The day my daughter was born, I knew we were in for a wild ride - starting with her arrival into the world, 4 weeks ahead of her anticipated due date.

Our feeding journey was rocky right from the start. As a late-preterm baby, we had a lot of feeding struggles.

She had a hard time nursing and transferring enough milk; because of this, her weight was closely monitored.

I measured my self-worth by the progress of her weight gain and the output of my breast milk. When the doctor recommended formula, I stubbornly refused.

Instead of supplementing, I resorted to using a supplemental nursing system (SNS), followed by pumping and trying to feed her expressed breastmilk.

The cycle of nursing, pumping and feeding took at least an hour, every 2 hours around the clock.

I spent so many of those nights attached to my pump in tears because I thought I was failing as a mom.

I was so adamant to breastfeed because I truly believed that was best for her. I thought breastfeeding is what made me a good mom. Never once did I consider how the pressure to breastfeeding was impacting my mental health.

Sadly, I think the enormous pressure I put on myself to breastfeed and the resulting struggles we experienced were major triggers for my postpartum depression.

It also made feeding something that was stressful for both of us, as I have no doubt she picked up on my own anxieties and insecurities.

Through the feeding struggles we faced, I learned that breastfeeding shouldn’t take priority over my mental health.

More than my breast milk, my daughter needed a mother who was mentally well.

I also learned that my short-sighted goal of breastfeeding at all costs was hindering the more crucial need to have positive experiences around feeding - for my daughter and me.

Understanding the Pressure to Breastfeed at All Costs

I know my story is one of many, where a mother feels unequivocal pressure to breastfeed her baby. Because of the mainstream messaging around breastfeeding, many mothers are made to feel as if it’s their sole duty, the admission price to pay for entering new motherhood.

Much of the messaging is well-intended. Whether coming from a health professional or a family member, the emphasis is on doing what is beneficial for the baby.

You may have heard messages such as:

• “Breastfeeding is the best thing you can do for your baby.”

• “If you want to have a healthy baby, you need to breastfeed.”

• “You should breastfeed for {X} amount of time.”

• “Breastfeeding will come so naturally!”

However, the fault of these messages lies on what goes unspoken. The decision to breastfeed shouldn’t be based solely on what’s best for our babies. Mothers are also part of the equation of the feeding relationship, and are automatically dismissed when we only talk about what’s best for the baby.

Poorly misused statements like, “Breast is best!” are misleading because it applies to only one party in the feeding relationship (the baby), while neglecting to highlight the importance of the mother in the feeding dyad. It’s called a feeding relationship because there are 2 people involved (baby AND mother), and pushing “breast is best” gives no consideration to what may be best for a mother in the dynamic of a feeding relationship between her and her child.

Because if breastfeeding is happening at the expense of a mother’s mental health, then it’s to the detriment of both a mother AND her baby.

Yes, breastfeeding is beneficial for your baby. But even more beneficial than your breastmilk to your baby is a mother who is mentally well. Your mental health and well-being are equally important to consider in the decision about how you will feed your baby. It’s about you and your baby, not just your baby.

Breastfeeding is not a blanket solution either, for a mother or her baby. Just because you breastfeed doesn’t guarantee your child won’t face any health problems or difficulties down the road, yet this is often how it’s interpreted.

Breastfeeding may be normal, but it doesn’t come naturally, and saying this is a disservice to mothers everywhere. This also creates unrealistic expectations for mothers who may try to breastfeed but have difficulties doing so. Shouldn’t it come naturally? Shouldn’t my baby latch effortlessly? I know these were things I questioned when my baby and I struggled with breastfeeding.

Ultimately, breastfeeding shouldn’t take priority over mental health. Your baby needs a mother who is well over your breastmilk.

With so much emphasis on breastfeeding, it’s easy to tie a mother’s sense of worthiness into how she feeds her baby. Her identity may unintentionally become wrapped up in whether or not she breastfeeds, - with the choice not to breastfeed feeling like a scarlet letter that is worn in shame.

These types of messages around breastfeeding have invented an impossible standard for mothers, creating the idea that breastfeeding should be pursued at all costs, even at the expense of mental health and well-being.

It’s also important to understand the mainstream messaging around formulas, too. In my earlier motherhood years, I heard formulas described as poison, toxic, unhealthy, unnatural.

What?!

This depiction of formula comes with a price tag: moms are made to feel less than worthy when feeding their babies with formula. On top of which, many mothers feel unnecessary guilt and shame for feeding their babies with formula.

Thank God we live in a world where we have access to formula, which is NONE of the things described above. In reality, formula is a suitable and safe way for feeding our babies.

But when mothers hear this messaging around formula, what kind of feelings do you think are created when she feeds her baby formula?

Sadly, this can trigger unnecessary shame and guilt around mothers, as though they are a failure or unsuccessful at keep their babies fed. Being able to breastfeed your baby is equivalent to the modern day marketing of “clean eating”, with messaging steeped in mainstream diet culture.

Worries Around Infant Growth and Weight Gain

On top of this, as mothers, we face many unrealistic expectations and unwarranted concerns about our children’s growth and health.

My daughter had more frequent weigh-ins initially to monitor the “progress” of breastfeeding. Every trip to the doctor’s was wrought with anxiety and stress. Any time I was met with disapproval with her weight gain, I left with a deep sense of failure, like I wasn’t trying hard enough with how I was feeding my baby.

Ironically, while I had come to let go of the scale in my own eating disorder recovery, it now re-emerged in my baby’s life with a new face of vengeance. The numbers on the infant scales were haunting of my past - a reminder of how I used to measure my own “progress”. Now I was looking to the scale again to tell me if my baby was progressing, if I was successful in breastfeeding or not.

For many mothers, myself included, stress over a baby’s weight and growth can become an obsession. The fixation on achieving a certain outcome can indeed become a trigger for anxiety, even depression, if it feels like your efforts are failing.

Stressors Surfacing in Early Motherhood Impact Mental Health

All this to say, it’s important to take a step back to see the big picture of what is happening here.

1 in 5 women will suffer from a maternal mental health disorder, like postpartum depression. Less than 15% of these women will receive treatment or support for recovery.

While we can’t pinpoint the cause of maternal mental illnesses on any one cause, we do know that a multitude of factors work together to create the perfect storm.

Some of the risk factors for maternal mental illness may include (but are not limited to):

• Traumatic birth experience

• History of mental illness

• Family history of mental illness

• History of perinatal mood and anxiety disorders

• Depressive symptoms during pregnancy

• History of physical, sexual, or childhood trauma

• Lack of social supports, marital strains

• Low self-esteem, body image distress

• Infant with a challenging temperament

• Unplanned or unwanted pregnancies

• Lower socioeconomic status

• Financial hardships

• Obstetric and pregnancy complications

• Medical complications with baby

• Recent difficult circumstances (such as losing a loved one, chronic illness, etc)

• Difficulty breastfeeding (more below)

These risk factors, in combination with the physical, emotional, and mental stressors mothers face throughout their journeys, can trigger the development of a maternal mental illness, such as postpartum depression or anxiety.

Breastfeeding Risk Factors Associated with Postpartum Depression

For mothers who may already have other risk factors for maternal mental health conditions, difficulties with breastfeeding can also be a trigger.

Challenges with breastfeeding can arise for different reasons, such as:

• Pain while breastfeeding

• Infant with feeding difficulties or medical complications

• Infant with allergies or sensitivities to breastmilk

• Lack of support

• Physical separation from baby

• Traumatic birth experiences

• Post-birth maternal complications

• Low maternal self-belief, self-confidence

• Maternal anxiety about infant well-being

Physical pain with breastfeeding can be especially triggering for a mother with risk factors for mental illness.

Research has found that pain is associated generally with increased risk of depression, and breastfeeding pain has been associated with increased risk of postnatal depression.

Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons, highlighting the importance of spending time with new mothers to help them with issues such as latch.

Mothers often report that they believed that breastfeeding would be straightforward, and then, when they encountered difficulties, they felt guilty, let down and upset by the experience, feeling that they had failed. These feelings themselves may increase risk of postpartum depression.

Many times, breastfeeding difficulties are dismissed, chalked up as nothing but normal, early feeding struggles.

From my personal and professional experience, I know that mothers encounter well-meaning statements like this when expressing their breastfeeding struggles:

• “That’s normal!”

• “It will get easier.”

• “You just have to push through it.”

• “It might be hard now, but it’ll be worth it in the end.”

However well-intentioned, these statements do nothing to validate the pain and discomfort a new mother may be facing. Many mothers I’ve worked with have shared how afraid they were of admitting pain or discomfort while breastfeeding, or of simply asking for help, due to fear of how others might respond.

Would they think of me as a lesser mother? Or not cut out for breastfeeding? Or simply weak and inadequate?

While the pressure to breastfeed can come from both internal and external forces, our new mothers in general have the greatest need for non-judgemental support.

Breastfeeding Elimination Diets

Another breastfeeding risk factor that might be associated with maternal mental illness includes prescribed breastfeeding elimination diets (either self-prescribed or professionally recommended).

Breastfeeding elimination diets may be recommended in the instance that a breastfed baby is showing adverse effects to breastfeeding. A mother might be advised to cut out certain foods from her diet. The danger is when multiple foods and/or food groups are eliminated in effort to improve a baby’s symptoms. However, the psychological effects of these types of diets on a mother can’t be overstated.

Many breastfeeding mothers, who are following the rigid rules of an elimination diet, may find this is a trigger for declining mental health, including symptoms like:

• Obsession, preoccupation with food

• Mood swings

• Increased stress, anxiety about food/eating

• Inability to cope with emotional stressors

• Poor cognitive abilities

Not to mention the negative physical ramifications of restricting food intake that come with inadequate nutrition intake for postpartum moms (where nutrition demands are at an all time high).

The negative physiological and psychological effects of an elimination diet may outweigh any potential benefits to the breastfeeding baby. The combination of the psychological effects of an elimination diet along with the physical consequences of malnutrition can ultimately be a trigger for a maternal mental health disorder, such as postpartum depression or an eating disorder (either new or recurring).

In these situations, it’s absolutely imperative to weigh the benefits versus potential risks involved with prescribing an elimination diet to a breastfeeding mother. If the food restrictions are so steep that she is left with limited options in her diet, this will likely not benefit her, mentally or physically.

Ideally, a new mother who may be facing these types of situations while breastfeeding, should have the support of a comprehensive and non-judgmental team who can help inform her with the information needed to make a decision to best support her and her baby moving forward.

Breastfeeding Tips for New Moms

Being on the other side of this challenging season in my life, I can see how I came into my breastfeeding experience with my daughter with multiple risk factors for mental illness. I had a history of mental illness, including an eating disorder and postpartum depression (with my first daughter). The feeding challenges we experienced were like the straw that broke the camel’s back.

I wish I could’ve understood this beforehand to spare myself and my family the agony we went through together.

I know I needed permission to prioritize my mental health, even if that meant supplementing my daughter with formula, knowing that we would both come through that period of our lives stronger because of it. Sadly, I know many mothers are experiencing this same thing, which is why I feel like it’s my duty to share my story.

So often, as a lactation consultant, I am asked about my best breastfeeding tips for new moms.

My response is always the same: It has to come down to understanding if breastfeeding is right for both you AND your baby.

Here are some tips I’d love to share with you, if you are also in a place in your motherhood journey where you’re wondering the same thing:

1. Does Breastfeeding Support Your Mental Health?

Remember that you are also part of the feeding equation. It’s important to consider how breastfeeding is supporting your overall health, including mental health. (Remember there is no real health without mental health).

This is something to assess each time you bring a child into the world, no matter what number baby it might be. Every pregnancy, birth, baby, and postpartum experience is different. You may be in different circumstances now than you were the first time you had a baby.

Understanding your risk factors for mental illness can also help you be more aware of how breastfeeding challenges might impact you.

2. Create an Individualized Feeding Plan:

Feeding your baby is not a one size fits all solution. You have the freedom and flexibility to create an individualized feeding plan to work for your family’s unique needs.

This may include a combination of feeding on demand, bottle feeding, pumping, supplemental feedings, using donor milk, or various other things.

Don’t let outside rules dictate what you should or shouldn’t do for your family.

Consider all of your needs and come up with a plan that works best for you. Remember: how you feed your baby is ultimately more important than what you feed your baby.

3. Pain is not Normal:

It’s important to know that pain while breastfeeding is not normal. If you’re experiencing pain or discomfort while breastfeeding, please connect with professional support as early as you possibly can.

A lactation consultant can assess your latch/positioning and help troubleshoot any potential problem areas to improve your breastfeeding experience.

You are not a martyr and don’t need to suffer unnecessarily for the sake of feeding your baby. Decreasing your experience of pain can help improve your overall mental health and postpartum experience.

4. Focus on nutrition, rest, and stress-management:

I know this might seem like a tall order for a new, postpartum mom. But you and your baby will thrive best when you are making your care a priority, too.

Nourishing your body as best as you possibly can, as well as prioritizing sleep and stress-management, can help support your physical recovery and overall mental health.

For more postpartum nutrition support, check out this post here: “Your Postpartum Nutrition Can Help Maternal Mental Health and Healing”

5. Connect with Support:

Having professional, non-judgmental support is crucial for your postpartum journey as a new mom.

This can include a breastfeeding support group, lactation consultant, therapist, and postpartum dietitian nutritionist, in addition to your perinatal health care provider.

You don’t need to walk through your journey alone, nor should you be expected to. Having your team lined up can help you build your village as you transition into motherhood.

Educating mothers (and wider family members) as to what normal patterns of breastfeeding are like may play an important role in reducing both breastfeeding difficulties and emotional distress around breastfeeding. This could be helpful in minimizing the impact of breastfeeding difficulties on maternal mental illness risk.

Building Your Worth and Identity as a Mother

Mothers, more than anyone, undergo a complete upheaval of their identity in the transition into motherhood.

Everything you thought to be true of yourself may have changed, as have the circumstances in your life. Bringing a baby into the world means everything is changing, including your relationships, career, aspirations, and how you relate to the world around you.

During a time of rapid change, it’s easy to look to tangible markers to help you feel some sense of control, especially in times of vulnerability.

There may also be a need for achievement and recognition. New mothers are often cast aside the minute a baby enters the picture. In many ways, moms may be looking to breastfeeding as a way to help fill in these gaps.

You may not have much control over your changing circumstances, but controlling what you feed your baby may feel like the only thing within your means. It can bring a false sense of control or superficially fill a need for achievement or self-worthiness.

If your worth and value as a mother has been wrapped up in your ability to breastfeed, it can be difficult to know who you are outside of this.

You may even grief the decision or choice not to breastfeed in order to protect your mental health.

As you navigate the many different challenges, which may surface during your motherhood journey, know your identity and worthiness as a human being are not attached to how your feed your baby or the progression of your baby’s weight.

Remember: Your mental health matters more than your breastmilk.

You’re more than your breastmilk, and your mental health has to be a factor when considering the optimal way to feed your baby

While it may be easy to boil down your worth as a mom to how you feed your baby and your breastmilk, there is always so much more to the story.

Remember this mama, you are more than just your breastmilk or how you decide to feed your baby. No matter how you feed your baby, you are still a great mama and doing the best you can with the information and resources you have at the time.

In this transition to motherhood, don’t forget that you matter, too. Your mental health, physical well-being, and overall wellness still matter and are important for helping you and your family thrive.

If you are a mother in need of more support, please consider connecting with Postpartum Support International, where you can find free or low-cost resources to help you navigate your motherhood journey. You’re not alone, and you are loved, mama.

How did your breastfeeding journey impact you?