Mothers Who Forgo Breastfeeding for Pumping
Not long ago, one of the mothers in my private practice arrived at my door with her husband. Like many new parents I see, they beamed with pride at their robust seven-and-a-half-month-old son, Bradley, who was growing and thriving on mother’s milk alone. Unlike most other new mothers I see, however, this one had chosen seven months earlier to give up on breastfeeding and to pump and give her milk to her baby by bottle.
During my two years in practice, I have worked with a number of women who decided to give up breastfeeding in favor of pumping and giving their milk by bottle. Because there is so little information available on this option, I decided to conduct a survey of these mothers, as well as several women in other areas of the US whose names La Leche League gave me for this purpose. I hope that the experiences of these ten mothers will be useful to other mothers considering this choice.
Why Mothers Choose This Option
The ten mothers in the survey gave a variety of reasons for their decision to forgo breastfeeding for pumping:
- the baby was nipple confused and fussed at the breast (2),
- the baby refused to latch on,
- the baby was rough with the breast during breastfeeding,
- the baby was unable to breastfeed due to a physical problem (one baby had a cleft palate, the other baby was unable to breastfeed due to the combined effects of prematurity, Down Syndrome and a congenital heart defect),
- the baby refused to go back to breastfeeding after a lengthy temporary weaning,
- the mother had sore nipples and found that pumping did not hurt,
- the mother found pumping and bottle-feeding more suited to her lifestyle with her first baby (who would not latch on) and chose to do it again with her second,the mother felt uneasy with the act of breastfeeding.
How They Did It
These mothers used a variety of pumps. Eight mothers used a hospital-grade automatic electric breast pump; two used a hand-held battery-operated pump. Three mothers used Ameda/Egnell’s Lact-E, one used Ameda/Egnell’s Lact-E Lite, three used Medela’s Classic, one used Medela’s Lactina Select, and two used the Evenflo hand-held pump. One of the mothers who used the Evenflo pump said she went through two pumps during the 21 months she expressed.
Although double-pumping would clearly have been a time-saver for these mothers, not all of them chose to do so. Seven of the mothers surveyed double-pumped, while three (including the two using the Evenflo pumps) pumped one breast at a time. The mothers who single pumped spent an average of 27 minutes at each pumping (ranging from 20 to 30 minutes per pumping) 4.6 times a day (ranging from 4 to 5 times per day) for an average of 124 minutes of total pumping daily (ranging from 113 to 135 minutes). The mothers who double pumped averaged 17.3 minutes at each pumping (ranging from 9 to 40 minutes) an average of 5.3 times per day (ranging from 4 to 7) for an average of 90 minutes of total pumping daily (ranging from 55 to 160 minutes).
The number of pumpings per day varied, depending upon whether the mothers were in the process of increasing their milk supply or it they were getting the amount of milk they wanted. Those who began pumping during first few days after birth, averaged 6.3 pumpings per day during the first week (ranging from 4 to 12 times per day). This number dropped to an average of 5.5 pumpings per day once their milk had increased and they were getting enough milk to sustain their babies.
Some of these mothers breastfed before they began pumping, while others did not. Three began pumping after a period of effective breastfeeding, one after three-and-a-half months (due to a medically indicated temporary weaning), the second after six weeks (due to nipple confusion), and the third after four days (due to sore nipples). The remaining seven mothers breastfed once or twice or not at all. Of these seven, four began pumping on their baby’s first day, two on the second or third day, and one on the sixth day.
Milk yield varied among the mothers. When the mother with the highest milk yield (96 oz per day) was eliminated (she purposely stimulated a larger milk supply than her baby needed in order to freeze extra milk), the average milk yield was 37 oz. (ranging from 21 to 55 oz.). Surprisingly, the mothers reported that the amount of milk pumped at each session was unrelated to time of day and correlated most closely with the length of time since the last pumping. The mothers who did not get up at night to pump reported that the first pumping in the morning yielded the most milk, but those who pumped during the night reported that the amount of milk pumped stayed consistent from pumping to pumping.
There was some variability of milk yield based on the type of pump used. The two mothers who single-pumped using the Evenflo pump reported average daily milk yields of 26 oz. and 32 oz. (with 5 and 4.5 daily pumpings respectively). The three mothers using the Ameda/Egnell Lact-E had average daily milk yields of 96 oz., 55 oz., and 32 oz.(with 7, 5.5, and 4 average daily pumpings respectively) . The mother using the Ameda/Egnell Lact-E Lite had an average daily milk yield of 32.5 oz. (with 5 daily pumpings). The three women using the Medela Classic reported average daily milk yields of 46 oz., 42.5 oz., and 42 oz. (with 4.5, 6, and 6 average daily pumpings respectively). The mother who used the Medela Lactina Select had the lowest average daily milk yield of 21 oz. (with 6 daily pumpings).
The mother with the highest milk yield pumped between 6 and 8 times per day from birth and produced about 96 ounces per day. Her goal was to freeze extra milk for her baby, who had multiple health problems, and when she returned her pump, she had enough milk frozen to sustain him for another six weeks of exclusive human milk feeding.
The Mothers’ Feelings
The mothers surveyed pumped and bottle-fed their milk for an average duration of 6.7 months (ranging from 2 to 21 months) and shared many positive comments about their experience. They all felt good about giving their babies the health benefits of human milk and agreed they would recommend pumping and bottle-feeding to others, as they considered it a better alternative than formula-feeding. Several of the mothers said that “it was important for the baby to get the milk” but felt it didn’t matter how he or she got it. One mother said her husband found it reassuring in light of the publicity on dehydration and breastfeeding to know how much the baby was getting. Another, who had pumped with a previous child and chose not to initiate breastfeeding with her second, commented on how well it worked within the context of her busy lifestyle. One mother said she was glad not to have to breastfeed in public and appreciated that anyone could feed the baby. Several mothers also acknowledged the extra time commitment involved, one referred to pumping and feeding as “taking double time.”
Some mothers were criticized by others; some were praised. Several said they were called crazy for pumping and bottle-feeding. One was told she was “a saint.” Several mothers expressed a plea for support and understanding. When her baby wouldn’t latch on in the hospital, one mother said the nurses and lactation consultants tried to discourage her from pumping and bottle-feeding. The mother said she was finally able to relax and feel good about her decision when a lactation consultant in private practice told her that it was okay. Another mother put it this way, “Every mother has her own way, which needs to be respected.”
If a mother is considering pumping and bottle-feeding, the information gleaned from these mothers’ experiences may help her decide if this option is workable for her. The mothers surveyed were able to successfully establish and maintain a full milk supply for many months by pumping on average 6 times per day at first and then settling into a 4-6 times per day routine. The mothers who single-pumped averaged 26.6 minutes of pumping 4 to 5 times per day (average total: 124 minutes per day), while the mothers who double-pumped averaged 17 minutes of pumping about 5 times per day (average total: 90 minutes per day). When sharing this information, however, be sure to note that these mothers were selected for this survey because they had been successful at long-term pumping. Mothers unable to establish a milk supply through pumping were not included, so not all mothers may achieve these same results.