Exploring the world of exclusive pumping: Guest post by Fiona Jardine, MA, LLM, MLS, CLC

Fiona Jardine, MA, LLM, MLS, CLC is a PhD candidate at the University of Maryland’s iSchool conducting research on the experiences and information behavior of those who exclusively pump breast milk. This week on Our Milky Way, she shares preliminary findings from her research, her motivations, and how she hopes to contribute to maternal child health. We look forward to hearing her conclusions as there is much to learn about exclusive pumping. 

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My PhD research topic came to me completely by surprise, given both the circumstances surrounding it and the incredibly circuitous route my life had taken up to that point. I don’t think anyone—including myself—thought that an undergraduate and master’s degree in law from the Universities of Cambridge and San Francisco respectively together with a Master’s of Library Science (interspersed with me opening and running a café and practicing law) would lead me to study exclusive pumping of human milk.

Given this unorthodox background, it’s not surprising that my research is a result of my own experience. I had a beautiful baby girl in April 2016 and unfortunately, due to a variety of obstacles and little to no professional support, my baby and I were not able to establish a direct nursing relationship. I was devastated that we would never have the “gold standard” of baby nutrition, bonding, and comfort, but was still determined to give her my milk any way I could. I knew vaguely how to express milk with a breast pump, but little clue how to do it as the sole means of extraction, despite having taken a breastfeeding class, spoken at length about breastfeeding with our doula, and done a great deal of online research on the topic. After doing more online research, I discovered the term “exclusive pumping” (EP, EPing, EPer) at about two weeks postpartum. Through social media, specifically Facebook groups, I learned how to sustainably EP, received answers to specific questions, and felt understanding and support for my situation.

We all know that human milk is seen by mothers, healthcare providers, and public health organizations as optimal nutrition for infants and, perhaps more importantly, most mothers want to breastfeed. We also all know that a variety of external barriers to breastfeeding exist, such as problems establishing a latch, getting milk to flow, or poor infant weight gain. Internal barriers, such as a perception that human milk alone is not sufficient and a desire for caregivers to be involved in infant feeding, are also responsible for breastfeeding cessation. EPing, defined as only expressing milk and not directly nursing at the breast, can—and successfully does—provide the solution to many of these barriers while still providing the benefits of feeding human milk.

However, research on EPing is scant and often limited to secondary analysis of existing data (such as the Infant Feeding Practices Survey II), content analysis of expressed milk, or mothers of infants in the NICU. I have not been able to find (and I would LOVE to be proved wrong) any published research documenting the experiences of EPers themselves, including why they EP, where they find information, what support they get, how they feel, and problems they have. The field of my PhD—Information Studies—provides me with enough latitude to ask all of these questions (and more).

And ask I did. In March 2017 (and after receiving IRB approval), I started collecting data through an online survey containing 170 open– and closed–ended questions (although almost no one answered all 170 questions, given respondents were routed based on their individual situations). Below is a flowchart containing the topics covered in this initial survey. In addition, women currently EPing were given the option to participate in follow-up surveys every two months until they ceased EPing. So far, the initial survey has been taken by over 2,300 current and former EPers, and follow-up surveys sent out in May and July 2017 have received 372 and 159 responses respectively (recruitment was limited to 500 for the May survey; only those that participated in May’s survey could participate in July’s). 

 

I am overwhelmed by the response to my research. The number of survey responses in itself is an indication of how passionately these women want their voices to be heard: this survey is long and has a fair amount of open-ended questions, yet women took their time (often over an hour) to share their experiences at length (consequently, I have a huge amount of qualitative data to analyze). However, it has been the support and messages I have received that have truly touched me and made me realize both the critical need for EPing research and that my research as already made a difference. Some women have shared with me that they experienced profound catharsis as they finally got to share their breastfeeding/postpartum/EPing journey; others have expressed joy and gratitude that someone is finally taking EPing seriously, getting the word out there, or trying to create a world where the women that come after them won’t face as many challenges or negative reactions as they did.

So, what am I doing with all this (and more—the initial survey is still open) data? As part of a department-required PhD milestone, I analyzed a small selection of the data focusing on prenatal information behavior (that is, the information needs, seeking methods, and use) of women who EPed postpartum. My findings were interesting and stress the need for more information about EPing to be provided prenatally. It was a little disheartening, however, to produce this word cloud, which represents the feelings of EPers about EPing. I am currently preparing a paper about these findings for journal submission. 

 

As I am working on my dissertation, I will be analyzing more of the data collected: next on my list is galactagogue use and how effective EPers perceive various popular ones to be, since this is a constant topic of conversation within various EPing discussion groups. To me, though, the most important findings from my research will be those that can make women’s experiences of EPing more positive. Anecdotally, I have discovered that a frightening number (read: vast majority) of EPers get no or bad advice from their healthcare providers, including but certainly not limited to lactation care providers of all kinds. This advice doesn’t usually come out of ill intention, but simply ignorance: giving an EPer the same advice about pumping as a nursing mother is usually going to result in failure for the EPer. As EPing grows in popularity as breast pumps sit on every new mother’s side table and continue to offer more technologically advanced features, it is the responsibility of lactation care providers to have the correct information to provide. One of my goals through this research is to discover and disseminate this correct information.

Finally, I want to make sure that those of you that have made it this far aren’t left with the wrong impression of what I am trying to achieve with my work. Just as no lactation care provider should force a woman to nurse against her wish, I don’t think that EPing should replace nursing for those that want to and are successful. In fact, I obtained my CLC qualification (and plan to become an ALC later this year) to help as many women be successful at nursing as possible. Nevertheless, there are some EPers who have or could have chosen to nurse successfully, but felt that EPing was the right choice for them. There are far more EPers, however, that tried to nurse and, for a variety of reasons (that shall be illuminated by my data), failed and resorted to the frustrating, challenging, but devoted path of EPing so they could still feed their babies their milk. It is for all EPers that I do this research, but especially those that felt, as I did, the double letdown of nursing failure together with little to no competent professional support for or advice about the only alternative that allowed them to feed their own milk to their babies.

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