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Trained to coach moms how to breastfeed, but on the frontlines of seeing the pressure that comes with it, Tiffani Ghere, a Pediatric Dietician, weighs in on Chrissy Teigen’s “normalize formula” tweets.
By now, we all know that breastfeeding is considered the ideal choice when it comes to feeding a baby. The World Health Organization, American Academy of Pediatrics, heck, every Hollywood celebrity touts the magic of breastmilk as the Gold Standard for a baby’s first food. I am a Clinical Pediatric Dietitian and have spent most of my career in the NICU treating infants. I have been trained in evidenced-based nutrition and to seek the latest scientific research on infant feeding practices, and to understand how a baby develops and ways to optimize the nutrition of a growing baby. I know that breastmilk is amazing. It’s a complex, genetically-specific tissue that is custom-made for a baby, with traits far beyond basic nutrients. I have studied the intricacies of the gut microbiome, immunity and brain development. I get it and promote using breastmilk whenever possible. But here’s the truth: none of the merits of quality matter if a baby isn’t fed enough quantity. A baby can’t grow and thrive without a basic amount of energy when it comes to nutrition. So when I see a mommy such as Chrissy Teigen speak the truth about formula being okay, I say, “Amen.”
We need less judgement, more support
Make no mistake, I love everything about breastmilk. I breastfed all three of my kids and was happy to provide what I could to them and even enjoyed it more than being pregnant. But I never made enough. As a Lactation Educator and someone who has spent years working with new moms on infant feeding, I was pretty well-versed in the tricks and tools of establishing a milk supply- enough time with baby at the breast, pumping, Fenugreek, fluids, gripe water, the SNS system (don’t get me started on that!)- I did it all. It usually worked for the first 3 months exclusively, but I never could keep the volume up, and when I pumped and stored the milk, I had the thinnest layer of hindmilk (milk fat) which meant I made nonfat milk. Not the greatest for growing a chubby baby. It seemed I was surrounded by skinny moms who made cream and had fat babies and freezers full of extra milk.They were literal Dairy Queens. I was tired, felt like a failure and I knew I needed formula. I felt the stigma. And with each subsequent baby, I thought, “I’ll make more this time” and started the whole self-flagellating cycle again (as if chasing toddlers while trying to breastfeed helps the situation). I continued to breastfeed as much as I could, supplemented with formula and was able to go almost a year with each baby, but I still felt like I wasn’t as good as I should have been.
Why do we do this to ourselves? We’re in an infodemic of science, research and content thrown at us, so there is no excuse not to know breastmilk is the very best, right? Everyone has an opinion and feels compelled to impose theirs on you. Parents are often met with judgment and rigid attitudes about feeding, rather than the support they so badly need. That there is shame associated with providing loving care while feeding a baby, breaks my heart.
The adoption of “Baby Friendly” practices in hospitals was founded on the principle that “Breast is Best”, and aimed to increase nursing rates, but ended up demonizing the use of formula. Not only has this created some very avoidable situations requiring medical intervention and sometimes hospital readmission, it’s simply not practical or reasonable. It has also reinforced the idea that you either breastfeed or formula feed a baby- one good, one bad. But the issue is not that black and white, and the evidence shows us otherwise.
I have counseled many tearful parents who fully intended to breastfeed and something happened that closed that door. I understand the heartbreak and disappointment in things not going as planned, but we are lucky to live in a time when we have good options that will allow a baby to grow and thrive. I try to redirect the focus of the new mom to her beautiful new baby and give her some education so she knows she’s not alone. The reality is that only 46% of moms are still exclusively breastfeeding by 3 months and this drops to 25% by month 6. This is not to say we shouldn’t try and improve these numbers where we can, but more important is ensuring babies are fed, moms are supported and allow families to make informed choices. We need to offer encouragement and meet parents where they are at, not tell them where they should be.
For a healthy mom who could breastfeed, there are many reasons nursing can be difficult. She may have had a heroic delivery, birth trauma, a preterm delivery, a history of breast surgery, pregnancy-induced hypertension, a history of fertility treatments- the list is very long. One study done at Stanford looked at 17 million deliveries from 2009-2014 and found that 71% of women received either epidurals or spinal anesthesia when giving birth. IV fluids are usually given with anesthesia (which can delay a mom’s milk coming-in), so nearly three-quarters of these moms were already at a disadvantage from day one. We expect moms to feed their baby 8-12 times a day, recover from birth, manage cracked and sore nipples, engorgement, plugged ducts, while trying to sleep and eat when she can. Physically, breastfeeding is demanding. Then we have the fact that, among high-income countries, the US is the only one that does not guarantee paid leave after childbirth, so mom’s may have to return to work sooner than expected. Add to this financial and social stressors and huge hormonal shifts. The time and commitment needed to successfully breastfeed is often surprising and overwhelming for new moms. Can it be done? Of course, but it’s okay to ask for help and change your plans.
It’s not breastmilk or formula, for most it’s both.
Feeding a baby doesn’t have to be an “either / or breastmilk vs formula” issue- it can be both. In fact for most parents, it is during the first year of life. But here’s the great thing, we have options and our bodies are amazing. If you can’t provide 100% breastmilk, you still get credit for what you do provide. If you don’t have breastmilk, you baby can grow a perfectly healthy child. What we need to do as a community is change the messages we send new parents and support their choices.
As a dietitian, I say: breastmilk is wonderful and preferred, but formula is okay too. Feed your baby the best way you can. Avoid the noise of hurtful opinions and don’t let it cloud your good judgement by feeling like you have to go to extreme measures at your own expense.
As a mom of 3 nearly grown boys, I say: pace yourself. You have eighteen years to instill good food behaviors in your kids and formula is only the first of many food choices you will make. Enjoy your baby because it is the most important work you will ever do.
And to Chrissy, I say: thank you for using your voice to be bold and truthful. As a mom and a clinician, I appreciate you sharing your experience to help others. Though I don’t know you, I would gladly share a glass of wine with you and toast your tweets!
https://pubs.asahq.org/anesthesiology/article/129/3/448/22292/Maternal-Body-Mass-Index-and-Use-of-Labor Stanford looked at 17 million deliveries from 2009-2014 and found that 71% of moms received epidurals or spinal anesthesia.
Source: Roosa Tikkanen et al., Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries (Commonwealth Fund, Nov. 2020). https://doi.org/10.26099/411v-9255a