Sarah's breastfeeding difficulties began in the hospital.
Her daughter, born three weeks early, was too little to properly latch and struggled with weight gain and jaundice.
When the two left the hospital, their troubles continued. Sarah, who requested her last name not be used, worked with a lactation consultant who helped some, but not enough. After six weeks of "struggling and fighting," she stopped nursing her daughter, though she did continue to pump and feed her newborn whatever breast milk she had.
"My feelings surrounding my breastfeeding experience have been all over the place," said Sarah, who works as a nurse in a neonatal intensive care unit. "My feelings of inadequacy were fueled by my own insecurities as a new mom as well as others who were 'disappointed' in my inability to nurse my daughter."
According to new research published Monday in the journal Pediatrics, there are many new moms like Sarah -- women who plan to breastfeed, but for one reason or another end up changing their plans.
Some 85 percent of mothers who wanted to breastfeed exclusively intended to do so for at least three months, but only 32 actually reached their breastfeeding goals.
Only 1 percent of moms set out to breastfeed for less than a month, but that was exactly how long more than 40 percent of moms lasted.
"What this says to me is that our low breastfeeding rates are not because women don't know about the benefits of breastfeeding, or because they don't want to breastfeed," said study author Cria Perrine, a researcher with the division of nutrition, physical activity and obesity with the Centers for Disease Control and Prevention. "It's because they're not getting support."
To study mothers' breastfeeding intentions versus the amount of time they actually breastfed, researchers relied on recent CDC data that tracked women during pregnancy and through their babies' first year. The World Health Organization and the American Academy of Pediatrics recommend that babies be breastfed exclusively for at least six months. But two-thirds of the moms surveyed did not breastfeed for as long as they'd intended, whether it was one month, six or more.
One of the main questions researchers tackled was how hospital practices affect new moms' ability to achieve their personal breastfeeding goals. They found that the biggest factor affecting moms was that hospitals were not following one of 10 steps required to earn the "baby-friendly" designation -- the withholding of supplemental formula. Researchers found that despite the recommendation, more than half of babies received some form of supplementation in the hospital.
"It's alarming that 40 percent of healthy babies whose mothers wanted to exclusively breastfeed were nevertheless given formula in the hospital -- and it underscores the low quality of care that's provided in maternity hospitals in the U.S.," said Dr. Alison Stuebe, an OB-GYN and assistant professor of maternal and child health at the University of North Carolina. Stuebe was not associated with the research.
While researchers found that formula supplementation was the only statistically significant factor influencing whether moms met their goals, Stuebe said it's also important for moms to follow other "baby-friendly" policies, like maintaining skin-to-skin contact and staying with their baby 24 hours a day. She said these things can help establish milk supply, making supplementation unnecessary.
"The more a baby suckles at the breast in the first few days of life, the more milk a mother will make," she said. "Giving a baby a bottle interrupts that relationship and thus can reduce mom's milk supply, setting her up for problems in the future."
Breastfeeding, which has been shown to protect babies and fight disease, has become an area of increased focus in the U.S., where there are currently 143 hospitals that have been designated "baby-friendly." Last year, U.S. Surgeon General Regina Benjamin issued a call to action to support breastfeeding, asking for increased community and clinician support for new mothers. But "no mother should be made to feel guilty if she cannot or chooses not to breastfeed,"she said.
What the new study suggests is that there may be large numbers of women grappling with exactly that guilt -- women who had planned to breastfeed, but fell short of their goals.
"As for forgiving myself, I'm still struggling with achieving full forgiveness," Sarah said. "Even though I have worked extremely hard to have breast milk to feed my daughter, I still feel as if I have failed her in some way."
In blogging about her experience, she has come into contact with many women who share her struggles, she said. She has also begun to spend hours working with women who she sees in the NICU struggling with breastfeeding.
"Women really need a lot of praise in the early baby period, and they're not given a lot of praise," said Susan Burger, president of the New York Lactation Consultant Association. "Often in the hospital, it's, 'Your baby isn't eating enough; he's crying.' Instead of just staying, 'Look, you're trying this and it's a great thing. Now let's get the two of you in sync.'"