The Risks of Breastfeeding "Realism"

The latest attempt at breastfeeding messaging is not working any better than past attempts

The oft-seen current messaging screamed on social media by parents and lactation care providers alike is that “breastfeeding is hard!”* Though well-intentioned (to support those who are finding it challenging and to “prepare” people for what they will then assume is the “reality” of breastfeeding), it is unfortunately not helping to achieve the objective of breastfeeding promotion, ie increasing initiation or duration of breastfeeding or people meeting their own infant feeding goals. In fact, it is having some consequences that were probably not intended.

{*I am fully aware that for some individuals, breastfeeding is, indeed, hard. In fact, it can be very hard.* But for others, it is not hard. People experience things differently - running is a great example of this. For some, running is exhilarating and feels incredibly intuitive and wonderful, while for others, running can feel excruciating and even painful. We can’t simply promote running as a healthy activity by saying that “Running is exhilarating!” or that “Running is hard!” Neither one works as a promotion strategy because the question of whether it is “worth it” to take up running isn’t answered by those definitions. If the goal is to promote running as a healthy activity, wouldn’t it be smarter to let people know that running training and support are available and that it feels different for everyone?}

What is the goal of the lactation field? Though we don’t always think about it this way, there are actually 2 sets of responsibilities set forth by the IBLCE, the certifying body for the IBCLC©. We are clinical professionals whose role it is to assist the individual who is breastfeeding or intends to do so. Additionally, we are responsible to “Provide evidence-based education about breastfeeding and human lactation to families, health professionals, educators and the community.”

This is where things can get complicated. We hear many discussions about respecting people’s own infant feeding goals, helping only those who want our help, and finding ways to support those who intended to breastfeed but ultimately did not (or did not meet their own goals.) While these are unquestionably necessary, at the same time we are asked to educate everyone about breastfeeding - and that means birthing and postpartum people who are unsure about it as well as the general public.

(Here’s why: as the specialists in human lactation, we have collectively assumed the responsibility to protect the practice of breastfeeding and the people who are impacted by it, and to advocate for the practice and the people in ways that no other profession explicitly does. Basically, it’s on us - and we’re good with that!)

Therefore, the IBCLC has the stated responsibility to publicly and generally promote breastfeeding while working with individual clients toward the pursuit of their own individual wishes and needs, which may or may not include breastfeeding. If we are really working to support people to do what they want to do while elevating the needs of breastfeeding folks, then our message should be focused on breastfeeding help being available, not whether or not people “should” do it.

Yet somehow we have added “breastfeeding is hard” to the list of failed/failing breastfeeding messages. A brief history of some of the biggest ones:

• “Breastfeeding is equivalent to formula feeding and no one should feel bad about their choices”

• “Breastfeeding is best”

• “Breastfeeding is natural”

• “Breastfeeding has amazing benefits”

The first is patently untrue and mainly benefits formula manufacturers, the second sets up breastfeeding as an idealized, barely attainable gold standard, the third is unhelpful in that it incorrectly implies that it will be straightforward and simple for everyone (or that “natural” is always a positive thing), and the last - well, I talk about that one a lot because we really need to remember that breastfeeding is the physiologic norm, so it can’t have benefits. The outcomes of breastfeeding are expected; they are not benefits. (It’s hard to get this one out of circulation, though, because so much of the research is set up to “prove” benefits instead of demonstrating outcomes of alternatives to the physiologic norm.)

The truth is that “we” do not define breastfeeding - it can only be defined by the person doing it. So why do our promotion messages ALL attempt to define it once and for all? Each person defines what “breastfeeding” means to them and whether breastfeeding is “worth it” for them.

Attempting to label what breastfeeding is disenfranchises and disempowers people. What about those for whom breastfeeding is not hard, painful, easy, lovely, complicated, natural, or the “best” choice in their circumstances - where do their feelings fit and where is it safe for them to share them? Do they perceive that their feelings don’t matter if all they read is breastfeeding promotion definitions that don’t seem to include them?

Our field has begun to accept that using the term “breastfeeding” to broadly cover all the logistics of how human lactation and infant feeding are accomplished (ie the “pumping IS breastfeeding” message) is more inclusive and respectful - but we have failed to bring along the thematic concept of breastfeeding in our language modernization efforts. We continually attempt to define breastfeeding for others when it is entirely defined by the people within a dyad.  

Here’s what I find heartbreaking: as a result of the messages of breastfeeding “realism,” the mothers and parents in my care and community have adjusted their thinking and actions to encompass these themes:

• People who breastfeed are able to do so because they are “lucky” and didn’t encounter any problems (“it wasn’t hard for them”)

• Fear of initiating breastfeeding because it will be hard and they are already experiencing life stressors or other medical conditions which could be exacerbated by a challenging lactation experiences

• Ignorance of or non-utilization of breastfeeding help and support because when it gets hard, well, it was “supposed to be hard”

• Reliance on products - a focus on products over improving the process of breastfeeding

I’ll close with this thought: our next attempt at breastfeeding promotion messaging should be fairly simple:

• Breastfeeding help and support are available {but MAKE THAT TRUE; make it the reality for the people you are addressing and make it abundantly clear how to access it}

• Get breastfeeding help and support promptly {but don’t make this conditional; everyone can get it whether it’s going great or it’s all uphill}

• Breastfeeding feels different for everyone {again, don’t put boundaries on this by naming the feelings - it’s simple; people have different reactions to the physical and emotional sensations of breastfeeding and all are normal}

-Christine, Jan 2022

P.S. Next time we’ll take a deeper dive into this piece of the conversation: people tend to “pick” a message (like breastfeeding is hard or painful or lovely or best) based on a personal bias. Lactation professionals don’t have that luxury if we want to practice ethically and put the client’s needs ahead of our own - but we have to do the work of processing and clearing our biases. I’ve got a solution for that.