Because I am new to the field of lactation and because I have not worked in a clinical setting, I was especially privileged to be surrounded by such an experienced, concerned group of lactation care givers.
When we weren’t engaged in remarkable presentations and discussions, us conference participants were forced to have a lot of fun. (Wink, wink) During group activities, I laughed myself to tears. We enjoyed entertainment from a special guest called Tippy, we raced milk ducks for a great cause and attendees viewed the premiere of Healthy Children’s newest film The Lost Secret of the Throne. Early in the week, we visited Sea World to learn about aquatic mammalian lactation- our Sisters of the Sea.
Between Monday and Friday, Healthy Children presented breastfeeding education that surpasses the idea that Breast is Best. Although accurate education is still crucial for breastfeeding success, we can begin to focus on the many dimensions breastfeeding connects to: economy, environment, public health, human development, perception of women, ethics, and the list goes on and on.
Below, I reflect on some of the overarching themes discussed at the conference.
Women are not powerless.
Why is it that most birth stories are stories of horror and pain and violence?
For one, today’s women are generally not exposed to the beauty that birth can be. Instead we’re inundated with dramatized, inaccurate versions of birth in the media and our own experiences reflect those.
Second and perhaps more significantly, the medical industry has seized women’s power.
Homebirth and hospital-attending obstetrician/ gynecologist and homeopath Ricardo Herbert Jones, MD explains the many reasons why there is a divide between evidence-based birth and current obstetric practice.
First, he spells out physicians’ fear of litigation. A doctor who performs a caesarean section will not face potential charges because he or she used available technology. People simply no longer believe in the safety of normal birth; instead, we glorify technology.
Intervention is convenient for physicians. Scheduling or calling for an “emergency” c-section allows doctors to make it home in time for dinner. One conference participant calls it the “five-o’clock cut.”
Dr. Jones also explains that intervention supports commercial interest. The more c-sections performed, the less time wasted and the less time mother and baby spend in the OB ward.
“Birthing is a factory process; there is no emotion,” Speaker Nikki Lee, RN, MSN, IBCLC, ANLC, CIMI, CCE, CKC observes.
Society does not believe in women’s innate ability to birth our children. We’ve been made to believe that our bodies are defective and untrustworthy and so, we must relinquish power.
Common practices including shaving women’s pubic hair transforms her into a child, a girl who exercises no choice, Dr. Jones explains. He also uses the chilling metaphor that by hooking women to IVs during labor, we become fused to the medical system.
“Birth mirrors everything that happens in society,” Dr. Jones says.
Babies are not incompetent.
Why do we assume neonates are vacuous, otherworldly creatures?
Common medical practices wrap infants like a popular Mexican delicacy (the infamous baby burrito), separate them from their mothers and disregard their distinctive language.
When a baby is placed skin to skin with her mother immediately after birth, she performs nine instinctive stages that ultimately allows for flawless latching to mother’s breast. The nine instictive stages were originally identified by Ann-Marie Widström, RN, MTD, Doctor of Medical Science and colleagues. Skin to skin also counters the stress of being born, regulates baby’s body temperature, allows oxytocin to flow freely and has profound self regulatory skill implications later in life. It is common medical practice which demonstrates incompetency when it interrupts this seamless, delicate system.
Healthy Children faculty Kajsa Brimdyr points to one study that indicates neonates’ brilliancy. When a mother’s labor gown was given to a crying baby, the baby stopped crying. So we know scent is a highly developed sense that plays a significant role in newborns’ inclination to survive.
Further, Brimdyr explains that when an infant is placed skin to skin after a vaginal birth, his knees and legs push on mother’s abdomen forcing delivery of the placenta. Another incredible accomplishment baby arranges when allowed to do so. 
During the nine stages toward the breast, babies often rest. Speaker Ann-Marie Widström says that the relaxation stage is yet another sign of an early survival instinct; keep still and quiet so not to draw attention from predators.
Conference participants explain that it seems nearly impossible for medical staff to remain onlookers during this process and usually allow their impatience to interfere with babies’ instincts.
Healthy Children faculty Dr. Karin Cadwell and Carin Richter sarcastically joke about the contrast between the way we treat infants and other patients:
Why don’t we have the same respect for babies?
It would be absurd to say to the cardiac patient: “Oh, you’re just having chest pain, oh you’re just blue…”
Babies have needs too. Why do we disregard or respond mistakenly to the way they communicate?
Birth, breastfeeding and parenthood are a continuum.
Fragmented specialty care in America makes it difficult to provide consistent, clear information for patients.
“Our system divides the nursing mother and baby into two specialty care divisions, peds and OB/Gyn,” Healthy Children faculty Cindy Turner-Maffei explains. “That would be considered ridiculous to do in pregnancy.”
It’s ridiculous too, to expect mothers and babies to be successful at breastfeeding when their birthing experience involves scalpels and suctions when not medically indicated.
And when mother and baby are not given the opportunity to organically bond through skin to skin and breastfeeding, parenting can become an increasingly difficult, unpleasant endeavor with long-lasting effects.
We must remember that birth has everlasting consequences.
When we disregard excuses, we will make change.
How many reasons can you think of why you cannot go on vacation? Brimdyr asks us to brainstorm reasons and the group creates a rather lengthy list.
“But you always find a way…” Brimdyr concludes.
Applying this idea to the humanization of birth and breastfeeding allows for less intimidating models of change.
Brimdyr, Widström and Kristin Svensson, RN, Midwife, Doctor of Medical Science offer several suggestions to initiate change within our medical system:
- Create internal and external will.
- Present mothers’ positive experiences with skin to skin and breastfeeding.
- Promote initiatives like The Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding and the Baby-Friendly Hospital Initiative.
Breastfeeding is not a personal or private issue.
Long-time, maternal infant caregiver Nikki Lee, RN, MSN, IBCLC, ANLC, CIMI, CCE, CKC recently wrote The dollar value of human milk. which has an incredible, fresh perspective on the value of breastfeeding. She shares an ingenious equation that calculates the monetary value of breast milk per state. Her post is a must-read. Find it here: http://www.breastfeedingalwaysbest.com/what-the-world-needs-to-know-about-human-milk/.
Specificity is key.
When The Joint Commission (TJC) expanded its performance measure requirements, many lactation care workers performed their happiest happy dances. Beginning in 2014, all hospitals delivering greater than 1,100 babies annually will be required to implement the Perinatal Core Measure Set which includes exclusive breastfeeding targets. Hurrah! But wait, TJC’s core set measures exclusive breast milk feeding. Breast milk feeding is not the same as breastfeeding, all of us conference-goers agree.
Cadwell and Turner-Maffei created an activity that opened conversation to define breast milk feeding. It was a challenging task! Our groups considered donor milk, wet nursing, cross nursing, shared human milk feeding… There is much room for interpretation. And while indirect human milk provision is still superior to artificial baby milk concoctions, breastfeeding between biological mother and baby is number one on the World Health Organization’s hierarchy of infant feeding.
A call for specificity can be applied to issues surrounding Step 4 of BFHI as well: Help mothers initiate breastfeeding within one hour of birth. An accurate interpretation of Step 4 is the implementation of skin to skin immediately, continuously and uninterrupted until completion of the first successful breastfeeding. We are getting closer, but what is skin to skin comprised of? Proper skin to skin implementation is a fully naked infant, only diapered, placed stomach down on its mother’s fully naked upper body. So you see when we fail to deliver specifics, moms, medical staff and supporters can get lost in translation.
A personal thank you to all of the conference participants for enlightening me and for furthering my passion for healthy children, healthy women, healthy families and healthy communities!
Congratulations to Dr. Julie Mennella for receiving Healthy Children’s prestigious Milk Shake award for shaking up lactation-based research. And congratulations to Kristin Svensson who was also awarded a prestigious Healthy Children award for her contribution to advancements in maternal infant health.
For more information about upcoming Healthy Children conferences, cruises and other educational opportunities please visit http://www.centerforbreastfeeding.org/.
It was so wonderful to have you with us at the conference, Jess! Thank you for a thoughtful review of the week. We feel so fortunate to have been surrounded by so many treasured colleagues, including speakers and participants, who are working so hard to make a difference for mothers and babies.