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Parenting

The Breastfeeding Option We Don't Talk About

More and more moms are exclusively pumping, but surprisingly little is known about it.

With my first baby four years ago, breastfeeding was a slog from the start. My nipples blistered and got infected. It took weeks of pumping after every excruciating feeding to get my supply up. I went to breastfeeding “circles,” met with four lactation consultants and never went anywhere without a nipple shield. For 8 1/2 months, I kept at it, not because I ever really loved it, but because I thought I had to. In hindsight, I regret how doggedly I kept at it in spite of the obvious toll it took on my mental health. I was so fixated on nursing him at the breast, it consumed me.

When I got pregnant again last year, I vowed, along with my husband, that I would not go down that path again. If breastfeeding came somewhat easily this time around, great. If not, I would move on. Within 48 hours of my son’s birth, my nipples had erupted into familiar blisters, and the baby and I were both in tears during every feeding — even as a hospital lactation consultant looked on and reassured me that his latch looked fine, and the pain would get better. But I was just... done.

When we got home from the hospital, I gave him 2 ounces of formula and immediately felt better. When my breasts started to ache a few hours later, I unpacked the Spectra 2 pump I’d received for free thanks to HuffPost’s health insurance plan — the pump I hadn’t planned to use until it was time to go back to work — and squeezed out an ounce or two.

My son is just over 6 months old now and gets a mix of formula and expressed breast milk — a solution that works well for us. Pumping is arduous, but I personally find it easier than breastfeeding.

But I’ve also had my moments, while my breast pump wheezes away, milking me like a dairy cow, when I wonder how much the hours I’ve spent hooked up to the pump matter. People — by which I mean the ridiculous range of people who consider themselves breastfeeding experts, from my kid’s pediatrician to the woman in my local-moms Facebook group who pastes KellyMom links to every thread — say that any breast milk a baby gets is a good thing.

But how much is enough? And are the benefits really the same if he’s eating from a bottle or directly from my boobs?

More women are pumping now than ever before

Electric breast pumps — which became widely available to women in the mid-1990s ― are now ubiquitous in this country, thanks in part to a provision in the Affordable Care Act requiring private insurance plans to cover them.

Research suggests 85 percent of babies in the United States who get breast milk are fed from a bottle at least some of the time. Many women pump when they’re at work or otherwise away from their babies and nurse them at the breast when they’re home, which is what I did with my first baby.

But there is a growing group of women who consider themselves “exclusive pumpers” — which means they pump in order to produce breast milk, and feed it to their babies from a bottle, never directly at the breast.

Exclusive pumpers now account for 5 percent of American moms who give their babies breast milk, according to the most recent U.S. infant feeding practices study conducted by Food and Drug Administration and the Centers for Disease Control and Prevention. And that came out a decade ago, so there is reason to believe the number is actually substantially higher now.

Some moms exclusively pump because they have a preterm baby who can’t be nursed at the breast. Others just want the ability to have someone else feed their baby.

“Some women actually prefer expressing their milk to feeding their infants at the breast,” note the authors of a 2011 commentary in the American Journal of Public Health, dramatically titled, “The Quiet Revolution: Breastfeeding Transformed With the Use of Breast Pumps.” That tone of surprise makes me laugh — as though women like me are oddities to be studied. (Technically not an exclusive pumper, I give my baby a combination of formula and breast milk, which is referred to as supplementing.)

Kendra Germenis, who had her first baby in November 2016, has written about her experience as an exclusive pumper. Because of latch problems, she too experienced searing pain when she tried to nurse early on, and though she wonders now if she might have benefited from seeing another lactation consultant — she saw one briefly in the hospital — she switched to the pump a week after giving birth and never looked back. For her, it was significantly less painful than breastfeeding.

Make no mistake: Pumping is not an easy way out. Exclusive-pumping moms do it five, six, seven times a day, regularly waking up at night when their babies are still asleep to keep their supply up.

“Ugh, I despise my pump,” laughed Germenis, detailing the commitment it takes to find time and space to pump, and then to wash pump parts throughout the day, and then to lug it with you wherever you go.

There is virtually no research on the benefits of pumped breast milk

Given how common pumping is — as well as how difficult it is, and how zealously public health campaigns plug the health benefits of breastfeeding — it is startling how little is known about the differences between pumping and nursing at the breast.

“There are very few studies that examine the differences between direct breastfeeding and exclusive breast milk pumping,” said Dr. Joan Meek, past chair of the American Academy of Pediatrics’ section on breastfeeding and a professor of clinical sciences at Florida State University College of Medicine.

“In most research studies, mothers that pump are not distinguished from those that breastfeed directly,” Meek told HuffPost.

No head-to-head controlled studies compare pumping and bottle-feeding with feeding a baby directly at the breast. This is mostly because researchers can’t just randomly assign women to one of those two groups. Some women — like me — have a hard time feeding their baby at the breast, or they don’t like it, so they couldn’t be put in the feed-at-breast group. Likewise, researchers can’t make a woman who detests the pump, and who would much prefer to just nurse her baby, hook herself up every few hours to see how both groups fare.

There are reasons to believe, however, that the two are not exactly the same, Meek said.

One of the only studies to look directly at the experiences of exclusive-pumping moms found that they tend to feed their babies breast milk for a shorter period of time and introduce formula earlier than moms who feed their babies directly with their breasts. It’s unclear why that is, but Meek says it could be because the skin-to-skin contact moms have with their babies during nursing works magic on their hormones, which in turn keeps their supply up. Likewise, breast pumps don’t do as good a job as babies do at removing breast milk; and because emptying the breast is what signals the body to make more, milk levels can drop over time.

Recent research also shows that babies who are fed directly from the breast have lower body mass indexes at 3 months than babies fed breast milk from a bottle. This suggests there is something about bottle-feeding in and of itself that influences a child’s subsequent risk of being overweight later on.

Then there is the research questioning whether freezing breast milk diminishes its nutritional value by decreasing its antioxidant punch.

“From a research perspective, it’s important we measure how the milk is reaching the baby, because there may be differences,” said Alison Stuebe, a maternal-fetal medicine physician and the medical director of lactation services at University of North Carolina Health Care.

Meek said exclusive pumping isn’t the same as feeding at the breast, but given breastmilk’s known benefits for babies, it is the next best thing.

“We do know in preemies that a human-milk diet has profound effects on outcomes,” Stuebe said. Of course, full-term babies have different health concerns than preterm babies do, she added, but argued that it’s not unreasonable to extrapolate that some of the benefits of giving babies bottles of breast milk apply more broadly. And research does suggest that breastfeeding protects infants against certain early illnesses and infections.

There’s no ‘wrong’ way to breastfeed

One thing that experts and moms are clear on is that nursing a baby is a different experience than hooking yourself up to a pump. Stuebe says the research world has to do a better job catching up with the idea that what matters perhaps above all is that women and their babies find a feeding approach that works well for them.

“If we do find that at-breast feeding is better than expressed-milk feeding, that’s [an] argument for why we need to make it easier for moms to have their babies with them,” she said. “If we were to find that it absolutely makes no difference whatsoever that the milk was pumped into a bottle, that would also be important to know.”

“But the other thing that’s important about it is that the mom’s experience of nurturing her baby is an important piece of the puzzle that is not typically measured in public health and discussions of this,” Stuebe added.

What little research there is on the topic, however, clearly shows that it is beneficial for moms to do what feels right, no matter what that is. A study published this fall found that women who felt happy about how they were feeding their babies had significantly fewer depressive symptoms at two, six and 12 months postpartum — and were less likely to experience full-blown postpartum depression. The same held true for postpartum anxiety.

And to the extent that the conversations happening in public health spheres, doctor’s offices and on social media influence women’s feelings about how they feed their babies, it is important to recognize that there is more than one way to “breastfeed” a child. Unfortunately, many of the stories on pumping that do exist are unnecessarily negative — warning moms what they’re “missing” by not feeding their babies directly or even trumpeting the “dangers” of exclusive pumping. I don’t personally feel any guilt about pumping and supplementing with formula, perhaps because I’ve had the experience of pushing myself relentlessly to feed at the breast. But it’s abundantly clear to me why many women would and do.

Even the language we use now has to adapt to the way women actually feed their babies. Does “breastfeeding” mean feeding a baby at the breast? Feeding a baby milk from the breast? When people ask me whether I’m breastfeeding, I’m never really sure what to say. Yes? Kinda? I think? Some breastfeeding experts have argued that it is time for the medical world to adopt new terms like “at-breast feeding” as well as to distinguish between “expressed” and “donated” milk. Those terms are more cumbersome, but at least they begin to capture the many ways in which modern parents give their babies breast milk.

Because what a lot of moms feel toward pumping is ambivalence, no doubt compounded by the lack of information about the extent to which their efforts are, for lack of a better term, worth it.

Moms like Germenis, who describes her overall pumping experience as positive. Her gut told her she was doing something good for her son by giving him whatever breast milk she could, and she was happy that it didn’t require her to feed him directly at the breast, which she found painful and somehow claustrophobic.

But she is thrilled her pumping days are behind her.

“I think about it,” Germenis said. “Like, if I have a second baby, will I go through that again for nine months? I don’t know.”