Celebrating Infant Mental Health Awareness Week

This summer, we are revisiting some of our previous publications as they relate to various national celebrations. 

This week is Infant Mental Health Awareness Week, so we are re-sharing “Breastfeeding is…” a 2014 piece. Based on an interview with Barb O’Connor, this piece describes how breastfeeding is so much more than nutrition, including establishing secure attachments which are fundamental to infant mental health. 

——

With a gentle pulsing of the sand, a baby sea turtle emerges from her hatching place. She breathes the salty ocean air and immediately begins her race to the rushing tide. She dodges stealthy crabs and gulls, mounts beach debris and endures what seems like an endless journey. Programmed for survival, she plunges into the abounding ocean, her lifeline.

Worldwide, there are over 70 conservation laws and regulations that protect sea turtles.

Not far from the briny ocean breeze, a mother hears her infant cry as she enters the world outside of the womb for the first time. Placed on her mother’s abdomen, the baby relaxes for several minutes until she begins to awaken. Soon, she makes mouthing and sucking movements signaling her interest in her mother’s breast. She leaps and crawls upward with intermittent periods of rest. When she reaches the breast, her hands become increasingly active and she familiarizes herself with her mother’s nipple. She suckles enjoying her first few sips of thick colostrum. After the first feed, she will rest again in the arms of her mother, her lifeline. [For more information about the 9 Stages visit: http://www.magicalhour.com/aboutus.html]

When a newborn is given the opportunity to practice early survival skills, amazing things happen.

But all too often, the newborn’s programming is interfered with by well-meaning health care professionals and popular, although non evidence-based health care practices.

“Our culture really discredits the importance of early beginnings,” Healthy Children faculty Barb O’Connor, RN, BSN, IBCLC, ANLC says. “If we protect and nurture mothers and infants, that’s going to impact future outcomes.”

Barb O’Connor (back left) pictured with colleagues from HCP and ALPP.

She goes on,  “Mothers and infants really have a synergistic recuperation from birth and if breastfeeding is supported and not interfered with, both parties are able to develop in a manner that leads to positive health outcomes.”

O’Connor discusses several cultural components that make establishing normal, healthy beginnings nearly impossible for families.

Our culture urges independence. Mother and baby are expected to properly function away from one another immediately after birth. Most birthing facilities don’t encourage or appropriately support the important practices of skin to skin contact or even rooming in.

Moreover, mothers are often expected to return to work or school while they are still bleeding from childbirth.

“There are other cultures that really value moms and babies and you can see it in the legislation,” O’Connor says.

Differently, our country provides mothers with zero paid maternity leave.

To be fair, there have been strides made in terms of promoting, protecting and supporting breastfeeding families in our nation. The Baby-Friendly Initiative (BFI) offers more and more families the opportunity to successfully breastfeed for instance. Particularly, BFI advocates for babies by requiring the facilities to provide the healthiest practices for mom and baby. O’Connor calls skin to skin contact and rooming in essential practices for all babies regardless of feeding method.

Still we have a lot to grasp, especially when it comes to older breastfeeding babies and children.

“Because we focus so much on breastfeeding being nutrition, our culture doesn’t really understand what breastfeeding really is for infants over one,” O’Connor says.  “We don’t understand as a population that nursing becomes a source of joy and communication and a way of life that should only be discontinued as mother and child mutually desire.”

O’Connor is particularly interested in the value of breastfeeding beyond nutrition.

“The delight I witness in the eyes of a baby who is nursing is indescribable; it is pure, unadulterated joy,” she says. “Every baby deserves the right to experience this loveliness.”

And skin to skin and breastfeeding are lovely in so many ways.

Breastfeeding is a stabilizer.

When a mother holds her baby skin to skin to breastfeed, she regulates her baby’s body temperature, heart and breathing rates, stress and glucose levels just to name a few. [For more information see these publications on skin to skin contact.]

O’Connor is fascinated by the findings of Dr. Nils Bergman and KH Nyqvist. Bergman, Nyqvist and colleagues have discovered that if the mothers of low birth weight babies practice Kangaroo Mother Care (KMC), they learn to breastfeed at incredibly young gestational ages. KMC also supports increased brain development and decreased mortality for low birth weight babies.

O’Connor’s daughter Brandy, mother and full-time caregiver of a special needs son who, born at 25 weeks gestation (now 5 years old), spent 110 days in the NICU, will speak at Healthy Children’s upcoming International Breastfeeding Conference about her experience with KMC and breastfeeding. She will share her perspective of the emotional turmoil, hospital practices, and challenges experienced by mothers of infants in the NICU.

“It has taken her a long time to come to a place where she could talk about this,” O’Connor says of Brandy’s experience. “I am extremely excited for my colleagues who work in the NICU to hear her perspective on how the experience affects new mothers”.

Breastfeeding is empowering.

The symbiotic relationship between breastfeeding mother and child and the infant’s programming for survival has a profound impact on the mother’s physical and mental well-being, O’Connor explains.

She continues that a child’s desire to breastfeed for comfort can be empowering. No one else but the mother has the capacity to console an upset child the way she does.

In Breastfeeding: A Feminist Issue, author Penny Van Esterik explains the many other ways breastfeeding is empowering including:  “breastfeeding confirms a woman’s power to control her own body, and challenges the male-dominated medical model and business interests that promote bottle feeding” and ”breastfeeding requires a new definition of women’s work – one that more realistically integrates women’s productive activities.”

Breastfeeding is immunity.

Maternal body flora and milk prime an infant’s immune system in a way that cannot currently be replicated and offers beneficial lifelong effects. O’Connor cites Lars Hanson’s immunology of breast milk research.

“A fully breast-fed infant receives as much as 0.5-1 g of secretory immunoglobulin A (SIgA) antibodies daily, the predominant antibody of human milk,” authors of Breast feeding: Overview and breast milk immunology write. “This can be compared to the production of some 2.5 g of SIgA per day for a 60 kg adult. These SIgA antibodies have been shown to protect against Vibrio cholerae, ETEC, Campylobacter, Shigella and Giardia.”

Breastfeeding is communication.

“If I see a baby who looks anxious or isn’t taking the breast well, it’s an immediate sign that something isn’t right in baby’s life,” O’Connor says.

As stated babies seek the breast for survival, so if baby refuses to breastfeed, they are communicating in a non-verbal way, she continues. Perhaps baby is ill or injured. When circumstances like these arise, it is important that the dyad receive help from a lactation professional who can assist with investigating the problem.

O’Connor reminds lactation professionals that it is always important to practice from a current, evidence-based perspective and to possess appropriate counseling skills.

“Most moms want to breastfeed,” she says. “It’s a matter of figuring out how to fit it in her life.”

Breastfeeding is regulatory.

A breastfed baby is offered control over the amount of milk she ingests whereas a bottle-fed infant’s intake is usually dictated by the amount of milk in its artificial container.

Consequently bottle feeding, regardless of the type of milk, may have future implications on obesity.

“Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast,” authors of Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? conclude.

Breastfeeding is survival.

O’Connor suggests we reevaluate our definition of survival. Survival goes beyond the performance of simple body functions.

“We have to look beyond that at a more encompassing definition,” she says. “Babies who are breastfed have a different potential for intellectual and interpersonal relationships.”

In fact, authors of Breast feeding and intergenerational social mobility: what are the mechanisms? conclude that “Breast feeding increased the odds of upward social mobility and decreased the odds of downward mobility.”

The effect was mediated in part due to stress mechanisms,” O’Connor comments.  “This is really fascinating.”

Breastfeeding has become of international concern because it offers protection against infant mortality. The World Health Organization’s Millenium Development Goals include breastfeeding as a strategy to combat child malnutrition and reduce child mortality.

In “Breastfeeding and Infant-Parent Co-Sleeping as Adaptive Strategies: Are They Protective against SIDS?” included in Breastfeeding: Biocultural Perspectives, James J. McKenna and Nicole J. Bernshaw explore the epidemiological studies that suggest that breastfeeding may be protective against SIDS.

What does breastfeeding mean to you? How else is breastfeeding more than nutrition? Please share your thoughts in the thread below.

 

Other relevant pieces

Field of lactation gains child psychologist

Cheap medicine: laughter

Implications of mother baby separation

Trauma-informed care

More awesome graphics at: https://stores.praeclaruspress.com/free-posters-and-graphics/

Johanna Sargeant’s BA, BEd, IBCLC Mastering Lactation Conversations: Creating Successful and Achievable Care Plans is an excellent reminder of compassionate and effective counseling. Early in her presentation, Sargeant unpacks the perception that lactation care providers (LCP) can sometimes desire breastfeeding “success” more than the clients themselves.

As LCPs, it can be easy to get wrapped up in checklists and targets and “perfect” latches, forgetting about the complexity of the human experience and how infant feeding is inextricably influenced by parents’ lived experiences. Parents must be allowed to define their own terms of success, and as LCPs, we must honor the complexity of their lives. 

April is Sexual Assault Awareness Month which is as good a time as any to focus on trauma-informed care, which should be the standard of care for all perinatal services.  

Sexual trauma is common and affects approximately 20 to 25 percent of women, according to  Kathleen Kendall-Tackett, Ph.D., IBCLC. 

Image by Nadezhda Moryak

“Abuse survivors can experience a full range of responses to breastfeeding: from really disliking it to finding it tremendously healing, “ she writes in an Uppity Science Chick publication.

All of those many years ago that I completed the Lactation Counselor Training Course (LCTC), one of the most striking bits I took away was learning about the “hands off” approach. I was perplexed that this even needed to be emphasized( though I had experienced a “handsy” LCP after the birth of my first daughter and have so many friends who share similar experiences.)

These cloth breasts are a solution to demonstration without touching people’s bodies. (It is advised to exercise care when dealing with breast models in childbirth and breastfeeding education as the symbolic dismembering of the female body can carry powerful negative messages.)

Jennie Toland’s BSN, RN, CLC article on trauma-informed care reminds us that acknowledging the existence of trauma and its effects is the first step LCPs can take to providing proper care.

“Recognizing signs such as anxiety or emotional numbing can prompt further discussion that builds trust and fosters collaboration and engagement,” Toland writes. “…It can be as simple as asking if someone would prefer the door shut for privacy, positioning ourselves so we are not standing over another person when performing assessments, or verbalizing next steps and asking for consent to move forward…. It can happen within just a few seconds as we ask, ‘What is your preference?’ to provide someone with control over their care.”

[Here’s an older piece that explains how the simple prompt “May I?…” changed the way I view healthcare.]  

Toland writes that trauma-informed care does not need to be complicated, and the approaches she suggests aren’t specific to any one kind of trauma. 

While birth and breastfeeding can be remedial and healing for trauma survivors, these experiences can also be the source of abuse and trauma. 

Dr. Gill Thomson’s work describes this phenomenon. 

Dr. Karen Scott’s work through Birthing Cultural Rigor challenges the reality of maternity care for Black Indigenous People of Color (BIPOC). Indeed,  “We cannot fix the maternal mortality problem without fixing the human rights problem at its core.

There are so many others acknowledging trauma and incorporating compassionate care. In Milwaukee, BOMB Doulas are providing wrap-around care services, thorough screenings like the Adverse Childhood Experiences (ACES) and sensitive, respectful care.

Photo by Mateusz Dach: https://www.pexels.com/photo/photo-of-baby-on-mother-s-arm-4504005/

The White Ribbon Alliance UK offers programming like Safer Beginnings which includes Free From Harm for maternity workers which works to address obstetric violence.  

There are those like Audrey Gentry-Brown, Full Spectrum Birth Sista, Certified Blactation Educator (CBE), Student Midwife, and Medicine Woman in Loudoun County, Va. working to  rewrite cultural norms within her community, introducing “Afrofuturist healing modalities” that reconnect to “ancestral magic.” 

Xavier Dagba’s words embody her work well: “As you focus on clearing your generational trauma, do not forget to claim your generational strengths. Your ancestors gave you more than just wounds.” 

Photo by Serdi Nam: https://www.pexels.com/photo/close-up-of-mother-breastfeeding-baby-19178588/

Shawn Ginwright, a Black clinician, shares a similar ethos in a piece that challenges traditional approaches to trauma-informed care by exploring the distinction between simple ‘treatment’ and true healing.

“A healing centered approach to addressing trauma requires a different question that moves beyond ‘what happened to you’ to ‘what’s right with you’ and views those exposed to trauma as agents in the creation of their own well-being rather than victims of traumatic events,” Ginwright writes. “Healing centered engagement is akin to the South African term ‘Ubuntu’ meaning that humanness is found through our interdependence, collective engagement and service to others. Additionally, healing centered engagement offers an asset driven approach aimed at the holistic restoration of young peoples’ well-being. The healing centered approach comes from the idea that people are not harmed in a vacuum, and well-being comes from participating in transforming the root causes of the harm within institutions.” Essential reading! 

Other relevant resources and articles