The relentless, ubiquitous pressure to breastfeed is emotional abuse

Sad woman

Lactation professionals have been successful in their attempt to “normalize” breastfeeding … and the harm has been incalculable while the benefits have been virtually imperceptible.

At this point, breastfeeding is the leading cause of newborn hospital readmission. 1 out of every 71 (!) exclusively breastfed newborns is readmitted to the hospital for complications of breastfeeding, amounting to tens of thousands of readmissions per year at a cost of hundreds of millions of dollars.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Normalizing breastfeeding hasn’t merely harmed babies’ physical health; it has taken a dreadful toll on women’s mental health.

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In defense of lactation professionals, they had no idea that breastfeeding promotion would have such a harmful impact. What is indefensible is that now that they have learned that aggressive breastfeeding promotion hurts so many babies, they aren’t merely ignoring it, they are vilifying the physicians and lactation consultants who are trying to prevent infant starvation.

But normalizing breastfeeding hasn’t merely harmed babies’ physical health; it has taken a dreadful toll on women’s mental health.

Women’s Choice Regarding Breastfeeding and Its Effect on Well-Being details the problem.

It starts, as nearly every paper about breastfeeding does, by paying obeisance to the theoretical (to date too small to measure) “benefits” of breastfeeding. Then it details some of the psychological harms:

Andrews and Knaak interviewed 60 Canadian and Norwegian women and found that greater breastfeeding rates were supported by cultures of pressure and judgment in these countries. [A] … study in Scotland … found that women perceived that formula-feeding was not a topic to be discussed by health care providers and that they felt pressure to breastfeed… [H]ealth care practitioners’ interpretation of the U.K. Baby-Friendly Initiative may be preventing prenatal discussion about infant feeding choices.

Sheehan, Schmied, and Cooke, in a small qualitative study in Australia, found that some women initiate breastfeeding in hospitals to avoid judgment by their health care providers. [Others] … found that among women who had ceased breastfeeding by 3 months after birth, those for whom breastfeeding was strongly related with maternal identity … were seven times more likely to show psychological distress … In a qualitative study encompassing 10 focus groups conducted with 51 health care professionals involved in breastfeeding promotion, Marks and O’Conner documented concerns about the dichotomy between breastfeeding promotion versus coercion but reported that some women also believed that promotion was not always carried out appropriately.

The authors state:

Based on these studies, we believe it is reasonable to extrapolate that women who choose to breastfeed and have difficulty breastfeeding or who have negative early breastfeeding experiences and must discontinue breastfeeding prematurely may experience increased stress due to their own internal pressure to breastfeed or/and external pressure, potentially from well-meaning hospital health care staff who are expected to promote and support exclusive breastfeeding.

The ugly reality is that the Baby Friendly Hospital Initiative and similar programs are emotionally abusive.

Emotional abuse is often associated with a power imbalance. It involves shaming, blaming and gaslighting, all of which are integral to contemporary breastfeeding promotion. Indeed, the Ten Steps of the BFHI would be considered akin to psychological abuse were they applied in other healthcare situations.

  • Imagine if overweight patients were repeatedly counseled throughout their hospital stay on the dangers of obesity.
  • Imagine if they were shamed and told that their weight was their “fault.”
  • Imagine if they were put on rigid diets, not allowed to supplement those diets and forced to sign consent forms signaling their awareness of the “dangers” of eating anything other than what was prescribed.
  • Imagine if any time they deviated, they were publicly humiliated by healthcare personnel.
  • And imagine when they complained of hunger, their hunger was both denied and derided.

Outrageous, right? But those tactics — shaming, blaming, and gaslighting — are integral to contemporary breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular.

But wait! Weren’t women “designed” to breastfeed? Sure, they were also “designed” to be heterosexual but that doesn’t mean that their sexuality is a choice that can be changed with “counseling” or that everyone should be pressured into using their organs for that which they were “designed.”

    • Imagine if gay patients were repeatedly counseled throughout their hospital stay on the “dangers” of homosexuality.
    • Imagine if they were shamed and told that their sexuality was their “fault.”
    • Imagine if they were subjected to gay “conversion therapy.”
    • Imagine if any time they resisted, they were publicly humiliated by healthcare personnel.
    • And imagine when they insisted that they were gay, their sexuality was both denied and derided.

Emotionally abusive, right? But those tactics — shaming, blaming, and gaslighting — are integral to contemporary breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular.

The paradigmatic example of the emotional abuse of breastfeeding promotion is the phrase “perceived insufficient breastmilk.”

It is gaslighting in the extreme, since insufficient breastmilk is common, affecting up to 15% of first time mothers in the days after birth. It is also gaslighting because it implies that women cannot be trusted to understand that their babies are screaming babies in hunger.

It involves blame because the subtext is that women are using the claim of insufficient breastmilk as an excuse to stop breastfeeding.

And it is shaming; women who have insufficient breastmilk are encouraged to view themselves as defective.

The authors of the paper note:

…[I]t is important for these health care providers to acknowledge that research has shown that difficulties in breastfeeding are not uncommon and that failure to meet breastfeeding intentions correlate with increased postpartum depression symptoms…

Health care providers also need to be supportive of women who choose to supplement with formula or who eschew breastfeeding altogether. It is not possible for health care providers to be aware of all the
factors that play a role in forming a woman’s infant feeding intentions, but so long as a woman is provided appropriate education to make informed decisions, clinicians must trust that a woman will choose to do what is best, even if the woman’s definition of best is different than that of the health care provider.

Compassionate behavior should be the rule:

Failure to acknowledge that the majority of mothers will not breastfeed exclusively for 6 months may contribute to undue stress in mothers who may not be exposed to or even educated about best practices in formula-feeding or formula supplementation, which most mothers are likely to benefit from. Educating women on safe formula-feeding represents an opportunity to protect the health and well-being of infants who might otherwise suffer as a result of potentially poor practices by well-meaning mothers.

Yet such compassionate behavior is literally prohibited by the BFHI.

The authors conclude:

Women who have difficulty breastfeeding can be subject to pressure to continue, which may contribute to anxiety and/or depression symptoms. Despite clinicians’ best intentions to promote women’s and infants’ health by encouraging exclusive breastfeeding, health care providers must continue to offer emotional support and reassurance to those women who cannot or will not breastfeed exclusively to avoid unduly stressing mothers about their infant feeding choices…

Anything else is emotionally abusive.

  • girtster

    I WANTED to breastfeed. Not because I was pressured to… it was my wish. ME. The patient, remember? You know what prenatal information regarding breastfeeding my obstetrician offered me: zip. The nurses left me with a crying infant for almost 24 hours. The pediatrician tried to tell me staying for a third day after my C-section when my milk hadn’t come in wasn’t necessary. It was lactation consultant that suggested supplementation. It was a lactation consultant that advised continued supplementation to maintain weight gain. It was a lactation consultant that advised me to look for underlying hormonal issues to investigate my issues with milk supply. Diana Cassar-Uhl’s book Finding Sufficiency led me to connect insulin resistance to my breastfeeding issues. Primary lactation failure is often a signal of underlying health problems. I was diagnosed by a naturopath with IR, correcting that got me pregnant at 39 after years of infertility. I was told by the medical community to eat low fat and calorie restrict. I was told my borderline low 100 blood sugars weren’t a problem and I just needed to lose 10 pounds. So I ate less. And I got fatter. It wasn’t until the naturopath suggested low carb/keto I realized how I had been lied to by food pyramid guides and so called diet experts. So excuse me for having zero faith in the medical community. If not for going an alternate route I wouldn’t have the baby I do, and I’d just be barreling towards Type II diabetes and thyroid disease. Why wouldn’t you investigate and treat lactation failure in a woman who wants to breast-feed? We wouldn’t just be told to accept the failure of any other organ. I should accept this because formula isn’t bad? Thank god for formula, until I addressed the issues causing my milk not to come in my little girl needed it. And thanks to a lactation consultant I fed my kid in the beginning what she needed, and now in my preferred method. You seem really bitter. Frankly, you are no better than the “lactivists” you rail against: asserting without evidence there is zero benefit to breastfeeding is ridiculous. Suggesting breastfeeding support is all exploitative is absurd. You’re a joke.

  • mabelcruet

    Personally, I’ve found that those health care staff who bang on and on endlessly about how they are compassionate, supportive, respectful advocates for women are actually the least respectful and the ones most likely to bully, undermine and patronise their patients.

    • Anna

      True story! My experience with “wise women” “sage femmes” “with woman” is that they are the first to sneer, tear down, gaslight and abandon other women and protect themselves.

      • JDM

        If they are wise they’re doing us all a favor by doing so. However, there’s that “if”; they never seem to question that.

      • mabelcruet

        I was once reading some maternity notes from a baby who had been stillborn. The whole way through staff had been writing comments like ‘sensitively asked mum if she wanted a shower,’ ‘offered condolences, and compassionately gave dad directions to the cafeteria’. It was honestly that ridiculous-just saying that you were compassionate or sensitive doesn’t make it so. Virtue signalling, basically.

        • Anna

          Absolutely. I’ve heard of a few loss Mums who’ve been told variations on “it was such a beautiful birth” “at least you didn’t have an episiotomy” “aren’t you glad you didn’t end up with a c-section”. In their minds these are appropriate things to say – they don’t actually mean harm, they truly believe it.

          • mabelcruet

            Look up the case of Claire Teague, a mother who died because of an incompetent midwife, Rosie Kacary (who ended up being struck off the nursing register permanently). At the inquest into Mrs Teague’s death, Kacary had the gall to tell the grieving husband that Claire had had the lovely spontaneous homebirth she wanted and one day she hoped he would remember that. His wife bled to death in their bedroom in front of him while the midwife sent text messages to other clients about unpaid bills. The paramedics described the scene as swimming in blood. The baby and her older sister were left motherless, and the father had witnessed his wife dying, but yes, the lovely homebirth she had wanted….

        • Shawna Mathieu

          I can’t remember who it was, but one of the natural childbirth bloggers wrote a long post on how awesome her homebirth was. She described in loving detail all the food and music and how she felt empowered – and only in the last paragraph did she say, using some stupid woo-ese euphemism, the baby died.

          • MaineJen

            Jesus. That’s…psycho.

            Not to mention…I don’t get their fixation on being able to eat. First of all, most hospitals now “allow” you to eat during early labor. Second? Eating was the LAST thing I wanted to do once my contractions got started.

  • AirPlant

    What honestly blows my mind in breastfeeding promotion is the obsession with exclusivity. I breastfeed my infant 99% of the time but every once in a while she will get a bottle of formula because that is the best way to get her fed at that particular moment. Super duper not a big deal in my opinion but it apparently makes me a failure at breastfeeding if you ask the internet.

    It is completely bananas to me because by any measure most of my baby’s nutrition comes from my milk, my supply has not suffered due to the missed feedings and my child tolerates the formula well which seems to me like a success story but I am supposed to feel some kind of guilt and failure because sometimes my husband takes the baby out in the morning before I wake up and if she gets hungry on the way he gives her some enfamil?

    • The Bofa on the Sofa

      Yeah, I think the fact that my wife breastfed our kids until they quit at 9 – 10 months should be celebrated as a success, and not considered a failure in the “EBF for 6 months” category because we supplemented with a mix of formula and expressed milk (we were conserving the expressed milk to make it last as long as possible) and started solids at 5 months.

      • AirPlant

        And in a sane world the metric for success would be that the baby was fed adequately in a way that caused a minimum of stress for the family.

        I am an exclusive breastfeeding failure but our method allows me to trade off nights with my husband and get eight straight hours of uninterrupted sleep multiple nights a week. I can have time away for hours at a time when I need to recharge, I can comfort nurse when nothing else will make my baby happy, I can get whatever nebulous benefits there may or may not be for my baby from breastfeeding and even better I have the reassurance from formula that my baby will never be anything but 100% fully fed. I am really happy with our system, my baby is thriving and that should be all that matters.

    • Glia

      The “only exclusive breastfeeding counts” thing is a personal sore spot for me. I let my first kid be so hungry until my milk came in, because I just didn’t know better, and I got the message that even one bottle was going to destroy our chance of BF. My second kid got formula before my milk came in. It was maybe a few ounces in total. Never needed it again after the first week or so (I would have given it to her, we just didn’t need it), but EBF from week 2-5 months doesn’t count. And definitely “points off” for letter her eat when she started grabbing food of the table and going to town before six months.

      • AirPlant

        Right? It does so much harm and causes so much stress for so little gain. Now that I have actually experienced lactation (and it went fairly well) all of these tasks that supposedly make or break your ability to nurse your child just seem absurd. I broke every single rule and my milk still came in on the second day after my c-section. Maybe I am just lucky but it really feels like the point of this system is less to promote breastfeeding and more to make it a completely miserable slog.

    • Sarah

      I think you know the answer to that question!

  • fiftyfifty1

    This post feels like a breakthrough–saying it in plain words that breastfeeding pressure is emotional abuse. It’s more than just “support gone a little too far”, it’s more than just a waste of public health dollars, it’s more than just something with unintended consequences, it’s more than just antifeminist, it’s more than just ethically dubious. Oh it’s all of those things, but more than any of that it is ABUSE.

    • Griffin

      Yes. It is emotional ABUSE. I managed to more-or-less avoid it but I felt its looming presence for sure when I was pregnant and had little kids. It was like a threatening, frightening, and very aggressive spectre.