OB/GYN sheds light on creating breastfeeding culture

alison_stuebe_abogMaternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine Alison Stuebe, MD, MSc recently wrote Breastfeeding and depression: It’s Complicated,  a fascinating post on the Academy of Breastfeeding Medicine’s blog. Her work is of such value because she recognizes that overstating the “benefits” of breastfeeding sometimes negates the reality of the experience for mother infant dyads.

Particularly intriguing is the story Stuebe tells of a mother who admits experiencing more concern about her milk production and her relationship with the pump than mothering her crying infant.

“When we emphasize breastmilk, we have completely misunderstood the biology of infant feeding,” Dr. Jack Newman replies in the post’s comment thread.

Stuebe fills me in on a theory that explains this woman’s (and other’s) obsession with milk production. Dr. Barbara L. Frederickson, Kenan Distinguished Professor of Psychology and Principal Investigator of the Positive Emotions and Psychophysiology Lab at the University of North Carolina, argues that obsessive passion comes from negative reinforcement.

“When we talk too much about the evil agents in formula, we risk creating obsessive passion,” Stuebe explains.

She describes obsessive passion this way: A fervid runner injures her ankle. Although continuing to run on that injury will decrease her chances of healing, she continues to do so. Her passion triumphs in an obsessive fashion and she ultimately risks destroying her ability to run all together.

On the contrary, a runner who exhibits harmonious passion will nurture her injury so not to risk the chance of never being able to run again.

Stuebe relates this analogy to the breastfeeding mother. If the risks of formula feeding are so ingrained in her mind, she may be motivated to neglect her child’s needs just as long as she never allows that baby to consume “rat poison”, or formula as Stuebe half-jokingly puts it.

Too often, breastfeeding advocates (including myself) become so hung up on the evils of formula that we leave mothers who do not successfully breastfeed in the dust with no other way to connect with their babies; hence the baby left to cry while mother squeezes out her last drop of milk.

Stuebe’s current research on breastfeeding and depression questions conventional thoughts about infant feeding and its relationship to the way mothers and infants connect.

If you look at a population of several hundred three-month-olds, you will find that more of the depressed mothers bottle feed, Stuebe explains.

However when longitudinal studies are considered, it’s hard to argue, “If she would just breastfeed, she wouldn’t be depressed,” Stuebe continues.

The study’s current results about oxytocin and depression are provoking.

“It could be that mothers who have lower oxytocin levels have trouble with breastfeeding and also feel more anxious and depressed,” Stuebe reflects in Breastfeeding and depression: It’s complicated. “Or it could be that, for mothers whose baseline oxytocin is lower, breastfeeding gives them a boost that’s essential for them to feel connected to their babies.”

She concludes, “The nuances of the biology suggest that doctors absolutely need to think about the effect of breastfeeding on a woman’s mood symptoms.”

Tackling a fragmented health care system

In fact, all health professionals caring for the mother infant dyad need to practice with this suggestion in mind.

Because of the nature of fragmented care in our nation, lactation professionals are often the only caregiver assessing the mother and baby as a couple.

“We’re that glue and we need to be watching really carefully,” Stuebe says.

She gives us simple advice and reminds us that the Edinburgh Postnatal Depression Scale or EPDS is a very easy test to administer to measure postpartum depression. It takes about five minutes and is translated into many languages.

Although there is sometimes a harmful disconnect between mother and baby providers, Stuebe says that there are breastfeeding medicine practices that serve to bridge the gap springing up around the country.

For instance, MilkWorks located in Lincoln, Neb. offers support from a variety of lacatation professionals including a medical doctor, lactation counselors and consultants, nurses, breastfeeding educators and dieticians.

In Chapel Hill, N.C., women have access to the Women’s Birth and Wellness Center which also offers lactation care within the community.

For the mother suffering from PPD, these centers offer an alternative to medication that might ultimately require her to stop breastfeeding.

While many communities are developing support centers for mother infant dyads, there is still a lot of scatter within our system. Stuebe says it would be ideal if these services were offered at YMCAs for instance, or if family physicians were able to provide a kind of “one-stop shopping” experience.

Stuebe says that pushing health care to be more woman-centered in general is a huge step in the right direction. To accomplish this, we need innovative ideas, new models, and new approaches.

Considering all of the science

“Those of us involved in breastfeeding advocacy need to be thoughtful about how we talk about the science,” Stuebe explains.

Getting people excited about breastfeeding research is a start, but it only goes so far. For the non-believers, the breastfeeding skeptics, getting a roomful of people fired up about breastfeeding makes them think, “This is a cult,” Stuebe half-heartedly chuckles.

(She makes clear that she is part of the cult, so she says that with love.)

It’s important for breastfeeding advocates to remain open about the research that doesn’t confirm what we already believe. Similarly, we should consider the studies that completely turn what we once believed upside down.

Stuebe explains that it’s too easy to dismiss new research on the grounds that someone involved in the process received money from a formula company. Instead, we should look at the findings critically.

Stuebe’s breastfeeding wisdom doesn’t end here.

Saving nipples two ears at a time

She suggests we remain receptive with clients as well.

“Communication starts with listening,” she says.

Lori B. Feldman-Winter, MD, MPH, Head of the Adolescent Medicine Division at Cooper University Hospital and National Faculty Chair of the Best Fed Beginnings project once offered Stuebe this analogy to consider: A doctor asks a pregnant woman if she plans to breastfeed. The woman replies that she’s apprehensive because she’s uncertain she wants to have her nipples pierced. The doctor explains that the holes for breastfeeding are already in place. “Well in that case, of course I’ll breastfeed,” the woman responds.

Feldman-Winter suggests always starting conversation with a parent by asking what he or she has heard about breastfeeding. Listening saves nipples!

Creating conversation in the workplace

Conversation is crucial among lactation professionals’ colleagues as well. Fittingly, Stuebe tells me about a book called Crucial Conversations: Tools for Talking When Stakes are High which discusses how to establish mutual purpose and mutual respect.

Establishing collaborative relationships within the workplace can be especially valuable in the hierarchical field of medicine.

Perhaps a misinformed doctor gives a patient incorrect breastfeeding advice. Stuebe suggests lactation professionals respectfully question the physician’s information privately. She advises resisting the urge to shout, “You stupid fool!”

“Feeling stupid in front of the patient doesn’t feel particularly good,” she explains.

When physicians are the least knowledgeable about breastfeeding, it can either motivate them to learn, or it can turn them off completely; they may decide that breastfeeding isn’t their problem, Stuebe tells me.

She adds that unfortunately there is no culture in place that dictates offering proper breastfeeding support is the physician’s responsibility.

Considering the breastfeeding OB/GYN

As a mother of three boys, Stuebe is able to speak not only to the physician’s experience but also to that of the breastfeeding OB/GYN.

The training process is generally unfriendly to nursing mothers, she tells me. Demanding schedules often don’t allow time for pumping. And when there is time, co-residents sometimes see a mother’s need to pump as an excuse to dump her work on someone else.

Sadly, when nursing OB/GYNS aren’t supported in their breastfeeding journeys, their guilt and anger can sublimates into their general perception of breastfeeding. The same might happen if an OB/GYN’s partner had a difficult time nursing.

Fortunately, Stuebe reports being blessed with a supply that withstood extended spans between pumping.

She started her internship the first day her son turned three months old and recalls “walking down Brookline Avenue to Brigham and Women’s Hospital with a Pump-in-Style slung on [her] back and a vague determination to breastfeed.” [Retrieved from: https://bfmed.wordpress.com/2012/11/16/building-a-breastfeeding-culture/]

Her decision to breastfeed was hardly influenced by medical school as breastfeeding was “not really in the mix at all.” Most of her initial breastfeeding education as a mother was self-sought; reading So That’s What They’re For and observing her sisters’ breastfeeding adventures. Stuebe says that breastfeeding eventually defined her as a mother.

“Breastfeeding became the one thing they couldn’t take from me,” she says of her time interning. “They could take my soul, sanity and sleep, but they would not keep me from nursing my baby.”

In Building a breastfeeding culture, Stuebe further explains what motivated her to nurse her children.

Sharing her stories

Perhaps it is Stuebe’s willingness to share her personal experience that makes her contributions to the field of lactation so extraordinary. She is so human, so humble yet so outstanding.

Take her Twitter description for example: High risk obstetrician, aspiring midwife, Breastfeeding researcher and advocate, mom of three. Aspiring midwife catches my eye.

“I love low risk birth,” she explains. “I believe in physiology, but I think that even in the sickest patients I’ve taken care of, I try to remember that this is still a life event for them.”

She recalls a mother with severe cardiac arrhythmia who birthed her baby in “low lights and lovely ambiance” with the cardiac intensive care unit outside the door. Her baby went skin to skin immediately after birth and latched within the first four minutes! Stuebe remembers the image of the baby’s small hand resting on its mother’s defibrillator pad.

Stuebe has worked closely with the Massachusetts Breastfeeding Coalition, helping with web design and a variety of educational initiatives. She’s currently involved with the Carolina Global Breastfeeding Institute at UNC where she serves as an institute-associated faculty member.

In her pre-medical life, Stuebe worked as a journalist which she says has significantly influenced her ability to communicate with the public and her patients.

To read more about Stuebe’s work, visit the Breastfeeding Medicine blog here and her compilation of articles at the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM) here.

Take chances, make mistakes, get messy

kathy_2012I was thrilled to have the opportunity to speak with health psychologist and lactation professional Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA a few weeks ago. I was equally thrilled when she mentioned The Magic School Bus during our interview. (For those of you unfamiliar with it, The Magic School Bus is a series of children’s books about Ms. Frizzle, a sprightly grade school teacher, and her class’ journeys aboard an anthropomorphic school bus to places like outer space, the past and my favorite, the human body.)

Kendall-Tackett tells me the best piece of professional advice she’s received is to allow yourself to make mistakes. She quotes Ms. Frizzle, “Take chances, make mistakes, get messy.”

While I failed to ask her if she drives a school bus or wears funky science-themed dresses, Kendall-Tackett is a bit of a Ms. Frizzle herself. As founder of UppityScienceChick.com, she shares Ms. Frizzle’s fascination with science and offers a forum for sharing current and noteworthy research on the mind-body connection.

Because of the career path she chose, Kendall-Tackett says she knew she wasn’t going to fit into a traditional mold.

“I had to find a way to make it work for myself,” she says.

Her entrepreneurial spirit allowed her to create a brand for herself but calls it a “weird balance” between her academic background and self-marketing. She claims five main job titles: author, editor, publisher, speaker and science chick.

“It’s been an interesting process, something I’ve kind of had to learn along the way,” she says of entrepreneurship.

One of Kendall-Tackett’s newest and most exciting ventures is the launch of Praeclarus Press, a small press that focuses on women’s health. It offers e-books, webinars, and uplifting art, uses new, eco-friendly publishing technologies, donates a portion of sales to worthy organizations that support women and children in the U.S. and abroad, and offers low cost products to provide information to the widest possible audience. [Retrieved from: http://www.praeclaruspress.com/About-Us.html]

In her Shift Happens: How Scientific Paradigms Change and Why These Shifts Should Matter to Lactation Consultants editorial, Kendall-Tackett discusses Thomas Kuhn’s work exploring how scientific revolution occurs. Relating his findings to the work of the lactation professional, she explains that it is not in our best interest to accept all new ideas, but that it can be equally detrimental if we shut ourselves off from all new ideas.

In a sense, Preclarus Press’s mission stands in line with this notion.

“If we can put new information out there, we do our best to promote change,” Kendall-Tackett explains.

For instance, she calls The Virtual Breastfeeding Culture: Seeking Mother-to-Mother Support in the Digital Age  by Lara Audelo, CLEC a “game-changer.” It offers lactation professionals advice on how and why they should connect with their clients through various social media platforms in a world of expanding digital communication.

Kendall-Tackett admits, “I haven’t even scratched the surface with what you can do with social media.”

Still, she’s active on Facebook. Even more, she offers mothers and health professionals innovative, evidence-based breastfeeding information on a variety of web-based platforms.

Of her many accomplishments, she and co- investigator Tom Hale received the John Kennell and Marshall Klaus Award for Excellence in Research in 2011 for the Survey of Mothers’ Sleep and Fatigue.

Kendall-Tackett tells me she finds inspiration for her research from concerns mothers express. Like when a mother sparked Kendall-Tackett’s interest to begin the Survey of Mothers’ Sleep and Fatigue after the mother admitted to co-sleeping on couches and sofas with her infant.

“My reaction was we need to find a way to document this,” Kendall-Tackett says.

Her research exploring normal maternal infant sleep behavior contributes to safe and realistic sleep recommendations for mothers and infants. Watch her short video Safe Sleep with Your Baby here.

Kendall-Tackett expresses hope that her research will counter standard policy. She has made her slides and much of her other work readily available to the public so that lactation and health care professionals have the evidence they need to push policy change within their communities. Kendall-Tackett calls it a grassroots effort.

Along with policy change, Kendall-Tackett emphasizes the importance for lactation professionals to build a relationship with a mentor.

“Having good teachers makes a tremendous difference,” she says.

And mentorship can be a two-way street. Upcoming lactation professionals possess digital skills that the older generation lacks.

A combined effort of all maternal infant health advocates have led to amazing strides in the protection, promotion and support of breastfeeding.

“I’ve really seen a lot of forces come together in an unprecedented way,” Kendall-Tackett says.

Kendall-Tackett and I agree that the general public is still missing an important angle when it comes to breastfeeding.

“If people can get breastfeeding right, a lot of other things take care of themselves,” she says.

While it doesn’t eradicate all of the problems, it has a significant positive influence on many of them like infant mortality, maternal depression and fatigue and child abuse.

Still, Kendall-Tackett would like to see more work done around childhood abuse and its effects on the breastfeeding experience. She has previously published work on this topic: http://jhl.sagepub.com/content/14/2/125.short.

Kendall-Tackett puts the notion of change into perspective when she explains that we don’t have to wait for sweeping societal changes. If we help one mom at a time, we’re getting there. Helping one mom can be just as significant as helping a community of them.

While Kendall-Tackett advocates for breastfeeding in the highest regard, she reminds us that overly generalized messages can be harmful.

Recalling watching a baby placed skin to skin on a new mother for the first time, she advises caution when promoting skin to skin for every new mother. Instead of experiencing the expected cascade of love hormones, as a sexual abuse survivor,  this mother recoiled in horror.

Lactation caregivers should always be cognizant of the fact that while we have the potential to positively influence a mother’s breastfeeding experience,  we also have the potential to make a mother’s experience worse if support is not offered in a cautious, sensitive and nonjudgmental manner.

Kendall-Tackett has spoken twice at Healthy Children Project’s International Breastfeeding conference in recent years; once sharing her knowledge on postpartum depression and another on sexual abuse and breastfeeding.

Visit her websites at http://www.BreastfeedingMadeSimple.com/, http://www.uppitysciencechick.com/, http://www.kathleenkendall-tackett.com/ and http://www.praeclaruspress.com/.

Lactation professional contributes to New Hampshire’s breastfeeding success

lisa picI started the interview like this: Congratulations on being ranked number one for perinatal care for the fifth year in a row. I know a lot of the work you do contributes to great outcomes for moms and babies in New Hampshire.

She replied so seriously: How do you know that?

Not at all expecting that response, I stuttered; the words stumbled out of my mouth: Well, all the work you do with breastfeeding. That’s what really matters.

Lisa Lamadriz, RNC, IBCLC is one humble woman. Before our interview, I read and heard a lot about her, leading me to believe that she indeed does have a lot to do with NH’s great perinatal care.

Lamadriz works at Dartmouth Hitchcock Medical Center (DHMC), a Baby-Friendly tertiary care center where she heads the Baby-Friendly team. In 2007, she created lactation support programs for families with infants at Children’s Hospital at Dartmouth’s (CHaD) Intensive Care Nursery (ICN). She created a nutrition group that provides staff education. [Retrieved from: http://chad.dartmouth-hitchcock.org/documents/pdf/chad_matters_winter_2007.pdf] She serves as New Hampshire Breastfeeding Taskforce’s co-chair. She contributes to CHaD’s breastfeeding episodes. And the list goes on.

During our chat, Lamadriz continued to prove that she and the collaboratives she’s a part of have a lot to do NH’s breastfeeding success.

As stated, back in April, the 2011 Maternity Practices in Infant Nutrition and Care (mPINC) Survey results from the Center for Disease Control and Prevention (CDC) showed New Hampshire as number one for the fifth straight year in perinatal care practices associated with breastfeeding success. The New Hampshire Department of Health and Human Services (DHHS) says the survey results are due largely to the efforts of the New Hampshire Ten Steps to Successful Breastfeeding Program, headed by Dartmouth-Hitchcock’s Bonny Whalen, MD. [Retrieved from: http://www.dhhs.nh.gov/media/pr/2013/04-apr/04032013survey.htm]

The Ten Steps program began as a hospital-based project but has grown into a state-wide initiative. DHMC’s journey to Baby-Friendly began about 15 years ago, but the facility recently revamped their efforts in 2009. The hospital was awarded designation in 2012. Read more about their efforts here: http://www.dartmouth-hitchcock.org/news/newsdetail/61662/.

Lamadriz tells me families have often told her they chose DHMC for their birthing experience specifically because of its Baby-Friendly designation; a great marketing tool as Baby-Friendly USA project manager Liz Westwater explains in Baby Friendly Hospitals decrease traumatic birth experiences, increase breastfeeding rates.

Getting DHMC staff excited about Baby-Friendly designation started with a large skin to skin campaign. Before the implementation of the Ten Steps began at the facility, Lamadriz admits that while they thought they were doing a great job getting babies skin to skin, they realized they could do a lot better (even with about a 30 percent population of high risk deliveries).

So bulletin boards showing evidence of the effectiveness of BFHI went up throughout the hospital. Staff champions mingled with resistant staff members.  Physician champions spread the word about breastfeeding.

Lamadriz names Dr. Whalen one of those physician champions. As a pediatrician, medical director of the Newborn Nursery and a certified lactation consultant, her positive influence on breastfeeding spreads far and wide. Even more, Lamadriz tells me she’s passionate about integrating breastfeeding education and support into young physicians’ curriculum.

Neonatologist Juliette Madan, MD, MS is equally encouraging about breastfeeding and breastmilk feeding. Her efforts allowed for an update of the ICN’s feeding guidelines. Mothers are now encouraged to provide colostrum for baby before any kind of supplementation is offered. Lamadriz says babies are never just automatically started on artificial baby milk.

“The gut is so fragile,” she explains. “It really needs that colostrum before we put anything else on it.”

The ICN’s support and patience with breastmilk feeding low birth weight babies has played a part in allowing the facility to significantly decrease the use of non-medically indicated formula supplementation. In fact, Lamadriz says their breastfeeding initiation rates are close to 98 percent. Any breastmilk feeding at time of discharge varies between 45 and 60 percent.

Because of the size of the facility, Lamadriz says it’s often difficult to engage everyone in the Baby-Friendly process, a common challenge facilities face when working toward designation.

However like many other successful Baby-Friendly facilities, DHMC formed a multidisciplinary quality improvement team comprised of clinicians including those from CHaD, the Prenatal Clinic, Birthing Pavilion, Newborn Nursery, INC, Pediatrics, Food and Nutrition Services, Finances and Purchasing to ensure every care provider a mother comes in contact with supports her breastfeeding goals. [Retrieved from: http://www.dartmouth-hitchcock.org/news/newsdetail/61662/]

“Our biggest improvement was in the area of prenatal breastfeeding education in the clinic,” Lamadriz says in a DHMC news release. “We updated our patient education materials, and created a process with the staff in the prenatal clinic to provide small amounts of breastfeeding education at each prenatal visit.”

While DHMC excels in its prenatal breastfeeding education, it still struggles with sustaining Baby-Friendly’s rooming-in model.

“Nurses feel like they are doing mom a favor if they take baby out for sleeping,” Lamadriz tells me, yet another common but not unconquerable challenge.

By improving prenatal education, Lamadriz says parents are better able to advocate for their families.

“They actually drive the practice,” she says. “They really take the initiative of keeping their baby with them.”

Postnatally, DHMC offers lactation support services including a Lactation Clinic and referrals to support groups like the Women’s Health Resource Center.  We know that continuity of care is essential when supporting moms’ breastfeeding goals, so DHMC lactation professionals make sure to communicate with mom and babys’ other health care providers.

Lamadriz says she and her co-workers connect with other maternal child health programs in NH through the state’s breastfeeding taskforce. Representatives from different organizations including WIC, universities, La Leche League and the Department of Health and Human Services (which heads the obesity prevention program) work toward a common goal to support breastfeeding throughout the community.

Members of the 10 Steps Collaborative including Lamadriz, Whalen, Joyce Kelly, RN, MPH and  Dr. Alison Holmes of Concord Hospital and Dartmouth-Hitchcock have educated staff at six  of the 20 birthing hospitals in NH about the 10 Steps program.

Through a survey, Lamadriz says they learned that one of hospitals’ biggest barriers to become Baby-Friendly is the cost of educating their staff. Lamadriz provides education and skills days to facilities in need.

“Hospitals are really working on the ten steps and trying to improve,” Lamadriz says. “I’m hoping that will increase our [breastfeeding] duration rates.”

According to the CDC’s 2012 breastfeeding report card, NH’s exclusive breastfeeding rates at six months came in just under 25 percent, about ten percentage points higher than the national average. While NH’s duration rate is one of the highest in the nation, 25 percent of babies breastfeeding at six months is still arguably a very dismal number.

The 10 Steps Collaborative provides education across the border to Maine’s Let’s Go! program, an initiative to reduce obesity that includes a breastfeeding component. Maine’s exclusive breastfeeding rates at six months come in just above 15 percent.

Despite the somewhat gloomy numbers, Lamadriz says she is very optimistic about future birth and breastfeeding outcomes in our country.

“I think we have a lot of work to do and I sometimes worry about the hightechness of everything,” she says. “But I am optimistic because I do see the younger mothers reading about breastfeeding and knowing a lot when they show up for their appointments.”

Lamadriz says it’s sometimes difficult to get people to slow down and recognize the importance of the biological and anthropological connection between mom and baby.

“It’s my generation’s responsibility to make sure young women are aware of how important this special time is.”

Lamadriz will take her responsibility to the next level this fall when she attends Boston University’s Master of Public Health: Maternal Child Health program. As a graduate of Union Institute and University’s Bachelor program in Maternal Child Health: Lactation Consulting, she says she gained a more global perspective on maternal child health issues. (The Healthy Children Project collaborates with UI&U to provide the lactation content of this degree program.)

“I became keenly aware of the horrible things happening to women and girls,” she says. “It flipped me upside down. Something inside of me said, ‘OK, now you know this so what are you going to do?’”

Celebrating dads with restructured breastfeeding support

Male nipples. What is their function? Well, if you are the parent of a breastfed baby, you have most likely had the experience of watching your infant try to latch or successfully latch onto dad’s chestly protrusions. For most parents, it’s a funny story to tell. But what if it’s more than that? My rudimentary research leaves me to believe that babies don’t seek their father’s nipples out of confusion or randomness. Instead, male nipples may serve as fleshy pacifiers and an important portal into father-baby bonding.

In honor of dads, this Father’s Day we decided to do something different on Our Milky Way; we take a glimpse into two fathers’ breastfeeding experiences.

The stories they share and their partner’s reflections prove that we need to modify the way we view dads’ roles and restructure the support we offer them.

Hope Elser, Union Institute and University Maternal Child Health student, WIC breastfeeding peer counselor and mother of two, and her husband Jason were kind enough to share their parenting journey with me. Hope and Jason are the parents of Kaitlyn, 6, and nursling Ryan, 18 months.

Additionally, I formally interviewed my darling husband Addison. Our daughter Willow just turned 22 months. Like Hope and Ryan, we practice natural term breastfeeding. We’re also excited to announce that we’re expecting our second child in early November.photo

Hope, Jason and I engaged in very friendly conversation. We chuckled about our toddlers’ requests for milk from dad. Then, Hope made a profound observation: Children request breastmilk from the people they feel nurtured by- at least this has been our common experience.

Addison and Jason let me in on the ways they feel most effective in connecting with their children.

For Jason, bathtime and plenty of skin to skin contact are great ways for him to build a relationship with his kids.

Addison says reading and playing with Willow on her activity mat are important bonding opportunities.

“I never ever felt like I was taking something away from [Jason] by breastfeeding,” Hope explains. “I think he took a lot of pressure off of me because he just found other ways to bond with them.”

I wish I could say the same; after interviewing Addison, I do feel like I took something away from him.

Interestingly, Addison cites the bond that Willow and I share as the best and worst part of being the father of a breastfed child.

“Willow can be so upset sometimes and you just nurse and she is so happy,” Addison says.

photoBreastfeeding is also an extremely effective way for me to put Willow to sleep. Up until about a few weeks ago, Addison hadn’t been able to put her to sleep unless he drove around in the car with her.

To be honest, before our interview, I always felt like it was Addison’s fault that Willow generally prefers to come to me when she’s upset, hurt, scared or tired. I felt like if he would have put more effort into bonding with her in other ways beyond feeding, he would share the same relationship that she and I do. But I’m not so sure that theory is valid.

Looking back, I wonder if encouraging my husband to “nurse” Willow would have allowed him to experience what it’s like for me to be a breastfeeding mom.

Addison continually expresses interest in actively offering our next child bottles of breastmilk, a request I continually deny.

Yet, I am completely open to the idea of male nursing as a nurturing act. Addison makes clear that the thought of male nursing makes him very uncomfortable.

Writer and director Peter Templeman made a fascinating and provocative short film called Milk Men which explores male lactation and breastfeeding and is certainly worth watching if you’re interested in this model.

Hope tells me that as a lactation professional, she sees moms and babies all day long, every day but very rarely sees fathers coming in for support. When she asks mothers about their partner’s feelings, perceptions and concerns about breastfeeding, most of them reply that it doesn’t matter because he’s not a part of it- not necessarily that the fathers are absent all together, but they are uninvolved in the process of breastfeeding.

Hope argues that fathers should very much be a part of the process.

“You have to allow him to be,” she advises. In the same breath, “Moms don’t know how to integrate dads into the breastfeeding relationship anymore than dads do,” she says.

She’s spot on when it comes to my husband and I. Leaving my pride at being able to satisfy Willow aside, I hypothesize that it’s difficult for me to acknowledge the important role a dad can play because my father has been absent all of my life. I learned about parenting from my mother who fulfilled both responsibilities.

I pushed Addison away when I took on virtually every aspect of parenting beyond earning a living. I didn’t have a clue how to allow him to integrate himself into our nursing relationship and he didn’t know how to advocate for himself. I never learned from my mother how to consider a co-parent or partner. The breastfeeding education Addison and I did receive together was so moronic. Perhaps we are psychologically flawed in that we didn’t find a healthy balancing act on our own… But then again, how would new, first-time parents learn do to this without support and guidance?

What if we had been introduced to male nursing? Would this mutual engagement in such an intimate act with our infant have allowed us to better connect as parents?

Our nation is most certainly not ready for the promotion of male nursing; we can hardly handle images of mothers feeding their babies, let alone an infant suckling at its father’s breast. Gasp!!

A less controversial solution is to better include fathers in breastfeeding imagery in other ways.

Take a look at this screenshot of a Google Images breastfeeding search. The images are stunningly beautiful, but who is missing?googlebreast

I smell a problem here, especially when we consider Addison’s and Jason’s thoughts about breastfeeding before they expected their own children: they didn’t have any.

“I never really came across [breastfeeding] at all,” Addison says. “I didn’t have any knowledge about what good things can come of it or anything like that.”

He doesn’t recall any of his family members breastfeeding. Before Willow’s birth, he had never noticed a woman breastfeeding in public and says he can’t remember any times seeing breastfeeding in the media.

And before Hope decided that she wanted to breastfeed, Jason hadn’t thought about breastfeeding either.

The inclusion of partners in breastfeeding imagery might also allow mothers to acknowledge the part a father can play on the nursing team.

I firmly believe that the decision to breastfeed is ultimately that of the mother. Her body. Her choice. Simple.

But when fathers are not engaged in any kind of conversation about breastfeeding prenatally, we pose the risk of disengagement throughout parenthood.

Addison wasn’t involved in my decision to breastfeed Willow. It isn’t something either of us remember having a specific conversation about and it was never something Addison questioned (aside from his initial concerns with me breastfeeding in public.)

Like my husband and I, Hope and Jason don’t recall having a conversation about deciding how to feed their baby.

“I just knew that I was going to breastfeed and having support to do so was very encouraging, especially from a man,” Hope says of her first born. “That was a new experience having that kind of support in such an intimate way.”

I am impressed with Jason’s ability to offer support without direction, because he expresses feelings of unpreparedness. He says he wishes there had been breastfeeding education and support offered directly to him as the father.

In fact, research teams in Italy, Brazil, and Australia have evaluated the impact of training dads to support their breastfeeding partners. They’ve discovered that educating fathers about basic breastfeeding management increases the duration and/or exclusivity of breastfeeding.

“If I would have had a little bit of knowledge about the dad’s role, we may have understood what was wrong with Ryan and why he wouldn’t latch earlier,” he says of Ryan’s tongue tie.

Much the same, Willow and I initially had a tumultuous time perfecting our latch thanks to the infamous hospital birth with all of the booby traps perfectly in place.

Addison spent days and nights with me enticing Willow to open her tiny mouth so I could shove my bloody nipples into her face. Knowing what I know now, I cringe when I look back on those days.

“I fetched lanolin and nipple diapers,” Addison remembers of my sore but surprisingly leaky breasts.

“I could have called the specialist and had them come help,” he says in hindsight.

Breastfeeding advocates spend a lot of time sharing information about why dads should care about breastfeeding. For example, The Leaky Boob shares Breastfeeding- Good for Dads Too.

Similarly, we put a lot of energy into communicating how dads can effectively support their breastfeeding partner. For instance, Best For Babes recently came out with Listen Up, Dads! 10 Ways You Can Support Your Breastfeeding Partner. It’s a simple yet fabulous resource for new dads and I cannot deny that the support dad offers is a crucial part of building a successful breastfeeding relationship between mother and baby.

But what about support for the supporters? Tailored support for the dads like Addison and Jason.

The breastfeeding support we offer is so much more complicated than the pamphlets handed to new parents directing them to LLL meetings. And the general breastfeeding advice new parents stumble upon from Google searches doesn’t even scratch the surface of what needs to be available.

“I wanted to be involved in everything,” Addison says of birth and breastfeeding. “I didn’t really know what I was supposed to do.”

The biggest challenge for Jason as a father to breastfed children is the ridicule he gets from family members and in-laws, pressuring Hope to wean.

“I get it practically every time I talk to my dad,” he says.

Jason also admits missing having his wife’s breast to himself. This seems to be a common concern for fathers. It is fascinating and frightening what our culture has done to the female body. Why is it difficult for us to separate breasts’ primary function from sexual pleasure? After all, does the penis not excrete urine as well as serve a sexual function?

Creating dad-centered support groups or simply encouraging and accepting fathers into mother-centered support groups might generate more diverse conversation about the issues fathers of breastfed babies face. It may also lessen the pressure on dads and in turn, equip them with better support tools for their breastfeeding partners.

Jason adds that support or counseling groups “would get them hungry for different ways to be hands on and to be a part of the nursing team.”

Addison remembers that we didn’t have any proper lactation support aside from my occasional phone calls and incessant emails to our Boobie Guru Ms. Cindy Turner-Maffei, MA, ALC, IBCLC of Healthy Children Project.

Moreover, leaving young children to return to work is a reality for a lot of dads. Unfortunately, only 11 percent of families in the U.S. have access to paid family leave through their employers, Anayah Sangodele-Ayoka of MomsRising.org reports in Celebrating Fathers Who ‘Leave’ to Be Home.

Jason was granted just two weeks family leave after Kaitlyn was born.

Then, when Kaitlyn was four months old, he was expected to leave for a tour in Korea and didn’t return until his daughter was 18 months old.

“That really pushed some levels of our relationship,” Jason admits. “And coming back from Korea it was kind of hard being around Kaitlyn because I kind of didn’t know her. We had to experience each other all over again.”

Jason expresses guilt in that he was unable to spend the time with his daughter at a young age like he has with his son now that he’s retired from the military.

And so my newfound obsession with male nursing continues. While it is unlikely that Kaitlyn would have immediately taken to Jason’s breast, could male nursing act as a bonding device for the fathers who spend much of their time away from home?

I’m so grateful that Addison’s job allows for an extremely flexible schedule and has never forced him overseas.

“I felt really comfortable leaving because I know how knowledgeable you are and I didn’t think you were going to need me,” he says. “I was very comfortable with you as a mother.”

He adds that he’s comfortable knowing that he’s needed to make a living.

While the challenges and sacrifices that fathers make are often overlooked, Addison and Jason reveal great appreciation for breastfeeding.

“We don’t have to make sure we have bottles packed,” Addison cites as a benefit. “We don’t have to get up in the middle of the night to go fix a bottle.”

“There’s something really special about [Hope] sitting in the chair holding her baby close to her and giving him exactly what his body needs, his heart needs and his spirit needs,” Jason says. “They seem so in tune with each other.”

The challenges Addison and Jason have faced allow them to offer valuable advice to new fathers.

“If your partner is struggling, you should seek the help of a lactation professional to help her because it will only make it easier,” Addison advises. “It doesn’t hurt to go get help if you think that there is something wrong.”

Jason suggests gathering as much breastfeeding information as possible because knowledge is power.

As he puts it: “Mortal Kombat said it the best.”

Let’s make a move and revolutionize the breastfeeding support we offer fathers so that we can continue to grow and strengthen support for our moms and babies.

Public education program focuses on African American breastfeeding disparities

The first several weeks after my daughter Willow’s birth were remarkable. I was full of the most incredible, indescribable love for my new infant. At the same time, I felt strangely alone.

As a fairly young mom, I didn’t belong to any kind of community of mothers going through experiences similar to mine, and I longed for those connections.

ION-bannerAbout two months ago, Surgeon General Regina M. Benjamin, MD, MBA announced the launch of the U.S. Department of Health and Human Services Office on Women’s Health’s project It’s Only Natural, a public education campaign aimed at increasing awareness among African American women of the importance of breastfeeding and providing helpful how-to tips.

Part of the campaign includes a My Breastfeeding Story component which provides new moms with inspiring personal stories from other mothers and even a new dad’s perspective on the journey of parenthood.

It’s Only Natural’s breastfeeding subject matter expert Ursuline Singleton, MPH, RD with the Office on Women’s Health at the U.S. Department of Health and Human Services reflects on the importance of storytelling and making connections.

“What stories do is they break down barriers,” she says and quotes Teddy Roosevelt: Nobody cares how much you know, until they know how much you care.

Which is why Singleton stresses the importance of lactation professionals truly understanding and embracing the reason for the It’s Only Natural campaign.

“Cultural sensitivity is a key factor in the success of this campaign,” Singleton explains.

Lactation care workers must listen to families’ concerns and must not make assumptions or judgements, she adds.

Responding to breastfeeding disparities

It’s Only Natural was developed in response to what Singleton refers to as unacceptable disparities in African American breastfeeding initiation and duration rates as addressed in the  CDC’s recent report on breastfeeding disparities.

With Surgeon General Regina M. Benjamin’s 2011 Call to Action to Support Breastfeeding in mind, the campaign responds with an action-based plan to squash breastfeeding barriers outlined by Benjamin.

Looking further back, It’s Only Natural is somewhat a continuation of the HHS Blueprint for Action on Breastfeeding released in 2000 by former Surgeon General David Satcher as well as HHS’s Babies Were Born to be Breastfed national campaign.

Extensive, formative research went into the creation of It’s Only Natural materials. Focus groups were initially conducted in three major cities: Montgomery, Ala., Washington D.C. and Chicago, Ill. Additional focus groups followed in New Orleans, La., Philadelphia, Pa., and Jackson, Miss.

Throughout the development of the project, contributors found that female family members have a very strong influence on a mother’s decision to breastfeed, especially in the African American community. In response, the campaign offers information on how to get your family on board with breastfeeding.

“We have a unique opportunity like never before to address breastfeeding rates through [this] campaign,” Singleton says.

Providing access to comprehensive materials

It’s not enough to acknowledge that breastfeeding barriers exist; action is needed to break them down.

It’s Only Natural offers comprehensive, action-based information for mothers including videos, storytelling, how-to advice and more. Moreover, the materials were specifically designed to reflect the experience of African American moms and families to better serve an underserved community.

The campaign keeps the lactation professional in mind, too. Campaign developers created the Leader’s Guide which details how to host breastfeeding sessions right down to planning the event.  Posters and fact sheets and radio PSAs are also available for the public’s use.

While the campaign’s materials are amazingly complete, Singleton reminds leaders to always acknowledge how different audiences learn; How will a group of teenagers best retain the information presented? What is the optimal way to teach a group of expecting mothers, a diverse group of adults, family members or community members in general?

Reaching more mothers through The Village

Another portion of the It’s Only Natural vision includes bringing together diverse partners to better reach new mothers. As we know, collaboration is a key component to helping breastfeeding moms and babies.

“We use the phrase ‘It Takes a Village,’” Singleton says. “The thing about the village is that it’s not just a catchy phrase.”

The village includes an entire health care system as well as a community that conveys a culture of breastfeeding, she adds.

Relatives, employers, and other African American breastfeeding mothers are also part of the village and create a positive breastfeeding culture.

Unfortunately, health care professionals often don’t expect African American mothers to breastfeed, so they fail to provide them with information or proper breastfeeding support to help these mothers be successful with their healthy infant feeding choice, Singleton tells me.

Part of the problem may be, as outlined in the Surgeon General’s Call to Action, a shortage of health care providers who specialize in lactation. Even more, our nation lacks African American lactation professionals to serve African American women.

In response, the campaign offers several support sections including building your breastfeeding network.

Anticipating campaign outcomes

While still early in the program, Singleton says there is a lot of excitement about the campaign.

Program manager and co-founder of the African American Breastfeeding Network of Milwaukee Dalvery Blackwell, BA, IBCLC agrees.

“I’m eager to start using the materials to see the reaction of the people we serve,” she says.

Blackwell was drawn to the campaign by its access to printed materials like the breastfeeding fact sheets.

In order to keep track of the success of the campaign, Singleton says they are and will track the use of radio PSAs as well as receive reports through partner organizations.

Ultimately, the real success of the program will come when African American breastfeeding initiation and duration rates rise and when the ethnic gap closes.

The campaign would benefit from expanding its traditional and nontraditional partners, Singleton says.

She wants the public to embrace the campaign and to utilize the various resources presented, because when the whole community supports breastfeeding as the normal infant feeding choice, mothers will gain confidence to feed their babies.

Singleton also reminds us that if there is a problem, there is a solution. It’s Only Natural offers a National Breastfeeding hotline open Monday through Friday from 9 am to 6 pm EST. Call them at 800-994-9662.

Click here to explore the It’s Only Natural website.

How will you use the It’s Only Natural materials in your community? Share your comments below.