When I had my daughter last year, I set out with the intention of breastfeeding her for a full 12 months. I had heard (many, many times) about how my mom had nursed me for a year, and most of my American friends seemed to be on the breastfeeding train. Except I live in France, where moms on average breastfeed to 17 weeks and less than 10 percent continue for six months, according to a 2015 study by Inserm, France’s National Institute of Health.

However, breastfeeding was harder than I expected. Getting my daughter to properly latch onto my breast was surprisingly challenging, and I hadn’t mentally prepared for the reality of nursing every two to three hours, day and night, after a 30-hour labor. The first night after delivery, I only got a few short bursts of sleep, and my poor nipples were soon stinging and bleeding from the near-constant feeding. I begged every nurse who came into my hospital room for help.

Fortunately, thanks to France’s affordable medical system, I was able to stay in the hospital for a week to get things on track. But over the next few months, breastfeeding became increasingly tough with my work schedule, and my milk supply couldn’t seem to keep up with one very hungry little girl. I faced pressure to add a bottle of formula from my husband and our nanny, who implied that my daughter was too skinny (she wasn’t, our pediatrician reassured me). But on the other hand, I was well-aware as a health journalist of the benefits of breastfeeding, and felt added pressure to nurse from my mom and friends, who had all made it seem like a breeze. I figured if I could make it happen, why shouldn’t I? Wouldn’t I be a bad mother for not choosing my child over my own personal frustrations?

Around six months, feeding my daughter adequately through breastmilk alone was difficult enough that I decided to give her a supplemental midday bottle of formula. We also continued nursing until she was just shy of a year. She’s currently happy and healthy—and I know now that I made the right choice for both of us.

Unfortunately, I’m far from the only new parent to struggle with breastfeeding. People have strong opinions on the topic, and they’re not afraid to share them. All too often, women are judged no matter what decision they make about breastfeeding—whether they choose not to, or conversely, choose to do it for “too long” or “the wrong way.” But the reality behind how a person feeds their newborn baby is far more complex—and personal—than just “breast is best.”

The benefits (and struggles) of breastfeeding

The American Academy of Pediatrics (AAP) recommends breastfeeding for at least the first 12 months of a child’s life, exclusively for the first six. They point to research-backed benefits of breastfeeding for babies, including protection against diarrhea, respiratory tract infections, ear infections, diabetes, obesity, autoimmune disease, asthma, allergies, and sudden infant death syndrome (SIDS). There’s also some evidence that breastfeeding helps build a baby’s microbiome. Per the AAP, there are also upsides for mom, including decreased risk of breast cancer, ovarian cancer, obesity, nonalcoholic fatty liver disease, type 2 diabetes, heart disease, and high blood pressure.

The process of making human milk fundamentally changes a person’s body, says pediatrician Lori Feldman-Winter, MD, FAAP, chair of AAP’s Section on Breastfeeding. After birth, it takes three days for breasts to start producing milk, with between 20 to 35 percent of women taking longer, she says. In the meantime, babies cluster-feed (where they latch and suckle every two to three hours) to stimulate supply. Breast size increases exponentially, hormone levels and metabolism get revved up, and you even temporarily lose up to 5 percent of your bone mass—all to support the breastfeeding process. While we don’t entirely understand all of the mechanics at play, “the science is pointing to a complex ecosystem between mother and baby,” Dr. Feldman-Winter says. “The bottom line is that breastfeeding matters for both the short- and long-term health of infants and their mothers.”

The health benefits of breastfeeding are so great that you’d be hard-pressed to find an expert who doesn’t support it. Beyond the AAP, the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) emphasize that babies should be exclusively breastfed for the first six months of their lives. But all of these benefits lead to the “breast is best” mentality, which inherently puts women who do not breastfeed down. And the fact of the matter is, some women just can’t do it.

“Breastfeeding can be a wonderful experience for mothers. However, it needs to be approached as a new skill for both mother and baby to learn,” says Sophia Komninou, PhD, a researcher and lecturer of public health, policy, and social sciences at Swansea University in the UK.

“Breastfeeding can be a wonderful experience for mothers. However, it needs to be approached as a new skill for both mother and baby to learn.” —Sophia Komninou, PhD

“The body’s process of producing milk is very complex, and it doesn’t take much to interfere with it,” Dr. Feldman-Winter says. She says that about 10 percent of women can’t breastfeed because their milk doesn’t come in or they have a medical contraindication (such as being HIV positive). Others might struggle with latching issues, painful nipples, infections like mastitis (clogged milk ducts) and thrush (a yeast infection that can affect a baby’s mouth and then be passed to the breast), or other complications that can arise from breastfeeding that make it difficult and painful—adding to the stress many new parents already experience in the first few weeks after birth. Moms with premature babies who start out life in the neonatal intensive care unit (NICU) face even more hurdles.

Fortunately, many women do get assistance for the first few feeds from hospital staff, especially at the growing number of Baby-Friendly hospitals (a joint UNICEF and WHO effort to identify breastfeeding-supportive facilities) in the U.S. Yet new moms are also discharged on average two days after delivery—before their milk is even in—leaving many feeling frustrated and alone if they struggle to breastfeed. Add to that the emotional fluctuations of postpartum hormones and ongoing sleepless nights, and it’s no wonder some people decide that breastfeeding is not for them.

Suzanne Barston, a journalist, blogger at The Fearless Formula Feeder, and author of Bottled Up, fully intended to breastfeed but struggled from the start. Her son was tongue-tied (a condition that restricts the tongue’s range of motion) and could not latch, and she suffered from severe postpartum depression. “Then it turned out he had a milk protein allergy and reacted to my milk, so he was sick all the time,” she says. Her nursing struggles made her feel like a failure at first. “Motherhood was just one big blur of pain, guilt, and sadness,” she says.

The Catch-22 of feeding your baby

Beyond health reasons, there are a variety of other factors that impact a person’s decision to breastfeed. Since federal law doesn’t mandate paid maternity leave (or even unpaid leave in many circumstances), many women are forced to return to work within weeks or even days of delivery, further hindering breastfeeding attempts. “There’s a push to return to the workplace sooner than what would be supportive for continued breastfeeding,” says Dr. Feldman-Winter.

Although laws now require that employers offer women the time and a safe space to pump at work, many workplaces still don’t fully comply. Just this year, a woman won over $1.5 million in a lawsuit after alleging that her fellow employees at KFC made it so difficult to pump at work that her breastmilk supply dried up.

Even with appropriate space and time, many mothers find pumping challenging and unpleasant. “Having to be locked away and unavailable for in-person meetings, washing and drying and washing again all those damn little pump parts, and awkwardly carrying your recently-expressed breast fluid to the shared refrigerator, makes me feel vulnerable, like a bit of a nuisance, and frustrated with the tedium,” says Kelly Kutas, a marketing research director in Chicago, IL, who has been breastfeeding her daughter for over three months.

Kelley Slocum, a retail consultant in New Orleans, LA, who has an 11-month-old son, started pumping almost exclusively as soon as she began traveling frequently for work at 12 weeks postpartum—a choice that opened her up to criticism. “People always question why I even bother. They often tell me it must be so much work to lug a pump and cooler with me everywhere I go… However, as a mom who has to leave her baby, I feel that one thing I can do for him is pump, and give him my breastmilk,” says Slocum, who now supplements with one bottle of formula per day.

Barston experienced a slightly different shade of shame regarding her decision to stop breastfeeding. At around six weeks postpartum, she realized that neither she nor her son was benefitting from breastfeeding, so she made the jump to exclusively hypoallergenic formula. “It was like the clouds lifted. I felt joy and was able to bond with my baby. I finally started feeling like I could be a mom,” she says.

“Each mother and baby are unique and have different needs. While breastfeeding is desirable, it must be the woman’s choice.” —Jody Segrave-Daly, RN, IBCLC, and co-founder of The Fed Is Best Foundation

Although Barston’s family, friends, and pediatrician were supportive of her decision, more than one doctor told her that she had made a mistake. “When I told [one doctor] that my mental health was affected by nursing and that it was better for us as a family…he laughed in my face and told me I should have just hired a nanny if I couldn’t handle it,” she says.

Barston says she felt alienated when she was the only mom she knew who pulled out a bottle instead of a breast. “I didn’t know where to go for support, and it felt very lonely,” she says. “It struck me that the beginning of motherhood is really mostly about feeding, because that’s all newborn babies do: sleep and eat. Of course we are all going to obsess about the one thing we can (sort of) control.”

There is also enduring stigma around breastfeeding in public (damned if you do, damned if you don’t, it seems) that can impact a person’s ability or desire to feed. Nursing mothers are often asked to cover up or leave public spaces when they attempt to feed their babies, despite the fact that breastmilk (or a baby’s hunger) doesn’t operate on a convenient schedule. There has been some progress on addressing this stigma, but a full 11 percent of Americans still don’t think that women should have a right to breastfeed in public, according to data released by the CDC in 2018.

Ultimately, breastfeeding is a deeply personal choice. Some women suffer from sleep deprivation and postpartum depression, which can make breastfeeding all the more challenging. Others just don’t want to breastfeed or don’t like it and stop—and that’s valid, too. “The elephant in the room is that perinatal mental health is not talked about,” says Jody Segrave-Daly, RN, IBCLC, and co-founder of The Fed Is Best Foundation. “Stable maternal mental health should be prioritized first, but it’s not unfortunately.”

While every expert will say that breastfeeding is the best option in terms of the baby’s nutrition and health, formula is recognized as a safe and effective alternative, and what matters most is that a baby is fed. If someone can’t or hates breastfeeding, they shouldn’t force it because of societal pressure. “Each mother and baby are unique and have different needs. While breastfeeding is desirable, it must be the woman’s choice,” says Segrave-Daly. “We [at The Fed Is Best] prioritize perinatal mental health, because breast milk does not care for, nurture, or bond with a baby. A healthy, loving parent does.”

How we can support all moms

It’s a disservice to moms for society to put so much judgment and pressure on one’s feeding choice. “We’ve made it a moral choice as well as a medical one. It’s the start of a parenting culture which is all about maximizing a child’s chance of success,” says Barston.

So how can we begin to reduce the stigma? For one thing, Dr. Komninou says we need to keep our language neutral when talking about feeding babies. Mantras like “breast is best,” for example, can make women feel guilty and dissatisfied if they are struggling to breastfeed. “It was originally designed to convey the health benefits of breastmilk and tackle the prolonged slump in breastfeeding rates. But, assuming every new mother wants the ‘best’ for her baby, it takes on a profoundly moralistic dimension that has become intertwined with the concept of ‘good parenting,’” she says.

Dr. Feldman-Winter says doctors also need to do a better job supporting patients. “Pediatricians need to be equipped with knowledge and skills in coordination with lactation consultants or other docs with breastfeeding expertise,” she says. That way, pediatricians and other healthcare providers will be able to accurately answer questions, or refer a new parent to a specialist who can help more directly.

To that end, doctors, midwives, and lactation consultants should absolutely discuss the science-backed benefits of breastfeeding with patients and guide women to available support. But if a mom decides formula is best for her and her family, her choice should be supported, Dr. Feldman-Winter says.

“The important thing is for doctors to support women to meet their own personal goals,” says Dr. Feldman-Winter. “If a mom is only intending to breastfeed for a short period of time, it’s important that we support that goal, knowing there are benefits. There really shouldn’t be pressure coming from doctors. It’s about providing evidence-based medicine. In the end if it’s not working out, or a mother chooses not to breastfeed, we need to be there for that mother to support her.”

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