"Breast Is Best": A Mantra to Promote Infant Health? or Stigmatizing Adage to Guilt Moms

In my last article “Becoming Dad: A Humbling Birth Experience of a New Father and Nurse,” I discussed my journey to becoming a first-time parent and included some of the challenges that being a nurse and a parent present when it comes to the health of your children. This article continues on my journey with the battle we fought against the “breast is best” movement, which advocates that mothers exclusive breastfeeding babies for the first six months of life.

"Breast Is Best": A Mantra to Promote Infant Health? or Stigmatizing Adage to Guilt Moms

Before I go too far into this article, and risk being stoned to death by the maternal-child nurses, lactation consultants, and midwives out there, I would like to make a few critical points.

  1. I'm not against breastfeeding.
  2. I absolutely believe that breastmilk is the best food and source of nourishment for babies.
  3. I think that mothers should be encouraged to breastfeed their babies and supported throughout the process.
  4. I make no claim to be an expert in neonatal, obstetric, or pediatric fields. However, I'm a husband and a father and I will fight for what is best for my wife and child; even if that means it doesn't fit with the strict guidelines of the "baby friendly hospital" or "exclusively breastfed movement."

As I mentioned in my last article, my wife and I are both nurses. Throughout this pregnancy, we have read every article about raising healthy babies/children and have committed to improving the health of our family. We live in a smoke-free home, try to cook healthy meals, engage in primary care regularly, and believe in the benefits of immunization/vaccination. So before our son arrived, it seemed like a no-brainer that he would be exclusively breastfed as recommended by the American Academy of Pediatrics (AAP) and World Health Organization (WHO), among many others. Fast-forward to after bundle of joy arrived as I helplessly watched my wife and son struggle with the complicated process of learning to breastfeed.

One-by-one each nurse caring for my wife and son would help with positioning and latching, but it never seemed to work correctly. After each nurse had left the room, I saw the look of exhaustion and disappointment in my wife's eyes because it was becoming harder with each feeding and not easier. We inquired about using one of the hospital's breast pumps to help stimulate milk flow but this was met with a great deal of hesitation and remarks of "It's really best to just keep trying naturally, he will catch on soon." Next came the lactation consultant, a nice enough woman who is clearly passionate about her job but made it clear that there is only one way to feed a baby "breast is best". To her credit, she spent an extensive period of time coaching my wife and helping my son. She strongly discouraged the use of a breast pump by suggesting that this be reserved until closer to when my wife would return to work. Whenever my wife voiced anxiety, concern, or disappointment she was told that this was "a part of the process", "completely normal" and "just because it's natural doesn't make it easy." We were discharged from the hospital with packets of paperwork, breast shields, and other tools that reminded us to keep up with the exclusively breastfeeding.

Over the next 24 hours at home my wife, put our son to breast at least every two hours (usually every hour), and he would latch for 15 - 20 minutes on each breast but continued to appear fussy after feedings. We were told that this was common with "cluster feeding" and not to worry or allow this to derail the breastfeeding efforts. He remained alert, active and had plenty of wet diapers, so we continued to watch him closely. At the next day appointment with the pediatrician we were told that our son had severely elevated bilirubin, lost 12% of his birth weight, and had to be readmitted to the hospital. As parents, we felt that we had failed our child. We followed the treatment team's discharge instructions implicitly, and still he decompensated so quickly. We are nurses, and yet we have missed such significant weight loss. How could we have let this happen? If I had only gone to the store and bought some formula, I might have avoided this.

He was readmitted to the hospital and placed in phototherapy, we sat by him and watched helplessly hoping that it would help his little body to remove the excessive bilirubin quickly. My wife remained quiet, but I saw the look on her face knowing that she felt like she was a failure as a mother. I requested that the nurses provide us with formula and a breast pump while we resumed a two-hour breastfeeding schedule with formula supplementation to ensure he received at least 1 oz. per feeding. Breastfeeding continued to be a struggle, but after each attempt, he was offered pumped breast milk and formula (if needed) to ensure he had enough to eat. In the morning the same lactation consultant came to our room to visit us with a commitment to help "fix the problem." She "permitted" my wife's use of the breast pump after each feeding to obtain additional breast milk but wanted to work on getting the baby "back to the breast where he belongs." She made no qualms about "strongly discouraging" any use of the formula because it "can't match the nutrition that your breast milk provides" and "we only want the baby eating the best and most nutritious food". Each time that my wife expressed concern with the idea of stopping the formula supplementation I saw the lactation consultant shut down her protests. As a psychiatric/mental health nurse, I knew that this form of coaching transitioned from inspiring and supportive to instilling guilt and dismissive of my wife's needs, a method that was sure to fail in the long-term.

Eventually, I decided that this dad had enough and I had a "come to Jesus" moment with the well-intentioned lactation consultant and spoke to her "nurse-to-nurse". I told her that my wife would continue to try to breastfeed, but I would not allow her to be bullied into doing things only one way and that my son will be fed in whatever way he needed to grow. I refuse to sacrifice her mental health and ability to bond with him just to say that he was "exclusively breastfed the natural way". While the consultant's intentions were good and she was clearly an expert in this area, I told her that this form of coaching does not best ensure a patient's long-term compliance with any health promotion intervention (e.g. weight loss, smoking cessation, breastfeeding). If a patient's needs are so easily ignored then it creates a divide between patients and providers that is unhealthy to the working relationship. As you might expect, this was not met with tears of joy or heartfelt thanks but we came to an understanding that we would do what needed to be done for our child.

We are now at home, my son primarily consumes breastmilk out of a bottle with some formula supplementation, and he is doing very well. This may not be what works for everyone and does not follow the strict recommendations of exclusive breastfeeding for the first six months of life but it works for us. I haven't told this story to discourage people from breastfeeding their babies or to imply that we ungrateful for all of the help and support we received in the hospital. I shared our story to help educate parents and healthcare providers.

Parents, you need to listen to their instincts and if you feel something is jeopardizing the safety of your child(ren) then you need to speak up. You need to work with your healthcare providers to achieve the best possible health your child(ren) because you are on ultimately the same team. Healthcare providers, we have a great deal of knowledge and access to resources that the public doesn't have but if we don't listen to parents/families then we won't be able to foster therapeutic relationships or achieve the best possible health outcomes for our patients.

I would like to begin a discussion with the allnurses.com readers include the perspective of parents/grandparents/family members and healthcare providers. Here are some questions to consider...

  • Do you think that we have gone too far in advancing the "breast is best" movement
  • Should we be advocating for "fed is best" instead?
  • Have you personally felt pressured that breastfeeding is the only correct way to feed a baby?
  • Do you see patients being pressured to feel this way in your workplace? If so, who are the groups/individuals who are responsible for this?
  • How do you feel about some baby-friendly hospitals refusing to provide parents with formula unless there is a physician's order (as a method of enforcing exclusive breastfeeding)?
  • What are your tips for encouraging breastfeeding in a way that is supportive of parents without being dismissive of their concerns and beliefs?
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cjcsoon2bnp

About cjcsoon2bnp, MSN, RN, NP

cjcsoon2bnp has been a registered nurse (RN) for six years and his specialties are emergency nursing and psychiatric/mental health nursing. He recently completed a MSN in Nursing Education degree and is currently pursuing a post-graduate certificate in family nurse practitioner (FNP) studies. He also teaches as an adjunct clinical instructor and is interested in problem-based learning, ethical dilemmas in nursing, and promoting success in the workplace through professional mentorship.

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Thank you for posting this- I went through almost the exact same experience as your wife, and was so thankful my husband understood what I was going through, and supported me!

Our daughter was born SGA two years ago, and she would. not. latch. While she did get a small amount of formula after she was born to improve her blood sugar, the lactatation consultants were adamant that she should only be breastfed. While that had been my plan from the beginning, I had no idea of just how hard that would be.

Thankfully one nurse taught me how to use the pump, and in fact encouraged me to give my daughter pumped milk if that was the only way we could get her to feed. I successfully used the pump for eight months; try as hard as I could, I just couldn't get my daughter to latch, which resulted in many tears, me not eating, and lots of anxiety.

I was so, so thankful for that one nurse, Hannah, for supporting me and helping me figure out how to give my daughter what she needed, and not feel ashamed about it. Thank you, Hannah! I now have a thriving toddler, and Hannah was one of the reasons I decided to pursue nursing as a second career- I hope to be able to bring the same support to others in need.

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I've been following an OB doc on FB who had been writing about this for awhile. Her mantra is "Fed is Best" She isn't against breastfeeding but thinks we've gone to far in promoting it without considering repercussions.

The lactivist lie that causes so many babies to suffer | The Skeptical OB

Hungry babies are suffering babies. Most mothers understand that instinctively and want to ease their babies' pain by supplementing. Lactivists prefer to let babies scream. Instead lactivists falsely reassure mothers with products that graphically represent a believe a lie.

That's not merely wrong and dangerous to infant health; it is insupportably cruel.

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Specializes in Neuro ICU and Med Surg.

When my son was born 7 years ago he would latch, but my milk did not come in for 3 days. Until we were at home. I asked for a breast pump in the hospital and never got one. I finally gave up and started formula in the hospital. Thankfully the nurses that gave me the formula were of the policy that "Fed is best". I was supplementing with some breast milk at home when I got a pump the night we got home from the hospital. I eventually switched to exclusively formula feeding at one month old. It was the best decision for me and my family.

I felt if the lactation consultant had looked at my medical history and known that I needed infertility medicaitons to become pregnant, maybe she would have understood why I was having issues. I feel that was overlooked. Also if I could have gotten the breast pump it would have also been a huge help as well. I was not even offered to rent one at home.

I felt the lactation consultant was little to no help when I had my son.

I also feel that we should not bully women into breast feeding. It just does not work for everyone. Some women cannot because of medication they need to take post partum, and some just do not want to. Fed is best.

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The whole notion of exclusive breastfeeding, health (mental and physical) of the mother and baby be darned, is as damaging as it is ludicrous. Yes, breast is best, in a general sense, but not for everyone. I had a horrible time breastfeeding, and I teach other women HOW to do it. I thank God for the grounded, sensitive IBCLC who sat me down and said to me that it wasn't worth sacrificing my mental and physical health to exclusively breastfeed. She looked at my bruised, blood blister covered breasts, my exhausted, disheveled appearance, and gave me the "permission" I so desperately needed to supplement my baby's feeds.

Some people act like infant formula is akin to poison, and that is not helpful for ANYBODY. What about adopted babies? Not everybody can or has the time to induce lactation, and the cost of donor milk is prohibitive. What about babies whose mothers die in childbirth? Yes, that STILL HAPPENS. What about women who have had breast reductions and have inadequate supply to meet their babies' needs? What about women who, for whatever reason, simply DON'T WANT TO BREASTFEED?

Some babies are born and breastfeed beautifully, like there was nothing easier in this world. Some babies are born, and they (and their mothers) struggle for every blessed drop. One thing I have learned in the 2 decades I have been helping women breastfeed is that for many people, it DOESN'T come naturally and it IS a struggle.

The shaming needs to stop, period. Mothers have enough pressure on them to do everything right, all the time, and it starts the moment that stick shows 2 lines. Enough. Is the baby loved, fed, clothed, and cared for by a loving and stable family that can meet its medical, physical, and emotional needs? Wonderful. That should be enough.

Yes, breast is best, most of the time. Not always, not for every circumstance. Do what works for you and your family, the judgment of others can take a hike. Healthy, happy, fed babies, regardless of how they are fed, is the ultimate goal here.

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Specializes in OB.

I'm so sorry that you and your wife had this experience. It sounds like you got really subpar care in the breastfeeding department. I often read stories of judgmental lactation consultants who bully and pressure mothers, to the detriment of their babies' health sometimes, although all of the LCs I've known would never do this. I have a 6 month old daughter who is exclusively breastfed despite multiple hurdles we've had to overcome---a posterior tongue tie and lip tie, me fighting a recurrent case of thrush, cracked nipples in the beginning. I know it is definitely NOT easy! I'm happy that you and your wife have found the best feeding plan for your family at this point.

I would just like to offer an additional point of view: that for every mom who is pressured to continue breastfeeding even when it's not working, there are many more mothers who are perfectly capable of successfully breastfeeding, but receive incorrect information from friends, family, and health care professionals about breastfeeding, have a lack of support at home or in the workplace, and undergo multiple routine hospital procedures during their L&D stay that evidence shows interfere with breastfeeding. The Skeptical OB, referenced by Spidey's mom, is pretty notorious for posting a lot of anti-breastfeeding posts under the guise of "Fed is Best." The Baby Friendly Hospital Initiative is often used as an example of inappropriately pressuring moms to breastfeed or stigmatizing formula, which is incorrect and unfair in my opinion. My heart really breaks for women who could have succeeded with breastfeeding, but were let down along the way by the system.

Just my two cents.

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Specializes in SICU, trauma, neuro.

I am hugely pro-breastfeeding, and I get the goal of supporting/educating moms. I mean in the past, moms were discouraged from it. Many decades/maybe a century ago there was even a stigma attached to breastfeeding. In an ideal world everyone would do it and nobody would have difficulty.

Trouble is, we don't live in an ideal world.

I feel like the pendulum has swung too far. Shaming women and making them feel less of a mother does not help, especially in such an emotionally delicate time as the postpartum period.

Ideology aside, the baby needs to eat. Sure keep trying if you want to, but in the meantime you can't malnourish the baby on a principle.

And thanks to modern innovation, they are making formula more like breastmilk all the time.

I also think the it's-natural-therefore-it-should-be-easy idea is oversimplified. I have 5 kids and breastfed all of them. I read everything I could get my hands on during my first pregnancy. One thing that every book said was "if you do it properly, it should not hurt." Imagine my surprise when for the first two weeks it felt like this toothless person was chewing my nipples off!! It was like nursing a piranha. My midwife (also an IBCLC) checked her latch, assured me it was fine... I kept going because I am that stubborn and it got better. Not what your wife experienced, but it's a pet peeve, setting up unrealistic expectations...which creates feelings of failure when those expectations are not met.

Good for you for standing up for your wife. I'm sure this is difficult for her -- she's putting all this effort in (and pumping is a huge effort!) That LC added insult to injury with her, uh, "coaching" style. And again, putting an ideology ahead of the baby's immediate need for food. You seem like an amazing husband and I'm sure are a great dad too!

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I had my heart set on breastfeeding. I bought the pump and the garments and the pillow, etc. It just didn't work out for me, though. By the second night of being encouraged to "starve the baby" at the hospital, I sent my husband to the store for pre-filled Similac bottles. I continued trying at home, but was only able to supplement formula feeding and feed for the baby's comfort.

My doctor said it's either really easy or really hard for each individual. She also said that breast milk was healthy, but that formula was very healthy, too. I can't say I ever felt ashamed, but I did feel sad about all the money I spent on supplies.

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Specializes in ICU; Telephone Triage Nurse.

You are my newest hero! The way you advocated for your wife and son was spectacular. Providers of all types need to do what is best for the patient - even if it is not what the provider/specialist wants.

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https://fedisbest.org/2017/02/given-just-one-bottle-still-alive/

Interesting that this came up on FB just yesterday. I can only imagine what this poor mother has gone through and lives with even now. The loss of a beautiful child for something that has achieved almost a political agenda status.

On a lighter note...

http://www.wimp.com/epic-mom-war-takes-it-to-the-playground/

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THANK YOU!! I've seen way too many NICU moms in tears, expressing feelings of inadequacy and guilt because they're struggling with supply.

By supporting the notion that 'breast is best,' we imply that anything other than breastfeeding is somehow sub-par parenting (regardless of whether a baby is formula-fed by choice or out of necessity). Parents already face enormous amounts of judgement and 'mommy-shaming' as it is, without us subconsciously adding to the problem. Our role is to support and educate, not to use our position of authority to coerce, judge or shame.

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Terribly sad about Little Landon. I hope the parents sued and won big time. It won't bring back their little guy but might help people reexamine the issue of breast only.

Common sense has got to prevail. Parents get to decide what is best for their family. So glad, OP, that you stood up for your family. Here's wishing you all the best as you get your feet under you for all the wonderful years of family life ahead of you. God bless.

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