Hear hear.  From personal experience - I had a child in 1980.  returned to work and had to give formula to eke out what I got with hand-expression - there were no decent pumps!  He was dairy intolerant and major issues with what formula I had to use.  I was a nurse working night shift in L&D.  I used to hand-express with 2 coffee cups, one under each breast and brace against the edge!  THANK GOD for the pump I was able to use in 1987 which was the first attempt at double pumping.  NO formula for that baby even though he was tongue-tied and I went back to work at 5 weeks fulltime!  This is not luxury working - it was necessary to feed the family!  IN the USA, it's not a choice in most cases, it's a requirement to go back to work.  I'm grateful for the improvement in consciousness about breast milk and more businesses "allowing" moms to pump.  There are women who have genetic capacity for oversupply - for them hand-expressing might be adequate, but it wasn't enough for me.  Thanks Marsha for speaking up for those of us who have fewer choices. 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Thursday, November 13, 2008 2:26 PM
Subject: Re: LACTNET Digest - 12 Nov 2008 to 13 Nov 2008 - Special issue (#2008-74)

I think that we all hope that pump companies market their products without equating them with feeding at the breast. However, I do not hesitate to recommend a suitable pump when i feel it is necessary to help initiate or preserve breastfeeding or being able to provide breastmilk for a baby. People are not obligated to use pumps in situations where they are unnecessary nor is anyone obligated to like pump companies. In the United States we have over a 12% rate of preterm birth, over a 30% cesarean rate and no national maternity leave policy. 
Pumps are a necessary part of breastfeeding in the US for many mothers, even if some contributors to Lactnet are unhappy with the notion of mechanical pumping. Many of our mothers do not have the luxury of staying home for 6 months or a year while collecting a paycheck. Most of our mothers cannot afford to take unpaid leave for more than a few weeks. In a study of approximately 2000 US mothers, 5.6% of those who breastfed were exclusively pumping.

Shealey et al. Characteristics of breastfeeding practices among US mothers. Pediatrics. 2008;122:S50-S5

Using the same sample as above from the Infant Feeding Practices Survey conducted by the CDC, another analysis of these breastfeeding mothers showed that the main reason for pumping was maternal employment. 
Remember that half of all mothers in the US with children under 1 year of age are employed and one third are employed full time.

Labiner-Wolfe et al. Prevalence of breast milk expression and associated factors. Pediatrics. 2008;122:S63-S68

Maybe we should cut these mothers a little slack. I too dislike any reference that equates pumping with feeding at the breast, but please remember that many of our mothers depend on pumping to preserve their milk supply. We don't need to encourage them to put pumps on their birth registry for baby showers but I don't think we should deprive them of a necessary tool because of a dislike for anything other than pure feeding at the breast.

Marsha Walker, RN, IBCLC
Weston, MA

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