Emily, good question! Yes, definitions are very important, and it's not until you read the fine print in many studies that you realize that the term "exclusive breastfeeding" also covers a multitude of omissions. For instance, in the literature on HIV and breastfeeding, where we know that "exclusive breastfeeding" makes such a difference in reducing transmission of the virus from an HIV+ mom to her baby, the term is used in one study where one "lapse" of formula-feeding or another food/liquid was given (Iliff, 2005) and in another study where a whole 3 lapses were permitted (Coovadia 2007). And in fact the term is so fluid (if you'll excuse the pun) that WHO themselves had a meeting about it in 2004 and decided that allowing up to 3 lapses would be OK to still fulfil the definition of exclusive breastfeeding ...... But the results speak for themselves. One lapse led to 1.3% of babies becoming infected, whereas 3 lapses led to 4% of babies becoming infected. But outside the context of HIV I've worked with many mothers who, for whatever reason, decided to exclusively breastMILK-feed by bottle. I cheered them all the way, because almost without exception if "permission" hadn't been granted for this type of modified exclusive breastfeeding, then they would have opted for exclusive formula-feeding. They wanted the "best" for their babies, but somehow couldn't get their heads around the baby-at-breast part, although they were very happy to pump. Other exceptions were, of course, for those babies who had a physical condition that prevented feeding at the breast. Some of these women fulfilled the recommendation for EBF for the full six months, and continued BF for months or a year or so afterwards. Some went on to breastmilk-feed-by-bottle several babies. One of them surprised me almost speechless by saying she wanted to try to actually breastFEED her third such baby after a few weeks of breastMILK-feeding, and then went on to happily breastFEED him permanently, saying she couldn't understand why she hadn't breastFED all of them right from the beginning. I learned a lot from these mothers. Firstly, that as long as the breasts are frequently drained, then they will go on producing tons of milk - in fact one of the mothers eventually only needed to pump three times each 24 hours, obtaining 250ml at a time, which she then split into baby-sized "feeds" as needed. Secondly, that in spite of dire predictions that a baby is needed actually _at_ the breast for milk production to be adequate over the long-term, this is simply not true. Thirdly, from observation, I'm convinced that the exclusively breastMILK-feeding mother is as closely connected and responsive to her baby as any other breastFEEDING mother, so I strongly suspect that the hormones produced during breastMILK-feeding are almost identical to those produced during breastFEEDING. It's this experience that makes me such a fan of the possibility that HIV+ moms could use their own heat-treated EBM from birth, and up to 2 years. I've been campaigning for more respect to be given to breastMILK feeding for nearly two decades, but amongst those who set policy, there is such a lot of scepticism and negativity about this wonderful possibility. Hence this rather long 0.2ml's worth this morning. It was an excellent question, Emily. I'll look forward to others' comments. Aren't we being a bit purist to suggest that an exclusively breastfeeding mom who needs to pump 2 or 3 bottles of EBM a day in order to maintain her baby's gut integrity and provide an exclusive full complement of all the goodies in her milk while she's away at work is _not_ exclusively breastFEEDING? Pamela Morrison IBCLC Rustington, England -------------------- I've closely followed the recent thread regarding "Breastfeeding in Combat Boots," and one question keeps coming to mind. Given the warranted emphasis on correct term use, at what point is a mother considered to be "breastmilk feeding," rather than "breastfeeding?" If only one nursing session a day is replaced with expressed milk, is the mother no longer considered to be breastfeeding? Does it take two sessions? Three? What if baby is reverse-cycling? In my reading, I frequently come across the terms "exclusively breastfeeding," which does not, to my knowledge, make a clear distinction in what percentage of feedings are given at the breast, and "exclusively pumping," which does. Please don't mistake my post for anything other than a very genuine desire for information- I'm still very new to lactation support, and strive to be precise in my use of language. - Emily in FL *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome