I avoid recommend pumping routinely or "just in case".  I think it's funny
we are careful to warn mothers about "dependence" on nipple shields and
their possible unintended side effects, but don't similarly explain the
potential consequences of pump use -- including dependence and the loss of
the direct supply-and-demand milk production system.
Though I think pumping can be very useful and of course I recommend it (as
an alternative to hand expression) in cases of separation, extended breast
refusal, etc., it is an intervention and I don't go along with the attitude
that "it can't hurt and it might help".  I think it *can* hurt and it might
*not* help and that it should therefore be used on a case-by-case basis.

I think we are so focused on protecting the milk supply that we forget all
the women with very abundant supplies.  An overabundant supply in a
mother  who doesn't know how to lower it can make every feeding a confusing
battle with a clearly overwhelmed upset baby who acts unsatisfied and gassy
and has "diarrhea", and calms right down when given a bottle... at which
point the mother may also get a plugged duct from skipping the at-breast
feeding...  Weaning is the obvious next step for many mothers at this
point.  I believe routine pumping can cause or worsen this and for that
reason, I wonder if it's really a good way to "prevent" plugged ducts.  It
strikes me as an inflationary setup: you get locked in to always having to
pump more in order to drain the breasts which then make more so you have to
pump yet more...and by the time the mother is making this much, it's the
determined baby who will nurse long enough to get much hindmilk.  How can
we preach "supply and demand" out of one side of our mouths, and recommend
*extensive*daily* pumping for a wide variety of common breastfeeding
glitches out of the other?  (Again I am not talking about separation,
complete non-nursers etc.)

Furthermore, once you've pumped, what are you going to do with the
expressed milk?  It's not in the baby yet.  Whether it goes into the fridge
or the freezer, sooner or later someone's going to feed it to the baby.  In
my experience it's sooner rather than later, and it's in a bottle.  This
does not help the baby learn to latch on the bare breast and may disincline
the baby for the breast even w/shield because of the faster flow from the
bottle.

Our dependence on pumps is affecting people's perception of how
breastfeeding works.  It's not a direct relationship between mother and
baby any more, it's a mediated relationship, with the pump as the central
indispensable element.  Yesterday three women asked me for or about
pumps.  One had normal engorgement, and another is 36 weeks pregnant and
wondered what kind of pump to get.  She had no reason to need one right
away, just assumed she would have to get one since she was planning on
breastfeeding.  Hello????  (The third was the one whose 3 week old was to
spend a full day with grandma -- in a previous post.)

Elise
LLLL, IBCLC
Swiftwater, NH

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