The breastfeeding-friendly baby shower

My oldest daughter was perusing through her baby book the other night and discovered an exhaustive list of the gifts we’d received at my baby showers. Without dismissing how incredibly generous our guests were, looking back, I’d deem 90 percent of the items we received (many of which I’d registered for) useless.

Then I remembered a dear friend of mine who participated in and later facilitated a wonderful, meaningful baby sprinkle activity.

Photo by Townsend Walton

The invitation’s poem read:

Bring two matching beads 

We’ll put them on a string

For Super Mom _____ to the hospital to bring (tweak for other birthing spaces)

Armed with our bead string, she’ll have our thoughts near 

When she brings forth a child…. So dear! 

One of the beads was strung onto a necklace for the mother and the other beads were strung onto bracelets for the guests to wear until the baby was born as a way to send prayers or manifest positivity during pregnancy, birth and beyond.

How I wish I had an artifact such as this to cherish in exchange for the heaps of plastic I’d acquired at my shower!

Now, as a baby shower guest, as tempting as darling baby outfits and beautifully printed blankets are, I generally opt for gifting some of my favorite breastfeeding books like Gill Rapley’s Baby-Led series. Knowledge is an incredible gift and it will never make its way to a landfill.

Pondering more about meaningful gifts for expecting parents and their babies, I got to thinking about how the baby shower is a microcosm of parenting culture. The avalanche of baby bottles, pacifiers, swaddling blankets and other gadgets and technology instigate detachment from baby rather than bonding. So, this week, we’ve compiled suggestions on how to make a baby shower breastfeeding-friendly along with ways to use this celebration as a source of education for parents and their guests.

 

Affirmation activity 

Provide seed paper or other stationary for guests to record birth and breastfeeding affirmations to be gifted to parents.

Photo by Ermias Tarekegn

Breastfeeding in pop culture game 

Show clips of breastfeeding and parenting in pop culture and ask participants to name that show. Some examples:  General Hospital, Sesame Street, Modern Family, Blackish, The Office, Rugrats, Mr. Rogers (around 3 minutes into video)

Feeding cues game

This feeding cues game can be adapted for baby shower guests. Not only is it important for new parents to recognize feeding cues, other caregivers need to understand when it’s ideal to feed the baby as well. If those attending the shower understand feeding cues, they’ll know just when to hand back the baby to be fed!

Help for parents sign up 

Use the baby shower gathering to post a meal train, house chores, or childcare for older siblings sign up sheet. You could also use this opportunity to gather other helpful postpartum resources.

Decorating and desserts

Swap baby bottles and other gadgets for breasts.  Please note, it is advised to exercise care when dealing with breast models in childbirth and breastfeeding education as the symbolic dismembering of the female body can carry powerful negative messages, and the same care should be considered in this case. That said, these colorful, cloth breasts could be used to decorate or given out as party favors!

Try making breast cupcakes in all shapes and sizes or these fun cookies for a special treat.

Breastfeeding bingo and other lactation games

These breastfeeding bingo sheets adapted by the Missouri Dept. of Health & Senior Services could be easily tweaked for a baby shower game. Many of the activities presented in Linda J. Smith’s Coach’s Notebook: Games and Strategies for Lactation Education can also be adapted.

Try this kahoot game here or create your own breastfeeding-friendly questions. Participants can play from their smartphones.

Phone tree game

The Grandmothers’ Tea curriculum has several interactive learning activities. The phone tree activity in particular can be adapted for a baby shower game with points and prizes.

Feed me game 

Similar to popular taste testing games at baby showers, this game was inspired by Gill Rapley’s activity at an International Breastfeeding Conference to bring attention to babies’ autonomy.

Ask participants to partner up. Set out several pureed baby food jars in front of each pair. Each partner takes a turn spoon-feeding the mush to their partner. Open up  a discussion about what it was like to be the feeder and what it was like to be fed. For more information about baby-led weaning visit https://www.ourmilkyway.org/the-baby-led-way/.

Books

It is becoming increasingly popular for books to be requested in lieu of cards.

The invitation poem often goes:

In lieu of a card, please bring

Your favorite childhood classic.

Let’s build a library for _____

That will be fantastic!

So instead of a card,

to baby and mother,

please give a book,

with your thoughts in the cover.

Photo by Helena Lopes

Consider purchasing a book that depicts and normalizes breastfeeding. Some options include Katie Morag, Noey Loves Nursing, A Mother’s Milk, The Creator’s Gift and First Sacred Food developed by Great Lakes Inter-Tribal Council, Inc. (GLITC), or check out this list.

Breastfeeding-friendly cards

If you are interested in sending a card, check out Dr. Tangela L. Boyd’s greeting cards which include text that reads:

“Wishing you all the best and hoping that mom will nourish you with the milk from her breasts.”

“Breastfeeding is a precious gift. Hoping you will receive all the love and nourishment that only mom can give!”

“Now that you are here, enjoy breastfeeding for as long as you and mom desire!”

Find Dr. Boyd’s cards here.

Labor as a labyrinth 

Denise Reynolds, a doula and Birthing From Within Mentor, wrote Labor as a Labyrinth inspired by a Birthing From Within concept developed by Pam England. Pass out or have participants design a labyrinth to follow along with mother’s journey.

Please tell us what other ideas you have for making a baby shower educational and meaningful. You can email us at info@ourmilkyway.org or write in the comments section below.

Physicians as breastfeeding supporters

Photo retrieved from: https://tobacco.stanford.edu/cigarette/img0079/

“More doctors smoke camels than any other cigarette,” claims the ad from 1950. Today, it’s preposterous to imagine that any physician would align themselves with the tobacco industry. Starting  in the 1920s and continuing well into the 1950s though, tobacco companies used doctors to help them sell their products. Stanford’s Research into the Impact of Tobacco Advertising has a collection of over 1,000 advertisements that feature doctors endorsing tobacco products. 

In an eerie parallel, WHO’s February 2022 report, How the marketing of formula milk influences our decisions on infant feeding, states that “Recommendations from health professionals are a key channel of formula milk marketing. Health professionals spoke of receiving commissions from sales, funding for research, promotional gifts, samples of infant and specialized formula milk products, or invitations to seminars, conferences and events.” (p. 7) 

Last week, Nikki Lee, RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, RYT500 and I shared our reflection on the forces that shape physicians’ personal infant feeding experiences. In this second installment, we explore how physicians as professionals can support breastfeeding despite being targeted by the breastmilk substitute (BMS) industry and despite generally being woefully equipped with proper lactation education, training and counseling skills. These predicaments can lead physicians to “explicitly or inadvertently, introduce doubts around the ability of women to breastfeed and the value and quality of their breast milk.” (WHO, p. 12) 

 

Pervasive industry influence for generations

Because “health professionals are among the most respected and trusted members of society…[their] advice…is highly influential for pregnant women and parents of infants and young children, including around infant feeding decisions.”  Formula milk companies exploit this relationship of trust. (WHO, p. 12)

Source: United States Breastfeeding Committee

BMS representatives target physicians “with a range of incentives, including funding for research, commissions from sales, ambassadorial roles, merchandise, gifts and all expenses paid promotional trips.” (WHO, p.13) 

The psychology behind gift-giving, both big and small is that “ it imposes…a sense of indebtedness…. The…rule of reciprocity imposes…an obligation to repay for favors, gifts and invitations…” (Katz 2003) Instead of supporting infant feeding purely through a health and wellness lens, physicians feel obliged to a company muddying their relationships with their patients. 

Interestingly, most physicians feel immune to marketing’s influence, despite clear evidence to the contrary, Frederick S. Sierles, MD lays out in The Gift-Giving Influence

Curious consumers can search their doctors’ names through ProPublica’s Dollars for Docs project to learn about gifts they have accepted. 

 

Mechanical culture 

Our culture fails to acknowledge the mother baby unit as a dyad, and this influences the way physicians can support breastfeeding too.

Source: United States Breastfeeding Committee (USBC)

“We are never taught, in our fragmented system, that the mother and baby are a unit,” Lee reiterates. “OB/GYN/midwife sees mama; peds sees babies. There are even different places for them in the hospital: nursery, postpartum unit. What a struggle we had with the BFHI to keep mother and baby together.” 

[As a side, Attorney Leah Margulies recently shared in Protecting Breastfeeding in the United States: Time for Action on The Code that formula companies provide architectural designs to maternity care facilities in a deliberate attempt to separate dyads.] 

The Alliance for Innovation on Maternal Health’s (AIM) Patient Safety Bundles offer models for how health professionals can use task force approaches that break down silos of care and open channels of communication. The strategies used in these bundles aim to ultimately shift from fractured care to continuity of care where the dyad is protected.  

We must also consider how physicians are compensated for their work. In the current U.S. healthcare system, physicians find themselves paid in Relative Value Units (RVUs), which bluntly put, is a pretty mechanical way to value providing care to other humans, as we mentioned in our first installment. In short, the more RVUs a physician racks up, the more they’re paid. Breastfeeding counseling takes time.

 

Inadequate education 

How are physicians to spend time with their patients, educating and supporting breastfeeding when they’ve had little to no breastfeeding education invested in them? Dr. Nigel Campbell Rollins pointed out in WHO’s How the marketing of formula milk influences our decisions on infant feeding webinar that faculty in medical schools themselves sometimes believe that formula products are inevitable or necessary. 

A cross-sectional study in the UK suggests that UK medical schools are not adequately preparing students to support breastfeeding patients.  

Source: United States Breastfeeding Committee

Samantha A Chuisano and  Olivia S Anderson’s findings in Assessing Application-Based Breastfeeding Education for Physicians and Nurses: A Scoping Review “… align with existing literature in finding a dearth of high-quality studies assessing breastfeeding education among physicians and nurses. The variability in teaching and evaluation methods indicates a lack of standardization in breastfeeding education between institutions.”

Elizabeth Esselmont and colleagues’ piece Residents’ breastfeeding knowledge, comfort, practices, and perceptions: results of the Breastfeeding Resident Education Study (BRESt) concludes: “Pediatric residents in Canada recognize that they play an important role in supporting breastfeeding. Most residents lack the knowledge and training to manage breastfeeding difficulties but are motivated to learn more about breastfeeding. Pediatric program directors recognize the lack of breastfeeding education.” 

 

A collection of physicians’ stories 

Often, it is a physician’s own struggle to breastfeed that seems to spur advocacy and change. Our Milky Way’s repository includes a breadth of physicians’ stories of personal struggles that have inspired them to become breastfeeding champions for their patients and communities. 

Source: United States Breastfeeding Committee (Photo by Sara D. Davis)

Some of those stories are linked below: 

Sarah Jacobitz-Kizzier, MD, MS, in Resident physician advances breastfeeding support,  shares that her lactation education in medical school included a one hour lecture about the anatomy of the breast and a brief discussion in physiology about lactogenesis.

“There was no training about [breastfeeding] technique, no discussion about common problems before discharge, no training about clinical problems as far as in the first few months postpartum…when to introduce complementary food,” she continues.

Physician calls for peer breastfeeding support features the work of Colette Wiseman, MD, CLC. 

In Breastfeeding in the healthiest county in Virginia, Janine A. Rethy, MD, MPH, FAAP, FABM, IBCLC, a general pediatrician in Loudoun County, Va. describes her dedication to improving breastfeeding outcomes. In it, she shares a resource she and her colleagues created –the Breastfeeding Support Implementation Guide for the Outpatient Setting which includes information on how to bill insurance for lactation services.

Skin to skin in the OR showcases Rebecca Rudesill’s, MD, CLC quest for more breastfeeding education. 

Kristina Lehman’s, MD, CLC work is featured in Internist looks to augment breastfeeding education

James Thomas Dean III, DO and Assistant Professor of Pediatrics at the University of Texas San Antonio Dr. Perla N. Soni, MD share their perspectives in Lack of breastfeeding education in med school harms families

Alison Stuebe, MD, MSc tackles big topics in OB/GYN sheds light on breastfeeding culture.

We are honored to have been able to feature the work of the late Audrey Naylor in Commendable contributions to the field of lactation. ​​With a lifetime interest in illness prevention, Naylor said she was quickly convinced of the power of breastfeeding after only attending a few hours of a breastfeeding seminar in 1976.

“Neither medical school nor pediatric residency taught me anything about breastfeeding,” Naylor said.  

Elizabeth Sahlie’s, MD, FAAP and Jesanna Cooper’s, MD work is featured in Birmingham Mother-to-mother support helps moms reach feeding goals. Cooper says that before she became a mother, she had no idea that her medical training and education had been so lacking.

“It is easy to become frustrated with nurses and physicians who – often inadvertently sabotage breastfeeding mothers and babies, but I also sympathize,” she explains. “We are in a position where we are supposed to have answers, but no one has taught us the skills necessary to provide those answers.”

Other stories and models for care 

Lori Feldman-Winter’s, et al  Residency curriculum improves breastfeeding care showed that “a targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.

 As part of their work to build a cohort of breastfeeding-friendly pediatricians, the Georgia Chapter of the American Academy of Pediatrics and the Georgia Breastfeeding Coalition launched a “Breastfeeding-Friendly Pediatrician Interest Form.” Georgia pediatricians who are interested in becoming certified as a “Breastfeeding-Friendly Pediatrician” are invited to fill out the form.

 

Further reading and resources

Physicians, Formula Companies, and Advertising: A Historical Perspective

Inspire Health, CHAMPS,  and the University of Mississippi Medical Center’s Breastfeeding, Human Medicine,  Interprofessional Education training   

CDC Physician Breastfeeding Education  

What Every Physician Needs to Know About Breastfeeding from the W.K. Kellogg Foundation

The Institute for the Advancement of Breastfeeding & Lactation Education (IABLE) is a nonprofit membership organization whose mission is to optimize the promotion and support of breastfeeding for families in the outpatient sector. IABLE is dedicated to building Breastfeeding Knowledgeable Medical Systems and Communities. 

Academy of Breastfeeding Medicine (ABM) Breastfeeding-friendly Physicians protocol 

 

Physician group position papers and recommendations on breastfeeding 

American Academy of Pediatrics (AAP)

American Academy of Family Physicians (AAFP)

The American College of Obstetrics and Gynecology (ACOG)