Breastfeeding: When Breast May Not Be Best
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Breastfeeding your baby – an action so natural, yet not so easy. Many women struggle in the postpartum period with breastfeeding, whether it is your first baby or your third. There is often pressure to breastfeed because we hear so much about how it is the best option for a baby. I have seen many women develop significant anxiety about breastfeeding, breast milk supply, and making the right choice for their child’s nutrition.
This article will provide the scientific evidence for and against breastfeeding, but the focus will be on those for whom the right choice may be to choose not to breastfeed.
Evidence for Breastfeeding
The guidelines by the American College of OB/GYNs and the American Academy of Pediatrics recommend breastfeeding for at least the first six months of life. There are a number of benefits noted for the baby, including immune benefits (breast milk carries antibodies to help infants fight off infections), easy digestibility, and a lower risk of sudden infant death syndrome (SIDS). There are also benefits for mom, including release of the hormone oxytocin which can help the uterus return to its normal size, weight loss, and financial savings. There are many articles available on the benefits of breastfeeding if you would like to learn more details.
When to choose supplementation and formula-feeding
There are certain instances when breast-feeding is not an option:
When taking certain medications that can be harmful through the breast milk. These may include medications for conditions such as multiple sclerosis, certain types of cancer, HIV, or others. Women taking medications for mental health reasons (such as certain mood stabilizers) may choose not to breastfeed because of insufficient data on safety. However, this is an important discussion with your reproductive psychiatrist and a very personal decision. I've had many patients successfully choose to breastfeed on various psychotropic medicines.
When sleep is a significant issue. For women with bipolar disorder, poor sleep is a common trigger for a mood episode. For women with severe illness, the risks of poor sleep may outweigh the benefits of breastfeeding.
When breastfeeding causes pain to a degree beyond what is typical. This may be due to medical complications such as recurrent mastitis.
When breast milk supply is poor (due to a multitude of underlying reasons).
When breastfeeding is not an option due to a woman’s medical history, such as a history of breast cancer and subsequent surgery.
When encountering these scenarios, many women become quite anxious about the health of their infant and the baby’s long-term prognosis. There can also often be feelings of shame and guilt when a woman is unable to breastfeed.
How to make the right choice
The first step is to understand the reasons behind the decision you are making. Some choose not to breastfeed because of anxiety about not knowing how. It is important to recognize that even though breastfeeding is “natural,” it is something that requires practice and for many new moms, assistance. That assistance may be from a lactation consultant, your child’s pediatrician, or a doula or midwife. From a practical perspective, it may, at least in the beginning, require the help of your partner to position the infant and help with logistics.
The second is to share your decision with a non-biased and non-judgmental clincian, who can help you weigh the risks and benefits and alternatives of your choice.
Third, it is important to recognize that some of the benefits of breastfeeding have nothing to do with the breast milk, but instead with the bonding experience the act provides. This bonding can be achieved with formula as well. It can also allow for bonding between the baby and other important family members.
How to feel confident with your decision
For many, the decision not to breastfeed or the decision to supplement with formula is not an easy one. There can be pressure from others to continue breastfeeding even at the detriment to one’s emotional health. When the act of breastfeeding becomes so difficult or painful that you begin to dread that time with your infant, a red flag is raised. It is perhaps not surprising that difficulty with breastfeeding is one risk factor for the development of postpartum depression. I have met many mothers whose inability to breastfeed as they had hoped led to feelings of shame, guilt, anxiety, and ongoing mental health problems.
On the other hand, the decision to breastfeed is also not without its own set of complications. For many women, returning to work after maternity leave poses challenges if one wants to continue breastfeeding. Many workplaces do not have appropriate lactation rooms, and even if they are available, the disruption in the work day causes many women to stop breastfeeding before they would otherwise choose to do so. Similarly, women are often encouraged to breastfeed yet find themselves turned away or asked to leave when they attempt to do so in public.
It is essential to recognize that the decision you make about breastfeeding is very individual and depends on your unique set of life circumstances, including physical and mental health issues. Having the support of a partner, family, other moms, or a clinician will help when making this nuanced choice.
Breastfeeding: When Breast May Not Be Best - Selected Resource(s):
Please note that while I am a clinical doctor, this article is not a substitute, and no one should be taken as medical advice. No specific health advice is being given in this article, and no physician-client relationship is created by you reading this article; all information provided in this article is for informational purposes only.
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