Jean Cotterman asks whether Mike Woolridge's latest ultrasound studies
of the mechanics of breastfeeding and bottle feeding are done without
commercial backing, and I can say they are not. He has had support
from Philips, who own another non-Code compliant pump company, Avent.
He does not try to hide his funding source.
That said, his findings would be difficult to spin into marketing for
any pump company, since he has found evidence that there is
compression/massage by the tongue during milk transfer, along with
vacuum during the downward jaw excursion.  He did not find any babies
in which compression was absent during active feeding.  None. Babies
varied in age but I can't remember the exact range; if I recall
correctly the same babies were followed over time.  Since Medela's
main sales message the last few years has been that suction is
all-important while compression hardly matters, and they quote 'their'
research in support of this notion in their advertising, it was a
welcome contribution to the scientific debate when he presented his
findings at a conference I attended in June.

I posted about it at the time, including mentioning that the two
identified Medela IBCLCs who were present, appeared to record his
entire talk on their mobile phone devices, and if that is indeed what
they were doing (phones carefully perched on their knees, the whole
time) it was certainly without his permission or the permission of the
conference organizers, researchers at the University of Central
Lancashire.  I was floored, so much that I could not find words to
challenge them on it then and there.
I found his talk a welcome contribution to the discussion about
mechanics of feeding, particularly since the discussion has at times
seemed more like a contest to make the best-selling breast pump rather
than an effort to understand what happens at the breast, in order to
help actual babies overcome problems at the breast.

I find myself despairing over our focus when I read tables of sucks
per minute and millimeters of mercury as *the* way of describing what
is happening when a very small premature baby suckles at its mother's
breast.  I hope no mother is ever going to call us and say 'I can feel
that my baby's suck is only xx mm Hg and the book says it ought to be
yy, what can I do?'  Almost like the mothers who phone, concerned that
they can *only* get 120 ml out of one breast in one 15 minute session
of expression, and the formula package says that a baby the age of her
baby should get 150 ml per feeding, and do they have to supplement
with 30 ml of formula (or even worse, do I have to take the baby to a
doctor to find out why the baby is content and thriving on too little
food!).  I do get some of those.  As soon as there are published
numbers showing common ranges of occurrences of events, they become
normative and then they start really doing damage because they change
how we think about something that at the outset has very little to do
with measurable quantities.  Think what clocks and time limits on the
different phases of labor have done to birth.  Rather than wondering
why labor seems to drag on and on without progress in many of the
places we have constructed for babies to be born in, we react to the
delay itself by escalating our efforts to force things to happen 'on
schedule' and look what has happened to the rate of spontaneous,
undisturbed birth as a result.  As long as breastfeeding was less
infested with seemingly measurable rates and quantities, it escaped
the interest of the reductionist, mechanistically obsessed
practitioners.   I fear for what is coming just beyond the current
horizon.

Yes, we need objective measures of the technical specs for pumps so we
can tell whether a pump is working as intended.  But (I hope!) we are
unlikely to start measuring in mm Hg the negative pressure exerted on
the breast by a baby when we are seeing that baby and its mother to
observe a feeding - EVEN if the baby isn't thriving and that's why we
are seeing them.  There are many other ways to observe and assess the
effectiveness of a feed without moving the focus away from the
mother-baby relationship, ways that empower the mother, strengthen her
self-confidence and her confidence in her baby, and reduce her
emotional dependency on gadgets, like clocks, scales and pumps.
I am not saying babies should never be weighed, we should never know
what time it is, or that pumps are evil.  I'm saying they should never
take center stage in a drama containing a mother and a baby. They are
props, not supporting actors.  Part of what I do is put those measures
into perspective so the mother can see that the part she needs to
concentrate on is eminently doable, and is best done by her: see her
baby, love her baby, and nurture it.

Rachel Myr
Kristiansand, Norway

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