Moms can and do have dignified conversations about touchy subjects

The notion of ‘The Mommy Wars’ is incessantly covered in the media. Some of it good, some of it repulsive. Most recently, I saw ‘The Mommy Wars’ come up in the Analytical Armadillo’s An Open Letter to Jamie Oliver about Breastfeeding.

“I’m a tad unimpressed with the whole situation too to be honest, particularly the newest trend to try and silence all discussion surrounding infant feeding for fear of offending, well, everyone,” the author writes. “Honestly if I hear the words “mummy wars” one more time, I fear I may lose it entirely.”

The letter brought to mind exchanges between two different friends.

The first was with a friend who feels very judged and stigmatized for her decision to breastfeed beyond infancy. During our latest exchange, I shared my inspiration from Anna Blair’s International Breastfeeding Conference presentation Motherhood: Identity, social stigmas and resilience. Blair’s insight allowed us the opportunity to not only acknowledge my friend’s feelings of being judged, but to talk about how and why we judge others.

I told her about Abby Theuring, MSW, The Badass Breastfeeder’s I Judge You piece, and how it’s helped me to own my own judgement of others. It also helped me to be cognizant about what I do with that judgement. My friend and I made an agreement that we would try to be more open to learning from our judgement. We agreed that instead of passing judgement and leaving it at that, we would attempt to ask respectful questions to learn more about the choices people make different from our own.

Several days later, another friend and I chatted while our kids played together. We talked about my upcoming anatomy scan, and learned that the OB I was going to see was the same OB who performed one of her son’s circumcisions. She told me she would recommend him if we end up with a boy.  

Instantly I remembered my earlier conversation with my other friend.

“We won’t be circumcising,” I told her. Then I took a deep breath– because I was afraid of what my question might turn into– and said, “May I ask why you chose to circumcise your boys?”  

She told me, and then she asked why I will not circumcise if I have a son.

I gave her a very honest answer. We are still friends.

I wanted to share this exchange, not to start a debate about genital cutting (which it inevitably will, right?) but to demonstrate that mothers can and do have dignified conversations about our parenting choices, even when it comes to something as sensitive and controversial as circumcision.

My friend and I might not see eye-to-eye when it comes to genital cutting, but I respect that her decision was not mine to make. She reciprocates with the same respect.

The Analytical Armadillo’s letter continues: “The great infant formula marketing machine (protecting its multi billion pounds profits), has done a great job of shutting down dialogue by suggesting mothers should feel guilty or are being judged…”

As I continue to reflect upon this experience, I wonder if it is too bold to think that companies not only have a hold on our conversations involving infant feeding, but that they have infiltrated and influence nearly every parenting choice that we make. 

The exchange of ideas is a debilitating thing to those that profit from our silence. Cindy Turner-Maffei reminded me of the Crucial Conversations approach (find the book here,) a technique developed to start conversations about touchy subjects like circumcision. Cindy explains that “the approach trains one to think of the other as reasonable, and to inquire about their rationale for holding belief/opinion from that position (rather than just ‘othering’ people with differing opinions.)”
What a powerful tool this could be for parents! (Alison Stuebe, MD, MSc also recommends Crucial Conversations for lactation professionals to help them establish mutual purpose and mutual respect with physicians and other colleagues.)

Please tell us about your respectful conversations about tricky subjects in the comments below!

Absurd and awesome products

Last year I wrote a post, Commercial products marketed at breastfeeding families, to call attention to the variety of companies and products that prey on mothers and babies. Many of the products are expensive, some of them are completely useless and several of them totally disregard how lactation and breastfeeding work, undermining mothers’ desire to breastfeed. The products ranged from for-profit donor milk to breastmilk enhancers to alcohol testing strips.

I’ve compiled two more lists of products to share with you today. The first list contains the most absurd baby products EVER (and one to use only when medically necessary.) The second is a compilation of awesome, innovative, helpful products that empower families. Sadly, you’ll notice that The Absurd list is much longer than The Awesome. If you have suggestions for The Awesome list, please let us know!

The Absurd

  • This one takes the cake. A vagina boombox for pregnant women. No joke. Pregnant mothers can insert a pink device into their vaginas, hook it up to their smartphones and play music for their unborn babies. The gadget costs over $100. So. Weird. So. Useless. As a friend of mine puts it, “babies can hear without being plugged in.”
  • Unlike vagina boomboxes, there’s nothing seriously wrong with fancy barf bags, except for the fact that I can think of 100 better ways to spend my money. On the bright side, they’re biodegradable!
  • Fetal keepsake imaging and heartbeat monitors used for creating fetal keepsake images and videos are strongly discouraged by the FDA.  In a consumer update, an FDA biomedical engineer Shahram Vaezy, Ph.D. is quoted saying: “Ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles (cavitation) in some tissues.” The long-term effects of tissue heating and cavitation are not known, the report goes on.
  • A gadget that tweets when baby kicks has been praised for being “a great way to keep dads in on the action by notifying them when mom is feeling little jabs from within.” I worry that products like this might completely wipe out face-to-face communication.
  • Baby perfume. Whhhyyyy?!! Why would you mask that naturally intoxicating human baby smell?!
  • This article reports that milk resembling human breast milk has been produced by genetically engineered cows.  “Chinese researchers announced in the journal PLoS ONE…that they had engineered cows to secrete milk containing lysozyme, a protein found in human breastmilk that boosts the immunity of breastfed babies,” the author writes. Gross! The article includes Professor Peter Hartmann’s response: “This is an interesting scientific achievement but it really has little relevance to feeding babies,” said Peter Hartmann, a professor at the University of Western Australia. He said lysozyme is only one of 279 proteins in human milk that provide protection to babies. Babies are also protected by antibodies circulating in the breastfeeding mother, said Hartmann, who is president of the International Society for Research in Human Milk and Lactation. “Breastfeeding is not just pouring breastmilk down the baby’s throat. It involves a very complex interaction between mother and infant,” he says. “Claims of producing cows that secrete breastmilk are naïve to the extreme,” he said, adding lysozyme would be largely destroyed during pasteurisation of cow’s milk.
  • This vest allows caregivers to attach a baby bottle to it. In one advertisement, the product is shown attached to a child sitting in his/her carseat. First off, aftermarket products are not safe to use in or on car seats. Secondly, regardless of infant feeding method, feedings provide the opportunity for a loving, intimate interaction. This product touts ending parents’ frustration with “the dropped bottle,” but I worry that it will only encourage solitary, disconnected feedings. Although this device isn’t exactly bottle propping, I also worry that it may pose some of the same risks. I have similar concerns with this bottle holder.
  • Complementary feeding devices like this, this and this aren’t only odd, they are completely unnecessary. Read more here, here and here in regards to Baby-Led Weaning.
  • This product analyzes a baby’s cry which “teaches parents to distinguish the different types of cries of their baby.” Parents have the capacity to learn their babies’ needs before they start crying, because babies communicate in many ways!

The Awesome

  • These pregnancy bands for expectant couples replicate any movement felt by the mother on a matching band for the partner so that he or she can “feel” the baby’s kicks. This product could be a great tool for surrogacy and adoption. Unfortunately, these bands are not actually for sale. 
  • This system allows bereaved families to spend more time with their babies.
  • PATH program officer Kimberly Amundson and colleagues with the University of Washington and the Human Milk Banking Association of South Africa developed a smartphone app to guide flash-heat pasteurization of human milk from donors. The mobile-phone app directs and monitors a simple heat-flash pasteurization process and transmits data to quality assurance supervisors.
  • Back in 2014, over 100 parents, engineers, designers and healthcare givers gathered at the MIT Media Lab for the “Make the Breast Pump Not Suck” Hackathon. Erin Freeburger and Robyn Churchill and their team created the Mighty Mom utility belt, “a fashionable, discrete, hands-free wearable pump that automatically logs and analyses your personal data.” Find out more about the Hackathon here, including other winning designs and a research paper and documentary about the Hackathon.
  • This Mashable article highlights eight apps and mobile-based services that revolutionize maternal child health care in developing nations.

What would you add to the list and why? Please add your comments below!

From MDGs to SDGs

Time does not stand still when you have two spunky, young children and another on the way. As I loaded our family calendar this month I thought, “Holy buckets! March already?!” And then I thought, “Holy buckets! Is it really 2016?!” Sure enough.

Dr. Cristiano Boccolini
Dr. Cristiano Boccolini

With the end of 2015, came the end of the Millennium Development Goals (MDGs) era. Back in January at the 22nd Annual International Breastfeeding Conference, Cristiano Boccolini, PhD, MS presented Moving Beyond the Millennium Development Goals: Research challenges in breastfeeding.

Dr. Boccolini pointed out that breastfeeding fit into all eight of the MDGs. Here are some examples of what conference participants came up with:

  1. Eradicate extreme poverty and hunger.

  • Breastfeeding is essentially free.
  • Children who are not breastfed are sick more often forcing families to miss more work and spend resources on medical care.
  1. Achieve universal primary education.

  • Breastfeeding promotes optimal interpregnancy intervals. When families have less children, they can invest more in them.
  • Children who are not breastfed have lower IQs.
  1. Promote gender equality and empower women.

  • The act of breastfeeding itself empowers women.
  • Women who do not breastfeed are forced to spend money on artificial feeding methods leaving them with less money to spend on other things like education.
  • Breastfeeding mothers have a better chance to educate themselves and/or work because their children are sick less.
  1. Reduce child mortality.

  1. Improve maternal health.

  • Women who do not breastfeed bleed more postpartum.
  • Breastfeeding mothers suffer from less anemia because they experience fewer menstrual cycles.
  • Breastfeeding reduces the risk of PPD.
  1. Combat HIV/AIDS, malaria and other diseases.

  • Breastfeeding provides improved response to injectable vaccines.
  1. Ensure environmental sustainability.

  1. Global partnership for development.

The 2015 MDG Report covers the progress we made and what challenges and inequalities we still need to tackle. Spoiler: We have a lot of work to do.

The Sustainable Development Goals (SDGs) pick up where the MDGs left off. They are “an even more ambitious set of goals” comprised of 17 goals and 169 targets to wipe out poverty, fight inequality and tackle climate change over the next 15 years. [http://www.un.org/sustainabledevelopment/blog/2015/12/sustainable-development-goals-kick-off-with-start-of-new-year/]

Dr. Boccolini shared his concern over the sheer number of goals and targets.

“Where are we in the global agenda?” he asked.

The SDG targets are certainly not as straightforward as the MDGs.

Dr. Boccolini also expressed his concern regarding measurement of the goals. How do we define conservation? How do we define restoration? he wondered.

A Council on Foreign Relations article covers SDG criticism reporting that they’ve been called “too broad” and “absolutist.”

“The SDGs are also expected to be more costly [than the MDGs,]” the author writes.

The same article quotes Sarah Hearn, associate director and senior fellow at New York University’s Center on International Cooperation.:“The MDGs were about resource transfer from rich countries. The SDGs are universal—they’re supposed to apply to all countries and try to overcome the ‘West lecturing the rest’ dynamic.”

Dr. Boccolini questioned if the SDGs were the product of a “Since-we-are-effect.” Since we are doing this, let’s do this…

He left us with this:

ODG (17 targets)=> SDG (169 targets)…. OMG!

“When you do everything, you don’t do anything at all,” he said. “I hope I am wrong. I hope we can find our way in the new global agenda.”

Happy Birth Day, a new project by Dr. Kajsa Brimdyr

I just finished watching the Happy Birth Day series, a vignette of real birth experiences produced and filmed by Healthy Children Project’s Dr. Kajsa Brimdyr, PhD, CLC and Emmy nominated producer Judy Blatchford with my two- and four- year-old-daughters… I am so excited to give birth again!

For me, watching these mothers, their partners and their babies reaffirms how remarkable normal birth can be.  Birth in its realness and rawness. Not some glammed-up, sensationalist reality birth show, like the ones I grew up watching obsessively.

“When you watch those other TV shows, it’s like you’re an anthropologist,” Brimdyr comments. “You’re learning, ‘In my culture, this is how we do it.’”

My first birth followed suit. Supine, legs spread, as I wailed in horror.

Then thanks to normal birth advocates like Brimdyr, I learned what birth can be. My second daughter was born differently. After Iris came earthside, I wanted to parade my new family around our neighborhood. I was so proud, so triumphant

The idea that a healthy baby is not all that matters during childbirth is beginning to take hold in our country. Google “A healthy baby is not all that matters” and you’ll find several great articles. But what does a respectful, family-centered, empowering birth actually look like? Happy Birth Day gives moms something tangible, something attainable.

“We learn so much from watching,” Brimdyr says. “And so much of natural childbirth doesn’t show up in our TV shows, in our movies, in our YouTube videos.”

Unlike their reality TV counterparts, the Happy Birth Day vignettes “entice through compassion and empathy rather than enticing through drama.”

“You fall in love with every one of these couples,” Brimdyr says. “You watch their experience and you’re drawn in. It’s amazing. Birth doesn’t need extra drama.”

Brimdyr and Blatchford filmed the births at Tobey Hospital in Wareham, Mass., a Baby-Friendly designated facility that offers nurse-midwifery care.

When I talked to Brimdyr for this article, I argued that the majority of moms aren’t birthing in Baby-Friendly facilities nor with midwives, but she reminded me of the prevalence of midwives in our country and of our increase in Baby-Friendly designated facilities. Currently, 12.8 percent of births occur at Baby-Friendly Hospitals, which exceeds our 2020 goal.

Brimdyr’s inspiration for Happy Birth Day stems from her most recently published research The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth (available here.) The research shows the negative impact of common labor drugs on breastfeeding and babies’ behavior immediately after birth. What’s more, most primiparas mothers who give birth in the U.S. will get some sort of epidural concoction. A 2011 National Vital Statistics Report concludes that “overall, 61 percent of women who had a singleton birth in a vaginal delivery in [the 27-state reporting area] in 2008 received epidural or spinal anesthesia…”

Saddened by the results of her study, Brimdyr says that ethically she needed to offer mothers an option as to what is possible when birthing their babies.

“If I’m giving a worry, I want to give a hope at the same time,” she says. “This is what’s possible.”

The Happy Birth Day project offers a unique setup of short videos that can be rented or purchased individually.

“We want to make sure that they’re really accessible to moms, dads, grandmas and anyone who is thinking about getting pregnant,” Brimdyr explains.

The setup also makes it easy for childbirth educators to incorporate the videos into their classes. Likewise, the Birth Strategies portion of the project is a great tool for educators. The videos include much of the same footage as the Birth Stories, but it’s reorganized to showcase key concepts like movement and massage.

While I see Happy Birth Day as a great tool for parents, I also think it is invaluable to healthcare providers who have never seen normal birth.

“Sometimes you are only familiar with what is happening in your institution,” Brimdyr comments. “It’s fun to be able to see a glimpse of what’s happening in other areas.”

When Brimdyr first presented her project to Tobey’s primary midwife Louise Bastarache, CNM, NP, MS, Bastarache didn’t understand Brimdyr’s interest.

She said that because birthing mothers typically go through the same stages, natural childbirth wouldn’t make compelling enough television.

“But every mother’s experience is slightly different and every mother’s experience is amazing and life-affirming and magic,” Brimdyr explains. “To get a glimpse into this time of a woman’s life is such an honor.”

Happy Birth Day documents how partners are transformed too. It is so refreshing to see fathers as active participants during their babies’ births.

Brimdyr specifically recalls one of the participating partners.

“He was unprepared for how profound it was going to be for him,” she explains. As he retells their birth story, Brimdyr goes on, you hear his passion of realizing how important it is for him to become a father.

“That authentic passion is so important,” Brimdyr comments.

Happy Birth Day oozes with “authentic passion.” There’s no doubt you’ll be struck by one mother’s exclamation, “That’s the best feeling in the world!” after she births her baby.

Another mother describes birth as “bliss.”

“Everybody deserves this feeling,” Brimdyr says.

Watching each blissful, Happy Birth Day with my young daughters was both special and enlightening. They had so many comments and questions! Is it going to be a girl or a boy baby? What is that bucket? What’s on her arm? Where are her feet? That baby needs some milk. What is she eating? Is that the midwife? She needs a pillow. Boobie!

I’m so pleased that there is a resource like this available, so that each new potential parent has the opportunity to explore the beauty of birth.

Find out more about Happy Birth Day here!

Improving relationships between parents and health care providers

I’ve been on a quest for the “perfect” pediatrician since before my first baby was born. Over four years later, I have yet to find him or her. Thankfully, I think we’ve come close with our current pediatrician. I’m not thrilled with her infant feeding suggestions, I despise the “ABCs (Always Alone, on Back, in a Crib) of Safe Sleep” message that scrolls across the computer screen in her exam rooms, and the office receptionist is sort of cranky. Even so, our current pediatrician is the first one to respect my husband and me as our children’s health authorities. She has created a space where we can have conversations about our choices, and she is committed to working as a team. That’s what makes her practically perfect.

d4f77497-2801-4d5c-9833-180a2957a4e8Over one month has passed since the 22nd Annual International Breastfeeding Conference, and I am still sifting through my notes. One of the themes that has struck me most recently is this idea of parental empowerment; it comes up in nearly all of the speakers’ presentations. I think it’s safe to say that the majority of conference participants believe that parents are the experts on their children and thus should be treated as their health authorities.

But how exactly does this play out in practice? How can parents and health care providers work hand in hand for the best possible health outcomes? How can an effective and respectful relationship be cultivated when many health care providers have worked in a landscape where they are regarded as the professionals and often assume the primary caretaker role?

As we discussed some of these conundrums, Healthy Children Project’s Elyse Blair RN, BSN, ANLC, IBCLC, a former NICU nurse and lactation consultant, shared how difficult it can be for nurses to relinquish control, even when it’s to the baby’s own parents.  

“These are our babies too,” she said, mentioning the bonds nurses often develop with babies in the NICU.

Conference speakers and participants soaking in the sun!
Dr. Maastrup and friends soaking in the sun at the International Conference!

Dr. Ragnhild Maastrup, RN, IBCLC, PhD  acknowledged this challenge.

“They (health care providers) are just as important as before, but they should use their knowledge to help the parents,” she commented.

Healthy Children Project’s Cindy Turner-Maffei,  MA, ALC, IBCLC directed us to the work of Anette Ekström. Ekström and colleagues’ research shows that process-oriented training is an effective way to improve professionals’ attitudes toward parental support. (Check out A Process-Oriented Breastfeeding Training Program for Healthcare Professionals to Promote Breastfeeding: An Intervention Study and Nurses and midwives professional support increases with improved attitudes – design and effects of a longitudinal randomized controlled process-oriented intervention.)

Health care providers need to be equipped with the proper tools in order to effectively interact with and teach parents, which will in turn equip parents with the proper tools to function as an empowered family.

During another discussion, Turner-Maffei shared that many care providers feel like they need to make all people breastfeed. She likened this mentality to cracking open someone’s skull and pouring in information. (What a gory and awesome analogy!)

This is not what it’s about, Turner-Maffei continued.

“It should be a dialogue!” she exclaimed. Of course this applies to any health-related decision.  

Certainly when policies and practices shift, like when facilities work toward Baby-Friendly designation, there is a learning curve for staff. Turner-Maffei suggested that change can be most difficult for mid-career professionals. Care providers who find themselves in this situation should evaluate their goals. Ask themselves, “What does success look like for me?” Turner-Maffei said.

Linda Smith, MPH, FACCE, IBCLC, FILCA added that people who see success in others as opposed to those who thrive on individual success tend to more easily welcome changes that empower parents.

I always believed that change was never easy, no matter what kind of person you are. But Cathy Holland, RN, BS, IBCLC, FACCE so brilliantly pointed out that change can be easy during her conference presentation Energy medicine and breastfeeding.

You too can try the simple exercise she shared with us. Clasp your hands together. Note which thumb is on top. Now clasp your hands so that the other thumb is on top. How does it feel? Reclasp your hands alternating which thumb is on top for one minute. Make sure to completely unclasp your hands at each rotation. Now reclasp your hands with the thumb on top that you initially began with. How does it feel?

Dr. Flacking speaks at the International Conference.
Dr. Flacking speaks at the International Conference.

Initially, many people report that when they change the placement of the top thumb, it feels severely uncomfortable, but after several alternating clasps, the placement of the thumb is no longer an issue.

“New experiences may feel strange at the beginning, but give them a chance,” Holland said. “New and great opportunities are at our ‘fingertips!’”
Finally, Dr. Renée Flacking, RN, PhD declared that parents are the driving force for change. We have the power to put pressure on policymakers and administrators. We have the right to demand respectful, family-centered care.