Is Breast still Best at the Expense of Mom’s Mental Health?

by Nadiah Mohajir & Hannah El-Amin

To breast feed or bottle feed? Perhaps one of the most emotional – external and internal – dilemmas facing new mothers these days. Every few decades, new research comes out promoting the benefits of one or the other. I was born to a generation of mothers who were told that bottle feeding was superior to breast feeding, while my daughters were born to a generation of mothers who were told the opposite: that breast is best. In fact, we now live in a time during which workplaces, public spaces, and society in general are being encouraged to not only embrace breastfeeding, but enable and make it accessible and easier for all mothers who want to commit to the practice.

While there is always room for improvement for breastfeeding to be even more accessible and acceptable, it is hard to deny that it’s a great time for breastfeeding moms. One cannot also deny the benefits of breastfeeding: research shows that babies who are breastfed have greater immunity, decreased risk of obesity, increased IQ scores, along with benefits to the mother with decreased rates of certain cancers. Additionally, breastfeeding is highly encouraged in Islam and has spiritual and religious benefits as well. It is indeed true, breast is best. But what many breastfeeding advocates forget to add to that well known slogan, is that breast may only be best, under ideal circumstances. In other words, is breast really best if it comes at the expense of mom’s mental health? Moreover, has breastfeeding become the standard for what defines a “good mother?”

Despite the increased accommodations many work and public places are making for breastfeeding moms, keeping up with pumping can be exhausting. Add in work and home obligations, other older children the mother may have in addition to the baby, sleep deprivation, unsolicited advice from others implying that the baby is not getting enough, and anxiety and depression, not being able to keep up with breastfeeding often adds to a mother’s feelings of inadequacy, and pushing moms to great lengths to keep up with what is “best” for their baby. What results, more often than not, is that mothers – who already have this enormous responsibility to love and care and raise their baby to the best of their ability – conflate the pressure with keeping up with breastfeeding to being a good mother.

Motherhood and all that comes with it is not meant to be easy. Yet, doctors are seeing too frequently mothers who are coming in not only sleep deprived, but those dealing with chronic nipple pain, around the clock pumping, and severe anxiety and depression. A number of women have shared with me – both in my personal capacity and professional capacity – the guilt they are carrying with them when they realize their bodies (and sanity) can literally not sustain breastfeeding. Many have shared that they question the return on investment – despite continuous pumping, their bodies are not producing enough to sustain their baby. As told in this article, many also shared their regrets: that perhaps the hours spent pumping may have been better spent bonding or playing with their babies.

And so it is important to consider the following question: While breast is indeed best, does this theory consider the realities of being a new mother, especially if the mother is juggling multiple obligations such as work, home, and other children? My experiences with breastfeeding were different with each of  my children:

• My oldest was born when I was just 23. I left my job and focused on being a mom. I exclusively breastfed her for a whole year. She hated breast milk through a bottle.
• My second was born four years later, as I was finishing up graduate school. I began breastfeeding her and bottle feeding her breast milk. She went back and forth from bottle to breast beautifully, with no issues. Yet, we quickly discovered she had a milk allergy, and so her pediatricians gave me two options: special formula, or eliminating dairy from my diet. I decided to introduce her to the formula to get her used to the taste, while eliminating dairy from my diet. That dairy-free diet resulted in me losing so much weight I was under 100 pounds and had no energy by the time she was 6 months old, due to the dairy-free diet and my excessive pumping. I eventually gave in and switched her to formula full time.
• My third was born when I was 31. He had horrible acid reflux and therefore cried most nights, and I had two older children in two different schools therefore was spending a lot of time in city traffic, and was also working close to full time. He was on breastmilk and formula from the beginning, and weaned himself when he was close to six months.

While anecdotal, these experiences demonstrate that it’s important to consider the unique circumstances with with each baby. It is no surprise that what I was able to offer at 23 as a stay at home mom was different than when I was older and had additional responsibilities. Often times, when mothers come to me and share their guilt of not being able to keep up with  breastfeeding, I encourage them to reflect on the following questions:

• What are the other obligations I am juggling along with breastfeeding (work, other children, housework, volunteer obligations, family obligations etc)
• Is my baby loved? Is my baby safe and happy and healthy? Am I bonding with my baby in other ways?
• Is keeping up with breastfeeding/pumping interfering with my physical and mental health?
• Is keeping up with breastfeeding/pumping interfering with my baby’s physical health (not gaining enough weight, etc)
• Is keeping up with breastfeeding/pumping interfering with  my ability to meet the needs of my other loved ones, such as my husband or other children?

Many times, the answers to these questions lead to the mother asking: is breastfeeding worth it? The science is clear: the benefits of breastfeeding are incredible and doctors and public health campaigns should definitely promote it to increase the numbers of breastfeeding moms. Yet, it’s important to also remember that often times, these messages are promoted in such a way that breastfeeding becomes synonymous with good mothering. And while there are many benefits to breastfeeding, the most important one being nutrition, let’s remember that at the end of the day, nutrition is just one aspect of good mothering, and there are many options available to nourish an infant and many ways to bond. It’s important for health care providers, nutritionists, lactation consultants and mothers to work together to find the balance that is best for the baby – and mom – at hand.

Finally, if you find yourself struggling, but want to keep with the goal of breastfeeding exclusively, consider these:

• Know you’re not alone. Find a friend you can talk to who’s been there or local or online parent support group.
• Find a way to break free for a bit. Even if it’s just going out for a walk, especially early on when feeding demands are highest.
• Make feedings pleasant. Indulge in a show. Keep some treats nearby. Light a candle. Put your feet up. Listen to audiobooks or music.
• Take care of yourself first. It’s ok to let you little one wait a couple minutes while you finish eating. Nourishing yourself means nourishing him/her.
• A little help can go a long way. Consult with a lactation consultant if you have ANY discomfort. Breastfeeding isn’t supposed to hurt. Insurance often covers this.
• Treat yourself. You’re saving a ton by nursing. Treat yourself to that hands free pump, or something totally unrelated to nursing. Pumping can be passive and less stressful with products like Milkies, Freemie and other cool gadgets.
• Be proud. Know that you should feel nothing but pride for whatever amount of breastfeeding you’re able to accomplish. You’re doing a great job. Know that you can choose to ignore and advice or criticism that doesn’t come from a professional.