Current recommendations from experts urge new mothers to breast-feed their newborns for the first six months of life. But, a new survey out of Scotland suggests that for many women, this expectation just isn’t realistic.

“Idealistic messages about breast-feeding and the representation of breast-feeding as easy and natural may exert pressure on some women,” said study author Dr. Pat Hoddinott. “Women do not find breast-feeding easy, and they require timely and appropriate support.”

Both the World Health Organization and American Academy of Pediatrics recommend six months of exclusive breast-feeding. However, many women don’t follow the guidelines completely. In the United States, the percentage who breast-feed only for that time is thought to be around 13 percent.

Meanwhile, support for breast-feeding has led to the hiring of “lactation specialists” who teach and support new mothers in hospitals, and critics complain of a culture of “breast Nazis.”

In the new study, researchers asked 541 women to take part in a survey. They ended up interviewing 36 of them and 37 others, including partners and relatives, about infant care.

The study authors write that some health care professionals put pressure on “unconfident” new parents: some women described it as “just one big guilt trip” and reported feeling “heartbroken” about stopping breast-feeding before six months. One spoke of “negative tension” for wanting to move to solid foods at 17 weeks.

“It all seems to be ‘don’t ever do anything that would interfere with breastfeeding,’” one woman told the researchers. “It’s all got to be very purist, which is fine, but it just doesn’t fit in with the rest of your life … I think people just give up because it’s too difficult.”

Another woman said that, “I think a reality check actually would be good, because they [healthcare professionals] make it sound so easy.”

Health workers should support women and build their confidence about breast-feeding, said Hoddinott, a senior clinical research fellow and general practitioner at the University of Aberdeen. “Our advice would be that women should breast-feed as long as they can and introduce solids as close to 6 months as possible.”

What do American doctors think?

The recommendations about breast-feeding remain valid and shouldn’t be ignored, contends Dr. Richard J. Schanler, associate chairman of the department of pediatrics at Cohen Children’s Medical Center of New York.

The goal for medical professionals should be to help women meet the guidelines, he said, although “it’s going to take years to get us moving in the right direction.”

Still, breast-feeding isn’t appropriate for every mother, added Dr. Bradley Thach, a professor of pediatrics at Washington University School of Medicine in St. Louis.

He said the guidelines make sense in underdeveloped countries, where onetime recommendations about using formula instead of breast milk turned out to be disastrous. “That led to lots of infectious diseases in young infants, which breast-feeding protects against, and a lot of deaths. As a world health thing, it’s commendable. Breast-feeding is good if you can do it.”

However, many women have trouble with breast-feeding for a variety of reasons and may suffer from pain, Thach said. At the same time, women in the United States may face pressure to breast-feed from people like lactation specialists at hospitals, he added.

Rahil Briggs, an assistant professor of pediatrics at Albert Einstein College of Medicine, cautioned that the number of women who chose to take part in the survey is small — just 36 of more than 500. “It’s safe to assume that these 36 women may have differed in some significant way from all those who declined,” Briggs said. “Perhaps they experienced particular difficulty related to breast-feeding, for example.”

While goals are important, Briggs said, “as a health care system, we need to provide timely, culturally respectful, informed assistance to families around these goals, to help each family interpret the recommendations in a way that works best for them.”

The study appears March 14 in the journal BMJ Open.

More information

For more about breast-feeding, try the U.S. National Library of Medicine.

SOURCES: Pat Hoddinott, BSc, MB BS, Ph.D., senior clinical research fellow and general practitioner, University of Aberdeen, U.K.; Bradley Thach, M.D., professor, pediatrics, Washington University School of Medicine, St. Louis; Rahil Briggs, Psy.D., assistant professor, pediatrics, Albert Einstein College of Medicine, New York City; and Richard J. Schanler, M.D., associate chairman, Department of Pediatrics, Cohen Children’s Medical Center of New York, Flushing; March 14, 2012, BMJ Open, online

Last Updated: March 15, 2012