What We Don’t Know About Pumping

What We Don’t Know About Pumping

October 5, 2016

What We Don’t Know About Pumping

What We Don’t Know About Pumping
Photo by @citypumper
What We Don’t Know About Pumping

On You Tube, there’s a nifty instructional video that explains how to use a hands-free pump bra. As the headless woman in the video deftly inserts cylindrical tubes through slits in her bra, she instructs users to slip the “breast pump horns” into the bra and “attach breast pump valves and bottles to the horns.” Next you “connect your tubing to the pump” and turn it on. The payoff? “You’re hands free from start to finish, giving you the freedom to do other tasks!”

Pumping breast milk has become an integral part of the American practice of breastfeeding. One study estimated that about 85% of women who breastfeed in the United States use a pump. Breast pump manufacturers put that number even higher, and American women represent 40% of the world breast pump market. There is nowhere else in the world, even in other developed countries, that pumping is such a universal feature of breastfeeding.

Many women don’t have much choice. Almost 60% of new mothers work. Almost 30% of them take no maternity leave at all. Among those who do manage to combine short term disability leave with vacation days to cobble together some kind of maternity leave, the average is 10 weeks. Faced with the yawning chasm between the recommendation to breastfeed exclusively for six months and the absence of federally mandated paid maternity leave, mothers are forced to pump breast milk so that someone else can feed their babies human milk from a bottle. They also pump to keep up milk supply so they can breastfeed when they get home from work. (Even mothers who don’t work pump milk so they don’t have to confront disapproval over breastfeeding in public.)

“…Nobody knows if human milk consumption is the same thing as breastfeeding.”

Women’s options have also been shaped by recent government policies designed to make pumping, but not breastfeeding, easier and cheaper. In 2011, the Affordable Care Act amended the Fair Labor Standards Act to require employers to provide nursing mothers with space to pump breast milk at work – during unpaid work breaks. In 2012, the IRS changed its rules to make breast pumps tax deductible. That initiative was superseded in 2013 when the ACA mandated that private health insurance plans and Medicaid must cover the cost of breast pumps for new mothers. Ironically, each one of these initiatives was heralded as a victory in the fight to normalize breastfeeding in the United States.

The quiet shift from breastfeeding to pumping depends on the unstated, and un-studied, assumption that what is valuable about breastfeeding is the chemical composition of human milk, not the mother child contact that goes along with feeding a baby at the breast. New York City’s controversial Latch-on breastfeeding campaign made the point explicit, with posters that touted the benefits of breast milk without ever mentioning breastfeeding at all. The New York City health commissioner who implemented that campaign, Dr. Thomas Farley, told me that the decision not to mention breastfeeding was deliberate. He didn’t believe that Mayor Bloomberg, who was well known for being business-friendly, would have sanctioned any campaign that implied a need for maternity leave. Policy makers are sensitive to the fact that feeding a baby breast milk is less threatening to employers than breastfeeding.

Companies like Medela, which makes breast pumps, and Prolacta Bioscience, which makes nutritional supplements from human milk, are also driving the shift from breastfeeding to pumping – by funding a new line of research into “human milk and lactation,” including such topics as what pumping speeds and technologies best mimic a baby’s feeding pattern, and the stability of human milk in storage. Reflecting the shift in funding and research, the American Academy of Pediatrics’ most recent statement on breastfeeding is called the AAP Policy on Breastfeeding and the Use of Human Milk.

Why does this matter? First, because nobody knows if human milk consumption is the same thing as breastfeeding. There is no research that compares outcomes among babies who are breastfed and babies who are bottle-fed breast milk. But there are some reasons to believe they may not be the same thing. Many studies have found that freezing, thawing, and heating milk degrades the proteins present in breast milk. One study found that even breast milk refrigerated for as little as one day was degraded into unbound fatty acids that can cause cell death in babies’ intestines. Studies have also found that when breast milk comes in contact with pump parts, storage containers, bottles and teats, it often picks up bacteria along the way. If breastfeeding boosts cognitive development, many doctors believe it is because of mother-infant interaction at the breast, not the chemical composition of breast milk. Some doctors also hypothesize that breastfeeding reduces ear infections because breastfeeding babies lie at a different angle, and use more suction, than babies who drink from a bottle.

The second reason to worry about the shift from breastfeeding to pumping is that pumping puts enormous pressure on mothers. It’s telling that the appeal of the hands-free pumping bra is that it leaves a mother free to multi-task, so that the time she spends pumping is not wasted.

“Mothers don’t have to choose, but in this case they pay a very high price for ‘having it all.’”

Many new mothers believe that breastfeeding is profoundly important to their baby’s health and development. They want to be good parents, and to give their child the best possible start in life. But if they work, as most mothers do, they will not be able to take time off work to stay at home and breastfeed their babies. Instead they lug a heavy pump back and forth to work every day. Sometimes they pump in the car on the way to work to save time. Once at work, they take two or three unpaid breaks to pump milk, often in a supply closet or a locker room. The Department of Health and Human Services suggests asking new mothers to come in early or stay late to make up that time. Often they endure harassment from fellow co-workers. Many women report that pumping at work is stressful because they are afraid someone will walk in on them. There are a surprising number of news stories about women who have discovered co-workers spying on them.

Not long ago we thought of work and breastfeeding as mutually exclusive – a mother could do one or the other, but not both. But now that women have the “right” to pump breast milk at work, “breastfeeding” appears to be perfectly compatible with full-time employment. As the Department of Health and Human Services crows, “Mothers do not have to choose between providing human milk for their baby and returning to work, and employers can retain valuable employees!” No, mothers don’t have to choose, but in this case they pay a very high price for “having it all.”


Courtney Jung is a professor of political science at University of Toronto and the author of Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy (Basic Books, 2015).


Courtney Jung is a professor of political science at University of Toronto and the author of Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy (Basic Books, 2015).

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