The “Breast is Best” campaign began as a way to encourage mothers to breastfeed when doing so had fallen out of fashion. It happened amidst the Nestle scandals that were forcing formula onto families in developing countries who couldn’t afford it, and didn’t have access to clean water. It was about empowering women to use their own natural abilities to feed their children and it was begun with good intentions. It is obvious to me now that the movement has gone too far–the pendulum needs to come back to the center if we are to properly support new mothers and truly care about their well-being and mental health. “Baby Friendly” hospitals are becoming hostile to mothers. I don’t think this is what the “Breast is Best” movement intended. But we find ourselves in a situation where vulnerable new mothers, in the hours after birthing, have to sign a waiver showing that they understand the drawbacks of formula and the risks associated with choosing not to breastfeed. They are made to feel that formula is a poison that will have long reaching negative health effects for their infants. They are given overblown information from lactation consultants and prenatal education facilitators about the magical health promoting benefits of breast milk. In her book Lactivism Courtney Jung eventually concludes that, when properly prepared, formula is very nearly as healthy as breast milk for a developing infant. While breast milk may help to prevent a small number of colds and other minor illnesses in a huge population, most other health benefits are vastly overestimated. If you breastfeed your baby for two years you might help to prevent one cold or one ear infection, but that’s about it from a medical perspective. Undoubtedly breastfeeding can be a beautiful experience that helps a mother bond with her baby, but you can bond with your baby just as well through bottle feeding. The term bottle nursing is a lovely one that suggests giving a baby the same focused attention during bottle feeding as you would during breastfeeding.
In my own prenatal course I was repeatedly given the information that “if you can make milk, you can make enough milk” which is an out an out lie. Research suggests that somewhere in the region of 5% of women are physically incapable of producing enough milk and that number might very well be low. We know that exhaustion, dehydration, and inadequate nutrition can lead to low supply as well. There haven’t been enough proper studies to corroborate that estimate and the number doesn’t account for women who can’t breastfeed due to the medication they are on, or because breastfeeding is having a negative impact on their mental health, or due to physical roadblocks like recurring mastitis. There are dozens of reasons why a woman may not be capable of breastfeeding or why she may choose not to breastfeed. Sexual assault survivors often choose not to breastfeed because the act of doing so brings up intense negative feelings and can increase symptoms of PTSD resulting from their trauma. Imagine being a victim of sexual assault who is choosing not to breastfeed so as to avoid flashbacks to their victimization and then being forced by hospital staff to sign a waiver showing that you understand the “risks” of breastfeeding. This has all gone to far and it’s time for hospitals and perinatal healthcare providers to do away with the “Breast is Best” and “Baby-Friendly” initiatives altogether. It’s time to move towards new rhetoric: Fed is Best. If we don’t make a shift we can expect to see more cases like the tragic story of Florence Leung.
Florence Leung was a young mother living in New Westminster, just outside of Vancouver, BC. She suffered from postpartum depression and took her own life. Her husband has now taken to social media to report that deep feelings of inadequacy that stemmed from Florence’s inability to exclusively breastfeed were a major contributing factor to her depression. In the Global BC news clip in the previous link there is an interview with a lactation consultant who is asked what should be done to better support women around breastfeeding. The lactation consultant first references her own experience, which involved “every challenge in the book” but still resulted in successful breastfeeding after much effort, and then goes on to suggest that “combination feeding” might be a good solution for women who can’t exclusively breastfeed. Combination feeding might work for some, but it isn’t the only answer. This interview does not go nearly far enough in normalizing formula feeding. We need to come out and say this loud and clear so that every new mother can hear it and believe it fully: IT IS OKAY TO EXCLUSIVELY FORMULA FEED YOUR BABY. We need to stop tiptoeing around this issue immediately. A baby needs a healthy mother far more than it needs breast milk. There are many diverse reasons for choosing to exclusively formula feed and it is totally valid, safe, and healthy to do so. At it’s outer extreme the “breast is best” movement is proving deadly. Women like Florence Leung who believe themselves to be failed and inadequate mothers because they were unable to exclusively breastfeed are at risk for major mental illness and possibly suicidal behaviour. While suicide is a very rare outcome, the “Breast is Best” movement is still contributing to deep unease in new mothers, intense feelings of guilt and despair, belief that we are not good mothers because we failed to give our infants breast milk, and grief that can last years.
My own inability to exclusively breastfeed my first child was a key issue contributing to my three year battle with postpartum depression and anxiety. I had a lactation consultant who drove me to my physical limits trying to force me to produce milk. It felt like an assault on my mind and body. Two out of every three hours, 24 hours a day, for six weeks were spent feeding my baby, pumping milk, and using a supplemental nursing system to give top ups of donated breast milk. I was driven to exhaustion and despair and when my unbelievable efforts failed, after I had taken every last drug and every last herb and used acupuncture and had seen two lactation consultants and I was STILL only producing 50ml of milk at each feed, I fell into a deep depression. When I had to give my baby formula I felt that I had failed him in the most fundamental way. I still believed that the failure was somehow my fault and still, five years later, I can be driven to tears thinking about that time in my life. It could have been my body found in the water. Thankfully I accessed help, but not everyone is that lucky. Florence Leung was not that lucky.
“Breast is Best” has failed. It has not protected mothers or babies. Florence Leung’s child is not getting the “best” by not having his mother. And her husband has been left devastated and bereft of the partner he loved.
If medical institutions really want to do what is best for mothers and babies then they need to be flexible enough to meet every mother where she is and help her to find solutions that serve her individual family. For some this will mean exclusive breastfeeding, for others combination feeding, and for others exclusive formula feeding. We need to stop saying that one solution is fundamentally better than another. “Breast is Best” takes a complicated, multi-faceted issue and condenses it into a pithy statement that paints every mother with the same brush. It needs to stop now.
Thankfully organizations like Pacific Post Partum Support Society are taking a stand when it comes to supporting women no matter how they decide to feed their babies. In this CBC news article “Sheila Duffy, director of the Pacific Post Partum Support Society, says she hears of breastfeeding difficulties from a lot of clients and it can be associated with feelings of failure.She told B.C. Almanac host Gloria Macarenko that if breastfeeding is causing undue stress, the mother might be better off stopping or supplementing with formula.”There’s so much pressure on new moms to be doing a perfect job, and so we want to see how we can really support moms and have a bit of gentleness around all of that,” she said.”If we keep saying ‘breast is best’ then people are going to feel terrible if that doesn’t work out.”
Please feel free to share this post widely. Talk to people. Talk to your healthcare providers. If you are pregnant or a new mother know that no matter how you feed your child you are caring for them to the very best of your ability. It’s time to make a change and we can all be part of the solution. Push back is already happening. The Fearless Formula Feeder blog gently supports formula feeding mothers. A different experience is possible for families.
When I gave birth to my daughter six months ago I promised myself not to go through breastfeeding hell again. I tried to breastfeed her, but ended up supplementing with formula on the second night of her life. I suffered from similar low milk supply issues to my first baby. My midwives, thankfully, were supportive of my decision to let breastfeeding go and checked in with me regularly to make sure I was feeling secure about my feeding choices. They offered exactly the nonjudgemental support I needed to stay mentally stable. By her third month I was exclusively formula feeding. It was absolutely the right decision for us and, so far, I have avoided a recurrence of postpartum depression. But despite my greater knowledge, my confidence in my choice this time, and my openness about my first horrific breastfeeding experience, people were still very judgemental about my decision to stop breastfeeding. The myth remains strong that breastfeeding is the best, and ultimate way, to feed your child and prove that you’re a good mother. No more. We need to drag this lie into the light, interrogate it viciously, and prove to ourselves that Fed is Best. If you are feeding your baby in a clinically safe way then you are a good mother. End of story.
P.S. Okay perhaps not quite the end of the story! A quick addendum based on some feedback I’ve received: I would like to add, for the sake of complete clarity, that I am in no way condemning breastfeeding mothers. I completely support the right of any woman to breastfeed and hope that all mothers have access to good quality and timely breastfeeding support if they need it. Breastfeeding can, in some instances, be protective against postpartum depression, but only if a mother wants to breastfeed and then is subsequently successful in doing so. If you are a mother who wants to breastfeed and then, for whatever reason, finds herself unable to do so, the risk of postpartum depression increases. This probably has a lot to do with the above stated pressures around breastfeeding. My greatest wish is for all mothers and their families to be supported in making feeding decisions that are right for them, without judgement or shaming. I want all families to have access to good quality research and information about feeding methods, and I want everyone to feel that their choice has been freely made and supported by the medical professionals to whom they have entrusted their care. I would love to see a medical system that provides relevant education in a variety of feeding methods so that families can be given advice that fits their own personal needs and circumstances. This article is not meant to be divisive! Entirely the opposite, in fact. I want all mothers to stand together and support each other, upholding the unifying notion that Fed is Best.