Breastfeeding shows up in a myriad of religious texts, and across most religions, breastfeeding is encouraged and revered as a sacred act.
In Rabbinic texts “…nursing is more than food—it plays a key role in transmitting religion, values and culture,” BJ Woodstein BFC, IBCLC writes in her piece on breastfeeding and Judaism.
Photo by Kampus Production
Breastfeeding and the Baha ́ ’ı ́ Faith documents that “Baha ́’ı ́ Writings clearly endorse breast-feeding…the frequent use of the language of human lactation in positive symbolic terms identifies breastfeeding as a practice that is both dignified and worthy of juxtaposition with the sacred.”
In Chinese religious and philosophical culture, which includes the syncretism of Buddhism, Confucianism, Taoism and the theory of Yin and Yang, this is also true. In Taoism for example, it has been written that “the conditions of oceanic ecstasy correspond to the experience of symbiotic unity of a baby and its mother during the period of foetal development and of breast feeding.” [Tortchinov, 1996, p. 20]
Art by: Khou Vue Courtesy of the Hmong Breastfeeding Coalition
Across most Native American groups, breastfeeding is revered as the first sacred food; their traditions have been largely passed down orally instead of documented in sacred texts.
In Islam, “a woman who breastfeeds more than five times a day a child who is not hers before the age of 2 years becomes a ‘milk mother’ for this child, who is then acknowledged as a full sibling to the foster-mother’s other children. This prohibits any possibility of subsequent marriage between them (sura 4: ayat 23).” The authors note that these rules have implications for human milk banking in Islamic countries.
Sarkar begins “Vedic and Ayurvedic texts glorify breastfeeding and project it as a natural attribute and sacred duty of good mothers. The Atharva Veda compares lactating breasts to pitchers full of divine nectar. Ayurvedic treatises like the Sushruta Samhita eulogise the nourishing powers of breastmilk and, by extension, of the lactating vessels, that is, the mother:
May the four oceans of the earth contribute to the secretion of milk in thy breasts for the purpose of improving the bodily strength of the child. O, thou with a beautiful face, may the child, reared on your milk, attain a long life, like the gods made immortal with drinks of ambrosia.”
Author Beatriz shares about her initiation into Santeria– an amalgamation of Yoruba beliefs and Catholicism– as a nursing mother in this Brown Girls Out Loud piece.
Photo by Luiza Braun
With more than half of the world’s population practicing some kind of religion, religious interventions can be an effective way to support breastfeeding.
One study found that Catholic women are more at risk to intend and practice exclusive formula feeding than women of other religious affiliations.
In partnership, the SC Department of Health and Environmental Control Bureau of Community Health and Chronic Disease Prevention, Eat Smart Move More South Carolina, Palmetto Health Richland Hospital, and the South Carolina Breastfeeding Coalition created a toolkit entitled Creating aMother-Friendly Environmentfor your Faith-BasedOrganization.
As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:
Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.
This week, in the body of the email, please share any experiences that you have had with infant feeding in a religious context.
Subsequent weeks will have a different prompt in the blog post.
We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.
Reflecting on her experience as a first-time grandmother, one of my colleagues and mentors expressed that, for most of us, “grandmothers are the closest thing to a village that we have.”
This colleague, a lactation care provider herself, described the intricacies, sweetness and sacredness of watching her daughter step into motherhood. My colleague’s notes described her thoughtful presence without overbearance, leaving space for her daughter and her new family to learn and to bond. For instance, she cleans the house, prepares their bed with sun-dried sheets, and sits at the foot of the bed while her daughter and granddaughter nurse. In this dreamy scenario, grandma, baby and parents are all met with challenges, however those challenges haven’t become insurmountable thanks in part to this level of grandmotherly support and care.
Photo by João Perini
Photo by cottonbro
Photo by Robert Stokoe
Photo by Kampus Production
This week we bring to you some work that details grandmothers’ powerful influence on the perinatal experience and beyond. A 2016 systematic review found that “a grandmother’s positive breastfeeding opinion had the potential to influence a mother up to 12 % more likely to initiate breastfeeding. Conversely a negative opinion has the capacity to decrease the likelihood of breastfeeding by up to 70 %.”
Healthy Children Project’s own Barbara O’Connor, RN, BSN, IBCLC, ANLC – Faculty Emerita designed and authored the Grandmothers’ Tea Project for the Illinois State Breastfeeding Task Force (2011).
Through O’Connor’s interactive curriculum, grandmothers are invited to learn about breastfeeding through three activities that pose breastfeeding scenarios:
“The Grandmothers’ Apron activity updates grandmothers’ knowledge about the importance of breastfeeding.
During the Grandmothers’ Cell Phone activity, grandmothers talk about breastfeeding myths and barriers.
In the Grandmothers’ Necklace activity, participants create a beaded necklace to remind them of ways they can offer support through loving encouragement, updating their breastfeeding knowledge, and being helpful.” (As described in A Grandmothers’ Tea: Evaluation of a Breastfeeding Support Intervention)
Source: United States Breastfeeding Committee.
Author Jane S. Grassley, RN, PhD, IBCLC and colleagues encourage perinatal educators to explore the curriculum for A Grandmothers’ Tea as they found that grandmothers and mothers who attended the teas in their study enjoyed their interactions with one another and with the class content.
Their work also unearthed a phenomenon of defensiveness in grandmothers who did not breastfeed their own children. The authors explain “Grandmothers who did not breastfeed may feel defensive about their infant-feeding decisions because of the current emphasis on the health benefits of breastfeeding (Grassley & Eschiti, 2007)” and advise that “perinatal educators can invite grandmothers to share their experiences and validate the cultural context in which these experiences took place.”
“Props to all the people navigating complicated mother child relationships as adults. Now that I am in my 40’s I find myself reconnecting with my own mother in a deeper way. There was a time when we were estranged from each other. I learned how to recognize that I needed boundaries and practiced maintaining them. I am learning not to get triggered by my mother’s ways, and have compassion for her reasons behind them. I extend this sentiment to all of my grandmas ancestors who are in my lineage.
I am having more compassion for myself, and the ways I am like her my mom. I am learning to love myself deeper and become a more conscious mama to my children. I am still learning to love my child self that did not get all of her needs met, and I reparent myself with love. I feel myself heal.”
Source: United States Breastfeeding Committee.
Cultural beliefs held by grandmothers have the potential to influence healthy infant feeding practices. In Grace Yee, Retired IBCLC and Tonya Lang’s, MPH, CHES, IBCLC Cultural Dimensions in Promoting, Protecting, and Supporting Lactation in East Asian Communities, they explained the prominent roles of aunties and grandmothers in the early postpartum. One example includes how colostrum is sometimes regarded in older generations as impure or unhealthy. Yee and Lang suggest that instead of positioning tradition and culture as a hindrance, to reframe barriers to breastfeeding into potential strengths. Respect of elders’ traditions and cultural practices will establish trust and foster positive relationships, as noted in Monique Sims-Harper, DrPH, MPH, RD, IBCLC, Jeanette Panchula, RN PHN, BA-SW, and Patt Young’s, Health Educator, CLE work entitled It Takes A Village:Empowering Grandmothersas Breastfeeding Supporters.
The physiological imprint of breastfeeding withstands generations and the sensations of milk production may surface decades later as mothers become grandmothers. Grandmothers who have previously breastfed have reported the tingling sensation of a phantom milk release when holding their grandchildren.
Barry Hewlett and Steve Winn’s study on allomaternal nursing indicates that while this practice occurs in many cultures, “it is normative in relatively few cultures; biological kin, especially grandmothers, frequently provide allomaternal nursing and that infant age, mother’s condition, and culture (e.g., cultural models about if and when women other than the mother can nurse an infant or colostrum taboos) impact the nature and frequency of allomaternal nursing.”
Photo by Наталия Игоревна from Pexels
For an illuminating anthropological perspective, read A Biocultural Study of Grandmothering During the Perinatal Period by Brooke A. Scelza and Katie Hinde. Their “findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being” and “show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants.”
We would love to learn about your perinatal and infant feeding experiences as grandmothers or with grandmothers. If you’d like to share, please email us at info@ourmilkyway.org.
For new families, healthy, evidence-based infant feeding education and support can be hard to come by, but among this often barren landscape of support, the VA Maternity Care Coordinator (MCC) program provides an oasis for military Veteran mothers.
Retired USAF Lt Col Tammy Tenace BSN, MS, APRN-BC, now Women Veteran Education, Outreach and Research Coordinator for James A. Haley Veterans Hospital in Tampa, Fla. says that the VA understands that pregnancy and parenthood often requires specialized care.
About a decade ago, as care providers started to notice that lactation and breastfeeding support was severely limited in civilian communities, they established the MCC role. MCCs maintain contact with Veteran families throughout the perinatal period, facilitating care that meets their specific needs.
Because the VA does not provide obstetric care, the MCC acts as a liaison between the VA and the community obstetrical provider. MCCs follow Veterans through pregnancy and postpartum at one and six weeks postpartum. [https://link.springer.com/article/10.1007/s11606-019-04974-z] The VA supplies Veterans with lactation supplies like breast pumps, nursing bras, nursing pads, storage bags, etc.
The MCC role has been established at every VA medical center, and Tenace has served as MCC at her hospital since 2016.
Photo by George Pak : https://www.pexels.com/photo/family-sitting-on-sofa-beside-house-plant-near-the-windows-7983863/
Throughout the COVID-19 pandemic, what little perinatal support existed in civilian spaces, dwindled to almost nothing, Tenace points out.
Hospital breastfeeding support groups, while only meeting a couple of times a week, stopped meeting altogether. Women weren’t allowed support people or their partners at appointments, and they began to feel isolated.
“I realized I needed to do something; I couldn’t depend on the community,” Tenace says.
Working through the Office on Women’s Health as a subject matter expert, VA National Consultant for Lactation Ashley M. Lauria, MA, RD, LDN, IBCLC helps establish standards of care in lactation programs at VA facilities nationwide.
Tenace and Lauria both comment that among the hundreds of parents they have cared for, it is truly a rarity for an individual to express disinterest in lactation. Their experience reflects national numbers, where most dyads start out breastfeeding.
Women Veterans are the fastest growing group among the Veteran population. In fact, “by 2040, VA estimates they will comprise 18% of the Veteran population, versus just 4% in 2000,” according to a VA Pittsburgh press release.
In order to keep up with this demand, Tenace and her colleagues are in the process of curating a Certified Lactation Counselor (CLC) program. Made possible through funding from the Women’s Health Innovations and Staffing Enhancements (WHISE), ten of their staff members are completing the Lactation Counselor Training Course (LCTC), including Tenace, physicians, a health coach, advanced practice nurses, among others.
“The most up-to-date information is really important,” Tenace begins. “[We are all] unlearning the things we thought we knew. The course has been instrumental to helping us feel like we are actually helping women, instead of relying on the knowledge that we thought we had. The course is detailed and professional, yet practical. The practicalness is what’s to our advantage. It’s how we actually help women breastfeed.”
Photo by Timothy Meinberg on Unsplash
Tenace and Lauria go on to explain that their efforts are Veteran-led. That is, their facilities host quarterly focus groups where they can learn about Veterans’ requests.
“We want to know from women: what do they want?” Tenace comments.
Because Veteran women often prefer support groups comprised of other Veterans, Lauria offers virtual lactation support groups that also act as social circles and a place for comradery.
As James A. Haley Veterans’ Hospital designs new facilities, Tenace has been invited to offer input on the creation of lactation space for both employees and patients. Tenace applauds their leadership for focusing on improvement for the patient and employee experience. She also highlights that the newly designed main entrance will host a lactation pod.
“I can’t think of a better way to show commitment,” she adds.
Tenace and Lauria have embodied a passion for birth and lactation since their youth. Their work with the VA allows them to continue their mission to celebrate parents and their families and position themselves as life-long learners, evolving with the needs of Veteran mothers.
Photo by Brianna Lisa Photography: https://www.pexels.com/photo/mother-breastfeeding-her-child-in-park-11620457/
“More doctors smoke camels than any other cigarette,” claims the ad from 1950. Today, it’s preposterous to imagine that any physician would align themselves with the tobacco industry. Starting in the 1920s and continuing well into the 1950s though, tobacco companies used doctors to help them sell their products. Stanford’s Research into the Impact of Tobacco Advertising has a collection of over 1,000 advertisements that feature doctors endorsing tobacco products.
In an eerie parallel, WHO’s February 2022 report, How the marketing of formula milk influences our decisions on infant feeding, states that “Recommendations from health professionals are a key channel of formula milk marketing. Health professionals spoke of receiving commissions from sales, funding for research, promotional gifts, samples of infant and specialized formula milk products, or invitations to seminars, conferences and events.” (p. 7)
Last week, Nikki Lee, RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, RYT500 and I shared our reflection on the forces that shape physicians’ personal infant feeding experiences. In this second installment, we explore how physicians as professionals can support breastfeeding despite being targeted by the breastmilk substitute (BMS) industry and despite generally being woefully equipped with proper lactation education, training and counseling skills. These predicaments can lead physicians to “explicitly or inadvertently, introduce doubts around the ability of women to breastfeed and the value and quality of their breast milk.” (WHO, p. 12)
Pervasive industry influence for generations
Because “health professionals are among the most respected and trusted members of society…[their] advice…is highly influential for pregnant women and parents of infants and young children, including around infant feeding decisions.” Formula milk companies exploit this relationship of trust. (WHO, p. 12)
Source: United States Breastfeeding Committee
BMS representatives target physicians “with a range of incentives, including funding for research, commissions from sales, ambassadorial roles, merchandise, gifts and all expenses paid promotional trips.” (WHO, p.13)
The psychology behind gift-giving, both big and small is that “ it imposes…a sense of indebtedness…. The…rule of reciprocity imposes…an obligation to repay for favors, gifts and invitations…” (Katz 2003) Instead of supporting infant feeding purely through a health and wellness lens, physicians feel obliged to a company muddying their relationships with their patients.
Interestingly, most physicians feel immune to marketing’s influence, despite clear evidence to the contrary, Frederick S. Sierles, MD lays out in The Gift-Giving Influence.
Our culture fails to acknowledge the mother baby unit as a dyad, and this influences the way physicians can support breastfeeding too.
Source: United States Breastfeeding Committee (USBC)
“We are never taught, in our fragmented system, that the mother and baby are a unit,” Lee reiterates. “OB/GYN/midwife sees mama; peds sees babies. There are even different places for them in the hospital: nursery, postpartum unit. What a struggle we had with the BFHI to keep mother and baby together.”
The Alliance for Innovation on Maternal Health’s (AIM) Patient Safety Bundles offer models for how health professionals can use task force approaches that break down silos of care and open channels of communication. The strategies used in these bundles aim to ultimately shift from fractured care to continuity of care where the dyad is protected.
We must also consider how physicians are compensated for their work. In the current U.S. healthcare system, physicians find themselves paid in Relative Value Units (RVUs), which bluntly put, is a pretty mechanical way to value providing care to other humans, as we mentioned in our first installment. In short, the more RVUs a physician racks up, the more they’re paid. Breastfeeding counseling takes time.
Inadequate education
How are physicians to spend time with their patients, educating and supporting breastfeeding when they’ve had little to no breastfeeding education invested in them? Dr. Nigel Campbell Rollinspointed out in WHO’s How the marketing of formula milk influences our decisions on infant feeding webinar that faculty in medical schools themselves sometimes believe that formula products are inevitable or necessary.
A cross-sectional study in the UK suggests that UK medical schools are not adequately preparing students to support breastfeeding patients.
Often, it is a physician’s own struggle to breastfeed that seems to spur advocacy and change. Our Milky Way’s repository includes a breadth of physicians’ stories of personal struggles that have inspired them to become breastfeeding champions for their patients and communities.
Source: United States Breastfeeding Committee (Photo by Sara D. Davis)
“There was no training about [breastfeeding] technique, no discussion about common problems before discharge, no training about clinical problems as far as in the first few months postpartum…when to introduce complementary food,” she continues.
We are honored to have been able to feature the work of the late Audrey Naylor in Commendable contributions to the field of lactation. With a lifetime interest in illness prevention, Naylor said she was quickly convinced of the power of breastfeeding after only attending a few hours of a breastfeeding seminar in 1976.
“Neither medical school nor pediatric residency taught me anything about breastfeeding,” Naylor said.
“It is easy to become frustrated with nurses and physicians who – often inadvertently sabotage breastfeeding mothers and babies, but I also sympathize,” she explains. “We are in a position where we are supposed to have answers, but no one has taught us the skills necessary to provide those answers.”
Other stories and models for care
Lori Feldman-Winter’s, et al Residency curriculum improves breastfeeding care showed that “a targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.
As part of their work to build a cohort of breastfeeding-friendly pediatricians, the Georgia Chapter of the American Academy of Pediatrics and the Georgia Breastfeeding Coalition launched a “Breastfeeding-Friendly Pediatrician Interest Form.” Georgia pediatricians who are interested in becoming certified as a “Breastfeeding-Friendly Pediatrician” are invited to fill out the form.
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