Revisiting the stress of modern mammalian motherhood
Happy National Breastfeeding Month!
With August being National Breastfeeding Month and a bunch of new readers (👋😁), I wanted to pop in a summary of prior posts on the stress of breastfeeding and baby feeding decisions. For those who already read each piece, please note, I seem to be incapable of writing a true summary, so there are a few new bits in here too.
While, in many ways, it feels like the culture war of “breast is best” vs “fed is best” has died down a bit in the last few years, the ripple effects of those campaigns continue affecting many lactating parents.
Case in point, this statement, shared in an earlier post, really resonated with folks:
“From a biological perspective, breast milk is a wonder.
From a stress perspective, that statement alone can be a trigger.”
How did we get to that point?
Breast milk, as a substance, is absolutely a biological wonder. Every mammalian species has a complex ratio of different sugars and proteins and fats perfectly suited to their unique needs. Every breast milk feed (within and between species) packs a different set of enzymes and vitamins and bioactive hormones and immunoglobulins in a way that depends on time and place and circumstances.
Compared to nearly every other source of human nutrition, we know shockingly little about the exact complexity of human breast milk. But we do know that it is important and perfectly calculated for the human baby at every stage of development, which is what makes it nearly impossible to replicate. I expect that as research catches up, the data will continue to double down on the emphasis that breast milk is an evolutionary superfood.
BUT, evolution operates far beyond the individual level. Evolution does not account for maternal pain or stress or mental health. Evolution does not favor every human in every scenario. Evolution allows for babies to die. Evolution allows for mothers to get sick. Those are unacceptable end points in the modern world. On our time scale, at our individual human level, we can and should question whether or not breast IS actually best for everyone.
Breastfeeding is important to examine through the lens of the maternal stress map because the individual interpretation and perception that labels the provision of this superfood as “stressor” versus “not stressor” is so personal and so flavored by the world we bathe in as soon-to-be and new parents. In addition, lactation as a life stage comes with its own suite of dynamic physiological and neurobiological changes that push our body and brain to a new limit as we continue adjusting from the shock that is the post-birth hormonal yo-yo.
For a side track on why the physiological dynamics are important to consider, see this post:
Ok, back to breastfeeding…
When breast (alone) is not best
Most of the available research connecting breastfeeding and maternal mental health start from the problematic focal point of “because breastmilk is good for the baby…” with little to no regard for what poor mental health means for the mother. That may seem like exaggeration, but, if you went down the research rabbit hole with me, you might reach the same conclusion (rabbit hole summarized in the post linked below).
Putting aside the decades of research looking at how maternal mental health affects breastfeeding, a review article from 2022 actually looked at the effects of breastfeeding challenges on maternal mental health. The team came up with the following conclusion:
“Breastfeeding recommendations must be individualized and consider the potential negative impact of breastfeeding challenges on maternal mental health. In such situations, recommendations may include discontinuing breastfeeding.” – Yeun et al. 2022
Dig in more here:
In summary – the “to breastfeed or not to breastfeed” question is personal and complicated and extends into a convoluted map of circumstances and stressors. Beyond the individual level, we need to balance advocacy for breastfeeding research and resources while looking at the real stressors that affect lactating parents facing this dilemma. As I wrote in that piece:
“We can fight for education + support and other broad solutions to limit exposure to the stressors associated with breastfeeding/feeding decisions while viewing breastfeeding/feeding decisions as a stress-inducing risk factor at an individual level. ”
Where are the balanced solutions?
One of my favorite people doing the critical work in this space is
, the CEO and founder of SimpliFed, a lactation support telehealth company that provides compassionate, human-to-human support and education at all stages of the breastfeeding journey.I had a wonderful conversation with Andrea about her personal feeding journey as well as the ins-and-outs of making sure every human in the country has access to comprehensive and respectful lactation+feeding support.
Read our discussion here:
The opportunities to change the stress of breastfeeding+feeding decisions exist beyond the individual
The available research connecting stress and breastfeeding tends to be… how to put it succinctly… less than ideal. The studies (again!) lean towards prioritizing the baby over the lactating parent’s health and when that research priority is set, researchers end up with conclusions like this: “It is of great importance to study how stress affects the high rates of premature relinquishment of EBF [exclusive breastfeeding]”.
Besides prioritization concerns (and gobbledy gook academic speak),“premature relinquishment of EXCLUSIVE breastfeeding” is a shitty metric to use. As Andrea pointed out in our interview, combo feeding (mixing formula + breast milk feeds) can be an excellent choice for so many parents and likely decreases the stress related to breastfeeding challenges. However, researchers prefer to limit variables so they rarely study combo feeding, leading to decades of breastfeeding research confined to a yes-or-no binary. This type of study design may have contributed to the all-or-nothing approach to breastfeeding advice that we cannot seem to shake.
With very limited research on the maternal stress side of things, let’s go back to the basics of stress and connect the dots:
“If it's the challenges of breastfeeding that causes stress, then how do we eliminate some of the challenges of breastfeeding? If it's the shame and guilt around feeding decisions that causes stress, how do we eliminate the sources of that shame and guilt? If it’s a lack of control (because true “choice” around baby feeding does not exist in the current structure of support at home, at work, in healthcare, in society) that causes stress how do we change the system and allow for personal decisions to be personal decisions? “
Read more here:
With the dots connected, we can see and elevate true solutions to decrease the stress related to this critical stage of life.
Now, to you!
Where do you see your lactating+feeding journey in the stressor map – the support, the lack of support, the sources of stress, the solutions you found, etc? How do you feel that your feeding choices affected your health? Negatively or positively!
For additional reading on breastfeeding and stress and where the “breast is best” campaign has gotten us when it comes to the advice we (and our partners!) get when leaving the hospital with a new baby, I absolutely adore this piece by
:
The Maternal Stress Project is an educational and idea-spreading initiative and I want it to be available to all so a free subscription will give you access to everything. With that said, this is a beast of a project, so please consider bumping up to a paid subscription if you are able (any little bit counts!). Your generous support will facilitate the growth of the project… and be much appreciated!
Sharing and spreading the word is equally valuable and appreciated!
Thank you for writing this and for all of your nuanced and thoughtful work on this topic.
Breastfeeding was probably at the level of traumatizing for me, and undoubtedly what led to PPD with my first child. Even seeing "breastfeeding" in a headline, even for work as compassionate as yours, causes me to pause and wonder if I have the stamina to read on. Like you say in your post, I think "breastfeeding" is a trigger word for me now.
Feeding decisions/breastfeeding challenges belongs in the CENTER of the new-mom stressor map alongside sleep deprivation. Babies exclusively eat, sleep, and poop for several weeks. A woman's entire mind and body is in service of this for a very intense period of time. And the fact that feeding mechanisms and decisions are at the heart of all of this, and the way we talk about it has been so exclusively been focused on the baby and not the mom, means that feeding to me goes smack dab in the center of a map of stressors for the first few months in my view.
My baby was excessively sleepy and had a very hard time waking to eat (we put ice cubes on her belly, played "turn down for what" in her ear - our pediatrician friend came over and said he wouldn't have believed it until he saw it) and she was born on the larger side and genuinely didn't seem to want to eat. I triple-fed her for one month. Triple feeding, in my experience, which is more common than I realized (SHOCKINGLY), means feeding, pumping, feeding baby through a syringe, and repeating this 90-minute process every 2 hours in the first few weeks. I remember thinking (while I still had brain function): what am I going to do with this 20-minute chunk of freedom? Eat? Get off the couch? Poop? Shower? Sleep? My life was live in increments of 90 minutes of pain and plastic tubes and switching positions and resenting the baby, and 30 minutes "to myself." I wept several times a day. The lactation consultants and home visitors all normalized this, saying "breastfeeding takes a little while to get used to" and "you're doing well" and "you have to keep going until she gains more weight." No one validated that triple feeding was CRAZY and next to impossible and should only be an extremely short-term tactic - it was just a price to pay to get breastfeeding established. One day I felt my mental health slip so low that I called it. My doctor helped, she said "it sounds like you're just done." But it felt like I was FAILING in the most enormous way, and every single thing I read about women loving breastfeeding or the wonders of breastmilk just make me fill with rage and sadness.
I hear of other moms who triple fed for as long or longer, or I hear of moms pumping for a year, and I feel so wholly inadequate. I experienced this as pure torture that just made me resent my baby - what's wrong with me when other people are normalizing this? I saved every. single. article. on the internet about feeling okay quitting breastfeeding/using formula, for which there were SO few in 2019. I must have spent a hundred hours just looking for anyone to tell me that that level of commitment was NOT worth it. That my mental health was worth it.
Thank you, Molly, for being that voice. There are a few more now. And the fact that studies are moving a little more into that direction around BFing and mental health is promising, but I just think about all the suffering moms out there who feel like they are failing out the gate when it isn't working. And carry that with them for a long time, even though their own choices to switch to formula proves they made the right call. We still have to change the narrative. And center the mother in the discussion. That's what ultimately convinced me to stop: healthy mom = healthy baby. Full stop.
Thank you for introducing this topic. Having followed the medical literature on benefits of breastfeeding over the last forty years, and followed the posts of social media greats like Scary Mommy, and having read the influential work of Emily Oster, it is no wonder that mothers are still confused and we are all still struggling with this topic. We know that difficulty breastfeeding is highly correlated with postpartum depression. No hormonal cause-and-effect has been delineated, but there is work being done to investigate this. We also know that inadequate support is a crucial factor in breastfeeding failure. Moreover, many pediatricians are inadequately trained to support problematic lactation. This is changing, but formula remains an easy out. Yes, fed and adequate growth is best, but we have far to go to assess the cultural, community, and familial factors that influence mothers’ behaviors. PPD is the most common complication of childbirth and depressed mothers rarely BF successfully. We have much left to learn!