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Is Breastfeeding Always Best?

At a mothers' brunch in New Haven, Connecticut, Amy Kimball had plenty to smile about: good company, fresh bagels, and -- best of all -- newborn Alexa gurgling in her arms. But Kimball was close to tears. "I felt as if I'd failed," she recalls. Despite help from a lactation consultant, Alexa wasn't learning to nurse gently -- and for Kimball, feeding her often meant agonizing pain. Her husband urged her to soldier on. "He said, 'Don't you want to do what's right for her?' It felt as though he was guilt-tripping me," she says. So were Kimball's in-laws. Still, she couldn't help wondering: Is it ever okay not to breast-feed?

The answer, experts say, is yes -- but it's not a decision to be taken lightly. Study after study has found that breast milk is more nutritious than formula, with benefits that include fewer allergies and ear infections, lower rates of SIDS and obesity, and possibly even higher IQ scores. Psychologists tout breast-feeding as an aid to mother-infant bonding. The American Academy of Pediatrics recommends doing it for at least a year.

Yet for all its virtues, breast-feeding doesn't work for every woman. And using formula doesn't make you a bad mom -- though disapproving friends, relatives, and strangers can sometimes make you feel that way. Millions of children have done just fine on formula. In fact, although the number of mothers who tried breast-feeding soared from 24.7 percent in 1971 to 64.3 percent in 1998, only 28.6 percent are still nursing when their babies are 6 months old.

To put it bluntly, breast-feeding is often harder than new moms anticipate. Learning to nurse comfortably can take weeks. Breast-fed babies need to feed more often than those on formula, which can mean less sleep for mothers. Nursing in public can still bring rude looks -- or worse -- from waiters and shopkeepers. Siblings (and husbands) may be jealous of the baby's intimacy with Mom. And though most nursing mothers find that the rewards outweigh the drawbacks, for some women the obstacles are insurmountable.

A significant minority of moms (up to 5 percent, according to La Leche League) are affected by physical conditions -- insufficient glandular development, for example, or the effects of breast surgery -- that make it impossible to produce enough milk. Women with HIV should never breast-feed, because they can pass the virus to their babies; the same goes for mothers taking certain medications. (A woman planning to breast-feed should check with her doctor before taking any drug; if there's a problem, an alternative can often be prescribed.) Infants with galactosemia, a rare genetic disorder, can't metabolize breast milk -- or milk-based formula.

Mental and Economic Factors

Sadly, economic factors can also rule out breast-feeding. If a working mother lacks the time or the privacy to pump on the job, her milk supplies may dwindle. Rep. Carolyn Maloney (D-New York) has introduced two bills in Congress that would prevent employers from discriminating against mothers who pump and would provide tax credits for businesses with lactation rooms. But until those goals are met, many moms will be forced to choose between making breast milk and making a living.

Other women simply find that breast-feeding gives them the blues. Dee Knudsen, the mother of a 20-month-old in Smyrna Beach, Florida, had always placed a high value on her independence. She breast-fed her daughter, Mackenzie, for ten weeks but found the nonstop round of nursing and pumping intolerable. "I felt that it took away my autonomy," she says. "The whole time I was doing it, I didn't want to be doing it."Knudsen's resentment got in the way of her maternal instincts. "And the minute we switched to formula, motherhood kicked in for me."

Some breast-feeding advocates would condemn Knudsen as selfish. But experts say that a baby is better off being bottle-fed by a contented mom than breast-fed by one who's miserable. "If the mother is depressed, the baby will pick up on it, and no one will benefit from the experience," says Joseph Campos, Ph.D., a professor of psychology at the University of California, Berkeley.

Physical Discomfort

Nor will a baby benefit emotionally if her mother is in constant pain, like Amy Kimball. Although such discomfort is usually temporary, it can be intense. Lactation consultants can't always fix the problem right away -- and the longer it persists, the more likely it is to be irreversible.

Gloria Molinari, of Howard Beach, New York, wishes she'd had help sooner after giving birth to Isabelle, now 3. By the time the consultant came, on day four, "the nipple was bleeding. The thought of the baby coming anywhere close to my breast was nearly unbearable." Molinari turned to formula. And because she had strep throat when she gave birth to her second daughter, she ended up feeding her formula too. "I feel guilty," Molinari says. "My younger child has a lot of health problems, and I've always felt that if I'd breast-fed, she wouldn't be this way today."

Molinari needn't worry. Even medical experts don't claim that breast-fed babies are always healthier -- or smarter. "Lots of Mensa-bright kids were bottle-fed," says Wendy Madore, R.N.C., a certified obstetrics specialist in New Haven. "And lots of average kids were breast-fed." Although Madore favors breast milk, she thinks that new moms have enough troubles without feeling inadequate for using formula.

That's the reason why Marjorie Young, B.S.N., R.N., tries never to guilt-trip her clients, no matter which feeding method they choose. "You want to make sure the mother makes an informed decision," says Young, a certified lactation consultant at Montgomery Regional Hospital Birthing Center, in Blacksburg, Virginia. "Then you need to support her choice."

Amen, says Amy Kimball. She finally switched to formula when Alexa was 8 weeks old and began enjoying motherhood as never before. If she has another child, Kimball says, she'll give breast milk a second chance -- at least in the beginning.

"I agree that breast-feeding is probably best," she says. Just not for everyone every time.

One of the biggest benefits of breast-feeding is the emotional closeness it fosters between mother and child. But you can still bond with your baby over a bottle. Some tips to make the experience more rewarding for both of you:

  • Go skin to skin. Whenever possible, place the baby next to your bare chest as she feeds.
  • Go slow. Babies get comfort from a good, long suck. If your child seems to be dawdling, don't grab the bottle away. And don't force her to finish the bottle if she doesn't want to.
  • Stay focused. Let the answering machine take calls at feeding time. If you must watch TV, don't forget to make eye contact with your baby.

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All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.