Explicit and implied “breast-is-best/formula-as-last-resort” messaging ignores — and potentially shames — women whose needs, abilities and preferences suggest otherwise.

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SOON after birth, my son struggled to breast-feed.

I’d learned about “science-proven” breast-feeding benefits at prenatal visits and baby showers. A clinician researcher myself, I was sold. But I soon realized the matter isn’t black-and-white. I share my experience and new evidence to illustrate that, despite prior calls to balance breast-feeding rhetoric, more change is needed.

Though my son writhed and screamed whenever he nursed, we were encouraged to persist, often with a “breast is best” refrain. When I stopped breast-feeding after six weeks, the nearly one-note cheer was easily reinterpreted as evidence of failure. Sadness at losing the nursing relationship I’d envisioned was joined by shame. Fear followed when several lactation consultants tenderly attempted to comfort me, suggesting his “impatient” temperament might be to blame.

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Thankfully, he mellowed considerably with bottle feeding. Advised to give breast milk instead of formula, I pumped and pumped. Although promised breast milk would provide better immunity and intelligence, I worried that precious bonding, sleep and sanity were unintended casualties. Instead of evaluating whether the costs were scientifically-justified, I trusted the chorus, including my inner voice, saying feeding him breast milk was best.

Eventually we fed him formula, thanks to those whose “common sense” tune helped us see there simply isn’t a single right way, underscored by a new study in Pediatrics disputing oft-touted cognitive benefits. Among 8,000 families in Ireland, there were no benefits from breast-feeding on the 13 cognitive indicators measured in 5-year-olds. The main limitation of this and other breast-feeding studies is that they’re not randomized trials, the only way to definitively determine outcomes. However, randomly assigning mothers to breast-feed or not would be unethical and impractical. This study statistically approximates a randomized trial, better accounting for factors like socio-economic status that may explain breast-feeding benefits in prior research.

Other high-quality research shows breast-feeding may reduce global childhood illnesses and deaths, undoubtedly worth pursuing. But balancing public health evidence with individual care is a complex and delicate endeavor. Empowering women choosing breast-feeding makes intuitive and empirical sense. But explicit and implied “breast-is-best/formula-as-last-resort” messaging ignores — and potentially shames — the many whose needs, abilities and preferences suggest otherwise.

According to the CDC, only half of U.S. women breast-feed at six months, and many breast-feeding women experience challenges, supplement with formula, and/or pump. Some, like adoptive families, consider giving others’ breast milk or induced lactation. To ensure optimal, equitable pre- and postnatal feeding care, I urge the following:

• Clinicians: Ask open-ended questions about feeding plans and practices. Engage parents in ongoing shared decision-making.

• Scientists: Study optimal feeding care. Communicate what findings do and don’t inform.

• Institutions and Insurers: Make patient-centered feeding support accessible. Use balanced messaging.

• Policymakers: Create policies that enable breast-feeding and early relationship development. Cover formula in WIC programs. Ensure safe water access for formula mixing.

• Parents: Find trusted support to weigh trade-offs and cope with challenges.

We often wield science like a magic wand, hoping to prevent suffering. But sometimes it functions like a sword, thrust against those meant to benefit. As a clinician-researcher-mom, I recognize there are myriad challenges and complexities, but firmly believe we can compose infant feeding care that — with compassion and nuance — empowers.