lactation Archives - Our Milky Way

December 29, 2024December 19, 2024

‘Breastfeeding myths and why they can cause difficulties’ guest piece by Donna Walls with intro by Jess Fedenia

Jacopo Tintoretto
The Origin of the Milky Way
about 1575
Oil on canvas, 149.4 x 168 cm
Bought, 1890
NG1313
https://www.nationalgallery.org.uk/paintings/NG1313

Our blog’s namesake is steeped in mythology.

While researching classical breastfeeding images for their Icons of Breastfeeding presentation, Cindy Turner-Maffei and Karin Cadwell came across art like Tintoretto’s The Origin of the Milky Way and Rubens’s Birth of the Milky Way.

“We were thrilled to find that the milk of a Goddess was thought by ancient peoples to be the source of our Galaxy,” Turner-Maffei shares. “This concurs with our view that breastfeeding is a core experience of human life.”

She and Cadwell retold the classic Milky Way story in their book Case Studies in Breastfeeding: Problem-Solving Skills & Strategies:

[Jacopo Tintoretto’s beautiful painting, The Origin of the Milky Way, depicts] “the Greek God Zeus (Roman name Jupiter) bringing baby Herakles (Hercules) to suckle at the breast of the sleeping Goddess Hera (Juno), Zeus’s wife. Zeus wants Herakles to receive the milk of a goddess, because it bestows immortal life, and will make Herakles into a god. Zeus anticipates that Hera will not willingly provide her milk to his love child [born to mortal woman Alcmena]. Therefore, he tries to sneak up on her while she is sleeping. However, foreshadowing his adult strength, the baby Herakles attaches forceably to Hera’s breast, awakening her. Hera reacts by pushing the baby off her breast. Her milk spurts forth into the heavens, and creates the stars of what becomes our galaxy, the Milky Way.” (Cadwell & Turner-Maffei, 2004, p. xi)

In a recent piece, we shared an excerpt from Radical Mom Union’s Natasha VC’s Let us Admire the Lactating Fountains of Italy: The most powerful representation of nature in art is a lactating woman.

“The Fontana della Spinacorona is a marble representation of the mythological founder of Naples, the winged siren Parthenope. Legend has it that the siren shot her breast milk onto the flames of the volcano Vesuvius to extinguish the fire. The work bears the Latin inscription Dum Vesevi Syrena Incendia Mulcet: ‘while the siren of Vesuvius calms the flames’…I must point out how absolutely METAL that is!!??? BREASTMILK TO EXTINGUISH THE VOLCANIC FLAMES OF VESUVIUS!!!!…”

She goes on, urging, “Think about that for a minute. We typically think of a postpartum woman as weak, drained, struggling. Here, the nursing mother with fountains of milk shooting from her ample breasts, puts her on par with the gods of the sky and sea. PURE, RAW POWER, que bella!”

Grabosky, Tom. Mothers. 01 Oct 1991. Web. 2024. <https://ark.digitalcommonwealth.org/ark:/50959/8s45wt479>.

Mythology offers powerful and inspiring pieces of lore, but myths as we have come to know them in modern times, can be powerfully harmful.

The visionary Linda Smith covered breastfeeding myths on Our Milky Way over a decade ago. Many persist in our culture today.

Praeclarus Press recently released Breastfeeding Myths: Busting the Misinformation Harming You, Your Baby, and Society by Lucy Ruddle. Unicef offers a page to dispel breastfeeding myths. Lactation care providers and maternal child health advocates address breastfeeding myths ad nauseam, and sometimes, we’re tasked with unlearning of our own.

This week, Donna Walls RN, BSN, ANLC takes the opportunity to dispel some myths she often encounters in her guest piece titled Breastfeeding Myths and Why They Can Cause Difficulties.

Donna is a frequent contributor to Our Milky Way. You can read her other pieces here.

——

Some breastfeeding myths seem to continue unchecked for decades. It seems no matter how much we teach, preach, beg, educate, cajole and insist, they persist. So, I guess I’m going to take one more swing at setting the record straight and hope we can dispel some of the more common ones.

Myth #1

Some women are just too stressed or ‘high-strung’ to breastfeed. Successful breastfeeding requires relaxation.

Nothing could be further from the truth. We know women have been successfully nursing their babies in highly stressful situations for eons. During times of war, weather disasters, personal crises, physical illness, financial distress, and so on and so on, they continue to make the quantity and quality of milk needed for their babies to thrive.

It would be very difficult for our species to survive if a stressful, anxious situation was all it took for our milk supply to shut down. This applies to widespread situations such as wars as well as individuals’ situations. When a new baby is brought into the family, whether it’s the first or fourth, it’s an adjustment. Changes in lifestyle, activities of daily living , sleep patterns and emotional adjustments…no one escapes without some moments of anxiety. It’s a good thing our bodies are designed to do everything it can to nourish and nurture the next generation.

Truly, prolactin is a wonderful hormone! We know it is responsible for milk production, but it is also actually involved in moderating stress responses in males, females, lactating and non-lactating mammals. In simple terms, it has a stress-reducing, calming effect. Even more amazing is our ability to actually increase our prolactin production in times of acute stress. In one NIH study, the levels of prolactin were significantly increased in women who reported long-term stress and resulting depression. So busting this myth should be easy; not only does stress not reduce milk supply, it can actually increase our levels of milk-producing prolactin and help to calm frayed nerves in the process.

Myth #2

Your milk will “come in” about day 3 or 4 postpartum.

This one could be one of the most harmful, because it’s an all-too-common phrase repeated continuously, everywhere. Unfortunately, new mothers, already worried about not having enough milk, are told this as a routine part of breastfeeding education and can result in mothers becoming discouraged in the first hours and days of breastfeeding. We commonly hear them express their fear of “starving” their newborn. Mothers have milk for the first feeds. We call it colostrum, but it’s milk! They have heard about breasts being so full it hurts, but they don’t see or feel that yet. The perpetuated message is clear but untrue: ‘You really don’t have milk now, but in 3-4 days, your milk will “come in” so don’t worry!’ This confirms moms’ number one concern about not having enough milk.

Truth is, colostrum is produced beginning about halfway through the pregnancy and is present, and designed for, the first feedings. Could it be that because we label it colostrum it is not perceived as milk?

It would be great if we could completely ditch the term “milk coming in”, reassure prenatal and new moms that they DO have milk (albeit called colostrum) available for the first feedings. Could we change our terminology from “milk coming in” to milk changing over to mature milk? Could we change the name of colostrum to “newborn milk” which sends the message that this is indeed milk?

Myth #3

You will need to give up the foods you like while breastfeeding.

While false, the lists of no-no foods can be quite extensive. No spicy foods are usually at the top of the list. It makes you wonder about all those babies in cultures that have curry, garlic, and chili peppers as a staple of their diets. Babies in Italy or Mexico aren’t fussier babies than in America or Sweden. Many years of work by Julie Mennella clearly demonstrates that newborns accommodate to the smells and tastes of their culture through exposure to those smells and tastes in the amniotic fluid. Infants learn to like the foods that are normal in their mother’s diet before they are born!

While we are on the subject of foods, another persistent and incorrect myth is that of the need for the “perfect diet” with extra calories to be able to breastfeed. It doesn’t take a lot of research to look at nursing mothers around the world and realize that successful breastfeeding and healthy infants are not reliant on the perfect diet. Women have breastfed in the most dire of circumstances without negative consequences to their babies. The misinformation stating that lactation requires a significant addition of calories, sometimes as many as 1,500/day, to successfully nourish her infant still persists. This can be discouraging to a new mother, anxious to lose pregnancy weight. I think we have all heard concerns expressed that maybe breastfeeding is not the right choice for those wanting or needing to lose postpartum weight. Again, not true. In reality the current CDC recommendation for calories during lactation are an additional 330-400 calories for maternal health, not for milk production. And remember, it’s not just calories but what foods are recommended. Eating a bag of processed chips gives you calories but does not contribute to better maternal health!

Myth #4

Your breasts are too big…too small. Your nipples are flat…too big…too small.

Oh how we love to judge nipples and of course, make sure the mother understands she does not have breasts or nipples that are perfect for breastfeeding. Then we wonder why women struggle in this culture to breastfeed. Maybe because we work so hard to destroy their confidence even before the newborn goes to breast for the very first time.

Care providers take one look and diagnose flat nipples, rarely considering how they actually function. Anatomy 101 reminder! Nipples are erectile, they stretch when stimulated. So when the baby touches the nipple either with their hands or mouth the nipple erects, some a little, some a lot. Sadly, many women compare their nipples to an artificial teat and worry that theirs is not the same, not quite right. Let’s set the record straight, we have the gold standard nipples, the rubber ones are a pathetic imitation!

And consider human infant feeding compared to other mammals. Many other mammals have long, exaggerated teats designed for the offspring to slurp it in and suckle the teat. Human infants breast feed- not nipple feed. Our offspring open their mouths wide and attach to the breast, not just the nipple. Correct latch involves the baby taking in lots of breast tissue. If they are sucking on just the nipple it will cause discomfort and result in inadequate milk transfer. It makes you wonder why we get so “judgy” about nipples! Let me take a moment to reassure you that babies don’t have a pre-set idea of measurements they want in a nipple. No, they want the one attached to their mother.

Nipples too big? I have seen small premies open wide and attach to nipples deemed “too big”. Did we forget to tell the infant that their mouth was not the right size to nurse? Asymmetric latch, with the baby starting nose to nipple, coming to the breast chin and bottom lip first, then bringing their head forward in an “up and over” motion can work like magic for little ones.

So before we start judging nipples and breasts, branding them not quite right, let’s first remember our number one job is to build the mother’s confidence and support their breastfeeding journey.

Myth #5

Drinking a lot of water will help you make more milk.

Another persistent one and untrue. I still read it in books and see it on well-meaning how-to websites which state that if you’re concerned about your milk supply the answer is easy: drink more water. Sometimes the amount can be more than a gallon a day with frustrating results. These results are spending more time in the bathroom and less time with your baby. Sadly, this shortcut skips asking pertinent questions like:

How often are you nursing? The answer should be 10-12 times/24 hours.
What is the baby’s output? The answer should be at least 4 urinations and 4 stools, with the stools changing color to a golden yellow and the urine a pale yellow, by the fourth postpartum day.
What is the baby’s weight gain pattern? It should be no greater weight loss than 7% in the hospital, no further weight loss by day 5 and regaining to birth weight by 14 days.
Have there been changes in the mother’s breasts? Ideally noticing fuller breasts in late pregnancy and breast becoming rounder, fuller, firmer and heavier as the milk composition changes over to mature milk.
Is the baby latching comfortably? Correct latch facilitates optimum milk transfer.

Shortcut answers like “just drink more water, eat oatmeal cookies, or drink lactation tea” bypass the need for assessment and can ultimately lead to poor outcomes for the newborn. Rather than setting arbitrary amounts of water, encourage mothers to drink enough to quench her thirst. Some research even shows drinking too much water can actually decrease milk production.

Myth #6

Breastfeeding is hard and difficult to learn.

Perhaps the saddest of the myths is that breastfeeding is so hard that your chances of success are really quite low. Breastfeeding is NOT difficult nor is it hard to do. Let me clarify: There can be difficult situations that arise but the vast majority of “problems” are generated by a hospital system or other systemic issues that are not designed to foster successful breastfeeding. Systems that separate mothers and their newborns might be the biggest reason for difficulties. When the newborn is immediately removed for the “experts” to tend to the baby, the message is that we can do a better job of caring for your newborn than you can, not the confidence- building care that supports breastfeeding. When newborns are housed in nurseries and brought out for scheduled feedings, the innate communication between mother and baby is interrupted. This exquisite communication is the foundation of breastfeeding as the newborn signals their needs and the mother’s body responds to provide the nutrition, nurturing and protection all newborns need and deserve.

Other practices that can reduce the chances of successful breastfeeding are:

-not encouraging skin to skin in the first hours and days after birth

-promoting a strict feeding schedule rather than teaching responsive feeding

-covering the newborn’s hands with mittens, denying them the use of their hand-to-mouth activities

-swaddling tightly and restricting their movements

– nursery housing so the mother “can get her rest” rather than talking with her about how to rest and sleep in the first days and weeks after birth

-allowing a brightly lit, noisy environment in the patient room rather than a calming, quiet environment for rest

-not honoring the magical connection between mother and baby

There are many other myths, of course but hopefully, with time, research and education, we can continue to support breastfeeding families with sound, evidence-based information and early and continued support for all families.

Sources

Agata Faron-Górecka. et al. The Involvement of Prolactin in Stress-Related Disorders. Int J Environ Res Public Health. Feb. 2023. doi: 10.3390/ijerph20043257. PMCID: PMC9959798 PMID: 36833950

Cadwell, K. et al. The Pocket Guide to Lactation Management. Jones and Bartlett Publishers,Inc. Fourth Edition. June, 2021.

CDCAP. CDC.gov. Breastfeeding. Maternal Diet. National Agricultural Library. NAI.USDA.gov

Kent, J. et al. Int. J. Environ. Res. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and TreatmentsPublic Health 2015, 12, 12247-12263; doi:10.3390/ijerph121012247

Mennella,J. Psychophysical Tracking Method to Measure Taste Preferences in Children and Adults. 2019 Apr 2.J Vis Exp. 2016 Jul 16; (113): 10.3791/54163. Published online 2016 Jul 16. doi: 10.3791/54163.PMCID: PMC6445264

December 22, 2024December 19, 2024

On being present, not perfect: compassionate communication in healthcare

It was over a decade ago that Elaine C. Meyer, PhD, RN, MBE, FSSH presented her TEDx Talk On being present, not perfect. Her message remains crucial, relevant, universal especially within maternal child health.

Dr. Meyer’s powerful piece incorporates personal and professional examples which bring life to the importance of holding space for compassionate communication and difficult conversations in healthcare.

She notes the essential ingredients of these conversations: Courage, Brains, and Heart, a clever Wizard of Oz mnemonic, and she emphasizes that “Practice makes better”, not perfect, as alluded to in her title.

Reflecting back, Dr. Meyer reports that we’ve accrued more awareness about these conversations. Compassionate communication is no longer a nice-to-have-it item; it has become an essential part of healthcare. Overall, Dr. Meyer has noticed that patients are more empowered, expecting this connection and level of care. Online rating tools have allowed for patients to evaluate providers specifically on their bedside manner.

Across the globe, On being present, not perfect has been incorporated into nursing and medical school curricula placing value on providers’ relational capacity early on in their careers.

In a culture where health care providers are often massively stressed and burnout can be of real concern, Dr. Meyer makes clear that honoring conversation is not only of benefit to the patient.

“… Being in relationship with the patient can be very fulfilling,” she begins. “This matters. At the end of day, a healthcare provider can say What I did matters. It can be the words that we speak, just being present, and showing up in all of your humanity. This doesn’t necessarily require extra time.”

Take for instance the personal vignettes she shares in On being present, not perfect: a nurse who held her hand, squeezing back in reciprocity, an anesthesiologist who told her “I will be with you the whole time. I will watch over you. We’ll get you through this.” Simple yet profound, words and actions that sustained her during harrowing procedures. “Gestures of humanity,” Dr. Meyer calls them.

What’s more, when this kind of respect and communication are established, patients have significantly better health outcomes and provider job fulfillment and retention increases.

“If a clinician feels like I did a good job today, I connected, that buoys the clinician. The clinician feels more efficacious,” she explains.

These conversations matter across the lifespan in any specialty, of course; however, the perinatal period is of special importance, because perinatal experiences have generational physiological and psychological implications. This time period influences the mother-child relationship for a lifetime.

Having endured multiple pregnancy losses and IVF, Dr. Meyer shares that when her son was born, her initial focus on breastfeeding was primarily nutritional.

“The connection and attachment that breastfeeding can foster wasn’t as much on my radar,” she says. “But after rising from the ashes of infertility, being able to nurse my baby boy was restorative and healing.”

Though she and her son were not up against monumental feeding challenges, she consulted a lactation professional as a support person. She says this was immensely helpful to have someone who believed in her, someone joining her in the journey, someone to fortify what was important to her.

As a provider, Dr. Meyer recalls a few highly distressing stories related to birth and infant feeding when she needed to show up with Courage, Brains, and Heart. She shares one in particular:

There was a preterm newborn who was admitted to the Intensive care unit with severe birth complications and prolonged anoxia. The baby’s mother was determined and dedicated to breastfeeding her baby. The baby was unable to nurse because she was sustained on life support with a ventilator. Dutifully and with great care, the mother pumped her breastmilk and the baby received the milk through a small nasogastric tube. As a psychologist, I had the great privilege of meeting with the parents to listen to their story, to bear witness to their fledgling parenthood, and to offer support….Those were tender and difficult conversations. We held several family meetings with the team to help determine the baby’s treatment. Given the infant’s devastating brain injury, and poor prognosis, the parents and team agreed with the difficult decision to withdraw life support treatment. After the ventilator was withdrawn, the baby passed away peacefully in her mother’s arms with the father at their side. In a final act of love and dignity, as the parents left the hospital for the last time, the mother left a little bottle of breastmilk at the nurses’ station counter. Testament to a mother’s love, it was a most precious parting gift. The parent-child relationship transcends death. The lactation consultant offered ongoing education and support to the mother who went home without her baby- to pump for comfort and to stand in a warm shower with her back toward the shower head, so as to ease any discomfort. Courage, brains and heart….

As she concludes her Tedx Talk, Dr. Meyer offers some final inspiration: “Once upon a time you wanted to change the world. You still can, one conversation at a time.”

Learn more about Dr. Meyer’s efforts here.

December 15, 2024December 11, 2024

Lactation and menopause

*This piece contains curse words.

Conjunctivitis? Eczema? Diaper rash? Just put some breast milk on it. [Witkowska-Zimny, et al 2019]

Breastfeeding is more than nutrition. Read our Breastfeeding is series to learn more about how breastfeeding is beyond what most people assume. Basically, breastfeeding and human milk are miracle elixirs, cure-alls!

Of course this isn’t entirely true. Read more about what we mean in A different angle and Still watching our language. Also check out Parts One and Two of Potential consequences of invoking ‘natural’ in health promotion.

Like Nikki Lee once analogized: “Human milk is not magic fairy dust. Human milk is nature’s seatbelt. A seatbelt does not guarantee survival in a car crash. We wear seatbelts because they increase our chances of survival…”

Thanks to breastfeeding, my family and I survived infancy, toddlerhood, and beyond.

Thinking back, my coffee dates were once accompanied by my nursing toddlers, their chubby little fingers cupping mini hot chocolates, scribbling with crayons, and chit-chatting with the elderly patrons; now, I spend more one-on-one time with friends at the coffee shop. With many of them quite a bit older than me, I am learning about their experiences going through menopause. It’s a new chapter. One morning, I observed a dear friend breathe through hot flashes, her face flush, as she shed her vest and scarf, then bundled up again, then squirmed out of them, over and over throughout our visit. I sat there entirely helpless, but not entirely speechless.

Breastfeeding. The magic elixir. The cure-all.

Her eyebrow raised.

I quoted Wenda Trevathan:

“Why is menopause stressful? The short answer to this question is that it is not stressful for most women in the world, as far as can be ascertained by social scientists… Anthropologists Jane Lancaster and Barbara King propose that modern women may experience the end of ovulation under a different hormonal milieu from that of our ancestors and women in ‘natural fertility’ populations today. For example, !Kung women reportedly breastfeed their last infant for a longer time than for previous infants and when they terminate breastfeeding, perhaps in their mid-40s, they simply do not resume ovulation. Thus, the hormonal milieu of menopause includes the hormones of lactation (especially prolactin and oxytocin), which may modulate the effects of other changes…” [Ancient Bodies, Modern Lives, 2010, p 168-169]

Her brow remained raised.

I offered: Christine R. Langton, MSW, MPH, et al, in Association of Parity and Breastfeeding With Risk of Early Natural Menopause, discovered an increase in parity decreased the risk of early menopause. What’s more, the authors note, “Breastfeeding was associated with significantly lower risk, even after accounting for parity. Breastfeeding at levels consistent with current recommendations may confer an additional benefit of lower risk of early menopause.”

And then, Natalie V. Scime, et al found that “In a dose-response manner, longer lactation was associated with reduced risk of natural menopause before age 50 (for ≥ 13 months of lactation, adjusted hazard ratio at age 45: 0.68, 95% CI 0.59–0.78), surgical menopause before age 55 (age 45: 0.56, 0.50–0.63), and indeterminate menopause before age 50 (age 45: 0.75, 0.69–0.82). Longer lactation was associated with lower odds of surgical (adjusted odds ratio 0.54, 95% CI 0.45–0.66) and indeterminate menopause (0.63, 0.55–0.73), compared to natural menopause.” [2024]

So you see, it’s breastfeeding, breastfeeding is the answer.

My friend was now not only struggling to regulate her body temperature, she was struggling to regulate her patience with me, because of course, this was all very interesting, but not relevant to her current challenges.

And that’s when all of the rage we’ve both learned to suppress and breathe through and gratitude-journal and downward dog away came boiling out into a frothy fuck you to the medical-industrial complex, to the patriarchy, to anything that’s gotten in the way of women enjoying healthy, fulfilled existences.

I was pissed because I know what the infant feeding landscape looks like in America and what this means for the future health of our offspring, ourselves, and our planet. She was pissed because she knows what it looks and feels like to get “care” during menopause (but really her entire lifespan) in America. So, basically, we were pissed, some might say hysterical, about the same thing.

We’re not the only ones.

Brené Brown spoke with Dr. Mary Claire Haver, a board-certified OB/GYN, on the Unlocking Us podcast, and they too, are fired up about women’s health care.

During all phases of our lives, we are considered emotional, dramatic, attention-seeking, imaginative (not in a good way), fragile, crazy over things that have major and long-lasting implications like family planning, birth, infant feeding, menopause. We are laughed at, dismissed, lied to, pitied…

In Unlocking Us, Dr. Haver says: “There’s a reason why hysterical is a word and we don’t have testerical. And that has got to stop…”

She goes on to explain: “I was taught that there’s a significant percentage of hyperemesis, now, this was in the ’90s, that is psychological. We were putting people on antipsychotics for hyperemesis. That has been completely debunked. We have found the receptor in the brain that is causing this. And I have to shout out to Shannon Clark, right in Galveston, who presented to the FDA, she’s done the most research on this.”

Dr. Haver compares this to current menopause care: “One of the most popular treatments for hot flashes that is being touted as, this is the route we should go, especially in Europe, is cognitive behavioral therapy. Which I love, for a multitude of things…

And Brown interjects: “I mean, I love too, but shut up and sit down.”

Dr. Haver continues sarcastically: “…cognitive behavioral therapy, if you just out think your hot flash, if you change your perception of your menopause…”

Dr. Trevathan wonders in Ancient Bodies, Modern Lives, “…does menopause have to be a ‘bad’ thing? This question derives from a fairly Western perspective that has pathologized the period of time when a woman is experiencing the physical and emotional transitions to a post reproductive state… It is often likened to diabetes as a disorder characterized by hormonal deficiency. In fact, menopause has been called an ‘estrogen deficiency disease.’” (p 161)

Laurel Wilson has looked extensively at estrogen and its interplay with lactation and [peri]menopause. Find her work here.

Trevathan goes on to offer “Whether perceived as a medical ‘problem’ or not, the menopause transition is associated with a number of physiological changes that are experienced by women at this time and are usually explained by changes taking place in ovarian function. (p 163)

Finally, she suggests: “The perspective of evolutionary medicine would argue that ‘returning’ to the lifestyles under which human reproduction evolved would alleviate some of the problems that women face today with menopause. Without taking the recommendations to extremes (no birth control, self-imposed undernutrition), it seems possible that by increasing exercise, reducing fat intake, and minimizing exposure to industrial biochemicals, women would experience fewer problems at menopause. In this way, adopting the behaviors and diets of our ancestors may go a long way toward not only reducing the stresses of menopause but prolonging healthy lives as well.” (p 169-70)

So, like I said, breastfeeding is (at least part of) the answer.

September 22, 2024September 20, 2024

The color pink is not the cure for breast cancer

Dr. Howard Markel (History of Medicine, University of Michigan) and Ira Flatow discuss in a Science Diction interview the origin of the word cancer citing Hippocrates as “he applied the Greek word karkinos, which means crab.”

Dr. Markel digs deeper: “… if you examine a tumor, if you actually feel a malignant tumor, you’ll note that it’s hard as a rock. And so some have explained that it reminded him of the hard shell of a crab. But others have said it may have reminded him of the pain that a malignant tumor induces. It’s much like the sharp pinch of a crab’s claw. And an even better version is that it suggests the tenacity with which, you know, a crab bites you…And then about 100 years later, another very famous doctor named Galen extended that Hippocratic metaphor even further. He was dissecting a breast tumor. He noticed all the veins and tributaries of malignancy around that mass, and he said it looks just like a crab’s legs extending outward from every part of its body. And so the term really stuck.”

At any point in the year, cancer will be heavy on many Americans’ minds, because over half of us know someone who’s been diagnosed. Then, during October, we’re bombarded with the color pink, in an apparent breast cancer awareness effort.

We wrote about the phenomenon back in 2014.

The breast cancer awareness industry and our culture at large neglect breastfeeding and the use of human milk in its preventative messaging. Breast cancer research has even been featured on a stamp but never breastfeeding, unlike many other countries over the past several decades. (Check out an amazing collage here.) The St. Louis Breastfeeding Coalition is working to change that through their breastfeeding stamp petition.

Research shows that “not breastfeeding is associated with health risks for both mothers and infants. Epidemiologic data suggest that [not breastfeeding] is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome.” [Stuebe, 2009]

Interestingly, an association between breastfeeding and cancer was noted in the late 18th-century by “medical men”.

This TIME article reads: “In 1772, man-midwife William Rowley wrote: ‘When the vessels of the breasts are over-filled and the natural discharge through the nipple not encouraged … it lays the foundation of the cancer.’ Frances Burney – an aristocratic novelist who underwent a mastectomy in 1811 – attributed her disease to her inability to breastfeed properly: ‘They have made me wean my Child! … What that has cost me!’

Nikki Lee, RN, BSN, MS, Mother of 2, MS, Grandmother of 2, IBCLC, CIMI, ANLC, RYT500 shares that back in the early 2000s, she contacted the American Cancer Society to suggest they include breastfeeding as prevention for breast cancer.

“They wrote back, saying there’s not enough evidence,” Lee recalls.

The most recent version of their website includes this verbiage:

But as Lee points out, “One has to know what to look for to find a mention of breastfeeding.”

She also argues, “It hasn’t been hard to study; look at the global research.” One study she cites can be found here, and from a quantifiable, preventive aspect, Lee cites Britta Stordal’s work.

And Columbia’s Mailman School of Public Health’s piece notes this bit:

“‘Women who had children but did not breast-feed had about 1.5 times the risk for ER/PR-negative breast cancer,’ said Meghan Work, MPH, doctoral student in the Department of Epidemiology and first author. ‘If women breast-fed their children, there was no increased risk for ER/PR-negative cancer. This is particularly important as breast-feeding is a modifiable factor that can be promoted and supported through health policy,’ Work said.”

The World Cancer Research Fund International offers a page on breastfeeding.

They say:

This message is different from the American Cancer Society’s of course, but it plants skepticism about the possibility of breastfeeding. Read Valerie McClain’s notes on the dubious phrase “if-you-can” here. Also check out our piece Taking ‘if’ out of the equation.

Twenty years ago, Healthy Children Project’s Barbara O’Connor, BSN, ANLC and her local breastfeeding task force attempted to secure a breastfeeding promotion table at a community breast cancer awareness run/walk. She shares about the struggle:

Our local task force decided that this would be very appropriate for us to have a breastfeeding promotion booth; the race was attended by a large number of community participants, and we believed we could reach many people with information about the research regarding the association of decrease in breast cancer with increase in breastfeeding rates. We contacted the race committee only to be told that our booth would be inappropriate at this event. We were very perplexed…

We were not allowed to have a booth the first year. Not disheartened, we requested again the next year. We actually had to have a phone conversation with the race director. Only after much discussion and a great deal of apprehension were we allowed to set up a booth.

[The booth] was incredibly successful. It was very tastefully displayed with much information regarding the benefits of breastfeeding emphasizing, of course, the reduction in breast cancer. Many community member stopped to talk and some were very surprised to learn about the research regarding breastfeeding and reduction of breast cancer. The task was pleased to have preserved and then allowed the opportunity to successfully educate the community.

We never did understand why the committee was so hesitant to allow us to participate. There were a host of other booths at this event, the majority being about reconstructive surgery and support after the diagnosis. No booth with the emphasis on prevention. And as soon as the word breastfeeding was mentioned in the conversations with those on the committee, there seemed to be this reluctance to allow the booth. Of course, no members of the committee understood the relationship between breastfeeding and cancer reduction. So, in the end, I suppose it was a good opportunity for education all around.

Acknowledging the cynicism, Lee continues, “One challenge to prevention is that it puts people out of work…The money it costs a woman to treat breast cancer goes to pay for drugs, machines, nurses, doctors and all the other accoutrements of health services.”

And of course, the commercial milk formula industry has a product and their bottomline to protect.

That product comes with risks. Author Alison Stuebe writes: “Several studies have examined associations between formula feeding and childhood leukemia based on the hypothesis that immunoreactive factors in breast milk may prevent viral infections implicated in the leukemia pathogenesis.47 Two meta-analyses1,48 found a 1.3-fold higher risk of acute lymphoblastic leukemia (95% CI, 1.1–1.4) among formula-fed children compared with children who were breastfed less than 6 months. Kwan and colleagues48 also found a 1.2-fold higher risk of acute myeloid leukemia (95% CI, 1.0–1.4) among formula-fed infants compared with infants breastfed more than 6 months.” [2009]

Direct breastfeeding is collaborative in a way that bottle-feeding is not, offering another form of awareness and protection. In this case, breastfeeding offered early detection of breast cancer in the mother because of her baby’s refusal to nurse from one side, a phenomenon known as Goldsmith’s Sign.

Source: United States Breastfeeding Committee.

Dr. Kathleen Arcaro’s research “has shown that exfoliated cells in breast milk provide valuable information on breast health and can help predict breast cancer risk,” noted in this article.

There’s research being conducted that suggests human milk might someday be used to treat and cure cancer. Read about that here in a piece by Donna Walls, RN, BSN, IBCLC, ANLC.

Lee– as one of us who knows someone diagnosed with cancer– also suffered from the death of a dear friend at the claws of cancer. In Milk Train Brings Healing to Baby and Mom, Lee recounts her experience providing milk for her friend while she was sick. It’s one of those pieces I keep reading over and over, a gripping account of beauty within tragedy, and a reminder of the power of human milk and mothers that has yet to be recognized in our country.

More to explore

Cherry blossoms: a nursing mother’s journey with Paget’s Disease and triple-negative breast cancer

The Lactation Pharmacist guest post in honor of Childhood Cancer Awareness Month

Cancer Does Not Define Anyone, It’s Just a Part of Her Story.

Research confirms safety of breastfeeding for breast cancer survivors with BRCA mutations// Two Recent Studies Provide Evidence That Breastfeeding After Breast Cancer May Be Safe

FRANKENBOOB

Association between breastfeeding, mammographic density, and breast cancer risk: a review

Posts and resources on cancer at IABLE here

Posts and resources on cancer at the Physician Guide to Breastfeeding here

October 15, 2023

Boston Public School teacher works to extend support to other lactating educators

Porshai Z. is a third grade teacher in the Boston Public School system, currently on maternity leave with her three-month-old son who cooed during our phone call on an early October morning.

“I absolutely love it,” Porshai says of teaching. “My [students] are at the most tender age where they’re still aiming to please adults, but they have a little sass and personality.”

After the birth of her first son, Porshai returned to work just four months postpartum, and she says it’s one of her biggest regrets. For one, it took away from her role as a teacher. She found herself pumping in a bathroom, stressing each and every time she needed to leave her full-of-personality third graders. Returning to work so soon after the birth of her baby also took away from the joy of feeding her first son, Porshai shares.

Though Porshai poured herself into research about unmedicated birth and how to breastfeed as soon as she became pregnant, she found herself unprepared for the physical demand of feeding her little human. There was one evening in particular where she felt enticed to open the commercial milk formula package sent by the formula company, but she ultimately persevered.

“I don’t know what quieted that voice,” Porshai reflects. Perhaps it was the investment she made learning and preparing for this relationship and her realization even through the challenge: “Wow, this is really special.”

This time, Porshai will remain at home with her new baby for a year. Simultaneously, she is completing the Lactation Counselor Training Course (LCTC). Porshai earned one of the most recent rounds of the Accessing the Milky Way Scholarships.

“I have really been enjoying [the course],” Porshai shares. “ There is so much I wish I knew the first time I was nursing.”

She says she appreciates that the course grounds breastfeeding as a public health issue and that she was surprised to learn about the composition of human milk. Learning about milk’s dynamic nature has allowed her to better understand her own infant’s behavior. More generally, she was fascinated to consider how our society has adopted nesting caregiving behavior though we are truly carriers.

“This is mind-blowing,” she says. “So many more women need to hear that.”

As a highschooler, Porshai was always fascinated by reproductive health. She’d watch documentaries on birth and her favorite science museum exhibit was one that depicted the stages of life. It wasn’t until later that she became aware of the option to become a lactation care provider.

Through Boston Medical Center’s Curbside Care for Moms and Babies, a mobile unit that provides “comprehensive mother-infant dyadic care during the first six weeks of life”– Porshai met her first duo of Certified Lactation Counselors (CLCs).

“I really do think the power of that training is what allowed me to continue [breastfeeding] in the first place,” Porshai reflects.

This wrap-around care was particularly influential as it ‘met her where she was at.’

Porshai goes on to say, “I hope to work in that way as well. I hope to be that visibility.”

More specifically, Porshai says she has been thinking a lot about how elementary education is a female-dominated industry; with many friends and colleagues growing their families, Porshai hopes to be a resource and support for them as they learn to feed their babies. She plans to create a network of breastfeeding mothers within the Boston Public Schools so that there is a designated space for parents navigating infant feeding and the unique challenges of teaching.

In addition, Porshai is considering becoming a postpartum nurse.

“[The LCTC] could very well be the thing that catapults me to go back to school.”

For more on teaching and lactation, check out this article. The PUMP Act now extends federal lactation rights and protections to all employees in K-12 schools.

Tag: lactation