Wednesday, December 05, 2012

Boob Hell: A book review

I've never been to boob hell. Not really even to boob purgatory, except for the plugged ducts I kept getting when Zari was around 4 months old. My experience with breastfeeding has ranged from mostly boob Omaha* to occasional boob paradise.

So I had mixed reactions to Rebekah Curtis' book Boob Hell. It's a memoir of breastfeeding her first baby, and it's filled with tortured descriptions of the pain and embarrassment she endured while trying to figure out how to nurse. This wasn't your ordinary sore-nipples-for-a-few-days kind of pain, it was close to 3 months of constant, excruciating pain, even when she wasn't nursing. She had a nipple so deeply cracked that it essentially split in two. She couldn't hold her daughter or bear to have anything brush against her breasts. Turns out she had a raging thrush infection and (my interpretation here) a baby who didn't latch on right. Between those two, she endured more than I think I ever could have. But Rebekah doesn't set herself up as a hero or even a warrior. She feels like she's failing no matter what she does: "I was failing at breastfeeding, and failing at quitting breastfeeding. Human history had never known a more stupendous failure."

Besides the physical pain of a bad latch, cracked and bleeding nipples, and a thrust infection, Rebekah also endures another form of hellish punishment: shame, embarrasment, and loneliness. At times, I felt impatient with the narrator. Newly postpartum, she has a houseful of family staying over. She feels trapped and overly self-conscious. So she ends up nursing her baby on a folding chair in her bedroom, completely miserable yet unwilling to either A) just nurse the baby and let others deal with it or B) ask the unwanted guests to leave. Yes, I know that it's hard to field friends and relatives when you're newly postpartum, but it's even worse to be "nice" and then suffer for it (and then complain/cry in secret).

Even after she's been nursing for a while, she still feels terribly awkward and embarrassed to breastfeed in front of anybody. Here's a scene when she's visiting her mom and grandma (referred to as "Grandma" and "Great Grandma"). 
     I positioned Baby to start on the safe boob. I had her burpie, a fresh nursing pad, and my receiving blanket. But when It came to the feature presentation, I found myself stalling, making unnecessary adjustments. I just didn't want anyone to watch me feed the baby; not my mom, not my grandma, not anybody. I grimly draped the blanket over my shoulder and Baby, reached underneath it to unhook my bra, and tried to hold her in the appropriate range, but she started flailing and gasping and soon the blanket was tangled around her head and arm, and my face was burning. Was Great Grandma still watching? I didn't want to look.
     "Come on, Baby," I muttered desperately, pulling the blanket back up. But she couldn't get it. Her hands flew and pulled off the blanket again and she cried in frustration. I wanted to do the same. "I'm sorry, we're terrible at this," I said angrily. "Well go upstairs and come back when we're done." I reassembled myself and hauled Baby upstairs where we could sequester ourselves in a bedroom.
     Dad [Rebekah's husband] knocked on the door a few minutes later and stuck his head in. "Doing OK?" he asked.
     "Why do they say you should just feed the baby wherever you are? Why don't they tell you that babies can't figure out how to eat without you being totally exposed? Why do they make you think that it's totally no problem to feed a baby under a blanket? Don't their babies kick and squirm and cry? I hate all those people, whoever they are!"
 Or this scene at a friend's house, where she and three other moms are gathered for lunch:
     We sat around Christine's table while the bigger kids ran and screamed. The lady with the newborn started nursing her, not with as much subtlety as I preferred to employ. I wasn't sure if I should look away. She didn't seem to be trying to make a point (no need in this group); apparently she just didn't care. It was distracting: although I wouldn't normally be looking at her chest, I now had to look consciously elsewhere. I struck me that this was how polite men must always feel around women in boob sweaters or short skirts.
     Baby also had lunch coming. But with Other Mom doing the deed at the table, I could hardly excuse myself to the living room. It would even feel rude to try the blanket trick, since she hadn't. My inner anchorite muttered, See, this is why you don't go out with people. I dug through my diaper bag at length as a signal that I was about to need everyone's eyes to be considerately averted. I straightened, unhooked, helped Baby latch, and hoped that my face wasn't as red as it felt. The other girls dutifully conversed around me.
     "Are you OK?" asked Christine after I started laughing at their comments again to signal my return to group interaction. "I mean, is it going OK?"
     "Yeah, it's no biggie," I said, smiling tightly.

Rebekah's character is aware of these inconsistencies. One time, she is sitting in her husband's office nursing her baby. A woman walks in, looking for Rebekah's husband. Rebekah's immediate reaction is to feel uncomfortable and embarrassed, even though the woman doesn't mind and hardly notices the nursing. Turns out the woman has been struggling with infertility. Rebekah reflects:
Why had I spent all this time angry about nursing mothers being forced out of society to feed their babies, and then when someone who doesn't have a problem with me feeding my baby shows up I get mad and scared?

Reading Boob Hell made me wonder how we ought to talk about breastfeeding. Should we teach that it's something that many or most women can accomplish with the right information and support? Or is talking about breastfeeding in a positive and encouraging way setting women up for failure? Should we instead focus on the potential problems and difficulties so we're not painting an unrealistic picture for new mothers? I understand the reasons for both approaches. Rebekah definitely feels duped by all the breastfeeding books she read. To her, breastfeeding is hard and painful, period. Anyone who says otherwise is simply not telling the truth: 
     Baby and I were in the middle of a feeding when my aunt stopped by to inspect the newest family member. "How's it going?" she asked me.
     Kind of rough," I said.
     "Rough how?"
     She nodded. "Yup, that's the way it goes."
     Maybe if we all know this, we could give each other a little warning? I thought. "Everybody at the hospital and all the books say that you might be sore for a day or two at first but after that you'll be fine as long as you're doing it right," I said.
     My aunt snorted and rolled her eyes. "Anybody who's ever done it knows that's not true," she said. "But at least you can drink again, right?"
     Can I?" I asked.
     "Oh, sure," she said, "You just can't get hammered."

On top of feeling shell-shocked at how difficult breastfeeding was, she can't even be honest about how she is actually doing:
     A friendly grandpa-type asked me how we were doing that Sunday at church. Just fine, I prevaricated.
     "You know, at this age, they pretty much just sleep and eat and cry!" he observed jauntily. "And the sleeping you don't mind, and the eating you don't mind, but that crying can sure wear you out!"
     I nodded, smiled. He patted me on the back and moved on. I stumbled into my husband's study so that I could get the crying over with before another caring person tried to be friendly. Why did I have to lie about this? Why did I have to pretend that I wasn't in the darkest valley of my life? Didn't anyone know, didn't anyone suspect that things might not be that great for a new nursing mom? Why were we all keeping up this act? I could only conclude that every acquaintance who'd talked to me since Baby's birth had no experience of breastfeeding, because if they had, their words to me would surely have been less presumptuous. The eating you don't mind. The eating you don't mind. The eating you don't mind.

Rebekah finally emerges from boob hell almost 3 months postpartum. Her constant pain between feedings finally dissipates and then, at a friend's urging, she tries gentian violet for her thrush infection. It does the trick after lots of ineffective remedies and useless advice from doctors and lactation consultants.

Boob Hell is self-published. I caught the occasional error and found her usage of titles rather than names confusing (her daughter was named "Baby," her husband was named "Dad," and her mom was named "Grandma"). The writing style is so-so, but her story is positively wrenching and at times frustrating. Frustrating that women go through so much suffering--whether undeserved, unexpected, or self-inflicted. Frustrating that she received so much bad/ineffective advice from numerous health care professionals Frustrating that she couldn't be open about her struggles with mothering and nursing.

I haven't ever been in Rebekah Curtis' shoes. And she's never been in mine. Towards the end of the book, she writes: "I don't understand the people who claim to have no problems and no pain, but I'll take their word for it since one of them was my grandma." I am hesitant to pronounce that breastfeeding WILL be hard and painful and difficult. Or that if you do everything right, you'll NEVER have problems. I know that it CAN be hard, and is for many women. But I'm still uncomfortable with spreading the idea that is is MEANT to be that way.

For those reasons, I'm not sure if I would recommend this book to someone who has never breastfed before. It's simply too overwhelming and discouraging. However, Boob Hell would be great for breastfeeding veterans--especially those who have faced and overcome challenges. Or for those postpartum moms who feel lost and isolated, whether they're cruising along in boob Omaha or stuck in the seventh circle of boob hell.

Paperback available at Lulu ($9.49) and Amazon (paperback & $2.99 Kindle). 

* Pleasant, nothing terribly remarkable, hum-drum (phrase borrowed from Rebekah Curtis)


  1. I am a doula and I've had a difficult nursing experience with all three of my kids. I usually tell new moms the immeasurable benefits of breastmilk and really emphasize those as the reason to breastfeed. I also tell them that most women have some soreness, some have none at all, and for some nursing is very difficult. I want to open and honest with them about all the possibilities. When they ask about my personal experience I'm very honest with them. I do want them to know how hard it can be. Some things are hard, that doesn't mean they aren't worth it. That's why I always stews the benefits and also say that most women who do have trouble and stick with breastfeeding end up getting better and nursing usually becomes easy. Most hospital LC's are horrible in my experience. They always say it shouldn't hurt at all if baby is latched correctly. That's just not always true.

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  3. My first could never latch well and we struggled with a supplementer and I pumped but quit altogether at 6 months. I was very sad not to have better success. The LLL leader was helpful and free, a great resource.
    My second had a grip like a barracuda and I did have some trauma and lots of pain as well as thrush that kept coming back. But she nursed for 3 years and it turned out well. I found that a vinegar/ water dip for nipples was a good way to fight the yeast. With #3 I think I will also try coconut oil instead of lanolin since it is antifungal. Nursing was hard both times at first, but worth it.

  4. I read this book when it was first published, as Rebekah Curtis is a friend of a friend of a friend (same church body). As someone who struggled painfully through the first few months of nursing and then finally had it come together, I appreciate her honesty. I was able to empathize with her struggles. I wouldn't want her experiences to scare away new nursing mothers, though. I think it is important to share the good and the bad; many times I felt like a failure because I was months in to my time nursing and still having problems.

    What really irked me was not the portrayal of painful nursing. Instead, I, too, was fed up with her desire to be covered, hidden, and secretive. Perhaps some of her negative feelings toward nursing could be attributed to unspoken or unexamined guilt?

    To her credit, she does go on to have and nurse many more children successfully, yes? The end of the book wrapped up so quickly after some agonizingly slow pages that I can't quite remember the conclusion.

  5. Thanks for reviewing this book. I haven't read it, but I plan to now. I think I agree with your reservations about the book--perhaps not appropriate for women who haven't yet experienced breastfeeding. On the other hand, I felt woefully unprepared for the reality of breastfeeding, and I wish there were more honest portrayals of it. First of all, so much emphasis is placed on giving birth, and so little on what comes afterwards. I thought giving birth would be the hard part, and that everything else after that would pale in comparison. I read The Womanly Art of Breastfeeding, and I thought I had it covered. How hard could it be? Breastfeeding is touted as so natural. Sure, all the books said it would hurt at first, maybe. But I read very little about the actual things I ended up dealing with.

    I had a wonderful pregnancy, and a challenging but virtually painless homebirth. But then what? She had a tiny mouth, and I couldn't get her to open it wide (yes, I tried all the tricks too, and they didn't work!). My nipples were sore, bleeding, cracked. By day 3, she had lost more than 10% of her birth weight. We went to an LC, where I got a nipple shield. In retrospect, I wish I'd never used it, and that I had been told to intersperse pumping with nursing in order to let my nipples heal. By 2 weeks, my little one had not gained any weight. The nipple shield was making it too hard for her to suck, and there was a foremilk/hindmilk imbalance. Back to the LC, who prescribed 10 minutes of nursing on each side, followed by 15 minutes of pumping every 3 hours. She didn't tell me how to pump effectively though.

    The nightmare started when I came down with mastitis. I thought it was a plugged duct. No one had told me about plugged ducts beforehand, beyond just a passing remark. I didn't know how religiously I should have been checking for them, and how important they are to deal with ASAP. When the pain became too much, I went into urgent care. I had a fever of 103, and I was immediately put on IV fluids and IV antibiotics. The following day, an ultrasound revealed that the mastitis had turned into an abscess. And thus began a month from hell that involved daily needle draining of the abscess by a breast surgeon, and daily IV antibiotics. Plus pumping every 2 hours around the clock so the infection wouldn't keep feeding off of the milk that kept being produced. I had to stop nursing because the frequent pumping took up so much of my time, and I needed the remaining time to sleep and recover. I basically missed the second month of my daughter's life.

    At the end of that month, I was finally recovered. I had to wait another month before the breast surgeon declared me 100% recovered. There were a lot of other hellish moments that I could talk about, like the lack of respect we got from doctors for having a homebirth, or being told there was a possibility I'd need a mastectomy. It was a very traumatic experience. My daughter is 3 1/2 months old now, and since then I've had plugged ducts multiple times. I seem to be very prone to them. Each time I got one, I would suffer from severe anxiety about what might result. I became obsessive about checking for them, to the point that I couldn't focus on anything else, not even my daughter. So yes, I made the very difficult decision to quit breastfeeding her at 3 months old. It seemed like the lesser of the two evils, although not at all ideal. And I'm still very sad about it.

    But where were the books and the stories about what I went through? I couldn't find any--no one else to relate to or who could effectively sympathize with me. All I felt was the message that I should have persevered with trying to breastfeed, that it was selfish to stop. It was (and still is) very lonely. I will always be pro-breastfeeding, but I'm no longer judgmental about it (like I was before I gave birth). I think, if I had been better prepared beforehand, a lot of the problems I went through could have been avoided, or at least put into perspective.

    1. Thanks Sarah (and everyone else) for sharing your stories. It's crazy what some of you have had to go through! I do think it's important to share our real range of stories and to avoid speaking in absolutes (breastfeeding WILL be hard and painful; breastfeeding will NEVER hurt as long as you're doing it right, etc.). I think connecting with other women is so important, because books just can't fill that gap.

      So here's another question: how can we better prepare women beforehand for breastfeeding? What would have really helped you?

    2. I think you are so right about not using absolutes. And for a while now I've been thinking about how I could have been better prepared, and it's such a difficult question. So much of it depends on one's body, as well as one's baby. I can speak to my specific situation now, but hindsight is 20/20, and before I figured out the specifics of my own body, it would have been hard to know what advice to give myself (i.e. that I'm very prone to plugged ducts so I need to do vigorous massage and breast compression while pumping, or that I apparently have a high pain tolerance which meant that my infection got very serious before I considered getting it checked out).

      Like you, I would be wary of telling horror stories to women who haven't yet breastfed. It feels similar to telling traumatic birth stories to women who are pregnant--why do it? And yet, birth feels different from breastfeeding too. If one conscientiously is seeking a positive birth experience, she'll likely achieve it, barring any unforeseen medical issues. But even if one seeks a positive breastfeeding experience, there are so many unknown variable that will dramatically affect the experience.

      In short, I don't know how women can be better prepared! I think I would have benefited from going to LLL meetings beforehand (but we don't have a second car so I had no way of getting to them). But I also think that books and classes could cover more than just touting the benefits of breastfeeding. I was fully on board with all the benefits--it was preaching to the choir. It was the nuts and bolts of it that were challenging, and that tripped me up. So perhaps more information on the actual "how," instead of the "why"?

      I think, too, that optimistic comments help, like the ones I've read here saying it WILL get better in time. But perhaps more than being prepared beforehand, I really wanted someone who could relate to my experience while I was in the middle of it. I know that abscesses are very rare (thank goodness!). But as I was dealing with it, so many other women started telling me about their own experiences with mastitis. Why hadn't I heard about those before? It seems like people don't talk about mastitis unless it happens.

      It seems like there are two very distinct camps: pro-breastfeeding at all costs, and formula-feeding while being defensive about it. I guess I wish there was more fuzziness between the two camps. I don't think the answer is to spread negative stories about breastfeeding, because it'll just scare more women off. But I wish it could be more than just a black and white issue.

      So basically, I have no concrete answers for you. :)

    3. I had a very difficult time with breastfeeding initially as well--it was two months before I started to think we *might* make it (and after exclusively pumping for 16 months with my first born who had a complex medical situation, I was committed as I think one can be to making breasteeding work). I, too, felt like I had no idea that either breastfeeding or a "normal" post-partum time could be *that* hard.

      We are now going strong with nursing at 18 months and it is much, much better (though I still deal with nipple pain and plugged ducts off and on). But I still feel somewhat like I'm standing in a glass box when I listen to most stories about the post-partum time because it sounds so much . . . less awful than my experiences. And I don't know how much of that is because people really do have different experiences, and how much of it is because the people whose stories I'm hearing tend culturally not to talk about the hard parts and just make nice in the way Rebecca Curtis describes doing.

      I wonder if one way to find a balance between preparing people and scaring people off is to 1) be vague and 2) follow a negative with a positive. I almost never hear, "Breastfeeding can be *hard*." I did hear a lot of "Breastfeeding will be *so* much easier than exclusive pumping. You'll *love* it!" And that is true *now.* But it sure wasn't at first, and I wonder whether it would have been helpful for me to hear something along the lines of "Breastfeeding was *really* *hard* for me at the beginning and I had moments I wanted to quit--but it did get better and I feel like it was worth it." I am thankful that my mother was there to tell me that while I was in the worst of it. I think our horror stories told in detail could be off putting, but I wonder whether just saying that it *can* be hard (but that it *can* get better) would be helpful.

      Another thing I wonder about is emphasizing the need to try different things until you find what works. For example, I read Jack Newman's book, saw a lactation consultant, a naturopath, my midwife, a nurse with a background as a doula and breastfeeding advocate, and all of them tried to help us with our latch. Finally a friend of the family with seven (breastfed) kids who has worked as a post-partum doula made a suggestion which was the fix that I think (along with time and practice) made the difference for us.

      I don't know if any of this would translate into something that would be helpful for someone else or not.

  6. I had "boob hell" with my first -- deeply cracked, bloody nipples, two bouts of mastitis (the first one landed me in the ER) within the first month, and then raging thrush as a result of all of the antibiotics from the c/section and to treat the mastitis. I eventually just stopped using the most problematic boob and nursed only from one side (with good weight gain -- at least milk production wasn't a problem!) from about 3 months to 19 months when I weaned the baby so I could get pregnant again. It was very, very painful for the first maybe three-four weeks, then pretty bad on the bad side until 6 weeks, then easier, then totally pain-free and wonderful from about 3 months to the end of our nursing relationship.

    With my second (unmedicated, intervention-free VBAC) I thought things were going to be so easy! I was a pro! I knew everything to watch out for! Believe me, I'd read the books and gone to the LLL meetings and trolled the BFing message boards. And it had been less than a year since I'd nursed my daughter and we were practically experts! Well, it definitely wasn't pain-free, and the bad side was bad again. I do think it was a lot closer to typical soreness that more women experience than boob hell, though, and after 2 visits to an LC and a LLL meeting, things have been smooth sailing from about 3-4 weeks out to now (we're only at 12 weeks so far).

    I think the "if it hurts, you're doing it wrong" and the mega emphasis on latch (again, something the mother is "doing wrong") are completely unhelpful.

    One thing I learned between #1 and #2 was to be a lot more aggressive and pro-active with health care professionals. Since weight gain was good with both, I think my doctors and nurses didn't want to do much or think they needed to do much -- I'd say, "this hurts; I don't think this is normal," they'd observe, give some pointers (mostly good ones!) and then send me on my way - I'd go home, suffer another week and go in with a new set of complaints and get a few more pointers and congratulations on the good weight gain the next week, repeat. This time, I said, "This hurts" and asked for an APNO prescription, got some pointers, and set up a follow-up appointment for the next day. I kept going back to the LC every couple of days until we got it completely worked out.

    Something I think would better prepare new moms would be a greater emphasis on what to do if things are painful (even if that is just to call an LC). Like I said, "if it hurts, you're doing it wrong" is pretty much just infuriating and "expect to be sore for the first few days/weeks" can let things get to a really bad place that's hard to come back from. I wasn't sure who I should call with problems (especially because they always seemed to crop up in the middle of the night). I also think that if a woman is having problems and brings them up with a medical professional, there should be some follow up until things are resolved.

  7. Wow, reading this and these comments makes my stomach hurt. I agree, the advice that "you are doing it wrong if it hurts" is unhelpful. Sometimes you can be doing everything right and the shape of your nipples, or the suction of your babe can just make it HURT. My LO is 6 months old yesterday, and yet again I'm sore. It's an ongoing battle, but I am still enjoying breastfeeding. I'll tell you what though, the first 6 weeks were HELL. Breastfeeding my little barracuda was WAY HARDER than my homebirth (which was easy, but intense). It looked as if a 3rd of my nipple was ripped off on my left side. I wanted to scream and crawl out of my skin every time she latched. On day three I was terrified when I looked down at my daughter nursing and she had blood dripping down both her cheeks. She was throwing up blood and skin for the first bit until she ripped it all off and then it was just RAW. Thinking about it makes me want to cry. But we pressed on, and now it's mostly enjoyable, and I'm able to donate milk now.

    I do know women who have absolutely no pain. I envy them because it would make the postpartum period blissful. I love my new little babies, but the pain just clouded the experience for me this time around.

    When I give advice, I tell women to give it at least 6 weeks. It usually is bearable at that point. However, reading the comment from the woman who had the abscess above was just heartbreaking. I'm sorry mama.

    My experience has made me less judgmental of mamas who need to stop. We are all doing the best we can! I LOVE breastfeeding, and I'm a HUGE advocate for breastfeeding and donating milk. But that first bit was a very trying time in my life.

  8. I think it's important to recognize that, as all women have different experiences and challenges breastfeeding, our babies are all different, too, and they are equal players in the breastfeeding relationship. My daughter, now 3, wanted nothing to do with the breast from birth. While there were a lot of factors that contributed to unsuccessful breastfeeding (not enough support, returning to work soon after birth, etc.), the fact of the matter is she was NOTHING like my son, who is 10 months old today and latched on soon after he was born. He is still nursing successfully today, and it has been easy-peasy. If he were my firstborn I would probably be one of those women who thinks, "Why doesn't everyone breastfeed? It's so much easier than giving bottles!" (And when your baby is as good a nurser as my son is, nursing is SO much easier!) But I endured a lot of suffering, judgment, guilt, and sadness with my daughter, for whom I ended up pumping for seven months. I know how easy it can be and I know how hard it can be, and I am honestly grateful for that lesson.

  9. I wanted so, so, so badly to breast feed and was prepared for it - did research, took classes, etc. but I have an autoimmune disease that dries out the moisture producing glands in my body. Saliva, tears, and, yes, milk. Plain and simple, I couldn't make any. I tried pumping, and could never get more than an ounce or two a DAY. We saw lactation consultants, who all made me feel like a failure as a new mom. I took supplements and pumped and pumped, and felt like a failure. I finally quit trying and decided it was better for my daughter if she didn't have a stressed out momma who was crying over (no) spilled milk. My daughter is now 13 months old and thriving and beautiful and smart and funny. I am 100% pro-breast feeding, and dearly wish we could have done it. I didn't venture near other moms for about 6 months, because it seemed like they could all do it so easily and looked at me like a formula feeding traitor. Long winded comment, sorry, but just one from the perspective of a woman who would have done anything to make it work. Breast is best, but you have to work with the cards you're dealt. The most important thing is for a baby to have parents that love and care for them.


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