Infants should be exclusively breastfed for the first six months after birth, says the American Academy of Pediatrics, citing research that says breastfeeding is healthy for infants. It protects against diseases, obesity and stomach issues, helps the mother lose weight and decreases the risk of some cancers. But although breastfeeding is “natural,” for many women, it’s not “easy.”

When Emma Pepper got pregnant, she was totally on board with breastfeeding — until her son was born.

“He could never quite latch properly,” she said. “And he was actually born on a weekend in the hospital and so the lactation consultants weren’t available to support me in the very beginning.”

Pepper lives in Charleston, West Virginia. West Virginia Public Radio reporters called 14 hospitals in the state and only two had breastfeeding consultants available around the clock, even though it’s common for women to struggle with breastfeeding after giving birth.

Unless doctors and nurses have undergone special training, they may not have the expertise to help new moms learn to breastfeed. Only four hospitals in West Virginia require formalized breastfeeding training for nurses and doctors on labor and delivery floors. These hospitals have a “baby friendly” designation from Baby Friendly USA, a World Health Organization and UNICEF program designed to improve the role of maternity services worldwide.

The hospital where Pepper gave birth is not one of the four. Pepper said she was told by a nurse to keep her son for more than an hour on each of her breasts to try to get him to latch. By the time she was discharged from the hospital, she said her nipples were raw.

“It ended up making my breastfeeding experience just more challenging overall,” she said.

A 2013 study published in the journal Pediatrics found that 60 percent of women don’t breastfeed as long as they intend to. This is because of latching problems, concerns about infant nutrition and weight, the need to return to work, or because they don’t have enough support as they try to figure out breastfeeding.

Kailey Littleton, a pediatrician and board-certified lactation consultant in Weirton, West Virginia, said a lot of women she sees have problems breastfeeding.

“Because the information is not great and a lot of the ‘help’ that women get is not the best for them, things tend to go awry,” she said.

Littleton said she hears stories from women about how friends and family or even doctors and nurses have encouraged them to supplement with formula. But supplementing with formula can impact breast milk supply, making it harder to breastfeed. She says many women are also told some pain is normal — but she says it’s not — and that pain is the sign of a bad latch.

When Pepper was discharged, her son still wasn’t latching properly. The doctor recommended she supplement with formula. Pepper was okay with that, but she still wanted to breastfeed. She worried that if she didn’t, her son would be sick more often.

In the meantime, she was being urged on by a lot of people. Her friends, her therapist, even her hairdresser, asked her if she was breastfeeding.

“And so I felt an extreme amount of just societal pressure to be able to live up to that,” she said. “And as a result of that, I made some pretty extreme demands on my body in order to be able to fulfill that wish that I had for him.”

Pepper said she spent hundreds of dollars on pumps to increase her milk supply. About a week after giving birth she also connected with a local lactation consultant who suggested a strict regimen: breastfeed, then supplement with formula, then pump to increase milk supply. But Pepper said she was either breastfeeding or pumping around the clock. It wasn’t sustainable.

“I felt such an enormous sadness that I was wearing this pump all of the time, and I couldn’t hold and bond with my baby while I was wearing it, and I only had a limited amount of time for maternity leave,” she said.

After about two months, Pepper would have to return to work. She struggled to breastfeed for six weeks, then the lactation consultant recommended she switch to formula.

“Receiving that advice from her was part of what gave me the confidence to go ahead and switch to formula feeding when I felt I had exhausted every single avenue available to me to make breastfeeding work,” said Pepper.

It’s a decision she said she wishes she had made earlier.

This article was originally published by West Virginia Public Broadcasting.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.