31 July 2012

Breast is NOT always best

Note: I'd like to refer everyone to a post I wrote a couple of months ago about the fact that there ARE antidepressants you can take while breastfeeding.

In today’s society, there is a HUGE push towards promoting breastfeeding for babies. The phrase/idea that “Breast is always best” gets thrown around a lot. We say things like “Women who don’t breastfeed are selfish” or “If she cared about her baby, she would breastfeed” or “When I have a patient who chooses not to breastfeed, I walk out of the room muttering ‘Selfish bitch’ under my breath and I hope her uterus falls out”. And yes, I have heard/seen ALL of these things said, the latter was actually by a nurse/lactation educator who was “venting” on a Facebook group). All of these phrases are tossed about in the interests of promoting the health of the new mothers and babies, we are passionate about their health, but we don’t really think about the effect that our passion and our well-intentioned phrases/attitudes and militant campaigns can have on the health of those we say we care about. The saying “The road to hell is paved with good intentions” applies all too well.

Now, before I go any farther, let me say that I am a HUGE supporter of breastfeeding. I breastfed my first until she was three months old and only stopped because I had to go on antidepressants to treat my PostPartum Depression. I had every intention before that of nursing her as long as she wanted to. I breastfed my second until she weaned herself at 13 months old; that was through the first and most of the second trimester of my current (third) pregnancy. She weaned HERSELF. Now granted, I was just about ready to start weaning her because nursing a child with teeth who used my poor breast as her teething ring was decidedly uncomfortable (especially since they were more tender than normal thanks to pregnancy) and because nursing plus pregnancy was taking a toll on me. But, she ended up weaning herself without any action on my part and I don’t regret one second of letting her nurse for that long and/or through that much of my pregnancy. When I was planning on going back to work (before the Army moved us away from my job), I had planned on pumping. I nurse in public, with or without a cover (and yes, I am still discreet and modest if I am nursing without a cover; you’re probably going to see more boob/cleavange/skin in a Victoria’s Secret ad, at the pool or beach, or even just glancing at someone in anything other than a turtleneck than when I nurse). I don’t think women should feel like they have to go to the restaurant bathroom to breastfeed (how about you take your dinner in there to eat first before suggesting I make my baby eat in a public restroom). I fully believe that there are health benefits to both mother and baby that can only be obtained through nursing/pumping, and that those benefits still occur when nursing beyond the first year. I wish that more pediatricians would truly support mothers who breastfeed instead of being so quick to throw formula samples at them and tell them they need to supplement with formula (no, not all doctors do this, but I personally have known doctors who did, and women whose doctors did this, and it sabotaged their nursing efforts).

Now that we have established that I am very much pro-breastfeeding, let’s establish something else: breast is not always best.

Let that sink in for a second. Breast. Is. Not. Always. Best.

The goal of the “Breast is best” movement is supposed to be promoting the health and well-being of both mother and baby, but what too many breastfeeding advocates who espouse this mindset and embrace this saying fail to take into account is that the health and well-being of mom and babe includes more than just physical health, it also includes mental and emotional health, both of which can be influenced by the decisions a new mother makes (or feels pressured to make) regarding or revolving round breastfeeding.
“Breast is always best” can - and often does – cause a new mother to feel that if she feeds her baby formula instead of breast-milk, she is doing wrong by them. It can cause a huge amount of guilt and a great deal of pressure to continue breastfeeding her baby, no matter what. This can cause her to feel that she cannot (and/or should not) seek help for PPD. It can also cause a huge amount of unnecessary guilt if she does get treatment and has to stop nursing her baby. It did in me.

One of the reasons why I put off seeking help for my PPD more actively until the night it got to a crisis point was because I felt that if I got help, I would surely be put on medication that would mean I had to stop nursing, and I couldn’t do that because breast is best. Once I did get help, I ended up having to take Lexapro and, sure enough, I had to stop nursing my daughter because the medication was not something that was safe for her to get through my breast-milk. I can’t even describe how much guilt I felt over this. I already felt a lot of guilt and felt like a failure just over having PPD and being hospitalized in the first place. I felt that it made me less of a woman and that I was not the mother I should have been, that if I were a better woman and better mother I would have been able to “shake it off”. The additional guilt I felt over having to give my baby a food source that was “sub-par” and was clearly less than the best for her made it that much harder to deal with the emotional and mental turmoil I was already fighting.

What I have come to realize since then is that what is truly best for my baby is for me to be in good health and for me to take care of myself, and that most certainly includes doing what I need to do to take care of my mental health. If a new mom has PPD, it’s not in anyone’s best interests for her to ignore it and continue breastfeeding at the detriment of her mental health all in the name of “breast is best”. It can actually have long-term negative effects on her, her baby, and her whole family if she forces herself to continue breastfeeding at the expense of seeking treatment for a legitimate medical issue.

This does not just extend to women who are struggling with a PostPartum Mood Disorder. Some women, for whatever reasons of their own, don’t want to breastfeed or don’t feel comfortable breastfeeding. And you know what? That’s okay. As with everything else surrounding non-life threatening parenting decisions, as long as they are making a well-informed and educated decision, that’s perfectly acceptable. What is NOT acceptable is to try to bully, badger, and guilt them into breastfeeding anyways. Here’s the deal: if a woman breastfeeds despite a strong desire not to, it CAN cause trouble bonding and cause her to feel resentment towards her baby and herself. As with a mother who breastfeeds at the expense of seeking medical treatment for a PPMD, this can cause lasting negative effects for her, her baby, and her entire family.
I understand that those who push so hard for breastfeeding are for the most part (I won’t speak for everyone) just trying to make sure that new moms and their babies are taken care of and educated. I commend that, I really do. But we as a breastfeeding community have got to realize that our militant efforts are doing the exact opposite of what we are trying for, we are hurting fragile women and children. Being militant is getting us nowhere good, it is only giving us a reputation for being stubborn (in a bad way), obnoxious, and putting down those who choose/feel differently than we do. We talk long and loud about how judgmental people are of us when we choose to breastfeed in public, and then we turn around and do the same thing in judging women who choose not to breastfeed at all.

The choice of how to best care for and feed our babies belongs to each of us and it is a deeply personal decision. We need to respect that and respect that there are women who, for whatever reason of their own, are going to choose to give their babies formula. We need to realize how much unnecessary guilt we are piling on these women and STOP IT. The last thing a mother with PostPartum Depression needs on top of all the negative emotions and thoughts she’s having because of her PPD is to also feel guilty about switching her child to formula. It can do irreparable damage to her to feel this way. I don’t know any breastfeeding advocates who intentionally set out to make women like me feel bad but the sad truth is that it does.
So please, the next time you’re about to start off about how “Breast is always best” and “Women who don’t breastfeed are selfish”, don’t. If your goal is education, educate (gently). Talk about the studies and facts showing the health benefits to both a nursing mother and her baby, but leave the platitudes and catch-phrases where they belong: unspoken. And don’t just be careful with your words, make sure your demeanor and attitude are also non-judgmental.

Breast is not always best. What is always best is for a mother to feel empowered, able, and confident in making decisions that she feels will best take care of her, her baby, and her family. What is always best is for a baby to be fed, nurtured, loved, and cared for. And you know what? Sometimes, that’s going to mean choosing formula over breast-milk.