Redefining “Breastfeeding” Initiation and Duration in the Age of Breastmilk Pumping

Breastfeeding rates have been chronicled in the United States throughout the past 50 years.The general purpose of these descriptive data collections has been to provide public health surveillance of infant feeding.The results have been used to identify demographic characteristics and the geographic locations of women who may need breastfeeding support and assistance.These statistics have helped create policy, set goals for the country, and provide benchmark measures from which to increase the proportion of children receiving breastmilk.Although investigators have used distinct methods of data collection in past studies, the definition of how ''breastfeeding'' was characterized has been relatively constant.If an infant was fed breastmilk even once, the mother was said to have initiated breastfeeding.For the period that a child was fed breastmilk, the mother was considered to be concurrently providing that breastmilk.If a child was fed breastmilk exclusively, predominantly, or nominally at any time, then the mother was categorized, respectively, as exclusively, predominantly, or nominally ''breastfeeding'' for that same period.The collection of breastfeeding statistics has always assumed the behavior between the mother and child to be a synchronized, simultaneous event, with both participating equally.This presumption in ''breastfeeding'' data collection is no longer uniformly true for mothers and their children in the United States, however.Approximately 70% of American women initiate breastmilk feeding in the postpartum period, 1 while approximately 70% of women with children under the age of 18 years work outside the home. 2 If women are going to maintain their milk supply when separated from their infant, they must extract their milk regularly.Thus, in addition to feeding their children directly ''at the breast,'' women in the United States now commonly extract milk from their breasts by mechanical means.A woman with a double-sided electric breast pump can easily and painlessly extract the contents of both breasts in a short period.This pumped milk may be fed to the infant immediately, left at ambient temperature, or stored in the mother's own refrigerator or freezer for variable lengths of time.In the Infant Feeding Practices Study II, the largest study on pumping by American mothers, 85% of 1,564 breastfeeding mothers of healthy, singleton infants 1.5-4.5 months old expressed milk from their breasts. 3Among the