Myth – You have to feed formula in the beginning until your milk “comes in.”
FACT – You do not have to feed formula if you do not want to and your colostrum IS ENOUGH.
I had an incredible breastfeeding journey with my first born that lasted a little over two years. It was difficult for me to think about other moms not having a positive breastfeeding experience.
That is when I decided to become a lactation counselor. During my training, I remember learning about helping mothers feel confident about their milk supply (when there are no medical reasons to be concerned about). I remember being fascinated with the Baby-Friendly Hospital Initiative and researching if there were any near me for when I deliver again or to recommend my patients to go to for the most pro-breastfeeding support. Unfortunately, there wasn’t one.
When I gave birth to my second born, I remember feeling overwhelmed by so many emotions following childbirth. I remember trying to remind myself that this was typical as our hormones are off the charts after experiencing what the amazing body just went through to bring new life into the world. I felt like there were so many things that I had little or no control over, but what I did have control over was advocating for immediate skin-to-skin and the opportunity to breastfeed my daughter. That made me feel grounded and confident.
However, that night came and my daughter wouldn’t stop crying. The nurse would come in and out of our room always looking angry, telling me that my supply was not enough, and that I needed to give my daughter formula for her to stop crying. I kept advocating for myself and reminded my husband that –
Formula was not what we planned for or want,
I have colostrum and,
My colostrum is in fact enough and the best thing that we can give to our daughter right now.
Although I knew this was true, the sad little cries broke my heart and the nurse’s comments and facial expressions made me feel uneasy.
Even with the breastfeeding education that I had, she eventually made me believe that perhaps I was wrong and what I had was not enough for my daughter. I dozed off crying quietly to myself, feeling like a failure as a mom. This was my Ah-Ha moment. I thought, “Wow, that was terrible and unfortunately too common of an event that mothers often experience in the hospital.” I would never wish for any mom to feel that way – to feel like she is not enough, or a failure as a mom.
I am now dedicated to providing breastfeeding education during pregnancy… to help moms feel prepared for the first few moments after baby is born. I strive to find a role in the hospital in order to advocate for parents who wish to breastfeed and to provide timely interventions so that they too can have a positive breastfeeding experience.
It’s early in the New Year. Every evening, I work out on my beloved stationary bike, not because of some expected resolution or disillusioned intentions, but because it’s where I am forced to breathe, and therefore it’s become a necessary part of my existence. After each workout, I move through a ritual, so absurd, before stepping into the shower.
Confronting my naked self in the mirror, my head cocks slightly, my eyes narrow, and I admire the tone I’ve achieved in my upper abs and the muscles that grip my ribs.
Simultaneously, I grimace at the places I obsess over sculpting but that which won’t respond to calorie deficits, macro-calculating, crunches, four minute planks, cardio, endurance training, barre, yoga, weight-lifting, mindfulness, willing myself into a satisfying form.
In an exasperated sigh, I roll my shoulders back, scowling at the beefy traps I’ve acquired. The scowl accentuates the crease between my eyes, a fissure carved by contemplation.
I “draw my navel to my spine.” This is the more sensitive version I’ve learned to replace “suck it in.”
I squint at the flakey, smudged mascara under my eyes, the substance I brush on my blonde eyelashes each morning to avoid people thinking I’m sick. (A former co-worker once insisted I must be sick when I arrived at work without it. “No, really, you do not look good,” she said, recoiling as if it were painful to look at me.)
I prop my hands on my hips, smoothing out the bulge so that it’s easier to envision myself at least one pant size smaller, just out of reach of kid sizing, a disgusting delusion I recognize.
When I prop my hands this way, it also makes my arms look thinner by avoiding the offensive spread when they’re at rest.
And then I clench my fingers around my waist, squeezing enough to whiten my knuckles, wishing there were somewhere else for my organs to go, wondering if maybe they are the reason I appear so wide.
My scrutiny moves next to the sinewy dangles suspended from my chest wall. They’re pruned, though more full than the year my husband begged me to see a doctor for the weight I had (intentionally) lost.
Shiny stretch marks radiate from auburn areolas punctuated by cylindrical nipples topped with depleted pigment, like tiny little snow-capped mountains. They’re cock-eyed yet knowing and they hold my attention offering me something like: “‘Fuck the patriarchy and boob idolatry!…’”
They demand respect.
I cup my hands around them. The flesh spills into the spaces between my fingers. They’re soft, not like how my former boyfriends would express; soft, not like how they felt after my babies had fed; soft, more like the powdery skin that hung from my grandmother’s triceps.
I pull them up toward my face, and the stretch marks wrinkle into themselves. A fold forms under my thick collarbones. I lift my arms above my head and my boobs fall to gravity. The muscle near my armpits lift the edges of my breasts into a mischievous smile. The bottoms hang pendulous. Each breast morphs into an elongated structure, like the way an octopus maneuvers and slips gracefully, awe-inducingly into secret crevices and caves.
My breasts don’t respond to the tricks I experiment with on other parts of my body: the pressing, sucking, tensing, flexing, tucking.
Still needing a shower, I cup my breasts again as if hand expressing milk. On other nights, I’ve envisioned thick, golden colostrum beading at my pores or milk like that that nourished my children sprinkling onto the bathroom floor, but as biology would have it, these substances don’t come.
When I draw my fingers down toward the nipples on this night, in a festive but discreet explosion, like the poof of a dainty flatulent, confetti detonates from my nipples. Beautiful colors and sparkle blast toward the mirror in a nebulous, celebratory swirl toward my reflection which distorts into an expression of utter disbelief.
The remnants drift gracefully onto the counter, into the sink, onto the tiled floor littered with my sweaty clothing. The confetti speckles the tile where I birthed my son, catching him with my own hands in a triumphant act that propelled me into my next evolution of motherhood.
I gather some confetti into a pile and examine the sheen of some pieces, the crepey texture of others, the dusty glitter that I dread will take me forever to clean.
Then I peek out of the bathroom door into my bedroom where my husband still lay asleep, undisrupted by this commotion. His gentle snore reverberates from under the sheets.
I tend to the remaining mess of confetti and dispose of the projectiles in the trash next to our toilet.
“What the fuck,” I mutter, finally stepping into the shower.
I wash myself, dry myself and settle into bed like any other night.
The clock nears midnight. I toss and turn. I sleep some. Numbness in my extremities wakes me to moonlight, mostly snuffed out by thick winter clouds, glowing just enough though to reveal a panorama of slouching silhouettes, snow-laden willows, pines, junipers and oaks that surround me.
The next day happens, and soon I’m brined in sweat standing in front of my mirror again. On this evening, I skip the self-loathing and move straight to the breast-fondling, because if my breasts can produce confetti, the possibilities seem endless. Perhaps tonight it’ll be that beautiful new mixing bowl I’ve had my eye on… a fancy pair of boots…all of the words of the Croatian language I’ve been trying to learn… assurance that my kids will enjoy a well-adjusted life… world peace.
There’s a lurching in my stomach, the one that comes with anticipation as I attempt to express the unknown. Then, lights.
My breasts are projectors beaming stories in some sort of visual diary of my memories. The picture is dream-like, bleeding and blended around the edges. At first the shapes sway like shadows in dappled sunlight.
Then there’s focus. I watch my seven-year-old self walking around my childhood home in soccer shorts, otherwise topless. I ask my mom if I look like a boy, and she tells me no. I ask her again and she confirms that no, she does not think I look like a boy.
I watch my fifth grade self sporting my new three quarter-length, hot pink top. It has glitter embedded in its purely synthetic fabric, and I absolutely love it. Walking to my desk, a boy shouts, “Put a bra on!” My cheeks ignite into a shade that’s between red and purple. I relive the combustion of embarrassment, shame and anger. I try to keep this potion from seeping out, but I hate this boy for a good portion of my life. It’s when I realize that he is someone’s misguided son that hatred dissipates, and then I pity him.
The clips keep playing.
I watch myself in ballet class. I’m “sucking it in” and constantly adjusting my leotard so that what little fabric is there will cover up as much of my growing breasts as possible. I see myself wishing that they were detachable, so that I’d be flat-chested in ballet class, but have the option to use them to my benefit outside of the studio.
The next clip shows my dear friend and I during our study abroad on a long train ride in Morocco. My eyes scan, hardly keeping up with the passing landscape, tumbling plastic bags, dusty cracked soil, and as we slow to a stop I notice a woman draped in textiles but her face and her breast. An older baby is positioned to feed, his lower body dangles on a diagonal. She holds his weight in one cradled arm. She’s striking. I’m saddened when the train’s speed picks up again, pulling me away from her captivating strength.
In another flicker, I’m approaching my grandma’s house. She greets me with her beautiful, comforting face. She embraces me and kisses me many, many times like she’s going to devour me, and then attempts to wipe off the lipstick she’s smudged on my skin. She holds my shoulders, looks directly at me, and tells me, “I just love you!” and while I was once perplexed by her unending-enthusiasm to see me, I now understand since becoming a mother. Now I kiss my children, devouring them, the way she used to kiss me. The clip continues to the part where my grandma tells me that she’s going to get breast implants. She says she wants others to feel what she feels when she hugs me. She’s felt insecure about her breasts for as long as she knows, I learn, and so at 70-something, she does something about it.
The reel transitions to depict me discovering colostrum leaking from my breasts while pregnant with my first daughter. My mind is absolutely blown. I call to my then fiance to share my fascination, but he’s seemingly less entertained by my body’s ability.
The reel reveals me riding this wave of fascination. My areolas have darkened and expanded after the birth of my first child, a target intended to guide her to survival outside of my body, and I show them to my friends, because seriously, how crazy is this?! My breasts have ballooned to a size much bigger than my baby’s head. Tingly let downs spray milk in spectacular fountains soaking my infant and all of our surroundings.
The projection pans to my toes curled. Like clenching fists, they channel discomfort as I breastfeed through a pregnancy, and then the overwhelm of breastfeeding a toddler and a newborn and ultimately the fatigue of having breastfed for a combined nine and a half years.
There’s a clip that shows the blossoming of one of my most treasured friendships. I am watching her breastfeed her young infant in the middle of a mom-and-me music class, and my face brightens for I feel instant connection and admiration.
Another clip of the woman who flashes me a smile and a thumbs up while I breastfeed my baby in a restaurant. I smile back and it’s a beautiful, unspoken exchange of understanding and pride.
The projections remind me of each of my children’s darling little bodies weighted across my lap feeding from my left breast, where my heart beat is most detectable. My rhythm and nourishment pulsing into them; their energy surges back into me.
In a final clip, I watch my husband administer a syringe of Lupron into my lower abdomen, the artificial hormone that will propel me into a menopausal state. The drug is part of the protocol that will attempt to trick my body into welcoming a frozen embryo, so that I can gestate and birth another couple’s baby. I look forward to lactating again and I visualize abundance, enough to express for their baby, enough to donate to others. The clip starts to fade, but of course I already know what happens. I do not birth their baby, and I do not make milk anymore.
There is a part of this story where I am supposed to be a gestational carrier that feels unresolved. A section of my heart withers into little bits of confetti, just like the other stuff, and drifts to the floor like snowflakes tumbling through the slow-moving molecules of a bitterly cold night.
The projections dim with a final flicker.
So I step into the shower again. I sleep again. I wake again. I sweat again. And this happens over and over.
And every night, there’s something oozing, spewing, dribbling, emitting from my breasts.
One night, a substance I can best describe as lava. Another it’s spider silk, then soil, the wafting scent of cedar.
“Each week on our program, we choose a theme….” It’s Ira Glass broadcasting not from WBEZ Chicago, but from my breasts.
Throughout this inconceivable sorcery, I question my sanity, but I’ve been worried about being crazy long before my breasts started blasting party paraphernalia and sound and other things.
Mostly, I am amused by the unpredictability.
There is no purpose to these substances I’m producing. It’s completely unlike the milk I made for my children. And it’s not like the perceived uselessness of say, foreskin, which holds a cultural misconception of being futile.
My breasts now truly perform no other function than amusement, dynamic works of art, in all their expressions, like eroding sea glass tumbled by the elements.
In just one year, the network grew to 11 states and 250 members. By the time the organization was five years-old, the network grew “to over 600 members across all 13 states in Appalachia – and beyond!” Today, ABM “continues to grow in its membership, its capacity, and its visibility.” [Retrieved from: https://www.appalachianbreastfeedingnetwork.org/abn-board.html]
When Our Milky Way first featured Hutchinson in 2017, she said that the exponential growth was not expected, but also not surprising.
“There was absolutely no organization that grouped Appalachia as a culture, together, to make an impact for change,” she said.
This year, ABN will host its first cohort of Appalachian LATCH (Lactation at the Center of Healthcare) Leaders which is their train-the trainer program. With grant funding provided by Gallia American Community Fund of the Foundation for Appalachian Ohio (FAO) and the I’m a Child of Appalachia Fund®, they will offer 20 scholarships for registration to the course.
Many years ago, before the birth of her daughters, Hutchinson shared that she never anticipated doing the work she’s been engaged in, but as we often say, “All roads lead to breastfeeding.” Now, reflecting on the most significant change she’s noticed in maternal child health in the last decade, Hutchinson says, “As a member of the LGBTQ+ community, I have noticed more inclusivity in education and support for all families. I am happy to see such wonderful changes to include everyone who is lactating.”
And the most helpful lesson she has learned along the way is to say ‘no’.
“This has probably been my hardest lesson learned, but there is only one of me and I know I cannot do all the things,” she reflects. “It’s okay to refer out to someone else, say no to a speaking gig, not go to every conference possible, and take care of myself. Once I learned this hard lesson, I noticed I am able to give more to my clients and my own family…I know that I am not the lactation consultant for every person and humbling yourself to collaborate with others will help your practice tremendously.”
Looking forward, Hutchinson says: “In 10 years, I hope Appalachian Breastfeeding Network has been able to grow enough to fit more into our budget and reach more parents, especially in those areas with little to no lactation support. It is my vision to duplicate our hotline and make it sustainable and available to anyone, anytime, for as long as possible. On a personal front, I hope to see my kids happy and thriving as adults and live out our empty nester lives.”
Josephine (Josie) W. Munene is the Director of Community Engagement at Maziwa Breastfeeding, an organization that helps mothers balance their babies’ health and their families’ economic well-being in Kenya. Munene leads the lactation education training programs and the Community Breastfeeding Ambassador peer support initiatives.
Munene completed her graduate work in the UK with a focus on international development, and while she imagined she would spend her life working globally, and after spending some time working in the corporate world, she determined a need for helping moms in her home country.
After her first son (now 14 years old) was born, she struggled to find breastfeeding support. Munene noticed that many of the resources and programs were established in the Global North and lacking for women in her community. So Munene switched gears and launched a business that sold breastfeeding supplies like breast pumps and nursing bras and nursing pads different from the “lumps” handed out by the hospital. She was looking to infuse dignity in the experience, she explains. But Munene quickly realized that it wasn’t enough to sell products to women, so she pursued the Infant and Young Child Feeding Counselor Training in order to meld her lived experience with technical knowledge and offer evidence-based care to breastfeeding dyads.
Kenya ranks quite well in the World Breastfeeding Trends Initiative (WBTi) coming in at number 10 worldwide. Still, Munene shares that in Kenya, lactation professionals are not widely accepted as competent nor essential care providers. Instead, they are often considered “quacks” or the profession is regarded as a “hobby”. Munene has therefore made it a priority to engage in policy change with a goal to establish a national accreditation curriculum in her country that will recognize lactation care as an essential part of the continuum of care. Munene sees engagement of social enterprises in public private partnerships as an important piece to this work; reliance on governments alone or donor partners alone has proven to be ineffective, she comments. Further, Munene emphasizes the importance of engaging the people who the policies are intended to benefit.
She sees an opportunity to adapt well-established accreditation programs in the Global North to Sub-Saharan countries’ needs. Growing the membership of the Kenya Association of Breastfeeding would signal to the Kenyan government the need for a local accreditation, she proposes.
Recently, Munene and her colleagues helped facilitate a Kenya Association for Breastfeeding workshop during the Amref International University (AMIU) Public Health Care Congress. A range of participants including gynecologists, pediatricians, students were invited to learn about the fundamental principles of lactation and breastfeeding. They then participated in reflecting on case studies using Healthy Children Project’s (HCP) 8-Level Problem Solving Process by Karin Cadwell and Cindy Turner-Maffei as a framework.
Munune reports that the most interesting finding from the interactions was the participants’ identification of the need for breastfeeding support early on to alleviate or to eliminate challenges.
Another takeaway illuminated the specialized care that breastfeeding can require. Munene explains that in Kenya, breastfeeding generally falls under the nutrition category which overgeneralizes the “benefits” of breastfeeding and ignores the need for practical support that is tailored and effective.
Munene mentions that Kenya employs Community Health Promoters which are important players in preventive health care, but the program does not address the need for more targeted support for breastfeeding dyads.
Overall, Munene sees a need for a more comprehensive approach to lactation and breastfeeding care in her country. She calls for policies that go beyond “paperwork and guidelines”.
For instance, Kenya has established lactation laws for working mothers, but she finds implementation and enforcement is lacking. [Check out this qualitative study for interesting perspectives from women, families and employers in Kenya.]
Munene also reflects on maternity cash benefits for those working in the informal sector. These interventions can only be effective if they come with proper education, she reports. Cash benefits have the potential to influence personal nutritional wellness, and if individuals use the money to purchase indigenous foods from their neighbors, they have the added potential to boost income for the community as a whole.
You can learn more about these endeavors and connect with Munune here.
You might also be interested in learning about The Cost of Not Breastfeeding in Kenya. Check it out here.
The multidimensional interactions we have with food begin with our mothers. A fetus is passively exposed to the flavors of the biological mother’s diet through amniotic fluid, and the infant goes on to interact with these flavors through human milk. Mennella and her colleagues have called this “intimate bidirectional chemosensory communication.” (Mennella, et al, 2023)
In this complex communication, “diet and xenobiotic exposures of the lactating parent, due to lifestyle choices or necessitated by medical treatments, affect not only milk production and milk composition but also the infant’s biological responses, either beneficially or adversely,” the authors continue. “Developing alongside the chemosensory signaling is the seeding and maturation of the infant microbiome, which transfers and exchanges with that of the parent and of the milk, forming additional bidirectional linkages.” (Mennella, et al, 2023)
Infant formulas, although available in many varieties, do not foster this elegant exchange and where developing food preferences are concerned, present a static flavor.
“That constant flavor doesn’t reflect the culture [a child] will grow up in,” Mennella comments.
The same goes for infants fed jarred and pouched baby foods (what we’ve referred to as “the packet apocalypse” where the convenience of “ready-to-feed-super- glop” has largely replaced the art of dining and sharing meals.) The explosion of the baby food industry means parents often don’t feed their children what they themselves eat. Families can feed their babies canned peas, but never eat a pea themselves, Mennella points out.
Mennella’s research has always been interested in flavor and nutritional programming in humans and the development of food preferences, but over the last decade, it has diversified to ask questions about the taste of pediatric medicines from a personalized medicine perspective, determinants of sweet and salt preferences during childhood, the development of psychophysical methods to study olfaction, taste and chemesthesis across the lifespan, biomarkers for dietary intake across the lifespan, and reproductive state effects on dietary intake and weight loss in women. [Retrieved from: Monell Center]
Collective, family- focused approach
Mennella summarizes a few key points from her work.
“Children live in different sensory worlds,” she says. ”They are really sensitive to the current food environment.”
And like she and her colleagues have written, the food environment rich in added sugar and salt that caters to preferred human taste, provides challenges for all of us.
“Fortunately, our biology is not necessarily our destiny. The plasticity of the chemical senses interacts with experience with foods to modify our preferences, producing an interface between our biology and our culture, our past and our present.” (Mennella, et al, 2020, p. 291)
In order to influence our destiny, Mennella says that the strategy can never be for the child alone. She suggests there be more attention paid to the family as a whole in order for healthy behaviors to be sustainable.
She nods to the success of peer counseling programs and recommends bolstering these opportunities for families to interact and learn from one another. She says she envisions primary care taking on a community approach to provide not only a forum for education but also opportunities for interaction between families.
Where science and policy meet
Mennella recognizes that ultra-processed, convenience foods are palatable and often inexpensive and deems this a “much bigger issue.”
As science evolves– where the picture gradually becomes more crisp and for every one question asked, fifty more arise– policies and practice must reflect and catch up to the robust body of evidence in order to best support child and family health.
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