Why 'breast is best' can send a harmful message: 'If your baby needs more, they need more'
Breast, bottle, whatever: How You Feed is a shame-free series on how babies eat.
Dr. Christie del Castillo-Hegyi wants new moms to know that exclusively breastfeeding isn’t for everyone — and that’s OK. It’s a lesson she learned “the hard way” after the birth of her first-born son.
As an emergency physician, del Castillo-Hegyi read all the guidelines on breastfeeding in preparation for giving birth to her first child in 2010. She was determined to exclusively breastfeed her baby, taking to heart the message that “breast is best” and formula use should be discouraged. She gave birth at the same Albuquerque, N.M. hospital where she worked to a healthy, 8-lb., 11-oz. baby, who started nursing immediately.
What del Castillo-Hegyi didn’t know was that her infant wasn’t getting enough milk, despite producing the expected number of wet and dirty diapers, and was slowly starving. Her baby was diagnosed with newborn jaundice (what was likely breastfeeding failure jaundice, which occurs when an infant doesn’t get enough breast milk), and was discharged 48 hours after delivery.
A follow-up appointment the next day revealed that del Castillo-Hegyi’s son had lost 1 lb., 5 oz .— about 15% of his birth weight. To put that in perspective, a healthy breastfed baby is expected to lose 7% to 10% of their weight in the first five to seven days after being born, according to the American Pregnancy Association.
She says her pediatrician told her she could either formula feed or wait for her milk to come in at day four or five. “Wanting badly to succeed in breastfeeding him, we went another day unsuccessfully breastfeeding and went to a lactation consultant the next day who weighed his feeding and discovered that he was getting absolutely no milk,” del Castillo-Hegyi — who co-founded the nonprofit Fed Is Best Foundation in 2016 with Jody Segrave-Daly, a veteran nursery and NICU nurse and retired international board certified lactation consultant — shared in a 2015 blog post. “When I pumped and manually expressed, I realized I produced nothing.”
She wrote that following the breastfeeding guidelines and her pediatrician’s advice “resulted in my child going four days with absolutely no milk intake requiring ICU care.” Her son experienced hypoglycemia (low blood sugar) and severe dehydration due to “insufficient milk intake from exclusive breastfeeding in the first days of life,” she wrote, adding that her son was subsequently diagnosed with multiple neurodevelopmental disabilities, which del Castillo-Hegyi attributes to the lack of milk.
“What I unwittingly did to my son was what I thought was best at the time — what I was taught was best,” del Castillo-Hegyi, who eventually was able to produce enough milk to exclusively breastfeed her son for several months, followed by supplementing with formula, tells Yahoo Life.
She went on to have twin daughters two years later and her breastfeeding experience was “worlds different,” she says. “I did not have hungry babies.”
While del Castillo-Hegyi was able to produce “plenty” of milk after her second pregnancy, it wasn’t enough for twins. The stress of going back to work only made things more challenging.
“The amount of time it took to breastfeed, supplement, pump, feed with pumped breast milk — even with all the privileges and all the help a person could have taking care of twin girls and a toddler — the stress slowly ate away at my milk supply,” says del Castillo-Hegyi. “Many women feel they’re just milk machines and are a gradual failure at it.”
She began to develop postpartum depression. “I could not keep up with the demands,” she says. “Eventually, I couldn’t produce 1 oz. of milk while pumping. I decided I’m not going to spend a single day not being present and happy for my children.” So she switched to solely formula and started taking an antidepressant.
The downsides of the "breast is best" messaging
Breast milk is considered the best source of nutrition for infants, according to the Centers for Disease Control and Prevention, and it contains antibodies that help protect infants from viruses and bacteria. But some have called out the downsides of “breast is best” — messaging touted by the World Health Organization that babies should be exclusively breastfed for the first six months of life — saying that “the practice could be placing potentially harmful pressures” on moms and that it “crushes every mom who is unable to give her baby what’s ‘best.’”
Looking back on her experience with her first baby, del Castillo-Hegyi says there are several things she would do differently if she had known that she wasn’t making enough milk or colostrum. “I would have wanted to breastfeed and supplement as needed — what mothers have done for millennia,” she says. “I would have known better to make sure my kids were fed but also forgive myself for not providing all the milk they needed.”
About 5% to 8% of women do not experience lactogenesis II — the stage where they produce “copious” amounts of milk 48 to 72 hours after giving birth — and instead only produce small volumes of milk, according to a 2020 study in Pediatrics. Another study published in the journal Nutrients noted “the high frequency of inadequate milk production in early lactation,” while pointing out that “if breast milk supply is actually inadequate, supplementary feeds are necessary.”
Breastfeeding is considered the “gold standard” for feeding infants. So for those who face breastfeeding challenges, it can feel like a one-two punch: Falling short by not breastfeeding exclusively can cause guilt and shame, while formula feeding, which can help supplement the milk supply, is viewed as “a moral failing” by some.
“The deep shame is to believe that your body isn’t functioning biologically normally and the deep shame that you’re failing … one of the most important people on this planet to you — that maternal instinct to provide the absolute best for your child cannot be overstated,” says del Castillo-Hegyi. “To be told because of your body’s failure and your effort’s failure that you're giving your child ‘second best’ or are literally harming your child because you're feeding them formula — there are infants whose lives are literally being saved by formula.”
New guidelines recommend breastfeeding even longer
When the American Academy of Pediatrics (AAP) recently updated its breastfeeding guidelines recommending that women breastfeed even longer, it was met with backlash, with some arguing that breastfeeding for even six months is a “difficult enough goal for many nursing parents.”
Under the new guidelines, the AAP still recommends exclusively breastfeeding for the first six months, but now touts the benefits to the mother of continuing for up to two years. The guidelines also suggest that pediatricians “discourage the use of nonmedically-indicated supplementation with commercial infant formula.”
But as a New York Times opinion piece points out, this is concerning given reports “about mothers who’ve been pressured by lactation consultants, nurses or pediatricians to reject formula in the early days of their children’s lives, and as a result their babies lost a dangerous amount of weight and, in rare circumstances, became gravely ill.”
It’s something that del Castillo-Hegyi knows firsthand. “They’re so focused on promoting breastfeeding to as many parents as possible that they don’t take responsibility for the negative effects of their message,” she says. But along with formula-feeding shaming, del Castillo-Hegyi acknowledges that there are people who will “judge” women who choose extended breastfeeding. Whether a parent breastfeeds for two years or relies solely on formula, “we shouldn’t judge anyone” for their feeding choices, she says.
6 signs a baby isn’t getting enough milk
To save other parents from what she and her son endured, del Castillo-Hegyi urges them to learn the signs that can indicate an infant isn’t getting enough milk by using the acronym HUNGRY:
Hypoglycemia — this is characterized by high-pitched and inconsolable crying, jittery hands, lethargy, low body temperature, seizures, and turning blue.
Unsatisfied nursing — feedings that last longer than 30 minutes or feeding more frequently than every two hours, along with “crying despite breastfeeding and repeated nursing,” she says.
Not waking up to feed every three hours for a newborn, difficult to arouse, limpness and sleepiness
Gaining no weight by day 5 — losing greater than 7% of body weight can indicate feeding problems and increases the risk of dehydration and jaundice.
Red brick-like dust on diapers is “a sign of concentrated, dehydrated urine,” says del Castillo-Hegyi. Reduced wet and dirty diapers or no wet diapers for six hours can signal that a baby isn’t getting enough milk.
Yellowing of the skin or eyes is a sign of jaundice.
If you spot these signs of hunger, the Fed Is Best Foundation recommends seeing your infant’s pediatrician immediately and supplementing feedings to prevent complications. “If your baby needs more, they need more,” del Castillo-Hegyi says.
As far as what she would tell other moms, del Castillo-Hegyi says: “You do not know what your milk supply will be, and there are ways to help your milk without starving your child. You can pump, you can supplement. In retrospect, most of [my children’s] nutrition came from formula — they’re smart, happy, funny, healthy. Like, what was I torturing myself over?”
She adds: “I have been an exclusively breastfeeding mom and a combination feeding mom and I was a formula-feeding mom — and I was the same loving mom through it all.”
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