Has the “Breast Is Best” Campaign Gone Too Far?

A note from Journal Watch Women's Health Editor-in-Chief, Dr. Andrew Kaunitz:

When I read Dr. Shah's Personal Perspective (Obstet Gynecol 2013; 121:869), I realized that its messages could encourage clinicians to hit the “pause” button and think about what we routinely do, with the best of intentions, in our practices. Thus, although her account does not present research findings, we have encapsulated it here to give it the wider audience it deserves.

Professional and public health organizations, many hospitals, and even some municipalities (e.g., Latch On NYC) promote exclusive breast-feeding for 6 months, with continued breast-feeding thereafter. But has this crusade stigmatized mothers who cannot breast-feed? In a Personal Perspective, a reproductive endocrinologist describes her persistent efforts to breast-feed her newborn daughter. Initial attempts caused severe pain. A procedure to release the baby's tight lingual frenulum, the supposed cause, lessened the pain, but low milk production persisted. When the infant lost weight, pediatricians advised formula supplementation — whereupon the hospital asked her to sign a release acknowledging that breast milk is the best form of infant nutrition and that she chose “to deviate from the practice of exclusive breastfeeding.”

After consulting with lactation specialists, trying homeopathic remedies, pumping endlessly, experiencing postpartum depression, and finally being given permission to “let it go” by her obstetrician, her pediatrician, and her partner, she discontinued breast-feeding. She admits, however, to feeling inferior in the face of health warnings on infant formula labels comparable to those on cigarettes, even as her daughter grows and thrives. She cautions that public policy and individual clinician attitudes can alienate women who, “despite motivation, persistence, and utilization of all available resources,” are unable to breast-feed.