My aggressive breast cancer diagnosis at 29 weeks pregnant came as a shock. It had major implications: I needed chemotherapy right away, with a strong possibility that my delivery would be brought forward by an induction and/or surgery.
I was also given the upsetting news that – due to the toxicity of the chemotherapy – I wouldn’t be able to breastfeed. This was my first pregnancy, and although healthy (until cancer), it had an unexpected psychological toll. Breastfeeding was a milestone I looked forward to; an opportunity to hopefully step back some of the emotional distance that grew between me and the foetus in my swelling womb.
In New South Wales, where I live, there’s a policy directive to promote breastfeeding “as the optimal way for a woman to feed her infant”. It instructs healthcare workers to “inform women and their families about breastfeeding being the biologically normal way to feed a baby, and about the risks associated with not breastfeeding”. Throughout the later part of my pregnancy, when cancer invaded our everyday, I was regularly reminded of this point.
I found total lack of support and information around formula and bottle-feeding. Whenever I reached out to midwives, nurses and lactation consultants for guidance, I was always given the same opening line: “breastfeeding is optimal and gives your baby the best start at life.” The people saying this knew I had cancer. They knew I was facing birth under difficult conditions. And yet they promoted breastmilk as the best feeding option for my baby, knowing that I would be physically unable to do so. One lactation consultant suggested that I buy breastmilk from a milk bank (at the cost of about $100 a litre, or $10 a 100ml bottle. The price has now increased to $22 for 100ml).
Sitting in the chemotherapy chair at 30 weeks pregnant, trying to count kicks and movements, I felt that I had failed at the most basic duty towards my baby: to protect them. Then, when I shared on social media that I wouldn’t be able to breastfeed, I received messages from well-meaning people, some total strangers, who told me that they’re intending to set breastmilk aside for me. I read these messages with anguish. I was meant to be grateful, I know. Instead, I felt distress (and guilty for feeling it). These messages reminded me that I couldn’t provide a fundamental (“optimal”) form of care for my unborn child; something so basic yet vital that even a well-intentioned stranger felt they were entitled to step in and supplement my lack.
Whenever I reached out to a NSW healthcare worker (such as midwives, nurses or lactation consultants), I desperately wanted to be reassured. I wanted to be told not to worry. To focus on my own health, that I’m going through so much, and that formula and bottle-feeding are legitimate forms of nourishment. That I could still bond with my child in a healthy and normal manner without breastfeeding. But I was never told this. Instead, I was told over and over again, “breastfeeding is best, but” (they would pause) “in your case …” I already knew what was waiting on the other side of that pause. Regardless of intent, the message I received was: you’re unable to provide for your child in the optimal and normal way. Your baby will not receive the best start to life.
This issue doesn’t impact me alone: in my network of women diagnosed with cancer while pregnant we all lamented being unable to breastfeed. We knew breastfeeding was optimal and normal. We were devastated at being denied this. Not one of us was told that formula-feeding is also normal. That we are normal. That we will bond and love and care and that we will still feed and nourish our children.
Once, during our baby’s stay in a neonatal special care unit, I overheard a conversation between a lactation consultant and a mum of twins, who asked about supplementing feeds with formula. The consultant told her “the nutrients and all the good stuff come from the breastmilk, so just buy the cheapest formula brand out there. Think of breastmilk as steak and veggies and formula as ice-cream”. I recall looking at my baby, picturing the bottle I was coaxing into his mouth as a cone of ice-cream. I remember apologising to him for being unable to provide him with the nutrition he needs to thrive, and crying.
I don’t hold a grudge towards any of the healthcare workers who promoted breastfeeding. They acted under policy directives they were given. But the current message for those of us who don’t breastfeed is: you’re doing something wrong. And for those of us who cannot breastfeed: you’re wrong. Pregnancy already entails an over-surveillance and scrutiny of bodies, even without the added pressure of “breast is best”. No one should feel unsupported and inferior about the way we feed our child.
