Why does expressing seem to be the new breastfeeding?

I have just finished an online lactation conference. I must admit it’s quite hard to motivate myself to this after a busy day but to remain certified as a lactation consultant I need regularly to attend conferences as well as, every five years, sit an exam. But I must confess it’s very good for me to do this. A colleague, recently retired, said to me she knew it was time to go when she had started to allow clients to take the easy option with breastfeeding, basically, agreeing to what they wanted to do, without trying to provide them with evidence-based information or trying to encourage them towards breastfeeding.

 As she was talking I realised that I was beginning to slip down the same slope. I had frequently found myself saying, “Do whatever you want to do, it’s your life” or words to that effect. After participating in the conference I was fired up again and filled with enthusiasm about breastfeeding and its benefits. I started to question why so much of my time is spent encouraging clients to breastfeed. Almost all of my clients believe that breast milk is the perfect food for their baby but many of them prefer to give expressed breast milk, rather than directly feed on the breast. Here are the most common reasons I have heard:

  •  Want to be in control; this often involves monitoring how much milk the baby is consuming over 24 hours by logging it on an iPhone/laptop application provided by the hospital.
  • Nipple pain or not liking the sensation.
  • Fear of failure; often feeling insecure about “technique” such as different “positions” or holds.
  • Believe the baby “prefers” the bottle.
  • Depression or anxiety; feeling overwhelmed and lacking in confidence  that they can do a good job; sometimes not wanting their baby near them some or all of the time.
  • Previous trauma to the breast or having suffered sex abuse.
  • Shy of exposing their breasts especially in public.
  • Not liking being tied to baby and the commitment that feeding their baby on the breast requires.
  • Want to share feeding with husband, nanny or helper so prefer to pump so everyone can be involved.
  • Worried about going back to work and not being able to transition the baby from breast to bottle.
  • Want to drink, smoke or eat junk-food, so prefer to “pump and dump” at times and give expressed breast milk for the rest.

 Whilst breast milk is clearly the perfect food for the baby, there are many additional benefits also for baby and mother in directly breastfeeding. So, when I reviewed this list I smelt a whiff of failure. Not my client’s failure, MY failure! As a lactation consultant and health visitor of many years I should be able to help with almost all, if not all, of the above objections. These are my clients, not Joe Public, and thus deserve more than my immediate acceptance, without at least endeavouring to help find solutions.  From now on I am determined to be more focused on actually helping clients to breastfeed directly, rather than taking the easy option!

 Jun 01, 2013   8 Comments

8 Responses to Why does expressing seem to be the new breastfeeding?

  1. Caroline van der Heijden says:

    Hi Yvonne! Thanks for writing this. So funny, I just started today to express more milk and give it (myself) in a bottle. My reason was another night without much sleep and a hungry 6.5 wk old babyboy. I just tried because I am thinking he might drink more from a bottle than from breast and so he might get more between 7 am and 11 pm, which hopefly results in better nights. My daughter got breastfeeding without bottles the first 4.5 months but she was more easy going during nights and less hungry. I also have the feeling the breastpump I rented is this time so much better and faster than the one I had in 2010? So it’s actually a lot easier… So just now after feeding the 2 and 6 pm bottles, I was actually quite happy with the result, but now I just read this. I would be interested in the benefits of the actual physical breastfeeding too, except from bonding?
    Ps the 11 pm feed is always a bottle given by my husband so I get some sleep..

  2. Alexis Rogers says:

    I second Caroline’s comment. Your article didn’t outline what those benefits were and I would be interested to know.

    I am not sure I agree that expressing and feeding bottles is the “easy” option. I have been exclusively feeding expressed milk since my baby started refusing the breast and wasn’t gaining weight appropriately in week 7. I have now been pumping every three hours around the clock for two months. My baby sleeps through the night, often 9-10 hour stretches, but I have to get up every three hours nonetheless. If I was feeding at the breast, I would be getting a lot more sleep. Also, breastfeeding is much easier to do when out and about than pumping, as it doesn’t require privacy. Therefore, I find myself staying home much more. And, pumping requires TONS of washing up – bottles and pumping equipment. And, if you feed the bottles yourself, even half the time, you aren’t saving time overall. I disagree it is an easy option and would encourage anyone considering it voluntarily to think twice before committing!

    I do believe some of the reasons for doing it outlined above can be benefits though. It does give you more independence, as you have a food source other than your breast, should the baby get hungry when you are having sanity-providing ‘me’ time. It also does allow your partner to share in the bonding experience of feeding. But you can get this with only occasional expressing (e.g. once a day or less).

    • Yvonne says:

      I’d like to thank all those who have given feedback on this blog, especially Caroline & Alexis for taking the time to write. At the outset, I want to re-emphasise that this blog is not meant to be critical of those who CHOOSE to offer EBM; rather, it is a criticism of health professionals who don’t put in the work to help mothers feed their baby from the breast. It is a quick and easier solution for professionals to advise pumping instead of working on and helping with any issues mothers have that lead them to express.

      I saw a lady recently who had a 5 month old baby, her second. She was an experienced breast feeder with her first child and had enjoyed the experience. For various reasons this baby had gradually become more and more EBM fed and she had reached the point where she was not able to express sufficient milk to feed the baby and he would no longer latch onto the breast. This mother really wanted to feed on the breast and found pumping unrewarding and increasingly producing a lower yield. I’m pleased to say that with a little effort she has got her baby feeding on the breast again; for me, it took a little effort but the outcome was very rewarding.

      Some of you have asked what the advantages are of direct breastfeeding and I have listed below some top-of-mind points about these benefits; I’m sure, for those interested to do so, there are many articles with much more scientific evidence.

      • Convenience: the milk is there and ready to go (think long-haul flights, travelling, half asleep in the middle of the night, staying longer on outings).
      • Less time commitment. No bottle cleaning and sterilising and, of course, time spent on pumping.
      • Bonding and the advantages of skin-to-skin contact.
      • The baby controls the intake (if breastfeed on demand), so long term milk production is usually better.
      • At times when baby needs more, more frequent feeding on the breast helps increase the supply.
      • Mum enjoys a unique closeness with the baby. Admittedly, this is sometimes a disadvantage but breastfeeding is one thing your helper or nanny can’t do.
      • Some studies have also shown that a baby sucking directly from the nipple lifts a mother’s mood. I believe it also gives her a sense of empowerment.
      • Milk straight from the breast is full of phagocytes which engulf bacteria. Freezing milk destroys these and some antibodies.
      • Direct breastfeeding helps the mother to make specifically targeted antibodies.
      • Helps jaw, mouth, teeth and facial development.
      • I have read studies which indicate breastfeeding helps with speech development

      But, as I’ve said before, there’s just nothing nicer than snuggling up and breastfeeding your baby on a rainy afternoon. Yvonne

  3. Lisa N says:

    I can say that having returned to work at week 13 in a very full on role, expressing milk was not an easy option for me! Constant pumping at desk, fretting about supply, watching every ml per feed, storing milk discreetly in communal work fridge, carrying milk in freezer bags, leaking milk from freezer bags (the best bags from boots in uk!), having to thaw it, use different bottle per freezer bag, washing/sterilising bottles, “stock take ” of freezer milk, being told supply is “low” by my helper “is this all?”, guilt at having low supply some days, researching how to increase to yield more pumping, drinking odd tasting tea, trying (but failing!!) to sleep more, constant pressure of pumping more… Not easy!! Am I proud I expressed and perserved for 6 months… Yes! Was it easy? No! To some extent a new mum, especially a working mum, cannot always choose to do what she wanted to do at the outset (I had visions of bubs coming to office for feeds which is impossible in reality with my schedule and no bf room) and circumstances don’t always allow what we wanted originally – we just have to do our best whether its direct feeding or expressed milk or formula- we should feel proud and happy we are feeding our babies well . mums- lets not feel guilty , lifes too short for mother’s guilt (famous last words as a new mum!). Xx

  4. Nikki says:

    Thank you for all the comments, I’ve just had my second child and am breastfeeding again but have been expressing to ‘increase supply’ as this was an issue for me last time (I’m still not sure how much of that was first time mum pressure v reality of trying to do everything that was new). Firstly, I want to thank you Yvonne for being honest as a health care provider, and secondly to those mums who have commented reminding of the hard work/ angst that expressing can bring too. It’s refreshing to have such honest conversations around being a parent.

  5. Ivy says:

    My baby refused my breast when she was 1 mth old because of confusion of nipple. Now she is almost 6 mths old, taking exclusivly expressed breast milk for 5 mths. I have a full-time job. Is it still possible or advisable to directly breastfeed her again? I found it very inconvinient to pump the milk when outing or travelling.

    • Yvonne says:

      Hi Ivy, It might be possible to recommence breastfeeding at 5 months, though it would take a lot of commitment and time, which you may not have a lot of as a busy working Mum. And at 5 months you have done a wonderful job to give your baby breast milk.
      But if you are keen to re-establish breastfeeding, the easiest way to do this is set aside a few days and stop bottles. Spend a lot of time with your baby skin to skin. Squeeze a little milk out of the nipple so that he can smell it. To maintain supply if he does not latch you will need to express every 3 to 4 hours. As long as your baby is a normal healthy weight he will be able to thrive without much feeding for a few days. Best wishes! Yvonne

  6. Alice says:

    Clearly there are pros and cons when it comes to breastfeeding or expressing. The ideal situation would be to find the right balance between the two. I’m lucky that with both my boys we managed to find this balance and i was able to enjoy the benefits of both. However, with both boys i had a horrendous time establishing in the first 2wks, and exclusive pumping and formula did cross my mind. Support from lactation consultants and perseverance are what got me thru. Fair to say that lactation consultants should promote breastfeeding more, however, in this day and age that we live in, push too hard for it and you will be known as the breastfeeding nazi who doesn’t listen to the wishes of clients. It’s all a balance and you’re doing a great job Yvonne!

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