The breast pump as a symbol: moral obligation or help to reconcile?

When Laura became pregnant with twins in 2009, she did not expect that, in the final stretch, preeclampsia would precipitate things.

Oliver Thansan
Oliver Thansan
08 June 2023 Thursday 10:21
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The breast pump as a symbol: moral obligation or help to reconcile?

When Laura became pregnant with twins in 2009, she did not expect that, in the final stretch, preeclampsia would precipitate things. The babies were born by caesarean section and for two days, Laura was admitted to the ICU of a private hospital in Barcelona. She has hazy memories of those forty-eight hours in intensive care, but there was an episode that she will not forget: "A nurse arrived, with a little green machine in her hand, who introduced me as a 'breast pump,'" she says. "After congratulating me, she told me that 'it would be nice' for her to start using it, to stimulate my milk production."

Laura was perplexed: "I couldn't even open my eyes, raising one arm was like running a marathon... I told her I was sorry, but I wasn't going to do it, I was too weak." Despite the circumstances, the nurse insisted, “twice”, that he try the breast pump until she finally left. “My feeling was a lack of sensitivity on her part. I felt very pressured, ”she sums up.

Now out of the ICU and more recovered: "Immediately my milk came in and I started using an electric breast pump, with two suction cups, which worked very well for me." The device became an indispensable ally for feeding the babies: “I didn't breastfeed because, being two of them, it was very complicated for me: so I expressed my milk, we prepared the bottles and me and my husband gave them one at a time. each one," he says. In total there were six months of exclusive breastfeeding using this system; a stage that Laura remembers living “very well”.

His case is a good example of the different aspects that a utensil such as a breast pump can have. On the one hand, the relief and help that comes from using it, especially when it comes to premature or sick babies, without the ability to suck. But, on the other, it illustrates the pressure that exists around its use to promote breastfeeding at all costs.

“Before there were safe and nutritious formulas, failure to breastfeed was fatal to the baby,” writes journalist Katherine Harmon in a Smithsonian magazine article on the history of breast pumps. Utensils that, during most of its history, shells: "They have been used in short-term crises, such as encouraging milk production when there are babies too weak to breastfeed, for the treatment of inverted nipples, the prevention of mastitis and the maintenance of lactation in case of illness of the mother”.

It was an emergency resource, used since ancient times: the Greeks already used ceramic vessels, with a spout, to create a vacuum effect and collect the milk. The Romans invented a glass breast pump, with a suction cup-shaped mouth at one end and a pipette at the other for suction. This model was used until the invention, in the 18th century, of manual extractors, which worked with rubber pumps, similar to the old horns. In the 19th century, bellows-based breast pumps arrived, true hulks that, according to The Smithsonian: "Took neither the basic physiology of breastfeeding nor comfort into account." They were also very difficult to clean, so their use caused all kinds of infections.

Electric breast pumps were invented in the 20th century for hospital use. They were inspired by those of the dairy, which is why they were as impractical as they were bulky. It wasn't until mid-century that a Swedish engineer, Einar Egnell, set out to design a comfortable yet electric breast pump that mimicked the rhythm of nursing babies. After years of testing he succeeded and, in 1970, his invention was the basis for founding the Ameda company, one of the best-known breast pump firms in the world. And it is that around this product there is a global market, millionaire and…in expansion. According to estimates by the consultancy Gran View Research, the world business of breast pumps will exceed 5,000 million dollars in 2030.

This meteoric growth is due, in large part, to the fact that in current breedings, extracting milk (in English, pumping) is something that is becoming more widespread. Especially in countries like the United States, where maternity leave is so insufficient that, at the turn of the century, 85% of lactating mothers practiced pumping at work to express their milk, bottle it, and store it. This percentage increased in 2010, when a law decreed that electric breast pumps be covered by medical insurers.

In the richest country in the world, expressing milk in the office is commonplace. Because it's a process that takes time, American women also pump while cooking, talking on the phone, or driving (there are "hands-free" models). In the cradle of capitalism, pumping is part of the daily life of millions of working mothers. In large part, this is due, as the political scientist Courtney Jung pointed out in the essay Lactivism (Basic Books): "Government initiatives to promote breastfeeding have focused exclusively on breast pumps", ignoring other key aspects such as paid maternity leave.

In Spain, with more generous maternity leave, milk extraction is not so widespread, but the breast pump, as happened to Laura, is present almost from minute one. The Spanish Association of Pediatrics, in line with the WHO, recommends exclusive breastfeeding for the first six months and combined up to two years. Thus, for Spanish mothers who work outside the home and want to meet these premises, the breast pump also becomes a vital instrument, since the sixteen-week low does not cover the six-month recommendation. As a consequence, mothers who return to face-to-face work (three out of four) and want to maintain exclusive breastfeeding opt for the breast pump.

This is revealed by the second Elvie Spain Barometer: Breastfeeding and returning to work, published this May. According to the data provided by Elvie, 50% of the respondents used a breast pump at work upon return to employment. Its use increased by 60% compared to those who used it during maternity leave. The Barometer also revealed that Spanish mothers have similar problems to American mothers when expressing milk in the office: 55% considered that they did not have enough breaks for it and 62% pointed out that they were not long enough. 65% indicated that they did not have adequate facilities either.

As in the United States, in recent years in Spain campaigns to promote breastfeeding have increased, both from institutions and from other, more informal means. To highlight, social networks, which are an excellent platform for lactivism or, as Wikipedia describes: "The doctrine or practice of vigorous actions to achieve a culture of lactation."

For this movement, linked to the current of so-called natural or "attachment" parenting, breastfeeding is the only viable way to feed the baby and create a bond with the child. A superchild, even, thanks to the status of "superfood" that breast milk enjoys and that makes a market for buying and selling exist on the internet, for which the breast pump is essential. Largely due to the pressure of lactivism, the bottle—until recently a respectable means of feeding—has become demonized. As the aforementioned Courtney Jung pointed out: “Today breastfeeding is no longer a way of feeding the baby”, it is “a moral marker”, which distinguishes good from bad mothers.

This almost moral obligation to give breast milk is another reason for the boom in breast pumps. From a market that is becoming more sophisticated and from a practice, pumping, that is normalizing. The aforementioned Elvie Barometer includes statements by midwife Laia Casadevall, influencer of attachment parenting, who considers it "important" that mothers who have to return to paid work be able to perform extractions: "This is key to maintaining production and breastfeeding longer, to be able to make a milk bank for the lactating creature and to relieve the breasts in case of need”, he writes.

Although no one doubts that it is a wonderful way to feed babies, breastfeeding is not always possible or convenient. Therefore, the breast pump can be both a useful tool and a way to prolong unsatisfactory lactation. Nor is the use of a breast pump always satisfactory. An informal survey, among several mothers who used it, ended with varied but mostly negative adjectives: "sacrificed", "slave", "practical but painful", "useful but annoying", "uncomfortable", "it didn't work for me" . Others describe it as “a relief” and even “quite addictive”.

For Beatriz Gimeno, one of the few Spanish authors who have dared to question the discourse of lactivism, breast pumps participate in the business of products related to lactation: "A huge market, which pro-lactation women categorically deny, and which includes the business of the same breast milk, which is already sold on the internet”, he explains. The author of Breastfeeding, politics and identity, (Ed. Cátedra) points out the contradictions of this apparatus: "Because what it does is contribute to redefining milk as a separate product from breastfeeding: the good thing is the milk itself, not how ingested... This would invalidate all attachment theories etc. However, no one seems to care."

The author also recalls that "rarely is it made explicit that if you don't want to breastfeed there are some pills that prevent you from using the breast pump." Gimeno, who considers that breastfeeding is also a political practice, observes that through this utensil "an alternative to breastfeeding seems to be being built." An alternative that uses breast milk but: "It makes the other possibility invisible: completely renouncing the slavery of the breast pump."