On Nursing in Public - Why Not Pump and Feed a Bottle?

I ran across an online discussion today about breastfeeding in public. Usually these discussions go one of two ways - they are dominated by those that are against it, or the overwhelming opinion is for it. I find it interesting how many of the most outspoken individuals against it are those that have not nursed or even those that don't have children. We still have a lot of misconceptions and misunderstandings when it comes to breastfeeding. I'd like to address one major point that is often an argument presented by people that are against nursing in public:

Why don't you just pump and feed expressed milk from a bottle?

This is a suggestion usually from someone that is for breastfeeding, but against doing so in public (some would argue that means they aren't exactly pro-breastfeeding if they have exceptions, but that's a discussion for another day). Typically, this is a suggestion from women that don't have children or men, but that is not always the case. The reality though, is that it is not always possible or practical to pump and give a bottle. Let's "discuss."

Convenience

If it's one thing that pumping and bottle feeding is, it is not convenient. There are a few moms out there that feed exclusively pumped milk and many that pump because they are away from their baby due to work or other obligations. They will tell you that pumping is not convenient. Most of them hate it. Pumping takes time. Time away from your family, time away from your baby, time away from other obligations. Carrying expressed milk is a hassle if it's not necessary, even more so than carrying formula. Formula is often dry so all you need is bottles, the powdered formula, and some clean water. When carrying expressed milk, you need cooler bags and carrying extra just in case the baby is extra hungry or you are out longer than planned takes up way more space. All this leads to longer prep time before you leave whether you are bringing previously pumped milk or pumping it fresh. It also means that while you are out and about, you have to fuss with a bottle - find some way to warm it if your baby won't drink it cold - and deal with a fussy baby during preparation. If it's one thing a mom doesn't need, it's more to deal with when out with kids (or even at home). By choosing to breastfeed instead, it's a matter of lift the shirt and latch on. Little fuss, little hassle.

Pump Response

Here is something that seems to get passed over and may come as a surprise: not all women respond well to a pump. Our breasts are designed to express milk into a baby's mouth with a particular suckling pattern. Did you know there are varying suckling patterns? Yep! Certain suckling patterns send a signal to the mom's body to let down the milk so it flows for the baby. Our bodies are not biologically adapted to respond to artificial, electrically driven suction. While pumps attempt to mimic the suckling pattern of a baby, no pump does as well as a baby does. That means some women get little more than a drop when pumping. Even among women that do respond to a pump, the average amount pumped is between 1/2 and 2 oz. for both breasts combined after a 20-30 minute pumping session. And that's assuming the mom has a good quality double pump. When you take into consideration the fact that many babies take 3 oz. per bottle, that means that some moms that respond properly to a pump may need to spend 3 hours pumping for one bottle. Let's revisit that convenience factor. Not everyone has 3 hours to spend pumping for a single outing. And for women that don't respond at all, they don't have that option available to them. Much better to leave the pump alone (assuming the mom even has one) and just nurse the baby. Babies are far more efficient than a pump and can pull out more milk in far less time. Tons of moms can't get a drop from a pump - even moms with oversupply - but have no problem nursing their babies.

Supply and Demand

Let's take a look at the mechanism of breastfeeding. Breastfeeding is based on a basic supply and demand principle. The more that is drawn out by nursing, the more the body will provide. Two problems can exist when pumping which makes pumping and giving bottles in public problematic. The first is that as discussed before, pumping does not pull out as much milk as nursing. That means the body is receiving a feedback not to produce as much as before because not as much is drawn out. This can greatly affect supply causing a decrease and lead to further issues breastfeeding. In addition, because of this supply and demand mechanism, it is recommended that a mom pump whenever the baby would normally be nursing if she is away from the baby. So, if it is time to feed and the baby is given a bottle, the mom should be pumping to be pulling out the milk that the baby otherwise would be pulling out to help maintain supply. I don't know about you, but it doesn't make sense to drag a pump with you everywhere you go so you can give your baby a bottle and pump at the same time. That just isn't practical. However, to maintain supply, that is what you need to do. Working moms typically need to pump multiple times a day (every 3-4 hours or so) to maintain supply while they are away from their baby. Even with pumping that frequently (which really isn't enough compared to how frequently some babies nurse, and every 3-4 hours is more than many moms are allowed) many working moms struggle to maintain their supply because the pump pulls out less than the baby would so their bodies tell them to cut down production. Allowing the baby to nurse on demand is the best way to maintain supply. That's not to say that it can't be done - many moms do it, but it's extremely difficult and certainly not worth the risk to supply just so you can give a bottle in public.

Nutritional Content

The claim has been made that expressed milk is the same as they get when nursing, so by pumping and providing a bottle, they are still getting the best thing from mom. A little known fact about nursing is that milk changes as the baby grows and develops. There is a mechanism in moms that responds to the baby's saliva and it alters her milk to suit the baby's needs at the current state of development. Exclusively pumped milk is not the same as milk consumed via nursing. Milk received when nursing is tailored to individual needs. Milk produced when a baby is a newborn is different than milk produced for a 10 month old, and it is the baby's development that indicates what they need, not the duration of nursing. This is why on the feeding hierarchy, nursing directly from mom is preferred to receiving expressed milk from mom. Now, technically, a few feedings of expressed milk isn't going to make a huge difference and it certainly is far better nutritionally than alternatives, however, it is important to know that what is in the bottle is not necessarily the same as what is received at the breast.

Nipple Confusion

Nipple confusion is a big problem when giving bottles. While some people will deny this even occurs, they are completely mistaken. When a baby nurses from the breast, they suckle with a specific pattern. Quick suckling will generate a let down, causing the milk to flow. After this, they switch to longer more forceful suckling to draw out the milk. When given a bottle, all they need to do is compress the artificial nipple and the milk flows freely and quickly. Sometimes, depending on the nipple, even that is more work than is required. What happens as a result is that the baby learns that they don't need to suckle as hard, nor do they even have the same latch as when they are suckling a the breast. There is little to no work required from the bottle and the milk is readily available. After learning that this instant source of milk is available, many babies, when returned to the breast will get frustrated. They don't want to work for the milk that they can get from mom because the artificial nipple is so much easier, thus, they form a preference for the bottle. The "confusion" part comes in when they don't understand the differences in latch. Latching on to the breast is much more specific and a proper latch is necessary for effective and efficient breastfeeding. Because babies simply suck on the bottle, they don't form the same latch necessary for breastfeeding and they get confused as to which they are supposed to do. They forget how to latch on to mom. For some babies, all it takes is one bottle to create this problem. And as we already discussed, the less the baby nurses at the breast, the less milk will be produced.

Overeating and Obesity

It is a well known fact that not breastfeeding can lead to obesity. This is in part due to the higher calorie content of breastmilk replacements. The other part of the equation is bottle feeding. Because milk is consumed so quickly when bottle feeding, babies can have the tendency to over eat. The milk comes so quickly that they stuff their stomach before their body signals their brain that they are full. It happens to adults too, that is why we aren't supposed to eat quickly. For a baby though, the problem is bigger than that, a
s they stuff themselves, their stomach expands and stretches. If it is constantly being expanded by too much milk, they will become accustomed to that feeling and the more it stretches, the more they will need to fill it. This means they take in far more than they would if they were nursing. Because nursing takes longer, babies learn to self-regulate and don't overeat. Bottle fed babies don't have this same advantage. They take what is given and what flows freely. That means that even babies fed breastmilk in a bottle are at risk of overeating and losing their ability to self-regulate their food intake which can lead to problems later in life.

So, if asked why not pump and give milk in a bottle, I have a whole list of reasons I'm willing to share. It's not convenient, it's not possible for some women,  it can affect supply, it is not as nutritionally sound, it can lead to nipple confusion, and bottle feeding can lead to overeating. It really isn't as easy as many people have been led to believe. I hope that more people can come to a better understanding of why it is not a practical option and begin understanding why breastfeeding is so important and should be welcomed in public, not just tolerated.

Do you have any additional reasons not to pump and give a bottle? Let me know in the comments!