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Saying 'breast is best' oversimplifies a complicated issue for mothers

It makes mothers feel guilty unnecessarily.

Saying 'breast is best' oversimplifies a complicated issue for mothers

It's on the walls of OB-GYN offices and maternity wards, and on the lips of friends, family and sometimes even strangers in the formula aisle. At times it's all a new mama can hear, even when she's sitting in silence with her thoughts.

When it comes to infant feeding, there is no phrase mothers hear more often than "breast is best" but new research, experts and moms who've lived a different truth say that while this message is amplified with the best intentions, new mamas need a lot more than those three words.

A recently published study, "The best of intentions: Prenatal breastfeeding intentions and infant health," suggests that there is a high societal cost to simplifying the cultural conversation around infant feeding into a three-word slogan.

The study found that moms who intended to exclusively breastfeed but ended up using formula had children with health outcomes similar to exclusively breastfed infants. They also, in many cases, have a lot of undue guilt.

A mom's perspective

When Nicole Rivet-Barton welcomed her first child nearly four years ago she fully intended to breastfeed, but it was a struggle from the start.

"My expectation for myself was that my body would provide what it needed for my baby and when that didn't happen and I had to accept that and transition [to supplementing with formula] I felt like I was failing somehow," Rivet-Barton tells Motherly.

"I felt like less of a person," she explains, adding that whenever she had to have an encounter with a medical professional that wasn't her regular family doctor, she felt judged. On more than one occasion nurses chided her for bottle feeding, telling her "breast is best" without knowing those words were already never far from her thoughts.

"It wasn't the 'best' that I could give her. She was still hungry. My breast milk didn't have what she needed to grow properly," she says.

With the help of a breastfeeding support group and a lactation consultant, Rivet-Barton was eventually able to shift her mindset from "breast is best" to "you do you" and says she felt lighter for it.

"We went to a lactation consultant to help get my milk up and she basically said to me one day, 'You're going to pick your path and you're going to do what's right for your baby. Don't feel guilty.' And I guess I heard her that day, and I let it go," she recalls.

A lactation consultant who doesn't say "breast is best"

Leigh Anne O'Connor is an International Board Certified Lactation Consultant in private practice. She's not the lactation consultant Rivet-Barton turned to, but she certainly shares the same views when it comes to acknowledging that infant feeding can't be boiled down to three-word slogans.

"I've never embraced that phase, 'breast is best' or 'fed is best.' They're both divisive terms. It creates a division in parenting and it creates conflict," she says. In place of catchphrases, O'Connor advocates for a more nuanced, thoughtful conversation on the topic.

She believes we can have individual and cultural discussions that both normalize breastfeeding and encourage parents to get their baby fed in the way that works for them, whether it's through nursing, pumping, using donor milk or formula.

"It's complicated. It's not one size fits all," she says. "Breastfeeding isn't always all or nothing, and there's a place for supplementation."

When "you do you" is best

For Rivet-Barton, supplementing allowed her to keep breastfeeding as much as she could for six months after both of her daughters were born.

She says that by the time her second daughter came along, she felt more confident in her parenting choices, and gave herself a lot more grace when it came to her infant feeding choices.

"I got into my stride and got confident enough to listen to my gut and not other people," she tells Motherly, adding that she wishes medical professionals and society would use more than three words when trying to educate new parents about infant feeding. "Give them options without putting expectations on them," she suggests.

More research and more support needed

There is a massive body of research suggesting that breastfeeding is great for babies. That's not in dispute at all. But the researchers behind that recently published study suggest that the link just isn't as simple as "breast is best."

"Our results suggest that formula offers similar health benefits for our relatively advantaged sample of infants, once we take prenatal intentions into account," the study's authors note.

The research suggests that moms like Rivet-Barton really have nothing to feel guilty about.

The authors—Kerri M. Raissian, an Assistant Professor in the Department of Public Policy at the University of Connecticut and Jessica Su, an assistant professor in University at Buffalo Department of Sociology—explain that it's not actually the intention to breastfeed that makes the health difference, but rather the fact that mothers who intended to breastfeed often have a certain kind of privilege: They're the mothers who have more access to medical care and therefore more access to information about infant health.

Raissian and Su suggest that instead of amplifying the phrase "breast is best" and potentially overstating the benefits of breastfeeding, society would do better to give mothers the support they need during pregnancy and beyond.

This means making sure that everyone has access to perinatal care, and the kind of parental leave that makes it possible to breastfeed in the first place.

"The U.S. is the only developed country with no federal paid parental leave, and only about 12 percent of mothers in the private sector have access to paid leave," Su explains. "Paid maternity leave likely increases breastfeeding success, and also seems to have additional health benefits for mothers and infants. If we have concerns about disparities in infant health we need social policies that support these recommendations and also go beyond simply encouraging breastfeeding over formula."

Breastfeeding is great, but maybe "support for mothers" would be a better three-word slogan.

[This post was originally published October 19, 2018.]

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A fascinating study explains why.

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"Infants under 6 months of age carried by a walking mother immediately stopped voluntary movement and crying and exhibited a rapid heart rate decrease, compared with holding by a sitting mother," say authors of a 2013 study published in Current Biology.

Even more striking: This coordinated set of actions—the mother standing and the baby calming—is observed in other mammal species, too. Using pharmacologic and genetic interventions with mice, the authors say, "We identified strikingly similar responses in mouse pups as defined by immobility and diminished ultrasonic vocalizations and heart rate."

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