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.

Glints of hope and control in a burning world

As I gathered my thoughts for an Earth Month and infant feeding installment, I got an email notification that Valerie McClain had published something new on her Substack. Of course I hurried over, because her pieces are always illuminating. She writes in Standing on the Precipice:  “We are self-destructing on our Mother Earth, and she may be the last woman standing amidst the rubble and miles of corpses.”

Photo by Tatiana Syrikova: https://www.pexels.com/photo/anonymous-little-kid-touching-tree-with-hand-3932861/

In all of the pieces and years past that we have covered the connections between infant feeding and planetary health, it never actually occurred to me that there might be a scenario where Mother Earth outlives us. This will surely strike some of you as naive, absurd, delusional, or something else considering what has happened and continues to happen on our planet. Even so, I envisioned humans dying alongside our planet, our self-destruction agonizing and inevitable, as we claw, infect, and deplete Mother Earth with our beastly antics, taking down the innocent in our path to complete decimation. 

On a recent trip to The Museum of Modern Art, I was shaken out of this sense of Doom and flurry of eco-emotions. Victor Grippo’s lead containers with beans first spoke to me, metaphors “for the force and persistence of life”. This display coupled with Niki de Saint Phalle’s phrase “What is now known was once only imagined” infused me with a little glint of hope that I’ve been craving. 

Then on a Throughline episode about consumer protections and trust in and accountability from companies and elected leaders, I heard the voice of Ralph Nader. He offered: Cynicism is “a cop-out. That’s an indulgence. That’s an indulgence of quitters that makes them feel good. Because when you’re cynical, you’re obviously smart, aren’t you? You think you’re smart. No, you’re not smart. You’re playing into the hands of the corporate supremacists. You’re playing into the hands of the few who want to control the many who could easily outvote the few and make the corporations our servants, not our masters.” This offered me a shift in perspective too.

Source: https://www.gifa.org/en/international-2/green-feeding/

Among the hopeful is coverage of the Green Feeding Tool by Kristi Eaton. Eaton quotes Julie Smith, co-creator of the tool: “…with the Green Feeding Tool—designed to provide policymakers, climate scientists, advocates and others with clear data about how increasing support for breastfeeding can help save the planet—we have the evidence to support action.”

Now, consider this headline: Breast milk can expose babies to toxic ‘forever chemicals’

“For decades, physicians and scientists have touted breast milk as liquid gold for its immunological benefits.

But nursing parents with considerable exposure to cancer-linked ‘forever chemicals,’ or PFAS, may unwittingly be exposing their babies to these compounds as well…” the author begins. 

The article acknowledges contaminated water could be a potential source of PFAS which infant formula is often mixed with. The author also includes that “the benefits of nursing likely outweigh the potential risk of PFAS exposure through breast milk.” [Note the language used here. There are generally no benefits to breastfeeding. Instead, there are risks associated with not breastfeeding.] 

Nikki Lee asks some important questions: “Why doesn’t formula get tested for these chemicals?  Do folks believe that somehow cows are protected against pollution?”

As with anything, there will be risks associated with any variation of infant feeding. 

Healthy Children Project’s Karin Cadwell points out that if toxins are being detected in human milk, it means we need to reconsider the products being used in industry.

Photo by willsantt: https://www.pexels.com/photo/woman-breastfeeding-her-toddler-under-the-tree-2714618/

The author of Study Finds High Levels of Toxic Chemicals in Mothers’ Breast Milk quotes Erika Schreder, science director at Toxic-Free Future who shares a similar sentiment: “’If we want to make pregnancy and breastfeeding safe and free from PFAS, we really need to eliminate the use of these chemicals and products, so that we can have clean food, clean air, and clean water… We really don’t believe that responsibility should be placed on individuals when we need regulations to end the use of these chemicals.’”

In the predicament(s) we find ourselves in, I’d like to leave you with a few more of McClain’s words: “A mother cannot control events such as: wars, sieges, shortages of infant formula and pitocin, fires, floods, hurricanes, tornadoes; but she has a semblance of control in her and her baby’s world through breastfeeding. Dependency on always having access to infant formula, health care, freedom from human or environmental violence, should be tempered with the reality that there may be times, when all the civility of life vanishes.” 

More for Earth Month 

Industry lies and the Code

Infant feeding and planetary health go hand in hand 

Breastfeeding is eco-friendly 

Goats and Soda’s How do you keep calm and carry on in a world full of crises?



Rambling about breasts

This week, I’m coming to you with some sort of ramble, an entry of things that have brought me joy over the last few weeks, all breast-related of course.

Wrought iron (assumed unintentional) breasts on Milwaukee building

To begin, a dear friend recently messaged me to share about a date she’d been on. She and the guy got on the topic of breastfeeding; she told him about how a mom’s body and baby’s saliva communicate to influence antibodies. 

“He shared [the info] with a friend who said she was going to switch to pumping her six month old because he got teeth,” she told me. “I was like wow, seriously, that is awesome. But then I also told him not to pump-shame!” 

Art positioned at the Henry Miller Memorial Library in Big Sur, Calif.

On another evening, I was at my kids’ grade school function in a circle with four other parents discussing Doomsday. What might it look like? we wondered. What’s the best approach to survival? What kind of supplies might we need? What will happen to currency? Isn’t it true that Hell is already here on Earth for so many? Breastfeeding and my milk were my answer to any distressing moment when I was lactating. Pink eye? Squirt some breastmilk on it. Kid scraped a knee? Breastfeed. Tumultuous bedtime? Breastfeed. And we know that breastfeeding is a lifeline in any true emergency situation. So I added to the Doomsday discussion, suggesting that I might work on relactation, mostly kidding but also reminiscing about how it used to fix all of my problems. One of my peers gasped, “Oh my god! Is that possible?!” I described how relactation could be possible for some. It was decided that this could be our savior in the event of an apocalypse.

El Niño advertisement at the Lincoln Center features breastfeeding Madonna

Then, last weekend, at an extended family gathering, we all oohed and aahed while the darling 10-month old at the table enjoyed his meal. My oldest daughter, 12, asked what her favorite food was when she was around his age. I thought about it, not remembering anything specific except, “The breast!” My kids liked nothing more than nursing. This embarrassed my daughter, but the rest of us had a good chuckle, and it was good to remember a time when my now preteen only wanted to be with me. 

The other sources of joy that I’d like to share with you come from the internet. 

I’ve been moved by and admiring these provoking, stunning pieces of art:

The Lactation Station 

Breastfeeding with Mother 

Workday Madonna with Child 

My Nurse and I 

Milky Way 

The Harvest

The Awakening Series 

Equally entertaining is an Instagram post by Dr. Katrina Mitchell: “​​The world’s most perfect dog toy: a burning bra, ‘Bite the Patriarchy’”.  

Pregnant belly formation at Crystal Caves on Grand Cayman Island

Then there’s Atlas Obscura which I frequent for oddball attractions in my area and across the globe. This week I came across the Mama Kannon Temple, a Buddhist temple in Japan dedicated to breasts. Somehow, this discovery led me to learn about the legend of Difunta Correa in Argentina. I’ve added both to my travel bucket list. 

And finally, I happened upon the Museum of Motherhood in St. Pete, Fla. It has a boob chair. This brings me immense joy, and I hope it’s a bright spot in your life too. 



School Age Parenting Program nurses complete Lactation Counselor Training Course enhancing support for students

Spring can be an especially busy time for pregnant and parenting teens. There’s prom, Easter egg hunts, Eid al-Fitr, Holi, Passover and other festivities,  the summer school enrollment process, all alongside their typical school responsibilities. Then there’s the excitement of pending graduation for some. 

Nurse Michelle and Nurse Ashlee

Michelle Alkinburgh, BSN, RN and Ashlee Anzalone, RN, health care coordinators at the Racine Unified School District’s School Age Parenting Program (SAPAR), recently completed the Lactation Counselor Training Course (LCTC) in an effort to further support their students who are managing the multiplicity of being pregnant or parenting in high school. 

The duo is proud to report that many of their young parents choose to breastfeed even while juggling all of their other demands.

“We have many moms who breastfeed the first few weeks and have had three moms who breastfed for a year!” they exclaim.  

In the U.S., one estimation suggests that of the  “approximately 425,000 infants born to adolescents… only 43 percent will initiate breastfeeding, in contrast to 75 percent of mothers of adult age…” [Kanhadilok, et al, 2015]

Over 30 years ago, the state of Wisconsin required school districts to provide programming and services to school-age parents. As such, SAPAR  programming has been in place since the requirement was established.  

SAPAR is intended to retain pregnant and parenting students in school, promote academic progress, increase knowledge of child development and parenting skills, improve, decision-making regarding healthy choices, prevent subsequent teen pregnancies and child abuse and neglect, including that of the teen mother, and assist in post-secondary education and/or employment.  The program is open to all students under the age of 21 years who are not high school graduates and are parents, expectant parents or have been pregnant during the last 120 days. [Retrieved from https://rusd.org/academics/alternative-programs/pregnant-parenting-teens

Alkinburgh and Anzalone report that they average around 100 enrolled students each year.  During the 2022/23 school year, they served 104 students.

Healthy Children Project’s Carin Richter notes that programs like SAPAR aren’t often sustained for as long as Racine’s programming; instead,  they’re often met with a lot of opposition and are frequently cut from school budgets, she observes.

“I am impressed with the school district that promotes her program and the school board, PTA, and school staff that encourage this type of program,” Richter offers. 

The team comments on their strength and sustainability: 

“[Our program] has two nurse case managers with extensive knowledge and experience in maternal and child health, allowing us to help when medical issues arise, not just for our parents but also their children.  We provide health education, childbirth and parenting classes, and assist with community resources and academic needs.  We work together as a team with our students, families, school staff, medical providers and community partners.  

The national average graduation rate for teen parents is about 50 percent,  but our program changes that!  Last year 94 percent  of our eligible Seniors graduated providing more job opportunities, financial stability and college or apprenticeship options. Teens 15 to 19 years old also have higher rates of infant mortality and maternal complications. We had zero percent.”

Students Anika Moreno and Gregory Sanders Jr. pictured with their child.

Each work day is different for the duo. There are no defined hours and they often work with students for several years.  

“Our work requires a lot of flexibility and patience, but it is so rewarding to see our students succeed,” they begin. “We provide school visits throughout the district, and also phone, virtual, home and community visits to meet the individual needs. You may find us busy helping students get health insurance, find a medical provider, manage pregnancy symptoms to stay in school, check a blood pressure, obtain a medical excuse, meet with support staff, talk to a parent, help enroll in community programs, get a crib or car seat, find diapers, etc.  We may be assisting with childcare, nutrition, housing, employment or transportation needs.  We also do a lot of health teaching and use evidenced-based curriculum specifically designed for young parents to help them learn and have an opportunity to earn additional credit toward graduation. Our goal is that our students stay in school, graduate high school and have healthy babies.”

Teenage dads can get a bad rap, but Alkinburgh and Anzalone note that “they really want to be great dads.” The nurses offer individual, joint and group meetings for young fathers and cover topics like infant care, co-parenting, child support, etc.  

“We try to make learning fun and engaging,” the duo says. “For example, we may have a diaper changing race or have them practice giving a baby a bath with our infant model and newborn care kit.” 

To add to their skill-base, the team needed to do some unlearning about breastfeeding myths through the LCTC.  

“Now that we know the newest research-based facts, we can best educate our students,” they say. “We already started using the awesome counseling skills they taught us in the training and it has really helped us ask more open- ended questions to address students’ concerns and goals.” 

Overall, the nurses have experienced a positive attitude for breastfeeding in their community at large. For instance, the district offers private lactation rooms in each of their schools for staff and students to use when needed. 

For those interested in supporting the program’s mission, the team offers: “Be kind, supportive and share with others how truly valuable a program like ours really is!” They also suggest donating, volunteering or partnering with community organizations that help support their students  like the Racine Diaper Ministry, Salvation Army, Cribs for Kids, Parent Life, Halo, and United Way. 

Find the program on Facebook here.

Jess Fedenia’s, CLC light bulb moment: “Life is full of ands instead of either ors.”

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

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

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

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


This is my light bulb moment.


That funny little mind blown emoji has peppered many of my interactions. I find it perfectly depicts my reactions to and revelations from the massive matrix of varying perceptions of reality that the internet has offered us. Before emojis were a staple in my vernacular though, I remember a light bulb moment that illuminated something in and around me and helped shape my perception of reality and identity.  

In Chantal Molnar’s 2013 piece Breastfeeding and Feminism she writes:

“Breastfeeding refutes the cultural bent that breast’s primary function is as sex objects. America has an uneasy relationship with breastfeeding and has a hard time facing the duality inherent in breast’s function. Sex versus nurture, or sex and nurture? We don’t seem to have any problem with the duality of our mouths, which can be for sex and for eating. We do not make people cover their heads with a blanket when they are eating in public simply because the mouth is frequently used sexually.”

When I first read this, my daughter was two and breastfeeding, and I was pregnant with my second daughter. Though I wanted to embrace an attitude that I had no qualms about breastfeeding in public, I was always truly a bit uneasy about the threat of being harrassed for doing so. But Molnar’s piece gave me the brilliant analogy I needed to defend myself in the case that I was approached by some dismayed onlooker (which never actually happened in all the years I breastfed three children.) 

That handful of sentences also ignited a recognition of the multi-dimension within me. Interestingly, while Molnar pinpoints American culture’s fixation on the sexual breast, I had a self-perception confined to “Milk Maker”. Though I felt the power of this identity and an appreciation of the magic of its intricate, complex and beautiful function, I failed to see myself as sexy after becoming a mother. Molnar’s words invited me to reconsider how I viewed myself. 

Maybe most importantly, I like to think that this recognition of the multiplicity within myself  has helped me to be more aware and accepting of the diversity and complexities outside of myself. Molnar’s piece revealed to me that life is full of ands instead of either ors.