Where are they now? Catching up with Lucy Ellen Towbin, LCSW

Towbin admires her grandchild in this recent photo.

Many of Lucy Ellen Towbin’s, LCSW endeavors are defined by nourishment. By the time she was two, Towbin was producing art and as she has continued to make multimedia art into her 70s, she nourishes her Self. As the eldest of four children, Towbin helped provide for her
younger siblings in their childhood. In her 30s, as a new mother,  she nourished her children.  As a social worker and lactation care provider, she supported other dyads in their infant feeding efforts. Later, Towbin started a business (which has since been sold) that offers clean, dehydrated parrot pellets, so that she and other parrot-owners could escape reliance on industry-produced pet food which usually contains additives and food coloring that parrots are particularly sensitive to.

During the first wave of the COVID-19 pandemic, Towbin retired from the
Arkansas Health Department, and while she no longer holds her IBCLC
credential, she continues to assist new mothers informally. Towbin now
practices as a part-time therapist for a psychotherapy clinic in
Arkansas.

The last time Towbin graced Our Milky Way was back in 2017 when we
featured the breastfeeding art contest she facilitated through the
Arkansas Breastfeeding Coalition.

We’re pleased to have chatted with Towbin as part of our Where are they
now? series. Responses have been edited for brevity.

 

Towbin poses with Ruth Lawrence roughly a decade ago.

How did you become interested in maternal child health? 

The first job I had at the Department of Health was as the refugee health program coordinator. We worked with mostly refugees from Southeast Asia.  I was really interested in and intrigued  by the difference in how
they were taking care of their children. They slept with their babies, which I’m sure plenty of people in the U.S. still did quietly, but back then, no one was talking about it.
During a panel discussion we once held, a speaker from Laos shared
that his six children born in Laos were breastfed, and the five children
born in the States were bottle-fed. This is when I really became
interested in the cultural aspects that affect infant feeding, and I started
to try to figure out what was going on.

Is there a current trend, project or organization that excites you?

I’m really not that up-to-date about trends in lactation, but what does
excite me are the portable pumps that working moms can wear. A close
friend of my daughter’s is a nurse practitioner and she showed me her
pump that she wears under her white jacket as she walks around seeing
patients. It makes almost no noise and it’s amazing because you don’t
even know that it’s under there. That would’ve been so incredible for me
to have as a working breastfeeding mom.

When I was working outside of the home, it was really difficult; even La
Leche League wasn’t very supportive of working moms at the time. With
my first child, I had a manual pump and my own office, but the pump was
miserable.  It hurt and wasn’t that effective. With my second child, I
stayed home longer with him and then he wouldn’t take a bottle, so I
didn’t do that much pumping. When I went back to work, my mother took
care of him and she lived close to where I was working, so I would nurse
him before work, and then drive back and forth to her house to feed him
about every two hours. It was a lot of back and forth.

What is the most significant change you’ve noticed within maternal child
health?

I have a very small sample size to talk about significant changes. All I
know is from my daughter and her friends. I’ve noticed that there seems
to be less unmedicated births happening in the hospital. I know there are
still a lot of people choosing home birth. But of those having babies in
the hospital, I haven’t heard about anyone doing what I did and having
mine in the hospital, but with no pain medicine or IV or anything.   I was
lucky to find the physicians that I did who went along with my wishes.  I
would expect there would be more supportive physicians now and instead, I don’t hear about any. I do want to reiterate that my observations are based on just a small group.

What is your best piece of advice for the next generation of lactation
care providers?

The most helpful lesson combines my training as both a therapist and
lactation consultant. New mothers need so much emotional support.
They don’t need people to take care of the baby. Bringing food and running errands for them is helpful. But I think what gets overlooked is
how much they need to be told that they’re going to make it, that they will
survive this early period of no sleep, and not knowing if they are doing a
good job. They need reassurance that this difficult time is normal and
they need to be told they will get through this.

My best piece of advice for the next generation is to take a holistic
approach, don’t just emphasize the physical exam. Equally important is
how much sleep the mother is getting,  what she is eating, if she is
getting exercise, if she has family and friends supporting her, if she has a
plan for if she’s going to be working outside of the home. It’s important to
equip new moms with coping strategies like easy breathing exercises or
something when she is feeling stressed that are doable in short time
frames and at home.

Where do you envision yourself in the next decade?

Asking someone my age where I see myself in the next ten years is
basically just hoping I’m still healthy and active! I do all the right things
and have good genes, so I’m on the pathway to that, but you never
know. Appreciate good health and youthful energy if you still have it.

A story of lactation and breastfeeding as a ‘Tummy Mummy’

Apryl Yearout, a school psychologist in Washington state, uses her body in powerful ways. For one, Yearout, known as Ariel Pain on the roller derby track, competes as a full contact skater excelling as both a jammer and a blocker.

Used with permission.

Yearout was drawn to roller derby well over a decade ago because of the “incredible community” it offered her.

“I heard ‘I’m proud of you’ and ‘good job’ more than I ever had,” she reflects. “It’s physically demanding and makes you feel strong and capable.”

In another manifestation of her power, Yearout birthed and breastfed her two daughters. Yearout’s eager body produced so much milk that she was also able to donate about 1,000 ounces of milk to local families.

Beyond this, Yearout helped create a family as a gestational carrier, or “tummy mummy” as the intended parents refer to her.

The idea of surrogacy came to her as a few realities collided. She’d anticipated having many more children of her own, but she and her husband divorced when their youngest child was 18 months old. As her children grew and without a new partner, she didn’t feel she was in the position to “start over” again with a baby.

Yearout watched her sister struggle to carry a pregnancy to term for some time, but ultimately, she was able to birth her own baby, so Yearout pursued the services of an agency and matched with a couple in need.

In April 2023, Yearout gave birth to the couple’s son. The baby and her youngest daughter wound up sharing a birth date, fulfilling her daughter’s birthday wish.

As discussed during her pregnancy, Yearout breastfed her surrobaby on occasion, for a few days after the birth while spending time with the new family.

“Overall, it felt like the natural completion of the pregnancy,” she shares. She also predicts it’s why she recovered so well from pregnancy.

Though she and the indented parents had already discussed direct breastfeeding as their plan while possible, Yearout expressed colostrum in the event that the intended parents felt strongly about being the ones to feed their baby first.

Unlike some surrogates, Yearout didn’t struggle with the idea that breastfeeding would create an unhealthy bond with the surrobabe.

She shares: “I was already very connected to this baby. I approached the surrogacy with a mindset that I need to make sure I have the right couple, I need to fall in love with them becasue I know I’m going to fall in love with this baby… physically and emotionally…everything is tied up… he’s not mine, I never felt like he was my child but I still love him… For me, not nursing, not having any breastfeeding experiences would have felt a little incomplete. I think it also would have put a physical strain on my body that could have pulled on those emotions and made it harder. I didn’t like the idea of forcing my body to stop [producing milk].”

The intended parents were not interested in managing the shipment of her milk after they returned home, so Yearout sought out a local family to donate to.

“And I get to see that little one grow up,” she says.

Yearout completed pumping and donating her milk in the autumn of 2023.

“Pumping alone is really hard,” she reports. In contrast, Yearout after a workday pumping for her keepers, she would come home to breastfeed through the night, and her body responded to this interaction much differently.

“When I was just pumping, [production] tapered off a lot faster,” she shares.

Thinking back on her experience as a tummy mummy, Yearout articulates her discomfort with the perception that gestational carriers are compelled solely by financial compensation.

She says in a somewhat joking manner, “I feel like I could sell pictures of my feet for more money.” (Let us note that this is not to diminish the financial burden that surrogacy can cause for many couples looking to create a family.)

“The thing that always bothered me was that people assumed that I did this for the money,” she goes on. “I had other motivations. [The arrangement]  helped me take my kids on a trip we would have never gone on before, but it wasn’t my reason…Money wasn’t a primary motivator but it did come up so often [with others].”

Instead, Yearout sought and found connection.

She comments, “This is what my body is good at and I’m going to use it to benefit other people.”

Yearout and her mom recorded an interview with StoryCorps. Unrelated to surrogacy, it’s a conversation about Native American roots, racism, white privilege, and their relationships with their extended family, and it’s worth a listen. You can find it here.

Infusing work-life balance in medicine: reflections from Katrina B. Mitchell, MD, IBCLC, PMH-C, FACS

— “…Breastfeeding isn’t about ‘success’ or ‘goals’ — it’s a human experience.” —
Mitchell’s son captures her on the job. Used with permission: https://www.instagram.com/p/CuN_G35Rc0h/

Katrina B. Mitchell, MD, IBCLC, PMH-C, FACS, a breast surgeon, lactation consultant, and perinatal mental health provider in Santa Barbara, Cali., went back to work at five weeks postpartum.

“Looking back…I have no idea how I did this,” she reflects.  “I know this is still far better than migrant workers on the central coast of California, who may not even have a week to recover.”

In part, Dr. Mitchell recognizes the support she received from a pediatrician; he counseled her on bed sharing during the time she was breastfeeding as a single parent in surgical training.

“This literally saved mine and my son’s physical and emotional health (as well as allowed me to exclusively breastfeed for six months and then onward for years),” Dr. Mitchell explains. “Sure, it was still terrible to have to pump milk in a bathroom by the OR and lug my pump all over the hospital, but I really believe I stayed on a postpartum high because I got to sleep and nurse my baby at night when I got home.”

She continues: “[Bedsharing] saved every possible complication we could have experienced with me being back at work operating 14 plus hours a day at that point in time…. I am forever grateful to this pediatrician…”

Dr. Mitchell captured these early experiences in a book she wrote for her son about being a surgeon mom.

In her practice today, Dr. Mitchell tells her patients who are going back to work that the ounces in a bottle during the day are not nearly as important as feeding baby at the breast when the dyad is together and feeding overnight on cue.

“Safe bedsharing is what facilitates this and results in continuation of breastfeeding far longer than separate surface bedsharing, sleep training, and feeding a pump rather than the baby,” she explains.

In particular, physicians have long struggled with “pouring from an empty cup” alongside being influenced by insidious industry tactics, mechanical culture and inadequate education. Nikki Lee and I wrote about these forces in Physicians as parents: How can one pour from an empty cup? and Physicians as breastfeeding supporters.

In New study calls for greater access, equity for breastfeeding surgeons author Hilary Brown reports on “A new vanguard of physicians… determined to make the field more hospitable to working mothers by establishing dedicated pumping spaces and allotting time for pumping without fear of retribution or punishment.”

Brown goes on, “… No one should be denied professional opportunities just for choosing to have a work-life balance. For too long, surgeons were lauded for not having families, or prioritizing their work over a personal life. To be a martyr to the field was considered the highest level of dedication. But ultimately, such devotion has proven to be a detriment. Excellent patient care, London-Bounds says, starts with self-care.”

Dr. Mitchell acknowledges that “..the surgical world is becoming more attune to this topic.”

In 2020, the Association of Women in Surgery released a position statement on supporting physicians and trainees who are breastfeeding.

In regard to lactation accommodations in the workplace though, Dr. Mitchell says she often thinks of something Kimberly Seals Allers pointed out many years ago when she said something along the lines of: “We are a pump nation — we shouldn’t be celebrating being gifted a pump from our medical insurance.  We should be demanding adequate paid maternity leave.”

“Accommodations should really be focusing on this governmental-level change,” Dr. Mitchell elucidates.  “Not only is it the right thing to do for human beings, but it reflects one of the fundamental principles of economics 101:  opportunity cost.  You lose some productivity up front by giving mom a longer maternity leave, but you exponentially recoup this cost when moms breastfeed rather than wean and have good mental and physical health when they return to work.”

In this landscape without paid leave, there can be a layer of tension that brews between colleagues.

“A  lot of the hostility towards lactation and lactating patients does stem from physician personal experience with lactation (which was unfortunately largely negative in the past, and can persist today no matter what accommodations we provide),” Dr. Mitchell begins.

“And these negative experiences are a direct result of the medical patriarchy, which provides little to no education on the breast and lactation in medical school, residency, or fellowship training.  Because of this, just like all other patients, physicians themselves are at risk for not receiving appropriate evidence-based support and education surrounding lactation and breastfeeding.”

She continues, “As we all know, the postpartum time period is one of great vulnerability, and a person’s experience with breastfeeding can play a central role in how they navigate early motherhood.”

Juxtaposing the way that we look at lactation and breast cancer care, Dr. Mitchell says that we would never tolerate breast cancer care as being reflective of personal experience, but this often happens with lactation.

“With breastfeeding, there’s the dismissive comments of ‘oh, it didn’t work for me, so it’s fine it doesn’t work for you.’  We would never say ‘that chemotherapy didn’t work for me, so it’s ok if it doesn’t work for you,’” she explains.

Clear to recognize that this is not the fault of the individual, Dr. Mitchell says it’s instead a reaction to “the fact that the patriarchy didn’t support them, either.”

And so, to influence real change, we have to start at a systems level in medical education, she says.

Training needs to include education about things like safe bedsharing, how formula feeding and breastfeeding are vastly different in terms of volume and infant behavior (e.g. the normal distraction of a breastfed infant at four months old versus a bottle fed infant taking a bottle on schedule), Dr. Mitchell explains.

“…This should be standard education for all of us.”

Physicians from less traditional backgrounds have great power to drive change too, Dr. Mitchell suggests, sharing her personal experience:  “I am the only person in my generation on one side of my family to go to college, much less medical school.  Three quarters of medical school matriculants come from the top two household-income quintiles — I was not one of them.  Since I was a teenager, I worked my way through school.  I had a liberal arts background and undergraduate degree, and I think all of this made me see things from a different perspective than other medical students and physicians.  I was also lucky that my mom pushed back against the tide of formula feeding in the late 1970s, and I was a breastfeed infant myself because of this.”

In a powerful Instagram post, a photo snapped by her seven-year-old son is captioned “I love this moment because it’s the ultimate rebellion against corporate medicine. No one can take away the power of human connection.”

The post is commentary on a simpler, more connected way of caring for patients.

“Instead of a patient having to login to the EMR or deal with a centralized scheduling call center to make an appointment, [the post] reflected the way we used to care for people in medicine and what I try to preserve as much as possible:  a patient needing help, contacting me directly on a weekend, us all going in with casual clothes and me just doing my job as a doctor,” Dr. Mitchell explains. “ No electronic medical record, no ‘15 minutes with each patient’ corporate mandates, no ‘you can’t do this or that’ by the administration.”

Ironically, Dr. Mitchell continues, she’s noticed that corporate medicine has made certain aspects of lactation accommodations better.

“The one positive aspect …is oversight and standardization and human resource departments,” she says.   “If there’s a law for accommodations, there is someone enforcing them (along with all the other not-so-helpful ‘enforcements’ like clicking through countless screens in the EMR simply to write a quick note on a patient).”

During the 2020 COVID-19 pandemic, Dr. Mitchell created the Physician Guide to Breastfeeding, a hub where she’s committed to sharing openly and advocating for improvements in broader maternal child health education. You can explore her collection here.

Balancing family health and economic well-being in Kenya

Josephine (Josie) W. Munene is the Director of Community Engagement at Maziwa Breastfeeding, an organization that helps mothers balance their babies’ health and their families’ economic well-being in Kenya. Munene leads the lactation education training programs and the Community Breastfeeding Ambassador peer support initiatives.

Munene completed her graduate work in the UK with a focus on international development, and while she imagined she would spend her life working globally, and after spending some time working in the corporate world, she determined a need for helping moms in her home country. 

After her first son (now 14 years old) was born, she struggled to find breastfeeding support. Munene noticed that many of the resources and programs were established in the Global North and lacking for women in her community. So Munene switched gears and launched a business that sold breastfeeding supplies like breast pumps and nursing bras and nursing pads different from the “lumps” handed out by the hospital. She was looking to infuse dignity in the experience, she explains.  But Munene quickly realized that it wasn’t enough to sell products to women, so she pursued the Infant and Young Child Feeding Counselor Training in order to meld her lived experience with technical knowledge and offer evidence-based care to breastfeeding dyads.   

Kenya ranks quite well in the World Breastfeeding Trends Initiative (WBTi) coming in at number 10 worldwide. Still, Munene shares that in Kenya, lactation professionals are not widely accepted as competent nor essential care providers. Instead, they are often considered “quacks” or the profession is regarded as a “hobby”. Munene has therefore made it a priority to engage in policy change with a goal to establish a national accreditation curriculum in her country that will recognize lactation care as an essential part of the continuum of care. Munene sees engagement of social enterprises in public private partnerships as an important piece to this work; reliance on governments alone or donor partners alone has proven to be ineffective, she comments. Further, Munene emphasizes the importance of engaging the people who the policies are intended to benefit. 

She sees an opportunity to adapt well-established accreditation programs in the Global North to Sub-Saharan countries’ needs. Growing the membership of the Kenya Association of Breastfeeding would signal to the Kenyan government the need for a local accreditation, she proposes. 

Recently, Munene and her colleagues helped facilitate a  Kenya Association for Breastfeeding workshop during the Amref International University (AMIU) Public Health Care Congress. A range of participants including gynecologists, pediatricians, students were invited to learn about the fundamental principles of lactation and breastfeeding. They then participated in reflecting on case studies using Healthy Children Project’s (HCP) 8-Level Problem Solving Process by Karin Cadwell and Cindy Turner-Maffei as a framework. 

Munune reports that the most interesting finding from the interactions was the participants’ identification of the need for breastfeeding support early on to alleviate or to eliminate challenges. 

Another takeaway illuminated  the specialized care that breastfeeding can require. Munene explains that in Kenya, breastfeeding generally falls under the nutrition category which overgeneralizes the “benefits” of breastfeeding and ignores the need for practical support that is tailored and effective. 

Munene mentions that Kenya employs Community Health Promoters which are important players in preventive health care, but the program does not address the need for more targeted support for breastfeeding dyads. 

Overall, Munene sees a need for a more comprehensive approach to lactation and breastfeeding care in her country. She calls for policies that go beyond “paperwork and guidelines”. 

For instance, Kenya has established lactation laws for working mothers, but she finds implementation and enforcement is lacking. [Check out this qualitative study for interesting  perspectives from women, families and employers in Kenya.] 

In Breastfeeding challenges for working mothers and their families in different workplace settings, around 18 minutes into the webinar, Munene presents on maintaining exclusive breastfeeding for working mothers.

Munene also reflects on maternity cash benefits for those working in the informal sector. These interventions can only be effective if they come with proper education, she reports. Cash benefits have the potential to influence personal nutritional wellness, and if individuals use the money to purchase indigenous foods from their neighbors, they have the added potential to boost income for the community as a whole. 

You can learn more about these endeavors and connect with Munune here

You might also be interested in learning about The Cost of Not Breastfeeding in Kenya. Check it out here.

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.