First-time mom Liz Lockerman prepared for breastfeeding by taking classes, reading books and practicing different baby-holding positions. She even bought a freezer for the basement, in anticipation of building a supply of frozen breast milk for her return to work.
But nothing went as planned after the birth of his daughter, Sophie. They struggled so hard to feed themselves that Sophie eventually ended up in hospital with dehydration. Finally, a therapist convinced the exhausted and stressed new mother that it was okay to give her baby formula.
“Society puts that shame and stigma on the formula,” said Lockerman, 36, of Philadelphia. “There should be no shame in how you choose to feed your baby.”
New parents are inundated with messages about the importance of breastfeeding. The American Academy of Pediatrics recommends exclusively breastfeed babies for the first six months of life, then switch to a combination of solid foods and breast milk until the age of one year. Hospitals win a World Health Organization baby-friendly designation encouraging parents to breastfeed as soon as possible after birth and limiting access to formula milk unless medically necessary.
Although well-meaning, the ‘breast is best’ campaign has put enormous pressure on parents – some say to the detriment of their own emotional well-being – and contributed to the stigma of switching to formula ‘by choice’. . Now a nationwide shortage of infant formula is bombarding parents with new guilt from strangers telling them they would have food for their baby if they just breastfed.
“It’s so unfair that parents get caught up in ‘Which side am I on?’ and “Did I do the right thing?” said Katy Baker-Cohen, who makes free home visits to new parents as a lactation consultant and nurse for Philadelphia Hospital. Nurse-Family Partnership. “There is research to support that breast milk is ideal for babies. But there’s also research that shows parents who are mentally stable are also ideal for babies.
READ MORE: These Philadelphia-area parents help each other find formula during shortage
Breast milk is considered the “ideal food” for infants because it contains the nutrients babies need to grow. The content of breast milk even changes from week to week to meet the baby’s current needs, such as providing extra antibodies when the baby is sick. The mother’s body can produce additional antibodies in response to any exposure to bacterial or viral infection, and the baby obtains protection through milk.
For many parents, breastfeeding is a valuable bonding experience with their newborn.
Commercial infant formula, designed to mimic the vitamin and mineral content of breast milk, is regulated by the United States Food and Drug Administration. Compared to breast milk, research has shown that infant formula is associated with a higher rate of infections and gastrointestinal problems, although other studies have concluded that the differences are smaller than we thought.
Breastfeeding is difficult and time-consuming — newborns need at eat every two to four hours around the clock. Doctors advise against giving bottles, even if they contain breast milk, until at least three weeksto ensure sustainable breastfeeding practices.
This isn’t always possible for parents who can’t take extended parental leave and whose workplaces don’t allow time for pumping or space to store milk. Same-sex couples, adoptive parents, people who have had cancer, or those with other underlying health conditions may not be able to breastfeed.
The vast majority of infants are first breastfed, but only a quarter are still exclusively breastfeeding at six monthsaccording to the US Centers for Disease Control and Prevention.
Too often, families don’t get the help they need when they face challenges, said Baker-Cohen, a lactation consultant in Philadelphia.
“You need someone by your side the day you go home, and that’s not a reality in our healthcare system for most people,” she said.
Private health insurance often covers visits with a certified lactation consultant, but it may not be possible to get an appointment immediately, especially during a pandemic when in-person contact is limited.
Breastfeeding Resources for new parents with Medicaid, which pays for health care for low-income families and pregnant women, varies by state. Many cover breastfeeding consultations in the hospital, but no home visits. Pennsylvania and New Jersey cover breastfeeding education, but are among the minority of states that does not cover breastfeeding consultations in the hospital or at home, according to an analysis by the Kaiser Family Foundation.
Other breastfeeding costs include supplies such as nursing bras and pads to prevent leaks, freezer bags and a breast pump. Under the Affordable Care Act, most insurance plans are required to cover a free breast pumpbut they can cost uninsured people hundreds of dollars.
Even with support, feeding a baby can be overwhelming for a sleep-deprived parent, recovering from a major medical event, and often trying to adjust to a new lifestyle.
When breastfeeding doesn’t go well, a parent’s mental health can suffer. They may feel inadequate if they think they are not producing enough milk, and hurt if the baby cannot latch on properly. In more severe cases, breastfeeding parents may experience sudden negative feelings while breastfeeding, a condition called dysmorphic milk ejection reflex.
At some point, parents struggling to breastfeed must decide if the benefits of breast milk are worth the detriment to their own health, said Sara Kornfield, a clinical psychologist and assistant professor at the University of Pennsylvania’s Perelman School of Medicine.
“The benefit to a child of having a happy, healthy, well-adjusted mother may outweigh the small difference in infection rates,” said Kornfield, who also works as a director of the maternal wellness initiative at the University of Pennsylvania Hospital.
Still, parents often struggle with the decision to switch to formula, especially if they were attached to the idea of breastfeeding, she said.
“Letting go of that expectation can be difficult because of what we hear about ‘best of breast,'” she said. “We come to assume that the formula is far from the best.”
This was Lockerman’s experience after his daughter, Sophie, had trouble locking herself properly. She constantly worried that her baby wouldn’t have enough to eat.
Her fears were confirmed when Sophie was readmitted to hospital with dehydration. Still, doctors and nurses encouraged Lockerman to keep trying to breastfeed.
READ MORE: Watering down infant formula and homemade recipes are not good ways to deal with shortages. Consider these alternatives.
So she kept trying – alternating between breastfeeding and pumping in an effort to increase her milk supply. After a month of exhaustion, stress, guilt and feelings of inadequacy, Lockerman’s therapist helped her break free from the stigma and try formula milk.
“It was a light bulb moment: I can give her formula and she’ll be fine,” Lockerman said, “and I can be her mom.”
Last September, Sophie, now 3 years old, became a big sister.
Lockerman decided to try breastfeeding again. But when her son, Logan, didn’t get it after several days, she bought formula without guilt.