How the Idea of “Breast is Best” is Hurting Caregivers

By Dr. Debra Rezendes, HMT Resident in Marriage and Family Therapy in Northern Virginia 

When caregivers are first embarking on their parenting journey, one of the primary questions they must often answer is whether they will choose to breastfeed their child. Breastfeeding has been shown to have a variety of benefits. Breastmilk is often discussed as nutritionally superior to formula, providing all of the nutrients necessary for the growing baby (American Academy of Pediatrics, 2005). Evidence also suggests a link between breastfeeding and enhanced cognitive growth, which may be associated with higher adult intelligence (Dujijts, Jaddoe, Hofman & Moll, 2010). One of the reasons for enhanced cognitive growth may be that infants who are breastfed show a quicker growth of myelinated white brain matter, which allows for better coordination and efficacy between specialized areas of the brain (Deoni et al., 2013). Various short-term benefits have been associated with breastfeeding, such as the reduction of infant morbidity due to infectious diseases in childhood (Horta & Victoria, 2013). Adding to this growing literature, Horta and Victoria (2013) examined the long-term influences of breastfeeding and found that breastfeeding may also protect against type-2 diabetes. The vast empirical literature supporting breastfeeding has led to the Surgeon General calling for universal support for breastfeeding (U.S. Department of Health and Human Services, 2011). This has also lead to various advocate groups, especially in the health care industry, to proudly exclaim that “breast is best” (Sloan, Stewart & Dunne, 2010). But, what if our zeal in pushing for families to adopt breastfeeding practices is doing more harm than good?

While there seems to be no debate in the literature that breastfeeding provides benefits to the baby, adoptions of the idea that “breast is best” without proper support to families and women may do more harm than good. Individuals may not have the right supports in place to be able to sustain long-term breastfeeding and the expectation that “breast is best” may set them up to experience guilt, shame, and/or distress if breastfeeding is not desired or possible. To understand the challenges that individuals face, it is important to explore the systemic challenges individuals face when attempting to breastfeed.

One important factor in individuals’ ability to continue breastfeeding successfully is the support that they encounter by those around them, including their partner; individuals who describe their marriages as satisfying and loving throughout the postpartum period were more likely to engage in long-term breastfeeding (Isabella & Isabella, 1994; Kim, 2010). Additional community support was found to prolong the amount of time that individuals’ chose to exclusively breastfeed their children (Renfrew, McCormick, Wade, Quinn, Dowswell, 2012).  Kim (2010) also found that breastfeeding problems and higher parental stress negatively contributed to individuals’ adaptation of breastfeeding. Other factors associated with shorter breastfeeding duration relating to biopsychosocial maternal risk factors, include lower pre-pregnancy BMI and exposure to severely stressful life events during pregnancy; these factors lead to a delayed onset of lactation, which influenced shorter breastfeeding durations (Zhu, Hao, Jiang, Huang & Tao, 2012). These findings suggest that the adoption of breastfeeding practices is multi-faceted and taking a system’s approach to understanding individuals’ needs may help to better support them during their breastfeeding efforts.

Looking through a broader lens, it is important to understand how broader systems may be impacting the individual’s adoption of breastfeeding. While community and family support may play a key role in the individual’s adoption of breastfeeding practices, it is hard to ignore the cultural messages that individuals receive about breastfeeding in both a larger cultural context and within the workplace. Recently, the American Civil Liberties Union rallies behind Angela Ames, a Nationwide Insurance worker who claims that she was denied a place to pump breast milk upon returning to work after maternity leave. When protesting her treatment, she alleges that she was told to “just go home and be with your babies” and coerced into

signing a resignation letter. Appeals to various courts have ruled in favor of Nationwide Insurance Company, shedding light on the realities that individuals who breastfeed face in the workforce (Sherwin, 2015). This case highlights the lack of support that individuals find as they try to continue breastfeeding in a world where various obstacles exist. And it doesn’t even begin to shed a light on other jobs and industries that are unable or unwilling to provide a space for individuals to pump in private or adequately store their pumped milk. Too many people have stories of having to pump in a bathroom! Beyond just experiencing challenges in the workforce, it is also important to understand and discuss cultural debates about individuals’ right to breastfeed their child(ren) in public. Countless stores, such as Victoria’s Secret, have come under fire for asking women to leave their premises while breastfeeding. Underneath this scathing debate about breastfeeding in public is often notions of breasts being a symbol of sexuality (Rodriguez & Frazier, 1995).  These conflicting cultural beliefs about sexuality and breastfeeding create cultural paradoxes that have a direct and indirect influences on the decision to continue breastfeeding.

While the various factors discussed above are not an exclusive list of the challenges that individuals face when deciding to breastfeed, they present a more realistic picture of breastfeeding in the modern world. The decision to breastfeed or not breastfeed is not necessarily correlated with if the mother endorses the idea that “breast is best” but rather a complicated picture of how various systems work together to impact her decision. There is no dispute that breastfeeding offers a variety of benefits to the child, some of which we are still uncovering. However, adopting a stance that breastfeeding is the only way to nourish a young child creates division among those individuals who may have tried and lack the support necessary to continue their efforts. Additionally, adopting a universal stance that “breast is best” lacks a compassionate understanding of those individuals who medically may not be able to breastfeed their child for reasons such as medical conditions and medications (Santrock, 2015) and for those who simply desire not to breastfeed.

So, instead, what if we as a community embraced the idea that “fed is best,” and support families in meaningful and significant (and systemic) ways to choose what is best for their family?

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About Dr. Debra Rezendes:

Debra has over ten years of community and clinical work with individuals, children, parents, and families and has been published in the Journal of Happiness Studies and Autism Research and Treatment. She received her doctorate in Marriage and Family Therapy from Eastern University and has gained specialized, intensive training in emotionally focused therapy (EFT) and Theraplay. She also has skills in cognitive behavioral therapy (CBT), strengths-based therapies, self-compassion training, attachment-based therapies, play therapy, and solution-focused therapy.

Dr. Debra Rezendes is a Resident in Marriage and Family Therapy and is working towards licensure as a Marriage and Family Therapist in Virginia. She works under the supervision of Marianne S. Coad, MAMFC, LMFT, LPC-S. In the event that clients have any questions or concerns about Debra’s work, her supervisor can be contacted at mariannesynergycounseling@gmail.com, (703) 657-9721, or 10379-B Democracy Lane, Fairfax, VA 22030.

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References:
American Academy of Pediatrics. (2005). Breastfeeding and the use of human milk. Policy Statement. Pediatrics, 115, 496-506.
Deoni, S. C., Dean, D. C., Piryatinsky, I., O’Muircheartaigh, J., Waskiewicz, N., Lehman, K & Dirks, H. (2013). Breastfeeding and early white matter development: A cross-sectional study. Neuroimage, 82, 77-86.
Duijts, L., Jaddoe, V. W. V., Hofman, A., & Moll, H. A. (201, June 21). Prolonged and exclusive breastfeeding reduces the risk of infectious disease in infancy. Pediatrics. doi: 10.1542/peds.2008-3256
Horta, B. L., & Victora, C. G. (2013). Long-term effects of breastfeeding-a systematic review. World Health Organization, Retrieved on September 14, 2015 from: http://biblio.szoptatasert.hu/sites/default/files/Long-term_effects_of_breastfeeding_WHO2013.pdf
Isabella, P. H., & Isabella, R. A. (1994). Correlates of successful breastfeeding: a study of social and personal factors. Journal of Human Lactation, 10(4), 257-264.
Kim, S. H. (2010). Factors affecting mother’s adaptation to breastfeeding. Journal of Korean Academy of Nursing, 40(2), 225-235.
Rodriguez-Garcia, R., & Frazier, L. (1995). Cultural paradoxes relating to sexuality and breastfeeding. Journal of Human Lactation, 11(2), 111-115.
Renfrew, M. J., McCormick, F. M., Wade, A., Quinn, B., & Dowswell, T. (2012). Support for healthy breastfeeding individuals with healthy term babies. Cochrane Database Systematic Review, 5(CD001141).
Rodriguez-Garcia, R., & Frazier, L. (1995). Cultural paradoxes relating to sexuality and breastfeeding. Journal of Human Lactation, 11(2), 111-115.
Santrock, J. W. (2015). Essentials of life-span development (4th Ed.). New York: N.Y.: McGraw-Hill
Sherwin, G. (2015). Firing a mom because she’s breastfeeding is sex discrimination. ACLU.
Retrieved on September 14, 2015 from: https://www.aclu.org/blog/speakeasy/firing-mom-because-shes-breastfeeding-sex-discrimination
Slone, S., Stewart, M., & Dunn, L. (2010). The effects of breastfeeding and stimulation in the home on cognitive development in one-year old infants. Child Care in Practice, 16, 101-110. 
US Department of Health and Human Services. (2011). The Surgeon General’s call to action to support breastfeeding.
Zhu, P., Hao, J., Jiang, X., Huang, K., & Tao, F. (2013). New insight into onset of lactation: mediating the negative effect of multiple perinatal biopsychosocial stress of breastfeeding duration. Breastfeeding Medicine, 8(2), 151-158.

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