Breast is Best

And the many edicts in postpartum life

“Breast is best,”—this is what everyone told me after I gave birth last summer. When my son was born, this phrase echoed through the loudspeakers, was implanted on my arm, and floated in my dreams. The expression was uttered by the midwives who were present at my delivery, by the doctors who monitored my C-section scars, and by relatives who were thousands of miles away. Everyone exclaimed with enthusiasm that my breastmilk, a golden elixir, was essential for the viability of my child. As a new parent, I was conflicted. The dictum was part of a daily aphorism, yet it felt like an empty cliché that did not resonate with my spirit.

Who was my breast best for?

The message suggested that my spongy milk ducts were not most advantageous for me. And yet, whenever I raised a doubt, I was told some unsubstantiated anecdote. “Your child will have a higher IQ if you breastfeed,” or “You’ll lose weight more quickly if you breastfeed.” Sleep-deprived and shell-shocked from the aftermath of bringing life into the world, I didn’t want to set my child up for failure. Yet, something else gnawed at me, and I didn’t want to be chastised by those around me for not trying hard enough. So, I did everything to stimulate my milk production: I drank 1.5 liters of water daily, massaged my mammary glands, and pumped with a factory-grade machine until the milky substance dripped from my stressed nipples. Each time I did this, my postpartum hormones triggered the release of prolactin and oxytocin, making me a walking restaurant for my baby. He would eat at 2 am and wake me up at 5 am. He would whimper at 8 am and try again at 11 am. Throughout the day, my activities revolved around his hunger, poo, and naps. The shackles of his ravenous—but—typical appetite held me captive. (Later, I found out I would feed him for about three to four hours for the first three months of his life.)

Anyone who has recently breastfed in Germany and wanted to stop doing so within the first month was probably told that they were compromising their child’s life or asked if they had a medical condition preventing them from doing so. They might have been discouraged by being told they would save money if they continued breastfeeding rather than purchasing formula.

But for me, behind every feeding was a lingering question, “When would this end?”

For the institutions I respected, such as the World Health Organization, officials recommended that people breastfeed for six months, if possible. Overall, these sources indicate that breastfeeding lowers the risks of asthma, allergies, or even SIDS. Yet, a characteristic of these directives felt hollow when the correlations were marginal. According to the NHS, one of the benefits of breastfeeding is that “you bond with your baby – breastfeeding is a lovely way to feel close and strengthen the bond between you and your baby.” Unsure, I felt I was bonding with my child while half asleep, feeding him in the middle of the night. This also suggests that people who do not breastfeed do not form a bond. The United States Centers for Disease Control and Prevention writes that breastfed infants have a reduced risk of asthma. Asthma is a long-term inflammatory disease caused by genetic and environmental factors, such as exposure to air pollution. However, it is unclear whether six months of breastfeeding can prevent a person from acquiring the disease later in life. According to the World Health Organization, “Breastfed children perform better on intelligence tests, are less likely to be overweight or obese, and are less prone to diabetes later in life.” Like asthma, obesity, and diabetes are triggered by genetic and environmental factors. But the intelligence remark left me wondering: if I stopped breastfeeding “too early,” would I be diminishing my child’s chances of getting into university? Probably not.

So much is left out of the public health decrees about infants’ health and breastfeeding, such as the class differences, inherited wealth, or education that mark children’s health. At the moment, individuals with higher education and social status tend to breastfeed more. As Emily Oster writes in Cribsheet,

“The relationship between breastfeeding and education, income and other variables is a problem for research. Having more education and more resources is linked to better outcomes for infants and children, even independent of breastfeeding. This makes it very difficult to infer the causal effect of breastfeeding.

Inspired by Oster’s book, I read peer-reviewed journals while breastfeeding for several weeks. For ethical reasons, scientists cannot conduct a study in which they “experiment” on postnatal people and their babies. Researchers often observe the patterns of people, with their consent, over several months or even years, if lucky. However, a challenge in many observational studies is having significant resources, time, and willing participants, allowing scientists to reach reasonable conclusions about trends. More importantly, they must detect substantial differences between a control and experimental group to establish certain claims.

Given all of this, one of the most comprehensive studies on the relationship between breastfeeding and an infant’s health was a randomized trial conducted in Belarus between 1996 and 1997. The Promotion of Breastfeeding Interventional Trial (PROBIT) study was a clustered trial involving over 17,000 mother-infant pairs and represents one of the most thorough studies on postnatal feeding in an industrialized nation. As the researchers pointed out, observational studies can have certain biases. Therefore, having a randomized trial with a yearlong follow-up was a significant advantage of the study, particularly one that could draw from 31 maternity hospitals and polyclinics in the Republic of Belarus. The intervention (or experimental) group included individuals who received assistance from healthcare workers to initiate and maintain breastfeeding. In contrast, the control group continued their infant feeding practices as they wished. By three months, 43% of the intervention group exclusively breastfed, while 6.4% of the control group practiced exclusive breastfeeding. That figure decreased to 7.9% and 0.6% by six months. While the data might seem low, the numbers did not mean people stopped breastfeeding altogether; sometimes, they introduced solids or formula into their baby’s diet. Given this, the significant question remained: were there major differences in infant health based on whether someone breastfed?

The likelihood of a baby developing a gastrointestinal tract infection in the experimental group was 9.1% compared to 13.2% in the control group, and for eczema, the rates were 3.3% versus 6.3%. The differences for respiratory tract infections were even more minor, at 39.2% and 39.4%. For the scientists, the differences in gastrointestinal tract infection and eczema were significant enough to warrant public health officials promoting breastfeeding. However, some might argue that a 4 and 3 percent difference is not significant. However, what was more notable is that most breastfeeding benefits occur in the first few months of life.

Beyond this, the PROBIT study suggests that if we want people to breastfeed, they should be given the space to do so. Many of the mothers I met in the U.S., where I was born, had to return to work within weeks or months after giving birth. There is no paid federal leave, and many working-class people (or freelancers without inherited wealth) do not have the option to breastfeed for more than six months. In Germany, there is a lot of pressure when it comes to breastfeeding, to the point that I felt there was a breastfeeding mafia waiting to see whether I pulled out a bottle or a boob.

In this brief life of motherhood, I have learned that whether or not people decide to breastfeed has a lot to do with their physical capability to do so, as well as whether they are granted paid maternity leave, access to a midwife, a free breast pump, a loving community, and free psychological support. I have also noticed that people with access to clean water and baby formula expressed relief from having a break from the 2 a.m. feedings.

Edna is breastfeeding in a Berlin hospital during the Summer of 2024.

Whether I decided to breastfeed had little to do with the act itself and more to do with the fact that, regardless of my choice, I would be failing as a parent, not my male partner. When I went on book tour in February, breastfeeding would have been complicated, especially since I was the primary caregiver. Writing, reading, and interviewing felt impossible, and I no longer wanted to be a 24-hour diner for my infant. Additionally, the mental health benefits of returning to work without the stress of rushing back for the next feeding felt liberating.

Our child's health, safety, and happiness were perceived as my responsibility, and a significant amount of judgment was directed toward me. The expectation that mothers should surrender their bodies and time without complaint or assistance is implied, which is why I tend to be rejected by a particular brand of mothers, because I do not approach mothering with taciturn solace or grace.

It is not clear to me that breastfeeding alone connected me to my child. Frankly, the process made me anxious about my unbalanced power in my son’s daily feast. But beyond that, mothering has been confusing because now, more than before, my desires are muted like someone whispering during a storm. I am embracing mediocrity, so I followed the WHO’s bare minimum recommendation and breastfed for 6.5 months. As I labored during the rhythm of postpartum flow, a voluminous message was pronounced: my breasts might be “best” for one person, but they weren’t mine.

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Some News

• I reviewed Zora Neale Hurston’s posthumously published novel, Herod the Great, for Nation Magazine. Please read and share the review with others.

• You can listen to my interview on Kirkus Reviews Podcast, where I discuss my book, literature, and more.

• My book was also reviewed in Undark Magazine. If you want to review it, please let me know, and I can send you a copy.

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Some Recommendations

• Clayton Dalton, New Yorker: A harrowing account about the destruction of the hospitals in Gaza.

• Milan Terlulen, Public Books: Some shade on why scholars have lost the plot.

• Geoff Dyer, Harper’s Magazine: Read a touching essay about how an author’s mother became invisible.

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If you like this post, please consider buying my latest book, A History of the World in Six Plagues, which examines the history of epidemics and the rise of public health in the modern era.

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