lactation Archives - Our Milky Way

September 10, 2023September 8, 2023

Changing the culture of mother baby separation in one Northeastern hospital

“I got to touch him once and they took him right away from me,” Northern Light Eastern Maine Medical Center labor and delivery nurse Jennifer Wickett says, remembering the birth of her first child 19 years ago.

Wickett desired non-medicated births, but her three children ended up being born via cesarean sections for various reasons. Wickett’s personal birth experiences coincided with her early professional life, working at a hospital in Massachusetts as a labor and delivery nurse.

At the time, she explains, the process was this: the baby was born, taken to the warmer, vitals and weight were recorded. The baby was wrapped in a blanket and held next to mom’s face for five to ten minutes and then taken to the newborn nursery.

Skin-to-skin in the OR, Healthy Children Project

“I hated that for my patients and I hated that for me,” Wickett says.

So Wickett singularly started changing that culture of mother baby separation.
Now, at Northern Light Eastern Maine Medical Center, Wickett attends about 95 percent of the c-sections, and she says she was able to “take control.”

“[Initially] I wasn’t tucking baby in skin-to-skin, but I was putting baby on top of mom with the support person helping hold the baby,” Wickett explains.
She deemed it the Wickett hold: baby placed chest down on mom with knees tucked under the left breast and baby’s head on the right breast.

Attending a Kangaroo Mother Care Conference in Cleveland galvanized her efforts: the evidence clearly supported skin-to-skin contact immediately after birth and beyond. Fellow nurses, anesthesiologists and other team members were resistant, but Wickett and a few other fellow nurses who created the Kangaroo Care Committee kept at it, always leading with kindness and communication. Rather than approaching the process with an “I have to do this” agenda, Wickett involves and acknowledges all of the participants in the room.

For instance, to the mother, she asks permission while also explaining the importance of skin-to-skin contact.

“They’re in hook line and sinker when I explain that their body regulates their baby’s temperature,” Wickett explains. “They don’t want to give that baby up; they are not letting that baby go.”

To the anesthesiologist, she facilitates open communication. Wickett lets them know that she assumes responsibility for the baby. “Are you good?” she often checks in with the anesthesiologist, while minding their space to work safely and efficiently.

Wickett makes certain to involve the partner in their baby’s care, asking them to keep a watchful eye over mom and baby.

Just about half of the babies she sees begin breastfeeding in the OR, she reports. From the OR, babies are kept on their mothers’ chests as they’re transferred to the recovery room, continuing the opportunity to breastfeed. All in all, Wickett says that babies born by c-section at her hospital spend more time skin-to-skin than those who are born vaginally.

After a vaginal birth, eager nurses often disturb skin-to-skin contact to complete their screenings and documentation. Excited partners wanting to hold their baby tend to do the same.

In the OR though, Wickett says there are at least 30 minutes without these disruptions. Once mother and baby are transferred to the PACU, mothers report decreased pain when skin-to-skin is practiced.

What’s more, Wickett reports hearing often “This baby is such a good breastfeeder!” because the babies have an opportunity to initiate breastfeeding within the first two hours of life.

The World Health Organization (WHO) recommends that immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. The recent Skin-to-skin contact after birth: Developing a research and practice guideline synthesizes the evidence. [Read more here.]

Wickett and seven other colleagues had the opportunity to complete the Lactation Counselor Training Course (LCTC) last year.
While she says she would have loved to have been able to take the course in-person, Wickett still found the material and resources “fabulous.”

For the past four years, there’s been a vacancy in the perinatal coordinator position at her hospital, so Wickett hopes that her new credentials will allow her to fill the need. In the meantime, Northern Light Eastern Maine Medical Center offers outpatient lactation visits. The center’s breastfeeding support groups halted during the height of COVID and have yet to resume; Wickett reports that they are trying to bring those back virtually.

Additionally, Maine residents have access to the CradleME Program which
offers home-based services to anyone pregnant up to one year postpartum.
In partnership with the Mothers’ Milk Bank Northeast , Northern Light Eastern Maine Medical Center became the first milk depot in the Bangor area.

You can read more Our Milky Way coverage on skin-to-skin after cesarean birth in Skin-to-skin in the operating room after cesarean birth , The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth , and Skin to skin in the OR.

Also check out Skin to Skin in the First Hour After Birth; Practical Advice for Staff after Vaginal and Cesarean Birth Skin to Skin.

Find some beautiful KMC imagery here.

August 6, 2023July 26, 2023

Educator and leadership team member shares breastfeeding experiences, supports lactating colleagues

When the PUMP Act was signed into law last year, it expanded the legal rights of some 9 million more lactating individuals, including teachers, who had been previously excluded from the 2010 Break Time for Nursing Mothers law as it only applied to hourly workers.

But even with the revamped legislation, teachers are in a unique position.

In Jill Inderstrodt’s I Study Breastfeeding Behavior. Here’s Why Nursing Teachers Have It So Tough, she explains: “…The bill’s prescriptions are often at odds with the day-to-day logistics of jobs.”

Inderstrodt goes on, “In many cases, teachers have to choose between finding coverage for their classroom or forgoing pumping. With one or two pumping sessions per day, this could mean finding coverage 40 times a month.”

Stacy Synold is an educator and part of the leadership team at a small, private school in the Midwest. She breastfed all three of her biological children, now 25, 22, and 19, beyond their second birthdays.

“I never thought I would breastfeed as long as I did but I followed their lead and found it to be supportive of my parenting choices,” Synold shares.

She continues, “Breastfeeding was so important for my kids, who all had asthma and allergy issues. I shudder to think of what their health may have been without nursing. What started as a nutritional imperative for me became some of the most treasured [moments] in my life. Given that I nursed toddlers and even a near preschooler, they were all very verbal and verbally loving about breastfeeding, and I remember all the little names and words they had for breastfeeding.”

There was “sie-sie” for nursies and “noonies” and “nonnies”.

“One time… my son said, ‘I give hugs to the nurse and hugs to the other nurse,” in reference to breastfeeding, Synold remembers.

As it sometimes is, weaning was a momentous event for Synold’s family. When her daughter was about to turn three, she hosted a weaning party.

“We had pink cupcakes and the whole family celebrated. She had stopped nursing except for once every few weeks so we decided to support her into her next phase. We gave her a baby doll to nurse if she wanted to and that was her favorite doll for a long time.”

Besides feeding her own children, Synold pumped her milk for the adopted newborn of a local woman who endured the death of her biological baby a year earlier.

“She had high hopes of relactating, but I very much wanted to help her in the short-term,” Synold says. For eight weeks, she pumped on a three to four hour schedule.

“It was almost like having a newborn again, and my 18-month-old daughter loved my increased production,” Synold remembers. “I would do it all again to see the smile on that mom’s face each time I delivered the milk!”

Synold served as a La Leche League Leader for nearly a decade under the mentorship of Kay Batt, who has been a LLL leader since 1967. Batt invited Synold to an evening meeting which turned out to be a meeting with an emphasis of supporting mothers and families who worked outside the home.

“She helped me become a better mom and shared so much knowledge, especially about how to support the unique needs of working families who breastfeed,” Synold reflects.

Since breastfeeding her own babies, Synold has witnessed a shift in infant feeding culture.

She cites being appreciative of the laws passed in protection of breastfeeding and the increase in designated places for mothers to breastfeed in public.

“I wasn’t bashful, but my children were easily distracted and needed a quiet place to nurse],” she begins. “I was kicked out of a restaurant in Mayfair Mall once in 2001 for breastfeeding at the table. Apparently, men and boys ate there…who knew! I said to the woman who was kicking me out when she stated about men and boys, ‘I know, I am feeding a little boy right now!’”

Because of the nature of her work outside of the home while she was breastfeeding, Synold didn’t find herself in the position of needing workplace accommodations. For instance, as a nanny at one point, she says she was easily able to nurse her son without special accommodation. In a different position, her daughter was two, so she was able to withstand longer stretches without emptying her breasts. Her toddler would then nurse throughout the night as they coslept.

In her recent leadership roles, Synold facilitates safe lactation spaces for her colleagues.

“I always have a comfy area in my office, I offer flexible schedules and plentiful breaks if needed, and seek better locations,” Synold explains. “One year, I had seven teachers give birth and my office was the only office with a lock. I ended up out of my office most of that year, so we gave a locking large closet a makeover for pumping. I did realize I sometimes needed an office!”

Like Inderstrodt concludes, “If we are going to recruit and retain our teaching workforce under such circumstances, teachers need all the accommodations we can give them. That means that legislation such as the PUMP Act must be accompanied by scheduling accommodations at both the school and district levels so that the legislation for lactating mothers transcends paper.” Even before it was signed into law, Synold has exemplified this support.

February 5, 2023

Breastfeeding is mammalian.

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

Breastfeeding is mammalian.

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

A mammal is an animal of the class Mammalia, an animal that suckles its young. Mammal is the 1800’s Englished form of the Latin “Mammalia” (1773). Dissecting the word further, it was coined in 1758 by Linnaeus for the class of animals from the neuter (things that have no gender) plural of Late Latin mammalis “of the breast.” [https://www.etymonline.com/word/mammal]

Predating language, milk and lactation are ancient; in fact, the origins may date as far back as 300 million years ago, according to scientist Mike Power, who curates and maintains the Smithsonian’s National Zoo’s milk repository, as reported by Catherine Zuckerman. That makes mother’s milk older than dinosaurs!

Since those many, many million years ago, mother’s milk, the “magic potion”, has been shaped by natural selection and has diversified among the thousands of mammals that are living today, Katie Hinde has explained. Species specific milk has allowed mammals to live in environments in which the young could not otherwise survive and to cope with unreliable food sources. This evolution to support infants while they’re developing has led to important mammalian adaptations like complex social relationships, Hinde goes on. The first social (and sometimes the only) encounter for mammals, is with their mothers.

Juan Brines and Claude Billeaud so graciously offer “a testimony of gratitude and respect to women who have assumed the responsibility of breastfeeding their infants because without them the human species would not have existed” in Breast-Feeding from an Evolutionary Perspective.

Additional resources

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

Check out Hinde’s March Mammal Madness inspired by the NCAA College Basketball March Madness Championship Tournament. This year’s fun and results can be found here.

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share with us: What is one of your earliest memories of infant feeding?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag, and this week we have made it to our tenth week celebrating Our Milky Way!

January 1, 2023January 1, 2023

Breastfeeding is part of a continuum.

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

Breastfeeding is part of a continuum.

It has been hypothesized that starting around nine weeks of fetal development, the pattern and sequence of intrauterine movements of the fetus seem to be a survival mechanism, which is implemented by the newborn’s patterns of movement during the first hour after birth (described as the 9 stages) when skin-to-skin with the mother to facilitate breastfeeding.

Photo credit United States Breastfeeding Committee

This very behavior refutes the idea that breastfeeding is “an adjunct to birth” as it is generally viewed in maternity care settings in America.

Not only are human babies hardwired to progress through 9 stages and self attach to the breast, mammalian bodies are hardwired to produce milk too.

Around 16 weeks of pregnancy, the body starts to prepare for breastfeeding. This phase, called Lactogenesis I is when colostrum begins to be created. During Lactogenesis II, the secretion of copious milk follows the hormonal shift triggered by birth and the placenta delivery. After this phase, milk production must be maintained through a supply-and-demand-like system. [Neville 2001]

Even before a pregnancy is achieved, individuals are being influenced by the infant feeding culture that surrounds them, consciously or subconsciously laying a foundation for how they feel about feeding their own babies.

Pat Hoddinott’s, et al study found that women who had seen successful breastfeeding regularly and perceived this as a positive experience were more likely to initiate breastfeeding.

Exposure to prenatal breastfeeding education also affects breastfeeding outcomes. Irene M. Rosen and colleagues found that women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls.

Mode of birth and birth experiences influence infant feeding too, for both members of the dyad.

A growing body of evidence shows that birth by cesarean section is associated with early breastfeeding cessation.

Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. [Brimdyr, et al 2019]

What’s more, the authors of Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways found “No positive relationships between the administration of synthetic oxytocin and breastfeeding.” They comment, “Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use of synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes.”

In Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum, author Miriam Labbok takes a detailed look at “the power and potential of synergy between and among organizations and individuals supporting breastfeeding, the mother-child dyad, and reproductive health to increase sustainable breastfeeding support.”

Labbok points out that a paradigm shift on the issues in the reproductive continuum – family planning, pregnancy and birthing and breastfeeding– is needed.

“These are issues that are intimately, biologically, gender linked in women’s lives, and yet ones that are generally divided up to be addressed by a variety of different professional disciplines,” Labbok begins. “Despite the impact of child spacing on birthing success, of birthing practices on breastfeeding success, and of breastfeeding on child spacing, we are offered family planning services by a gynecologist, birth attendance by an obstetrician or midwife, and baby care by a pediatrician. Having these ‘silos’ of care, each with its own paradigm and priorities, may lead to conflicting messages, and hence, may undermine the search for mutuality in goals, and collaboration.”

One such initiative looking to deconstruct siloed care is the Baby-Friendly Hospital Initiative which includes standards and goals for birthing practices, for breastfeeding-friendly communities, and guidance for birth spacing, in addition to reconfirming the original Ten Steps to Successful Breastfeeding, in recognition that breastfeeding occurs along a continuum.

Source: United States Breastfeeding Committee

1,000 Days emphasizes how breastfeeding fits within the global picture as a crucial part of a whole.

In the U.S. context, the 1,000 Days initiative recognizes comprehensive health coverage, comprehensive guidelines on nutrition during pregnancy, lactation, and early childhood for women in the first 1,000 days, paid family and medical leave policy for all workers, and investments to ensure parents and caregivers can access good nutrition as solutions to a well nation and a well world.

——–

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share with us some or all of your birth stor(ies).

Subsequent weeks will have a different prompt in the blog post.

November 20, 2022November 18, 2022

Enhancing national network of nonprofit donor milk banks and diversifying nation’s production of infant formula to secure infant nutrition in U.S.

The Infant Feeding Action Coalition USA, Inc. (IN.FACT.USA) has put together a piece detailing the global recall of contaminated Abbott powdered formulas.

In February 2022, the largest U.S. infant formula manufacturer recalled three brands of its powdered formula and one breastmilk fortifier and shut down its main manufacturing facility in Sturgis, Michigan following reports of Cronobacter infections in infants who had consumed formula manufactured at the Sturgis plant. It’s noteworthy that the initial recalls were voluntary–not required by the US Food and Drug Administration (FDA)— and they only came after nine babies died between September 2021 and January 2022 from infections.

Let’s focus on that, the death of these babies, Tameka L. Jackson-Dyer, BASc, IBCLC, CHW urges in her Great Lakes Breastfeeding webinar Feed the Baby: Lactation, Contamination, and the American Formula Crisis.

One infant death is one too many. Initially, two deaths were reported; however, Freedom of Information requests and whistleblower action revealed that not only two, but another seven infants in the U.S. were reported to have died after consuming powdered infant formula manufactured at the Abbott factory.

“During the same period, 25 severe infections categorized as ‘Life Threatening Illness/Injury’ and 80 instances of ‘Non-Life Threatening Illness/Injury’ were reported among infants who were fed these formulas,” The Abbott Powdered Formula Scandal also points out.

“Until Cronobacter infections require mandatory notification, the number of cases of illness or deaths will never be known. Neither will their extent in the 37 countries which imported the potentially contaminated Abbott formula.”

In The Four Pillars of Infant Nutrition Security in the United States, author Amelia Psmythe Seger points out that “The U.S. has not regulated the marketing practices of the commercial milk formula industry, unlike 70% of the world, which has implemented at least some part of the WHO’s International Code of Marketing of Breast-Milk Substitutes. In the absence of regulation, these marketing practices are predatory.”

Psmythe Seger goes on to urge, “Diversify the nation’s production of infant formula. Plainly it is a mistake to allow 42% of the infant formula in this country to be produced not only by one company but by one factory of that company. Infant formula companies are part of an infant food security system, but we don’t have to be so dependent on that industry.”

[For more on commercial influence, you can watch USBC’s series of Unpacking Commercial Milk Formula Marketing Webinar Recordings]

A history of breastmilk substitutes laid out by Jackson-Dyer reminds us that before the advent of commercial infant formulas, wet nursing was the original supplemental feeding.

Considering the infant feeding landscape today, Jackson-Dyer quotes Michigan Breastfeeding Network Executive Director Shannon McKenney Shubert, MPH, CLC: “In my 12-year career in the field of human milk feeding, I have never once met a birthing parent who ‘chose not to breastfeed.’ In this country, whether to breastfeed is not a choice. In this country, whether to breastfeed is a question of ‘Within all the systems of oppression that I navigate, what is the best combination of things I can do to ensure the survival of my baby, myself and the rest of my family?’”

With this context in mind, Jackson-Dyer confronts the idea that yes, babies must be fed, but fed is not best; instead, it is required, she says in her webinar.

“It is the absolute minimum to sustain life,” she reminds us. “We can’t just feed the baby anything.”

Again in The Four Pillars of Infant Nutrition Security in the United States, Psmythe Seger shines light on nonprofit donor milk banks which provide pasteurized donor human milk for human babies, “the next best thing to mom.”

“Enhance the national network of nonprofit donor milk banks,” Psmythe Seger writes. “Support innovative partnerships across existing structures, taking a cue from a national model such as what exists in Brazil. Consider: Red Cross has the infrastructure to support donor screening; WIC offices or community health clinics could be donor drop-off sites; more hospitals could provide space and equipment for donor milk processing and distribution, as some have done. Models exist to create an affordable and plentiful alternative to commercial milk formula when a parent’s own milk is not available.”

Photo by: Sara D. Davis/
Source: United States Breastfeeding Committee (USBC)

This fall, the Access to Donor Milk Act (ADMA) was introduced in the House. ADMA would increase federal support for nonprofit milk banks and access to donor milk for medically-vulnerable infants.

What’s more, the legislation would allow state agencies to use WIC funding to promote the need for donor milk, provide emergency capacity funding when there is a demand for donor milk, create a donor milk awareness program, and require the secretary of HHS through the FDA to issue a rule clarifying the regulatory status of donor milk provided by nonprofit milk banks.

Stay tuned for how you can help support this legislation. For other legislative and policies opportunities that support healthy infant feeding, visit USBC’s Take Action page here.

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