(NEW YORK) — As a pediatrician, Dr. Kristina Lehman knows the ins and outs of the evidence around breastfeeding better than most.
But as a mother, she also knows that breastfeeding is hard and that following evidence-based guidelines isn’t possible or the choice for everyone.
“I’m more proud of my breastfeeding relationship than even my [medical degree],” Lehman, who is also a breastfeeding medicine specialist, internal medicine physician and associate professor at the Ohio State University Wexner Medical Center, told ABC News.
The American Academy of Pediatrics (AAP) recommends that infants be exclusively breastfeed for the first six months of life and continue breastfeeding along with other food until two years of age.
Research shows breastfeeding has many benefits, including decreased infant infections and childhood cancers as well as a decreased risk of diabetes, high blood pressure, breast, ovarian and endometrial cancer in the mother.
But only about a quarter of women meet those recommendations, according to data shared by the U.S. Centers for Disease Control and Prevention. Experts said that’s partly because health care and social systems aren’t set up to support breastfeeding.
The gap may mean groups like the AAP should consider adjusting their recommendations to remove the emphasis on exclusivity regarding breastfeeding and amend the two-year time frame due to the unattainable standard for so many, argued Seattle physician Dr. Amy Kennedy in a recent editorial in the New England Journal of Medicine.
“I encourage the AAP and other national health organizations to consider how their statements on exclusive breast-feeding are perceived by the public,” Kennedy wrote. “Everyone’s journey is different.”
But other experts said increasing support is the best way to close the gap — not changing the guidelines. Last week, Lehman and Dr. April Castillo, a preventive medicine physician and breastfeeding specialist, published an article in response on the physician-facing website KevinMD.
They argued that the health care system — including doctors themselves — needs to improve the support of women in their infant feeding choices.
The lack of social support, limited education for physicians around breastfeeding, and marketing from the formula industry adds to the stress, anxiety and isolation during an already fraught time, according to Dr. Anne Eglash, a family medicine physician and president of the North American Board of Breastfeeding and Lactation Medicine.
Postpartum depression and anxiety — which affect 1 in 8 people after delivery, according to the CDC — can make the process even more challenging.
The current system makes it difficult for parents to actually make a choice either way, according to Eglash, who told ABC News that “no one is supporting” parents.
Eglash described a situation in which medical providers tell the public people should breastfeed, but then send new parents, “out to run that marathon and there’s a desert and no one’s offering any water.”
Changes that could help might include improving doctors’ education around breastfeeding, putting resources towards systems that can help parents find infant feeding experts like lactation consultants, and increasing awareness around postpartum depression, according to Eglash and Castillo.
There also need to be more resources around mixed feeding, which combines breastfeeding and formula feeding, Castillo told ABC News.
But even with improvements in support, meeting guidelines still might still not be feasible for some parents, according to Kennedy.
She said she had many resources at her disposal and a supportive partner, but breastfeeding was difficult for her. She said she wasn’t able to exclusively breastfeed for six months, much less breastfeed for two years.
Still, all the experts agreed that people feeding infants need compassion, regardless of the way they navigate the journey.
“I think a lot of women think that it is all or nothing. And so when they try all and it’s too hard, they totally quit instead of backing off a little bit. But that’s where you need that individualized support to be able to say, what are your goals?” Lehman said. “It’s a conversation and it has to be individualized.”
Eglash noted that the goals aren’t the problem — the system needs to change to help people have the best possible experience.
“I think the big thing is that we all want babies fed, right? And we want parents to meet their intentions, to have the right to feed their babies the way they intend,” Eglash said.
Danielle Craigg, MD, is a senior general preventive medicine and public health resident at Renaissance School of Medicine at Stony Brook University and a member of the ABC News Medical Unit.
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