"A mother should not need a breast pump to breastfeed except under very
extraordinary conditions (baby in NICU, terribly premature, etc.), and a
mother shouldn't need to express milk from her breasts unless she is saving
milk for bottles/cups when she must be away from her baby (working
mothers)."

Right in theory, but not reflective of real-world (in North America, anyway)
practices (and, since Pamela, who started this line, is in Africa, probably
*not* just NA!) In hands-on, down-in-the-trenches daily working w/BF women,
there's a broad range of things women do, not all of them necessarily
conducive to perfect, ideal, the-way-nature-intended BF practices - I look
it as "well, at least this baby is getting breastfed", give the mom the
straight information, and try to help her figure out what will keep her &
her baby BFing in the way that works for them.

And like it or not, there are times when women "need" ("need" not in a
biological sense, but in reponse to the conditions which they themselves may
have participated in creating) to know that it's better for their
breastfeeding and better for their own breast health to express milk
remaining after the baby has done its part. Example: a woman who's had a
medicated birth, with a sleepy baby who might nuzzle, mooch around, take a
couple of sucks, & conk out. Is this a "normal" situation? Well, in pure
terms, probably not - but in practice, there it is and we see it every day.
So we make sure the baby's getting fed, we put mom & baby to bed, we share
with her about lots of skin-to-skin & the importance of cuddling her babe,
etc., etc. But we also tell her to express her milk, because we *know*
('cause we see it all the time!) that the pressure exerted by too much milk
left in her breasts will decrease her supply tomorrow or the next day, and
we know that that causes problems both for her and for her baby.

And, sadly, working mothers "needing" to be away from their babies is not an
"extraordinary circumstance". Now, we could talk forever about that "need"
(and whether or not it's the best way for families to go, other ways to meet
that need, etc.) but what's most relevant in the heat of the moment is what
*this* mother sitting in front of you, with *this* baby and *this*
circumstance perceives as her need. So we can help her widen her perspective
a bit (maybe), and if we're lucky toss in some alternative ways of thinking
about her situation, but it's her concerns we're addressing, and our agenda
is to help that mom feed that baby.

"I cringe to think of women expressing and discarding all that wonderful
milk."

Me too, but I don't think anyone (at least here!) would ever recommend
discarding all that precious milk! Who said anything about discarding it?

Cathy Bargar, RN, IBCLC Ithaca NY

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