Breast is best shouldn’t be absolute. Here’s why.

I read another post about the poison of GMO, corn syrup, baby formula.  One more post in an extensive newsfeed.  It is opinion, and I can scroll past, but it feels like another not so subtle reminder of the “breast is best” undercurrent that permeates everything baby related.

As a physician, I feel that breastfeeding is ideal.  When I was a third-year resident, and I had my first baby, I was adamant about exclusively breastfeeding.  I cried when my milk didn’t come in right away after a long induction.   I also relished the fact that my newborn grew into a chubby, giggly infant and it was due to my own body.  I pumped and breastfed, it was a blur of insomnia knowing that I would have to go back to work.  I took time off and managed to keep a freezer full of breast milk in case my supply dropped off when I did go back.  As a resident with overnight calls, I knew I couldn’t be sure how often I could pump, pagers go off, codes happen, patients, admissions, rapid responses, they don’t wait for pumping.  I was determined, I continued to pump, overnight, sometimes in bathrooms, call rooms, it depended on how far of a walk, and which were occupied.   I was determined to make the one year mark.

With my second child, I was an attending working part time, and it definitely went more smoothly.   Somewhere around the fifth month, I noticed my supply dropping.  I did everything I could, but I had to supplement, and I remember stopping around eight months. I was disappointed and heartbroken.  I resigned myself to formula feeding, and when I felt lumps in one breast, I chalked it up to milk ducts.

That was when I was diagnosed with breast cancer.  The fear was overwhelming and paralyzing; I could only think about my babies, a nine month old and a two year old.  It was biopsy after biopsy, ultrasound-guided, stereotactic, MRI-guided.  They saw abnormalities on the other side, and I had additional biopsies.   I was waiting for surgery for final staging.  I thought about how precious our time is and our health is.  I opted for the bilateral mastectomy. It was a personal decision.

Fast forward almost four years, past a stage one diagnosis, a year of treatment, and we were blessed with another beautiful, healthy baby.  It felt like a gift, directly from God, I have living breathing snuggly, proof that a very difficult time was over.  Like all parents, I want the best for my baby, and I opted for formula.

The baby is happy, healthy, and then I have to question why the articles about poison formula make me so angry.  Why do I want to wear a sign that says “I breastfed two babies and had breast cancer.”  Why does it need an explanation, an excuse? Is it because I’m around educated moms that tend to exclusively breastfeed? I couldn’t figure out why I felt so much guilt taking out a bottle.

I thought about a particular conversation I had with a friend after diagnosis and her comment was “wow, I just couldn’t do it, make a decision and choose to have a mastectomy like that.”   That was when I realized that this wasn’t something I chose.  Everything was secondary to my family and health.  So much worse happens to wonderful people who didn’t “choose” the situations they went through.  With breastfeeding, we need to stop shaming women for situations that are beyond their control.  So many women I know keep tally lists, they track things like how long they breastfed, if they supplemented, was it exclusive breastfeeding, bottle feeding, natural births, c-sections, epidurals, and the list could go on.   Being a mother is hard work, and no one chooses less than their best for their babies.  Why do we compare so much? I doubt that fathers are asking each other how many games they attend, how many times they read before bed, or if their kids still crawled into their beds at night.

Yet it’s “best” to read to children before bed, and it’s “best” to have a sleep schedule with children.   If we want more moms to breastfeed, instead of assuming they made the choice to do less than “best,” and making them feel guilty for it, maybe we should analyze the barriers to breastfeeding. The majority of mothers in this country start off breastfeeding and over time that number significantly drops. Why? Are there places to pump privately? Is there time off for breastfeeding, or does the day simply get extended? Is there maternity leave, paid time off, uninterrupted time, is it convenient at work?

How do we counsel moms in the hospital? Is it a one size fits all approach? Maybe a little formula before your supply kicks in, is really okay. Maybe nipple confusion isn’t as large of a problem as it seems.   I had a mother who breastfed for years, and if it wasn’t for her support, I might not have breastfed as long as I did.  The singular statement of “breast is best” has finality to it that any alternative is giving your baby simply less.

What if you don’t have breasts? I might be a minority, but there are numerous reasons a mother might not exclusively breastfeed, medications, work schedules, supply issues, surrogates, mental health issues.  I still think they’re doing their best.  Not smoking is “best,” an hour a day of exercise is “best,” a healthy BMI is “best,” do we adhere to it?  So why are we making so many mothers feel guilty if they don’t breastfeed?

I know lots of great moms taking awesome care of their kids, free-range, tiger moms, gluten free, dairy free, formula feeding, stay at home, working, helicopter, paleo, vegan, breast feeding mothers.  I know they love their kids, I know they are doing their “best” every day.

Emily Stanford is a hospitalist.

Image credit: Shutterstock.com

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