It’s not that easy to ‘just breastfeed’

As the United States faces a baby formula shortage, many parents are also facing the suggestion from others that they simply breastfeed their babies instead of relying on formula.

The problem is that choosing to or being able to breastfeed isn’t that simple, and many factors influence whether someone can “just breastfeed their baby” to avoid the need for formula.

As a nurse-scientist whose research is focused on optimizing maternal-infant health, here’s what I can share about breastfeeding and what others can do to support parents and child caregivers, especially in a time of formula shortage.

The ways breastfeeding can be difficult

The challenges of breastfeeding can’t be understated. Successfully starting and continuing to breastfeed can be very hard or sometimes impossible for a parent who suffers from the following, many of which aren’t uncommon:

• Nipple injury (abrasion, bruising, cracking and/or blistering with pain)
• Engorgement (breast swelling because of excess fluid or milk)
• Plugged milk ducts (localized areas of milk stasis)
• Mastitis (localized infection of the breast that causes fever, muscle aches and pain)
• Thrush (yeast infection of the breast that causes deep, shooting and burning pains)
• Breast abscess (localized collection of pus within the breast tissue)
• Delayed lactogenesis (a delay in plentiful milk production)
• Insufficient lactation (lack of an adequate breastmilk supply)

Breastfeeding can also be made more difficult when a parent or child faces additional health challenges. Birthing parents might be recovering from a stressful labor or birth process, recovering from a cesarean delivery or facing a chronic health condition. A baby could have an anatomical barrier to successful breastfeeding or a developmental, neurological or respiratory illness, such as with some babies who are born too early.

What are current recommendations for breastfeeding?

When health care providers talk about breastfeeding, they usually have three goals in mind:

1. Begin breastfeeding
2. Exclusively breastfeed
3. Continue breastfeeding

Those come from national and global guidelines — the American Academy of Pediatrics (AAP), for example, recommends exclusively breastfeeding a baby for their first six months, followed by continued breastfeeding with complementary foods for the first year or more of life.

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How many children today are breastfed?

Our most recent U.S. data, which reports on children born in 2018, found that about 84% of American children have been breastfeed for some length of time, 46% were exclusively breastfed through three months of life and 26% were exclusively breastfed through six months of life. These rates are higher than those reported about 10 years ago, but they’ve been relatively stable over several years.

What factors influence whether someone breastfeeds their baby?

The decision to breastfeed or formula-feed is personal, and many factors are associated with whether someone meets those AAP recommendations.

We know from research that, historically, people who are less likely to meet breastfeeding recommendations include individuals…

• Who are younger, non-Hispanic Black and unmarried, and with fewer years of education, lower household incomes and/or living in the Midwest, the South or in an urban area
• From families that haven’t historically breastfed, don’t have friends who have breastfed, have less social support or have a partner with negative attitudes toward breastfeeding
• Who are feeding their first baby, experienced a pregnancy complication, had a baby with a health complication or are experiencing symptoms of postpartum depression
• With less workplace opportunity for breastfeeding, such as shorter maternity leaves or inadequate time or space for pumping
• Who don’t have a clear intention to breastfeed, have more negative attitudes toward breastfeeding, report lower confidence in their ability to breastfeed or have more difficulties with breastfeeding

Despite years of research on this topic, it still remains unclear how all of these factors work together to shape breastfeeding intention and success. Importantly, correlation (an association between two things) shouldn’t be mistaken for causation (that one thing caused the other). These individual circumstances don’t necessarily determine any individuals’ personal outcomes when it comes to breastfeeding.

What such data can do is provide opportunities to think about how we can better support parents and caregivers as they navigate important decisions and challenges as unique individuals, whether we’re working as individuals or as systems and structures within and beyond the health care industry.

We do know there are benefits to breastfeeding

When needed, formula is an excellent source of nutrition for babies, and it’s an especially important tool for parents of babies with certain allergies or special nutritional needs.

There are, of course, monetary benefits to avoiding the cost of formula, as well as benefits to avoiding the struggles associated with the current formula shortage. But the strongest scientific support for breastfeeding comes from studies showing that breastfed newborns do have lower risk for complications early in life, particularly serious infections such as sepsis.

While breastmilk is a complex mixture with many benefits, some of its major early benefits seem to come from substances that boost the newborn’s ability to fight germs, including antibodies against specific germs. For example, SARS-CoV-2 antibodies have been noted in the breastmilk of parents vaccinated against COVID-19 and breastfeeding parents previously infected with COVID-19, which may offer some protection for the baby. Of course, this is an active area of research with many questions that haven’t been answered yet.

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Some studies also suggest longer-term benefits for both the child and breastfeeding parent, such as decreased risk for childhood asthma, obesity and diabetes and positive effects on the breastfeeding parent’s cardiometabolic health and postpartum weight loss.

Tips for everyone: Listening and understanding can go a long way

As a working mother of two, I’ve personally experienced many of the trials and tribulations of breastfeeding described here, bringing me to tears on more than one occasion despite my years of training and experience as a nurse. But, ultimately, I believe that supporting one another as we all do our best to navigate this world is key, both personally and professionally.

For friends, families and even health care providers who want to support new parents and caregivers in feeding their babies, it can go a long way to listen and truly aim to understand each person as an individual. Sometimes, a new parent needs advice and technical support. Sometimes, a new parent just needs to know they’re not alone, and could use a kind individual ready and willing to help them in whatever form that takes.