Emily, good question!

Yes, definitions are very important, and it's not until you read the 
fine print in many studies that you realize that the term "exclusive 
breastfeeding" also covers a multitude of omissions.  For instance, 
in the literature on HIV and breastfeeding, where we know that 
"exclusive breastfeeding" makes such a difference in reducing 
transmission of the virus from an HIV+ mom to her baby, the term is 
used in one study where one "lapse" of formula-feeding or another 
food/liquid was given (Iliff, 2005) and in another study where a 
whole 3 lapses were permitted (Coovadia 2007).  And in fact the term 
is so fluid (if you'll excuse the pun) that WHO themselves had a 
meeting about it in 2004 and decided that allowing up to 3 lapses 
would be OK to still fulfil the definition of exclusive breastfeeding 
...... But the results speak for themselves.  One lapse led to 1.3% 
of babies becoming infected, whereas 3 lapses led to 4% of babies 
becoming infected.

But outside the context of HIV I've worked with many mothers who, for 
whatever reason, decided to exclusively breastMILK-feed by bottle.  I 
cheered them all the way, because almost without exception if 
"permission" hadn't been granted for this type of modified exclusive 
breastfeeding, then they would have opted for exclusive 
formula-feeding.  They wanted the "best" for their babies, but 
somehow couldn't get their heads around the baby-at-breast part, 
although they were very happy to pump.  Other exceptions were, of 
course, for those babies who had a physical condition that prevented 
feeding at the breast. Some of these women fulfilled the 
recommendation for EBF for the full six months, and continued BF for 
months or a year or so afterwards.  Some went on to 
breastmilk-feed-by-bottle several babies.  One of them surprised me 
almost speechless by saying she wanted to try to actually breastFEED 
her third such baby after a few weeks of breastMILK-feeding, and then 
went on to happily breastFEED him permanently, saying she couldn't 
understand why she hadn't breastFED all of them right from the 
beginning.  I learned a lot from these mothers.  Firstly, that as 
long as the breasts are frequently drained, then they will go on 
producing tons of milk - in fact one of the mothers eventually only 
needed to pump three times each 24 hours, obtaining 250ml at a time, 
which she then split into baby-sized "feeds" as needed.  Secondly, 
that in spite of dire predictions that a baby is needed actually _at_ 
the breast for milk production to be adequate over the long-term, 
this is simply not true.  Thirdly, from observation, I'm convinced 
that the exclusively breastMILK-feeding mother is as closely 
connected and responsive to her baby as any other breastFEEDING 
mother, so I strongly suspect that the hormones produced during 
breastMILK-feeding are almost identical to those produced during 
breastFEEDING.

It's this experience that makes me such a fan of the possibility that 
HIV+ moms could use their own heat-treated EBM from birth, and up to 
2 years.  I've been campaigning for more respect to be given to 
breastMILK feeding for nearly two decades, but amongst those who set 
policy, there is such a lot of scepticism and negativity about this 
wonderful possibility.  Hence this rather long 0.2ml's worth this 
morning.  It was an excellent question, Emily.  I'll look forward to 
others' comments.  Aren't we being a bit purist to suggest that an 
exclusively breastfeeding mom who needs to pump 2 or 3 bottles of EBM 
a day in order to maintain her baby's gut integrity and provide an 
exclusive full complement of all the goodies in her milk while she's 
away at work is _not_ exclusively breastFEEDING?

Pamela Morrison IBCLC
Rustington, England
--------------------
I've closely followed the recent thread regarding "Breastfeeding in 
Combat Boots," and one question keeps coming to mind. Given the 
warranted emphasis on correct term use, at what point is a mother 
considered to be "breastmilk feeding," rather than "breastfeeding?" 
If only one nursing session a day is replaced with expressed milk, is 
the mother no longer considered to be breastfeeding? Does it take two 
sessions? Three? What if baby is reverse-cycling? In my reading, I 
frequently come across the terms "exclusively breastfeeding," which 
does not, to my knowledge, make a clear distinction in what 
percentage of feedings are given at the breast, and "exclusively 
pumping," which does. Please don't mistake my post for anything other 
than a very genuine desire for information- I'm still very new to 
lactation support, and strive to be precise in my use of language.

- Emily in FL

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