Dr. Arun Gupta of the Breastfeeding Promotion Network of India (BPNI) and Manager-Communication & Campaigns IBFAN Asia/BPNI Nupur Bidla point out in an email that Nestlé is the biggest player in the artificial baby milk industry. Nestlé, a constant violator of the Code, aggressively markets baby foods contributing to the death and suffering of infants globally, they go on.
Sign up to find out when the forthcoming feature film Tigers will be screening near you. Tigers is new film from Oscar-winning Director, Danis Tanovic, based on the true story of former Nestlé Pakistan salesman taking on the baby milk industry with the help of IBFAN.
Campaigning works. For example, Nestlé changed its statement of support for breastfeeding in its response to boycotters during Nestlé-Free Week 2015 to bring it into line with WHO recommendations, as stated on Baby Milk Action’s website.
Gupta and Bidla point out other campaign merits. Mike and Patty from Baby Milk Action UK take part in Nestlé shareholder meetings and voice dissent. The boycott has stopped Nestlé from promoting complementary foods for children below 6 months of age, a change that took nine years. Campaign pressure led to Nestlé’s public statements on breastfeeding from “4 – 6 months” to “2 years and beyond” in its 2013 report.
“The boycott holds Nestlé to account and forces it to make changes, while also keeping the issue in the public eye,” Gupta and Bidla reiterate.
“Observing this campaign becomes even more important,” urge Gupta and Bidla.
The boycott will continue until Nestlé accepts and complies with Baby Milk Action’s four-point plan for saving infant lives.
The plan states:
Nestlé must state in writing that it accepts that the International Code and the subsequent, relevant World Health Assembly Resolutions are minimum requirements for every country.
Nestlé must state in writing that it will make the required changes to bring its baby food marketing policy and practice into line with the International Code and Resolutions (i.e. end its strategy of denial and deception).
Baby Milk Action will take the statements to the International Nestlé Boycott Committee and suggest that representatives meet with Nestlé to discuss its timetable for making the required changes.
If IBFAN monitoring finds no Nestlé violations for 18 months, the boycott will be called off.
At a WIC clinic a few miles north of Dallas in an immigrant community, a pregnant woman confided in a male peer counselor–part of the WIC Peer Dads Program— that she wanted to breastfeed her baby. Her boyfriend wasn’t at all interested in supporting this journey though. The counselor offered to speak to the father; the mother agreed, so the counselor called him just then. Ring, ring, ring. After introductions, this conversation ensued:
Counselor: We heard you have an issue with breastfeeding.
Father: So you are calling me to convince me that breastmilk is better?
Counselor: No, I just want to give you some information.
Father: I will come to your office. You prove to me that breastfeeding is better.
The next morning, the father arrived at the clinic before it opened.
“Tell me why she should breastfeed,” the father demanded of the counselor, who was feeling rather intimidated.
The counselor replied: Forty-five years down the road, your unborn son is guaranteed to be the president of the United States. What are you going to do today?
The father looked at him perplexed and laughed.
“You tell me,” his retort.
The counselor handed him a sheet of paper instructing him to write these letters: B-R-E-A-S-T-F-E-E-D, providing corresponding ‘benefits’ to breastfeeding with each letter. (B is for bonding and so on.)
“Dude! You’re good,” the father exclaimed, changing his demeanor. “Ok, you got me,” he agreed to open his mind to breastfeeding.
Muswamba Mwamba, MS, MPH, IBCLC, RLC, a public health nutritionist, told me this story during a fascinating interview for Our Milky Way. Having worked in nutrition for nearly three decades, Mwamba has acquired a brilliance for carefully interpreting and reflecting on the stories of the people he encounters.
“The guy was bold,” Mwamba remembers of the father. In fact, the father planned to dump his pregnant girlfriend after she became pregnant.
“A lot of men may know how to change diapers, know how to carry the baby,” Mwamba begins. “But something they don’t know is how to befriend the woman. When they don’t know, they run away.”
This couple’s story took a happy turn. Mwamba reports that they married with their peer counselor as their witness.
“You saved my relationship,” the father heartfully expressed his gratitude to the counselor.
But Mwamba’s career goals didn’t always point specifically to breastfeeding. Always fascinated by nutrition as the foundation of health, Mwamba found himself in a microbiology lab in Belgium completing two master’s degrees in Food Science and Technology and Agricultural Engineering & Human Nutrition.
He quickly realized that he “prefers people to mice.” So when Mwamba, a Congolese native, came to the States in 1997, he searched for a doctoral program that might better fit his passion for behavioral science. Mwamba made his way to Columbia University in 1999 where he studied Nutrition Education, exploring the intersections between science and behavior, environment and genes.
At the time, Mwamba remembers being happy to be in the U.S. but in retrospect, he says he realizes he was naive about racial disparities in health care. It wasn’t until later that he learned about the historical forces in the United States that make health disparities a reality.
“Thinking backward, I didn’t see anyone in my class who was local; they were all caucasian female,” Mwamba recalls.
Except for himself of course, the only Black man, and an immigrant at that. Institutions have policies written to encourage diversity, Mwamba begins.
“When they see Black, they see diversity,” he says. These policies ignore the heterogeneity of Black culture.
“As an immigrant, I was privileged when I got the scholarship,” he explains. Mwamba already held two master’s degrees and had seen the world. His experience was vastly different from those of the People of Color living in the community he was to serve.
“We have the same color of skin, but not the same stories, not the same backgrounds,” he reiterates.
Mwamba adds that African immigrants are the fastest growing and most educated group of immigrants in the U.S. From 2000 to 2004, four percent of immigrants in the U.S. were African. Today, African immigrants account for 8 to 10 percent, he reports.
Mwamba stresses, money needs to be properly allocated to serve those in need.
“The gap is increasing within the [Black] community,” he says of health disparities. “…Diversity is not the solution for the disparity.”
Little did he know, his opportunity to work to close this gap and to give a voice to “the folks who think they have nothing to say because nobody ever listened to them” was just around the corner.
Discussing a course’s simplicity with his professor at Columbia one day, a woman from Ghana happened to be listening in on their conversation. She was the director of a WIC clinic and recruited Mwamba as a nutritionist one year later.
Mwamba was instantly fascinated by the components of artificial baby milk, inspired by the questions his clients asked, and curious about the effects of clients’ infant feeding experiences.
He noticed that mothers who fed their babies formula often came to the clinic with various complaints.
Then there was a woman he remembers who exclusively breastfed her baby for one year. When she came in, she seemed happy and had only one concern: Why hadn’t her period returned yet?
Mwamba needed to do some research. He read everything he could. He worked to develop appropriate language to discuss infant feeding with his clients.
He began to grasp delicate intricacies like the sexualization of breasts in America. One client in particular expressed concern about her baby touching her “boobs.” (As a self-taught Anglophone, Mwamba never encountered “boobs” in his literature.)
As he discovered more and more about breastfeeding, he shared the information with his team. Mwamba became a breastfeeding champion.
In 2003, Mwamba moved to a WIC clinic in Dallas. Here, he received structured training through breastfeeding modules.
In 2005 he and his wife, an OB/GYN, welcomed their first babies to the world, a three pound baby girl and a four pound baby boy. Over the next couple of years, they added three more children to their family. Mwamba spent several months at home with their infants.
Aware that a primary reason a mother chooses not to breastfeed is her perception of the father’s attitude toward infant feeding, Mwamba launched the City of Dallas WIC Peer Dad program. The program was promptly a success.
Perhaps most importantly, the clinic was already breastfeeding-friendly. Secondly, there were several men already working in the clinic– including Mwamba who understood rich, complex immigrant culture. As Kimberly Seals Allers puts it, “The experience of being interpreted is different from the experience of being understood.”
Mwamba and his team worked by the motto Prepare, Equip and Empower.
They validated men in their role as a father and gave them tools like how to speak up and say, “Hello, I’m here!” when others failed to recognize their presence.
“Equip the father with tools they can use today,” Mwamba begins. “If you start talking about the future, they won’t get the information. Meet people where they are.”
Mwamba started conversations with his clients in an attempt to get fathers to connect with their relationships with their fathers; Emotion is more valuable than hard science.
For instance Mwamba describes one client, the father of five children, who “was over six feet tall with dreadlocks and his underwear showing.” He remembers this client had an air about him: I’m the dude here.
Mwamba discussed with him his role to protect and provide for his family. He asked, “Is there a man you look up to?” The father reported that he had a close relationship with his big brother. Mwamba wondered if he looked to his own father as a hero, or if he would change his relationship with his father. At that, the father’s voice cracked. He began to sob. This father was in the position to reflect on his role as a father and accept the influence he would have on his family. And a father’s role is profound. When he is indifferent about breastfeeding, mothers will breastfeed 26 percent of the time; if he is pro-breastfeeding, mothers will breastfeed 98 percent of the time.
Tapping into the generalization that “men like the brag,” Mwamba and his colleagues encouraged their clients to spread forth their infant feeding experiences into their communities.
In his years working with the peer counselor program, Mwamba listened to stories that seriously question one’s capacity to have hope in humanity. In these moments, he didn’t have a script. Whatever rage he felt, whatever sympathy he bestowed, he couldn’t find a book or a module to learn how to accept the rawness, the vulnerability of his clients. Instead, Mwamba offered his presence and his willingness to listen, learn and understand.
This week on Our Milky Way, we are reposting our most popular article since the blog’s birth back in 2012: an interview with Greg Notestine, DDS on tongue tie published in May 2015 . The tongue-tie controversy continues to grow; in fact, Clinical Lactationdedicated its entire September 2017 issue to the issue.
When a chef learns how to shuck an oyster in culinary school, she is unlikely to be receptive of new shucking methods presented thereafter. Ohio-based dentist Dr. Greg Notestine, DDS uses this analogy to explain many physicians’ refusal to learn about tongue and lip tie treatment as it relates to infant feeding problems and beyond.
“Because they weren’t taught in medical school, their minds are really, really closed to learning something new and that’s kind of true in anything,” he says. “We just close our minds once our formal education stops. It’s human nature to do what we are taught.”
In a way, Dr. Notestine continues, he and others who practice frenotomy regularly are “rebels confronting the medical industry… because more women want to breastfeed.”
Discovering tongue tie in infants
In dental school, Dr. Notestine learned about tongue tie as it relates to children and adults, but never as it relates to infant feeding difficulties.
His introduction to tongue tie in infants was through La Leche League. His sister led a group where a mother of a three week old infant wasn’t breastfeeding as comfortably as her previous two children had. Dr. Notestine’s sister asked him if he would check the baby’s mouth. When he noticed a very obvious tie, his sister and the mothers expected he would release it.
“When you have seven crying women in your office, you better do something,” he says. “I was scared to death.”
So Dr. Notestine consulted his anatomy book and found that infants possess the same parts of the 80 year old mouth, just much smaller.
And then, “I cut it,” Dr. Notestine reports. “Immediately the breastfeeding got better.”
The influence of formula companies
After this experience, Dr. Notestine called the family’s pediatrician and obstetrician wondering why they hadn’t treated the child.
“We don’t do that anymore,” he remembers them replying.
Before the 1940s, tongue and lip ties were treated regularly, but as formula companies began to heavily influence doctors, the desire to treat ties for breastfeeding success diminished greatly. As a result, physicians learn almost nothing about the mouth in relationship to feeding in medical school today, Dr. Notestine explains.
Other than breastfeeding, tongue and lip tie can influence speech, dental hygiene, and oral-facial development which can lead to narrowed airways and sleep apnea.
These short or tight frenums, or frenulums, which also may include the cheek attachments–restrictions now referred to as Tethered Oral Tissues (TOTS)– should be examined at birth, Dr. Notestine explains.
TOTS are birth defects that require treatment, he goes on.
“A physician would not hesitate to recommend releasing webbed fingers or toes even though the person could in many cases lead a totally normal life functionally with this defect, it just wouldn’t be too pleasant cosmetically.Therefore it gets treated,” Dr. Notestine says.
For 30 years, Dr. Notestine’s been on a quest to educate physicians about frenotomy as a simple intervention to help breastfeeding difficulty.
Dr. Notestine has also tried to become involved with the medical school just a couple miles down the road from his office with little welcoming, he says. Last year though, the school hired a female dean. She sent a few senior students interested in pediatric work to observe Dr. Notestine in action. The students were awed.
“At least I’ve planted seeds in their minds,” he says.
Dr. Notestine also lectures at Linda Smith’s Lactation Consultant Exam Prep Course yearly. Because there are usually three to four breastfeeding babies in the course, Dr. Notestine is able to offer a hands on learning experience for participants. Treating babies in the class allows participants to feel what they have been reading and hearing about up until this point in their studies.
Recently, Dr. Notestine spent time with second year medical students as part of an elective course where he briefly discussed the mechanics of a baby’s mouth and how proper function is necessary for proper milk removal.
“The entire idea of oral-facial muscle development depends on breastfeeding,” he explains. “You don’t use the same muscles with a bottle, so if we can help physicians learn the value of breastfeeding then perhaps they’ll look at why it’s not successful when it’s not successful… It’s not always the mom’s fault.”
Treating ties with the laser
For 25 years Dr. Notestine successfully performed releases with sharp scissors. Now to release tongue and lip ties, he uses a relatively low level laser that seals the nerve endings and blood vessels along the way. The laser stimulates some pain, but as with most mouth wounds, heal quickly. Sometimes he uses topical anesthetic or injects local anesthetic. With the laser, the wound penetrates only a few cell layers deep whereas other methods can go as far as 100 cell layers deep, Dr. Notestine explains.
All babies fuss while they are restrained for the 30 to 60 seconds it takes to perform the release, but they calm down in one to two minutes. Then they go straight to the breast with their new “freedom,” Dr. Notestine reports.
Post-op care involved with the procedure includes sweeping and pressing on the tissue to prevent regrowth of the frenulum in its troublesome positioning. Dr. Notestine admits this post op care can be unpleasant for parents and infants, but he finds most parents are receptive because the alternative is repeat surgery.
Laser treatment offers parents psychological relief because there is less blood loss involved than other methods. This is especially true in the case of the posterior release.
Babies often develop very tense faces, necks, shoulders and backs while they struggle to feed with these oral restrictions. Dr. Notestine recommends body work such as chiropractic care craniosacral therapy (CST), massage, acupressure and others to help restore overall muscle balance.
Having built “little networks all over the place,” Dr. Notestine receives 30 to 40 calls per day from families seeking help with suspected TOTS.
“I can’t treat them all immediately, I still have a general dental practice to run”, he says.
Dr. Notestine understands that breastfeeding challenges are time sensitive, so he refers out to a small handful of doctors he has trained in the area if necessary.
Most of his referrals come from Lactation Professionals, perinatal workers, or from satisfied moms of children that Dr. Notestine previously treated. There are a few pediatricians in his area that recognize the defect and refer to him.
Because his office experiences such high volumes and mothers usually want to share their detailed stories from the beginning, it can be stressful and difficult to accommodate so many patients.
Dr. Notestine and his staff encourage mothers to email him, or to simply make an appointment and share the details then.
Not long ago, Lillian Scott, MS, CCC-SLP, CLC, a Speech Language Pathologist at Baptist Health in Lexington, Ky., saw a mother and her four month old baby for feeding difficulties including maternal breast and nipple pain. Scott reports that the mother sought out help from other community lactation specialists; still, her pain continued.
“It came as a challenge to me,” Scott begins. If this mother has already sought out information and support, why does she still have lesions on her breasts? She wondered.
Ultimately, Scott discovered that the baby latched shallowly onto the breast, so she worked with the couplet to find a more comfortable position. In the meantime, Scott knew she needed to tend to the mother’s sores; that’s when she consulted a specialist from the wound care team at Baptist. The wound specialist suggested the mother keep the lesions moist, rather than attempt to keep them mostly dry as she had been doing. Eventually the mother healed, and she and her baby went on to breastfeed comfortably.
Scott’s recollection exemplifies wonderfully the importance of creative problem solving, collaboration and interdisciplinary teamwork within maternal child health care, all methods Scott has embraced in her journey to serve families.
Before becoming interested in lactation and breastfeeding, Scott was a special education teacher where she focused on the various needs of children when things don’t go as planned in school. When she became a speech pathologist and transitioned to work in the NICU with Amber Valentine, MS, CCC-SLP, BCS-S, IBCLC as her mentor, she started to question infant feeding methods for fragile babies and mothers when things don’t go as planned after birth.
Her work today focuses on helping Baptist Health transform and evolve its NICU to reflect the latest evidence in health care improvement, like adopting a team-based and allied health approach.
She works to change NICU culture by engaging in positive conversations with her co-workers and sharing education opportunities.
Scott presented at ROSE’s 6th Annual Breastfeeding Summit: Health Equity Through Breastfeeding, where she reviewed the challenges presented when mothers and babies endure traumatic separation after birth. She talked about what to do when breastfeeding isn’t appropriate due to babies’ skill level. Skin-to-skin is almost always first on the list, because it regulates body temperature and respiration rates, naturally sedates mother and child, among a slew of other benefits.
When babies advance and begin to show feeding cues but still might not be able to sustain a full feed, recreational nursing– where baby engages in non-nutritive sucking– is encouraged. Mothers then pump to ‘empty’ the breast. This practice allows bonding between mother and child to continue, and prompts mothers’ bodies to continue to produce milk.
As baby continues to rehabilitate and demonstrates readiness to breastfeed entirely, usually sometime between 32 and 37 weeks gestation when the the suck-swallow-breath pattern and respiratory stability begin to mature, Scott encourages more frequent feedings.
After completing The Lactation Counselor Training Course, Scott says she gained new perspective on feeding difficulties. While her work once focused on the infant, Scott says she gained appreciation for understanding the mother too.
“I was mind-blown all week,” she says. “Why didn’t I have this education before?”
“I love The Milk Mob and having access to the resources to better help my clients,” she says.
Scott also celebrates inclusion in her practice as an Ally to the LGBTQ community, officially credentialed through OutCare Health, a nonprofit dedicated to providing cultural knowledge to medical and other care providers. Tomorrow, Scott will present about breastfeeding at the University of Louisville which will be recorded and included on OutCare Health’s website as part of its evolving health certificate.
In March 2018, Scott and colleagues will present about breast wound care at a state language pathology conference.
Turner-Maffei calls the R.A.C.E. “something incredible.”
“I’ve never experienced anything like it before,” she says.
Fashioned after the reality TV show The Amazing Race, NAPPLSC’s Clifton Kenon and Nekisha Killings–designers of The R.A.C.E– challenged 39 participants to come up with an unmet need for breastfeeding and develop a plan to address the need. In slightly less than 24 hours, teams were required to share a Powerpoint presentation of their proposal that met a realistic budget to implement.
Already a complex task, participants were up against other elements on their race through the city:
Sorted into balanced groups (individuals of varying professional backgrounds and of different ethnicities,) competitors were allotted $25 per team member to cover everything they might need in the following 24 hours: food, public transportation, other incidental expenses. Participants could not spend any of their own money, and they needed to keep record of all expenditures. NAPPLSC’s Membership Chair, Brenda Reyes, acted as the Financial Manager and conducted audits.
The event took place from 5 p.m. on August 22 to about 4 p.m. on August 23 when team presentations began, so participants raced through the night. The event closed out with a celebratory event sponsored by HealthConnect One that included bowling, food and refreshments.
About every two hours participants were challenged with side-tasks, like creating a media piece that showed predatory marketing in an hour and writing a grant proposal. If these tasks were satisfied, fake money was added to their final project budget.
“It was so intense,” Turner-Maffei emphasizes.
NAPPLSC President Felisha Floyd, BS, CLC, IBCLC, RLC points out that the intensity present at the R.A.C.E. reflects the environment POC work and live through everyday.
“Our communities are in crises,” she stresses.
Weaving heavy realities into game format made for dynamic energy, excitement and an element of mystery, Killings describes.
Members of the winning team were: Camie Goldhammer, Khyrej Jones, Nikia Fuller-Sankofa and her daughter, Chauntel Norris, and McInerney. NAPPLSC hasn’t shared the rubric for deciding on the winning team.
Over one month after the event, NAPPLSC Executive Director Stacy Davis reports that she’s still receiving emails from participants expressing their appreciation.
Killings noticed competitors’ elation to be around like-minded professionals, their excitement for what is to come and the gratification of realizing what they could create together.
Some have shared that the R.A.C.E. was life-changing.
Turner-Maffei reflects on the valuable process: “Part of my learning was realizing where my strengths are and knowing where to cede. I had to to refrain from sharing opinions. I’m not from this community. While I may know what works in general, the other folks in my group are the experts.”
She wonders, “How do I put my needs and skills out there so I can be truly useful?”
The R.A.C.E. helped Turner-Maffei realize the value of letting go of her perception of what is real and to be willing to accept another perception of reality.
Floyd considers her experience as a competitor life-changing too.
“It’s pretty amazing how quickly you can come up with ideas and really facilitate solution driven strategies under pressure,” she says. She points out though, that outside of the R.A.C.E., POC don’t always benefit from the team component.