Sisters on a milk mission

 When sisters Kendra Valton and Gina VanCant first became pregnant around the same time, they were living several states apart. But it wasn’t long before Valton and her husband picked up and moved from New York City to just across the street from VanCant and her family. 

“We got to be moms together,” Valton reminisces. “We were conjoined at the hip.”

Enjoying their young sons, they would sit and talk. 

“Breastfeeding is all we ever talked about,” Valton says. 

Both moms endured their own breastfeeding challenges and some shared, namely when they returned to work. Impassioned by their experiences, the duo started dreaming up ways to help other parents navigate breastfeeding. 

At first, they got excited about facilitating milk shipment for mothers who needed to be away from their babies, a model similar to the services offered by Milk Stork

But as they dug into their research, Valton says they realized parents’ realities in their state:

  • Very few women continue exclusive breastfeeding for longer than eight weeks. 
  • Women who are less educated, Black, or receiving Medicaid services have lower rates of breastfeeding.
  • Ohio initiation rates and exclusive breastfeeding rates at six months remain below Healthy People 2020. [retrieved from: Ohio Department of Health]
    • Find out how your state compares here
  • Racial disparities in infant mortality are striking. 

Stunned by these stats, the sisters shifted their focus slightly to education and breastfeeding visibility, especially in the African American community. Their social enterprise, The Milk Mission, was born. 

Last month, The Milk Mission received some funding from SEA Change, to help shape their vision. 

The organization is multifaceted. It will offer an “Online Breastfeeding University” where moms can take a number of modules from their phone or other devices. The Milk Mission is also in the process of creating a breast pump distribution program. 

The duo plans to continue connecting with parents and community members with an interest in maternal child health (everyone!), by providing culturally appropriate infant feeding education. 

Valton acknowledges that there is often “cultural unattachment” from care providers who serve families of color, and she hopes to help fill in the gap.

Cecilia Obeng and colleagues point out in African-American Women’s Perceptions and Experiences About Breastfeeding:  “Historically, African-American women were utilized as ‘wet nurses,’ where women were required to breastfeed children of households where they rendered service as caregivers (27). Perhaps, after the ‘wet nurse’ era ended women within the African-American community perceived breastfeeding as a symbol of powerlessness or objectification.” 

Valton says: “We heard those stories from our grandma.” 

Valton’s approach is to bring these stories to the forefront without making those involved in the conversation feel like it’s wrong or shameful. 

As with any social organization, partnership is important to the duo. They’ve partnered with community centers in Cleveland, done work with CelebrateOne, and plan to build a relationship with Ohio State University. 

Valton recently completed the Lactation Counselor Training Course (LCTC). She calls the course an eye-opener; whereas she once connected with parents with her personal story, she now has evidence-based support tools to better uplift families.  

You can find The Milk Mission on Facebook. Stay tuned for the launch of their new website anticipated soon!

New insight into skin-to-skin contact

By Healthy Children Project 

Kristin Svensson, Karin Cadwell, Ann-Marie Widström, Eva Nissen, and Kaysa Brimdyr are the authors of a new paper suggesting that the nine stages of a newborn’s skin-to-skin contact with the mother after birth reflect a linked development pattern of behaviors learned in utero.

Healthy Children Project faculty members Kajsa Brimdyr and Karin Cadwell and colleagues from Sweden have published a new paper in Medical Hypotheses, available this month. The paper, titled “A Plausible Pathway of Imprinted Behaviors: Skin-to-skin Actions of the Newborn Immediately After Birth Follow the Order of Fetal Development and Intrauterine Training of Movements,” discusses whether the competence of a newborn in the first hours after birth is the direct result of behavior training that begins in the first 12 weeks of fetal life.

The paper posits there is a link between the behavior that develops when newborn babies are placed skin-to-skin with their mother within the first hour or so after birth – Widström’s 9 Instinctive Stages – and the pattern of motor skills developed and practiced in utero, representing a pathway to ensure survival of the newborn and the mother.

With the nine stages – birth cry, relaxation, awakening, activity, rest, crawling, familiarization, suckling, and sleeping – practiced in utero in the same specific order, the authors conclude that the newborn has been training for and prepared for this experience immediately after birth to find the breast, to initiate breastfeeding, and to contribute to post-birth maternal uterine contractions which service to minimize blood loss and speed placental expulsion.

To read the entire paper, click here.

Sugar, sugar

The behemothic bag of Halloween candy my kids have acquired over the last few days of trick-or-treating has been inducing some serious salivation and requiring my family and I to exercise some serious self-control. 

Our ancient bodies can’t help but gravitate toward this once-limited form of energy— sugar. 

In the spirit of Halloween and Dia de los Muertos, where sweet treats abound, let’s explore a few sugary-concepts as they relate to infant feeding.  

Sugar Replacements 

The obesity epidemic in the United States and other countries has increased the use of artificial sweeteners. Philip O. Anderson’s How Sweet It Is: Sweeteners in Breast Milk summarizes current knowledge regarding the transmission of sweeteners into human milk. 

Dr. Anne Eglash of the Milk Mob points out in her Clinical Question of the Week

Photo by Dane Deaner on Unsplash

There is preliminary research evidence that a maternal diet high in fructose may increase body weight and fat mass in breastfed infants. When mothers consume foods or beverages high in fructose, the level of fructose rises in breastmilk. This is not true for glucose, because maternal insulin rapidly normalizes the maternal glucose level after glucose ingestion. Insulin does not moderate the fructose level like it does for glucose.

And increasing sweetness of breastmilk via artificial or natural sweeteners in the maternal diet might predispose to later obesity. This may be partially mediated by an alteration in the gut microbiome by the sweeteners.

Human milk sugars and the microbiome 

Vanderbilt University assistant professor of chemistry Steven Townsend and colleagues’ work, Sugars in Breast Milk Help Babies Ward Off Infection, shows that the complex sugars (called human milk oligosaccharides or HMOs)  in human milk appear to provide a growth advantage for good bacteria. 

Townsend notes, “…breastfed infants have a microbiome rich in two species of bacteria: Bacteroides and Bifidobacteria. Both species are symbiotes, meaning they live with us on a daily basis, but typically cause no harm. They live in the human gut where they use human milk oligosaccharides as energy sources to grow, whereas pathogens do not.” 

Moreover, their work demonstrates that HMOs prevent the growth of Group B strep and have antibiotic properties against a number of additional pathogens, including staph.

Interestingly, Townsend and colleagues found that different women produce HMOs with varying levels of antibiotic activity.

Low carb diet and lactation 

Similar to the increase in alternative sweeteners, varying diets that limit sugar intake have become particularly popular. 

“The ketogenic diet is a weight loss strategy involving a diet that is high in fat, adequate in protein, and very low in carbohydrates,” Dr. Eglash explains in another Clinical Question of the Week. “By eating low carbs, the body is forced to break down body fat for energy, causing a rise in blood and urinary ketones.” 

When blood ketones become too high, blood pH becomes too low, resulting in a sometimes life-threatening condition called ketoacidosis. 

While an average non-lactating individual on a keto diet probably wouldn’t reach a high enough level of blood ketones to become dangerous, lactating women are at a higher risk for ketoacidosis because of the energy expenditure required by lactation, Dr. Eglash continues. 

She concludes: “Based on the cases in the literature, it would seem wise to advise breastfeeding mothers to avoid a strict low carb diet, particularly in situations of very high energy demand, such as if she is exercising heavily, donating extra milk, or nursing multiples.” 

Candy and formula companies 

Avoiding or limiting sugar intake in today’s world is quite a challenge, and so is being an ethical consumer. 

If you do succumb to that Stone Aged craving or simply like to indulge in velvety-chocolate decadence, you might like to know that many candy companies are owned by formula companies that don’t have maternal child health in their interest. 

Join us for the 26th Annual International Breastfeeding Conference!

There is a lot to love about autumn in Wisconsin, but when the wind howls, chilling to the bone, I start dreaming of Floridian palms and sunshine. Just as the magnificent maple leaves begin to fall and the sky begins to darken, Healthy Children Project’s Annual International Breastfeeding Conference flyer is released, sparking great anticipation for four days of friends, old and new, fascination, inspiration, and… the beach. 

Deerfield Beach, Fla.

The 26th International Breastfeeding Conference will be held from January 14 to 17, 2020 in Deerfield Beach, Fla. As it’s proven year after year, this conference is sure to broaden our perspective and enhance our skills caring for parents and their babies, challenge us to integrate new knowledge, and reignite any dimming passion for the work we set out to do.  

This year’s conference faculty lineup is just as impressive and culturally diverse as years’ past. In the next several weeks, we will feature new presenters as well as some of those returning. Stay tuned!

In the meantime, you can check out previous posts featuring work from:

Dr. Cristiano Boccolini scheduled to present Evaluating the International Code of Marketing of Breast-milk Substitutes in Brazil: Multi-NBCAL Study

Stephanie Carroll, MBA, IBCLC, CLC, CLS returning to share Barriers to Breastfeeding in Appalachia: A Sociocultural Perspective

Melenie Duval, ALC, BA sharing Building Community for All Families: A Collaborative Care Model for Pregnancy through the First Year

Felisha Floyd, BS, CLC, IBCLC presenting Will the Real Slim Shady Please Stand Up?”  The Importance of Hospital and Community Connection on Maternal Child Health

Maureen Groer, PhD, RN, FAAN will present Human Milk, Lactation, and the Gut Microbiome

Fiona Jardine, MA (Cantab.), LLM, MLS, ALC and her work Breastfeeding without Nursing: Why Do Some Breastfeeders Exclusively Pump? 

Ragnhild Maastrup, RN, PhD, IBCLC presenting Nipple Shield Use in Preterm Infants: Prevalence, Reasons for Use, and Association with Exclusive Breastfeeding and Possibilities for Closeness Between Infants and Parents in Neonatal Wards: Results from 36 Countries in the Neo-BFHI Survey 

Erin McKinley, PhD, RD, LD, CLC, CHES presenting Baby Steps: Improving Pregnancy, Breastfeeding, and Parenting Services for Students and Employees on College Campuses

Rebecca Powell, PhD, CLC returning to share more about Virus Killing by Specialized White Blood Cells in Breast Milk: How Breastfeeding Can Be Protective Against HIV Infection

Work from Patricia Officer, BA, CLC, CLS

Lillian Scott, MS, CCC-SLP, IBCLC offering When Milk is Hard to Swallow

Ravae Sinclair, JD, CD (DONA), LCCE presenting A Public Health Offering: How Exploring Implicit Bias Can Improve Breastfeeding Outcomes, Reduce Inequities, and Reshape the Lactation Workforce and …Continuing the Conversation

The conference is also a great time to reconnect with Healthy Children Project faculty that you may have learned from during trainings throughout the U.S. 

We invite you to learn more about this wonderful opportunity ahead. Click here for more conference information and registration. 

OT weighs in on holistic approach to infant feeding support

The difference in health outcomes in a proactive versus reactive medical system can be pretty striking. And while proactive medicine invests more time and resources up front, as blogger Todd Hixon points out, it ultimately reduces healthcare cost overall.

“…Proactive medicine is by far the most powerful opportunity to both improve health status and reduce the bloated cost of the U.S. healthcare,” Hixon writes.  

In the U.S., most families are subject to reactive medical care; they (sometimes) receive treatment when complications arise and progress.  

There are pockets where care is shifting though. Last year, we featured Dr. Ann Croghan’s work where she’s implemented a prenatal and postpartum physical therapy program at Heart of the Rockies Regional Medical Center (HRRMC) in Colorado. 

Croghan focuses on decreasing birth intervention, conducts postpartum day one physical therapy visits in the hospital, and follows up with a six week postpartum visit for a pelvic floor muscle assessment, biomechanical assessment, and a plan for safe exercise progression.  

Proactive care addresses health holistically, looking at social and environmental, physical and mental health needs.  

Tracer pictured with her children.

Another such superstar care provider is Sipporah Tracer MS, OTR/L,CLC practicing in Bergen County, New Jersey and formally in the Hudson Heights neighborhood of New York. Tracer’s work includes her occupational therapy (OT) practice where she works primarily with pediatric patients, running a breastfeeding lending library– the Teaneck Breastfeeding Gemach— and facilitating a free community breastfeeding support group. 

This comprehensive article offers a window into the type of sensory work she’s doing.

“What’s so nice about this profession is that it has such a holistic approach,” she begins. “We’re not just looking at the latch and suck–although that’s all so important– we’re looking at the baby and mother as a whole… looking at all of the factors that impact the baby’s performance.” 

Tracer highlights a few important components to create an environment ideal for babies’ development. She makes clear that each baby has their own threshold for stimulation.

Starting around the time babies are four to six months old, they become interested in becoming mobile. During this time, a breastfeeding parent might notice that their child wants to crawl, pivot, and move and have a decreased attention during breastfeeding. 

“We can try to meet the baby’s needs by providing sensory input in order to affect their behaviors and their arousal levels,” Tracer begins. “Rhythmic vestibular movement is calming input for many children and often assists them with focusing.”

In Tracer’s experience, having mothers rock babies in a glider that gives linear vestibular movement allows the baby to receive sensory stimulation and helps them to focus more on the breastfeeding.

Tracer subspecializes in reflex integration work.

“Understanding  primitive reflexes can really assist in breastfeeding,” she adds. 

For instance, the Babkin reflex— where infants open their mouths in response to pressure on their palms– may be useful if the mother and baby are struggling to latch.  

Another tool Tracer uses is baby wearing. 

“We have lots of places to put our babies down, especially on their backs with restricted mobility,” she says referring to car seats and swings and cradles and bouncy contraptions, etc. 

She goes on to say that as much as these “nests” can be saviors, babies set down for long periods of time aren’t receiving sensory stimulation from a human, which is vital to setting up their future programming 

Interestingly, researchers found that newborns were more apt to shift gaze toward touch when the touch was from another person as opposed to from an object. 

What’s more, increased carrying reduces infant crying which creates a less stressful environment for all. 

And as Danielle Downs Spradlin of Oasis Lactation Services points out, “Babies have a sniffable head that is easily accessed when carrying. It’s a perfect system.” The smell of babies triggers rewards in parents’ brains. 

Carrying a child constantly can be quite a frustration for some parents, Tracer acknowledges, especially in our culture where babies are often deemed needy or clingy for requiring connection. 

She suggests reframing that mindset: carrying infants builds a strong foundation for their sensory systems. 

“Parents are contributing to their baby’s development, ” Tracer says. “The things we do during these critical early stages become the building blocks for the future. .” 

There are potential long-term risks to not providing healthy environments for babies’ development.

“We do know that underdeveloped systems really do impact learning and behavior in schools as well as general motor-development,” she explains.

Her main point though, is not to instill fear in parents, but empower them with this knowledge. 

Having recently completed the Lactation Counselor Training Course (LCTC), Tracer says she feels well-equipped to guide mothers and families to spending their energy and limited resources on evidence-based practices.   

“So many times I find that as mothers who are breastfeeding, we are so dedicated, we want to do anything [for our babies],” Tracer begins. “Being empowered and equipped with the most accurate information is really life-changing and powerful.”