A Guest Post by Ellen McNally

As well as breastfeeding her own children, Ellen has studied lactation and worked with women who have needed help with breastfeeding and expressing milk.

For a lot of women, pumping is a labour of love. I have spent time with women in CICU (Children’s Intensive Care Unit) with some of the sickest babies in the country. You can see the heartbreak and devotion in the mother’s eyes whilst they pump away for their seriously ill babies, many of whom are fed their milk by kangaroo pumps, syringes and nasogastric tubes (often called just an NG Tube). The sentiment of these women all seems to be consistent “It is all I am able to do for them”

Similarly, there are plenty of women who for cultural, emotional or personal reasons beyond needing an explanation exclusively pump for their babies. Often their barrier isn’t quite as obvious as those in the unfortunate position of having sick babies and toddlers but their labour is just the same.

Finally there are those who pump due to breastfeeding difficulties. Usually this is done at the recommendation of another and sadly is done too often in an off handed manner without any investigation into the cause of the difficulties or serious attempts to rectify these issues (and if this is you and not your preferred outcome, please contact an Internationally Board Certified Lactation Consultant for further assistance )

What nobody who routinely or casually recommends pumping to these women ever seems to tell them, is that pumping is really difficult. More so when you are predominantly or exclusively pumping than just casually pumping. As long a way as breast pumps have come in recent years, sadly they remain inferior models at extracting milk to a healthy baby.  When women have trouble expressing their milk, the best way around this is to attempt to fool the body into believing it is a baby at the breast, rather than a plastic or silicon shield. For some women this is simply replicating the suck pattern of a baby- the quick, light sucks when first placed to the breast to stimulate the let down and then slowly increasing the strength of the vacuum whilst slowing down the speed.

But unfortunately not all women respond so easily to pumping, regardless of how exceptional their pump is and sometimes women need to go to great lengths to extract enough milk to ensure their baby is getting adequate nutrition without introducing alternative milk sources (usually tinned infant formula but there is a growing trend of utilising donated milk from other women or milk banks too…). These women go to great lengths at providing adequate milk such as smelling their babies clothing whilst they pump, getting up at odd hours of the morning when their prolactin levels are at their highest (around 4-5am, for those interested…), looking at photos and videos of their child whilst pumping and even holding heat bags to their bodies- all in an attempt to replicate the breastfeeding experience and allow the body to believe there is a baby at the breast.  The other factor affecting exclusive or predominantly pumping Mums, is that it can be difficult to extract a whole feed in one standard session or in the same time an efficient breastfeeding baby is able to. So these lactational women (I use the word lactational because the efforts they go to are nothing short of sensational and extraordinary!) find they need to set routines and pump more frequently than most exclusive breastfeeders, which can be really difficult. These are Mums who are both expressing and separately feeding their babies as well as trying to find their feet within motherhood, possibly dealing with a sick child or recovering from a birth which may have included surgery AND trying to find a life something close to normal (or at least their own definition!).

Sadly, a lot of women struggle to maintain the balance of both, start introducing artificial milks and before long completely give away the breast milk; despite their wishes and hard work. It would seem in the drive to encourage mothers to breastfeed not enough knowledge of benefits are shared about it not needing to be all or nothing- which could go a long way to improving the feelings of failure or hurt experienced by too many mothers who are unable to exclusively breastfeed or lactate. When they seek assistance at this stage the answer is too often ‘Well at least you tried…. And this is how you use formula’

And whilst this all seems a bit on the biological side- the main purpose of this blog is to talk about understanding. Lactating is completely emotionally and hormonally driven. Too many exclusive or routine pumpers are left on the outer within parenting groups and even society. They sit in the abyss of not quite being breastfeeders, often judged or at least feeling judged for bottle feeding their babies rather than putting them to the breast… but also not quite formula feeders either. There is lots of information and support available for breastfeeding issues and hiccups but little education for medical professionals or even lactation counselors about pumping, how pumps work and how to help those exclusively or predominantly pumping. This can make it pretty difficult when you are passionate enough about lactating to go to the lengths of pumping but have difficulty finding acceptable or a sense of acceptance within breastfeeding groups; unless of course you are able to connect with other in the same boat (Hurrah for the wonders of the internet and social media!!)

Motherhood, particularly in the early days is really emotional. All women need to build connections, create acceptance and sponsor a lactational woman, regardless of how the breast milk is being delivered. Ask regularly how they are going, without judgement. Celebrate their triumphs and nurse them through their tough days. Be their cheer squad, helping to remember why they started, allowing them to change their goals but encouraging them not to end their lactational journey on the toughest days.

Hopefully if we can build a place, education and support for lactation in all its forms, it will go a long way to reducing not just post natal depression rates but the general heartbreak, burnt and sometimes even scarred psyches left in women whose lactation journeys ended sooner than they had planned, wanted or desired. That sadly can be a heartbreak beyond healing and something I have witnessed in women well into their seventies and eighties. Far too long and too deep, to not be acknowledged or spoken about.