Breastfeeding is collaborative.

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

Breastfeeding is collaborative.

A breastfeeding dyad is a beautiful, fascinating, complex organism. Mother and bab(ies) attend and respond to one another facilitating nourishment, the flow of hormones, immunity, learning and bonding, comfort, fun, an all-encompassing sensory experience that has generational impacts on social, emotional and physical health.

Photo by Luiza Braun

In this intimate depiction of a breastfeeding dyad, a world of collaborative intricacies occur: the undulation of baby’s tongue to help with milk removal, the contraction of myoepithelial cells thanks to oxytocin elicited by baby, the removal of milk to signal mother’s body to produce more, to name a few.

It’s clear that breastfeeding is so much more than “the healthiest feeding choice” nutritionally speaking. Take the following anecdotes for example.

Nikki Lee offers her commentary to this case report on infant botulism in an exclusively breastfed baby explaining how interactive feeding can save a baby’s life.

https://unsplash.com/@luizabraun

“One doesn’t have to ingest honey to contract botulism. Exclusively breastfed babies can get botulism. Some parts of the continental US have c.botulinum in the soil; construction stirs up the soil, and the germ floats in the air. The breastfeeding mother is the one to notice that the baby’s suck isn’t as strong. This is a reason that breastfed babies survive botulism, because they get diagnosed and treated sooner than bottle-fed babies.”

In this case, breastfeeding offered early detection of breast cancer in the mother because of her baby’s refusal to nurse from one side. This phenomenon is known as Goldsmith’s Sign.

To demonstrate the importance of  the relationship that breastfeeding affords, we might consider the implications of separation. Lee again offers insight on the implications of mother baby separation in this piece.

Zooming out to view breastfeeding less individualistically and instead as a global food security system, we must recognize the collaboration necessary to support the breastfeeding dyad and abandon the idea that breastfeeding is a solitary act, a “one-woman job”.

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In Breastfeeding as a ‘Resilient’ Food Security System: Celebrating…. And Problematizing Women’s Resilience in the face of chronic deprivation as well as emergencies, Dr. Vandana Prasad, MBBS, MRCP (Ped) UK, MPH describes breastfeeding as “wholly community-based”. Dr. Prasad continues that breastfeeding is potentially universally accessible and sustainable because it  “depends wholly upon the status of time, energy, health, nutrition and general availability of women”. This achievement, breastfeeding as definitely universally accessible and sustainable,  would require collaborative efforts by “governments, decision-makers, development partners, professional bodies, academia, media, advocates, and other stakeholders” working together, as Dr. Tedros Adhanom Ghebreyesus writes.

In the U.S., WIC has created an interactive resource “to help reinforce the important role that family and friends play in supporting breastfeeding moms.” The resource invites WIC staff to “click through the prompts with parents, grandparents, and others discussing when and how to offer helpful support so that mom and baby continue to thrive.”

At an organizational level, the United States Breastfeeding Committee (USBC) uses a collective impact approach to manage multi-sectoral collaborations, working to protect, promote, and support breastfeeding and human milk feeding.

Source: United States Breastfeeding Committee.

Internationally, the Global Breastfeeding Collective calls on donors, policy makers and civil society to increase investment in breastfeeding worldwide.

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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, tell us: Who is your s/hero in the field of maternal child health?

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.

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.

Toxic Stress, Resilience Building, COVID-19 and Breastfeeding

As I write this, I’ve logged exactly two weeks at home in self-quarantine due to Covid-19 with my husband and three children. Technically, we’ve only made it through the kids’ scheduled spring break, but they’ll start an indefinite distance learning journey on Monday.

Our socially-distanced days have been filled with laughter of a couple kinds. The pandemic has offered us the opportunity to connect without the distraction of our robotic, go-through-the-motion schedules. We find simple entertainment: puzzles, charades, tiptoeing along sidewalk cracks. The situation has helped me rediscover how to be playful, and I’ve surprised myself and  kids with genuine laughter (or maybe it’s because I’m utterly deranged) over things that might have otherwise made me blister in anger. 

When I look outside my household, I laugh in discomfort. It’s this disturbed kind of cackle; a psychological response to the panic, the destruction, the trauma, the unknown that this pandemic has burdened the globe with. 

My most recent interviews with Nikki Lee about breastfeeding policy in shelters and Healthy Children Project’s Anna Blair and Karin Cadwell about their upcoming webinar on Covid-19, breastfeeding and resilience went this way: we seemed to laugh more than in interviews before the pandemic hit our country. 

Photo by Toa Heftiba on Unsplash

For me, I laughed because it was a simple joy to hear my friends’ and colleagues’ voices, to connect with those outside my immediate family. But even when the conversations turned dark, still I laughed. I laughed until I actually started sweating. What is the matter with me?

Blair and Cadwell pointed out something about the status of the crisis we’re currently in. When a hurricane tears through a community, we know there’ll be an end to the devastation. With Covid-19, we have no idea when this ends, and that’s sure to threaten mental health

Cadwell shares that while she does not consider herself a joyful person, she often thinks about joyful things in the future. 

“One of the things this has done for me is it has taken away my anticipation of joy,” she says. 

Some will argue that we’ve gained something through the shared experience; we’re together by being apart. “Rediscovered humanity,” in the words of the head of my children’s school.

We’ve lost a lot though too. Lives most importantly and second to that, control. 

In Hidden Brain’s episode An Unfinished Lesson: What The 1918 Flu Tells Us About Human Nature guest Historian Nancy Bristow recounts, “To remember the flu would be to admit to the lack of control that people had had over their own health. It would be to admit that the U.S. was not necessarily all powerful but was like everywhere else in the world subject as victims to something beyond their control.”

Almost a century later, these words ring true. Where there was opportunity for control, or a fair degree of preparedness at least, our nation failed. 

Cadwell has pointed out time and time again that our country has better emergency preparedness plans for our pets than we do for our moms and babies. 

“The unfortunate reality of the coronavirus pandemic is that it has shown how unprepared and underfunded the public health infrastructure in the U.S. is to address the basic needs of our citizens,” Monica R. McLemore begins in her piece COVID-19 Is No Reason to Abandon Pregnant People. 

Now we’re in what feels like an impossible place. 

Kimberly Seals Allers exposes the fact that infant formula quantities are scarce.  

“There, I said it! Cue swarm… I have time,” KSA begins in a Facebook post. “Everybody is talking about ‘choice’ & blasting #breastfeeding advocates until there’s a global pandemic, a panic-induced international run on infant formula & quantities are scarce. Now the ‘just give a bottle’ folks want to teach you how to re-lactate.” 

Doulas have been deemed non-essential, partners of birthing people considered visitors. (Refer to McLemore’s piece above.)

“We are taking so many steps backward,” Blair comments.

She continues: “We have heard so many times, not just locally, but colleagues around the country that there has been a misunderstanding about what the protocols are for babies being born now.  Babies are being automatically separated from their mothers for two weeks in some cases, even if the mother is Covid-19 negative. That is not best for the baby and that is not best for the family. Story after story. It worries us tremendously.” 

A member of the Certified Lactation Counselor (CLC) from ALPP Facebook group shared this account: 

“Mom had baby yesterday and was forced to wear a mask and gloves for all of labor and delivery. She had low o2 sat(91%) when coming into the hospital. No other symptoms. She is now separated from baby. Baby with dad in postpartum room and she in ICU pending covid test. She has not seen baby since and they will not let her until she gets a negative (test pends for 5 days apparently. They gave her a pump but didn’t show her how to use it. She’s a young first time mom and has now pretty much given up breastfeeding and seems highly depressed. She claims the hospital told her the CDC said to quarantine moms away from baby.” 

Later, the member provided an update.

“She’s with him now and he is currently latched <3 she’s still mentally in a dark place but things are looking up now that she’s finally got to hold him skin to skin without gloves or a mask.” 

Another participant suggested that this mother might need timely birth trauma therapy. 

The original poster replied: “I completely agree. She is very flippant and now seemingly unbothered and lacking emotion. Dad is worried and said he’s never seen her like this before.” 

Dr. Amy Gilliland of Doulaing the Doula is raising questions about mother baby separation on her social media outlets.

In one post Gilliland describes the effects of separation after birth: “The infant experiences loss and has a grief response – that’s the only interpretation – Where did my mother go? And it’s a loss they never recover from because their initial impression is abandonment and isolation. We are screwing up their capacity to trust and creating insecurity. We know this from research and therapy with young children, older children and adults. www.birthpsychology.com (also the Alliance for Infant Mental Health)…” 

Photo by Gift Habeshaw on Unsplash

Toxic stress is bubbling up in mothers, babies, families and equally their care providers.

What’s worse, Cadwell explains, is that many of us have accumulated toxic stress over our lifetime and in the current situation, many of our regular stress relief outlets have been stripped from us.   

Gutted by the situation, Cadwell and Blair put together Toxic Stress, Resilience Building, COVID-19 and Breastfeeding, a webinar that focuses on how to build resilience in ourselves and in others. 

“How can we find a resilient future?” Cadwell wonders. 

The webinar refers to Dr. Kenneth Ginsburg’s The 7 Cs: The Essential Building Blocks of Resilience

Healthy Children Project and Health Education Associates are offering the webinar at no cost. Continuing education credits for nurses, lactation consultants and lactation counselors are available.

You can request the free module here

In closing, I offer you this PSA:

“Unless you have prior experience navigating the emotional, psychological, and financial implications of a global pandemic- all while suddenly becoming a homeschool teacher to kids with cabin fever and unlimited snack requests… give yourself some grace.”  

Photo by Miguel Bruna on Unsplash

And one of my favorite quotes, quite applicable when the entire world is becoming unglued, “As long as there is breath, there is hope.”