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Defending EPing as breastfeeding

As I’ve mentioned, I’ve done presentations at a couple of online conferences this year. One of the fantastic outcomes of this is getting my work out there to far bigger audiences than ever before and therefore getting to hear feedback from a wide range of people.

One of the emails I received recently was from someone disagreeing with my use of the term “breastfeeding” as an umbrella term to include direct nursing AND milk expression (and therefore exclusive pumping (EPing)). Here’s my response:

I think we are going to have to agree to disagree, as I will forever class EPing as breastfeeding. Breastfeeding, in common parlance, is the umbrella term and to say to an EPer “you’re not breastfeeding” is so upsetting, hurtful, and demotivating (and I have the data to back that up). If you say EPing is not breastfeeding – or imply it through actions or attitude – to an EPer, you would quickly find yourself in that category of lactation consultants that were rated the worst by study participants. Support and information for EPing is all well and good, but EPers (both in my experience and in my data) want to feel non-judgmentally and emotionally supported and included in that is using the language that they use. Since most EPers say that they are breastfeeding, they are breastfeeding. And they are indeed feeding a substance produced by their breasts/chest. But, as I said in my presentation, there are also better ways to ask certain questions that don’t even raise this as an issue, for example asking “how are you feeding your baby?” rather than asking “breastfeeding or formula?” or “breast or bottle?”

As for academically, my opinion is that I don’t think breastfeeding is a particularly good term in general (see my 4-minute essay on this). I think that human milk feeding is far better and then we MUST define further whether that’s direct nursing (or some other term like at-breast/chest feeding) or milk expression with bottle feeding or a combination of both. But when we’re talking to parents, “human milk feeding” isn’t what they’re calling it and it makes us sound like cold scientists, so I think that’s a term best reserved for academia.

4-minute essay: Human milk has no gender: 21st century breastfeeding language

I presented this 4-minute essay at the 2019 Breastfeeding and Feminism International Conference and thought I should share it on my blog. It will be published later this year in the Journal of Human Lactation!


My name is Fiona Jardine and I use she/her/hers pronouns. I’m a lactation consultant, postpartum doula, and PhD candidate. And I think we should bring lactation language into the 21stcentury. To assume that only women and mothers breastfeed ignores gender and bodily diversity and fails to recognize those who do not identify as women or mothers, yet still lactate. These caregivers may breastfeed, chestfeed, and/or express milk; they may call themselves mothers, fathers, parent, or something else entirely. There may be those who lactate to feed children other than their own: for example, grief donors express milk to donate after the loss of a child; gestational surrogates may express milk to feed the child they carried or to donate; others induce lactation to feed a child in an emergency, or a one they adopted, fostered, or was carried by someone else.

In one-on-one interactions, there’s no reason not to use 21st century lactation language. Instead of asking “breast or bottle?”—which is also problematic for exclusive pumpers—ask “how are you feeding your baby?” If you’re there to give lactation advice, ask “how can I help you?” and you’ll often organically find out what your client calls what they’re doing. And instead of assuming the lactating person is “Mommy” or “Mama,” instead ask what their parent name is. And let’s normalize providing your gender pronouns when introducing yourself and simply asking others if you’re unsure. It makes the world of difference to those outside the cisgender binary.

But to me, the real challenge is in what we do as a discipline (in the English language. I can only speak to my native language!). We can talk about the biological process as lactation: “when a person lactates,” for example. No need for “mother” or “woman” in that sentence. And I’ll vehemently defend the singular “they” as grammatically acceptable. While “human milk” feels a little less warm and fuzzy compared to breast milk, it’s logical when compared to cow milk, goat milk, or nut milk. And by now, you should see why to avoid “mother’s milk” entirely: use “parents’ own milk” when we know that’s the source.

But I remain conflicted about the umbrella term for the act of feeding a child human milk. For example, when I wrote the abstract for this four minute essay, I used “breastfeeding”. Because biologically speaking, isn’t that technically correct? Don’t we all have breast tissue and isn’t it required to produce milk? But that doesn’t really solve the problem of perpetuating the dysphoria for those whose breasts contributed to those feelings—especially during a time when their dysphoria may be at an all-time high. Chest-slash-breastfeeding doesn’t roll off the tongue and probably is not compact enough to be widely accepted in titles and organization names. Nursing suggests directly from the source and therefore excludes pumping.

So, if breast milk is human milk, then why can’t breastfeeding be human feeding? Human milk feeding? That works for less “fluffy” settings like academia, but I can’t imagine parents cooing over their cute babies saying, “our human milk feeding journey has been just magical.” Perhaps breastfeeding, while a less-than-perfect umbrella term, is the least-worst option with the greatest appeal? I think no matter what we decide, we need to define what we mean by the words we use, while also being inclusive of gender and lactational diversity.

But why does this all matter anyway? Legal protection: if laws only protect “breastfeeding mothers,” are you protected if you’re a “chestfeeding father”? Research: if you’re recruiting “nursing women,” can you participate if you’re a “genderfluid exclusive pumper”? Support: would a group with the slogan “Happy Mothers, Breast Fed Babies” be a place to find support if you’re “Papa” “Maddy,” or “Ren” to your baby?

And finally, acceptance: if we are intentional and purposeful in the language we use, we can make sure everybody is included in the promotion, protection, and support of breastfeeding, so that both they and their child have the very best physical, emotional, and developmental outcomes.

Spring 2019 Updates

It’s been all go this semester for me! Here are the highlights so far!

Conferences

The year started off with the Healthy Children Project’s fantastic International Breastfeeding Conference in Deerfield Beach, FL and my presentation Breastfeeding Without Nursing: Information needs of exclusive pumpers. I will admit to being slightly disappointed at not being crowned the Milk Duck Queen, even though Georgie (my daughter) helped the ducks get to the other side!

I then recorded my presentation for iLactation’s Nutrition + Love conference. It’s still happening! So head over there to see my presentation, Breastfeeding without nursing: myth-busting exclusive milk expression to improve support given to exclusive pumpers, well as so many other brilliant speakers.

I had an amazing time at my first Breastfeeding and Feminism conference, where I presented Breastfeeding Without Nursing: What should we do about the prejudice against exclusive pumping? during a discussion workshop and a four-minute essay, Human milk has no gender: 21st century breastfeeding language.

Next week, I’m presenting online again at the GOLD Lactation conference, this time on Breastfeeding Without Nursing: Why do some breastfeeders exclusively pump and what can we do to support them? This conference is also still happening and also has some incredible speakers, so go register before you miss the opportunity.

On Campus

Last week was so busy for me. I got a Top 3 poster at Public Health Research @ Maryland Day, which was meaningful because it represented acceptance into the public health world, especially when there were so many other amazing posters.

I also competed in my campus Three-Minute Thesis (3MT to those in the know) finals. I was one of the three winners and also got the People’s Choice Award (thanks y’all!). My 3MT will be professionally recorded and one of the three winners will be put forward to represent UMD at the international competition – there’s a people choice award there too, so if I’m selected, I’m going to be spamming everyone to go vote!

I’m continuing to work on a project to improve lactation and feeding spaces on campus, which is both very rewarding (when we can really improve the facilities and therefore the experience of parents) and frustrating (when university bureaucracy makes everything more laborious and expensive).

Other Projects

Continuing with what I got started with the Universal Breastfeeding Symbol, I’ve been systematically redesigning baby feeding symbols. You can even buy stickers and merchandise!

My Research

My research – or rather, data analysis – keeps ticking along and will be turned into three-ish journal submissions in the coming year (the basis of my 3-paper dissertation…).

The bigger news is that I submitted a book proposal today. I’m super excited, but also realistic that this is the first ever book I’ve proposed and I’ve only sent it to one publisher, so success on the first try is super unlikely. It is the first step though!

My thoughts on new findings of the CHILD cohort study

This newly published study† has been creating waves in the EPing community. Here’s my take. I’m sorry that I can’t really do a TL;DR for this, but I really want to stress that starving a child through nursing is definitely worse than feeding them well with pumped milk.

Firstly, this is a cohort study, which means the researchers are following the children throughout their childhood to find relationships between breastfeeding and various outcomes. This newly published article is just one of many findings that will come from the study. I am fairly familiar with the study and the researchers and rest assured that it is a rigorous study with reliable findings (especially given that it was published in Cell, which is an extremely hard journal to get published in). I also know that the researchers are vehemently in favor of ALL kinds of breastfeeding and would DEFINITELY agree that pumping is worth all the time and effort!

Secondly, there is likely always going to be more “bad” bacteria in pumped milk because of the equipment it passes through. A PhD researcher at Cornell I know did her thesis on this and found that simply sterilizing pump parts (even in microwave bags) or dishwashing reduced the bacterial contamination greatly. BUT even she questions “so what?” – there were no reports of sickness in the babies from the pumped milk that had more contamination. The levels of contamination from well-cleaned pump parts is probably irrelevant (poorly cleaned pump parts or immunocompromised babies is another topic though).

Thirdly, yes, this study finding does provide evidence in favor of nipple-saliva transfer. One study a while ago‡ found that a baby’s saliva does backwash into the milk ducts when they DN. It has be theorized that this would change the composition of the milk, but there hasn’t really been any evidence about how, since we also know that mom being in the same environment as baby’s germs also changes milk composition. This study really indicates that the microbiome (that all the different living organisms, good and bad) of the milk is on the whole different between those who only pump and those who directly nurse.

Fourthly, there is SO much research out there about the milk microbiome and the effect it has on the baby’s own microbiome. What those other studies have found is a HUGE difference in the milk microbiome between different people, different living environments, different countries…the list goes on and on. This is all REALLY new science so the consequences of it are really just not known right now.

Fifthly, we really should think for a second about the microbiome of pumped milk versus formula. Formula has little to no microbiome (you could argue that probiotics in formula add something of a microbiome, but if you use water hot enough to kill any pathogens in milk powder, as recommended, you’d kill those probiotics anyway). And there are also studies about the negative effects of formula the gut microbiome of babies. But again, rest assured, formula mamas: we still don’t really know what lifelong consequences this actually has.

Lastly, this study is just a piece of information. Could it lead us to greater insights in the future? Yes. If findings like this enabled us to add something to pumped milk (like the beneficial bacteria that might be missing from it) to make it even better, would that be a good thing? IMO, yes. Are parents still doing amazing jobs, making sure their babies are fed? DEFINITELY YES!!!!!! Are they better parents because they’re feeding their babies in the best way that they can? DEFINITELY YES!!!!!!


† Moossavi, S., Sepehri, S., Robertson, B., Bode, L., Goruk, S., Field, C. J., … & Turvey, S. E. (2019). Composition and Variation of the Human Milk Microbiota Are Influenced by Maternal and Early-Life Factors. Cell host & microbe, 25(2), 324-335.

‡ Ramsay, D. T., Kent, J. C., Owens, R. A., & Hartmann, P. (2004). Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics, 113(2).

Happy New BUSY Year: The Affective Outcomes of Choosing to EP

TL;DR: If you choose to EP, your emotional outcomes are going to be A LOT more positive than if you EP because of a reason that is, to whatever degree, out of your control.
 
We MUST support all forms of breastfeeding and work hard to help those feeding babies to fulfill their goals and expectations, whatever those might be.
 
***
I’ll be doing lots of data analysis this week in preparation for THREE conference presentations due this month (in person at the Healthy Children’s Center for Breastfeeding‘s International Breastfeeding Conference and online at GOLD – Lactation Online Conference and iLactation). Today’s analysis yielded some expected, but still depressing, findings.
 
My survey asked respondents why they EPed. From a list of reasons, one of the options was “just wanted to”; all the other options represented some degree of non-choice for the EPer. I also asked respondents to select emotions/feelings (as many as they wanted) that they experienced as a result of their EPing.
 
Those who “just wanted to” EP, i.e. chose this form of breastfeeding, were statistically significantly (p < .05) more likely to report feeling:
– happy
– intimate
– capable
– loving
– adequate
– productive
– humble
– strong
 
Those who EPed because of any other reason than “just wanted to” were statistically significantly (p < .05) more likely to report feeling:
– disappointed
– inadequate
– discouraged
– grieving
– envious
– cheated
– frustrated
– guilty
– bitter
– anxious
– resentful
– insecure
– sad
– regretful
– miserable

New semester – same frenetic pace!

News and Updates!
🎓 My university published a blog post I wrote today: https://gradschool.umd.edu/about-us/blog/4173
🇯🇵 This time next month I’ll be in Japan presenting my poster, “Breastfeeding without nursing: Reasons for initiation and cessation of exclusively pumping human milk,”. I found out what poster of distinction means: top 15% 🎉. You can find all the abstracts for the conference here: https://www.liebertpub.com/doi/pdf/10.1089/bfm.2018.29100.abstracts (I’m poster P-62, if you want to find me).
👩‍💻I was accepted to present “Breastfeeding Without Nursing: Why do some breastfeeders exclusively pump and what can we do to support them?” at the GOLD Online Lactation Conference next April. This is a HUGE online conference (over 2800 people register 😲) and where loads of lactation care providers advance their knowledge and get their continuing education credits. It’s an exciting opportunity!

It’s been a busy few months!

UPDATE! It’s been a really busy few months for me!

ALC TRAINING: At the beginning of May, I took the course and exam to become an Advanced Lactation Consultant through the The Academy of Lactation Policy and Practice. It’s the most advanced training I can get without becoming an IBCLC (which is basically going to be impossible for me because of the prerequisite academic classes). I haven’t heard whether I passed yet 🤞, but I had an amazing time learning yet more of the nuances of lactation consulting 🤱.

DISSERTATION PROPOSAL DEFENSE: In the middle of May, I SUCCESSFULLY defended my proposal 🎉 (Read my proposal! It’s really long and Chapter 3 is going in the trash 🗑. For those of you less familiar with PhD programs, it’s pretty standard to write a proposal for what and how and why regarding your topic before you actually collect data. I did that kinda backwards…but regardless, I got approved to do the research I’ve already done 😂! Which means I can get into the nitty gritty of data analysis and get some findings out there! 🎓

JOURNAL ARTICLE: I finally got through all the rounds of required revisions for a journal submission I sent in a year ago 🤨 and it has been sent to the publisher for final copyediting 📝! So in the next few months(?), “Breastfeeding without nursing: “If only I’d known more about exclusively pumping before giving birth” will be published in the Journal of Human Lactation 📰.

POSTPARTUM DOULA TRAINING: My work in the ivory towers of academia 🏫 only goes so far (not very, in fact). I feel a calling to also help with the greater problem of lack of postpartum support in general. I’ve been told that I have a reassuring demeanor about me when I’m talking to new parents 😌, so I felt like working as a postpartum doula would be way to continue to help. This past weekend, I took the most amazing training (though I am thoroughly exhausted 😴) and hope to complete the other requirements for certification in the next few months.

CONFERENCE PRESENTATION: While I was at the training, I got the email telling me that I have been accepted to present “The Information Needs of Exclusive Pumpers” at the Healthy Children Project’s International Breastfeeding Conference in January 2019 in Florida 🏝. I am so excited to be getting my findings out there to those folks working with breastfeeders themselves😄!

UPCOMING ATTRACTIONS: I have submitted a few other conference proposals (🤞Japan in October🤞), have a few more proposals to submit, am working with an amazing grad student who is helping me code some of my qualitative data 👩‍💻, will be working with a world-renowned epidemiologist to analyze my quantitative data, am doing some classes in the School of Public Health so I can reframe my work into that perspective (I thought I was done with classes 😭), and have a publisher potentially interested in publishing the book I am planning to write 📚. PHEW!

Summer 2017 update

Just dropping by to write a quick update. I’m working on editing the paper about prenatal information behavior to submit to a journal. They want it so short so it’s proving a bit of a challenge to cut it down but still retain all the great data EPers gave me.

I’m heading to Norman, OK on Sunday to do a course called “Maternal and Infant Assessment.” It’s run by the same organization as the CLC course I took and focuses on case studies and how to solve more advanced problems. I’m taking it so I can take the Advanced Lactation Consultant course in September (since I’m not a medical professional, I have to take this extra course).

The reason I’m getting these qualifications is to increase my credibility so lactation care providers of all kinds listen to my findings (they are the number one target audience for my research – they are the main people who need to know more about EPing so they can help their moms). I am also really enjoying the courses because they are totally evidence based (the bibliography in the CLC course book was 40 pages) so it helps with my own research and with knowing what other research is out there (and therefore how to argue that whatever it says doesn’t work for EPers!).

I also have a paper in my head about galactagogues as well as a full length book.Of course, all of what I am trying to get done is somewhat delayed by a massive house renovation and moving into said house, as well making sure my now 15 month old has plenty of fun with Mummy!