I've held off responding to this thread as some of the responses took other 
people's comments as judgmental - which I am sure they were never meant to 
be. So I thought I'd let the topic cool down a bit. Let's go back to give a 
comparable example where lack of clear definitions did a great disservice to 
breastfeeding mothers, and partly breastfeeding mothers, and their babies.

A generation or two ago, in the 1960s-1980s, papers comparing infant feeding 
methods seemed to find that there was really "no difference" between 
"breastfeeding" and exclusive artificial feeding. So doctors and nurses 
often saw no point in supporting breastfeeding, especially if there were 
early difficulties. There also wasn't the knowledge of how breastfeeding 
worked.  Consequently, since breastfeeding wasn't trusted to work and seemed 
to be a waste of time, mothers who sought answers and help through what 
should have been easily fixable challenges were actively discouraged as 
being unreasonable.

Why was this? It was because of sloppy definitions and study designs, or no 
definitions. In too many studies, babies were entered in the "breastfeeding" 
group with anything from ever-breastfed (e.g. an attempt to latch on day 1), 
through various degrees of partial breastfeeding, to predominant 
breastfeeding, to exclusive breastfeeding. Some studies used "intention to 
treat" (or intention on feeding method) in allocating babies to groups, and 
so babies were included who had never breastfeed, or who hadn't breasted for 
some time before the ages at which data were collected. It look efforts to 
create clear definitions in 1990-1991 (by Miriam Lobbok and a colleague, and 
WHO), and even bigger efforts to get them into use, before better studies 
began to show that breastfeeding wasn't a waste of time.

It is because of definitions that we can say with confidence that 
breastfeeding isn't a waste or time, that some breastfeeding is better than 
nothing, and that there is good evidence for exclusive breastfeeding. Some 
of the mothers I most admire could never produce much milk because of breast 
hypoplasia or surgery, but they maximised what they could give their babies 
from their bodies, and gave supplements by supplemental tube device or 
bottle while holding their babies close. One such mother, who gave me 
permission to share her story, only ever produced small amounts, but some of 
her babies stayed at breast at night till age 2-4 years. When there are 
barriers, mothers can be encouraged to define their personal success. That 
said, because we help remarkable women who cope with individual situations, 
doesn't mean that we don't need to define the mode of delivery of the 
breastmilk, because only by studies with good definitions and methodology 
can we learn. We can only measure the effects of what we know. Ultimately, 
we can then be more effective in giving mothers informed choices.

Here's another example of misunderstanding the use of definitions or 
descriptors. In the 1970s, I discussed in a newsletter for breastfeeding 
counsellors the fact that in many areas we weren't serving the needs of 
lower-socio-economic women. Someone read this, not understanding that this 
was a term used in a number of disciplines, and totally missing the point 
with a hostile letter stating that we shouldn't be "telling" women they were 
"lower-socio-economic" - which wasn't what I said. The descriptor was used, 
in-house, to identify where we were letting mothers down. Supporting them 
didn't mean "telling" them they belonged to a particular category, but 
meeting them on their own terms. Identifying who needs more support is a 
good step towards providing that support.

I'm sorry that this is such a long post, but I hope you can take time to 
read it fully if this topic interests you.

Virginia

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA, GD Counselling
in Brisbane, QLD, Australia

----- Original Message ----- 
From: "heather" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, November 24, 2013 4:12 AM
Subject: Re: Using correct language: bmilk feeding v breastfeeding


> >Heather that is a big BUT!
>>
>>I don't believe I am 'fudging' anything, nor did I say it to make people 
>>feel better. My post was in reply to a comment about 'correct language'. 
>>OMS has a very wide definition of breastfeeding and I agree with them.
>>
>>Heather, why is there a but? They are breastfeeding, period. You, 
>>yourself, warn against categorising.
>
>
> Well.....I warned against categorising  mothers' *reasons* for 
> breastfeeding/breastmilk feeding.....I am somewhat in favour of 
> categorising different ways of getting breastmilk into babies, otherwise 
> how the heck are we gonna know what we are talking about?!
>
> That doesn't mean I think women should be judged, criticised or 
> disparaged.
>
>>
>>I have not said anywhere that at-the-breast-feeding and 
>>expressed-milk-feeding are the same - I said that they are both 
>>breastfeeding.
>
>
> They may be 'the same' for research and international policy purposes, but 
> they are not 'both breastfeeding' , and if they have the same *name*, it 
> does rather make them sound the same :)
>
> I don't mind a bit if individual women who are breastmilk-feeding (and 
> their HCPs in dialogue with them)  use the term 'breastfeeding' to cover 
> what they are doing. But on a list like this one, and in debates where we 
> discuss the strategy, tactics, education and generality of infant feeding, 
> we should use the correct terminology.
>
>>
>>
>>>by this than by a pretence that what they are doing is 'the
>>>  same' and that the difference doesn't matter.
>>
>>I was quite offended by that - I did not say it. If this comes across in 
>>my post, then please point out where and I shall edit.
>
>
> You said "I believe that emphasising the difference between breast milk 
> feeding and breast feeding is discriminatory against those of us who 
> simply cannot enjoy a 'normal' breastfeeding relationship" and it was 
> this, along with your strong feeling that we should call both 
> breastfeeding and breastmilk feeding  the same thing, that made me believe 
> that you are aiming to minimise the difference between breastmilk feeding 
> and breastfeeding....not just with individual mothers, but generally. I 
> don't want to offemd you, and I would not emphasise the difference to 
> mothers.
>>
>>>their equally
>>>  wonderful gift is their *presence* at the time of the feeding.
>>>  Breastmilk feeding needs to be done *as if the mother was
>>>  breastfeeding direct* when possible.
>>
>>This comment makes me think  you do not know the reality of exclusive or 
>>predominant pumping - on facebook there is a photo going around of a baby 
>>in a rocker being bottle fed by a mother who is also pumping. I have been 
>>there and done that and was not proud of it - but there are only 24 hours 
>>in a day, especially if you have other children - this is often the 
>>reality of expressing. There may be some EPers who are so efficent they 
>>can fill a chest freezer (and they are obviously the ones who talk about 
>>it loudly, not the ones who struggle to make enough to be one bottle 
>>ahead, or who never make cover their child's nutritional needs and 
>>supplement. I don't know how many times  I was a 'wonderful presence' - 
>>rarely I would think. My husband and I were both sleepless zombies in the 
>>early months, I would pump and pass the bottle to him and he would feed 
>>the baby - every couple of hours. I only mention my personal experience as 
>>it's something parents are reticent to talk about. It is painful to know 
>>that you were NOT a wonderful presence who bonded through bottle feeding.
>
>
> Yes, I can understand it is painful to know that - but  are you saying on 
> Lactnet we cannot say (as I did) 'Breastmilk feeding needs to be done as 
> if the mother was breastfeeding direct when possible'????  I don't want to 
> cause anyone pain, but there is nothing 'wrong' with what I said, and 
> Lactnet should be a safe place for me to say it.
>
> No parent can ever be wonderful all the time, and we have Winnicott to 
> thank for the concept of the 'good enough' parent and for the notion that 
> not being wonderful all the time is actually beneficial to our children :)
>
>
>>
>>Having parents who feel alone, excluded and crying into their pumps (I am 
>>not exaggerating) because they feel like failures, is not a good outcome.
>
> Of course it isn't....
>
>>Parents proud to be pumping would be a good outcome.
>
>
> Yes! I am, however, also in favour of people having good information, and 
> that includes parents knowing that it's not all about the milk (however 
> it's done...and whatever the milk is) and enabling them to value 
> themselves as more than milk suppliers (whatever the milk is). I am 
> certain you feel the same :)
>
>
>>  Currently, I use;
>>
>>Breastfeeding, umbrella term (as defined by OMS)
>>followed by the subcategories;
>>
>>at-the-breast-feeding and expressed-milk-feeding - for those times when we 
>>need to know the details.
>>Look forward to hearing thoughts on that.
>
> That's ok by me - there are times we do need to know the details and we do 
> need to label, so we know what each of us is talking about :)
>
> Heather Welford Neil
> NCT bfc, tutor, UK
> -- 
>
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