Pressure to Breastfeed, From inside or out?

Published first on KevinMD on Feb 7, 2021.

I had very difficult experiences breastfeeding both of my children.  I had constant pain, recurrent plugged ducts, and a lot of latch problems.  There were many times when I considered quitting, but I persevered because it meant a lot to me, and I would have felt like I was failing had I stopped.  Does this sound familiar?

I’ve been thinking about this a lot lately.  There has been a huge pushback in the last few years AGAINST exclusive breastfeeding, with one of the reasons being that public health campaigns such as the Baby Friendly Hospital Initiative (BFHI) are putting pressure and guilt onto moms to keep going, fight through the pain, lose sleep to pump as much as possible, even to the detriment of mom’s own health.  And while I admit that the BFHI has not been perfect (and is in the process of being revamped to make it more “mom and baby friendly”) this pushback has not been sitting well with me.  I completely agree that there should be no pressure put on moms, but why are so many people blaming the BFHI and lactation professionals for putting this pressure on moms?  

In my case, I am quite certain that all the pressure was my own. Yes, I was informed by others about how valuable and beneficial breastmilk is to babies and how breastfeeding has so many health benefits for moms.  Should I not have been given that information?  Those things certainly provided the underlying reasoning for wanting to breastfeed.  But I'm a type A physician, and I was determined to meet my own goals, regardless of how I had come to them.  Nobody else forced me to do anything. 

Regardless of the fact that it doesn’t always work out perfectly, the benefits of breastfeeding cannot be debated.  They are backed by science.  There are benefits for both moms and babies.  And I do think it is important for new moms to be aware of these benefits and that each mom’s breastmilk has its own little recipe that changes day to day, moment to moment, in order to provide the nutrition that will benefit your baby at that particular moment in time.  

Does the fact that there are things about breastmilk and breastfeeding that make it nutritionally optimal for babies make formula evil?  Not at all.  Thank goodness we have formula.  It is lifesaving.  It is there when we need it, whether for medical reasons or plain old personal preference. 

Does providing information on these benefits inherently force or pressure moms to breastfeed?  No.  Would we not recommend car seats or seat belts because people may feel guilty if they choose not to use them?  No, we want to be able to make an informed, educated choices in our lives, and campaigns to raise awareness of the benefits of breastfeeding do just that. 

What could have changed my own experience? More support, for sure.  More physicians educated about breastfeeding so that they could better support me. I did see a number of IBCLCs who were able to support me with my first baby. But with my second, they were at a loss to help with my particular issues. It turned out, I needed physician-level care, but I didn’t know that existed! If I had known there were Breastfeeding Medicine physicians within a 2-hour radius, I would have happily driven that distance to get some help. I was a breastfeeding-supportive physician working on my IBCLC, and even I didn't know that "Breastfeeding Medicine" doctors exist.  Knowing what I know now from my Breastfeeding Medicine education, there are definitely things I could have done differently that may have improved my experiences (though I want to emphasize that no matter how much support we receive, we still may not always be able to reach our goals). 

When I see moms who are struggling, many say that they just wish they had known how difficult breastfeeding could be before their baby was born.  Funny that we still have these magical images of perfect, dreamy breastfeeding relationships that click from the first moment.  I have found that it rarely works out that way, and helping moms set appropriate expectations could help quite a bit to minimize the letdown (pun intended) that can come when things don’t work out the way you had planned.  Medical professionals need more breastfeeding education so that moms can get support and knowledge every step of the way – including prenatally.  Ideally, moms at risk for breastfeeding problems need to be identified early in their pregnancy, so that they can consult with breastfeeding professionals to help come up with a plan for when the baby comes, and also develop reasonable and flexible expectations. 

I understand where the culture of blaming the breastfeeding community (IBCLCs, medical providers) for putting pressure and guilt on moms in order to get them to work so hard on breastfeeding that sometimes they forget to take care of their own physical and mental health.   But I don't think it helps to vilify the very people who are trying to help women achieve their breastfeeding goals - goals they have come to themselves based on very real evidence that breastfeeding has very specific health benefits.  Most of us moms are pretty hard on ourselves, even more so in this day and age of social media, when it sometimes seems that everyone around us is happier, luckier, more successful than we are at just about everything. 

We need to change the system.  We need more breastfeeding support.  We need more breastfeeding education in the medical profession.  We need more TIME in our clinics to help the moms and babies that need help.  We need to normalize breastfeeding, but in a way that also stresses that breastfeeding is not what makes a mom a mom, and it’s OK to make the choices that make the most sense for us and our families.  That is what being a mother and a parent is truly all about.