<<it's at least breastmilk in the bottle.  I really have a hard time
understanding why this great reliance on pumping has grown in the last couple
of years.>.

I think it has to do with some of the low cost pumps, that actually work,
being readily available.
One sad side effect I have seen is the dramatic increase in exclusive pumping
(no feeding directly at the breast). I and Cindy Curtis (and I believe a few
other LC's) belong to an email group called pumping moms. I was asked about a
year ago to mentor the list. There are lists out there devoted to the moms
who exclusively pump (EP). You need to know that this is an epidemic. These
are the clients that we LC's don't know about because they are doing it
without us.
I have read story after story about how moms end up as exclusive pumpers
(EPer). Some EP for nearly 2 years. Members of the list tell how they were
able to succeed at Eping for months and help other mothers along. I am proud
of them though because everyone encourages the Eper's to try to get the baby
back to the breast.
In the past, I only saw about 1 or 2 moms a year who exclusively pumped
either for sexual abuse issues or infant facial deformities or suckling
disorders and plain cussedness at not wanting to give the baby formula. Those
moms didn't pump for very long. However since the AAP statement the moms that
EP are trying to hang in there for at least a year. It is a real celebration
on the pumping list when a Eping mom makes it to a year.
The profile of the Eper is rapidly changing. I see a definite trend -- a
domino effect -- and I don't like what I am seeing.
Time after time a mother has latch on problems or jaundice (yes it's still a
big issue out there) in the first few days of nursing and is rightly advised
to get a pump. She gets her supply going. The baby gets bottle fed, finger
fed, cup fed or whatever and then the baby won't latch on. After struggling,
(I have read horror stories about days and hours of struggling), the moms
figure it isn't worth trying anymore and think I can "at least give milk out
of the bottle."  So they continue to pump. It may not even dawn on them to
keep trying to gentle the baby back to breast.
Doctors get blamed, nurses get blamed and sometimes the mother strongly
blames the hospital LC (most don't know if the LC person was qualified or
not) for their circumstances.
Lack of consistent advice/instructions is a huge hurdle for these moms. The
doctor tells them one thing, the nurse another and the LC still another. The
moms recognize the significance of deep suctioning on the baby's desire to
nurse. They recognize the role that not nursing right away and often has on
the baby's ability to latch on.  They complain about the aggressiveness of
some of the LC's out there. Moms tell me that the LC rammed the baby into
their chest and the baby arched and fought. They also describe long latch on
sessions (1 to 3 hours) with the LC and an angry baby followed by a baby who
just "hates" the breast. The moms don't go back to either type of this LC.
Moms tell of frustrations with alternate feeding methods. They feel that it
is too time consuming and almost all of them turn to the bottle eventually.
Still sadder is the LC who tells the mom "if he hasn't latched on by now he
never will." I was so grateful for Dr. Jack's section in his book on babies
who "refuse" the breast, and the 22 month old who finally latched on to help
these moms see that it is possible. The BAB has a lot of great information on
the aggressive non-nurser too but the BAB is not readily available to the
moms.
Some of the moms have told me that they or the baby have been blamed for
being "lazy."  Some have been told it is their fault because they let the
baby have/or gave bottles. Some get upset because they are told that they are
not breastfeeding (technically they aren't but in their minds they are).
Obviously we have successfully taught that breast milk is best. What we have
failed to do is convey that breastfeeding is more then feeding.
For whatever it's worth.
Marie Davis, RN, IBCLC

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