Tag: lactation

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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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Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model

Photo by Luiza Braun

Over half of the Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program peer counselors were once served by the program as mothers enduring mastitis or going back to work early or other barriers to healthy infant feeding. Yet, some of these mothers still managed to breastfeed into toddlerhood.

“They took the knowledge to not only be able to succeed but [brought] it back into their community,”  BHP program manager and lactation consultant Cody Cuni, IBCLC, BS says. “This is a success story.”

BHP is a person-centered, peer support counseling program intended to increase breastfeeding initiation, duration, and exclusivity among low-income, minority women in the greater Hartford, Connecticut area. For over 20 years, the program has existed in some form. In 2000, an official review of the program was completed and solidified the peer-counseling model.

The program’s name was born out of community feedback, mainly from Puerto Rican families. Cuni explains that as community Puerto Ricans were heavily targeted by formula marketing,  the name ‘Breastfeeding Heritage and Pride’ grew from the idea of reclaiming breastfeeding as part of their heritage.

Photo credit: United States Breastfeeding Committee (USBC)

Often, the lactation model of care is rooted in colonization, but Cuni says that their program  strives to respect and celebrate diversity.

“Our program seeks to empower…” she begins. “[Breastfeeding] is something that is yours, and something that has always been yours,” she says, speaking to the people they serve.

As program manager, Cuni trains the peer counselors through a 40-hour comprehensive lactation training. She approaches the training through a lens of diversity and cultural competence, helping peer counselors learn to have respectful conversations and teaching them how to be an advocate.

She explains, “Our peer counselors are working with mothers who do face a lot of bias in their health care and in lactation, so we have whole trainings on how to communicate with a provider, how to approach hospital staff who say things like ‘Don’t waste your time on that mother…’”

Peer counselors embark on visits with senior peer counselors and other lactation care providers as part of their mentorship model.

Photo by Felipe Balduino

The program also provides continuing education to stay relevant and weekly meetings to complete case reviews.

As part of their grant funding, BHP is required to track their breastfeeding rates, but Cuni says that what she finds more compelling than these numbers, is the documentation of the lactating person’s individual goals.

Empowering mothers to seek their own goals is our ultimate goal, Cuni says.

BHP is nestled in the Hispanic Health Council’s Parent and Family Learning department which offers other supports throughout the “cycle of learning throughout a family’s lifespan”.

Photo by Omar Lopez

“A holistic approach of care is vital especially for maternal child health care,” Cuni explains. “The first 1,000 days of life are critical to laying a healthy foundation.”

Practicing on a continuum of care gives Cuni and her colleagues the ability to gain a deep understanding of the families they serve, she says.

“Because we work so closely with the families, we establish trust and are able to refer in a way that they might not be open with [other providers].”

The clients that BHP serves are up against every breastfeeding challenge that every family faces in our country, but the issues are compounded and amplified by the stress of living in communities steeped in systemic racism and lack of resources, Cuni explains.

Their clients are managing intergenerational trauma and all of the symptoms associated with trauma, at a cellular level and beyond. For instance, BHP clients have a higher propensity of birthing babies with complex medical needs because of higher rates of preterm labor, gestational diabetes and other health concerns.

Cuni points out other challenges like those associated with being an undoumented immigrant. Gaining access to basic tools like breast pumps can be nearly impossible. Some of their clients return to work at two weeks postpartum after a cesarean section, not by choice of course, but for fear of losing their work as part-time employees.

And although Connecticut has workplace lactation laws in place, mothers will find that if they make noise about those protections, they might not see their name on the schedule any longer.

Photo source: United States Breastfeeding Committee (USBC)

Yet, despite all of these obstacles, Cuni says, “There is a sense of resiliency. They’re overcoming so much and they’re not even sitting in that; they’re just living their lives and wanting to do the best for their baby. That resiliency is really inspiring.”

Cuni shares about a mother who lost her baby late in her pregnancy and decided to pump and donate her milk for six months.

“This mom, her experience, her unimaginable tragedy…she still wanted to do something with her milk, and it was really a privilege for our peer counselors to support her.”

Another client they served, after struggling to assert her workplace lactation rights, had a position created for her by their HR department as “breastfeeding liaison”. Now, she is an advocate for any breastfeeding or lactating mother at her workplace.

“Not only did she win for herself, she left it better,” Cuni comments.

Cuni came to this work as a stay-at-home mom with ten years of breastfeeding experience. She was a single mother, returning to the workforce after leaving an abusive marriage.

“My breastfeeding experience was valued as an asset,” Cuni remembers. “My lived experience counted.”

She goes on, “As women, and especially as mothers, we’re always caring for someone else. The pressures that we face make wellness difficult. Our society needs to do more to recognize the value that women have and the support they need to succeed. I want to …. amplify the voices, because if we listen, the answers that we need to solve the maternal mortality crisis, the answers are there if we listen to the women and families we are working with.”

For those interested in supporting the work of the Hispanic Health Council’s BHP, they are looking for donated breastfeeding supplies. You can get in touch at  codyc@hispanichealthcouncil.org.

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For many, grandmothers are the village

Reflecting on her experience as a first-time grandmother, one of my colleagues and mentors expressed that, for most of us, “grandmothers are the closest thing to a village that we have.”

This colleague, a lactation care provider herself,  described the intricacies, sweetness and sacredness of watching her daughter step into motherhood. My colleague’s notes described her thoughtful presence without overbearance, leaving space for her daughter and her new family to learn and to bond. For instance, she cleans the house, prepares their bed with sun-dried sheets, and sits at the foot of the bed while her daughter and granddaughter nurse. In this dreamy scenario, grandma, baby and parents are all met with challenges, however those challenges haven’t become insurmountable thanks in part to this level of grandmotherly support and care.

This week we bring to you some work that details grandmothers’ powerful influence on the perinatal experience and beyond. A 2016 systematic review found that “a grandmother’s positive breastfeeding opinion had the potential to influence a mother up to 12 % more likely to initiate breastfeeding. Conversely a negative opinion has the capacity to decrease the likelihood of breastfeeding by up to 70 %.”

Healthy Children Project’s own Barbara O’Connor, RN, BSN, IBCLC, ANLC – Faculty Emerita designed and authored the Grandmothers’ Tea Project for the Illinois State Breastfeeding Task Force (2011).

Through O’Connor’s interactive curriculum, grandmothers are invited to learn about breastfeeding through three activities that pose breastfeeding scenarios:

“The Grandmothers’ Apron activity updates grandmothers’ knowledge about the importance of breastfeeding.

During the Grandmothers’ Cell Phone activity, grandmothers talk about breastfeeding myths and barriers.

In the Grandmothers’ Necklace activity, participants create a beaded necklace to remind them of ways they can offer support through loving encouragement, updating their breastfeeding knowledge, and being helpful.” (As described in A Grandmothers’ Tea: Evaluation of a Breastfeeding Support Intervention)

Source: United States Breastfeeding Committee.

Author Jane S. Grassley, RN, PhD, IBCLC and colleagues encourage perinatal educators to explore the curriculum for A Grandmothers’ Tea as they found that grandmothers and mothers who attended the teas in their study enjoyed their interactions with one another and with the class content.

Their work also unearthed a phenomenon of defensiveness in grandmothers who did not breastfeed their own children. The authors explain  “Grandmothers who did not breastfeed may feel defensive about their infant-feeding decisions because of the current emphasis on the health benefits of breastfeeding (Grassley & Eschiti, 2007)”  and advise that “perinatal educators can invite grandmothers to share their experiences and validate the cultural context in which these experiences took place.”

In this realm of validation and healing, Midwife Andrea Ruizquez of Partera Midwifery explores the implications of the Mother Wound. On Partera Midwifery’s Instagram page, Ruizquez writes:

“Props to all the people navigating complicated mother child relationships as adults. Now that I am in my 40’s I find myself reconnecting with my own mother in a deeper way. There was a time when we were estranged from each other. I learned how to recognize that I needed boundaries and practiced maintaining them. I am learning not to get triggered by my mother’s ways, and have compassion for her reasons behind them. I extend this sentiment to all of my grandmas ancestors who are in my lineage.

I am having more compassion for myself, and the ways I am like her my mom. I am learning to love myself deeper and become a more conscious mama to my children. I am still learning to love my child self that did not get all of her needs met, and I reparent myself with love. I feel myself heal.”

Source: United States Breastfeeding Committee.

Cultural beliefs held by grandmothers have the potential to influence healthy infant feeding practices. In Grace Yee, Retired IBCLC and Tonya Lang’s, MPH, CHES, IBCLC  Cultural Dimensions in Promoting, Protecting, and Supporting Lactation in East Asian Communities, they explained the prominent roles of aunties and grandmothers in the early postpartum. One example includes how colostrum is sometimes regarded in older generations as impure or unhealthy. Yee and Lang suggest that instead of positioning tradition and culture as a hindrance, to reframe barriers to breastfeeding into potential strengths. Respect of elders’ traditions and cultural practices will establish trust and foster positive relationships, as noted in Monique Sims-Harper, DrPH, MPH, RD, IBCLC, Jeanette Panchula, RN PHN, BA-SW, and Patt Young’s, Health Educator, CLE work entitled It Takes A Village: Empowering Grandmothers as Breastfeeding Supporters.

The physiological imprint of breastfeeding withstands generations and the sensations of milk production may surface decades later as mothers become grandmothers. Grandmothers who have previously breastfed have reported the tingling sensation of a phantom milk release when holding their grandchildren.

In South Sudan, grandmothers are relactating to help manage severe acute malnutrition. This practice has been documented elsewhere like Natal, South Africa and Vietnam for example.

Barry Hewlett and Steve Winn’s study on allomaternal nursing indicates that while this practice occurs in many cultures, “it is normative in relatively few cultures; biological kin, especially grandmothers, frequently provide allomaternal nursing and that infant age, mother’s condition, and culture (e.g., cultural models about if and when women other than the mother can nurse an infant or colostrum taboos) impact the nature and frequency of allomaternal nursing.”

Photo by Наталия Игоревна from Pexels

For an illuminating anthropological perspective, read A Biocultural Study of Grandmothering During the Perinatal Period by Brooke A. Scelza and  Katie Hinde. Their “findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being” and “show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants.”

We would love to learn about your perinatal and infant feeding experiences as grandmothers or with grandmothers. If you’d like to share, please email us at info@ourmilkyway.org.

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

Leslie Southard, PharmD, BCACP, CLC is a community pharmacist turned lactation activist on a mission to “provide up-to-date, evidence-based information regarding medications and lactation so individuals are able to make educated decisions regarding their health while reaching their lactating goals, and so healthcare providers can make the best recommendations for their lactating patients,” as she describes in her The Lactation Pharmacist bio.

Last year, Southard published Stop Using the Words “Just” and “Only”, a piece describing part of her journey navigating childhood cancer.

In honor of Childhood Cancer Awareness Month, Southard’s work and her family’s journey fighting cancer, we’re republishing that piece here on Our Milky Way.

You can find more at The Lactation Pharmacist blog here.

Stop Using the Words “Just” and “Only”

LESLIE SOUTHARD

As a newly inducted member of a group no one wants to be apart of – the Cancer Mom group – I’ve had a lot of emotions. Our world changed with one touch, and then one doctor’s appointment, and then a series of tests that led to the ultimate diagnosis: cancer. I’ve never experienced so many emotions in such a short period of time and forced to keep going with the rest of my life. This has led to a lot of thinking and working through what I’m feeling, because you can’t earn a living to support your family if you’re an emotional blob that breaks down every 5 minutes.

Multiple people recently told me “it’s just/only hair, it’ll grow back” when I told them that my daughter’s hair was falling out. This made my blood boil, and it took me a while to figure out why. Here’s the deal – it’s NOT “just” hair. If it was, we’d all be able to just up and shave our heads without any concern. My daughter’s hair represents so much in this cancer journey. We lost our lives as we knew them as soon as the doctor’s appointments and tests started. My daughter is losing a chunk of her childhood – no, not just the part that involves treatment, but the years after for follow up. My husband and I were robbed of the “easy” parental concerns. Now, we’re on high alert any time she spikes a fever, stumbles, mentions something is cold when it’s not, doesn’t pee or poop as much as normal, complains about her stomach hurting, etc. Any of those issues could mean a call to the doctor, a trip to the emergency room, or a side effect of her chemotherapy. Cancer has given me a whole list of worries I never expected. This person had no way of knowing how I’d feel about such a seemingly harmless statement, but it’s important to know that it isn’t and won’t ever be “just” or “only” hair.

This has made me think of all the other times we use the words “just” or “only”. I “just” had a cesarean birth. I “only” lactated for 2 days. I “only” pumped 2 ounces. I “only” lost 2 pounds. It’s “just” a job.

STOP.

By using the words “just” and “only”, you are dismissing all the emotional turmoil something caused you, dismissing all the hard work you put into something, dismissing what the rest of that statement means to you. DROP the “just” and “only” words from your vocabulary. What you did, what has happened to you, what you’re going through MATTERS, and the words ”just” and “only” rob you of that importance.

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