Brenda Hwang’s, MA, CCC-SLP, CLC, CDP light bulb moment: “My colostrum is in fact enough…”

[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. 

This is Brenda L. Hwang’s, MA, CCC-SLP, CLC, CDP illuminating moment. 

******

Myth – You have to feed formula in the beginning until your milk “comes in.”

FACT – You do not have to feed formula if you do not want to and your colostrum IS ENOUGH. 

I had an incredible breastfeeding journey with my first born that lasted a little over two years. It was difficult for me to think about other moms not having a positive breastfeeding experience. 

That is when I decided to become a lactation counselor. During my training, I remember learning about helping mothers feel confident about their milk supply (when there are no medical reasons to be concerned about). I remember being fascinated with the Baby-Friendly Hospital Initiative and researching if there were any near me for when I deliver again or to recommend my patients to go to for the most pro-breastfeeding support. Unfortunately, there wasn’t one. 

When I gave birth to my second born, I remember feeling overwhelmed by so many emotions following childbirth. I remember trying to remind myself that this was typical as our hormones are off the charts after experiencing what the amazing body just went through to bring new life into the world. I felt like there were so many things that I had little or no control over, but what I did have control over was advocating for immediate skin-to-skin and the opportunity to breastfeed my daughter. That made me feel grounded and confident. 

However, that night came and my daughter wouldn’t stop crying. The nurse would come in and out of our room always looking angry, telling me that my supply was not enough, and that I needed to give my daughter formula for her to stop crying. I kept advocating for myself and reminded my husband that –

  1. Formula was not what we planned for or want, 
  2. I have colostrum and,
  3. My colostrum is in fact enough and the best thing that we can give to our daughter right now. 

Although I knew this was true, the sad little cries broke my heart and the nurse’s comments and facial expressions made me feel uneasy. 

Even with the breastfeeding education that I had, she eventually made me believe that perhaps I was wrong and what I had was not enough for my daughter. I dozed off crying quietly to myself, feeling like a failure as a mom. This was my Ah-Ha moment. I thought, “Wow, that was terrible and unfortunately too common of an event that mothers often experience in the hospital.” I would never wish for any mom to feel that way – to feel like she is not enough, or a failure as a mom.

I am now dedicated to providing breastfeeding education during pregnancy… to help moms feel prepared for the first few moments after baby is born. I strive to find a role in the hospital in order to advocate for parents who wish to breastfeed and to provide timely interventions so that they too can have a positive breastfeeding experience. 

Thank you for reading my story.



The elegant and complex systems of flavor and nutritional programming

— This post is part of our “Where are they now?” series where we catch up with some of our very first Our Milky Way interviewees from over a decade ago! — 

“The societal and clinical impact of promoting sustainable food habits is significant, since what a child eats determines in part what the child becomes. (Mennella, et al, 2020, p. 291)

 

The pop of poppy seeds in aloo posto, cough-inducing spice in stir-fried lotus root with chili peppers, the meaty texture of a bowl of Cuban black beans. 

The dishes we crave tell stories. 

“Our food preferences have meaning,” Julie Mennella, PhD begins. “They’re more than just a source of calories. Food preferences provide families with identity.”

[Rough Translation’s Tasting at a Distance and Forgotten Foods of NYC’s Appetite for Home — Bitter-Sweet Memories of Learning to Cook & Eat in America both present beautiful audio embodying these connections.]

Elegant and complex learning systems 

The multidimensional interactions we have with food begin with our mothers. A fetus is passively exposed to the flavors of the biological mother’s diet through amniotic fluid, and the infant goes on to interact with these flavors through human milk. Mennella and her colleagues have called this “intimate bidirectional chemosensory communication.” (Mennella, et al, 2023)

In this complex communication, “diet and xenobiotic exposures of the lactating parent, due to lifestyle choices or necessitated by medical treatments, affect not only milk production and milk composition but also the infant’s biological responses, either beneficially or adversely,” the authors continue. “Developing alongside the chemosensory signaling is the seeding and maturation of the infant microbiome, which transfers and exchanges with that of the parent and of the milk, forming additional bidirectional linkages.” (Mennella, et al, 2023

Infant formulas, although available in many varieties, do not foster this elegant exchange and where developing food preferences are concerned, present a static flavor.

“That constant flavor doesn’t reflect the culture [a child] will grow up in,” Mennella comments.  

The same goes for infants fed jarred and pouched baby foods (what we’ve referred to as “the packet apocalypse” where the convenience of “ready-to-feed-super- glop” has largely replaced the art of dining and sharing meals.) The explosion of the baby food industry means parents often don’t feed their children what they themselves eat. Families can feed their babies canned peas, but never eat a pea themselves, Mennella points out. 

Mennella’s research has always been interested in flavor and nutritional programming in humans and the development of food preferences, but over the last decade, it has diversified to ask questions about the taste of pediatric medicines from a personalized medicine perspective, determinants of sweet and salt preferences during childhood, the development of psychophysical methods to study olfaction, taste and chemesthesis across the lifespan, biomarkers for dietary intake across the lifespan, and reproductive state effects on dietary intake and weight loss in women. [Retrieved from: Monell Center

Collective, family- focused approach

Mennella summarizes a few key points from her work. 

“Children live in different sensory worlds,” she says. ”They are really sensitive to the current food environment.” 

And like she and her colleagues have written, the food environment rich in added sugar and salt that caters to preferred human taste, provides challenges for all of us. 

“Fortunately, our biology is not necessarily our destiny. The plasticity of the chemical senses interacts with experience with foods to modify our preferences, producing an interface between our biology and our culture, our past and our present.” (Mennella, et al, 2020, p. 291

In order to influence our destiny, Mennella says that the strategy can never be for the child alone. She suggests there be more attention paid to the family as a whole in order for healthy behaviors to be sustainable. 

She nods to the success of peer counseling programs and recommends bolstering these opportunities for families to interact and learn from one another. She says she envisions primary care taking on a community approach to provide not only a forum for education but also opportunities for interaction between families.  

Where science and policy meet 

Mennella recognizes that ultra-processed, convenience foods are palatable and often inexpensive and deems this a “much bigger issue.” 

Her research has guided national and global health initiatives like the USDA and HHS Pregnancy and Birth to 24 Months (P/B-24) Project, the Breastmilk Ecology and the Genesis of Infant Nutrition (BEGIN) Project, and the World Health Organization’s (WHO) Commission on Ending Childhood Obesity. [WHO recently released its new guideline for complementary feeding of infants and young children 6-23 months of age. Read about it here.]  

As science evolves– where the picture gradually becomes more crisp and for every one question asked, fifty more arise– policies and practice must reflect and catch up to the robust body of evidence in order to best support child and family health.  

Read our 2012 coverage with Dr. Mennella here



Toxic Stress, Resilience Building, COVID-19 and Breastfeeding

As I write this, I’ve logged exactly two weeks at home in self-quarantine due to Covid-19 with my husband and three children. Technically, we’ve only made it through the kids’ scheduled spring break, but they’ll start an indefinite distance learning journey on Monday.

Our socially-distanced days have been filled with laughter of a couple kinds. The pandemic has offered us the opportunity to connect without the distraction of our robotic, go-through-the-motion schedules. We find simple entertainment: puzzles, charades, tiptoeing along sidewalk cracks. The situation has helped me rediscover how to be playful, and I’ve surprised myself and  kids with genuine laughter (or maybe it’s because I’m utterly deranged) over things that might have otherwise made me blister in anger. 

When I look outside my household, I laugh in discomfort. It’s this disturbed kind of cackle; a psychological response to the panic, the destruction, the trauma, the unknown that this pandemic has burdened the globe with. 

My most recent interviews with Nikki Lee about breastfeeding policy in shelters and Healthy Children Project’s Anna Blair and Karin Cadwell about their upcoming webinar on Covid-19, breastfeeding and resilience went this way: we seemed to laugh more than in interviews before the pandemic hit our country. 

Photo by Toa Heftiba on Unsplash

For me, I laughed because it was a simple joy to hear my friends’ and colleagues’ voices, to connect with those outside my immediate family. But even when the conversations turned dark, still I laughed. I laughed until I actually started sweating. What is the matter with me?

Blair and Cadwell pointed out something about the status of the crisis we’re currently in. When a hurricane tears through a community, we know there’ll be an end to the devastation. With Covid-19, we have no idea when this ends, and that’s sure to threaten mental health

Cadwell shares that while she does not consider herself a joyful person, she often thinks about joyful things in the future. 

“One of the things this has done for me is it has taken away my anticipation of joy,” she says. 

Some will argue that we’ve gained something through the shared experience; we’re together by being apart. “Rediscovered humanity,” in the words of the head of my children’s school.

We’ve lost a lot though too. Lives most importantly and second to that, control. 

In Hidden Brain’s episode An Unfinished Lesson: What The 1918 Flu Tells Us About Human Nature guest Historian Nancy Bristow recounts, “To remember the flu would be to admit to the lack of control that people had had over their own health. It would be to admit that the U.S. was not necessarily all powerful but was like everywhere else in the world subject as victims to something beyond their control.”

Almost a century later, these words ring true. Where there was opportunity for control, or a fair degree of preparedness at least, our nation failed. 

Cadwell has pointed out time and time again that our country has better emergency preparedness plans for our pets than we do for our moms and babies. 

“The unfortunate reality of the coronavirus pandemic is that it has shown how unprepared and underfunded the public health infrastructure in the U.S. is to address the basic needs of our citizens,” Monica R. McLemore begins in her piece COVID-19 Is No Reason to Abandon Pregnant People. 

Now we’re in what feels like an impossible place. 

Kimberly Seals Allers exposes the fact that infant formula quantities are scarce.  

“There, I said it! Cue swarm… I have time,” KSA begins in a Facebook post. “Everybody is talking about ‘choice’ & blasting #breastfeeding advocates until there’s a global pandemic, a panic-induced international run on infant formula & quantities are scarce. Now the ‘just give a bottle’ folks want to teach you how to re-lactate.” 

Doulas have been deemed non-essential, partners of birthing people considered visitors. (Refer to McLemore’s piece above.)

“We are taking so many steps backward,” Blair comments.

She continues: “We have heard so many times, not just locally, but colleagues around the country that there has been a misunderstanding about what the protocols are for babies being born now.  Babies are being automatically separated from their mothers for two weeks in some cases, even if the mother is Covid-19 negative. That is not best for the baby and that is not best for the family. Story after story. It worries us tremendously.” 

A member of the Certified Lactation Counselor (CLC) from ALPP Facebook group shared this account: 

“Mom had baby yesterday and was forced to wear a mask and gloves for all of labor and delivery. She had low o2 sat(91%) when coming into the hospital. No other symptoms. She is now separated from baby. Baby with dad in postpartum room and she in ICU pending covid test. She has not seen baby since and they will not let her until she gets a negative (test pends for 5 days apparently. They gave her a pump but didn’t show her how to use it. She’s a young first time mom and has now pretty much given up breastfeeding and seems highly depressed. She claims the hospital told her the CDC said to quarantine moms away from baby.” 

Later, the member provided an update.

“She’s with him now and he is currently latched <3 she’s still mentally in a dark place but things are looking up now that she’s finally got to hold him skin to skin without gloves or a mask.” 

Another participant suggested that this mother might need timely birth trauma therapy. 

The original poster replied: “I completely agree. She is very flippant and now seemingly unbothered and lacking emotion. Dad is worried and said he’s never seen her like this before.” 

Dr. Amy Gilliland of Doulaing the Doula is raising questions about mother baby separation on her social media outlets.

In one post Gilliland describes the effects of separation after birth: “The infant experiences loss and has a grief response – that’s the only interpretation – Where did my mother go? And it’s a loss they never recover from because their initial impression is abandonment and isolation. We are screwing up their capacity to trust and creating insecurity. We know this from research and therapy with young children, older children and adults. www.birthpsychology.com (also the Alliance for Infant Mental Health)…” 

Photo by Gift Habeshaw on Unsplash

Toxic stress is bubbling up in mothers, babies, families and equally their care providers.

What’s worse, Cadwell explains, is that many of us have accumulated toxic stress over our lifetime and in the current situation, many of our regular stress relief outlets have been stripped from us.   

Gutted by the situation, Cadwell and Blair put together Toxic Stress, Resilience Building, COVID-19 and Breastfeeding, a webinar that focuses on how to build resilience in ourselves and in others. 

“How can we find a resilient future?” Cadwell wonders. 

The webinar refers to Dr. Kenneth Ginsburg’s The 7 Cs: The Essential Building Blocks of Resilience

Healthy Children Project and Health Education Associates are offering the webinar at no cost. Continuing education credits for nurses, lactation consultants and lactation counselors are available.

You can request the free module here

In closing, I offer you this PSA:

“Unless you have prior experience navigating the emotional, psychological, and financial implications of a global pandemic- all while suddenly becoming a homeschool teacher to kids with cabin fever and unlimited snack requests… give yourself some grace.”  

Photo by Miguel Bruna on Unsplash

And one of my favorite quotes, quite applicable when the entire world is becoming unglued, “As long as there is breath, there is hope.”