I thought it might be interesting to speak with folks working in the field of lactation who are all at different points in their careers; someone in the beginning, middle and end of their careers. I was curious to hear their thoughts on the work and if there were any similarities at different stages of the path.
The first person I spoke with is Calliope. They are in the very beginning of their career. Calliope became a doula and a CLC in 2022. They have attended four births. They are primarily a birth doula but have had a few post-partum clients. However, since they are a CLC they say they stay on longer than maybe some other doulas might. They consider themselves a full spectrum doula. While they do not do doula work full time, they try to do it as much as their schedule allows.
What is the process like for you as you are helping these birthing people?
I love taking a doula client any time I can. This most recent one was extra special because she was a friend so we had a jump start on all of the “getting to know you” stuff. But also, it was a totally different challenge to get to know someone in this other way from what our relationship had been up to this point. But the thing I am struck by every time I do it is how do people do this without support? And like beyond that, how am I supposed to ask someone to pay me for this? If you want it, it should just be free flowing from the tap.
And then I am also really amazed and I learn a lot every time. I learn about how different people want to be interacted with both in a doula client relationship and just in life. I get a lot of good practice listening to people. I think it is also really important to be living in a community of support so that if I need a net, hopefully someone will be there to catch me. I think that is quite beautiful.
If you could change something in the healthcare system around birth and caring for mothers, what would you like to see?
I think more midwives would be really helpful. No shade to OB’s but I have noticed that sometimes doctors don’t really have the time to sit with a mother and help through what can be a stressful time. It feels a little like we are doing emotional clean-up from that lack of care. Especially first-time parents in a high-risk pregnancy which has been the clients I have had so far. Also, lower cost of care across the board.
Tell me about your work in Texas
I worked through an organization called GALS in Austin, which stands for Giving Austin Labor Support. They are an amazing organization! They pair every birthing person who walks into the hospital with a free doula. The client never pays anything, its state funded so I was paid through the state not from the parents. And I think more programs like that, all over would be amazing.
How do you think that could happen?
I don’t know. But my friend Juju, who is also a doula, and I are making grand plans for someday in the future to start one of here in New York. The success rates at GALS were amazing and they also provided lots of outside support with prisons which I thought was very cool.
When you say success rates, what does that mean to you?
When I think of success rates as a doula I’m talking ideally of a healthy everyone at the end. And luckily for everyone so far that has been my experience. And for the client, I think success is a sense of satisfaction on their part and a job well done. For the birthing person, that this event that is so personal and can really feel isolating is actually a massive empowering success. Empowering is a weird word but the idea that they feel really proud of themselves and they see themselves as incredibly capable.
And tell me about breastfeeding. How has it been helping these folks with breastfeeding?
That has also been great! All four of my clients have been able to exclusively breastfeed. For some of them, I didn’t keep up with after six months but they were all planning on nursing until either they or the baby were done. One of the families I worked with had three kids under five and then the father broke both his wrists so I stayed on a long time with them. I think I stayed for three months. That mother had breastfed all of her kids and had only just recently weaned the eldest. She found breastfeeding to be a huge way to bond with her kids. All of my clients so far have all really wanted to breastfeed and didn’t need much education on the benefits. So, they were all eager to troubleshoot if something wasn’t right. Like the latch or oversupply. Oversupply is the thing that I’ve come across most, which is interesting.
Why do you think breastfeeding was so successful for the folks you’ve helped?
I think for all four of them it was something that they were excited to do and I think that helps tremendously. For two of my clients it was the first baby. And for two it was the second or third and they had varying rates of success the first times around. I think for them it was about getting some external validation that they were doing a good job. Just someone telling them that is really important.
Validation is so important.
Yes. And skin to skin! They were all skin to skin for I think the entire first week! As much time spent skin to skin is key! My third client had a really rough road starting breastfeeding with her previous birth and we talked a lot about spending as much time as possible skin to skin and how helpful it is.
I also make it my practice to make sure we get a good latch before I leave on that first day. I also like to point out feeding cues and particularly rooting. I like to include the partner in this too. It gives them a little game to play, to look for the cues!
What are your goals for the future with regards to birth and breastfeeding work?
I am actually thinking about midwifery school. But I’m on the fence because it seems like you don’t really get as much time with a client and I think that’s the part that I love the most. But I definitely want to keep this work as part of my life. Especially as my friends have kids, I want to be able to support them.
Any other thoughts on the work in the birthing and breastfeeding space?
Yes, I feel very lucky that I know that if I had a scenario with a client as a CLC and I needed more support, like I needed help troubleshooting, I would have you all to call. I think in general, the birth work world could use a bit more community support. I know a lot of doulas and we all think that more community support for the practitioner would be awesome.
Next week, I’ll speak with someone in the middle stages of their career. Let’s see if there are similarities! Have a great week, and may all your ways be milky ways!
Jacopo Tintoretto The Origin of the Milky Way about 1575 Oil on canvas, 149.4 x 168 cm Bought, 1890 NG1313 https://www.nationalgallery.org.uk/paintings/NG1313
“We were thrilled to find that the milk of a Goddess was thought by ancient peoples to be the source of our Galaxy,” Turner-Maffei shares. “This concurs with our view that breastfeeding is a core experience of human life.”
[Jacopo Tintoretto’s beautiful painting, The Origin of the Milky Way, depicts] “the Greek God Zeus (Roman name Jupiter) bringing baby Herakles (Hercules) to suckle at the breast of the sleeping Goddess Hera (Juno), Zeus’s wife. Zeus wants Herakles to receive the milk of a goddess, because it bestows immortal life, and will make Herakles into a god. Zeus anticipates that Hera will not willingly provide her milk to his love child [born to mortal woman Alcmena]. Therefore, he tries to sneak up on her while she is sleeping. However, foreshadowing his adult strength, the baby Herakles attaches forceably to Hera’s breast, awakening her. Hera reacts by pushing the baby off her breast. Her milk spurts forth into the heavens, and creates the stars of what becomes our galaxy, the Milky Way.” (Cadwell & Turner-Maffei, 2004, p. xi)
“The Fontana della Spinacorona is a marble representation of the mythological founder of Naples, the winged siren Parthenope. Legend has it that the siren shot her breast milk onto the flames of the volcano Vesuvius to extinguish the fire. The work bears the Latin inscription Dum Vesevi Syrena Incendia Mulcet: ‘while the siren of Vesuvius calms the flames’…I must point out how absolutely METAL that is!!??? BREASTMILK TO EXTINGUISH THE VOLCANIC FLAMES OF VESUVIUS!!!!…”
She goes on, urging, “Think about that for a minute. We typically think of a postpartum woman as weak, drained, struggling. Here, the nursing mother with fountains of milk shooting from her ample breasts, puts her on par with the gods of the sky and sea. PURE, RAW POWER, que bella!”
Grabosky, Tom. Mothers. 01 Oct 1991. Web. 2024. <https://ark.digitalcommonwealth.org/ark:/50959/8s45wt479>.
Mythology offers powerful and inspiring pieces of lore, but mythsas we have come to know them in modern times, can be powerfully harmful.
This week, Donna Walls RN, BSN, ANLC takes the opportunity to dispel some myths she often encounters in her guest piece titled Breastfeeding Myths and Why They Can Cause Difficulties.
Donna is a frequent contributor to Our Milky Way. You can read her other pieces here.
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Some breastfeeding myths seem to continue unchecked for decades. It seems no matter how much we teach, preach, beg, educate, cajole and insist, they persist. So, I guess I’m going to take one more swing at setting the record straight and hope we can dispel some of the more common ones.
Myth #1
Some women are just too stressed or ‘high-strung’ to breastfeed. Successful breastfeeding requires relaxation.
Nothing could be further from the truth. We know women have been successfully nursing their babies in highly stressful situations for eons. During times of war, weather disasters, personal crises, physical illness, financial distress, and so on and so on, they continue to make the quantity and quality of milk needed for their babies to thrive.
It would be very difficult for our species to survive if a stressful, anxious situation was all it took for our milk supply to shut down. This applies to widespread situations such as wars as well as individuals’ situations. When a new baby is brought into the family, whether it’s the first or fourth, it’s an adjustment. Changes in lifestyle, activities of daily living , sleep patterns and emotional adjustments…no one escapes without some moments of anxiety. It’s a good thing our bodies are designed to do everything it can to nourish and nurture the next generation.
Truly, prolactin is a wonderful hormone! We know it is responsible for milk production, but it is also actually involved in moderating stress responses in males, females, lactating and non-lactating mammals. In simple terms, it has a stress-reducing, calming effect. Even more amazing is our ability to actually increase our prolactin production in times of acute stress. In one NIH study, the levels of prolactin were significantly increased in women who reported long-term stress and resulting depression. So busting this myth should be easy; not only does stress not reduce milk supply, it can actually increase our levels of milk-producing prolactin and help to calm frayed nerves in the process.
Myth #2
Your milk will “come in” about day 3 or 4 postpartum.
This one could be one of the most harmful, because it’s an all-too-common phrase repeated continuously, everywhere. Unfortunately, new mothers, already worried about not having enough milk, are told this as a routine part of breastfeeding education and can result in mothers becoming discouraged in the first hours and days of breastfeeding. We commonly hear them express their fear of “starving” their newborn. Mothers have milk for the first feeds. We call it colostrum, but it’s milk! They have heard about breasts being so full it hurts, but they don’t see or feel that yet. The perpetuated message is clear but untrue: ‘You really don’t have milk now, but in 3-4 days, your milk will “come in” so don’t worry!’ This confirms moms’ number one concern about not having enough milk.
Truth is, colostrum is produced beginning about halfway through the pregnancy and is present, and designed for, the first feedings. Could it be that because we label it colostrum it is not perceived as milk?
It would be great if we could completely ditch the term “milk coming in”, reassure prenatal and new moms that they DO have milk (albeit called colostrum) available for the first feedings. Could we change our terminology from “milk coming in” to milk changing over to mature milk? Could we change the name of colostrum to “newborn milk” which sends the message that this is indeed milk?
Myth #3
You will need to give up the foods you like while breastfeeding.
While false, the lists of no-no foods can be quite extensive. No spicy foods are usually at the top of the list. It makes you wonder about all those babies in cultures that have curry, garlic, and chili peppers as a staple of their diets. Babies in Italy or Mexico aren’t fussier babies than in America or Sweden. Many years of work by Julie Mennella clearly demonstrates that newborns accommodate to the smells and tastes of their culture through exposure to those smells and tastes in the amniotic fluid. Infants learn to like the foods that are normal in their mother’s diet before they are born!
While we are on the subject of foods, another persistent and incorrect myth is that of the need for the “perfect diet” with extra calories to be able to breastfeed. It doesn’t take a lot of research to look at nursing mothers around the world and realize that successful breastfeeding and healthy infants are not reliant on the perfect diet. Women have breastfed in the most dire of circumstances without negative consequences to their babies. The misinformation stating that lactation requires a significant addition of calories, sometimes as many as 1,500/day, to successfully nourish her infant still persists. This can be discouraging to a new mother, anxious to lose pregnancy weight. I think we have all heard concerns expressed that maybe breastfeeding is not the right choice for those wanting or needing to lose postpartum weight. Again, not true. In reality the current CDC recommendation for calories during lactation are an additional 330-400 calories for maternal health, not for milk production. And remember, it’s not just calories but what foods are recommended. Eating a bag of processed chips gives you calories but does not contribute to better maternal health!
Myth #4
Your breasts are too big…too small. Your nipples are flat…too big…too small.
Oh how we love to judge nipples and of course, make sure the mother understands she does not have breasts or nipples that are perfect for breastfeeding. Then we wonder why women struggle in this culture to breastfeed. Maybe because we work so hard to destroy their confidence even before the newborn goes to breast for the very first time.
Care providers take one look and diagnose flat nipples, rarely considering how they actually function. Anatomy 101 reminder! Nipples are erectile, they stretch when stimulated. So when the baby touches the nipple either with their hands or mouth the nipple erects, some a little, some a lot. Sadly, many women compare their nipples to an artificial teat and worry that theirs is not the same, not quite right. Let’s set the record straight, we have the gold standard nipples, the rubber ones are a pathetic imitation!
And consider human infant feeding compared to other mammals. Many other mammals have long, exaggerated teats designed for the offspring to slurp it in and suckle the teat. Human infants breast feed- not nipple feed. Our offspring open their mouths wide and attach to the breast, not just the nipple. Correct latch involves the baby taking in lots of breast tissue. If they are sucking on just the nipple it will cause discomfort and result in inadequate milk transfer. It makes you wonder why we get so “judgy” about nipples! Let me take a moment to reassure you that babies don’t have a pre-set idea of measurements they want in a nipple. No, they want the one attached to their mother.
Nipples too big? I have seen small premies open wide and attach to nipples deemed “too big”. Did we forget to tell the infant that their mouth was not the right size to nurse? Asymmetric latch, with the baby starting nose to nipple, coming to the breast chin and bottom lip first, then bringing their head forward in an “up and over” motion can work like magic for little ones.
So before we start judging nipples and breasts, branding them not quite right, let’s first remember our number one job is to build the mother’s confidence and support their breastfeeding journey.
Myth #5
Drinking a lot of water will help you make more milk.
Another persistent one and untrue. I still read it in books and see it on well-meaning how-to websites which state that if you’re concerned about your milk supply the answer is easy: drink more water. Sometimes the amount can be more than a gallon a day with frustrating results. These results are spending more time in the bathroom and less time with your baby. Sadly, this shortcut skips asking pertinent questions like:
How often are you nursing? The answer should be 10-12 times/24 hours.
What is the baby’s output? The answer should be at least 4 urinations and 4 stools, with the stools changing color to a golden yellow and the urine a pale yellow, by the fourth postpartum day.
What is the baby’s weight gain pattern? It should be no greater weight loss than 7% in the hospital, no further weight loss by day 5 and regaining to birth weight by 14 days.
Have there been changes in the mother’s breasts? Ideally noticing fuller breasts in late pregnancy and breast becoming rounder, fuller, firmer and heavier as the milk composition changes over to mature milk.
Is the baby latching comfortably? Correct latch facilitates optimum milk transfer.
Shortcut answers like “just drink more water, eat oatmeal cookies, or drink lactation tea” bypass the need for assessment and can ultimately lead to poor outcomes for the newborn. Rather than setting arbitrary amounts of water, encourage mothers to drink enough to quench her thirst. Some research even shows drinking too much water can actually decrease milk production.
Myth #6
Breastfeeding is hard and difficult to learn.
Perhaps the saddest of the myths is that breastfeeding is so hard that your chances of success are really quite low. Breastfeeding is NOT difficult nor is it hard to do. Let me clarify: There can be difficult situations that arise but the vast majority of “problems” are generated by a hospital system or other systemic issues that are not designed to foster successful breastfeeding. Systems that separate mothers and their newborns might be the biggest reason for difficulties. When the newborn is immediately removed for the “experts” to tend to the baby, the message is that we can do a better job of caring for your newborn than you can, not the confidence- building care that supports breastfeeding. When newborns are housed in nurseries and brought out for scheduled feedings, the innate communication between mother and baby is interrupted. This exquisite communication is the foundation of breastfeeding as the newborn signals their needs and the mother’s body responds to provide the nutrition, nurturing and protection all newborns need and deserve.
Other practices that can reduce the chances of successful breastfeeding are:
-not encouraging skin to skin in the first hours and days after birth
-promoting a strict feeding schedule rather than teaching responsive feeding
-covering the newborn’s hands with mittens, denying them the use of their hand-to-mouth activities
-swaddling tightly and restricting their movements
– nursery housing so the mother “can get her rest” rather than talking with her about how to rest and sleep in the first days and weeks after birth
-allowing a brightly lit, noisy environment in the patient room rather than a calming, quiet environment for rest
-not honoring the magical connection between mother and baby
There are many other myths, of course but hopefully, with time, research and education, we can continue to support breastfeeding families with sound, evidence-based information and early and continued support for all families.
Cadwell, K. et al. The Pocket Guide to Lactation Management. Jones and Bartlett Publishers,Inc. Fourth Edition. June, 2021.
CDCAP. CDC.gov. Breastfeeding. Maternal Diet. National Agricultural Library. NAI.USDA.gov
Kent, J. et al. Int. J. Environ. Res. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and TreatmentsPublic Health 2015, 12, 12247-12263; doi:10.3390/ijerph121012247
It was over a decade ago that Elaine C. Meyer, PhD, RN, MBE, FSSH presented her TEDx Talk On being present, not perfect. Her message remains crucial, relevant, universal especially within maternal child health.
Dr. Meyer’s powerful piece incorporates personal and professional examples which bring life to the importance of holding space for compassionate communication and difficult conversations in healthcare.
She notes the essential ingredients of these conversations: Courage, Brains, and Heart, a clever Wizard of Oz mnemonic, and she emphasizes that “Practice makes better”, not perfect, as alluded to in her title.
Reflecting back, Dr. Meyer reports that we’ve accrued more awareness about these conversations. Compassionate communication is no longer a nice-to-have-it item; it has become an essential part of healthcare. Overall, Dr. Meyer has noticed that patients are more empowered, expecting this connection and level of care. Online rating tools have allowed for patients to evaluate providers specifically on their bedside manner.
Across the globe, On being present, not perfect has been incorporated into nursing and medical school curricula placing value on providers’ relational capacity early on in their careers.
In a culture where health care providers are often massively stressed and burnout can be of real concern, Dr. Meyer makes clear that honoring conversation is not only of benefit to the patient.
“… Being in relationship with the patient can be very fulfilling,” she begins. “This matters. At the end of day, a healthcare provider can say What I did matters. It can be the words that we speak, just being present, and showing up in all of your humanity. This doesn’t necessarily require extra time.”
Take for instance the personal vignettes she shares in On being present, not perfect: a nurse who held her hand, squeezing back in reciprocity, an anesthesiologist who told her “I will be with you the whole time. I will watch over you. We’ll get you through this.” Simple yet profound, words and actions that sustained her during harrowing procedures. “Gestures of humanity,” Dr. Meyer calls them.
What’s more, when this kind of respect and communication are established, patients have significantly better health outcomes and provider job fulfillment and retention increases.
“If a clinician feels like I did a good job today, I connected, that buoys the clinician. The clinician feels more efficacious,” she explains.
These conversations matter across the lifespan in any specialty, of course; however, the perinatal period is of special importance, because perinatal experiences have generational physiological and psychological implications. This time period influences the mother-child relationship for a lifetime.
Having endured multiple pregnancy losses and IVF, Dr. Meyer shares that when her son was born, her initial focus on breastfeeding was primarily nutritional.
“The connection and attachment that breastfeeding can foster wasn’t as much on my radar,” she says. “But after rising from the ashes of infertility, being able to nurse my baby boy was restorative and healing.”
Though she and her son were not up against monumental feeding challenges, she consulted a lactation professional as a support person. She says this was immensely helpful to have someone who believed in her, someone joining her in the journey, someone to fortify what was important to her.
As a provider, Dr. Meyer recalls a few highly distressing stories related to birth and infant feeding when she needed to show up with Courage, Brains, and Heart. She shares one in particular:
There was a preterm newborn who was admitted to the Intensive care unit with severe birth complications and prolonged anoxia. The baby’s mother was determined and dedicated to breastfeeding her baby. The baby was unable to nurse because she was sustained on life support with a ventilator. Dutifully and with great care, the mother pumped her breastmilk and the baby received the milk through a small nasogastric tube. As a psychologist, I had the great privilege of meeting with the parents to listen to their story, to bear witness to their fledgling parenthood, and to offer support….Those were tender and difficult conversations. We held several family meetings with the team to help determine the baby’s treatment. Given the infant’s devastating brain injury, and poor prognosis, the parents and team agreed with the difficult decision to withdraw life support treatment. After the ventilator was withdrawn, the baby passed away peacefully in her mother’s arms with the father at their side. In a final act of love and dignity, as the parents left the hospital for the last time, the mother left a little bottle of breastmilk at the nurses’ station counter. Testament to a mother’s love, it was a most precious parting gift. The parent-child relationship transcends death. The lactation consultant offered ongoing education and support to the mother who went home without her baby- to pump for comfort and to stand in a warm shower with her back toward the shower head, so as to ease any discomfort. Courage, brains and heart….
As she concludes her Tedx Talk, Dr. Meyer offers some final inspiration: “Once upon a time you wanted to change the world. You still can, one conversation at a time.”
[Source]Breastfeeding is more than nutrition. Read ourBreastfeeding is series to learn more about how breastfeeding is beyond what most people assume. Basically, breastfeeding and human milk are miracle elixirs, cure-alls!
[Source]Like Nikki Lee once analogized: “Human milk is not magic fairy dust. Human milk is nature’s seatbelt. A seatbelt does not guarantee survival in a car crash. We wear seatbelts because they increase our chances of survival…”
Thanks to breastfeeding, my family and I survived infancy, toddlerhood, and beyond.
Thinking back, my coffee dates were once accompanied by my nursing toddlers, their chubby little fingers cupping mini hot chocolates, scribbling with crayons, and chit-chatting with the elderly patrons; now, I spend more one-on-one time with friends at the coffee shop. With many of them quite a bit older than me, I am learning about their experiences going through menopause. It’s a new chapter. One morning, I observed a dear friend breathe through hot flashes, her face flush, as she shed her vest and scarf, then bundled up again, then squirmed out of them, over and over throughout our visit. I sat there entirely helpless, but not entirely speechless.
Breastfeeding. The magic elixir. The cure-all.
Her eyebrow raised.
I quoted Wenda Trevathan:
“Why is menopause stressful? The short answer to this question is that it is not stressful for most women in the world, as far as can be ascertained by social scientists… Anthropologists Jane Lancaster and Barbara King propose that modern women may experience the end of ovulation under a different hormonal milieu from that of our ancestors and women in ‘natural fertility’ populations today. For example, !Kung women reportedly breastfeed their last infant for a longer time than for previous infants and when they terminate breastfeeding, perhaps in their mid-40s, they simply do not resume ovulation. Thus, the hormonal milieu of menopause includes the hormones of lactation (especially prolactin and oxytocin), which may modulate the effects of other changes…” [Ancient Bodies, Modern Lives, 2010, p 168-169]
Her brow remained raised.
I offered: Christine R. Langton, MSW, MPH, et al, in Association of Parity and Breastfeeding With Risk of Early Natural Menopause, discovered an increase in parity decreased the risk of early menopause. What’s more, the authors note, “Breastfeeding was associated with significantly lower risk, even after accounting for parity. Breastfeeding at levels consistent with current recommendations may confer an additional benefit of lower risk of early menopause.”
And then, Natalie V. Scime, et al found that “In a dose-response manner, longer lactation was associated with reduced risk of natural menopause before age 50 (for ≥ 13 months of lactation, adjusted hazard ratio at age 45: 0.68, 95% CI 0.59–0.78), surgical menopause before age 55 (age 45: 0.56, 0.50–0.63), and indeterminate menopause before age 50 (age 45: 0.75, 0.69–0.82). Longer lactation was associated with lower odds of surgical (adjusted odds ratio 0.54, 95% CI 0.45–0.66) and indeterminate menopause (0.63, 0.55–0.73), compared to natural menopause.” [2024]
So you see, it’s breastfeeding, breastfeeding is the answer.
My friend was now not only struggling to regulate her body temperature, she was struggling to regulate her patience with me, because of course, this was all very interesting, but not relevant to her current challenges.
And that’s when all of the rage we’ve both learned to suppress and breathe through and gratitude-journal and downward dog away came boiling out into a frothy fuck you to the medical-industrial complex, to the patriarchy, to anything that’s gotten in the way of women enjoying healthy, fulfilled existences.
I was pissed because I know what the infant feeding landscape looks like in America and what this means for the future health of our offspring, ourselves, and our planet. She was pissed because she knows what it looks and feels like to get “care” during menopause (but really her entire lifespan) in America. So, basically, we were pissed, some might say hysterical, about the same thing.
We’re not the only ones.
Brené Brown spoke with Dr. Mary Claire Haver, a board-certified OB/GYN, on the Unlocking Us podcast, and they too, are fired up about women’s health care.
During all phases of our lives, we are considered emotional, dramatic, attention-seeking, imaginative (not in a good way), fragile, crazy over things that have major and long-lasting implications like family planning, birth, infant feeding, menopause. We are laughed at, dismissed, lied to, pitied…
In Unlocking Us, Dr. Haver says: “There’s a reason why hysterical is a word and we don’t have testerical. And that has got to stop…”
She goes on to explain: “I was taught that there’s a significant percentage of hyperemesis, now, this was in the ’90s, that is psychological. We were putting people on antipsychotics for hyperemesis. That has been completely debunked. We have found the receptor in the brain that is causing this. And I have to shout out to Shannon Clark, right in Galveston, who presented to the FDA, she’s done the most research on this.”
Dr. Haver compares this to current menopause care: “One of the most popular treatments for hot flashes that is being touted as, this is the route we should go, especially in Europe, is cognitive behavioral therapy. Which I love, for a multitude of things…
And Brown interjects: “I mean, I love too, but shut up and sit down.”
Dr. Haver continues sarcastically: “…cognitive behavioral therapy, if you just out think your hot flash, if you change your perception of your menopause…”
Dr. Trevathan wonders in Ancient Bodies, Modern Lives, “…does menopause have to be a ‘bad’ thing? This question derives from a fairly Western perspective that has pathologized the period of time when a woman is experiencing the physical and emotional transitions to a post reproductive state… It is often likened to diabetes as a disorder characterized by hormonal deficiency. In fact, menopause has been called an ‘estrogen deficiency disease.’” (p 161)
Trevathan goes on to offer “Whether perceived as a medical ‘problem’ or not, the menopause transition is associated with a number of physiological changes that are experienced by women at this time and are usually explained by changes taking place in ovarian function. (p 163)
Finally, she suggests: “The perspective of evolutionary medicine would argue that ‘returning’ to the lifestyles under which human reproduction evolved would alleviate some of the problems that women face today with menopause. Without taking the recommendations to extremes (no birth control, self-imposed undernutrition), it seems possible that by increasing exercise, reducing fat intake, and minimizing exposure to industrial biochemicals, women would experience fewer problems at menopause. In this way, adopting the behaviors and diets of our ancestors may go a long way toward not only reducing the stresses of menopause but prolonging healthy lives as well.” (p 169-70)
So, like I said, breastfeeding is (at least part of) the answer.
We’re pausing our month-long series commemorating late maternal child health advocates for another important observation: National Native American Heritage Month. It’s our honor to share the work of Indigenous Full-Spectrum Doula Skaniehtiiohstha Kasokeo of A’nowa:ra Owira Doulas serving those on the borderlands of Canada and the U.S. This piece was originally published in 2021.
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In a matrilineal society, ancestral descent is traced through maternal lines. Indigenous Full-Spectrum Doula Skaniehtiiohstha Kasokeo of A’nowa:ra Owira Doulas— serving those on the borderlands of Canada and the U.S.– points out that of the hundreds of Native American tribes across North America, many of them are matrilineal and this framework contributes to the interconnectedness of life.
Skaniehtiiohstha Kasokeo
But because of the devastation of colonization and forced assimilation, many of the birth and infant feeding traditions passed down through clans by mothers have been disturbed. Kasokeo and her colleagues are working to empower Indigenous families through birth, restoring these traditions.
“A lot of things were taken,” Kasokeo says of the effects of colonization. “We all have bits and pieces of that big picture; we’re healing from historical trauma. We can use this time of birth to bring healing to [families].”
She shares that an elder once told her that through the messages we tell our children, we send messages to our future.
“I personally relate that back to the birth experience,”Kasokeo begins.“The messages we send about our bodies, our connection to each other and the strength of women, in my mind happens through breastfeeding. Especially in the first hours after birth, the first messages we relate are about our bodies and the connection to babies’ matrilineal line through breastfeeding.”
Kasokeo emphasizes that this path will look different for every person.
“It doesn’t have to look a certain way,” she says.
“There is a problematic tendency… to generalize within dialogues about Indigenous communities,” Sprenger writes. “It’s critical to remember that ‘Indigenous’ is a very broad term, and that each community has different practices and traditions. Within these communities … each mother and family will have different outlooks, personal histories, and levels of comfort and desires.”
Kasokeo and her colleagues embrace this approach with the overarching theme to give power to women, instilling in them the confidence that their bodies will help their babies to thrive.
The doulas in their group lean on one another, strengthening their collective as support people. Kasokeo talks about how she, in part, pursued doula work in order to become what she needed.
Sign reads: “My Mom, Sisters, Aunties + Grandmas are Sacred” Photo by Dulcey Lima on Unsplash
When Kasokeo became pregnant at 19, she immediately sought out the very limited midwifery care where she was living in Saskatchewan (Treaty 6 Territory). With only 12 midwives in her entire province, she sent in her application as early as possible, but was denied due to the sheer number of parents seeking out midwifery care.
Author Amanda Short details that “Jessica Bailey, President of the Midwives Association of Saskatchewan, said that her team of six at Saskatoon City Hospital turns away anywhere from 40 to 50 percent of people asking for care monthly. Across the province, it’s somewhere from 20 to 50 percent.”
During this time though, she learned about doulas, connected with one in her area and says she “fell in love with everything about it.”
As a survivor of sexual abuse, Kasokeo says it was important to her to know what procedures were going to be done to her perinatally and to be equipped with as much knowledge as possible. Having a doula by her side helped her achieve that.
Despite laboring for over 20 hours and ultimately deciding on pain medication not originally planned, Kasokeo reports having had an orgasmic birth. She says she thought, “Everybody should have this!”
During her second birth, Kasokeo hemorrhaged and was later forced to navigate an unjust healthcare system with retained placental fragments eight weeks postpartum.
Having endured the challenges she found herself in, Kasokeo says she sees herself as well-situated to meet other women where they’re at.
In 2017, she and her colleagues formed A’nowa:ra Owira (Baby Turtle) Doulas serving those in Akwesasne, Canada and surrounding areas.
Akwesasne is a uniquely situated point on the map. Joshua Keating writes in The Nation That Sits Astride the U.S.-Canada Border: “This Mohawk community is home to around 13,000 people and sits astride the world’s longest border (three hours’ drive northeast of Syracuse or two hours’ travel southwest from Montreal), not quite a part of either country, but not quite independent either…The town has three different governments: one elected council recognized by Canada, one by the United States and a traditional government affiliated with the Iroquois Confederacy, of which the Mohawk are one of the six constituent nations, or tribes. All told, including the United States, Canada, the state of New York and the provinces of Quebec and Ontario, there are eight governments with some level of jurisdiction over a territory with an area of less than 40 square miles…”
Kasokeo explains that this means not everyone has access to the same health care systems, so she and her colleagues work to fill in the voids that many families face when in need of maternal child health care.
As the world learns to manage life amidst a pandemic, she and her group are beginning to open up more meetings and social gatherings in hopes of reaching more birthing and lactating individuals.
“I loved the training!” she exclaims. The myth busting and the counseling skills were notable, and she says she appreciated the convenience of being able to simultaneously learn and stay at home with her children.
Kasokeo admits that covering the counseling skills stalled her at times throughout the course; she says she felt guilty reflecting back on past clients and how she might have interacted with them differently and better served them.
“I needed to find the confidence in myself,” she adds. “It was really scary for me, but the course has given me the tools to be confident in my ability to become a lactation care provider. Moving forward, the number one thing will be not making assumptions and asking people to clarify things.”
Kasokeo’s fascination with and passion for maternal child health persist, and she says she would love to network with others. She is particularly interested in learning about how to nurture a homegrown organization with limited funds. You can reach Kasokeo directly at skasokeo@anowaraowiradoulas.org or connect with A’nowa:ra Owira Doulas here and here.
Esther nurses baby Aven. Image from ‘Visualizing change’ a piece about Andrea Mietkiewicz’s, RN, CPM, CLC and filmmaker Nicolle Littrell’s work. Read it at https://www.ourmilkyway.org/visualizing-change/
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