Not Breastfeeding, Not Guilty

I have often been asked, ‘do you think you could be making mothers feel guilty by being such an advocate of breastfeeding? ‘

Yes, I am pretty committed to supporting and promoting breastfeeding –I am an internationally certified lactation consultant (this requires thousands of documented hours helping mothers breastfeed in clinical settings, study hours and a stringent, internationally scheduled exam – and recertification every five years). I also breastfed my own five babies for a total of more than twenty years. However, I beg to disagree that promoting and supporting breastfeeding also means promoting guilt.

Although I encourage parents to explore options and make choices that are right for each parent and their particular child, I don’t see feeding breastmilk substitutes as simply an ‘option’ like so many other aspects of preparing to nurture a baby. The choice of infant feeding has consequences – for the health of the mother and the health of the child. And what informed person would deliberately choose to risk their own or their child’s health? Parents are making choices on their child’s behalf. The person most affected by the parents’ choice of infant feeding is the child. As a parent, you are your child’s advocate.

As a lactation consultant, though, I know how hard it can be for many women to breastfeed or to breastfeed as long as they want to: I see women who are working against huge odds to give their baby the optimum nutrition and health protection that breastfeeding conveys. Many of these women have received unhelpful advice from everyone around them, including health professionals. I have seen babies who are upset every time they go near a breast because they have been handled roughly by hospital staff (mothers’ breasts have been grabbed and their baby’s head shoved onto a breast); I have seen women who have been told they don’t have enough milk or ‘your milk isn’t strong enough’ (this is never true and usually comes from an older relative who may have been told this a generation ago); women who have been advised to give their babies a top-up bottle only to have the baby find the fast milk flow easier than working at the breast so consequently, weaning begins before breastfeeding even becomes established. I have seen women struggling to feed the baby, then pump (when they have finally settled the baby) around the clock when, for that particular woman, this can be an unsustainably stressful experience; I have seen women with wrecked nipples that cause toe-curling pain at the very thought of a baby coming near them, often because of undiagnosed issues such as a baby with tongue tie. There is also enormous pressure from some so-called ‘experts’ to implement rigid feeding routines (with the promise of a good night’s sleep). Unfortunately, this isn’t compatible with the physiology of breastfeeding and can also result in premature weaning.

Then there are women who are battling against medical conditions that make breastfeeding challenging despite their best efforts. Some of these include: polycystic ovary syndrome, diabetes, postpartum haemorrhage, fragments of retained placenta (which fools he body into thinking it is still pregnant so affects levels of breastfeeding hormones) and rarely, insufficient glandular tissue (‘red flags’ are a lack of breast development during puberty and pregnancy). Then there are mothers who may need to take medications that aren’t compatible with breastfeeding because they have adverse effects when passed through breast-milk (the choice here is obvious if there is no suitable alternative medication – your baby needs a healthy mother!).

As for promoting guilt, when we pussyfoot around about making women feel guilty, we are patronising them – how can anyone make an informed choice if information is deliberately withheld? In any other circumstances, if we deliberately withheld information, we would be considered dishonest or even negligent. When we are prescribed any medication or medical treatment, if we are sensible – we will ask, “what are the risks?” / “are there any side effects?” We expect to make informed choices, and give informed consent about health care – and isn’t breastfeeding the optimum preventative health care?

We have no hesitation about informing parents about car safety restraints, sun protection, or reducing the risks of SIDS. The dangers of smoking are well promoted – and health care providers have no qualms about using guilt to discourage parents from exposing their babies to cigarette smoke. While we are on the topic of guilt, let’s consider weight loss advertisements – what about all those mothers in the ‘before’ and ‘after’ photos, and the implications in so many advertisements that women must have been neglecting their children when they were overweight. Now that they are trim and terrific, of course these women can participate in numerous happy family activities and no doubt have renewed energy to meet their children’s needs. Above all, what about the shame of being an overweight mother? How many of the women in the “after shots” smilingly claim “my husband/ kids/ family are so proud of me now!

I don’t believe the emotions felt by mothers who don’t breastfeed or who wean early are as simple as ‘guilt’: when we really examine mothers’ feelings about things gone wrong, it is rarely guilt that they are expressing, especially about not breastfeeding or not breastfeeding as long or as completely as they would have liked to: well informed mothers who reach for the bottle after a struggle with breastfeeding know they have done the best they could with the resources they had at the time (health, energy, knowledge, support) – these mothers may feel deeply sad and disappointed, they may be grieving, but guilt isn’t an appropriate label for these overwhelming feelings of loss for themselves and their babies.

Amanda, a mother who breastfed her first child for three years but weaned before she was ready with her second says, “The hardest part for me was knowing that we were feeding on borrowed time. Whilst I at least had the opportunity to ‘treasure’ those last feeds – every feed brought bittersweet tears to my eyes, even the memory does now! The strangest thing is that everyone said that I’d done so well to feed him that long (8 months). After feeding Chloe for almost 3 years – I felt Jesse and I were at the beginning of our breastfeeding relationship – not the end. I definitely didn’t feel guilty (although I wonder if the use of the dummy contributed and I did feel a little guilty about that). How could I feel guilty when I have woken him at 3am as a newborn to feed him (to keep up my supply), when he would rather sleep. In the end I woke twice a night to sneak a breastfeed or two in! No – Jesse didn’t want to continue breastfeeding and that is all there is to it. People think I am crazy as everyone says how much easier it is when they are on the bottle. I agree in some ways it is, but I’d give my right arm for those cuddly breastfeeds, fingers playing with my lips and teeth and the little rhythmic pats on the chest. I’d also give anything to combat his intolerance to milk – WHY DIDN’T HE JUST KEEP ON BREASTFEEDING???

Mothers who later discover that they were ‘short changed’ by receiving inappropriate information or a lack of support (for instance, women who have inadequate maternity leave to establish breastfeeding) are likely to feel angry or betrayed. These mothers don’t feel guilty either.

A mother who gives up on breastfeeding because she allowed herself to be talked into something that was less than perfect for her baby, is likely to find that her self image as a competent mother is compromised. It is perfectly normal for a mother to feel she would do anything to protect her baby – and most mothers would! So when mothers give in to external pressures to wean their babies, they lose confidence in their ability to protect their young.

And if there are later consequences from a decision not to breastfeed, such as a child who becomes ill with a condition that may have been prevented, the emotion felt is not guilt -but regret. That awful feeling of, if only…. If only I had known, if only I had done things differently.

Guilt is only legitimate if we have let another person down – if we haven’t honestly done all that we could have or should have. And nobody can make us feel guilty without our permission. Feelings of guilt may be triggered by external factors -like an over zealous health professional telling us about the hazards of artificial feeding, as we are reaching for the bottle – but these are OUR feelings. This is our own internal value system at work. We each need to decide whether this guilt is legitimate or not – or whether it is in fact, guilt or some other feeling and how we will act on this feeling.

For the sake of your relationship with your baby, it is important to differentiate between feelings of guilt and other emotions or perhaps, unrealistic expectations that create guilt whenever we don’t live up to our own standards of what we feel a ‘good’ mother does. To help work out what we are feeling, we can ask ourselves:

“Where is this feeling coming from?”
“Is this the best I can do right now?”
“What are my responsibilities?”
“What can I change?”
“Where can I find support?”
The positive thing about guilt is that we CAN act on it: If we feel guilty about the choices we are making, we can use these feelings to motivate us to make better choices. There is a vast difference between guilt and regret. We can act on guilt. The sad thing about regret is that it is too late. We don’t get another chance to go back and do it all differently with each baby.

Breastfeeding promotion is not about promoting guilt. It should never involve persecution of mothers who make other choices. If a mother has made an informed choice not to breastfeed, that is her right. If a mother has given up breastfeeding due to overwhelming challenges or a health problem for instance, she will need extra support. No mother, whatever her choices, needs to feel judged or criticized. If we offer understanding, mothers are more likely to work through their feelings, to be open to trying to breastfeed with a subsequent baby – and to seek all the support they will need to make breastfeeding happen. In my work I see many gutsy women who have experienced awful grief about weaning early with previous babies (often this is their third or fourth baby) but they are facing their fears of ‘failure’ and giving breastfeeding a go with subsequent babies – and winning this time around!

There is no excuse for using maternal guilt as an argument for withholding information about breastfeeding – this very information could prevent feelings of guilt, sadness, anger, inadequacy, betrayal and regret.

As well as acknowledging breastfeeding as the perfect infant food, we must also acknowledge that breastfeeding is more than just a method of feeding – breastfeeding is an intimate relationship and an intrinsic aspect of our biological femininity. When the breastfeeding relationship is ended prematurely, rather than guilt, most mothers feel a deep sense of loss. This emotion is grief – not guilt! And while we offer mothers platitudes like “you have given him a good start” in the hope of alleviating guilt, we are not giving them permission to mourn the loss of this intimate relationship. We are dismissing their very real feelings of grief.

Catriona’s story from my book Parenting by Heart

‘When my first-born son, James, was five months old I was diagnosed with Hodgkin’s lymphoma, a malignant disease of the lymphatic system. Naturally this was a huge shock, as I had assumed that ‘cancer’ only happened to other people — especially older people. It certainly should not be happening to a 26-year-old who had just begun a family and wanted to live to raise a new little boy. I was admitted to hospital for tests over a one-week period, during which time baby James was not allowed to stay with me. I was told to wean him straight away, as I would have to undergo chemotherapy, and the drugs would be secreted in my breast milk.

‘Looking back on that time now I remember the pain and grief of the initial diagnosis. But the major cause of my suffering was the enforced weaning and separation from my baby, rather than the threat of a potentially terminal illness. Weaning was such a trivial issue to the doctors (and friends and relatives) when my life was at stake. But not to me! My baby was the focus of my life at the time, and it was such a wrench to discard such an effective, healthy, and almost “mystical” bond between us.’

Pinky McKay is an IBCLC Lactation Consultant, best selling baby care author and creator of Boobie Bikkies , all natural and organic cookies to boost energy and support a healthy breastmilk supply. Download Pinky’s FREE ebook ‘Making More Mummy Milk,Naturally’.