by Cynthia Billiar, RN, IBCLC, ANLC, ICD, ICCE
More than 85% of lactating women in the United States express their milk some of the time. Of those pumping, 5.6% are exclusively pumping and feeding by bottle, (Keim, Boone, Oza-Frank, & Geraghty, 2017). This is not surprising because we know that 70% of women with children under the age of 18 in the United States participate in the labor force, (“https://www.dol.gov/wb/stats/stats_data.htm,” 2016). Women who are actively serving in the United States Armed Forces make up 15% and this number continues to rise, (Feinstein, 2016).
The AAP recommendation is to exclusively breastfeed for the first 6 months, followed by continued breastfeeding along with complementary foods for 1 year, or longer, as mutually desired by mother and infant, (Eidelman & Schauler, 2012). Listed in order of least healthy to healthiest, the best feeding choices are first, direct breastfeeding, second, mother’s expressed milk, then human donor milk, and last, formula, (Mohrbacher, 2010, p. 236). Many mothers choose to exclusively pump and feed their breastmilk from a bottle for various reasons.
With the explosion of breast pump manufacturers and insurance companies covering breast pumps, exclusive pumping is becoming more popular, so much so, that it now has a nick name, “EPing”. We teach our expecting families the importance of looking at the risks, benefits, and alternatives before making any decision. You can imagine there are many questions as to the risk of choosing EPing. Let’s start with the pump itself.
There are many different pumps and choosing the right pump can be confusing. Mothers respond differently to different pumps. There is a risk that the pump will not remove milk efficiently, causing an end result of low milk production. A recent study found that EPing is associated with a shorter milk feeding duration and an earlier introduction of formula compared to those mothers feeding at the breast and not pumping, (Keim et al., 2017).
Storage of breastmilk, whether in the refrigerator or freezer, is found to have a reduction of some of the cells and antioxidants, (Rasmussen & Geraghty, 2011). When an Eping, mother does not get the skin to skin contact and closeness with her baby, the mother’s perception of stress and mood are affected negatively, (Mezzacappa & Katkin, 2002). This lack of closeness can also affect the bonding of mother and baby.
Next, let’s look at the bottles themselves. Bottles can increase the risk for future orthodontic problems, such as needing braces and the increase risk of cavities. Direct breastfeeding encourages better lower jaw development and stronger facial muscles, helping with speech development, (Bechtloff, 2012).
We also need to consider the risk of contamination and the time it takes to sterilize the bottles and nipples. There are several studies that indicate feeding from a bottle causes babies to overeat, increasing the risk of obesity, (Li, Fein, & Grummer-Strawn, 2010).
The most interesting information I found was the studies that indicate there is a difference in the milk itself. Research demonstrates that when an infant is breastfeeding, and he has an infection, leukocytes specific to his infection increase in his mother’s breastmilk. The mechanism behind how the leukocytes move into the breast during an infant infection is unclear. One possible thought is that during breastfeeding saliva from the baby’s mouth is back washed into the mother’s breasts, which stimulates an immune response, (Hassiotou et al., 2013). This protection in breastmilk is both antibacterial and antiviral. These immunities are lower in the nonexclusive breastfeeding dyad compared to the exclusively breastfeeding dyad, (Hassiotou & Geddes, 2014).
As you can see there are risks to EPing. There are times when a mother has no choice but EPing and I salute you. I know it can be very difficult to be an EPing mother, much more difficult at times than breastfeeding directly. The demands of this busy world can make life difficult but the strength and determination of a mother can withstand it all.
Eidelman, A. I., & Schauler, R. J. (2012, March). Breastfeeding and the use of human milk. Pediatrics, 129(3). Retrieved from http://pediatrics.aappublications.org/content/129/3/e827
Hassiotou, F., & Geddes, D. T. (2014). Immune cell-mediated protection of the mammary gland and the infant during breastfeeding. Advances in Nutrition. Retrieved from advances.nutrition.org
Hassiotou, F., Hepworth, A. R., Metzger, P., Tat Lai, C., Trengove, N., Hartmann, P. E., & Figueira, L. (2013, April 12). Maternal and infant infections stimulate a rapid luekocyte responds in breastmilk. Clinical & Translational Immunology, 2. https://doi.org/10.1038/cti.2013.1
Keim, S. A., Boone, K. M., Oza-Frank, R., & Geraghty, S. R. (2017). Pumping milk without ever feeding at the breast in the mom2mom study. Breastfeeding Medicine, 12(7). https://doi.org/10.1089/bfm.2017.0025
Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2010). Do infants fed from bottle lack self-regulation of milk intake compared with directly breastfedinfants? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20457676
Mezzacappa, E. S., & Katkin, E. S. (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Retrieved from http://psycnet.apa.org/record/2002-00946-009
Mohrbacher, N. (2010). Breastfeeding answers made simple. Amarillo,TX: Hale Publishing.
Rasmussen, K. M., & Geraghty, S. R. (2011, August). The quiet revolution; breastfeeding transformed with the use of breast pumps. American Journal of public heatlh, 1356-1359. https://doi.org/10.2105/AJPH.2011.300136