Identify and network with an individual or organization with a mission that intersects with maternal child health. This shouldn’t be a challenge… “All roads lead to breastfeeding!” (A popular adage at Healthy Children Project.) Often, we find ourselves preaching to the choir, shouting in an echo chamber, whatever you want to call it. It’s time to reach beyond our normal audience.
Follow Dr. Magdelena Whoolery on social media to stay up to date on strategies that combat the multi-billion dollar artificial baby milk industry.
Originally from New Orleans, Erin Bannister, lab instructor and dietetic intern at Northern Illinois University, says that food is tied to her identity. Bannister was ten when she first learned to make a roux. Those early skills prepared her for her later work as a chef, which she describes as a kind of manual labor with long, hot hours.
Bannister shares with a laugh, that she started to wonder how she could work with food and continue to nourish people with weekends and holidays off. Eventually, she discovered the field of dietetics.
Currently in the thick of her Master’s thesis, Bannister is exploring the metabolic energy needs in adults and determining whether the default equations we use are accurate in the populations they’re used in.
For instance, it is widely accepted that an average allowance for a roughly 170 pound man is 2,300 kcal/day; for women, it is 1,900 kcal/day. We expect that pregnant and lactating people will have higher metabolic energy needs.
As Bannister spends a swath of her days compiling and extracting data, she says she’s discovering that some of the accepted equations need to be delineated.
“The real root of my thesis and the root of most of my studies and the goals that I have, is to use accurate evidence-based interventions in the populations that they are meant to be used in and to not remove ourselves from that evidence,” Bannister begins. “… Often times, things are taught and then they are believed because the person that taught it is an expert and the evidence gets lost on the way; don’t forget to review the evidence.”
As Bannister continues to pursue this idea that we can do better than sludging through the status quo, she sought out the Lactation Counselor Training Course (LCTC). Although Bannister has great interest in the complexities of nutrition and health from cradle to grave, she says that there is a solid argument that the health of a population is highly correlated with the health of its mothers.
“[I want] to be as helpful and effective as possible… to have the knowledge to be able to contribute meaningfully, and the certification adds credibility,” she explains. “The training was quite eye-opening, almost embarrassing to say how little I knew about breastfeeding.”
Bannister goes on that ultimately, she would like to work with nutrition intervention in low and middle income countries where the burden of improper nutrition is most severe. Currently, many countries worldwide face the double burden of malnutrition – characterized by the coexistence of undernutrition along with overweight, obesity or diet-related noncommunicable diseases (NCDs). In fact, nearly one in three people globally suffers from at least one form of malnutrition: wasting, stunting, vitamin and mineral deficiency, overweight or obesity and diet-related NCDs. (WHO 2017)
As Bannister buckles down at the end of the semester, she says, “I want to make sure I am utilizing all the forks I’ve got in the fire.”
A friend of mine works in a healthcare building; her office, windowless. Stark white walls frame the shiny tiled floors in the also windowless laboratory that surrounds her office. Rectangular fluorescent lighting looms eerily overhead. Working in this space for the majority of her waking hours amounts to constant longing for sunshine and an overall agitated demeanor. I imagine the architect of this space wasn’t much of an empath.
This effect is being documented in a growing body of research demonstrating how color, texture and patterns affect human emotions.
Generally, humans are quite robot-like, performing our daily duties without a great deal of attention paid to the building structures, layouts or designs that we move through.
“When we don’t notice the built environment, it’s silently affirming our right to be there, our value to society. When we do, too often it is because it’s telling us we don’t belong. Those messages can be so subtle that we don’t recognize them for what they are,” Kim Tingley writes, later quoting architect Joel Sanders: “‘We sleepwalk our way through the world…Unless a building interior is strikingly different or lavish or unusual, we are unaware of it.’”
The first time I saw a lactation pod at an airport– unusual at the time– I had mixed emotions. Part of me became excited that this was an option for traveling, lactating, pumping, and breastfeeding people, but most of me scoffed, annoyed, thinking something along the lines of: “Of course breastfeeding moms would be given this messaging to go hide themselves away from the public eye.”
What Tingley wrote, that our built environment affirms our right to be in a space, affirms our value to society, is certainly a powerful concept.
The COVID pandemic has forced us to think more about the built spaces we move through, adding layers to this idea of how and what and who we value.
In a recent episode of Uniquely Milwaukee Salam Fatayer of 88Nine Radio Milwaukee poses the question: “What could our city, neighborhoods and community spaces look like if they were created based on people’s emotional, psychological and social needs?”
Local architects and scholars answer with ideas about how they’re supporting the users of the spaces they create, with the goal of making sure people feel safe, at peace and nurtured by those built environments.
On Our Milky Way, we’ve had the honor of highlighting the work of those thinking about how built spaces affect birth, lactation and beyond.
“This architectural structure provides the family with an opportunity to be with their child in the neonatal intensive care unit day and night providing facilities for parents’ basic needs including the need for privacy. This design has been suggested to be associated with a lower rate of hospital-acquired infections, similar to single patient rooms in adult intensive care (48), earlier full enteral nutrition, higher breastfeeding rates and a more soothing environment with, for example, lower ambient sound levels (49). As this design has been shown to reduce the length of stay in hospital significantly, for example, by 10 days in preterm infant below 30 weeks of gestation in a Swedish study (50), it shortens the time of separation for the infant from the home and family. Parents have reported that they felt that a single family room design in a NICU facilitated their presence with their infant (51), but the increase in parent–infant closeness gained by a single family room model during hospital care is not well documented in scientific literature.”
Read Our Milky Way’s coverage on this concept here.
In stark contrast, attorney Leah Margulies recently shared in Protecting Breastfeeding in the United States: Time for Action on The Code that formula companies provide architectural designs to maternity care facilities in a deliberate attempt to separate dyads, making bonding and breastfeeding difficult and consequently, families more likely to become reliant on their artificial products. It’s a sickening example of how the industry saturates our systems, down to the skeletons of our buildings.
Venturing beyond the very early postpartum period, it’s exciting to explore how community spaces are supporting young families. The Henrico County Public Library – Fairfield Area Library is accommodating families with their Computer Work + Play Stations which were conceptualized by library staff and materialized by architects at Quinn Evans and TMC Furniture staff. Read more about that inspiration and process here.
Supporting lactation and breastfeeding in the workplace is a vital part of ensuring that lactating individuals feel valued. Setting up lactation spaces sometimes calls for innovation and creativity. You can explore our collection of stories about workplace accommodations in the stories below:
Pulling back the lens further, the architecture of communities themselves influences well-being too. One of the effects of redlining is poor health outcomes. Part of this equation involves the placement of industrial buildings and factories. Vann R. Newkirk II points out in Trump’s EPA Concludes Environmental Racism Is Real that The National Center for Environmental Assessment released a study indicating that BIPOC are much more likely to live near polluters and breathe polluted air. “Specifically, the study finds that people in poverty are exposed to more fine particulate matter than people living above poverty,” he writes.
Circling back to Tingley’s piece, the article raises the concern that although we’re equipped with knowledge about how under-resourced populations are being affected by current structures and practices, “funding earmarked for expanding inclusivity [may] be diverted toward making existing facilities safer for those they already privilege.”
Drawing on Sanders’ work, Tingley writes, “Throughout history… the built environment has reflected and reinforced inequality by physically separating one group from another, often in the presumed interests of health or safety. Women-only bathrooms, so designated by men, supposedly preserved their innocence and chastity; white-only bathrooms separated their users from supposedly less ‘clean’ black people. It’s no coincidence that Covid-19 has disproportionately sickened and killed members of demographic groups — people who are black, Indigenous and Latino; who are homeless; who are immigrants — that have been targets of systemic segregation that increased their vulnerability. It’s also not hard to imagine the pandemic, and a person’s relative risk of infection, being used to justify new versions of these discriminatory practices.”
In this vein, Glenn Gamboa details where some funding gets funneled in a piece published this spring.
“Twelve national environmental grant makers awarded $1.34 billion to organizations in the Gulf and Midwest regions in 2016 and 2017, according to a 2020 study by The New School’s Tishman Environment and Design Center. But only about 1% of it — roughly $18 million — was awarded to groups that are dedicated to environmental justice.”
The climate crisis is an accelerating threat that is both affected by and affects architecture.
“Architecture has to mediate between the perceived needs of the moment versus the unknowable needs of the future; between the immediate needs of our bodies and the desire to create something that will outlast generations,” Tingley goes on to write.
Across the globe, architects push to be “mindful of their projects’ environmental impacts and resilience, including an emphasis on upcycling, the use of solar power, better building practices, and, of course, structural longevity,” Alyssa Giacobbe writes. [More on ecological design here.]
Alongside resilience and sustainability, there must be a focus on design that specifically serves mothers and their children. Mothers are too often left out, unseen, underserved despite there being about two billion of us worldwide, with an increasing likelihood of women becoming mothers.
Lisa Wong Macabasco puts it this way: “Although the experience of human reproduction touches all of us at least once in our lives, its effects remain taboo, under-researched and excluded from exhibitions and publications covering architecture and design history and practice. In these spheres, maternity is treated furtively or as unimportant, even as it defines the everyday experiences of many – some 6 million Americans are pregnant at any given time.”
It isn’t surprising that “design for children, design for healthy spaces, design for those with disabilities, care of and for their colleagues – these discussions and follow through are happening largely through female-led firms and initiatives,” Julia Gamolina comments in The Unspoken Burden on Women in Architecture.
In an exciting development, Wong Macabasco describes design historians Amber Winick and Michelle Millar Fisher’s Designing Motherhood, “a first-of-its-kind exploration of the arc of human reproduction through the lens of design. Their endeavor encompasses a book, a series of exhibitions and public programs in Philadelphia, and a design curriculum taught at the University of Pennsylvania.”
This is exciting, and it’s progress. But as Wong Macabasco quotes Juliana Rowen Barton– architecture and design historian and curator who also helped organize Designing Motherhood– “Progress is not the fact that this show happened – progress is these conversations continuing to happen.”
Designing Motherhood is on view at the Mutter Museum in Philadelphia through this month of May 2022.
“‘I have too much mental health and breastfeeding support,’ says no family EVER!” Felisha Floyd of The B.L.A.C.K. Course has accurately asserted. Around the world, as many as 1 in 5 new mothers experience some type of perinatal mood and anxiety disorder (PMADs). Often, PMADs go unnoticed and/or untreated and can have tragic and long-term consequences to families and subsequently societies.
“It didn’t look anything like what the brochures told me it would look like….For me, PPD/PPA was a sneaky vixen that tricked my mind into thinking that every new mom felt like this,” one contributor writes. “That I was living in a cruel joke of a world where no one tells you that as soon as that baby pops out, you will never feel the same way again. The sneaky vixen told me that we’d made a huge mistake. We weren’t supposed to have a baby. That what I thought I wanted more than anything my whole life, was something that just wasn’t for me. I didn’t feel like this baby I was holding was mine. It belonged to the universe but I wasn’t his mom.”
Another shares, “I would look into the mirror and wonder who was the person looking back at me. She looked like me, but did not feel like me. There was no spark in her eyes. She was living, but she wasn’t alive.”
May 4 marks World Maternal Mental Health Day, time to reflect on why we need to pay attention to maternal mental health, influence policy and drive social change, reducing the stigma of maternal mental health.
The MMH Taskforce has curated a hub for individuals and organizations to find information about MMH and suggest a variety of ways to get involved including a social media toolkit with simple actions.
Last year, the Maternal Mental Health Leadership Alliance (MMHLA) compiled the Perinatal Mental Health Advocacy Toolkit, “designed to help perinatal mental health (PMH) advocates understand the importance of their voices in raising awareness and influencing public policy to better support the mental health of women and other birthing people during the perinatal timeframe. Recognizing that advocacy and lobbying may sound scary or feel overwhelming, this Toolkit provides information and tools to empower advocates to tell their stories effectively, to build an advocacy network, and to put advocacy into action.” The document is complete with worksheets so that participants can build their own Toolkits with items like talking points, scripts for telephone calls, sample emails and letters, and more.
This work is of critical importance as we know that the health of mothers influences the health of the entire family.
Dr. Beryl Watnick, PhD has pointed out that the “mother infant bond is of profound importance. The brain patterns in babies can mirror the brain patterns in depressed mothers, but when women with depression are taught how to engage their babies in spite of their depression, their children’s depressed brain patterns can reverse themselves. This is the power of parenting.”
Although it is true that there is a vast amount of work to do in order to de-stigmatize maternal mental health and better support mothers and their families, there are also simultaneously a great deal of successes to celebrate. There are effective and well-researched treatment options available to help women recover, like breastfeeding. Individuals can connect with knowledgeable providers using Postpartum Support International’s database.
“Everybody Wants to Hold the Baby, Who Will Hold the Mother?” Coleman’s poignant credo. On her website, she lays out how to effectively hold mothers, with an emphasis on addressing the maternal mortality crisis that affects Black women who are dying three to four times the rate of their white counterparts.
In addition to the resources provided by the MMH Taskforce, MMHLA, and The Lactation Therapist, there are a variety of other opportunities to learn about and support MMH.
The Michigan Breastfeeding Network is hosting “Human Lactation and Mental Health: Best Practices” with presenters Tameka Jackson-Dyer, BASc, IBCLC, CHW, Rosa Gardiner, RN, IBCLC, Mistel de Varona, IBCLC, and Kara Smith, BSN, RN, CLC, PMH-C. You can register for the webinar here.
Kathleen Kendall Tackett’s, PhD, IBCLC, FAPA presentation Does Breastfeeding Protect Maternal Mental Health? The Role of Oxytocin and Stress is available here.
The American Heart Association, with funding support from the Center for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health program, is hosting a webinar titled “Mixing Milk + Meds: Assessing Infant Risk during Breastfeeding” on Wednesday, June 15, at 2 p.m. ET. Speakers from the Infant Risk Center will discuss how to evaluate which medications are safe for breastfeeding patients.
In her role at the City of Philadelphia Department of Public Health, Lee noticed the challenges breastfeeding people face in shelters.
The barriers are a result of our cultural attitude toward lactating people and misunderstandings about their bodies and needs.
Lee talks about issues of privacy and ‘fairness’ in a shelter. Organizational dress codes often require residents to dress modestly, so when a person exposes their breasts to feed a baby, other residents can wonder why they’re not allowed to wear short shorts. Parents can express concern about the teenage boys in their families seeing breasts while a baby is being fed.
There’s the concern over safe milk storage and the mythology around reimbursement through the Child and Adult Care Food Program. Shelter staff may believe that if a mother breastfeeds, the facility will lose money to buy food because the allotted amount for infant formula isn’t getting used. Lee clarifies that if a mother breastfeeds, the institution will have more money to spend on food.
Just like in the rest of the US, there tends to be a push for formula feeding because the baby’s intake is easily measured, and staff are more comfortable with what is familiar, i.e. bottle-feeding
Lee continues, “There is a genuine honesty from people who don’t understand anything about breastfeeding, ‘Why are we breastfeeding?’ ‘Why are we bothering?’” Staff in hospitals have been educated about breastfeeding over the past few decades; staff in shelters have not.
So when she conducts trainings, she starts at the rudimentary level of ‘what are mammals?’
“All the worst mythology that you can imagine is in the shelter,” Lee says. “All the worst in how society treats mothers and babies gets magnified in shelters.”
With the problem identified, Lee says she started “from scratch in a way,” looking for a written policy to support breastfeeding people. Early on in her search, she followed up on a news story featuring a homeless mother in Hawaii. She posted inquiries on Lactnet, CDC listserv, international online forums, Facebook groups, and reached out to shelters at random wondering if they had breastfeeding policies .
“Nothing,” Lee reports. “There is probably a shelter somewhere that has a policy, but after two years of a global search, I wasn’t able to find it.”
In all her search, Lee found one published document— a Canadian study looking at the factors that influence breastfeeding practices of mothers living in a maternity shelter– that could be helpful.
She sent it out to colleagues at CHOP’s Homeless Health Initiative for feedback, and for quite a while, there was none. Lee’s colleague Melissa Berrios Johnson, MSW, a social work trainer with HHI, and the convenor of its breastfeeding workgroup subcommittee, helped to make the policy reality.
Partner agency Philadelphia Health Management Corporation (PHMC) received a grant that funded research which took the policy to four different shelters for staff and resident feedback.
“Everyone, residents and staff alike, felt this policy was important and feasible,” Lee says.
PHMC’s next step was to identify a shelter staff member to become a breastfeeding champion. This champion would be provided with free breastfeeding training, and receive an honorarium.
As program oversight changed though, “breastfeeding champion” became a job, with a list of responsibilities. So far, Lee says they’ve only found four people out of 10 shelters who are willing to take on the task.
“There are some folks in shelters working hard to make things better,” Lee says. “They are those champions, most of whom have breastfed themselves.”
Currently, Lee and colleagues are in the process of developing training for staff members and ironing out how to help staff implement the policy.
Lee’s and co-authors Alexandra Ernst MPH, and Vanesa Karamanian MD, MPH landmark paper about the 10 Steps to a Breastfeeding Friendly Shelter has been submitted to the Journal of Human Lactation (JHL).
At present, COVID has put all of this work on hold.