Hi all,
I've been reading with interest the posts about what I would describe as an explosion in the numbers of women who are pumping and feeding their milk by bottle as opposed to directly breastfeeding.  In my work there seem to be 4 routes to becoming a pumping-and-feeding mother:

1. the rarest in my experience: the mother/baby with real inability to feed at the breast due to something like cleft palate.

2. the mother who's searched and failed to find help for problems that weren't actually insurmountable (like the mother who's told by several HCPs in a row that tongue-tie isn't a problem and doesn't need treatment).

3. the mother who won't consider direct breastfeeding but will pump (and then the question is, would she give in and breastfeed if that was the only way to give her baby mother's milk? or would she be formula-feeding?)

4. Most common among the mothers I see: the mother who sees pumps as an integral part of the breastfeeding experience and sees the solution to often even minor issues as 'well, I'll just pump and give by bottle'.  This view of the pump as an essential part of breastfeeding is so common nowadays that I have a hard time convincing mothers not to start in using the pump within days or even hours of giving birth - often just to see how much milk they have - and you know what issues that can raise :(.  

And, I hate to say, the idea that the answer to most problems is a pump also comes from  HCPs - including some LCs.  When mothers are having problems they're immediately told to start pumping - often without even a basic assessment of latch.  Moms are told to start pumping if they raise concerns about their supply - without an assessment of whether baby's actually getting enough.  There's an emphasis on getting breastmilk into the baby (Rule #1: feed the baby) and getting the mom to pump is the easiest way to make sure that happens (you don't even have to see them in person, then).  But then often there's way too little (if any) follow-up on getting the baby back to the breast.  Once started on the pump, the moms continue on in the way they've now been taught, and don't realize that,  with the right help, they could be getting back to feeding directly at the breast.

The women I see may not be the same demographic as those that come to an online forum for support. Those in the online forum seem to be moms who are really dedicated to breastfeeding.  Most of the pumping-and-feeding moms I see watch their supply dwindle and/or eventually reach the point where it's too much work to continue. The CDC's finding that most of these moms last less than a month agrees with what I see.

If you haven't guessed by now, I've been feeling especially fed-up lately with this whole issue.  I'm just afraid we view pumps as benign when in many situations they're not.  The temptation (and yes, I feel it too) is to recommend pumping 'just to be safe', to make sure the baby's being fed. Yet lately I'm starting to see that the effect of that advice isn't so benign after all but often leads to early weaning.

Thinking maybe she shouldn't post at night when she's tired and grumpy,
Marcia in Minnesota (IBCLC)


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