The politics of pumping

While I think it’s a good thing The Case Against Breastfeeding was written, I still found some of the assumptions underlying both the article and the podcast discussion a bit grating. The issue that bothered me the most, I think, was the discussion about whether the benefits from breastfeeding are all about the milk, or is it all the holding, cuddling and interaction that goes along with the breastfeeding that is responsible for at least some of the beneficial effects of breastfeeding.

Foremost among these was a quote from Dr. Michael Kramer, lead author of the PROBIT trials done in Belarus. Kramer’s team found a small but statistically significant improvement in IQ among children breastfed for longer periods as compared to those breastfed for shorter ones. Kramer’s take on his results
is that they “could be banal,” —simply the result of “breast-feeding mothers’ interacting more with their babies, rather than of anything in the milk.”

Kramer goes on further to say that he even prefers the latter explanation be true, because “it would suggest something the formula companies can’t reproduce.” (And to think that some lactofanatics accused this guy of being a Nestle stooge!). There is a similar assumption made in the podcast.

It seems rather clear to me, at least, that the overwhelming proportion of the benefits accrued from breastfeeding are due to the milk, especially in the case of the areas of the largest benefit (e.g., infectious disease protection). Studies in premature infants -which usually show the largest benefits of breastmilk – are also usually about providing milk or formula via a nasogastric tube, as such small infants are usually unable to feed normally. Nor is it a foregone conclusion that babies who are breastfed are necessarily ‘interacting’ more – either with Mom or anyone else – than a bottle fed baby. Because you just know those bottlefeeding parents prop those bottles just as soon as they can…as opposed to those oh-so-caring NAK (nursing at keyboard) women who spend hours each day visiting online messageboards, racking up 5-digit post counts and barely noticing Baby’s latched on. Right?

But let’s say we’re wrong. What does that say about the growing number of women who pump their milk at work so another caretaker can bottlefeed their babies? Are they wasting their time sacrificing their lunch hours to pumping of milk, and maybe the real solution would be to feed the baby formula during the day and nurse (and cuddle) around Mom’s working hours without all the hassle -and take it from one who’s done it, it is a hassle – of providing enough expressed breastmilk for baby to avoid even a drop of formula?

Realistically, many women at many jobs don’t have the opportunity or the luxury to pump breastmilk at work, or can afford a good $300 pump. As things stand, the ability to pump at work is often a matter of class:

But as pressure to breast-feed increases, a two-class system is emerging for working mothers. For those with autonomy in their jobs — generally, well-paid professionals — breast-feeding, and the pumping it requires, is a matter of choice. It is usually an inconvenience, and it may be an embarrassing comedy of manners, involving leaky bottles tucked into briefcases and brown paper bags in the office refrigerator. But for lower-income mothers — including many who work in restaurants, factories, call centers and the military — pumping at work is close to impossible, causing many women to decline to breast-feed at all, and others to quit after a short time.

Apparently, women can even be fired for taking time to pump, if it suits an employer’s fancy.

Jill Lepore, writing in the New Yorker a couple of months ago, also assumes that breastfeeding’s benefits are due to the hugs and cuddles aspect. She correctly points out that “non-bathroom lactation rooms” are a poor substitute for on-site daycare and/or long maternity leave, but let’s get real: the AAP suggests nursing continue for a full 12 months, 6 of those exclusively nursing. What are the chances that, absent a very serious hike in taxation (unlikely in this economy), the US will ever come close to providing even 6 months of maternity leave? Nor can on-site daycare be mandated…which means that even if universal maternity leave is enacted, pumping will still be with us. To which Lepore responds: “Holy cow. We are become our own wet nurses.”…You say it like it’s a bad thing, Jill!

Lately, pumping paraphernalia has again come under attack from the lactation crazies. Lactofanatics have always been uncomfortable with the idea of women providing their breastmilk not 100% from the source (preferring the “mothering at the breast” paradigm; even the latest edition of LLL’s The Womanly Art of Breastfeeding, after a discussion about pumping and working, still gives the idea of “choosing to stay home” a hard sell). But to boycott the leading manufacturer of breastpumps, Medela, because it didn’t allow the sale of its merchandise below a certain price (making it, presumably, an eeeeevil corporation which cares about its bottom line as opposed to a non-profit enterprise!) takes a good deal of naivete and chutzpah. But that’s what the lactofanatics at LACTNET and LLL have been doing lately.

Medela further sinned, apparently, by marketing its bottles and nipples for use with its pumping system. This has brought its marketing practices in contravention of the sacred-to-lactofanatics’ WHO International Code of Marketing of Breast-milk Substitutes. Never mind that the Code was written (by mere mortals, not God) in the days before breastpumps for personal use existed, and that Medela is not in any way, shape or form promoting formula – and has, in fact, explained that it feels (IMO correctly) it’s adhering to the spirit, if not the letter, of the Code. It seems to me that ultimately, lactofanatics are shooting themselves in the foot here – their demand for such a level of breastfeeding purity is such that very few women (especially women who have to work for a living, or even just want to) can achieve. They might end up with a larger and larger contingent of women concluding that the best thing would be to feed formula during the day, and cuddle the baby a lot.

Which would be just fine in my opinion, but I suspect the ‘crap in a can’ brigade would have a cow…

UPDATE: Very long, but an interesting analysis and suggested solution to the current dilemma.

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14 Responses

  1. “Nor is it a foregone conclusion that babies who are breastfed are necessarily ‘interacting’ more – either with Mom or anyone else – than a bottle fed baby. Because you just know those bottlefeeding parents prop those bottles just as soon as they can…as opposed to those oh-so-caring NAK (nursing at keyboard) women who spend hours each day visiting online messageboards, racking up 5-digit post counts and barely noticing Baby’s latched on. Right?”

    *snerk*

    That update article link promises to be fascinating to me. Right at the start it prompts a question — when, exactly, were breastfeeding and breastmilk NOT commodified? Seriously, with the history of wet-nursing alone, I’d like to see a serious discussion of the commodity chain of women’s bodies and this most intimate of labors…

    The whole cuddling/skin-to-skin contact issue is also interesting — not to just once again bring up my husband’s feeding behaviors, but since he feeds in the middle of the night and first thing in the morning, he tends to be shirtless while doing so, and he’s a super-cuddler, although he also feeds with our son resting on his (dad’s) upright knees, and he holds/strokes his head and talks to him. He also often has his computer next to him, and in the middle of the night feedings, uses that to help him stay awake.

    • It’s a very interesting paper, to be sure. One of the nice things about it is that it doesn’t dwell on the “is it the bonding or the milk?” question for very long. Unlike the examples mentioned in the post (and I might add the idea of breastfeeding as a vehicle for bonding/attachment, while very prevalent, is not really research-based).

  2. Did you ever read the post I wrote about the time Mothering magazine refused to allow an exclusive pumper to advertise her bottles for sale once she’d finished with them? (yeah, shamelessly hawking own blog here)

    On a totally different subject, have you read Peggy O’Mara’s latest spew (reposted at http://alisaterry.blogspot.com/2009/03/assault-on-freedom-of-conscience.html )? I’ve written a blog post about “My right to make whatever choices they like and act as though they don’t affect anyone else!” attitude, but I’d love to hear your take on her claims about HIV/breastfeeding/AZT.

    • My take is that she’s an idiot, and a dangerous one at that. Weren’t Christine Maggiore and EJ enough of a lesson? (Oh wait, they didn’t die of AIDS. Or that’s what Peggy’s friends are telling her).

      Off the top of my head from what I remember reading – exclusive BF helps protect a child from acquiring HIV as compared to mixed feeding, and exclusive BF is better in places where formula can’t be prepared safely, because they’ve seen babies live longer even having acquired HIV (i.e., they may still acquire HIV via breastmilk, but they don’t die at young ages from other infectious diseases because of breastmilk’s protective effect. And thanks to that antiretroviral therapy Peggy so maligns, HIV is no longer an automatic death sentence). Which is why it might make sense to push exclusive BF in AIDS-stricken areas in Darkest Africa. Where a woman can fully FF safely and her baby is not at risk of dying from acute gastroenteritis, exclusive FF is still recommended.

      Also, taking advice about antiretroviral treatment from a woman who doesn’t believe HIV causes AIDS is nothing short of suicidal.

      And Sarah – linky-dink to that post about the EPer and her bottles, pls?

      *Just another addendum: How come these loons are so reluctant to see the difference between FF in the developed vs. the developing world, but somehow don’t think the the huge measles death rates in the developing world are a reason to vaccinate their own children against measles?

  3. I have definitely seen the 2 class system in my office. The physicians and NPs I work with- who can afford to take their 12 week unpaid leave are also the ones who come back ready to pump and do so for as long as they want (that is what I did).

    The front and back staff (receptionists, Medical Assistants, etc) generally can barely afford to stay out their 4-6 weeks paid short term disability (if they have that) and if not whatever vacation time has accrued. They usually come back already FF their babies (another class thing, I work in a very blue collar town where it is still unusual for mom’s to BF). Yes, longer maternity leave would help. Yes, a more BF friendly and supportive community would help. But realistically, unfortunately they would have trouble pumping at the office- there is no where to do it (providers pump in their exam rooms between patients) and the electric double pumps needed to really pump efficiently while working really are too expensive for a lot of people (while WIC helps with the cost of formula). So, while it seems difficult for many breastfeeding advocates to understand there really are many real obstacles to breastfeeding for a large number of mothers, that the advice to “get more support” really doesn’t help (I know you have blogged on this in the past, just chiming in).

  4. I forgot to mention that so far all the MDs and NPs who have come back after maternity leave have chosen to come back part time. The front and back staff don’t have that choice -they can’t afford to only work part time (or to not work at all). In general, it is much easier and more realistic to pump if you are only working part time rather than full time. It is doable for some women who work full time to pump- for example the majority of pharmaceutical reps who come to our office pump but they also have the flexibility to pump whenever they want -in their cars- which is again a bit of a class thing. But that is certainly not true for many women.

  5. Esther – Glad you asked. 😉 http://goodenoughmummy.typepad.com/good_enough_mum/2007/01/storm_in_a_bott.html. It’s one I’m rather proud of, if I do say so myself.

    • Good post, Sarah. 🙂 . How the hell are EPers supposed to get their EBM into their babies, anyway, according to the ultra-orthodox Codists ? Nothing but cupfeeding or an SNS?

  6. Esther, I just want to clarify that WIC (although I am not a WIC advocate or defender) also provides pumps for moms, not only formula.

  7. Thanks, Ines. Do they provide good pumps (e.g Medela or Ameda), and is it their default position to promote BF these days? Or does it depend on the region/state?

  8. I don’t work for WIC so I am not up to their specific policies and practices. At the same time I know there are regional differences in terms of the breastfeeding promotion and support WIC provides. However, WIC does provide good enough pumps (Medela in my state) even hospital grade ones (as I understand) for babies that have to be separated from their mothers.

  9. WIC in my state provides Ameda Purely Yours, according to LLL friends. It’s about the equivalent of the more popular Medela Pump In Style.

  10. The issue that bothered me the most, I think, was the discussion about whether the benefits from breastfeeding are all about the milk, or is it all the holding, cuddling and interaction that goes along with the breastfeeding

    This argument “for” breastfeeding always bothers me, too. I breastfeed, and quite happily, too, but it occurs to me that there is possibly less interaction with a breastfeeding baby, not more. First, the baby can’t (usually) make eye contact with you, the way he/she is latched on; so there’s no (or very little, during the actual eating) eye-to-eye interaction. Second, a bottle-fed infant is held and cuddled during feeding as much a breastfed one (or would be, by the same parent). Third, a bottle-fed infant is more likely to be fed by multiple caregivers rather than just the mother (so, more varied human interaction).

    Just to entertain another thought experiment. (Since the “maybe BF babies are more cuddled” is also an idle thought experiment! I mean, as long as we’re entertaining idle thought experiments …)

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