Stephanie Walton’s breastfeeding challenges began as soon as her first baby was born. She needed an emergency C-section and wasn’t able to try feeding him for hours. When she did, her son clamped down hard on her nipples, which soon cracked and bled. For the first few days, she struggled to breastfeed him at all. In five days, he lost 13 percent of his body weight. She developed thrush (a yeast infection that moms and babies can pass back and forth) and mastitis (breast inflammation that causes searing pain).
But the doctors, nurses and her husband all urged her to keep trying, so she did.
Every time the baby cried for food, she rigged herself up to a supplemental nursing system, a set of tubes that gave her son formula as well as whatever milk he could get from her breasts. She was prescribed Reglan, or metoclopramide, a medication sometimes used to boost milk supply. She pumped before and after feedings, and she dutifully nursed every two hours, even when it meant waking her son and sacrificing her precious sleep.
Her quest to breastfeed was exhausting. For months, Walton hadn’t slept for more than an hour or so at a stretch.
Then came the depression.
“Breastfeeding made me feel like I hated my baby,” Walton, now a 34-year-old mom of three, told HuffPost. “There were times when I was home alone and he’d cry and I’d be like, ‘Oh, God, please no. I don’t want to have to feed him.’ And that made me feel so awful and guilty as a mom.’”
(Depression is a potential side effect of taking metoclopramide.)
“Breast is best” is a dictum repeated to new moms relentlessly — by public health groups, by health care providers and on social media. The goal is clear. The American Academy of Pediatrics recommends that women breastfeed exclusively for the first six months of their babies’ lives and continue for one year or beyond while supplementing with solid foods. The group points to benefits like decreased risk of infant infection.
Although many women feel they’re the only ones “failing,” the vast majority of American mothers don’t come close to hitting that recommendation.
More than 80 percent of moms start out breastfeeding, a significant jump over previous decades, and only 58 percent are still going at six months, according to the Centers for Disease Control and Prevention. And at that point, only 25 percent are breastfeeding their babies exclusively, as the AAP advises, meaning they’re not giving them any formula or solid food.
There are many reasons women do not breastfeed or do not breastfeed exclusively or for as long as recommended, such as latch problems, pain, milk supply issues, other medical complications, the need to return to work early and choosing not to. Many women find it is physically, logistically and emotionally draining to keep another human being alive with one’s body.
All of which means there is a huge gulf between the breastfeeding standards women are held to and what they do. And that leaves plenty of room for feelings of guilt and shame to creep in at a moment in women’s lives when they are, in so many ways, their most vulnerable. Those feelings can dominate women’s early motherhood experiences, putting them at greater risk of developing postpartum mental health challenges, even as the public discourse around breastfeeding has begun to shift to embrace the idea that fed is best and to better account for women’s desires and mental health.
“When I got pregnant again, I had to go see a therapist, because it felt almost like I had PTSD from my experience with the first one,” Walton said. “I was like, ‘I can’t live like that again.’”
Why breastfeeding guilt is pernicious
For many women, modern motherhood feels like a parade of missteps they are judged for relentlessly, no matter what they do. According to a recent survey conducted by Time, more than 70 percent of moms polled said they feel pressure to do things a certain way, and half said they feel significant guilt or shame about how they’re handling their role.
There is something about the guilt and shame that can accompany breastfeeding challenges that is unique. And for new moms, it is their first brush with the rampant shaming — inadvertent and outright — that accompanies motherhood in this country
“We can’t make blanket statements, but I think there is a level of guilt or shame or just, sort of, psychic trauma that comes with not being able to breastfeed that seems to surface more readily — and run deeper — than some of the other issues we see around motherhood,” said Kate Kripke, a clinical social worker and the founder of the Postpartum Wellness Center of Boulder in Colorado.
One reason? Hormones.
During and after pregnancy, women experience shifts in hormones such as progesterone and estrogen that help their bodies produce milk. But those hormonal changes can also alter brain chemistry, in some cases upping women’s risk for developing depression and anxiety.
But even if women don’t develop mental health complications, those hormonal fluctuations influence how intensely women feel and react to their early motherhood experiences, and something like struggling with a bad latch can take on outsize importance. Meanwhile, mental health challenges can contribute to decreased milk supply, so for many new moms, depression, anxiety and breastfeeding get snarled in a complex knot.
Kripke said she believes breastfeeding-related guilt stands apart from other forms of guilt that women experience simply because it’s incredibly common — and many women go through it, at least to some degree.
“I think very, very, very rarely does breastfeeding go really well from the get-go,” she said. “Which means most women are going to experience some degree of that guilt that comes with breastfeeding challenges. You’re really talking about a pretty universal situation.”
Universal and yet largely unspoken. Many new moms don’t discuss their breastfeeding problems, increasing feelings of isolation, even though most women do not hit current public health recommendations. Those women may feel ashamed to admit that they are struggling to provide this most basic, fundamental need in what’s painted as the right or natural way.
Who gives moms ‘permission’ to stop?
“I’m a lactation consultant, and I see these women who are overcome with guilt if breastfeeding isn’t going well or if it didn’t go well and it ended earlier than they’d planned,” said Carrie Bruno, a Canada-based lactation consultant and the founder of The Mama Coach, which offers women postpartum support.
“Quite often I see moms around the three-to-four-month marks. I walk into their homes ... and they’re just burned out from trying to breastfeed, and it’s affecting their bond with their baby,” she said. “That’s where I have an issue. Somewhere along the way, the definition of a ‘good mom’ got tied to whether you breastfeed or not. I don’t think that’s fair at all. But I do think women carry that.”
For Jenna Robinson, a 26-year-old from New York, breastfeeding troubles started in the hospital. Her son would not latch consistently, no matter how many different positions she tried or how many staff lactation consultants popped in and out of her room.
She was exhausted, emotionally and physically, after days of crying with her son through every failed feeding. She said she wanted to simply switch to formula, but as she was leaving the hospital, her doctor told her, “It’s really important that you keep trying to breastfeed.”
So she did — while supplementing in secret. Finally, she told her son’s pediatrician. Instead of pushing her to try different breastfeeding remedies, the doctor told her that what she was doing was great and that all that mattered was her son was getting fed. For Robinson, that conversation offered a first glimpse of what motherhood could be like without breastfeeding guilt, and she stopped hiding the fact that she was giving her baby formula — though she said she still felt ashamed every time she shopped for formula.
Shawna Beckner’s milk supply plummeted when her first daughter was 8 months old. But Beckner, a 36-year-old from Missouri, said she felt she needed to keep breastfeeding until the one-year mark. She pumped several times a day, reaping only about 1 ounce per session — which meant she was hooking herself up to the pump for more than an hour a day so that her daughter could get one bottle of breast milk every three days or so.
“Why did I continue?” Beckner said. “Out of guilt. It was so ridiculous.”
Often women don’t need help breastfeeding; they need help stopping.
In 2017, Bruno wrote a blog post about an experience she had telling a client that it was OK to stop breastfeeding and give her baby formula. “I realized in this moment what this woman needed from me, a registered nurse and lactation consultant. She needed permission,” Bruno wrote. “I told her that the most important thing was that her baby felt loved and that as a mom she had the ability to nurture and care for her baby.”
Such is the power of breastfeeding dogma that a statement as seemingly benign as that can ignite controversy. Bruno told HuffPost that two years after writing that piece, she still receives angry letters from lactation groups every week or so asking how she could write and believe such a thing.
That’s why experts say what it is needed to conquer breastfeeding guilt is a multipronged approach: to continue to change the conversation so that well-intentioned public health goals do not make women feel undue pressure and shame; to give women the support they need to reach their personal breastfeeding goals, whatever they might be; and to remember that women’s mental health must be a part of the conversation.
“I think it’s important for women to keep having conversations about ‘what’s good for me’ versus ‘what’s good for my baby,’” Kripke said. “That’s tricky, and the answer is not going to be the same for everybody.”
She added, “I really encourage women to be thinking about breastfeeding more as a hope than an expectation, because it leaves more room for self-compassion and empathy.”