Considering evolving language in perinatal care and beyond

In the 90s, Diane Wiessinger, MS, IBCLC wrote Watch Your Language, an iconic piece that got us thinking about how we talk about infant feeding simultaneously, warning us of the dangers of “inverting reality” as it relates to breastfeeding and artificial feeding methods. 

Wiessinger writes, “When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food…the logical response is, ‘So what?’ Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy–and thus safety and adequacy–of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.”

Photo by Hanna Balan on Unsplash

“Health comparisons use a biological, not cultural, norm, whether the deviation is harmful or helpful…” she continues. “…We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.”

At present, infant feeding behavior has changed so greatly that the authors of The Meaning of “Breastfeeding” Is Changing and So Must Our Language About It  write “the term ‘breastfeeding’ is now so ambiguous that it is impossible to discuss contemporary breast milk feeding behaviors using this word.” 

To illustrate the diversity of infant feeding experiences, some of the ways infants and young children may receive milk include:

  • from their biological parent directly at the breast
  • human donor milk from a bottle or cup 
  • at the breast with a supplemental nursing system (SNS)
  • exclusively pumped milk via syringe 
  • wet nursing 
  • at the chest using an SNS with a combination of human donor milk and artificial milk 
  • feeding with purchased human milk 

Infant feeding is not black or white, nor one or the other. 

Given the multitude of ways that infants may be fed, the authors The Meaning of “Breastfeeding” Is Changing and So Must Our Language About It make several proposals for preferred language in order to develop clear communication around the feeding of breast milk to infants. 

They note:  “These terms are not intended to convey a value judgment about any of the behaviors described, but rather to provide an improved means of describing the wide variety of behaviors now encompassed by the word ‘breastfeeding.’” 

Language comes up often on Our Milky Way. We first explored it here, then went on to write about it here, featured transliteracy here and thought about language some more here and  here

This week, we’re adding to the ongoing discussion about terms that may be obsolete, using language to be more inclusive and evolving language to more accurately and positively describe certain behaviors and phenomena during the perinatal period and beyond. 


On-demand feeding or responsive feeding 

Photo by Nubelson Fernandes on Unsplash

Up first is the problematic term on-demand feeding

Caring for young humans is surely a massive responsibility, but to deem them demanding seems unfair and connotes negativity between the child and their caregiver.  

Instead, UNICEF suggests the term responsive feeding  which encourages relationship building through feeding responsively (regardless of feeding method) and recognition that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and caregiver. 


Sleep regression or sleep progression 

Many care providers have argued that the term sleep regression discredits what is actually happening: our babies’ brains are growing rapidly. 

Oasis Lactation Services posted, noting that #languagematters: “Sleep regression? It’s a sign of development and brain growth! Sleep shift is a better way to describe it. Your baby is gaining skills, not regressing.”


At risk or underserved 

The way that we communicate about barriers, inequities and populations that have inadequate access to health care services matters. Advocates warn us to use caution when speaking about barriers to breastfeeding and other behaviors. For instance, the increased mortality rates experienced by Black Indigenous People of Color (BIPOC) are not biologically-based; instead the systems of power and the oppressors create the risk. 


Foremilk and hindmilk or simply milk  

The foremilk/ hindmilk myth comes up often in lactation professional networks. 

Nancy Mohrbacher writes that “There are not “‘two kinds of milk.’ … Despite this common belief, there is no ‘magic moment’ when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.”

In fact, the concept is even more complicated than this. While more fat is transferred when milk flows well, due to circadian rhythms, foremilk from one feeding may be higher in fat than hindmilk from another feeding, as Healthy Children Project’s Cindy Turner-Maffei details.  

Mohrbacher and others point out that research indicates there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer. 


Breastfeeding and chestfeeding and  human milk feeding and bodyfeeding and

Photo by Sergiu Vălenaș on Unsplash

Serena Kalish, PA-C, CLC got interested in the various terms used for feeding babies during her Lactation Counselor Training Course (LCTC). It was the first time she had heard the term chestfeeding and it got her wondering how many other care providers are unaware of the term chestfeeding as well as when and where the term is being utilized. 

Kalish created a poll on a social media page curious to learn what terms lactation care providers are using and prefer. The majority of the respondents replied with breastfeeding, followed by nursing, followed by breastfeeding & chestfeeding. Respondents added feeding, lactation/lactating parent/lactation journey, bodyfeeding and chestfeeding (as a standalone from breastfeeding) to the options.

The results of the poll didn’t necessarily surprise her, she reports, but she says she found the added options interesting. 

Photo by Nathan Dumlao on Unsplash

Kalish shares that for a medically-minded person like herself, the term nursing sounds archaic.  She wonders if by using the term nursing that we are perhaps adding to the stigma of breastfeeding by not using a term that specifically identifies anatomy. 

Many respondents noted that inclusivity matters to them in their practice, so the terminology that they use is determined by whatever their clients prefer. 

This sentiment reflects ABM’s Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients which states that “Although the terms introduced previously may be unfamiliar to some providers, recognizing and affirming patients’ names, pronouns, and family members are a cornerstone of providing affirming care for patients who identify as LGBTQ+…  Affirming health care, including using affirming names and pronouns, and recognizing individual patients’ families and communities, can help to mitigate the effects of stigma and improve health.” 



Kalish goes on to present an interesting anecdote. As a participant in many “mommy groups” on social media, she became familiar with FTM to stand for “first time mom”. At one point, she noticed that some individuals were confused by a post that mentioned FTM because in LGBTQ circles, FTM stands for “female to male”. 

“It was an interesting perspective to learn that there are other contexts where certain terms and phrases and abbreviations are used,” Kalish comments. “It helps you realize that you have to be more sensitive sometimes and learn other terminology.” 


Language of inclusion and compassion  

Language comes in many forms. Hand Waves Birth Services’ Childbirth Educators and Full Spectrum Doulas Ally Balsley (she/her) and Brittany Noschese (she/her) touched base with us about non-verbal language and how to better serve individuals who are deaf or hard of hearing in a blog post from earlier this year.  

La Leche League International recently released a statement that announces the organization’s plan to increase audio and visual resources to better support those with vision or hearing impairment as well as those living in communities where we have not yet identified translators.

The statement also refers to their Cultural Sensitivity in Publications Policy, a trend that has been adopted by many companies and organizations as the national conversation about race amplifies.

Photo by Solen Feyissa on Unsplash

Finally, while many of us may have grown up on the playground chanting that bit about sticks and stones– stick and stones may break my bones, but words will never hurt me— it’s time we reckon with that falsehood. The words we chose when addressing birthing people and the conversations we have with them are impactful and can influence a lifetime. 

The Practising Midwife Journal posted for Birth Trauma Awareness Week: “…What we say and how we say it – can make a woman’s birth experience either transforming or harrowing. We have that potential impact.”

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