How The Pressure To Exclusively Breastfeed Can Harm Mothers

Efforts to promote exclusive breastfeeding have led to a culture of formula-shaming that very few of us talk about. And if you do happen to speak up about formula-shaming, you risk being seen as someone who isn’t pro-breastfeeding. 

In developing countries, where access to sanitary formula preparation is limited, exclusive breastfeeding is a matter of safety. But in industrialized nations, where sanitation is not a concern, is there really a need for such polarized language when it comes to feeding our babies?

In my case, I had always intended to breastfeed. Yet as a new mom, I felt immense pressure not just to breastfeed, but to exclusively breastfeed for the first six months of my baby’s life. For my first child, postpartum recovery was rough. So this meant I breastfed when I could, but had to supplement with formula for my own health. 

At the time, I didn’t realize I had an infection. Every part of my body was in pain. I remember shivering and feeling so weak that I needed help going to the bathroom. I crawled into bed every chance I had. 

And yet, my baby needed me. He had jaundice and needed to be fed every two hours. I struggled taking care of my own body while simultaneously nourishing my baby from my breasts. I was blessed to have a supportive family who bottle fed him while I recovered. And yet every time I learned they had let me sleep instead of waking me up to breastfeed, I would be ridden with frustration and guilt. 

The more I pressured myself to exclusively breastfeed, the more disconnected I felt from my son. I started to wish that I didn’t have a baby, that I could go back in time to undo things. I felt more numb than I felt love for my child. 

And then it hit me. These dark feelings and thoughts were familiar. I had overcome depression several times in my life, and I recognized that I was on the brink of what would have been a new form of depression for me: postpartum depression. 

I refused to go down that road. What was really so terrible about giving my baby formula? Why was I holding myself to this arbitrary moral standard? I realized I had to let go of the idea of exclusively breastfeeding, and reminded myself that every ounce of breast milk counts. 

There is no shame in formula feeding, and I was not a bad mother for choosing not to “tough it out” in order to exclusively breastfeed. I chose to put my mental health first. Frankly, the benefits of breastfeeding can be negated if the accompanying struggles worsen mom’s mental health. 

At around 3 months old, my son was diagnosed with a cow’s milk protein allergy. I went on a dairy-free diet, but he was still experiencing symptoms. The next step would be a soy-free diet (as some babies with a cow’s milk protein allergy also have a cross-reactivity to soy). 

Again, mom guilt hit me hard. After all, I’m a pediatric dietitian. I remember rationalizing to the pediatrician why I could not do both a soy-free and dairy-free diet. Being Asian, soy is a vital part of my diet. My appetite was already poor. Removing dairy and soy would only make it harder to nourish myself. (Side note: Malnutrition can lead to a lower mood that mimics depressive symptoms).

In hindsight, I realize I was looking for the pediatrician’s permission to stop breastfeeding. He was a kind man, and fully validated my desire to switch to formula 100%. I was too vulnerable at that moment to realize that I did not need anyone’s permission to make that decision. 

Breast milk is amazing, and this post is not meant to spark a debate about its benefits. But I hope it encourages new moms and healthcare providers to rethink the messaging that women should breastfeed at all cause. Because the truth is, not all women can successfully breastfeed, let alone exclusive breastfeed — and there isn’t enough discussion around this. 

In our efforts to promote breastfeeding, many health professionals have managed to skew the perception of formula into something that is negative. A colleague once told me about a friend — also a healthcare provider — who was embarrassed to bottle feed her baby at the hospital. I have seen PSAs stating that formula-fed babies will end up obese, or are more likely to be diagnosed with diabetes as adults. That even one bottle of formula will impact the gut microbiome. Fear-mongering messages like these only add to the polarity. Instead, we should have an open dialogue about when formula feeding is appropriate. 

When it is indeed safe to formula feed a baby, why can’t we tell moms that it’s okay to breastfeed and supplement with formula?

Breastfeeding has many benefits, and we need to support it without causing guilt or shame. But there are instances when exclusive breastfeeding may not be realistic — mental health struggles including trauma, low milk production, severe allergies, or the need to return to work early. We need to recognize that each mother-baby dynamic is unique, and support informed decision-making when it comes down to how a mother chooses to feed her baby. Once I let go of the idea that I must exclusively breastfeed, I felt a heavy burden lift. I gave myself permission to supplement with formula so that I could be mentally and emotionally present for my baby… and myself. 

I think it’s time we ask mothers how they want to be supported in their efforts to feed their babies. In my perfect world, women would be aware of the benefits of breastfeeding and have support from healthcare providers and families to do so. But women would not feel shame (or be shamed) for choosing formula. We shouldn’t have to justify how we feed our babies. 

To all the formula-feeding mamas out there: If formula is the “worst” thing you are doing to your baby, you are doing a wonderful job!