Nina states:
"exclusive EBM feeding should not be a lifestyle choice but a compromise when breastfeeding
is, for some reason (like a cleft palate) not possible. In most cases, I would hope it is a temporary solution "

While this is certainly the ideal, we have to be careful that we are not "putting down" the mom for whom this is a lifestyle choice.  In addition, those who wind up EPing because of problems should not be judged if they do not make it atemporary solution only. 

In researching for the talk I gave, a number of moms poured their hearts out to me about why they made this choice and, more disturbing, the lack of support and downright discourtesy they received from the professionals who should have been of help.  I think we do agree that when a problem with the baby such as a major cleft occurs, giving EBM by bottle may be the only viable option.  However, even these moms reported that professionals who should have known better (that includes some LCs) told them it wouldn't work or they would only be able to do it for a short time.  In some cases, it was never offered to them as an alternative to formula feeding!  For the moms who are trying to work through major breastfeeding difficulties, a common theme was, "neither the baby or I could handle the struggle any more, so I decided to pump and bottle feed.  We were both happier."  These moms report grieving over the loss of the hoped for breastfeeding experience.  Some did keep trying to breastfeed and a couple did later succeed at returning to direct breastfeeding.  Others did not due to fear of having to face the same disappointment all over again.  Some of these went on to EP for later babies due to this fear of another similar "train wreck".
Again, few had this option presented by the professionals they were dealing with and even more faced disbelief, doubt and downright discouragement.  As for the mom who EP by personal choice from the beginning-whether it is because they have some 
"hangups" about putting baby to breast, want to avoid the horror stories they have heard of or experienced previously or whatever, they experience the most disappointment from those who should have been supportive.  Yes, we would hope they would be able to work through/overcome whatever is preventing them from breastfeeding directly.  Howwever, who are we to judge?  We have never been her, in that particular set of circumstances at that particular time in her life.  Again, these moms chose EPing over formula feeding, not because it was offered as another apporach by professionals but because they heard about it from other moms or stumbled on it purely by accident.  When we meet a mom who has these concerns, we may not be able to  "turn her into" a directly breastfeeding mom in time for the baby she either has or will have soon.  Such issues have taken a lifetime to develop.
We as a profession need to learn more about what these moms need, why they make this choice and how to support rather than undermine them.  In the vast majority of cases, if they were not EPing, they would be giving formula.  We don't need to convince them about the value/normalcy of breastmilk!  We need to recognize that they are doing something that takes a whale of a lot more work than direct breastfeeding or giving formula!  They need our support, understanding and praise, not discouragement and cirticism!!!
By not making moms aware of this third option for fear of "discouraging her from 'really' breastfeeding", are we not being just as patronizing as those who will not tell the truth about the risks of formula for fear of "making her feel guilty"?

Sorry for the length, but I had to get this off my chest.  I mean these remarks not as a direct criticism of Nina for her post, but as an appeal to all of us to be more understanding and supportive.

Winnie

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