Go read the Disclaimer again. I am not a doctor. This is not medical advice. Seriously.
Most advocates of breastfeeding focus on the importance of breastmilk. Pumping and feeding with a bottle or some other device is considered largely equivalent to breastmilk at the breast. This is not true, for either the mother or the baby, although it is a great second best, certainly far better than formula in a bottle (or even through a supplementer).
By feeding exclusively at the breast (or nearly exclusively) she can avoid a pregnancy with no side effects. Breast feeding stimulates the nipple much more effectively than pumping or hand expressing, which keeps prolactin levels up. Other benefits to mama from breast feeding include reduced lifetime risk of osteoporosis and breast cancer. We do not understand completely why this is, but if that reduced risk involves time spent not ovulating, or any other effect of the increase in prolactin from breast feeding, pumping is second best for mama.
Breast feeding is a feedback loop. The baby is exposed to various microbes. These are passed along to mama from the baby's mouth to mama's breast. From there, mama may be able to create specialized antibodies for those microbes and deliver them promptly to the baby. Any delay in this loop (by pumping and serving later or, worse, freezing, which kills the antibodies) reduces the efficacy of this system. The more it is disrupted, the more the baby is reliant on an immature immune system, along with any assistance that immunization might confer. An exclusively breastfed at the breast baby rarely relies upon that immature immune system exclusively to recover from an exposure to illness.
As more and more women work full time and attempt to maintain a full supply via pumping, more and more women find that their supply recovers over the weekend, and then declines through the week. Mothers who attempt to night wean sometimes find their milk supply drastically reduced. I think it is likely that the women who have so far been able to pump and work full time outside the home, separated from their baby, are very unusual women. As more and more women are encouraged to nurture their babies with breastmilk, more and more women are finding that pumping does not work for them.
There are other solutions. Parental leaves buys a woman a few weeks, if her family can afford for her to take it (although I would argue that few families can truly afford for her not to take it, given the high cost of formula when you consider the future cost of ill health). Reduced hours for both spouses and child care to make up the difference might enable her to spend enough hours of the day breast feeding to keep her supply up. If her baby can be brought to her at work at least once during the day (or she can visit her baby), that often helps maintain supply.
Longer parental leave would take a lot of the pressure off establishing the breast feeding relationship. It would be cheaper for us as a society to pay mothers to nurture their babies at the breast. It would, however, reduce our GDP substantially, as all those babies would be much healthier. We could, like Norway, add breastmilk to the GDP.
Working from home or taking the baby to work without assistance caring for the baby is a stopgap solution. The women and babies who are able to function in this way are rare indeed, and probably non-existent once the baby is more than a few months old.
Copyright 2006 by Rebecca Allen.
Created February 5, 2006 Updated February 5, 2006