As I stumble over piles of unpacked boxes in the dimly lit interior of our new home in Philadelphia, I hear the friendly voice of one of our new neighbors calling through our open door. Her name is Tiffany, she lives across the street with her husband James, and they have a three-day old baby named Joey. After our brief introduction, she quickly moves on to more pressing matters, “Yeah, I’m trying to breastfeed, but he’s just not latching on right — I’m really worried he’s not getting enough milk.” “Did you get to see a lactation consultant in the hospital?” I ask. “Yes,” she tells me, “but Joey was sleeping while she was there. We tried to wake him up, but he wouldn’t have it.” Home she went, a first time mother, with a sleepy newborn with a bad latch.

I ask her if she knows how to hand-express her milk, “I’ve tried but it’s not working,” I ask her if she has ever heard of La Leche League and she frowns, “I don’t know, aren’t they really militant?” In a worried tone and with palpable disappointment she says, “I think I’m going to just give him formula, I mean, I just don’t know what else to do.” A wave of sympathy, frustration and dread washes over me because I’ve seen this situation and many others like it more times than I can count in the ten years since I started researching and writing about breastfeeding. I’ve heard it in the stories of family, friends, acquaintances, and strangers; I’ve read it in magazine articles, online forums, and letters; I’ve seen it unfold in postwar households and in the homes of my 21st century peers; and I’ve even experienced a small slice of it myself when my wife and I had our daughter.

When I began researching breastfeeding ten years ago, there was very little public criticism of breastfeeding promotion programs, but that slowly started to change as my work progressed. In 2009, Jill Lepore published a piece in The New Yorker that highlighted some of the problems with contemporary breastfeeding practices — specifically those surrounding the breast pump. Since then, a steady stream of increasingly effective and well-researched critiques has been launched against the rise of public health and medical pressures on mothers to breastfeed at almost any cost. Academics (myself included), journalists, and bloggers have taken on what they rightfully highlight as a misplaced focus on the personal infant feeding behaviors of individual mothers.

Most of their criticisms are warranted: breastfeeding carries physical, emotional, and economic costs that are almost never adequately considered when the mantra “breast is best” is doled out; breastfeeding’s health benefits are likely overstated given the published studies and the baseline of hygiene and healthcare that the majority of babies born in the U.S. typically enjoy; breastfeeding disrupts work and life routines to such an extent that many mothers would rather have another option; and more often than not, today breastfeeding actually means breast pumping for most mothers, and there is not nearly as much evidence supporting that nor is it the same experience for mother or baby.

How did we come to be in this moment, when breastfeeding is both increasingly mandatory and simultaneously impossible, burdensome and laborious? Ultimately, that is one of the questions I set out to answer in writing my book, Back to the Breast: Natural Motherhood and Breastfeeding in America (University of Chicago Press, 2015). It may come as a surprise to some readers that it hasn’t always been this way. Continuing a downward trend that started in the earliest decades of the twentieth century, mothers in the 1950s were less and less likely to breastfeed their infants than previous generations. By the 1960s, it seemed that bottle feeding and the early introduction of solids had become the new normal, and medical experts could lean on all sorts of scientific and anecdotal evidence to justify their disinterest in promoting or supporting breastfeeding.

And yet, despite the steep decline in medical interest in breastfeeding by the mid-twentieth century, there emerged a network of researchers, mothers, fathers, and doctors who saw an opportunity to make breastfeeding modern and relevant again. In small pockets of American society, breastfeeding knowledge lived on, thrived and evolved through the work of scientists of human and animal behavior, in the dedicated work of maternity and postpartum nurses, in the childbirth education movement inspired by English obstetrician Grantly Dick-Read’s classic book Childbirth Without Fear, and most of all in the self-conscious and embodied experiences of mothers themselves. While breastfeeding rates continued to drop throughout the postwar decades, a new and distinctly modern synthesis of biological and political motherhood took shape and helped breathe new life into the practice of breastfeeding. In my work, I have called this the ideology of natural motherhood.

Mid-century researchers in human psychology and animal behavior laid important conceptual groundwork for the ideology of natural motherhood. Efforts by psychoanalysts to theorize the mental world of the newborn infant combined with observations of maternal bonding behaviors in animals to form a newly scientifically-charged argument for the importance of instinct and nurture in the health and adjustment of infants and mothers alike. Key figures helped translate this body of theoretical knowledge into an ideology of motherhood in which breastfeeding held the key to maintaining a connection to an important store of embodied maternal instinct. Among these were certainly the founders of La Leche League, women such as Mary Ann Cahill, Mary White, and Betty Wagner, who collected and disseminated practical information on breastfeeding as well as the scientific and theoretical underpinnings that helped support their mantra “better mothering through breastfeeding.”

Just as important, if not more so, however, were the efforts of people like Dr. Niles Newton, a Columbia-trained psychologist and mother whose research into the psycho-biological aspects of maternity, childbirth, and infant care provided a much-needed scientific validity to the burgeoning back-to-the-breast movement. Other key female researchers and physicians played important roles as well, helping to translate the all-too-often misogynistic mid-century science of motherhood into a maternal-centric framework that sought to humanize childbirth and infant care practices in a way that empowered women as mothers and respected their bodily experiences.

By the early 1970s, when the environmental and feminist movements were in full swing, the model of breastfeeding and natural motherhood that postwar women had helped to forge offered liberated and environmentally-conscious mothers a natural and empowering choice in breastfeeding. Not surprisingly, then, breastfeeding rates climbed for the first time in decades in the 1970s, reversing the twentieth century’s decline.

Despite the appearance of success, however, breastfeeding’s return was fraught from the outset. Second-wave feminism challenged many of the traditional family arrangements and gender norms of the postwar era, and brought the concept of “the natural” under scrutiny. In the conservative environment of the 1980s, breastfeeding became a flashpoint for debates over “working mothers,” daycare, and early childhood development. In the context of the techno-utopian ‘90s, it made sense that the solution to the problem of working mothers and breastfeeding would be sought in the technology of the breast pump. Hand pumps, electric pumps, pink carry cases, bottles, nipples, refrigerators — these became the hallmark accoutrements of the liberated natural mother by the turn of the twenty-first century.

At least so it seemed for a little while, until 2009, when Lepore’s piece helped give voice to a growing backlash against the breast pump. The pump has since been lambasted for its inadequacies, its discomforts, its unnaturalness, and most of all the oppressive demands it seems to allow society to place upon mothers, especially those who work in paid jobs outside the home. Today criticism has moved well beyond the breast pump, to call into question the scientific validity of breastfeeding itself, again.

As a feminist and a mother, I support women’s efforts to gain control over their experiences of motherhood and to do so without guilt in an environment that respects just how difficult parenthood can be. As a historian, I hope that my work can inform contemporary efforts to shift our approaches to breastfeeding by highlighting the degree to which breastfeeding is not now, nor has it been, simply a matter of personal choice. Breastfeeding is a culturally-embedded process, one that rests upon the continuing existence of networks of female knowledge and support (even today), and it resists disentanglement and medicalization. At one point in our not-so-distant past that reservoir of experiential knowledge about breastfeeding had all but disappeared. That American mothers today have gone back to the breast is due largely to the struggles and efforts of women themselves over much of the past century.