If ‘breast is best’, why do moms quit nursing so soon?

The surprising reasons why many moms stop nursing too soon—plus real-life solutions

When my second child Nicolas was born several years ago, I already knew the drill. Among other things, I planned to give him only breast milk for the first half-year. At four months, I would return to work with my rented super-duper double breast pump in tow and keep the breast milk flowing. Then, as I had done with my daughter, at six months I would gradually transition him to cereal and solid food before easing him off the breast sometime around his first birthday.

But that’s not what happened. As fate would have it, my father died the same day my son was born, leaving me so empty I thought I’d dry up and blow away. Between the newborn, my energetic toddler, work, and grief, I couldn’t keep up with my son’s growing appetite and the breastfeeding started to fall apart. Despite my resolve to only feed my baby breast milk for six months, at month four I gave in and mixed some formula into his bottle of pumped milk. On some evenings, I even threw in a little cereal to fill him up and help him sleep. By six months, I had weaned him altogether.

Breast intentions

Mountains of research support the idea that “breast is best” both for mothers and infants. Evidence compiled by the American Academy of Pediatrics (AAP) Work Group on Breastfeeding shows that breastfed babies have lower rates of diarrhea, allergies, digestive disorders, and infections. Breast milk also helps protect against sudden infant death syndrome, meningitis, diabetes, obesity, and future heart disease. Some studies even suggest that breastfed children develop fewer psychological, behavioral, and learning problems as they grow older.

For moms, breastfeeding reduces the risk of both breast and ovarian cancer. It protects against osteoporosis later in life, encourages weight loss after pregnancy, and it helps build the emotional bond between mother and child. Plus, breast milk is free, compared to formula that can cost thousands of dollars per year.

“Breastfeeding promotes optimal health and well-being for babies and mothers,” says Diana West, IBCLC, the media director for La Leche League and co-author of The Womanly Art of Breastfeeding (8th Edition). But it’s not just breastfeeding that’s important. According to the experts breastfeeding exclusively—with no formula supplementation—for six months is key. Both the AAP and the American College of Obstetricians and Gynecologists encourage women to feed babies only breast milk for the first six months and then breast milk and solids for a year or longer.

And there’s the rub. Like me, the vast majority of women fall short of this standard. While some 70 percent of American women breastfeed initially, by six months the number is down to 33 percent, ­according to AAP research. These rates are even lower for black women. Why? What causes the disparity between what experts so strongly recommend and what real mothers actually do?

Expectation vs. reality 

On paper, it seems like millions of American moms are simply ignoring indisputable medical evidence about what’s best for their babies. But that’s not true. According to Gina Ciagne, Certified Lactation Counselor and Senior Director of Professional Relations at Lansinoh Laboratories, “Most new moms I speak with understand the importance of breastfeeding and plan to do so for at least one year. However, a variety of factors like poor latch, busy work schedules or a lack of support lead these women to give up early. I always urge moms to seek help and community because asking questions and getting answers can help make a world of difference.­­ Connecting to moms who have been there is really the best support any woman can benefit.­­ There are a multitude of online resources like #BFchat on Twitter, blogs like OnCloudMom and of course Kellymom.com that are readily available at no cost.

Many women believe, as I did, that they aren’t producing enough breast milk, and their babies aren’t getting enough to eat.­­ Many women also report that breast-feeding is too physically and emotionally draining.

“What happens to a lot of women is that there’s a disconnect between expectation and reality,” says Barbara Dehn, a nurse practitioner in Northern California and author of a series of women’s health guides, including Your Personal Guide to Breastfeeding. 

Dehn adds, “Some women aren’t prepared for the different stressors they might be having postpartum. Breastfeeding takes between 8 and 10 hours a day. That’s like having a full-time job. Others are in significant discomfort, especially if they’ve had a C-section. Some babies take to it easily, while others have challenges. When you add everything together, for some women, all of it becomes too much and they aren’t able to stick with it.”

Stephanie Neurohr of Dallas, mother of seven children and director of a video series on breastfeeding (motherof7.com), agrees. “Mothers think breastfeeding will be a natural experience, but all of the sudden a new baby is handed to us and we don’t know what to do,” she explains. “Breastfeeding is only natural after you know how.”

Is baby hungry?

Worried that her baby daughter wasn’t getting enough to eat, Arlene Cabrera stopped breastfeeding after three months. “My breasts weren’t producing all the milk they should have, so my baby was always hungry,” says Cabrera, a full-time mom who lives in New Market, MD. “She was crying and totally cranky, because she wanted a full tummy. When I’d mix the milk with formula she was totally happy.”

Experts don’t like to hear stories like Cabrera’s, especially because many women who believe they can’t produce enough milk are probably mistaken. “Every woman has enough milk,” says Dehn. “Even a woman with small breasts has enough. Even one breast can get four to six ounces.”

To know whether your baby is getting enough, watch her weight. Though newborns typically lose 10 percent of their birth weight right away, in two weeks, they should gain it back. Your infant will be weighed at each “well baby” check up, including at least two visits during the first two months. If you’re worried that your baby isn’t eating enough, don’t assume, but do share the concern with your health care provider.

“A healthy baby gains about half an ounce, maybe more, a day in the first few months,” says Dr. James Sears, an ob/gyn and co-author of The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two. “That means if your baby is gaining about a pound or two a month, that’s great.”

Outside of the doctor’s office, keep an eye on the diapers. Four to six very wet diapers every 24 hours means your baby is getting plenty of milk. Or inspect your baby’s stool. “On about day five, look for a bright yellow bowel movement,” says Dr. Jane Morton, a Stanford University professor of pediatrics and medical director of breastfeeding medicine at Lucile Packard Children’s Hospital. “That’s a sign that your baby is getting enough breast milk. In general, if your baby is passing stools, everything’s fine.”

Crying, on the other hand, is generally not a good way to gauge hunger. Your newborn may not always be crying for food, but for something to suck on. “Babies are programmed to suck, not just for food, but for comfort, for fun, or to put themselves to sleep,” says Dehn. “Some babies may seem hungry, but really all they might need is some extra suck time.” To figure out the difference first offer your baby a clean finger or pacifier. “A baby who is truly hungry will not be satisfied with a finger or pacifier, so she needs more milk,” Dehn explains.

Workplace woes

Nearly half of all mothers return to work sometime within the first year of their baby’s life, studies show. But breastfeeding on the job can be inconvenient and uncomfortable.

Many women give up after returning to work because they’re unable to find a private room to pump in or a safe place to store breast milk. Others are just too tired from work and lack of sleep to pump enough milk to keep up with baby’s demand. Hope Levav, of Brooklyn, NY, had planned to breastfeed her son, Aaron, for up to a year, but by the end of her first week back at work as a middle school teacher, she started supplementing with soy formula. “I had loved breastfeeding Aaron, but pumping wasn’t the same. It was disruptive to my day, but even more, I was worried that his demand was exceeding what I was producing,” she says.

“We don’t live in a culture that values breastfeeding,” says Lebbing. “It makes no sense that companies give employees breaks to go outside and smoke but are reluctant to give women time in the work day to breastfeed. The bottom line is that it is to an employer’s advantage to support a breastfeeding mother.”

Experienced working moms have discovered some tricks to make the transition easier. “I invested about $40 in a hands-free pumping bra, so I could pump breast milk on my way to work,” says Robin Elise Weiss, a doula and childbirth educator who lives in rural Kentucky. The bra holds the pump in place. Adds Weiss, who is also a pregnancy/childbirth expert for about.com, “Renting a double pump is a huge timesaver. I was working in a cubicle, so I borrowed an office and pumped during lunch and during my breaks. With a double pump, it’s like you pumped for 20 minutes during a 10-minute break.”

Ultimately it’s up to you to make sure your employer and co-workers understand the value of breastfeeding. “You have to ask your employer—before your baby is born—to provide a private place for you to pump, the time to do it, and someplace to keep it,” says Neurohr. “Make your case in financial terms. Breastfeeding saves the company an enormous amount because babies and their mothers aren’t sick. Employers will hear that. Returning to work and continuing to breastfeed is only a problem if you make it one.”

Dehn, who has an 11-year-old son, offers moms this practical advice: Pump some extra milk in the morning and give it to your baby at night. “Morning milk has a higher fat content, because Mom has been able to rest,” she explains. “After a day of working, doing laundry, cooking dinner, and running after a toddler, the milk a woman produces has a higher water and sugar content and isn’t as satisfying. So rather than formula, let Dad or someone else give the baby that nice rich milkshake from the morning. Both you and the baby will be able to get some rest.”

Some breast milk is better than none

Many women find breastfeeding difficult and frustrating, particularly at the beginning. “If a woman expects to put her baby on her breast and it’ll just happen, she may be disappointed and take it personally,” says Weiss. “When a baby isn’t latching on correctly, a woman may think ‘I don’t know what I’m doing; my baby’s going to starve.’ Or worse, ‘my baby doesn’t like me. He doesn’t cry when he’s with the nurse.’ ”

A number of issues, including babies who don’t latch on right away and painful nipples, can often be avoided by learning the proper technique as early as possible. It’s wise to get practice by taking a workshop or class while you’re still pregnant and seeking help from a certified lactation consultant in the hospital or birthing center immediately after your baby is born.

It’s also essential not to panic. “Studies show that 90 percent of babies aren’t that good at latching right away,” says Dr. Morton. “But babies aren’t born starving. They don’t have a high need for calories, so there shouldn’t be a desperate urge to figure everything out right away.”

Even more importantly, there’s no need to beat yourself up if you aren’t able to exclusively breastfeed for the entire six months. “I know it’s against the official recommendations, but if giving your baby a bit of formula or cereal is going to make a big difference in how soundly you sleep or how well you’re parenting, then I wouldn’t hesitate to do that,” says Dr. Sears. “There’s no reason to feel guilty if you can’t follow the breastfeeding advice to the letter. A woman has to do the best she can. Guilt is a bad feeling to have as a mother.”

Agreed. My son Nic is now in seventh grade; he’s got bright eyes and boundless energy. He towers over the other kids in his class and eats like a grown man. He does have allergies, and sometimes I worry that not breastfeeding him exclusively for six months prompted his hair-trigger sneezes and stuffy nose. Then I look at the pile of discarded tissue by my own bed and remember my father’s runny nose during hay fever season. I may never know if I’m responsible for his allergies—except through my genes—but I do know his health and happiness are about much more than that.

— Linda Villarosa is a freelance writer specializing in health. The author of several books, she lives in Brooklyn, NY.

By Pregnancy Contributor

Pregnancy Magazine draws on a wide range of editorial sources including working doctors, midwives and doulas, as well as journalists writing about fertility, pregnancy and new motherhood.