Where "Breast is Best" Keeps Missing the Mark

If mothers should breastfeed for a year, then mothers need a year of paid leave. Full stop.

Photo by Africa images

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The first time I breastfed my daughter, the nurse was impressed. “Wow,” she said. “Your baby latched right on.” Latching, it turned out, would never be the problem. The problem was that she latched too hard.

A few weeks later, a lactation consultant was similarly impressed by the number of ounces of milk that my daughter managed to extract from my breasts over the course of a few minutes. It’s possible she set a record. “Well,” the consultant remarked. “Your baby’s doing just fine.”

I knew my baby was doing just fine. My nipples, on the other hand, were not. They were sore and chafed, and within the next month, one of them would become infected. My left breast would swell to the size and color of a red balloon, my temperature would soar to 103 degrees, and I would beg a God I didn’t really believe in for mercy.

So, yes, my first breastfeeding adventure got off to a rocky start. But eventually my nipples adjusted to my daughter’s ferocious latch, and we settled into a rhythm that I came to mostly enjoy.

My baby wanted to nurse about once an hour, which shocked me, but which I was casually told was on the frequent side of “normal.” This meant I more or less had to plan my entire day around the ability to sit down for 15–20 minutes once an hour. Of course, whenever and wherever I sat, something I needed would inevitably be just out of reach.

The second time around, I was more prepared for the reality of breastfeeding, and my son’s latch was decidedly less aggressive. I had figured out how to nurse lying down (why did no one clue me in on this sooner??), and how to hold a book while nursing. I spent many happy hours on our front porch reading while my baby ate and dozed. This, I thought, was everything breastfeeding should be.

The voracious appetites of both my children mitigated any embarrassment I might have otherwise felt about breastfeeding in public. I did so liberally because I wanted to be able to leave the house with them for more than 45 minutes at a time.

I learned after the fact that some men at a weekly neighborhood gathering I attended were uncomfortable that I fed my baby in front of them. I was proud that I’d caused them discomfort — it was good for them. I was even more proud that I had once unintentionally added to this discomfort by forgetting to pull my shirt back over my nursing bra and proceeding to walk around the gathering for a full 10 minutes with my nipple exposed.

Despite some of my initial challenges, breastfeeding my babies during my all-too-short maternity leaves was a mostly tender and gratifying experience.

It was when I had to go back to work that the trouble began.

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Both during and after my pregnancy, I was inundated with messaging from the medical community about the health benefits of breastfeeding. This rigorous education was a direct response to steep declines in breastfeeding in the first half of the 20th century — largely because of cozy relationships between formula manufacturers and healthcare professionals, as well as deceitful and aggressive marketing tactics employed by Nestlé and other infant formula companies.

While the patently false claims peddled by formula manufacturers have been reigned in, formula is, unfortunately, still vigorously marketed in the United States, unlike many other countries that follow the World Health Organization’s (WHO) International Code of Marketing of Breast-Milk Substitutes. So yes, in many ways it still falls upon medical professionals and breastfeeding advocates to push back.

But in 2011, when I had my daughter, no one really had to go out of their way to convince me that breastmilk is healthier for babies than formula. It was a no-brainer to me that the milk our own bodies produce has everything our babies need, and an ultra-processed, lab-concocted substitute is going to fall short.

I’m not alone in this. A 2024 survey of 1,500 new mothers and caregivers found that the vast majority “acknowledge that breastfeeding is the healthiest option.” And yet, “most use a mix of breast milk and infant formula to feed their infants during the baby’s first year.”

I began supplementing with formula when each of my babies was six months old, and I continue to feel, if not ashamed, at least sheepish about this choice. My kids are now 10 and 13, and whenever they get sick, a niggling voice in the back of my head wonders if I’m partially to blame. If I could have just stuck it out and pumped at work for another six months, perhaps their immune systems would be better equipped to fight the endless parade of viruses and other illnesses that circulate so viciously around schools.

Why did I start supplementing with formula? What happened when I went back to work? My story is neither dramatic nor acutely traumatic. I was simply another bleary-eyed new mom returning to my job before my baby could hold her own head up, carting pumping supplies on the metro and occasionally leaving them in the office microwave, much to the chagrin of my coworkers.

My office had a little windowless room with a couch in it where I could pump, which was luxurious compared to the closets and bathroom stalls where so many other new mothers were relegated. But I still dreaded those twice- or thrice-daily sessions. Pumping at work was nothing like breastfeeding at home. It was a weirdly dehumanizing, mechanical experience that made me feel great empathy for industrial milk cows. I missed gazing into my baby’s eyes as the milk flowed; I even missed my daughter’s ferocious latch. Her warm, roving tongue was vastly preferable to those heaving plastic suction cups.

It was hard enough to carve out time during my workday to pump, but it wasn’t just the pumping. I also had to sanitize the equipment (including remembering to take it out of the microwave), and store the milk (making sure it was discreetly placed in the office refrigerator so as not to gross anyone out). I had to remember to bring the milk home, and remember to label the milk, and remember to monitor the milk supply in our freezer, and remember to defrost the milk, and remember to purchase more milk bags, and remember to bring the equipment home from the office on Friday, and remember to take the equipment back to the office on Monday, and so on and so forth.

I had to remember all these things while getting an average of 5–6 non-consecutive hours of sleep, and attempting to function at my full-time paid job, and still having enough energy to attend to my baby in the evenings and throughout the night.

Nursing is so often portrayed as a casual thing women do when their baby gets hungry. We don’t talk much about how often babies get hungry, or how long they nurse for, or how our bodies become tethered to them, or how much time and labor is required to produce the milk that sustains human life.

While all of these things came as quite a shock to me during my first go-around, they weren’t ultimately such a big deal during my maternity leave. But they became a very big deal when I went back to work. And this is where the “breast is best” messaging continually falls short.

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We say breastfeeding is natural. The medical community and breastfeeding advocates tout all the ways that the various naturally occurring nutrients in breastmilk benefit babies. That’s all well and good, but there was nothing natural about me being away from my baby for 9–10 hours a day. There was nothing natural about hooking my breasts to a machine to express milk into a plastic bottle. There was nothing natural about my baby suckling on a plastic nipple.

The mother who pumps occasionally to allow herself some time away from her baby is one thing; the mother who pumps multiple times a day to ensure an adequate milk supply for the 40–50 hours a week that she is away from her baby is quite another. But while so many “breast is best” advocates focus their attention on adequate pumping facilities and access to breast pumps — both helpful things in our current reality — there is very little acknowledgment that pumping full time for the better part of a year really, really sucks.

I share my own story not because it’s remarkable, but because it’s so unremarkable. My babies were healthy and had healthy appetites. I was healthy and produced plenty of milk. I had a comfortable room in which to pump and mostly understanding co-workers. As a salaried employee, my pay didn’t get docked for being off the clock. It could even be argued that my story is one of privilege, though I get quite wary when we conflate privileges with basic human rights — like a mother’s ability to feed her infant with the milk her body is producing.

Even with everything I had going for me, by the six-month mark during my first go-around, I just couldn’t do it anymore. There were three other women at my job who’d had babies during my tenure there. One never came back from maternity leave. One tried to come back and then quit. The one who stayed and successfully pumped for a year looked and acted absolutely wrecked. She quit shortly thereafter, seeking a part-time job.

As the sole income earner in my family, I didn’t have the option of quitting, and at six months, I was already feeling pretty wrecked myself. So I decided to continue breastfeeding evenings, nights, and weekends and supplement with formula during my workdays. It wasn’t a decision I made lightly, and it’s not a decision I would have made if I’d had a year off from work to spend with my baby.

But when the medical community and breastfeeding advocates talk about viable reasons to not exclusively breastfeed, they are nearly all related to health issues in the baby, health issues in the mother, issues with milk quality, or issues with milk production. Says Johns Hopkins Medicine:

Breastfeeding only is almost always recommended. But your healthcare provider may have reasons to recommend giving your baby formula or other liquids. They include:

Your baby has certain health problems…

You have or have had certain health problems…

Says Prowers Medical Center:

In certain circumstances, breastfeeding is not the best choice, however. Moms on certain prescription medications, for example, should not breastfeed because the drugs can harm the baby. Mothers who use marijuana should also refrain from breastfeeding.

No one ever talks about the mental and emotional toll exclusive breastfeeding takes on a healthy enough mother with a healthy enough baby, who is being asked to pump two to three times a day while also engaging in paid labor while also caregiving for an infant.

La Leche League, one of the predominant breastfeeding advocacy and support organizations, has only a few pages on its very extensive website that make any mention of the importance of paid leave. They do support paid leave and have advocated for it at the federal level, but the vast majority of their advocacy work is focused on education and workplace accommodations.

I am grateful for La Leche League. It’s likely because of them and similar organizations that I was able to access a high-quality breast pump, didn’t have to pump in a bathroom stall, didn’t get fired for taking breaks to pump, and mostly felt comfortable breastfeeding in public. Breastfeeding advocates are doing important work, but there are crucial dots they aren’t connecting.

It’s posts like this one, Getting Creative, Making it Work, posted on La Leche League’s blog in November 2024 that frustrate me the most. In it, women share their pumping stories, like this one:

I’m a neonatal intensive care unit nurse, and I went back to work twelve weeks after my first child was born… It was always very busy, but providing breastmilk was important to me, so I always made it a priority to get away and pump. I remember one shift where I was responsible for attending deliveries, I was paged to a c-section mid pump. That got a little messy! I love being a pumping/working mom, because it’s super important even if it’s a difficult hat to wear.

Or:

I was the first employee to ever take maternity leave at my workplace!… On my days in the office… I’d nurse my daughter and dash off for the metro. Sometimes I’d pump on the metro with a manual pump.

I appreciate these women’s positive can-do attitudes, I really do. But I am so sick and tired of living in a society that asks mothers to “get creative” and “make it work.” That demands we employ “mommy hacks” to feed our babies.

Can we talk about this, please?

As another case in point, the CDC’s Breastfeeding Report Card provides four recommendations for increasing breastfeeding rates, starting with this advice: “Celebrate mothers who breastfeed and provide breast milk to their babies.” (And what about those who don’t? Dismiss them? Shame them?)

The CDC then proceeds to highlight the importance of ensuring that daycares support breastfeeding and hospitals improve maternity care. Those two I can get behind. It’s the last recommendation in particular that makes me want to bang my head against a brick wall:

Help communities develop and implement breastfeeding programs to meet the needs of populations disproportionally affected by structural barriers that can lead to lower breastfeeding rates.

Structural barriers, like… NO PAID LEAVE? Breastfeeding programs are all well and good, but when we don’t remove the structural barriers, we’re not going to get very far. It’s not a coincidence that “populations disproportionally affected by structural barriers,” i.e. people at the lower end of the socioeconomic spectrum, are less likely to breastfeed. Lack of education may be a factor, but it’s not the only factor and it’s not the primary factor. It’s also because lower income women are more likely to return to work sooner after childbirth, and they’re more likely to be paid hourly, which makes taking breaks for pumping particularly onerous.

A friend of mine attempted to return to her job as a Nordstrom sales associate not too long after giving birth. She lasted a couple of weeks. She was losing valuable commissions every time she left the floor to pump and the math didn’t add up. So she “got creative” and “made it work” by opting instead to stay home with her baby, which she and her husband couldn’t really afford. They proceeded to rack up tens of thousands of dollars of credit card debt.

If the CDC is serious about increasing breastfeeding rates during the first year, the very first thing they should recommend is that every mother in the United States have access to 12 months of paid leave. Full stop.

There is ample precedent for this. In fact, amongst the 38 countries that are part of the Organization for Economic Co-Operation and Development, the average total paid leave available to mothers is 51.9 weeks. It should be noted that even in many of these countries, paid leave is not necessarily available to all mothers, and this is absolutely crucial to removing the socioeconomic barriers to breastfeeding. Still, they are all lightyears ahead of the United States, which sports a big fat depressing ZERO in every single column of the chart linked above.

In the limited research that’s been conducted, there is a positive correlation between maternity leave and breastfeeding; even in the U.S., states with paid leave policies see higher breastfeeding rates than those without. And keep in mind, when analyzing the benefits of state paid leave policies in the United States, we’re generally still only talking about 8–12 weeks of paid leave. We’re still asking mothers to pump on the job for 9–10 months if they are going to exclusively breastfeed for a year.

It’s not a given that paid leave, on its own, will automatically translate to significantly higher rates of breastfeeding. We also need a culture shift, in which caregivers are not punished for taking the time they need to engage in the vital labor of sustaining and nurturing human life. We also need to continue our ongoing efforts to educate expecting parents around the benefits of breastmilk, normalize breastfeeding in public, and push back against the slimy marketing tactics employed by formula manufacturers.

But we’re not going to get anywhere if “breast is best” doesn’t make universal paid leave a central tenet of its argument. Not a side project, not a nice-to-have, but an upfront acknowledgment that breastfeeding works best when mothers are physically present with their babies most of the time. That pumping and workplace accommodations are not solutions, but rather responses to an economy that denies women the basic right to be physically present with their babies. That women who struggle to work and pump full-time should in no way be shamed for their inability to “get creative” and “make it work.” That “mommy hacks” aren’t going to cut it. That what capitalism demands of new mothers is, quite simply, inhumane.