#FactsNotFear

“What do you think of that Fed Is Best movement?” my dear friend wondered when it became prominent on social media.

“Um, I don’t really like it,” I replied so inarticulately. Since then, I’ve reflected on the movement and continue to struggle to express anything coherent.

Kimberly Seals Allers and me (and George!) at the International Breastfeeding Conference 2017 after presenting on her book ‘The Big Let Down.’
[Find it here: http://www.kimberlysealsallers.com/book/]
Just last week though, the remarkable Kimberly Seals Allers, published My Struggle To Find My Voice & Raising A Collective One to Protect Mothers to introduce the launch of the #FactsNotFear campaign which advocates for FACTS, not fear-mongering. Seals Allers and 1,000 Days shared a new blog Facts Not Fear: Protecting the One Place Where Fear Does Not Belong and developed suggested social media posts and graphics for both Facebook and Twitter so that we can easily support the cause.

We are publishing Seals Allers’ guest post here on Our Milky Way in support of the #FactsNotFear campaign.

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We live in a world of fear. From the recent terrorist attacks in England to last year’s Orlando nightclub massacre. We have seen how the fear of outsiders has sparked powerful political movements around the world. As a frequent business traveler I sense my own anxiety as I sit on planes and trains, and as a mother I know the feeling that sweeps over me whenever I receive an incoming phone call from my children’s school.

Yes, we live in times of fear and anxiety—much of which is beyond our control.

But there is one place where fear should not exist. There is one area, where, as women and mothers, that we should insist that fear not enter—that is in the precious act of feeding our babies. From the time they are first placed in our arms, we are anxious that we will do our best. Yes, we are nervous that we will make mistakes. But we should not be made to dread our ability to mother—particularly when it comes to feeding our infants—one of our very first tasks.

That’s why a recent spate of fear-based marketing, particularly from the Fed Is Best Foundation, stoking fears that exclusive breastfeeding kills babies is both erroneous and irresponsible. But it is also the type of insidious marketing that preys on a mother’s existing insecurities that should make all women concerned. If the only way Fed Is Best can make its point is by sensationalizing infant deaths and undermining our confidence in our bodies—then maybe their point needs to be carefully considered.

Or, as women, we insist that they make it with valid facts and sans the fear mongering.

Let’s face it, women are sold fear and anxiety as a marketing tool every day. In fact, the strategy, officially known in business circles as FUD—fear, uncertainty and doubt—was designed by an IBM executive decades ago to persuade buyers to feel “safe” with IBM products rather than risk a crash, virus or server disruption. By the early 90’s it was generalized to refer to any kind of misinformation used as a competitive weapon.

Today, weaponizing fear takes many forms. We fear our faces aren’t pretty enough, so we buy cosmetics. We worry that our body isn’t the right “type” so we are sold diet plans and surgical procedures. We are told our hair isn’t shiny, bouncy or thick enough so we are sold multitudinous hair products. And then we are told to fear that our bodies may not properly do what they are biologically made to do, and we are sold infant formula.

The truth is, our bodies were uniquely made to feed the infants we create. Decades of scientific research proves that formula is nutritionally inferior to breastmilk. Admittedly, societal pressures, structural barriers such as a lack of paid maternity leave, and physicians who receive little to no training in lactation science in medical school, make it very difficult for some women to fulfill their biological norm. Many women who want to breastfeed find undereducated physicians and nurses and limited post-natal support—particularly in the early days after discharge. We have much to overcome.

To be clear, infant formula is necessary. When a mother’s own breastmilk or human donor milk is not available, then infant formula is an important third option that can, at times, save lives. However, women should come to that decision fully informed, not because of marketing efforts designed to incite distrust in their own bodies or threatened with the fear of the death of their infant.

It’s no secret that, especially in the Western world, women already fear they will have insufficient milk. For some, this fear can become a self-fulfilling prophecy because fear and anxiety can literally limit lactation by stifling the letdown reflux that stimulates the milk glands. Feeding into this insecurity by promoting early formula supplementation “just in case” has been a go-to move by the formula industry for years.

As far back as the 1940s, the manufacturers of Borden KLIM evaporated milk ran a radio jingle in the Congo that stoked mother’s fears over insufficient milk. The song went:

The Child is going to die

Because the mother’s milk has given out

Mama o Mama the child cries

If you want your child to get well

Give it KLIM milk

So when Fed Is Best frequently promotes eerily similar headlines claiming, “One bottle would have saved my baby”—it seems to make early supplementation innocuous, while deploying a similar tactic used to spur sales of infant formula. The insidious message is that your breast cannot be trusted but a bottle can—this type of marketing should concern all women.

Instead of fear, we should demand the facts about why physicians and nurses don’t have more education to properly identify lactation dysfunction or failure. We should demand knowledge about other options to increase milk output such as hand expression, which can extract more milk than a pump. If formula must be used, it should be administered as a temporary bridge until a mother’s supply is established, not a breastfeeding killer for mothers who want to nurse. And we should demand standard home visitation immediately after discharge, as is the practice in the UK and other European countries.

Ultimately, women deserve facts not fear. Women have a right to guilt-free, confidence-building information and support. And it’s time that we demand it of everyone—including, and especially, from those claiming to support mothers. We cannot stand by while Fed Is Best insists that fear is best.

Kimberly Seals Allers is an award-winning journalist and nationally recognized infant health advocate. Her fifth book, The Big Letdown—How Medicine, Big Business and Feminism Undermine Breastfeeding was released in January by St. Martin’s Press. Learn more at www.KimberlySealsAllers.com and follow her on Twitter @iamKSealsAllers.

Breast milk for their ‘Nemo’

After three years of IVF treatments, Elizabeth (Elizabeth has asked that we keep her last name private,) MSN, ARNP, PNP-BC, CLC, CPN learned that her baby, her last frozen embryo, would be born with at least a bilateral cleft lip. 

“My husband, the entire pregnancy after we found out about the cleft lip, was hoping it would go away, that the ultrasounds were wrong or it would fix itself,” Elizabeth remembers. “He was in complete denial.”

But after their son was born, Elizabeth overheard her husband compare him to the popular Disney character Nemo; He is our Nemo. Nemo had a gimpy fin and our son has a birth defect, she recalls him saying.  

“For him to have that pride and comparison to Nemo is breathtaking,” she goes on. 

Elizabeth, a pediatric nurse practitioner and doctoral student at the University of Florida, currently teaches undergraduate nursing students at the local children’s hospital.  

Her first job as a registered nurse was in the NICU which strengthened her support for human milk and breastfeeding.

“I saw first-hand the benefits of breast milk for those tiny little babies, not only for the children but for the moms as well,” she says.

It was after the birth of her son that she became especially determined to earn lactation credentials so she could help families achieve their infant feeding goals.

In May, Elizabeth completed The Lactation Counselor Training Course.  

‘Not this month’

Elizabeth says she always thought she would have four children, but several years of IVF treatments proved to be exhausting.

“It was one of the most difficult times of my life,” she says.  

In the beginning, Elizabeth shared her IVF journey with friends and family in search of support. But when treatments failed, it became too draining.  

“I would be curled in the fetal position crying hysterically while my poor husband had to be the one to tell everyone ‘not this month,’” she remembers. “I got tired of everyone feeling sorry for us…”

She acknowledges that people’s remarks like “It’ll just take time,” were intended to be encouraging, but they weren’t. 

“Unless you have lived the agony of wanting to be pregnant and month after month not getting pregnant, you have no idea,” Elizabeth explains.

Co-workers were unaware of the heartache Elizabeth endured those years of trying to conceive, but she remembers crying the entirety of her drive to work, washing her face inside and proceeding to her duties. 

“Going to work I felt like a stranger. A separate person,” she recalls.   

It was on Mother’s Day 2014 when Elizabeth and her husband publicly announced their pregnancy.  

Two years of breast milk

Elizabeth always planned to breastfeed her baby. Breastfeeding was one of the things she looked forward to most as a mother. And after learning of her baby’s bilateral cleft lip, she had only one question: “May I still breastfeed?” 

In preparation to feed her baby with special needs, Elizabeth contacted lactation counselors, met with a cranio-facial surgeon, made spread sheets with pumping times, and talked to everyone she knew in the medical field about cleft disorders. 

Despite avid preparation, Elizabeth wonders if the feeding support she received immediately following the (frank breech, unmedicated, vaginal) birth of her baby could have been better.

“We did not get skin to skin after delivery which still makes me sad,” she says.  A lactation specialist helped Elizabeth to pump her milk, but her baby wasn’t even in the room when the specialist came to visit her. 

Presently, the hospital where Elizabeth birthed is Baby-Friendly. Looking back, she wishes this had been the case during her stay.

“I know it would have truly made a difference,” she says.

While Elizabeth eventually learned that her son’s latch and transfer would not allow him to breastfeed directly exclusively, lactation specialists from the hospital’s Mother Baby Tea and their occupational therapist, helped her use the supplemental nursing system (SNS) and Haberman feeder. Elizabeth provided breast milk for her son for two years!

“There is absolutely nothing better in this world than feeding the son you love and smelling him and holding him close,” she reminisces.

Breastfeeding her baby also gave her the gift of feeling connected to other women. While nursing her baby at a doctor’s office, she looked up to the smile of another woman.

“It was one of those knowing smiles only women who breastfeed can share,” she says. 

Ongoing challenges

When he isn’t busy at weekly occupational and speech therapies for feeding difficulties and a speech delay, Elizabeth’s son, now two years old, loves to swim and read books about Nemo.

There’s a lot to anticipate throughout Elizabeth’s family’s journey; A child with cleft disorders will undergo an average of nine surgeries before she/he is 21 years old, she reports. She asks that we all remain sensitive to the ongoing challenges cleft disorders present, especially after watching videos by adolescents affected by cleft disorders.

“I cried and cried hearing about all the teasing these young people endured,” she says.

Reflecting on her own journey, Elizabeth says: “Motherhood, breast feeding, cleft disorders are all hard. If I can help or make a difference for just one mom and baby, that is all I can ask.”

Highlights from the 10th annual MAINN conference: Nutrition & Nurture in Infancy and Childhood: Bio-Cultural Perspectives

A small group of Healthy Children Project faculty were honored to attend and present at the University of Central Lancashire, Maternal and Infant Nutrition and Nurture Unit (MAINN) conference in lovely Grange-over-Sands, England last week. (For highlights of last year’s MAINN conference, visit this page). The MAINN conference has been held not only in the UK, Australia, and Sweden, but next year will be held in conjunction with Healthy Children’s International Conference in Deerfield Beach, Fla. from January 9 to 12, 2018.

This conference brings together researchers and experts in fields that support the establishment of the maternal-infant bond and related issues in nutrition and nurture. The remoteness of this seaside town in the Southern English Lake District created a container for further discussion and networking during and between sessions, as well as before and after the conference day. The schedule of the 3-day conference was prodigious, encompassing six plenaries, 72 breakout sessions, four workshops, and a poster session featuring the work of 17 research teams.

The HCP team offered to share insights with me from the conference, but struggled to do justice to all the learning insights and meaningful intellectual interactions that occurred. Therefore, they decided to blog about what they learned from one particular presentation.

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One of the amazing presentations we attended was Renee Flacking’s report on the research that she had done with Fiona Dykes of the UK regarding the use of nipple shields in the neonatal intensive care unit (NICU.) We can’t think of any superlatives beyond “Wow!” to describe the level of excellence, passion, and insight contained in this presentation. In order to collect the data for the ethnographic study, Flacking spent more than 600 hours “living” in four NICUs in Sweden and England. Observations, field notes, and interviews were searched for themes related to parents’ and staff’s perceptions and experiences of using a nipple shield in transitioning a preterm infant to feeding at the breast.

As background, Flacking acknowledged the debate over nipple shield use and presented two influential nipple shield studies: one small study that indicated that transfer of breast milk was enhanced when mothers of premies used a nipple shield to breastfeed (Meier et al., 2000), and a large study that found that premies who were exposed to nipple shields were significantly less likely to continue breastfeeding and to breastfeed exclusively (Kronborg, Foverskov, Nilsson, & Maastrup, 2016.)

Dr. Fiona Dykes, conference coordinator

Flacking & Dykes found that parents and staff thought of nipple shields as a transitional tool to progress to feeding at the breast, but mothers had some mixed and negative feelings as well. Mothers felt that the need to use a shield indicated that their breasts weren’t good enough and expressed that the nipple shield became a barrier between them and their baby. The researchers found two organizing themes: 1) the need for the baby to learn quicker, in order to get to full breastfeeding faster, and thus the nipple shield could be a short-term bridge to this goal, and 2) the interference of the nipple shield in the relational aspect of breastfeeding; that the shield impacts the development of the relationship between the mother and the baby. Holding these two organizing themes “in balance may be the key to appropriate use of the nipple shield,” Flacking stated.

The mother and baby’s needs must be taken into account in determining strategies to facilitate breastfeeding in a person-centered and ongoing way.

As we thought about and discussed Flacking and Dykes work among ourselves and with others, we couldn’t help but agree that nipple shields are often presented as a quick means to an end (as we have heard mothers complain about “helpers” latching the baby mechanistically like screwing in a light bulb), without taking into consideration the potential negative ramifications of the meaning of the shield to the family. We would never want any mother to think that she was not enough for her baby, that her breast was somehow suspect or inadequate, or that a piece of silicon could come between her and her baby. Particularly when we are working with the potential of feelings of inadequacy or guilt coming from the incomplete pregnancy, we must assume that mothers need help decoding the meaning.

HCP Faculty and Colleagues

We also pondered the resonance between Flacking and Dykes’ findings and those of Kronborg and colleagues, who cited that while nipple shields may be help mothers in the early period, but are “not necessarily a supportive solution to the inexperienced mother who needs extra support in the early process of learning to breastfeed.”

Growing Green Families

On World Environment Day last week, The World Alliance for Breastfeeding Action (WABA) and Pesticide Action Network Asia and the Pacific (PAN AP) reminded us that The Earth is Our Mother, and caring for her is essential to our health.

It’s easy to feel defeated by the burden of environmental degradation we have created and carry though; To be aware is to be afraid.

“…How can we become aware, take action, and not let ourselves become so vigilant, so aware, so motivated, and so afraid that we forget to enjoy the beauty of the Earth around us, the sounds of our children and grandchildren laughing, the calm music softly playing, and living our best life?” Master Herbalist and Certified Aromatherapist Donna Walls, RN, BSN, IBCLC, ICCE, ANLC wonders.

Released earlier this year by Praeclarus Press, Walls’ Growing Green Families: A Guide for Natural Families and Healthy Homes offers families a concise, practical guide complete with simple recipes on how to reduce their exposure to environmental toxins. Walls’ casual tone is easy to digest and makes for a speedy read.

She presents a collection of natural alternatives for personal care and housecleaning products, lawn and garden care, recycling strategies and a cleaner way to feed our families.

The recipes she shares come from years of experience as a lover of nature, all used by herself, friends and family or in classes she teaches.

When asked for her favorite recipe… “That’s like picking your favorite child– impossible, but the ones I use most are general cleaning and many of the aromatherapy recipes like the hand sanitizer,” she says.

Many of the recipes Walls suggests are concocted with easily accessible and relatively inexpensive ingredients like vinegar, plain yogurt, witch hazel, olive oil, baking soda, castile soap, to name a few. Still, some people have concerns about the perceived price of “going green,” like the cost of essential oils and organic food.  

“My usual response is that we all prioritize our budget, so it really is a matter of making healthy, clean living a priority for lifestyle and budget,” Walls begins.

“My snarky response: cancer co-pays are also very pricey,” she alludes to reports by the Environmental Working Group and the Environmental Protection Agency which estimate that many of the products we use are human carcinogens.

Walls’ granddaughter passes on the tradition of green cleaning.

Homemade product preparation has been criticized for being too time-consuming, too.

“Much as with money, we all have priorities,” Walls says. “We have time to do the things we value.”

She suggests combining activities, like preparing products while watching TV or prepping cleaning supplies while cooking. After all, “cleaning with a conscience” starts with vinegar, lemon juice and baking soda, all kitchen cupboard basics!

Of bigger concern is access to organic, clean food in food deserts. It is an opportunity for community and personal activism, Walls says.

She suggests supporting local community gardens, volunteering at local food pantries to help obtain healthy food, and establishing and contributing healthy options to street food cupboards.

Growing Green Families touches on concerns about toxins during pregnancy and nods to breastfeeding as “the best first food.” With fingers crossed, Walls says she hopes to publish her next book with a focus on childbearing years.

Potential consequences of invoking ‘natural’ in health promotion: Part 2 of 2

Source: United States Breastfeeding Committee.

When this conversation about breastfeeding being natural and its implications started, I thought a lot about how many families, including mine, get a good dose of parenting advice and health care information on the internet. Because I tend to distrust medical professionals, I almost always consult other resources (trusted individuals and the internet) for supplementary information when making choices that impact my children’s health.

But the internet is saturated with articles that claim this and that and the other thing, and there’s “evidence” to prove it all. Many parents, including myself, don’t have the expertise to recognize good research design or truly grasp the abstract nature of statistics. Other things happen when we seek out information on the internet and elsewhere: confirmation bias and the backfire effect. These terms are used by cognitive scientists and psychologists to describe the following reactions:

Confirmation bias is our drive to prefer information that appears to affirm our core beliefs.

On the other hand, when we are exposed to information that runs counter to our core beliefs, we may have one of the following responses:

  • Motivated skepticism: examining information with doubt that it is true, actively looking for flaws in the information
  • The backfire effect: rejecting information that challenges our strongly held beliefs; research indicates that being overwhelmed with a good deal of such information may actually strengthen the belief it is meant to challenge.

Turner-Maffei provides a few examples from the lactation world.

“The first news about Vitamin D deficiency in breastfed babies resulted in motivated skepticism on the part of breastfeeding advocates,” she begins. “Many dug into the research looking for problems and oversights, demonstrating motivated skepticism. The fact that we are motivated to attack information that seems to run counter to our beliefs (in this case, breast is best, why would babies need extra vitamin D?) shows how deeply held these beliefs are, close to our personal and group identity. We are less likely to be skeptical about findings that appear to confirm our core beliefs, such as studies showing a link between breastfeeding and positive health outcomes.”

On confirmation bias: When the World Health Organization’s guidance on safe preparation of infant formula was first added to the Baby-Friendly Hospital Initiative guidelines in 2009, many lactation professionals expressed a belief that instructing parents of newborns about how to safely prepare powdered infant formula to protect the infant might actually “scare” some new parents into breastfeeding to avoid Cronobacter, a potentially fatal infection. However, the current understanding of the backfire effect indicates that this viewpoint may be flawed. (Meanwhile this information triggers confirmation bias on the part of lactation activists, as it aligns with the strongly held belief that ‘breast is best.’)

A You Are Not So Smart podcast (about 28 minutes in) offers insight into these phenomenon covering research about the belief that vaccines can cause autism. It demonstrates how we are more heavily influenced by stories than by complex research.

It is easy to understand that parents might feel autism is a greater risk than the common diseases that childhood vaccination protects against: whooping cough, pertussis, measles, mumps, rubella, etc. The media is replete with stories of autism on the rise (up from one child in 150 in 2000 to one in 68 in 2012) while outbreaks of these diseases are reported sporadically in limited geographic locations.

While there are rare side effects to vaccinations, high level research has not found a causative link between vaccination and autism (IOM, CDC, WHO). Some have suspected that mercury found in the preservative, thimerosal may be linked to autism; not only does research deny this linkage, but the originator of this theory was found to have engaged in ethical misconduct.  Nonetheless, the U.S. government recommended removing this preservative from vaccinations in 1999 (although it is still used in some multi-dose vials of flu vaccine.)

When expert opinion regarding lack of linkage between vaccination and autism is shared with concerned parents, research indicates that the backfire effect may cause those who are most against vaccination to accept the lack of evidence, but also to strengthen their commitment to avoid vaccinating their children, as shown in Effective Messages in Vaccine Promotion.

As a side note, the low incidence of things like hemorrhagic disease as described in Dekker’s article means that most parents have not seen or heard of a family member or friend with this outcome . The likelihood of a child contracting a vaccine-preventable disease in the U.S. is relatively low too, in this case thanks to herd immunity or community immunity.

Turner-Maffei points out that the CDC reported that 667 people in the U.S. had measles in 2014, and the last death in the U.S. from measles occurred in 2015 for instance.

“With 4 million children born annually, the risk of contracting measles whether one vaccinates or not is incredibly low,” she explains which might explain a false-sense of security against disease among those who choose not to vaccinate. “But the more people who decide not to vaccinate, thinking they’re safe from this risk, the greater the potential spread of the disease in the unimmunized pockets of the community, thus the greater the risk to children as the trend grows. The safety of not vaccinating decreases with the herd immunity.”

Today, health officials are dealing with the largest outbreak of measles in Minnesota in almost 30 years after a population “fell under the sway of anti-vaccination activists.”

The same type of risk/benefit ratio pertains to the risk of a newborn contracting a Cronobacter infection from contaminated infant formula, Turner-Maffei reports. Again, the occurrence of these infections is low. (CDC reports that it learns of four to six cases per 4 million infants annually, although they note that many cases are likely not reported.)

Expectant parents who are made aware of the potential contamination of infant formula may also be falsely reassured by the rarity of this infection, she suggests.

Is it possible all humans are prone to believe we’re protected from rare negative outcomes associated with our core values?

The release of WHO recommendations on infant feeding by HIV-positive mothers, based on new evidence, suggests that HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding. This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV, Breast is always best, even for HIV-positive mothers reads.

Over 1,000 words earlier I quoted, “The term natural has a lot of values packed into it.” And here we are about 1,000 words later still with much to consider. When we engage in activities designed to convince people something is best, or the natural choice, we are entering into complex endeavors that may trigger sophisticated cognitive responses, including the backfire effect, in some individuals.

So what can we do to propagate evidence-based thinking, we wonder. In response to a question from You Are Not So Smart’s Dave McRaney, Jonas Kaplan states that currently science can’t tell us how to make others accept the facts we consider unassailable (around 37:00 minutes), Turner-Maffei reiterates. Rather, Kaplan proposes that we strive to be more flexible when encountering information that runs counter to our beliefs, to be aware of the tendency toward motivated skepticism, and to learn to distinguish our beliefs from our identity as individuals.

Turner-Maffei suggests, “Perhaps in this way we can model cognitive flexibility while becoming more open to the beliefs of others, less centered in our own worldview, and hopefully less likely to contradict the beliefs of others since contradicting core values may trigger the backfire effect.”

Research which suggests a delay in breastfeeding at the time of the oral rotavirus vaccine to “overcome [breastfeeding’s] negative effect” on the potency of the vaccine has been met with outrage by some breastfeeding advocates.  As an exercise in cognitive flexibility, we invite you to read the publication and take note of your feelings and cognitive process.

Also for your consideration, a list of common misconceptions that corrects erroneous, widely-held beliefs.