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A friend who got married recently asked me whether I experienced more joy or more suffering since having my daughter. My instinctive response was: both, simultaneously, on an ongoing basis. There’s no better example of this strange phenomenon than my experience with breast-feeding.

There were so many moments during our 13 months of breast-feeding when my daughter and I were completely in sync. Those moments made me feel inextricably connected to her, as if there was a line of emotional and physical energy that bonded us together.

Then there were other moments. When I threw a bottle across the room in rage because she went on a bottle strike for 10 days and I was terrified she wasn’t getting enough calories at day care. When I got my first clogged duct. When my daughter’s weight gain temporarily plateaued and I had to cart her around to multiple health-care providers and lactation consultants.

Scientists generally agree that breast milk is the best option for babies, offering nutritional benefits as well as crucial physical and emotional benefits. The American Academy of Pediatrics recommends that women breast-feed for at least six months and up to a year or longer “as mutually desired” by mother and child.

Throughout my daughter’s first year of life, I couldn’t shake the feeling that there was something inherently anti-feminist about what was going on. I was promised by natural birth guru Ina May and La Leche League that breast-feeding would be a beautiful and natural process, the ultimate manifestation of my feminine energy. I was not prepared for the reality of it: the constantly interrupted sleep, the stress of managing nursing and pumping logistics, and the inability to delegate so much of this essentially physiological task. Most of the time, despite my husband’s offers to help, I was so tired I didn’t even know what to tell him to do. Even the thought of pumping a bottle so he could take over feeding our daughter every so often seemed too overwhelming and exhausting.

The terms “emotional labor” and “mental load” happened to go viral during my maternity leave. The mental load associated with breast-feeding is immense. Every day that you’re breast-feeding, some variation of these questions are running on a loop in your head:

I am pro-breast-feeding but also pro-mother. What we need in this country, and around the world, is more systemic support for all mothers. (What we don’t need is more misleading marketing of formula to vulnerable populations, many of whom may not have access to the clean drinking water needed to make formula.) This includes support for mothers who may not produce enough milk for their babies or be able to breast-feed at all, and mothers who choose not to nurse for a variety of very personal reasons.

Many women can and want to abide by the AAP’s recommendations, but not at the expense of their own mental health, the equality in their relationship or their career trajectory.

Hanna Rosin said it best:

Not only the actual time spent with the pump or nursing our babies, but the time spent planning, debating, worrying, cleaning and organizing everything having to do with breast-feeding. It’s a mental load that is uniquely difficult, if not impossible, to equally share with your partner. It’s borne by women who are still recovering from their deliveries and too often returning to work before they are mentally and physically ready.

The more I talked to others who are breast-feeding, working mothers in my personal and professional circles, the more I realized I wasn’t alone in experiencing this daily internal monologue of worry and stress. Below are some of their stories.

“Breast is best” can have the unintended consequence of aiming the focus solely on what’s best for the baby, but not necessarily what’s best for a mother and her family, and little to no regard for the mother’s postpartum experience. First of all, it can hurt — a lot — and sometimes for weeks.

For Becca Ruben, mother to 4-month-old Charlotte, this was made clear in the hospital after her delivery. “Every time they were trying to teach me how to do it, I just had this feeling that I didn’t matter, and it was all about getting her to latch.”

Two other women described to me going to their doctor with symptoms of sharp pain, only to be told that the pain was normal and that they should power through, when they really had thrush, a very common condition for breast-feeding mothers that their doctors weren’t familiar with.

Medical professionals largely focus on mothers’ physical recovery, the establishment of breast-feeding, and the growth and health of the baby, as they should (and there are still severe gaps across the spectrum of postpartum health care in the United States, disproportionately affecting disadvantaged populations). Beyond physical measures of recovery and health, there is little proactive investment in the emotional and mental health of mothers.

There’s an overall expectation that mothers must be dedicated selflessly to the needs of their babies above all else. But what babies need most is healthy, happy caregivers who have the energy and strength for the job. It’s difficult to be the parent you want to be if you haven’t slept for more than a four-hour stretch in months.

Parenting roles can get set in those early days, when you and your partner are finding your identities as mothers or fathers. Because breast-feeding is a constant job, and central to the baby’s major health indicators in the first weeks and months of life, the primary caregiver role often gets cemented on the breast-feeding mother.

Alexis DeBernardis, mother of Grace and Michael, who chose and was able to breast-feed both of her children past their first birthdays, says that multiple factors led her to assume the role as the primary caregiver, but perhaps the largest and least obvious factor was her decision to breast-feed. “I had a comfortable maternity-leave policy and flexibility to adjust my schedule at work, combined with being the sole source of my infants’ nutrition, it always just made sense for me to be doing more – and I would not have given it up anyway.”

Equality in her partnership is a big reason Shelley Rosenberg, who just gave birth to her son Leo, says she’s leaning toward not breast-feeding. “If I’m the source of food every two or three hours, it’s all on me. Not breast-feeding would make the division of labor a lot more equal. We could split it up, like, this is your night, this is my night.”

Given all the other physical and structural imbalances with pregnancy, delivery and paternal leave, breast-feeding can be one more factor that skews the burden toward women.

And even when two parents can actually split up the physical work of breast-feeding, it’s still a lot of work. Erin Abrigo describes how she and her partner, Manda Lamb, had to navigate a shared responsibility of feeding after Abrigo induced lactation ahead of the birth of their daughter, River. “We had a lot of conversations about how to divide up the breast-feeding. It was amazing to be able to share it, but there’s other complications. It created a lot of work for both of us. We needed to pump if the other one was nursing. It took a lot of communication, and there were definitely challenges.”

For Andrea Ippolito, mother to 4-month-old Mae, the fact that she didn’t have enough supply to keep up with Mae’s needs ended up being “the biggest gift” for the division of labor in her family. “Because I was told I needed to supplement from Day One, it took off an enormous pressure. My parents could feed her, my husband was able to do night feedings. I was able to focus on rest and healing from delivery. Everyone was able to help out, it wasn’t just on me.”

In other parts of the world, women face these choices, fears and anxieties within the context of more systemic support. A key reason that women stop breast-feeding is the need to return to work, and the inability to continue both exclusive breast-feeding and their jobs. In other developed countries, women often have a year or more of paid and/or job-protected maternity leave, which more than covers the AAP’s recommended breast-feeding goal. Other countries’ leave programs can often be used or split by both parents, allowing partners to take on greater responsibility and provide much-needed support from the very start.

Employees in the U.K. are guaranteed up to 52 weeks of maternity leave, which can start up to 11 weeks before the birth (especially important for women who have health issues during pregnancy or go into early labor). The first six weeks are paid at 90 percent of average weekly earnings (AWE), and the following 33 weeks are paid at £145.18 per week or 90 percent of their AWE, whichever is lower. Leave can also be shared with a partner. NHS England also offers routine home visits by nurses to check in with new mothers after birth and assist with breast-feeding or any general issues the mother may be having.

Canadians receive multiple types of parental benefits. Mothers can receive up to 15 weeks of employment insurance paid at 55 percent of average earnings, and both parents can share 35 weeks of standard parental benefits paid at 55 percent, and extend up to 61 weeks at 33 percent of average earnings, up to a maximum amount. Telehealth Ontario also offers free, 24/7 support to breast-feeding moms from nurses speaking over 300 languages.

One of the world’s most generous leave policies, Norway offers 46 weeks of paid leave, up to 14 weeks of which can be taken by the father. They also have a right to work part-time until their youngest child is 12, and universal access to affordable child care. Norwegians have comparatively high breast-feeding rates over time and strong female participation in the workforce, as Norwegian women can take advantage of multiple state-sponsored supports to achieve a better balance between work and family.

I am lucky and privileged, and many of the women I spoke to about this topic acknowledged their privilege as well. I have a husband who splits home and family-related work with me pretty close to evenly. I have a work environment that is extremely supportive, including a boss (also a working mom) who once drove us between meetings while I pumped in the back seat of the rental car. I have an office with a door that locks and a mini-fridge. My employer subsidizes a day care across the street that allowed me to run over, nurse and be back at my desk in 20 minutes.

And I would still say that making it to a year of breast-feeding is one of the hardest and most consistently stressful things I’ve ever done. For most women who don’t have access to these kinds of resources and benefits, it is much harder, if not impossible.

Breast-feeding brought me confidence and closeness with my daughter in the first weeks and months of motherhood, despite the exhaustion.

For me, the pros outweighed the cons, and I would do it again. But it doesn’t need to be this hard for women who want to follow the national guidelines for breast-feeding.

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