The mother and former international public health nutritionist in me knows that mothers should be in a supportive environment with many others helping her care for her infants and young children.  Richard Manoff gave a speech many years ago where he tallied up the time it would take a mother to implement the main interventions that UNICEF proposed back when UNICEF actually looked at the five things that had the biggest impact on infant mortality (which included putting breastfeeding front and center rather than an asterisk).  By the time he made us think about this it was very clear that women could not really accomplish these tasks easily without support.  

In this line of thinking, i tend to think of the relief of the bottle and pumping along the same lines as handing your baby over to your cowife, sister, mother, wetnurse, etc while you go out an pull weeds in the pineapple patch (I was once asked to be the fifteenth cowife by the chiefs first wife because I was pretty good at this) or other "production" work that has always been a part of being a woman. Woman have always balanced the work of production (which sometimes means income) and caregiving.  Now it is more segregated which makes the balance harder and we have less support and respect for our caregiving roles. So when a mother uses the pump and a bottle, I consider it a sterile (in more than just the sense of bacterial count) equivalent of those other cuddlier options for infant feeding.

Yet, the epidemiologist in me tells me that researchers need to be more precise in their definitions, even when it comes to breastmilk feeding versus fed from the breast.  There is plenty of research to show that being fed from a bottle is different from feeding from the breast beyond the occasional baby that will then reject the breast. The ramifications of using a pump and a bottle are quite different from swapping your baby with your cowife, relative or wetnurse.

Here our modern society has completely transormed infant feeding into something it never was.  A chore to be dispensed with as quickly and as infrequently as possible.  We have trained generations to be fed in the stuff and starve mode.  Now we are transferring this form of artificial feeding developed for an artificial substitute for breastmilk back to breastfeeding.  I believe the current mode of modeling breastfeeding and breastmilk feeding after bottlefeeding formula will minimize the difference between the breastmilk fed infant and the formula fed infant in terms of later eating disorders (e.g. obesity, anorexia and bulimia).  I just once again had a question about a seven month old who was being stuffed with huge amounts of cereal because she rejected a bottle.  She was being given seven ounces of cereal with a tiny bit of breastmilk during her 8 hours of day care.  The day care workers reportedly are very amenable to doing things differently, just no one ever told them that a seven month old really cannot get enough nourishment from cereal to compensate for the breastmilk this baby is refusing to drink from a bottle.  The fact that this ignorance exists in our modern societies has not to do with the day care workers, but with the transformation of infant feeding into something so alien from normal eating that it is no longer recognizable.  

I think if one were to study HOW babies were being fed their breastmilk as well as what other substances they were being fed, there would be as many nuances as one finds in the SIDS literature when one barely scratches the surface of how abysmally imprecise the definitions of sleeping arrangements have been.  Clarity in research is essential.  Lumping all sorts of behaviors into one gross term really can lead to many false conclusions.

So, while I can empathize and certainly encourage mothers to continue to express milk for their babies when separations occur, I do not think that health care practitioners and researchers should consider exclusive breastfeeding and exclusive breastmilk feeding exactly the same.  I think we need to delve deeper into how the breastmilk feeding is influencing infant's health so we can better advise mothers to make it as healthy as possible.

Best, Susan E. Burger, MHS, PhD, IBCLC
 

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