It's time to retire the phrase "breast is best" once and for all

It was 3 a.m., and we had reached the end of our rope with our perpetually crying newborn. She was becoming increasingly prone to long fits of inconsolable crying and, though I nursed constantly, I was never able to soothe her. Finally, in the middle of the night on her fifth day, we picked up the phone and called the nurse’s line.

The nurse was curt and prompt with her diagnosis—the baby was dehydrated—and she suggested that we go to the ER. After some sobbing on my part, my husband decided to run to the 24-hour pharmacy for formula and a bottle instead. My daughter couldn’t drink it fast enough and fell into the first deep sleep she’d ever known. I cried myself to sleep.

To say that I felt I’d let her down is an understatement. In the days leading up to that moment, I knew, deep down, that I wasn’t keeping her fed, despite my healthcare providers’ insistence to the contrary. It was both their staunch belief in “breast is best” and mine that kept us from admitting she was hungry, and I realized then that maybe breast isn’t always best.

Before we go any further, please know this: I think breastmilk is the ideal food for babies and, in most cases, breast is best. That being said, I also think it’s time to retire the phrase because it crushes every mom who is unable to give her baby what’s “best.”

“Breast is best,” the ubiquitous public health campaign that urges women to give their babies nothing but breastmilk for the first six months, made me feel like a failure. It followed me home from the hospital, in pamphlets handed to me by nurses who were too busy to actually show me how to breastfeed. It echoed in my head when I fed on demand every two hours and pumped in between feeds; when I sat in my hospital’s breastfeeding support clinic, sobbing and feeling overwhelmed; when I struggled with a complicated tube system for supplemental feeding that allowed my baby to drink formula while nursing; and when I filled my body with supplements and medication. I could still hear it in my head when I gave it all up and waved the white flag.

“Breast is best” left me feeling broken, ashamed, overwhelmed and exhausted. Those feelings, echoed by thousands of other women who struggle with nursing, explain the growing backlash against the exclusive-breastfeeding movement, even among people who agree with it in principle.

The positive impact of “breast is best”

While its precise origins aren’t clear—even to the lactation consultants with whom I spoke for this story—the breastfeeding advocacy initiative, as we know it today, can be traced back to at least the 1960s and ’70s, at a time when many women in Western countries were turning to formula more often than breastfeeding.

In the mid-1960s, only 25 percent of Canadian women were even attempting to breastfeed, according to Statistics Canada. When I was born, in 1979, my mother turned to formula when nurses were unfazed by her struggle to get me to latch. In fact, most of my friends were formula-fed. By the early 1990s, though, the number of Canadian women who were initiating breastfeeding had risen to 75 percent, thanks in part to the Baby-Friendly Hospital Initiative, which was launched by World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) in 1991 to promote and support breastfeeding worldwide. And by 2012, the most recent year for which Statistics Canada has data, 89 percent of new mothers were breastfeeding their babies. If these trends are any indication, current rates are likely higher.

What these statistics mean is that the breast-is-best campaign has had a positive impact on breastfeeding at home and elsewhere. Women are nursing in higher numbers and longer into their baby’s childhoods. It has also helped normalize breastfeeding in public while empowering women to pump at work, all of which is worthy of celebrating.

The flip side of the movement

There’s a devastating fallout to the breast-is-best movement, though, and one we don’t talk about enough. For mothers who struggle with pain, low milk supply, injury, fatigue, work demands and illness, the pressure to breastfeed exclusively can have a profound impact on their mental health.

For me, the effort it took to maintain my milk supply made the first six months of motherhood almost unbearable. The constant nursing, pumping, medications and stress left me exhausted and depressed. I also felt embarrassed that I gave my daughter food that many people view as substandard. I’d proudly breastfeed her in public and then head to my car to top her up with formula in private for fear of judgment. I would make sure that the aisle was empty before taking a carton of formula off the grocery store shelf and then hide it under food so no one would notice.

When my second daughter was born and my midwife asked if I wanted a breast pump and a prescription for Domperidone to increase my milk supply, I told her no. She smiled, told me that whatever was best for my mental health was best for my baby and gave me a hug. It was one of the most liberating moments of my life, and I learned to simply enjoy feeding my baby.

Maternal mental health is nothing to shrug at. According to WHO, about 13 percent of new mothers experience a mental health disorder, primarily depression, and research has shown that depression can be exacerbated by added stress and anxiety. In some cases, the outcome is tragic.

The cries for help

In 2016, a Vancouver woman named Florence Leung took her own life after struggling with postpartum depression. Her grieving husband turned to social media, begging healthcare providers to ease up on new mothers when it comes to breastfeeding. “Do not EVER feel bad or guilty about not being able to ‘exclusively breastfeed,’” he wrote in a Facebook post shortly after her death, “even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes and teachings at breastfeeding classes.”

In 2017, new mom Mandy Dukovan’s disturbing photo and viral story about inadvertently starving her newborn because she felt pressured to breastfeed exclusively despite having a low milk supply further ignited the debate. “I was told that breastfeeding was the best thing I could do for my baby, so I kept going at the expense of my baby’s health and my well-being,” she wrote in a follow-up essay for The Fed Is Best Foundation (fedisbest.org). “I only heard stories about how amazing and natural breastfeeding was and that every mother could breastfeed if she just tried hard enough.”

When her baby was two months old, Dukovan switched to formula, and she says he finally began to gain weight. “Now, when I look at my healthy, happy, thriving little boy, I know that I’m not a failure as a mom,” she says. “I know that my worth as a mother isn’t a reflection of how he was fed.”

Ottawa mom Ashleigh Lewis also took to Instagram recently to condemn the trend of shaming moms for how they feed their babies. “I was shamed by strangers more than once for feeding formula to my daughter,” wrote Lewis, who struggled with a low milk supply with her first daughter. “I was told that I was a horrible mom on mom groups. To all the milk makers out there who are throwing in the towel and switching to formula, I was you […] and I have not a single regret. Do what’s best for you.”

Celebrities, too, have weighed in on the relentless pressure to breastfeed. Actress Whitney Port posted an emotional video on YouTube, just a week after her son was born, discussing her difficulties with breastfeeding and guilt for wanting to quit. “I’ve heard people talk about this pressure, and I never thought I’d let it get to me,” she says in the video, wiping away tears. “I think because [breastfeeding] is so painful, I’ve sort of demonized it in my head, and now the thought of doing it is dreadful. I’m not blaming myself for it hurting. I’m blaming myself for possibly quitting.” In a recent podcast episode, the comedian Amy Schumer shared that she chose to switch to formula, as well. "There's so much pressure to breastfeed, but really it's all in your head," she said. "You matter, and it's going to be better for your baby that you're OK."

The recent fed-is-best initiative is trying to undo some of the damage done by the intense pressure placed on women to breastfeed at all costs. But “breast is best” is still everywhere, especially in new-parent handouts and discussed often at well-baby check-ups.

Even the Government of Canada is unwavering. “Breastmilk is the best food you can offer your baby,” according to the Public Health Agency of Canada’s website. “Health Canada and WHO recommend that it should be the only food or drink for the first six months of life... There are rarely reasons not to breastfeed…so don’t give up—it is important for your baby.”

The message sent to moms is "Don’t give up." But what if you have to?

Mission accomplished

The breast-is-best movement has done what it set out to do: Formula is no longer the default option for new mothers, and most of us are well aware that breastmilk is the ideal source of food for our babies. Now, it’s time to lower the megaphone and instead focus on better support for new moms, free of judgment.

It’s painful to think back to that overwhelming night, nearly six years ago, when we couldn’t get my daughter to stop crying. It’s ludicrous that new parents should have to call toll-free health lines at 3 a.m. to learn that their newborn is starving. It shames me to admit that a bottle of formula was the only thing that kept my baby out of the emergency room that night because I should have given it to her earlier.

My story isn’t unique. Women across this country are struggling with guilt, confusion and grief over not being able to breastfeed properly, so let’s put “breast is best” to bed.