Sometimes I feel like “formula shaming” is the final frontier of judgment. The same person who would be careful not to “body shame” or “slut shame” her best friend might be the first one to raise an eyebrow at her sister-in-law for not breastfeeding. And that is partly because we are saturated with information about the benefits of breastfeeding and partly because it is perceived as a choice you make mainly for your baby’s sake. Though breastfeeding does have some major health benefits for mothers, the focus is typically on the benefits for the baby. For the mother who cannot or chooses not to breastfeed, her action can be perceived as a reflection of her mothering — and that seems to be fair game for criticism in a way that some other cultural shaming is not.
“Formula shaming is so pervasive, and I found that it started during pregnancy. Every book about childbirth and raising babies talks about how crucial breastfeeding is— about it being required for at least six months. The way it’s treated, like a given fact, is ridiculous,” says Kathryn, a first-time mom who made the decision not to breastfeed before she gave birth.
There are no support groups for formula feeding moms, and even hospitals have educated their staff on breastfeeding to the degree where formula feeding is often treated with a wrinkled nose of disapproval. Kathryn found that her obstetrician was pleasantly supportive of her decision, yet she noticed later the formula samples he gave her had expired. “That’s how little people talk about formula as an option.”
“We learned in class that breastfed babies are smarter than formula fed babies,” recalls Krista, in new mom’s a support group. Her peers nod in agreement. This kind of unsubstantiated information is still being taught in prenatal classes. In fact, when I received my training for teaching the topic, I could rattle off a list of health concerns that were more likely to occur if you formula-fed your baby: Type I diabetes, childhood obesity, colds and ear infections, allergies, asthma, even leukemia! It did not occur to me back then that by over-praising the wonders of breastmilk, I was vilifying formula to an entire group of impressionable, expectant parents. Later on, I created a presentation that addressed both topics with realistic expectations including benefits and risks, much as one would teach about unmedicated birth and epidurals in the same class.
Thankfully, the super-popular author Emily Oster in her two books drills down into the prevailing evidence about newborns and shows us evidence to the contrary. She has been vocal about how the breastfeeding narrative has inherent language that can alienate and shame new mothers. Recently she Tweeted, “It’s fine to encourage people to breastfeed. But claims like ‘it’s a special bond’ are (1) totally not based in fact and (2) just make people feel bad.” Then she nudged the American Academy of Pediatrics, “Think about your messaging.”
It’s hard to believe that for American women giving birth prior to the 70s, breastfeeding was considered unusual and even “a little disgusting,” according to Wikipedia. In their book, “The One Best Way?” authors Nathoo and Ostry write, “It was something practiced by the uneducated and those of lower classes.” In fifty years the tide has changed completely as breastfeeding benefits for mother and baby have become better understood. The response to this, like many issues with birth and parenting, has often been woefully polarized. Our current culture’s emphasis on breastfeeding has been fueled by the well-intentioned Baby-Friendly Hospital Initiative which sounded like a wonderful idea when it was first introduced. This initiative, which was co-sponsored by Unicef and the World Health Organization, was going to be a complete paradigm shift for hospitals. No more pushing formula, no more taking away baby to the nursery at night, nurses and staff would all be well informed on the benefits of breastfeeding and would get mom and baby off to a great start by initiating and supporting breastfeeding exclusively. However, all of this enthusiasm can take an ugly turn when hospital personnel become too strident about protocols.
One mom who gave birth at a very highly rated New Jersey hospital reported that her nurse said, “You’re not planning on feeding your baby that poison, are you?” when she attempted to formula feed. That she was already mourning the ability to breastfeed (due to separate health issues), this comment seared her psyche. Another mom says, “My hospital told me, if I give formula, I’ll ruin everything.” These are not isolated incidents; they happen more often than people would expect. When new moms are feeling vulnerable and insecure shortly after delivery, virtually anything said to them on this topic can be painful. Many hospitals, in an effort to comply with the metric needed to either attain or remain BFHI certified, send new mothers home confused and feeling defeated because their baby is not getting enough milk from the breast. Sometimes the second phase of breastfeeding, when the mature milk comes in, happens later than a baby’s hunger levels can tolerate. I’ve seen many babies come home dehydrated or with borderline high bilirubin levels (infant jaundice). This becomes the pediatrician’s problem to deal with at the baby’s first doctor’s appointment, but it’s a huge stressor for parents, even causing post-traumatic stress disorder in some cases.
“It seemed more important to our hospital that I was breastfeeding and weirdly less concerning that my baby was not doing well,” explains Lauren, a Jersey City mom.
“I wasn’t allowed to use any supplemental formula unless the hospital pediatrician okayed it. Meanwhile, my baby was clearly not getting what he needed from me. Even I could see that! I’m so angry about the way we were treated, specifically regarding breastfeeding, that I will not even go back to that hospital for any reason, let alone give birth there again.”
Incidentally, this mom went on to successfully breastfeed despite offering formula in the first few days as she was sternly cautioned against.
With this kind of militancy toward even temporary use of formula, it’s understandable that women feel conflicted and shamed even by medical personnel.
Though I’ve worked with hundreds of new mothers, I can count on one hand those who formula fed with defiance and pride. “This is what works for me and my mental health. If you’re going to challenge that, you have a serious problem,” one mom explained in an online support group, condemning the judgment she felt from her peers. Another mom expressed it this way:
“I find it ironic that the battle cry among modern women, ‘your body, your choice,’ seems to completely fall by the wayside when it comes to breastfeeding. Suddenly what I chose to do with MY body is a point of inquiry, judgment, and speculation by everyone.”
Sometimes that judgment is unspoken, yet clearly perceived; you may feel inclined to explain yourself even though the other person didn’t say anything overtly negative.
“I felt a wave of guilt wash across me whenever someone assumed that I was breastfeeding, and I chose to correct them. I’m mostly okay with my decision until someone implies that what I’m doing is second best or not natural,” relates Briana, a first-time mom.
“My reasons for formula feeding should be private, but everyone feels you somehow owe them an explanation as to why you’re not on the ‘breast is best’ bandwagon,” adds another mom from the Facebook support group “Fed is Best.”
The pressure can come at you from all sides: family, friends, doctors, hospital staff. Even your partner may pressure you to continue breastfeeding when it’s evident you are overwhelmed.
“I couldn’t shake the feeling that I was doing something that had been oversold to me, something that was both more difficult and less important than all the books and websites and articles suggested. They had undervalued my time and my sanity,” writes Meaghan O’Connell in “And Now We Have Everything.”
When I read this passage, I felt like she had summed up everything we need to address in one fell swoop, especially the part about her sanity. Women who struggle with the rigors of breastfeeding and the exhausting chore of around-the-clock pumping can spiral into a postpartum mood disorder in no time. Breastfeeding should never be prioritized over a mother’s mental health, yet it is often difficult to explain that to someone in the throes of new motherhood. A new mom needs support both learning how to breastfeed and letting go of the endeavor if it isn’t working. In order to do that, she has to feel positive about formula feeding instead of reluctant or embarrassed.
“I finally feel like I can enjoy my baby and my maternity leave. Before I was consumed by pumping and bleeding nipples,” admits one local mom. “Stopping pumping and my agonizing attempts at breastfeeding was the best decision I ever made. I can’t believe I tortured myself for so long.”
No one wants the words “torture” and “new motherhood” to be used in the same sentence.
In order to relieve some of this guilt, our attitudes about mothers’ choices need to be adjusted. More realistic expectations around breastfeeding from educators and birth workers would be a start, neither inflating the benefits nor disparaging formula. How about embracing all modes of feeding? Pumping, formula feeding, combination feeding. No more sideways glances or unsolicited lectures on how superior breastfeeding is. Perhaps just not pushing any of our personal experiences or criticism toward any woman who might be formula feeding after any number of experiences you are not privy to: an exhausting mental battle, a traumatic birth, a mastectomy, a lengthy stay in the neonatal intensive care unit, a thyroid condition, a breast reduction, or simply because she wanted to, without any excuse at all?
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