The Mental Health Benefits of Formula Feeding – a Guest Post by Anna Glezer, MD

I’m so thrilled to be able to bring you the following guest post, from Harvard-trained clinician Anna Glezer, MD.  Dr. Glezer holds joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center, and recently launched a new website, Mind Body Pregnancy.


-The FFF

The Mental Health Benefits of Formula Feeding

A guest post by Anna Glezer, MD


In my clinic, I have spoken with many women who struggled with the decision about how to best provide nutrition for their baby. I remember Cindy, a new mom who had low milk supply postpartum and supplemented her baby’s diet with formula, who expressed feeling inadequate as a mother. I remember Sarah, a second time mom who was taking medications that led to her decision not to breastfeed and the difficult time she had making that decision for herself and her baby. I remember Anne, a woman who felt judged by her peers and even strangers in the street when she would bring a bottle out to nourish her crying child.

As a new mom, you may have heard repeatedly from various clinicians, other parents, and perhaps even random strangers about the benefits and importance of breast feeding. However, not all women are able to breast feed and this article is for you. After reviewing the reasons when formula is the right choice and the negative feelings many women experience when making it, we will discuss all the emotional benefits of choosing to formula feed your baby.

Reasons When Formula is the Right Choice

There could be a wide variety of reasons for choosing formula:

– When taking certain medications that can be harmful through the breast milk. These may include medications for conditions such as multiple sclerosis, certain types of cancer, HIV, or others. Women taking medications for mental health reasons (such as certain mood stabilizers) may choose not to breastfeed because of a lack of data at this time on safety.

– When sleep is a significant issue. For women with bipolar disorder, poor sleep is a common trigger for a mood episode. For women with severe illness, the risks of poor sleep may outweigh the benefits of breastfeeding.

– When breastfeeding causes pain to a degree beyond what is typical. This may be due to medical complications such as recurrent mastitis.

– When breast milk supply is poor (due to a multitude of underlying reasons).

– When breastfeeding is not an option due to a woman’s medical history, such as a history of breast cancer and subsequent surgery.


The Feelings of Many Women Choosing Formula

Women who initially planned to breastfeed but for whatever reason cannot often go through several stages of feelings:

Guilt – Many women describe feeling like a failure as a mother and guilty for being unable to provide breast milk for their infant. I have had women describe this when they are supplementing with formula and when they are exclusively formula feeding, when they are using formula temporarily and when it is for months.

Anxiety – Moms describe feeling worried about their infants’ future. Am I providing my baby with the best possible start? What about my baby’s health?

Shame – While guilt is the feeling you place on yourself with responsibility, shame is what you feel when the judgement of others falls upon you. Women have told me that their parents, partners, clinicians, friends, and acquaintances have made them feel ashamed of their choosing to formula feed their infants.

Depression – Postpartum depression affects 15% of moms, and difficulty with breastfeeding is a significant risk factor.

Grief – A grieving process is not unusual after a significant loss. In this case, the loss is the expectations a mom may have had about what postpartum will be like and what breastfeeding will be like.

How to Manage These Feelings: Looking at the Emotional Benefits of Formula Feeding

Once the decision to formula feed is made (and this is often not an easy decision to make, requiring careful weighing of choices, hopefully with the support of a partner and nonjudgmental health care professional), the next step is managing all those feelings mentioned above that come with that decision.

Recognizing all the positive mental health benefits of formula feeding can help you achieve this.

  1. First, one of the main reasons breastfeeding is considered so important is that it is an essential time of bonding between mom and baby. This doesn’t change with formula! This benefit remains regardless of what the baby is drinking. The key is in how the baby feeds – in mom’s arms, in a loving, strong embrace, looking into mom’s face and seeing her love. This attachment time between mom and baby leads to healthy bonding and positive well-being for both.
  2. Second, formula feeding can help moms work on their emotional wellness by providing them with flexibility. That might mean that while the partner feeds baby, mom has the opportunity to attend an exercise class, go to a therapy appointment, or call a supportive friend. That might also mean that mom can share night-time duties with her partner or others, allowing for better sleep. Sleep is crucial for good mental health, particularly in vulnerable women.
  3. Third, by formula feeding, you might be avoiding some of the emotional costs of breast feeding. One patient of mine suffered severe mastitis from breastfeeding, complicated by a systemic infection requiring hospitalization, which led to the consequence of post-traumatic stress disorder. Others describe the pressure to breastfeed, coupled with feelings of inadequacy, as the trigger for postpartum depression. Anxiety can rise also after the transition back to work, if you are trying to pump and breastfeed while working full-time. These emotional complications – PTSD, depression, and anxiety can potentially be avoided if a woman is able to move past her and others’ expectations and accept formula feeding as a wonderful way of nourishing a baby.
  4. Fourth, formula feeding helps to promote a loving bond between baby and dad. Some fathers have said they feel left out of the relationship with young infants. This helps to foster that bond, which can also have a positive effect on the partner relationship, alleviating the sense of helplessness and jealousy that can sometimes arise.

In summary, it is essential to recognize that the decision a mother makes about breastfeeding or formula feeding is very individual and depends on her unique set of life circumstances, including physical and mental health issues. Having the support of a partner, family, other moms, or a provider will help when making this choice. Being aware of the positive mental health benefits of formula feeding might help you if you are struggling with this decision and experiencing some of those common negative feelings like guilt or anxiety.


About Dr. Glezer:

Dr. Anna Glezer is a Harvard-trained clinician with current joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center. She is the founder of Mind Body Pregnancy, a new online educational resource that helps women with their emotional well-being and mental health during pregnancy, delivery, and postpartum

FFF Friday: “Please don’t ask.”

Very often, reading your FFF Friday submissions, I think I could seriously just retire from doing this and leave your stories up here as an archive, and it would be just as effective. Because your stories are so powerful, that they speak for themselves – and all the rest of it just becomes unnecessary background noise.

Fawn’s story, below, is a perfect example of what I’m talking about. It pretty much sums up everything I’ve tried to say in the past 7 years, in a much more concise and artful way. So.. here you go. One of the best diatribes ever written on this issue, in my opinion.

Happy Friday, fearless ones,



Fawn’s Story 

Two weeks ago, I was foolishly optimistic enough to believe I wouldn’t have reason or need to write this.  It’s frustrating to find out that my optimism was misguided naiveté.

I am a mom of four.  I have a brilliant six year old son, a hilarious four year old son, and a beautiful pair of newborn identical twin daughters.  After each birth (and frequently leading up to them), I have been surprised by the number of people who feel the need to ask about our feeding situation.  I’ve been here before; I’m not sure why I thought maybe people wouldn’t ask this time around.  But they do.  And it catches me off guard every time.

So it’s been on my mind lately.  And do you know what my well-considered answer is?  My answer is, “Why do you need to know?”

If you are not my doctor, or my babies’ doctor, why do you need to know?  Are you asking because you’re looking for an ally for whichever side of this ridiculous battle you’re on?  Are you asking out of concern for my babies?  Are you asking, because you’re about to offer to buy some formula?  If it’s that last one, ask away, please, and thank you for the help… if it’s for another reason, please reconsider asking.

If you’re asking because you imagine there’s some sort of right vs. wrong, and you need to know which side I’m on, please don’t ask.  I have more important things to worry about than how other people feed their children.  I trust them to make the best choices for their families, just like I do my best to make the best choices for my own family.quotescover-JPG-94

If you’re asking out of concern for the health of my babies, please don’t ask.  Do you really think you’re more concerned about my children’s wellbeing than I am?  Do you think you know more than our doctors or I do, or that I’m incapable of doing the same research you’re capable of?  Please understand that I am a relatively intelligent person with very reliable reading skills.  I have the same access to the internet that you do, and I have had plenty of time to scour PubMed and other sources for actual scientific research. Don’t insult my intelligence or my love for my children by implying that you care more for them than I do.

If you ask about our feeding situation, and I do let you know that yes, we use formula, please don’t try to convince me otherwise.  See the above paragraph, please.  That should suffice.  But if it doesn’t…

Do you want me to describe for you, in detail, what it’s like to watch your firstborn son cry nonstop for days, until he’s exhausted, and unable to even wake up to eat? How it feels to watch him slowly wither and grow weaker as his tiny little body gets even smaller and lighter?  And then, what it’s like to be nursing, and pumping, constantly around the clock, under the watchful supervision of the lactation consultant.  She’d cheered his beautiful latch even in the hospital!  How, in exhaustion, at twelve days old, we went into her office to weigh him before and after, to discover he was getting almost nothing to eat.  Well, how often did I feel let-down?  How long had I experienced engorgement? I wasn’t sure, perhaps because neither of those things ever really happened.  At this point, our six-pound, twelve-ounce newborn had lost nearly a pound.  There in her office, he turned blue from being so thin and pale, and she scooped him up, grabbed me by the hand, and rushed us downstairs to the emergency room.  I can tell you about how tragically sad it is to watch an ER doctor hold your tiny baby down while they do their best to draw blood from his miniature arm.  Is this what you want to hear, when you ask me why we’re using formula?  I pumped for him for six weeks.  It was six weeks of tears, sorrow, and feeling like a failure, as I sat for an hour at a time to wind up with maybe an ounce of “liquid gold” to give my baby, while other people were getting to actually spend time with him and enjoy him.  I would give anything to go back and have the chance to really enjoy him during that time too.  To offer him a mama that is present and happy.   But at least he got the important part of me.  Right?
Have you seen the sunken eyes and cheeks of a baby that’s slowly being starved?

Should I then go on to tell you how I researched while expecting my second-born son?  How I was determined to get it right this time, this thing that supposedly everyone can do, if they just try hard enough?  I was not a new mom; I knew better than to assume breastfeeding would just happen naturally.  It took work.  I spent months reading everything I could about nursing positions, latches, tongue ties, proper diets.  I would set myself and my baby up for success.  I looked forward to the lactation consultants visiting us in the hospital; I had a number on hand for another IBCLC in case we needed her later.

We needed her later.

Did you know that different babies respond differently to intense, long-term hunger?  This baby didn’t cry.  Or sleep.  He attempted to nurse, literally, around the clock.  And we let him.  For days, he and I slept, ten minutes at a time, every few hours.  The rest of the time, we were topless, sequestered in the bedroom, while he did everything he could to be nourished from my body.  When he began to literally nurse my nipples off, we had the IBCLC over as quickly as we could.

I started supplements to increase my supply.  I drank water.  I ate oatmeal.  We weighed him before and after feeds, and he continued to lose weight.  Eventually our IBCLC resignedly informed me that there was not a lot left that we could try.  I was so thankful when she gave me permission to “give up;” I was tired, depressed, and feeling the struggle of following the same road I’d followed the first time around.  Even with education and support, it just wasn’t working.  I refused to put this baby through what the first had suffered through.  I decided that he deserved a present, happy mom.  And he got it.

Our twins are now eleven days old.  They are vibrant and beautiful.  They are also 34-week preemies.  So far, they’ve spent their entire lives in the hospital, finishing up their development and growing.  It is emotionally trying to be a parent of NICU twins; I cannot imagine what would happen to my self-esteem if I was trying to pump for them.  I know what my body can and cannot do.  I also know that this experience is hard enough for me without failing to feed them properly.  They are thriving on formula under the care of the amazing NICU nurses, and my husband and I (and assorted grandparents) bond with them by giving them bottles and snuggling them every day, as often as we are able.  We are so in love, and we cannot wait to bring them home!

When you second-guess the decision my husband and I made to formula feed them, you send a pretty offensive message.  You’re implying that we don’t care enough about our babies to do what you think is best for them.  You don’t know our history, and I shouldn’t have to relive it by having to explain it to you.  It’s not your business. It was painful enough when it happened; I’d rather not dredge it all up to random acquaintances and strangers who feel entitled to ask.

I thought I was impervious to comments and judgements about our family’s formula use, but I’ve discovered I’m not.  If you’re not directly responsible for my family’s medical care, please don’t ask.  That goes for every mom and baby, everywhere.


Feel like sharing your story? Email the FFF –

FFF Friday: “I made a choice and it was the right choice.”

There’s something so quietly profound about the quote I pulled out of Sarah’s story. “I wasn’t going to stop myself from being able to look after him in every other way in order to give him (breastmilk),” she says. That’s really the crux of our argument, isn’t it? That sometimes, you have to choose something that seems less than ideal in order to have what is truly ideal: a bond with your child, a healthy body, a functioning mind.

When you make those kinds of choices, you thank whatever deity you believe – God, Jehovha, Allah, Buddha, Science- for the invention of viable substitutes, that can fill in when the ideal is not ideal. And you know what? I thank him/her/it every time I look at my children’s ideal faces, marvel at their ideal minds, and treasure our ideal bond.

Happy Friday, fearless ones,




Sarah’s Story

When I fell pregnant for the second time (first pregnancy was a miscarriage), I was asked by every health professional whether I planned to breastfeed. I was all for it, it was everything I wanted to do. I thought it would just happen naturally so I didn’t go to any classes and didn’t do much research on it at all.

My son measured big throughout my whole pregnancy and at 38 weeks he was estimated to be about 4.5kg. The doctor decided It was best to be induced which I really didn’t want but I agreed anyway. We had a date within the week and I went into hospital at 39 weeks and 1 day to be induced. Things did not progress overnight with a catheter inserted so I was put on the drip the following morning. I did not cope very well with the pain and I had an epidural which I was adamant I wasn’t getting before labour started! Baby was sitting funny so the pain of the contractions was gone, but I had back pain which lasted the entire time I was in labour. I was so exhausted I spent he whole day drifting in and out of consciousness. By 10pm the midwife told me I had fully dilated but baby’s head wasn’t descending as he was very big. I was terrified of the idea of a cesarian but I agreed. I was taken to theatre at around 12am I believe, I don’t have much memory of the day at all. I was hysterical with fear and exhaustion.

Finally at 1:30am my son was born. He was weighed at 4.9kg and wrapped in a towel and my partner held him on my chest for a few minutes. Suddenly I was passing out again, my baby was taken to nursery and my fiance kicked out of the OR. I don’t remember much except the anesthetist telling me I may need to be put to sleep. I came in and out of consciousness and at one point I was in recovery with nurses all around doing things. I was taken to the adult special care unit and I could barely move my limbs. I had oxygen tubes in my nose, three different canulas with lines going into my arms and i was so tired. My baby was no where to be seen but my fiance assured me he was okay, but hypoglycemic. He had already given him his first bottle in the nursery and while i was disappointed it wasn’t me, I understood why and I wasn’t upset. I was glad it was him that fed him.

The next day I found out I had lost 4 litres of blood when my tired uterus didn’t contract after my son was born. I was very anaemic and that was why I was so tired.  It had also tore bigger than the incision site and I wasn’t allowed to try for more babies for well over a year.  I was encouraged to attempt breastfeeding with the help of the nurses. I felt so overwhelmed with random people touching my breasts, telling me what to do and it was so painful. We didn’t have much success feeding and it was always painful despite being told it would get better it never did. We gave him formula bottles in the hospital after attempting to feed and he took to them very well. They told me because of the large blood loss my body was focusing on producing blood rather than milk. I was sent home on the 5th day after my son was born, still barely able to walk from cesarian pain. It took a week for my milk to come in and it was a very small amount, I tried pumping and I got less than 40ml from both breasts. I discovered I have flat nipples and it was very hard for my son to latch on and the whole experience was very frustrating leaving us both in tears. I began to resent my baby for the way I felt when feeding him. I then got an infection in my wound site and had to take pain medication which was unsafe for breastfeeding. I pumped the whole time I was taking them with the intention of trying again after I was off them.


Afterwards I sought out the help of a lactation consultant at the hospital where I gave birth. I went in for weekly appointments and we discovered he was getting less than 30ml from each breast. He also had a terrible latch but we had most of this corrected. I tried nipple shields, I even borrowed a hospital grade pump from them and I was about to start taking drugs to increase my supply. I tried a SNS which was too fiddly for me and I couldn’t see myself using it in public. We were giving him bottles this whole time after every feed and I wish i had just stuck with them earlier.

The final stroke happened when my son was just under five weeks old. I was taken to hospital in an ambulance with severe abdominal pain. It was diagnosed as pancreatitis caused by gallstones blocking a duct. It was the worst pain I have ever experienced and I spent a whole night hooked up to morphine just to make it through. I was away from my baby for a week in hospital waiting for surgery to have my gallbladder removed. I missed him so much. By the time I got home my milk was completely gone and I was barely able to pick him up without pain, let alone feed him. I made the call to switch him to full formula feeds.

I struggled for many weeks with the guilt. I cried and cried about my traumatic labour experience, my inability to breastfeed, everything. I still don’t know what it took to realize that I had done nothing wrong. That I’d done my best for him and done the best thing for both of our health and sanity. My partners mother told me that she had formula fed all four of her children from birth, by choice. I don’t feel now that I was unable to breastfeed and was forced into formula feeding. I made a choice and it was the right choice. A stressful breastfeeding relationship was damaging my ability to bond with my baby, and health concerns meant I’d have to put my own health second, keep myself in pain just to give him breastmilk. I wasn’t going to stop myself from being able to look after him in every other way because I was sick, to give him that when it wasn’t benefiting either of us.
I wish there was more information and support out there for mothers who choose to formula feed. Bottle safety, how to prepare a bottle, etc. I have been lucky to not receive judgement from anyone except myself. Even the LC was very supportive with bottle feeding. Mothers, please start supporting each other and your choices. It doesn’t matter whether your baby is formula fed, breast fed or fed with expressed milk, as long as it’s done with love and care. My son is now a happy and healthy 4.5 month old who benefits from having a mum who isn’t stressed to the max while trying to feed him, and we have a beautiful relationship.

FFF Friday: “I didn’t want to fail her anymore.”

The American Congress of Obstetricians & Gynecologists (ACOG) recently release a new policy statement on infant feeding, with language that subtly implies a woman’s autonomy and ability to make an informed choice must be respected. Good news, right?

Well, I thought so, at least. After all, the policy statement (read it here) was abundantly pro-breastfeeding and pro- Baby-Friendly Initiative; they just threw in a scrap (a desperately needed, much appreciated scrap, don’t get me wrong) for us formula feeders, stating that we have the right to make our own choices. 

But some didn’t think this was good news. The instagram thread of a leading breastfeeding peer supporter (one who truly does support infant feeding choice, and is extremely open-minded and kind, by the way) evolved into a full discussion of why the concept of “choice” was detrimental to women and to breastfeeding efforts; this was not a huge shock, as the “choice is only choice if its informed choice, and informed choice means telling women formula is bad for babies” opinion isn’t a new one. But I was shocked to see a comment from a woman who recently became insta-famous for a media-friendly breastfeeding story. This woman, who is now a popular voice in the breastfeeding community (i.e., people are listening to her), left a comment suggesting that she was incredulous that breastfeeding promotion could cause women pain and shame, ending it with the hashtag #byefelicia.

Bye Felicia? Really?

I hope this woman reads Claire’s story, but I doubt she will. And even if she does, a woman who would so quickly dismiss another woman’s pain is unlikely to be swayed by even an essay as emotional and raw as this one. 

Luckily, most women aren’t like her. Most women are like the members of ACOG, who understand. And women like you, who know that just because you personally haven’t experienced something doesn’t mean it isn’t true. These are the women who will bring us to where we need to be, where stories like Claire’s cease to happen, or at least happen far less frequently. 

Stay the course. And in the meantime, say #byefelicia to ignorance and judgment.

Happy Friday, fearless ones,



Claire’s Story

I have a 3 and a half year old daughter. She is bright, enthusiastic, funny, kind and get this, she is healthy. She was also formula fed!

Backtrack, I was young pregnant and positive that I would breastfeed, I mean why wouldn’t you? “That’s what they are there for, it’s easy, saves cleaning bottles” and all the other things people tell you. My midwife insisted that I went to my local Breastfeeding workshop. Wow. 20 minutes on why you should breast feed, I think we were all at the breastfeeding workshop because that was what we wanted to do, we didn’t need convincing. I also think that all of the Google searching and pregnancy websites we read adequately informs us pregnant ladies. So in I went all positive, then I was told for the next ten minutes all the benefits my baby would receive through breast milk;

  • It’s natural
  • It builds a strong bond between baby and mother
  • It protects your baby from infections and diseases
  • It will make your baby healthier
  • It will make your baby more intelligent

The list increases. So does the pressure. They gave a statistic about how many of the 30 of us in the room would go on to breastfeed. We looked at each other nervously, which ones of us would fail? A breastfeeding Mum arrived to tell us how easy it is. I wondered why there was so much encouragement, pressure and information being thrown about? If it was that easy and natural why did we all need convincing? Why did we need a class? Nobody talked about what happened if you COULDN’T. Can’t was not an option.

Skip forward, I had given birth to my beautiful baby girl. Due to the pethadine I received in labour she was a little sleepy, so we did not try feeding until later. It is probably important that I tell you a little bit of awkward personal information about myself. I was sexually assaulted, many years prior to this day. Despite this negatively affecting my view on relationships, it more importantly affected my nipples. To put it lightly around 7 years prior to giving birth someone chewed on my nipples until they bled. It hurt. After that no one ever touched them again, and I high spiritedly thought that a baby sucking on them would be fine, ignorance is bliss as they say. My midwives agreed. I was not fine. It hurt. It made me cry. A lot. They kept telling me she had a perfect latch and it shouldn’t hurt. Well it did! Why did no one care about that? All of a sudden your feelings are cast aside. It turned out the hospital I gave birth in had received an award for the highest amount of breastfed babies, and were unforgiving in their approach to breastfeeding. I should point out that all the midwives were wonderful, they were just following their hospital policies. I could see the pain in their eyes while they sat with me, crying in the middle of the night, comforting me on my failure, but unable to tell me that it was ok. Trying pumping with me while I squeezed my eyes shut, clenched my fists and curled my toes, telling me that I was doing my best. They were not allowed to tell me that it was ok if I couldn’t do it. I kept being told that she would be losing weight, which caused more pressure and anxiety. When they weighed her she was surprisingly ok. Eventually my husband went and stocked up on all the necessities for formula feeding. They wouldn’t let me go home until they had seen her drink a bottle, you see after all the failed breast feeding attempts they said she might not know how to drink from a bottle. I sobbed my heart out while she guzzled the entire bottle, obviously hungry.

Do you know whilst on the ward I was next to a breastfeeding Mum who smoked. She told the midwives that she had breastfed her last child up until 18 months and that she smoked outside. NOTHING MORE WAS SAID!! I wanted to breastfeed and couldn’t and they could not say ok, good for you. Is this a joke? Were they actually playing on my fears and emotions to win an AWARD? I was then left thinking my baby would be unhealthy, slow, ill, wouldn’t bond, and be less intelligent because I couldn’t do what was natural. Hello Post Natal Depression! who knew you would stay with me so long that you have become a normal part of my life?

When I was going home, more downtrodden and disheartened than I had ever been, one midwife whispered to me “I bottle fed. It’s not that bad, but I’m not supposed to tell you that” She probably saved my life. Her words were just enough to keep me going.quotescover-JPG-48

I persevered at home, but every time she cried I insisted she wasn’t hungry. I cried while we tried. I was anxious and on edge. I tried pumping, but because I wasn’t relaxed I just wasn’t producing any milk. I even tried sniffing her clothes while I pumped as my midwife suggested, I felt uncomfortable doing that. I was pumping about an oz and adding it to her formula. A lady came with her daughter to buy my car, she was a midwife and saw my struggles. She told me I needed to look after myself in order to look after my baby and I should end the emotional and psychological torture I was putting myself through as it was affecting our bonding and my mental health. She was a stranger but was more caring towards me than those providing my care, she talked sense. Once I decided to bottle feed I bonded with my baby. I wanted to hold her close. Unfortunately the guilt I felt made me overcompensate with the rest of her care, I didn’t want to fail her any more.

3.5 years later I have learnt;

  • Your baby won’t hate you for bottle feeding
  • bottle feeding also builds a strong bond between baby and mother
  • My baby has not suffered any infections or diseases that her breast fed cousin hasn’t also had
  • She is healthy
  • She is intelligent
  • She is happy

I also learnt that a friend who had her baby in a hospital 30 minutes away from mine was asked, after her little boy was born “breast or bottle?” She said “bottle” and get this, they got her one! She too has a happy health baby and nothing bad happened to her baby, or to her feelings or her mental health. I still take antidepressants to this day, I cry when I see breastfeed pictures on Facebook and can’t even think about what I experienced. Thankfully my daughter is too busy holding slugs, wearing dresses, riding her bike and asking me endless questions about what her guinea pig is saying to her, to notice my unnecessary strife. Don’t get me wrong I am a happy parent, I love my daughter and she brings me joy and laughter every single day, but I don’t think I could have another baby again, I couldn’t relieve that experience. (What’s that? single child guilt? NOOOO!)

Moral of the story? Stop pressuring women, you are doing lasting damage emotionally and mentally to women, and this will not assist their ability to raise children. We must look after each other whatever we choose to do, we must care for the children and those raising children, and support each other. We must love ourselves, we must love each other.

Thank you for listening to me.


Want to share your story? Email me at

A public health perspective on formula use & breastfeeding advocacy – Guest Post

I’m incredibly thankful that someone in the field of public health is taking a stand on how we ignore the reality of formula use, and I really hope others will follow. We need decision-makers and influencers – physicians, scientists, public health professionals, nurses, politicians, hospital administrators – to start looking more closely at these issues, and to speak up when they see flaws in the current system. It’s the only way true change can happen.



A public health perspective on formula use and breastfeeding advocacy:

What we don’t say matters


by Hillary Kuzdeba, MPH


In the United States, the majority of babies will receive formula at some point during their first year. Despite what we may personally believe about the importance of breastfeeding, it is critical that medical and public health professionals keep this fact in mind when we design infant feeding educational initiatives for families. When we fail to discuss formula with families, or worse, when we purposefully withhold information on formula from them, we are doing families and infants a great disservice.


Today, most of the breastfeeding advocacy programs implemented in hospitals, birth centers, and OBGYN/midwifery practices utilize a two pronged approach to encourage breastfeeding. The first method, which is the active promotion of breastfeeding, is immediately apparent. Women are empowered to breastfeed through intensive educational materials, classes, consultations, and support groups. The second method is less noticeable, but important nonetheless. Here, strategic obstacles deter women from formula feeding. The obstacles include the reorientation of discussions about formula back towards the “breast is best” message, limiting access to formula during hospitalization, and generally withholding any information on formula lest it “encourage” the family to use it. Used in tandem, both methods create an environment where breastfeeding is presented as the only healthy feeding option. This is why pro-breastfeeding institutions rarely disseminate any information on formula feeding, except to mention that it is suboptimal. In these environments, families will find a myriad of resources on lactation, breastfeeding positions, latching, pumping, and other breastfeeding topics. Meanwhile, practical guides discussing formula selection, appropriate mixing, safe storage, and feeding have been almost completely eliminated.


The first method employed by these programs is wonderful. Most of us agree wholeheartedly that women who want to breastfeed should receive extensive support. I did, and I am so thankful for the resources that helped me breastfeed for as long as I did. But it is the second part of the advocacy approach that worries me, both as a public health professional and a mother. The strategy of withholding health information from patients and families, out of a misguided fear that more information might encourage an undesired behavior, has long been debunked by the scientific community as ineffective and potentially harmful. And yet we continue to implement this strategy in regards to formula feeding.


Some public health researchers, advocates, and other parties may balk at this statement. They may point to evidence suggesting that placing obstacles in the path of a decision can “nudge” individuals towards a different choice. That may be true in specific instances, such as smoking or alcohol use, where the undesired behavior is recreational, unnecessary, addictive, and downright harmful. But infants must eat, formula is a proven healthy option, and breastfeeding can be very challenging for numerous physical, psychological, and social reasons. Most women in the US initiate breastfeeding. So when they do use formula, it is usually a conscious decision for reasons outside of personal preference. Withholding information from these women does not “nudge” them towards breastfeeding. A lack of knowledge about formula does not make extreme nipple pain disappear, or milk flow. It does not change a baby’s mouth structure, or eliminate a working mom’s 12 hour shift. All it does is create the impression that a parent has no option other than breastfeeding.


How does this strategy really play out?


  • When a parent who is aware of the benefits of breastfeeding still wants to talk formula, twisting the conversation into another discussion of how “breast is best” is not education – it’s intimidation. This behavior alienates and stigmatizes her, while simultaneously undermining her intelligence and personal authority. It is a form of intellectual bullying, and it delays the provision of requested education on formula feeding. When we use this approach, the message we are sending is clear: “You must not be aware that formula is a poor choice. Let me reeducate you because you clearly aren’t getting it. Maybe now you’ll come to the right decision.”


  • If a woman is really struggling to breastfeed and we oppose her when she requests formula, we create a power struggle with a vulnerable parent who is just trying to feed her child. This undermines her trust in us and causes anxiety. She may begin to question whether we really care about her and her infant. This can be devastating for our relationship with poor women, minorities, or other groups who already have reason to be suspicious of the medical establishment or government due to past medical and scientific abuses.


  • When we send new parents home with absolutely no education on even the basics of formula feeding like appropriate bottle cleaning and safe storage, we are purposefully withholding critical safety information that could potentially result in harm to an infant. Even parents who appear committed to exclusive breastfeeding should still be educated on these subjects given that most will end up using formula at some point. Assuming they won’t need this information is wishful thinking.


Worst of all, when we create an environment that strongly implies that we are against formula, we accidentally send the message that breastfeeding should be prioritized above all else, including the health of mother and baby. In this environment, our silence on formula use speaks volumes. It overexaggerates the risks of not breastfeeding to the point where mothers may actually endanger themselves and their babies in a desperate effort to avoid the dreaded F word. No mother should be so hesitant to give her child a bottle that the baby ends up hospitalized for extreme dehydration or malnutrition. No mother should be so afraid of formula that she spirals into depression over her inability to breastfeed. And no mother should be led to believe that formula is so risky that she is willing to turn to unscreened, unregulated human milk from an anonymous stranger on the internet to feed her child. And yet, this is happening every day across the US.

Educating families on safe formula selection, preparation, feeding and storage in no way undermines breastfeeding. If a mother is committed to exclusive breastfeeding, providing her with an extra handout on formula use is not going to change her mind. But including that same information can make a world of difference to a family who finds themselves in need of formula. When we include formula in our discussions, our classes, and our educational materials, we create a safe space that shows parents we are on their side – regardless of how they feed their baby. I think that is a strategy we can all get behind.

Hillary Kuzdeba holds a Master of Public Health (MPH) with a focus on social behavioral science, health promotion, and women’s health. Over the last few years, she served as the program coordinator for a large nursing research group at a renowned Children’s Hospital. Today, she spends her days at home taking care of her beautiful, formula-fed daughter.

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