“Thank you. You’re the first to say it’s OK for me not to breastfeed.”
These words have been said to me before by tearful, exhausted mothers. It had been sporadic, but now, it feels like I hear this every day in the clinic. Each time, I feel a rush of mixed feelings as I explain that other options had not been explored because of the known benefits of breastfeeding. I tell the mother this does not mean formula will harm her child. As I say this, deep inside me, I feel a flicker of frustration and sorrow because someone inflicted this unnecessary stress on her during an already physically and emotionally trying adjustment period. Before these emotions fully surface, the satisfaction of being the first empathetic physician to get the thank you takes over. I then move on to the next patient and don’t think twice about it.
On this day, with those same words, this mother’s gratitude could not suppress the anger and sadness inside me. I am not sure what it was about this visit. It was probably the accumulation of all the other mothers who uttered these same words previously throughout my career. But I finally saw the shame lurking behind those words. It was not the formula that was her main concern. It was whether she could still be a good mother if she did not breastfeed. Her worth was intimately intertwined with breastfeeding. But why does this happen? Why have I been wrongfully benefiting from so many “thank yous” for years?
Breastfeeding conveys lifelong benefits for both mother and infant. I know the evidence. I support breastfeeding, but does that mean every mother can and must do it? I grew up purely formula-fed. I have never thought my mother wronged me by feeding me formula or that I would be better off now if I had been solely breastfed. When I imagine how she would feel as a new mother today, my heart sinks. How dare someone make her feel like she failed me? And yet, some so many mothers think that they and their bodies have failed. In reality, it is us who failed.
We failed to make it known to everyone that there is an unspoken breastfeeding “secret.” It can be hard. Let me rephrase – it is hard for the majority of women, and countless mothers struggle. Some succeed. Others either cannot succeed, or it’s not their priority. I witness so many mothers struggle because of an outcome that is affected by so many factors and circumstances outside of their control and our control. Somehow, we created this illusion that every woman has the ability to breastfeed. She just needs to will her breasts to produce milk, stop worrying about job security, let her other children raise themselves, and rely on others to help with her extra responsibilities. Reasonable enough, right?
The pendulum has swung too far in our relentless quest of “breast is best.” It is wonderful that we are educating people about the scientific evidence of breastfeeding. However, even the best evidence-based recommendations can be pushed too far. We are trying to make progress in medicine with diversity, equity, and inclusion, and yet we have gone backward with breastfeeding. Mothers who cannot or do not breastfeed get labeled as the “bad mother.” They feel judged by us, their physicians in the medical community, and by their friends and families in the lay community. What happened to empathy, personalized care, and actually listening to our patients’ and families’ needs?
Change needs to happen. We all have the power to restore a more nuanced and empathetic approach to breastfeeding. Yes, we should provide the evidence and the breastfeeding support, but we need to break the association that a mother can only be “good” if she breastfeeds. If we are so keen on pressing all mothers to breastfeed, we cannot leave them alone trying to understand how to make it work with their breasts while trying to balance all their other responsibilities. We need to improve breastfeeding education for both providers and mothers and change public policy to succeed when they return to work and invest in scientific advances to help mothers who physiologically have insufficient milk supply. This will take time. In the meantime, we need to tell all mothers that breastfeeding is not the end all be all. Right now, all mothers everywhere just need to know “being you is enough.”
Helen C. Wang is a pediatrician.
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