The advice to breast-feed infants exclusively until they’re at least 6 months old is unequivocal: it’s healthier for mom, and it’s healthier for baby. But it can also be really hard.
A recent Scottish study that consisted of multiple interviews with 36 mothers and some of their relatives — 35 of whom intended to breast-feed their babies — concluded that the widely touted recommendations are in fact “unhelpful” and overly idealistic.
The study, published in an open-access publication of the British Medical Journal, acknowledges the health benefits of breast milk that have prompted many governments — including the U.S. — to urge moms to nurse their infants. But they argue that scaling back expectations is necessary if more mothers are going to give it a try.
How to feed a baby is one of the great parental powder kegs, so it’s not surprising that breast-feeding advocates are outraged at the study. Even the editor of BMJ Open, Dr. Trish Groves,proactively released a statement in an attempt to head off the uproar:
“Any research or other article that seems to be ‘anti-breast feeding’ is, rightly, highly controversial. This study is not, however, against breast-feeding: far from it. It provides first person accounts of how families actually feed their babies and how they feel about it, and the researchers have discussed their findings sensitively and in great depth.”
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Researchers from the University of Aberdeen found that mothers perceived a significant gap between what they were expected to do and what their reality dictated. One mom lamented that experts “make it sound so easy.” Another wondered why she hadn’t had the “lovely bonding experience” she’d anticipated. At certain “pivotal points” — when babies changed their behavior patterns — frustrated mothers chose in response to change how they fed their babies. It was, they indicated, an attempt to promote family well-being.
Dr. Melissa Bartick, a Massachusetts internist who is on the board of directors of the U.S. Breastfeeding Committee, said the Scottish women in the study “really looked like they were suffering.” It was clear that the women didn’t receive adequate support — they reported getting mixed messages from various providers and often weren’t seen by a “health visitor” until up to two weeks postpartum. Women in the U.S. typically bring their babies to see the pediatrician two days after delivery; if there are problems, a doctor can theoretically address them at this visit. “Two weeks is way too long,” says Bartick. “Most people have given up breast-feeding by then.”
But U.S. breast-feeding experts say the answer isn’t to dilute the recommendations, which promote public health. Rather, it’s to ensure that breast-feeding moms get the support they badly need from the medical community and their own social circle.
Decades ago, Miriam Labbok, director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill, reported on research that found that group prenatal counseling with a mix of experienced breast-feeders and first-timers resulted in the highest rates of sustained exclusive breast-feeding.
But group lactation counseling is not the norm, neither in the U.S. nor in Scotland. Instead, women are urged to breast-feed despite a minefield of what breast-feeding advocacy group Best for Babes terms “booby traps.” These traps include iffy support from doctors, hospitals that hand out freebie bags stuffed with formula to new moms and inadequate legislation protecting breast-feeding mothers who feed their babies in public or pump at work.“Telling moms to breast-feed without full cultural, institutional and legal support is like being encouraged to run a marathon in a pair of flip-flops without any coaching,” says Best for Babes co-founder Danielle Rigg.
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One way to make it to six months, says Rigg’s co-founder, Bettina Forbes, is to break down the recommendation into achievable chunks: the first few days, two weeks, one month, six weeks and so on. It’s not much different, she says, from making a commitment to exercise regularly or to change your eating habits: you do it a little bit at a time.
Although 75% of U.S. mothers choose to breast-feed, just 44% have stuck with it by six months — and only 15% are breast-feeding exclusively then. “The gap between the ideal and reality is acute,” says Megan Renner, executive director of the U.S. Breastfeeding Committee. “All women should be able to access the same opportunities to breast-feed, yet in the United States, many women still lack the information or support they need to continue.”
Says Bartick: “We know what’s best for kids and moms, and we have to recognize it’s a challenge and do better at supporting them instead of asking that the bar be lowered.”