Gestational carrier provides milk for babies born via surrogacy

Erin Graham suffered six bouts of mastitis and a subsequent antibiotic allergy while breastfeeding her firstborn. Moreover, when her daughter was just five weeks old, Graham required emergency surgery for gallstones she’d developed. The care team reported that she would need to pump and dump her milk on account of the anesthesia, but Graham made a point to connect with a lactation care provider who dispelled this misinformation.

Photo courtesy of Erin Graham

Despite it all, Graham persevered and went on to breastfeed her daughter for a year.

When her son came along, breastfeeding proved much easier.

“Breastfeeding my son was a piece of cake,” she recalls.

Becoming a mother was the most transformative and defining experience of her life, Graham goes on to say. So, when she witnessed friends and family members struggling to create and grow their own families, she felt especially touched and inspired. That’s when she applied to become a gestational carrier (surrogate). Graham has given birth to three babies as a gestational carrier since then and has pumped milk after each pregnancy.

The decision to pump milk for her surrogate babies started with a simple conversation early on in the surrogacy process, during match meetings where prospective surrogates and intended parents connect. Graham says there was never any pressure from any parties.

“It was all just gratitude and positivity,” she remembers. The first intended mother she worked with would even make her snacks to help keep her energy up while pumping around the clock.

During her first two experiences, the families were local, so they would coordinate meet ups to drop off the milk. She and her family became quite close to both of the families, so she found herself sometimes pumping at their houses during get togethers.

After her final surrogacy, Graham and the family coordinated shipping through FedEx, and while Graham says she’s  heard horror stories of lost and thawed milk upon arrival, she never experienced any of these misfortunes.

When one of the families decided that they no longer needed Graham’s milk, she was connected to another family whose surrogate was unable to provide milk. Graham wasn’t ready to wean, so she provided milk for this infant instead. It’s one of her favorite infant feeding stories.

Graham shares how her experiences breastfeeding and pumping were so different. While breastfeeding, Graham says she never thought about how many ounces of milk she produced; instead, she focused on her babies’ cues. While pumping, she didn’t have the babies’ cues to prompt her, so she’d rely on an alarm and found that she became quite focused on her output. Pumping also required her to hone in on her organizational skills, making sure the freezer bags laid just right so that she could store and package them most efficiently.

Graham has remained deeply connected to the infertility and surrogacy space and has worked for a surrogacy agency and fertility marketplace where she helped both intended parents and surrogates find the agencies and clinics that fit their particular needs and desires.

In order to best serve her clients, Graham recently completed the Lactation Counselor Training Course (LCTC).

Having had the vastly different experiences of directly breastfeeding her own babies and pumping milk for her surrogate babies, now coupled with the LCTC training, Graham offers a unique perspective to her clients.

Graham has been featured in a GoStork Q&A where she offers more of her experience as a surrogate and fertility care advisor. You can find that here.

Centering and celebrating cultures in health: Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities

During the first week of April each year, the American Public Health Association (APHA) brings together communities to observe National 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.

Photo by Angela Roma

A beautiful example of the convergence of these two themes is work being done by the Asian Pacific Islander Breastfeeding Task Force (APIBTF) a part of  Breastfeed LA, tailoring the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities. This project augments APIBTF’s sister organization Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Continuity of Care (CoC) Blueprint Project Prenatal Toolkit for AANHPI families. The prenatal toolkit was adapted from an existing toolkit in Alameda County, and is available in English, traditional Chinese, and Vietnamese.

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. 

Judy Li and Cindy Young presented their work during NACCHO’s The First 1,000 Days Nutrition: Improving Nutrition Security for Infants and Toddlers in Communities of Color where the Improving Infant and Young Child Nutrition during the first 1,000 days in Communities of Color summary report was introduced. 

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. 

 

Helpful links

ASAP!’s Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Social Media Toolkit 

National Public Health Week’s shareables and toolkit (available in Spanish)  

USDA’s Dietary Guidelines for Americans (2020-2025)

The Association of State Public Health Nutritionists (ASPHN) brief on Transition Feeding 

Public Health Nutrition Deserves More Attention

Undernourished and Overlooked

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!

Breastfeeding is mammalian.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is mammalian.

(Okay, there are also the non-mammals who “produce nutrient-rich elixirs” to feed their young, including flamingos, cockroaches and male emperor penguins, and a species of jumping spider.)

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]

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.

 

Additional resources

Healthy Child Manitoba put together “Mammals: Feeding their babies since the beginning of time” which can be used as a breastfeeding lesson in a variety of settings.

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.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

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.

Many current textbook depictions of the anatomy of the lactating breast are largely based on research conducted over 150 years ago, Donna T. Geddess points out in The anatomy of the lactating breast: Latest research and clinical implications.

“…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.

 

Lactation duration and stroke risk 

In February 2022, Ziyang Ren, MD, et al released Lactation Duration and the Risk of Subtypes of Stroke Among Parous Postmenopausal Women From the China Kadoorie Biobank.

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.

 

Marijuana exposure in utero 

Birth Outcomes of Neonates Exposed to Marijuana in Utero: A Systematic Review and Meta-analysis by Greg Marchand, et al, the largest meta-analyses on prenatal cannabis use to date, the authors  found significant increases in seven adverse neonatal outcomes among women who were exposed to marijuana during pregnancy versus those who were not exposed during pregnancy.

Photo by Solen Feyissa on Unsplash

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.

With increased marijuana legalization in mind, Kara R. Skelton, PhD and  Sara E. Benjamin-Neelon, PhD, JD, MPH in Reexamining Risks of Prenatal Cannabis Use—Mounting Evidence and a Call to Action urge states that have legalized and commercialized cannabis to retroactively prioritize protection of 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.

 

Measuring optimal skin-to-skin practice 

The authors of Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth show how process mapping of optimal skin-to-skin practice in the first hour after birth using the algorithm, HCP-S2S-IA, produced an accurate and useful measurement, illuminating how work is conducted and providing patterns for analysis and opportunities for improvement with targeted interventions.

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.

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.

Subscribe to SPLASH! Milk Science Update

Check out The International Society for Research in Human Milk and Lactation

 

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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, 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.