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Subject:
From:
Miriam Pokharel-Wood <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 25 Mar 2019 13:10:23 -0700
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The lactation field needs to have more research and discussions about
Exclusive Pumping.  To answer the original post, I don't think there are
any studies looking at the health benefits/outcomes for Exclusive Pumpers
(EPers)/mothers compared to those who Direct Nurse (DN) at the
breast/chest. There are few, if any, current studies looking at EPers at
all.  We do parents and clients a disservice when we take what they are
asking about (in this instance EPing) and instead try to refocus them on
DN. We've been emphasizing "breast is best" for a  long time, and yet when
parents attempt to exclusively feed their children breast milk, but for
whatever reason are not able to or do not want to DN, many in the lactation
field are discouraging rather than supportive.

I take serious issue with the assertion that appears to be made, below,
that the only way to bond with a child is to feed a child at the breast,
particularly in a discussion of Exclusive Pumping. Anecdotally, I have seen
plenty of direct nursing (DN) mothers check out while nursing at the
breast. Everyone deserves some time to decompress and disengage,
particularly new parents. I think that the trope that breastfeeding is the
only way to bond with a child has caused stress, guilt and mental health
concerns for parents who are not able to DN. Attendance at Postpartum
Emotional Support groups and my work as a Therapist with new parents and
young children can attest to this. This kind of insulation is one of the
reasons that EPers tend to have negative experiences with LCs and
breastfeeding professionals.

As an IBCLC and an EPer for my 5 mo child, I can honestly say that we are
often trying to make the best of a difficult, painful experience. I saw an
IBCLC weekly during my child's first 2 months (bubble palate, PTT,
hyperactive gag reflex), tried Cranio-Sacral Therapy, physical therapy, PTT
revision, BF support groups, triple feeding with any accompanying tool you
can imagine (syringe, SNS, bottle, nipple shield, you name it), etc. It is
very hard to bond lovingly with a nursing child who screams every time you
try to bring them to the breast due to oral/facial abnormalities. (I will
say that I make lots of great loving eye contact while snuggling my baby
close with a bottle. Also sometimes baby and I both check out and avoid eye
contact. He's still social, engaging and securely attached).

Is EPing more difficult, time consuming, and labor intensive? Obviously
yes. Do I wish that I could nurse my child at the breast?  Yes, I wouldn't
have cried and grieved over this experience if I didn't. Do I wish that the
LC I see during weekly BF support groups would ever once praise me and the
other EPing mama for all of the extra work I put into giving my baby breast
milk? Of course. Please don't over simplify the experience of nursing or
breast/chestfeeding to an assertion that if parents had more support they
would be able to DN. For most EPers I've talked to, and the vast vast
majority (~90%) EPer in the studies I have read, it is not a "choice" to EP
-- it is an alternative we choose because DN doesn't work out the way we
planned. For others, DNing was never the best option for them. A poster at
the 2018 ABM conference (I believe), looked at a small cohort of EPers from
a larger study (n=18) (Martin H., Dozier A., Rosen-Carole, CB "Lack of a
Latch: Risk Factors and reasons for feeding breastmilk by bottle only"),
and found that 88.9 percent exclusively pumped due to latch issues, and 0%
initially wanted to EP. For all of them it was the "next best" option.

I know that expressed BM is not the same as DN. I doubt that there are any
EPers who do not know this information. What we want, instead, is to be
validated for the labor-intensive work that we do to provide our children
with breastmilk, as we've been told over and over how beneficial it is for
our children. Our only other option is formula, and we all know how much
that is demonized in the lactation field. Maybe what would be more helpful
is for lactation professionals to do more research into EPing, how to
support EPing families, and what advice or guidance to give. Fiona M.
Jardine is another research who is looking at Exclusive Pumping and she is
on the forefront of this research and presenting at two conferences this
year (https://fionamjardine.com/).
I did some anecdotal research on what EPing families would like to have
learned from their lactation professionals via a closed Facebook group that
I am a part of for Exclusively Pumping mothers. I've summarized below the
feedback that I received. I received approval from posters to share this
anonymous/aggregated information.  I would be happy to continue the
discussion around Exclusive Pumping with anyone, and find additional ways
to support this small, but noteworthy portion of breastfeeding families.

*Ways Exclusive Pumpers hope that Lactation Professionals would support
them:*

- Acknowledge/Suggest Exclusive Pumping as a valid option, particularly
when a dyad is having difficulties with latching/weight
gain/TT/cleft/NICU/etc. Many EPers have to find out that EPing is an option
on our own and find community on our own through FB groups. People
identified wishing that a LC told them it was ok to not directly
nurse/latch, that triple feeding was not the only option. (Personally,
after 2 months of screaming at each feed and poor milk transfer even on the
best of days, I psychologically could not handle nursing any more, and I
wish that one of my LCs had even identified EPing as an option, given how
committed I was to providing breastmilk to my child). As a new IBCLC
myself, training on EPing, in particular, and pumping, in general, is
sorely lacking in our profession.
- Understand that triple feeding (nursing at the breast, pumping, bottle
feeding) is time consuming, labor intensive, and for many families,
unstainable longterm.
- Acknowledge that EPing is hard, but in a kind, reassuring supportive way
(more difficult/time intensive/more increase in commitment than DNing)  As
one mother said “encourage don’t discourage, support and help not shame.”
Be informative and encouraging.
- Avoid making it seem that pumped BM is not as
beneficial/nutritious/protective in regards to antibodies than DN. EPers
already know about the saliva/nipple transfer for antibody production, and
when lactation professions bring it up as another reason we should try to
latch again, it makes many women feel that the should just give up and
increases guilt at our “failure to latch successfully”.
- EPers struggle with mental health concerns (guilt, shame, failure,
embarrasment). *Do not insinuate that bottle feeders will bond **less** our
children*. Many EPers do not feel welcome at BF groups (hospital groups,
LLL, etc) because we are not DNing and we are not sure if it is appropriate
for us to attend.
- Babies who don’t latch well aren’t “lazy”, people who exclusively pump
aren’t “lazy” nor have they “not tried hard enough to latch"
- LCs should have more information on supplements: Fenugreek doesn’t work
for some, has the potential to reduce supply. Other options for increasing
supply (Moringa, goats rue, etc)
- EPers wish lactation professionals would receive more training on EPing
(including flange fit (this is a BIG issue - improper flange size causes
trauma), pump settings/suction, pumping until empty, pace feeding, how much
to feed, milk storage, different kinds of pumps, how to stimulate letdown,
gentle breast massage, ways to deal with plugged ducts that don’t involve
having baby nurse on one side, ways to relactate if a parent indicates
interest, weaning).
- Many EPers pump until empty to maintain their supply (upwards of 30-40
mins), every 2-3 hours. Pumping for only 15mins often does not empty the
breast for many mothers. Oversupply can be seen as a goal, so that the more
milk that is stored can reduce the amount of time that you pump for.
If you have already asked someone if they would like assistance getting the
baby back to the breast, and they tell you no, do not pressure them to get
back to the breast.
- Acknowledge that formula is a thing, and it’s not the end of the world if
parents are using it for whatever reason.
- Acknowledge what a breastfeeding parent’s goal is and how to reach that
goal with what is available.


Best,
Miriam Pokharel-Wood, IBCLC, MSW, BA
San Francisco, CA, USA
[log in to unmask]



>
> ------------------------------
>
> Date:    Wed, 20 Mar 2019 02:00:24 -0400
> From:    Debra Swank <[log in to unmask]>
> Subject: Re: Exclusive Pumping and Health Benefits
>
> Hi Julie,
>
> I haven't yet searched for such a study, but a photograph used by UNICEF
> for many years quickly comes to mind.
>
> The image was of two mothers sitting side-by-side, feeding their babies.
> The mother on the viewer's right was nursing her baby, actively engaged
> with her baby while nursing, and appeared delighted by her baby.  The
> mother on the left was bottle-feeding her baby, who was not held nearly as
> close as the breastfed baby was being held by the mother on the viewer's
> right, and the bottle-feeding mother appeared unhappy as she looked at the
> obviously happy nursing dyad.  If memory serves, the Riordan & Auerbach
> text used this image in one or more of their earlier editions.  I need to
> look at the current Wambach & Riordan edition to see if it's still used in
> that text, Breastfeeding and Human Lactation.  Such a wonderful photograph
> - - I wonder how the bottle-feeding dyad's lives would have been different
> if they had been in need of skilled care in breastfeeding and human
> lactation, and had access to such care.
>
> I would love to see a study comparing the number of minutes spent making
> eye contact between each member of actively feeding nursing dyads, and
> comparing this to the number of minutes spent making eye contact between
> each member of actively feeding bottle-feeding dyads.  Over the years, I
> have often observed bottle-feeding mothers and other bottle-feeding parents
> and caregivers who do make eye contact with their babies at the beginning
> of a bottle-feeding, but often quickly look bored, checking the bottle
> periodically to see how the emptying-the-bottle process is transpiring.
>
> When babies are at the breast, there is often the luxury of time to spend
> looking at the baby during the feed.  I imagine this extensive gazing
> between the members of the dyad enhances and facilitates their bonding.
>
>
> This 2018 study found decreased odds of maltreatment of those who were
> breastfed, including neglect and sexual abuse:
>
> Title:  Breastfeeding is associated with decreased childhood maltreatment.
>
> In:  Breastfeeding Medicine 2018 Jan/Feb;13(1):18-22. doi:
> 10.1089/bfm.2017.0105. Epub 2017 Nov 10.
>
> Authors:  Kremer KP, Kremer TR.
>
> https://www.ncbi.nlm.nih.gov/pubmed/29125322
>
>
> With kind regards,
>
> Debbie
>
> Debra Swank, RN BSN IBCLC
> Program Director
> More Than Reflexes Education
> Ocala, Florida USA
> http://www.MoreThanReflexes.org
>
>
>

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