The power of positive stories

The other night at prenatal yoga, my teacher, classmate and I talked birth and breastfeeding. (Of course we did!) I was appalled and saddened to hear their stories and the tragic stories of their friends that they shared. My heart stays heavy remembering their experiences; what an impact they’ve had on me. I wonder what kind of influence those stories might have had if I were a first time mom; if I didn’t have the positive birth experience I had to show me what becoming a mom can really be like.

Horror stories seem to be the norm. Doesn’t it seem like most pregnant moms are welcomed into motherhood with stories of fear, shame and defeat?

Bankston and her mother nursing their children together. Bankston reports it is one of her favorite pictures.
Bankston and her mother nursing their children together. Bankston reports it is one of her favorite pictures.

I love Katie Bankston’s CMA, CLC story because it demonstrates the power of positive birth and breastfeeding experiences.

Bankston was attending phlebotomy class one day when she overheard a conversation between a mature student with grown children and a pregnant peer.

She remembers the mature student talking about how wonderful breastfeeding is and how it helps your uterus contract back to pre-pregnancy size.

Up until this point, Bankston reports that she didn’t even know what breastfeeding was. She says it was well before she even thought about having children of her own.

Bankston is now the mother of a preschooler and a toddler.

Throughout her prenatal care and the birth of her first son, Bankston developed a strong relationship with her nurse.

She was my support system when my family was hundreds of miles away,” she says. “She saved me. Had I not had her support and encouragement, I wouldn’t have talked to my doctor about my depression during my pregnancy.”

Bankston’s nurse also served as her breastfeeding advocate.

“This is where I was inspired to become ‘that support’ for someone else,” she says.

Not long after Bankston’s first son was born, she moved back to her hometown. During this time, Bankston’s little brother was born.

“My first lactation ‘client’ was my mother, who had not nursed me or my brother,” Bankston says. “I encouraged her to nurse my second brother. After a rocky start she went on to nurse him until he was three years old.”  

Bankston currently works full time as a Certified Lactation Counselor and a Certified Medical Assistant in an OBGYN practice.

Recalling her Lactation Counselor Training, Bankston says the most valuable thing she learned was how people receive information differently. She says it has helped her to understand that her interactions with each mother will be unique, and that she will have to adapt to address each mother’s concerns in different ways.

Bankston also acknowledges the importance of helping a mother take ownership of her relationship with her baby.

Bankston and her colleagues serve the entire Big Bend area of Tallahassee, Fla. at the OBGYN practice. Their practice delivers between 1,500 and 2,000 babies a year; about half of the babies born each year in the area. The hospital is currently working toward Baby-Friendly designation.

“I get the chance to see a lot of different families with different backgrounds,” Bankston says. “It’s amazing.”

Bankston is the only lactation counselor within her practice.

“It’s a good start,” she comments. “I would love for them to one day have more CLCs.”

Bankston is confident in the breastfeeding support an OBGYN clinic can offer to mothers.

“We’ve developed this relationship over their entire pregnancy,” she explains. “Sometimes an obstetric office is the first time these women are learning what their body is capable of.”

Bankston recently attended the 2016 International Breastfeeding Conference.

“It was amazing. I want to see and do everything now!” she exclaims. “I can’t wait to go next year.”

Specifically, Bankston was struck by Dr. Cristiano Boccolini’s, PhD, M.S. presentations and his discussion of Brazil’s Breastfeeding Friendly Primary Care Initiative (IUBAAM.)

“I’d love for something like that to be here,” she says.

Bankston is working to apply for a grant that would allow physicians and nursing staff to become better educated about lactation and breastfeeding support.

I want to make it easier for obstetric offices to implement lactation education into their care,” she says.

Some of Bankston’s other goals include starting a non-profit for further lactation education and advocacy research in the prenatal and postpartum settings, finishing her DONA postpartum doula certification, and becoming a midwife.

Bankston has also been in touch with the IT department at the OBGYN office so that she can begin to track their breastfeeding outcomes.

“The IT guys tells me about computers,” Bankston begins. “And I tell him about areolas and montgomery gland secretion. He finds it fascinating.”
Check out Bankston’s blog at http://lovecraftedlactation.com/.

Fitting in, standing out: Acknowledging stigmas and biases

Parents attend MommyCon, a “boutique style,” natural-parenting convention for many different reasons.  

Last year, my dear friend and I traveled over 100 miles with four children under four to attend the convention out of curiosity.

We arrived after a tumultuous two hour drive. Immediately upon entering, I was struck by the sea of women who looked exactly like me. Sure, our baby carriers were different brands and styles, but overall there was a tremendous lack of individuality. I was so freaked out. What an odd sensation drowning in the ordinary!

(A quick side note: I vow never to return to Mommycon after learning that the breastfeeding presentation was sponsored by a bottle manufacturer. The Boob Geek wrote a great post about that sponsorship: Mommycon is not for me.)

Dealing with stigmas

Anna Blair, PhD, IBCLC, CLC presented Motherhood: Identity, social stigmas and resilience at the 22nd Annual International Breastfeeding Conference last month. Unknowingly, Blair’s presentation perfectly complimented Karin Cadwell’s presentation from earlier that morning.

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During Blair’s presentation, we talked about the challenges we face as “others” trying to fit in, and how we react to those different from us. She asked participants to reflect on things that we feel stigmatized for and to reflect on things that we stigmatize others for.

Blair discussed visible stigmas like race and invisible stigmas like being HIV positive or suffering from mental health disorders.

She pointed out Katz, Nilsson and Rasmussen’s study Danish health care providers’ perception of breastfeeding difficulty experienced by women who are obese, have large breasts, or both. which looked at how health professionals who support lactating women perceive visible maternal characteristics as obstacles to breastfeeding.   

Their findings “indicate the importance of recognizing and treating large breasts and maternal obesity as separate obstacles to successful breastfeeding and that interventions to reduce these obstacles should be designed to account for characteristics of the person providing them.”

In Stigma of visible and invisible chronic conditions, authors Joachim and Acorn present a “beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility.”

d4f77497-2801-4d5c-9833-180a2957a4e8Blair revealed that through our interactions with others, we engage in the social comparison theory. Part of the social comparison theory involves the downward comparison theory which brings ourselves up and puts others down.  

The perceiver is more disdainful if the person is assumed to have control over the issue– like weight, Blair pointed out.

The power of thought also influences our interactions with others, presenter Cathy Holland explained. A participant asked how to help children with down syndrome breastfeed better. Holland replied that approaching the mother and child with an “Oh, no that poor child” attitude will likely negatively influence their feeding experience. Surely, babies with down syndrome should be provided with appropriate care, but they should never be expected to fail. The power of positive thought can be applied to any “other.”

Judging others, important conversations  

Throughout Blair’s presentation, I couldn’t get Abby Theuring, MSW, The Badass Breastfeeder’s I Judge You piece out of my mind.

She writes: “The ‘mommy wars’ are imaginary. They do not exist. People judge. It’s normal and it’s natural. It’s not a human flaw.”

“Oh goodie, justification for bullying,” someone commented on her blog.

Theuring is not an advocate for bullies. She’s simply acknowledging judgement as something that happens. Consequently, she encourages us to have conversations about our differences.

She continues: “The ‘mommy wars’ is a silencer. It keeps us from being able to have important conversations. It makes it so that whoever expresses an opinion, whoever discusses breastfeeding (or maternity leave or daycare or whatever) or whoever shares their experiences is seen as a bully. It’s not in corporation’s best interest for us to become informed, make our own choices and create alliances with each other.”

In her presentation, Blair challenged us to practice active-noticing versus intentional blindness. Look for the unexpected, be serendipitous, she said.

Acknowledging bias

During another conference presentation, Mona Liza Hamlin of the National Association of Professional and Peer Lactation Supporters of Color (NAPPLSC) asked us to be honest about our biases and stigmas.

A report from the University of Illinois at Urbana-Champaign shows that being honest about our biases, specifically racial bias, might be more complicated than we think. The analysis shows how racial bias affects pulling the trigger of a gun.

“‘People were quicker to shoot black targets with a gun, relative to white targets with a gun. And … people were more trigger-happy when shooting black targets compared to shooting white targets,’” Mekawi told NPR.

What’s more, Gabrielle Canon writes in a Mother Jones article: “‘What this highlights,” Mekawi told NPR, ‘is that even though a person might say, ‘I’m not racist’ or ‘I’m not prejudiced,’ it doesn’t necessarily mean that race doesn’t influence their split-second decisions.’”

Canon continues: “Racism, it turns out, can actually be hardwired into our brains.” She goes on to include information from an Inquiring Minds podcast with neuroscientist David Amodio on why we discriminate even if we don’t want to. Find more here.

486d7d71-2727-4653-a1bd-5b6aa0a41f30This is all so much to process! When I’m overwhelmed with information, I try to synthesize it into something that I could explain to my brilliant four-year-old. Here it goes: Some days we will struggle to showcase our uniqueness. Some days we will struggle to fit into “normal.” It’s important to embrace and celebrate our differences. It’s just as important to acknowledge how we feel about and treat people who are different from us.

As health care providers, lactation professionals, breastfeeding advocates, I urge you to reflect on these important pieces and consider how your biases affect the mothers, babies and families you interact with. Are you honest about your biases? Are you able to provide unprejudiced care? Can you recognize your limitations? Asking ourselves and exploring these difficult questions will only help us to provide better, woman-centered care.

The Opposites Game

Karin chats with Maha Mohammed Al-Madani at the International Conference.
Karin chats with Maha Mohammed Al-Madani at the International Conference.

What’s the opposite of breastfeeding? It’s easy to think of formula feeding as the antithesis of breastfeeding, right? But Karin Cadwell invited 22nd Annual International Breastfeeding Conference participants to explore this question in depth a few weeks ago in Orlando, Fla.

Here’s the game we played at the conference to brush up on our antonym skills: Working in groups, we thought of any word, then the opposite of that word, then a word that started with the last letter of the former word, then the opposite of that word. Get it?

Here’s an example: Hot, Cold, Down, Up. And another example from my group: Left, Right, Table, Chair. This is where I got hung up. Is “chair” really the opposite of “table”? I questioned nearly every antonym our group came up with. I’m certain my teammates were annoyed with me!

Behavior and conceptual framework

The Opposites Game!
The Opposites Game!

When all groups reconvened, we discussed behavioral opposites. What’s the opposite of eating meat? Not eating meat. What’s the opposite of doing vigorous physical activity? Not doing vigorous physical activity. Those seemed fair to me.

Then Karin broke down the reasons behind why people eat or don’t eat meat; why people do or do not do vigorous physical activity. The number one reason why people don’t eat meat is because of animal cruelty. The number one reason why people do eat meat is because they like it.

“The behavior is separate from the conceptual framework,” Karin pointed out.  In other words, people who eat meat don’t do so because they like to kill animals.

Richetin, Conner and Perugini’s research states that “…cognitions about not performing a behavior are not simple opposites of cognitions about performing the same behavior because they rely on separate goals.”  

Next, Karin invited us to think about the reasons why women choose to breastfeed and why women choose to formula feed.

The top three reasons women choose to breastfeed are: for their baby’s health, because it is natural, and to bond with their baby.

Women choose to formula feed because of their perception of the father’s attitude regarding infant feeding, concerns over the quantity of milk they will produce, and the perception that they will be able to return to work sooner than if they were to breastfeed.

With Richetin’s research in mind, the opposite of breastfeeding is not formula feeding. Rather, the opposite of breastfeeding is not breastfeeding, or not feeding the baby, and that’s not an option, so formula becomes the most accessible alternative.

In The impact of attitudes on infant feeding decisions, Mary E. Losch, et al point out that, in the profiles of women who decided not to breastfeed, one of the most consistent findings was that “women who decide to formula feed are not so much embracing this method of infant feeding as rejecting breastfeeding.”

Sales or customer service?

Karin posed another question to the roomful of breastfeeding advocates. Are we acting as sales reps or customer service reps?

She suggested we leave sales up to the formula companies and focus on individualized maternal care. Forget about being breastfeeding-centered; the support we offer must be woman-centered, she said.   

In fact, Karin mentioned that it takes less time to give quality woman-centered care than a one-size-fits-all approach. When lactation professionals provide woman-centered services, we are dealing specifically with the woman’s own concerns instead of going through a premeditated spiel, checking the boxes off of a list.

Similarly, while prenatal breastfeeding education has been shown to increase mothers’ breastfeeding success, Karin challenged us to provide prenatal support rather than prenatal education.

I thought back to my prenatal breastfeeding education options when I was pregnant with my first baby. My choices were an eight hour Saturday class or a four week series. Karin described the type of information typically divulged in prenatal breastfeeding classes: the advantages of breastfeeding and the “ooey-gooey” stuff like mastitis, plugged ducts and engorgement. Yikes. While trying to be comprehensive, what kind of message are we sending? What about the valuable time we are wasting?

“At 2 a.m., moms aren’t thinking, This is the healthiest for my baby. They are thinking, Who is going to help me?!” Karin explains.

Even if we as a nation fall short of our goals, there’s no doubt most moms want to breastfeed.

“We don’t ask women if they want to deliver their placenta. Why are we asking about breastfeeding?” Linda Smith commented at the conference.

She suggested we approach new mothers with something like: “Your milk is going to come in; how do you want me to help you with that?”

Results of our belief in opposites

There has been damaging backlash as a result of our implicit belief in opposites: The case against breastfeeding, Lactivism, Bottled Up, Guilt-free bottle feeding, Is breast best? Karin named a few.

There’s also No Nursery, No Formula, No Pacifier: Are “baby-friendly” hospitals unfriendly to new mothers?, Is the Baby Friendly Hospital Initiative really the Baby Deadly Hospital Initiative, and Surviving the “baby friendly” hospital: Tips for those planning to formula feed.

1f7c8f61-77ee-4283-adde-12ae73efdd11A conference participant suggested that, with this notion of opposites at play, that all hospitals not designated “Baby-Friendly” must be “Baby-Unfriendly.” She went on to explain that in her community, many believe that Baby-Friendly Hospitals must not be friendly to formula-feeding families. She shared that this is not the case at the hospital where she practices; they support mothers’ choices.

Judging by the previous titles shared, there is a gigantic misunderstanding of what the Baby-Friendly Hospital Initiative stands for.

BFHI USA’s website states: “The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.” (bold text added)

But as Healthy Children’s Cindy Turner-Maffei points out in Is any progress good progress?: “Practice in health care settings does not always mirror written policy. What administrators and staff believe is happening does not always mirror the experiences reported by mothers…”

During our continued opposites discussion, another participant commented, “Breastfeeding is so hard that we need experts to help us do it. No one is certified as formula feeding consultants.”

But a 2009 revision to BFHI requires mothers show that they know how to safely prepare formula for their babies. Formula feeding can be tricky. Breastfeeding can be tricky. Implementing policies that influence the health and well-being of all babies regardless of their feeding method may help close the divide that we often perceive between breastfeeding and formula feeding.

Consider this

Other important questions that resulted from Karin’s presentation were: Do formula companies benefit from our implicit belief in opposites? Do they want consumers and lactation providers alike to believe that formula feeding is the opposite of breastfeeding?

Also, if Karin is suggesting that we leave the sales business behind and focus solely on providing mother-centered, customer service, how can we combat formula companies’ marketing strategies?

How can we navigate the fine line between denouncing formula marketing while still supporting families who formula feed? (To start, check out Best for Babes’ article We Support Formula-Feeding Moms AND We Fight Formula Marketing.)

In this Leadership Pittsburgh presentation about “Milk Money,” Todd Wolynn proclaims, “Economics dismantled us as a species.” He’s referring to formula companies.

The Analytical Armadillo writes in Stick Your “Mummy Wars” Advert Up Your…..:

“The news can report that formula cans are overloaded with aluminium at unsafe levels for babies, or that the excessive iron in follow on milk (only ever invented to get around the marketing restrictions of first milk) is linked to developmental delays.  Yet loyal users still believe the formula companies give an actual damn about anything but billions in profit. This ‘faux empathy’ is sucked up and in turn it builds a trust between supplier and customer, and further increases the divide between parents – who by now all believe the ‘mummy wars” exist.’”

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Formula companies do phenomenal work profiting off of our inherent belief in opposites! Formula companies do phenomenal work pitting us against each other in the sneakiest fashion. We have the power to dismantle them.

Breastfeeding promotion during soap operas

I used to watch General Hospital with my mom when I came home from morning kindergarten back in 1994. Even though I was started on the show at such a young age, I can’t say I’m an enduring fan. To be completely honest, I think soaps are obnoxious. That was until I learned that GH recently aired a positive storyline about nursing in public! You can watch a short clip here. And another one here.

Hardcore GH fan and Healthy Children faculty Donna Walls exclaims: “My dreams have all come true. So proud to be a General Hospital fan!”

Healthy Children’s Elyse Blair, also a hardcore GH fan, exclaims, “I loved that GH brought breastfeeding to the forefront!”

Walls describes the scene when GH character Olivia “was about to nurse [in public] and the mayor pitched a fit and had her arrested.”

The episode continues with “a lively conversation” about breastfeeding being legal and how important it is for mothers to be able to breastfeed whenever their babies need to, Walls goes on.

While at the police station, Olivia’s baby cues that he needs to nurse, so she demands that the officer help her because she is handcuffed. Ultimately, the baby begins to breastfeed (although covered) and Olivia’s lawyer takes a picture of them. Lovely! Of course, the scene would have been even more wonderful if the baby hadn’t been covered with a blanket.

Blair comments that the NIP situation was “very realistic.”

“Unfortunately, this occurs all too often,” she comments on the discrimination of mothers NIP. She also points out one great example of support for mothers discriminated against: Jill Miller’s The Milk Truck.

The use of soap operas to promote breastfeeding is not a new idea. Healthy Children’s Cindy Turner-Maffei points out that “promotional pieces during soap operas was part of Brazil’s breastfeeding campaign in the 1980s.”

Through its National Breastfeeding Promotion Program launched in 1980, Brazil increased the median length of breastfeeding from 2.5 to 10 months over a period of 25 years.

The second phase (1982-83) of Brazil’s National Breastfeeding Promotion Program included a popular soap opera that aired “pro-breastfeeding messages and celebrities appeared in TV PSAs in further attempts to reach the intended audience.” [Retrieved from: Updating the USDA National Breastfeeding Campaign: Workshop Summary]

Commercials with breastfeeding content were then added, Turner-Maffei continues.

The book Nutrition and an Active Life: From Knowledge to Action includes more information about Brazil’s 1980s breastfeeding campaign.

Brazil continues to feature pro-breastfeeding and pro-human milk messages on soap operas.

For example, a 2014 article, Brazil’s Maternal Milk Banks A Global Model, reports that “public awareness campaigns feature the stars of prime-time soap operas urging new mothers to give milk.”

Back in America, Walls reports that there’s more breastfeeding to come on GH.

“The magazine owner (Nina) got an idea to write an article about nursing in public,” she says.
Brazil as our model, soap operas seem to be an effective avenue to promote breastfeeding and human milk. Although the National Breastfeeding Promotion Program took over two decades to see significant progress in breastfeeding duration rates, imagine the impact strong women breastfeeding on television (and breastfeeding support) might make for all of the kindergarteners coming home to watch soaps with their moms!

Thank you for a wonderful conference!

A couple of weeks ago, I had the privilege of attending the 22nd Annual International Breastfeeding Conference. Every year I participate, I come home with a profuse amount of information and insight to digest. I take pages and pages of notes, and it usually takes me quite a while to process them into something coherent to share on the blog. This year isn’t any different in that regard. This year though, I have a newfound appreciation and respect for the conference organizers, participants and presenters.1f7c8f61-77ee-4283-adde-12ae73efdd11

I’ll start here: I arrived at the conference Wednesday morning, groggy and morning sick. Those unpleasant feelings immediately disappeared when I was greeted by the amazing Healthy Children faculty with smiles and big bear hugs. Nikki Lee writes on her Facebook page Nikki Lee Health: “I’ve been going to every International Conference since the first one in 1995; that’s one reason it is my favorite breastfeeding conference because I always feel as though I am returning home.” Exactly my feelings! While I’ve only been attending for three years, I still feel like I am returning home.

Former Milk Duck Queens Sheri Garner and Nikki Lee crown the 2016 Milk Duck Queen Cathy Holland.
Former Milk Duck Queens Sheri Garner and Nikki Lee crown the 2016 Milk Duck Queen Cathy Holland.

When you’re home, someone is always looking out for you. The dearest Cathy Holland offered me fresh ginger each morning of the conference to combat my early pregnancy queasiness. Then, when Cathy’s workshop filled before I could find a seat, one of my fellow participants scrambled to get me a chair, and another insisted I take hers. Another day, I watched Karin Cadwell gently help a presenter place an ice pack on her neck to combat a headache. These little things matter.

Dr. Cristiano Boccolini
Dr. Cristiano Boccolini

During one of his presentations, Dr. Cristiano Boccolini showed a set of satirical graphics that illustrated the perseverance and hard-work it requires to do and present research. I am so grateful for the presenters’ generosity in sharing their work with us. The work of maternal child health advocates is a labor of love; they do it to elicit positive change, to save lives and to influence our quality of life.

This year, the generosity and kindness of the conference participants was confirmed by a record sale of famous milk ducks. The milk ducks raced for their friends, the Lucky Iron Fish to fight anemia. By Thursday morning the ducks were sold out, a first in milk duck history.  Conference-goers raised enough money to purchase over 107 Lucky Iron Fish, enough for an entire village!


On my way back to my hotel one evening after the conference, my taxi driver informed me of another conference being held down the road from the Breastfeeding Conference. He told me that the people he had driven from that conference seemed miserable, and they told him that they hated attending every year. How sorry I felt for those conference-goers! I feel so lucky and proud to have the opportunity to network with such a brilliant group of maternal child health advocates. Thank you all for making the 22nd Annual International Breastfeeding Conference such a special experience.