Dear friends,

I would like to thank everyone who participated in this conversation, both on and off-list. To receive such support from around the world is truly a blessing for which I am thankful. 

In thinking and writing about the hair-splitting we must do in this field when we speak of behaviors and their implications, I do understand the need for specificity. 

I especially understand it when I consider that research drives policy; if we want a policy, our research to support it has to be infallible. If we want to use breastfeeding as our foundational argument for why a universal maternity leave policy is necessary in the United States, then feeding expressed milk *can't* be just as good as breastfeeding. If it is, we have no basis for our case. The World Health Organization even ranks methods of infant feeding by superiority, and expressed milk is clearly #2. In a research and policy context, the distinction is vital, and we are correct to hold each other to that standard. 

Where my nerve was touched, though, was first, the (inferred, by me, so perhaps not really there) presumption that mothers in the military don't feed their babies at the breast. I realize cinematic depictions of my occupation don't support this, but I didn't push my babies out, then drive away in a tank to go shoot people in the desert until my children went off to kindergarten. :) The realities of my career more closely approximate the life of a symphony musician ... perhaps that of the first female who dared infiltrate the ranks of the fraternal Vienna Philharmonic? The first woman in the history of my unit to bear a child and not be discharged served with me; sadly, she was among my steepest obstacles when I needed to advocate for myself, likely because the experience of mothering her instincts urged was sorely denied by the environment in which she was determined to excel. 

And, as I have shared here and elsewhere many times over the years, my babies pretty much refused to be breastmilk-fed. I understand I am an anomaly for sustaining both breastfeeding and military service under the circumstances -- and please know that I don't recommend my path to anyone, ever. I do believe, though, that the severity of my experience coupled with my inability to become numb to the nuances of it have propelled me to make my life's work of ensuring no mother ever has to do what I did unless she wants to. I accept that "it was all for a reason."

My other source of upset was the context from which this conversation began. Of course, we make a distinction between breastfeeding and breastmilk feeding (imagine the implications if that distinction were not clearly articulated in education about the lactational amenorrhea method of child spacing, where even the use of a pacifier can significantly impact a mother's hormonal state!). But when do we emphasize that distinction? When does it further our effort, and when does it diminish it? Being able to tell the difference may be an important consideration in our work. 

I am, like Rachel Myr, extremely thankful for this forum for discussion and for the depth with which we can respectfully investigate these important issues. 

--Diana Cassar-Uhl, IBCLC 
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