Lindsey Brown McCormick’s, PhD, LPCC-S, PMH-C, CLC light bulb moment

[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.

Lindsey Brown McCormick, PhD, LPCC-S, PMH-C, CLC is the owner of Women Thrive Counseling & Consulting LLC. This is her light bulb moment. 

——

Dr. McCormick
Used with permission

I did not go into the field of mental health counseling with the goal or intention of working with mothers/birthing people and babies. It was never on my radar as something that clinicians even specialized in. The birth of my daughter changed everything for me. 

I’ve been working in the field of trauma and traumatic stress since 2010. My spouse and I welcomed our daughter, currently our only child, into the world November 2021. I was induced and labored for 22 hours before I was whisked away into the operating room for an emergency cesarean. Though everything was seemingly normal on the surface, between the complications faced in labor and the OR, internally I was far from okay. The spiral of postpartum anxiety had entered the chat. 

It was after we came home, in the stillness of the village that lived so far away, crying on my couch with a cluster feeding newborn, I realized two things: 1) I didn’t know anything about perinatal mental health, and 2) I didn’t know where I could even go to learn. 

In the following weeks, my spouse would arrive home from work and I would dump everything that I had discovered that day onto him. I was so energized, so eager to learn, and I was jumping into the deep end of this new clinical niche. I enrolled in a perinatal mental health training program. Upon completing that, I enrolled in the Certified Lactation Counselor training course. Bridging these disciplines, as a practitioner, just made sense to me. There can be a significant amount of mental health problems that arise from attempting to body feed: anxiety, trauma, and grief, to name a few. And, as an attachment theory and parenting nerd, I absorbed research on skin-to-skin care like a sponge. 

As I’ve continued to specialize in this field, I greatly appreciate the value of blending perinatal mental healthcare and lactation care, the healing benefits of skin-to-skin care after a traumatic birthing experience, and the neuroscience of matrescence and infant (0-3) development. It’s provided me opportunities to learn more about the relationship between my daughter and me. It’s positively influenced my parenting style. It’s positively influenced my approach as a counselor and an educator. There are FEW psychotherapists who have lactation credentials out there, and I feel honored to be one of them. 

 

Conflicts of interest everywhere one turns

The authors of Call to end sponsorship from commercial milk formula companies published in The Lancet last month urge all health-care professional associations (HCPAs) to commit to ending sponsorships from companies that market commercial milk formulas (CMFs) by the end of 2024.

Greed depicted in an image that is part of a series of prints of the Seven Deadly Sins, engraved by Pieter van der Heyden after drawings by Pieter Bruegel the Elder. More at https://www.metmuseum.org/art/collection/search/338698

The CMF industry targets healthcare providers, because they understand providers’ influence on parents’ decisions.

The group of leading HCPAs  is working to compile case studies, references, guidance on how to manage without sponsorship, and more to help any associations in ending such relationships. 

The effort is not a restriction on parental choice, and the authors recognize that all healthcare professionals (HCPs) must support parents on a case-by-case basis. 

Instead, this work focuses on combating the inappropriate marketing of CMFs which interferes with parents getting accurate information to make decisions. The 2023 Lancet Series offers much more information on the industry’s tactics. Find it here.

The CMF industry has its tentacles tangled in affairs beyond the health care provider-patient relationship, raising concerns about conflicts of interest everywhere one turns. 

Healthy Children Project’s Karin Cadwell, PhD, RN, FAAN, ANLC, CLC, IBCLC points out that other fields have separated themselves from industry.  For instance, the Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest. The American Medical Student Association (AMSA) adopted policies opposing gifts to physicians and medical students from the pharmaceutical industry in the early 2000s. This piece describes some of the more recent policies governing physician interactions with industry. 

Yet, formula companies and breast pump companies are right in the middle of the baby feeding arena at conferences, like at  WIC (Women, Infants, and Children) and the American Academy of Pediatrics (AAP). 

Industry at conferences 

Rob Revelette MD, PhD FAAP questions the AAP’s relationship with formula companies in this essay where he notes that the AAP, both at the national and state level, accepts money from formula companies for advertising and sponsorship of meetings.https://www.metmuseum.org/art/collection/search/335169

Greed Breaks the Bag (“La codicia rompe el saco”)
Leonardo Alenza y Nieto Spanish
1807–45
https://www.metmuseum.org/art/collection/search/335169

Saroj Jayasinghe offers in Pharmaceutical industry sponsorship of academic conferences: ethics of conflict of interest, “The most definite way to prevent COI is to completely avoid industry funding of conferences…” 

Because this isn’t always feasible, Jayasinghe writes, it is crucial to establish these proposed guidelines:  “(1) avoid the sponsors having any influence on the decision-making of conference; (2) avoid promotion of specific products; (3) transparency of sponsorship; (4) develop guidelines for future interactions; (5) consider contextual factors such as the trust in the profession and social roles of physicians; (6) ensure that the long-term objective of the organisations is independent of influences of the industry.” 

Dr. Revelette points out that The Royal College of Pediatrics and Child Health and the British Journal of Pediatrics have both cut ties with formula companies. He writes that “The time for the American Academy of Pediatrics to do the same and comply with the Code is long overdue.” 

CMF companies in science 

CMF marketing commonly and effectively uses science to build brand credibility and influence the scientific community as Rollins, et al detail in Marketing of commercial milk formula: a system to capture parents, communities, science, and policy.

‘Landscapes and seaports’ (Paysages et ports de mer, dans des ronds)
Stefano della Bella Italian
1639
https://www.metmuseum.org/art/collection/search/412519

The authors detail how they misrepresent research and their sponsorship of journals and conclude “the capture of science as a strategic objective of CMF marketing fundamentally shapes medical practice in addition to boosting CMF sales. Science is used in a pincer movement: parents looking to resolve problems accentuated by marketing, with health professionals offering marketing-constructed solutions.” 

One government employee, a practicing physician, who asked to remain anonymous suggests that “most academicians can’t survive (as academicians) without getting sponsor grants for research”. That’s because public funding has decreased in the last couple of decades.  

Patricia Baird notes in Getting it right: industry sponsorship and medical research “…the pharmaceutical industry has become the single largest direct funder of medical research in Canada, the United Kingdom and the United States.”

The anonymous physician says that the number and type of potential competing interests do not tend to concern him especially when there is supplementary data available for review. 

He shares that “Most multi-center studies are done by funding from sponsors since no one Institution has deep enough pockets to do these critically important studies.  I get red flags going off and my ‘BS detector’ starts sounding when I see a small, short author list with a single sponsor funding the study that lacks supplementary data and is making extraordinary claims.” 

One of the touted benefits of working with industry in research is the development of new therapies for patients, as Baird writes and is also noted in ‘Deal with the Devil’: Harvard Medical School Faculty Grapple with Increased Industry Research Funding

However, Baird shares: “…a lack of balance in research activities, with a focus mainly on potential medications, is likely to divert talented researchers from the pursuit of profound scientific questions, or divert them from the pursuit of questions without market relevance but with an aspect of public good. A company has little incentive to support trials evaluating whether inexpensive, off-patent drugs, or whether nonpharmaceutical interventions, could replace their profitable patented drug.”

Because profits are foremost for industry, Baird continues that “it is unrealistic to expect drug companies to stop making drugs to treat diseases that result from [unhealthy behavior].”

This reality, Baird goes on, “highlights the need for funding of research into new and effective ways to get people to change behaviour, and of research into policies that provide incentives and support for healthier behaviours at a population level.” 

*Ahem… Family-friendly policies that support breastfeeding and adoption and adherence of the Code!*  One has to wonder, would maternal infant health look differently if we put as much effort into breastfeeding and supportive policies as we did responding to the formula crisis

One group, the Access to Nutrition Initiative (ATNI) conducts the BMS and CF Marketing indexes which assess the marketing policies of the 20 largest baby food companies globally. This spring, the organization released the Breast Milk Substitutes and Complementary Foods Marketing in the United States: Launch of the 2024 Country Report as a complement to the indexes. The recording of this event can be accessed here

ATNI has created a model policy for companies’ full compliance with the Code. 

Interestingly, ATNI itself has been criticized for its interactions with CMF companies. 

During the release event, ATNI presenters addressed their involvement with CMF companies. It was reported that ATNI consults independent expert groups and releases their methodology on their website. It was also stated that ATNI engages companies at certain points in their process, but that companies cannot decide whether or not they will be evaluated and do not have influence over the research results.

CMF business affairs within nations 

The United States has an enmeshed relationship with formula companies.

L’Avarice (Greed), from “Les Péchées Capitaux” (The Deadly Sins)
Jacques Callot French
ca. 1620
https://www.metmuseum.org/art/collection/search/417673

For instance, in Scorched Earth Legal Tactics author Valerie McClain illuminates that “Both the CDC and the FDA have foundations that partner with corporations that donate to their organizations. While these US governmental bodies are not allowed to take money directly from corporations, their foundations through partnerships donate for programs run by the CDC or FDA. The CDC Foundation has a long list of partners who donate various amounts.” 

McClain goes on: “From a political science perspective, corporations entangled with governmental agencies is part of the definition of fascism-a merger of state and corporate power. Every US governmental agency that I have seen has a foundation. So one gets the impression that is one way to pretend that corporations have no influence on governmental policy.” 

She details some of these relationships with specific dollar amounts in the remainder of her piece. 

In another revealing article– The U.S. Government Defended the Overseas Business Interests of Baby Formula Makers. Kids Paid the Price.— author Heather Vogell demonstrates how “the U.S. government repeatedly used its muscle to advance the interests of large baby formula companies while thwarting the efforts of Thailand and other developing countries to safeguard children’s health.” 

And there was the disgraceful act when the U.S. opposed a WHA resolution in 2018 and “blackmailed” Ecuador. 

An administrator from Breastfeeding Advocacy Australia (BAA) explains their country’s involvement with industry: “…Our Government gave the Formula Industry co-operative body, the Infant Nutrition Council (INC) a government grant to expand their international markets. This government one was for India, a country working hard to improve breastfeeding. Last government gave a grant for expansion in Cambodia, a country with historically high breastfeeding now rapidly plummeting. It is immoral and unjust. We must fight for women and babies. It gets worse here in Australia as a developed nation who is enabling this industry. One of our main research organisations SAHMRI has joint trials with Nestle and validates their participation. Unsurprisingly, the result of one trial we’ve seen requires the administration of a Nestle product as an outcome. Then our Doctor group the RACGP, the doctors that virtually all Mums and Bubs see, has their annual conference sponsored by Nestle and that’s just what we’ve seen publicly stated. There is probably much more. We have much work to do.” 

Until our governments do a better job of protecting health over profits and untangle their industry ties, how can we, as maternal child health advocates,  turn down the commercial noise when its notes seem to play everywhere? 

Steven R. Brown’s, MD, FAAFP American Family Physician editorial Physicians Should Refuse Pharmaceutical Industry Gifts offers guidance that is easily adopted for those working as lactation professionals. 

Certified Lactation Counselors should remember the specific line in the Academy of Lactation Policy and Practice (ALPP) Code of Ethics for Certified Lactation Counselors (CLC) which reads that we must “Abide by the International Code of Marketing of Breast-Milk Substitutes and subsequent resolutions which pertain to health workers.”  

The aforementioned Call to end sponsorship from commercial milk formula companies is a promising launching pad in the dismantling of inappropriate care provider- industry relationships. It signifies progress and as BAA offered, we have so much more work to do.  

 

Further reading/ related resources 

 

Brenda Hwang’s, MA, CCC-SLP, CLC, CDP light bulb moment: “My colostrum is in fact enough…”

[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 Brenda L. Hwang’s, MA, CCC-SLP, CLC, CDP illuminating moment. 

******

Myth – You have to feed formula in the beginning until your milk “comes in.”

FACT – You do not have to feed formula if you do not want to and your colostrum IS ENOUGH. 

I had an incredible breastfeeding journey with my first born that lasted a little over two years. It was difficult for me to think about other moms not having a positive breastfeeding experience. 

That is when I decided to become a lactation counselor. During my training, I remember learning about helping mothers feel confident about their milk supply (when there are no medical reasons to be concerned about). I remember being fascinated with the Baby-Friendly Hospital Initiative and researching if there were any near me for when I deliver again or to recommend my patients to go to for the most pro-breastfeeding support. Unfortunately, there wasn’t one. 

When I gave birth to my second born, I remember feeling overwhelmed by so many emotions following childbirth. I remember trying to remind myself that this was typical as our hormones are off the charts after experiencing what the amazing body just went through to bring new life into the world. I felt like there were so many things that I had little or no control over, but what I did have control over was advocating for immediate skin-to-skin and the opportunity to breastfeed my daughter. That made me feel grounded and confident. 

However, that night came and my daughter wouldn’t stop crying. The nurse would come in and out of our room always looking angry, telling me that my supply was not enough, and that I needed to give my daughter formula for her to stop crying. I kept advocating for myself and reminded my husband that –

  1. Formula was not what we planned for or want, 
  2. I have colostrum and,
  3. My colostrum is in fact enough and the best thing that we can give to our daughter right now. 

Although I knew this was true, the sad little cries broke my heart and the nurse’s comments and facial expressions made me feel uneasy. 

Even with the breastfeeding education that I had, she eventually made me believe that perhaps I was wrong and what I had was not enough for my daughter. I dozed off crying quietly to myself, feeling like a failure as a mom. This was my Ah-Ha moment. I thought, “Wow, that was terrible and unfortunately too common of an event that mothers often experience in the hospital.” I would never wish for any mom to feel that way – to feel like she is not enough, or a failure as a mom.

I am now dedicated to providing breastfeeding education during pregnancy… to help moms feel prepared for the first few moments after baby is born. I strive to find a role in the hospital in order to advocate for parents who wish to breastfeed and to provide timely interventions so that they too can have a positive breastfeeding experience. 

Thank you for reading my story.



LCTC participant fueled by daughter’s poor experiences

Shipley pictured with her grandchild.

As Tanya Shipley, a recent Accessing the Milky Way scholarship awardee, shares her experience working through the Lactation Counselor Training Course (LCTC) thus far, I sense both enthusiasm and relief.

“I love it!” Shipley exclaims. “I am learning so much stuff, oh my gosh, I love it. I  am just in awe.”

She goes on to explain that while she has always been interested in women’s health and wellness, she only became interested in maternal child health after her 35-year-old daughter’s pregnancy and birth this year.

Not unlike many women, and especially BIPOC women, Shipley’s daughter did not receive competent lactation care in the hospital.

“She was really bummed about it,” Shipley begins. “When she got home, she was having issues because she thought that she wasn’t producing enough milk. She felt like she let the baby down.”

Shipley blames some of what was lacking on her “own ignorance” as the grandmother.

At one point Shipley recalls suggesting: “Why don’t you just [give the baby] a little formula right now because she’s hungry.”

“It bothers me today because everything I am learning now,” Shipley reflects.  “It didn’t have to be that way.”

Shipley circles back to how much she is learning through the LCTC. This is where I hear a sense of relief in her tone; she is now well-equipped to share the knowledge she gains with not only new families but women her age, so that they can help their children, as she explains. It’s well-known that grandmothers have the capacity to influence exclusive breastfeeding. [More here and here.]

“After I finish a module,  I will call my daughter and I will share with her some of the things I am learning,” Shipley says.

Shipley recently left the entertainment industry and started volunteering for the Happy Mama Health Baby Alliance and Joy in Birthing Foundation. She also completed a birth doula workshop and finds herself exploring where she can make the biggest impact. She’s considering starting her own non-profit and providing lactation care in the hospital setting, fueled by the lack of care that her daughter received.

You can read more about grandmothers’ influence on infant feeding in For many, grandmothers are the village.

Medical librarian to perinatal services manager, LCTC participant strives to improve Black maternal health

Christian Minter, MSLIS is the eldest of twelve siblings. Her mother gave birth both at home and in the hospital, and she breastfed all of her children, so Minter says she was accustomed to seeing the full range of options when it comes to maternity care.

About ten years ago, Minter became interested in maternal and child health after hearing friends share their often less than ideal birth experiences. She discovered that informed choice was a rarity in their care. As Minter learned more about the disparities in birth outcomes among Black women and babies, she became passionate about working to improve Black maternal health.

At the time, Minter worked as a medical librarian supporting families with access to health information. 

“There was only so much I could do as a librarian to support maternal and child health,” Minter reflects. 

Her work evolved and in 2019, Minter began her public health graduate studies. As a project for the course Introduction to Health Disparities and Health Equity at University of Nebraska Medical Center College of Public Health, Minter created a beautiful mini-documentary about doula care for Black women. 

Minter also served as the manager of maternal infant health initiatives for March of Dimes Nebraska, Black maternal health organizer for I Be Black Girl and collaborated on the Omaha Reproductive Well-being Project

Now, Minter works as the perinatal services manager at Community of Hope in Washington, D.C. She is currently on maternity leave with her first baby who is three months old and cooed sweetly during our phone call. 

“Breastfeeding him has been an eye opening experience,” Minter shares.  “It’s one thing to talk about maternal and child health, and another to experience it firsthand. It’s giving me a greater appreciation of the breastfeeding journey of families.  It’s  increased my passion to support other families.” 

Minter shares that she had her eye on the Lactation Counselor Training Course (LCTC) for quite some time, but could never sacrifice the time away from work for the week-long, in-person training. As one of the most recent awardees of the Accessing the Milky Way scholarship, Minter says she’s enjoying the online, self-paced format and learning about the physiology of breastfeeding. 

Minter plans to use her training to support their patient population at Community of Hope. Additionally, she says she’d like to make lactation education and support more accessible to those living in Prince George County, Md., as families often need to travel outside the county for community-based support. 

Minter encourages readers to follow Community of Hope on social media. Their breastfeeding classes are open to the general public. The organization also accepts donations of supplies for families like diapers, maternity clothing and books. Check out their wishlist here and learn about other ways to support their work here.