3.4.10: If Breast is Best, Why don't we do it?
The American Academy of Pediatrics recommends women exclusively breastfeed for the first six months and continue breastfeeding (while introducing solid foods) for a full year. Hands down, breastfeeding provides the best nutrition and immunity support for babies and endless health benefits for mothers. Breast is best and most women start out strongly committed to doing their best. And yet, the majority won’t make it to six months.
Why do so many well-intentioned women quit breastfeeding? The top reasons relate to pain, work, low milk volume, illness and lack of support. When it hurts, you have to work, your baby is screaming for more milk than you’re making, you get the flu and people keep saying “just give that kid a bottle;” eventually, giving that kid a bottle seems like a good idea.
If, however, these same women were offered support from a lactation consultant (a nurse-expert in breastfeeding) and fully supported by their families and employers to breastfeed, they’d continue at least six months. Developed countries aren’t so great at supporting breastfeeding mothers. We’re pretty good at sending them out the delivery room doors breastfeeding but once they get home, not so much. According to the Centers for Disease Control, almost 74% start out breastfeeding but only 43% are still at it at six months and only 33% are exclusively breastfeeding at even three months. We expect our mothers to recover, bond, adjust to sleep deprivation and life with a baby on board and then, get back to work.
In other countries, mothers aren’t expected to return to work within a few short months. They’re expected to feed their baby. They’re well supported get past some of breastfeeding’s rough patches. Here in the US, when the going gets tough, we say, “give that kid a bottle.”
At the risk annoying staunch breastfeeding advocates, I think formula has its place. Sometimes (and it should be the exception, not the rule), the only way to manage is with a little formula. Most American women can’t stay home from work for a year. They don’t have an arsenal of aunties to help them breastfeed. If something’s got to give sometimes that means a bottle. Let’s not be judgmental, shall we? It’s formula, not whisky. I breastfed all my kids the full year (while working), except my youngest. She got three months then I got chemotherapy. Judgmental women who made “breast is best” comments and gave me the stink eye when I gave her a bottle in public were unintentionally cruel. One even suggested I’d be a “better mommy” if I delayed cancer treatments so I could breastfeed longer. Idiot.
Stories like these from friends, patients and readers are all too common and represent the challenges many women face when trying to breastfeed exclusively:
Sara’s baby is four months old and is exclusively breastfed and Sara is a freaking’ hero because it’s been a non-stop marathon of trouble. She’s seen lactation consultants nine times with recurrent yeast infections and cracked nipples. Sara returned to work last month and pumps several times per day to keep her milk supply up and her freezer filled. Sara’s a lucky woman. Her insurance covers lactation consults. Her employer is supportive and doesn’t give her any flack about pumping. That’s not how it is for many women.
Desiree is breastfeeding her 5-month-old because her boss lets her have an extra 15-minute pump break. Desiree’s boss knows it’s the right thing to do and wants to be supportive but a few employees have voiced resentment and that makes Desiree’s work environment uncomfortable.
Jackie’s thinking about giving up because the only private place to pump is a bathroom shared by all her co-workers. The first day she hooked up her electric pump, she over heard good-natured joking that it sounded like a vibrator. Jackie’s coworkers are essentially supportive but Jackie feels bad about hogging the bathroom and a little embarrassed.
Monesha got the flu when her son was six weeks old. She got dehydrated and at the same time her baby was going through a growth spurt. She struggled to keep up milk production. She also had a 4-year-old son and no daytime help. Her husband convinced her to let him give the baby some formula at night so she could get some badly needed sleep. It was a nice idea except she didn’t have a decent breast pump to keep her breasts stimulated. Her milk supplied dwindled, her baby became more frantic and eventually, formula was just easier.
Most of the time, formula isn’t the answer. Patience, commitment, good health care, lactation consultants and liberal employment policies are. As bosses, friends, coworkers and family members, we have to get over our embarrassment and any inconvenience it might cause and commit to being the village our mothers need. C’mon, people, a girl can only take so much stress and still be expected to make milk. She’s feeding the next generation.
Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children.
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