Breastfeeding pressure is real, and research suggests it’s linked to mental health conditions in mothers

Families are under enormous pressure to exclusively breastfeed from major health organizations such as the WHO, Baby-Friendly USA, CDC, AAP, ACOG, WIC offices, and the majority of US  hospitals.  

The “Breast is Best” public health campaign has permeated US culture and influenced hospital policies; even though US families face impossible barriers to breastfeeding exclusively, the pressure remains, and it is up to families to meet the unattainable guidelines for the majority of families.

By the way, there is no evidence that Baby-Friendly policies are effective for increasing long-term breastfeeding rates.

It has been shown in ample research that exclusively breastfeeding can cause serious complications for infants experiencing insufficient milk intake, a concern we discuss daily. The same pressure to exclusively breastfeed has now been linked to mental health complications, according to a recent research paper published in Research Psychiatry.

Breastfeeding pressure even has a pseudonym, “BRESSURE,” but it’s not funny. 

 

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My baby went hungry under the care of three IBCLCs, so I became an IBCLC to promote evidence-based lactation care

 

As a result of my traumatizing breastfeeding experience, I became an IBCLC. My goal as an RN and IBCLC is to help moms reach their feeding goals in a safe and evidence-based way and, most importantly, to ensure that babies are fed, not forced to go hungry, and to listen and believe moms when they say they are not making enough milk! After all, the number 1 rule in lactation is to feed the baby, but that rule no longer applies. The rule is to breastfeed exclusively, at all costs. That was the price my baby had to pay, and I am determined to change that. 

I was just beginning my career as a labor and delivery nurse when I became pregnant with my first child. According to our standard breastfeeding policies, all our patients were encouraged to breastfeed. It was common for patients to complain that they didn’t have enough milk, but we were taught this was “rare” as babies have small stomachs and need little colostrum. Because of this, I assured my patients that everything was fine. 

 

There is a myth regarding a newborn’s stomach size that perpetuates the underfeeding of EBF babies, and now it is beginning to infiltrate formula-fed babies as well.  The myth is found in every hospital and is not supported by current research.  According to seven research articles, the stomach size of a term 7-pound baby ranges between 20 and 35 ml.

 

Another myth is that colostrum is all your baby needs.  Note: One teaspoon of colostrum contains three calories. Feeding a newborn baby drops of colostrum is never enough for adequate feeding and fluids.

There is also a myth that low milk supply is rare. 

Scientific Studies SHOW THAT DELAYED ONSET OF LACTOGENESIS II (DOLII), LACTATION DYSFUNCTION, AND LOW MILK SUPPLY (LMS) ARE COMMON.

After my first baby was born, I immediately began breastfeeding her, and everything seemed to be going well with latching and nursing, but she cried a lot, which was unsettling to me as I couldn’t comfort her.  However, excessive crying was considered normal. (Note: Excessive crying is not normal) Gradually, my baby developed excessive jaundice, and the neonatologist was so concerned he recommended supplementing her with formula after nursing before we could be discharged. I tried to hand express, and all I could get was the tiniest clear drop, but the IBCLC said I probably didn’t respond to hand expression and told me I didn’t need to supplement because my baby’s  bilirubin level wasn’t “too high.” Sadly, I followed the advice of the IBCLC.  (Note: The IBCLC violated her Code of Professional Conduct and Scope of Practice, putting this baby in unsafe conditions without adequate nutrition and fluids and increasing bilirubin levels.)

 

That night, my baby did not sleep at all because she was crying. As I slept, my husband tried latching her onto my breasts as I was exhausted and falling asleep. In the morning, she was re-examined, and her bilirubin levels got worse, and she also lost a whopping 10 ounces! I was told by the neonatologist that I needed to supplement urgently.  

With terror in my heart, I trembled, and I began supplementing right away. My baby finally stopped crying and slept for the first time.

I nursed and supplemented her every 2 hours because she was so hungry. However, another IBCLC and the breastfeeding support group I was in told me that supplementing my baby would hurt my supply, so I slowly eased her off the formula and began EBF again at one month old.  (Note: supplementing does not decrease milk supply if adequate breast stimulation and milk removal are provided with every supplemental feeding.) 

Even though I was finally exclusively breastfeeding, my baby would nurse every 15 minutes, and I would have maybe one 15-minute break all day when my husband took care of her. She would cry the whole time. Whenever she fed, I told myself it was “cluster feeding.” Her continuous feeding was good for my supply; I should keep it up. 

Cluster feeding is another myth parents are taught when babies feed non-stop in the hospital. Find out what “cluster-feeding” really is here: cluster-feeding

I went to see another IBCLC, and she did a weighted feed. After feeding her, the weight didn’t change at all. The IBCLC said a mistake must have occurred, “that never happens.” She suggested I come back after another weighted feeding when my breasts were painfully full. At this weighted feeding, my baby had only gained one ounce, but I was only encouraged to continue exclusive breastfeeding because her weight was slowly going up. (Note: The IBCLC violated the Code of Professional Conduct and scope of practice.  The baby was placed in unsafe conditions because of inadequate feeding. The baby should have been supplemented, and a feeding plan should have been implemented to improve milk supply while supplementing.  Her pediatrician should have been notified; follow-up lactation appointments to monitor weight gain were essential.  

At nine weeks old, despite me constantly nursing her, her weight percentile dropped from the 76th percentile at birth to 7th. She had gone ten days without pooping; she even had a few brick dust diapers during the month of exclusive breastfeeding. At this point, I was at my breaking point. Both my baby and I were not thriving. I vividly remember reading the signs of HUNGRY on the Fed Is Best website in the middle of the night. I burst into tears knowing my baby had some of the symptoms and realized she was hungry! 

There was no way to describe the guilt I felt. The truth is no mother can believe she wasn’t giving her baby enough milk when she was doing the “right” thing by exclusively breastfeeding. The result was that I had to suffer through the depths of the worst mom guilt hell.

 

The fact that she ate all the time was not normal. Still, many breastfeeding support groups said it was all normal (cluster feeding, baby can go two weeks without pooping, percentile charts are not accurate for breastfed babies, and some babies are just smaller, etc.).

These breastfeeding support groups are harming babies every day, and I shudder to think about how many babies are suffering from hunger or worse. 

My pediatrician recommended I begin supplementing with formula again, and I finally decided I needed my baby to be happy and healthy.  I began following the Fed’s Best Supplementation Guide and supplemented with 15cc at a time after breastfeeding both sides and using a slow-flow nipple when supplementing her. She gained five ozs in two days, was finally content and happy, and began sleeping better. Her weight gain percentiles began CLIMBING rapidly, and I was so relieved.

I am here to tell you it’s possible to successfully combo-feed your baby; I successfully combo-fed my baby until she was a year old, with 1/3 of the milk from my breasts, and the rest was life-saving infant formula.

 

She has grown into a healthy, intelligent, beautiful girl in four years.  I have since had two more children, and I have combined breastmilk with formula from the start. I still sometimes feel a pit in my stomach, wondering what would happen if I continued exclusively breastfeeding. I am so grateful to Fed is Best Foundation for helping me see the evidence that my baby was hungry. 

Sarah F., RN, IBCLC

Dec 12, 2018 — The aim of this Scope of Practice is to protect the public by promoting that all IBCLC certificants provide safe, competent and evidence-based care

IBCLC Assessment, Diagnosis, and Referral

IBCLC Code of Professional Conduct

IBCLC scope of practice



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My Baby is Healthy (and so am I) and That’s All That Matters: A Pediatrician’s Perspective

I didn’t have the easiest pregnancy; for one thing, I was considered a geriatric pregnancy, given that medicine was my second career, and I waited until after residency to get pregnant. 

I also have a history of depression and anxiety; thankfully, my depression was under control during pregnancy, but my anxiety certainly wasn’t – it worsened when I learned I was diagnosed with gestational diabetes (likely due mainly to my advanced maternal age). 

In my mental preparations to have my baby, there was one thing I was always sure of: I would certainly attempt to breastfeed my child, but if it didn’t work out, that would be okay because, in my clinical experience, formula-fed babies did just fine. Furthermore, from the years of my struggles with my mental health, I learned the importance of choosing my battles, and it simply wasn’t worth it to me to agonize over breastfeeding if it didn’t come easily.   Continue reading

My Baby Scream-Cried The Entire Second Night In The Hospital

My name is Amber, and I am the mother of a charming, beautiful, and vivacious baby boy. I want to share with you a story: the story of my son’s birth and his first few months earthside. It is a multidimensional story full of love and heartbreak, but I think it’s important that other new mothers hear it. I hope they will know they are not alone if their early motherhood experiences are not what they always dreamed of.

I was working in an emergency room as a nurse and heading into my second-to-last semester of school to become a nurse practitioner. My husband and I had only been trying to conceive for a month. Because I have polycystic ovary syndrome (PCOS) and irregular periods, I figured getting pregnant would take longer, but there I was on September 1 with a positive test. We were ecstatic. As a planner, I spent most of the next nine months thinking about and planning everything about my son’s birth. I consider myself a well-educated woman and medical professional, so it was no surprise that the heart of my plans included breastfeeding my son. I spent months researching the best pumps for when I had to return to work, deciding on a storage-and-feeding set, and learning about ways to strengthen the breastfeeding bond. Formula feeding never crossed my mind. After all, I was always told breast was best. Sure, I had some friends who gave some formula here or there, but I just knew I would be one of the ones who would exclusively breastfeed and pump for my son. Continue reading

I No Longer Judge Other Mothers; My Breastfeeding Challenges Have Absolutely Changed Me As a Mom, a Woman, And a Friend

As a nurse, I knew I wanted to breastfeed my baby. I learned everything I could about breastfeeding, and I just knew that it would work for us. In nursing school, we were told that anyone could breastfeed who wanted to and I believed it. I would not even consider the possibility of feeding my children in any way other than nursing and was extremely judgmental of anyone who did not breastfeed their children. I honestly thought they were lazy, selfish, and unwilling to do the work.  I lived by the mantra that “breast is best!” My son was born, and I was so excited to meet him and begin our breastfeeding journey.  Unfortunately, we struggled from the very beginning.  It was very difficult to get him to latch, and when he did, he wouldn’t stay on very long.  Eventually, our son became difficult to wake up, but the nurses responded to our frustrations by saying, “he must not be hungry!” By discharge, I didn’t feel like I knew what I was doing. I bravely went home,  believing this was normal.  We would figure it out because “breast is best.”

Dehydration2My husband and I cried a lot during the first 24 hours at home. We fought to wake our sleepy newborn up, but we were rarely successful, and when we were, we couldn’t get him to eat. I kept on refusing to allow my husband to give our son any formula because I didn’t want it to ruin our breastfeeding relationship. We went to his newborn appointment when he was four days old. I knew at that point things weren’t going well but wasn’t prepared for the realities we were about to face. Our son had lost 13% of his body weight, he was hypothermic with a body temperature of 94.9, he was hypoglycemic, and had lost his reflexes. Our pediatrician looked at us with very sad eyes and kindly but firmly, explained our son was very sick and needed to eat now. Continue reading