Supporting the Human-Milk-Feeding Mother
Cincinnati, Ohio, USA
From: LEAVEN, Vol. 37 No. 1, February-March 2001, p. 3-6
Many mothers today are choosing to feed their babies human milk without putting their babies to the breast. Instead they exclusively use artificial means, such as a breast pump, to express their milk for their babies. Modern technology has made it possible for mothers to establish, maintain, and even increase a milk supply with only a breast pump. This trend is upsetting to many breastfeeding advocates, who agree that expressed human milk is better than formula for a baby, but also understand the importance of the emotional aspects of the breastfeeding relationship and the physiological benefits a baby receives when he suckles the breast. This ambivalence on the part of breastfeeding advocates, along with the uniqueness of human-milk-feeding in the familiar cultural paradigm of breastfeeding or bottlefeeding, has made many mothers who feed their babies human milk in bottles feel shunned, inferior, and isolated. In order that La Leche League Leaders may better support these mothers, it is first necessary to understand why they are not feeding their babies at the breast.
Why Some Mothers Choose to Human-Milk-Feed
Many factors may motivate a mother to opt for full-time pumping over breastfeeding; there is no single and complete profile that fits every mother. It is important for La Leche League Leaders to understand why some mothers choose to human milk feed and what support they need from breastfeeding counselors.
For some mothers, lifestyle and parenting philosophies impact their decision. They may feel that pumping will be more convenient, allowing someone else to feed the baby while mother is away or asleep. They may begin pumping immediately after birth because they are concerned about making a transition from breastfeeding to bottle-feeding upon returning to work. They may have the opinion that pumping will allow them to put the baby on a feeding schedule. They may decide to pump exclusively because they are worried about nursing in public. A few women are deciding while still pregnant to human milk feed because it seems like the best of both worlds: giving their babies the benefits of human milk while they enjoy the perceived convenience of bottle-feeding.
Some women choose to pump their milk after they experience difficulties with breastfeeding early in the postpartum period. They may have problems with flat or inverted nipples, sore nipples, or engorgement. They may have difficulty waking a sleepy newborn to nurse, or getting baby latched on to the breast correctly. They may experience problems with nipple confusion. And some mothers may have difficulty breastfeeding because of a history of sexual abuse. Often these women wanted to breastfeed and are motivated to pump their milk because they want to give their baby the benefits of human milk even though their attempts at breastfeeding were unsuccessful.
Finally, some mothers choose to human milk feed because their babies are unable to breastfeed due to a physiological condition. While some babies may be unable to breastfeed only temporarily, such as premature babies, others may never be able to breastfeed, such as babies with bilateral cleft palates, babies with Pierre Robin Sequence*, and babies with severe neurological impairments. These mothers are motivated to pump exclusively because of the significant benefits their milk provides for their babies, whose health may be compromised as a result of their special conditions.
*Editor's note: This syndrome manifests with an unusual smallness of the jaw combined with cleft palate, downward displacement of the tongue, and an absent gag reflex.
How Leaders Can Support the Human-Milk-Feeding Mother
Leaders already possess the skills and resources to support human-milk-feeding mothers: they know how to practice reflective listening, dialoguing, and problem-solving and they have the most current and accurate information available through La Leche League publications and support channels. Like breastfeeding mothers, human-milk-feeding mothers need acceptance, respect for their decisions, encouragement, and mother-to-mother support. However, because of their special circumstances, there are special implications for the La Leche League Leaders who support and encourage them.
Support in Situations Where Breastfeeding Is Still Possible
In many cases, perhaps even the majority of cases, human-milk-feeding mothers started to pump full-time because they experienced common breastfeeding difficulties. Most likely, they did not receive adequate support and assistance in initiating breastfeeding. Furthermore, they may have experienced problems at home and didn't know where to get help. For these mothers, human-milk-feeding may have seemed like a positive solution to mounting difficulties with latch-on, sore nipples, engorgement, or a baby who refused to go to the breast at all because of nipple confusion or sleepiness.
In communicating with a mother in this situation, it can be tempting for the Leader to jump in and try to fix the breastfeeding problem. However, what these mothers need immediately is acceptance and patience. For them, breastfeeding was unpleasant and even traumatic. Many different emotions can motivate a mother's decision to pump exclusively, including fear, frustration, anger, panic, helplessness, sadness, isolation, and guilt. Some human-milk-feeding mothers may react to the well-intentioned attempts of others to salvage their breastfeeding relationship with anger and resentment. They may feel as if they failed as a mother, and place blame for the whole experience on breastfeeding itself and those who advocate for it. Therefore, the best approach for Leaders in this situation would be to respect the mother's decision and establish a trusting rapport through reflective listening.
The Leader can help a mother regain her confidence by affirming the tremendous benefits her milk provides for her baby. Pumping exclusively is grueling, time-consuming work that often, though certainly not always, goes unnoticed by friends, relatives, and health care professionals. Leaders can offer sincere encouragement to the human-milk-feeding mother about her decision to pump exclusively, recognizing it as a gift of love and a commitment to give her baby the best she can at that time.
Because human-milk-feeding mothers often do not feel accepted in breastfeeding social circles, and for the same reason may even choose not to read breastfeeding literature, they often do not have accurate information about maintaining a milk supply and/or storing and using human milk. This often leads to problems including breast injury as a result of using an inferior pump, developing mastitis, suffering from untreated thrush, relying on ineffective methods to increase milk supply (such as drinking excessive amounts of water), discarding human milk because it was left at room temperature for a short time, and feeding baby only frozen milk because it is perceived to be safer than refrigerated milk. By providing accurate information, Leaders can help the human-milk-feeding mother to maintain her milk supply safely and effectively and to retain the maximum amount of protective properties in her milk for her baby.
Often, Leaders help a human milk feeding mother one-to-one, over the phone, or in person. However, occasionally a human-milk-feeding mother may decide to attend a La Leche League meeting in order to connect with other mothers and to find support for her decision. As Leaders, we can evaluate the environment at our meetings to ensure that human-milk-feeding mothers would feel welcome. We might ask ourselves questions about how these mothers would feel. Are there vocal mothers at meetings who would express surprise, disapproval, or anger over the mother's decision to human milk feed? Are derogatory comments made at meetings about bottles and mothers who use them? Are off-handed comments made about mothers who "just didn't try hard enough" or who "don't care enough about their babies to breastfeed"? Leaders can take steps to set a positive, welcoming tone for a meeting by personally welcoming each mother and affirming her right to be there and by keeping the discussion on the appropriate topic. Leaders can also encourage mothers to take home what suggestions work for them and leave those that do not; this can serve as a reminder to all mothers that it is not their place to judge or proselytize at meetings
If a human-milk-feeding mother who experienced common difficulties with breastfeeding feels accepted by the Leader and welcomed by others at LLL meetings, the chances are great that at the very least, she will seek help and support with her next baby. Over time, she may become open to examining her initial experience with breastfeeding and decide to do things differently next time. Furthermore, there is every hope that she may resume breastfeeding her baby. Some human-milk-feeding mothers will come to La Leche League for information about pumping exclusively and come away with a breastfeeding baby. If nothing else, they will come away with confidence in their mothering and a better understanding of how to make things work in the future.
Sometimes, Patience Pays Off
Several years ago, I received a call from a new mother with triplets. The babies had been born prematurely; two had been home with her for two weeks and the third had just come home.
One baby was nursing well, another baby was nursing fairly well, and the third baby, Brian, the smallest and weakest, would not take the breast at all.
The mother was very happy about having triplets and that they were all well. She was very relaxed and was pumping in addition to breastfeeding and making sure that baby Brian would at least get some of her milk each day. When I assessed her situation, many of the tips I would have suggested to a mother of a singleton did not seem feasible with having three babies to care for. It became apparent that baby Brian was not going to be taking the breast any time soon. I told her how wonderful it was that she was providing her milk for all of her babies. Privately I thought that she was doing more than most women would even attempt.
I remarked that she shouldn't give up on baby Brian, but try putting him to the breast once each day. Perhaps baby Brian would grow strong enough or perhaps his mouth would grow big enough so that he would be able to handle actually taking the breast. I remarked that she'd have nothing to lose and who knows, some day he just might decide that he was ready.
Imagine my surprise when about five months later, I received a call from the triplet mother saying that she had been continuing to pump and breastfeed and spending a few minutes each day allowing Brian to fool around at one breast while she was pumping on the other. Excitedly she told me, "Today he just took the breast and nursed as if he'd known how to all along." His gestational age was just over three months and he finally figured it out. This was such a wonderful story and I was so happy to get that call - it made my week.
Supporting the Mother When Breastfeeding Isn't Possible
As La Leche League Leaders, it is our sincere hope that every mother and baby will share a long, happy breastfeeding relationship. For most mothers and babies, the potential for such a relationship is real. Since breastfeeding failure is so often caused by preventable problems, such as poor breastfeeding management or lack of emotional support, we may feel wary when anyone suggests that for some babies, breastfeeding may not be possible. We may privately wonder if a mother really tried hard enough or wanted badly enough to breastfeed her baby. It may be difficult for us as Leaders to accept the reality that for a few mothers and babies human milk feeding may be the best possible option. Nonetheless, it is crucial that we do so in order to offer them the unconditional support and encouragement they desperately need and deserve.
Helping a Mother Grieve the Loss of Breastfeeding
In industrialized Western culture, if a mother loses a baby or gives birth to a baby with a congenital disorder or disease, she will usually find sympathy and support as she moves through the grieving process. However, if a mother loses the breastfeeding relationship, she will often meet resistance from others if she tries to express her feelings about her loss. Initially, the human milk-feeding mother might hear comments such as, "Oh, that's too bad. But, it's not the end of the world. Your baby is getting your milk. What more do you want?" Well-meaning relatives, friends, and health care professionals may become uncomfortable and even angry if a mother "gets hung-up" on mourning the loss of breastfeeding. These reactions can make a mother feel isolated and ashamed that she would miss something that others believe to be so trivial. However, when breastfeeding is not possible for the mother who planned to breastfeed, there will be grief. Our society has no trouble understanding the grief of a person with legs who cannot walk or with eyes who cannot see, but we fail to recognize the pain of a mother with breasts whose baby cannot nurse. One only has to look at a woman's body to realize that breastfeeding is a natural part of life and that when a woman cannot experience that aspect of motherhood, it is only natural for her to mourn the loss.
In La Leche League, we believe that mothering through breastfeeding is the most natural and effective way of understanding and meeting the needs of a baby. The human-milk-feeding mother will grieve this loss. She will not be able to comfort her baby at her breast through illness, accidents, sadness, and tantrums. She will grieve the spontaneity, the restfulness, the portability, and the ease of taking care of a baby that breastfeeding provides. She will grieve the naturalness of breastfeeding, the sensation of letting down her milk in response to her baby's cry or feeling his silky touch, instead of the feel of cold plastic flanges against her skin and the hum of the breast pump. And she will grieve the social connection of breastfeeding; because her experience is uncommon, she may feel that she has little common ground with either breastfeeding or bottle-feeding mothers. "Am I the only one doing this?" is the lonely anthem that she sings to herself as she goes about meeting the needs of her special baby.
When silence is demanded of the human-milk-feeding mother as she mourns, is anyone them to listen? A compassionate La Leche League Leader may be the only person who is willing to acknowledge that losing breastfeeding is painful and very much worth grieving. Perhaps the most precious gift a Leader can give this mother would be the opportunity to talk about her loss and to receive reassurance that her pain is natural and valid. Of course, if a mother is having a particularly difficult time working through her grief, a Leader can refer her on to other professionals. But, often, it can make a world of difference to a mother to be listened to with compassion and understanding as she talks about the place in her heart where she will always long to nurse her baby.
Mothering Through Breastfeeding When Breastfeeding Isn't Possible
When my son, Avery, was born with Pierre Robin Sequence, I was dumbstruck at the prospect of mothering without breastfeeding. With my older daughter, Emma, I had wholeheartedly embraced breastfeeding as the core of my mothering; it was the most essential tool I possessed to meet the needs of my baby. So, when breastfeeding was not possible, I was left to figure out how I would give my son the love and nurturing that were his birthright.
Instead of turning my back in anger on breastfeeding, I chose to use all that I had learned when I breastfed Emma as my guide to mothering Avery. For example, I knew that if Avery were nursing, we would share sleep and I would keep him close in a sling or in my arms to enable unrestricted feeding. Therefore, even though Avery didn't need to be in my arms all day long to eat, I kept him very close to me to satisfy his emotional hunger for his mother. Also, I knew that if Avery were nursing, he would get lots of skin-to-skin contact, so I kept him next to my naked chest as often as I could, especially while sleeping. I recognized that if Avery were nursing, he would most obviously be getting my milk and he would be getting it for quite a long time. And so I decided to pump for him and made a goal for myself to do it for as long as I could within the context of the needs of my whole family. Finally, I realized that a loving relationship can happen even when breastfeeding is impossible; Avery and I have developed our own loving rituals and routines that make us feel close, connected, and loved.
Entering on this journey as an experienced breastfeeding mother has made all the difference. I am sure that Avery will receive many gifts from his sister over the years. But, perhaps the most precious gift Emma will ever give him is the mother she made of me through our breastfeeding relationship.
Acknowledging the Gift of Human Milk
In a culture where breastfeeding is not the norm, a woman who chooses to undertake the enormous burden of providing her own milk for her baby by artificial means may receive little encouragement from others. While it is practically undisputed that human milk is the superior infant food, many people may question why a mother would go to all the trouble to pump exclusively when she can choose to formula feed. All around her, the human-milk-feeding mother hears and sees advertisements, television commercials, and other mothers extolling the wonders of artificial baby milk. One mother who had been pumping for her two-month-old baby with a cleft palate was shocked and disappointed to read on a medical report for her son that he had been receiving formula. It was demoralizing to her that the baby's doctor, a well-respected geneticist, didn't seem to believe human milk was worth official documentation. In the quiet hours of the night when she is hooked up to her breast pump, a mother may wonder if her efforts really do make any difference at all. This is where the La Leche League Leaders encouragement can be extremely significant. An occasional pat on the back for the day-to-day work of pumping or an offer of information about the amazing benefits of human milk may give this mother the strength and vision to reach her goal.
Making the Connection
At La Leche League meetings around the world, women come together to help each other through all sorts of breastfeeding situations, from nursing in public to managing a toddler with a new baby. Indeed, La Leche League is built upon the powerful energy of mother-to-mother support. No matter how many helpful and accurate publications a woman reads about breastfeeding, often what matters most is the almost magical connection she makes with other nursing mothers who believe in what she is doing. This same energy can prove life changing for the human-milk-feeding mother as well, boosting her confidence in her body's ability to nourish her child and helping her to feel connected to others instead of isolated as a result of her unique situation.
What many people don't realize is that there are many mothers in La Leche League who have pumped exclusively. These are women who may have pumped for employment or for a premature baby, or for a baby with nipple confusion or for multiples. Whatever their reason for pumping, these mothers who attend the Group have a wealth of practical information to share about making full-time pumping work. For example, they may be able to offer tips to the new human-milk-feeding mother for traveling, special nighttime situations, pumping at the hospital, or pumping with young children at home. Most importantly, they can offer much-needed words of encouragement: the "been there, done that" support that human-milk-feeding mothers may not find anywhere else. If Leaders are vigilant about creating a welcoming environment for all mothers at La Leche League meetings, their efforts will bear fruit in the confident, connected women they see coming back again and again, who are nurtured in the spirit of mother-to-mother support.
Human-milk-feeding is truly a phenomenon of the new millennium. It simply couldn't exist as a significant trend without the modern technology that makes it possible. In the past Leaders have grappled with cutting-edge issues of mothering and breastfeeding, and have learned to embrace the diversity of the mothers who came to them for help while they themselves still remained faithful to La Leche League philosophy - so it is now with the human-milk-feeding mother. Supporting and encouraging these special women and their babies and watching them grow in their loving relationship as they learn from La Leche League about mothering through breastfeeding, can only make ours a stronger, even more compassionate organization.
Editors Note: After considerable discussion, the term "human-milk-feeding mother" was selected to describe those mothers who choose (for whatever reason) to express their milk and feed it to their babies using an alternative feeding method. This terminology may seem awkward to some. While we needed to acknowledge the difference between feeding human milk and feeding a baby at breast, we also tried to avoid the term breast milk, as it does not identify the type of milk but rather the source of the milk. Because this is one of the first articles to address these mothers and their specific needs, we wanted to be careful to avoid offending these mothers. They certainly deserve respect and support for their Herculean efforts to provide their own milk for their babies. We welcome your input and thoughts. Thank you to Jill Landis for writing such a ground breaking and thought-provoking article!
Jill Landis lives in Cincinnati, Ohio USA with her husband and children Emma, 4 years old, and Avery born April 3, 1999; She joined LLL in October 1996, was accredited as a Leader in July 1999, and is currently leading with the Blue Ash-Kenwood Group in Cincinnati. Jill writes, "Before starting my family, I was a graduate student, earning my master's degree in French from Pennsylvania State University in August, 1996. My son, Avery, was born with Pierre Robin Sequence and I have been a human-milk-feeding mother for 19 months now, with a pumping goal of two years (April 1, 2001). In my spare time, I enjoy walking, yoga, and vegetarian cooking."
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