I've been watching this thread unfold and the one thought that keeps coming to my mind is of my own experience.
I had a child with a soft cleft palate whom was fed exclusively on breastmilk. Each time we went to see her doctor (or team of them rather) they didn't ask "How are you feeding your baby?". Rather they would ask " are you breastfeeding or formula feeding?". Some would ask "are you breastfeeding or bottlefeeding?" and by bottlefeeding they implied formula. 

Never once did I encounter a nurse/provider who had appeared to consider that a mom could be pumping exclusively and providing nothing but breastmilk. 

It got to the point that I would just answer breastfeeding and save myself the trouble of explaining what we did. No one seemed to question that,  even though the majority of babies with clefts cant/don't nurse well.  

As I worked through trying to nurse her (we tried for 5 months and I continued to pump the whole first year) I had to re-define what breastfeeding was (in my head) as a way to cope with the loss of the "normal" breastfeeding relationship. I had breastfed children before her and this didn't feel like breastfeeding, it was 1000x times harder- but it was.  Was she eating AND being comforted at the breast with a simple lift of my shirt ? no. but was she being fed from my breast ? yes. Pumping is a true labor of love, one of the hardest things I've ever had to do. Not all breastfeeding relationships look the same. Breastfeeding can look very different for many people, even among different babies. 

I still did skin to skin with my baby, we still co-slept, I was still awoken to full breast, I still let my little one lay her head on my chest and often my bare breast while she was using her haberman. I didn't know how to mother a baby without nursing but I was breastfeeding. There was a lactation consultant that had listened to me talk about my experience and then saw my little one and said "she certainly seems like a breastfed baby to me! its all in how you define it". She was a breastfed baby alright, every last roll on her body, it was just different than I had ever imagined breastfeeding to "look" and it took her comment to make me realize that it doesn't always look the same. But its an accomplishment none the less. 

I think (in most cases) for moms who are going through the effort to provide their babies with breastmilk they desperately want to be breastfeeding directly. When it doesn't work out how they imagined it, or they have to be separated they learn to rely on the pump. Im so glad no one ever discounted my breastfeeding by calling it breastmilk feeding. I was a hot mess those first few months. I had a love/hate relationship with that pump but it was a "tool" that helped me breast"feed" my child past the first year.  Thank God for it and all the support I received on my journey. 

Jessica Harper, IBCLC, LLLL
Fairbanks Alaska 

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