Are We Asking the Wrong Questions?

The emotional outcry in response to the Pacific Standard article “The Unseen Consequences of Pumping Breast Milk” was so strong and sustained that it was difficult to ignore. The article’s aim is to differentiate between breastfeeding and feeding expressed breast milk by bottle, informing readers that, while research on the subject is very limited, the two are most definitely not equivalent. The author, Olivia Campbell, quotes a noted lactation consultant and researcher, Virginia Thorley, who states, “The new challenge is to use language accurately, and tell mothers the truth that feeding their milk to their babies by bottle is less than equivalent to breastfeeding.”

Now in an effort to be completely transparent, this is a discussion that I’ve entered into before. I do not believe that breastfeeding and feeding expressed breast milk are equivalent; however, I do work hard to encourage and support mothers who are exclusively pumping and to emphasize the amazing thing they are doing for their children. Having both exclusively pumped for one child for a year and breastfed another child for three years, I recognize that there are indeed differences. But you know what? I think most mothers who are exclusively pumping are also very much aware of those differences.

It is these recognized differences that lead exclusively pumping moms to obsess over milk handling and storage, to worry about the composition of their milk (is my milk fatty enough? should I be feeding milk I express at night to my baby at night?), to question their own diet, to discuss the immunological components of milk and how they change as a result of storage, to stress over bonding and feeding amounts—they get it! And yet they persist to provide breast milk for their babies—sometimes through extraordinary challenges—something that is neither convenient nor an avenue by which to “have it all”.

As someone who has communicated with and supported exclusively pumping moms for more than ten years, I worry that the wrong questions are being asked in regards to this issue. The question isn’t whether feeding expressed breast milk is equivalent to breastfeeding; instead the question is why are so many women exclusively pumping?

Those interested in membership in my exclusively pumping Facebook group must message me and explain why they would like membership in the group. As a result of this initial contact, I have a good understanding of why women are exclusively pumping, and I emphatically state that it is not because it was a choice between breastfeeding and exclusively pumping. The vast majority of exclusively pumping moms switch to exclusively pumping because of breastfeeding difficulties, either real or perceived, and a lack of support to help them through these difficulties. Yet in these situations a mother is not choosing to pump instead of breastfeed. No, most mothers desperately want to breastfeed, but when they are faced with difficulties (pain, non-latching baby, concerns over supply, poor weight gain) they turn to a breast pump to provide their own milk to their babies. If the option to express milk and feed by bottle was not available, most of these mothers would be feeding formula.

So the real comparison here, as far as exclusively pumping moms go, is whether formula is equivalent to expressed breast milk. For the vast majority, exclusively pumping is an alternative to formula feeding, not an alternative to breastfeeding, and it is for this reason that the attempts to “tell mothers the truth that feeding their milk to their babies by bottle is less than equivalent to breastfeeding” isn’t looking at this issue from the necessary vantage point, but instead is only serving to enflame the emotions of a group of women who already feel marginalized, often ignored, rarely supported in a meaningful way, and who, in many cases, are grieving the loss of the breastfeeding relationship they had expected and desired.

Are there those who are exclusively pumping as a first choice? Sure. Are they the majority of exclusively pumping women? Not in my experience. Are there people who present breastfeeding and feeding expressed breast milk as equivalent? Absolutely. Is this position encouraging women to exclusively pump instead of breastfeed? That I can’t say.

We need to listen more to the emotions of mothers who have experienced breastfeeding difficulties. Pointing out the risks/benefits of one feeding method over another isn’t working anymore—perhaps it never worked. Women understand that “breast is best” and can list many reasons why breast milk is “best”, but this discussion doesn’t help them overcome the real challenges they are facing. What’s missing in this discussion is an emphasis on relationship, and while relationship factors largely into breastfeeding, we mustn’t forget that it also is a critical component in our efforts to support moms. Rather than focusing energy on explaining why breastfeeding and feeding expressed breast milk are not equivalent, I’d like to see a focus on how we can support new mothers to reach their breastfeeding goals and reduce the number of women who turn to exclusively pumping as a “last resort” to provide their babies with breast milk.

Daily, my heart breaks for women as they share the difficulties they’ve had trying to develop a breastfeeding relationship with their babies and share the pain, grief, and loss they feel when it did not worked out as expected—not to mention their struggles to exclusively pump. The outcry against the Pacific Standard article simply highlights these many strong emotions and should serve to remind all of us who work to support breastfeeding mothers that above all the research, risks, benefits, and decisions there are women—women who are trying to do their best for their babies, who love their babies, and who would love support.

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