Proximity and profit

The red bud in my yard is bursting with magenta. The remnants of nighttime thunderstorms, gems of rain dangle from its branches glistening under late morning sun. There’s a lot of anticipation in our backyard woods; a buzzing of green that will soon become too dense to see the railroad tracks that curve through the neighborhood. 

When I open the grill on one of these beautiful spring days, I’m confronted by a mother mouse perched in her nest. Her black, beady eyes send me shrieking, foolishly and frantically flailing into my house. 

My partner, much less ruffled by the tiny animal, uses the grill utensils to relocate the mother mouse and her nest. Upon removal, he notices that her tiny, pink babies, nearly translucent, are attached to her teats. 

“Oh my god!” he exclaims. “Oh my god, they’re nursing! They’re just hanging on!” And then, minus the flailing, proceeds to freak out, because he is so affected by the fact that he has disturbed a nursing mother and her babies. Despite the assault of grill tongs and  humans giant relative to their size, the mother and her babies remain together, in an act of survival. 

A few days later, at my daughters’ soccer game, my son finds an empty field to kick around his soccer ball. His location and the girls’ game are separated by a small parking lot. I want to finish watching the girls’ game, so my son and I establish a meeting spot. When I go to check on him the first and second time, he is happily occupied, working on what looks like some fancy footwork and big boots. The next time I go to check on him, I scan the landscape, but he is not there. There’s a berm, so I swiftly walk over to see if he’s hidden behind the mound. Still, I don’t see him, so I panic, shouting for him, over and over with no response. 

Perhaps I will reveal too much about my character here…I start to conjure up all of the possibilities: he’s been abducted by a stranger, driven away in a van and I’ll never see him again; he’s been swallowed by the marsh on the other side of the road; he’s wandered off into the woods on the perimeter of the field and wolves will eat him; he’s been coerced by someone in the stands and they’ve snuck off with him somewhere. 

At this point, my heart is beating in my forehead. Blood drains from my arms and legs and they begin to tingle. It feels like I could be staggering from light-headedness, but I manage to make my way over to recheck our meeting spot; he is not there either. I walk up into the bleachers and ask a familiar face if she has seen my son.

“Yep, he’s right there; I’ve been keeping my eye on him,” she points to the other end of the bleachers… not our meeting spot. 

I exhale, thank her quickly, rush to him, embrace him, scold him through trembles. He holds my hand as we make our way to the top of the bleacher seating. He curls his arm around my waist and we sit side-by-side this way watching the reminder of the game together. 

My son is no longer a nursling, but my point in sharing these vignettes is that the connection we have to our children, the instinct to be with them, near them, is mammalian, primal. It’s beautiful and powerful. 

From the start, our infants’ survival depends on proximity. Of the many things that Karin Cadwell and Kajsa Brimdyr have taught me and that have stuck with me is how babies instinctively crawl to the breast, so even when infant feeding hasn’t been a part of the prenatal conversation, or even if a mom has been on the fence about “committing” to breastfeeding, the baby often makes that initial decision, questing to the breast when given the opportunity in uninterrupted skin-to-skin contact after birth. 

“[Babies] are 10,000 years old when they are born,” Nikki Lee has said. “If they’re not next to a heart beat, they are saber-toothed tiger lunch.”

As well as being ancient, breastfeeding is a natural progression in a continuum. Linda Smith once remarked at an International Breastfeeding Conference: “We don’t ask women if they want to deliver their placenta. Why are we asking about breastfeeding?” Smith was not making a point about the removal of choice; instead she was commenting on the fact that breastfeeding is biological

Yet, we find ourselves in a culture that has stripped us of these sacred experiences through marketing and medicalization. We have been acculturated to believe that separation is normal, acculturated to believe that tending to our babies’ basic needs will spoil them, acculturated to believe the only way we can be rested and sane is by separation from our babies, acculturated to believe that we require gadgets to properly raise our children, because somewhere along the line, we started to believe the marketing that nature must be flawed. We fell into the corporate trap, succumbed to their greed, allowed it to dim our instincts. 

Now, the language we use refers to the “benefits” of our mammalian behavior: the benefits of physiological birth, the benefits of skin-to-skin contact, the benefits of breastfeeding. Max Ramirez of IBFAN & MOH Panama has said that “Talking about the advantages of breastfeeding versus the risks of not breastfeeding is like talking about the advantages of breathing instead of the consequences of smoking.”

The idea that without breastfeeding, a baby is significantly disadvantaged, is not in our vernacular. 

As commentator Frn Ange wrote on a The Natural Parent Magazine post “…Proximity is not profitable…” and so we have been forced away from the power of the dyad, the power of our innate abilities as babies and parents. Marketing propaganda created the breast versus bottle wars because it drives profits, further dismantling our power. 

In this Leadership Pittsburgh presentation about “Milk Money,” Todd Wolynn goes as far as to say, “Economics dismantled us as a species.” (He’s referring to formula companies.) 

All is not lost. In fact, Camie Jae Golhammer has said of Indigenous traditions, that they’ve gone dormant rather than have completely died off. 

 

Like the boasting red bud in my yard, these sacred moments during our reproductive years will not always lay dormant and there are bright spots to celebrate. 

Programs like the Baby-Friendly Hospital Initiative empower families with practices and messaging like: “Every mother has the right to evidence-based information, free from commercial interests to help her decide how to feed her baby and should be equally supported and treated with dignity and respect for her infant feeding decision.” 

Global recognition of the importance of midwifery care came to the forefront late last year when midwifery was inscribed on the Representative List of the Intangible Cultural Heritage of Humanity. This recognition is not only well-deserved by the many, many generations of midwives who have supported and continue to support healthy families, but essential in order to safeguard those in the practice of protecting fundamental human rights and these sacred moments. 

 

Another ray shines as the people at the United States Breastfeeding Committee (USBC) do lots and lots of hard work to advance policies that actually allow people to be with their babies. The organization offers a hub for policy action that makes it incredibly simple for citizens to engage and influence change. 

 

Further reading 

Interrupting the mother-child dyad is not the answer to infant safety

Ancient bodies in a modern world 

Mothers matter 

Nuturescience and Kangaroo Mother Care 

The Hidden Pregnancy Experiment which explores anxieties around surveillance.   “As a general rule, these devices don’t lead to better outcomes for the babies they monitor. More often—like social media, which promises connection as a salve for the loneliness created by social media—parenting tech exacerbates, even calls into existence, the parental anxieties that it pledges to soothe.”

Where are they now? Lessons from ruins with Carin Richter RN, MSN, APN-BC, IBCLC, CCBE

Photo by Aykut Eke on Unsplash

The peafowl is a bird known for attracting attention. Whether flaunting their colorful, unfurled plumage or delivering a resounding cry, peafowl are undoubtedly expressive, insistent creatures.

Occasionally, when Healthy Children Project’s Carin Richter, RN, MSN, APN-BC, IBCLC, CCBE hosts Lactation Counselor Training Course (LCTC) competencies from her Florida home, a curious peacock will poke its head into the frame of the video call demanding attention from her and the participants. 

“The big inquisitive bird insists on being part of the session on breastfeeding!” Richter exclaims.  

Since we featured her last, Richter has fully retired from her responsibilities at St. Anthony’s Medical Center in Rockford, Ill. and now helps facilitate the online LCTC once a week.

Our Milky Way caught up with Richter this winter as part of our Where are they now? series. 

Now 70 years old, Richter shares with a stirring of anger, worry and dismay in her tone: “Women’s health… We are in crisis mode. I’m personally struggling with any kind of optimism.”

She cites a few culprits: a political climate that tolerates division and disrespect, the marginalization of maternal child health issues, and the stripping of rights as marked by the reversal of Roe v. Wade. 

From these ruins, Richter has constructed several lessons. For one, she implores us to become politically involved. 

“Keep women’s issues right smack dab in the conversation,” she advises. “Look around. Search out areas where you can sit at that decision making table.” 

Political involvement, Richter suggests, can come in the form of participating on a shared governance board, community advisory boards, church councils, and rotary clubs. Engagement doesn’t need to look like shaking hands with the mayor. 

She continues, “My friends always say, ‘Oh Carin, you never have one conversation without the word breast coming through.’ We need to live that! Because if we don’t we’re going to lose what we have.”

Photo by Nicole Arango Lang on Unsplash

In other words, be a peafowl. Demand attention. 

Richter lays out what happens when we don’t. 

During her nursing career, Richter and her colleagues’ involvement with the Baby-Friendly Hospital Initiative (BFHI) eventually gave rise to seven hospitals in her area being designated by 2013. As of 2022, only one of those hospitals had retained their designation. 

“Because there was no one sitting at the decision making table speaking for the initiative,  administration lost sight of it and breastfeeding took a back seat or perhaps didn’t have a seat at all,” Richter reflects. “No one spoke of keeping breastfeeding issues in the forefront. It’s an experience that brings me to tears.”

Another insight she’s gained is the difficulty in beginning and sustaining a community-based lactation business. She watched friends with solid business plans, well-researched proposals, and passionate ambitions to help dyads get crushed by lack of insurance reimbursement, lack of mentorship and lack of collaboration.

“We need a lot of work on that front,” Richter comments. 

She suggests a reimagination of the way lactation services are viewed where insurances and companies recognize the importance of breastfeeding and elevate lactation support to a professional state. 

For instance, while working at the hospital, Richter brainstormed ways to give value to and justify the services of in-house lactation care providers. She found that postpartum breastfeeding support offered in-hospital  resulted in a marked increase in patient satisfaction scores. A creative solution suggested that  initial lactation and breast care be embedded in the room rate available for all patients, not billed as a separate line item, allowing for a higher reimbursement rate, Richter explains.  

Photo by Hannah Barata: https://www.pexels.com/photo/woman-having-skin-to-skin-contact-with-her-newborn-baby-19782322/

After retirement from the clinical setting, Richter cared for her aging parents. She says she felt the pinch many women of today experience as they juggle personal, familial and work responsibilities.

As she lived the struggle to find workable solutions for the care of her elder parents, she says she was surprised to find that barriers were similar to those she encountered while working for change in the community surrounding breastfeeding. For both, breastfeeding and elder care, resources are often limited, frequently expensive, and often inaccessible or unavailable.

Her focus now has broadened from maternal child health advocacy to the broader realm of family care issues. She finds herself
advocating for maternal child health and family care issues like pay equity and affordable child care.

“The struggle continues across the continuum, in arenas frequently dominated by women who bear the majority of responsibility,” Richter reflects. 

Despite a sometimes discouraging climate, Richter says she sees “little bright spots” here and there. 

“Not a week goes by that I don’t have a [medical professional] seeking lactation credentialing… I am thrilled with this,” she begins.  The practitioners seeking lactation credentials are not only specializing in women’s health; instead they’re an interdisciplinary group of folks, a sign that breastfeeding and lactation care is breaking free from siloed confines.  

“This is what keeps me excited,” Richter says. “More knowledgeable, eager voices speaking for mothers and babies.” 

Looking back, Richter remembers when it caused a fight to require lactation credentialing for OB nurses. 

“We got so much backlash not only from administration but from OB nurses themselves,”  Richter recounts. “Some OB nurses took no ownership of lactation. ‘That’s the lactation counselors’ job,’ they would claim.”

In this culture, Richter pointed out that trauma nurses are required to be trauma certified, oncology nurses  are required to be oncology certified; why were OB nurses not required to be certified in lactation when it’s such a large portion of their work?

“It was a bit of an eye opener,” Richter says. 

Retrieved from ALPP. Used with permission.

Now almost all hospital OB nurses need to be certified within the first one to two years of hire, and Richter says she’s encouraged by the ever-increasing number of OB nurses she speaks with weekly who are seeking breastfeeding certification and are supported by their department managers.

As for physicians certified in lactation, an already developed template existed. The state of Illinois had issued a Perinatal state wide initiative to mandate that all anesthesiologists caring  for pregnant patients were to be certified in Neonatal Resuscitation Program (NRP). All obstetricians soon followed. Richter says her wish would be that the template could extend to mandating lactation credentials to all professionals caring for pregnant and breastfeeding families.

Another bright spot Richter’s noticed are the larger, private sector industry and private employers in the Midwest offering adequate workplace lactation accommodations and services  that go beyond what is mandated by law. 

Moreover, Richter continues to be  impressed by the work that the United States Breastfeeding Committee (USBC) is doing, namely increasing momentum for workplace protections across the nation.

Though she adds, “The spirit is really strong, but the body is really weak. Getting the body to make the decisions and the policies is difficult.” 

Retrieved from ALPP. Used with permission.

Yet another area of encouragement is the inroad made into the recognition of perinatal mood disorders (PMD). Acknowledging that there is always room for improvement, Richter extols the improvements in detection, treatment and the lightened stigma around PMDs.  

Richter shares on a final note that while maternal child health issues have been largely well promoted and mostly supported in the last decade, she hopes to see more emphasis and energy put into the protection leg of the triad. That will require involvement in the work of policy change at the institution, community, state and national level. Policy development and change is the first stepping stone, she advises. 

“Do not be afraid of policies, because policies have power,” Richter states.  “Get involved and find your place at the decision making table.That’s your homework assignment for the year!” 



Brenda Hwang’s, MA, CCC-SLP, CLC, CDP light bulb moment: “My colostrum is in fact enough…”

[Photo by Andrea Piacquadio]
We consider ourselves life-long learners here at Healthy Children Project. Sometimes learning occurs gradually, and sometimes there are the ‘light bulb’ moments.

We put a call out to our followers to share “Aha!” moments with us. Maybe it was a myth busted during the Lactation Counselor Training Course (LCTC) or maybe it happened during a visit with a dyad.

We also called for stories about your babies’ and children’s ‘light bulb’ moments. When have you seen your little ones’ faces light up in discovery and understanding?

The call for stories is still open! Please send your reflections to info@ourmilkyway.org with “Light Bulb” in the subject line. 

This is Brenda L. Hwang’s, MA, CCC-SLP, CLC, CDP illuminating moment. 

******

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 –

  1. Formula was not what we planned for or want, 
  2. I have colostrum and,
  3. 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. 

Thank you for reading my story.



Human milk banks around the world

Of all the known approaches to saving infant lives, human milk has the greatest potential impact on child survival. (PATH) When direct breastfeeding or mother’s expressed milk is not available, donor human milk is the next best option.

Photo by Samer Daboul

As such, the 2018 WHO/UNICEF implementation guidance on the Baby-friendly Hospital Initiative stated that “Infants who cannot be fed their mother’s own milk, or who need to be supplemented, especially low-birthweight infants, including those with very low birth weight and other vulnerable infants, should be fed donor human milk.” The American Academy of Pediatrics, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition, and other national and global policy groups also call for use of donor human milk as the feeding of choice, if mother’s own milk is insufficient, unavailable or contraindicated. (WHO)

Now, WHO is in the process of developing guidelines on donor human milk banking.

The ISRHML Trainee Interest Group recently presented A Global View of Human Milk Banking with Kimberly Mansen (PATH), Dr. Victoria Nakibuuka (Nsambya Hospital), Debbie Stone (Rogers Hixon Ontario Human Milk Bank), and Dr. Maryanne Perrin (The University of North Carolina Greensboro) which brought to light several, wonderful resources and is the inspiration for  this week’s post.

Let’s take a look at some human milk banks around the world.

This tableau map depicts publicly known human milk banks. If you know of a milk bank that is not shown on the map, you can fill out this form and/or email kamundson@path.org or humanmilkbankmap@gmail.com.

Brazil 

Donor milk banking thrives in countries such as Brazil, where there has been a concerted effort at the Health Ministry level to incorporate milk banks into health policy. (Arnold, 2006)

 

Uganda

In commemoration of World Prematurity Day, Uganda introduced its first human milk bank at Nsambya Hospital on the 26th of November 2021 at Pope Square. [More here.]

 

Canada 

The Rogers Hixon Ontario Human Milk Bank in Ontario has dispensed over 1 million ounces of human milk. The Rogers Hixon Ontario Human Milk Bank is a non-profit organization and a joint initiative of Mount Sinai Hospital, The Hospital for Sick Children (SickKids) and Sunnybrook Health Sciences Centre. It is a member of the Human Milk Banking Association of North America.

 

Ukraine 

The first and currently only Ukrainian Human Milk Bank was established in Kiev at the Perinatal Centre where approximately 80 percent of all premature babies in the city are born.

 

South Africa

The South African Breastmilk Reserve (SABR) has set up a total of 44 in-hospital human milk banks in public and private hospitals across South Africa.

 

Vietnam

The first human milk bank in Vietnam was officially opened on February 17, 2017, at the Danang Hospital for Women and Children. This facility is supported by the Vietnam Ministry of Health and the Danang Provincial Department of Health, and is the first human milk bank in Vietnam to be operated within the public health system and to international standards. (PATH)

Take a virtual tour of the bank here.

Also consult:

Efforts to curtail dubious marketing practices of commercial milk formula industry

The commercial milk formula (CMF) industry uses marketing tactics similar to those of the tobacco, alcohol, and ultra-processed food industries.

Photo Credit: Boston Public Library
Date: ca. 1870–1900 https://ark.digitalcommonwealth.org/ark:/50959/3b591d51p Please visit Digital Commonwealth to view more images: https://www.digitalcommonwealth.org.

Earlier this winter, the Lancet published a three-paper series outlining the multifaceted and highly effective strategies used by commercial formula manufacturers to target parents, health-care professionals, and policy-makers.

“The industry’s dubious marketing practices—in breach of the breastfeeding Code—are compounded by lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations,” the Lancet summarizes.

Two new publications corroborate WHO findings on the digital marketing of commercial milk formulas in Mexico:

In another recent publication, Pediatricians’ Reports of Interaction with Infant Formula Companies, the authors found that: “Of 200 participants, the majority reported a formula company representative visit to their clinic (85.5%) and receiving free formula samples (90%). Representatives were more likely to visit areas with higher-income patients (median = $100K versus $60K, p < 0.001). They tended to visit and sponsor meals for pediatricians at private practices and in suburban areas. Most of the reported conferences attended (64%) were formula company-sponsored.”

The authors write that “Seventy percent of countries follow the World Health Organization International Code of Marketing Breast Milk Substitutes that prohibits infant formula companies (IFC) from providing free products to health care facilities, providing gifts to health care staff, or sponsoring meetings. The United States rejects this code, which may impact breastfeeding rates in certain areas.”

The Lancet series authors provide recommendations to restrict the marketing of CMF to protect the health and wellness of mothers and babies, and ultimately society and the planet.

  • Curtail the power and political activities of the CMF industry
  • End state practices that do not uphold, or that violate, the rights of women and children
  • Recognise, resource, and redistribute women’s care work burdens in support of breastfeeding
  •  Address structural deficiencies and commercial conflicts of interest in health systems
  •  Increase public finance and correct the misalignment between private and public interests
  • Mobilise and resource advocacy coalitions to generate political commitment for breastfeeding

In Mexico, UNICEF and Instituto Nacional de Salud Pública have designed infographics for policymakers as well as parents and caregivers to educate on the impact of digital marketing.

The partners are also working on proposed modifications to current Mexican regulations that involve commercial formula milk and ultra processed food marketing to infants and young children. Further, development is underway for a mobile app tool for monitoring the Code in Mexico.

Legislation in El Salvador was recently passed–“Love Converted into Food Law, for the Promotion, Protection, and Support of Breastfeeding.”

PAHO is monitoring the implementation of the Baby-friendly Hospital Initiative in the Americas BFHI requires full compliance with the Code and subsequent WHA resolutions.

In other efforts to protect parents and babies, Breastfeeding Advocacy Australia released a video on how the organization monitors predatory marketing. Find it here. You can find their Facebook group here.

Also read:

Follow IBFAN’s coverage of the 43rd Codex Nutrition Session of the Committee on Nutrition and Foods for Special Dietary Uses here.