From Africa to Appalachia, improved relationships and communication through nutrition research

 From Africa to Appalachia, Stephanie L. Martin’s, PhD, CLC research on nutrition during pregnancy, lactation, and childhood, has gone beyond nutrition alone.

In a world where infant feeding is commonly reduced to input and output, “perfect” latches and weighted feeds, Martin’s work illuminates the added benefit of improved relationships and communication. 

In Zambia for instance, Martin and her colleagues have looked at how to engage family members to support nutrition in women living with HIV and their children. 

Twenty years ago, when antiretroviral therapy (ART) was less accessible, the risk of transmitting HIV through breastfeeding was high. Today though, with an increase in availability and access to ART, the World Health Organization (WHO) recommends the use of antiretroviral drugs as a safe way to prevent postnatal transmission of HIV through breastfeeding. 

Still, Martin has found that mothers talk about their fears of transmitting HIV to their infants the same way they did two decades ago. Mothers often use unfounded strategies like breastfeeding for shorter durations, breastfeeding less often or offering other liquids in an effort to limit the risk of transmission. So, Martin and her team have counseled mothers not to cut feedings short. Martin shares that her most recent Lactation Counselor Training has offered new insight.

“I’m going to change things in our counseling materials based on what we learned in the CLC training [in regard to] how we phrase things about breastfeeding for longer periods of time; if there is efficient milk transfer, we don’t need to focus on this longer length of time,” she explains.   

Additionally, in an effort to reduce caregivers offering infants under six months food or drink other than breastmilk, alternative soothing recommendations were offered. Martin remembers one mother who tried the suggestions to calm her crying baby. The mother reported that propping her infant onto a specific shoulder alleviated the baby’s discontent. “I don’t know what it was about that shoulder, but she stopped crying,” Martin quotes the mother, noting the importance of empowering mothers and caregivers through counseling. 

In Tanzania, Martin and partners at Kilimanjaro Christian Medical University College sought to identify  facilitators and barriers to exclusive breastfeeding among women working in the informal sector. And in Kenya, Martin and colleagues have worked to improve adolescent nutrition in informal settlements.

Martin pictured with colleagues from Kilimanjaro Christian Medical University College and Better Health for the African Mother and Child organization

Throughout all of her work in East and Southern Africa, Martin says they are reliant on community health workers to roll out their programs. 

“It’s so important to understand their experiences,” Martin says of hearing out the helpers. 

Through her research , Martin has explored the experiences of peer educators, community health workers, WIC breastfeeding peer counselors, health care providers, and program implementers.

Surveying global health professionals provides an opportunity to learn from their experiences and fill gaps in the peer-reviewed literature to strengthen intervention design and implementation as concluded in Martin, et al’s Experiences Engaging Family Members in Maternal, Child, and Adolescent Nutrition: A Survey of Global Health Professionals

Through Facilitators and Barriers to Providing Breastfeeding and Lactation Support to Families in Appalachia: A Mixed-Methods Study With Lactation Professionals and Supporters, Martin draws parallels in the challenges lactation care providers in Africa and Appalachia face, including compensation and availability of services. 

Specifically in Appalachia, the authors heard lactation care providers expressing the desire for additional training for providing support around mental health, chest feeding, drug use, etc. 

Martin says that she found the Lactation Counselor Training Course (LCTC) covered many of these topics. 

“[The course] seemed very intentional in all of the right ways,” she says. 

The Appalachian Breastfeeding Network (ABN) also offers an Advanced Current Concepts in Lactation Course which covers these desired topics with scholarship opportunities. 

When asked if she’s optimistic about the future of maternal child health, Martin answers with a slightly tense laugh: “I feel like I have to say yes.” Martin goes on to explain the inspiring work of ABN and all of the lactation care providers she’s interacted with.

“If they were in charge of the world, it would be such a better place,” she begins. 

“When I think about them, I feel optimistic. I’d like to see different laws that are supportive of women’s health and families. We have all the right people to make positive changes.”

Breastfeeding is not binary.

–This post is part of our 10-year anniversary series “Breastfeeding is…” When we initially curated this series, we planned for 10 weeks, but breastfeeding is so many things that we just couldn’t fit it all in.  Thus, two bonus weeks in our anniversary series! — 

Breastfeeding is not binary.

There’s solid evidence that direct breastfeeding offers the most protective and beneficial effects to mothers, babies and ultimately society.

Photo by Luiza Braun on Unsplash

When breastfeeding, a baby’s saliva transfers chemicals to their mother’s body that causes her milk to adjust to meet the changing needs of the baby. [Al-Shehri, et al 2015]

Even more fascinating, the combination of baby saliva and fresh breastmilk generates enough hydrogen peroxide to inhibit growth of Staphylococcus and Salmonella. Read about the science behind it all here.

Breastfeeding encourages proper mouth and jaw development and promotes oral health. 

When babies breastfeed, they are less likely to become obese for reasons like self-regulation of milk intake and seeding of their gut microbiomes. [Pérez-Escamilla, 2016] 

Infants at the breast, compared to bottle-fed infants, have better heart and respiratory rates and higher oxygen saturation rates because breastfeeding consumes less energy.

Photo by Zach Vessels on Unsplash

Breastfeeding has implications on mother-infant bonding and children’s future behavior. One study found that “compared to children whose mothers breastfed them, children who were not breastfed showed an increased number of internalizing behavioral problems, particularly anxious/depressed and somatic symptoms… A duration effect (dosage effect) appeared such that breastfeeding for 10 months or longer had the strongest impact on reducing anxious/depressed and somatic symptoms in children.”

Direct breastfeeding does not require feeding paraphernalia that may be vectors for disease. 

Even if the contents of a bottle contain human milk, the effects achieved through direct breastfeeding may not be possible.  

However, the reality of families’ lives, and sometimes choice, mean that most babies in the U.S. will not exclusively breastfeed or go on to breastfeed in conjunction with appropriate complementary feeding as recommended.

Photo by Lucas Margoni on Unsplash

The most recent CDC Breastfeeding Report Card acknowledges, “Numerous barriers to breastfeeding remain, and disparities persist in breastfeeding duration and exclusivity rates by race, ethnicity, and socioeconomic status. Policy, systems, and environmental changes that address breastfeeding barriers, such as better maternity care practices, paid leave policies, and supportive ECE centers, can help to improve breastfeeding rates and reduce disparities.” 

For these reasons and others, infant feeding often takes many forms. Infant feeding in America is not either/or, it’s both/and

Fiona Jardine and Aiden Farrow present experiences that do not fit into how we often generalize the infant feeding experience. 

Universal pumping icon by Fiona Jardine

Jardine’s work follows those who exclusively pump human milk. Farrow too pumped milk for their child born with cleft complications and then went on to directly chestfeed their baby.

Farrow has explained: “Feeding methods are not mutually exclusive. There are always windows and doors.” 

Lactation care providers, other care providers, health policies and procedures must all acknowledge the incredibly diverse experiences of families while honoring the very ubiquitous human desire that we all want what’s best for our babies.   

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Our 10-year anniversary giveaway has ended. Thank you to everyone who participated!

Lactation counselor invents one-of-a-kind, hand expression education device

For as long as there have been humans, there has been human milk. As it happens, according to Greek mythology our entire galaxy originates from breastmilk. 

Although people have been breastfeeding for millennia, breastfeeding doesn’t necessarily come naturally, especially in our modern world where common birth practice, industry influence and cultural phenomena are at play. 

Adhering to a mentality where breastfeeding is viewed as completely natural, is one of the most “harmful and hurtful” beliefs because it assumes that lactating people don’t need support, Founder/CEO of Orolait Ana Rojas Bastidas, CLC explains. 

“The majority of women are not able to fulfill their [infant feeding] goals, and that’s unbelievably sad,” Rojas Bastidas says. 

“That’s where innovation comes in,” she continues. 

Rojas Bastidas’s company Orolait, is a breastfeeding apparel company at its core, but this summer she released a one-of-a-kind lactation education tool: the LactoPRO Trainer

The LactoPRO is an anatomically-correct, tissue-mimicking human breast used for demonstrating hand expression. The device features a realistically-sized areola, nipple, and six lactiferous ducts and effectively ejects a human milk-like or colostrum-like substance. The breast is available in various skin shades too. 

In April 2020, Rojas Bastidas shifted Orolait operations to help provide Personal Protective Equipment (PPEs) to a hospital in Haiti alongside a Houston-based company that creates surgical organs.  With Rojas Bastidas’s vision and entrepreneurship and the company’s patented technology, the LactoPRO Trainer came to fruition. 

Rojas Bastidas and the team are working to create a model with inverted nipples as well as fashioning a breast that can develop clogs and mastitis. 

Rojas Bastidas emphasizes that she is always working to make her contributions more affordable and accessible.

“Having great things that are not accessible to the community are not helpful to anyone,” she says. 

Through her movement PowerToPrevail and other projects,  Rojas Bastidas has been a force for body positivity, cultivating self worth and supporting modern motherhood. This work led her to complete the Lactation Counselor Training Course (LCTC) earlier this year. 

“As I was going through the course and tried to teach hand expression, I became frustrated by the lack of options to demonstrate it accurately and in a constructive way,” she reports. 

Evidence-based lactation care emphasizes a hands-off approach. Couple this with the idea that infant feeding is a learned behavior and in American culture we don’t grow up seeing lactating breasts and breastfeeding, hand expression is a terribly abstract practice to teach. 

The LactoPRO helps fill this void. 

“Innovation in the lactation space has been slow and overlooked, so this is really exciting for me,” Rojas Bastidas says. “I’ve created something for the private sector that’s going to push public perception.” 

She likens her invention to the evolution of professional lactation care services; maternal child health advocates took a stand and refused to let women suffer, she explains. Like lactation care, Rojas Bastidas has created something that validates people’s stories and experiences. 

Rojas Bastidas’s influence stems from her experience as a new mom and the way she viewed her evolving body. 

“I didn’t realize that the way I viewed my body was impacting so much of my life including my breastfeeding journey,” she says. 

So many parents sympathize with the conundrum of breastfeeding in public spaces for instance. To do so discreetly often means lifting your shirt and exposing the midsection.

It seems vain and trivial, Rojas Bastidas acknowledges but when you multiply it by the millions of moms who experience challenges like this, there’s got to be a solution.

“Don’t be afraid to tackle whatever problem you see,” Rojas Bastidas encourages. “Innovation is for anyone.” 

Rojas Bastidas’s apparel serves as functional fashion. Simultaneously, her pursuit celebrates the bodies that have been largely misrepresented and often altogether censored. 

“The absence of bodies sends a broader message that those bodies don’t exist,” she explains. 

“It makes every battle so much harder, but that’s what keeps driving me. I  should have just closed up shop because this is so hard, but  I’m going to make as many people as uncomfortable as humanly possible,” Rojas Bastidas says of being a female innovator in health and wellness advocacy. 

She adds that by showing the public what bodies actually look like, it frees us, elevates us and empowers us. 

“Lactating individuals deserve to be seen, heard and helped.”

Rojas Bastidas has a lot to offer on her website including her shop, lactation counseling services, a member forum and blog. Check it out here

Follow her on social media @orolaitofficial and @powertoprevail

Breastfeeding in shelters

Among the many effects of the novel coronavirus, the pandemic has exposed our nation’s deficiencies: emergency unpreparedness, racial health disparities, our “highly polarized, fragmented, and individualistic society…” (I would add arrogant), and the failure of capitalism.  In marginalized populations, poverty, health inequities, and other burdens are amplified during an outbreak or other emergency. 

Long before the pandemic hit, individuals and advocacy organizations have been ringing the alarm, calling for better access to education, better healthcare, and equity and justice for all.

Of these trailblazers is Powerhouse Nikki Lee RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, CKC, RYT whose recent endeavor includes creating and implementing the 10 Steps to a Breastfeeding Friendly Shelter

In her role at the City of Philadelphia Department of Public Health, Lee noticed the challenges breastfeeding people face in shelters. 

The barriers are a result of our cultural attitude toward lactating people and misunderstandings about their bodies and needs. 

Lee talks about issues of privacy and ‘fairness’ in a shelter. Organizational dress codes often require residents to dress modestly, so when a person exposes their breasts to feed a baby, other residents can wonder why they’re not allowed to wear short shorts. Parents can express concern about the teenage boys in their families seeing breasts while a baby is being fed.

There’s the concern over safe milk storage and the mythology around reimbursement through the Child and Adult Care Food Program. Shelter staff may believe that if a mother breastfeeds, the facility will lose money to buy food because the allotted amount for infant formula isn’t getting used. Lee clarifies that if a mother breastfeeds, the institution will have more money to spend on food.  

Just like in the rest of the US, there tends to be a push for formula feeding because the baby’s intake is easily measured, and staff are more comfortable with what is familiar, i.e. bottle-feeding

Lee continues, “There is a genuine honesty from people who don’t understand anything about breastfeeding, ‘Why are we breastfeeding?’ ‘Why are we bothering?’”  Staff in hospitals have been educated about breastfeeding over the past few decades; staff in shelters have not.

So when she conducts trainings, she starts at the rudimentary level of ‘what are mammals?’ 

“All the worst mythology that you can imagine is in the shelter,” Lee says. “All the worst in how society treats mothers and babies gets magnified in shelters.” 

With the problem identified, Lee says she started “from scratch in a way,” looking for a written policy to support breastfeeding people.  Early on in her search, she followed up on a news story featuring a homeless mother in Hawaii. She posted inquiries on Lactnet, CDC listserv, international online forums, Facebook groups, and reached out to shelters at random wondering if they had breastfeeding policies . 

“Nothing,” Lee reports. “There is probably a shelter somewhere that has a policy, but after two years of a global search, I wasn’t able to find it.” 

In all her search,  Lee found one published document— a Canadian study looking at the factors that influence breastfeeding practices of mothers living in a maternity shelter– that could be helpful. 

Lee wrote the first draft of the 10 Steps to a Breastfeeding Friendly Shelter with policies like the Ten Steps to Successful Breastfeeding and Ten Steps to Breastfeeding-Friendly Child Care in mind. 

She sent it out to colleagues at CHOP’s Homeless Health Initiative for feedback, and for quite a while, there was none. Lee’s colleague Melissa Berrios Johnson, MSW,  a social work trainer with HHI, and the convenor of its breastfeeding workgroup subcommittee, helped to make the policy reality. 

Partner agency Philadelphia Health Management Corporation (PHMC) received a grant that funded research which took the policy to four different shelters for staff and resident feedback. 

“Everyone, residents and staff alike, felt this policy was important and feasible,” Lee says. 

PHMC’s next step was to identify a shelter staff member to become a breastfeeding champion. This champion would be provided with free breastfeeding training, and receive an honorarium.

As program oversight changed though, “breastfeeding champion” became a job, with a list of responsibilities. So far, Lee says they’ve only found four people out of 10 shelters who are willing to take on the task.

“There are some folks in shelters working hard to make things better,” Lee says. “They are those champions, most of whom have breastfed themselves.”

Currently, Lee and colleagues are in the process of developing training for staff members and ironing out how to help staff implement the policy.  

Lee’s and co-authors Alexandra Ernst MPH, and Vanesa Karamanian MD, MPH landmark paper about the 10 Steps to a Breastfeeding Friendly Shelter has been submitted to the  Journal of Human Lactation (JHL)

At present, COVID has put all of this work on hold.