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Breast Pumps a “Double-Edged Sword”?

Amid a rash of controversial pieces in the mass media about the intersection of breastfeeding, motherhood, and feminism, a new study in the Journal of Perinatal Education reveals an uneasy relationship between professional lactation consultants (LCs) and breast pumps. The piece gives us a fascinating look – from the front-lines of lactation – at the cultural and economic forces that have rendered the breast pump one of the indispensable accessories of new motherhood.

The qualitative pilot study analyzes lactation consultants’ beliefs and experiences related to the increased availability of breast pumps on the practice of breastfeeding. The researcher conducted interviews with lactation consultants about the reasons women use breast pumps, changes in patterns of use over time, mothers’ experiences, and perceived advantages and risks. All 12 interview participants were registered nurses with board certification and at least one year of experience as lactation consultants.

All of the LCs who were interviewed acknowledged a tectonic shift in the role of the breast pump over the past decade or so, a trend that many believed was fueled by aggressive marketing of breast pumps as well as our collective cultural enthusiasm for technology. Once reserved for mothers of premies, women experiencing breastfeeding problems, and those returning to work, breast pumps now feature prominently on baby registries of nearly every mother who plans to nurse, and often get packed right into the birth bag, despite the fact that hospitals themselves make breast pumps available to every new mother. This increased availability of breast pumps in health care settings was troubling to some of the LCs. One of the interview respondents said,

We have pictures in the room behind the bed that you slide up and there is oxygen and [resuscitation] equipment behind them. It’s hidden because it has a subliminal message that we think you might die here. One message [to mothers] is that you need a breast pump and should consider buying one. We didn’t have to fight too hard to get 35 pumps free of charge hauled in there. They’re not philanthropists. They’re just good business people.

The respondents also felt that “technological birth” naturally led to “technological breastfeeding,” both in the sense that technology has been normalized as a part of the processes of childbirth and breastfeeding, and because the overuse of high-tech obstetrical interventions has led to more breastfeeding problems that must be managed with breast pumps. Many LCs also commented that use of breast pumps satisfied women’s desire for control over a process that they did not trust to unfold easily, similar to the perception that labor interventions offer greater control over the unpredictable process of birth.

But perhaps the most interesting theme that emerged from the interviews was that the prevalence of breast pumps has affected the profession of lactation consultation itself. Many of the LCs earned a significant proportion of their income through breast pump rentals and sales, a situation that was widely acknowledged as fraught with ethical problems. In addition, respondents felt that some LCs were overly dependent on breast pumps. “If a mother is having trouble in the hospital, it’s ‘Get her a breast pump’ and not, ‘Let’s work with her more and get her to breastfeed,” said one. In addition, just like the women they provided services to, a few of the LCs lauded the increased “control” of breast feeding afforded by breast pumps as well as the enhanced ability to measure how much the baby was getting, while others were ambivalent or felt that the control was a false promise. Said one of the LCs

“In a way, I wonder if this technology doesn’t help us and has given us an out. We don’t have to give good maternity leave because we are going to give a pump to every mom and give her 15 minutes twice a day to pump her milk.”

This article made me think twice about how I talk about breast pumps with expectant and new mothers. Of course pumps have an important role in the care of premature and sick infants, when women need to temporarily disrupt nursing for medical reasons, and to allow women to go back to work or simply get out of the house in the early months of motherhood. But their routine use, just like any routine intervention, may be doing more harm than good – undermining women’s confidence, unnecessarily complicating the transition to new motherhood, and possibly even leading to early cessation of breastfeeding. The article also made me remember that there is a low-tech alternative to breast pumps that we should be telling to every new mother: hand expression of breast milk. I’ve found myself apart from my own breast pump on enough occasions that I probably owe the fact that I have never had mastitis to my hand expression skills. For readers who don’t know how to do or teach hand expression, here is a great video that teaches one simple technique.

Citation: Buckley, K. M. (2009). A double-edged sword: lactation consultants’ perceptions of the impact of breast pumps on the practice of breastfeeding. The Journal of Perinatal Education, 18(2), 13-22.

Do No Harm, New Research , , ,

  1. June 3rd, 2009 at 17:41 | #1

    That’s very interesting. I generally only give breast pumps to the mom’s with a baby in the NICU. I advise other mom’s that they really do not need an electric pump, unless they are going back to work soon. Otherwise they could manually pump. As a side note, the only thing I hated about breastfeeding was pumping. I just hated it with a passion! I am not sure why someone would want to pump “routinely” unless they really had to.

  2. June 3rd, 2009 at 22:07 | #2

    I recently had a mom during a postnatal visit who was complaining about engorgement, (and in the same sentence told me she wasn’t sure if her milk had come in, or if baby was getting enough). So I asked how breastfeeding was going. She mentioned that she was feeding baby every 2 hours, and pumping just about every time in between that. She was making a LOT of milk most likely due to the fact that she was emptying her breasts so often!
    Her reasoning being that she wanted to be able to sleep at night and have her hubby feed baby.
    I mentioned that while it’s nice for dad to be able to feed baby, that there are other ways he can tend to the newborn (3 days old) so she can sleep.
    I mentioned changing diapers, cuddling and soothing when baby isn’t hungry, just needing some loving. helping get baby to sleep after eating.
    and taking care of baby during the day so mom can nap.

    she was concerned that she wasn’t making enough milk, because when she pumped.. she wasn’t producing very much at all.
    I’ve nursed two babies. Both healthy and growing perfectly. I know that my breast milk production is high (still nursing my almost 16 month old). Yet, when i pumped I could only get about an ounce!
    Pumps can’t produce that let down like a baby can. There’s no emotional connection at all (besides maybe hate lol)

    i think you’d love my friend Sara’s blog over at http://custommademilk.wordpress.com/ she’s brilliant. I love her.

  3. June 4th, 2009 at 05:53 | #3

    I have to say that pumping was my least favorite part of nursing, too, so I was really interested to read the piece in the New Yorker that I linked to above (http://www.newyorker.com/reporting/2009/01/19/090119fa_fact_lepore). Reading that article, and then again reading this research, made me realize that the breast pump has really been an unexamined technology in maternity care. I was lucky to have a job where my baby could sometimes be brought to me for feeds (I was working in a birth center at the time) and I did lots of travel for Lamaze and CIMS at the time and my babies came right along with me. I’m proud to say I have literally breastfed in a board room – while presenting a report to the board of directors of Lamaze! If only more work settings were so baby-friendly…

    Michael, I wonder if the increased involvement of dads in parenting is another cultural trend that has affected breastfeeding. On the one hand, it is so important to have that partner support to get off to a good start with breastfeeding, but I worry about couples who think that that support can only come in the form of feeding the baby. What about cooking a nutritious meal, bringing her a glass of water, telling the mother she’s doing a great job, handling an older child’s needs? Involvement doesn’t need to mean complete equity as far as doing half of all of the aspects of the work (half the feeding, etc.) I usually try to convince couples to hold off on daddy feeds for at least 4 weeks because the milk supply is vulnerable during that time. I also love to teach women to nurse in bed on their side, which makes those night time feeds so much easier. Thanks for the link to Sara’s blog!

  4. June 4th, 2009 at 10:33 | #4

    Has technological birth lead to technological breastfeeding?!? Sometimes I feel like that. I certainly have a love/hate relantionship with my pump. I love that the technology is available so that my son can have breast milk when I am gone, but I HATE that I have to use the pump at all! We should be spending more time and effort on making sure that women get a good maternity leave. We need to make sure that women can have a postive work life balance. I say that as I am also listening to NPR discuss women asking for (and some getting!) more work/home balance with their careers. This blog post and JPE article remind me of the New Yorker editorial that caused such a stir earlier this year. We need to remember that as much as we love technology, it does not solve everything. It cannot replace us as mothers!

  5. June 5th, 2009 at 14:13 | #5

    I haven’t blogged now for about 6 months because I had grown weary of feeling like a salmon swimming upstream. Thanks for sharing this study which is the nudge I needed to once again join in the conversation.

    I have lived through the past 3 decades of breastfeeding history as a nurse in maternal-child health. A lactation consultant since 1986, I am in a unique position to know life both pre and post pump mania. Back in the day, babies drove a milk supply, hands could express milk out of a breast and the beauty of breastfeeding was that it was low tech and convenient.

    Then along came the Pump N Style and droves of new lactation consultants coming into the profession. It was a perfect storm. When that pump was released to the market through the lactation community in the early 90′s the dye was cast. Medela had found an army of affiliate marketers for their product line of pumps, SNS, scales, etc. that extracted, delivered and measured the intake of the commodity of breastmilk.

    In the same insidious fashion that formula had become endorsed by the Pediatricians, pumps became part of the practice model for many of the new and seasoned lactation consultants. The art of the latch was giving way to the number of cycles on a piston pump.

    Sadly, lactation education and support has shifted away from the actual skill of breastfeeding. These days lactation consultants are more likely to be experts on the mechanics of pumping and using gadgets and are much less confident with upgrading the latch. They assess feedings by the ounce of breastmilk pumped and doing weight checks. Although this may appear to be scientific, emphasis on measurements can make feedings stressful for the breastfeeding mothers. In addition to the obvious ethical considerations, I have noticed an increase in unnecessary supplementation, over-feeding, reflux and early weaning over the decade plus of pump.

    Over the past two decades I have focused my lactation practice exclusively on managing breastfeeding from the inside out: Mother-Breast-Baby vs. Pump/Scale-Baby-Mother. Even though I have a deep background in science, I have distinguished myself as the only consultant in my community who does not routinely use gadgets. I have chosen a model of practice that is the polar opposite of my colleagues who hold clinics and support groups implying that problems are to be expected. Instead, I empower the mother to take charge of her experience through the approach I call Conscious Breastfeeding. It’s all about the latch.

  6. June 6th, 2009 at 21:53 | #6

    first, let me tell you i write this with one hand while nursing, so forgive the lack of capitals.

    i hated pumping with my first but did it because everyone said i’d need a relief bottle (which he never took). it was not till now, with my third, that i found a way for pumping to truly benefit me and the baby. i switched to a manual pump, which worked a lot better for me, actually producing milk. and i have pumped once a day from the start, even though, like her brothers, she laughs in the face of a bottle. it has allowed me to freeze a few months worth (and donate some) for use in cups as she has gotten older, but it has also helped me produce a great amount of milk.

    my point? this time, i am pumping to help me be with her better, rather than to get away from her, and that’s why it has been so much more pleasant.

  7. June 10th, 2009 at 11:10 | #7

    Maire, thanks so much for sharing your perspective. If only every community had mother-breast-baby-led lactation support! Please do continue blogging!

  8. avatar
    ari
    June 18th, 2009 at 22:38 | #8

    Hello,

    What a great topic. I want to put my own selfish opinion in here, which is that the pump can relieve pressure when you are away from your baby. As a teacher, I am required to stand in front of groups of up to 30 teenagers without going to the bathroom for six hours at a stretch. My milk let down once (right before lunch) and it was mortifying! Having that one free period and a 25 minute lunch break to hide in the corner of a locked room and pump was such relief! (imagine a wall of windows 30 feet high looking out across a courtyard at other classrooms and a door with a huge window where unsuspecting kids and colleagues come knocking whenever they see fit and you will understand why I literally hid).

    I am a huge fan of hand expression and of massaging with that free hand to get the lumps out and the hind milk forward while the baby nurses. I never measured ounces, probably because I had had two months of blissful breastfeeding before I went back to teaching and so my baby had a well established supply and demand function. And the best part… I had my mother back at home to take care of my son while I was at work.

    Main Idea: if you are away from your baby for anything more than 2 or 3 hours, you might want to 1) rush home or 2) bring something to help you take the top off that milk – or you will be in pain.

    Again, nursing exclusively for a few months until proper breastfeeding has been established is a precondition. Your baby needs you, and you need him.

  9. avatar
    Barbara Hein Hall RNC,BSN,IBCLC.LCCE
    June 19th, 2009 at 10:33 | #9

    @Máire Clements, RN, IBCLC
    So well said. Thank You. Just as Jack Neuman’s associate said at the ILCA San Diego conference promoteing these gadgets is unethical. I always tell my pt’s we have been breastfeeding for years without all this stuff but if it helps you keep breastfeeding on a good road go for it. I try not to promote gadgets unless needed. Like you implied and as any expert will note it’s all in the latch and positioning that makes a big plus in the breastfeeding dyad. Teach and empower!!!!!

  10. June 22nd, 2009 at 15:32 | #10

    The ONLY part about breastfeeding I hated, and I mean HATED with a passion hot enough to set the room on fire, was pumping. However, I HAD to pump because I had to come back to work. Because of that pump, I am still breastfeeding my son 13 months later. I “hung up the horns” when he turned one, and just kept breastfeeding at home, and I have to say that our nursing relationship improved 10-fold once I didn’t have to worry about that stupid pump anymore. Things are so much easier now. But, I live in America where we’re all lucky if we get 3 months of unpaid leave, so the only way to keep breastfeeding (if you’re a working mother) is to become a slave to that machine. Hand expression isn’t going to work on a 15 minute pumping break. I needed maximum efficiency. I really hated it, I’d do it all over again though (and will with my next children.)

  11. avatar
    Rachael
    March 31st, 2010 at 21:43 | #11

    I just had a friend today tell me that she pumped, and pumped and pumped some more… to get only 2oz of milk out. She said she was stressing herself out and she gave up breastfeeding at 3 months, at the urging of a family member. She had a cesarean after planning for a vaginal birth and I made the connection that she was trying to control breastfeeding because she had been unable to control birth. I told her that 2oz for the pump is not a clear indicator of her ability to produce breastmilk. It was hard to tell my friend (whose daughter is 8 now) that she had essentially “done it wrong”, or come at it with the wrong attitude and information but it occurred to me that she may someday have another baby or share her experience with a new mom, and her memory/attitude needed to be changed.
    As a matter of fact, the less technology I had at my own births, the less I tried to pump afterward. I really think you have a point here! Great post!

  12. November 14th, 2010 at 10:14 | #12

    feeding babies may be a bit tiring but i enjoy this job specially when the baby smiles back at you “‘~

  1. September 19th, 2010 at 11:17 | #1