Originally published in The Ottawa Citizen January 8, 2002

Mother’s milk is best for a baby, but it’s not a mother’s only option.

The American and Canadian pediatric societies advocate breastfeeding for the first 12 months of life. Health care professionals universally support this recommendation. Breast milk is the best source of nutrition for newborns and infants.

In my practice, I observe many mothers equating breastfeeding to their competency to be good mothers. This narrowed perspective — the dependency upon one aspect of newborn care — can be damaging to the mother’s well-being. There can be tremendous guilt if breastfeeding does not go well, their baby is not gaining weight, not latching properly, or their technique is poor.

The stress from these problems can in themselves make matters worse.

Despite the best of intentions, women are bombarded with messages that lead them to believe if they stray from breastfeeding they are potentially harming their newborn child. It may not necessarily be an overt action, but nonetheless it is damaging to the mother’s self-esteem. She begins to question her ability to be “a good mother.”

There is a minority of breastfeeding advocates/consultants who imply the harm aspect. This happened to my wife after the birth of our first son. A consultant told her she was “jeopardizing the life and health” of our baby because she was not breastfeeding him every two hours. This message makes its way into many of my patients’ homes.

Parents have enough on their plate without having to contend with the guilt or the feeling that they are inadvertently harming their newborn child. There must be a balanced approach to newborn feeding. If a mother is unable to breastfeed, and yes this does happen, she should not be made to feel that she is a failure.

Any form of dogma implies an inflexible attitude. Of paramount importance is the survival and health of the newborn. Newborns should gain about 30 grams (one ounce) per day. Family doctors and pediatricians use standardized infant growth curves to monitor weight, length and head circumference measured at each well-baby visit. Appropriate infant growth and development indicates appropriate nutrition.

The use of lactation consultants and the advice of experienced mothers can rectify many issues, leading to successful breastfeeding. Using a breast pump is a reasonable alternative, especially if mothers suffer from severely cracked nipples or poor milk flow. It can stimulate more milk production. Failing that, for those who are unable to produce enough milk, I often suggest formula supplementation.

I have yet to see nipple confusion if there is an altering schedule of breast and bottle feeding. Formula supplementation after breastfeeding provides the infant the extra few ounces needed to encourage growth. In fact, the more quickly they gain weight, the stronger they become. Their suckling ability and breastfeeding usually improves.

I stress to parents that the emotional well-being of the mother is of paramount importance. A depressed mother, secondary to guilt and sleep deprivation, is not healthy or helpful to anyone.

Recently, one of my patients was breastfeeding for two hours per feed because her newborn son had difficulty suckling. He had not gained weight after his first week of life. She cut down the time to 10 minutes a breast and bottle fed formula thereafter. Her son is now growing well. She gets more sleep and her mood is improved. Her husband assumes some of the feeding responsibilities.

I do not want anyone to misconstrue what I am advocating. Breastfeeding remains the gold standard. The emphasis on breastfeeding can at times distract us from the effect it has upon the mother. Fathers feel useless because there is little they can do to help with breastfeeding problems. Our focus should be broadened to include the emotional well-being of the mother and father and the growth and development of the infant.

There are many methods and alternatives to achieve this. Some mothers are able to breastfeed without any complications. But no biological system is without flaws. To state that every woman can breastfeed is not accurate.

Every woman should be encouraged to breastfeed but should not be subjected to judgment of her maternal skills in a punitive fashion. We must not lose sight of the main goal: a healthy growing newborn and a supported mom. It is a difficult enough job without the added pressure.