Nutrition During Pregnancy and Lactation: Exploring New Evidence Day 2

Last week,  Cindy Turner-Maffei, MA, ALC, IBCLC shared a summary of what she learned at the Nutrition During Pregnancy and Lactation: Exploring New Evidence – A Workshop through her tweets. This week, she shares Day 2.

NASEM has made the videos from the workshop available here.

Cindy Turner-Maffei, MA, ALC, IBCLC at the academy.

 

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Guest post by Cindy Turner-Maffei, MA, ALC, IBCLC

Dr. Thorlton

On January 30, 2020, the presentations on the impact of Nutrition during Pregnancy & Lactation continued at the National Academy of Sciences in Washington DC began with Janet Thorlton of University of Illinois-Chicago College of Nursing with an update on the impact of caffeine in this time frame:

  • Genetic variance determines whether we’re slow (SCM) or fast (FCM) caffeine metabolizers. If exposed to high doses of caffeine, SCMs may have increased risk of preterm birth, and FCMs of smaller babies.

Kjersti Aagaard of Baylor College of Medicine reported on the impact of maternal diet on the developing infant microbiome:

  • The diversity of vaginal microbes decreases in pregnancy. The neonate’s early biome looks very different than that of the vagina. 
  • The neonate’s microbiome may reflect the amount of fat in the mother’s diet. High fat diet (>35% of calories as fat) is more correlated with infant dysbiosis* than with maternal obesity. (This difference persists—it seems irreversible with dietary changes later.) [*dysbiosis=imbalance in the microbiome—a less than desirable microbial community]
  • We should stop focusing on treating obesity in pregnancy/lactation and focus instead on supporting dietary change. Within days of changing the diet (less added sugar and fat and more fiber), the mother’s metabolic markers and those in her milk change for the better. 
  • Similarly, “we must come to value nutrition over weight.” 
  • Encourage nutrient quality: “fresh from the source produce” is best. Address equity issues in access to fresh produce.
  • Today’s research does not show that giving probiotics in pregnancy protects mother or infant.
  • Fun fact: Did you know that “there are Pseudomonas species that can exist solely on caffeine”???!!!

    Dr. Aagaard

Michael Goran of Children’s Hospital of Los Angeles and the University of Southern California on fructose and oligosaccharides in breastmilk and the effects on infant body composition and cognitive outcomes:

  • Children who were BF >12 m were less likely to be obese at 4 y, even when regularly fed sugar sweetened beverages (SSB). Does human milk offers some protection against effects of SSB?
  • Maternal diet alters the type of human milk oligosaccharides (HMO) in milk. HMOs are also found in amniotic fluid by mid pregnancy. Is this part of how the baby comes to tolerate (and not attack) commensal microbes?

 

Dr. Allen

Lindsay Allen of U.S. Department of Agriculture on maternal micronutrient status and intake and their effect on milk composition:

  • Maternal status and intake has no effect on calcium, folate, iron, zinc and copper content of human milk
  • Many other micronutrients are lower in milk when status/intake is low.
  • Research is needed to determine specific micronutrient needs in these time frames.

Ellen Demerath of University of Minnesota on the implications of maternal weight and metabolic status for lactation and breastmilk composition:

  • Why are BF rates and duration shorter in obese folks? It’s complicated! There are biological, social, and emotional contributors. 
  • Some intriguing new insights, e.g., leptin is thought to suppress oxytocin, thus potentially decreasing milk release. Leptin levels are higher in obesity.
  • Those with higher pre-pregnancy BMI have more leptin and insulin in their milk. 
  • There may be even higher insulin in their milk when they have female infants. 
  • In diabetic individuals, insulin and glucose are higher in colostrum, but this normalizes in mature milk.
  • Focus on helping new moms improve nutrition and get more sleep, and work for paid parental leave, instead of focusing on weight loss. The diseases BF protects against are crucial to women’s health. Paid leave and more support would both increase BF success and thereby public health.
Lunch break Day 2, needed a brain expansion, appealed to this guy for some help. -CTM

Erica Gunderson of Kaiser Permanente Northern California on lactation and the future risk of cardiometabolic diseases in women: 

  • Pregnancy and lactation are a metabolic continuum. Pregnancy requires adaptations that would be considered pathological in any other state (e.g. suppressed immunity, inflammation)
  • Complicated pregnancy, preterm birth, and preexisting conditions such as hypertension and diabetes increase risk for metabolic disease in the future. Lactation may reset maternal metabolism (higher HDL levels, lower blood glucose and insulin, etc.)
  • BF is associated with 7% risk hypertension overall over maternal lifetime. More protection (12% reduction) for BF >12 mo. 
  • Cardiovascular mortality risk also decreases with increased BF duration. But most studies do not explore preexisting conditions that impact risk.
  • Ongoing SWIFT study is following ~1,000 women with gestational diabetes (GDM) for10 years, watching for conversion to Type 2 Diabetes (T2DM). So far, longer duration of BF is showing 50% reduction in risk of T2DM. Similar to findings of CARDIA study.
Drs. Goran, Aagaard & Myatt

Leslie Myatt of Oregon Health & Sciences University spoke on the role of the placenta in delivering nutrients and in developmental programming of the fetus:

  • The placenta’s metabolic activity is ~5X greater than the fetus’s! It’s not a passive portal. 
  • The placenta consumes about 1/3 of energy transferred from mother to make peptides and grow—it’s called a “selfish organ” for this reason.
  • The placenta adapts to nutrient shortages.
  • At term, its’ surface area is the size of a parking spot
  • The placenta functions differently for male vs female fetuses, supporting sexual dimorphism.

Angela Odoms-Young launched the final session examining community solutions to improve nutrition access and equity in pregnancy and lactation.

Rafael Peréz-Escamilla on systems changes for improving maternal nutrition during pregnancy/lactation:

  • Social justice issues and inequities in access to and quality of lactation care are profound. 
  • The breastfeeding gear model identifies key partners for creating equity and systems change. 
    • [CTM Note: Check out the breastfeeding gear model here.]

      The Gear Model

Kate Keenan of University of Chicago on using nutrition science to reduce perinatal health disparities:

  • “Poverty=Stress=Health Disparities.” 
  • A pilot RCT of DHA supplementation of black pregnant women of low income status found a reduction in perceived stress among mothers, and higher birthweight and APGAR scores in their babies.

Barbara Laraia of University of California, Berkeley on food insecurity and stress as common challenges to optimal nutrition during pregnancy:

  • Her recent study provided mindfulness training and support, finding decreased stress, but no effect on % with high gestational weight gain (GWG). Some women had low GWG and lower scores on oral glucose tolerance tests. 
  • San Francisco is giving $40/month in additional vouchers for vegetables to WIC participants in pregnancy through 3 mo. postpartum. Preliminary data shows reduction in preterm birth and high utilization of the vouchers.

Darlena Birch of the National WIC Association (NWA) on the role of WIC in supports nutrition during pregnancy and lactation:

  • NWA is employing a health equity framework to address disparities in care experienced by WIC participants. 
  • WIC’s BF Peer Counseling program is a powerful tool in closing gaps in communities of color.

Patsy Brannon of Cornell University tackled the unenviable task of summarizing the entire two days of the meeting in 20 minutes:

Planning Committee chair Anna Siega-Riz of University of Massachusetts at Amherst graciously closed the workshop.

My reflections:

As I left the meeting, my brain felt incredibly full. I felt such gratitude to the Committee, the Planning Committee, the truly amazing presenters and the National Academy of Science for a fabulous crash course on the state of nutrition knowledge regarding pregnancy and lactation.

On my way home, I jotted this note synthesizing a few overarching threads:

Changemakers are prone to singling out and manipulating individual entities (nutrients, people, etc.) rather than examining the complex webs they inhabit. A needed shift is to understand the webs (systems) first.

Nutrition During Pregnancy and Lactation: Exploring New Evidence

Guest post by Cindy Turner-Maffei, MA, ALC, IBCLC

Cindy Turner-Maffei, MA, ALC, IBCLC at the academy.

Did you know that the Dietary Guidelines for America (DGA), now 40 years old, have never included guidance for nutrition during pregnancy, lactation, infancy or for children under age 2? Worrisome when you think about the lifelong impact of nutrition in these crucial formative time frames.

Congress mandated that the next edition of the DGA, due later this year, provide nutrition guidance for pregnancy, lactation, and through age 2 years.

At the end of January, I had the great honor and pleasure of attending Nutrition During Pregnancy and Lactation: Exploring New Evidence – A Workshop, a 2-day workshop at the National Academy of Sciences (NASEM) in Washington, DC.  The National Academies of Health and Medicine sponsored this workshop to “explore the current state of the science on nutrients, dietary patterns, nutritional supplements, and other nutrition-based topics relevant to pregnancy and lactation. The workshop topics will include discussion of equity in access to nutritional care for women of childbearing age.” The last in-depth compilation of knowledge about this crucial topic was published by the Institute of Medicine (now the National Academy of Medicine) in 1990!

Conference opening slide.

Backstory of this workshop: In developing the 2020 DGA, the 2020 Dietary Guidelines Advisory Committee (DGAC) has developed a list of questions about nutrition needs in this crucial timeframe, and has begun an evidence review. A new Ad Hoc Committee led by Dr. Kathryn Dewey was identified to explore the infancy questions. This January meeting is the DGAC bringing together  top notch researchers who could share cutting-edge information about the research to inform their knowledge on those questions. Attending 2 days of concise and information dense presentations beginning at 8 am and running through 5 pm, was kind of like sitting in on a high-level nutrition briefing, in a similar vein to the intense briefings I was sure were going on right across the street at the Department of State. It was definitely nutrition science brain gym for me!

In order to summarize my learning, and share that knowledge with all of you, I live-tweeted the event. Below are my tweets in chronological order. Next week we will share a summary of Day 2. NASEM has made the videos of the Nutrition during Pregnancy & Lactation available here.

January 29, 2020

Anna Maria Siega-Riz updated us about changes among new parents since the 1990 IOM reports on nutrition in pregnancy and lactation: birthing folk today are older, heavier, less likely to smoke, more likely to birth surgically, and more likely to be diabetic.

Alison Steiber of the Academy of Nutrition & Dietetics (AND) shared that AND has launched a study examining how dietitians work with breastfeeding families.

Maria Makrides of SAHMRI Women and Kids at South Australian Health and Medical Research Institute reported on research about docosahexaenoic acid (DHA – an omega-3 fatty acid) supplementation during pregnancy, finding no significant decrease in postpartum depression, and no impact on cognition in children. 

  • On the 2018 Cochrane review of impact of DHA supplementation in pregnancy, she states:  “preterm birth < 37 weeks and early preterm birth < 34 weeks were reduced in women receiving omega-3 (Ω-3) long-chain polyunsaturated fatty acids (LCPUFA).” However, the DOMInO trial does not support this finding. 
  • Paraphrasing Makrides: “Women who start pregnancy with low omega-3 levels are at risk of preterm birth; that risk is reduced by supplementation with Ω-.. We found no benefits related to preterm birth for supplementation of pregnant folk who are Ω-3 replete*.” (*replete refers to having adequate stores in the body)
  • “Our research also concluded that DHA supplementation in pregnancy does not significantly decrease risk of allergies and asthma in children at hereditary risk.”
  • Consumption of 8 to 12 ounces of wild caught fatty fish weekly should maintain appropriate Ω-3 levels. Farmed fish is less ideal. 
    • {CTM note: check out safe dietary Ω-3 sources for pregnancy consumption here and here.)

 

Dr. Elango

Rajavel Elango of University of British Columbia on protein needs in pregnancy and lactation: 

  • “Protein needs were developed based on the needs of males. DRIs (Dietary Reference Intates) for pregnancy are based on males.” (?!?)
  • Our research in British Columbia suggests that protein needs in pregnancy are higher than the DRIs.
  • When protein intake is too high (>25% of kcal), the risks for high weight gain and fetal death increase
  • While pregnancy increases protein needs, not all amino acid are needed at the same level. Some individuals following plant-based diets may need help on how to balance protein and amino acid needs. We need more research on vegan and vegetarian diets in pregnancy.
  • In a well-nourished mother, variety of plant-based foods is probably fine (some dairy is a good addition, as it includes many needed amino acids). In a poorly nourished woman, assessing and meeting protein and amino acid intake is more crucial.
  • My lab has not evaluated how body type (overweight, underweight, obesity) impacts protein needs. Our work is with women of normal weight.

 

Leanne Redman of Pennington Biomedical Research Center on carbohydrates and energy requirements in pregnancy and lactation: 

  • In pregnancy, carbohydrate need increases 35% to fuel the fetal brain. 
  • In lactation, carbohydrates need doubles over non-pregnancy need, as glucose is used to make lactose. 
  • All carbs are not the same. Surveys of pregnant North Americans suggest intake of carbs is too high and fiber too low.
  • The National Institutes of Health (NIH) recommends decreasing added sugars (<10% of daily calories) and increasing fiber (28 g/d) in pregnancy.

 

Yvonne Lamers of University of British Columbia on folate and Vitamin B-12 in pregnancy and lactation:

  • The neural tube closes at 3 weeks gestation, before many know they are pregnant. WHO recommends 400 micrograms daily starting preconceptually through 12 weeks gestation. Women with previous child with neural tube defects need more.  
  • 20% of American women do not have sufficient folate in their red blood cells. Insufficient blood levels of folate are higher in African-American women (~35%).
  • In an era of food fortification, are folate supplements still required for pregnant women? YES! For all women, as it is needed early in pregnancy, before many know they are pregnant.
  • Response from Lamers to a later question about folate supplementation for those with the MTHFR genetic variant: The original concern about this arose in Europe where there is no universal FA fortification and lower folate status. Due to universal folate fortification, we are folate replete in No. America. Thus no difference in folate status between these genotypes and risk of neural tube defects. Theoretically there should be no difference between 5methyltetrahydrofolate and other folate sources, but research is needed to assure us that it is absorbed in the same manner as other folate sources. 
  • In pregnancy, fetal development requires adequate vitamin B12 levels.

 

Marie Caudill of Cornell University on the benefits of choline for mothers and infants:

  • There is a high demand for the essential nutrient choline in pregnancy, to meet fetal needs: Choline, a methyl-donor, is necessary for epigenetic expression and for many metabolic reactions in the body; it plays multiple roles including developing myelin sheaths around nerves, increasing speed of message transmission. 
  • Higher choline intake increases DHA status in women of childbearing age. “This suggests increasing choline in pregnancy may be a way to increase DHA supply to the developing fetus.”
  • Those with higher pregnancy choline intake were less likely to have babies with neural tube defects. Increased choline intake may also ease baby’s response to stress as measured by infant cortisol level.
  • Higher maternal choline intake decreases preeclampsia risk and improves lifelong cognitive functioning in offspring (at least in baby rats). Rodent studies also show protection against Alzheimers, fetal alcohol syndrome, autism, and others.
  • Higher maternal choline intake improves infant information processing speed + other cognitive performance measures.
  • The amount of choline in cow’s milk based formula is similar to human milk (HM), but lower in soy-based formula. The form of choline in formula is different than HM. Absorption is likely best from HM. Current AI (adequate intake recommendation)  for choline is likely too low.
  • Only 8% of women achieve the recommended intake of 550 mg of choline daily. Best sources are animal source foods, which poses a challenge for those on plant-based diets. Most prenatal vitamins do not contain choline. Human milk has15x more choline than maternal blood; thus, need in lactation is great too.
  • Choline-rich foods include egg yolks, beef, chicken, fish at about 100 mg/3 oz serving. Best plant sources are legumes and cruciferous vegs, which provide 3~0 mg/serving. Overweight women and those with fatty liver disease likely need more.
    • CTM Note: Information about choline requirements and food sources may be found here.

 

Kimberly O’Brien of Cornell University on iron (Fe) requirements in pregnancy and lactation:

  • US recommendations on pregnancy need is based on 400 women in Finland, UK and Sweden (ethnicities not reported). Dosage of iron provided was 7X the U.S. RDA.
  • Fe-deficiency highest in African Americans

 

Corrine Hanson of University of Nebraska Medical Center on nutritional antioxidants during pregnancy and lactation: 

  • Levels of antioxidant nutrients (vitamins C and E, selenium, and β-carotenoids) are lowest among those living in food deserts. 
  • These nutrients fight oxidative stress, helping the body recover.
  • Take home message: we need to increase population access to fruits, vegetables, nuts and seeds.
  • Calcium(Ca)  is also a population challenge in pregnancy and lactation. However, a Cochrane review found no clear benefits of Ca supplementation.
  • Activated vitamin D has a half-life of 4 hours. Therefore, regular input of D is important. Yet studies on the impact of D supplementation have inconsistent outcomes. 
  • 20% of North American women are vitamin D deficient (<20ng/ml).
  • Response from Hanson to a later general question about nutrient supplementation: Nutrients are not benign. They are powerful bioactive chemicals. Giving replete individuals more of a specific nutrients does not usually result in good outcomes. The individual’s circumstances need to be taken into account.

 

Elizabeth Pearce of Boston University School of Medicine on iodine (I) needs in pregnancy and lactation:

  • Iodine levels in the population are decreasing, according to NHANES (the National Health and Nutrition Examination Survey). 
  • The most critical period for adequate iodine intake is the 1st trimester of pregnancy
  • The longest list of negative impacts of iodine deficiency accrues to the fetus, including cognitive deficiencies, increased risk of stillbirth, cretinism, etc.
  • Iodized salt has decreased I-deficiency worldwide. UK research shows lower maternal I levels in pregnancy correlate to lower child IQ, even for those with the mildest level of deficiency. 
  • Vegans and vegetarians are at greater risk for I-deficiency. 
  • Prenatal supplementation of 150 mcg/d is recommended. However, current research does not demonstrate that supplementation is effective.
  • There are potential risks of excess iodine consumption. For example, an estimated 10% of pregnant women have thyroid autoimmunity. Hypothetically, a big dose of iodine could trigger hypothyroidism in the susceptible woman and also in her child.
  • CTM: Interesting question from a participant: Could the decrease in iodine status be related to concerns about sodium intake and the use of non-iodized salt products (e.g. sea salt, artisanal salt products)?

 

Dr. Bailey

Regan Bailey of Purdue University on dietary supplement use during pregnancy and lactation:

  • Who takes supplements in preg/lact? 77% of pregnant women. Older women (35-44) are the most likely to do so. By ethnicity: most likely among Non-Hispanic (NH) Whites, followed by Hispanic/Mexican Americans and then NH Blacks.
  • Many prenatal vitamins (PNV) do not contain any choline. 
  • There is a lot of variability among PNVs. 
  • Many pregnant women do not consume enough of several nutrients, and almost all are at risk of excess sodium intake and insufficient iron and folate intake.

 

Dr. Borgelt

Laura Borgelt of University of Colorado Anschutz Medical Campus on prenatal supplement formulations:

  • Prescription vs. over-the-counter PNVs: Rx version have higher doses of Fe and folic acid. Non-Rx versions tend to contain choline and extra ingredients (e.g. botanicals).
  • Research has found that both Rx and non-Rx PNVs may have more or less of ingredients than are listed on the label. 
  • If looking for a safer PNV, look for PMVM Quality Assurance (QA) designations on the label, such as: USP, NSF, Consumer Labs. These QA seals don’t address health outcomes, but that the contents are what the label states + there are no known safety issues. 
  • Guidelines needed for safe lead levels, avoiding other potentially toxic ingredients, etc.
  • Diet is the safest source of nutrients.

CTM Note: Check out the NIH Prenatal Multivitamin + Mineral (PMVM) Calculator – your tax dollars at work! 

‘Breastfeeding As An Act Of Resistance For The Black Mother’ guest post

By Nichelle Clark, Certified Breastfeeding Specialist

Originally published January 31, 2020 on SonShine & Rainbows Lactation

Black History Month in the breastfeeding community is normally littered with posts and articles about the dark history of African American Breastfeeding in this country. I firmly believe that in order to understand where you are going, you must first understand where you have been. However, Black Mothers in today’s society face a very different dilemma: actually being Black History.

We’ll start with the sordid history of Black breastfeeding women in America. Beaten and broken, then used as wet nurses for the children of slave owners. The children of these wet nurses were fed condensed or cows milk, that was prepared in filthy conditions. This history has cultivated a stigma and bias against what infant feeding should look like in African American families.

However, this has not deterred the rise of Millennial and Gen X parents in the Black Community. The Center for Disease Control Report Card, published in 2019, showed that only 74 percent of African American mothers had initiated any breastfeeding. By 6 months, the percentage of mothers exclusively breastfeeding drops to 27.1 percent. These numbers are up from previous years, at 69.4 and 17.2 percent respectively. According to the the American Academy of Pediatrics, breastfeeding protects against type 1 and 2 diabetes, as well as the likelihood of childhood obesity. The CDC lists diabetes as the number 6 killer of Black Men and the number 4 of Black Women (over all ages). Of African Americans aged 20 and over, 28.4 percent of men and 17.6 percent of women have been found to be obese. In our community, breastfeeding can truly be life or death. While it doesn’t preclude African Americans from these diseases, the advantage against them is something we most desperately need.

So, how is breastfeeding an act of resistance for the Black Mother? We must first define resistance. While not the most commonly used definition, resistance, in this case, is defined as “the ability not to be affected by something, especially adversely”.  And for Black Mothers in America, this is most certainly an act of resistance. Because of the traumas our ancestors faced, the majority of us simply did not grow up seeing mothers breastfeed. There weren’t many breastfeeding classes or clinics (this is still an issue in our community) and there was little familial support. I meet Black Mothers daily who still don’t know there’s an entire profession dedicated to assisting parents in mapping and meeting their breastfeeding goals. Even if we remove all these obstacles, a study by Chapman University found that African American mothers are more likely to be offered formula in the hospital than any other demographic. The “whys” are still being researched, but those of us belonging to the African American community know exactly why: There’s this social construct that Black Women just don’t breastfeed. But….. why? Because after years of being forced to nurse children against our wills while ours were fed dirty formula concoctions and died, African American mothers did not pass the practice down to their children. Couple that with diminished resources in our communities and lactation care providers that don’t understand our cultural history and social makeup, you can see why becoming Black History is a dilemma.

Black Breastfeeding Mothers are making history. We are educating ourselves and slowly changing what a Black breastfeeding mom looks like. Sometimes, we are outright defying our support systems and significant others. Make no mistake; all the reasons for NOT breastfeeding and the trauma in our communities still exist. Lack of Black IBCLCs still exist. Lack of resources and evidence based support still exists. Defiant child care providers still exist. Many mothers find solace in online support groups, where like minded parents understand the difficulties of healing these traumas in our own families. Again, therein lies the dilemma. We’re in this unique position of changing our history, while navigating the uncharted waters of not only breastfeeding, but motherhood and womanhood ourselves. While it is not fair to ask this of Black Women, it is something we gladly take on. Because our history is only part of the story. We are writing the next chapter.

We ARE Black History.

A special thanks to fellow Black Breastfeeding Mama, Yolanda Williams of the Parenting Decolonized Podcast.

Want to hear our conversation on the topic? Listen here!

“My people are destroyed for lack of knowledge…”

Evon Lavergne-Prudhomme, CLC, IBCLC was led to maternal child health advocacy sixteen years ago when she became pregnant with her son. On her path to motherhood, she sought and found information and support from WIC, nursed her son until he was over two years old and eventually became a WIC peer counselor.

When her son was about seven years old, he went to visit his aunt who had just had a baby. 

“She was new to the breastfeeding world and she was panicking,” Lavergne-Prudhomme remembers. “My son was like, ‘It’s really simple: all you have to do is put the baby to the breast. Just call my mom!”  

“For me, that was the greatest story,” she continues. “My son, who knew he was breastfed and understood why we breastfeed, was able to advocate for someone else in the family.” 

Today, her teenaged son continues the conversation around infant feeding with his peers, and Lavergne-Prudhomme serves families from a range of backgrounds in Lake Charles and surrounding areas in Louisiana through her home visiting service Back@theBreast with E.B.A.B.ES. Lavergne-Prudhomme also makes hospital visits at families’ requests and facilitates prenatal education. 

Louisiana suffers from poor health outcomes in general with large gaps in health equity including some of the lowest breastfeeding rates in the nation.  

Lavergne-Prudhomme reports hearing many stories about SIDS, prematurity, and other tragic outcomes in her state. 

“Moms are having to try to understand what’s going on,” she says. 

With this in mind, Lavergne-Prudhomme has made education an integral part of her work. 

“Health care really starts with mom,” she states. “If they’re healthy, their kids end up being healthy.” 

She also stresses health education for families so that they can make informed decisions based on their needs. 

“For me, it goes beyond a financial gain,” she adds. “It’s always making sure that the families I serve understand the importance of good health outcomes, the importance of breastfeeding, the importance of being able to have that voice for themselves, so they can actually turn around and advocate for others.”

This month, Lavergne-Prudhomme’s Back@theBreast will bridge services with Cafe au Lait to offer once a month, free community support gatherings. The peer-to-peer support model is facilitated by an advocate of color with lactation care credentials to ensure families receive evidence-based information. 

Lavergne-Prudhomme’s reach extends further. She’ll teach basic breastfeeding education with a couple of other colleagues through Community Birth Companion’s doula training in March.

In April, she will host Healthy Children Project’s Maternal Infant Assessment.

Lavergne-Prudhomme quotes the Old Testament’s Book of Hosea: “My people are destroyed for lack of knowledge…” So, she works tirelessly to empower the families she supports helping them thrive and flourish.  

The words we use

“Is ‘jerk’ a swear word, Mom?”

“Can I say ‘Hell’ if I’m talking about a place, Mom?”

“Mom! George said a bad word!” 

More than ever, my kids are experimenting with words. Exposure to new phrases– especially through media and books, friends at school, even us parents, etc.– requires the careful navigation of appropriate vernacular. What one might consider distasteful, hurtful, impactful, another may consider harmless or meaningless. These are murky waters we travel! 

Photo by Raphael Schaller on Unsplash

Take this exchange offered by Ravae Sinclair, JD, CD (DONA), LCCE in her presentation at the International Breastfeeding Conference for example.

A white-presenting lactation professional working with a black mother and her baby shortly after birth exclaimed something along the lines of, “Awww, look at him, he looks just like a little thug!” commenting on the slight sag in his newborn hospital cap. 

Photo by Andrae Ricketts on Unsplash

“Little thug”– a heavily loaded term generally carrying negative connotations– was understandably a trigger for the mother. She shut down no longer feeling safe in the space and asked to be discharged early. Most likely, the lactation professional did not intend to offend, but the impact of this short exchange has much further reaching consequences than the intention itself. 

As Sinclair points out, there are potentially life-threatening consequences associated with early hospital discharge, especially for a first time mother and a woman of color. The ripple effect of one word, one phrase can be traumatizing and immense. 

A Rough Translation podcast entitled We Don’t Say That illustrates this phenomenon, the power of words, poetically. 

We’ve written about the power of words as they relate to maternal child health in the past. Here and here for example, but this topic is ever-relevant. 

Just a few weeks ago, International Breastfeeding Conference goers were invited to participate in an Ask the Experts session. One question read as follows: 

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

Healthy Children Project’s Cindy Turner-Maffei shared her reflection:  

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

A fellow maternal child health advocate (who is black) shared with me recently that another fellow maternal child health advocate (who is white) approached her after a presentation and exclaimed, “I had no idea you were such a great public speaker!” 

This language is considered a microaggression. And again, while the intent isn’t to cause harm, it often can. Here is a detailed article on microaggressions, but if you’re looking for something shorter, Fusion Comedy presents a punchy video on microaggressions (Note: the video contains some strong language.) 

Photo by mostafa meraji on Unsplash

Even when we aren’t talking about charged topics, language matters in maternal child health. Dr. Abla Al Alfy has dedicated herself to improving maternal child health outcomes in Egypt through Our Dream Initiative. One strategy she has employed is Kangaroo Mother Care (KMC), but in Egypt, she explains, most mothers don’t know what a kangaroo is. And when they find out, they tell Dr. Al Alfy that they don’t want to be likened to wild animals. Instead, Dr. Al Alfy and her colleagues adopted Warm Hug Care, a term more culturally applicable.  

Language has been studied by Virginia Schmied and colleagues in their work ‘This little piranha’: a qualitative analysis of the language used by health professionals and mothers to describe infant behaviour during breastfeeding  which reveals some of the ways care providers describe the newborn baby during the first week after birth and how that language can affect breastfeeding. 

The authors found that the most frequent personality trait ascribed to newborn infants was impatient and/or lazy.

Photo by Aix Style on Unsplash

The authors also found that “the impact of this type of negative construction of the baby was evident in the interview data collected some 4–6 weeks after birth. There were a number of occasions where women were noted to repeat the same language that the midwife had previously used in their interactions with the woman, in those early days after birth.” 

You can find a commentary piece by one of the study’s authors here

Choosing our words in whatever capacity we’re working in should be a careful craft.  This may be quite a challenge on occasion, but let us remember this quote: “We have two ears and one mouth so that we can listen twice as much as we speak.”