Heather, thank you for your eloquent post.  It’s a keeper!

Jean Ridler  RN  RM  IBCLC
Cape Town, South Africa

> Alice - I absolutely hear what you are saying. Just recently, I was
> contacted by a mother who had expressed milk long-term for her baby
> because of serious difficulties with 'direct'  breastfeeding.  She
> wanted to know how her feeding would be 'classified' and it was
> important for her to feel there was an official  difference between
> what she did, and how bottle feeding with formula was classified.
> 
> I told her that in international definitions, breastfeeding and
> bottle feeding with EBM are treated the same.....the baby who gets
> nothing but breastmilk by whatever means is counted in studies as
> exclusively breastfed.
> 
> She was very pleased at this.
> 
> BUT.
> 
> Breastfeeding and breastmilk feeding is *not* the same. We cannot
> fudge this, when sharing information with mothers when they are
> making choices.  Sparing the feelings of mothers who are unable to
> get breastmilk into their babies in any other way than with a bottle
> is a laudable aim but it does not help other mothers make an informed
> decision.
> 
> Mothers who express long-term should **not** be divided into categories of
> 
> i)women who have to because their baby has a cleft palate (for example)
and
> 
> ii) women who make a lifestyle choice because breastfeeding direct is
> not appealing to them for some reason
> 
> because who are we to judge  which cartegory to place a mother in?
> 
> A mother who has a history of sexual abuse involving her breasts
> might make a 'lifestyle choice' not to battle these feelings but she
> is under no obligation to share her reasons; a mother with a baby who
> will not attach to the breast because of perinatal factors may decide
> not to keep persevering with direct, and may make a 'lifestyle
> choice' to use a pump instead....whatever, not everyone fits into a
> category and nor should we expect them to.
> 
> Instead, we need to support and enable women who want to/have to
> express long term, and explain to them that breastmilk is absolutely
> worth giving instead of formula. That their efforts are worthwhile,
> and their wonderful gift should be celebrated.....but 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.
> 
> On purely bio-medical grounds, it means the mother shares the same
> pathogenic environment as the baby and therefore the antibodies she
> makes will go into the milk.
> 
> But on other *relationship* grounds, the baby whose exclusive bottle
> use means *anyone* can feed the baby, the baby whose exclusive bottle
> use means the mother can take a holiday away from him :( :( :(, the
> baby whose exclusive bottle use means he can go into day care at some
> ridiculously early age....is a baby who is *missing out* (and a
> mother who is missing out, too).
> 
> Mothers who are using bottles of EBM exlusively need to value their
> own presence and their own relationship with their babies. They need
> to give the bottle as if they were breastfeeding (skin to skin when
> possible, paced bottle feeding, responsive bottle feeding, bottle
> feeding in bed, in the bath and anywhere they want to be close). This
> will go some way to close the gap between the experience of direct
> breastfeeding and breastmilk feeding by bottle.  Mothers are
> *mothers* and not just suppliers of breastmilk.
> 
> Alice, your mothers need to know this too.....and they are more
> empowered by this than by a pretence that what they are doing is 'the
> same' and that the difference doesn't matter.
> 
> Heather Welford Neil
> NCT bfc, tutor, UK

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