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.

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When infectious diseases make headlines parents naturally get a little worried, and this week coronavirus is in the news constantly. The coronavirus has infected more than 600 people worldwide, though mostly in China. As of Jan. 23, Chinese authorities have reported 17 deaths from the virus so far. Only two cases have been confirmed in the U.S. and officials are monitoring 63 suspected cases.

Here's what you need to know, mama.

1. Don't panic.

According to the World Health Organization the coronavirus outbreak is not an international public health emergency.

"CDC believes the immediate risk to the U.S. public is low at this time, but the situation is evolving rapidly," Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, said on a conference call with media on Friday. "We have our best people working on this problem," Messonnier explained, adding that we will likely see more cases in the coming days.

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2. There have been no fatalities in children.

The youngest victim of a confirmed case of novel coronavirus is 36 years old. Most of the fatal cases in China have been in people over 60 and more men than women have been impacted.

3. The family of coronaviruses is a spectrum of severity.

According to the CDC, most people will be infected with a coronavirus at some point in their lives. The common strains of coronavirus cause "moderate upper-respiratory tract illnesses, like the common cold" while more severe strains, including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrom (MERS) can be fatal.

The strain that is making headlines is a severe and novel coronavirus. It's new and the similarities to influenza make it difficult for experts to distinguish it from all the other respiratory illnesses floating around this time of year.

4. There is a test for it.

When public health officials suspect someone may have coronavirus they can send respiratory and serum samples to the CDC and find out if it's coronavirus or just the flu within about 24 hours.

5. There are steps to take for prevention.

To prevent the spread of the virus the U.S. State Department has issued its most severe travel advisory for the area of China (the province of Hubei, where the city of Wuhan is) most impacted by the coronavirus.

The CDC offers the following tips for protecting your family from the coronavirus (as well as other respiratory illnesses):

  • "Wash your hands often with soap and water for at least 20 seconds."
  • "Avoid touching your eyes, nose, or mouth with unwashed hands."
  • "Avoid close contact with people who are sick."
Bottom line: Don't panic, mama. The illness is likely to be in the headlines for months, but that doesn't mean we need to live in fear. We just need to be proactive and keep washing those little hands.
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We often think of the unequal gender division of unpaid labor as a personal issue, but a new report by Oxfam proves that it is a global issue—and that a handful of men are becoming incredibly wealthy while women and girls bear the burden of unpaid work and poverty.

According to Oxfam, the unpaid care work done by women and girls has an economic value of $10.8 trillion per year and benefits the global economy three times more than the entire technology industry.

"Women are supporting the market economy with cheap and free labor and they are also supporting the state by providing care that should be provided by the public sector," the report notes.

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The unpaid work of hundreds of millions of women is generating massive wealth for a couple of thousand (predominantly male) billionaires. "What is clear is that this unpaid work is fueling a sexist economic system that takes from the many and puts money in the pockets of the few," the report states.

Max Lawson is Oxfam International's Head of Inequality Policy. In an interview with Vatican News, he explained that "the foundation of unpaid work done by the poorest women generates enormous wealth for the economy," and that women do billions of hours of unpaid care work (caring for children, the sick, the elderly and cooking, cleaning) for which they see no financial reward but which creates financial rewards for billionaires.

Indeed, the report finds that globally 42% of women can't work for money because of their unpaid care responsibilities.

In the United States, women spend 37% more time doing unpaid care work than men, Oxfam America notes in a second report released in cooperation with the Institute for Women's Policy Research.

"It's an economy that is built on the backs of women and of poor women and their labour, whether it's poorly paid labour or even unpaid labour, it is a sexist economy and it's a broken economy, and you can only fix the gap between the rich and the poor if at the same time you fix the gap between women and men," Lawson explains.

According to Lawson, you can't fight economic inequality without fighting gender equality, and he says 2020 is the year to do both. Now is a great time to start, because as Motherly has previously reported, no country in the world is on track to eliminate gender inequality by 2030 (one of the Sustainable Development Goals adopted by 193 United Nations member countries back in 2015) and no country will until the unpaid labor of women and girls is addressed.

"Governments around the world can, and must, build a human economy that is feminist and benefits the 99%, not only the 1%," the Oxfam report concludes.

The research suggests that paid leave, investments in childcare and the care of older adults and people with disabilities as well as utilizing technology to make working more flexible would help America close the gap.

(For more information on how you can fight for paid leave, affordable childcare and more this year check out yearofthemother.org.)

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For new mamas back to sitting behind their desks at work some six weeks (or fewer) after their babies are born, the institutionalized parental leave policy in Denmark is the stuff of daydreams: Over in that Scandinavian paradise, parents are granted 52 weeks of paid leave to divide between them.

There's no denying this is much, much better than the state of parental leave in the United States, but it isn't quite as perfect as it seems from the outside. According to Denmark's Directorate of Employment, Labour and Social Affairs, women take an average 93% of leave allotted to couples. And when they do return to work, mothers' wages suffer both in comparison to men and women without children.

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The good news is that it seems the solution to this gender income gap is something we—the mothers of today, even here in America—can do something about.

A new paper from the US National Bureau of Economic Research that examined Danish administration information from 1980 to 2013 found the motherhood penalty “creates a gender gap in earnings of around 20% in the long run," which is comparable to the gap in the United States.

What's more, the income discrepancy only increases for each child a family in Denmark has: If a woman has four children, her income is only $0.60 to every dollar a man makes—10 years down the road.

While this indicates paid parental leave alone may not be the panacea for the gender income gap, the researchers suggest that changing the way we think about roles in the workplaces and homes could help—at least when it comes to the next generation.

“As a possible explanation for the persistence of child penalties, we show that they are transmitted through generations, from parents to daughters (but not sons)," the researchers note, explaining that the more a daughter's mother worked while the girl was growing up, the less the daughter's income was affected when she became a mother.

“Women tend to adopt a balance of paid work and childcare that is correlated with the one they saw their mother strike when they were growing up," Henrik Kleven, a Princeton economist and the paper's lead author, tells Quartz At Work.

What this looks like in practice is splitting household responsibilities from the get-go and encouraging fathers to take more leave. (In Sweden, where fathers are penalized for not taking advantage of paternity leave, women's earning rose an average 7% for each month of leave that men took.)

According to the State of the World's Fathers' report, produced by Promundo (a non-profit organization dedicated to engaging men and boys in gender equality in partnership with Dove Men+Care) 85% of dads surveyed in the United States, the UK, Argentina, Brazil, Canada, Japan and the Netherlands want to take paternity leave, and yet less than 50% of fathers take as much time as their country's policy allows, and social norms, financial pressures and a lack of support from their managers are all factors.

The report also found that if fathers are able to do just under an hour of unpaid work per day, mothers can cut their unpaid labor time by the same amount.

"We need men to do our share. Fifty minutes more to relieve women of 50 minutes less would get us really close to equal," the president and CEO of Promundo, Gary Barker, told Motherly.

This may help shift us toward more income equality today—and, as the research shows, our daughters will really be able to reap the benefits.

[A version of this post was first published January 29, 2018. It has been updated.]

News

Each day, licensed clinical social worker Ofra Obejas has appointments with a number of parents—with the idea that this is a designated time for them to decompress, turn their attention inward and concentrate on the counseling session. Yet, Obejas says she has noticed a disappointing trend: Many clients don't disconnect for that brief period.

"Parents have sat in therapy session with me and checked every time their phone alerted them, 'In case that's my kid calling me,'" she tells Motherly. "The smart device allows parents to never be away from the child."

Unlike in generations past, today's parents can be always "on" due to everything from high-tech baby monitors to a stream of pictures and updates sent to their phones. That's what we at Motherly have termed "continuous parenting," and the risk is it not only sets parents up for fatigue, but also sends children unhealthy messages about their own boundaries.

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The answer isn't to erase our kids from our minds every so often—because that simply isn't possible. But we can benefit from making the effort to step back from actively "parenting" every now and then.

Parents spend more time than ever with their kids

According to a recent study from The Economist, American moms now spend twice as much time with their children compared with women 50 years ago. That works out to be an average of 125 minutes per day of devoted mom-child time. (Kudos to dads, too: Since 1965, they have tripled the time spent with their kids. It's now up to an average of 59 minutes daily.)

Experts credit this to increasingly flexible work schedules and options to punch in from home. Likely also at play is the fact that the newest generation of moms and dads are embracing the duty like few before, with 99% of millennial parents reporting they truly love parenting.

We're leaning into parenting—but are we overdoing it?

It's one thing to identify first and foremost as a parent and take pride in that role. It's another thing, however, to confuse our sense of worth with our children's accomplishments, which is something former Stanford University dean of freshmen Julie Lythcott-Haims says was commonplace among the parents she encountered.

"When I ask parents why they participate in the overprotection, overdirection, hand-holding frenzy, they respond, 'So my kid can be happy and successful,'" she writes in How to Raise an Adult. "When I ask them how it feels, they respond, 'Way too stressful.'"

This constant investment in children's lives can take a toll on the parent-child relationship when the parent doesn't take time for him or herself, too. "The parents feel that they 'sacrificed' their own time for the benefit of the child, even though during much of that time there was no direct engagement with the child," Obejas says of those hours spent shuttling kids around town or waiting outside the doctor's office. "The parents' own emotional and mental cup becomes empty, and when the child asks for more attention, the parents feel like they have already given enough."

The expectation of constant contact 'is draining for the brain'

Even outside the category of helicopter parents, the expectation that we should constantly know what our children are doing is problematic. "'Always on alert' didn't start with children," says Obejas. "It started with devices and apps designed to be addictive. It overtaxes our fight or flight response and leads to toxic stress when levels of cortisol and adrenaline don't ever subside."

Compared with the days when it was the norm for kids to roam free until the streetlights came on, it's commonplace today for parents to expect regular updates of their kids' exact whereabouts either by texts or GPS tracking tools.

"While this can be a safety backup, it increases the type of hypervigilance we know is draining for the brain," says Urszula Klich, licensed clinical psychologist and president of the Southeast Biofeedback and Clinical Neuroscience Association. "[This] can also cause incredible anxiety as parents hear and read things they wouldn't normally be subject to, that is, let's face it, a normal part of kids growing up."

Roles have reversed

Not so long ago, parents would go to the store or out on a date only with the faith that everything was fine at home. Now? That's almost unthinkable—as we've instead shifted to the mentality that our children or their responsible caregivers should be able to contact us at any given moment. Despite the good intentions at play here, this comes at an expense.

"In what other job do you never get a break? It is truly exhausting to never get to turn off the parent brain," says LMHC Jasmin Terrany, author of Extraordinary Mommy: A Loving Guide to Mastering Life's Most Important Job.

Driving this is the trend toward maternal gatekeeping, which describes the subconscious desire to micromanage child care even when someone else is perfectly capable of holding down the fort. As uncomfortable as this may feel, it's healthiest for everyone when parents can hand over the reigns on occasion.

"We must have regular practices to refuel," Terrany tells Motherly. "We don't need to feel guilty about taking this time for ourselves—our kids will not only learn that self-care is essential, but when we are good, they will be good."

This is also how we let our children know another adult can attend to their needs, which is an important step in fostering their sense of independence and confidence. As Esther Perel, author of Mating in Captivity, previously told Motherly, "Let your partner actually figure it out on their own and know that the system survives even when you are not there."

Being 'always on' can degrade quality time, too

Much of being "always on" is a two-way street: Not only do we bring our children into our work days and social lives, but we also bring other obligations home with us in the form of emails sent to our smartphones and mid-playtime breaks to check social media.

"Our children need us, the parents to be 'there,'" says Tom Kersting, licensed psychotherapist and author of Disconnected: How To Reconnect Our Digitally Distracted Kids. "They need us to talk to them, play with them and be present with them. This is literally impossible if we are multitasking between the iPhone and our interactions with them."

As expert as we may consider ourselves at multitasking, there is also something to be said for setting boundaries. "In today's world it's become difficult not to carry that phone around you all the time, even more so when your job is tied to it," says Klich. "Set boundaries for yourself for when you will check, even if it's once an hour, and stick to that making it clear to the kids what you are doing and why."

And when we're away from the kids, remember this hack: Calls from favorite contacts can still come through when you're on do not disturb mode. So tell your partner or your babysitter or your kids to call if it's a true emergency—and then allow yourself to go off the clock. You'll be better for it.

[This post was first published June 25, 2018.]

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