One of the most common push backs that breastfeeding advocates face is the idea that we should not encourage breastfeeding because we will make mothers feel guilty if they ultimately feed their child formula. Despite having heard it time and again, it’s an argument that still baffles me.
As a Pediatrician I provide my patients with evidence-based advice and counseling at every visit. I repeatedly suggest that parents quit smoking while evaluating their children. Teens regularly suffer through my sex talk; heavy on self-respect and condoms. And if that teen is using illegal drugs, they receive an unambiguous statement from me that their choice is medically unwise and unsafe. Every new parent is told to put his or her baby “back to sleep” and always travel in a car seat. Never is there an outcry that I could be making the patients or parents feel guilty about these choices.
Just like anti-smoking and back-to-sleep campaigns, medical evidence supports the unambiguous medical recommendation that all mothers breastfeed. Yet, if I strongly recommend breastfeeding and discuss the well-studied health risks of formula with a new mother, I have crossed the line and will be responsible for her guilt should she formula feed. As an aside, doesn’t every psychologist hold to the truth that no one else can make a person feel (fill in the blank) guilty, sad, happy and so on? Aren’t we responsible for our own emotions? More importantly, why is an unambiguous medical truth forbidden or at least restricted when the topic is breastfeeding?
Here’s why. Formula manufacturers have successfully established formula feeding as a choice and a mother’s right. They have created the perfect set-up for guilt. Their slick “closest to breastmilk” advertising and their endless unfounded and borderline illegal bragging about the health benefits of their products have confused most parents in the USA. Frighteningly, they have even been successful in convincing some physicians that formula is as beneficial as breastmilk. A mere 100 years ago formula was not an option. Non-breastmilk feeding occurred only in extreme circumstances. Those infants usually ended up malnourished, ill, and often died. Despite the horrendous outcomes of bottle-feeding, back then, guilt was not part of the discussion because it wasn’t advertised as a choice, it was done out of necessity.
Modern formula is appropriate or even ideal in certain circumstances. In cases of adoption, galactosemia, maternal street drug use, and other scenarios formula is a critical and lifesaving medication. But like any medication it should be used only when there is a clear indication. And like every medication there are risks. In fact, formula caries a wide array of very serious, undesirable, risks.
No one can make someone else feel guilty. But, a person can and usually does feel guilty when they determine they have made a “bad” choice. Mothers don’t intentionally make a “bad” choice to formula feed. They are making a decision based on the information they have; the information formula companies have given them. Mothers generally do not breastfeed because they were never educated on the risks of formula coupled with inadequate support for breastfeeding. Instead of guilt, mothers should really feel anger or frustration that they have been deceived. Mothers need to be helped to move from guilt to anger, preferably an anger that they can use proactively for themselves and/or others. Anger that they weren’t told about the countless health and financial problems formula causes. Anger that instead of education and support they encountered roadblocks, misinformation and downright bad medical advice. Frustration when her employer obstructs breastfeeding. Anger that society perpetuates negativity towards this essential and normal behavior. And finally, frustration when unsupportive (which really means uneducated) family members discourage or thwart breastfeeding.
So no, I am not going to stop advising mothers and families to breastfeed their newborns for fear of causing guilt. I am going to hope that I can educate another patient to live a healthier life with a healthier baby.
Dr. Laura Sinai is a pediatrician in North Carolina. She serves as NC Chapter Breastfeeding Coordinator for the American Academy of Pediatrics and chair of the North Carolina Breastfeeding Coalition.