Breastfeeding advocates and breastfeeding mothers often find it challenging to talk about the benefits and rewards of breastfeeding without accusations of being judgmental or making other mothers feel guilty. We cringe each time we hear mothers say things like "I tried to breastfeed but my body just didn't make enough milk," knowing that mother probably did her best and wishing she'd had better support. We are caught between not wanting to make that mother feel "guilty," but wanting to increase awareness among other mothers listening about how this situation can be avoided.

Given an overall societal lack of support for breastfeeding, and a high level of misinformation about breastfeeding challenges and solutions, those wanting to spread the word about breastfeeding must walk a careful line. And now, on the heels of a major study published by Pediatrics, the journal of the American Academy of Pediatrics (see my article "Breastfeeding and Health Care Costs", in related links at the end of this page), there's been a great deal of discussion of how to meet study's goal of 90% of mothers breastfeeding exclusively until the baby is 6 months of age. There's been a great deal of talk about workplace support and hospital policies, but to reach this goal, influencing the commitment of individual mothers towards breastfeeding will have to be addressed.

This issue of breastfeeding and guilt issue is a tough one, as the advocacy of breastfeeding, whether intended or not, is necessarily a criticism of formula feeding. I don't see any way around educating mothers-to-be about the hazards of formula without making those who are already mothers feel bad about having used it. I think approaching it with good intentions can mitigate this slightly, but not altogether.

There are some advocates who feel that those who never try breastfeed or who throw in the towel early on *should* feel guilty, so why should we care. I can't say I quite agree with this sentiment, although I understand where they are coming from. Having struggled mightily and painfully myself and persevering, it is certainly hard to completely bury that feeling of pride and yes, superiority, that sometimes rears its head.

I don't believe there is any value in simply trying to make others feel bad for not living up to some standard for which we advocate. But ultimately, I don't intend to pull any punches in terms of educating mothers-to-be about the relative values of formula and breastfeeding in order to shield the feelings of those for whom it is "too late." So it's a bit of a dance....

In my article about healthcare, I mention that YES, workplace issues and hospital issues absolutely have to be dealt with -- especially hospital issues. But without a societal *expectation* that woman *should* breastfeed (not just support for those who want to) we won't reach the goals we are trying to achieve. And any expectation of that kind will necessitate, to some extent, judgment and yes, guilt. I don't see a way around it, despite our best intentions.

I think that the best we can do to mitigate this issue is to assure mothers that, in the words of the instructor for my lactation education program, they did the best thing for their baby with the support and information they had available. Every mother's story is unique and often complex. But that doesn't change the facts we now know about the relative value of breast milk and formula.

We should offer knowledge, our example and our support with pride and a true desire to be of service to mothers with sensitivity, but without embarrassment or apology. If handled well, perhaps formula-feeding mothers will become not our enemies in the cause, but our allies, desiring to share the information with other mothers (and later, their own children) that they wish they had known.