The TIG Blog invites any interested trainees to write a guest post about a topic that interests them. These blogs can be about a current issue in human milk and lactation research, a description of their own research, or simply a question of interest. This guest post was written by ISRHML trainee Fiona Jardine who is a lactation consultant, a postpartum doula, and an Information Studies Ph.D. candidate at the University of Maryland’s iSchool.
Although my professional background is in law and library and information science, like so many, I came to breastfeeding research as a result of my own experiences. I was determined to breastfeed my daughter after her birth in 2016, but unfortunately, due to a variety of obstacles, my baby and I were not able to establish a direct nursing relationship. My struggles were not unique: in the United States, 83% of babies receive at least one breastfeed, but only 47% are exclusively breastfed at 3 months and 35% at 6 months.
My breastfeeding journey did not stop with a failed latch. While I was devastated that we would never have the “gold standard” of baby nutrition, bonding, and comfort, I was still determined to give my daughter my milk any way I could. I knew vaguely how to express milk with a breast pump, but, despite having taken a breastfeeding class and having spoken at length about breastfeeding with our doula, I had little clue how to do it as the sole means of extraction. Online research on the topic didn’t help either, until, about two weeks postpartum, I finally discovered the term “exclusive pumping” (EP, EPing, EPer). 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. Because of this online peer-to-peer help, my daughter was exclusively breastfed until we introduced solids.
Despite the vitally important health benefits of breastfeeding to both the breastfeeder and the recipients of human milk, as well as the increasing number of EPers, research on EPing is scant. The research that exists is often limited to analysis of the composition of expressed milk, pumping in the context of the neonatal intensive care unit, or secondary analysis of existing data. When I started my research, I found some general studies about milk expression in the literature, but no published research documenting the lived experiences of EPers, specifically why they EP, where they find information, what support they get, how they feel, and problems they have. Although my field of expertise is Information Studies, it encompasses such a broad variety of topics—human–computer interaction, information management, library science, and archives, to name a few. Therefore, I was able to explore this gap in research, while at the same time collecting data on public health and lactation science issues such as formula feeding, milk supply, and postpartum health.
My data collection used a cross-sectional, self-report, mixed methods online survey. Between March 2017 and March 2018, I collected both qualitative and quantitative data through an initial survey, gathering over 2,000 qualifying responses. In addition, anyone currently EPing was given the option to participate in periodical follow-up surveys: over 700 follow-up surveys were completed by 341 respondents over a period of 18 months. While some PhD researchers struggle to collect enough data, I suffer from the opposite problem. The initial survey is long and has quite a few open-ended questions, yet respondents took their time (often over an hour) to share their experiences at length. This is a clear indication of how passionately EPers want their voices to be heard; many report that lactation care providers and other healthcare professionals dismiss EPing as a legitimate option.
While data analysis is ongoing, I published my initial findings about EPers’ prenatal information needs, seeking, and use in a paper for The Journal of Human Lactation. For that paper, I also analyzed the feelings of EPers about EPing, which resulted in a pretty disheartening word cloud (from a list of 57 words, respondents were asked to pick all those that they had ever felt about EPing. In this weighted word cloud, the bigger the word, the greater number of respondents selected it).
I presented data answering the question “why do EPers exclusively pump?ˮ at the ISRHML 2019 conference—it seems to be the burning question most people, whether researchers or parents, have. I can confidently say that, for most, it is not a lifestyle choice: only about 8% of my respondents “just wanted to” EP. Almost 70% tried, but failed, to establish a successful latch. For the most part, these breastfeeders are not choosing between nursing and EPing, they’re choosing between EPing and formula.
Compounding their feelings of frustration, grief, and disappointment over the failure to successfully nurse, EPers don’t, in general, feel well supported by lactation care providers. Respondents felt that lactation care providers were judgmental of EPing, pushed “back to the breast” (the very last type of information that respondents reported needing), and espoused many of the myths surrounding EPing (e.g., that EPing was not a long-term option, that it negatively affects bonding, that milk doesn’t change in response to age/environment etc.). I see one of the critical impacts that my research can make is changing these attitudes and educating lactation care providers so that ALL parents, regardless of their feeding method, feel welcomed and supported.
Lastly, my research also identifies the knowledge gaps of both breastfeeders and lactation care providers, as well as strategies to fill these gaps. The identification of these strategies is vital to creating evidence-based changes to both breastfeeding policy and practice, such as better support for feeding human milk no matter the method and more adequate provision for milk expression outside of the home. I believe changes such as these will increase the incidence and duration of breastfeeding and therefore promote child and parental wellbeing, as well as improve the lived experiences of EPers and the practice of EPing more generally.
Trainee Fiona Jardine and her daughter.
Thank you, Fiona, for sharing your research and experience with us! If you’d like to contact Fiona about this piece, or about any aspect of exclusive pumping, you can email her at email@example.com. You can also follow along with her findings through her Facebook group
As an ALPP Advanced Lactation Consultant and postpartum doula, Fiona provides the support that she believes is so desperately needed, especially in the fourth trimester. On campus, Fiona participates in the “Need to Feed” project, which is gathering data about existing lactation/feeding facilities and working with facilities to improve them. She redesigned the breastfeeding symbol to be inclusive of both nursing at the breast and pumping (universalbreastfeedingsymbol.com) and is gradually designing other more inclusive symbols (babyfeedingsymbols.com). Fiona enjoys crafting, is an ardent animal lover, and is progressively failing to live up to the English stereotype of drinking lots of tea as she increasingly realizes that coffee is life. Find out more about Fiona on her website: fionamjardine.com.
 I define direct nursing as directly feeding at the breast, rather than eating from a bottle. I use “breastfeeding” as an umbrella term, meaning feeding a parent’s own milk, regardless of the method. For more about my stance on this, see my blog post, “Defending EPing as Breastfeeding” http://fionamjardine.com/2019/05/09/defending-eping-as-breastfeeding/.
 Centers for Disease Control and Prevention (2018). Breastfeeding Report Card 2018. Retrieved from https://www.cdc.gov/breastfeeding/data/reportcard.htm on September 7, 2018.
 Jardine, F.M. (2019). Breastfeeding without nursing: “If only I’d known more about exclusively pumping before giving birth.” Journal of Human Lactation, 35(2) 272-283. https://doi.org/10.1177/0890334418784562