Health over profits

“The only legitimate way to prevent commercial influence is to refuse commercial funding.” — Kathleen C Parry, Catherine Sullivan, Alison M Stuebe; Health professional associations and industry funding—reply from Parry et al

It was almost a year ago that I wrote about my ethical conundrum over ice cream and how it relates to infant feeding. It led me to become involved with Public Citizen’s Commercial Alert’s 2016 WHO Code Day of Action. This year on May 18, Public Citizen’s Commercial Alert is teaming up with  Reaching Our Sisters Everywhere, 1,000 Days, and Best for Babes to host a Day of Action to Protect Parents and Babies.

Health Over Profits

Because families deserve access to commercial-free infant feeding information so that they can make informed decisions, the organizations are asking us to take action.

Here are their suggestions on how to take part:

  1. Take photos or videos holding a homemade sign. “Protect Parents and Babies – Keep Marketing out of Healthcare Facilities,” “Infant Health over Corporate Wealth!” or

“Follow the Code” are suggestions. Include your kids and show it if you’re expecting!

  1. Post your photos on the event page.

(By posting photos to this page, you agree to let us publish elsewhere, including company’s pages).

  1. Post photos/videos/personal messages to the pages of Code violators:

Similac US (Abbott’s brand)

Enfamil (Mead Johnson’s brand)

Nestlé (owner of Gerber Good Start)

The Honest Company

Where to share:

Facebook, Instagram and Twitter

We will share your event page posts to the company pages throughout the day.

Last year, activists shared over 100 photos as part of the event.

WHO, UNICEF and IBFAN also presented the first joint global report on the status of the Code in 194 countries last year. The report presents the legal status of the Code, including to what extent Code provisions have been incorporated in national legal measures, and provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Find it here.

As the IBFAN organization responsible for monitoring the Code in the U.S., the National Alliance for Breastfeeding Advocacy (NABA) is calling on us to help in reporting incidences of Code violations. Help with Code monitoring here.

The Breastfeeding Promotion Network of India (BPNI) enacted The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act (IMS) in 1992 which includes several clauses regarding the promotion of milk substitutes, sponsorship, labeling, etc. Non-compliance is a criminal offense. This organization’s accomplishments battling predatory marketing of infant formula companies are something to aspire to!

If you’re looking for Code- compliant companies to support, Best for Babes established The C.A.R.E. Code Alliance which awards companies for upholding the Code.

The World Health Organization recently released The International Code of Marketing of Breast-Milk Substitutes – 2017 Update: Frequently asked questions. USBC points out that the purpose of this booklet is to provide easy-to-read detailed information on specific questions related to the Code, including what products are covered by the Code, infant formula labeling, and information about implementation and monitoring. It is intended for policy-makers, health workers and others concerned with the Code, as well as the general public.

Public Citizen created a petition telling infant formula makers to stop using hospitals as marketing tools. Sign it here. Last year, I wrote to pediatric clinics in my area suggesting they adopt breastfeeding-friendly policies.

This year, I’m writing to one of my favorite television networks after I noticed sponsorship from a formula company.  I’ve included it below should you have any interest in using it as a template for your own letter-sending.

May 3, 2017

Public Broadcasting Service

2100 Crystal Drive

Arlington, VA 22202

To Whom it may concern:

I am writing to express my concern with your sponsorship from Enfamil. Accepting funding from a company that preys on the health of mothers and babies interferes with the quality of your programming and dilutes the integrity of your network.

Please allow me to inform you about the predatory marketing of formula companies like Enfamil and its detrimental effects.

Formula companies have a knack for undermining women’s efforts to breastfeed (1), a behavior essential to public health (2). For decades, [formula] “companies raked in profits, and babies died in droves (3),” until international outrage led the World Health Organization to pass the International Code of Marketing of Breast-Milk Substitutes in 1981 to regulate predatory marketing tactics by infant formula companies (4). Still, the United States is one of very few countries to uphold the Code (5).

Highly regarded health organizations like the American College of Obstetricians and Gynecologists (ACOG) state that families should receive noncommercial, accurate and unbiased information to make informed decisions about how to feed their infants and children (6). 

By running Enfamil’s advertisements, specifically their Enfagrow follow-on formula, you are feeding corporate greed (7) while simultaneously allowing them to heavily influence and encourage families to purchase products that offer no additional value to a balanced diet (8).

Surely a generation of PBS viewers fed on what is essentially powdered bovine hormonal secretion and corn syrup solids won’t enjoy a healthy future. With young children of my own who are delighted by your programming on PBS Kids, I am deeply disappointed to see funding by such a heinous company and hope you’ll consider cutting ties with their mission.

Jess Fedenia

(1)  Seals Allers, Kimberly . The Big Let Down . New York : St. Martin’s Press, 2017.

(2)  “A Call to Action on Breastfeeding: A Fundamental Public Health Issue.” American Public Health Association . 06 Nov. 2007. <>.

(3)  Solomon, Stephen. “THE CONTROVERSY OVER INFANT FORMULA.” The New York Times . 6 Dec. 1981. <>.

(4)   Stuebe, Alison, MD, MSc. ” Physicians blogging about breastfeeding It’s time to disarm the formula industry.” Breastfeeding Medicine . 20 May 2016. <>.

(5) “Marketing of Breast-milk Substitutes: National Implementation of the International Code Status Report 2016.” World Health Organization .<>.

(6)  Optimizing support for breastfeeding as part of obstetric practice. Committee Opinion No. 658. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e86–92.

(7) Baumslag, Naomi, MD,MPH. “Tricks of the Infant Food Industry.” World Alliance for Breastfeeding Action .<>.

(8) “’Growing-up’ formula: No additional value to a balanced diet, says EFSA.” European Food Safety Authority. 25 Oct. 2013. <>.

March for Moms on Mother’s Day

It was a former Our Milky Way interviewee who really got me thinking about how maternal child health affects us all. In response to how he became interested in the field he said, “I first became interested when I was born, I suppose, as are most infants.” An obvious, perfectly sensical response. Maternal health affects every single one of us.

Tragically, the United States suffers the highest maternal mortality rate of all industrialized countries. Women of color die at four times the rate of white women.

This Mother’s Day, March for Moms will host its first rally to shed light on the dismal state of maternal health in our nation. The peaceful rally takes place in Washington D.C. at the Jefferson Memorial from 1 to 4 p.m. on Sunday, May 14.

“March for Moms is nonpartisan and does not represent interests of any singular professional group, entity, or association,” as stated on Lamaze International for Parents. “They represent consumers and health providers to voice a shared platform, demanding national dialogue to improve care for mothers and babies.”

The event is family-friendly and will include professional kite flyers, children’s activity tables and breastfeeding and diaper changing tents. An impressive list of speakers will present at the gathering including Chanel Porchia-Albert, CD, CLC, Founder of Ancient Song Doula Services (ASDS) and MFM Advisor.

My speech will address the impact of the infant and maternal mortality on African American women and families living within the United States,” Porchia-Albert writes on the ASDS Facebook page. “This speech means even more as the infant and maternal mortality extends beyond just birth outcomes but speaks to the many young men such as Jordan Edwards, Tamir Rice, and so many countless African American women, men and children.”

March for Moms explains the rise of our maternal mortality rate and poor health outcomes through these key issues:

  • Perinatal depression
  • Healthcare inequities and disparities
  • Premature birth
  • Maternity and family leave policies
  • Lack of access to healthcare

Before and after the Mother’s Day Rally, March for Moms will lobby at the Hill and Senate for the importance of increased focus and funding for maternal health issues. Volunteers are needed. Sign up here. View active and passed legislation pertaining to maternal health here.

Find more event details here. You can also watch this video.

If you cannot attend the rally, you can still join the crusade and advocate virtually at the March for Moms Thunderclap.

The Milk Mob optimizes infant feeding support in the outpatient sector

We have heaps and heaps of evidence to show the importance of human milk, breastfeeding and support for breastfeeding families yet, the United States lags pitifully behind in providing proper support to ensure the mother-baby dyad can breastfeed successfully. Bringing light to this deficit, Anne Eglash, MD, IBCLC, FABM, founder of the non-profit The Milk Mob, poses this question: Can you identify any other health behavior besides breastfeeding that the majority of mothers and babies are engaged in for which medical professionals are not educated?

In the U.S., an impressive 80 percent of mother-baby dyads leave the hospital breastfeeding; still, very few outpatient medical care providers and staff are equipped with evidence-based education and training that support healthy infant feeding.

When medical care providers lack the tools to support breastfeeding, families often seek lactation care outside of their pediatrician, OB or family physician which “…places the United States population at risk for racial and ethnic disparity in breastfeeding support since families with more resources will have a greater chance of accessing lactation care in their communities.” []

Dr. Eglash founded The Milk Mob in 2014 with the mission to optimize support for breastfeeding families in the outpatient sector by building Breastfeeding Friendly Medical Systems and Communities through education and collaboration.

Training breastfeeding champions

The organization offers the Outpatient Breastfeeding Champion Training, a basic, clinically-focused, 16 hour course for medical or community breastfeeding supporters. To date, the organization has trained about 1,000 Breastfeeding Champions.

Dr. Eglash has found that staff working in the front lines have great interest in learning the skills to help breastfeeding dyads.

The Milk Mob is currently working to train WIC staff as Breastfeeding Champions in five Midwest states. In an effort to disseminate the training, the Outpatient Breastfeeding Champion Training functions with an Instruct the Instructor model. Participants complete the initial training, then complete an instructor’s course, so that they are equipped to teach small groups in their own communities. This approach cultivates culturally-appropriate and relevant instruction.

Through The Milk Mob, Dr. Eglash provides a variety of continuing education including The Breastfeeding Medicine Podcast, The Clinical Question of the Week, and breastfeeding handouts so Champions can stay up to date with current policies and new research. Dr. Eglash says that the outpatient breastfeeding program has been a stepping stone to The Lactation Counselor Training Course for many of its participants.

Educating providers

The Milk Mob offers separate breastfeeding education modules for healthcare providers: a one- day primary care breastfeeding medicine basics training and a three-day advanced breastfeeding medicine training.

Interestingly, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics and Gynecology (ACOG) all have formal statements advising breastfeeding education during specialty training.

“But the staff of the medical schools and residencies don’t have the education to provide the comprehensive education,” Dr. Eglash explains.

A host of problems succeeds. For one, when a medical student or resident learns about lactation and breastfeeding support from someone other than a physician, the education is out of context; that is, they do not learn how to incorporate breastfeeding support into their care, Dr. Eglash explains. With this approach, students and residents get the illusion that lactation is not something they need to learn, she continues. Further, lactation professionals and physicians have different scopes of practice.

When physicians do provide lactation training, the education reflects what they’ve learned about breastfeeding: the information is often inaccurate and the message about the importance of breastfeeding is diluted.

“[Students] are learning from someone who may not value breastfeeding because that instructor was never showed the value of breastfeeding,” Dr. Eglash adds.

Fortunately, as a clinical professor, Dr. Eglash witnesses residents’ enthusiasm to learn about breastfeeding. Many of them are having children of their own and are influenced by their own birth and breastfeeding experiences. At this pivotal point, Dr. Eglash says that the future will depend on making sure we have the means to educate medical students and residents, so that when they begin to practice, they will be able to “hit the ground running.”

The Milk Mob recently released the 6th edition of The Little Green Book of Breastfeeding Management for Physicians and Other Healthcare Providers, a pocket-sized reference manual for the most commonly asked questions that breastfeeding families have throughout the course of lactation.

Encouraging community collaboration

The mother-baby dyad requires support prenatally, immediately postpartum, in the outpatient sector and as they integrate into the community as a new couplet. Establishing a continuum of breastfeeding support throughout this journey is another component of the Breastfeeding Friendly Medical System.

A unique example is that of the collaboration between the Aurora WIC program in Milwaukee, Wis. and Aurora Sinai Medical Center. In fact, the WIC office is housed inside of the hospital. This setup facilitates daily communication and consistent messaging between staff and accessibility for families.

Facilitating conversations

The Milk Mob will host its first Art & Science of Breastfeeding Conference on May 12, 2017.

The conference attempts to connect bench scientists and clinicians, coupling “both the art of infant feeding with new and emerging scientific explanations of clinical phenomena that we observe when working with breastfeeding dyads.” []  

“If we could start having more conversations between the bench and clinical science folks, we will move along further in what we are doing,” Dr. Eglash says.

Visit The Milk Mob here.

Register for the conference here.

Bridging the gap for skin-to-skin

It’s dangerous to think it’s up to mothers alone to successfully breastfeed. Support for breastfeeding moms in the home, in the community, and at the national level matters.  

Regina Hirt, RN, IBCLC and her team at Froedtert & the Medical College of Wisconsin Community Memorial Hospital in Menomonee Falls, Wis. are making sure breastfeeding dyads are protected and supported beyond their initial postpartum period in the hospital setting.

Last winter Hirt and her colleagues launched an initiative, Bridging the Gap for Skin-to-Skin, which educates and trains hospital staff and EMS providers in the community how to implement skin to skin contact between mother and baby. Skin to skin contact has seemingly endless benefits including increased breastfeeding success.

Hirt and her team started with hospital grand rounds in February 2016. When a mother comes to the hospital, even for a non-obstetrical related procedure, skin to skin with her baby is now offered as a standard of care.

Hirt and Johnston present their poster at the 2017 International Breastfeeding Conference.

Two months later, Hirt, EMS Liaison Julie Brady, Nurse Educator Pamela Johnston RNC, BSN, and the Medical OB Director collaborated to develop new training for EMS providers in the community. This piece was of particular importance because newborns admitted after precipitous births were arriving hypothermic and with delayed breastfeeding initiation. Training these providers how to implement skin to skin contact was the answer. The practice regulates babies’ body temperature better than any device on the market and allows baby direct access to its food source.

Skin-to-skin in the OR

Obstetrical emergency training was given too including how to safely assist with a precipitous birth in the field or in the ED, assist with initial skin to skin contact, safely assist with shoulder dystocia, and be able to identify cord prolapse and manage care until delivery.

The team extended the training to outlying EMS systems: a freestanding Emergency Department and local fire departments in Waukesha and Washington Counties.

“There was a lot of education that was needed,” Hirt says.

For instance, emergency responders were surprised to learn that the umbilical cord should be cut after baby is placed skin to skin on its mother.

One fire department claimed that transporting baby placed skin to skin on mother was against their policy; that baby must be placed in a separate restraint. Transporting baby and mother belted to the same restraint is indeed safer, Hirt explains. Training included showing personnel how to properly belt mother and baby to the restraint while implementing skin to skin contact. Hirt shared the case of the newborn baby who was severely burned by a foil blanket while transported separately from her mother after an unexpected birth as an example of how dangerous it can be to separate mother and baby.

Despite minor pushback from this department, Hirt and her team applaud 100 percent positive feedback from 150 staff and EMS personnel.

EMS personnel surveyed reported that is was “awesome education, new information was presented, and the hands on practice was great.”

In an effort to ensure changes are continuously and safely implemented and so new staff receive proper training, quarterly hospital-wide education is performed. Emergency department orientation occurs monthly, and Hirt’s team offers yearly education and site visits to the local fire departments, all of which have welcomed the opportunity.

Eventually, Hirt says they’d like to extend this training to Froedtert & the Medical College of Wisconsin in Milwaukee and the Milwaukee Fire Department.

“It’s a big undertaking,” Hirt states.

Compared to the smaller communities this program has been working in, the sheer size of a bigger city could present interesting challenges. Moreover, Milwaukee staffs their providers whereas some communities in Waukesha and Washington Counties typically also employ volunteers.

Father and his baby skin-to-skin

In the meantime, Hirt and her team look forward to their Birth Center Skills and Education Fair this Fall where there will be a continued emphasis on skin to skin as well as practical information about supporting pumping mothers and helping lactating mothers access sound information about pharmaceuticals.
Hirt is currently piloting equipment to launch virtual lactation and breastfeeding support. Virtual breastfeeding support could benefit mothers who have other children and can’t easily leave the home, or mothers who have undergone a c-section and cannot drive for instance. The virtual support will be offered free of charge to patients. Hirt hopes to eventually offer 24 hour lactation services.

CLCs bring diversity of experience to lactation field

Healthy Children Project has welcomed doulas, nurses, physicians, midwives, WIC counselors, social workers, occupational and speech language therapists, to name a few, to its Lactation Counselor Training Course. A pediatric practice dental assistant, state legislators, a bartender and a children’s consignment shop owner are also among those who have taken the course.

The diversity of experience that CLCs bring to the lactation field benefits families and communities.

This week, the spotlight turns to Lucy Vest, CLC, an HR recruiter and former Program Director for Mom2Mom KMC (2012-2014.)

Vest assembles furniture for the new Lactation Room sponsored by M2M KMC at Landstuhl Regional Medical Center.

Mom2Mom Global Executive Director Amy Smolinski, MA, ALC, CLC calls Vest the “driving force” for Mom2Mom KMC.

“I still remember when we interviewed her for the newly-formed Mom2Mom KMC board,” Smolinski begins. “We were completely blown away that someone with her business acumen and managerial expertise would volunteer her time for our tiny little breastfeeding organization.”

Vest was drawn to Mom2Mom KMC because she’s a “busy, sociable, career-oriented person.”

“I can’t stand being at home with nothing to challenge my brain; that’s why I first applied to join M2M KMC’s Board of Directors,” she explains.  “I wanted something outside of just being a mom that would give me back my sense of self and achievement that I need.”

Military life can be hard, lonely and isolating too, Vest says.

She birthed her daughter while her husband was deployed. Her family lives in the UK.

“I had no mom friends and I had no reason to get out and about during the day so I looked up local mom and baby activities,” she says.

Vest announces prize winners at the Big Latch On 2014
Photo credit, Laura Karoline Photography

She says she felt Mom2Mom KMC might offer an experience where she’d immediately share common ground with others, so she attended a meeting. Her first experience wasn’t what she’d expected.

“I hated it because no one talked to me!” she recalls her first meeting.

Even so, Vest went on to become finance director and then program director for the organization.  

“Not only did [Lucy] prove herself a deeply compassionate and competent lactation counselor, but she brought her business skills to our grassroots support group and grew it into a thriving organization that revolutionized our community to the idea that breastfeeding is simply the normal way to feed babies,” Smolinski applauds her.

Vest first worked to smooth minor issues and concerns by implementing small, gentle changes with the help of the incumbent board.

“You can’t just take over an established organization and rip it to pieces expecting everyone to be on board and support you,” Vest explains.

They changed their meeting format from every other week table meetings to weekly breastfeeding cafes with sweet treats and hot drinks.

“Exactly what every breastfeeding mother wants!” Vest exclaims.

Most importantly, Vest encouraged board members to be welcoming and socialize with everyone in the room.

Photo credit, Laura Karoline Photography

“The team at large really focused on being…inclusive,” Vest explains. “Everything a vulnerable, nervous, first-time attendee needs when faced with an intimidating group of women.”

The organization’s formal Facebook page became a private group, which could reach the whole community, not just those who came to breastfeeding cafes.

During the time Vest began directing, Landstuhl Regional Medical Center (LRMC) hosted the Lactation Counselor Training Course.

“So we had a lot of newly qualified people in the community to support our team disseminating good, research-based evidence and information rather than old wives tales that are often thrown about freely in place of hard facts,” she says.

Vest and her team worked to develop relationships with other local parental support military programs and LRMC departments like the NICU.

“[We] raised our profile slowly but surely within the community,” she explains.

Vest’s interpersonal skills came of good use anytime the organization needed volunteers.  Smolinski shares this memory: “[Lucy] would take a clipboard around at breastfeeding cafes and ask people one on one to sign up to volunteer for our next activity.  No one could say no to her!”

Vest explains it this way: “No one tends to put their hand up and volunteer for anything, especially helping to man booths at the Big Latch On, or staff tables at membership drives so I’d go around with my clipboard and a list of duties and ask people face-to-face to help out. It’s an awful lot harder to say no to someone when they’re stood in front of you waiting for an answer.”

She goes on to explain that blanket posts on social media are routinely ignored, so a personal approach is always far more successful.

Vest instigated a simple budget for the organization: a monthly, quarterly and annual Profit and Loss management tool.

“We worked strategically; smarter, rather than harder, in our fundraising efforts,” Vest explains.  

Two years ago, Vest moved away from Kaiserslautern Military Community, so she’s no longer involved with M2M KMC. Still in Germany though, she became an admin on a local military, new baby Facebook group and provides home visits as a CLC,  mostly for friends and friends of friends.

She’s also back in her old career field, something she waited six years for.
“I truly am thrilled to be doing the day-job again, but I hugely attribute the maintenance and expansion of my business skill-set to my time with M2M KMC,” Vest says.