We’re very pleased to share an interview about exclusive pumping with Stephanie Casemore, author of Exclusively Pumping Breast Milk.
Stephanie is also author of Breastfeeding, Take Two: Successful Breastfeeding the Second Time Around, a book for mothers who had difficult breastfeeding experiences with a first baby and are now expecting a new baby.
What are some of the more common reasons why moms end up pumping exclusively? Is there any data on the number of moms who do it?
There are numerous reasons why a mother might end up pumping exclusively, but overwhelmingly, at least from my own experience over the past several years supporting and communicating with women who are exclusively pumping, most women turn to it as an alternative to formula feeding when breastfeeding hasn’t worked out the way they’d hoped it would. Women may have experienced concerns with pain, milk supply, or have a baby with latching difficulties, slow weight gain, or other such issues. The root causes are extremely varied, but for whatever reason, breastfeeding is not going as planned.
There are also a significant number of women who pump exclusively due to health or medical concerns with their baby: prematurity, illness, or cleft palate, for example. These mothers often resort to exclusively pumping out of necessity, often pumping to initiate supply in the hopes of eventually transitioning to breastfeeding. Some moms do make the transition, while others may continue exclusively pumping long-term.
And while not very common, at least not among the women I hear from, some women do choose to pump starting immediately after their baby is born and do not wish to breastfeed. For some this is due to a discomfort with the idea of breastfeeding but a strong belief in the importance of breast milk. For others this may be more of a logistical decision if, for example, they must return to work shortly after the birth of their baby.
There has not been, to my knowledge, any research or data collected on exclusively pumping moms. Not only have the numbers of women exclusively pumping not been collected, but very little research has been done at all on the option of exclusively pumping with most information on expressing milk focused on mothers of preemies or pumping in combination with breastfeeding.
What are some common feelings moms have when the end up exclusively pumping?
Breastfeeding is an emotional issue and when breastfeeding expectations aren’t met, there are many feelings that a mother experiences. Often, moms will feel that they have failed their child and failed at breastfeeding. Even when a mother has fought to make it work, often seeing numerous lactation consultants and seeking support and information, women often express feelings of guilt believing that they haven’t done enough. However, at the root of that emotion is usually grief and a sense of loss. The breastfeeding relationship they expected to have hasn’t materialized and that takes time to work through and process. While feelings of failure and guilt may be commonly expressed, this is far from reality. Many women I hear from have gone to extraordinary lengths to provide breast milk for their babies, often persevering through pain, multiple consultations with lactation consultants, the use of supplementation devices such as a Supplemental Nursing System (SNS), and the exhausting cycle of breastfeeding, bottle feeding, and pumping.
Mothers who exclusively pump also often feel alone. Pumping exclusively isn’t often acknowledged as an option or mentioned to new or expecting mothers, and so many women will start pumping exclusively thinking that they must be the only ones doing it—they must have invented the idea. I can’t tell you the number of emails I have received saying, “I’m so glad to have found your website. I thought I was the only one doing this.” This sense of isolation can affect not only a woman’s confidence and determination, but it also limits the amount of accurate information she receives, and accurate information is critically important in order to exclusively pump long-term.
Mothers who exclusively pump also often feel misunderstood. Because it isn’t often acknowledged as an option, it can be difficult to make people not only understand the process of how you’re feeding your child, but also the reason why you are feeding this way. Mothers who are exclusively pumping are kind of in limbo: they aren’t really breastfeeding, but they aren’t formula feeding, and bottle feeding tends to be synonymous with formula feeding. They are, as some people call it, breast milk feeding. There can sometimes be judgment from breastfeeding moms and advocates suggesting that mothers who are pumping didn’t try hard enough or didn’t really want to breastfeed (although support and understanding is definitely growing), and at the same time formula feeding moms may not understand why a mother would go to all the effort to express and bottle feed, instead of just switching to formula. When you go to the doctor’s, you are asked if you are breastfeeding or bottle feeding. How do you answer that question with only those two answers as options? You simply don’t fit neatly within one of the check boxes. When an acquaintance—or complete stranger—asks if you are breastfeeding, do you bother to explain what it means to exclusively pump? Sometimes the effort it takes to repeatedly explain your choices is very overwhelming.
But the emotions are not all difficult ones; with exclusively pumping comes pride and love and a sense of commitment and dedication. In my own experience, exclusively pumping certainly wasn’t the road I was expecting to travel when my first child was born, but being able to provide for him in that way gave me a sense of satisfaction and helped me to work through the lost breastfeeding experience. I had many emotions including unresolved grief over the circumstances of my son’s premature birth, and exclusively pumping allowed me to have some control and offer something that only I could do. While I would rather have been able to breastfeed, exclusively pumping played a large role in my ability to come to terms with my experience and see some measure of success.
Emotions play such a big part in breastfeeding and breastfeeding loss. In my most recent book, Breastfeeding, Take Two: Successful Breastfeeding the Second Time Around, I discuss the emotional aspects of breastfeeding and how important it is to grieve the lost relationship and heal from it—and then how to move into a more positive experience the next time around.
What are the biggest challenges for moms who exclusively pump? What are the rewards?
Aside from the emotional challenges discussed above, there are two main areas of challenge that are repeating themes for exclusively pumping moms: logistics and lactation. Logistically, it takes a lot to exclusively pump. In reality, it doubles the workload. Unlike breastfeeding where milk removal and baby feeding happen simultaneously, you can’t easily feed your baby while you express your milk, so it can become extremely difficult to care for an infant and pump as frequently as required. Once you’ve spent the time expressing the milk and washing the pump kit and storing the milk, you then need to actually feed your baby, which requires management of the expressed milk and cleaning of bottles. In the early days, it can seem like you have no time to do anything but pump and feed, and this might not be too far from the truth! Thankfully, as milk supply is established and a routine falls in place, sessions can often been reduced providing more flexibility in a mother’s day.
“It gets easier” is commonly said to women just starting out with exclusively pumping, and while little consolation in those early weeks, it really does get easier. However, the frequent pumping schedule and additional work of pumping and bottle feeding can be difficult. New moms generally are overwhelmed and exhausted, and with the added work of exclusively pumping, this isn’t made any easier.
Logistics also come into play if a woman needs to return to work. While thankfully employers are offering more support for breastfeeding and pumping mothers, it can still be a challenge to find the time to express milk frequently throughout the day and provide enough for your baby. With good knowledge and support though, this is something that many women are able to do.
On the lactation side, the biggest challenge is accessing good information. I have grieved far too many times with women who were given inaccurate information early in their breastfeeding and pumping journey. Far too often I hear from women who were told by medical professionals that long-term exclusive pumping just doesn’t work and that a mother’s milk supply cannot be sufficiently maintained with only a breast pump. This can lead to poor pumping practices or harmful breastfeeding management, and a lack of information can ultimately interfere with a mother’s supply and as a result, “How do I increase my milk supply?” is the most common question I’m asked. With better information given early in the process, fewer moms would be asking this question.
While not impossible to increase milk supply weeks or months after the baby is born, it is far easier to establish a strong supply right from the start. Establishing a strong supply as soon as possible gives a woman options and allows some flexibility in scheduling. Regardless of whether a woman is breastfeeding or exclusively pumping, I strongly urge them to learn about the process of lactation, understanding how milk supply is established and maintained. With a good understanding of the basic science behind it, it is easier to make choices that support that process.
My book, Exclusively Pumping Breast Milk: A Guide to Providing Expressed Breast Milk for Your Baby, discusses many other challenges that exclusively pumping moms might face.
And of course, it isn’t all challenges. Although it can be a tough road, there are many rewards to exclusively pumping. I think the biggest reward is seeing your baby thrive and knowing that despite the challenges and difficulties, your baby is growing as a result of your milk—love and dedication materialized. Even when it is still necessary to supplement with formula, knowing that your baby is getting your milk gives a sense of satisfaction. I think most women are exclusively pumping because they believe in the importance of breast milk—it certainly isn’t the easier option—and so simply being able to provide that to their baby is an incredible reward.
From my own experience, I have also learned that the challenges give way to knowledge and strength. I am a much stronger person as a result of my year exclusively pumping. I learned that I can be persistent and successful and have recognize that while expectations may not play out the way we hoped, we can still find success and satisfaction from the challenges. For me, it was also an important lesson in love. I did what I did because of my love for my son. Having breastfed my second child for three years, I can say that the dedication and love was no different between the two children—it was just expressed differently (pardon the pun). My son and I will always have the bond of common challenge that presented itself to us when he was born. It’s our story and one that I’ve learned (am still learning) to embrace.
What are your favorite support resources for moms who exclusively pump?
Aside from my own book, Exclusively Pumping Breast Milk, and website, as well as the book’s Facebook page which is continuing to grow and has turned into a wonderfully active, supportive community, there are a number of support resources for pumping moms. It is so important to find a supportive community. As I mentioned above, so many women feel as though they are the only ones doing this, but this is far from the truth. I always encourage women to talk about their experience exclusively pumping with anyone who will listen, and especially their doctors and lactation consultants, so that support communities will be easier to find, and that support will begin to be established locally. For the time being though, the primary source of support is online.
Many online discussion boards have groups for moms who are exclusively pumping. When I was pumping, it was the group on iVillage that provided me with the support and information I needed. But this group is not unique. A very large group on Yahoo is called PumpMoms. This group is for any mom who may be pumping, not just those exclusively pumping. EPers is another Yahoo discussion group that is aimed specifically at women who must exclusively pump.
For information about lactation and many issues dealing with breastfeeding and expressing, Kellymom.com is the site I most often recommend.
For support dealing with the emotions felt when breastfeeding doesn’t work out, Mothers Overcoming Breastfeeding Issues (MOBI) is a great source of information and support. They also maintain a number of Yahoo groups.
What do you think many moms who are exclusively pumping want others – other moms and support people in particular – to understand about it?
This is really a difficult question for me to answer because I think there are as many possible answers as there are women who are exclusively pumping. But I guess I would have to say—and largely this is what I would want to say—that many moms who are exclusively pumping would want others to understand this: They are just moms—like every other mom—trying to do the best they can for their children. Support and love is needed and welcomed, but judgment has no place. Whether they “tried hard enough” to breastfeed or not, or never wanted to breastfeed, they are giving a great deal of themselves to provide breast milk for their children. It is impossible to judge the efforts of others as we can never accurately know the truth of their experience, so in the meantime it is best to simply accept where they are, listen to where they want to be, and love and support them while they make that journey.
While we work to increase the support and information available for new moms to make breastfeeding more accessible to all, let’s support and commend those women who are giving what they can and doing what they can do, in the face of the challenges they may be going through. In today’s society, the challenges to breastfeeding are many and sometimes they are not always rooted in a woman’s or baby’s ability to breastfeed, but also society’s ability to support the breastfeeding mother and baby. Women who are exclusively pumping have so often come up against these societal and informational challenges and they have chosen to persevere and triumph in their own way.
And finally, let’s share far and wide that it is possible to exclusively pump long-term. The World Health Organization recognizes expressed breast milk as the next best option when breastfeeding isn’t possible. It would be wonderful if everyone involved in supporting and educating new mothers would share the option of exclusively pumping before formula feeding, not fearing that more women will choose it over breastfeeding, but instead hopeful that it will result in more babies receiving breast milk for a longer period of their lives.
Whether you pump for work, for an occasional bottle, or you pump exclusively, there are a few things you should know if you’re planning to travel with your milk.
Flying: Bringing breast milk on board
Back in 2006, when the Transportation Security Administration (TSA) adopted restrictive policies regarding liquids brought on board planes, mothers who were traveling without children reported being told to dump out their pumped milk before boarding.
Fortunately, things have improved significantly since then. The TSA policy is now as follows:
We recommend that you print out and bring a copy of the TSA regulations with you in case an agent has questions.
Flying: Checking containers of breast milk
Breast milk can also be packed in your luggage and checked. If you do pack it in a suitcase be sure to enclose it in multiple layers (several zip lock bags inside an air tight plastic container, for example) to guard against spillage.
Some mothers who are transporting a lot of milk opt to check a well-sealed cooler of milk. Bear in mind that frozen milk will likely thaw, partially or completely, in transport. To keep the milk at refrigerator temperature or lower, we’d recommend packing your milk in ice or dry ice.
Traveling by car
If you’re traveling by car and expect to need to pump, you’ll want to either plan for periodic pumping stops or invest in a cigarette lighter adapter in order to pump while driving (check to make sure one is available for your brand of pump). Obviously, it’s safest if you pump while someone else is driving, or stop to pump. We’d caution against pumping while driving if you find it distracting enough to make driving unsafe. We want you to get there safely!
Milk you pump on the road will stay good in an insulated cooler pack with ice packs for up to 24 hours. See below for milk storage guidelines once you get the milk to your destination.
If you’re planning to be on the road with already pumped milk, your options are much like those for flying with breast milk. Fresh milk can be transported at refrigerator temperature in a cooler bag or cooler with ice, and then stored in the refrigerator at your destination (see below). If your milk is frozen, you can pack it in a cooler with ice or dry ice. It will likely partially or fully thaw. See below for milk storage guidelines once you get the milk to your destination.
How long is it good after I get it home?*
Since fresh milk can be kept in the refrigerator for five days, fresh (not frozen) milk that is transported at a temperature at least as cold as a refrigerator should be good for up to five days (in total).
And since frozen and thawed milk can be kept in the refrigerator for up to 24 hours after thawing, frozen milk which thaws in transport but remains cool (refrigerator temperature or lower) should be good in the refrigerator for up to 24 hours after thawing. It’s not recommended that milk be re-frozen.
*Milk storage guidelines from the Academy of Breastfeeding Medicine’s protocol, “Human Milk Storage for Home Use for Healthy Full-Term Infants.”
We’re very pleased to share an interview with Stephanie Casemore, author of Breastfeeding, Take Two: Successful Breastfeeding the Second Time Around.* This book is written for mothers who had a difficult breastfeeding experience with a first baby and are looking ahead to a new breastfeeding experience with a new baby.
What were your breastfeeding experiences like with your first and second babies?
My breastfeeding experiences were vastly different and yet they are closely connected. The birth experience played largely into each as well.
My first baby, my son, was born at 31 weeks gestation after I developed pre-eclampsia and was hospitalized at 30 weeks. His birth was an induction and was a very clinical experience. I was separated from him immediately and didn’t get to see him for another sixteen hours. I began using a breast pump soon after delivery to initiate my milk supply and am thankful for the good advice I received from the hospital staff about pumping.
I started breastfeeding attempts a week or so after my son was born, but soon breastfeeding too became very clinical with pre and post weights being expected and a nipple shield introduced. After five weeks in the NICU, two of those with me living in a care-by-parent unit caring for my son 24 hours a day, I finally introduced a bottle in order to be allowed to bring my son home (he had to be taking all his feeds by mouth). Breastfeeding was getting no easier and in fact my son had now started to cry and flail at the breast and, soon after he arrived home, started to projectile vomit. I was stressed, overwhelmed, and lost.
Life became a cycle of attempted (and often rejected) breastfeeding, bottle feeding expressed milk, and then pumping. Shortly after he reached his due date, I decided that I would continue to pump exclusively and feed my milk by bottle. I had asked many people for advice and help, but it never helped. I was told by two different professionals that it was okay to just feed formula, but that wasn’t what I wanted, and not the advice I needed. After five months of asking for help and seeing multiple medical professionals, I finally was told to try an over the counter medication for reflux and my son’s feeding behaviour changed overnight. Had I got that information and help months earlier, would I have been able to breastfeed my son? I’ll never know. By that point I was well into the routine of exclusively pumping—and continued pumping for a year—and my son was receiving all breast milk with no supplementation needed. But the lost breastfeeding relationship was difficult to accept.
Three years later I became pregnant with my second child, my daughter. When I first found out I was pregnant, my first thought was about breastfeeding: would I be able to breastfeed this child?
I had a great deal more information than I had with my first and knew going in that the birth experience affected initial breastfeeding, so I did everything I could to protect that early breastfeeding experience with my daughter. It wasn’t always easy, but I was determined. My daughter was born at about 37 weeks and her birth was quick and normal. She nursed within the first half hour following her birth and I kept her with me—in my bed most of the time—while we were in the hospital. She gained weight well and was above her birth weight by six days of age.
By all accounts, things were going well. But I didn’t believe it.
I kept waiting for something to go wrong.
The emotions and fears and worries of my experience with my son started to pop up and it was difficult to separate the two experiences. Any time my daughter cried inconsolably, any time she didn’t nurse well, or any time I became a bit engorged, I worried that breastfeeding wasn’t going to work out. I had to learn to trust my abilities, my body, and my baby. My daughter and I had some ups and downs, but we persisted and just kept going. I was amazed when we hit six months and thought a year seemed a long way off. Once we hit one year, I couldn’t imagine stopping. Breastfeeding became an easy way to mother and an easy way to connect with my daughter when she needed closeness. She self-weaned when she was three years and two months old after declaring she didn’t “need” to nurse any more. It was a bittersweet moment.
You write that there is no such thing as ‘breastfeeding failure.’ How do you instead view difficult breastfeeding experiences?
Our world is consumed with the idea of evaluation and measurement. Everything—even breastfeeding—seems to be evaluated and held to certain standards. But the concepts of “success” and “failure” when it comes to breastfeeding, which is at its core a relationship, are arbitrary measurements.
What constitutes “failure” when it comes to breastfeeding? And who determines what failure looks like?
There are certain guidelines in place, but even those are arbitrary and often adjusted. Success might look very different for a mother of a preemie or a mother of twins or a teen mother or a mother who must return to work full-time shortly after the birth of her child. Failure then too, is very hard to define. For these reasons, I would much prefer to look at breastfeeding in terms of simply “did” or “did not”.
Failure is also a perspective. Thomas Edison is quoted as saying “I have not failed. I’ve just found 10,000 ways that won’t work.” Everything for him was a learning experience, and I think for women, breastfeeding—regardless of whether they “failed” or not—can be a learning experience. It’s all in the perspective of how you look at your experience. With my son, I did feel as though I failed him for a very long time, but then I realized that my experience strengthened me in many ways and in the end has been a very positive thing. Do I wish I had been able to breastfeed him? Of course. But that is a feeling of regret, no longer a belief that I failed.
Difficult breastfeeding experiences are more a reflection of our society’s failure than a mother’s failure. Mothers, by and large, do everything they can to breastfeed their babies. Yet when accurate information and meaningful support isn’t accessible for every mother, mothers are going to do what they need to do in those circumstances to feed their children. I find no failure in that.
You say that what is often characterized as guilt over an unsuccessful breastfeeding experience is actually more accurately described as grief. What’s the difference, and what does it mean for a mom contemplating another breastfeeding experience?
Guilt is an emotion that is felt when you do something you know you shouldn’t do or you don’t do something you know you should do. Almost every mother I’ve communicated with over the last several years did everything they could to breastfeed. “Everything” though is largely influenced by the information and support that they have access to.
So, if you were given poor advice to supplement with formula in the hospital and this negatively affected your milk supply and led to early weaning, should you feel guilty? In my opinion, no. Anger at the inaccurate information and lack of support is likely appropriate, but when a mother has tried to access information and support and that information and support has been faulty, lacking, or led to difficulties, guilt is misplaced. Many moms will say they feel guilty or that they “failed” at breastfeeding and while they may name the emotion as “guilt” I think grief is more often what is felt.
Our society often doesn’t recognize breastfeeding as a meaningful relationship, but it is—and it’s a biologically-expected relationship for both mom and baby. When breastfeeding doesn’t work out, there is a loss and that loss is often felt as grief. Just as with any other loss in life, we need to work through the grief.
If you push it to the periphery and don’t work through it, as often happens with a new mother who must “get on” with life and family and the care of her new baby, the grief remains, often to resurface with the expected arrival of a new baby and another opportunity to breastfeed. Working through the grief and loss of the first experience will help a woman move into a second breastfeeding relationship. Understanding breastfeeding as a relationship, more than merely a means to feed a baby, will lead to a better understanding of the loss that is felt when breastfeeding ends sooner than desired, and this recognition of the loss will help a woman recognize the grief that she may be feeling.
Can you list a few things moms can do to process a difficult prior breastfeeding experience, in preparation for a new nursing experience?
There are many things that can be helpful to process a difficult past breastfeeding experience. I’ll list some of these things below.
1. Acknowledge emotions that are still lingering from your first experience. Chances are as you move into your pregnancy many of these will start to surface on their own, and, over the first few weeks of your new baby’s life, you will likely have a surge of feelings that relate more to your past experience than the present.
2. Recognize everything you did do for your first baby and that breastfeeding relationship. It is more common for us to look at what we do wrong than what we do right. Chances are your baby is now a healthy, happy infant or toddler and that means you did something right! Give yourself credit where it is due. Not one of us is a perfect mother, but we all love our children.
3. Flip your thinking. Rather than seeing your experience as a negative, look at it as a positive. I think in most cases a challenging experience helps us to grow and learn, and become stronger and more committed. It might not have been the experience you wanted, but it was the experience you got, so accept it and consider how it made you better.
4. Talk about your experience. Find support from others who understand how emotional breastfeeding—and not breastfeeding—is and share your story. As you share, you will be working through the lingering emotions and preparing yourself for a breastfeeding relationship with your next baby.
5. Forgive. Part of processing the past experience is the need to forgive. Do you blame yourself? Do you blame others? At the risk of sounding like a twelve step program, it is important to forgive in order to move on.
6. Educate yourself. We can’t change our past, but we can grow from it. Learn about normal birth and breastfeeding and empower yourself. Figure out what you’ll do differently the next time around and use your past experience, as Edison did, to figure out what didn’t work and to make a plan for the next opportunity.
*We were provided with a review copy of this book.
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