Breast is best.

Fed is best

Informed is best.

Fed is first.

What really is best and first when it comes to infant feeding: support. Support is best. Whether we are talking about infant feeding or frankly anything else related to postpartum or the fourth trimester, support is critical.

The other slogans just fall short.

Breast is best. Breastmilk is the most ideal nutrition for infants. Milk is created specifically for infants and changes in composition as they grow to adjust for their needs. It benefits brain growth, gut microbiome, and immune function. Breastmilk is linked to reduced risks of infections, childhood leukemia, asthma, diabetes, and SIDS. It has also shown benefits for the mother/lactating person, including lower risk for cancer, hypertension, arthritis, heart disease, and diabetes.

However, is it really the best when breastfeeding is not an option, when it affects the mental or physical health of the person lactating, or if it is the mother’s/birther’s choice not to do so?

Fed is best. A baby needs to be fed, obviously. But, as above, formula is not the best source of nutrition. Thousands of studies and counting show the benefits of breastmilk and risks of formula feeding. However, when breastfeeding is not an option, formula is absolutely an adequate alternative to keep babies fed.

Words matter. With this slogan, you are implying that all feeding options are equal and you are completely disregarding the mother’s/birther’s choice and need for support and information. It is like saying, goals and information don’t matter as long as they are fed. But it does matter. When 85 percent of mothers/birthers intend to exclusively breastfeed for 3 months, but only 32 percent meet that goal, something is wrong.

Mothers/birthers deserve to have support in achieving their goals around infant feeding. To just disregard a mother’s/birther’s concerns and challenges is harmful to that individual and the community.

Informed is best. There is a lack of information provided to families about infant feeding. The idea that breastfeeding is natural and so should be easy is a common thought. Prenatal visits focus on pregnancy and birth planning; preparation around infant feeding is often disregarded. When challenges inevitably arise, there is limited access to trained lactation consultants and, arguably worse, vast amounts of harmful and misinformed recommendations on social media.

It is not enough to attend breastfeeding classes, have discussions with a physician/midwife, follow evidence-based recommendations on social media, make fully informed decisions, and set goals that work best for the mother/birther. If society does not support those goals, they are unlikely to be achieved. Mothers/birthers may truly want to breastfeed, but they come against barrier after barrier in their effort to do so (medical reasons, low production, unsupportive family, return to work, unable to pump at work, etc.). On the other hand, a mother/birther may formula feed and feel shamed by social media or, as evidenced by the current formula shortage crisis, are unable to obtain the necessary formula. It is not just about making informed decisions; those decisions need to be supported, whatever they may be. So no, informed is not best.

Fed is first. This tagline is used by the Facebook group Dr. Milk, a support platform for lactating physicians. The priority is that the baby needs to be fed. However, this approach does not undermine the goals of the mother/lactating person. It is instead about working to support a mother/lactating person who is struggling. The focus is to make sure that the baby is fed, whether breastmilk (own or donor) or formula, while protecting the current production through pumping or direct feeding and then identifying the underlying issue or concern. The mother/lactating person may hopefully be able to have a successful breastfeeding journey, whatever that may look like for them.

This concept addresses individual support by helping to identify the issues and working towards solutions. However, on a global scale, this still misses the mark. We need more than individual support only when things aren’t going smoothly or problems arise. We need, as a society, supportive measures to prevent them in the first place.

Support is best. What does support look like?

It is a society that values and respects mothers/birthers and their decisions.

It is access to education and evidence-based resources about breastfeeding and formula feeding addressing the risks and benefits of both.

It is becoming comfortable with and supporting public breastfeeding.

It is access to lactation consultants early and often that are culturally proficient and not cost-prohibitive.

It is increasing medical, perinatal mental health, and lactation professionals who are BIPOC and members of the LGBTQQIP2SAA community.

It is holding insurance companies accountable for covering lactation services by law.

It is training physicians in breastfeeding medicine and lactation.

It is universal paid parental leave policies for one year.

It is formula companies that don’t use predatory marketing.

It is formula companies providing reliable access to safe, quality-made formula with no risk of supply chain/production issues.

It is access to donor breastmilk.

It is places of employment allowing unhindered paid pumping time based on the mother’s/lactating person’s need not a set schedule of the employer’s choosing.

It is affordable childcare.

It is accessible, free, and safe contraception options and abortion services.

It is addressing and dismantling systemic racism, especially as it relates to maternal health.

It is supportive care of the birther during the 4th trimester, including childcare, meal support, home care, etc.

It is access to birth and postpartum doulas.

It is universal screening for perinatal mood and anxiety disorders and access to perinatal mental health services.

It is 4th-trimester medical care in the home, focusing on the mother/birther, not only the infant.

As a society, we need to fight for these changes through policy and legislation; access to services; holding employers, insurance companies, and formula companies accountable; and working to bring back our villages of support.

Support of informed goals is best and is what mothers/birthers and infants need and deserve.

Michelle Haggerty is an integrative family physician and breastfeeding medicine specialist. 

Image credit: Shutterstock.com