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. 



Nurturing care is critical to improving health outcomes

Photo by Greta Hoffman

A friend recently told me, “I vowed to never use the word ‘diet’ in front of my daughter.” She explained how as she was growing up, her mother was fixated on dieting, and how that affected her relationship with food and her body image. I sympathized. My grandmother was a model, and I grew up in a ballet school, so body image was always at the forefront of my existence. My friend and I discussed the challenge of modeling healthy eating for our kids when we ourselves have been inflicted with such detrimental habits; things like eating in secrecy and restricting calories. 

Our conversation segued, soon chatting about convenience and ultra processed foods, what exactly are healthy choices?, and this incessant feeling of being rushed. We lamented about the after-school pace: hurry-up homework, hurry-up mealtime, hurry-up extra-curriculars, hurry-up bedtime.

Photo by August de Richelieu

The time to model healthy eating and the ability to engage socially over a meal is so condensed, families often forgo the art of dining and sharing meals entirely. Many of us have fallen to “the packet apocalypse”, propped bottles, hurled yogurt tubes to the back of the van, and scarfed- down burgers from the drive-thru.

Checking my email later this day, I was pleased to find Global Health Media’s recent announcement of their Nurturing Care Series.  While the 10-video collection is intended for health workers and not necessarily for direct family use, the resource felt like the perfect reminder of the importance of prioritizing responsive, nurturing and reciprocal interactions in all of our behavior, including meal time. 

Photo by Keira Burton

Global Health Media’s series is in partnership with USAID’s Responsive Care and Early Learning (RCEL) project which focuses on “good health, adequate nutrition, safety and security, responsive caregiving, and opportunities for early learning” as critical components to improving early childhood development (ECD) outcomes. 

“Integrating responsive care and early learning messages into existing nutrition counseling has significant potential to improve both nutrition and ECD outcomes,” the organization’s Advancing Nutrition page states. 

Over the years, Our Milky Way has produced quite a collection highlighting responsive feeding and interactive relationships. Stewed in a bit of irony, as I write to you from the glow of my computer, I’d like to spend this week resurfacing these pieces. 

 

 

 

  • Photo by Luiza Braun

    Mother and bab(ies) attend and respond to one another facilitating nourishment, the flow of hormones, immunity, learning and bonding, comfort, fun, an all-encompassing sensory experience that has generational impacts on social, emotional and physical health. Breastfeeding is collaborative covers the intimacy of the breastfeeding dyad up to breastfeeding as a collaborative global food security system. 

 

 

  • Cindy Turner-Maffei’s coverage of the “Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives” conference… well, it’s really all in the title. 

 

  • Humans are carry mammals, not nest or cache animals. Baby-wearing facilities things like  the development of healthy physiological functions to providing a interactive social interactions for infants and young children, where they are included in the “action” rather than strapped into devices with little stimulation. Babywearing as a public health initiative  highlights Rebecca Morse’s work and further explores the importance of baby wearing.

 

 

  • Finally, we couldn’t close out without noting skin-to-skin, where connections are first fused outside of the womb. Find Our Milky Way’s collection on skin-to-skin and kangaroo mother care here and here

The elegant and complex systems of flavor and nutritional programming

— This post is part of our “Where are they now?” series where we catch up with some of our very first Our Milky Way interviewees from over a decade ago! — 

“The societal and clinical impact of promoting sustainable food habits is significant, since what a child eats determines in part what the child becomes. (Mennella, et al, 2020, p. 291)

 

The pop of poppy seeds in aloo posto, cough-inducing spice in stir-fried lotus root with chili peppers, the meaty texture of a bowl of Cuban black beans. 

The dishes we crave tell stories. 

“Our food preferences have meaning,” Julie Mennella, PhD begins. “They’re more than just a source of calories. Food preferences provide families with identity.”

[Rough Translation’s Tasting at a Distance and Forgotten Foods of NYC’s Appetite for Home — Bitter-Sweet Memories of Learning to Cook & Eat in America both present beautiful audio embodying these connections.]

Elegant and complex learning systems 

The multidimensional interactions we have with food begin with our mothers. A fetus is passively exposed to the flavors of the biological mother’s diet through amniotic fluid, and the infant goes on to interact with these flavors through human milk. Mennella and her colleagues have called this “intimate bidirectional chemosensory communication.” (Mennella, et al, 2023)

In this complex communication, “diet and xenobiotic exposures of the lactating parent, due to lifestyle choices or necessitated by medical treatments, affect not only milk production and milk composition but also the infant’s biological responses, either beneficially or adversely,” the authors continue. “Developing alongside the chemosensory signaling is the seeding and maturation of the infant microbiome, which transfers and exchanges with that of the parent and of the milk, forming additional bidirectional linkages.” (Mennella, et al, 2023

Infant formulas, although available in many varieties, do not foster this elegant exchange and where developing food preferences are concerned, present a static flavor.

“That constant flavor doesn’t reflect the culture [a child] will grow up in,” Mennella comments.  

The same goes for infants fed jarred and pouched baby foods (what we’ve referred to as “the packet apocalypse” where the convenience of “ready-to-feed-super- glop” has largely replaced the art of dining and sharing meals.) The explosion of the baby food industry means parents often don’t feed their children what they themselves eat. Families can feed their babies canned peas, but never eat a pea themselves, Mennella points out. 

Mennella’s research has always been interested in flavor and nutritional programming in humans and the development of food preferences, but over the last decade, it has diversified to ask questions about the taste of pediatric medicines from a personalized medicine perspective, determinants of sweet and salt preferences during childhood, the development of psychophysical methods to study olfaction, taste and chemesthesis across the lifespan, biomarkers for dietary intake across the lifespan, and reproductive state effects on dietary intake and weight loss in women. [Retrieved from: Monell Center

Collective, family- focused approach

Mennella summarizes a few key points from her work. 

“Children live in different sensory worlds,” she says. ”They are really sensitive to the current food environment.” 

And like she and her colleagues have written, the food environment rich in added sugar and salt that caters to preferred human taste, provides challenges for all of us. 

“Fortunately, our biology is not necessarily our destiny. The plasticity of the chemical senses interacts with experience with foods to modify our preferences, producing an interface between our biology and our culture, our past and our present.” (Mennella, et al, 2020, p. 291

In order to influence our destiny, Mennella says that the strategy can never be for the child alone. She suggests there be more attention paid to the family as a whole in order for healthy behaviors to be sustainable. 

She nods to the success of peer counseling programs and recommends bolstering these opportunities for families to interact and learn from one another. She says she envisions primary care taking on a community approach to provide not only a forum for education but also opportunities for interaction between families.  

Where science and policy meet 

Mennella recognizes that ultra-processed, convenience foods are palatable and often inexpensive and deems this a “much bigger issue.” 

Her research has guided national and global health initiatives like the USDA and HHS Pregnancy and Birth to 24 Months (P/B-24) Project, the Breastmilk Ecology and the Genesis of Infant Nutrition (BEGIN) Project, and the World Health Organization’s (WHO) Commission on Ending Childhood Obesity. [WHO recently released its new guideline for complementary feeding of infants and young children 6-23 months of age. Read about it here.]  

As science evolves– where the picture gradually becomes more crisp and for every one question asked, fifty more arise– policies and practice must reflect and catch up to the robust body of evidence in order to best support child and family health.  

Read our 2012 coverage with Dr. Mennella here



Recent happenings linking maternal child health and planetary health

Late this autumn, I went for a hike with my family that moved me to tears. As I looked over the rolling foothills cascading in green, its beauty, while simultaneously reflecting on the horrors in this world, provoked a surge of emotion like the swell of ocean waves just over the mountain range we perched upon. 

I shared this experience with one of my dearest mentors and she replied: “I also find nature a powerful midwife and teacher about life. I remember being moved to tears by redwoods standing firm bearing deep gouges and gaping wounds from lightning strikes and subsequent fires… yet continuing to grow and foster another generation.” 

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

When I returned to my neglected inbox after this respite hiking and exploring new-to-me land, I came across the juxtaposed images of a human fingerprint and the dissection of a tree trunk suggesting that ‘we are nature’. 

With my mentor’s poetry in mind and the concept of “human nature,” I’d like to invite you to explore the following happenings, documents and projects as they all pertain to the inextricable connection between planetary and human health and the influence of infant and young child feeding practices on greater population health, a concept coined One Health

First up, the 46th Session of the Codex Alimentarius Commission (CAC46) came to a close this month. The CAC is a UN body established by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) in 1963 with a mission to protect consumer health and promote fair practices in food trade.

The International Baby Food Action Network (IBFAN) participated in the session, and as the organization reports:  “After more than a decade of challenging negotiations within the industry-dominant Nutrition Committee, the Revision of the 1987 Follow-up Formula Standard has been officially adopted this week – now renamed the Standard for Follow-up Formula for Older Infants and Product for Young Children.

Thanks to the relentless advocacy efforts of IBFAN, WHO, UNICEF, public interest NGOs, Brazil, Ecuador, Nigeria, and numerous [other] countries, the new standard now makes specific references to the International Code of Marketing of Breastmilk Substitutes and relevant WHA Resolutions in a Preamble. Despite sustained opposition from the USA, these safeguards were retained during CAC, although some of IBFAN’s warnings were removed from the CAC46 report.” 

You can find more detailed coverage at the Baby Milk Action blog here

Also this month, WHO hosted a webinar covering the release of the new WHO guideline for complementary feeding of infants and young children 6-23 months of age

Dr. Francesco Branca began by pointing out some hopeful news.

“The past decade we have seen important gains in improving maternal and child nutrition, including a one-third decline in the proportion of children suffering from stunting, and a tend point increase in exclusive breastfeeding on the way to reaching the 2025 World Health Assembly nutrition target of 50 percent of infants below six months exclusively breastfed. Yet multiple forms of malnutrition, poor growth, micronutrient deficiencies and overweight continue to jeopardize children’s ability to survive and thrive…” 

Dr. Larry Grummer-Strawn summarized that while some of what is in the report is repetitive, there are several key updates. 

For instance:

  • “Milks 6–11 months: for infants 6–11 months of age who are fed milks other than breast milk, either milk formula or animal milk can be fed… Milks 12–23 months: for young children 12–23 months of age who are fed milks other than breast milk, animal milk should be fed. Follow-up formulas are not recommended… (p. 15)
  • “Starchy staple foods should be minimized. They commonly comprise a large component of complementary feeding diets, particularly in low resource settings, and do not provide proteins of the same quality as those found in animal source foods and are not good sources of critical nutrients such as iron, zinc and Vitamin B12. Many also include anti-nutrients that reduce nutrient absorption. (p. 24) 
  • “Foods high in sugar, salt and trans fats should not be consumed… Sugar-sweetened beverages should not be consumed… Non-sugar sweeteners should not be consumed…Consumption of 100% fruit juice should be limited…” (p.32) 

There is also an emphasis on responsive feeding (pages 43 to 47). 

Around 38 minutes into the recording of the webinar, Grummer-Strawn recognizes the reality of consumption of unhealthy food and beverages, the convenience of UPFs and calls on the need for broad policy actions to protect child health. 

Finally, Conference of Parties (COP) 28 wrapped up this month. At COP27, Healthy Children Project’s (HCP) Karin Cadwell presented research on the environmental impact of powdered baby formula milks in North America and HCP’s Kajsa Brimdyr on skin-to-skin contact (SSC) in the first hour after birth as a simple and easy, inexpensive, appropriate for all dyads with countless benefits intervention. (Read more coverage here.) 

Notable from this year’s session, among other important endeavors, includes work by the London School of Hygiene and Tropical Medicine (LSHTM) like the Children, Cities and Climate Action Lab and a partnership to understand how floods and heat driven by climate change affect the delivery of maternal and child health care in Brazil and Zambia

For further reading on climate action, check out Hidden Brain’s newsletter blurb:

“Psychologists have studied how to raise awareness about climate change and get people to take action on the issue. The answer can vary depending on a range of factors, like culture, age, gender, political ideology — the list goes on. An international team of scientists behind a recent paper has created a tool that shows which messages and interventions are most effective with different demographics. ‘To maximize their impact, policymakers and advocates can assess which messaging is most promising for their publics,’ said study co-author Kimberly Doell, who also helped lead the project. Check out the tool for yourself here.

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.   

___

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