"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. Nurses General Nursing Article

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?
Specializes in Psych, Addictions, SOL (Student of Life).

Thank you for writing this - MY son was born mildly premature and had seizures. He was whisked away from my arms to a NICU within hours of being born. During my pregnancy my breast never became engorged and I was never successful at breastfeeding or pumping. I had two different lactation consultants. the first was full of Rah Rah keep trying - the second thought I had something called aplastic breasts and would not be able to breastfeed. She helped me understand that the most important thing was that my son got enough to eat. He required a specific formula high in magnesium to prevent his seizures. As he matured his seizure disorder just simply went away. He is a healthy happy 15 year old today.

Thanks again


Thanks for sharing. My second was born "late pre-term", a week shy of what would've been considered full term. So the nurses suggested supplementing with formula, which was my intent anyway. Despite spending one night in NICU for elevated bilirubin, he's now a healthy, chunky 11 month old. He was breastfed and supplemented for 3 months til I went back to work and it just became too much between work and the baby and a toddler.

I say it should ultimately be each mom's choice. Educate moms but don't shame them.

Specializes in Nurse Leader specializing in Labor & Delivery.

Okay, I have just read the OP, not any of the responses. And I will preface this with full disclosure: I am an OB nurse and an IBCLC.

I am also a mom of three children, all of whom were breastfed, but all of them with their own sets of challenges, including primary lactation failure with my last child, which resulted in my son being diagnosed with failure to thrive at a month old, and necessitated supplementation for half of his nutritional needs until he was well into solids.

My philosophy as a lactation consultant is that I need to meet the mom where she's at. I cannot and will not be MORE invested in making breastfeeding work than she is. I never spend more than about 10-15 minutes at a time trying to get baby latched. More than that means an exhausted baby and a frustrated mom, and those are not conducive to learning a new skill.

The first rule that any good lactation consultant knows is: FEED THE BABY. If breastmilk isn't available, formula is the next best thing. If baby is not eating well at the breast, we know that pumping is important both to stimulate milk production and to extract milk that we can give to the baby.

Formula is something that we are glad we have when needed, but it is not the best for baby, and does carry risks. Ideally, if mom does not have milk to give baby, every nursery should have pasteurized donor breastmilk available with which to supplement.

The Baby-Friendly Hospital Initiative, when implemented as it was designed, is a beautiful thing. If a woman doesn't want to breastfeed, or cannot breastfed, she does not need a physician's order to give her baby formula. For women who are trying to make breastfeeding work, it makes sense to have a physician's order to provide parameters for which nurses are to give formula. But at any time, if the parent wants to give formula, they can. They don't need an order. It's YOUR child. Not your pediatrician's.

I'm sorry you were failed by the providers at your hospital. I could tell you stories, because in many ways, I too was failed with my last child.

But in the grand scheme, breastmilk or formula, it's such a tiny blip in your child's life. If your child is fed and loved, that's all I, as a nurse and a lactation consultant and a mom, ultimately care about.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.

This is a great article!!! I am about to have my second son & I always feel guilty when the nurses ask the question if I will breast or bottle feed. I take such a high dose of Topamax & Zoloft that it's not healthy for the baby. I feel like I have to explain why I don't breast feed & it shouldn't be that way. But I have never been shamed for it. Actually, when I had my first son both the nurse & doctor were adamant about me *not* breast feeding! I'm glad they were, it made me feel better about what I was doing.

I just read an article similar to this topic. The baby lost too much weight & ended up dying. Here is the link:

Baby Died From Cluster Breastfeeding | POPSUGAR Moms

At the end of the day as long as the baby is getting fed (whether it's bottle, breast or both) does it matter?

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.

I disagree with some of the things Dr. Tuteur says about political things. But as a former L&D nurse who worked with a "Breast Is Best" lactation consultant, I really think we need to back off a bit from the idea that only breastfeeding is best.

I think if you gave moms a chance, with supplementing formula, then they might succeed with breastfeeding.

All my kids had a bottle in the hospital - back in 1983 the goal was to breastfeed for 6 months and I did that with the 1st one and then had a lot of trouble with my son having issues with formula. We ended up with a pre-digested protein formula. The other 3 kids were breastfed for 18 months, 3 years, 3.5 years. All were at times supplemented with formula.

As a nurse, there were times when the baby just wouldn't latch and didn't get any nutrition for days. What is the harm in giving a bottle of formula?

Someone should do a study investigating baby blues and breastfeeding experiences among new moms. I think the results would show stories similar to your own, op.

I had tremendous difficulty breastfeeding, pumping or nursing hourly, supplementing with a "tube feed" attached to my nipple so the baby didn't get used to bottles until my own milk supply came up, etc...Lots of other problems/details I won't get into, but it was horrible for weeks but, with significant help from a lactation consultant who came out to my home, it finally worked out, which was fortunate because my son ended up being intolerant to all formula. Of course I have friends and family who couldn't nurse despite their best efforts. I have others that just decided they didn't want to, & a few that shouldn't due to medications, and so they bottle fed from the beginning. Obviously no shame in any of that, and of course if the baby is losing weight you should supplement until the baby is getting enough. All that being said, breast milk does have important benefits, so I think it is deleterious to push the idea "it doesn't matter." Breast milk is better, so the message should be along the lines of breastfeed if possible. I'm not sure how to eliminate the guilt factor if a mom really wanted to breast feed but couldn't, or you couldn't juggle it, or didn't want to nurse, whatever the reason. If you were going to feel bad about it I think you would whether "Breast is best" was the motto or not. I know I cried a river about it when it wasn't going well; felt like I was failing my child. No one accused me of that, I just felt that way, wrong or not. Certainly I would have gotten over the disappointment if it hadn't of worked out, but I would have probably still felt bad. I think guilt associated with breast feeding can be just as much if not more of a human nature thing vs. other people making us feel bad. As far as shaming goes, from personal experience I feel like nursing mothers face more shaming remarks, or at least rude-try-to-make-you-feel-bad (or weird) comments. I was a discreet person and am very modest, yet still had a number of really rude things said to me. I never knew any bottle feeding Moms having to deal with rude comments in the midst of trying to feed their baby. So either way, no matter what your decision, you may very well get comments or shaming. You can't please everyone, right? So you have to do what's right for you and your baby at the time, and that's the best thing. Anyway, I guess my larger point is there probably is a better mantra out there, hopefully less guilt inducing, but we should tread carefully in putting any message out there that would work to decrease breastfeeding attempts vs. encourage mothers to do so if they are able.

Specializes in Ortho, CMSRN.

Your story sounds like my sons, up until his first dr's appointment. He was crying at the breast, latching, but acting like he wasn't getting enough or couldn't stay latched. I was determined to make this work after feeling like I gave up too soon with my daughter so he was constantly feeding, or trying to for the first 5 days. His urine was dark orange, and just a little stain on each of his diapers, and he was jaundiced by his first doctors appointment. His pediatrician said to feed him formula Q2 for 24 hours and pump and store the milk each time I fed him. He was SO much happier, as was I. He started peeing like a normal baby and wasn't constantly crying. I tried to go back to the breast, briefly, but the crying and struggle started again. I gave up and was ashamed, cried for a day. I don't really care now. I've been pumping and giving him bottles. It's worked great for almost two months, but now my supply has dwindled to where I feel like he's getting half/half. That's ok too. My daughter was almost completely formula fed and is one of the least sickly children that I know, unlike my SIL's two young children that were exclusively breastfed. I don't really think being breastfed or not has anything to do with how healthy or intelligent a child will become. It's great for bonding, sure. The immune benefits are also great, but how long does it take breastfeeding for the immune benefits to transfer from mother to child? I am up right now with a sleepy, contented and full baby on my lap who just ate from a bottle. It takes more time to pump, and pumping is quite honestly a pain in the butt, but at least he's fed and healthy.

Stories like baby Landon's and that of the physician that is one of the founders of the "Fed is Best" movement are heartbreaking and so sad. Should NEVER have happened! That could have been my story had our pediatrician not encouraged us to try something different when breastfeeding wasn't working. Grateful for her.

Specializes in Nurse Leader specializing in Labor & Delivery.
Someone should do a study investigating baby blues and breastfeeding experiences among new moms. I think the results would show stories similar to your own, op.

I had postpartum depression which went undiagnosed until he was about a year old, and it stemmed from not being able to produce enough milk.

Specializes in OB.
I disagree with some of the things Dr. Tuteur says about political things. But as a former L&D nurse who worked with a "Breast Is Best" lactation consultant I really think we need to back off a bit from the idea that [i']only[/i] breastfeeding is best.

I think if you gave moms a chance, with supplementing formula, then they might succeed with breastfeeding.

All my kids had a bottle in the hospital - back in 1983 the goal was to breastfeed for 6 months and I did that with the 1st one and then had a lot of trouble with my son having issues with formula. We ended up with a pre-digested protein formula. The other 3 kids were breastfed for 18 months, 3 years, 3.5 years. All were at times supplemented with formula.

As a nurse, there were times when the baby just wouldn't latch and didn't get any nutrition for days. What is the harm in giving a bottle of formula?

Again, I think it's terrible that there are lactation consultants who are bullying women at the expense of their babies' health. I just haven't personally met one.

Of course, for a lot of breastfeeding moms, supplementing with formula can be necessary. I just feel like I constantly hear about mom-shaming, "mommy wars," the terrible pressure on women to breastfeed, judgment for not breastfeeding, and defense of why formula can be necessary, but at the same time, little attention given to the flip side of the argument. Pediatricians and OBs routinely give out formula samples to pregnant women for no reason other than that formula companies ask them to. Formula companies purchase the addresses of pregnant women from doctors and send them samples in the mail with inaccurate and misleading information to try to convince them to buy their products. Babies in lots of hospitals are routinely separated from their mothers after birth for hours, given formula because of outdated, non evidence-based hypoglycemia protocols, and as a result, breastfeeding is difficult from the start. I've heard nurses tell moms to feed for X amount of minutes on each side, when we know that feeding should be cue-based, not based on the clock. Moms go home and have no support from their families, have trouble breastfeeding, have no community-based resources to use, and give up. Just as it is not OK to stigmatize moms for giving formula, it is also not OK to undermine breastfeeding when it is a mom's goal to breastfeed exclusively. We need to give moms the best tools we have to help them meet their personal feeding goals, whatever they are.

As a OB nurse and mom I strongly believe Fed is Best. Yes, I promote breastfeeding and will give you all the support in the world, however feeding your baby is priority whether it is breast or formula.

I ran into a very pushy lactation consultant after having my daughter. During my pregnancy, I had problems with frequent bursts of SVT and was taking a betablocker up until a week prior to delivery. After delivery, I passed out in the shower and they didn't know if it was r/t SVT, so I was on maternity, but wearing a heart monitor. When I tried to breastfeed my daughter, she latched beautifully and had no issues, but I suddenly felt dizzy, chest pain, nausea, heart racing. The nurse said it was probably the rush of hormones, but then my cardiologist ran in and said that I was, in fact, sustaining SVT. Each time she latched, my heart rate hit 200bpm. So he said no more breastfeeding, no way, no how. That evening a lactation consultant came in and I told her that I appreciated her stopping by, but I was unable to breastfeed because of a heart problem and she told me that that was nonsense, everyone can breastfeed, you just aren't trying hard enough. I tried to explain to her that my cardiologist said that it was a significant risk to my health and she persisted. I had to tell her to leave. The interaction with her made me feel like a complete failure, despite knowing that I had no control over my heart's reaction.

My SIL is one of the pushy-it was easy for me to nurse so it should be easy for you too- types and when she saw me bottle feeding a few weeks postpartum, so started in on how she'd never poison her child with formula and she would have kept trying to breast feed because it's natural and doesn't cause any problems, by this point I was less inclined to be nice and told her that had I kept trying maybe she could have breastfeed my daughter while the rest of the family planned my funeral. Some people(lay persons, doctors, nurses, consultants) take things too far. My peds office has a poster that says "Breast is great, but fed is best" I'm going with that slogan for this baby when he arrives.