Yes, I discuss this option. Sometimes a mom asks for a pump, never intending
nor in fact initiating breastfeeding. She pumps her milk.
In my experience, most of these moms also give formula. Sometimes a mom is
having trouble getting baby latched, for example with a premie or late
preterm infant, or an infant with tongue-tie. In my experience, many of
these moms continue pumping, and never again offer the breast. Some moms
initiate bf for one or two feeds, and state that it "weirds them out" (have
heard this several times) or "I'm just not comfortable with bf" or
statements like that. Sometimes they will accept the option of expressing.
Once in a while (not often) a doctor will suggest bf to a formula feeding
mom whose baby is throwing up the formula. Sometimes the mother will accept
the option and start bf, or she might express. Rarely a mom herself will ask
about expressing if she has a formula fed baby who  is not keeping the
formula down well. In my experience, most will try several different
formulas instead.

I'm going to be honest with you, there is not alot of direct breastfeeding
going on in my world. At my hospital, an average of 40% of moms "initiate
bf" altho this could mean expressing only and could also mean the baby had
several formula feeds first. I would say about 1/2 of these continue any bf,
and I have not been able to get in touch with enough moms to know the
continuation rates. I kept track for awhile but most returned to work early
and I could not get in touch with them. The CDC has the rates and
Mississippi has the lowest in the USA. Going back to the 40%, it is quite
rare for a mom to be exclusively bf here.

I hope, before I die, or retire, whichever comes first, I will be able to
experience a bf culture, because it is really sad not to have one.
Laurie Wheeler RN MN IBCLC

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