During the first week of April each year, the American Public Health Association (APHA) brings together communities to observeNational Public Health Week. This year’s theme is Centering and Celebrating Cultures in Health and highlights the importance of fostering cultural connections to health and quality of life.
Last month, we celebrated National Nutrition Month, an annual campaign by the Academy of Nutrition and Dietetics which highlights the importance of making informed food choices across the lifespan.
The initiative is supported by the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity (CDC/DNPAO). NACCHO selected seven communities to strengthen community lactation support through the implementation of the Continuity of Care in Breastfeeding Support: A Blueprint for Communities from November 2022 to July 2023. The purpose of this project is to support the implementation of CoC strategies by local-level organizations among oppressed communities with historically low rates of chest/breastfeeding. [https://www.naccho.org/programs/community-health/maternal-child-adolescent-health/breastfeeding-support#early-childhood-nutrition]
Photo by Roderick Salatan
The dietary resources which include an Educational Handout from Dietary Guidelines, Nutrition Resource Directory, and social media posts can be found here, available in English, Chinese and Vietnamese. The materials include a dietary guidelines hand out with two toddler-friendly recipes (with a fun suggestion to use green onion to decorate steamed eggs), three social media messages with a timeline for infant feeding, human milk recommendations, and complementary food recommendations, all commonly eaten in Asian communities. The deliverables are full of color and easy to navigate.
Li, Young and their team’s work was community-informed, standing by the sentiment, “Nothing about us, without us.” The team spoke with community members about eating habits and learned that families do not eat according to the MyPlate graphic. Instead, they enjoy their meals in family-style servings from bowls. Recipes developed were tested by community members with children and tailored according to their suggestions; for example, the addition of different dipping sauces.
Participants also offered feedback stating that they appreciated the accessibility of the ingredients.
–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 allhere.
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!
A mammal is an animal of the class Mammalia, an animal that suckles its young. Mammal is the 1800’s Englished form of the Latin “Mammalia” (1773). Dissecting the word further, it was coined in 1758 by Linnaeus for the class of animals from the neuter (things that have no gender) plural of Late Latin mammalis “of the breast.” [https://www.etymonline.com/word/mammal]
Photo by Kym Ellis on Unsplash
Photo by Sangeet Rao
Photo by Vik Joshi
Photo by Chris Stenger on Unsplash
Predating language, milk and lactation are ancient; in fact, the origins may date as far back as 300 million years ago, according to scientist Mike Power, who curates and maintains the Smithsonian’s National Zoo’s milk repository, as reported by Catherine Zuckerman. That makes mother’s milk older than dinosaurs!
Since those many, many million years ago, mother’s milk, the “magic potion”, has been shaped by natural selection and has diversified among the thousands of mammals that are living today, Katie Hinde has explained. Species specific milk has allowed mammals to live in environments in which the young could not otherwise survive and to cope with unreliable food sources. This evolution to support infants while they’re developing has led to important mammalian adaptations like complex social relationships, Hinde goes on. The first social (and sometimes the only) encounter for mammals, is with their mothers.
Juan Brines and Claude Billeaud so graciously offer “a testimony of gratitude and respect to women who have assumed the responsibility of breastfeeding their infants because without them the human species would not have existed” in Breast-Feeding from an Evolutionary Perspective.
Check out Hinde’s March Mammal Madness inspired by the NCAA College Basketball March Madness Championship Tournament. This year’s fun and results can be found here.
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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:
Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.
This week, in the body of the email, please share with us: What is one of your earliest memories of infant feeding?
Subsequent weeks will have a different prompt in the blog post.
We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag, and this week we have made it to our tenth week celebrating Our Milky Way!
Breastfeeding is an opportunity to learn. Although breastfeeding is an ancient practice, there is still so much to learn about the lactating breast, breast function and the process of breastfeeding, especially as our modern lives continue to change.
“…Few studies have actively investigated the anatomy of the lactating breast despite the obvious importance a clear understanding of the lactating mammary gland has to both mother and infant,” Geddess writes. “Perhaps this lack of information is a part of the greater reason why many women continue to experience breastfeeding problems.”
Katherine Lee writes in Katie Hinde Championing the Fun Side of Science Through Virtual Animal Games, Thunderdome Style about Hinde’s hope to change the perception about breastmilk and quotes her saying “‘Still to this day, there is no integration between breastfeeding and milk composition and volume,’ noted Hinde. ‘In Pubmed, there are more articles about tomatoes than human breast milk.’ When they listed the human microbiome project, they didn’t include breastmilk…”
This week we present several recent (in the last 5 years) publications that are helping to shape our understanding of infant feeding. We have also included studies that relate specifically to pregnancy as pregnancy, birth and breastfeeding are all part of a continuum.
It is important to note that research published in medical journals is not the only way to capture and develop an understanding of infant feeding experiences. For instance, Camie Jae Goldhammer, MSW, LICSW, IBCLC, (Sisseton-Wahpeton), founder of Hummingbird Indigenous Doula Services says that their program is proudly not rooted in “evidence”; instead, it’s a community designed program. Anecdotal evidence and indigenous knowledge and wisdom should be honored. Moreover, as with any research, we must always consider how the research is funded, who is or is not being represented, and how the research is presented. For more on equity in science, check out Increasing equity in data science and the work being done at the Urban Indian Health Institute.
Stroke is a growing global health problem. It is the third leading cause of disability adjusted–life years (DALYs) worldwide and the first leading cause of DALYs in China, Ren, et al point out. Stroke imposes a financial burden on patients, families, and society. The cohort study found that lactation duration significantly lowers the risk of stroke.
Up until now, most research has focused on the association between lactation and cardiovascular diseases (CVDs), but this piece lays out the association between lactation and stroke subtypes.
Specifically, the study found that parous postmenopausal women with lifetime lactation duration of at least 7 months had lower risks of ischemic stroke and intracerebral hemorrhage (ICH) compared with women who never lactated. For subarachnoid hemorrhage (SAH) though, such associations were found only in participants with lifetime lactation duration of longer than 24 months. In addition, the authors found that those with an average lactation duration per child or lactation duration for the first child of at least 7 months were less likely to develop stroke and its subtypes.
The systematic review and meta-analysis demonstrated higher rates of low birth weight (<2500 g) and small for gestational age (<fifth percentile), lower mean birth weight, preterm delivery (<37 weeks’ gestation), higher rate of admission to the neonatal intensive care unit, poorer Apgar scores at 1 minute, and smaller head circumference in those exposed to marijuana.
The prevalence of marijuana use during pregnancy is significant, and many people cite the belief that marijuana use is relatively safe during
pregnancy. This work may help to raise awareness and be used to educate patients about adverse outcomes with the hope of improving neonatal health.
More on cannabis during the perinatal period here.
Childhood obesity
The authors of Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties-Spatial Analysis of the Lactation Support Landscape examined the relationship between childhood obesity and breastfeeding rates in Pennsylvania (PA) counties, the relationship between geographic access to professional lactation support providers (LSPs) in PA counties and breastfeeding rates, and the relationship between geographic access to professional LSPs and childhood obesity in PA counties. They found a significant, inverse relationship between breastfeeding rates and childhood obesity prevalence at the county level and a significant, inverse relationship between the number of CLCs and the number of all professional LSPs and childhood obesity rates at the county level. Thus, the authors conclude, the availability of breastfeeding support is significantly related to breastfeeding rates and inversely related to childhood obesity rates across Pennsylvania.
More specifically, the algorithm provides a tool to help reduce delays or decrease interruptions during skin-to-skin contact (SSC). The authors note, “Not suckling in the first hour after birth places newborns at higher risk for neonatal morbidities and mortality. Examining patterns and developing strategies for change optimizes patient outcomes.”
Acknowledging the social determinants of health
Pregnancy and the origins of illness(2022) by Anne Drapkin Lyerly begins by acknowledging that the COVID-19 pandemic has induced a collective trauma that is expected to be felt for generations after the virus is contained. The study of epigenetics has shown that children gestated or born during times of great tragedy, carry a genetically coded and inherited imprint of their mother’s experience with lifelong consequences to their health.
Photo by Jenna Norman on Unsplash
Photo by Nathan Dumlao on Unsplash
Photo by Guille Álvarez on Unsplash
Recognizing the “maternal-fetal interface” as the “nexus of inter-generational trauma” raises the question of how we should think about this implication of maternal bodies, especially in light of the current pandemic.
The author explores the growing field of developmental origins of health and disease (DOHaD) and its use of epigenetics. Thinking about the tools of history, philosophy, and gender studies of science, the author advises we proceed with caution as we consider maternal effect science which raises several concerns that can impact practice and the well-being of mothers and consequently their children.
Namely, there may be a tendency to ascribe blame on pregnant people for the health outcomes of their offspring that are well beyond their control. This approach doesn’t adequately weigh the effects of paternal, postanal, and other social and environmental factors that also influence the long-term health of children.
Analyzing epigenetics can eventually contribute to the erasure of the mother as a person, and further, characterizing the maternal body as an environment may excuse women from being appropriately considered in public health policies, clinical care and health research.
The author considers DOHaD research a corrective approach to near-sighted fetal origins science and urges that we expand our understanding of the gestational environment from not simply the womb, but to the broader environment in which a person gestates, marking the importance of acknowledging the social determinants of health. To best direct our efforts during the current pandemic, the author suggests shifting the focus off of maternal behavior and choices and instead focus on limiting the harm of climate change, racism, and other structural inequities.
Can’t get enough?
Check out the Breastfeeding Medicine Podcat’s episode Review of a Potpourri of Research Topics with co Hosts Anne Eglash MD, IBCLC and Karen Bodnar MD, IBCLC. You can find a full list of their podcast episodes here.
As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:
Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.
This week, in the body of the email, tell us: What fascinates you about breastfeeding and/or what do you wonder about breastfeeding?
Subsequent weeks will have a different prompt in the blog post.
We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.
Through mother’s milk, human infants are “exposed to a bewildering variety of flavors that influence subsequent liking and choice.” [Beauchamp & Menella]
Differently, baby milk substitutes (BMS) or baby formulas offer static flavor. Formula manufacturers are only able to add flavoring to follow-on formulas at which point, it is too late to stimulate flavor detection, explains Dr. Julie Menella.
Photo by Tamilles Esposito
Photo by Ganta Srinivas
A breastfed baby experiences textural variations such as viscosity and mouth coating so “breastfeeding provides an even richer variation in oral sensory stimulation,” as recorded in Flavor Perception in Human Infants.
Before birth, flavor learning begins around the sixth month of gestation when the fetus begins to inhale and swallow amniotic fluid marking its first chemosensory experiences. [Thomas, 2022]
Photo by Amina Filkins
The flavors a baby is exposed to signal things like the flavors of one’s culture, which foods are safe to eat, and biodiversity which later impacts food choice thereby affecting overall health and wellness.
Mennella makes clear, “breastfeeding confers greater acceptance of healthy foods…only if they are part of the mothers’ diet…”
One study which looked at the effects of maternal garlic ingestion on the odor of milk and the suckling behavior of the infant, found that the nursling detected changes in mother’s milk and stayed attached to the breast for longer periods of time, sucked more when the milk smelled like garlic, and tended to ingest more milk.
Similar findings were noted when vanilla ingestion was investigated.
Just as infants can detect the flavors of healthy and aromatic foods in their mother’s milk, they can also detect those of potentially harmful substances. For instance, Menella found that “infants can readily detect the flavor of alcohol in mother’s milk but…the decrease in consumption at the breast after maternal alcohol consumption is apparently not due to the infants rejecting the flavor of alcohol in their mothers’ milk.”
It has also been found that babies can detect the flavors in cigarettes in breastmilk. Still, the researchers note, “We do not suggest that lactating women who smoke occasionally should stop nursing. However, the knowledge that the milk of mothers who smoke smells and may taste like cigarettes provides an additional reason to avoid smoking.”
Photo by Derek Owens
As artificial sweeteners gain prevalence in the food industry, Philip O. Anderson’sHow Sweet It Is: Sweeteners in Breast Milk summarizes current knowledge regarding the transmission of sweeteners into human milk.
As infants transition to complementary feeding at six months of age, the flavors they’ve already been exposed to in utero and through breastmilk will help them to explore a breadth of healthy table foods. While human milk is meant to be the primary staple of infants’ diets, human milk alone cannot provide everything babies need nutritionally, especially micronutrients like zinc and iron. [More on appropriate complementary feeding here— Food before one is NOT just for fun.]
Newer research is starting to investigate odor-active volatile compounds in preterm breastmilk and the effect of smell and taste of milk during tube feeding of preterm infants. Find some of those studies here, here, and here.
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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:
This week, in the body of the email, tell us: Do you have a funny infant feeding story?
Subsequent weeks will have a different prompt in the blog post.
We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.
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