‘Feeling like a failure’: Mums tell how pressure to breastfeed led to anxiety, depression

SINGAPORE — Ms Ethel Yap, 36, who has a four-year-old child, remembers “feeling like a failure” when she resorted to feeding her son formula milk within the first week of his birth.
Surrounded by positive breastfeeding experiences from the other mothers in her family, the singer-songwriter thought that nursing her son would be easy when the time came.
However, without a supply of breast milk by the time her newborn was discharged from the hospital, she had to turn to feeding her son formula milk for a while. 
“It was a massive, massive hit to me, because within the first two days of his birth, already my supply was just not coming in fast enough, and he was getting jaundice, his urine was crystallising, and all these horrible things.”
Later, even as her breast milk supply started flowing, Ms Yap found that she had trouble getting her baby to latch for feeds.
“I was very, very depressed that we couldn’t exclusively latch,” Ms Yap said, referring to the practice of feeding one’s child directly from the breast, as opposed to feeding expressed breast milk through a bottle. 
“So even though it was sort of a half-latching-half-pumping routine, I just felt like a failure every time I had to pump, every time I had to bottle-feed him.
“My mind kept drifting to thoughts such as, ‘The only reason why my son is still alive is because we live in modern times, when formula has been invented and breast pumps have been invented. But if we were living in an earlier time… my son would have died because the latching was unsuccessful.’
“And I really tortured myself with these thoughts.”
The pressure she felt to breastfeed was compounded in part by reading and watching social media content of other mothers showing how much they had pumped, how big their stash of extra breast milk was, or pictures of their child latching in what was portrayed as a “beautiful bond” between mother and baby. 
“Breastfeeding and struggling to latch my baby was quite a big contributor to the initial stages of my postnatal depression and my postnatal anxiety, which I had for 18 months,” recalled Ms Yap, who is also a theatre actress and art educator.
The third National Breastfeeding and Child Feeding Survey — done by the Health Promotion Board (HPB) between October 2021 and February 2022 — found that 97 per cent of mothers here breastfed their babies at some point.
A decade before that in 2011, the national survey found that 96 per cent of mothers breastfed their babies at some point, similar to the 95 per cent in 2001. 
Despite the high prevalence of mothers attempting to breastfeed in Singapore, the surveys found that the proportions of mothers who exclusively breastfed, or who were still breastfeeding their child six months after birth, were significantly lower.
The 2021 survey found that 46 per cent of respondents exclusively breastfed their infants aged zero to three months. The proportion fell to 35 per cent of respondents for those who were breastfeeding their infants aged four to five months.
And six months after giving birth, 3 per cent of mothers were exclusively breastfeeding their child.
Several mothers interviewed by TODAY said that while they were aware of the benefits of breastfeeding, it was not always easy in practice.
Some women said they struggled to produce enough breast milk for their child while other working mothers told TODAY that continuing to express milk when they returned to work was cumbersome.
Across the board, however, the women said that they could not help but felt a twinge of guilt when they chose to stop breastfeeding or were unable to breastfeed their child.
Ms Tsuraiya Zakaria said that she felt pressured when she struggled to breastfeed her newborn.
The 33-year-old entrepreneur and mother of two recalled how when breastfeeding her firstborn, who is now five years old, she had blocked milk ducts and a low initial breast milk supply.
“I truly felt the pressure as a first-time mum, with the nurse emphasising that my son’s diaper was dry, which meant that the milk was not enough.
“It did take a mental toll on me and I was still healing from childbirth.”
The global push in favour of breastfeeding, beginning in the 1990s, has led to the widespread adoption of the belief that “breast is best”.
For some mothers, they started to feel an implicit pressure to breastfeed and a subsequent sense of having “failed” when their own breastfeeding journeys were not smooth and did not measure up to what they understood to be the standard journey of a new mother. 
Ms Gwendolyn Toh who has three children under five years old, including a three-month-old infant, said that breastfeeding was “challenging” for the first child, when her milk supply took longer than expected to start.
“I’ve heard that breast milk can take around four days to kick in, but for me, it was more like a week plus,” the 30-year-old graduate researcher said.
“It was very stressful hearing (my) baby cry and thinking that he was not getting enough.”
“I ended up getting some breast milk from a friend who had given birth around the same time, but it was difficult to see my baby gulp down that milk hungrily,” she said, adding that it made her “feel like a failure”.
She eventually overcame such a mindset when she found peace with nursing her baby at her own pace.
“I think there is this societal push that as a mother, you need to breastfeed.
“I have come to terms with accepting that my journey with breastfeeding is my own and it is not important what others expect me to do. I have to follow my own pace and do what works for me.”
Lactation consultants told TODAY that new mothers can be harsh on themselves when it comes to breastfeeding, especially when they forget that they are doing something new to them.
Ms Eliza Koo, an international board certified lactation consultant and founder of her own lactation consultancy Tender Loving Milk, said: “The misconception that breastfeeding should come naturally and easily, when it may not, may shock many new mothers.
“Breastfeeding is a natural act (but) it is also a learned skill for mothers.
“In (our) society, we’re simply not exposed to breastfeeding as children, so we grew up not knowing what’s normal or abnormal with breastfeeding a baby.”
Although lactation support is offered in hospitals here to parents after their children are born, most families may not get the dedicated attention they need to learn fully from the lactation nurses due to time constraints, Ms Koo explained.
“It is a huge challenge for families to learn about breastfeeding within a short period of time — usually 10 to 15 minutes (in the hospital environment), for example,” Ms Koo added.
Generally, healthy full-term babies are born with the innate ability to breastfeed. For most mothers, producing breast milk is also a naturally occurring process after she delivers her baby and the placenta, or the temporary organ in the womb that feeds the baby.
However, some women — a small group — may have diagnosed health conditions that can increase their risk of low milk supply. These conditions may include hormonal imbalances, autoimmune diseases, consuming certain medications, or having had breast surgery, Ms Koo said.
Lactation consultant Jessica Wong from Oriental Jamu, said that having tuberous breasts — a congenital condition that results in an irregular breast shape — may also affect a mother’s ability to produce an adequate milk supply.
Experts said that the mounting anxiety and internalised pressure to breastfeed that some women experience may be a result of certain online depictions of motherhood, and they were possibly comparing themselves to other positive breastfeeding experiences that they see on social media channels.
Ms Ong Hui Tze, a lactation consultant and founder of postnatal services firm My Milkie Way, sees an average of about 20 clients a month.
“Among the breastfeeding mums I support, most are overwhelmed because breastfeeding has not been what they visualised, as social media shows relaxed mums feeding babies, or mums displaying the many bags of expressed breast milk in their freezers.
“As with everything else, people tend to always compare themselves with others, which inevitably causes unnecessary stress,” she said. 
If not addressed, a build-up of such pressure may eventually lead to adverse ripple effects on the mothers’ mental and emotional health.
Last December, a 33-year-old Singaporean woman was found dead at the foot of a public housing block, about a metre away from her three-week-old son.
An Aug 6 report by news channel CNA on the coroner’s inquiry into the incident revealed that those around the woman had suspected that she was suffering from postpartum depression. 
The mother had reportedly felt overwhelmed about being unable to take care of her newborn son and was worried about his persistent jaundice and her own struggles with pumping enough breast milk.
Medical experts told TODAY that anxieties around breastfeeding — including worries about establishing or maintaining breastfeeding — can contribute to a woman’s mood disorders after giving birth, such as postnatal depression and postnatal anxiety.
Ms Qi Zhai-McCartney, a psychotherapist and counsellor at psychological services firm Alliance Counselling, said that at least 20 to 30 per cent of new mothers among her own clients do raise some kind of breastfeeding issue or concern.
After all, breastfeeding is time-consuming and not always convenient, and exclusive breastfeeding for the first six months of the baby’s life can mean interrupted sleep for the mother.
Head of NUH’s department of psychological medicine, Dr Cornelia Chee, said that some women may have mental health conditions that deteriorate rapidly with sleep deprivation, for example.
Dr Chee, who set up the Women’s Emotional Health Service at NUH in 2008, said that hospital staff work with each mother to assess her situation, and may propose a workable arrangement such as partial breastfeeding during the day, if the impact of night feeding is likely to affect her mental health negatively.
“In such cases, ‘something is better than nothing’ and presents a compromise that allows the mother to still feel she is able to breastfeed, thus avoiding too much guilt, and she may get the sleep recovery she needs,” Dr Chee added.
Dr Chua Tze-Ern, senior consultant and head of the women’s mental wellness service at KK Women’s and Children’s Hospital, added that though wonderful, breastfeeding is often a “labour of love” and comes at a “cost” to each and every mother.
“It costs a mother time, energy, effort and sometimes, even pain. The pain could be physical from engorged breasts and cracked nipples, or emotional from anxiety, self-doubt, and in some cases, past trauma,” she said. 
While the evidence on the benefits of breastfeeding is clear, this recommendation should be considered holistically within the broader context of a mother’s overall well-being, said experts.
Dr Chee said: “While we will always have the stance that breastfeeding can and should be the first-line for babies where possible, we also need to balance this against the individual mother’s unique circumstances and mental health constraints.”
Ms Zhai-McCartney the counsellor agreed.
“My advice is that all things being equal, ‘breast is best’, but it’s most important to do what is ‘best for you’. A happier, better-rested, more physically comfortable mother can better meet the needs of her child. Striving to meet a certain ‘standard’, even if it’s set by reputable international organisations, and suffering through it isn’t ‘best’. In a sense, it misses the point. 
“No organisation has ever recommended ‘breast is best even if you’re physically or mentally suffering, if you’re exhausted, if you’re cranky and reactive toward your baby as a result of trying to slog through breastfeeding’,” she said. 
Society at large should also help to promote a more nuanced view of the ‘breast is best’ approach, Ms Zhai-McCartney added.
“A better message is one that values maternal emotional and mental well-being as being critical parts of what is ‘best’ for a child.
“This includes educating our family members and peers to avoid explicitly or implicitly pressuring mothers to breastfeeding.”
Beyond this, gender experts told TODAY that the culture around breastfeeding is also emblematic of the wider issue of “one-size-fits-all” standards being imposed on women and mothers.
Ms Sugidha Nithiananthan, director of advocacy, research and communications at the Association of Women for Action and Research (Aware), said: “Women are often expected to live up to idealised, one-size-fits-all notions of motherhood, leading to judgement in many aspects of their lives, whether it’s how they give birth, how they feed their babies, or how they balance work and family. 
“These societal expectations can be overwhelming and harmful, particularly when they ignore the diverse experiences and challenges that women face.
“The pressure that some mothers face to conform to a single ideal of motherhood, such as breastfeeding, adds unnecessary stress during an already challenging time of recovery and adjustment.”
To strike a better balance, it is crucial for society to reduce the pressure on mothers by being supportive and non-judgemental, regardless of a mother’s decision to breastfeed or not. 
“What truly matters is that mothers feel empowered to make informed decisions, with full support from their communities, healthcare professionals and their workplaces,” Ms Nithiananthan added.
And just as women should not feel pressured to breastfeed at the expense of their own emotional health and well-being, empowering them to make their choice also means ensuring that there are enough resources provided to support the mothers who do still wish to breastfeed.
Ultimately, breastfeeding is also a team endeavour and not a solo effort and mothers require a supportive ecosystem, Ms Wong of Oriental Jamu said. 
“Spouses and family members need to be supportive, since certain compromises are necessary to accommodate a breastfeeding schedule.
“This might include choosing to go to malls with nursing rooms, dining at restaurants that cater to breastfeeding mothers, and having understanding friends who are willing to meet when it aligns with the mother’s breastfeeding schedule.”
Beyond familial support, some mothers are turning to external support groups.
Ms Toh remembers calling the Breastfeeding Mothers’ Support Group (BMSG) support group’s hotline between 3am and 4am when she first started breastfeeding. 
“I was distraught and the counsellor on duty picked up my call groggily. I had woken her up. She was able to calm me down and offered me encouragement and tips. It really made a difference to hear someone calm and knowledgeable on the other end of the line.
“It wasn’t just about getting tips and advice on how to troubleshoot or improve breastfeeding, but also a lot of support and commiserating with other like-minded mothers,” she said of the charity focused on breastfeeding advocacy, support and awareness.
The BMSG told TODAY that it receives an average of 300 counselling queries each month.
All of the group’s counsellors must have had breastfed or are still breastfeeding.
They are trained to provide mother-to-mother support through its channels, which include its breastfeeding counselling phone and WhatsApp lines, a private Facebook group for women, in-person breastfeeding support meetings and workshops.
Its spokesperson said: “As much as possible, we handhold the mother to think about her goals and how realistic they can be in light of their unique conditions and circumstances.
“Ultimately, we want to empower mothers to become good problem solvers… It takes a village to raise a child, but it also takes a village to make a mother.”
Samaritans of Singapore hotline: 1767
Institute of Mental Health’s helpline: 6389 2222
Singapore Association for Mental Health helpline: 1800 283 7019
NUH Women’s Emotional Health Service helpline: 6772 2037
Breastfeeding Mothers’ Support Group hotline: 6339 3558