Is breastfeeding promotion bad for mothers?
That’s the provocative question behind the headline, “Breast not always best for mums,” reported at http://www.stuff.co.nz, a New Zealand news site. The article reports on recent research by psychologist Leanne Taylor-Miller. Taylor-Miller set out to study cesarean birth, and she found that 8 of 32 women interviewed were psychologically distressed by their experiences with breastfeeding.
One mother has dubbed midwives and health workers “the breastfeeding Gestapo” while others have spoken of being left broken-hearted, and feeling they have failed as mothers.
Tayler-Miller suggests that it’s time to rethink the way we talk about infant feeding:
I understand why breastfeeding is promoted. However, I think it needs to be acknowledged that there is potentially a significant negative impact on women who cannot breastfeed, and I don’t feel that’s been addressed. I think that is potentially a big problem.
There are some limitations to this research – first and foremost, all 32 mothers had cesarean births, and breastfeeding difficulties may be less common among women with vaginal births. All mothers gave birth in 2005, and changes in support for breastfeeding mothers may have addressed some of these problems in the past 6 years. But after reading a related discussion on an Australian mothers’ bulletin board , I was convinced that she had hit a nerve. I couldn’t help but wonder whether we need to refine the way we talk with mothers about breastfeeding.
We should not change the public health message that breastfeeding is the physiologic norm. Soft-pedaling medical advice because we might hurt someone’s feelings is patronizing at best, and unethical at worst. Further, backing away from evidence-based medical recommendations for 6 months of exclusive breastfeeding gives policy makers permission to cut back support for mothers and families.
In so many cases, a terrible breastfeeding experience is the downstream effect of subpar maternity care, unsupportive family and friends. poor medical advice, and unrealistic expectations of motherhood. If we start saying that breastfeeding doesn’t really matter, we lose our argument for tackling these booby traps and enabling more mothers to achieve their infant feeding goals. Changing the medical facts is losing proposition.
But there is a major difference between a public health message on a billboard and a conversation between a struggling mother and her medical provider.
In routine care, we need to ask each mother how she feels about how feeding is going, and then we need to take time to listen to her response. And if, for this mother, and this baby, extracting milk and delivering it to her infant have overshadowed all other aspects of their relationship, it may be that exclusive breastfeeding is not best for them – in fact, it may not even be good for them.
We also need to recognize that breastfeeding distress may be a symptom of postpartum depression, a common, underdiagnosed and incredibly morbid problem affecting 1 in 10 new mothers. Postpartum depression is characterized, in particular, by anxiety and guilt. And there’s ample evidence that women with symptoms of postpartum depression have more negative infant feeding experiences and wean earlier than women who are not depressed.
A mother who is depressed, overwhelmed with motherhood, and feeling guilty at baseline will no doubt feel particularly persecuted by a “breast is best” message — and, indeed, she may assume that breastfeeding, rather than depression, is the root of the problem. The treatment, however, is not to tear down the billboard. What she needs is psychotherapy and/or medication to treat the underlying depression – and to create the emotional space to determine whether, as her depression is treated, breastfeeding is helping or hindering her relationship with her baby.
That emotional space can be difficult to find in a world where formula samples show up on doorsteps with alarming regularity in the first months of new motherhood, and where the formula industry has co-opted generations of physicians and nurses into believing that breastfeeding encouragement “makes mothers feel guilty.”
This formula-industry-underwritten expectation of failure makes it complicated for those of us on the front lines of breastfeeding advocacy. It can be hard to discern whether we are honoring a woman’s informed decision to wean, or abandoning her when she most needs our encouragement to keep going. And there’s a sense that if we admit that sometimes, breastfeeding doesn’t work out, we’ll undermine the confidence of women who are working through the normal growing pains of early feeding.
But that’s why this nuanced discussion doesn’t happen on a billboard or a bumper sticker. Instead, we need to listen to the individual mother in front of us, without judgment. We need to ask her what her goals are for her relationship with her baby, and find out how we can help her accomplish them.
I’m hopeful that Tayler-Miller’s study will generate a thoughtful conversation about how we can listen better to every woman who is struggling with breastfeeding. If we take the time to hear her story, we can help her to integrate her expectations and experiences into a positive relationship with her baby, regardless of whether she decides to continue breastfeeding.
Alison Stuebe is a maternal-fetal medicine physician and a member of the board of the Academy of Breastfeeding Medicine.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.