Like many pregnant women, Clara James planned to exclusively breastfeed her baby-to-be throughout his first year of life -- as much for the nutritional benefits as for the bonding time nursing would provide. And at first, it looked as though the 39-year-old New York City mom's dreams would come true. Even after a difficult cesarean section, baby Zach nursed in the hospital, latching on well.

But once home, Clara's blissful ideas of breastfeeding were turned upside down. "If Zach wasn't on the breast, he was crying," she remembers. "The lactation consultant I called weighed him after a feeding and said she wasn't sure he was getting enough milk. But she told me not to supplement and to put him on my breast as often as he wanted to be there, which was every hour and a half." She followed the consultant's instructions, using a supplemental nutrition system (or SNS, a device that allows milk to be suspended in a container around a woman's neck and delivered to a feeding baby through a tube laid next to the woman's nipple) while she breastfed as well as pumping in between feedings.

Clara, who was taking a few months off from her job, managed to keep up with this grueling schedule for several weeks. Eventually -- rundown, tearful, and anxious about her baby -- she developed mastitis. Zach got thrush (a yeast infection of the mouth) from Clara's antibiotics, Clara herself got nipple thrush, and, on top of all that, Zach was still crying all the time. Meanwhile, she hadn't slept for more than a two-hour stretch since she'd given birth. "Because of the terrible fatigue and my anxiety over his not gaining much weight," she says, "I thought I might have to give up breastfeeding altogether, which I really didn't want to do."

Fortunately, Clara's pediatrician took one look at the crying, unhappy baby and mom on the verge and advised Clara to supplement with formula, right away. Although her lactation consultant had warned her against it, she felt that she had exhausted all other options.

Almost immediately, the situation improved. Zach, finally satisfied, switched easily between breast and bottle. Clara's anxiety lifted, she got more sleep, and she began bonding with Zach during feedings. "I guess I just needed someone to give me permission to supplement," she says. "It made our lives easier, and we still had the advantages of breastfeeding. But no one ever told me I could do it."

Doing the Combo

Okay, before an army of lactation consultants rises up in protest, let's be clear: No one is questioning whether breastfeeding is best. It's not only the clear nutritional choice, but it provides a closeness to one's infant that borders on magical.

But let's also finally admit it: Breastfeeding exclusively is extremely difficult for some 10 to 20 percent of women, says James Sargent, M.D., a pediatrician and researcher at Dartmouth Medical School, in Lebanon, New Hampshire. And according to Babyalk contributing editor and lactation specialist Marianne Neifert, M.D., author of Dr. Mom's Guide to Breastfeeding and one of the country's top experts on the subject, up to 5 percent of women suffer from breast milk shortage, making exclusive breastfeeding practically impossible.

But when one of these frustrated moms hears from ardent breastfeeding advocates that she shouldn't supplement with a bottle (let alone formula), she may decide to abandon breastfeeding altogether, thinking it's an all-or-nothing proposition. "Moms are often told very strongly that regardless of how hard a time they're having, they should breastfeed exclusively," says Dr. Sargent. "But that may not always be appropriate. The downsides (ranging from a distressed baby and a miserable mother to a malnourished and dehydrated infant) can actually outweigh the benefits."

The answer for many women who struggle with exclusive nursing may be to combine breastfeeding with bottlefeeding. Many experts agree that some breastfeeding is better than none at all.

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