Many lactation consultants and health professionals are encouraging a dependence upon pumping.  They have been sold on the notion that the pump is as good, if not better than a baby feeding directly from the breast.   They tell mothers, “Pump to see how much milk you are making.”  Another common piece of advice is “Pump after every feeding to increase your milk supply.” 

Clinical evidence shows that pumping is always second best when compared to direct breastfeeding with an excellent latch.   What is obtained from pumping is only a percentage of what the baby can get when properly positioned on the breast.  

The impression of increasing the milk supply often comes from the fact that the breast seems fuller with the combination of breastfeeding and pumping.  Assessing the quality of breastfeeding is essential because the appearance of fullness can be misleading. 

• If the baby has a poor latch and the mother is relying more heavily on the pump for removal of her milk, the breast will build up its storage capacity. 
• An excellent latch leads to a breast in equilibrium rather than having a leaky, full and uncomfortable breast.

Pumping most definitely has a place in the breastfeeding experience of some, but not all, new mothers.  Those mothers who encounter challenges due to prematurity, maternal/infant illness or those who work outside the home, will most likely need to pump if they are to  maintain their milk supply.  

It is both ironic and disturbing that such a profound lack of confidence in milk supply by mothers has grown in an environment where there are legions of lactation consultants and breastfeeding advocates now among us.   It turns out that the allied health profession of lactation consulting (IBCLC) and Medela, the leading manufacturer of pumps world-wide, have been closely linked throughout the past 25 years.  (I don’t seem to be alone in voicing my concerns.) Read more here.

• A rise in individual pump ownership and use since the mid-1990’s is directly proportional to this increased focus on breast milk supply versus direct breastfeeding.  

 As far as I can tell,  mothers do not lose sleep worrying about how many ounces of amniotic fluid their placenta is making for their babies.  They trust in the wisdom of their bodies to manufacture what is needed to get the job done.   Before the advent of routine sonograms, “the bag of waters” was not even on the radar until time for labor.

Breasts would be see-through or come with alarm systems if the volume was the critical factor to be considered.  The notion of volume  being important comes from a formula feeding model-nothing changes in that processed food save for calories delivered by the ounce.

This collective obsession, pun intended, with proving how much breast milk we have, makes me think of the biblical figure, Doubting Thomas.  

Why do we need to see our milk  in order to believe in the ability of breastfeeding to nurture our babies?

Early in the 20′th century, drug companies started selling commercial artificial baby milks, aka formula. Gradually women were persuaded that breastfeeding was a choice, rather than the natural food needed to ensure the optimal growth and development of their infants during the first year of life and beyond. In the late 1960’s, formula began to be marketed directly to the medical community and a sharp decline in the initiation and duration of breastfeeding was noted throughout the world. In less than a century, it was no longer the birth right of human babies to be fed their mother’s milk.

What’s a breastfeeding advocate to do to combat the marketing prowess of Big Pharma? For the past 25 years legions of dedicated lactation professionals and breastfeeding women have pondered this question, myself included.

The basic approach has been to promote breastfeeding by proclaiming that it is natural and full of health benefits for both the mother and her nursling. Education and peer support have been the primary tactics to shift the global paradigm back to breastfeeding as the accepted norm.

Unfortunately, modern breastfeeding advocacy has been fashioned from a defensive mindset. Marketing efforts take on formula, tit for tat, pun intended. The activity of breastfeeding has been steadily taking a backseat to the commodity of expressed breast milk.

In their efforts to create an evidence-based model, many lactation consultants have moved their attention away from direct breastfeeding and are promoting pumping and breastmilk to go up against the competition, one-on-one, bottle by bottle.

The current breastfeeding marketing strategy is in desperate need of an overhaul. What do you think?

Had an interesting call this week from a dad.  He wondered what were the chances of relactating at 7 weeks? 

And no, before you go there, it wasn’t a crank trying to get a rise out of this passionate lactation advocate.  This call was legitimate.  He was a friend of a father in my practice who had encouraged him to reach out to me across state lines to sort out his dilemma.

He called me to suss out the situation and shared a very sad, but typical scenario.  His wife, had been buffeted on the seas of lactation support with inconsistent advice, emphasis on pumping and after two weeks was summarily dismissed and told to bottle-feed.  For approximately 6 weeks now his son has been bottle-fed formula.

In general, I always prefer to speak directly with the mother.  However, his voicemail touched a heart string as he confessed that he was calling without having yet broached this subject with his wife.  He was genuinely concerned and felt badly that they were missing out on breastfeeding because of the questionable support and consultation they had received in the early weeks.  

The reason for the abrupt weaning was the usual  ”Not Enough Milk”.  This was determined, of course, by his wife’s inability to pump enough to bottle-feed after the delivery.   More bottles and pumping led to formula and weaning.  The reason it was bothering him so much was that he noticed her leaking tons of milk a few days ago.  He didn’t understand why she didn’t just offer the breast to their son as clearly there was milk.

This dad was walking on egg shells. He was the support team during the initial battles and was now fearful of incurring her wrath by bringing up the notion of trying it again.   

I can empathize.  I’m often called in for these kind of situations and find the solution is not as simple as merely choosing between offering the breast or a bottle filled with human milk or formula.  The weeks of reinforcing a behavior other than breastfeeding and living a bottle-feeding lifestyle with their new baby could make the transition difficult on many levels.  

 I complimented this dad on his thoughtful and loving inquiry.  My suggestions were simple:

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1.  He could now share honestly some of his impressions about that stressful time with his wife.  Sharing empathy without the stress and pressure biting at their heels.

2.  He could share some of his conversation with his friend that led him to call me.  It would be helpful to emphasize that these situations are usually not truly black and white, but rather if she were empowered and given consistent support much would be possible.

3.  He could gently suggest that she offer their son the breast without worrying now if she had enough. Without pressuring her, he could point out it would be a shame if what she was still producing for their son would ultimately go to waste.

4.  He could share what he intuitively knew, and I corroborated, that milk supply is not increased by the pump, but rather by the baby breastfeeding.  Any amount of breastfeeding would greatly increase the odds of them being able to shift the balance of feeds away from the bottle and back to the breast.

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5.  He could continue to offer his love and support reassuring her that it was ultimately her decision.  Sometimes knowing that it is a real team effort can make these transitions seem more possible.

Breastfeeding is a relationship and is relational.    It is the mother who ultimately breastfeeds and chooses whether or not she will continue or resume if there have been challenges.  However, her choices do indeed have an impact on everyone in her inner circle.  Breastfeeding does not exist in a vacuum and is very much a family affair.

How many of us sisters, moms, friends, partners, spouses, and  even lactation consultants, can identify with this dad? Have you ever been afraid to further encourage or advise a mom who had been beaten down and had weaned because of a negative experience with breastfeeding ?

Have you ever felt like you were walking on egg shells?  And what did you do?

I see many parallels between midwives and lactation consultants as they both share a fundamental belief in the natural wisdom of a woman’s body.  Ideally, they have a vocation and are answering a call to support other women through the natural processes of birth and breastfeeding.  Midwives and lactation consultants should be advocates for these mothers-to-be and help them to avoid the business of being born

 which is full of pitfalls for having a natural birth and breastfeeding experience.

I heartly urge you check out one of my favorite blogs by Pamela Hines-Powell, an articulate and amazing midwife .   Pamela and I are kindred spirits… midwiving new mothers and their babies on their journey into motherhood through an empowered experience of pregnancy, childbirth and Conscious Breastfeeding.

Blessings to Pam and all the midwives in our midst.