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CONTENT WARNING: This story contains mentions of suicide, postpartum depression, and infant loss, and may be triggering or activating for some.
In the midst of World Breastfeeding Week, some heartbreaking headlines have emerged here in Singapore: “Woman found dead with baby told loved ones about stress over pumping milk, son’s jaundice,” says one article. News of the tragic discovery of this 33-year-old Singaporean mother and her newborn in December 2023 sent shockwaves through the local maternal collective.
She conceived her son after a miscarriage and confided to her husband and younger sister about her “dark thoughts” and overwhelming stress over childcare and her ability to pump enough breast milk, according to reports. Despite having plans to transition from pumped breast milk to feeding her baby formula milk, the mother expressed guilt and felt that she was lazy.
For better or worse, many mothers internalise the message of ‘breastfed being best’, but at what cost to themselves? And with what resources? While well-meaning, the message is often force-fed to mothers with little nuance, tangible support or room for flexibility. Opinions from sciolists on feeding and all that lactation entails (breastfeeding, pumping, or formula) come thick, fast, and often unsolicited, leaving mothers having to reconcile polarising societal expectations with their individual lived experiences. At this vulnerable time, it’s mothers who bear the burden not only of finding the “right” evidence-based support, but shouldering the mental and physical load of this unpaid, and taxing task of feeding.
‘Breast is best’ is often set up in opposition to ‘fed is best’ yet both are realities for mothers. Who or what is imposing these standards?
“For those struggling with breastfeeding, the prevailing narrative that “breast is always best” can feel suffocating,” muses Sasha Carroll, mother and community director of Wellbub, a Singapore-based platform for pre- and postpartum support. “The medical system, social media and at times the lactation support network drive home this message in various ways. When you’re already in such a vulnerable postpartum state, and breastfeeding isn’t going to plan, it can feel like the end of the world.
“Your worth as a mother is not measured by how much milk you can produce, or how blissful your breastfeeding journey is,” states Carroll
Eliza Koo, international board certified lactation consultant (IBCLC) and founder of Tender Loving Milk observes that mothers are often “expected to breastfeed without much needed support and evidence-based information and education”. Because of the immense amount of information online and on social media, many mothers inevitably may perceive pressure to breastfeed.”
Why is breastfeeding viewed in such binary, pass or fail terms?
As a lactation consultant, Koo’s work seeks to bust two key myths surrounding breastfeeding. Namely, “Assuming that breastfeeding is automatic: Many people assume that since breastfeeding is natural, it should also be automatic, thus they do not go through any learning process (e.g., attending a breastfeeding workshop) while pregnant. Breastfeeding is still a learned skill that both mother and baby need time to learn and practice. Learning about breastfeeding before the baby arrives helps with postnatal expectations and life.”
“Not knowing where to seek proper help: Insufficient support from healthcare providers, caregivers, and social circles can contribute to various inaccurate breastfeeding information,” Koo continues. “Many parents still do not know specialised breastfeeding support exists. Imagine being pregnant for nine months with monthly to weekly checks with the OBGYN. After the baby arrives, families are usually left alone to navigate postpartum life by themselves after being discharged from the hospital, which can already be tough, before adding breastfeeding concerns into the mix.”
“Breastfeeding is a journey. It takes more than just wanting to breastfeed to succeed. Sufficient preparation is important. Many mothers may also require support from IBCLCs, community, healthcare providers, workplace, caregivers, family, and more,” Koo adds.
But what if you’ve done the breastfeeding workshops, read the books, sought various forms of help and are still at your wit’s end?
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How all-or-nothing thinking affects feeding mothers
“It can feel catastrophic,” says Carroll on finding middle ground. “You couldn’t manage something that’s purported as biologically straight-forward and essential for your newborns wellbeing. This is an incredible amount of guilt and pressure for a vulnerable new mum and can lead to the worst possible outcomes for those struggling with their mental health.”
Carroll attributes these societal expectations to numerous factors: “The demonisation of formula over the last 15 years, the major breastfeeding support institutions still having a very binary view on “breast being best”, and the lack of available resources out there on successful alternative journeys. For example, combination feeding, formula feeding or pumping. If all we consume is textbook perfection with breastfeeding, it leaves a lot to be deemed as a failure in this regard.”
Ultimately, for Chantel Kismet, trauma-informed doula, somatic practitioner, and founder of Blooming Birth Doulas, “Prioritising a mother’s mental health is crucial. No mother should be made to feel less than for choosing what’s best for her mental wellbeing and her baby’s nourishment.”
“My philosophy is that “fed is best”—if a mother chooses to breastfeed and can do so successfully, then “breast is best”. However, if breastfeeding is not an option and formula is necessary to help her baby thrive, then “fed is best”,” says Kismet
“Society imposes unrealistic standards and pressures on mothers, creating a culture of judgment rather than support. This binary thinking ignores the complex, individual experiences of each mother and baby. Mums can make the right decision for themselves by tuning out societal noise, seeking comprehensive information, and embracing a supportive community,” Kismet explains. “There is no one-size-fits-all answer to motherhood.”
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When direct latching is not an option
“When breastfeeding isn’t possible, I advocate for donor’s milk, pumping or formula without hesitation,” says Kismet. “I encourage mothers to explore their “why” for wanting to breastfeed, and their long-term and short-term goals. At the end of the day, the decision should be based on what maintains the mother’s and baby’s health and well-being.”
Views differ. Unlike Kismet, Koo describes utilising infant formula milk as the “last resort”, “if it’s medically needed and if breastfeeding ceases before the baby turns one year old.”
“There is a very small population of mothers with chronic low milk supply and it is usually attributed to health and development conditions, some of which are underdevelopment of breast tissues, hormonal imbalance and others,” Koo explains. Other than expressing breast milk by hand or via hospital-grade electric pumps, “there is a community-led donor breast milk page where mothers readily and willingly donate their excess breast milk.”
How can we better support mothers in their postpartum journey?
“We need to take mental health more seriously in the postpartum period, and that starts with being transparent and forthcoming with information on safe, suitable alternatives to exclusive breastfeeding,” Carroll affirms. This includes being “collectively aware of the language we use around new mums when we talk about feeding.”
“Know that all mothers want to do the best they can for their babies based on whatever environment, resources and support they have. Singaporean society needs to re-frame how we approach supporting mothers during the postpartum period,” shares Koo. In addition to getting credible help, “it is also crucial to eliminate the ‘bounce-back’ pressure as well as educating family members and friends to learn how to recognise the highs and lows of maternal mental health and being open to seeking trained mental health support.”
The signs of waning maternal mental health in postpartum life to watch for
“Warning signs are non-stop, uncontrollable crying, recurring negative words used such as “I made a mistake”, no eye contact during conversations, speaking in a very low voice with very little confidence. The other extreme is masking anxiety or depression with loud and repetitive laughter, and finally, a hollow-looking expression,” shares Koo, who looks out for signs of postpartum anxiety and depression in mothers during her home visits.
For Carroll who is often at the epicentre of Wellbub community events, “Isolation is the biggest warning sign for us that someone is struggling in the community, particularly when we think about feeding. When new mums are overwhelmed with pumping schedules, feeding challenges, or introducing formula—we know this is a pivotal moment to reach out and check everything is ok.”
What resources are available for those determined to continue their breastfeeding journey?
“Choosing to breastfeed or not, is a personal decision depending on the mother herself. In our community, parents may still often seek breastfeeding advice from people who are not credentialed with breastfeeding management education—such as the masseuse, the confinement lady or even the GP. These professionals have different roles in helping mothers. Instead, mothers can approach the Breastfeeding Mothers’ Support Group (BMSG), Singapore’s one and only charity group that provides assistance to breastfeeding mothers through counselling, support and education. Additionally, parents should seek trained lactation help from an IBCLC (International Board Certified Lactation Consultant) when there is need—as an IBCLC is a specialised healthcare professional in the clinical management of breastfeeding.”
“Regardless of socioeconomic status, all mothers have access to IBCLCs and lactation support in maternity hospitals and polyclinics, as well as IBCLCs in private practice,” says Koo.
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You are not alone. For information on breastfeeding, visit Breastfeeding Mothers’ Support Group or HealthHub. If experiencing distress relating to postpartum anxiety, depression, contact: Samaritans of Singapore Hotline: 1767; Institute of Mental Health’s Helpline: 6389 2222; Singapore Association for Mental Health Helpline: 1800 283 7019.
