Is breast always best? Breast milk is undoubtedly the ideal nourishment for an infant and baby. Many women plan to breastfeed their babies, and for the lucky, breastfeeding is a rewarding and easy experience that facilitates bonding and nurturance. However, for some moms, the act of breastfeeding can range from difficult, to taxing and painful, to absolutely impossible, and the inability to attain this goal can supercede the joys in having a newborn. Our culture often focuses on breastfeeding at the expense of a new mother’s mental health and wellness, too often forgetting that filling baby’s belly is ultimately all that matters.
Here are four reasons why I, as a doctor, think that you don’t always need to breastfeed.
1. Breastfeeding was originally a necessity due to unsafe bottle-feeding, an issue that no longer exists in the Western World. Breast milk was considered the optimal baby nutrition in the 18th and 19th centuries. Mortality rates were incredibly high for bottle-fed babies due to factors such as poor bottle sanitation procedures, unpasteurized animal milks, and malnutrition.
The early 20th century saw a profound reduction in infant mortality owing largely to the introduction of glass bottles and the subsequent release of Liebig’s formula, the first artificial formula considered a reasonable alternative to breast milk. By the 1940s, the general consensus among pediatricians and the overarching opinion of the American Medical Association (AMA) was that formula was a safe alternative to breast milk.
Rates of breastfeeding declined steadily until the late 1960s into the 1970s. People viewed breastfeeding as an uncultured practice maintained by the uneducated and those unable to afford formula. Many viewed the practice as ‘disgusting.’
Since that time, though, public support for breastfeeding has swung back into the pro camp, partly driven by recommendations to breastfeed from the American Academy of Pediatrics and other health organizations. Healthcare professionals believe that breast milk, which caters to babies’ needs as they grow, provides the healthiest, most adequate nutrition for infants, which can provide immunity against various illnesses and infections. What’s more, more recent studies have shown a correlation between breastfed babies and lower rates of SIDS (sudden infant death syndrome). Support for breastfeeding has increased so much over the past 20 years that in some circles there is currently almost a blind enchantment with the practice. Formula advocacy is not about replacing breast milk, but instead reasserting the idea that health of mom and baby is ultimately what is most important; the drumbeat of breastfeeding advocacy sometimes obliterates this message.
2. Using a bottle can help with postpartum self-preservation. A lot of overwhelmed women who feel they are failing at breastfeeding and thus at motherhood turn up at my practice after consulting friends, social media, and lactation consultants. Instead of concern and helpful guidance, these mothers are greeted with criticism and a myopic focus on the “breast is best” narrative; and the messaging is not subtle.
One of my patients who tried to calm her fussy infant with a pacifier during a breastfeeding information session was called out as a ‘bad example.’ She was told she was being lazy and was ultimately ejected from the event. Nipple confusion is typically cited as the reason why pacifiers should be avoided, yet multiple studies have failed to find causality between pacifier use and reduced rates of breastfeeding. Pacifiers may actually confer safety benefits as they have been linked with a decreased risk of sudden infant death syndrome (SIDS).
Knowing that she was at particularly high risk for postpartum psychosis, a pregnant, bipolar patient of mine painstakingly mapped out a plan to fulfill her dual goals of breastfeeding while remaining emotionally well: she would breastfeed by day and have baby receive a bottle at night while she optimized sleep. Unfortunately, after baby arrived via a complicated C-section birth, she was shamed for her nighttime formula request and was woken every two hours to nurse her new baby. After barely sleeping for three days, she was discharged feeling broken and scared and subsequently developed the very postpartum psychosis she had hoped to avoid.
Some women who don’t have issues nursing can also develop exhaustion and end up struggling as time goes. They are engrossed in an all-consuming breastfeeding schedule -- day in, day -- and oftentimes, nursing their babies become a chore rather than an anticipated bonding time. This can lead to a sense of disconnection, resentment towards partners, and even anxiety and depression.
In any of these cases, bottle feeding, whether it be with breastmilk or formula, could help tremendously in preserving not just your sanity, but also your appreciation and love for this new journey you just embarked on.
3. Formula is not only safe, it can save your baby’s life. Breast milk is the optimal source of nutrition for an infant, yet there are a wide variety of modern formula options that are very similar to breastmilk in terms of nutrients, and sometimes opting out of breastfeeding can actually be protective.
A 2018 study out of UCSF found that supplementing with formula in the first few days of life does not harm baby. Instead for babies who had lost significant weight after birth, providing formula reduced rates of hospital readmission compared with babies exclusively breastfed. In rare cases, a bottle of formula can literally be lifesaving. Furthermore, supplementing with formula does not lead to premature weaning, as is often suggested by breast-is-best adherents, and it does not change baby’s gut flora.
Study after study shows that mom’s mental health is intimately bound to baby’s short- and long-term health and welfare. Consistent data indicates that maternal depression is associated with impaired child cognitive and neuro-development, behavior problems in preschool and beyond, and depression in the teen years.
If breastfeeding is for whatever reason detrimental to mom’s mental health, then bottle feeding is a reasonable alternative. Medical evidence and common sense favor this approach, so it’s a mystery as to why our culture continues to shame moms who opt out of breastfeeding.
4. Happy (and Fed Baby), Happy Mommy. Breastfeeding isn’t always an option for everyone; and in some case, it may even be discouraged. The crux of it is that there is no right or wrong answer - the best way to feed your baby is to do what works: breastfeed, bottle feed, do it all - just don’t beat yourself up or feel like a failure.
Whether the breast glands work or not has absolutely nothing to do with whether someone is a loving, kind and engaged mother. The ability to breastfeed has become a litmus test by which one’s worth and value as a new mom is measured, and this is ridiculous.
It’s time to move beyond the politics of breastfeeding and respect each parent’s decision for how they feed their baby. Babies need to be fed -- the mode is not as important as the love provided while doing so. Being a mom is a long journey with countless opportunities to nourish and support your child -- this is only the first.
Dr. Snyder is a reproductive and perinatal psychiatrist with a unique approach that combines integrative medicine-based treatments. She maintains a private practice in Manhattan and specializes in women’s mental health. Dr. Snyder graduated with a BS from Emory University in Neuroscience & Behavioral Biology. She is a frequent lecturer on the subject of Women's Mental Health and Wellness, and has received extensive medical training in Reproductive Psychiatry from New York University, Beth Israel Medical Center, and Payne Whitney Women’s Program at New York Presbyterian Hospital – Weill Cornell Medical Center. She is also an executive board member for Postpartum Support International. Her weekly radio show, "MD for Moms," can be heard anytime on her website. Dr. Snyder’s Huffington Post parenting blog shares the "MD for Moms" moniker. Dr. Snyder resides in NYC and the North Fork with her husband and three awesome children. In her free time you can find Dr. Snyder training for a marathon, skiing or gardening. For more information, you can check out her website, on Twitter, or on Facebook.