You know Kathy, I agree with every single word you wrote about the risks of
separating the product and the process, but I still couldn't advise
bottle-feeding formula if there was any prospect of bottle-feeding
breastmilk.

That's partly emotional, because I have a son with a gut full of scar
tissue as a result of the product, who wouldn't have those scars if
breastmilk banks had been available and neurotic staff comped with women's
milk. (In fact it may still lead to his untinely death.) But it is the
clinical versus public health tension of trying to do the best possible for
the individual baby for whom I am personally accountable, versus the larger
scale reality of what is best for public health in the long-term. And the
"best for public health" mentality has to be scrutinised very carefully: it
can lead to some scary scenarios of rationed care and prioritising of
treatment in which the "defective" and the powerless go under.

>I think breastfeeding is about a whole lot more than the transfer of a
>nutritious fluid from mother to child,...the cuddling and skin-to-skin,
>and the smell, touch, sound, etc. of mother's arms are just as important
>to the baby's health and well-being as the antibodies {AND the rest!!] in
>the breast milk.

Absolutely. And there are fantastic scientific pieces of argument to say
so. Which we should talk about in the same way and the same breath as we
talk about the benefits of the milk per se. Hormones are important to
maternal and child health, maternal role adjustment and much more that we
can't quantify and explain, but can witness to.

>But the funders of medical research view c.f. as a non-problem, now that a
>"solution" has been found... Again, this means less research
>into>prevention, less research into therapies, less support for public
>education>

I'd agree entirely with this whole argument too. Barbara Katz-Rothman's
book, The Tentative Pregnancy, should be required reading for everyone in
MCH work. But you're talking about medical care and education, for children
who are incredibly privileged in the real world. Consider the fact that we
have had measles vaccines for how many decades, and  how many children
world-wide die every year of measles? More than of AIDS when I last asked
about this. Public health perspectives don't change political realities.

I agree pumps are a problem in the US (and I gather in Saudi Arabia, where
those with money consider that the more gadgets the higher the status of
the activity: is that report correct, anyone?) But I still think the answer
is more education about all the issues: the products, the processes, the
effects of both (for the act of bottle-feeding is profoundly disempowering
for a child compared with the act of breastfeeding, as well as all the
obvious things like facial deformation and other risks) pump technology and
its consequences.

>If the separation of the product of breast milk from the process of
>breastfeeding continues, then no one will be concerned about whether or not
>babies actually ever get to breastfeed.
Not if we get as strong on the problems of the process as we are of the
product. Which are numerous. It isn't a coincidence that America pioneered
orthodontics, another "cure" available only to the wealthy.

I agree with all the scenarios you paint: they could all be an outcome of
the pump mentality. But realistically, how long
* before obstetricians change labour in the US;
* before people stop comps of formula not breastmilk for sleepy babies;
* before the US gives women decent maternity leave work-based childcare etc
etc: and
** will the total absence of pumps will hasten that day?

If the answer is yes, you are right to crusade about this issue (and I
think it's very useful to do so anyway, as it makes people think harder
about what they're doing with pumps, which should NEVER be an automatic or
unexamined option)

All I can see for certain as an outcome of absolutely no pumps is more sick
babies as people feed formula, and more mastitis as unskilled people
manipulate breasts to try to hand express.

I agree, hand expression is a priority area for education. I agree, pumps
can be a problem. But because I know so many families who are paying the
price for infant formula exposure, I could never agree that I should do
worse for any one child than was humanly possible. And formula in a bottle
is a *lot worse* than breastmilk in a bottle.

If that makes me an obstacle to progress in breastfeeding, I'm sorry. But
I've never been a big fan of the end justifying the means philosophy. Too
often the end is not attained but the means have been appalling.

We have pumps here in Oz, and there is a minority of mothers who are
misusing and will misuse them. But they are also helping lots of other
mothers to achieve successful breastfeeding, and that's fine by me. And the
socialite mother who's merely making milk for the nanny to feed is still in
a better hormonal state to be a mother than if she were leaving cans of
formula for the sitter. Who knows what that means for her future mothering
of this child or the next..Breastmilk  (as well as Breastfeeding) is a
powerful connector in many cultures.

I think we're looking at the same coin from two sides, and there's value in
both, myself. I look forward to your reply! And I agree AAP have come a
long way...
Must go to bed. Adieu! Maureen





Maureen Minchin, IBCLC
5 St, George's Rd., Armadale Vic 3143 Australia
tel/fax after March 1: 61.3.95094929 or 95000648