Breastfeeding
Because it’s not easy, or even possible, for many of us.
Breastfeeding is a wonderful way to feed a newborn baby — for those who are willing and able to do it. The reality, however, is that there are many women who quite simply cannot or choose not to breastfeed for various reasons that are really no one's business but their own. But, in an effort to expand minds and generate compassion, it's really important to discuss the many reasons why some women can't breastfeed. In doing so, maybe more women can be met with empathy and understanding for their situations and choices, rather than judgement or shame. Particularly in light of the updated American Academy of Pediatrics (AAP) guidelines suggesting that women breastfeed for two years, hopefully we can set the record straight about the many, varied reasons that women opt not to do so.
The "breast is best" mantra has infiltrated modern motherhood as the benefits of breast milk for babies — and of breastfeeding for mothers — has become more well understood. Unfortunately, the pendulum seems to have swung too far, in that many mothers feel awful if they can't breastfeed or decide it that breastfeeding is not right for them. In fact, not being able to breastfeed can even lead to depression for some women. “When breastfeeding doesn’t go as planned and mothers aren’t able to provide as much breast milk as they had intended, some feel like they have failed their baby and that they aren’t good mothers,” explains Dr. Melissa E. Glassman, Medical Director of the Newborn Clinic and Outpatient Breastfeeding Support Program, Associate Professor of Pediatrics at Columbia University Vagelos College of Physicians and Surgeons, and an International Board-Certified Lactation Consultant (IBCLC). “At all times, it’s really important to support mothers in whatever their breastfeeding goals might be.”
In light of that, it may be helpful to get a sense of why a woman may not be breastfeeding her baby. Here are nine common reasons why a woman might not be able to breastfeed or might choose not to.
1Mammary hypoplasia
Mammary hypoplasia — also known as glandular insufficiency or insufficient glandular tissue — is a condition in which, as Glassman explains, “the glandular tissue does not develop as expected, either in utero or during puberty.” Women with mammary hypoplasia cannot produce the full volume of breast milk required to exclusively breastfeed a baby.
2HIV infection or other severe illness
“Certain infections are contraindications to breastfeeding, such as HIV infection in the U.S.,active herpes outbreak on the breast/nipples, hepatitis C in the setting of bleeding nipples,” explains Glassman. And it’s not just moms who sometimes can’t breastfeed because of illness or infection. Some babies are born with conditions that mean that they shouldn’t be breastfed, Glassman says. For example, “those with classic galactosemia (a metabolic disorder) should not be breastfed.”
3Chemotherapy
Clearly, a woman going through cancer treatment has a lot on her plate. But it’s not just the fact that she may be overwhelmed emotionally that may prevent her from breastfeeding. It’s likely that her doctor will have recommended that she not breastfeed if she is undergoing chemotherapy. “While many medications are safe during breastfeeding, there are some, such as radioactive medication and chemotherapeutics, that if she is taking them, she should not breastfeed,” explains Glassman.
4Breast surgery
If you've had any type of past breast surgery — including biopsy, reduction, or augmentation, you could have trouble with low supply, which could make breastfeeding extremely challenging.
5Low milk supply
Many women struggle with bouts of low milk supply. Some can employ certain techniques to help — like pumping to increase milk supply — while others will not be able to fix it. Many things can negatively impact a woman’s breast milk supply, explains Glassman, including “hormonal issues due to medical conditions such as thyroid disease and polycystic ovary syndrome that can affect milk production.” In addition to things going on with the birthing parent’s body, there can be things going on with baby that make it more likely for low milk supply to happen. For example, “babies born prematurely or who have difficulty with latching for various reasons. If baby isn’t able to latch frequently and deeply, mom’s breasts will not get the stimulation they need to produce milk,” says Glassman. “Mothers can use the pump to take the place of baby latching, but sometimes mothers don’t start pumping right away and a long delay in removing milk or not removing milk frequently enough can result in low production in the long-term.”
6Drugs and other medications
It's recommended that you talk to your doctor about any and all medications — including supplements — you may be taking if you are thinking about breastfeeding and how they not only impact your breast milk, but your own alertness while breastfeeding. However, many medications are safe to take while breastfeeding. Drugs are another story, though. “Mothers who are actively using illicit drugs, such as illicit opioids, cocaine, and PCP, should not breastfeed,” says Glassman. “Additionally, the safety of marijuana while breastfeeding has not been established so mothers who are actively using should not breastfeed.”
7Postpartum depression or anxiety
If a mother is having problems with breastfeeding it may trigger depression. “A mother's mental health can really be impacted by breastfeeding when it’s not going well and can be an additional stressor for women,” explains Glassman, “particularly those dealing with perinatal/postpartum mood and anxiety disorders (PMADs). Getting early breastfeeding support is key, as problems or concerns arise.”
8Allergies
This one may be hard to diagnose or figure out, but it happens. According to Kelly Mom, a baby could be allergic to something in their mother's milk. Most likely, it's a dairy intolerance, sensitivity, or allergy. If a mother can't seem to figure out what her baby is allergic to in her milk, she may opt to use formula in order to ease her baby's discomfort or symptoms.
9Past trauma
The thought or act of breastfeeding can trigger difficult emotions for some rape and sexual assault survivors, according to Pandora's Project. Many survivors opt out of breastfeeding without trying, or some try and realize that it can't happen for them, and that is OK.
As hard as it may be, it's recommended that survivors tell their doctor, midwife, doula, nurse, or lactation consultant that they're a survivor. Doing so will help the survivor get the appropriate help and resources she needs for her baby feeding journey, whether it involves breastfeeding or not.
It doesn't matter why a woman doesn't breastfeed her baby. Let me repeat again for those in the back, it doesn't matter why a mother chooses not to breastfeed. If she doesn't want to breastfeed for any reason at all, that's her business and she doesn't have to explain it to anyone.
Experts:
Dr. Melissa E. Glassman, M.D., MPH, IBCLC, Medical Director of the Newborn Clinic and Outpatient Breastfeeding Support Program and Associate Professor of Pediatrics at Columbia University Vagelos College of Physicians and Surgeons
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