Celebrating Infant Mental Health Awareness Week

This summer, we are revisiting some of our previous publications as they relate to various national celebrations. 

This week is Infant Mental Health Awareness Week, so we are re-sharing “Breastfeeding is…” a 2014 piece. Based on an interview with Barb O’Connor, this piece describes how breastfeeding is so much more than nutrition, including establishing secure attachments which are fundamental to infant mental health. 

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With a gentle pulsing of the sand, a baby sea turtle emerges from her hatching place. She breathes the salty ocean air and immediately begins her race to the rushing tide. She dodges stealthy crabs and gulls, mounts beach debris and endures what seems like an endless journey. Programmed for survival, she plunges into the abounding ocean, her lifeline.

Worldwide, there are over 70 conservation laws and regulations that protect sea turtles.

Not far from the briny ocean breeze, a mother hears her infant cry as she enters the world outside of the womb for the first time. Placed on her mother’s abdomen, the baby relaxes for several minutes until she begins to awaken. Soon, she makes mouthing and sucking movements signaling her interest in her mother’s breast. She leaps and crawls upward with intermittent periods of rest. When she reaches the breast, her hands become increasingly active and she familiarizes herself with her mother’s nipple. She suckles enjoying her first few sips of thick colostrum. After the first feed, she will rest again in the arms of her mother, her lifeline. [For more information about the 9 Stages visit: http://www.magicalhour.com/aboutus.html]

When a newborn is given the opportunity to practice early survival skills, amazing things happen.

But all too often, the newborn’s programming is interfered with by well-meaning health care professionals and popular, although non evidence-based health care practices.

“Our culture really discredits the importance of early beginnings,” Healthy Children faculty Barb O’Connor, RN, BSN, IBCLC, ANLC says. “If we protect and nurture mothers and infants, that’s going to impact future outcomes.”

Barb O’Connor (back left) pictured with colleagues from HCP and ALPP.

She goes on,  “Mothers and infants really have a synergistic recuperation from birth and if breastfeeding is supported and not interfered with, both parties are able to develop in a manner that leads to positive health outcomes.”

O’Connor discusses several cultural components that make establishing normal, healthy beginnings nearly impossible for families.

Our culture urges independence. Mother and baby are expected to properly function away from one another immediately after birth. Most birthing facilities don’t encourage or appropriately support the important practices of skin to skin contact or even rooming in.

Moreover, mothers are often expected to return to work or school while they are still bleeding from childbirth.

“There are other cultures that really value moms and babies and you can see it in the legislation,” O’Connor says.

Differently, our country provides mothers with zero paid maternity leave.

To be fair, there have been strides made in terms of promoting, protecting and supporting breastfeeding families in our nation. The Baby-Friendly Initiative (BFI) offers more and more families the opportunity to successfully breastfeed for instance. Particularly, BFI advocates for babies by requiring the facilities to provide the healthiest practices for mom and baby. O’Connor calls skin to skin contact and rooming in essential practices for all babies regardless of feeding method.

Still we have a lot to grasp, especially when it comes to older breastfeeding babies and children.

“Because we focus so much on breastfeeding being nutrition, our culture doesn’t really understand what breastfeeding really is for infants over one,” O’Connor says.  “We don’t understand as a population that nursing becomes a source of joy and communication and a way of life that should only be discontinued as mother and child mutually desire.”

O’Connor is particularly interested in the value of breastfeeding beyond nutrition.

“The delight I witness in the eyes of a baby who is nursing is indescribable; it is pure, unadulterated joy,” she says. “Every baby deserves the right to experience this loveliness.”

And skin to skin and breastfeeding are lovely in so many ways.

Breastfeeding is a stabilizer.

When a mother holds her baby skin to skin to breastfeed, she regulates her baby’s body temperature, heart and breathing rates, stress and glucose levels just to name a few. [For more information see these publications on skin to skin contact.]

O’Connor is fascinated by the findings of Dr. Nils Bergman and KH Nyqvist. Bergman, Nyqvist and colleagues have discovered that if the mothers of low birth weight babies practice Kangaroo Mother Care (KMC), they learn to breastfeed at incredibly young gestational ages. KMC also supports increased brain development and decreased mortality for low birth weight babies.

O’Connor’s daughter Brandy, mother and full-time caregiver of a special needs son who, born at 25 weeks gestation (now 5 years old), spent 110 days in the NICU, will speak at Healthy Children’s upcoming International Breastfeeding Conference about her experience with KMC and breastfeeding. She will share her perspective of the emotional turmoil, hospital practices, and challenges experienced by mothers of infants in the NICU.

“It has taken her a long time to come to a place where she could talk about this,” O’Connor says of Brandy’s experience. “I am extremely excited for my colleagues who work in the NICU to hear her perspective on how the experience affects new mothers”.

Breastfeeding is empowering.

The symbiotic relationship between breastfeeding mother and child and the infant’s programming for survival has a profound impact on the mother’s physical and mental well-being, O’Connor explains.

She continues that a child’s desire to breastfeed for comfort can be empowering. No one else but the mother has the capacity to console an upset child the way she does.

In Breastfeeding: A Feminist Issue, author Penny Van Esterik explains the many other ways breastfeeding is empowering including:  “breastfeeding confirms a woman’s power to control her own body, and challenges the male-dominated medical model and business interests that promote bottle feeding” and ”breastfeeding requires a new definition of women’s work – one that more realistically integrates women’s productive activities.”

Breastfeeding is immunity.

Maternal body flora and milk prime an infant’s immune system in a way that cannot currently be replicated and offers beneficial lifelong effects. O’Connor cites Lars Hanson’s immunology of breast milk research.

“A fully breast-fed infant receives as much as 0.5-1 g of secretory immunoglobulin A (SIgA) antibodies daily, the predominant antibody of human milk,” authors of Breast feeding: Overview and breast milk immunology write. “This can be compared to the production of some 2.5 g of SIgA per day for a 60 kg adult. These SIgA antibodies have been shown to protect against Vibrio cholerae, ETEC, Campylobacter, Shigella and Giardia.”

Breastfeeding is communication.

“If I see a baby who looks anxious or isn’t taking the breast well, it’s an immediate sign that something isn’t right in baby’s life,” O’Connor says.

As stated babies seek the breast for survival, so if baby refuses to breastfeed, they are communicating in a non-verbal way, she continues. Perhaps baby is ill or injured. When circumstances like these arise, it is important that the dyad receive help from a lactation professional who can assist with investigating the problem.

O’Connor reminds lactation professionals that it is always important to practice from a current, evidence-based perspective and to possess appropriate counseling skills.

“Most moms want to breastfeed,” she says. “It’s a matter of figuring out how to fit it in her life.”

Breastfeeding is regulatory.

A breastfed baby is offered control over the amount of milk she ingests whereas a bottle-fed infant’s intake is usually dictated by the amount of milk in its artificial container.

Consequently bottle feeding, regardless of the type of milk, may have future implications on obesity.

“Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast,” authors of Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? conclude.

Breastfeeding is survival.

O’Connor suggests we reevaluate our definition of survival. Survival goes beyond the performance of simple body functions.

“We have to look beyond that at a more encompassing definition,” she says. “Babies who are breastfed have a different potential for intellectual and interpersonal relationships.”

In fact, authors of Breast feeding and intergenerational social mobility: what are the mechanisms? conclude that “Breast feeding increased the odds of upward social mobility and decreased the odds of downward mobility.”

The effect was mediated in part due to stress mechanisms,” O’Connor comments.  “This is really fascinating.”

Breastfeeding has become of international concern because it offers protection against infant mortality. The World Health Organization’s Millenium Development Goals include breastfeeding as a strategy to combat child malnutrition and reduce child mortality.

In “Breastfeeding and Infant-Parent Co-Sleeping as Adaptive Strategies: Are They Protective against SIDS?” included in Breastfeeding: Biocultural Perspectives, James J. McKenna and Nicole J. Bernshaw explore the epidemiological studies that suggest that breastfeeding may be protective against SIDS.

What does breastfeeding mean to you? How else is breastfeeding more than nutrition? Please share your thoughts in the thread below.

 

Other relevant pieces

Field of lactation gains child psychologist

Cheap medicine: laughter

Implications of mother baby separation

Weird Findings

 In the era of the International Breastfeeding Conference, Cindy Turner-Maffei and Karin Cadwell would present their beloved Weird Findings segment on the last day of the conference. I always found it delightful and now wistfully reminisce about the session sometimes.

One year, we learned about pink yak milk, spider milk, goat wet nurses and donkeys with “good moral reputations” with the alleged ability to cure distemper and poisoning. That year, I was also introduced to the jaunty tune “I’m a Mammal”.  It was all great fun; entertaining and educational.  

So, this week’s post is my attempt at a Weird Findings collection, a nod to all that is quirky. I landed on quirky as the best word applicable to most of the items below, but quirky and weird are really just umbrella terms for those things that might also be totally awesome, maddening, perplexing and all of the things in between and just outside of these descriptors. 

 

The artificial womb 

My high school biology teacher once asked our class to contemplate a riddle about the Nacirema people. Part of it contained a description of their reproduction which read like an excerpt from a science-fiction novel. Really, it described Americans. 

Reading about the development of an artificial womb to support premature birth had me thinking back to this exercise. 

Like any technology,  great promise and great unknown surround “advancements”. Because this womb is not available to humans yet and because of my overall skepticism, I thought it necessary to point out that we have a means to help very premature babies right this very moment…our bodies.

 

Be inspired, maddened, saddened, weirded out by the remainder of the comments here

 

Exercise and breastfeeding 

This study found that adiponectin concentrations increased in breast milk after high intensity interval training (HIIT). “It has been postulated that higher breast milk adiponectin concentrations may prevent rapid weight gain in infancy,” the authors write. The real-life implications of this discovery?  South China Morning Post’s coverage on the study points out how exercise has physical and mental benefits for mom and baby. 

 

Tomatoes and erectile dysfunction 

Around three minutes into this amazing video, Katie Hinde points out: “When we zoom in on the number of articles just investigating breast milk, we see that we know much more about coffee, wine and tomatoes… We know over twice as much about erectile dysfunction.

I’m not saying we shouldn’t know about those things — I’m a scientist, I think we should know about everything. But that we know so much less about breast milk — the first fluid a young mammal is adapted to consume — should make us angry.” 

 

The disgraceful CMF industry 

As sophisticated as the commercial milk formula industry’s insidious marketing tactics are, they are truly a disgrace in the event of pregnancy loss or stillbirth. The authors of an ABM blog post share the perspectives of mothers who endured pregnancy loss and stillbirth and subsequently received infant formula samples. 

 “‘It feels like a slap in the face, a punch to the gut,’ Caitlin C. says, after discovering formula samples at her door following two second-trimester losses. ‘If [the formula company] somehow knew I was pregnant, couldn’t they also know I’m not anymore?’”

 

Amphibian milk 

It wouldn’t be a proper Weird Findings collection without the inclusion of a creature that challenges our Linnaean classification system. NPR reported that “a species of worm-like amphibian has been caught on camera feeding milk to its young…The creature, known as a caecilian, lives underground. Researchers believe that the animal developed the ability to produce a milk-like substance independently of mammals…” Weird. 

 

Milk composition 

There’s weird and then there’s WEIRD: Western, educated, industrialized, rich, and democratic.   

Klein’s, et al work found variations in milk composition across populations classified by four subsistence patterns: urban-industrialism, rural-shop, horticulturalist-forager or agro-pastoralism. The authors synthesize: “Populations living in closer geographic proximity or having similar subsistence strategies (e.g. agro-pastoralists from Nepal and Namibia) had more similar milk immune protein compositions. Agro-pastoralists had different milk innate immune protein composition from horticulturalist-foragers and urban-industrialists. Acquired immune protein composition differed among all subsistence strategies except horticulturist-foragers and rural-shop.” 

It was found that “When compared with western populations, some of these groups have genetic profiles that favor… immune responses and elevated levels of immune molecules throughout life…” 

 

Microbiome and breast cancer 

Other examples of the microbiome and immune connection come from Nikki Lee’s ponderings.  “This new world of research is astounding!” she shares. 

In Microbiome and Breast Cancer: New Role for an Ancient Population, the authors show “a significant difference in the microbiome composition of nipple aspirate fluid between healthy individuals and patients with BC suggested the potential role of the ductal microbiome in BC incidence.”

In L-asparaginase from human breast milk Lactobacillus reuteri induces apoptosis using therapeutic targets Caspase-8 and Caspase-9 in breast cancer cell line the authors conclude that “Breast milk L. reuteri L-asparaginase induces apoptosis via Cas8 and Cas9 upregulation in the breast cancer cell line. L. reuteri L-asparaginase treatment may be the hopeful approach for the management of breast cancer. Furthermore, the results may highlight the fact that the presence of L-asparaginase-producing L. reuteri isolates in human breast milk may aid in breast cancer improvement or even prevention.”

“Could the microbiome be a reason that breastfeeding reduces the chances of breast cancer?” Lee asks.  

 

Choose and embrace breast milk

The Nigerian Federal Ministry of Health created a mass communication campaign to increase awareness of the importance of exclusive breastfeeding for infants in their first 6 months. This video features a Nigerian celebrity and family. Watch it here

The final element of a Weird Findings segment is song and dance! 

This video is a public health announcement rolled into song by Rodah Amakal, a gospel musician from West Pokot County for the Pokot community in Kenya. Enjoy! 

 

 



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.