Breastfeeding is part of a continuum. 

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is part of a continuum.

It has been hypothesized that starting around nine weeks of fetal development, the pattern and sequence of intrauterine movements of the fetus seem to be a survival mechanism, which is implemented by the newborn’s patterns of movement during the first hour after birth  (described as the 9 stages)  when skin-to-skin with the mother to facilitate breastfeeding.

Photo credit United States Breastfeeding Committee

This very behavior refutes the idea that breastfeeding is “an adjunct to birth” as it is generally viewed in maternity care settings in America.

Not only are human babies hardwired to progress through 9 stages and self attach to the breast, mammalian bodies are hardwired to produce milk too.

Around 16 weeks of pregnancy, the body starts to prepare for breastfeeding. This phase, called Lactogenesis I is when colostrum begins to be created. During Lactogenesis II, the secretion of copious milk follows the hormonal shift triggered by birth and the placenta delivery. After this phase, milk production must be maintained through a supply-and-demand-like system. [Neville 2001]

Even before a pregnancy is achieved, individuals are being influenced by the infant feeding culture that surrounds them, consciously or subconsciously laying a foundation for how they feel about feeding their own babies.

Pat Hoddinott’s, et al study found that women who had seen successful breastfeeding regularly and perceived this as a positive experience were more likely to initiate breastfeeding.

Exposure to prenatal breastfeeding education also affects breastfeeding outcomes. Irene M. Rosen and colleagues found that women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls.

Photo by Luiza Brain

Mode of birth and birth experiences influence infant feeding too, for both members of the dyad.

A growing body of evidence shows that birth by cesarean section is associated with early breastfeeding cessation.

Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. [Brimdyr, et al 2019]

What’s more, the authors of Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways found “No positive relationships between the administration of synthetic oxytocin and breastfeeding.” They comment, “Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use of synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes.”

Photo by Olivia Anne Snyder on Unsplash

In Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum, author Miriam Labbok takes a detailed look at “the power and potential of synergy between and among organizations and individuals supporting breastfeeding, the mother-child dyad, and reproductive health to increase sustainable breastfeeding support.”

Labbok points out that a paradigm shift on the issues in the reproductive continuum – family planning, pregnancy and birthing and breastfeeding– is needed.

“These are issues that are intimately, biologically, gender linked in women’s lives, and yet ones that are generally divided up to be addressed by a variety of different professional disciplines,” Labbok begins.  “Despite the impact of child spacing on birthing success, of birthing practices on breastfeeding success, and of breastfeeding on child spacing, we are offered family planning services by a gynecologist, birth attendance by an obstetrician or midwife, and baby care by a pediatrician. Having these ‘silos’ of care, each with its own paradigm and priorities, may lead to conflicting messages, and hence, may undermine the search for mutuality in goals, and collaboration.”

One such initiative looking to deconstruct siloed care is the Baby-Friendly Hospital Initiative which includes standards and goals for birthing practices, for breastfeeding-friendly communities, and guidance for birth spacing, in addition to reconfirming the original Ten Steps to Successful Breastfeeding, in recognition that breastfeeding occurs along a continuum.

Source: United States Breastfeeding Committee

1,000 Days emphasizes how breastfeeding fits within the global picture as a crucial part of a whole.

In the U.S. context, the 1,000 Days initiative recognizes comprehensive health coverage, comprehensive guidelines on nutrition during pregnancy, lactation, and early childhood for women in the first 1,000 days, paid family  and medical leave policy for all workers, and investments to ensure parents and caregivers can access good nutrition as solutions to a well nation and a well world.

 

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share with us some or all of your birth stor(ies).

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model

Photo by Luiza Braun

Over half of the Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program peer counselors were once served by the program as mothers enduring mastitis or going back to work early or other barriers to healthy infant feeding. Yet, some of these mothers still managed to breastfeed into toddlerhood.

“They took the knowledge to not only be able to succeed but [brought] it back into their community,”  BHP program manager and lactation consultant Cody Cuni, IBCLC, BS says. “This is a success story.”

BHP is a person-centered, peer support counseling program intended to increase breastfeeding initiation, duration, and exclusivity among low-income, minority women in the greater Hartford, Connecticut area. For over 20 years, the program has existed in some form. In 2000, an official review of the program was completed and solidified the peer-counseling model.

The program’s name was born out of community feedback, mainly from Puerto Rican families. Cuni explains that as community Puerto Ricans were heavily targeted by formula marketing,  the name ‘Breastfeeding Heritage and Pride’ grew from the idea of reclaiming breastfeeding as part of their heritage.

Photo credit: United States Breastfeeding Committee (USBC)

Often, the lactation model of care is rooted in colonization, but Cuni says that their program  strives to respect and celebrate diversity.

“Our program seeks to empower…” she begins. “[Breastfeeding] is something that is yours, and something that has always been yours,” she says, speaking to the people they serve.

As program manager, Cuni trains the peer counselors through a 40-hour comprehensive lactation training. She approaches the training through a lens of diversity and cultural competence, helping peer counselors learn to have respectful conversations and teaching them how to be an advocate.

She explains, “Our peer counselors are working with mothers who do face a lot of bias in their health care and in lactation, so we have whole trainings on how to communicate with a provider, how to approach hospital staff who say things like ‘Don’t waste your time on that mother…’”

Peer counselors embark on visits with senior peer counselors and other lactation care providers as part of their mentorship model.

Photo by Felipe Balduino

The program also provides continuing education to stay relevant and weekly meetings to complete case reviews.

As part of their grant funding, BHP is required to track their breastfeeding rates, but Cuni says that what she finds more compelling than these numbers, is the documentation of the lactating person’s individual goals.

Empowering mothers to seek their own goals is our ultimate goal, Cuni says.

BHP is nestled in the Hispanic Health Council’s Parent and Family Learning department which offers other supports throughout the “cycle of learning throughout a family’s lifespan”.

Photo by Omar Lopez

“A holistic approach of care is vital especially for maternal child health care,” Cuni explains. “The first 1,000 days of life are critical to laying a healthy foundation.”

Practicing on a continuum of care gives Cuni and her colleagues the ability to gain a deep understanding of the families they serve, she says.

“Because we work so closely with the families, we establish trust and are able to refer in a way that they might not be open with [other providers].”

The clients that BHP serves are up against every breastfeeding challenge that every family faces in our country, but the issues are compounded and amplified by the stress of living in communities steeped in systemic racism and lack of resources, Cuni explains.

Their clients are managing intergenerational trauma and all of the symptoms associated with trauma, at a cellular level and beyond. For instance, BHP clients have a higher propensity of birthing babies with complex medical needs because of higher rates of preterm labor, gestational diabetes and other health concerns.

Cuni points out other challenges like those associated with being an undoumented immigrant. Gaining access to basic tools like breast pumps can be nearly impossible. Some of their clients return to work at two weeks postpartum after a cesarean section, not by choice of course, but for fear of losing their work as part-time employees.

And although Connecticut has workplace lactation laws in place, mothers will find that if they make noise about those protections, they might not see their name on the schedule any longer.

Photo source: United States Breastfeeding Committee (USBC)

Yet, despite all of these obstacles, Cuni says, “There is a sense of resiliency. They’re overcoming so much and they’re not even sitting in that; they’re just living their lives and wanting to do the best for their baby. That resiliency is really inspiring.”

Cuni shares about a mother who lost her baby late in her pregnancy and decided to pump and donate her milk for six months.

“This mom, her experience, her unimaginable tragedy…she still wanted to do something with her milk, and it was really a privilege for our peer counselors to support her.”

Another client they served, after struggling to assert her workplace lactation rights, had a position created for her by their HR department as “breastfeeding liaison”. Now, she is an advocate for any breastfeeding or lactating mother at her workplace.

“Not only did she win for herself, she left it better,” Cuni comments.

Cuni came to this work as a stay-at-home mom with ten years of breastfeeding experience. She was a single mother, returning to the workforce after leaving an abusive marriage.

“My breastfeeding experience was valued as an asset,” Cuni remembers. “My lived experience counted.”

She goes on, “As women, and especially as mothers, we’re always caring for someone else. The pressures that we face make wellness difficult. Our society needs to do more to recognize the value that women have and the support they need to succeed. I want to …. amplify the voices, because if we listen, the answers that we need to solve the maternal mortality crisis, the answers are there if we listen to the women and families we are working with.”

For those interested in supporting the work of the Hispanic Health Council’s BHP, they are looking for donated breastfeeding supplies. You can get in touch at  codyc@hispanichealthcouncil.org.