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The pressure to exclusively breastfeed is hurting mothers' mental health

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[Content warning: This article references maternal suicide.]

Before she gave birth to her daughter, Dr. Stephanie Liu, a Clinical Lecturer with the Department of Family Medicine at the University of Alberta, expected she would breastfeed, but after extolling the benefits of breastfeeding to her patients for years, nursing did not come easily for Liu—but the guilt did.

"I struggled to get her to latch and when she did latch it was very painful. As a result, my milk supply was insufficient. For the first two weeks, I supplemented with formula and was racked with guilt that I was not doing the best for Madi," she writes for The Conversation

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She is hardly alone in this. A recent commentary in the journal Nursing for Women's Health explains that "[p]sychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions."

Liu points out that a large 2011 study found mothers who had negative breastfeeding experiences were more likely to have symptoms of depression. On a personal level, she understands why.

"Breastfeeding was one of the things I looked forward to most when I was pregnant. In medical school I learned about the bond between mothers and babies when they are breastfeeding. I could not wait to experience this," Liu explains, adding that breastfeeding her daughter Madi turned out to be way more challenging than she had anticipated.

For Liu, this experience changed the way she practices medicine, and she hopes that in sharing it she may change the way other medical professionals counsel their patients.

"As a family doctor, I know that breast milk is the optimal feeding choice for health benefits, but as a mom, I know the extreme pressures that we are placed under as women to produce milk every time our baby needs it," she says.

The extreme pressure to breastfeed

The American College of Obstetricians and Gynecologists recommends mothers exclusively breastfeed their babies for the first six months of life, but ACOG also officially recognizes that a baby's mother "is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding or formula feeding is optimal for her and her infant."

Unfortunately, many moms don't feel that they have a choice. They just want to do what is "best" for their baby, and when they can't they feel like failures.

Mom Jen Harper was convinced that breastfeeding was the way to go, and felt devastated (and exhausted) when no matter what she tried, it just didn't work for her and her son. "I'd been conditioned to think that since I was a woman, breastfeeding would be the most natural thing I've ever done," Harper writes.

She finally found relief when an ear, nose and throat specialist told her that not every baby is a fit for every breast.

"I had to give up the notion that this was, in fact, a failure, because it wasn't. I had to let go of my notion that everyone around me was judging me for pulling out a bottle and powder instead of delicately unclipping my cute nursing bra," she explains.

Harper came to terms with the fact that supplementing with formula was better for her son than having "a sobbing mommy."

But research shows a lot of moms are sobbing over this issue and don't get the advice Harper did.

"Breast is best" was a super successful public health campaign, but it has created a maternal mental health crisis. A growing number of new moms are dying by suicide, and some of the fathers left to raise babies as single dads are speaking out about the role the extreme pressure to breastfeed can play in fatal cases of postpartum depression.

Vancouver father Kim Chen lost his wife Florence Leung in 2016 shortly after they became parents. Their dreams were coming true, but Leung was under so much pressure and died by suicide.

"I still remember reading a handout upon Flo's discharge from hospital with the line 'Breast Milk Should Be the Exclusive Food For the Baby for the First Six Months.' I also remember posters on the maternity unit 'Breast is Best.' While agreeing to the benefits of breast milk, there NEED[s] to be an understanding that it is okay to supplement with formula, and that formula is a completely viable option," Chen wrote in a Facebook post after his wife's death.

Their son thrived on formula after his mother died. He was in the 90th percentile.

Support is best

According to Suzanne Barston, the author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn't, it's time for those who support mothers—physicians like Liu, but also midwives, doulas, and those leading mom and baby support groups—to offer "solid, sensitive, personalized advice" to all mothers.

It's been over a decade since Barston launched her blog, The Fearless Formula Feeder and witnessed the evolution of online discussion of infant feeding go from "breast is breast" to "fed is best", but she says the conversation really needs to be a lot more nuanced than three word catch-phrases.

In 2018 she spoke to Motherly about why moms who use formula often feel unsupported in our society, and noted that while there has been a big shift in the last decade in terms of how people speak to and about moms who choose to supplement with formula, the choice to not breastfeed altogether is still not seen as a legitimate choice.

Moms feel like society doesn't support them overall, but when it comes to infant feeding, moms feel very unsupported. Moms are told they must do everything possible to succeed at breastfeeding, but that's extremely difficult in a society where many parents must go back to work when their infants are mere weeks old.

Yes, breastfeeding rates in America are lower than the World Health Organization would like, but this isn't because moms aren't educated about the benefits of breastfeeding. There are few among us who don't know the benefits of breastfeeding. In many cases, moms would like to breastfeed but can't because they don't have the support system to actually make it work.

"Whether you're feeling physically uncomfortable from your birth or you have to make dinner for your two other kids or you have to go back to work in three weeks, those are all very real issues that women have to deal with and no amount of awareness or education about breastfeeding changes," Barston told Motherly.

How to help mothers

Like Barston, Liu harnessed the power of the internet after her own infant feeding journey, and now supports other mothers in theirs through her blog, her blog Life of Dr. Mom.

It took having her own postpartum experience for Liu to learn that breast isn't always best, and she's changed the way she supports new mothers as a medical practitioner. There's just so much more nuance to this than "breast is best." You can't fit her thoughts as neatly on a poster, but her words are worthy of maternity ward walls and pamphlets and could save the lives.

"I always support the idea to breastfeed if you can, to reach out for support, and if you are struggling, there are other safe and healthy options to ensure your baby is well fed," she explains.

If you are struggling with postpartum depression, here are the resources you need.

If you are feeding your baby formula, breast milk or both, know that we support you and that you are a good mother.

You might also like:

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As a mid-Spring holiday, we never knew exactly what to expect from the weather on Easter when I was growing up in Michigan: Would we get to wear our new Sunday dresses without coats? Or would we be hunting for eggs while wearing snowsuits?

Although what the temperature had in store was really anyone's guess, there were a few special traditions my sister and I could always depend on—and it won't come as a surprise to anyone who knows me that my favorite memories revolved around food. After all, experts say memories are strongest when they tie senses together, which certainly seems to be true when it comes to holiday meals that involve the sounds of laughter and the taste of amazing food.

Now that I'm a parent, I'm experiencing Easter anew as my children discover the small delights of chocolate, pre-church brunch and a multi-generational dinner. While I still look forward to the treats and feasting, I'm realizing now that the sweetest thing of all is how these traditions bring our family together around one table.

For us, the build-up to Easter eats is an extended event. Last year's prep work began weeks in advance when my 3-year-old and I sat down to plan the brunch menu, which involved the interesting suggestion of "green eggs and ham." When the big morning rolled around, his eyes grew to the size of Easter eggs out of pure joy when the dish was placed on the table.

This year, rather than letting the day come and go in a flash, we are creating traditions that span weeks and allow even the littlest members of the family to feel involved.

Still, as much as I love enlisting my children's help, I also relish the opportunity to create some magic of my own with their Easter baskets—even if the Easter Bunny gets the credit. This year, I'm excited to really personalize the baskets by getting an "adoptable" plush unicorn for my daughter and the Kinder Chocolate Mini Eggs that my son hasn't stopped talking about since seeing at the store. (You can bet this mama is stocking up on some for herself, too.)

At the same time, Easter as a parent has opened my eyes to how much effort can be required...

There is the selection of the right Easter outfits for picture-perfect moments.

There is the styling of custom Easter baskets.

There is the filling of plastic eggs and strategic placement of them throughout the yard.

But when the cameras are put away and we all join together around the table for the family dinner at the end of the day, I can finally take a deep breath and really enjoy—especially with the knowledge that doing the dishes is my husband's job.

This article was sponsored by Kinder. Thank you for supporting the brands that support Motherly and mamas.


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Last month Katy Perry and Orlando Bloom announced some big news: The engaged pair are expecting a baby!

Perry announced her pregnancy when the music video for her single, "Never Worn White" showed her rocking a bump and this weekend she announced she's expecting a girl...by posting a photo of Bloom's face covered in pink frosting.

She geotagged the photo "Girls Run the World" and captioned it "💕 It's a girl 💕."

Clearly, this man is thrilled about becoming a #girldad.

Perry is due in the summer, as she previously noted on Instagram.

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"Let's just say it's gonna be a jam packed summer..." she captioned her original pregnancy announcement.

"OMG, so glad I don't have to suck it in anymore," Perry tweeted after the big news went public.

"I am excited. We're excited and happy and it's probably the longest secret I've ever had to keep," Perry explained in a live stream with fans.

Of course not long after Perry announced her pregnancy the world changed due to the coronavirus pandemic. Because of the pandemic, Perry and Bloom have postponed their wedding, according to People and are pretty much just laying low at home trying to enjoy Perry's pregnancy as much as possible during this difficult time.

Perry recently told Stellar Magazine that the wedding is about more than throwing a big bash, so while it would be totally normal to be disappointed by having to postpone it, the mom-to-be seems to be in a good place regarding her nuptials.

She told Stellar: "It's not about the party. It's about the coming together of people who will hold us accountable when things get really hard. Those are just the facts when you're with someone who challenges you to be your best self."

The little girl Bloom and Perry are expecting will have a lot of people to love on her. While this is the first child for Perry, Bloom is already a dad to a 9-year-old boy who will soon be a big brother.

Congratulations to Perry + Bloom!

News

Pink opened up about her family's fight against coronavirus late Friday, taking to Instagram to make a big announcement.

"Two weeks ago my three-year old son, Jameson, and I are were showing symptoms of COVID-19," Pink revealed, noting that she tested positive and has since recovered.

She continued: "My family was already sheltering at home and we continued to do so for the last two weeks following the instruction of our doctor. Just a few days ago we were re-tested and are now thankfully negative. It is an absolute travesty and failure of our government to not make testing more widely accessible. This illness is serious and real."

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After dealing with the virus on a personal level and recognizing her privilege in being able to access testing, Pink decided to donate $1 million to fight coronavirus and hopefully protect others.

"In an effort to support the healthcare professionals who are battling on the frontlines every day, I am donating $500,000 to the Temple University Hospital Emergency Fund in Philadelphia in honor of my mother, Judy Moore, who worked there for 18 years in the Cardiomyopathy and Heart Transplant Center. Additionally, I am donating $500,000 to the City of Los Angeles Mayor's Emergency COVID-19 Crisis Fund," she announced via Instagram.

Pink ended her update by thanking the brave healthcare workers on the front lines and reminding the rest of us to stay home.

For more information on COVID-19 and how it is impacting families, visit mother.ly/coronavirus.

News

On Friday President Trump announced that the Centers for Disease Control is now advising people to wear a cloth mask if they need to go out in public. It's not a rule, he says, but a recommendation.

"It's really going to be a voluntary thing," President Trump told reporters. "I'm not choosing to do it."

First Lady Melania Trump is urging others to do it, tweeting, "As the weekend approaches I ask that everyone take social distancing & wearing a mask/face covering seriously. #COVID19 is a virus that can spread to anyone—we can stop this together."

What the CDC says about cloth face masks:

The CDC says it's recommending cloth face masks because recent studies show that people can have COVID-19 while asymptomatic, meaning they feel fine and because they don't know they are sick they might still be going about their daily routine in their community.

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Basically, masks don't protect the wearer as much as they protect people from the wearer (who might not know they are sick) by blocking respiratory droplets

"So it's not going to protect you, but it is going to protect your neighbor," Dr. Daniel Griffin at Columbia University, an expert on infectious diseases, tells NPR.

CDC experts are "advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure."

They say if you're going somewhere where it's hard to maintain the proper social distance of six feet, like a grocery store or a pharmacy, then it's a good idea to wear a simple cloth mask.

"The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance," the CDC states.

"You may need to improvise a cloth face covering using a scarf or bandana," the agency notes on its website.

A DIY cloth mask is an extra layer of protection:

The CDC still says that staying home and practicing good hand hygiene is the best protection against COVID-19, but a cloth mask would be an extra layer of protection if you must go out to get food or unavoidable medical care.

According to Dr. Scott Segal, chair of anesthesiology at Wake Forest Baptist Health in Winston-Salem, North Carolina, certain types of fabric are better than others when it comes to making a mask. While he CDC says improvised bandanas or scarfs are better than nothing, Segal says DIY mask makers should aim a little higher for the masks to be effective.

"You have to use relatively high-quality cloth," Dr.Segal, who is researching this topic, tells NBC News.

According to Segal you don't want to use a knit fabric (like an old T-shirt) but rather a woven fabric. He suggests a double layer of heavyweight cotton with a thread count of at least 180 (like quilters cotton). If you don't have a cotton with that high of a thread count, line it with flannel.

For more tips on how to sew a fabric face mask, check out these instructions from Kaiser Permanente.

No-sew methods:

If you're not a sewer you can still fashion a mask, and there are plenty of no-sew tutorials online showing you how. Use heavyweight woven fabric like Segal suggests and make one of these without a sewing machine.

How To Make a Pleated Face Mask // Washable, Reusable, No-Sewing Required youtu.be

Should kids wear masks? Talk to your doctor.

The CDC is not recommending masks if you're just going for a walk around the block or playing in the backyard (which is the extent of most kids' outings these days). The masks are more for grocery runs, which many parents are opting to do alone these days.

But solo parents and those with partners who are in the military know that leaving the kids behind isn't always an option if you're the only adult in the home. If that's your circumstance, choose delivery options when possible to avoid taking your children to public places like grocery stores and pharmacies (the kinds of places the CDC recommends masks for).

If you are concerned that you may need to take your child somewhere where a mask would be required, call your pediatrician for advice on whether a mask is appropriate for your child's age and circumstances. Babies' faces should not be covered.

If you have no one to watch your children while you get groceries and cannot get them delivered try contacting your local government, community groups and churches for leads on grocery delivery help. They may be able to put you in touch with someone who can fetch groceries for you so that you don't have to take your children to the store with you.

News

Starting this weekend Target and Walmart will be limiting the number of people allowed in its stores to give shoppers and staff more space to spread out and adhere to social distancing recommendations during the coronavirus pandemic.

"Beginning April 4, Target will actively monitor and, when needed, limit the total number of people inside based on the store's specific square footage," Target notes in a news release.

Walmart's corporate message is similar: "Starting Saturday, we will limit the number of customers who can be in a store at once. Stores will now allow no more than five customers for each 1,000 square feet at a given time, roughly 20 percent of a store's capacity."

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At Target you will also notice staff wearing gloves and masks over the next two weeks as the company steps up its coronavirus protection measures.

Many people are choosing to stay home and order groceries online, but that's not an option for everyone as long lines at some Target's prove.

"We're incredibly proud of the commitment our more than 350,000 frontline team members have demonstrated to ensure millions of guests can count on Target, and we'll continue to focus our efforts on supporting them," says Target's Executive Vice President and Chief Operating Officer, John Mulligan.

Target is open this weekend but—along with Costco, Aldi, Publix and Trader Joe's—Target stores will be closed on Easter Sunday to give the essential employees in these stores a much-deserved break.

News
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