纽约客原文
http://www.newyorker.com/reporting/2009/01/19/090119fa_fact_lepore?currentPage=all
Baby Food
If breast is best, why are women bottling their milk?
byJill LeporeJanuary 19, 2009
There are some new rules
governing what used to be called “mother’s milk,” or “breast milk,”
including one about what to call it when it’s no longer in a mother’s
breast. A term, then, nomenclatural: “expressed human milk” is milk that
has been pressed, squeezed, or sucked out of a woman’s breast by hand
or by machine and stored in a bottle or, for freezing, in a plastic bag
secured with a twist tie. Matters, regulatory: Can a woman carry
containers of her own milk on an airplane? Before the summer of 2007,
not more than three ounces, because the Transportation Security
Administration classed human milk with shampoo, toothpaste, and
Gatorade, until a Minneapolis woman heading home after a business trip
was reduced to tears when a security guard at LaGuardia poured a two-day
supply of her milk into a garbage bin. Dr. Ruth Lawrence, of the
breast-feeding committee of the American Academy of Pediatrics, promptly
told the press, “She needs every drop of that precious golden fluid for
her baby”; lactivists, who often stage “nurse-ins,” sent petitions; and
the T.S.A. eventually reclassified human milk as “liquid medication.”
Can a woman sell her milk on eBay? It has been done, and, so far, with
no more consequence than the opprobrium of the blogosphere, at least
until the F.D.A. decides to tackle this one. The Centers for Disease
Control and Prevention, however, does provide a fact sheet on “What to
Do If an Infant or Child Is Mistakenly Fed Another Woman’s Expressed
Breast Milk,” which can happen at day-care centers where fridges are
full of bags of milk, labelled in smudgeable ink. (The C.D.C. advises
that a switch “should be treated just as if an accidental exposure to
other bodily fluids had occurred.”) During a nine-hour exam, can a woman
take a break to express the milk uncomfortably filling her breasts? No,
because the Americans with Disabilities Act does not consider lactation
to be a disability. Can a human-milk bank pay a woman for her milk?
(Milk banks provide hospitals with pasteurized human milk.) No, because
doing so would violate the ethical standards of the Human Milk Banking
Association of North America. If a nursing woman drinks to excess—some
alcohol flows from the bloodstream into the mammary glands—can she be
charged with child abuse? Hasn’t happened yet, but there’s been talk.
Meanwhile, women who are worried can test a few drops with a product
called milkscreen; if the alcohol level is too high, you’re supposed to
wait and test again, but the temptation is: pump and dump.
An
observation, historical: all this is so new that people are making up
the rules as they go along. Before the nineteen-nineties, electric
breast pumps, sophisticated pieces of medical equipment, were generally
available only in hospitals, where they are used to express milk from
women with inverted nipples and from mothers of infants too weak and
tiny to suck. Today, breast pumps are such a ubiquitous personal
accessory that they’re more like cell phones than like catheters. Last
July, Stephen Colbert hooked up to a breast pump on “The Colbert
Report.” In August, the Republican Vice-Presidential nominee, Sarah
Palin, told People that she has often found herself having to “put down the BlackBerries and pick up the breast pump.” Pumps, in short, abound.
A
treatise, mercantile: Medela, a Swiss company that has long been a
breast-pump industry leader, introduced its first non-hospital,
electric-powered, vacuum-operated breast pump in the United States in
1991; five years later it launched the swank Pump In Style. Since then,
its sales have quadrupled. The traffic in pumps is brisk, although
accurate sales figures are hard to come by, not least because many
people buy the top-of-the-line models secondhand. (Manufacturers argue
that if you wouldn’t buy a used toothbrush you shouldn’t buy a used
breast pump, but a toothbrush doesn’t cost three hundred dollars.) Then,
there’s the swag. “Baby-friendly” maternity wards that used to send new
mothers home with free samples of infant formula now give out manual
pumps: plastic, one-breast-at-a-time gizmos that work like a cross
between a straw and a bicycle pump. Wal-Mart sells an Evenflo electric
pump for less than forty dollars. Philips makes one “featuring new iQ
Technology”; the pitch is: the pump’s memory chip makes it smart, but
the name also plays on dubious claims that human milk raises I.Q.
scores. State-of-the-art pumps whose motors, tubes, and freeze packs are
wedged into bags disguised to look like black leather Fendi briefcases
and Gucci backpacks are a must-have at baby showers; the Medela Pump In
Style Advanced Metro model—“the C.E.O. of breast pumps”—costs $329.99 at
Target. Medela also sells Pump & Save storage bags and breast
shields. (The shield is the plastic part of the contraption that fits
over the breast; it looks like a horn of plenty.) Medela’s no-hands
model can be powered by your car’s cigarette lighter. Strenuous
motherhood is de rigueur. Duck into the ladies’ room at a conference of,
say, professors and chances are you’ll find a flock of women with
matching “briefcases,” waiting, none too patiently and, trust me, more
than a little sheepishly, for a turn with the electric outlet. Pumps
come with plastic sleeves, like the sleeves in a man’s wallet, into
which a mother is supposed to slip a photograph of her baby, because,
Pavlov-like, looking at the picture aids “let-down,” the release of milk
normally triggered by the presence of the baby, its touch, its cry.
Staring at that picture when your baby is miles away, well, it can make
you cry, too. Pumping is no fun—whether it’s more boring or more
lonesome I find hard to say—but it has recently become so common that
even some women who are home with their babies all day long express
their milk and feed it in a bottle. Behind closed doors, the nation
begins to look like a giant human dairy farm.
This makes it all
the more worrying that the evolving rules governing human milk,
including the proposed Breastfeeding Promotion Act of 2007, look a
muddle. They indulge in a nomenclatural sleight of hand, conflating
“breastfeeding” and “feeding human milk.” They are purblind, unwilling
to eye whether it’s his mother or her milk that matters more to a baby.
They suffer from a category error. Is human milk an elixir, a commodity,
a right? The question is, at heart, taxonomical. And it has been asked
before.
In 1735, when the Swedish naturalist Carl Linnaeus first sorted out the animal kingdom, he classed humans in a category called Quadrupedia: four-footed beasts. Even those of Linnaeus’s contemporaries who
conceded the animality of man averred that people have two feet, not
four. Ah, but hands are just feet that can grip, Linnaeus countered.
This proved unpersuasive. By 1758, in a process that the Stanford
historian of science Londa Schiebinger has reconstructed, Linnaeus had
abandoned Quadrupedia in favor of a word that he made up, Mammalia: animals with milk-producing nipples. (The Latin root, mamma, meaning breast, teat, or udder, is closely related to the onomatopoeic mama—“mother”—thought
to derive from the sound that a baby makes while suckling.) As
categories go, “mammal” is an improvement over “quadruped,” especially
if you’re thinking about what we have in common with whales. But, for a
while, at least, it was deemed scandalously erotic. (Linnaeus’s
classification of plants based on their reproductive organs, stamens and
pistils, fell prey to a similar attack. “Loathsome harlotry,” one
botanist called it.) More important, the name falls something short of
capacious: only female mammals lactate; males, strictly speaking, are
not mammals. Plenty of other features distinguish mammals from
Linnaeus’s five other animal classes—birds, amphibians, fish, insects,
and worms. (Tetracoilia, animals with a four-chambered heart,
proposed by a contemporary of Linnaeus’s, the Scottish surgeon John
Hunter, was at least as good an idea.) Linnaeus had his reasons.
Naysayers might doubt that humans are essentially four-footed (whether
on scriptural or arithmetic grounds), but no man born of woman, he
figured, would dare deny that he was nourished by mother’s milk.
Then, too, while Linnaeus was revising his “Systema Naturae” from the twelve-page pamphlet that he published in 1735 to the two-thousand-page opus of 1758—and abandoning Quadrupedia in favor of Mammalia—his
wife was, not irrelevantly, lactating. Between 1741 and 1757, she bore
and nursed seven children. Her husband, meanwhile, lectured and
campaigned against the widespread custom of wet-nursing. The practice is
ancient; contracts for wet nurses have been found on scrolls in
Babylonia. A very small number of women can’t breast-feed, and wet
nurses also save the lives of infants whose mothers die in childbirth.
But, in Linnaeus’s time, extraordinary numbers of European mothers—as
many as ninety per cent of Parisian women—refused to breast-feed their
babies and hired servants to do the work. In 1752, Linnaeus wrote a
treatise entitled “Step Nurse,” declaring wet-nursing a crime against
nature. Even the fiercest beasts nurse their young, with the utmost
tenderness; surely women who resisted their mammalian destiny were to be
ranked as lowlier than the lowliest brute.
Enlightenment doctors,
philosophers, and legislators agreed: women should nurse their
children. In “mile” (1762), Rousseau prophesied, “When mothers deign to
nurse their own children, then morals will reform themselves.”
(Voltaire had a quibble or two about Rousseau’s own morals: the author
of “mile” had abandoned his five illegitimate children at birth,
depositing them at a foundling hospital.) “There is no nurse like a
mother,” Benjamin Franklin wrote in 1785, after discovering an
infant-mortality rate of eighty-five per cent at the foundling hospital
in Paris that relied on wet nurses (the hospital where Rousseau’s
children all but certainly died), a discovery that explains why
Franklin, in his autobiography, went to the trouble of remarking of his
own mother, “She suckled all her 10 Children.” But wet nurses were not
nearly as common in Colonial America as they were in eighteenth-century
Europe. “Suckle your Infant your Self if you can,” Cotton Mather
commanded from the pulpit. Puritans found milk divine: even the Good
Book gave suck. “Spiritual Milk for Boston Babes, Drawn Out of the
Breasts of Both Testaments” was the title of a popular catechism. By the
end of the eighteenth century, breast-feeding had come to seem an act
of citizenship. Mary Wollstonecraft, in her “Vindication of the Rights
of Woman” (1792), scoffed that a mother who “neither suckles nor
educates her children, scarcely deserves the name of a wife, and has no
right to that of a citizen.” The following year, the French National
Convention ruled that women who employed wet nurses could not apply for
state aid; not long afterward, Prussia made breast-feeding a legal
requirement.
There was also a soppy side to the Age of Reason. In
1794, Erasmus Darwin offered in “Zoonomia; or The Laws of Organic Life”
a good summary of the eighteenth century’s passionate attitude toward
the milky breast:
When
the babe, soon after it is born into this cold world, is applied to its
mother’s bosom; its sense of perceiving warmth is first agreeably
affected; next its sense of smell is delighted with the odour of her
milk; then its taste is gratified by the flavour of it; afterwards the
appetites of hunger and of thirst afford pleasure by the possession of
their objects, and by the subsequent digestion of the aliment; and,
lastly, the sense of touch is delighted by the softness and smoothness
of the milky fountain, the source of such variety and happiness.
A
half century later, across the Atlantic, this kind of thing had turned
into a cult of motherhood, abundantly illustrated in daguerreotypes from
the eighteen-fifties that showed babies suckling beneath the unbuttoned
bodices of prim, sober American matrons, looking half Emily Dickinson,
half Leonardo’s “Madonna and Child.”
Then, bizarrely, American
women ran out of milk. “Every physician is becoming convinced that the
number of mothers able to nurse their own children is decreasing,” one
doctor wrote in 1887. Another reported that there was “something wrong
with the mammary glands of the mothers in this country.” It is no mere
coincidence that this happened just when the first artificial infant
foods were becoming commercially available. Cows were proclaimed the new
“wet nurse for the human race,” as the historian Adrienne Berney has
pointed out in a study of the “maternal breast.” Tragically, many babies
fed on modified cow’s milk died. But blaming those deaths on a
nefarious alliance of doctors and infant-food manufacturers, as has
become commonplace, seems both unfair and unduly influenced by later
twentieth-century scandals (most infamously, Nestlé’s deadly peddling of
infant formula in Africa and elsewhere, which led, in 1981, to the
landmark International Code for Marketing Breastmilk Substitutes). In
the United States, nineteenth- and early-twentieth-century physicians,
far from pressing formula on their patients, told women that they ought
to breast-feed. Many women, however, refused. They insisted that they
lacked for milk, mammals no more.
In 1871,
Erasmus Darwin’s grandson Charles published “Descent of Man,” in which
he speculated that the anomalous occurrence in humans of extra nipples
represented a reversion to an earlier stage of evolution. If our
ancestors once suckled litters of four or six, and if—as was
supposed—men had nipples because male mammals once produced milk, maybe
women, too, were evolving out of the whole business. In 1904, one
Chicago pediatrician argued that “the nursing function is destined
gradually to disappear.” Gilded Age American women were so refined, so
civilized, so delicate. How could they suckle like a barnyard animal?
(By the turn of the century, the cow’s udder, or, more often, its head,
had replaced the female human breast as the icon of milk.) Behind this
question lay another: how could a white woman nurse a baby the way a
black woman did? (Generations of black women, slave and free alike, not
only nursed their own infants but also served as wet nurses to white
babies.) Racial theorists ran microscopic tests of human milk: the
whiter the mother, chemists claimed, the less nutritious her milk. On
downy white breasts, rosy-red nipples had become all but vestigial. It
was hardly surprising, then, that well-heeled women told their doctors
that they had insufficient milk. By the nineteen-tens, a study of a
thousand Boston women reported that ninety per cent of the poor mothers
breast-fed, while only seventeen per cent of the wealthy mothers did.
(Just about the opposite of the situation today.) Doctors, pointing out
that evolution doesn’t happen so fast, tried to persuade these Brahmins
to breast-feed, but by then it was too late.
The American
epidemic of lactation failure depended, too, on the evolving design of
baby bottles: so sleek, so clean, so scientific, so modern. The first
U.S. patent for a baby bottle was issued in 1841; the device, shaped
like a breast, could be held close to a mother’s chest, almost like a
prosthetic. Year by year, bottles became less like breasts. The familial
cylindrical bottle, called the Stork Nurser, dates from 1910 and is
tied to the rise of the stork myth: milk comes from the milkman; babies
come from storks. Perversely, Freud’s insistence that infants experience
suckling as sexual pleasure proved a boon to stork-style repression,
too: mothers, eager to keep infantile incestuous desire at arm’s length,
propped their babies up in high chairs and handed them bottles.
Meanwhile,
more and more women were giving birth in hospitals, which meant that,
for the first time in human history, infants born prematurely, or very
small, had a chance of survival—if only there were enough milk and a way
to get it into the belly of a baby that was too tiny to suck at the
breast.
In 1910, a Boston doctor, Fritz Talbot,
spent three days searching for a wet nurse. He failed. Exasperated,
Talbot established a placement service, the Boston Wet Nurse Directory.
Across town, Francis Parkman Denny, caring for a sick baby, asked a
neighbor to hand-express her milk for him. When the infant improved
after drinking just three ounces, Denny, a bacteriologist, became
convinced of the “bactericidal power” of human milk. The year after
Talbot started his Wet Nurse Directory, Denny opened the first
human-milk bank in the United States, collecting milk from donors using a
breast pump whose design was inspired by bovine milking machines.
(Milking machines are still cited in breast-pump patents; mechanically,
Medela’s Pump In Style has much in common with DairyMaster’s Swiftflo.)
Denny’s plan worked better: families who needed and could afford human
milk did not generally like having poor women live with them; they
preferred to have the milk delivered in bottles. Talbot stopped placing
wet nurses and instead began distributing their milk; he renamed his
agency the Directory of Mother’s Milk.
Once milk banks replaced
wet nurses, human milk came to be treated, more and more, as a medicine,
something to be prescribed and researched, tested and measured in
flasks and beakers. Denny’s bottled, epidemiological model prevailed.
Laboratory-made formulas improved, and aggressive marketing of processed
infant food—not just bottles of formula but jars of mush and all manner
of needless pap—grew to something between badgering and downright
coercion. By the middle of the twentieth century, the majority of
American women were feeding their babies formula. But, all the while,
Erasmus Darwin’s rhapsodic view of the milky breast endured. “With his
small head pillowed against your breast and your milk warming his
insides, your baby knows a special closeness to you,” advised “The
Womanly Art of Breastfeeding,” originally published by La Leche League
in 1958, just two years after the league’s first meeting. “He is gaining
a firm foundation in an important area of life—he is learning about
love.” In the nineteen-sixties, nursing as a mammalian love-in began
making a comeback, at least among wealthier women. (A brief history of
food: when the rich eat white bread and buy formula, the poor eat brown
bread and breast-feed; then they trade places.) In the decades since,
the womanly art of breast-feeding has yielded, slowly but surely, to the
medical science of human milk.
In 1997, the American Academy of
Pediatrics issued a policy statement on “Breastfeeding and the Use of
Human Milk,” declaring human milk to be “species-specific” and
recommending it as the exclusive food for the first six months of a
baby’s life, to be followed by a mixed diet of solid foods and human
milk until at least the end of the first year. In that statement, and in
a subsequent revision, the A.A.P. cited research linking breast-feeding
to the reduced incidence and severity of, among other things, bacterial
meningitis, diarrhea, respiratory-tract infection, ear infection,
urinary-tract infection, sudden-infant-death syndrome, diabetes
mellitus, lymphoma, leukemia, Hodgkin’s disease, obesity, and asthma.
The benefits of breast-feeding are unrivalled; breast-feeding rates in
the United States are low; the combination makes for a public-health
dilemma. In 2000, the Department of Health and Human Services announced
its goal of increasing the proportion of mothers who breast-feed their
babies “at initiation” (i.e., before they leave the hospital) from a
1998 baseline of sixty-four per cent to a 2010 target of seventy-five
per cent; until the age of six months, from twenty-nine per cent to
fifty per cent; at one year, from sixteen per cent to twenty-five per
cent. (The same targets were announced in 1990; they were not reached.)
Attempts to improve initiation rates have met with much, if spotty,
success. The Rush University Medical Center, in Chicago, which runs a
peer-counselling program called the Mother’s Milk Club, has achieved an
astonishing initiation rate of ninety-five per cent; nationally, the
rate is not quite seventy-five per cent. More difficult has been raising
the rates at six and twelve months. The C.D.C., which issues an annual
Breastfeeding Report Card, has announced that for babies born in 2005
the rate of exclusive breast-feeding at six months was only twelve per
cent (although the rate of some breast-feeding at six months had risen to forty-three per cent).
One
big reason so many women stop breast-feeding is that more than half of
mothers of infants under six months old go to work. The 1993 Family and
Medical Leave Act guarantees only twelve weeks of (unpaid) maternity
leave and, in marked contrast to established practice in other
industrial nations, neither the government nor the typical employer
offers much more. To follow a doctor’s orders, a woman who returns to
work twelve weeks after childbirth has to find a way to feed her baby
her own milk for another nine months. The nation suffers, in short, from
a Human Milk Gap.
There are three ways to bridge that gap:
longer maternity leaves, on-site infant child care, and pumps. Much
effort has been spent implementing option No. 3, the cheap way out.
Medela distributes pumps in more than ninety countries, but its biggest
market, by far, is the United States, where maternity leaves are so
stinting that many women—blue-, pink-, and white-collar alike—return to
work just weeks after giving birth. (Breasts supply milk in response to
demand; if a woman is unable to put her baby to her breast regularly,
she will stop producing milk regularly. Expressing not only provides
milk to be stored for times when she is away; it also makes it possible
for a working woman to keep nursing her baby at night and on weekends.)
In 1998, Congress authorized states to use food-stamp funds granted to
the U.S.D.A.’s Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) to buy or
rent breast pumps for eligible mothers. Breast-feeding rates rise with
maternal age, education, and income. Medela offers a Corporate Lactation
Program, free advice for employers seeking to reduce absenteeism and
health-insurance costs by establishing “Mother’s Rooms,” equipped,
ideally, with super-duper electric pumps, because “breastpumps with
double-pumping options save time and can even help increase a mother’s
milk supply.” The loss of productivity, Medela promises, is slight: “If
each employee uses safe, effective, autocycling breastpumps, each visit
to the Mother’s Room should last no longer than 10 to 15 minutes.”
Even
more intensive has been the energy directed toward legislative reform.
Many states have recently passed laws about breast-feeding, having to do
with option No. 3. Must companies supply employees with refrigerators
to store milk expressed during the workday? Twenty-one states, along
with Puerto Rico and the District of Columbia, require employers to make
a “reasonable effort” to accommodate nursing mothers and their bottled
milk, although these laws are, generally, toothless. As a rule, the
posher the employer, the plusher the pump station. Traders at Goldman
Sachs can use an online booking service to reserve time in dedicated
lactation rooms, equipped with pumps and chairs; baristas at Starbucks
are left to line up to use the customers’ loo. In 2007, Oregon became
the first state to pass a law requiring companies with more than
twenty-five employees to provide “non-bathroom” lactation rooms. (A
national media campaign asks, reasonably enough, if you wouldn’t make
your kid a sandwich in a public rest room, why would you expect a woman
to bottle her baby’s milk in one?) Virginia and Maryland recently joined
twenty-three other states and the Virgin Islands in exempting women who
expose their breasts while suckling infants from indecency laws.
Whether pumping in public is obscene has not yet been tested—honestly,
who would want to?—but, what with all these lactation rooms, maybe that
won’t come up.
More rules are under consideration. Can a woman or
her employer get a tax break for producing or storing milk? Maryland
exempts breast pumps from its sales tax, but a congressional
sub-committee is still mulling over the Breastfeeding Promotion Act. The
goals of the bill are to add the word “lactation”—defined as “the
feeding of a child directly from the breast or the expressing of milk
from the breast”—to the Civil Rights Act of 1964, and to allow a tax
credit of up to ten thousand dollars per year to companies that provide
their employees with pumps or pump rooms. A better title for the
proposed legislation might be the Breast Pump Promotion Act.
The
cynical politics of pump promotion would seem, at first, to be obvious.
Breast pumps can be useful, even indispensable and, in some cases,
lifesaving. But a thing doesn’t have to be underhanded to feel
cold-blooded. Non-bathroom lactation rooms are such a paltry substitute
for maternity leave, you might think that the craze for pumps—especially
pressing them on poor women while giving tax breaks to big
businesses—would be met with skepticism in some quarters. Not so. The
National Organization for Women wants more pumps at work: NOW’s
president, Kim Gandy, complains that “only one-third of
mega-corporations provide a safe and private location for women to pump
breast milk for their babies.” (When did “women’s rights” turn into “the
right to work”?) The stark difference between employer-sponsored
lactation programs and flesh-and-blood family life is difficult to
overstate. Pumps put milk into bottles, even though many of
breast-feeding’s benefits to the baby, and all of its social and
emotional benefits, come not from the liquid itself but from the smiling
and cuddling (stuff that people who aren’t breast-feeding can give
babies, too). Breast-feeding involves cradling your baby; pumping
involves cupping plastic shields on your breasts and watching your
nipples squirt milk down a tube. But this truth isn’t just rarely
overstated; it’s rarely stated at all. In 2004, when Playtex débuted a
breast pump called the Embrace, no one bothered to point out that
something you plug into a wall socket is a far cry from a whisper and a
kiss. Rhode Island’s Physicians’ Committee for Breastfeeding gives an
annual award for the most “Breastfeeding-Friendly Workplace,” a merit
measured, in the main, by the comforts provided in pumping rooms, like
the gold-medal winner’s “soothing room,” equipped with “a sink, a lock
on the door, and literature.” It appears no longer within the realm of
the imaginable that, instead of running water and a stack of magazines,
“breastfeeding-friendly” could mean making it possible for women and
their babies to be together. Some lactation rooms even make a point of
banning infants and toddlers, lest mothers smuggle them in for a quick
nip. At the University of Minnesota, staff with keys can pump their milk
at the Expression Connection, but the sign on the door warns: “This
room is not intended for mothers who need a space to nurse their
babies.”
Lately, some WIC officers
have begun to worry that pump promotion might be backfiring, having
“the unintended effect of discouraging breastfeeding.” But such cautions
have hardly stopped the anti-formula fire and brimstone. Between 2004
and 2006, a National Breastfeeding Awareness Campaign included TV ads
that likened a mother feeding her baby formula to a pregnant woman
riding a mechanical bull: “You’d never take risks before your baby is
born. Why start after?” No one seems especially worried about women
whose risk assessment looks like this: “Should I take three
twenty-minute pumping ‘breaks’ during my workday, or use formula and get
home to my baby an hour earlier?”
Pumps can be handy; they’re
also a handy way to avoid privately agonizing and publicly unpalatable
questions: is it the mother, or her milk, that matters more to the baby?
Gadgets are one of the few ways to “promote breast-feeding” while
avoiding harder—and divisive and more stubborn—social and economic
issues. Is milk medicine? Is suckling love? Taxonomical questions are
tricky. Meanwhile, mamma ex machina. Medela’s newest models offer
breakthrough “2-Phase Expression” technology: phase one “simulates the
baby’s initial rapid suckling to initiate faster milk flow”; phase two
“simulates the baby’s slower, deeper suckling for maximum milk flow in
less time.” These newest machines, the company promises, “work less like
a pump and more like a baby.” More like a baby? Holy cow. We are become
our own wet nurses.
说说我的感想
吸奶器是协助现代社会桎梏女性的另一工具，因为有了它，妈妈们就没有借口不回去工作，政府和雇主们不必面对产假长短影响哺乳的背后的更严峻的问题（经济发展VS人口下降的更宏观的问题）。
16世纪流行乳母，后来又流行牛乳，但都在时间的推移下被证明是错误，谁知道吸奶器的将来会是如何呢？只有最自然的方得长久
我曾经听到两个母亲的对话，说女佣自己是母亲，却不知道热冻奶的温度怎样最合适；另外一人立刻搭话：她们全部latch-on，哪里会知道？语气中的轻蔑，仿佛latch-on的是下等人，pump的是上等人。就像文中白人女性没法接受自己和黑人一样哺乳。吸奶器于是又被赋予社会等级的意义。
是因为有了吸奶器，宝宝们就不latch-on了吗？
周围越来越多不吸奶的宝宝，于是妈妈们就开始pump出来，后来发现这样方便规律，就一直pump了，然后宝宝就再也不latch-on了。
这要放中国古代怎么办呢？
邢纪
续
我把后面待续的东西补起。
今天又收到了一个妈妈的来信说她在追奶中。真的就是一边宝宝不肯吸或者吸起来无力，一边吸奶器在挤。但是奶不但不增反而越来越少。妈妈的心也越来越焦急。我看到这样的现象很多。我总结几点：
1 很多妈妈都知道要想多产奶，就要让宝宝多吸，可是宝宝不愿意吸怎么办？具体表现有：宝宝不肯吸，不肯持续的吸，一吃奶就睡觉，奶出来慢不肯吸，哭闹，非要加配方奶才安静等等。那么宝宝不肯吸怎么办？妈妈们首先想到的就是用吸奶器来弥补应该是由宝宝来给乳房的吸吮。
2 吸奶器吸不出多少奶。不少妈妈说努力半天也就几十毫升。真着急。
3 感觉自己奶少，因此在宝宝吸吮自己乳房的时候常常觉得宝宝没吃多少，更是担心会饿着宝宝。吸吮自己的乳房后，再加配方奶，一看仍旧加那么多，信心就没了。
问题的根本就是很多时候，当妈妈在用吸奶器来吸奶期望增产的时候，宝宝是用奶瓶和奶粉来喂养的。这样就把一个奶粉宝宝或者混合喂养的宝宝的表现看成了母乳宝宝应该有的表现。这将会使的妈妈感到困惑：为什么宝宝奶瓶一吃就太平了，而且一睡几小时，而吃我的奶就几乎时时刻刻都在吃？
两点必须注意的是：1 母乳喂养就是频繁的，尤其在前3个月，夜间哺乳也很重要。所以，如果你的宝宝是混合喂养并且瓶喂的，现在转成纯母乳，他的吃奶习惯会改变，而且也要经历一定的调整时期。因此，如果之前你的宝宝每3个小时才吃一次，那么现在可能2小时就吃一次，而且吃的时间会长。要记住的是，母乳喂养和人工喂养是两种喂养方式。
2 如果你想靠吸奶器来增加产奶量，首先吸奶器的质量是要好的。而且要记住的是，在条件允许的情况下，双吸的医院级别的吸奶器对建立充足的产奶量有效。不过现实生活里，可能找到这样的吸奶器也不容易，即使有，价格也很昂贵。要知道，在发展中国家，不少妈妈也就是用手动吸奶器的。你要确保你的吸奶器的吸力是在正常的范围。并且你吸奶一定要频繁于目前宝宝吃奶的次数。你的宝宝目前是在混合喂养，那么实际上他吃奶的频率可能要比吃母乳来的少。我常说，吸奶也要按需，这就是说，如果你的宝宝每天吃8次奶，但是混合喂养，那么你最好吸10次奶。在追奶的时候，妈妈吸奶最好是频繁的短时间吸。我举个例子：每2个小时吸一次，每次一共30分钟的话，你可以每次左边5分钟，右边5分钟，再左边5分钟，再右边5分钟，再左边5分钟，再右边5分钟。频率很重要。而且因为没有双吸的吸奶器的话，用单个吸奶器短时间轮流吸两边会比较平衡和有效的吸奶。
3 母婴配合问题。这个是问题的关键。归根结底，妈妈们希望摆脱吸奶器，然后都让宝宝来吸吮。那么现在宝宝不吸吮怎么办？这有很多解决办法，比如不给宝宝其他的吸吮，没有奶瓶人工奶嘴。这样他会对妈妈的乳房有兴趣。但是勺喂杯喂慢，怎么办？专业的哺乳顾问最喜欢让宝宝吸吮妈妈的乳头的时候再同时给与额外的乳汁（吸出来的母乳或者配方奶）来鼓励宝宝在妈妈的乳房上多吸吮。比如使用哺乳辅助器，或者宝宝在吸妈妈的乳房时，其他人使用牙科的注射器往宝宝嘴角里慢慢注入乳汁。我们要知道，当宝宝表现出不愿意吸妈妈乳房的时候，对妈妈打击是很大的。因此，我们要想办法，让宝宝对吸妈妈的乳房有兴趣，这是很关键的。在先给配方奶后吸妈妈的乳房这个增加产奶量的方法里，其实关键就是让宝宝吃少量的配方奶，使得他不怎么饿，然后有耐心在妈妈乳房上多吸吮。此外还有不要让宝宝太饿了才喂奶，这样他耐心更不够，更不原意在妈妈出奶慢的乳房上吃奶。
4有效吸吮。很多妈妈描述宝宝吃妈妈的奶好像在出工不出力。有时候这也是因为吃了奶瓶的缘故。人工奶嘴真的只需要抿抿嘴就能出奶，而吃妈妈的奶可没那么轻松。有些宝宝很喜欢吸妈妈的乳房，但是就是浅浅的抿。对于这样的情况，妈妈要注意一定要在衔奶上让宝宝衔的深，如果你还是要用奶瓶来喂宝宝，也要让宝宝张大嘴含住人工奶嘴的宽底部分，而不是仅仅吸奶头的头部。这部分内容真的很多。我想以后有机会在会上，我们来看看宝宝们的吸吮，了解一下什么是好的吸吮。
从3，4来看，扔掉吸奶器能直接亲喂的最关键就是让宝宝喜欢吸妈妈的乳房。以前我提到过母乳喂养的乳汁和非乳汁的益处。这里要提醒妈妈们注意的就是，让宝宝喜欢你，不但是你提供乳汁给他，而且你提供温暖，安全和舒适等等。这后面的母乳喂养益处你任何时候都可以给与的。不要因为忙于吸奶，孩子常常都由他人来抱。这样你了解孩子的机会就更少了。抱孩子，和他有最大的皮肤对皮肤的接触，把孩子抱在胸前，观察他任何想吃奶的迹象，鼓励他自己来找奶吃。你的眼睛看着孩子的，温柔的对他说话。。。
要记住，只要你不是上班的妈妈或者是其他原因不得不和宝宝分开的情况下，吸奶器是阻挡在你和宝宝之间的障碍。而且吸奶器的吸吮不能代替宝宝的吸吮。对于大多数妈妈来讲，她们想实现的最终目标就是母乳亲喂。很多妈妈在挤奶之后，即使挤出了足够的奶来瓶喂宝宝，但是她们仍旧想亲喂的。母乳喂养真的不仅仅是提供乳汁，相信很多妈妈都理解这个道理而且有着深刻的感受。所以，克服乳头混淆和乳房拒绝才是问题的关键，只要你的宝宝愿意吸你的乳房，那么你就该在好的衔奶和有效的吸吮上努力。这也是把奶瓶奶粉和吸奶器戒掉的关键。再强调一下，你的乳房不仅仅提供乳汁，你还可以提供很多其他给宝宝。如果你提供很多其他的给宝宝，也会促进宝宝和你之间的关系和相互了解。这也有利于乳汁的分泌。
相信看了我前面的1-5的妈妈，都有这样的感觉，那就是我并不推荐使用吸奶器。在这里，我很想强调的一点就是，一定要把吸奶器看成是和奶瓶连在一起的东西，你们就知道了，为什么吸奶器和奶瓶一样可以造成母乳喂养的困难。事实上，当你使用吸奶器来吸奶的时候，的确底下就连着奶瓶。妈妈们要是意识到这一点，就会知道，这现在吸到奶瓶里的奶，很可能也只能用奶瓶的方法喂进去。
有不少妈妈问，她们想知道什么时候该使用吸奶器，并且该如何正确使用。我这里来个原则大总结。到底何种情况下要使用吸奶器？
1早产儿，新生儿缺陷和严重疾病等情况必须在产后立即进入新生儿重症监护病房而母婴不得不分离的。这时候妈妈需要使用医院级别的吸奶器来建立母乳产量。
2 妈妈去上班而长时间离开宝宝。
3妈妈的一些乳房乳头因素，比如以前有一些手术史的，乳腺发育不全的，乳头凹陷宝宝实在衔奶困难的（有时吸奶器可以帮助乳头凸出），妈妈乳头疼痛剧烈，病理性涨奶。
除此之外，很多情况，比如吃完奶了要不要吸啊？半夜起来要不要吸啊？两餐之间要不要吸啊？等等，我的回答都是：不必须。原则是1不要干扰正常的母乳喂养2以你自己身体舒适为宜。比如夜间妈妈涨奶，宝宝又睡的很香，那么挤出来一点让你舒服即可，不要拼命挤很多，一来挤奶时间长妈妈也休息不好，二来也不容易达到供需平衡，三来万一你挤得很“干净”，宝宝不久就醒来要吃奶怎么办？
至于如何正确使用吸奶器，可以说每个厂家都有说明书，使用前仔细看说明书应该就能正确使用。不过我在这里提几个关键的：
1 正确选择合适你的尺寸的吸奶器。吸奶器的乳房罩部分有个管道连到吸奶器的机体部分。你的乳头应该可以自由的在这个管道里滑进滑出，而且每次挤完奶，你的乳头没有受到挤压的痕迹。有的妈妈尤其乳头大的妈妈会发现挤完奶后，乳头的根部会有一圈白印子，这就是说明这个乳房罩导管对你来说太小了。这样会损伤你的乳头。即使开始吸的时候乳头不大，但是随着吸奶，你的乳头也会渐渐变大。所以要选择合适的尺寸。
2在你能承受的经济条件下，尽量选择好的吸奶器。不要使用别人拿来的二手吸奶器。这对于上班的妈妈来说是很重要的。你一定要多对比，看看你使用哪个拿起来最顺手，用起来最舒适。吸奶器的质量是吸奶的一个很关键的因素，所以买的时候也最好问问售后服务有没有测试吸力的。因为一个漏气的吸力不行的吸奶器是完全没有效力的。
3吸奶的时候一定是调到你感觉舒适的力度，而不要一味追求最大力度。
4合理预期你的吸奶量，上午比下午多，晚上可能更多，不是每次都能吸出同等量的乳汁来。
5 再次提醒，吸奶的关键是频率，放松和喷乳反射。频繁的吸每次短时间比间隔时间长而一次长时间的吸效果要好。放松非常重要，紧张和匆忙本身就抑制了催产素的分泌。喷乳反射是需要催产素的分泌来催发的。而催产素的分泌可以受到听觉视觉嗅觉感觉甚至想象来的。这在之前的文章里提到过具体的方法。
5储存母乳的最好使用硬质聚丙烯（polypropylene）材料做的瓶子，就是那种不透明的塑料瓶。玻璃奶瓶也很安全。透明的塑料瓶（聚碳酸酯）近年来在被质疑含有BPA，一种和雌激素有类似结构的化学物质，因此和某些癌症的发生有着还未明确证明的联系。我在美国的一个朋友，生第三个孩子的时候听到这个消息之后把所有以前的透明塑料奶瓶全部换成了玻璃奶瓶。如果你有透明塑料奶瓶，那么最好不要直接用此加热里面的母乳。母乳保存袋原则上只适合短期保存，尽管可能厂家说可以使用长期。
至于如何安排吸奶，比如一天吸几次，每次吸多少时间，这对上班的妈妈来讲比较重要。这和孩子的大小，你上班离家的时间以及你母乳产生的情况有关。真的不是一概而论。我举个例子，只是个例子，你肯定知道一个小孩子不可能那么规律，我只是让大家有个大致的印象，这个事情应该往哪几个方面考虑。这个例子是：你的孩子现在6公斤，他每日吃奶量大概是1000毫升。他每天吃奶8次。你不上班的时候一共亲喂是5次，那么你上班期间就要挤奶3次，基本上每三个小时一次。每次挤奶量在120毫升就差不多了。所以对于上班妈妈来讲，挤奶的原则也是按需挤奶。
这个吸奶器系列写到这里，我相信看过所有123456的妈妈应该对吸奶器有了新的认识。我希望大家对这样一个塑料和或者不和小型马达制成的产品抱有一个谨慎的态度，因为如果你的宝宝就在你的身边的话，请记住，他/她的嘴巴的功能就是用来吸吮的。