Celebrating Father’s Day

This summer, we are revisiting some of our previous publications as they relate to various national celebrations.  This week, we’re celebrating fathers with our 2017 piece “Fathers profoundly influence breastfeeding outcomes”, a piece highlighting Muswamba Mwamba’s, MS, MPH, IBCLC, RLC work with families.

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At a WIC clinic a few miles north of Dallas in an immigrant community, a pregnant woman confided in a male peer counselor–part of the WIC Peer Dads Program— that she wanted to breastfeed her baby. Her boyfriend wasn’t at all interested in supporting this journey though. The counselor offered to speak to the father; the mother agreed, so the counselor called him just then. Ring, ring, ring. After introductions, this conversation ensued:

Counselor: We heard you have an issue with breastfeeding.

Father: So you are calling me to convince me that breastmilk is better?

Counselor: No, I just want to give you some information.

Father: I will come to your office. You prove to me that breastfeeding is better.

The next morning, the father arrived at the clinic before it opened.

Source: United States Breastfeeding Committee

“Tell me why she should breastfeed,” the father demanded of the counselor, who was feeling rather intimidated.

The counselor replied: Forty-five years down the road, your unborn son is guaranteed to be the president of the United States. What are you going to do today?

The father looked at him perplexed and laughed.

“You tell me,” his retort.

The counselor handed him a sheet of paper instructing him to write these letters: B-R-E-A-S-T-F-E-E-D, providing corresponding ‘benefits’ to breastfeeding with each letter. (B is for bonding and so on.)

“Dude! You’re good,” the father exclaimed, changing his demeanor. “Ok, you got me,” he agreed to open his mind to breastfeeding.

Mwamba demonstrates ways to hold baby during a class for parents .

Muswamba Mwamba, MS, MPH, IBCLC, RLC, a public health nutritionist, told me this story during a fascinating interview for Our Milky Way. Having worked in nutrition for nearly three decades, Mwamba has acquired a brilliance for carefully interpreting and reflecting on the stories of the people he encounters.

“The guy was bold,” Mwamba remembers of the father. In fact, the father planned to dump his pregnant girlfriend after she became pregnant.

“A lot of men may know how to change diapers, know how to carry the baby,” Mwamba begins. “But something they don’t know is how to befriend the woman. When they don’t know, they run away.”

This couple’s story took a happy turn. Mwamba reports that they married with their peer counselor as their witness.

“You saved my relationship,” the father heartfully expressed his gratitude to the counselor.

After serving nearly 10 years as the City of Dallas WIC Peer Dads Program Coordinator, Mwamba is currently Director to Reaching Our Brothers Everywhere (ROBE), a descendant of Reaching Our Sisters Everywhere (ROSE). ROSE and ROBE are dedicated to reducing breastfeeding disparities among African Americans.

But Mwamba’s career goals didn’t always point specifically to breastfeeding. Always fascinated by nutrition as the foundation of health, Mwamba found himself in a microbiology lab in Belgium completing two master’s degrees in Food Science and Technology and Agricultural Engineering & Human Nutrition.

He quickly realized that he “prefers people to mice.”  So when Mwamba, a Congolese native, came to the States in 1997, he searched for a doctoral program that might better fit his passion for behavioral science. Mwamba made his way to Columbia University in 1999 where he studied Nutrition Education, exploring the intersections between science and behavior, environment and genes.

At the time, Mwamba remembers being happy to be in the U.S. but in retrospect, he says he realizes he was naive about racial disparities in health care. It wasn’t until later that he learned about the historical forces in the United States that make health disparities a reality.

Mwamba pictured with colleagues Brenda Reyes and Mona Liza Hamlin.

“Thinking backward, I didn’t see anyone in my class who was local; they were all caucasian female,” Mwamba recalls.

Except for himself of course, the only Black man, and an immigrant at that. Institutions have policies written to encourage diversity, Mwamba begins.

“When they see Black, they see diversity,” he says. These policies ignore the heterogeneity of Black culture.

“As an immigrant, I was privileged when I got the scholarship,” he explains. Mwamba already held two master’s degrees and had seen the world. His experience was vastly different from those of the People of Color living in the community he was to serve.

“We have the same color of skin, but not the same stories, not the same backgrounds,” he reiterates.

Mwamba adds that African immigrants are the fastest growing and most educated group of immigrants in the U.S. From 2000 to 2004, four percent of immigrants in the U.S. were African. Today, African immigrants account for 8 to 10 percent, he reports.

Mwamba stresses, money needs to be properly allocated to serve those in need.

“The gap is increasing within the [Black] community,” he says of health disparities. “…Diversity is not the solution for the disparity.”

Little did he know, his opportunity to work to close this gap and to give a voice to “the folks who think they have nothing to say because nobody ever listened to them” was just around the corner.

Discussing a course’s simplicity with his professor at Columbia one day, a woman from Ghana happened to be listening in on their conversation. She was the director of a WIC clinic and recruited Mwamba as a nutritionist one year later.

Mwamba was instantly fascinated by the components of artificial baby milk, inspired by the questions his clients asked, and curious about the effects of clients’ infant feeding experiences.

He noticed that mothers who fed their babies formula often came to the clinic with various complaints.

Then there was a woman he remembers who exclusively breastfed her baby for one year. When she came in, she seemed happy and had only one concern: Why hadn’t her period returned yet?

Mwamba needed to do some research. He read everything he could. He worked to develop appropriate language to discuss infant feeding with his clients.

He began to grasp delicate intricacies like the sexualization of breasts in America. One client in particular expressed concern about her baby touching her “boobs.” (As a self-taught Anglophone, Mwamba never encountered “boobs” in his literature.)

As he discovered more and more about breastfeeding, he shared the information with his team. Mwamba became a breastfeeding champion.

In 2003, Mwamba moved to a WIC clinic in Dallas. Here, he received structured training through breastfeeding modules.

In 2005 he and his wife, an OB/GYN, welcomed their first babies to the world, a three pound baby girl and a four pound baby boy. Over the next couple of years, they added three more children to their family. Mwamba spent several months at home with their infants.

Source: United States Breastfeeding Committee

Aware that a primary reason a mother chooses not to breastfeed is her perception of the father’s attitude toward infant feeding, Mwamba launched the City of Dallas WIC Peer Dad program. The program was promptly a success.

Perhaps most importantly, the clinic was already breastfeeding-friendly. Secondly, there were several men already working in the clinic– including Mwamba who understood rich, complex immigrant culture. As Kimberly Seals Allers puts it, “The experience of being interpreted is different from the experience of being understood.”

Mwamba and his team worked by the motto Prepare, Equip and Empower.

They validated men in their role as a father and gave them tools like how to speak up and say, “Hello, I’m here!” when others failed to recognize their presence.

“Equip the father with tools they can use today,” Mwamba begins. “If you start talking about the future, they won’t get the information. Meet people where they are.”

Mwamba started conversations with his clients in an attempt to get fathers to connect with their relationships with their fathers; Emotion is more valuable than hard science.

For instance Mwamba describes one client, the father of five children, who “was over six feet tall with dreadlocks and his underwear showing.” He remembers this client had an air about him: I’m the dude here.

Mwamba discussed with him his role to protect and provide for his family. He asked, “Is there a man you look up to?” The father reported that he had a close relationship with his big brother. Mwamba wondered if he looked to his own father as a hero, or if he would change his relationship with his father. At that, the father’s voice cracked. He began to sob. This father was in the position to reflect on his role as a father and accept the influence he would have on his family.  And a father’s role is profound. When he is indifferent about breastfeeding, mothers will breastfeed 26 percent of the time; if he is pro-breastfeeding, mothers will breastfeed 98 percent of the time.

Tapping into the generalization that “men like the brag,” Mwamba and his colleagues encouraged their clients to spread forth their infant feeding experiences into their communities.

In his years working with the peer counselor program, Mwamba listened to stories that seriously question one’s capacity to have hope in humanity. In these moments, he didn’t have a script. Whatever rage he felt, whatever sympathy he bestowed, he couldn’t find a book or a module to learn how to accept the rawness, the vulnerability of his clients. Instead, Mwamba offered his presence and his willingness to listen, learn and understand.

Check out the rest of Our Milky Way‘s collection celebrating dads here.

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

Lindsey Brown McCormick’s, PhD, LPCC-S, PMH-C, CLC light bulb moment

[Photo by Andrea Piacquadio]
We consider ourselves life-long learners here at Healthy Children Project. Sometimes learning occurs gradually, and sometimes there are the ‘light bulb’ moments.

We put a call out to our followers to share “Aha!” moments with us. Maybe it was a myth busted during the Lactation Counselor Training Course (LCTC) or maybe it happened during a visit with a dyad.

We also called for stories about your babies’ and children’s ‘light bulb’ moments. When have you seen your little ones’ faces light up in discovery and understanding?

The call for stories is still open! Please send your reflections to info@ourmilkyway.org with “Light Bulb” in the subject line.

Lindsey Brown McCormick, PhD, LPCC-S, PMH-C, CLC is the owner of Women Thrive Counseling & Consulting LLC. This is her light bulb moment. 

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Dr. McCormick
Used with permission

I did not go into the field of mental health counseling with the goal or intention of working with mothers/birthing people and babies. It was never on my radar as something that clinicians even specialized in. The birth of my daughter changed everything for me. 

I’ve been working in the field of trauma and traumatic stress since 2010. My spouse and I welcomed our daughter, currently our only child, into the world November 2021. I was induced and labored for 22 hours before I was whisked away into the operating room for an emergency cesarean. Though everything was seemingly normal on the surface, between the complications faced in labor and the OR, internally I was far from okay. The spiral of postpartum anxiety had entered the chat. 

It was after we came home, in the stillness of the village that lived so far away, crying on my couch with a cluster feeding newborn, I realized two things: 1) I didn’t know anything about perinatal mental health, and 2) I didn’t know where I could even go to learn. 

In the following weeks, my spouse would arrive home from work and I would dump everything that I had discovered that day onto him. I was so energized, so eager to learn, and I was jumping into the deep end of this new clinical niche. I enrolled in a perinatal mental health training program. Upon completing that, I enrolled in the Certified Lactation Counselor training course. Bridging these disciplines, as a practitioner, just made sense to me. There can be a significant amount of mental health problems that arise from attempting to body feed: anxiety, trauma, and grief, to name a few. And, as an attachment theory and parenting nerd, I absorbed research on skin-to-skin care like a sponge. 

As I’ve continued to specialize in this field, I greatly appreciate the value of blending perinatal mental healthcare and lactation care, the healing benefits of skin-to-skin care after a traumatic birthing experience, and the neuroscience of matrescence and infant (0-3) development. It’s provided me opportunities to learn more about the relationship between my daughter and me. It’s positively influenced my parenting style. It’s positively influenced my approach as a counselor and an educator. There are FEW psychotherapists who have lactation credentials out there, and I feel honored to be one of them. 

 

Continuing the conversation about language use in perinatal health

What is ‘appropriate’ language? What one might consider distasteful, hurtful, impactful, another may consider harmless or meaningless.

Photo by Miguel Á. Padriñán

Take this exchange offered by Ravae Sinclair, JD, CD (DONA), LCCE at the early 2020 International Breastfeeding Conference for example:

A white-presenting lactation professional working with a black mother and her baby shortly after birth exclaimed something along the lines of, “Awww, look at him, he looks just like a little thug!” commenting on the slight sag in his newborn hospital cap.

“Little thug”– a heavily loaded term generally carrying negative connotations– was understandably a trigger for the mother. She shut down no longer feeling safe in the space and asked to be discharged early. Most likely, the lactation professional did not intend to offend, but the impact of this short exchange has much further reaching consequences than the intention itself.

We have explored the impact of language to a relatively great extent here on Our Milky Way. You can check out these pieces for examples:

In a recent exchange, Nikki Lee added to this ongoing conversation about language in maternal child health. She shared an observation about how “the media rarely misses a chance to plant negative seeds in the public’s mind about breastfeeding”.

Citing an example from a PubMed alert that morning– Sudden Death in a Breastfeeding Woman with Arrhythmogenic Mitral Valve Prolapse— Lee commented “I ask you, how in the world does the infant feeding method have to do with the death of this mother? She had some kind of cardiac defect; pregnancy and labor place huge stresses on the cardiovascular system. What would you think and how would you feel if you saw a headline ‘Sudden death in a formula feeding woman with arrhythmogenic mitral valve prolapse’?”

Julie Smith’s, et al 2008 paper Voldemortand health professional knowledge of breastfeeding – do journal titles and abstracts accurately convey findings on differential health outcomes for formula fed infants?  “showed a surprising ‘Voldemort effect’ in the studies examined; formula feeding was rarely named as an exposure increasing health risk in publication titles or abstracts.” The authors conclude that “ If widespread, this skew in communication of research findings may reduce health professionals’ knowledge and support for breastfeeding.”

In her own reflection on the use of language in perinatal support, Donna Walls, RN, BSN, ANLC shares her guest post Our words need to send a supportive message- how can we do it? this week on Our Milky Way.

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As a child I often repeated “sticks and stones can break my bones, but words can never hurt me”. As an adult, I know this is not true. Words are powerful. In our breastfeeding advocacy world, words can be used to build a new mother’s confidence, or they can be used to undermine it. Below, I offer you some of my pet peeves,  words and phrases we commonly use without  thinking about their impact.

Source: United States Breastfeeding Committee

First, maybe the most common and certainly one of the most harmful is talking about “milk coming in”. We know that the number one fear of new moms, especially first-time moms, is not having enough milk. In the first days after birth,  there aren’t often  visible signs of milk production. New parents have often heard about engorgement and how breasts get so full, they look like they are ready to explode. But, they see no signs of exploding breasts in the first one to two days after birth. They may be able to express drops which is encouraging but no big reassurance that there is plenty for their baby.

We often see at about two days of age the occurrence of “cluster feeding” when their quiet, precious newborn seems ravenous and so, so hungry. Many moms think, or unfortunately are told, that this is a sign of not having enough milk. This is not even slightly, vaguely true but rather a normal newborn feeding pattern. We dutifully tell this anxious mother not to worry; her “milk will come in” in a day or two. The not-so-subtle message is that there is no need to worry about not having milk now, that  it soon will come in.

What has happened is that we have reinforced her biggest worry about not being able to adequately feed her baby. I don’t believe for a minute that this is intentional on our part, really just one of those things we have always said and never really examined the consequences.

I sometimes feel sorry for underappreciated, often ignored colostrum. Maybe it’s time we change the language. So instead of saying “your milk will come in”, might I suggest we instead say “the milk you’ve been making for your baby while you were pregnant is there for the first feeds. It is newborn milk, sometimes called colostrum, and this small volume is all your baby needs in the first hours and days. When you nurse frequently in these first days the newborn milk will change over to mature milk and you will see an increase in the amount as your breasts will become fuller, firmer and heavier.” You can of course  come up with your own wording just as long as new parents get the message that there is milk NOW- not “coming in” later!

Source: United States Breastfeeding Committee

My second pet peeve is judgey diagnoses of flat nipples. Way too often when prenatal breast assessments are done, there is a diagnosis of flat nipples, usually based only on the appearance with no regard to assessing function. Once these misunderstood nipples are labeled, the mother is deemed not quite right for feeding. Silly exercises and gadgets are recommended to make already elastic skin behave appropriately. First point: nipples are erectile by nature, some stand up a lot, some a little. Sadly most new mothers have seen artificial nipples and think they should look like these, not ever recognizing that we have the real nipples so why aren’t bottle nipples more like ours?! When counseling mothers, ask the mom if she notices her nipple erecting in cold weather or with sexual/manual stimulation.

As a clinical lactation care provider for many years, I would often be saddened by the words used to make a mother feel her nipples weren’t quite right, not good enough. I have seen too often women struggling with breastfeeding because they were told even before the baby’s birth that the chances were slim for successful breastfeeding; bad nipples would certainly cause problems.

I am quite sure males are not discouraged about the abilities of their erectile tissue at the onset of sexual activity. This is not to say that there may not be challenges  with inverted nipples; they may cause challenges  when they are retracted enough to not ever be stimulated or stretched for hormonal release, but flat nipples will evert. They just want to do it their way. We need to remind moms that the nipple their baby will prefer is attached to their favorite person.

Third, let’s talk about the term engorgement. By definition, engorgement  is not normal. It is a state brought on by interruptions in the expected initiation of lactation [Source]. Unfortunately, the term is used by professionals and families to mean a fullness in the breasts. Signs of engorgement include hot, reddened, uncomfortably swollen breasts which can be hard for a newborn to correctly latch to the breast. This needs to be distinguished from normal signs of lactation when breasts become rounder, fuller, firmer and heavier. Too often a mother may complain about her breast “engorgement” and interventions are recommended to help reduce the discomfort and swelling when in reality she just needs to be reassured that what she is feeling is normal and actually a good sign that she is producing milk. So, my request is that when a mother talks about her concerns about engorgement, our response needs to be to ask something along the lines of “what exactly are you feeling?” as well as the usual questions of frequency of feedings, adequate output and signs of comfortable  latch.

Source: United States Breastfeeding Committee

Our words can have a profound effect on the success or failure of breastfeeding. A huge part of our job, our responsibility to our patients and their families is to build confidence in their ability to nourish and nurture their newborns. Be aware of the message that is being sent and choose words that will build confidence, be generous with realistic praise and couch our intervention suggestions with success in mind. Ask for parents’ input; we want them to know their thoughts are important to the process!

Reference Cadwell, K. and Turner-Maffei, C.  Pocket Guide for Lactation Management. 2022. Jones and Bartlett. Burlington, MA.

Glints of hope and control in a burning world

As I gathered my thoughts for an Earth Month and infant feeding installment, I got an email notification that Valerie McClain had published something new on her Substack. Of course I hurried over, because her pieces are always illuminating. She writes in Standing on the Precipice:  “We are self-destructing on our Mother Earth, and she may be the last woman standing amidst the rubble and miles of corpses.”

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

In all of the pieces and years past that we have covered the connections between infant feeding and planetary health, it never actually occurred to me that there might be a scenario where Mother Earth outlives us. This will surely strike some of you as naive, absurd, delusional, or something else considering what has happened and continues to happen on our planet. Even so, I envisioned humans dying alongside our planet, our self-destruction agonizing and inevitable, as we claw, infect, and deplete Mother Earth with our beastly antics, taking down the innocent in our path to complete decimation. 

On a recent trip to The Museum of Modern Art, I was shaken out of this sense of Doom and flurry of eco-emotions. Victor Grippo’s lead containers with beans first spoke to me, metaphors “for the force and persistence of life”. This display coupled with Niki de Saint Phalle’s phrase “What is now known was once only imagined” infused me with a little glint of hope that I’ve been craving. 

Then on a Throughline episode about consumer protections and trust in and accountability from companies and elected leaders, I heard the voice of Ralph Nader. He offered: Cynicism is “a cop-out. That’s an indulgence. That’s an indulgence of quitters that makes them feel good. Because when you’re cynical, you’re obviously smart, aren’t you? You think you’re smart. No, you’re not smart. You’re playing into the hands of the corporate supremacists. You’re playing into the hands of the few who want to control the many who could easily outvote the few and make the corporations our servants, not our masters.” This offered me a shift in perspective too.

Source: https://www.gifa.org/en/international-2/green-feeding/

Among the hopeful is coverage of the Green Feeding Tool by Kristi Eaton. Eaton quotes Julie Smith, co-creator of the tool: “…with the Green Feeding Tool—designed to provide policymakers, climate scientists, advocates and others with clear data about how increasing support for breastfeeding can help save the planet—we have the evidence to support action.”

Now, consider this headline: Breast milk can expose babies to toxic ‘forever chemicals’

“For decades, physicians and scientists have touted breast milk as liquid gold for its immunological benefits.

But nursing parents with considerable exposure to cancer-linked ‘forever chemicals,’ or PFAS, may unwittingly be exposing their babies to these compounds as well…” the author begins. 

The article acknowledges contaminated water could be a potential source of PFAS which infant formula is often mixed with. The author also includes that “the benefits of nursing likely outweigh the potential risk of PFAS exposure through breast milk.” [Note the language used here. There are generally no benefits to breastfeeding. Instead, there are risks associated with not breastfeeding.] 

Nikki Lee asks some important questions: “Why doesn’t formula get tested for these chemicals?  Do folks believe that somehow cows are protected against pollution?”

As with anything, there will be risks associated with any variation of infant feeding. 

Healthy Children Project’s Karin Cadwell points out that if toxins are being detected in human milk, it means we need to reconsider the products being used in industry.

Photo by willsantt: https://www.pexels.com/photo/woman-breastfeeding-her-toddler-under-the-tree-2714618/

The author of Study Finds High Levels of Toxic Chemicals in Mothers’ Breast Milk quotes Erika Schreder, science director at Toxic-Free Future who shares a similar sentiment: “’If we want to make pregnancy and breastfeeding safe and free from PFAS, we really need to eliminate the use of these chemicals and products, so that we can have clean food, clean air, and clean water… We really don’t believe that responsibility should be placed on individuals when we need regulations to end the use of these chemicals.’”

In the predicament(s) we find ourselves in, I’d like to leave you with a few more of McClain’s words: “A mother cannot control events such as: wars, sieges, shortages of infant formula and pitocin, fires, floods, hurricanes, tornadoes; but she has a semblance of control in her and her baby’s world through breastfeeding. Dependency on always having access to infant formula, health care, freedom from human or environmental violence, should be tempered with the reality that there may be times, when all the civility of life vanishes.” 

More for Earth Month 

Industry lies and the Code

Infant feeding and planetary health go hand in hand 

Breastfeeding is eco-friendly 

Goats and Soda’s How do you keep calm and carry on in a world full of crises?