A healthy dose of oxytocin


Last week I wrote about how the 26th Annual International Breastfeeding Conference made my brain buzz and realized that that doesn’t exactly sound like fun. This week I’d like to share that the conference was also full of smiles and a healthy dose of oxytocin.

Milk Duck Race

Each year, Healthy Children Project puts on a Milk Duck Race to raise awareness and funds for a chosen maternal child health organization. This year’s race raised over $800 for Our Dream Initiative’s Warm Hug Care which encourages Kangaroo Mother Care (KMC) as an intervention to reduce infant mortality in Egypt. 

The winning duck’s handler is crowned Milk Duck Royalty. Sheri Garner now holds repeat Queen-dom thanks to much feather-to-skin contact (get it?). 

Weird findings

Cindy Turner-Maffei and Karin Cadwell close out the conference with their ‘Weird findings’ presentation. It’s equally fascinating and entertaining and they manage to sprinkle in just the right amount of silliness and seriousness. We learned about pink yak milk, spider milk, goat wet nurses and donkeys with “good moral reputations” and the alleged ability to cure distemper and poisoning. And what’s a breastfeeding conference without music and a quirky little dance? This year, the duo performed to the jaunty tune “I’m a Mammal”.  

An effervescent two-year-old 
Gia announces in Portuguese, “I just want to sing”.

Cristiano Boccolini’s, PhD and Patricia Boccolini’s, PhD two-year-old traveled all the way from Brazil to accompany her parents during their presentations. She was such a joy to have in the space! It was a beautiful example of how families can function in a professional setting. 

Fun and games 

Participants had the opportunity to join in on a scavenger hunt throughout the conference week, socialize during the nightly hotel reception, and play a game called Thinking Outside the Box.  

Here’s a sampling of questions:  

Q: Sweeteners (such as sorbitol) in the diet of a breastfeeding mother can be a cause of diarrhea in a baby under 3 months old. True or False 

A: Find it here

Q: A systematic review of factors influencing non-medically indicated formula supplementation of newborns found that newborns born ______ were more likely to receive formula supplements. 

  • During the day
  • During the night

A: Find it here

Q: A recent study of 797 newborn boys found that circumcision should be performed in the second week to preserve exclusive breastfeeding. True or False

A: Find it here

Q: A breastfed infant who has a zinc deficiency will improve if the lactating mother increases the zinc in her diet or takes a zinc supplement. True or False 

A: Find it here

Q: According to a 2019 study, is it possible to “know the flow” based on the nipple bottle label?

  • Yes
  • No

A: Find it here

Q: The source of calories in breastmilk for nurslings over 2 is mainly ____.

  • Lactose
  • Fat 

A: Find it here

Q: In a 2019 Chinese study about breastfeeding and air pollution, breastfeeding was associated with a _____ risk of lung function. 

  • Lower
  • Higher

A: Find it here.  

Q: A Spanish study reported in 2019 that first time mothers are _____ to have problems with lactation. 

  • More likely
  • Less likely 

A: Find it here.

Q: According to a 2016 meta-analysis, breastfeeding ____ the risk of osteoporotic hip and forearm fracture in premenopausal women. 

  • Increases 
  • Decreases 

A: Find it here

Q: According to a CDC study of breastfeeding in the U.S. of children born from 2009 to 2015, the difference for exclusive breastfeeding through 6 months between black and white infants ______. 

  • Widened 
  • Narrowed 

A: Find it here

Q: According to a report from all U.S. Poison Control Centers, two of the categories of drugs for most calls were ethanol and insulin. True or False 

A: Find it here

Participants were given stamped letters corresponding to their answer and then asked to unscramble the phrase.

Q: Probiotics in infant formula improves the mineral content of the baby’s tooth enamel. True or False 

A: Find it here

Ask the Experts
Conference participants gather at the hotel.

In the Ask the Experts session emceed by Cindy Turner-Maffei, participants had a chance to ask the panel of presenters their burning questions. The format illustrates well how the conference set up is intimate and engaging. 

Below is a summary of the Q&As. Answers are not given in direct quotes for brevity. 

You can find the full list of the conference speakers and presentations here.  

Q: Often many hospitals will not allow mothers to breastfeed in the NICU because they claim babies will expend too much energy and consequently lose weight. What recommendations do you have? 


Dr. Maureen Groer- These babies don’t grow no matter how much we give them. It’s not because they’re not getting enough calories, but because they don’t have the microbiome to metabolize the foods. The best thing we can do is give them mother’s own milk because it contains the microbial infusion, the pioneers, that help avoid the terrible dysbiosis that makes them not grow very well. 

Dr. Maastrup- Babies can’t lose weight from sucking at the breast.  Will they also lose weight from sucking on a pacifier? They’re losing weight from using their energy being sad and crying in an incubator.

 Dr. Al Alafy- When they are not sucking, they are really stressed, and stress burns more calories. Mother hugging the baby while breastfeeding and being in close contact reduces energy expended to warm himself.

Dr. Cadwell- VLBW babies who experience intermittent KMC grow better and are discharged faster. 

Lilian Scott- From a swallowing standpoint, babies have more control at the breast. With self regulation, they only take what they can manage. If there’s a forceful letdown present, there are modifications we can help with. 

Q: One mom told me she has crazy dreams– like sexy exotic dreams while breastfeeding.  Is this just sleep deprivation?


Dr. Cadwell– I have come across some women who have these really sexy dreams. In a breastfeeding group, one mom shared her experience and all the other moms were like “huh?!” Lactation is a low estrogen, low libido state but there are some women who just feel like Earth Mother and they want to take everything in and nurture it. 

Q: Is there any research on what affects high lipase?


Fiona Jardine- I’d like to point out that saying milk is sour after storage is not just high lipase. It can also be rancid fats which is safe to feed, it just smells like legit vomit. Scalding milk works for some, not others. 

Q: What are the flat nipple breastfeeding statistics?


Dr. Al Alafy: In our population, the incidence is high in my personal experience, but solving the flat nipple is easy. We can teach the mother how she can erect it.

 Dr. Cadwell-  We received a phone call from a care provider at a hospital saying, “We don’t know what’s happened. I’ve been working at this hospital for 5 years and never had this before, and now I make my rounds and all of the sudden everyone has flat nipples.”  I went to the hospital and I made rounds with her and she was right: all of the mothers who were newly delivered had flat nipples. I thought it was crazy. I said, tell me what’s changed. The nurse said, “Well we got a new anesthesiologist who does epidurals.” We found out he was putting muscle relaxant into the epidural. Did you realize the uterus is a muscle? we wondered. The c-section rate had also gone up during that time. When the anesthesiologist changed, the flat nipples disappeared.  

Q: Could you share the cliff notes version of I Have My Certification… What’s Next? Helping Mothers Reach Their Breastfeeding Goals–Without Giving Away the Store with Paula Hart and Carin Richter? 


Paula Hart- Look at your practice from a regular business standpoint and then a medical standpoint. You will likely need malpractice insurance, you’ll have to prove to the government you are who you say you are, and please find someone in your area who has started a practice before and talk with them.  

Q: Could you share the cliff notes version of Releasing Yourself from the Pressure of Fixing the Breastfeeding Problem with Patricia Officer?


Patricia Officer- I was a breastfeeding peer counselor and when I came to the hospital, I had a huge list. I thought, “How am I supposed to do that all by myself?” So I had to say, “This is what I can do; this is the expectation and this is what is realistic.” I realized that my time would be so much better used if I trained the nurses instead of me running trying to fix the problem. So, set some realistic expectations and see if you can do some training. 

Q: What is the advice on nipple shield use for a dyad that is post-discharged and bottle-fed but trying to move back to the breast? 


 Fiona-  Like everything, a nipple shield is a tool that can be used if it’s appropriate and should be considered on a case by case basis. It’s important we don’t use a blanket ‘yes’ or ‘no’.  There are different kinds of nipple shields out there; some have better responses to others. Coming up with a good plan for the parent is vital; what does it look like if I do manage to get baby to breast with the shield? Can I get them off?

 Dr. Al Alafy- Switching from bottle feeding to latching to the breast is often mainly changing the baby from keeping mouth closed to opening with latch and getting used to the flow of the milk. The bottle has good flow and this is what the baby doesn’t like at the breast. One could use a supplementer to simulate the flow.  

Q: My kids tell me I am the furthest thing from woke. What should be my first step? 

Note: This question is heavily loaded. Turner-Maffei comments, “The wording of this question made me, as the emcee of this session, uncomfortable.To me, it implies that the questioner does not understand or perhaps respect what this term refers to. I avoid this term myself, as a white woman, it seems to me that it’s not my term to use. (I’m assuming here that the questioner identifies as white, which is, in itself, not very aware as assumptions go.) We are all on a journey…we hope to be welcoming and inclusive to all, no matter who we are, where we’re from, how we identify, how we dress, how we look. We are all perfectly imperfect human beings.”


Stephanie Carroll-  When you are trying to learn new things about being inclusive, that is on you, not on the marginalized community. Google is there for a reason. 

Q: We had a mom whose glands in her armpit blew up to tangerine size. There was no fever present and no pain. Should we be concerned?


 Dr. Cadwell- With tail of Spence and/or supernumerary breasts, which are rare, people can have them all of the way down the milk line (from the underside of the upper arm through the trunk and to the upper thigh) . When it’s in the armpit, really the only thing to do is comfort techniques– compression on the milk cells is the way they involute. Compression works but hurts like heck if milk is escaping, one can have an inflammatory response and can develop mastitis. In one case, breastfeeding was continued, but  between the end of lactation and the beginning of pregnancy, we suggested this person have them excised.  

Q: Can fenugreek block medication absorption?


Donna  Walls- Fenugreek is high in fiber which can block absorption. What I see with fenugreek really scares me.  Fenugreek is used a lot in Europe to treat pre-diabetes, so it can decrease blood sugar. It has an anti-coagulant effect also, which could be an issue with people with blood clotting disorders.  We have to be really careful about the info we’re giving. Find out who in your community is credentialed, perhaps someone from the American Herbalist Guild. If you’re telling someone to take capsules, we have to remember that that’s not fixing the problem.  

Felisha Floyd- A common conversation in maternal child health is that we have to be careful about the language we’re using:  suggesting is prescribing. Families hear all sorts of things they’re so desperate to feed their babies their own milk, they’ll do anything. 

Patricia- I like to remember the 3 steps to counseling: Tell me more about that, then repeat it, then let her say ‘yes, that’s what I mean,’ or she can add to it.  Praise her for sharing the information. Some women don’t understand how milk production works so make sure they understand the basics.

Q: Do you foresee a day where the recommendation in the U.S. will change for HIV positive moms?


Rebecca Powell- In this country, no, I would never expect it. It’s all about risk, one risk over another. What we call the developing world, where formula is not available in the right amounts and clean water is often unavailable, places where you absolutely should breastfeed exclusively, there’s a lot that will kill the babies in that day or within that week, and there’s a chance they will get HIV, but probably won’t kill them. I can never imagine when that recommendation will change here because there’s not a zero percent chance that the HIV will get passed to the baby. 

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