COVID-19 Is Making New Moms Feel Even More Pressure to Breastfeed

Jewel Pfaffroth could barely move while she pumped. She had struggled since her son was born in April to produce breast milk—he was underweight at his first doctor’s appointment, and she immediately had to supplement with formula. Her doctor had recommended she sit at specific angles while she pumped—“to let gravity do its thing”—but those positions caused her such intense backaches that she couldn’t do basic things like carrying her baby. Yet despite the debilitating pain, she was pumping twice a day to create less than one-tenth of what her son ate. It was crucial to her that he have some breast milk in his diet.

“Had COVID not been a thing, as soon as I found out that my body just couldn’t make enough milk, I probably would have gone straight to formula feeding,” she says. “Instead what I did was meet with a lactation specialist once a week, took a bunch of supplements and did everything single woo-woo thing that I could find that had even a tiny bit of science behind it.”

Pfaffroth was desperate to find any way she could to minimize her chances of getting sick. Since getting pregnant, she had barely left her neighborhood near Richmond, Va. hadn’t even eaten outdoors at a restaurant and had chosen an out-of-the-way pediatrician in a less crowded neighborhood so that she would encounter fewer people every time she took her son to the doctor. After he was born, the 34-year-old stay-at-home mother had tracked down a study that indicated she might be able to pass antibodies to her newborn through her breast milk, so even though she had gotten vaccinated while pregnant, which research suggests may offer some protection to the baby, she forced herself to continue to pump as an additional precaution.

“It cost a lot of money and a lot of heartache because it’s something you’re ‘supposed to do’ for your child,” she says. “And there was so little information out there about breast milk and antibodies, but I was like, ‘If I don’t and my baby caught COVID, I would feel like it’s my fault.’” After four months, she finally decided she was useless to her family if she could barely move and switched her baby to a full formula diet.

Pressure on women to breastfeed isn’t new. The “breast is best” movement has long touted the health benefits of breastfeeding but also created anxiety for new mothers who struggle physically, mentally or emotionally with the sometimes painful and always time-consuming task of breastfeeding. As TIME explained in a 2017 cover story, the image of a mother who happily sacrifices her well-being and time spent on her career to breastfeed is part of the “goddess myth” of motherhood that places unrealistic expectations on new mothers and causes feelings of inadequacy among parents. (Many doctors have adopted a “fed is best” philosophy as a counter to that pressure.)

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The pandemic has added another layer of stress for new mothers. Kids under 12 are not yet eligible for the COVID-19 vaccine, so many moms want to do whatever they can to offer some level of protection. That prospect is particularly compelling to women who did not get vaccinated until after they gave birth, either because the vaccine was not available when they were pregnant or because the CDC had not yet officially recommended that pregnant people get the vaccine, but it also appeals to those who did get the vaccine while pregnant and hope breastfeeding will boost any immunity. (Before August, the CDC had said pregnant women were eligible to get the vaccine but had not outright recommended it, instead urging them to speak directly with their health care providers.)

While preliminary data from studies indicating that breast milk might contain antibodies have been trickling out all summer, few have been published because the vaccine hasn’t been around for that long and the peer-review process for such studies takes time. In late August, The Journal of Breastfeeding Medicine did publish a small study conducted by researchers at the University of Florida. The team took blood and breast-milk samples from 21 new mothers before and after they received the Pfizer-BioNTech and Moderna vaccines and found that, after vaccination, there was a 100-fold increase of immunoglobulin A antibodies, one of the many defenses the body needs to mount against the virus. (The antibodies also remained in breast milk that was frozen and stored rather than fed to the child immediately.)

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“Basically breast milk likely provides a kind of hazard protection,” says Joseph Larkin III, a senior author of the study. Researchers don’t know, however, how robust the immunity is or how long it will last. “We are actively working on that right now in the lab,” he says. He emphasized that the best thing parents can do for their baby is get vaccinated themselves to drastically decrease the likelihood they’ll pass on COVID-19 to their child.

The revelation—really, even the possibility—that breast milk could play a role in protecting babies from the virus has sent parents scrambling. Parenting groups on Facebook and doctor influencers on Instagram have been flooded with questions like how long the antibodies from breast milk remain in the baby’s system as a defense against the virus (we don’t know but likely not longer than a few days based on other vaccines, says Dr. Rebekah Diamond, who runs the blog Parent like a Pediatrician and fields such questions on Instagram) and what proportion of a baby’s diet needs to be breastmilk vs. formula for the protection to work (there’s no magic number, says Diamond—there’s no way to be certain that after some X number of ounces, the baby is fully protected). In March, New York Magazine reported that parents who could not produce breast milk themselves were seeking out breast milk with antibodies on the internet.

Jenn Kominsky, a project manager at a creative agency in Tampa, Fla., went so far as to reach out directly to researchers working on studies on breast milk to see if she could glean any insights on the data before they were published. Kominsky, 35, gave birth to her first child in October. After about five months, her daughter stopped wanting to breastfeed, so Kominsky switched to pumping. “Pumping sucks,” she says. “It’s exhausting. You can’t really do anything else including playing with your now mobile baby. And it’s hard to live your life when you’re attached to a pump 24/7 and have to carry it around like a giant battery pack.” But breastfeeding had been far easier for her than it had been for many of her friends. It helped that she was working from home. “I was like, ‘Oh my gosh, how horrible of a mom would I be if I could still breastfeed and chose not to and potentially took away some of that protection from her?’” she says.

Dana Usndek, an adjunct professor at Macomb Community College, says that she and her friends briefly researched whether, if they’d gotten a COVID-19 shot, feeding breast milk to their children who are no longer babies but not old enough to get vaccinated might offer them some protection. “It sounds crazy, and after a little research, we realized that wasn’t actually an option,” she says. (The effect of milk antibodies are “dose-dependent,” Rebecca Powell, a human-milk immunologist at the Icahn School of Medicine at Mount Sinai, told in May, meaning that although breast milk with antibodies may help a baby who is consuming it and not much else all day, adding breast milk to a 6-year-old’s smoothie would contribute so little to their daily diet that it would be unlikely to be effective.) “We’re not crunchy, essential-oils type women,” Usndek says. “We believe in science. But it’s just anything to create some barrier for your kid.”

Usndek describes her breastfeeding journey with her first child as wonderful. She fed her breast milk for nearly two years with no problems and hoped to do the same with her second baby. Vaccines were not yet available when her child was born in May 2020, but Usndek figured that just in case she’d had asymptomatic COVID-19 already, she could maybe pass along some antibodies by breastfeeding. (She got her shots when they became available the next year while the child was still in the breastfeeding stage.) But her son is a “violent nurser” and she has been bleeding during nursing for months. “Once I got the vaccine, I could not bring myself to stop, which I normally would because he bit me, I’m bleeding, it’s terrible,” she says. “But I read about children winding up in hospitals, and I don’t want my child to be that statistic. So I just kept going and going.”

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She is still nursing him nearly a year and half later and says she will feel comfortable stopping only when her 5-year-old can get vaccinated because she believes her daughter is the person in their household at the highest risk of catching COVID-19 and passing it to the baby. Currently, in the U.S., only the Pfizer-BioNTech vaccine is authorized for children ages 12 to 17; the companies are expected to submit a request for emergency use authorization (EUA) for those between 5 and 11 years old in the next month or so. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the chief medical advisor to the President, has said he thinks there’s a “reasonable chance” that Pfizer or Moderna could get EUA approval before the winter holidays.

Diamond, the doctor who runs the Parent like a Pediatrician blog, says she’s received hundreds of questions on social media about breastfeeding during the pandemic and noticed a shift in what moms say they are hearing. At first, many of the women who reached out to her said they were told by fellow mothers and, in some cases, their doctors not to get the vaccine because its effect on the fetus was unknown, advice that Diamond says was “overly cautious or just plain wrong.” But now that the CDC has recommended vaccination for pregnant people, she’s hearing from more moms who have gotten their shots and are feeling pressure to nurse in order to protect their babies. “We’ve gone from mothers thinking, ‘Nobody can tell me the benefits [of the vaccine] outweigh the risks so I’m going to be nervous’ to a new, equally oppressive narrative that you need to pump every ounce of milk out of your body to help the baby,” she says. “Either way, the mother’s health and happiness doesn’t really matter.”

Most of the women who spoke to TIME said their doctors suggested not only that they get vaccinated but that they try to breastfeed because of the antibody benefits to the baby. Those doctors told them to stop breastfeeding if it caused undue stress, a fuzzy parameter that one mother might interpret as breastfeed until it’s inconvenient and another might take to mean until you need to seek medical attention because you’re in so much distress.

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Diamond counsels her patients that any immunity they pass on is a bonus, but they shouldn’t overexert themselves mentally or physically to do something they wouldn’t do, like breastfeed through immense pain, if COVID-19 were not a threat. “As a country, we’ve become so myopically focused on fetal and infant health instead of maternal health,” she says. “I keep asking why do we pretend that maternal health and infant health are separate? All of this only works if the parents are healthy and able to care for their baby.”

Kominsky, in Florida, eventually came to the same conclusion. She made it until her daughter was 9 months old, when pumping started to hinder her work too much for her to continue—she didn’t feel comfortable doing it on Zoom calls with colleagues. But she stopped only after checking in with her friends and other women on Facebook and Reddit groups for moms. “I think I needed a lot of validation from other people to not feel guilty,” she says.