Celebrating World Refugee Day

This summer, we are revisiting some of our previous publications as they relate to various celebrations. World Refugee Day was honored on June 20 this year. As such, we are resharing our 2019 piece “Initiative empowers refugee and migrant women”.

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Before Florence Ackey, MSW knew what public health was, she was inquisitive about prevention. Having lost her 12 year old cousin during her young childhood, she found herself perpetually asking “How can I make things better?”

A lifelong investigator and learner, Ackey completed two years of law school in her home country Niger followed by completion of the University of South Florida Master’s of social work. She is currently pursuing a second master’s degree and will begin her doctorate in public health in fall 2019. She recently completed the Lactation Counselor Training Course (LCTC).

Ackey serves as the State Refugee Health Coordinator for the Florida Department of Health Immunization, and Refugee Services. In this position, she connected with a woman who would inspire her to found Refugee and Migrant Women’s Initiative (RAMWI), a not for profit 501(c)(3) which serves and empowers refugee and migrant women during their resettlement.

This particular woman would come to Ackey’s office almost every day and sometimes simply sit with her. Despite a language barrier, Ackey eventually learned that the woman was lonely and depressed; she couldn’t have children, and her husband was out of work.

These circumstances caused great strife, but connecting with Ackey uplifted her spirit.

Mindful of her mental health, Ackey helped cultivate a social circle around this woman. At the same time, Ackey was driven to incorporate a practical component to the gatherings,  so she taught the women to crochet.

“We made a lot of scarves,” she remembers. “We sold them and [the woman] was able to raise enough money to pay for two months rent. It changed her confidence.”

Ultimately, their informal, weekend meetings grew too large for home meetings, so RAMWI was created. Today RAMWI, run entirely by volunteers, has served over 400 families over roughly six years.

“It’s just beautiful to see how far we’ve come,” Ackey says.

Refugee and migrant women suffer from things like trauma, discrimination and anxiety.

Ackey explains: Often the story goes that the woman arrives with her husband and children from their home country; the husband finds work and grows a social life and the children go to school and make friends. In the meantime, the woman is left alone at home, sometimes too uneasy about the unfamiliarity of their new settlement to leave the confines of her home. Even when her family returns from their daily routines, she’s further isolated because their experiences become less and less common and relatable.

In light of this phenomenon, RAMWI offers corresponding, age-appropriate workshops for mothers and children in order to bridge conversation topics.

“The mom is no longer left alone; she has something she can contribute,” Ackey explains.

RAMWI offers its social, support network and classes and workshopsin a way that allows women to integrate into their new communities while still preserving their cultural identity. For instance, RAMWI’s Annual International Fashion Show during Welcoming Week offers refugees and migrant women the opportunity to share pride in their culture through clothing.

Participants pose during the Annual International Fashion Show during Welcoming Week
Photo courtesy of RAMWI

The show usually represents about 48 countries with over 80 participants.

Monthly support groups cover topics like women’s health, grief and coping mechanism, U.S. healthcare system and resources, nutrition, safety, domestic violence, disaster preparedness, life balance and personal finances among other topics.

Ackey emphasizes that female empowerment doesn’t need to be granted externally.

“Women have the power within in them to freely give,” she begins.

She goes on to describe a visual installation she’ll present at an upcoming RAMWI session to illustrate this idea.

Ackey asks participants questions like ‘Have you helped someone without anything in return?’ or ‘Have you paid a genuine compliment to someone?’ Each time a participant answers ‘yes’, she pokes a hole with a thumbtack into a blank board. The holes initially appear to be randomly placed, but when a light shines through the back of the board, the silhouette of a decorated city appears. The installation represents the seemingly small acts of women impacting entire communities.

This month, RAMWI members will assemble 240 care packages for the homeless.

RAMWI participants at a monthly meeting
Photo courtesy of RAMWI

When it comes to infant feeding, migrant women often look to formula as a status symbol. It’s a mindset Ackey encounters often, but she says the lactation counselor training course has equipped her to become a better healthy infant feeding advocate.

Ackey has also found that hospital staff generally do not take the time to discuss and educate migrant women about breastfeeding. She predicts this is sometimes due to language barriers.

“It’s easier to give them formula and go,” she explains.

Mothers are often happy with the “gift” of formula and all of the “swag” that can come along with formula feeding.

Surely birth and infant feeding culture varies greatly among the women in RAMWI, but Ackey has found that immigrant women tend to share the common value of a strong mother -child bond which stems from their collective upbringing, she explains.

Mother and child, one of Ackey’s favorite photos
Photo courtesy of RAMWI

She shares that this “it takes a village” mentality is reflected in the way they feed their babies.

“Women take care of all the children,” says Ackey.

In some cases, women breastfeed children that are not biologically their own in the spirit of shared duties, but for survival in other circumstances.

“Women breastfeed other children especially from some African countries,” Ackey begins.

She recalls one woman who adopted a child she picked up on the road next to the dead body of his mother. Ackey makes clear this imagery isn’t representative of the entire refugee population, but it is a story that embodies how the women she works with will raise any child.

Amidst the tragedy and hardship that many of the families have faced, there’s so much beauty and hope within RAMWI.

“Hope can, and will heal the world,” its mantra.

One volunteer said:  “The thing I love the most is the environment of support and empowerment that RAMWI creates for women from all over the world…the women learn from each other…form a bond that as women is something that connects you no matter where you are from.”

For Ackey, success is achieved when a woman makes a choice because she has been fully informed and she’s aware of all of her options.

Visit https://www.ramwi.org/ for more information. Connect with RAMWI on Facebook here.

Other relevant pieces

Prioritizing infant and young child feeding in emergencies during National Preparedness Month and beyond

To know is to do: retired nurse dedicates time to humanitarian aid in East Africa bringing awareness to the paradox of direness and vibrancy

A collection of stories by and about those in the AANHPI community

Caesarean Doulas: Implications for Breastfeeding at 24th Annual International Breastfeeding Conference & Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives

Breastfeeding, peace and justice

Babywearing as a public health initiative

Celebrating Infant Mental Health Awareness Week

This summer, we are revisiting some of our previous publications as they relate to various national celebrations. 

This week is Infant Mental Health Awareness Week, so we are re-sharing “Breastfeeding is…” a 2014 piece. Based on an interview with Barb O’Connor, this piece describes how breastfeeding is so much more than nutrition, including establishing secure attachments which are fundamental to infant mental health. 

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With a gentle pulsing of the sand, a baby sea turtle emerges from her hatching place. She breathes the salty ocean air and immediately begins her race to the rushing tide. She dodges stealthy crabs and gulls, mounts beach debris and endures what seems like an endless journey. Programmed for survival, she plunges into the abounding ocean, her lifeline.

Worldwide, there are over 70 conservation laws and regulations that protect sea turtles.

Not far from the briny ocean breeze, a mother hears her infant cry as she enters the world outside of the womb for the first time. Placed on her mother’s abdomen, the baby relaxes for several minutes until she begins to awaken. Soon, she makes mouthing and sucking movements signaling her interest in her mother’s breast. She leaps and crawls upward with intermittent periods of rest. When she reaches the breast, her hands become increasingly active and she familiarizes herself with her mother’s nipple. She suckles enjoying her first few sips of thick colostrum. After the first feed, she will rest again in the arms of her mother, her lifeline. [For more information about the 9 Stages visit: http://www.magicalhour.com/aboutus.html]

When a newborn is given the opportunity to practice early survival skills, amazing things happen.

But all too often, the newborn’s programming is interfered with by well-meaning health care professionals and popular, although non evidence-based health care practices.

“Our culture really discredits the importance of early beginnings,” Healthy Children faculty Barb O’Connor, RN, BSN, IBCLC, ANLC says. “If we protect and nurture mothers and infants, that’s going to impact future outcomes.”

Barb O’Connor (back left) pictured with colleagues from HCP and ALPP.

She goes on,  “Mothers and infants really have a synergistic recuperation from birth and if breastfeeding is supported and not interfered with, both parties are able to develop in a manner that leads to positive health outcomes.”

O’Connor discusses several cultural components that make establishing normal, healthy beginnings nearly impossible for families.

Our culture urges independence. Mother and baby are expected to properly function away from one another immediately after birth. Most birthing facilities don’t encourage or appropriately support the important practices of skin to skin contact or even rooming in.

Moreover, mothers are often expected to return to work or school while they are still bleeding from childbirth.

“There are other cultures that really value moms and babies and you can see it in the legislation,” O’Connor says.

Differently, our country provides mothers with zero paid maternity leave.

To be fair, there have been strides made in terms of promoting, protecting and supporting breastfeeding families in our nation. The Baby-Friendly Initiative (BFI) offers more and more families the opportunity to successfully breastfeed for instance. Particularly, BFI advocates for babies by requiring the facilities to provide the healthiest practices for mom and baby. O’Connor calls skin to skin contact and rooming in essential practices for all babies regardless of feeding method.

Still we have a lot to grasp, especially when it comes to older breastfeeding babies and children.

“Because we focus so much on breastfeeding being nutrition, our culture doesn’t really understand what breastfeeding really is for infants over one,” O’Connor says.  “We don’t understand as a population that nursing becomes a source of joy and communication and a way of life that should only be discontinued as mother and child mutually desire.”

O’Connor is particularly interested in the value of breastfeeding beyond nutrition.

“The delight I witness in the eyes of a baby who is nursing is indescribable; it is pure, unadulterated joy,” she says. “Every baby deserves the right to experience this loveliness.”

And skin to skin and breastfeeding are lovely in so many ways.

Breastfeeding is a stabilizer.

When a mother holds her baby skin to skin to breastfeed, she regulates her baby’s body temperature, heart and breathing rates, stress and glucose levels just to name a few. [For more information see these publications on skin to skin contact.]

O’Connor is fascinated by the findings of Dr. Nils Bergman and KH Nyqvist. Bergman, Nyqvist and colleagues have discovered that if the mothers of low birth weight babies practice Kangaroo Mother Care (KMC), they learn to breastfeed at incredibly young gestational ages. KMC also supports increased brain development and decreased mortality for low birth weight babies.

O’Connor’s daughter Brandy, mother and full-time caregiver of a special needs son who, born at 25 weeks gestation (now 5 years old), spent 110 days in the NICU, will speak at Healthy Children’s upcoming International Breastfeeding Conference about her experience with KMC and breastfeeding. She will share her perspective of the emotional turmoil, hospital practices, and challenges experienced by mothers of infants in the NICU.

“It has taken her a long time to come to a place where she could talk about this,” O’Connor says of Brandy’s experience. “I am extremely excited for my colleagues who work in the NICU to hear her perspective on how the experience affects new mothers”.

Breastfeeding is empowering.

The symbiotic relationship between breastfeeding mother and child and the infant’s programming for survival has a profound impact on the mother’s physical and mental well-being, O’Connor explains.

She continues that a child’s desire to breastfeed for comfort can be empowering. No one else but the mother has the capacity to console an upset child the way she does.

In Breastfeeding: A Feminist Issue, author Penny Van Esterik explains the many other ways breastfeeding is empowering including:  “breastfeeding confirms a woman’s power to control her own body, and challenges the male-dominated medical model and business interests that promote bottle feeding” and ”breastfeeding requires a new definition of women’s work – one that more realistically integrates women’s productive activities.”

Breastfeeding is immunity.

Maternal body flora and milk prime an infant’s immune system in a way that cannot currently be replicated and offers beneficial lifelong effects. O’Connor cites Lars Hanson’s immunology of breast milk research.

“A fully breast-fed infant receives as much as 0.5-1 g of secretory immunoglobulin A (SIgA) antibodies daily, the predominant antibody of human milk,” authors of Breast feeding: Overview and breast milk immunology write. “This can be compared to the production of some 2.5 g of SIgA per day for a 60 kg adult. These SIgA antibodies have been shown to protect against Vibrio cholerae, ETEC, Campylobacter, Shigella and Giardia.”

Breastfeeding is communication.

“If I see a baby who looks anxious or isn’t taking the breast well, it’s an immediate sign that something isn’t right in baby’s life,” O’Connor says.

As stated babies seek the breast for survival, so if baby refuses to breastfeed, they are communicating in a non-verbal way, she continues. Perhaps baby is ill or injured. When circumstances like these arise, it is important that the dyad receive help from a lactation professional who can assist with investigating the problem.

O’Connor reminds lactation professionals that it is always important to practice from a current, evidence-based perspective and to possess appropriate counseling skills.

“Most moms want to breastfeed,” she says. “It’s a matter of figuring out how to fit it in her life.”

Breastfeeding is regulatory.

A breastfed baby is offered control over the amount of milk she ingests whereas a bottle-fed infant’s intake is usually dictated by the amount of milk in its artificial container.

Consequently bottle feeding, regardless of the type of milk, may have future implications on obesity.

“Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast,” authors of Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? conclude.

Breastfeeding is survival.

O’Connor suggests we reevaluate our definition of survival. Survival goes beyond the performance of simple body functions.

“We have to look beyond that at a more encompassing definition,” she says. “Babies who are breastfed have a different potential for intellectual and interpersonal relationships.”

In fact, authors of Breast feeding and intergenerational social mobility: what are the mechanisms? conclude that “Breast feeding increased the odds of upward social mobility and decreased the odds of downward mobility.”

The effect was mediated in part due to stress mechanisms,” O’Connor comments.  “This is really fascinating.”

Breastfeeding has become of international concern because it offers protection against infant mortality. The World Health Organization’s Millenium Development Goals include breastfeeding as a strategy to combat child malnutrition and reduce child mortality.

In “Breastfeeding and Infant-Parent Co-Sleeping as Adaptive Strategies: Are They Protective against SIDS?” included in Breastfeeding: Biocultural Perspectives, James J. McKenna and Nicole J. Bernshaw explore the epidemiological studies that suggest that breastfeeding may be protective against SIDS.

What does breastfeeding mean to you? How else is breastfeeding more than nutrition? Please share your thoughts in the thread below.

 

Other relevant pieces

Field of lactation gains child psychologist

Cheap medicine: laughter

Implications of mother baby separation

Nutrition and facial development

When I was a freshman in high school, I had these tiny little ramp-like structures fused to the back of my upper incisors so that my overbite wouldn’t interfere with my bottom braces. I called them “rabbit teeth”, because that’s what they resembled: prominent, cartoon-like rabbit teeth. They were so embarrassing, though I was lucky I didn’t need to contend with headgear or what I’m about to share next.

Photo by Kenny Eliason on Unsplash

A friend recently described her son’s orthodontia as a “medieval torture device.”  Every night, she has to insert a key into the expander across the roof of his mouth and crank it multiple times in an effort to widen the canal. He’s also endured multiple tooth extractions, multiple phases of metal braces, a retainer, and his parents have forked over thousands of dollars for these treatments. 

I’m forking over thousands of dollars too, for my oldest daughter’s orthodontia. About every six weeks, we haul over for adjustments. Currently, she’s in the rubber band phase. Tiny little bands hook diagonally onto her braces in order to train her jaw into proper positioning. 

Though my own orthodontic care wrapped up about two decades ago, I’ve discovered these hilarious facial exercises– face yoga– regimens marketed at those of us who aren’t pleased with our face sculpture. 

Torture devices, face toning, what have you, these interventions have come to rise in modern times to address our changing faces and it’s not just vanity at stake. Jaw and other facial development, dental occlusion, tooth spacing have all been affected by how and what we eat and they have real effects on our overall health and function. 

“…The problem we face is that we have entered a space age world with Stone Age genes—genes that evolved to produce jaws adapted to a hunter-gatherer diet. Today’s jaws epidemic is concealed behind the commonplace. Its most obvious symptoms are oral and facial: crooked teeth (and the accompanying very common use of braces), receding jaws, a smile that shows lots of gums, mouth breathing, and interrupted breathing during sleep…” Sandra Kahn and Paul R. Ehrlich write in Why Cavemen Needed No Braces.  

The authors go on to explain: “The epidemic’s roots lie in cultural shifts in important daily actions we seldom think about; things like chewing, breathing, or the position of our jaws at rest, and these changes have in turn been brought about by much bigger sociohistorical developments—namely, industrialization.”

Photo by Etienne Girardet on Unsplash

More specifically, Americans’ diets have become saturated by ultra processed foods (UPFs). According to the documentary Food Inc. 2, on average, UPFs make up 58 percent of Americans’ total energy intake, compared to 17 percent in Italy. 

While we might think of UPFs contributing to things like obesity, diabetes, and heart disease, Daniel E Lieberman, et al conclude in Effects of food processing on masticatory strain and craniofacial growth in a retrognathic face that “…food processing techniques have led to decreased facial growth in the mandibular and maxillary arches in recent human populations.” This shifting development of our facial structures comes with its own set of health concerns.

 Weston A. Price delves into the relationship between diet, the development of teeth and bones and overall health in his book Nutrition and Physical Degeneration.  

Starting in utero, researchers have suggested that the amount of protein consumed by pregnant women can impact the facial development of their offspring. 

It is well established that infant feeding and the introduction of complementary foods impacts facial development.

Photo by Helena Lopes on Unsplash

“Breastfeeding is not mere nutrition and can be considered as a natural orthopedic appliance for the harmonious development of face,” as the authors of Validation of Association between Breastfeeding Duration, Facial Profile, Occlusion, and Spacing: A Cross-sectional Study put it. 

In Relationship between Nutrition and Development of the Jaws in Children, a small pilot study, the authors reference a study conducted in Beijing by Chen, et al that “revealed that children who either did not receive breastfeeding or breastfed for less than six months were more susceptible to subsequent crossbite, which is directly linked to the position of the terminal plane.” 

The authors also write that “initiating [complementary] feeding with solid foods [as opposed to porridges] may lead to a lower tendency for crowding. Primate spaces and interincisive diastemas are considered essential and important as they facilitate the proper alignment of permanent teeth by occupying the necessary space for a harmonious occlusion.” 

Alas, the packet apocalypse is upon us. The convenience of “ready-to-feed-super-glops and slops” have largely replaced the art of dining and sharing meals and chewing our food. Stocked shelves offer an overwhelming array of mostly highly processed snacks and meals in a pouch that generally lack texture diversity.

Photo by Derek Owens on Unsplash

Yvonne Luxford’s Was the Tooth Fairy Breast Fed? The Politics of Infant Tooth Decay is a fascinating doctoral thesis that teases out the flaws in 1970s research that linked breastfeeding to tooth decay (and has stuck around in many spaces.) 

In one section, Luxford cites Babu Jose and Nigel M King’s research which found that “the  [addition of sugar in local snack food preparations and the increasing frequency of snacking] may have been a factor that has affected data from other studies where breast-feeding was high; in other words, this may serve as a warning to communities that the good practice of breast-feeding may be counteracted by adverse factors that are not reported by caregivers, and these factors may be cultural or social in nature.” 

This bit nods to snack culture and industry influence where multinational corporations work to influence infants’ and young children’s diets in order to increase their profits.    

During this research, I came across a device shaped like a mouthguard intended to promote chewing. How incredibly bizarre, I thought. When I shared the device with one of my mentors, she pointed out that humans who are tube fed or those living with other medical complexities might benefit from a device like this, but for those of us who can chew regular, whole foods… we both cocked our heads– our heads formed with great influence by the foods we eat– in bewilderment at this silicone product. 

 

Further reading 

Global human mandibular variation reflects differences in agricultural and hunter-gatherer subsistence strategies

Malocclusion: Disease of Civilization

Ultra-Processed People

Evolution of Diet 

How the Western Diet Has Changed the Human Face



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.”

Continuing the conversation about language use in perinatal health

What is ‘appropriate’ language? What one might consider distasteful, hurtful, impactful, another may consider harmless or meaningless.

Photo by Miguel Á. Padriñán

Take this exchange offered by Ravae Sinclair, JD, CD (DONA), LCCE at the early 2020 International Breastfeeding Conference for example:

A white-presenting lactation professional working with a black mother and her baby shortly after birth exclaimed something along the lines of, “Awww, look at him, he looks just like a little thug!” commenting on the slight sag in his newborn hospital cap.

“Little thug”– a heavily loaded term generally carrying negative connotations– was understandably a trigger for the mother. She shut down no longer feeling safe in the space and asked to be discharged early. Most likely, the lactation professional did not intend to offend, but the impact of this short exchange has much further reaching consequences than the intention itself.

We have explored the impact of language to a relatively great extent here on Our Milky Way. You can check out these pieces for examples:

In a recent exchange, Nikki Lee added to this ongoing conversation about language in maternal child health. She shared an observation about how “the media rarely misses a chance to plant negative seeds in the public’s mind about breastfeeding”.

Citing an example from a PubMed alert that morning– Sudden Death in a Breastfeeding Woman with Arrhythmogenic Mitral Valve Prolapse— Lee commented “I ask you, how in the world does the infant feeding method have to do with the death of this mother? She had some kind of cardiac defect; pregnancy and labor place huge stresses on the cardiovascular system. What would you think and how would you feel if you saw a headline ‘Sudden death in a formula feeding woman with arrhythmogenic mitral valve prolapse’?”

Julie Smith’s, et al 2008 paper Voldemortand health professional knowledge of breastfeeding – do journal titles and abstracts accurately convey findings on differential health outcomes for formula fed infants?  “showed a surprising ‘Voldemort effect’ in the studies examined; formula feeding was rarely named as an exposure increasing health risk in publication titles or abstracts.” The authors conclude that “ If widespread, this skew in communication of research findings may reduce health professionals’ knowledge and support for breastfeeding.”

In her own reflection on the use of language in perinatal support, Donna Walls, RN, BSN, ANLC shares her guest post Our words need to send a supportive message- how can we do it? this week on Our Milky Way.

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As a child I often repeated “sticks and stones can break my bones, but words can never hurt me”. As an adult, I know this is not true. Words are powerful. In our breastfeeding advocacy world, words can be used to build a new mother’s confidence, or they can be used to undermine it. Below, I offer you some of my pet peeves,  words and phrases we commonly use without  thinking about their impact.

Source: United States Breastfeeding Committee

First, maybe the most common and certainly one of the most harmful is talking about “milk coming in”. We know that the number one fear of new moms, especially first-time moms, is not having enough milk. In the first days after birth,  there aren’t often  visible signs of milk production. New parents have often heard about engorgement and how breasts get so full, they look like they are ready to explode. But, they see no signs of exploding breasts in the first one to two days after birth. They may be able to express drops which is encouraging but no big reassurance that there is plenty for their baby.

We often see at about two days of age the occurrence of “cluster feeding” when their quiet, precious newborn seems ravenous and so, so hungry. Many moms think, or unfortunately are told, that this is a sign of not having enough milk. This is not even slightly, vaguely true but rather a normal newborn feeding pattern. We dutifully tell this anxious mother not to worry; her “milk will come in” in a day or two. The not-so-subtle message is that there is no need to worry about not having milk now, that  it soon will come in.

What has happened is that we have reinforced her biggest worry about not being able to adequately feed her baby. I don’t believe for a minute that this is intentional on our part, really just one of those things we have always said and never really examined the consequences.

I sometimes feel sorry for underappreciated, often ignored colostrum. Maybe it’s time we change the language. So instead of saying “your milk will come in”, might I suggest we instead say “the milk you’ve been making for your baby while you were pregnant is there for the first feeds. It is newborn milk, sometimes called colostrum, and this small volume is all your baby needs in the first hours and days. When you nurse frequently in these first days the newborn milk will change over to mature milk and you will see an increase in the amount as your breasts will become fuller, firmer and heavier.” You can of course  come up with your own wording just as long as new parents get the message that there is milk NOW- not “coming in” later!

Source: United States Breastfeeding Committee

My second pet peeve is judgey diagnoses of flat nipples. Way too often when prenatal breast assessments are done, there is a diagnosis of flat nipples, usually based only on the appearance with no regard to assessing function. Once these misunderstood nipples are labeled, the mother is deemed not quite right for feeding. Silly exercises and gadgets are recommended to make already elastic skin behave appropriately. First point: nipples are erectile by nature, some stand up a lot, some a little. Sadly most new mothers have seen artificial nipples and think they should look like these, not ever recognizing that we have the real nipples so why aren’t bottle nipples more like ours?! When counseling mothers, ask the mom if she notices her nipple erecting in cold weather or with sexual/manual stimulation.

As a clinical lactation care provider for many years, I would often be saddened by the words used to make a mother feel her nipples weren’t quite right, not good enough. I have seen too often women struggling with breastfeeding because they were told even before the baby’s birth that the chances were slim for successful breastfeeding; bad nipples would certainly cause problems.

I am quite sure males are not discouraged about the abilities of their erectile tissue at the onset of sexual activity. This is not to say that there may not be challenges  with inverted nipples; they may cause challenges  when they are retracted enough to not ever be stimulated or stretched for hormonal release, but flat nipples will evert. They just want to do it their way. We need to remind moms that the nipple their baby will prefer is attached to their favorite person.

Third, let’s talk about the term engorgement. By definition, engorgement  is not normal. It is a state brought on by interruptions in the expected initiation of lactation [Source]. Unfortunately, the term is used by professionals and families to mean a fullness in the breasts. Signs of engorgement include hot, reddened, uncomfortably swollen breasts which can be hard for a newborn to correctly latch to the breast. This needs to be distinguished from normal signs of lactation when breasts become rounder, fuller, firmer and heavier. Too often a mother may complain about her breast “engorgement” and interventions are recommended to help reduce the discomfort and swelling when in reality she just needs to be reassured that what she is feeling is normal and actually a good sign that she is producing milk. So, my request is that when a mother talks about her concerns about engorgement, our response needs to be to ask something along the lines of “what exactly are you feeling?” as well as the usual questions of frequency of feedings, adequate output and signs of comfortable  latch.

Source: United States Breastfeeding Committee

Our words can have a profound effect on the success or failure of breastfeeding. A huge part of our job, our responsibility to our patients and their families is to build confidence in their ability to nourish and nurture their newborns. Be aware of the message that is being sent and choose words that will build confidence, be generous with realistic praise and couch our intervention suggestions with success in mind. Ask for parents’ input; we want them to know their thoughts are important to the process!

Reference Cadwell, K. and Turner-Maffei, C.  Pocket Guide for Lactation Management. 2022. Jones and Bartlett. Burlington, MA.