I weaned my second child about four years ago. He’s nearly seven now. My daughter nursed for two and a half years.

 I gave birth at home and both my babies were lifted onto my belly just after birth. Both latched on right away and sucked like champs. From the start, my milk was abundant. Neither child ever really knew what to do with a bottle or a pacifier. As soon as they showed any sign of hunger, they got the boob for as long as they pleased. Didn’t matter where I was or what I was doing. If the baby wanted “boobie” (my son’s designation), the baby got it, right then and there. Dirty looks were met with indifference. A few times, children passed by and saw me sitting there with a child tucked under my shirt and asked me what I was doing. I got to be the first to explain to them what breasts are actually for.

 In those days, I was a total boob Nazi. The very sight of infant formula being mixed made me apoplectic. I harshly judged mothers who didn’t breastfeed for the recommended six months to one year. How selfish! Don’t they know how much healthier their children would be if they had…I’d think. Proper bonding while bottle-feeding? Impossible! Child who gets sick all the time? Must not have gotten enough of this holy lactational liquid! As some poor mom desperately tried to get her formula situation figured out while her baby turned purple with unmet need, I would fantasize about snatching the infant and putting it to my own bountiful bosom. I even wrote a book with pediatrician and functional medicine physician Robert Rountree about the ideal diet for breastfeeding mothers—one that would help to make Mom’s milk as nutritious and toxin-free as possible (http://www.amazon.com/New-Breastfeeding-Diet-Plan-Breakthrough/dp/0071461604/ref=sr_1_1?ie=UTF8&s=books&qid=1271362545&sr=8-1). 

 (When I call myself a boob Nazi, I separate myself from the hard-working women who devote time, love and energy to helping women to breastfeed...lactation consultants, la Leche League volunteers, educators. I was just opinionated and judgmental. I wasn't doing a damn thing to help anyone. To all those others who did and continue to: Thank. You. So. Much.)

 Last week, a new study was published in the medical journal Pediatrics about the financial cost of insufficient breastfeeding in the U.S. The authors found that if new mothers would breastfeed for the first six months of their babies’ lives, 911 lives and $13 billion would be saved each year. One could almost hear the cheer rising from the broad fellowship of boob Nazis. When I didn’t feel like cheering, I realized that I was no longer among their ranks.

 Here’s why.

 According to the CDC, in 2009, only 74 percent of mothers in the US even started breastfeeding their newborns, and only 33 percent were still exclusively nursing (with no supplemental formula) at three months. At six months, only 14 percent were feeding their babies breast milk exclusively. This, despite the recommendations of the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, the World Health Organization and the Centers for Disease Control and Prevention to give infants only breastmilk until they are six months old.

 Okay. So, obviously, something’s amiss. What could it be? Having learned a bit about human lactation, I know that some mothers just can’t do it. Their breasts don’t work properly. Their babies can’t latch on properly. They have to take medications that would harm the baby if the baby nurses. But this isn’t the case with most mothers. My old boob Nazi self would assume that the cause for the rest must be laziness. Sloth. Selfishness. Vanity. A squeamishness borne of a ridiculous assumption that boobs are sex toys for men, and that therefore, letting a baby suck on them would be weirdly incestuous. That sort of thing.

 Now, imagine for a moment that you’re not a hoity-toity white-collar intellectual middle-class college graduate hanging out and reading OS for the immeasurable enrichment you know is to be gained here. Imagine that you make $12,000 a year working in a factory or at a fast-food restaurant, and that you only have a high school education or less. Imagine that every adult in your family has to work many hours each day at low-wage jobs just to pay the bills. Now, imagine that you’ve just taken two weeks off to squeeze out your latest bundle of joy. Everyone’s telling you that you’re supposed to nurse this new babe for at least a few months. These are the same people who’ve been hollering at you that you can’t keep feeding yourself or your older children fast food and processed food, despite the fact that you have no time to cook and that vegetables cost way more than fast food per calorie.

 So…what do you do? Do you stay home with this new baby so that you can nurse him the way the WHO and your doctor tell you you should—and lose the income that may mean the difference between staying in your home or being evicted because you can’t pay the rent? Nursing on demand means spending all day and all night with your child, and some of us just cannot do this. As a freelance writer, I was able to stay home with the kids and nurse them whenever they liked. Some moms don’t have to work at all. But most do. Some of them go through the ordeal of pumping and sending bottles to the day care center. Having pumped a few times myself, I can say with confidence that this is far from optimal. There’s a great article about by Jill Lepore of The New Yorker: http://www.newyorker.com/reporting/2009/01/19/090119fa_fact_lepore.

Besides: a breast pump costs hundreds of dollars. Is it any wonder that so many women choose formula? Does anyone have the right to judge them for doing so?

And this isn't just about women who are poor. There are plenty of professional women who work away from home and have to pump in bathroom stalls, trying to think of their babies without crying so they can get the milk to come faster. 

I do know many women who make it work - who pump for months or years while holding down an outside-the-home job. Amazing. I couldn't have done it.

 The authors of the Pediatrics study say that doctors need to better educate women about the whys and hows of breastfeeding. But is it any wonder that doctors resist pressuring their patients on this front? They know that for many women, the ideal is just impossible. They know the same when they counsel families about how best to feed their older children and themselves. They can recommend healthier foods and exercise, but they know that when people are in situations where they can’t afford enough healthy food to feed everyone in the household, it’s just plain unfair to keep pushing this point.

 More breastfeeding and the concomitant health savings won’t come from pressuring or guilt-tripping mothers or doctors. It will come through a leveling of the ever-widening gap of socioeconomic inequality that makes things so hard for so many and so, so, so great for a few. It will come when the US catches up with more progressive nations who make it possible for mothers to avoid the choice between breastfeeding and work.