I'll freely admit that "pumping is the new breastfeeding" is what tipped me over the edge, but it was after something about not leaving a six month old.  I probably overreacted at the moment after a sleepless night with a teething one year old. 

My point, though, is that value judgements and evidence-based discussion can and should be two different things. Laurie mentioned a family member who chose a primary elective C-section. As an OB, I counsel about this, about inductions, about circumcisions, vaccinations, etc. I work hard to present relevant factual information and best practices   but to keep value judgments out of it, even when I strongly disagree with what my patient chooses. I suppose I need to remember that what's posted here isn't necessarily what a client hears. 

You can pump and be fully engaged with your baby while bottle feeding; you can nurse and be totally distracted. Virginia makes a great point, though, about losing the mechanical advantage. 

This isn't the only discussion thread in which I've seen what I consider snarkiness. It happened in the discussion of pelvic floor repair and breastfeeding. Rather than giving consideration to the surgeon's concern about hypoestrogenism and wound healing in the highly estrogen dependent tissues of the vagina, many responders went straight for a version of "oh yeah? Well how do c sections heal, huh?" rather than a "I wonder why he thinks that, since we don't seem to worry about C sections healing." The presumption in a response such a the first is that there's no possible valid reasoning for her physician's recommendation. 
Further, I think of it as something that signals an unwillingness to learn or consider a different perspective. It's a knee-jerk response. 

I can't imagine leaving my one year old, let alone my six month old- I hate being gone on my call nights and would never want to be gone longer than that.  I can't imagine choosing to EP or choosing a primary elective C-section. Having said that, though, I practice in a country where patient autonomy is valued. I counsel, she decides, and then I do my best to support without judgment. 

I would imagine that many of us who are very interested in lactation also have an interest in attachment and parenting theory. Focusing on attachment will necessarily lead to discussion of nursing, but I have many patients who are interested in breastfeeding only because "breast milk is better than formula."

All of that is to say: yes, I also think it's sad to go on vacation without a six month old, but someone has decided to do it and wants help maintaining her supply. Maintaining the supply in that circumstance should be our focus, not what we think about her vacation. 

Circling back around, I do think there's a heavy emphasis on the pump and developing a "stash". Some of that is marketing driven; some of that is driven by moms who really do want babies to be EB(milk)Fed, and are concerned that they'll need formula when they do go back to work. 

I do very much appreciative the constructive discussions here, and the willingness of listserv members to engage on this topic. I've learned a lot here despite my sometime frustrations!

Elizabeth

Elizabeth Boggs, MD
Women Physician Associates
Columbia SC 29201
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