It has been 10 years since we authored our first blog post here on Our Milky Way. Ten. Years. This milestone is accompanied by a myriad of emotions!
I’m so proud of our collection of publications, promoting fantastic work by fantastic people.
I am stunned by the elusiveness of time; I first took the Lactation Counselor Training Course (LCTC)– which propelled me into this work– when my first child was only a few months old and now she is 11.
I am deeply grateful for everything I’ve learned from our participants and my colleagues and mentors who have shaped this blog. It’s such a thrill to connect with people across the continent and across the oceans, and I consider it such a privilege to have spent time with all of the beautiful minds featured on this blog.
I am both discouraged and encouraged. Scrolling through a decade’s worth of stories leaves me inspired by maternal child health advocates’ tireless work and triumphs both big and small. Lactation spaces have been carved out and employers have adopted breastfeeding-friendly policies, breastfeeding murals have been painted, generous human milk donations have been made, babies have gone skin-to-skin in the operating room, World Breastfeeding Weeks have been celebrated, important research has been conducted and published, and the accomplishments go on and on!
I’m also disheartened by the darker spaces where negative forces are at play like conflict among care providers, our culture’s disconnect between birth and breastfeeding, systemic racism, no paid parental leave, and the pervasive industry influence in infant feeding and beyond. These, among other forces, leave the United States consistently dangling near the bottom of the WBTi World Ranking list.
Despite our country’s poor performance in supporting healthy beginnings, I still find myself with a sense of wonder and cautious optimism for what the next decade holds for familial, community and global health.
In celebration of Our Milky Way’s 10th birthday, we’re launching a series called “Breastfeeding is…” For ten weeks, we will revisit a topic that describes breastfeeding. This series was inspired specifically by our 2013 piece Breastfeeding is… where Healthy Children Project faculty emeritus Barbara O’Connor, RN, BSN, IBCLC, ANLC discusses what breastfeeding can be and the cultural forces at odds with positive health outcomes.
Join us in celebrating and honoring healthy infant feeding by sharing what breastfeeding means to you. You can post in the comments below, find us on social media @centerforbreastfeeding, or email us at email@example.com.
What’s more, I am so pleased to announce that we will be giving away an online learning module with contact hours each week of our 10 week celebration. Here’s how to enter into the drawings:
This week, in the body of the email, tell us what breastfeeding means to you. 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.
As a whole, our nation lacks support for fathers and male identifying partners to bond with their babies. The father–infant relationship should be honored “in its own framework rather than as an alternative to mother–infant theory.” (Cheng 2011)
“Infant massage is such a neglected modality, especially in the NICU, where it reduces both the risk of sepsis and bilirubin levels, and gets babies home sooner because their brains mature more quickly and they gain weight faster,” Nikki Lee points out.
Beyond its benefits to infants, Cheng and colleagues have found that “infant massage appears to be a viable option for teaching fathers caregiving sensitivity.” Their work showed that “fathers were helped by increasing their feelings of competence, role acceptance, spousal support, attachment, and health and by decreasing feelings of isolation and depression. Although not all fathers saw the direct benefit of infant massage instruction, they did note they enjoyed participating in an activity that gave them special time with their infants and appreciated the opportunity to meet other fathers.”
More broadly, skin-to-skin contact has a positive effect on paternal attachment.
Ontario artist Lindsay Foster’s viral image of fathers BJ Barone and Frankie Nelson meeting Baby Milo captures perfectly the flood of oxytocin that skin-to-skin affords fathers and male-identifying parents.
WABA suggests that fathers should be engaged and involved throughout the 1,000 days and health systems and care providers can provide knowledge on breastfeeding through antenatal visits, other breastfeeding classes and enabling their participation during labor and delivery and postnatally.
There is also “a need for greater vigilance against promotion and unethical marketing of breastmilk substitutes targeting fathers to ensure that they also get unbiased information.” [More here.]
In our national sphere of advocacy, last month, Foundations of Fatherhood Summit hosted Wide World of Fathering with a mission to advance fatherhood and families in Michigan communities and beyond. The speaker lineup was full of individuals passionate about fatherhood and working to shift the way we view males as parents.
Presenter Reginald Day, CLC for instance, hosts a podcast called Get At Me Dad which reveals the true narrative of BIPOC fathers–”present, connected and raising strong families.”
Reaching Our Brothers Everywhere (ROBE), an organization which seeks to educate, equip, and empower men to impact an increase in breastfeeding rates and a decrease in infant mortality rates within the African-American communities, hosts a monthly virtual call where males can discuss maternal child health related topics.
In partnership with Reaching Our Sisters Everywhere (ROSE), ROBE will host the 11th Annual Breastfeeding and Equity Summit in New Orleans from August 25 to 27, 2022 where presentations center on equity in breastfeeding, maternal health, fathers and partners, and infant health initiatives.
A medical student once told Nikki Lee, RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, RYT500 about an obstetrician who loved to pump while she was catching babies because she collected more milk than usual. Lee theorizes that perhaps it was due to the high levels of oxytocin in the atmosphere during childbirth.
It’s a fascinating concept, and quite unusual considering physicians often find themselves in a terrible paradox. As Lee puts it, they are supposed to take care of everybody else, and no one takes care of them. They’re expected to be experts on everything; as childbirth educators and lactation care providers, we often disclaim “this information is not meant as a substitute for medical advice.”
With insufficient support in their personal infant feeding goals, physicians’ struggles sometimes seem to spur advocacy and a “do-better-for-my patients” attitude. Just the same, these experiences can lead individuals to harbor resentment, despair, resignation and defeat, and might unintentionally influence the breastfeeding support they are able to offer their patients.
When physicians’ basic needs aren’t met, we can’t expect them to meet the needs of their patients. How can one pour from an empty cup? Kathleen Kendall Tackett offers Burnout, Compassion Fatigue, and Self Care for Members of the Perinatal Team which presents insights on the effects of little institutional support and specific strategies for integrating self-care into care for others.
Self-care is sustainable only when everyone can do it.
Before physicians are done with their decade or more of training, they are challenged by inadequate support in their efforts to feed their own children.
What’s more, a recent research letter, American Board of Medical Specialties Board Examination Lactation Accommodation, evaluates the American Board of Medical Specialties (ABMS) member boards’ lactation-specific board examination accommodation policies highlighting that a minority of female physicians (42%) achieve the recommendation that infants receive mother’s milk at least until age one.
“Board examinations are a key aspect of medical training,” the authors begin. “With up to 22% of female trainees delivering a child during postgraduate training, and nearly 59, 000 female physicians in residency and fellowship in the US, there is a large group potentially affected by board examination lactation accommodations.”
About a decade ago, in a landmark case that has implications for all testing organizations in Massachusetts, a unanimous Massachusetts Supreme Judicial Court ruled that breastfeeding mothers are entitled to special accommodations to allow them sufficient time to pump milk during lengthy testing for medical licensure. [https://www.wbur.org/news/2012/04/13/breastfeeding-doctor-ruling ]
The elephant in the room is the issue of parental leave. Honestly, it’s hard to stomach that we are still arguing that there are medical and psychosocial benefits of protected parental leave for both parents and children. The U.S. is the only Organisation for Economic Co-operation and Development (OECD) member country—and one of only six countries in the world—without a national paid parental leave policy. The U.S. is also one of the few high-income countries without a national family caregiving or medical leave policy. [https://bipartisanpolicy.org/explainer/paid-family-leave-across-oecd-countries/ ]
Women don’t breastfeed; societies do. The societal burden on the mother is magnified when the mother is a physician and is compelled to take care of everyone else, with no support for their own breastfeeding. Breastfeeding is blamed for being difficult, instead of us all getting furious that we don’t have paid maternity leave.
In the current U.S. healthcare system, physicians find themselves paid in Relative Value Units (RVUs), which bluntly put, is a pretty mechanical way to value providing care to other humans. In short, the more RVUs a physician racks up, the more they’re paid. Often that leaves lactating physicians forgoing pumping to spend more time with patients. The Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act would close the loopholes that force physicians to choose income or feeding their babies. The PUMP Act advanced out of the Senate HELP Committee with unanimous bipartisan support in May 2021 and then passed with significant bipartisan support (267-149) in the House last October. Despite this strong bipartisan support, the bill has languished in the Senate for almost a year. Get updates on progress here.
The policy reports that the Institutional Requirements of the Accreditation Council for Graduate Medical Education require training programs to provide written policies regarding leaves of absence, including parental leave, and these policies must comply with current legislation such as the Family Medical Leave Act (FMLA), but that the length of leave has considerable variability among residency programs. The statement outlines the challenges of parental leave policies in training programs and gives recommendations to protect trainees and their families. One challenge is that education calendars are set long before a person enters a medical program, but labor, delivery, and the establishment of breastfeeding don’t fit into a predetermined calendar.
Despite this dismal landscape, the medical world is changing and there are stories and models to celebrate.
Catherine Wagner, a cardiothoracic surgery resident at Michigan Medicine, managed to breastfeed and pump for a year during her residency with a network of support.
Got Milk? Design and Implementation of a Lactation Support Program for Surgeons describes an initiative where “Multiple faculty members offered to offload resident workload before starting cases to provide time for a lactating resident to express milk… The University of Wisconsin adopted a ‘cross-cover’ model encouraging lactating residents to have other residents assist in the operating room during non-critical portions of the case if the primary operating resident needed to express milk that has been very well received and easily implemented.”
There’s attention being paid to lactation accommodation information in urology residency programs too.
In this study, “Of 145 urology residency programs, 72.4% included information about lactation accommodations anywhere on the institution’s website.” The authors conclude that “efforts to recruit and retain female urologists should include making [lactation accommodation] information more easily accessible.”
Authors Annery G Garcia-Marcinkiewicz andSarah S Titler call on anesthesiology as a workforce and specialty, to support the unique need of lactating and breastfeeding anesthesiologists in Lactation and Anesthesiology.
This study offers the first comprehensive scoping review of the literature on breastfeeding policies pertaining to surgical residents in Canada.
The authors write: “…We aim to use these data to advocate for breast feeding for surgical resident physicians through the creation and improvement of current breastfeeding policies as applicable. This work aims to help change surgical culture to be more inclusive, which is vital in creating a breast feeding-friendly environment. This would include leadership endorsement of the policy, a culture shift (for example, no repercussions to resident for coming back on a modified schedule or taking breaks for expressing milk), visible educational notices throughout the workplace (ie, ‘breast feeding-friendly workplace’ notices, common in Canadian public settings), and creation of a network of ‘new moms’ within the surgical resident programme to ensure there is support and mentorship for new moms returning back to work. ”
While we wait for policies to catch up to the needs of lactating physicians, wearable pumps are helping them reach their infant feeding goals. The Impact of Wearable Breast Pumps on Physicians’ Breastfeeding Experience and Success found that “those who had used a wearable pump reported statistically significant shorter lactation breaks (p < 0.00001) and were more likely to be able to provide breast milk to their infants for their entire intended duration (p = 0.005) compared to the traditional pump group.”
The support network Dr. MILK (Mothers Interested in Lactation Knowledge) has been successful at helping physicians mothers reach their infant feeding goals.
Where else are you seeing physician parents being supported in their infant feeding journeys? Email us at firstname.lastname@example.org
Ten point nine trillion dollars is so much money. Ten point nine trillion dollars is so much money that if you’re not a numbers person like me, it’s kind of impossible to even conceptualize. Ten point nine trillion dollars is the amount of money, according to a recent report by Oxfam, that women would have earned last year if paid minimum wage for their unpaid work, as Kimberly Seals Allers points out in her March 2020 The Washington Post piece 10 ways to honor the work of motherhood during Women’s History Month.
This work includes “routine housework, child care, shopping for household items, tending to elderly relatives and other caregiving that is never acknowledged by economists or society.”
What might this amount look like if calculated during COVID-times, when we consider the added responsibilities many mothers took on as schools closed down, as many reinvented and re- engineered our careers, household duties and other contributions?
No one says it better than Seals Allers:
“No one should work free, yet our society accepts and even expects that mothers do just that. Being priceless and worthless at the same time is a terrible state of affairs.
And if we only celebrate our ‘worker’ identity and not our ‘mother’ identity, we risk contributing to the ongoing division of roles that forces many women to feel like they have to choose which identity is more important, then prove it. This can’t be good for women’s futures.”
Breastfeeding in America just might be the epitome of Seals Allers’ “priceless and worthless at the same time” argument.
In a publication from this spring, authors Julie P. Smith and Nancy Folbre write “Breastfeeding is an example of how the economy is mismeasured: the market value of milk formula production and sales are counted in a nation’s GDP, but the value of breast milk production is not.”
Smith and Folbre further consider that women and children who have not breastfed have higher rates of illness, chronic disease and hospitalization- a financial detriment to the health system “and to families of this additional illness and disease are (perversely) counted as increasing GDP.”
What’s more, several years ago “a path-breaking study estimated that premature cessation of breastfeeding cost the global economy around $300 billion a year due to diminished human capital,” Smith and Folbre write. More massive numbers generated by the humans and their work that are completely undervalued in our society.
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