Go read the Disclaimer again. I am not a doctor. This is not medical advice. Seriously.
The medical community is now firmly in the world of sanity on this question, at least in principle: breast is best. There are still some leftover assumptions and procedures that interfere with establishing and maintaining breastfeeding, not least of which is the holdout committee on nutrition at the American Academy of Pediatrics that really thinks you should supplement a number of things, definitely by four months if not sooner. Until recently, the AAP was also firmly opposed to co-sleeping or the family bed, which makes breastfeeding at night considerably more doable. They are slowly relaxing that opposition. Culturally, legal and social strictures against exposing a woman’s breast have made breastfeeding in public a less acceptable act than bottlefeeding in public. More and more states have added statutes that explicitly exempt breastfeeding from indecent exposure and support a woman’s right to breastfeed wherever she and her baby have a right to be. Family courts are increasingly recognizing the importance of breastfeeding in deciding custody. Some states are beginning to introduce workplace regulations to support working mothers who would like to continue breast feeding, or pumping milk for their baby.
One of the reasons the family bed or co-sleeping is so helpful for breastfeeding involves newborn sleep patterns. While some people persist in claiming that they were very lucky to have a baby that "slept through the night", with the exception of some extremely irresponsible right-wing whack jobs, no one suggests that a newborn that sleeps through the night is a desirable goal. Babies who are breastfed digest their food more quickly and tend to therefore feed somewhat more often. A formula-fed baby is likely to sleep in larger blocks of time. Do not expect your baby to consolidate sleep for the first month or two. If your baby does sleep more than four hours at a block during the night, your health care practitioner may encourage you to wake your baby up for nursing during the night, especially if that baby is gaining weight slowly.
Nevertheless, many obstacles make it hard for mothers to establish breastfeeding and to maintain it. Previous generations had been told that breast milk was no more healthful than or even less healthful than formula. Nurses and doctors learned, directly or culturally, to treat human milk as a slightly disgusting and useless bodily fluid. Generations of bottlefeeding have interrupted the transfer of good technique. Organizations like La Leche, ILCA, IBLCE and others get the word out, train and/or certify lactation consultants who can help teach women who have not been able to breastfeed painlessly the techniques (mostly involving correct positioning of the mother and her infant) that make breastfeeding work right. Undoing generations of opposition to breastfeeding and efforts to stamp it out, however, is hard work.
Generally speaking, women who intend to breastfeed will make that decision quite early on in their pregnancy. How successful they are in establishing breastfeeding will depend a great deal on the support they can rally to their decision. Having a lactation consultant visit in the home in the event of any difficulty is crucial. Assistance immediately after birth is helpful, but problems can arise later. Telephone consultations, reading books and watching videos are poor substitutes for a compassionate expert who can identify problems quickly and work with you to correct them. Finding an effective expert may take more than one attempt.
While breast pumps are wonderful, they do introduce complications to the process (although surely no more than preparing formula), and there is a risk that baby will decide to prefer a bottle over the breast (or vice versa). Many women have difficulty pumping enough milk; supplementing with formula tends to become a downward spiral towards weaning early. An early return to work can thoroughly disrupt breastfeeding, particularly if your employer is unsympathetic.
The current ideal according to WHO is breastfeeding for at least two years. The American Academy of Pediatrics promotes whatever length of breastfeeding can be done, but strongly encourages it for one year, to be continued as long as mutually desired by mother and child. In many cultures, children wean themselves (usually as a result of peer pressure) around age 4, but you can find exceptions in both directions. I would say it is never the case that a woman breastfeeds Too Long (in the sense that she is somehow misusing or abusing her child by continuing to breastfeed).
Breast is best. But abusing a woman for making a decision that a short generation ago was the preferred, overwhelmingly normal decision is not compassionate. I’d far rather hear a woman say she chose not to breastfeed, than to hear the overused I-tried-but-I-couldn’t. There is no way we’d have made it this far if so high a percentage of women were unable to feed their babies at their breasts. Some medical treatments necessary to the mother preclude nursing (but there are a lot fewer on those than you might think). And surely there are some women unable to produce any or enough milk. But for the rest of us, the problems lie in a lack of support in transitioning back to work; other women who, directly or otherwise, discourage breastfeeding or push supplements; romantic partners who find the whole thing freaky and disturbing and do not want to share access to the breasts with the new arrival; and lack of access to trained assistance in learning how this part of our bodies works. Of these things, the easiest intervention we can make is to hire lactation consultants. They, in turn, might be able to help us through the rest of the issues. But if they can’t, then when someone asks you why you don’t breastfeed, if you trust them, consider whispering in their ear the real reason you decided not to breastfeed. Get the word out who really is to blame, so if it happens to them, they won’t feel quite so isolated and alone. And maybe together, we can work effective change.
The above was written before Teddy was born. While I added to the file, those additions have since been moved to the breastfeeding network. This work constitutes my thinking before ever breastfeeding.
Copyright 2005 by Rebecca Allen
Created May 20, 2005 Updated March 8, 2006