UCLA faculty voice: When it comes to breastfeeding, a mother’s health and happiness matter too

Dr. Vivien Burt is a professor emeritus of psychiatry and biobehavioral sciences and the co-director of the Women’s Life Center at the Resnick Neuropsychiatric Hospital at UCLA. Dr. Sonya Rasminsky is an associate clinical professor of psychiatry at UC Irvine. Dr. Robin Berman is an associate professor of psychiatry at UCLA. This column appeared March 3 in the Washington Post’s “On Parenting” blog.

Whoever said, “Don’t cry over spilled milk” couldn’t possibly have been talking about breast milk. As reproductive psychiatrists who specialize in treating women who suffer from depression and anxiety during pregnancy and the postpartum, we see far too many tearful new mothers for whom breastfeeding is a source of self-recrimination.

Doggedly determined to provide breast milk exclusively for their babies, these moms endure breast and nipple pain, around the clock pumping, sleep deprivation, anxiety, and chronic feelings of inadequacy — all for the sake of doing what’s “best” for their babies. As physicians, we think we know better, but as mothers, we too bought into the dogma that breast is best at all costs. We would never have taken our own advice: when it comes to breastfeeding, your health and happiness matter as much as your baby’s.

Sheepishly we recently shared our secret stories of shame with one another:

Vivien Burt

“I proudly accumulated a freezerful of stored breast milk by routinely pumping immediately after nursing. I was happy that my baby never had to have formula, and I was devastated when I had to throw away gallons of expired milk. To this day, I have deep regret about my choices. I wish that I had never bought the pump; my time would have been better spent bonding with my baby.”

“When I went back to work when my baby was five months old, I was so ashamed that I had switched to formula, I lied to all my friends and coworkers.”

“For me, nursing was harder than medical school. My milk was slow to come in and my baby howled whenever I put him to the breast. It hurt so much that I cried. I was so determined to feed him breast milk that I didn’t realize that he was getting dehydrated. Even when he was hospitalized with an IV, I felt that my most important task was to try to pump milk for him. In retrospect, I wish that I had transitioned to formula — we both would have been happier.”

Sharing these stories, we wished that we had put less pressure on ourselves. Despite our knowledge about the importance of maternal mental well-being to healthy mother-baby bonding, we let shame and guilt eclipse our good sense.

Robin Berman

The potential benefits of breast feeding are extensive and well-documented: decreased rates of infection, diabetes, leukemia, obesity, increased IQ scores; more rapid weight loss in nursing mothers; decreased rates of breast and ovarian cancer in women who nursed. But these statistics do not tell the whole story. Most benefits are small in absolute numbers, and do not take into account unique maternal and family issues that make up the reality of new parenthood.

Like the mythological giant Procrustes, who captured hapless travelers and cruelly adjusted their bodies to fit his bed despite their differences in size, the health care system has colluded to ignore the individual circumstances of mothers in order to promote a one-size fits all prescription: breast milk-only nutrition for infants. The American Academy of Pediatrics recommends that infants be exclusively breast fed for the first six months of life, followed by continued breast feeding “for one year or longer as mutually desired by mother and infant.” The American College of Obstetricians and Gynecologists emphatically seconds these recommendations and has charged its members “to encourage and enable as many women as possible to breastfeed and to help them continue as long as possible.” Neither body addresses the individual needs and circumstances of new mothers; neither allows for the possibility of overwhelming physical or psychological challenges. Let’s not forget that the mother-baby bond is comprised of healthy mothers and babies and we can’t overlook that half of the equation.

These recommendations were put in place with a public health motive in mind: to increase the number of women breastfeeding in the United States. Breastfeeding often requires time and patience, and lactation consultants can be helpful to make the experience work in a meaningful and gratifying way. However, thinking only about the benefits for the baby, one could easily come to the conclusion that it’s worth going to any length to provide baby with breast milk. From a very early age, babies respond to what they experience. It’s important to remember that breastfeeding involves far more than just nutrition; it’s also about holding, cuddling and emotionally connecting with baby in a way that facilitates the development of a secure, bright, and engaged child. And this may be accomplished in ways that do not involve exclusively breastfeeding.

The professional guidelines are based on good science. But for many new mothers, the recommendations carry the force of a threat: if I don’t breastfeed, my child is more likely to get sick; if I don’t breastfeed, my child won’t be as smart; if I don’t breastfeed, I’m not a good mother.

Here’s what not enough people talk about: just as new babies are vulnerable, so are their mothers. And a mother’s mental health is crucial — not just to her, but also to her baby. A depressed and anxious mother isn’t able to provide the nurturing that her baby needs to develop and grow. And if that depression and anxiety is caused or worsened by the breastfeeding experience, breastfeeding isn’t worth it.

Breastfeeding can be a wonderful way to bond with a baby, but it’s not the only way. It certainly is not synonymous with good mothering. A good mother? One who is calm, well-rested, and emotionally engaged with her baby in whatever way works. She nurtures her own mental health, and is free to determine what works for her and her family. She’s the one most likely to provide what her baby needs to be soothed, calm, content and healthy.

We all know not to throw baby out with the bath water — but let’s not throw mother out for her milk either. Here’s our prescription: If breastfeeding works for you, great. If it doesn’t, don’t tie yourself in knots to make it happen. Under some circumstances, formula (alone or as a supplement to breast milk) can be the better choice. And sometimes it just might make sense to dump the pump.

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Vivien Burt, Sonya Rasminsky and Robin Berman