Amid a rash of controversial pieces in the mass media about the intersection of breastfeeding, motherhood, and feminism, a new study in the Journal of Perinatal Education reveals an uneasy relationship between professional lactation consultants (LCs) and breast pumps. The piece gives us a fascinating look - from the front-lines of lactation - at the cultural and economic forces that have rendered the breast pump one of the indispensable accessories of new motherhood.

The qualitative pilot study analyzes lactation consultants' beliefs and experiences related to the increased availability of breast pumps on the practice of breastfeeding. The researcher conducted interviews with lactation consultants about the reasons women use breast pumps, changes in patterns of use over time, mothers' experiences, and perceived advantages and risks. All 12 interview participants were registered nurses with board certification and at least one year of experience as lactation consultants.

All of the LCs who were interviewed acknowledged a tectonic shift in the role of the breast pump over the past decade or so, a trend that many believed was fueled by aggressive marketing of breast pumps as well as our collective cultural enthusiasm for technology. Once reserved for mothers of premies, women experiencing breastfeeding problems, and those returning to work, breast pumps now feature prominently on baby registries of nearly every mother who plans to nurse, and often get packed right into the birth bag, despite the fact that hospitals themselves make breast pumps available to every new mother. This increased availability of breast pumps in health care settings was troubling to some of the LCs. One of the interview respondents said,

We have pictures in the room behind the bed that you slide up and there is oxygen and [resuscitation] equipment behind them. It's hidden because it has a subliminal message that we think you might die here. One message [to mothers] is that you need a breast pump and should consider buying one. We didn't have to fight too hard to get 35 pumps free of charge hauled in there. They're not philanthropists. They're just good business people.

The respondents also felt that "technological birth" naturally led to "technological breastfeeding," both in the sense that technology has been normalized as a part of the processes of childbirth and breastfeeding, and because the overuse of high-tech obstetrical interventions has led to more breastfeeding problems that must be managed with breast pumps. Many LCs also commented that use of breast pumps satisfied women's desire for control over a process that they did not trust to unfold easily, similar to the perception that labor interventions offer greater control over the unpredictable process of birth.

But perhaps the most interesting theme that emerged from the interviews was that the prevalence of breast pumps has affected the profession of lactation consultation itself. Many of the LCs earned a significant proportion of their income through breast pump rentals and sales, a situation that was widely acknowledged as fraught with ethical problems. In addition, respondents felt that some LCs were overly dependent on breast pumps. "If a mother is having trouble in the hospital, it's 'Get her a breast pump' and not, 'Let's work with her more and get her to breastfeed," said one. In addition, just like the women they provided services to, a few of the LCs lauded the increased "control" of breast feeding afforded by breast pumps as well as the enhanced ability to measure how much the baby was getting, while others were ambivalent or felt that the control was a false promise. Said one of the LCs

"In a way, I wonder if this technology doesn't help us and has given us an out. We don't have to give good maternity leave because we are going to give a pump to every mom and give her 15 minutes twice a day to pump her milk."

This article made me think twice about how I talk about breast pumps with expectant and new mothers. Of course pumps have an important role in the care of premature and sick infants, when women need to temporarily disrupt nursing for medical reasons, and to allow women to go back to work or simply get out of the house in the early months of motherhood. But their routine use, just like any routine intervention, may be doing more harm than good - undermining women's confidence, unnecessarily complicating the transition to new motherhood, and possibly even leading to early cessation of breastfeeding. The article also made me remember that there is a low-tech alternative to breast pumps that we should be telling to every new mother: hand expression of breast milk. I've found myself apart from my own breast pump on enough occasions that I probably owe the fact that I have never had mastitis to my hand expression skills. For readers who don't know how to do or teach hand expression, here is a great video that teaches one simple technique.

Citation: Buckley, K. M. (2009). A double-edged sword: lactation consultants' perceptions of the impact of breast pumps on the practice of breastfeeding. The Journal of Perinatal Education, 18(2), 13-22.

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