Wednesday, January 26, 2011

When DNA isn't just DNA

Me, my mother, and my new baby sister, brought home 1 week
prior, circa nineteen seventy*mumblemumble*.

(That is to say, pretty much never.)

Adoption is always a part of me, but has been actively on my mind more than usual recently, for a few reasons. A few days ago, a blog post that's mostly about egg donation but also gets into the virtues of adopting really got my attention. Then there was the startling and emotional reveal from Oprah that she had found a half sister who had been relinquished for adoption in secrecy (along with the news that Oprah herself had given birth as a teenager; the baby sadly passed away). And finally, a film project currently being produced about adoption by my own "birth sister" has sparked some very thought-provoking discussion.

I read a timely post a few days ago by Christie Haskell, a blogger I respect and like very much, entitled "DNA doesn't make a family". Simple statement, yes? But even seeing the title and the opening lines, even before reading the rest of the post itself, my gut was protesting. No, DNA alone - whatever that could possibly mean - does not equal Family.

But DNA is almost always more than just DNA.

I understand the importance of the nurture portion of the equation. It's what my parenting decisions are based on, in fact. But the ability to make statements like the above is a luxury that only non-adopted people* can make. If DNA did not matter, there would be no such thing as genealogy, no such show as "Who Do You Think You Are", wherein various celebrities are taken on a globetrotting tour of their lineage. Who could ever possibly care about their ancestors if all that mattered were the actions of the people who raised them, period, black and white, end of story? If DNA made absolutely no difference, ancestry would be of no interest to anyone.

Even beyond the ancestral threads of DNA, though, the core experience of adoption is also more than merely biological, animal, anatomical.

The writer of the post in question, Christie Haskell, who publishes on The Stir at CafeMom (and again, also rocks as a person, as a writer, and as an advocate, for the record), opens with this: "Both of my kids are biologically mine and my husband's. There are times I've actually felt guilty that we had our own biological kids instead of adopting, especially knowing how many children out there need homes." I admire Christie very much, and the bulk of her post turns out to have more to do with egg donation than adoption, but adoption is part of the discussion, both in her writing and in the ensuing comments section, and in that discussion I see some very common sentiments about the moral merits of adoption that, based on my experience, I view somewhat critically.

In case you don't know my background, in a nutshell: I was adopted when I was three days old, have had a generally good relationship with my parents, and am fortunate beyond belief to have been able to not only reunite with, but also develop a close relationship with, my birth mother. And not just with my birth mother, but also with her family, including her children, my half-siblings. My younger sister was adopted when I was 4 years old, at two weeks of age.

Recently, the eldest of my birthmother's children, Kate, started filming a documentary about adoption as a class project. It tells the stories of three women, all of whom have had adoption play a significant role in their lives, from three different angles. There's me, the daughter who was relinquished. There's my birth mother, who gave her baby away when she was 16 years old. And there's my sister's friend Ashley, who is currently pregnant and is looking into an open adoption for her baby. (She also interviews the midwife who will be attending Ashley's birth.)

Before we go further, I implore you to listen to this excerpt of Ashley's interview. Yes, it's 95% just her talking, but this is one extraordinary person in an extraordinary situation - I was hanging on every word. Prepare to be equally heartbroken and blown away by her sorrow and her insight.

Women's Bodies, Women's Wisdom from Neil Ransom on Vimeo.

So, returning to the post that got my own wheels turning. During my own interview process, both on film and in outside discussions, Kate and I spent some time discussing the Standard Public Narrative of adoption, the one where adoption is an inherently virtuous act, where adoptive parents are the shining armor benefactors, the baby is lucky to be rescued from what would surely be a terrible fate, and the birth mother is, if anything, an afterthought - an afterthought who is often commended for her courage and/or thanked for her sacrifice, but ultimately doesn't really count. Because DNA doesn't make a family.

I could go on and elaborate on why this is a problematic paradigm, but what I'd end up doing is just parroting much of what someone else already wrote (and blew my mind in the process). Instead, I'm going to quote an old post of mine which includes excerpts from her piece. Be warned, her language is very strong, and she makes this clear by the title itself, "Adoption Sometimes Gets All Fucked Up". Not for the faint of heart, but if you can, I strongly encourage you to read this if you've ever had any thoughts about adoption, from any angle. Starting with my commentary:

I just happened to read a blog this week that shook me to my relinquished core. It was written in response to the recent scandal wherein an adoptive mother "returned" her behaviorally difficult child to Russia, with the note: "To whom it may concern: After giving my best to this child, I am sorry to say that for the sake of my family, friends and myself, I no longer wish to parent this child."

The blogger, Fugitivus, talks more specifically about international adoption, but also about the larger issues that accompany any adoptive scenario, and tackles them with insight and anger and empathy and perception and pulls no punches whatsoever, including 'polite' language: Adoption Sometimes Gets All Fucked Up 101 (consider yourself warned on the cussin').

This is NOT an easy read (in content OR length). But it's an amazingly, *brutally* honest one, full of difficult truths. But I am so grateful that someone is willing to lay some of this stuff out there, stuff I've never seen anyone acknowledge before. And simply as a person who has sometimes thought some of the very things that she reveals to be privilege at work, I am humbled and all the more grateful for having had that privilege called to task. I can own up to it. One snip, though I encourage you grab a coffee and read the whole thing with an open mind:
For our modern, legal concept of adoption to exist, families must be broken. Adoption is not, and can never be, a best-case scenario. It relies upon the worst-case scenario having already come to fruition. From there, you’re working with what is instead of what should be. That should be will never go away. For the entire lifetime of everybody involved in adoption, that should be exists, and it hurts. What is can still turn out to be wonderful, beautiful, incredible, but what is will never be what should be. It is that should be that necessitates education, sensitivity, and trigger warnings, because it never goes away.

When a story like this arrives, the impulse is to compare it to the opposite and compare it to more of the same. The news drags up stories of other Families Gone Wrong, and Families Gone Inspiring As Hell. A false dichotomy is implied: there are adoptions that go right and adoptions that go wrong. But the truth is, behind every adoption is a family that went wrong. . .

My main point here is to warn everybody against coming up with – and expressing out loud and in public – black and white assumptions about how good or bad adoption can be. Adoption is not easily judged as good or bad, because adoption itself is a symptom of something else. If the origin of adoption is the destruction of a family, then nothing that comes from that can be explicitly good. At the point where adoption is a viable option, we have already failed to do our best, and all alternatives are an equal failure of the village that should have been raising this child.

To be more concrete, avoid sentiments such as, “You would rather zie should have…” As in, “You would rather he stayed in the orphanage?” or “You would rather his adoptive mom be arrested?” or “You would rather he be in American foster care?” There is no perfect option; they are all painful, and they are all wrong, because none of them should have to be options.
This really resonated with me. There's an incredible pressure that many adoptees feel to only express gratitude for their situation, with the implied belief that their birth parent was an undesirable person from whom you have been rescued (open adoption is changing that somewhat, in many cases). Expressing any feelings of grief or loss marks you as an ingrate, an "angry adoptee", as Fugitivus mentions, and is seen as questioning the benevolence of one's birth parents. Sometimes even curiosity is unacceptable. Identity is the very definition of multi-faceted: biology is certainly not the only thing, but it is a very real piece of it, and absence of its knowledge can be felt as a loss. Yet wondering about the biological piece of your identity is often viewed as a slap in the face to the adoptive parents. How dare you want to know about these other people? After all we've done for you. Nurture is the only thing that matters, nature plays no part. We're your REAL family now.

She's not saying that adoption never turns out wonderfully, not at all (she addresses that further here, in a post about the above post); my own story has MUCH that is wonderful, make no mistake - but she's talking about it in ways that step outside of what have become the only acceptable storylines about adoption in our culture:
I also understand the desire to keep adoption a positive narrative. There are so many kids in the world who need homes, and putting some of the uglier sides of adoption out there diminishes their chances of finding any home. Of course, I don’t believe in any home for children — I believe in the right home, the permanent home, and I don’t think that home can be found if the pill is sugared so much it’s not a pill anymore. So, it’s a perspective I understand, but now that I’m not a member of the adoption industry anymore, it’s not a game I’m willing to play.
I hope that sheds some light on why I bristle a bit at simplistic sentiments extolling the virtue of adoption that ignore the significant pain that is its very source (all experiences being variable). To mention this pain is frequently being, at best, a party pooper, and at worst, in my case, an ungrateful, angry adoptee.

There is the pain of the mother relinquishing her baby, due in the majority of cases to her circumstances, not out of lack of love or desire for the child. And there is also the pain of the baby - more difficult to quantify, since babies cannot speak to tell us exactly how this affects them, but you only need to look as far as this blog and the internet circles we all run in to find reams of writing on the precious minutiae of how birth affects the baby. Skin to skin, immediate contact, rooming in, initiation of breastfeeding as soon as possible and desired, low intervention - it's all stuff I believe in and advocate and promote.

For so many adoptees (though again, doors are now being unlocked by open adoption situations), none of the above could ever happen. Is this nature being violated, or nurture? I'd say it's both, actually; that how our babies are born is where nurture becomes an extension of nature. In fact, I posit that birth is, potentially, where the synthesis of the two factors begin - and BOTH matter. What does that mean for adopted babies, many of whom were whisked away from their mothers within seconds, literally never to be seen again? It means that nurture must become all the more important, and this has so much value, but I don't think this means we should pretend that the primal wound, the separation of the dyad, didn't happen or doesn't matter.

Point out that it would be better if babies could remain with their mothers, in an ideal world - and people will seriously say "But what about all the wonderful infertile couples out there who can't have children of their own?"

Really think about that. What is being said here? What is being implied, however unintentionally? I know no one in this day and age could actually consciously believe that some women should have to breed on other womens' behalves, in some sort of Handmaid's Tale dystopian nightmare. Nor that babies should have to endure separation from their mothers simply because they are a desired commodity. But that statement diminishes the experience of the biological mother and baby in favor of the couple who wants a baby for themselves.

To reiterate something Fugitivus states but I feel is worth repeating: This is not to say that adoptions don't make wonderful next-best-things in many cases. They do. They did in my case. But I think it's important to respect, deeply, the source and the history.

There needs to be a follow-up to this post. I set out to address all my thoughts in one fell swoop, but as I've already meandered all over the place, I best not try your patience with the next part. Coming up: During my interview for Kate's documentary, she asked me two questions that had me stumped. I rambled on and improvised, but they both deserved much more than I was able to come up with on the spot.

1. You say that in an ideal world, adoption wouldn't have to exist. What would that ideal world look like?

2. What do you think Ashley's baby would say to her, if she could?

To be continued.

*Some adoptees feel differently, too - I don't claim to be the spokesmodel for all of us. But I do know and have read enough about our experiences to be familiar with certain common threads.

Monday, January 10, 2011

Birth Sense on The Impact of Labor and Delivery Nurses

Every once in a while a post comes along that's just so good I have to write a post that consists of just about nothing but "Read this post!" And so it is with the latest from Birth Sense, a.k.a. The Midwife Next Door, with How a Labor Nurse Impacts Your Birth. Everything she writes is a home run, frankly, but this is a grand slam, I think.

You are pregnant, and excited! You like the idea of a home or birth center birth, but think that, for your first baby, it would be a good idea to be in the hospital just in case there are any problems. After all, you don’t know yet if your pelvis is big enough, or if you’ll have other complications. Maybe with your second you’ll consider a home birth.

You’d like to have a midwife, but there aren’t any midwives with hospital privileges in your area. But you’ve found a great OB who definitely has the heart of a midwife. She even encourages you to write up a birth plan! You’ve toured the hospital labor unit, and the rooms are beautiful. Some even have large jacuzzi tubs to labor in. You’re confident you will have a lovely, home-like birth in the hospital. You’ve done your homework, and are looking forward to a beautiful experience.

Wait a minute. . .factor in your labor nurse. Or nurses. No problem, you think. The nurses have to follow whatever orders the doctor gives them, right? Right?

The conversation in the comments is very much worth reading, too. There is, of course, the expected "But I had/am a wonderful L&D nurse! Therefore this isn't true!" There are ABSOLUTELY some wonderful nurses out there. No question. At Your Cervix is definitely one of them, but she's certainly not alone. If you had one of these, or are one of these, awesome. I say that with zero sarcasm or snark - really, that's awesome. But we all know people whose births were derailed by someone who was not so wonderful.

You can have done ALL your homework, taken the best classes, and selected a truly supportive provider in OB/CNM choice, and even hired a doula - and if you get one of these nurses, you're still going to have to battle for your birth . And who you wind up getting is a total crapshoot. Having a doula IS probably your best defense here, though as discussed, if you have a nurse who is hostile to them, it can actually backfire in some rare cases, I'm sorry to say. I don't mean to diminish the importance of childbirth preparation, using a doula (obviously), or especially careful choice of care provider, but it is still true that whether you go with an OB or a CNM, they are going to be present the least amount of time. This may be different with some CNMs, but despite their best intentions, many others are just as overscheduled and likely to have to be running-in-at-the-last-minute to catch, snip & run as an OB. (Again, there are exceptions.) And in the meantime, the nursing staff can make it or break it.

Many a post or article written about the pitfalls of hospital birth results in commenters sharing their own positive hospital birth experiences. I have no doubt that these stories are true; with some, their hopes and criteria for their birth might be quite different than mine, but with some, they might be quite similar. I firmly believe the biggest factor in those positive stories is the roll of the dice that is the L&D nurses. If you're choosing hospital birth, hire a doula to improve your odds, absolutely, but be very aware of the impact they can have, and follow Birth Sense's advice in her post on how to get your best chance.

Tuesday, January 4, 2011

Lact-Aid Demo: In which I take one for the team and bare it all for the greater good.

If you're a mother who found herself struggling with either supply issues or your baby's serious latch issues, you might have needed to supplement, whether with your own pumped milk, whenever possible, donor milk, or, if neither is available, formula. With getting back to exclusive breastfeeding as a goal, if you were getting informed support from a reputable source, you may have been advised to try an at-the-breast supplementer, such as a Lact-Aid or an SNS (the "supplementary nursing system" by Medela) in order to avoid the pitfalls of using a bottle too early, nipple/flow confusion in particular. Finger- or cup-feeding are also frequently recommended by good lactation professionals, and are great in the short term, but some mothers occasionally need to supplement for longer while their supplies are established or their babies suck coordination is improved.

But without adequate instruction - and good demonstration - these supplementers seem devilishly complicated to the point of maddening, and understandably, many mothers get fed up with trying to figure them out. A search online for a decent YouTube video turns up a few Jack Newman offerings. I have the utmost respect for Jack Newman, and the information he makes available is incredibly valuable - but to be brutally honest, these supplementer videos are of little to no use to a mother who is trying to figure the damned thing out, and in particular, how to get their baby latched using the supplementer all by herself, which is going to be the reality for 99.9% of all moms out there. He's doing it all FOR her. It's nice to show it in action, and promote its benefits, but not helpful at all in learning HOW.

Moveover, the way he pushes the tubing into the baby's mouth after the latch is established is completely impossible to do if you're using a Lact-Aid instead of an SNS (which I do strongly recommend; more on that later), because its tubing is so much softer than that of the SNS. This is one of the reasons a Lact-Aid is preferable in the first place, but you MUST put the tubing in at the same time the baby latches on.

So, I'm taking it upon myself. Pretty much literally. Why? Because I believe so strongly in supplementing at the breast whenever supplementing is needed, whenever it is possible. In addition to the way supplementers circumvent nipple confusion, it also makes it possible for mothers who have supply issues to increase the amount of stimulation, and thus production, their breasts are getting. (Regular pumping sessions may still be advisable for a while - please consult an IBCLC about this if it is your own situation - but why not kill two birds with one stone? Pumping and supplementing is hard enough.)

And perhaps most importantly but more challenging to quantify, it IS breastfeeding, and will help to improve baby's latch (again, see IBCLC for advice on how to monitor this) AS you are feeding, whereas with a bottle, even slow flow and/or "breast-like" bottles like the Breastflow, one can only cross one's fingers and hope too much damage to baby's technique isn't done. Using paced feeding and an upright position helps, but it's challenging.

This is also personal: The Lact-Aid made it possible for us to make the transition to the breast after struggling for months, and I firmly believe we never would have made it without it.

An important note: I mentioned that there are two major types of supplementers out there, the Lact-Aid and the SNS by Medela. I have used both, and FAR AND AWAY, I feel that Lact-Aid is the superior product. I write about this in our nursing story, but in a nutshell: It is much, much more user-friendly in several ways, including the way you wear the bags around your neck, the fact that no taping is necessary, and the fact that the tubing itself is very soft and shouldn't disturb baby at all - they probably won't even notice, especially if they're newborns. I started using it when Lily was 4 months old and she was fine, whereas the harder tube of the SNS makes many a baby balk. YES, it's true, I also have ethical issues with Medela, but I promise you I felt this way long before I learned of some of Medela's questionable practices.

Make no mistake: if you choose to use the Lact-Aid, and I sincerely hope you do if supplementing is necessary, there is still going to be a learning curve. I cannot tell a lie: the first few days are pretty much gonna suck. But every feeding is practice, and within a few days, you'll start to really get the hang of it. And in a week or possibly two, it'll be down pat. To be honest, for the first couple of days, I only did Lact-Aid feeds a few times a day, during the times when Lily (and her mom) was at her 'best', i.e. not in the middle of the night. And then I gradually added more Lact-Aid feeds in. You might want to try phasing-in this way, too. Take it one feed at a time.

OKAY. Without further ado, here's a very short video, starring my boob and the baby of one of my clients, with whom I became friendly. I actually had been donating some milk to her privately as a result (she had breast reduction surgery years ago, and like some, though not all, BFAR moms, had to supplement a bit). I also occasionally babysat, and we mutually decided, Well, if she's getting my donated milk anyway, why not offer it from the tap?

Let me be clear: this isn't exactly an official extra service I regularly offer to clients, it just kind of worked out that way. I had worked with them on using the Lact-Aid, too, and one day, after struggling with descriptions and coaching, I said hey, since I've nursed her anyway, would you mind if I simply showed you on myself? She was totally fine with that, and so I did. It was IMMEDIATELY much easier for her. And then it occurred to me that, due to the dearth of existing videos it might be helpful for the internet masses to see as well. She offered up her beautiful little one for me to film (isn't she precious?), and here we are, our other kiddos chattering in the background.

There you have it. Please, in the comments, ask me about anything that needs clarifying, or anything to do with the Lact-Aid. One thing I can think of right off that merits a bit more explanation: If you want to start off the feed with milk from the breast and add the supplementation at the end, which is preferable, you can either delatch and relatch, or, even easier, as I demonstrate, simply start the feed with the tubing pinched off in one of the notches in the body of the Lact-Aid device, then, when babe's sucking slows down, release the tube from the notch and the supplement will start to flow. Oh. and one other note, the bag of milk is hanging kind of low here - you can adjust the strap so it's much higher, and you can nurse in lots of different positions.

Again, feel free to deluge me with questions.

Somehow I knew it would just be a matter of time before, one way or another, I showed my boobs on the internet. But here it's for a noble purpose, right? RIGHT? If it convinces even one mom go with the Lact-Aid instead of a bottle, or instead of tearing her hair out with an SNS - and then giving up and going with the bottle, it is all worthwhile.


When I shared this with my own LC, Jennifer of Intuitive Parenting Network, she quoted my statement, "Because I believe so strongly in supplementing at the breast whenever possible, any time supplementing is needed," and said "I am allowed to smile, right?"

I feel it's only fair to point out what she's getting at, which is that when faced with doing this myself, I fought it tooth and nail. I talk about this in the link to our nursing story I posted towards the beginning, but I think it's worth repeating here as well. Yeah, I literally resisted using this for months. MONTHS. My experience trying to use an SNS at about 6 weeks was just so indescribably awful that I desperately wanted to avoid using anything like it ever again if I could. So I kept pumping around the clock and bottlefeeding my milk to Lily. I was using the upright "paced" technique, and I would try various ways to offer the breast before, during, after, and in-between feedings, but I was still bottlefeeding her. And was really making little to no progress towards our goal. Treading water is all it really amounted to, and driving myself nuts with frustration in the process.

Jennifer, and other moms in our support group who had trod the Lact-Aid path tried many times to convince me that the Lact-Aid was going to be a much different, much better experience, and more importantly, because I was at a total standstill in progress with the bottlefeeding, it would likely be the one thing that got me over the hump. And they were absolutely right about both things. If I had tried using the Lact-Aid earlier than I did, I could have started nursing her many weeks, even months earlier than we finally did. No exaggeration.

People often commend me for sticking it out the 5 months it took to get Lily nursing, and I appreciate that and do take it in, but honestly, the stubbornness that I tapped into to get her ON the breast is the same stubbornness that made me resist using the Lact-Aid, and therefore held up our progress much longer than was probably necessary. I just had to get to the end of my rope, my absolute wit's end, the point where I was truly on the edge of just giving up altogether and EPing for her. I was trying to figure out how I could make my peace with this decision, and I realized that the only way I would ever be able to be okay with giving up on breastfeeding is if I truly KNEW that I had tried everything. And the Lact-Aid was the final frontier. If things didn't work after that, then I would be able to forgive myself, knowing that I had done my very honest best. But only then.

So I took the proverbial deep breath and threw myself into it. And it was tough for a few days, but after that, grew progressively easier - and I saw progress. Real progress. Within 3 weeks she was only taking about 2 ounces per day from the supplementer (I used it at every feed, but only released the flow of the tubing when she was starting to slow down). I kept using it for another week, just to be on the safe side, but really, we had made it. We had crossed over. And it was totally the Lact-Aid - and those who convinced me to try it - that did it.

I'm grateful beyond words that Jennifer can now smile at my stubborn ass. If you're facing anything similar to what we faced, any variation on it - look, DON'T follow my example. Don't torment yourself for months, fearing that breastfeeding will be impossible for you, out of fear of some frustrating feedings and having to learn a new technique. Supplementing at the breast is a godsend in the right situation. Just do yourself a favor and use the superior product, commit to overcoming the learning curve (because you WILL), and go for it. I'm rooting for you!

Monday, January 3, 2011

Pop Quiz! From perky to ptosis: what's to blame?

Which of the following affects the shape and overall appearance of your breasts?

A. Number of pregnancies

B. Age

C. Yo-yo dieting

D. Smoking

E. Breastfeeding

F. A through D, but not E

If you guessed F, ding ding ding, you are correct! This was studied recently, not by a bunch of lactivists, even, but by a group of cosmetic surgeons. Despite the myth that a nursing baby ravages one's bosom of its beauty, it turns out that the most significant changes occur as a result of pregnancy, period, regardless of the infant feeding choices made thereafter.

Age is also a major factor, of course, as gravity gets to all of us, losing and gaining large amounts of weight, which in turn loosens the skin and weakens the Cooper's ligaments which help give the breast its structure, and, possibly most surprising, smoking status is a significant factor as well. For the same reason that smoking causes wrinkles - the breakdown of elastin - smoking contributes to sagging of the breasts, clinically known as 'ptosis'. (Fitting term. Makes me think "ptooie!")

Alas, there is a very pervasive belief out there that breastfeeding, rather than pregnancy or any of the above, directly causes sagging, or otherwise 'ruins' one's breasts. This is especially disheartening when one looks at the perceptions of young women: a survey in the UK found that almost a third of them planned not to breastfeed because they believed it would "ruin the look of their breasts". I don't think it's a stretch to guess that the numbers in the US would be similar.

It's frustrating, to say the least, knowing that the same women who would deny both their babies and themselves breastfeeding due to this myth (especially considering that many of those same women maybe smokers). Add to this the possibility that smoking mothers might also believe that they would be better off formula feeding their babies due to nicotine being passed into their milk. While there is no denying it is far, far better to quit, if a baby IS to be in the household of a smoker, breastfeeding is absolutely still the better choice, as it helps to protect the baby from some of the damage that they would be exposed to regardless. (See for more in this.)

But I digress. Back to aesthetics. I bring this up because of a debate that took place a few days ago. How exactly do we begin to break down what seems to be a deeply-ingrained belief in this harmful myth? Well, one breastfeeding advcacy site, Dispelling Breastfeeding Myths took the initiative and started a volunteer gallery of post-breastfeeding breasts, issuing a call over ye olde information superhighway for submissions from mothers. And some other breastfeeding advocates, like Just West of Crunchy, took issue with this approach.

Where do I stand? I'm going to go out on a limb and say that I see both sides.

Oooooh, courageous, I know. But truly - I understand that this is a serious problem that needs a really assertive approach to start changing public perceptions, and a provocative approach has a lot of appeal. But I also see that there may be some real problems with execution and interpretation, and it IS sadly true that a lot of the furor about nursing "in public" (used in quotes because really, it shouln't ever need the qualifier) is framed by the opposition as the exhibitionism of mothers who just love to use any excuse to, as the phrase goes, whip 'em out.

Once more with feeling: breastfeeding DOES NOT affect ptosis. Pregnancy does, as does number of pregnancies. Age does. Genetics may. A history of SMOKING does. History of large amounts of weight being gained and lost in general does (sometimes associated with pregnancy, but also on its own). But whether or not a woman chooses to USE her existing expanded breast volume to feed her baby does not change the shape of the overall breast. Now, the nipple, yes, it will become somewhat more drawn out. But sagging? It has been studied and dismissed.

So, as I stated in JWOC's comment thread, can we brainstorm? What are some other ways to get the word out that breastfeeding does NOT ruin the shape of your breasts, and moreover, that smoking is far more harmful? Can we come up with a different provocative way to get this message out?

P.S. If you need some more food for thought and visual illustration, check out this gallery of the ravages of smoking on one's appearance. The pictures of twins are particularly potent.

P.P.S. PhD in Parenting has a good post on this study as well.