Karleen asks about our clinical experiences with the phenomenon of mothers
who are BFg but still pumping, and now have excess to offer as donor human
milk: "There were a significant number who said that they had excess
expressed milk because they needed to pump to maintain their milk supply."

Hoo Boy.  What a [professional] raw nerve you have poked.  Pick up some
coffee, sit, and ruminate with me.

I firmly believe that mothers -- everywhere --  do the very best they can,
given the support and information they have at the time.  I firmly believe
that mothers -- everywhere -- should receive "mother-centered" care" (or,
"parent-centered" care, perhaps) from their IBCLCs and other healthcare
providers.  That means we make *no* assumptions about what the family can
do, does want, is able to afford yadda yadda yadda.  Instead we  (gasp!)
talk to the mother, and form a care plan *with her* that takes into account
her history, our clinical assessment, and a careful consideration of *her*
infant-feeding goals.

But what happens in the real world?

In many places around the world, we live in a non-BFg-friendly culture.
 Bottle-feeding is seen as the norm, in everything from baby cards and
wrapping paper (storks! bottles! teddy bears!) to images of Happy Parents
smiling in ubiquitous and pervasive ads, as they offer a bottle to their
babies as "proof" of their warm and participatory parenting.  Women who
have every legal right to BF in public, or on breaks from work, are shamed
and scolded, and we only know about those who bravely told us of the
humiliation they suffered at the hands of others. Women who offer their
milk by cross-nursing or expression-and-donation, as our ancestors have
done since the days of Eve or the Cave Woman (whichever theory you
espouse), are publicly vilified for imposing risks for the sharing of (more
gasping!) human fluids.  Maternal and child healthcare is, by-and-large, to
this feminist's way of thinking, still largely patriarchal, and patronizing.

Now let's add in some "barriers," as our literature so politely calls it,
at least here in the USA (which is my personal and clinical experience).
 Wage-earning mothers must return to work outside the home, for 12+ hours a
day, at 4- 6- or 8- weeks postpartum.  They do not have paid maternity
leave; they lose health insurance if they fail to return to work, they lose
income that pays for the house, clothing, medical, etc. needs for the rest
of the family.  They are not supported at work or in the community to BF or
express milk, despite their right to do so. The care-giver for the child is
unfamiliar with the care and handling of expressed breastmilk, or the
attachment needs of a BFg child.  Mothers are jeered and joked-at by
co-workers, bosses, neighbors and family members who don't understand why
they'd want to "do THA,T" whether "that" is expressing milk at work, BFg in
public, BFg a child over 3 months of age, BFg or co-sleeping at night,
using a sling or other upright carrier, and on and on and on and on.

So -- let me ask you this.  If you are a brand new mother, entering this
hostile environment, armed primarily with the conflicting and erroneous
information about BFg you've heard from a friend, or dug up on Facebook or
Twitter, especially after your birth which was odds-on full of
interventions and medications throwing basic biology off kilter so you are
already swimming upstream with weights around your arms and legs ... and
you heard that pumping will "bring in" your supply, or "increase" your
supply, or "protect" your supply (all of which is correct information,
given specialized sets of circumstances ...) what would YOU do?  I'd pump
too.

And when your milk surge occurred, and your "sleepy" (translation: drugged)
baby was able to rouse to BF effectively and often, and the bilirubin
dropped, and the baby reached term adjusted gestational age, and BFg is
actually now a breeze ... but you know you have to go back to work in a
matter of days or weeks, when the meconium can hit the fan all over again,
what would YOU do? I'd pump too.

Is this good, or right, or desirable?  Not in a heartbeat. I like to say:
Every mother deserves to enter the "white tent" upon birth, where every
other woman in her circle of family and friends is there to offer excellent
BFg support, because each of them happily and comfortably BF her own baby
until the child self-weaned. Ahh, to dream ....

Darwin talks about *adaptation* as the key to survival ... not just being
strong or fit.  I see this surge of pump use and milk "hoarding,"
regardless of effective breastfeeding, as one way today's mothers are
having to adapt to the incredible odds, stacked so horridly against them,
in their homes, workplaces and community.  That their incentives to
continue pumping turn to more altruistic objectives (donation ...) ignores
the "survival motives" that initially got mothers on the treadmill of
pumping-and-breastfeeding-and-pumping-some-more.

Deep breaths everyone -- I am not speaking here about mothers who are
breastmilk feeding by choice or circumstance, who use expression to meet
their own children's needs.  I am talking about the phenomenon that opened
the query: Why do mothers who don't need to pump continue to pump?

A wonderful speaker at a recent conference I attended works in public
health, and trauma is her area of interest and expertise.  She defines it
very broadly, as "Anything that happens to you that prevents you from
coping."  When some people do not have coping skills or social supports,
they may turn to drugs, or alcohol ... resulting even in addiction, which
our cultures find quite distasteful, right?  Who likes an addict; who wants
to be an addict?  Her suggestion, when working with victims of trauma, is
NOT to ask "What's WRONG with you?!" (blaming the victim, so to speak) but
rather to ask, 'What HAPPENED to you?"

I wonder how they'd answer if we asked all those moms, on that treadmill
 to acquire excessive milk over-and-above their own children's needs ...
"What happened to you?"


Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA
IBCLCs empower women and save babies' lives!
Learn more <http://tinyurl.com/3nj2p3c> and visit www.ILCA.org

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