This is in response to Karleen's observation and question, while keeping in 
mind Liz Brooks long response based on more recent and current US 
experience.

My research advice and beliefs in the twentieth century in Australia has 
shown that a recurrent theme in advertising for the many articifial 
substitutes for breastfeeding was that the mother's milk supply might fail. 
Advertisers knew it was good for sales to appeal to mothers' fears and 
existing community beliefs that lactation was unreliable. Fears about the 
unreliebility of lactation continue, and - as Liz has written so 
passionately - are compounded for US mothers by the sadly early mandatary 
return to work, lack of support in the community, at work and elsewhere, and 
outright hostility towards them for daring to attempt to maintain their 
lactation. With these pressures, Liz explains that desperately pumping is 
one response to provide them with reassurance and milk security.

Looking more broadly, there is nothing new about the instruction to mothers 
to express their milk to increase or maintain supply. However, when this was 
a common practice in England and Australia and elsewhere, mothers used their 
hands to express after feeds - they rarely pumped (Thorley, 2012). It is 
always a contentious point to try to name "the first" to advocate a 
particular regimen. However, while Drs Eric Pritchard and the New Zealander, 
Truby King, had previously been influential on infant feeding in Britain, I 
believe the impetus in the mid-20th century to advise new mothers to express 
after each feed appears to have come Dr Harold Waller at the Woolwich 
Hospital in S-E England (Waller, 1946; Waller, 1947; Waller, 1950). Hospital 
stays then were long.  The Truby King system recommended external 
stimulation (breast massage) for low supply, while strictly restricting 
frequency and length of feeds (Thorley, 2003). The Queensland (state) 
Maternal & Child Welfare system recommended expressing after feeds, but only 
in cases of low supply, not for all mothers (Thorley, 2003). Mothers in 
other states expressed for a variety of reasons, until this practice fell 
from favour (Thorley, 2012).

In an era when restrictive feeding times were unquestioned, Waller saw 
hand-expressing as the way to get breastfeeding off to a good start and 
support the MER. He implemented hand-expression to prevent what was clearly 
engorgement, drain the fattier milk that remained, and safeguard the supply. 
He advocated teaching expression antenatally, and hospital stays were 12-13 
days, but longer if there were breastfeeding difficulties. I have been 
unable to find evidence of any instructions for when to stop. In the 
introductory part of a 1947 lecture he talked about dairy cows and how the 
milking at set intervals caused excess milk production and the stretching of 
the cows' udders, and he also described his observations of sheep in the 
field and the lambs' response to the MER. Although he described the very 
frequent feeding by the lambs, he didn't apply this to human lactation. The 
milking of dairy animals seems to have influenced his thinking.

Other systems also used expressing after feeds in the 1960s and 1970s, 
whether influenced by Waller's Woolwich methods or local adaptations of the 
Truby King system. These were systems in which the 4-hoursly schedule was 
considered sacrosanct and the length of the feed restricted, too.  Back in 
1965 in the after-care Maternal & Child Welfare hospital, I myself was 
forced to express after each feed in my first baby's early weeks and the 
mothercraft trainees did hot-and-cold-splashed and breast massage for 
external stimulation, but my supply continued to decline. Why? - because my 
baby was kept in the nursery or shut in the Matron's office, to which I had 
no access, and she screamed for about 45 mins before each feed. After 
unsuccessful feeds by an exhausted, sleepy baby, she was topped up by bottle 
and I expressed, hardly anything. It didn't help that come staff made 
negative comments, including that I was a bad mother who "didn't love [my] 
baby", because "if I loved her" I'd have her exclusively on the bottle. That 
really hit my MER!

Heroic methods to maintain lactation are used when access to the breast is 
restricted (whether by hospital regimens or long working hours). In the 
mid-nineteenth century, under the gang system of agricultural labour, 
mothers were obliged to be away all day in distant fields, with no access to 
their babies. To keep the babies calm, they left opiates in the rags the 
babies sucked on. Opiates were commonly used in England for babies by the 
urban and rural poor, usually in "soothing syrups", for a variety of reasons 
(Phillips V, 1978).

My references are below.

Virginia Thorley, OAM, PhD, IBCLC, FILCA
Cultural Historian of the History of Medicine
Brisbane, QLD

References:
Phillips V [Thorley V]. Children in early-Victorian England: infant feeding 
in literature and society, 1837-1857. J Trop Paediatr Envir Child Health 
1978 (Aig): 158-166.
Thorley V. Printed advice on initiating and maintaining breastfeeding in 
mid-twentieth century Queensland. J Hum Lact 2003;19(1):77-89.
Thorley V. Human milk use in Australian hospitals, 1949-1985. Breastfeeding 
Review 2012; 20(2): 13-23.
Waller H. Arch dis Childhood 1946; 21; 105.
Waller H. Some clinical aspects of lactation. Arch Dis Childhood [1947?]: 
193-199.
Waller H. The early yield of human milk, and its relation to the security of 
lactation. Lancet 1950; I: 53-56.
~~~~~~~~~~
Karleen wrote:
I'm just writing up some research and am somewhat puzzled by some mother's 
descriptions of how they came to have excess milk to donate to another 
mother. There were a significant number who said that they had excess 
expressed milk because they needed to pump to maintain their milk supply. I 
thought that this might be the first time this was described but, no, 
Osbaldiston, R. and L. A. Mingle (2007). "Characterization of human milk 
donors." Journal of Human Lactation 23(4): 350-357; quiz 358-361. also found 
a significant % of mothers donating to a milk bank who "had to pump to 
stimulate lactation" and these mothers were large volume donators.
I'm very interested in people's experience with this phenomenon. I think 
that some of these mothers' beliefs about the need to pump may come from 
popular books which insert pumping into a breastfeeding mother's schedule 
for the purposes of ensuring that there is enough milk. I wonder how 
commonly LC and peer counsellors are seeing this and, have any of you come 
across a mother who needed to do such a thing to be able to breastfeed her 
baby- I can't think of a mechanism by which this would be necessary! 
Osbaldiston et al suggested that such women should be targeted as milk 
donors! Not my first thought for an appropriate response!
Karleen Gribble
Australia
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