November 2022. I lay on my bed in a disarrayed nightgown, like a Victorian consumptive. My husband approached, holding our newborn son. By now, I had come to regard him as my torturer and my son akin to a pair of pliers or an electrical cable. “He’s hungry,” he said. I shuddered in anticipation. As Cyrus began to feed, I looked down at my feet and saw my toes fold back on themselves. Toe-curling pain, I thought. I had never before realised how literal the cliche was.
When I was pregnant, I barely thought about how I would feed my son. If asked, I would say I would breastfeed if possible, but use formula milk if not. When Cyrus was born, the midwife laughed as she handed him to me. “He’s rooting already,” she said. His mouth searched for my nipple and latched on immediately, his ears still slick with amniotic fluid. That night, I overheard the woman in the bay opposite me ask for formula. “Why?” asked the midwife, with a challenge in her voice that made me feel relieved I didn’t have to ask.
My sanity and my nipples began to corrode around day three. First they bled, staining my white nursing bra. Deep fissures appeared, like the cracked surface of a freshly baked cake. The scabs wouldn’t heal and oozed a crust that stuck to my nursing pads. Breastfeeding Cyrus day and night through an open, infected wound felt like being scrubbed with wire wool and doused with battery acid. At my day-five checkup, I showed the maternity support worker my battered nipples. She watched me breastfeed, flinching with pain. The latch was good, she said. It would get easier.
I can trace my subsequent mental disintegration through my Google search history. Four days after birth: bleeding nipple breastfeeding. How do I keep breastfeeding with bleeding nipples? Benefits of breastfeeding. Six days after birth: first week breastfeeding pain. How should nipple look after breastfeeding? Three weeks after birth: breastfeeding hell. Breastfeeding I hate it. Breastfeeding I can’t cope.
The NHS website told me to keep breastfeeding while seeking support. For £150, a lactation consultant visited me at home. She showed me how to feed the baby lying down and said that he had a possible tongue-tie, meaning that the strip of skin connecting his tongue to his mouth – the lingual frenulum – was tighter than normal, making it difficult for him to latch on. At the GP for Cyrus’s checkup, I told her about my pain. She told me that this appointment was just for the baby, but a doctor would call me. No one did.
I cried all the time. I barely left the house. My husband begged me to stop breastfeeding, but I refused. I couldn’t. Why? Why was I willing to give up my wellbeing to pour my milk into that tiny, perfect mouth? And why did none of the professionals tell me to stop?
***
Before the invention of formula in the 19th century, breastfeeding was the only safe way to feed babies. Infants whose mothers could not breastfeed either died, were breastfed by other women or were fed animal milk and contracted infections that often killed them. Nowadays, formula provides a safe alternative, providing parents have access to clean water and facilities to sterilise bottles.
In the UK, the NHS recommends exclusive breastfeeding – meaning no top-ups with formula – for six months, then breastfeeding alongside food into the child’s second year. “Breast milk is human-specific milk that is a live product,” says Prof Amy Brown, a public health researcher at Swansea University. “It contains antibodies and other properties to protect your health.” According to the NHS, breastfeeding reduces a baby’s risk of infection, diarrhoea, vomiting, sudden infant death syndrome, obesity and, in adulthood, cardiovascular disease, while for mothers it reduces their risk of breast and ovarian cancer, osteoporosis, cardiovascular disease and obesity.
Not everyone agrees. “I don’t think there is overwhelming evidence of the benefits of breastfeeding,” says Dr Ruth Ann Harpur, a psychologist and the co-founder of the Infant Feeding Alliance, a campaign group that calls for “compassion, autonomy and safety” in infant feeding practices. She says that breastfed children tend to come from wealthier families, who have better health outcomes anyway. Harpur is also concerned about the number of newborn babies being admitted to hospital with dehydration, due to parents attempting to persevere with breastfeeding even when the baby isn’t drinking enough milk.
The economist Emily Oster reviewed the scientific literature for her 2019 book Cribsheet and concluded that breastfed babies were less likely to have allergic rashes, gastrointestinal disorders, necrotising enterocolitis and possibly fewer ear infections, while mothers were less likely to have breast cancer, but that “the data does not provide strong evidence for long-term health or cognitive benefits of breastfeeding for your child”.
Brown rejects interpretations of the science that minimise the benefits of breastfeeding or say that breastfed babies have better health outcomes only because they tend to come from richer families: “Well-conducted studies control for those things and take them into consideration.” From a public health perspective, she argues, relatively small benefits for an individual baby can be really effective when multiplied across entire populations. “We know on a population level that breastfed babies have a lower risk of illness, particularly gastroenteritis and respiratory infections. When people say the evidence is only there on breastfeeding to reduce gastroenteritis – that’s still a pretty big thing for a small baby. If that was the only benefit, that would still be a huge benefit.”
But she is clear that parents who formula-feed are not harming their children. “Everyone has got to look at their own individual circumstances and make the decision that is right for them,” she says. “Breastfeeding is not the definitive factor that will affect your baby’s health over and above everything else. We know it helps to protect babies’ health on a population level, but you can’t just apply that data to any one baby.” If your baby is formula fed, she adds, “it will still thrive”.
***
When my son was six weeks old, I made an appointment with a tongue-tie expert and lactation consultant for £65. She looked at my nipples. “You have one of the worst cases of thrush I’ve ever seen,” she said. She gave me a letter to give to my doctor, explaining what antifungal medication I would need.
The medication made breastfeeding less painful, but the thrush kept coming back. My GP insisted that what I needed was antibiotics for mastitis, even though antibiotics are known to worsen thrush. Against my instincts, I did what I was told and took the antibiotics. The thrush got worse. Eventually, after much Googling – and I absolutely don’t recommend this – I took matters into my own hands. I visited three pharmacies, buying Canesten, an over-the-counter antifungal, at each, and improvised my own medication regime.
Eight weeks after my son was born, I breastfed him for the first time without pain and felt a new sensation radiating from the tips of my uncurled toes to the top of my unwashed hair. It was rage. I had traded my sanity for milk and only now was I returning to myself.
***
In the UK, most women want to breastfeed their babies, but stop a few weeks after birth. Accessing reliable data is difficult, because the government suspended its Infant Feeding Survey in 2010. At that time, only 1% of women were exclusively breastfeeding at six months. More recent data from Scotland suggests improvement, with 21% of toddlers being breastfed at 13 to 15 months of age.
If most women want to breastfeed, why do they stop? “This is my gripe with the Baby Friendly Initiative,” says Olivia Hinge, a midwife and lactation consultant who troubleshoots common breastfeeding problems for her 48,000 Instagram followers. She is referring to the Unicef programme for boosting breastfeeding implemented in many UK hospitals. “It’s all about reducing formula usage. But you can’t then not provide the service to support people.”
Hinge has worked in compliant hospitals. “They don’t mandate that you have to have certified lactation consultants or tongue-tie experts,” she says. Hinge is also concerned that parents are being told their babies have tongue-ties and are paying privately for frenulotomies (surgery to snip it) “when very often the baby doesn’t”. Last year, the New York Times reported serious complications, including babies being fed via feeding tubes, as a result of poorly performed frenulotomies by US providers.
There isn’t always a solution to common breastfeeding problems, says Hinge, because “no one is bothering to do any research into this”. Like thrush: some doctors believe it is not possible to get thrush in your nipples and that these women have subclinical mastitis. “All you can do is try stuff,” says Harpur. “There’s no evidence to inform how to help people with common breastfeeding problems. Many of them resolve on their own with time. But individual women need to know their own limits in terms of what to persist through.”
Doctors often aren’t up to date on what little research is being carried out. Take mastitis: the NHS advises women to apply heat to swollen, painful breasts. But a 2022 protocol from the Academy of Breastfeeding Medicine states that the best way to reduce swelling is with cold compresses. “When the hell is the NHS website ever going to get updated?” says Hinge. “Probably never.”
This is not a purely British problem. In Canada, too, medical students are barely taught about breastfeeding. “I always ask medical students when they come through the clinic,” says Dr Jack Newman, the founder of Toronto’s International Breastfeeding Centre. “They don’t know the first thing about breastfeeding.”
Throughout it all – from antenatal classes to postnatal wards – women are patronised by the medical system, particularly in the unnecessarily restrictive guidance about alcohol and breastfeeding. The NHS warns that “alcohol can pass into your breastmilk”. In reality, a woman’s milk alcohol level is the same as her blood alcohol level. Even if she had a blood alcohol level of 0.4% – enough to endanger her own life – her milk alcohol content would be 0.4%, about the same as a glass of fruit juice. “The amount that gets in the milk is insignificant,” says Newman. “The real issue with alcohol is: are you competent to deal with your baby if you are drunk?”
Some antenatal classes won’t teach women how to formula-feed. “I find that incredibly patronising,” says Hinge. “Silly little women. If we show them how to make a bottle of formula, that is what they will do. Monkey see, monkey do.” Infantilising baby-friendly guidelines encourage staff to praise women for any breastfeeding they do. Harpur recalls being praised by a health visitor shortly after she fell down the stairs due to sleep exhaustion compounded by breastfeeding at night. “She said I was doing really well,” Harpur says. “When I stopped breastfeeding, she said: ‘I am deeply sorry.’ But I was thriving. Why was she acting as if someone had died?”
This failure to consider the mental health of breastfeeding mothers can be enraging. Exclusive breastfeeding without pumping means that mothers are responsible for every night feed, with all the sleep deprivation this entails. “It does a real disservice not to consider women’s sleep needs as an essential component of their health and wellbeing after having a baby,” says Harpur.
Lauren, a 31-year-old social worker from Norwich, agrees. “Having an emergency caesarean under general anaesthetic didn’t leave me traumatised, but my feeding experience has,” she says. Lauren gave birth to her son in April 2023, but struggled to breastfeed. A hospital lactation consultant put together a plan that required her to breastfeed, then formula-feed, then pump, every two hours, day and night. “It was brutal,” she says.
She endured this regime for 10 days before realising that “it was ridiculous”, because she was pumping only 80ml of milk a day – barely enough for one bottle. “I would like the NHS to have a true framework around infant feeding that recognises some of the problems that people might face are insurmountable.”
Improving breastfeeding rates would save the NHS £40m a year, yet much breastfeeding support is carried out by unpaid volunteers. “This wouldn’t happen with a male problem,” says Hinge. “Would it?” In desperation, women turn to the internet. “There are times when we have 70 posts in one day and the inbox has 60 messages,” says Becky O’Connor, 31, a breastfeeding peer supporter from Liverpool. “You’re overwhelmed.” She is the founder of a Facebook support group with 54,000 members. O’Connor has helped women with “shocking cases of mastitis, breast abscesses, women who’ve been told [by doctors] that they won’t investigate what is wrong until they stop breastfeeding.”
She sees it as part of a bigger problem. “It’s medical misogyny,” she says. “The fact that women are being failed unfortunately doesn’t surprise me.”
***
The truth is that I have very few good memories of the first months of my son’s life, because they were ruined by breastfeeding. In my darkest moments, I would read online forums and rage at the mothers who said they enjoyed breastfeeding, because they made me feel like a failure for wanting to stop. Only I couldn’t, because I had internalised the notion that motherhood was sacrifice. “There’s this outside force telling you that it’s something you have to do,” says Lauren. “And if you do it, you’re a superstar. You’re a wonderful, amazing person.”
Now, 14 months on, to my astonishment, I am still breastfeeding, because I love it. Sometimes, when he is feeding, chubby little hands balled into fists, eyelashes fluttering, Cyrus smiles to himself. In that moment, I feel that there is something holy in this transubstantiation of milk from blood and bone.
I know that this will be a difficult thing for some women to read, because it will make them feel bad for not being able or not wanting to breastfeed. I want to say that it is absolutely fine to stop, or never start. Very often, that is the most loving thing to do, for you and your family. I wish I had stopped. The pain I went through wasn’t worth it. But if you do want to breastfeed, know that it should never hurt. If it does, something is badly wrong and you need help.
Recently, I found a bloodstained bra at the bottom of my laundry basket. I threw it in the bin. Never again, I thought.
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