As mothers, our sense of self-worth is closely tied to our ability to care for and nurture our children. This begins during pregnancy and is at its most powerful when breastfeeding, as our babies rely solely on us for their nutrition. An inability to breastfeed, for whatever reason, can have a devastating impact, as mother-of-two Amanda discovered.
“With both of my sons, I desperately wanted to breastfeed. But, despite trying what I felt was everything under the sun, I was not able to exclusively breastfeed either of them due to low milk supply. With my first son, I was so adamant that I would breastfeed that I did not even have one bottle or any formula in the house when we brought him home. Nearly four days after he was born, my milk had still not come in and my son would not sleep, and would scream for hours on end. I was determined to nurse all day if I had to – which I did.
“For the next week, I would nurse my son around the clock. Literally 24 hours a day, he was on my breast. If he dozed off and I tried to take him off the breast, he would wake and cry, so I would have to put him on again. My nipples were so red and raw and cracked. It caused shooting pain to feed, but I was determined. When we went back to the paediatrician, I was devastated to learn that my son was still losing weight and had not regained his birth weight.
“After six weeks of agony, almost no sleep, and finally giving in to one formula-feed per day, I found myself one morning in the throes of post-partum depression. I could not get out of bed, my son was crying next to me and I just did not have the energy or desire to feed him. My husband took one look at me and decided he was going to take the baby for the day, feed him formula and send me to see my doctor. It was a very difficult decision, but I finally went on anti-depressant medication and I also decided to stop breastfeeding.
“I struggled, as initially I felt even more depressed when I stopped breastfeeding, but after about three days, the change in me and my son was astronomical! He was finally sleeping, and when he was awake and well-fed, he was happy, smiling and we could interact with each other. I was also in the best state of mind I had been since I gave birth. I felt as if a dark cloud had been lifted and I could finally see in colour again and enjoy my baby!”
A recent Time Magazine cover featuring a mother breastfeeding her toddler with the title “Are You Mom Enough?” was just one of many controversial pieces about breastfeeding that have been popping up in the media around the world this year. Some claim that too much pressure is placed on new mothers to breastfeed, and that the ideal doesn’t always meet the reality. Then there are those who fight for breastfeeding and its benefits, and demand that healthcare professionals and the media stop bombarding us with the idea that choosing not to breastfeed is OK.
When I started my research for this article, I requested input on an online forum for Hong Kong-based mothers. I was overwhelmed by the response I received and moved by the number of women who wanted to share their experiences with me. But there was also something quite disturbing that came to light. The first batch of responses on the forum were mainly from mothers who were able to breastfeed successfully, despite some initial difficulties in most cases, and many of them were vehemently outspoken against formula. Then I asked to hear from those who had not found it so easy, and was saddened by the fact that many of these women had not wanted to share their stories publicly. They emailed me privately, asking for their names to be changed, afraid of being vilified for the choices that they had made.
Many women used the word “failure” to describe their inability to breastfeed, while most said they felt “horrible” or “ashamed”. One mother went into such a deep depression that she was physically incapable of feeding her son. Jane described her feelings of frustration: “It is hard enough to have to make the switch due to dire circumstances; as a mother you already feel horrible about it and as if you have ‘failed’. Reading article after article that fail to acknowledge that, sometimes, it just doesn’t work, makes things even worse. I read loads of sites and articles implying that if I had just ‘tried a little harder’ or ‘waited a little longer’, things would have been fine … I now know that I would have had a more severely underweight child (with all of the accompanying issues) if I had not switched to prescription, hypoallergenic formula when I did. I only made it to six weeks, and I had another painful six months of ‘justifying’ why I didn’t breastfeed to so many mothers. I regret that the guilt, the explanations, the justifications, the people who said hurtful things, darken my memories of my son’s infancy even to this day.”
Obstacles to overcome
The many critics of today’s breastfeeding policies, which recommend exclusive breastfeeding for six months, followed by breast milk and solids until two years of age, cite a 2006 Scottish study. The study, investigating both the feeding practices and views on breastfeeding education within families, found that many parents made the decision to change to formula or introduce solids when breastfeeding had a negative impact on their daily lives. The immediate well-being of the family, particularly when there were other children to worry about, was of greater concern than longer-term health benefits. The study concluded that the idealism of exclusive breastfeeding clashed with the reality of a busy family life. For most, the decision to change to formula became necessary when the obstacles, such as physical issues, a return to work, or simply a desire to “get their lives back”, were just too difficult to overcome. Another common complaint from the participants was a lack of practical and compassionate support from healthcare professionals when the going got tough.
I still feel guilty that I wasn’t able to breastfeed my first baby exclusively, and I often wonder if I would have been more successful if I had had more support. I blame myself for not seeking that support, when, in fact, I should probably blame the professionals whose support I did seek. From the doctor who told me formula was my only option, to the midwife who advised me to do nothing but breastfeed all day every day if that’s what it took, at no point did anyone realise that I needed more options. Healthcare professionals who routinely work with breastfeeding mothers have a responsibility to educate themselves about lactation and, if they can’t provide appropriate advice, then they should know where to send their patients to find it.
There are a number of women who simply cannot breastfeed, and for a small minority, formula is the only option. For those who can, and who choose to do so exclusively, the key to their success lies in building their knowledge about the mechanics of breastfeeding, surrounding themselves with a good support network, knowing how to access professional support when necessary, and persevering despite the cultural and social barriers that exist. For those who do manage all of that successfully the benefits are numerous, and they find that the experience of breastfeeding is well worth the effort, for them and their babies.
I’m currently breastfeeding my second child, successfully, and it’s a remarkable experience. Knowing that I’m giving him the best start possible has done wonders for both of us. But after my experience the first time round, I am ever so grateful that I can. I wish all mothers and babies could have this experience, with all its inherent benefits, but it isn’t always possible. At the end of the day, whether we can breastfeed and do, or make a conscious choice not to for whatever reason, or if, despite our best efforts and intentions, we simply have to give our babies formula, we are all exercising our right to choose how we feed our children. Rather than criticising each other’s choices, we should be fighting for those things that will ensure that we make the most educated and supported choices possible: adequate maternity leave, better trained midwives and doctors, better post-natal follow up care and inclusive mothers’ groups where all that unites us is love for our children, however they’re fed.