by Heidi Bitsoli, Sunshine Behavioral Health
If there’s one thing pregnant women get in spades, it’s advice. From your relatives to your neighbors to your coworkers to strangers in line at the grocery store, everyone has an opinion on how to best care for the child you’re about to birth.
And one of the most common pieces of advice you’re likely to hear is how important breastfeeding is, for both mother and baby. But what all those opinionated folks won’t tell you is how hard it is for some women.
The truth is, that your mental and physical health is just as important as your baby’s. If you have trouble breastfeeding, or simply decide it’s not for you, you are not alone. You also aren’t a failure as a parent if you have difficulties breastfeeding or decide against it.
How Common Are Breastfeeding Difficulties?
Breastfeeding difficulties are extremely common. One study conducted by Nutrients followed mothers who were breastfeeding when they were discharged from the hospital, within 72 hours of delivery. At the time of discharge, 95% of the mothers were breastfeeding exclusively.
After one week, 81% were still breastfeeding exclusively. The majority of these women continued with complementary breastfeeding. At one month, only 73% were exclusively breastfeeding. 19% still provided breast milk complementary feedings, and 7% had transitioned to exclusively formula feeding.
By 3 months, only 68% were exclusively breastfeeding, 14% were complementary breastfeeding, and 17% were exclusively formula feeding. Over the 3-month period, 27% of mothers who were breastfeeding when they left the hospital had stopped or transitioned to complementary breastfeeding.
This statistic isn’t the most startling, however. Out of the study participants:
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- 70% of women who participated said they had breastfeeding difficulties.
- 63% of mothers stated that the difficulties occurred during the first month of breastfeeding.
- 9% had difficulties during the second month.
- 10% experienced problems during the third month.
What Are the Most Common Breastfeeding Difficulties?
According to the Nutrients study, the most common breastfeeding difficulties reported by mothers are:
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- Cracked nipples
- Insufficient milk supply
- Pain not caused by cracked nipples
- Fatigue
Another study published by the Surgeon General states that 50% of women have trouble breastfeeding due to inadequate supply.
Inadequate Supply
Low milk supply is more common than you may think. Lactation consultants quoted in a New York Times article cited it as the top reason clients seek their help. And in a 2003 study of healthy mothers who attempted to exclusively breastfeed and had lactation support, 22% experienced delays in milk production. These delays increased the risk of excessive weight loss in their newborns 7-fold. First-time mothers often struggle the most with insufficient supply. A 2010 study found that 42–44% of first-time mothers have delays in copious milk production. A National Institutes of Health meta analysis looked at many studies, and determined that on average 33% of women weaned early due to insufficient milk supply.
When breastfeeding, the best indication of healthy nutrition is the baby’s growth pattern. It can alert your baby’s doctor to look more closely at how breastfeeding is going and can prompt a consultation with a lactation consultant to evaluate breast milk supply and milk transfer to the baby. Such an evaluation can provide lactating parents valuable advice on how to improve breastfeeding technique but also determine if actual low milk supply makes supplementation of breastfeeding necessary to ensure healthy infant growth. This can elicit negative emotions as the idea of having an “inadequate” milk supply can make one feel like an “inadequate” parent. Unfortunately, ubiquitous messaging about the importance of exclusive breastfeeding along with the widely perpetuated myth that low milk supply is rare can make a parent feel like not only are they failing their child, but they are also alone in not being able to feed their child in the way that everyone tells them they should be able to.
In fact, research actually measuring the breast milk supply of mothers during the first month after delivery shows that persistent low milk supply is quite common occurring to 15% or 1 in 7 of first-time mothers in one study and to a third to two-thirds of breastfeeding parents in another more recent study. So if someone tells you that insufficient breast milk is rare, they are unequivocally wrong, and research has shown it. It’s no wonder that difficulties with breastfeeding is one of the most common reasons a mother develops postpartum depression and anxiety. Not only are they struggling with the demands of breastfeeding, supplementing, and pumping to increase their supply, sacrificing much needed sleep in order to do so, the messages their receive from society tells them they are failing if their can’t achieve what has been deemed as “best” for their child, and few others are struggling with the same problem because they are “rare.”
Other Common Breastfeeding Difficulties
Other common breastfeeding difficulties include cracked nipples, pain not related to cracked nipples, and fatigue. Sore or cracked nipples typically result from improper positioning or an incomplete latch.
Cracked or painful nipples should not be a normal part of breastfeeding, and you shouldn’t be expected to grin and bear it long term. This can make the problem worse.
Pain not related to cracked nipples can stem from a variety of causes. Causes of pain can include engorgement, yeast, muscle strain, mastitis, and vasospasms. Again, you shouldn’t be expected to tolerate the pain and not seek help.
Fatigue is also a common breastfeeding problem. Breastfeeding mothers have many demands. They may return to work six weeks after birth or sooner. They may have a partner or other children to care for.
Breastfeeding can be very demanding. It takes an incredible amount of energy to produce milk and feed your baby. For some women, the fatigue is so great they need to stop breastfeeding. This is not a failure on the part of the mother. If the mom isn’t okay, the baby can’t be their best either.
Letting Go of the Guilt
The “Breast is Best” messaging has had a serious unintended consequence. In the push to encourage women to breastfeed, we’ve created the message that “good” mothers breastfeed. This implies that if you don’t breastfeed, you aren’t a “good” mother.
Parenting is fraught with challenges, victories, and yes, failures. However, the inability to breastfeed shouldn’t make you feel like you’ve failed your child. The sad reality is that at least half of women view it as a failure, according to a BBC survey.
The survey went on to reveal that one-third of the women in the survey felt guilty for giving their baby formula. The mom shaming begins before we even leave the hospital, and it creates an unnecessary mental health struggle.
One often overlooked aspect of stopping breastfeeding is grief. Many women want to breastfeed, but find that it doesn’t work for them or their babies. When this happens, they can experience more than guilt. They can experience a deep sense of grief.
Problems breastfeeding can lead to shame both for women who do so without trouble (as they report being shamed for breastfeeding in public or relegated to restroom stalls) and those who struggle with it, and they report being made to feel “inadequate” as mothers. Mothers are commonly told that exclusive breastfeeding is the biological norm and being unable to do so creates a message that they are biologically abnormal and their child will receive less-than adequate nutrition.
And in reality, sometimes the opposite is true. In a 2017 BBC article, mother Suzanne Barston discussed her difficulty to get her son to directly breastfeed, leading her to pump for several hours a day. This caused exhaustion for her – worsening her postnatal depression- and failure to thrive for her son, who developed a rash and often had bloody stool. At the advice of a doctor, she switched to hypoallergenic formula, and her son made a full recovery. Looking back, Barston feels angry that she was pressured to breastfeed when bottle feeding was safer for her son. She went on to write about the issue in her book Bottled Up.
An article in the journal Nursing for Women’s Health agrees, saying “[p]sychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions.”
A 2011 study backed up this finding. And a 1990 study found that as many as one in seven women have difficulty breastfeeding. And the messages that breast milk should be the sole mode of nutrition for the first six months of the baby’s life have had some devastating consequences.
Sasha Howard, a London pediatrician, reports many cases of dehydration caused by exclusive breastfeeding, which can lead to brain damage and death.
Jen Harper told the website Motherly in 2019 that she was devastated when her attempts to breastfeed her son failed because she had “ been conditioned to think that since I was a woman, breastfeeding would be the most natural thing I’ve ever done.”
Finally, Harper visited a doctor who explained that every baby isn’t a fit for every breast.
“I had to give up the notion that this was, in fact, a failure, because it wasn’t,” she said.” I had to let go of my notion that everyone around me was judging me for pulling out a bottle …”
Vancouver father Kim Chen, who lost his wife Florence Leung to suicide after she was unsuccessful in breastfeeding her newborn, agrees. After his wife’s death, their son thrived exclusively on formula, the Motherly article noted.
“While agreeing to the benefits of breast milk, there NEED[s] to be an understanding that it is okay to supplement with formula, and that formula is a completely viable option,” he wrote in a Facebook post.
These stories and many others underscore the importance of offering parents and society at large a more accurate and inclusive narrative about infant feeding. In reality, some lactating parents have adequate milk supply to exclusively breastfeed and experience few to no problems; some need a lot of help to achieve their breastfeeding goals; others have a partial supply no matter what they do and must supplement breastfeeding to provide their child the best possible nutrition; and others cannot or choose not to breastfeed at all due to a myriad of important and valid reasons. The good news is that for families with access to safe and healthy breast milk alternatives like formula, healthy infant nutrition is available to every single one of them so long as their babies are being safely and adequately fed.
So, if you’re having trouble breastfeeding, don’t blame yourself. The most important thing is that your baby is fed all that they need to thrive. Beating yourself up over issues with breastfeeding you can’t control will only add more stress to your workload. And with a new baby, you’ve got enough of that already.
Heidi Bitsoli has been a content writer with Sunshine Behavioral Health since 2019, where she researches and writes articles, guides, and blog posts on mental health and addiction. Prior to that, she wrote extensively on health, medicine, business, and human interest topics for a variety of clients. Her writings have appeared in numerous university publications, magazines, newspapers, and websites. She has a degree in English from Lake Superior State University in northern Michigan. A lifelong lover of learning, she enjoys researching and writing about the complexities of mental health.
Dr. Christie del Castillo-Hegyi provided medical review of this content.
The Fed Is Best Foundation is a tax-exempt 501(c)(3) non-profit, volunteer organization of health professionals and parents who study the scientific literature on infant feeding and real-life infant feeding experiences of families through clinical practice and social media connections. We work to identify critical gaps in current breastfeeding protocols, guidelines, and education programs. We provide families and health professionals the most up-to-date scientific research, education, and resources to practice safe infant feeding with breast milk, formula, or a combination of both. We provide safe, infant feeding education for breastfeeding, mixed-feeding, formula-feeding, pumped-milk-feeding, and tube-feeding mothers and families to prevent feeding complications to babies that have become too common from the pressure to exclusively breastfeed at all costs. Please consider making a donation so we can keep advancing our mission to provide safe, evidence-based, judgment-free, inclusive infant feeding support to all families.
Sources
Ncbi.nlm.nih.gov – Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation
Ncbi.nlm.nih.gov – Barriers to Breastfeeding in the United States
Nytimes.com – How to Deal with Low Breastmilk Supply
Pubmed.ncbi.nlm.nih.gov – Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss
Pubmed.ncbi.nlm.nih.gov – Delayed Onset of Lactogenesis Among First-Time Mothers is Related to Maternal Obesity and Factors Associated With Ineffective Breastfeeding
Ncbi.nlm.nih.gov – Maternal Perceptions of Insufficient Milk Supply in Breastfeeding
Sunshinebehavioralhealth.com – Dual Diagnosis Treatment
Pubmed.ncbi.nlm.nih.gov – Shame if you do–shame if you don’t: women’s experiences of infant feeding
Bbc.com – Are there downsides to ‘breast is best’?
Sciencedirect.com – Women’s Choice Regarding Breastfeeding and Its Effect on Well-Being
Pubmed – Early breastfeeding experiences and postpartum depression
Onlinelibrary.wiley.com – The Influence of Breast Surgery, Breast Appearance, and Pregnancy-Induced Breast Changes on lactation Sufficiency as Measured by Infant Weight Gain
Fedisbest.org – If I Had Given Him Just One Bottle, He Would Still Be Alive.
Mother.ly – The pressure to exclusively breastfeed is hurting mothers’ mental health
Facebook.com – Remembering Mother Florence Leung
