"Breast Is Best," But Harder Than It Seems

by Jen Thompson, MPP

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Why don’t more U.S. women breastfeed their babies for longer?  Both the World Health Organization and the American Academy of Pediatrics recommend that babies be exclusively breastfed – meaning that they receive only breast milk, and no formula, other liquids or solid foods -- until they reach 6 months of age. Yet few U.S. mothers follow these recommendations.  According to the most recent data available from the Centers for Disease Control and Prevention, only 19% of babies born in the U.S. in 2011 were exclusively breastfed at 6 months.

Before giving birth to my first child in August 2014, I didn’t think much about breastfeeding, other than to blithely assume that I would do it.  This was at least in part because I work on the PROmotion of Breastfeeding Intervention Trial (PROBIT), a longitudinal study tracking health and other outcomes among more than 17,000 thousand breastfed babies.  Through PROBIT, we’ve examined the associations between breastfeeding and childhood infections, asthma, eczema, overweight/obesity, cardiovascular health and many other health measures (Patel et al, 2013).  Given all of the evidence of the health benefits of breastfeeding, it seemed obvious that I would nurse my own child.

Reality proved more complicated.  My son was born three weeks before his due date in the midst of a brutal heat wave.  Despite faithfully nursing him every two hours around the clock, he lost more than 10% of his birth weight in the first week after his birth. His pediatrician suggested that we give him formula, in addition to breast milk, to boost his growth.  While I was glad that formula existed as a safe alternative to give him the extra calories he needed, I was still disappointed to give up exclusive breastfeeding after only a week.

Figuring that some breastfeeding was better than none, I kept nursing. This led to my second nursing setback – namely, that breastfeeding is hard.  Through a haze of sleep deprivation, I counted the number of wet and dirty diapers my son produced each day to make sure that he was getting enough to eat.  For one long week, a blocked milk duct made me feel like I was nursing an angry piranha, not an adorable baby.  And I was lucky; other new mothers told horror stories of cracked and bleeding nipples that failed to heal, infected milk ducts that required antibiotics, and babies that demanded milk every hour or that refused to nurse at all.

Returning to work presented new challenges. Lactation operates by supply and demand; if you don’t create sufficient demand, either by nursing or by expressing milk at regular intervals, you may reduce or even lose your milk “supply.”  I am lucky that my health insurance covered a high-quality double electric breast pump, our office has a dedicated lactation room, and I can work while expressing milk. Still, it all takes time and effort – cleaning and sterilizing the pumping equipment, measuring milk into portions for freezing, even walking to and from my office to the lactation room.  I now understand why so many women switch to formula when they return to work, and I regret my earlier judgment of women who “choose” not to breastfeed. I now know that it’s a choice only made possible by supportive family, physicians, friends and colleagues. If we want more women to exclusively nurse their babies through their first months of life, we need to consider the many factors that currently conspire to make breastfeeding difficult for many women.