Thursday, February 9, 2017

Pumping experiences survey - Post 1 of the Series

First off, a giant THANK YOU to all the mothers who participated in the online survey. Your assistance was amazing! Three blog posts will be dedicated to the survey – expect them on 2/10, 2/28, 3/15.  I also have to apologize for the day in getting this out – I have actually been overseas managing our other giant milk project.

We started the pumping experiences survey to see how mothers would respond to differences in pump output, based on their normal pumping experiences. We had predicted that mothers who had dramatic changes in output in the experiment – either randomized to much more or much less than they typically produced – would have strong reactions to the images and the responses would tell us a lot about how women perceive their milk supply.

The survey randomly assigned each mother to one of three images showing expressed breast milk– one photo showed 1 ounce of pumped milk, the second photo showed 6 ounces of milk, and the final photo showed 12+ ounces of milk. The volumes were classified as “low”, “intermediate”, and “high” volume.

The photos created an experimental condition where women might be mismatched to their normal pumping output – either more or less – or pump the same amount. For the purposes of this post, we’re just going to focus on the two groups – pumped less and pumped more.

An equal number of mothers were exposed to each photo and were then asked to rate if they pumped the same, more, or less than the mother typically pumped. Of the 899 mothers who completed the experimental condition, 412 reported the volume in the photo was more than they usually produced, 269 reported a reduction in volume, and 218 reported no change.

We will not talk about the group that were randomized to the photo that best matched their output (and overwhelmingly, this was the intermediate volume) in this post.

The most common response in the increased volume group: “Great!”, followed closely by “Awesome”, accounting for 30% of all responses in this group. But their increased outputs weren’t just great and awesome – mothers were ecstatic, thrilled, and amazed. Mothers also responded that they felt successful and accomplished. Happy tears and happy dances were also reported, as well as feeling like winning the lottery. Several mothers reported that they would feel like supermothers or milk goddesses.

Disappointment was the most common response in the decreased volume group, followed by stress. Several women reported frustration, and 2% of mothers believed that if such output continued, pumping would be a waste of time and viewed continued pumping as counterproductive to their own happiness. Several mothers voiced concerns about further decreases in supply or losing their supply. However, about 10% of mothers took a more pragmatic approach, stating that they must have been dehydrated while a similar number of mothers suggested that there may have been a problem with the pump suction or that they may have pumped too soon. A small group of women reported feeling devastated, with multiple women stating that (I) would feel like I had let my baby down.

For a group of mothers, perceptions of milk supply based on pumping output were linked with their identities as mothers.  Tomori (2014) and others have written on this perception, especially in the context of the United States, of breastfeeding and milk volume being socially identified as aspects of maternal identity. Knaak (2006) suggests that such associations may arise from perceptions of risk, as breastfeeding being viewed as a "scientifically valid" strategy for minimizing risk . Marshall et al., (2007) however, argue that perceptions of good mothering associated with breastfeeding and milk supply are much more dynamic and fluid, changing for individual women over the course of their motherhood. Women's' perceptions of good mothering, as partially defined by exclusive, extended breastfeeding, while frequently present in early lactation shifted as the infant aged, and good mothering became increasingly defined by whatever maternal actions resulted in a "healthy, happy baby" - with happy baby defined by the mother (Marshall et al., 2011).

Responses to the change in output were also consistent between groups. Mothers in the decreased group overwhelmingly planned to drink more water, and a significant portion also planned to nurse more. A few mothers were committed to oatmeal, brewer’s yeast, and herbal galactagogues. Mothers in the increased production group planned to review the day and figure out what I did so I can do it again, to paraphrase several mothers.  

Next post in this series: Breastfeeding and pumping practices in mothers


Knaak SJ. 2006. The problem with breastfeeding discourse. Can J Public Health 97(5):412-4.

Marshall JL, Godfrey M, Renfrew MJ. 2007. Being a 'good mother': managing breastfeeding and merging identities. Soc Sci Med. 65(10):2147-59.

Marshall JL. 2011. Motherhood, breastfeeding, and identity. The Practicing Midwife 14(2):16-8. 

Tomori, C. 2014. Nighttime Breastfeeding: An American Cultural Dilemma (Fertility, Reproduction and Sexuality). Berghahn Books.