body is making enough for him. DH: What was your experience like returning to work and having child care, if that applies? MW: I was off for eight weeks and went back to work. For his first three months, my grandmother was with us, so he stayed home with my grandmother. I would pump, bring the milk home, and she would warm it up and give it to him during the day. My workplace is really mother-friendly. I was free to go and nurse whenever I needed to. And, at first, I did feel some conflict because I felt guilty taking a break for 15 or 20 minutes to pump when I knew that I had patients to see. But, I got over that. You know, it s very uncomfortable when your breasts get full of milk and then they re hard and warm and swollen. I had the sensation of ants crawling under my skin. I had to get it out, so I would drop what I was doing and go pump. It got to the point where I was like, I need to, I need to go and do this. So, I would just go and pump. I had a little lunch bag that I would put my milk in and put it in the refrigerator. Every day, I d bring it home, and whatever was excess, I d freeze it. I didn t really have any problems with that. There was some awkwardness at times when someone would come to my office, sit in a chair and be like, Oh! What s that? And, I d say, Sorry, that s just some milk spilled on the desk. Don t worry about it. It s okay, it s clean. I would have to make a point of making sure I didn t have any spilled milk anywhere or dried up milk crusted on my drawer or anything like that. But, it wasn t bad, it was alright. I m sure it probably inconvenienced my employers a little bit, because sometimes patients would get backed up, but I didn t care. DH: Is there anything that you found helpful at work, as far as being able to pump or breastfeed. Or, is there anything that you would have found helpful? 4
MW: Just the fact that there was a policy to allow breaks for pumping. That was really helpful. It also helped that there was a refrigerator for me to store the milk in. That helped a lot. DH: Is there anything that you would have liked to see at work, that you would have found helpful? MW: No, not really. Nothing more than what they already provided. DH. Great. This is the last question. What do you think is important for breastfeeding success from an African-American perspective? MW: I think we need to support our women. We need to support our mothers, our breastfeeding mothers. Support them at home, support them in the community, support them at work. I recognize that I was privileged enough to have an employer that has a good pumping policy, that I am fortunate enough to go to a church that is progressive, a little on the crunchy side, that supports breastfeeding. And, I m also privileged enough to have the knowledge and be able access to information that supported breastfeeding. But, not everyone does. So, just spreading the gospel that breast is best, that it s natural, that it s beautiful. I think if more black women saw more black women nursing, nursing out in public to show that they aren t marginalized, that it isn t just some quirky subset of the population that breastfeeds, that it s normal and it s so rewarding. It s very rewarding. Obviously, my son is my own child, but I just felt so close to him just through the act of nursing and nursing him for something like 22 months. Just having that support and knowing that it s natural and it s beautiful. That s how it should be. It s not gross. It s not perverse. And that it doesn t ruin your breasts. I hear that a lot. You shouldn t, your breasts will sag. No, that s just age. But yea, just that support. 5