First let me thank all who regularly post to this list.  It has been a 
incredible source of information for me over the last couple years that I 
have lurked.  With the present discussion of exclusively pumping though, I 
felt I would like to add my thoughts and experience.  I exclusively pumped 
for just over a year.  It certainly was not a choice I wanted to make but 
due to difficulties breastfeeding my son who was born at 31 weeks, it was 
the lack of options that led me to EP.  (And I can happily report that I 
am enjoying now breastfeeding my new daughter who is just 3 months old.)  
I should also add that after weaning my son, I wrote a book on the subject 
of exclusively pumping, so I have had the opportunity to think indepth 
about the subject and come in contact with many women who end up- or 
choose- to exclusivley pump.

I do believe that while it is certainly possible to exclusively express 
breast milk long-term it needs to be seen as an alternative only to 
formula and not an alternative to breastfeeding.  I do believe that 
acknowledging it as an alternative to breastfeeding equates it to 
breastfeeding and does not acknowledge the benefits of breastfeeding that 
are not present in just breast milk. Yet, most women that I have 
communicated with who EP, faced a point of desparation where they were 
prepared to wean and switch to formula and if not for the option of 
exclusively pumping, their babies would not be receiving any breast milk. 

This is not to say, however, that there aren't women who make the choice 
to EP prior to the birth of their baby.  In fact, I believe over the past 
3 years that I have been involved in this population of women, the number 
who are EPing by choice as opposed to coming to it by circumstance are 
increasing.  I think this is in part due to the acceptance that breast 
milk is best but not a belief that breastfeeding is best.  They are women 
who want spouses and family to participate in the baby's care and believe 
bottlefeeding is the way for that to happen.  Some women have had 
difficulty breastfeeding a previous child and don't want to face the same 
challenges again (Although many who EPed for one baby go on to breastfeed 
a subsequent child).  Some who believe that since they have to return to 
work soon after the birth of their baby that they might as well just pump 
from the start since they would have to pump once they return to work.  
And some who simply do not want to put a baby to breast.  None of these, 
in my opinion, are valid reasons to exclusively pump (not to mention the 
lack of knowledge they highlight and the need for honest discussion and 
education about the norms of breastfeeding and mothering), but at the same 
time, one has to ask how many of these women would simply feed formula if 
pumping was not possible.  My guess is many of them would.  

Lara mentions her yahoo group which is a great source of support.  There 
are numerous others on the internet, many on more "commercial" web 
communities and it is on these discussion boards that I see more and more 
women who are choosing to EP prior to delivery.  In fact, there are some 
who believe that offering advice on these boards about breastfeeding or 
suggesting a mother at least give breastfeeding a try is being 
unsupportive of those who choose to EP from birth.  The mind-shift is an 
interesting one. 

Ultimately, women should breastfeed.  But the barriers are many: lack of 
knowledge, poor support networks, little or no access to knowledgable LCs, 
a society that only gives lip service to the importance of breastfeeding, 
governments/employers that refuse to give mothers time off work after 
having babies, a hospital system that medicalizes pregnancy and birth 
making women feel disconnected from their bodies and makes the process of 
labour one that requires doctors and machines and hospitals...  It is my 
opinion that anything that allows babies to get breast milk, if they are 
not going to receive the benefits of breastfeeding, should be encouraged 
and supported.  And without the option of EPing mentioned to mothers- and 
not just mothers who are experiencing difficulties since many women will 
simply quit breastfeeding without seeking help- there will be many, many 
more babies than necessary who will be fed formula .

Breastfeeding is emotional and for a new mother to have difficulty doing 
something that is suppose to be so natural makes the emotional toll that 
much more devestating.  The vast majority of women I come in contact with 
were dedicated to breastfeeding, sought out help from LCs, and continue to 
work at breastfeeding their babies, but there does come a point where the 
emotional pain of not seeing success and the exhaustion of the cycle of 
breastfeeding/bottlefeeding/pumping becomes so overwhelming that a line 
has to be drawn to say, "I am exclusively pumping" and not "I am trying to 
establish breastfeeding".  In my experience though, once this line has 
been crossed most babies do not make a switch to breastfeeding.

I think in order to decrease the number of women who are EPing there needs 
to be honest information presented to women on the normal course of 
labour, the normal process of lactation, and the normal needs of a newborn 
infant.  Too many women seem to accept medicalized births, separation of 
mother and baby, and buy into the belief that a one month old should sleep 
through the night; how can a normal breastfeeding relationship be 
established admist all this?  

Anyhow, hope I'm not out of place sharing my ramblings.

Sincerely,
Stephanie Casemore

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