Why is breastfeeding so hard?

March 29, 2012 · 22 comments

breastfeeding mother

breastfeeding mother

This article (or a version of it) about the difficulties mothers face in reaching a goal of 6 months exclusive breastfeeding has been making the rounds. The most common reaction I’ve seen?

DUH!!

Yes, breastfeeding is hard.

It is a rare and fortunate woman in this day and age who quickly and easily picks up breastfeeding with her first child, and is able to continue exclusively for at least six months. There is a long list of reasons why, including:

  • Common birth practices that can make breastfeeding initiation difficult
  • An interruption of breastfeeding knowledge caused by generations of mostly formula-fed children
  • Lack of cultural support for new mothers and expectations that life should immediately return to normal (and for many, a very rapid return to work)
  • Societal pressure that says “breast is best” but a lack of resources and knowledge for how to make that happen

In this recent article, researchers suggested that in light of all the things that make breastfeeding difficult, the recommendations should be scaled back to something more realistic, so women don’t feel like they’ve failed.

This highlights so well the dilemma of modern motherhood.

There is the “best for society” role — that of public health and what makes the most sense for the human race, and there is “best for mother” role — which is supporting a mother in her choices and needs.

One only needs to spend a few minutes on one of my favorite blogs, Fearless Formula Feeder, to see how these collide with painful results.

We can talk about the benefits of breastfeeding until we’re blue in the face, but the fact is that many mothers will choose an alternative. It might be because formula is their preference, but there are many, many, many women out there who desperately wanted to breastfeed and for one reason or another aren’t able to.

As a breastfeeding advocate and La Leche League leader, this is a really, really delicate line to walk.

I work with new mothers who have difficulty breastfeeding, and if they’re talking to me, are doing everything they can to be successful at it — to either reach the government goal of six months exclusive breastfeeding or another goal they’ve set for themselves. Some moms have minor problems and need some reassurance, but others face larger obstacles – chronic mastitis, chronic thrush, underweight babies caused by undersupply of milk, or babies that constantly pull away from the breast and fight every single session.

How far do I push them to continue breastfeeding? Although almost every breastfeeding hurdle can be overcome, when it’s bad, jumping those hurdles is rarely easy. When is it time to give the mom a hug and reassure her that her baby will be just fine if she has to give them formula?

For me, it depends on the mother. The only way to know is to get to know them, and talk to them, and listen to their concerns. There is no blanket verdict when it comes to individuals — no magic formula that provides an easy answer.

And this is why breastfeeding is so hard.

We are all individuals. We all have different needs, different personalities, and different babies. There isn’t an all-encompassing government recommendation that will work for all of us, and there isn’t an all-encompassing solution that will make it all better, either.

If we want to help women breastfeed, we need to understand the two levels of advocacy — the macro level where it absolutely is best for society if the majority of mothers breastfeed exclusively for six months, and the individual level where we have no idea if that’s the case or not.

At the macro level, there is so much work to do — protecting the rights of mothers who want to breastfeed or pump at work, providing longer maternity leaves, and enacting policies in hospitals that support breastfeeding initiation.

On the micro level, there is also so much work to do — recognizing that “best for baby” and “best for mother” are not mutually exclusive, understanding that a multitude of factors impact a mother’s breastfeeding success, and removing stigmas attached to both breastfeeding and formula feeding so new moms don’t feel the added performance pressure attached to one or the other.

The workings of the human body are mysterious and beautiful things. It would be wonderful if the government could say “this shall be so” and we could all turn on a magic switch to make it happen, but we’re not designed to work like that. Until we recognize the different levels of advocacy and how blanket statements affect real women, we’re going to fall short in providing mothers with the support they need to reach their own goals and breastfeeding goals set by health agencies.

Photo credit: dlisbona on Flickr

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{ 20 comments… read them below or add one }

1 Melanie March 29, 2012

I found breastfeeding very difficult at first. It was awkward and painful. I hadn’t ever been around it so I didn’t even have any examples to look to. I had no family and very few friends around when my daughter was born, and nothing could replace the support of a female for me. It took us weeks to get the hang of it, weeks for her to figure out a proper latch. I cried every time she nursed, bit my tongue until it bled sometimes, but once in a while it would be painless so that kept me going, knowing that it COULD be painless if we just figured it out…

Luckily, I had you, the La Leche League, my doula and midwife and my family and friends just on the other side of my cell phone screen offering advice and a compassionate ear. “Sometimes it just hurts.” That sentence was my rock, I pulled it out and replayed it in my head every time I just wanted to pull out a bottle and cut off my boobs entirely. But I am one of the lucky ones. I had a natural birth with immediate skin to skin, I had support, I had a great supply, I had a baby who did most of the work, and I had 12 weeks of at least partially paid, fully protected, maternity leave from my job so I didn’t have to worry or stress. Without that support I could never have reached my goals and I am astounded that our country doesn’t feel the need to support new mothers and babies; that rich, white women will stand up AGAINST their own sisters for needing that support. That we’re forced to trade biological needs for “equality”. It really breaks my heart.

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2 Hillary March 29, 2012

Well said and I love how you talk about macro and micro perspectives. As a doula I support individual women’s choices. My job is to help inform and give emotional and informational support without judgement. If there’s one thing I know it’s that I *don’t* know what’s best for anyone but myself.

But as a birth activist with various state and national orgs there is a larger systemic system that needs to be addressed and my work on that level is not to be confused with my support of individual women’s choices.

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3 Viri March 31, 2012

I came here from Janet Landsbury’s Facebook page. Thank you for this. I was bent on breastfeeding. Took classes. Watched videos. Read books. Found a pediatrician’s office with a wonderfully kind lactation consultant on staff. Chose a hospital that was very breastfeeding positive. I. Was. Ready.

And yet I found myself, five weeks after my daughter was born, crying in that lactation consultant’s office during what was probably my 10th visit. She hugged me and said, “It’s okay. It’s time to let go and enjoy your daughter.” After trying every “trick” in the book to stimulate my supply, including taking metoclopramide on which I had horrible side effects…I was literally at the end of my rope. But it was like I needed “permission” to let it go. And I don’t know if I’ll ever get over the guilt.

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4 Suchada @ Mama Eve March 31, 2012

Viri, I hope you can let go of your guilt one day. Formula might not be the “perfect” food, but it’s perfectly good food, and babies can thrive on it. You breastfed your daughter for five weeks, which is an amazing start and gave her the liquid gold colostrum and early milk which coated her gut with beneficial bacteria. Every day you breastfed her was beneficial. And then letting go is exactly what you needed to do to be the mother you needed to be to her. Spend some time on the Fearless Formula Feeder page. There are so many healing stories there. I wish I could give you a big hug — there should never be guilt in nourishing your child, and it takes such strength to go against conventional wisdom and say you have a different “best” that fits your individual situation. It sounds like you did exactly the right thing, and I’m so glad you had an LC who supported you in that place. There are many, many more who support you too.

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5 Viri April 1, 2012

Thank you. I was having to supplement almost from the start but I do know that she got at least some of my breastmilk. She has always been incredibly healthy. I will check out the Fearless Formula Feeder page. My daughter is a toddler now and it’s not something that I dwell on, but when I read anything about breastfeeding or see it going on, I always feel a little twinge.

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6 Judi Hall April 2, 2012

I would so like to give you a hug. I was you, 29 years ago and remember so many details. I was very sad and had a difficult time handling the fact that my child had mostly formula. A co-worker told me, “you know, Judi, it won’t be on his college application.” It gave me a bit more perspective. I just knew how important breast milk was and wanted him to have the best. He is a successful young man with a Master’s degree in computer science and doing well for himself. Sometimes things are better with a second baby, but sadly for me they were not. Mothering is so much more than just breastfeeding. I am thankful my children thrived on formula. I wish I could take away the guilt we mothers feel over so many things. It is out of our control most times if the supply does not come in.

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7 Alicia C. March 31, 2012

This is really a great post. I am one of those rare women who never had more than the occasional sore nipple while breastfeeding. I’ve often offered to support any women I know who chose to breastfeed, but it can be hard when someone comes to you with a problem you’ve never encountered!

I have seen many women who tried so very hard to make breastfeeding work for them and their children… but it just didn’t. I remember watching my sister nurse her 4-month-old. The pain on her face, the tense way she held her little one, the way she curled her toes… she went through this every single time he needed to eat. And, he never got a full tummy at any one nursing session, so she was nearly constantly feeding him. He turned out to be tongue-tied. An attempt was made to fix it, but it didn’t work. She finally gave up. She felt so guilty and very jealous of my ability to lift my shirt and stick a boob in my son’s mouth without missing a beat in our conversations.

Many women nurse or don’t nurse for many reasons. I think that, for my part, all I can do is support them in their choices. Many times, formula feeding is NOT mom’s choice, she needs as much support as the mom who is having trouble getting her newborn to latch on.

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8 Mary April 1, 2012

Thank you for this article. I worked on breastfeeding for 3 months. My baby was too small to latch on to my nipples and I kept waiting for her to get bigger. Every breastfeeding session was tortuous. She cried, I cried. And when she started to latch on, she would stay on for such a long time. She wanted the bottle. Finally, I gave up and pumped exclusively for a year. And then I read that expressed milk is not as good as feeding from the breast. What more could I do? It was an awful experience and I honestly did not like my daughter for the first few months of her life. At least I could manage the pumping once I went that route. Now I am terrified of having another child because I don’t know if I could go through that again. If it doesn’t work again, I wonder how I could give the baby formula and go through the pain of having my milk dry up. There is too much pressure on mothers of young children.

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9 syanik April 1, 2012

Viri – I was the same as you. I was hell bent on breastfeeding. I had a ton of support while I was trying. When I finally got to the point where I had tried everything I had read, all the suggestions of my doctor, the pediatrician, the lactation consultant and all of my breastfeeding friends who had much success and it still was not working out. I gave up. I felt awful and guilty (didn’t help that I had one close friend who did her best to make me feel guilty over not being successful with it…many times making a comment that I did not try hard enough). While making the decision to give up, I thought the guilt would never go away.

Then I fed my son formula, and in the first time since he had been born 7 weeks earlier, my child was happy and content (and he started sleeping better because he was actually full… which meant I started sleeping better also). Feeding time felt like the true bonding experience it should have been from the beginning (it had become instead, the most stressful, dreaded part of my day while I was still trying to breastfeed). It was relaxed and enjoyable. My guilt faded away, because while breast is best, formula was the best choice for me and my son at the time. Breast milk wasn’t the only way to give my child the best. That stressed out, teary eyed mommy that would hold him trying to nudge him along at the breast was not the comforting, nurturing care giver I was supposed to be. The stress got overwhelming and in turn was affecting him as well. As much as it pained me to give up, it was best for him and I. With that realization, the guilt slipped away.

You have to look at all the other things you give your child, love, caring, support, protection… breastfeeding is one small part.

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10 justdoit April 2, 2012

syanik, I felt like I was reading my story-the friend, the lack of bonding, the relief for bub and myself to actually get some sleep….. etc. Many years later my friend did apologise. For one my son thrived, didn’t get sick and did extremely well at school. He children did get sick and had learning difficulties. Also she became a lactation consultant and saw over and over the difficulties that some woman faced, that she didn’t and she realised she couldn’t actually help everyone to succeed.

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11 Alexandra April 1, 2012

It was a pleasant surprise to read this post. I had heard that the La Leche League was very hard core pro-breastfeeding and, thus, although it would be nice to have help and support I steered clear because I did not want to be pressured to breastfeed my child to someone else’s standards. If all La Leche League leaders were as open minded as you however I might be interested in joining.

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12 Suchada @ Mama Eve April 1, 2012

Alexandra, LLL leaders have to go through standardized training which includes listening, but the tone of the individual meetings is dependent on the leaders. I know many who have a similar philosophy to me — that we’re trained to help women breastfeed, but we understand that all new mothers need support. I don’t know if I’ve just been fortunate in the meetings I’ve attended, because I’ve heard the same thing as you but haven’t seen it myself. I always encourage people to try it out and see for themselves — with almost all breastfeeding resources, there’s a bit of trial and error to find a good fit.

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13 Fearless Formula Feeder April 1, 2012

Beautiful, as always, Suchada.

I love the “macro” and “micro” discussion. Unfortunately, parenting-related public health efforts tend to suffer from this trap across the board (i.e., the recent backlash against co-sleeping). The “experts” have been trying to tell parents how to raise their kids for ages- and frankly, it was that kind of advice that led to a formula-prevalent culture in the first place. If everyone could look at this volatile subject as clear-headed and compassionately as you do, we’d be much better off…

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14 Donna April 1, 2012

This is brilliant. Recently the breast/bottle ‘debate’ has been reignited here in NZ for a number of reasons, with this study being amongst them. One of the items in the media lately has been a longitudinal study started in 2009 mirrored the Scottish study in terms of women managing to meet the goal of 6m exclusive bf. http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=10793982 Although, astoundingly, the media spun this as ‘well, maybe we should change the recommendations.’

I guess this is where the micro vs. macro thing needs to happen. We don’t need to change the recommendations, but we need to create the environment in which women are supposed to achieve them. And, indeed, we need to take the sole responsibility off women, and place it back into the public arena. Maternity leave, sick leave, flexible work, protection for bf in public etc. are all things that EVERYONE can have a say on.

I think at the moment we have a bizarre thing happening where govts. are recommending bf, women are not finding support for doing it, and then they are demonised for bottlefeeding.

All mothers need support, across the board, for their own individual decisions based on their own individual circumstances.

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15 Alison April 2, 2012

What a thoughtful, sensible approach you have. I wish you’d been around to help me with breastfeeding, and the women you support are really lucky to have you!

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16 Teri April 2, 2012

I appreciate your compassion, and your emphasis on the individuality of all women. You’re spot-on that the real challenge of breastfeeding support is not in some meaningless “breast is best” message spammed over and over again to everyone, but in listening to each woman’s story. I agree with Alison, I wish I’d been lucky enough that 3 out of the 4 LCs I’d consulted with were as willing to listen as you seem to be.

I do have two areas in which I disagree with you, probably because I’m coming from a radically different place than you are. First, your statement that “Although almost every breastfeeding hurdle can be overcome,” is unfortunately not really true, and also pretty unhelpful. Statements like that can really be harmful to the many women who are and never were good candidates for breastfeeding, or their children weren’t. (I realize you probably have seen a lot of cases of women who struggled through extreme challenges to breastfeed–and that’s awesome–but many folks like me would never even get to the level of consulting LLL because our conditions are such that no amount of support is going to change the fact that we’re just plain bad candidates for breastfeeding.) Things like what you said often come from a good place–out of a desire to help and encourage people who are really struggling but who are, in the end, appropriate candidates for breastfeeding (or their children are). But unfortunately the idea that almost all breastfeeding hurdles can be overcome often encourages everyone from health care professionals to regular janes on breastfeeding advocacy sites, forums, and in person to view anyone who doesn’t breastfeed either as someone who let herself be booby trapped out of it, or as someone who is just making an excuse because she was too lazy to try every possible tactic to get it to work. Speaking as someone who was treated that way by a pediatrician and LCs (who cited the “breast is best” mantra to justify what they said and did), I cannot even begin to describe how devastating it was to be treated in such a dehumanizing way, much less to have your precious child treated that way. It is pretty common to be a bad candidate for breastfeeding, and not just for the 1-5% cited (with no real evidence) by breastfeeding support organizations, so I caution any breastfeeding advocate against minimizing issues that preclude breastfeeding because the ripple effect can be like a tsunami to those who suffer it.

The medical reality, which you can see perusing FFF’s Friday submission entries, is that not every woman or every child is a candidate for breastfeeding. This brings me to my second level of disagreement: on the macro level, we really don’t need more of the same–what you put as “the macro level where it absolutely is best for society if the majority of mothers breastfeed exclusively for six months.” It still boils down to “breast is best,” when we know full well that for a lot of people, it isn’t. The macro level that we need is an absolute, ironclad understanding that what is best for society is what you put as your micro level–individualized assessment. Simply put, we need your micro to be the macro, too. We need what you do–listening–to be the norm.

If we pushed individualized assessment as best–taking a neutral stance on breastfeeding vs. bottle-feeding (provided the water supply is clean and the economic issues that might preclude one or both are taken care of) then what would the result be? More women being screened for things like IGT and PCOS before birth, which might look like counseling to help them avoid heartbreak if they can’t nurse exclusively, as well as individualized counseling on how to nurse, pump, and bottle-feed. Women with underlying medical conditions (anything from auto-immune disease to a strong family history of food allergies to a history of back pain) presented with information that will help them decide what is best for their families and then education on how to achieve their personal best. Women who work jobs or in industries that are difficult to juggle with breastfeeding (e.g. independent contractors, women who don’t work in knowledge-based office jobs, women who are in the entertainment industry or other high-pressure, time-sensitive industries) getting individualized help so they can determine their personal best and how to achieve it. In short, women getting individualized infant feeding counseling on an individual level BEFORE even giving birth.

I believe wholeheartedly that the recommendations should be changed–because we’re only short-changing women when we recommend that all women strive to breastfeed. It’s anti-feminist because it denies the ability of women to decide for themselves what is best for themselves and their families. It is unethical because it denies women and children proper medical care (numerous examples of which you can see on FFF’s blog)–the “breast is best” macro is completely contradictory with the truly excellent micro you describe, so how can health care professionals practice medicine properly under such a dichotomy? And it’s unrealistic because it denies the true biological diversity of humanity, which only encourages subtle or overt discrimination against people because of their individual circumstances.

I feel we’d be better off approaching breastfeeding on the macro level like we do optometry. We wouldn’t dream of telling everyone “perfect vision is best.” We wouldn’t dream of seeing glasses, contacts, and surgery as merely the result of a failure to educate people properly, or as if Bausch & Lomb is out to trap everyone into using their contact lens solution. Obviously, it would be great if everyone could just see effortlessly, but we know life is more diverse and complicated than that. So the best macro for peoples’ eyes–the best macro for society–is if everyone gets individualized, routine care for their eyes that catches problems as early as possible, treats biological differences without moral judgment, and recognizes that the worst possible outcome for society is when we try to pidgeonhole everyone into one standard of care.

Your micro level description of breastfeeding quite honestly made me want to cheer. As I said, I really wish I would have had that kind of micro-level support from the professionals I consulted with. Even though the outcome would have been the same–breastfeeding was not an option for me–I would have been spared the terrible heartache I felt until I discovered FFF and the wonderful community she’s fostered. I commend you for not having the blinders on that others in the breastfeeding world seem to have, and hope that you can keep supporting people with the obvious respect for their individuality that you’ve shown in this article.

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17 Suchada @ Mama Eve April 3, 2012

Hi Teri, I had to spend a long time absorbing what you said. I appreciate your perspective, and I think I understand where you’re coming from, but I think we just see this from two different places. When I say that most breastfeeding problems can be overcome, I mean that most women are physiologically able to breastfeed. This excludes medical contraindications, and doesn’t take into account support, lifestyle (whether chosen or by circumstance), and a particular “it” factor that is intangible. It’s obviously a difficult thing to talk about in a space like this, because it’s like speaking to an auditorium — how to you share a story about a military mother who breastfed her child for two years even though she returned to work after eight weeks and was deployed for six months (she pumped and shipped her milk) as an example of how breastfeeding can be successful in almost any circumstance without making the stay-at-home mother who stopped pumping after two months feel like she failed? Part of what is difficult for many women is the idea that the difference between the two cases is how hard the mother tried, but I don’t think that’s the case at all. Breastfeeding is a complex behavior that’s influenced by too many factors for it to simply rest on the shoulders of an individual mother. If anything, I think the recognition that most women should be able to breastfeed but many can’t even though they want to should send up alarm bells for us as a society.

As for my macro-level thinking, I get where you’re coming from in saying that making a proclamation about what all women should do is harmful. And in that, I agree. Still, I believe that having the majority of women breastfeeding is good for society. I don’t think “Feed your baby” should be the standard we strive for. Breast milk is the biologically normal food, and it’s a biologically normal process that occurs after giving birth. I don’t think it’s a good thing to have the majority of mothers depend on a food that requires labs, factories, warehouses, and supply chains. My worldview (which I know is not the same as everyone else’s) is that allowing our bodies to do what is biologically normal is a good thing — and for me, this extends beyond breastfeeding to birth, nutrition, exercise, and almost every other part of our lives.

But you have me thinking about the “macro” level a lot more, and I’m not sure what the right answer is. I fully support women who choose not to breastfeed, because trusting women to make their own decisions about their bodies and ensuring all new mothers receive lots of support is more important than whether or not individual mothers breastfeed. But at the same time, I see how much breastfeeding knowledge has been lost in a couple of generations due to widespread formula use. It’s not something that there is an easy answer or easy fix for, especially since it’s hard for many people to see beyond black and white.

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18 Jenny April 2, 2012

Lovely piece. I also totally agree with Teri, who posted above. Thank you both!

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19 Amanda April 3, 2012

Great article. Wonderful comments too. I have to admit my head is spinning a little bit. I breastfed my oldest until she was 18 months old. (The benefits for both of us were huge, but I did not realize this until years later.) For *some reason*, I let societal pressure I felt decide that I wouldn’t breastfeed for this amount of time again. With my second child, I introduced formula right away so that I would have that option as well as breastfeeding. This of course meant less milk production. I breast (and bottle) fed him for 8 months. For my third child, I had realized the benefits of solely breastfeeding. But we were in the middle of moving across the globe, and my milk supply was gone after all of the driving which included not stopping and handing bottles to the backseat. I breast (and bottle) fed her for 5 months. She is 12 months now, and I wish I had that breastfeeding time with her. If and when I have another baby, I want to go back to solely breastfeeding for as long as I can. There are many reasons some women cannot breastfeed. There are also many reasons some women won’t breastfeed. *The reason* I strayed from something so naturally great was that I let a societal attitude I was feeling win over what was best for me and my babies.

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20 Snorkel April 22, 2012

I, sorry, but your list of why breastfeeding is hard is a bunch of baloney.

Breastfeeding is hard because a tiny little milking machine is gnawing and sucking for dear life on your sensitive nipples every 2 to 3 hours.

This means
- you have sore, raw and bleeding nipples
- don’t get a lot of sleep, especially if they take a long time to burp after a feed, meaning you have to go again almost as soon as you’ve finished the cycle
- feel like a life support system instead of being an independent person
- the baby is learning as much as you are and can take weeks to settle into a gentle pattern

Bretfeeeing is ACTUALLY HARD. You can’t blame hospital birth or not being breastfed, or breastfeeding not being ‘normalised’. Breastfeeding is very normalized here in Australia, and guess what? It’s still hard.

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