The decision to stop breastfeeding as an act of love

Young Mother With Her Newborn Baby

I’ve written repeatedly about the toll of illness, injury and death that the relentless promotion of breastfeeding takes on babies. That’s because it is easy to see the damage: tens of thousands of babies readmitted to the hospital each year, as well as babies who suffer permanent brain injuries or even die due to dehydration, hyperbilirubinemia and hypoglycemia.

But as bad as that is — and it is inexcusable — the toll on women may be worse. It’s just less visible because it involves their mental health.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who choose to stop breastfeeding often do so for the BENEFIT of the baby.[/pullquote]

A reader shared a fascinating scientific paper that attempts to outline and explain those harms. The paper is Existential security is a necessary condition for continued breastfeeding despite severe initial difficulties: a lifeworld hermeneutical study.

There’s a lot of jargon in the paper, but it’s not hard to wade through to reach valuable insights.

The authors start by attempting to understand what happens to a mother when her baby fails to thrive on breastmilk. Of note, the study takes place in Sweden, a country with one of highest breastfeeding rates in the world, with extensive support for breastfeeding and with maternity policies designed to promote breastfeeding.

Nonetheless:

Almost 30% of mothers initiating breastfeeding experience some kind of difficulty and is a major reason for breastfeeding cessation. Breastfeeding success is often taken for granted during pregnancy and difficulties are thus largely unexpected by mothers. Such idealistic expectations evoke emotional distress when difficulties occur. Severe initial breastfeeding difficulties can lead the mother to feel lost in her role as a mother, leading to a constant struggle both emotionally and practically.

In other words, even when women have substantial breastfeeding support, almost a third of all mother-baby dyads will have difficulty.

Moreover, in contrast to the lactivist insistence that women who stop breastfeeding are lazy and selfish, many do so for the benefit of the baby.

The mother’s perceptions of the infant guide her breastfeeding decisions and her experience of herself in the breastfeeding relationship. Her own understanding of the infant’s response will determine whether she feels confirmed as a breastfeeding mother or not. When the mother … does not feel confirmed [because the infant is not thriving], she loses faith in herself as a breastfeeding mother. She concludes that the infant is mistreated by breastfeeding and her motivation to continue breastfeeding is lost.

In such situations, breastfeeding can become psychologically unbearable:

When the body gives positive responses, such as a good milk supply or less painful breasts, it provides hope and confidence in the body’s ability, which becomes a positive sign. A lack of positive signals from the body contributes to a sense of being trapped in the body, making the mother mistrust its function. The feeling that the body desires to be released from suffering arises and the situation is so painful that breastfeeding becomes unbearable.

But doesn’t she just need more support? It depends of what’s being supported, the act of breastfeeding or the wellbeing of the baby and mother.

…[C]are can be experienced as non-caring as, for example, intrusive hands-on breastfeeding help, or care that focuses solely on the infant or the body. Such care is degrading in that it objectifies the woman and reduces her to solely an instrumental functionality…

Such “care” is the opposite of support:

An instrumental way of giving care undermining mothers’ breastfeeding and seems to be based on the idea that a woman who has just given birth does not have the same need for extra care as for patients who, for example, are being treated for some medical condition. A new mother can nevertheless be exhausted, in healing from surgical procedures, and under the influence of the hormonal transition that occurs when the milk comes in… Being allowed to have the same care needs as for a “real” patient appears to be significant for the mother’s possibility to overcome breastfeeding difficulties … [I]n the absence of such acceptance, suffering becomes overwhelming, leading to her feeling forced to cease breastfeeding. (my emphasis)

The result?

Mothers who initiate breastfeeding with severe difficulties may feel overtaken and violated by the needs and demands from her infant, the extensive pain and/or changes in her body, and her own as well as others’ expectations for her to succeed. Contact with professional carers whom she experiences as too demanding or her own feelings of anger and loneliness may further enhance these feelings of being overtaken and violated…

Continuing breastfeeding in this situation can harm the mother-infant relationship.

When feelings of being overtaken and violated make her consider her body primarily as a biological tool, separated from the mother-infant relationship, feelings of alienation easily emerge. The intended reciprocal and intimate relationship with the infant becomes the opposite wherein it is difficult to feel closeness…

It’s hardly surprising then that stopping breastfeeding in such situations is an act of love.

The mother’s overwhelming feelings of suffering, anger and loneliness lead to a feeling of alienation from the breastfeeding relationship that can encourage her to see the decision to stop breastfeeding as an act of caring responsibility.

How should healthcare providers respond?

It is therefore important that health care professionals have the ability to extend their care beyond the biological body and the instrumental way of caring …

With this in mind, new mothers, especially those with severe initial breastfeeding difficulties, need to be met in a sensitive way that allows them to reconcile themselves to their feelings of alienation and come close to their infant, regardless of continued or stopped breastfeeding.

In other words, lactation professionals should be focused on WOMEN, not just on their breasts. Most importantly, they should understand that many women who stop breastfeeding do so not out of selfishness but out of love.

  • Shawna Mathieu

    OMG, thank you for posting this! I was gung-ho about breastfeeding YEARS before I had kids. I had my son, put him to the breast for that magical moment…and he couldn’t latch because I had flat nipples. OK, well, LLL and other groups said just keep trying, it’ll happen.

    My husband was supportive, my friends were supportive, my parents were supportive, so was my doctor. The LC I saw told me things like “If he’s hungry enough, he’ll latch” and berated me for “giving in” when, after an hour of fruitless attempts at latching, I gave my very hungry hysterically crying son a bottle of breast milk. When it still didn’t work, she terminated the visits.

    I got a bad case of PPD thanks to previous bipolar disorder. I did what the books said, refused to wean, demanded BF friendly meds. None worked, I bounced in and out of the hospital, 3 or 4 one to two week admissions.

    It took four months to realize that my son needed me at home more than he needed my breast milk. And for YEARS I felt like a failure, because I did what all the literature said, and everyone was supportive…and it didn’t happen. Was I lazy, did I not try hard enough?

    I found this site, along with FFF, while pregnant with my daughter, and it was so healing to see other people had the same experiences. I’d decided to formula feed only with her, and stayed on my meds. When signs of PPD showed up, doctor could adjust meds w/o having to worry about BF issues. That’s what kept me out of the hospital.

  • sheistolerable

    This gives me chills. Moving to combo feeding and then, stopping breastfeeding entirely improved my ability to bond with my son by leaps and bounds. I knew that the negative feelings I was having about our relationship as a result of struggling so hard to breastfeed could not be good for us.

  • MainlyMom

    I was probably among the most fortunate 5% when it came to breastfeeding. Easy latch, huge supply (oversupply really, and quite a few bouts with mastitis, but none in the early weeks). I did as much to “prepare” for that as i did to have a natural birth (i read some books and come from a family of natural birthers and breastfeeders). The birth went sideways. DD1 needed an emergency c-section due to heart rate issues, and i was induced at 41.5.

    I mention all this because i definitely got that “you failed and didn’t try hard enough” vibe and talk from the childbirth community (mostly from the friends i met at la leche). But having one thing go totally not according to plan and the other being absolutely zero effort easy peasy made me realize early on that i had very little to do with either outcome. I can’t imagine how hard it would be to follow the pressure of a “failed” delivery with “failed” breastfeeding, when both are primarily rolls of the dice.

  • yentavegan

    It’s all just theory and speculation until reality comes knocking at your door. The new mom in question has support, motivation, education and socio-economic status in the plus column. A full term healthy newborn and a text book easy non-eventful delivery. What she didn’t have was plentiful milk production. Never engorged, never had the whoosh of milk coming in…just barely minimum ounces produced. Her newborn is not passing frothy diaperfull bowel mov’ts, Heck he is not having enough pishy wet ones either. This mother is not getting any rest trying to nurse and then pump to supply her 2 weekold with enough nutrition. I told her it’s time for formula. It’s time to get some rest and her baby is not having enough bowel mov’ts and I believe she has done her best and has tried her hardest. But a schedule of nursing for 40 minutes followed by pumping for 20 minutes and a newborn who is not sleeping in his crib for more than an hour before she has to start the routine all over again is driving her to sadness when this time of her life should be filled with wonder and excitement not overwhelming exhaustion and self doubt. 3 decades of hands on face to face lactation support education under my belt and there is nothing I can do to create breastmilk magic for this mother. My old stand by retort of “feeding a babay is never the wrong answer” usually meant picking up the baby to nurse again. But this time I mean it is time to give that infant formula. He needs a restful sleep. She needs a restful sleep. This baby is active alert healthy but is at risk for failure to thrive if a boost of additional calories are denied.

  • Sarah

    I formula fed my baby from birth due to needing to take a medication (lithium) highly advised against in breastfeeding due to the risk of puerperal psychosis which I believe to be a far greater risk to my health and bonding with a newborn than use of formula. I’ve had side-eye from lots of people about never even trying to breastfeed. Interestingly, other than my psychiatrist, the Health professional most supportive of me EFF was the charge midwife of the postnatal ward, a woman in her 50s who told me (paraphrasing) that breastfeeding is great for many women but not suitable for all and she wished that women would be supported to supplement with formula when needed, especially in the early days. Of course, openly espousing this view could cost her her job.

    • Sarah

      And she told me that formula feeding is fine and not going to harm my baby at all.

    • Shawna Mathieu

      I wish to God I’d thought about that when I got pregnant with my son. I knew I was at higher risk for PPD b/c of my bipolar disorder, but I seriously didn’t know how bad it could get, so I went off meds for pregnancy, and only asked for BF friendly drugs. I had a HIDEOUS case, very suicidal. It was hell, took four months before I decided to wean.

      With my daughter, I decided from the start, stay on my meds and formula feed. I still got PPD, but my doctor was able to adjust meds to keep me out of the hospital.

  • fiftyfifty1

    OT: what ever happened to the “recent comments” section on the right side of the screen? I used to enjoy seeing what conversations were going on, and sometimes jumping in.

    • Who?

      I came here from there-maybe your computer is being weird?

      • fiftyfifty1

        Ok. Maybe I need some sort of update.Thanks.

    • rational thinker

      So Im not the only one. I used to be able to only get the recent comments if I came here from google search link. If I used bookmarks it would not show up, but now I cant get the recent comments either way and I am quite frustrated about it. I think it is probably our computers to blame or maybe my fire fox browser if every one else can still see it.

  • fiftyfifty1

    I look forward to the day when expectant mothers will receive accurate info: Breastfeeding will go well about 2/3 of the time, but 1/3 will experience significant pain, low supply or other major problem. Luckily, breast and formula have nearly identical excellent results unless you lack access to clean water or your baby is a preemie. Done.

    • alongpursuit

      I wish the doctors and nurses I saw respected me enough to give me this straightforward information! How I wish my family doctor told me this from the start! Instead, she didn’t say anything about it (presumably because she didn’t want to be seen as discouraging BF).

      • niteseer

        I wish they were upfront about the risks of mastitis. Anyone know what percentage of women come down with that? I have not had it, but I find the idea horrifying. It was already not fun with the nipples scabbed and bleeding, and the baby spitting up blood that she swallowed along with the milk.

        • MelJor

          And as someone who has had a c diff infection, and is terrified to take antibiotics again, if I had gotten mastitis I probably would have weaned rather than risk it again. I never got it in over a year of nursing (May have gotten one minor breast infection where I felt sick and my breast was tender, but no fever and managed to get it under control within the 24 hours my OB allowed me to wait before really considering antibiotics).