A serious pregnancy complication sent first-time mom Missy Boss into an emergency cesarean section; by the time she delivered, her blood pressure was at pre-stroke levels. Boss says since she didn’t have the all-natural, drug-free childbirth she’d planned, she was “determined to do at least one thing right: breastfeed.”
In the 56 hours after coming home from the hospital with her son, Boss never slept. Her son wouldn’t nurse. She spent one entire eight-hour stretch just trying to get him to latch onto her breast, but he wasn’t having it. She’d had as many lactation consultant visits as her insurance would cover and couldn’t afford the $600 per visit after that. “I already felt like a failure as a mother in so many ways,” Boss says. “Could I do nothing right?”
When she told her doula (who she didn’t end up needing at the birth) about how much trouble she was having breastfeeding, she told Boss that she had experienced similar problems with her first child, and ended up exclusively pumping her breast milk for two years. Missy decided to give it a try.
Exclusive pumping—feeding your baby only breast milk, only from a bottle—is traditionally the territory of mothers whose babies are in the neonatal intensive care unit or otherwise medically unable to suckle directly at the breast. With the widespread availability of portable, personal electric breast pumps that can empty both breasts at the same time, hands-free, in a matter of minutes, more moms have begun to jump on the “EPing” bandwagon. These moms, like Boss, were unable to establish a successful breastfeeding relationship despite their best efforts, but they still wanted to feed their babies breast milk.
The practice of pumping frequently or exclusively is continuing to grow. According to data from the latest iteration of the Infant Feeding Practices Survey (2005-07), among U.S. moms of healthy, full-term infants, 85 percent have used a breast pump at some point, 25 percent pump their milk regularly, and six percent pump exclusively. Problematically, the rise of pumping also implies that moms don’t need as much time at home to spend with their babies—they can simply pump, store, and go back to work. What most moms may not know is that beneath the perceived convenience of pumping, there are potential consequences both for workplace norms and for the health of themselves and their infants. There’s an assumption that bottle-feeding breast milk to a child is equivalent to breastfeeding, but that may not be the case.
section-break
“Unbeknownst to most health professionals, a revolution is taking place in the way U.S. infants are fed human milk. The possible benefits or harms resulting from exclusive pumping merit careful study,” a recent commentary in the American Journal of Public Health noted. The authors wrote that this “quiet revolution in milk expression” (when milk is removed from the breasts sans baby, either manually or with a pump) could be good for babies if they receive more human milk and for a longer period; where it may be problematic is if babies are fed too much, given milk that is an inappropriate composition, or, worse, contaminated.
More specifically, “While expressed breast milk is recognized as far superior to infant formula, the lactation community has begun to question whether [it] confers similar protection to that derived by directly breastfeeding,” according to Donna Chapman, writing in the Journal of Human Lactation. Such protections include reducing the incidence of gastrointestinal illnesses, upper respiratory infections, asthma, obesity, both types of diabetes, and certain childhood cancers.
Part of the problem is a lack of research. A 2013 systematic review of literature on the subject by researchers at the Royal Women’s Hospital in Victoria, Australia, found only 22 research papers addressing breast milk expression. Most papers discussed expression for sick or premature infants; the rest were commentaries calling for more research. With only seven papers reporting on expression by mothers of healthy, full-term infants, the authors concluded that there is “limited evidence” on the outcomes of the practice—and some studies resulted in contradictory results. Compounding the inconsistencies is that “breastfeeding was the term used to describe any breast milk intake, regardless of the mode of its delivery.” Since pumping has become more popular, studies should make a distinction between direct breastfeeding and feeding a baby breast milk from the bottle, the authors write.
“Promotion of breast-milk feeding as identical to breastfeeding is misleading,” says Virginia Thorley, a lactation consultant and honorary research fellow at the University of Queensland in Australia. “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.”
Thorley has written extensively on the potential perils of “normalizing” the separation of breast milk from breasts. She says that bottle-feeding of breast milk has a place in specific circumstances, such as when a baby is unable to adequately stimulate the mother’s milk supply, or in cases like Boss’, where a baby is unable to nurse directly. And while she agrees bottled breast milk is better than infant formula, “breastfeeding is about more than the milk.” Babies don’t just breastfeed for nutrition; they nurse for comfort, closeness, soothing, and security.
Boss admits that, at first, she was worried about missing out on some of the benefits that breastfeeding ensures: the bonding, the closeness, the skin-to-skin contact. “But then I realized that parents can bond with their children in so many other ways,” she says. “Breastfeeding is just one thing of many that we can do to make sure our children know we love them and care about them.”
Despite the need for additional research, current studies point to several problematic aspects of exclusive pumping. One concern is that babies only fed by bottle eat more and thus grow differently. A 2010 analysis shows that babies fed breast milk by bottle in early infancy were more likely to empty their bottles later in infancy than their breastfeeding counterparts. Infants fed both at the breast and with bottles of expressed breast milk gained weight at a similar rate to those only breastfed, but infants gained more weight per month when fed only by bottle (formula or breast milk). There are multiple theories for why: Babies can get milk out of bottles quicker than breasts, caregivers tend to encourage infants to finish their bottles, and it is thought that breastfeeding teaches babies when to stop eating.