No one told me breastfeeding would be so hard!

Here is my first newsletter since welcoming our baby boy in October last year. Writing it was my first step emerging out of maternity leave…and well, it took me over months to get it out. I realized I was mostly writing to process my experience breastfeeding, which a MyAdvo member put beautifully: “While breastfeeding is natural, it often doesn’t come naturally.”

For those of you new to MyAdvo, welcome! My name is Esther, and I founded MyAdvo in 2024, after more than a decade of navigating healthcare largely on my own: a uterine and vaginal septum, fibroids, adenomyosis, a spinal fracture, and PCOS. I didn’t know anyone with my conditions, so I created a space for women to feel like they could meet at least one other woman who could relate. I also realized our stories could shine a light for someone else working through their own health journey.

MyAdvo is a community dedicated to empowering women with endometriosis, fibroids, adenomyosis, and PCOS to advocate for their health by sharing our stories. We primarily chat on WhatsApp. These newsletters are where I think out loud. I cover what’s happening in our community, including our webinars with experts like endometriosis excision specialist Dr. Khalil, what’s on my mind in women’s health–lately things like how GLP-1s may be helpful with PCOS or RFK Jr.’s war on vaccines–and my own ongoing health journey because I think there’s value in watching someone figure it out in real time.

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MyAdvo took a hard pivot last year when I found out I was pregnant, and so did I.

It’s been a humbling year…

Shedding preconceptions of myself, rethinking ambitions, all while revving my advocacy muscle back up to navigate maternal care.

Breastfeeding is a maternity topic that we just don’t talk about enough, especially while pregnant. It reminded me of when I was first thrown into the healthcare system because of my uterine and vaginal septums. I was simply not ready for the mental and physical toll and the choices I needed to make about it. But, I think the way I navigated it says something important about what advocacy looks like in practice. There’s finding the information and knowing your options, and then there’s the harder part of making decisions in real time, while you’re exhausted and emotional and your body is doing things you didn’t expect. To be honest, being postpartum (and just a mom in general), advocating is now a constant. During pregnancy, your brain rewires to learn how to make a thousand small decisions a day that didn’t exist before, not just for yourself but for your baby.

I personally felt that giving birth was something many of the women in my life from my mom, girlfriends, coworkers, doctors would openly talk to me about. I read books, listened to podcasts, took classes, went to pelvic floor therapy, even hired a doula. For the most part, I could get advice and opinions about birthing anywhere I turned. More importantly, I felt compelled to seek this information. Of course, that comes with its own territory. Everyone’s birth story is different, and you can only control so much about the birthing process. Between my obstetrician and doula, I felt like I was doing what I could to prepare. But breastfeeding, I honestly barely had conversations about it. Even my OB (and I really like my OB) didn’t really bring it up until after I gave birth. I had specifically hired a doula who was also a lactation consultant because I knew I wanted to try breastfeeding, and I’m so grateful I had that foresight.

While breastfeeding is natural, it often doesn’t come naturally.

The same way delivery is a hot topic, so is how you feed your baby. But, I found it can even be taboo to discuss because it triggers very strong emotions often attached to notions of willpower and devotion. I personally had a very reductive idea of breastfeeding. I thought it required two things: either your breasts can make milk or they can’t, and the baby either latches or doesn’t–both figured out within the first three days in the hospital. I was in for such a surprise…

In the first few days of life, newborns lose their birth weight, so you are meant to feed them every 2-3 hours from the start of the last feed until they regain that birth weight. If you are breastfeeding, you are encouraged to nurse or pump frequently to stimulate milk production and get supply to come in. Starting this process right after giving birth while recovering from a C-section was more physically distressing than I had anticipated.

I had a scheduled C-section due to placenta previa, a complication that causes the placenta to cover the cervix. C-section delivery often causes delay in milk production, which can make immediate breastfeeding more difficult. In my case, I wasn’t able to have skin-to-skin contact right away per my hospital operating room’s rules (I was able to get cheek to cheek though). I also wasn’t able to hold Baby for longer than a few minutes at a time during my first 24 hours post delivery because I was nauseous and throwing up from the spinal anesthesia (something I knew would happen from prior surgeries).

However, my milk was definitely coming in. My breasts felt rock hard and swollen. I honestly felt like I’d gotten a really bad boob job! I was nursing Baby every two hours around the clock and hand-expressing, which is when you use your hands in a C-shape to press, compress, and release right above your nipple to remove the milk. I wasn’t getting much relief at all. Baby seemed to latch but the suckling became increasingly excruciating. He’d often fall asleep at the breast, which isn’t uncommon but meant each feed lasted over an hour before we’d have to start again barely an hour later. I’d flinch whenever his mouth came near. My entire body would stiffen and I would wince throughout. For the record, it’s not supposed to hurt THAT badly.

Definitely not the magical experience I’d heard about.

By my third night, the nurses were concerned Baby wasn’t emptying my breasts and began painfully hand expressing for me, urging me to start pumping. The hospital pediatricians suspected a tongue tie, a condition that restricts tongue movement and prevents a baby from latching and drawing milk correctly, and were concerned he’d lost 10% of his birth weight. It was in this state that we left the hospital after three days.

Let me tell you how grateful I am to my postpartum doula (who was also our first night nurse) but also for allowing myself to hire help. I chose a doula who was also an International Board Certified Lactation Consultant (IBCLC). When she met us the first night home from the hospital, she took a look at my nipples before and after the baby fed. They were flattened, cracked and bruised. She agreed that it was highly likely the baby had a tongue tie and to confirm with a pediatric ENT. In the meantime, she reminded us that “fed is best” and encouraged me to rest my nipples from nursing for a week while I switched to exclusively pumping to alleviate engorgement and bring in my supply. This was our first feeding decision. We chose to switch Baby to formula and received further positive reinforcement that this was the right decision at our first pediatrician wellness check. Baby had almost crossed the critical threshold of too much weight loss but made a comeback overnight and was back on track regaining his birth weight.

We consulted a pediatric ENT who confirmed Baby’s tongue tie, so we opted for a frenectomy where they laser it off. It was a 30 seconds procedure with localized numbing. I shed more tears than Baby. We did tongue exercises for a month to prevent reattachment and help Baby retrain his range of motion. I was so hopeful we would start nursing again, but Baby had gotten used to a fast bottle flow! We tried nursing for a couple more weeks, but it usually ended up with both of us in tears.

Once again, not the magical experience I’d heard about.

I consulted a dedicated lactation consultant. We tried a nipple shield, which worked for a day before Baby got over it. By our second session, the LC said that if I really wanted to nurse, I would likely need 1-3 days of removing any bottle-feeding and only offering the breast.

We were in a battle of wills.

That’s when I made a second decision about feeding for my mental health.

Baby could win this one.

I could not handle days of endless crying only a month postpartum. And so began my exclusively pumping journey. We combo-fed formula and breastmilk for about three months. My supply was low to moderate for a long time, but it eventually came in, and I was making just enough for what he needed! He got two solid months of just breastmilk before I started weaning at five months.

I had originally planned to breastfeed for only 3 months because I wanted my body back both for fitness and health. I wanted to start easing my body out of postnatal depletion. Even in writing this, I feel a twinge of guilt.

Am I being selfish at Baby’s expense?

The World Health Organizations (WHO) and American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for six months and encourage it for up to two years. The evidence shows breastfed babies have reduced risk of respiratory infections, ear infections, GI illness, and longer-term conditions like asthma and obesity. For mothers, breastfeeding is associated with lower risks of breast cancer, ovarian cancer, and type 2 diabetes. It’s hard to not think that you are putting your baby at risk if you do not exclusively breastfeed or do so for less than 6 months. But research is based on population data, not individual mothers, and full context matters. I choose to believe that a happy mom = a happy baby. Plus, it’s not an all or nothing situation. Six months is the most evidence-backed milestone, but even partial breastfeeding is associated with meaningful benefits. And FWIW, I’m a formula baby and turned out fine!

The phrase that carried me through most of my feeding decisions was simply: fed is best.

Making decisions on how you feed your baby and how you take care of your postpartum health shouldn’t be judged. It’s also alright to change your mind as things progress. I personally decided to continue breastfeeding past three months because it took about that time to figure out how to breastfeed. Once I did figure it out, I didn’t want to go through the stress of winding it all back down. Even though nursing didn’t work out for Baby and me, I’d worked hard to get my supply up and it had finally come in!

Now at five months postpartum, I’ve begun to wean and Baby is back to being combo-fed. I’m taking a gradual approach, dropping one of my six daily pumps every two weeks, to prevent clogged ducts and manage the emotional transition. Weaning is a real biological transition not just a lifestyle change. When you wean, two key hormones drop: prolactin, which supports milk production and often has a calming effect, and oxytocin, which is linked to bonding and often a stress reducer. This means that as women wean, they can experience mood swings, anxiety, irritability and feelings similar to postpartum “baby blues.” OBs and mental health therapists will often remind mothers to check-in past the first three months postpartum as postpartum depression can develop later on.

If I wasn’t going back to work, I think I would continue breastfeeding by exclusively pumping, but I personally know I’ll have a hard time keeping to my pump times between meetings. I’ll be going back to the office, and sadly, I just don’t want to get any comments about my breastmilk in the office fridge. I wish I didn’t care as much and maybe I won’t with our next baby, but I’m trying to minimize triggers as I ramp back into it all.

Like giving birth, breastfeeding involves choices, pivots, and an element of unpredictability you can’t fully plan for. What you can do is go in informed—about how your body and hormones will change, the different feeding approaches, and what to watch for. I hope this helps at least one of you feel a little less alone in it. It took me months and a lot of tears to figure out what worked for us. And even now, as I’m winding it down, I’m still making decisions in real time.

• Supply can take months to fully come in. Patience matters. (These Legendairy Milk supplements with herbs like goat’s rue and milk thistle really helped me.)

• How much I eat and hydrate directly impacts how much milk I produce. Eat and drink more than I think I need.

• It’s not supposed to hurt THAT badly. If nipples are flattened, raw, and Baby keeps falling asleep after an hour of trying to feed, it’s time to see a pediatric ENT to evaluate for a possible tongue tie.

• Think of lactation consultants like second opinions. Consult more than one, and do it early. Everyone’s breasts and baby are different!

  • A friend who was experiencing Baby becoming fussy while nursing consulted a second LC who helped her identify that she has an over supply and was unknowingly overfeeding Baby!

• Nursing was my most effective relief for clogged ducts, even when I wasn’t nursing regularly.

• Re-check flanges a couple months in to make sure they still fit to prevent clogged ducts.

• Introduce a bottle early if you plan to use one, but balance bottle and breast to avoid preference.

• Uterine cramps while breastfeeding (especially early on) are normal.

• There is a 2-3 day period right after giving birth where my breasts will feel rock hard and full, likely engorged. This is normal and will pass.