No, breastfeeding isn’t really free

During my pregnancy, I looked forward to breastfeeding my son. I’d heard that not only does it provide optimal nutrition for baby, it also fights infection and disease, reduces the risk of SIDS, and decreases the mother’s risk of breast and ovarian cancers. It helps with mother-baby bonding, as well as postpartum depression. And breastfeeding is “free!” Well, kind of.

“There’s no free ride on breastfeeding,” clarifies Linda M. Hanna, IBCLC, NP, a certified lactation consultant and nurse practitioner. “But the cost of breastfeeding is significantly less [than formula] in general.”

Related: Supporting breastfeeding could save the world economy almost $1 billion a *day,* says new study

According to the Surgeon General, breastfeeding families can save between $1,200 and $1,500 on formula costs in one year. And on a larger level, a 2007 study estimated that if 90% of American families exclusively breastfed for six months, the U.S. would save $13 billion annually from reduced medical “and other” costs.

Still, for many women, the milk doesn’t always flow freely. While I knew breastfeeding challenges were a possibility, experiencing them was eye-opening. And one thing that struck me was that breastfeeding’s selling point that it’s “free”—or at least cheap—is overstated. All of the products and services it can take to successfully breastfeed can easily cancel out that estimated $1,200 to $1,500.

Let’s break down some of the costs of breastfeeding.

Here’s how the cost of breastfeeding adds up

1. Latching & positioning

You can bring baby to breast, but you can’t make them drink. Babies need to latch onto the nipple correctly to transfer an adequate amount of milk, and this doesn’t always come naturally.

The good news is that more hospitals are starting to recognize the importance of lactation assistance in the hours after birth. “Hospital-based lactation support is becoming extremely prevalent so women don’t have to go out and pay $300 for a lactation consultant to come in,” Hanna says. (A lactation consultant’s fees will vary based on the consultant and location, but tend to be from $60 to $150 an hour.)

Related: The nipple ointment our midwife recommends to all her patients

However, there will be a percentage of women who need additional support for latching and positioning. “An issue we thought was a latching problem actually turned out to be identified 10 or 15 years ago as the baby having a lip tie or tongue tie,” Hanna says. “It can also be the anatomy of the mother, including women who have issues with their nipples, like nipple inversions.”

Motherly’s annual State of Motherhood survey revealed that 25% of GenZ and millennial moms either didn’t reach their breastfeeding goals with their most recent child or didn’t breastfeed because their child had difficulty breastfeeding. 37% of moms reported that they were not physically able to breastfeed.

Issues with latching are common, but can be remedied with a slew of products and services:

1. Nipple shield (allows baby to connect to your breast more easily): $7 –$10

2. Nipple everter (helps extract inverted nipples): $7

3. Breast shells (helps extract inverted nipples): $10 –$15

4. Frenotomy (procedure to correct baby’s tongue or lip tie): about $750 on average, but the cost depends on medical insurance coverage

2. Supply, demand & pumping

In a perfect world, you’ll supply the amount of milk your baby demands by how often they latch onto your breast. There are endless reasons why a baby and mother might not unite immediately after birth, which can lead to issues with supply in the days postpartum. Taking supplements like moringa ($10) and starting an early pumping regimen may boost supply.

The Affordable Care Act requires that most insurance companies cover the full cost of a breast pump “for the duration of breastfeeding.” But insurance may limit what type of pump you’re able to buy for free. It may also limit the amount of time you’re allowed to rent a pump on their dime. Though the AAP recommends breastfeeding for six months, my pump was only covered for three, which left me with two options: 1) Rent the pump for a monthly out-of-pocket fee. 2) Purchase my own pump. (Fortunately, a dear friend gave me her Spectra S2—though technically most breast pumps are considered single-user devices, so this loan wasn’t necessarily FDA-sanctioned).

Related: The key to breastfeeding success? The right supplies and resources

For those who are forking over cash for a pump, dual electric pumps run anywhere from $100 to $400, with hospital-grade pumps costing as much as $2000, and wearable pumps, like the Willow and Elvie, being closer to $500. Manual pumps, which many moms purchase in addition to an electric pump for on-the-go pumping and emergency situations, are around $15 to $25.

3. Milk storage & feeding

A breast pump is only part of the equation. Once you express milk, you’ll need to store it and then feed it to your child—which can require another arsenal of equipment. Aside from a functional refrigerator or freezer, you may need:

1. Bottles and nipples: $2 –$15 per bottle

2. Milk storage bags: $12– $15 for a pack of 100

3. Extra pump parts like flanges, valves and tubes: $30 for a set

4. A pumping bra (not essential, but helpful): $20

5. A bottle warmer (not essential, but helpful): $15–$30

6. Breast pads for leakage (not essential either — but most of us would rather not walk around in public with milk stains on our chests): $10 for a box

7. If you’re a breastfeeding working mom, you might consider investing in an insulated cooler bag ($10 –$25) for transporting your pumped milk to and from the office.

You’ll also need hot running water and dish soap, as well as a dishwasher or a bottle sterilizer to keep your hardware safe and clean for baby.

Related: Let’s normalize talking about how hard breastfeeding is

4. Nursing nutrition

“There’s also the cost of eating healthy. The best health a mother could have for herself long-term is the health and wellness that she has during pregnancy and the first year or two while breastfeeding,” Hanna says.

According to La Leche League International, eating a diet of nutritious, whole foods during pregnancy sets the stage for breastfeeding success. The general consensus is that nursing women eat a minimum of 1,800 calories per day, and those calories should ideally come from wholesome, fresh foods.

Related: Here’s why I personally feel validated by the new breastfeeding guidelines

In 2020, the average American household spent $411 a month on groceries (note: that was before inflation spiked), but not all mothers have access to traditional grocery stores. In 2010, the USDA reported that 23.5 million Americans live in food deserts: areas with a dearth of supermarkets offering fresh meats and produce. Food deserts are often found in impoverished areas, which can pose health challenges for their breastfeeding mothers and babies.

5. Breast health

Breastfeeding can be a real pain in the boob, with maladies ranging from cracked and bleeding nipples to plugged ducts and—ouch!—milk blisters. Infections like thrush and mastitis require medical attention, which, if you have insurance, could incur a co-pay for care or warrant a prescription.

Hanna says women get plugged ducts and infections because they don’t empty their breasts completely. Skipped, missed or delayed feelings can lead to these problems, but with the schedules we keep today, it’s impossible to drain our breasts on time every single day.

Related: Is it safe to get a tattoo when breastfeeding?

“There are things that can be done to avoid infection, but sometimes it’s unavoidable. Some women are more prone to them because of their own anatomy, but we can proactively try to prevent these things from happening,” Hanna says.

Supplements such as sunflower lecithin ($10), and coconut oil ($7), as well as a lactation massager ($40) can help prevent clogged ducts, which, if ignored, can lead to mastitis. Cooling gel pads and nipple balm ($8, both miracles) can help soothe sore nipples.

6. Nursing-friendly clothes

The breastfeeding industry is vast. Between nursing pillows and fashion lines designed for easy breast access, you could go on a spree with the number of non-essential nursing accessories out there. My current wardrobe consists of a rotation of nursing tops and dresses (all $20 to $50 a piece), and I recently invested in a special backpack with a breast pump compartment that I can take to work ($50).

Related: 14 best nursing bras that are stylish and comfy

7. Intangible investments

A year of breastfeeding adds up to approximately 1,800 hours, which is basically a full-time job. So that means working breastfeeding mothers essentially have to juggle two jobs, often in workplaces that don’t offer support in terms of lactation rooms or break time to pump, despite the federal Fair Labor Standards Act. And unfortunately, breastfeeding discrimination is still widespread in the workplace, and it has serious potential financial consequences for breastfeeding mothers and their families.

So, is breastfeeding free?

Sure, if you have zero trouble with latch and supply, never pump and bottle-feed your baby, and are fortunate enough to avoid plugged ducts and cracked nipples—and you have a workplace that supports your breastfeeding and pumping needs.

In reality, most women require some level of breastfeeding assistance, requiring time, money, and emotion. Whether or not the return on investment for breastfeeding is worth it is a personal calculation every mother will have to do for herself.

A version of this post was originally posted on Apparently. It has been updated.