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An interview on exclusive pumping, with the author of Exclusively Pumping Breast Milk

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 pagewhich 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.comis 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.