Why is bf so hard in the US?

[bluedaisy]

I've lived in cultures where the vast majority of women breastfeed, and it's never talked about as being hard or challenging at all. When I was pg, nobody even asked me if I was planning to bf, it was just assumed.

I've been really surprised at how many american women have a really hard time with bf, and even pg moms often qualify their desire to bf with "if I'm able to" or something like that.

I am NOT disputing that bf is very hard for some women, and I don't want to debate that or offend anyone (and I hope this post doesn't come across like that)

But i've been thinking a lot lately about WHY bf is so hard for so many american women, and i'm curious to know what you all think. here are some things i've thought of:

- Births with medical interventions - studies have shown that different interventions can cause problems with baby's sucking and can get bf off to a bad start

- antibiotics given at birth or overused at other times, which can lead to trush

- the high number of premature babies born in the US - I imagine bf must be a lot harder when you're starting out with your baby in the NICU

- Horrible advice from OBs and peds, many of whom are male and have never bf a baby (where I had lived before, new mamas got bf advice from mom, aunts, sisters, friends, etc - all experienced women who had breastfed)

- not enough help postpartum (again, where i lived before women would "move in" with the new mama for 1-2 months and take care of the cleaning, cooking, etc so the mama could recover from birth and focus on caring for her baby)

- very little maternity leave and having to go back to work soon

- unrealistic expectations of jumping back into "normal" life with a baby and not realizing how time consuming and "limiting" breastfeeding is

- I also wonder if the high levels of hormonal birth control plus other endocrine disruptors like BPA, pthalates, etc mess with women's hormones and make bf harder

what do you think???

[2lilsweetfoxes]

I think those are all reasons. I'd also include that we have had 2+ generations of formula feeding. Knowledge of breastfeeding--what is normal and all that--has been all but lost. We have the "ew" factor. When a woman has issues, the default seems to be to tell her to switch to formula or encourage supplementation, which often leads to full-time formula feeding if mom isn't absolutely determined to breastfeed.

ETA: Even when a mom is having problems and knows someone who has sucessfully breastfed, she might not contact her for advice for fear of "bothering" her. I've told friends and friends/coworkers wives to call me anytime if they have any questions.

[Pepper44]

I think the worst part is the way mom and baby are separated in most hospitals. The baby is automatically given sugar water and/or formula and a pacifier in the nursery right from the start. This happened to us even when I specifically said no artificial nipples or formula.

[Peony]

Lack of support is a big one that I see. No one has bf in the family, the mom constantly hears that she has no milk, the baby is starving, etc... Along with lack of support comes a lack of knowledge, if there are no moms, aunts, cousins, etc... that have bf, the mom often has no idea that babies eat constantly, so spit up, etc... If the mom was surrounded by supportive woman who had bf, she'd just be told "eh, that's a baby". She doesn't hear that so she thinks there is something wrong with her, her milk, the baby, the baby has allergies. Problems are created where there are none. Yes, sometimes there are real problems, but a good portion of the bfing support I do is because there is a perceived problem.



Which feeds into society's notion of babies, they should be sleeping through the night, eating mostly solids at one year, on and on. And then once again there is something wrong because the child isn't when there often isn't anything wrong at all.


I'll add one more, Dr. Google. In this day and age, sometimes there is a thing as too much info. That comes into play when the mom or a family member is so focused on doing things "right" instead of going with the flow.

I totally agree that there are many, many factors that go into how bfing is so difficult.

[knittinmama82]

I personally think that we live in a culture where we want everything to be easy and convient and nobody really wants to work at anything. Breastfeeding is difficult but if you are persistant about it, you can do it. How else did it work back before there was formula? It was a life and death issue and women did what they could to make nursing work. Today, its not like that. You get discouraged and you can very easily go get a can of similac and you're good to go.

[writteninkursive]

Yes yes yes yes yes yes and yes. Your reasons are all part of it, I'm sure!

And our lifestyles. We rush off to work and school and don't take just months to sit back and enjoy and get to know our babies. And when we can do that, we get depressed because our lives are pretty miserable here in the U.S. (for a lot of people!) with bad marriages and crappy relationships. Imagine the difference between enjoying your new baby with the husband you love dearly versus trying to tolerate being alone with your new baby (who is so demanding because he's a baby) and your husband who you hate. It's a completely different story. I say that because my first two babies were born to me and my ex-husband, and my first had health problems and I was so depressed. The baby wouldn't breastfeed (because she was ABO incompatibility jaundiced) and my ex was a miserable excuse for support. I just wanted to get away and go back to work and feel normal, so I did. And the hope of breastfeeding fell away, as I was unable to pump enough to keep up with what a newborn needs solely by pumping. With my recent baby, it's a completely different story. I am HAPPY with his daddy, and I can just sit back and enjoy him and breastfeeding and take the time to have that bonding experience and nurture him.

Also in America, breastfeeding IS a bit taboo (sadly), and it isn't well-understood. The doctors make it sound so hard. You remember the bullshit they feed you in the hospital about how you baby "has to latch correctly" and there's all these sounds you're supposed to listen for, and they tell you that "nursing is a learned art, and isn't instinctive". It's so ridiculous! If anything got in the way of my nursing, it was trying to follow their ridiculous instructions! My babies KNOW how to latch on in their own ways, and once I stopped listening to the lactation consultants (not that they're all bad), I stopped having any problems with nursing. Never had mastitis or sore nipples or any pain. It's so natural once you let go and let nature take control! We're so out of touch with nature here in the States. And people think you're "weird" if you are!

[ps4624]

I agree with previous posters - breastfeeding is simply not the norm in American culture. I had 5,001 people tell me to put rice cereal in the baby's bottle to get her to STTN when I was pregnant - no one even considered the possibility that I might be breastfeeding.

Also, I think so many women are encouraged to believe they can't breastfeed when they run into problems that can be solved - I was at a party once where, out of 7 women, I was the only one who breastfed past 6 weeks. 4 out of the 7 said that they "couldn't" breastfeed. Again, not to pass judgment on the women who genuinely can't breastfeed, I thought that was an alarmingly high number of women. I think there is a general lack of support and education.

Really interesting discussion topic - thanks for bringing it up.

[ladyleah]

Just a comment- I never, ever, ever thought I would have issues BF. My mom BF'ed all of us, with no issues. I have always viewed it as natural and easy....

However, if you read my other post on this board, it has been an awful experience so far, not the ideal I had imagined! (however, I would never consider "giving up"-- we will never do that!)

I had a totally unmedicated birth (no IV's no fluids, no hep lock, nothing whatsoever), and I refused the antibiotics in the eye ointment...I never had antibiotics while pregnant (or for 10 years for that matter until now), he wasn't a preemie, he roomed in with me and was given no formula, no water, no pacifiers, and I think I had great help the first 13 days (but I probably didn't take full advantage). Of your list I find the advice I got at the hospital (which was SO different at each turn) is what started this for me. I had cracked and bloody raw nips at 2 days post pardom. Then it all went downhill from there.

I also believe that the hormonal disruptors in our food and environment have played a major issue in this, and many problems we have as women. We have been poisoned (and our mothers) for years, and the effects are showing up in a huge way now....

[annekh23]

Well I've had two babies in the UK and one in the US. I looked up what the breastfeeding rates were, turns out the UK had a slightly higher initiation rate, but not significantly so, but at 6months the rate in the US was twice that in the UK, approx 30% compared to 15%.

I've thought hard about this statistic, so many of the things that are considered bad for breastfeeding in the US are the same or better in the UK, it's hard to find any that are definitely worse.

The biggest difference that I can see is that in the US there is support and very good support available if you pay for it, or your insurance covers it. If you have a problem it is the norm, at least amongst a significant chunk of society to go and see a LC. In the UK when I last looked there were less than 100 LCs and only a tiny proportion of them are working in private practice, most are midwives or LLL leaders who did the exams because of their own love of supporting breastfeeding, not because they can make money that way.

In the town I had my babies there were about 8hrs/week of paid work in breastfeeding support including what was available in the hospital and work in the community, for an annual birth rate of about 5000 babies.

The main problem in the UK is money, the basic structure and desire is there and some areas are doing very well, I can't find actual data, but my anecdotal experience is that breastfeeding rates amongst premies are good.

Socialised medicine favours breastfeeding, as mum and baby are seen as an almost inseparable unit, discharging one without the other is only done rarely. There are gaps when mum needs to be admitted for other issues, but baby is usually admitted too if a hospital stay is needed for PPD.

On the other side of the coin there is a distinct lack of specialist help if there is a problem, thankfully, my baby with major issues was born here, she's 7mths now and receiving entirely breastmilk and entirely from the breast, my suspicion is that had she been born in the UK I'd be eping for her.

If you mixed up the two systems I think you'd get bfing rates up, but they'd still be lagging behind goals that have been set by various organisations.

Honestly, I think american women are doing great 30% breastfeeding at 6mths when most of them are working is amazing and represents that almost 50% of those who plan to breastfeed are still doing it, which is a lot more encouraging than less than a quarter still doing it in the UK.

[Bokonon]

Originally Posted by Peony

Lack of support is a big one that I see. No one has bf in the family, the mom constantly hears that she has no milk, the baby is starving, etc... Along with lack of support comes a lack of knowledge, if there are no moms, aunts, cousins, etc... that have bf, the mom often has no idea that babies eat constantly, so spit up, etc... If the mom was surrounded by supportive woman who had bf, she'd just be told "eh, that's a baby". She doesn't hear that so she thinks there is something wrong with her, her milk, the baby, the baby has allergies. Problems are created where there are none. Yes, sometimes there are real problems, but a good portion of the bfing support I do is because there is a perceived problem.



Which feeds into society's notion of babies, they should be sleeping through the night, eating mostly solids at one year, on and on. And then once again there is something wrong because the child isn't when there often isn't anything wrong at all.


I'll add one more, Dr. Google. In this day and age, sometimes there is a thing as too much info. That comes into play when the mom or a family member is so focused on doing things "right" instead of going with the flow.

I totally agree that there are many, many factors that go into how bfing is so difficult.

This, totally. I think the other factors may make initiating breastfeeding more challenging, but don't preclude it.

I had a pretty traumatic first birth, with a c-section with no labor at 32 weeks for severe preeclampsia. DS's first Apgar was 1. I didn't get to hold him for about 30 hours, and didn't get to try to breastfeed him for 5 days. He spent 6 weeks in the NICU, and I pumped. I was able to get him exclusively breastfeeding after a couple of months at home, and nursed him until 22 months. He may have had a tiny bit of formula in the NICU before my milk came in, but after that, not a drop.

I didn't have any breastfeeding role models either. I was just incredibly stubborn and persistent, and fortunate that I had an ample supply.

I had a similar experience with DD, who was born under similar circumstances at 34 weeks, but only spent 10 days in the NICU.

It seems so prevalent that when a new mom asks for support, she ends up getting support to switch to formula, rather than help and encouragement to continue breastfeeding. I got lambasted on another forum for giving a mom a bunch of reasons why she should persevere through some breastfeeding challenges in the early weeks, because when she asked for support, she really meant that she wanted to be reassured that weaning wasn't the worst thing in the world.

[babygirlsmama]

I think it is all those things together. Perhaps the most important being unnecessary medical intervention compounded by separation from baby in early hours/days, and lack of education about the overwhelming benefits of BFing.

I just realized this: I am 36 years old and just had my first baby recently. Until she was born I had NEVER seen another mom up close breastfeeding her baby. NEVER. In other words, BFing is very under wraps I think in this society.

Now that I am EBFing my babe, I find it amazing and crazy that I don't see moms all over the place BFing their babies. I'd say one reason is that many people don't even talk about it, even BFing moms, and the whole thing is kept sort of on the down-low.

Even proud breastfeeding mamas talk about how to discreetly breastfeed. Granted, each situation is different, but I wonder if more moms wouldn't be encouraged if everyone weren't so discreet. (I'm not so much talking about whipping a boob out in public, but just nursing in public and not slinking off to the ladies' room or the backseat of a car). When I'm out and need to nurse her, I usually ask the storeclerk or whoeever, "Is there a good place I can sit and nurse her?" I have been delighted by how helpful people have been.

On the other hand, I do think the fact that it is not talked about so much in the US in most circles encourages women who do feel strongly about BFing to really support each other. I went to my hubby's work xmas party recently and slipped off several times to BF my babe. Several other women figured out what I was doing and were super-encouraging of me, telling me stories of how they breastfed. One woman said she BFed her 4 kids for a total of 10 years, another bragged about BFing her daughter to age 2. It was nice to hear that!

So, I'd say there are pros and cons. IT is funny, isn't it, that by BFing you are doing the most normal, natural thing for your baby, yet honestly sometimes I feel like sort of a renegade! Frankly, it appeals to the rebel in me!

[2lilsweetfoxes]

I thought of another one. "Helpful" friends and relatives. You know the ones. The ones that come to "help" the new mom and baby. The scenario goes something like this: Grandma comes to help new mom. Mom is taking a nap. Baby wakes up fussing because he's hungry. Rather than wake mom, because she needs rest you know and grandma does not really see the value of breastfeeding-it is six of one, half dozen of the other, grandma decides to just fix baby a bottle of formula. Then, the "downward spiral" starts.

[mabaker]

you are so right....as a non US citizen....

I came from a warm close community and it's shocking how bf here is so not popular....
I think it's got to do with the culture- the distance between family members-everyone is in different place, small families, not a lot of tradition to pass etc...

I almost never see here a woman breastfeeding in a public place. Where I'm coming from this is something you do out in the public near your family etc...

Here it became this shamful dirty thing you need to hide behind doors.

Thank this forum/magazine that has a place for women who are interested with bf and not afraid of it.

[Phoenix~Mama]

I think all of your reasons... especially the crappy maternity leave we get. Moms are expected back at work within the time frame that you should be waiting to even introduce a bottle... so figure out pumping and intro-ing a bottle all within the week before you are supposed to go back to work... and sorry but a month off is absolutely nothing, and certainly not restful when you are nursing a baby round the clock.

I was blessed that I was able to fight for more time off and built up a decent freezer stash during that time... and that has been the only thing to help me still nursing now.

Another big one is the "taboo" ness... All my family and such would be telling me I needed to go cover up and stuff... it was really annoying... my Mom liked to do this in my own home when other family members would be visiting. I could see someone being less commited feeling shamed and just going to bottles.

A PP mentioned not ever seeing other BFing Moms out in public.... I ditto this one. I still think it's strange! lol I have only ever seen one Mom out in public BF, and that was in the family room at Babies R Us... but never once on a mall bench or in a restruant... they all had bottles.

[Pookietooth]

I think never seeing anyone do it makes a big difference -- you don't know how to do it right if you never see it and you feel uncomfortable feeling like the only one when you do. I very rarely see anyone bf in public.

[ElliesMomma]

with my first baby i had the idea that bf was incredibly complicated. of course we also got off to a bad start with a hospital pushing bottles due to jaundice. DD developed a bad latch and it hurt for 10 weeks. i came within one feeding of giving up, but decided to keep going. finally i happened to see the "friends" episode where carol bfs ben, and it just looked so easy, grabbing a pillow on the couch. i decided to try it that way, and viola, it worked. i am still nursing my first; she is 3.5 yo.

with my second baby, i had the continuity of "still nursing," plus all the learning and experience i had to go through with #1. i chose a different hospital, one that respected natural birth and giving baby to mom right away and not disrupting bf at all. DS latched within a couple minutes of being born, and although he was jaundiced too, we did the bili lights instead of bottles. bf him has been incredibly easy. of course it is time consuming. and of course i am nursingi two.

OP: i have thought about your question a lot lately too. one more story: when i first had DD (baby 1), my DH actually referred to the idea of breastfeeding as if it were something new and experimental. how warped is that notion? as if formula feeding was the natural thing to do, and moms who bf are trying something "new".

i nurse in public. i see quite a few people nursing in public. most cover up though. i don't really. i try to be somewhat modest when i'm out and about. all bets are off though in my own home.

finally let me confess my wildest fear. some might think this is far fetched. but you know how in evolution if a species doesn't "use" something, that in time over (many) generations, the something they don't use, dies out. my fear is that if enough women stop breastfeeding for long enough, that the ability to bf at all (physically) will also stop. you know, use it or lose it. what do you guys think of that idea? far fetched? or a possibility? and if so, to the determent of the survival of our species altogether...

[prothyraia]

Originally Posted by ElliesMomma

but you know how in evolution if a species doesn't "use" something, that in time over (many) generations, the something they don't use, dies out. my fear is that if enough women stop breastfeeding for long enough, that the ability to bf at all (physically) will also stop. you know, use it or lose it. what do you guys think of that idea? far fetched? or a possibility? and if so, to the determent of the survival of our species altogether...

Women who could breastfeed but choose not to still pass on their "able to breastfeed" genes to their formula-fed children, even if they don't make use of them. The only way we could lose the ability to breastfeed as a species is if enough women who biologically couldn't breastfeed and would otherwise have their babies die continue to pass on their genes because their infants survive (nursing these babies at another woman's breast would have the same effect, incidently).

Natural selection is nasty business; I'm fine with us fooling it.

[Vaske]

A couple more:

Bad advice from hospital nurses--how many nurses have breastfed long-term?? Seems like it would be very difficult for them to take pumping breaks during busy shifts. And they are usually the first ones to provide breastfeeding instruction to new mothers....

Overtreatment of neonatal jaundice. Some jaundiced babies are jaundiced because breastfeeding isn't going well, and then the hospital puts the final spin on the breastfeeding relationship death spiral by treating the jaundice with supplementation, and by putting the baby under bili-lights away from mom, instead of providing real breastfeeding help.

Metrics: How many hospitals (or midwives) follow up with mothers to see how many are still nursing, and for how long? If it's not measured, then no one worries about improving it. I think there should be equivalents of the APGAR score for breastfeeding and for maternal postpartum health.

[boobs4milk]

in my personal experience, there are two leading factors: lack of education and lack of support.

i've counseled hundreds on bf, both irl and online and many i talk to are very misinformed and uninformed about the mechanics of breastfeeding. you wouldn't believe the amount of women who give up because they are SURE they have no milk because milk isn't gusing out of them in rivers after the first day!!!

as to the support, living in the bible belt doesn't help! i've only ever witnessed another mother NIP at LLL meetings! and the support you get when you go to the dr and ask for help is 'why not just give her a bottle? it's easier and voila, no more plugged duct/mastitis/thrush/low supply/bad latch, etc. UGH. it's a good thing i'm so damn stubborn because i've had at least 5 PROFESSIONALS tell me to just give her formula.

and i know the OP asked that it not be an issue, but it IS an issue: bf is DIFFICULT, especially because we have become so used to measuring everything and scrutinizing every chartable milestone in our babies. this leads to a distrusting of our bodies and our abilities, and our minds tell us something's just not right. i've bf 5 kids now (with varying degrees of difficulty, this 5th one being the most challenging) and i STILL wonder 'is she getting enough.' we shouldn't fool ourselves or belittle others by saying bf is easy and natural and you just DO it. maybe that would be the case if we didn't have formula, bottles, charts, and ridiculous expectations about what new mothers HAVE to do.

[Lilly Milly]

Yeah, it can be so hard here unfortunately. All of the above reasons are true. I just want to "yeah, that" on some that I experienced.

The jaundice thing - absolutely a problem, and combined with the nurses giving bad advice, was something I experienced. My LO had v. mild jaundice and of course they say they have to put them under the lights etc. Well, that leads to slight dehydration. So then they want to give formula. This is when I flipped my lid (after a lot of other frustrations, this was my last straw)! "NO, I DON'T WANT TO GIVE HER FORMULA. I JUST WANT TO TAKE MY BABY HOME!!!!!!!!!!". Anyway, then they say that I would have to feed her every 2 hours then. Well, what the heck else am I going to do sitting in a hospital all day and night waiting to take my daughter home?!?! (Sleep, of course, but anway...) My question is, if BFing was an option WHY didn't they mention it? It should have been the first thing they recommend. All of this was at a very pro-bfing hospital, I might add. What do you think happens at a not very pro-bf hospital?

Culture - it is just not part of our "culture" right now, so no one knows anything much about it. Everyone I know does breastfeed and even DH and my parents BFed us, but everyone only knows their own experience. If it was a part of our culture we would just have more of a collective knowledge and experience with it. Like, you've heard all about "how to make your child independent" because this is so much a part of our culture.

Maternity leave - ABSOLUTELY. I took 12 weeks and would have cried buckets to go back at 6 weeks. I'm not even talking about not being ready to be separated from my LO, but because I WAS EXHAUSTED. Come on! This is seriously mean, misogynistic and outrageous that we are expected to go back to work so soon. And some women don't even get that. It is totally awful, IMO. A disgrace.