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Our Milky Way - Healthy Children Project Center for Breastfeeding
[Photo by Andrea Piacquadio]We consider ourselves life-long learners here at Healthy Children Project. Sometimes learning occurs gradually, and sometimes there are the ‘light bulb’ moments.
We put a call out to our followers to share “Aha!” moments with us. Maybe it was a myth busted during the Lactation Counselor Training Course (LCTC) or maybe it happened during a visit with a dyad.
We also called for stories about your babies’ and children’s ‘light bulb’ moments. When have you seen your little ones’ faces light up in discovery and understanding?
The call for stories is still open! Please send your reflections to info@ourmilkyway.org with “Light Bulb” in the subject line.
I did not go into the field of mental health counseling with the goal or intention of working with mothers/birthing people and babies. It was never on my radar as something that clinicians even specialized in. The birth of my daughter changed everything for me.
I’ve been working in the field of trauma and traumatic stress since 2010. My spouse and I welcomed our daughter, currently our only child, into the world November 2021. I was induced and labored for 22 hours before I was whisked away into the operating room for an emergency cesarean. Though everything was seemingly normal on the surface, between the complications faced in labor and the OR, internally I was far from okay. The spiral of postpartum anxiety had entered the chat.
It was after we came home, in the stillness of the village that lived so far away, crying on my couch with a cluster feeding newborn, I realized two things: 1) I didn’t know anything about perinatal mental health, and 2) I didn’t know where I could even go to learn.
In the following weeks, my spouse would arrive home from work and I would dump everything that I had discovered that day onto him. I was so energized, so eager to learn, and I was jumping into the deep end of this new clinical niche. I enrolled in a perinatal mental health training program. Upon completing that, I enrolled in the Certified Lactation Counselor training course. Bridging these disciplines, as a practitioner, just made sense to me. There can be a significant amount of mental health problems that arise from attempting to body feed: anxiety, trauma, and grief, to name a few. And, as an attachment theory and parenting nerd, I absorbed research on skin-to-skin care like a sponge.
As I’ve continued to specialize in this field, I greatly appreciate the value of blending perinatal mental healthcare and lactation care, the healing benefits of skin-to-skin care after a traumatic birthing experience, and the neuroscience of matrescence and infant (0-3) development. It’s provided me opportunities to learn more about the relationship between my daughter and me. It’s positively influenced my parenting style. It’s positively influenced my approach as a counselor and an educator. There are FEW psychotherapists who have lactation credentials out there, and I feel honored to be one of them.
When I was a freshman in high school, I had these tiny little ramp-like structures fused to the back of my upper incisors so that my overbite wouldn’t interfere with my bottom braces. I called them “rabbit teeth”, because that’s what they resembled: prominent, cartoon-like rabbit teeth. They were so embarrassing, though I was lucky I didn’t need to contend with headgear or what I’m about to share next.
Photo by Kenny Eliason on Unsplash
A friend recently described her son’s orthodontia as a “medieval torture device.” Every night, she has to insert a key into the expander across the roof of his mouth and crank it multiple times in an effort to widen the canal. He’s also endured multiple tooth extractions, multiple phases of metal braces, a retainer, and his parents have forked over thousands of dollars for these treatments.
I’m forking over thousands of dollars too, for my oldest daughter’s orthodontia. About every six weeks, we haul over for adjustments. Currently, she’s in the rubber band phase. Tiny little bands hook diagonally onto her braces in order to train her jaw into proper positioning.
Though my own orthodontic care wrapped up about two decades ago, I’ve discovered these hilarious facial exercises– face yoga– regimens marketed at those of us who aren’t pleased with our face sculpture.
Torture devices, face toning, what have you, these interventions have come to rise in modern times to address our changing faces and it’s not just vanity at stake. Jaw and other facial development, dental occlusion, tooth spacing have all been affected by how and what we eat and they have real effects on our overall health and function.
“…The problem we face is that we have entered a space age world with Stone Age genes—genes that evolved to produce jaws adapted to a hunter-gatherer diet. Today’s jaws epidemic is concealed behind the commonplace. Its most obvious symptoms are oral and facial: crooked teeth (and the accompanying very common use of braces), receding jaws, a smile that shows lots of gums, mouth breathing, and interrupted breathing during sleep…” Sandra Kahn and Paul R. Ehrlich write in Why Cavemen Needed No Braces.
The authors go on to explain: “The epidemic’s roots lie in cultural shifts in important daily actions we seldom think about; things like chewing, breathing, or the position of our jaws at rest, and these changes have in turn been brought about by much bigger sociohistorical developments—namely, industrialization.”
Photo by Etienne Girardet on Unsplash
More specifically, Americans’ diets have become saturated by ultra processed foods (UPFs). According to the documentary Food Inc. 2, on average, UPFs make up 58 percent of Americans’ total energy intake, compared to 17 percent in Italy.
While we might think of UPFs contributing to things like obesity, diabetes, and heart disease, Daniel E Lieberman, et al conclude in Effects of food processing on masticatory strain and craniofacial growth in a retrognathic face that “…food processing techniques have led to decreased facial growth in the mandibular and maxillary arches in recent human populations.” This shifting development of our facial structures comes with its own set of health concerns.
Weston A. Price delves into the relationship between diet, the development of teeth and bones and overall health in his book Nutrition and Physical Degeneration.
Starting in utero, researchers have suggested that the amount of protein consumed by pregnant women can impact the facial development of their offspring.
It is well established that infant feeding and the introduction of complementary foods impacts facial development.
In Relationship between Nutrition and Development of the Jaws in Children, a small pilot study, the authors reference a study conducted in Beijing by Chen, et al that “revealed that children who either did not receive breastfeeding or breastfed for less than six months were more susceptible to subsequent crossbite, which is directly linked to the position of the terminal plane.”
The authors also write that “initiating [complementary] feeding with solid foods [as opposed to porridges] may lead to a lower tendency for crowding. Primate spaces and interincisive diastemas are considered essential and important as they facilitate the proper alignment of permanent teeth by occupying the necessary space for a harmonious occlusion.”
Alas, the packet apocalypse is upon us. The convenience of “ready-to-feed-super-glops and slops” have largely replaced the art of dining and sharing meals and chewing our food. Stocked shelves offer an overwhelming array of mostly highly processed snacks and meals in a pouch that generally lack texture diversity.
In one section, Luxford cites Babu Jose and Nigel M King’s research which found that “the [addition of sugar in local snack food preparations and the increasing frequency of snacking] may have been a factor that has affected data from other studies where breast-feeding was high; in other words, this may serve as a warning to communities that the good practice of breast-feeding may be counteracted by adverse factors that are not reported by caregivers, and these factors may be cultural or social in nature.”
During this research, I came across a device shaped like a mouthguard intended to promote chewing. How incredibly bizarre, I thought. When I shared the device with one of my mentors, she pointed out that humans who are tube fed or those living with other medical complexities might benefit from a device like this, but for those of us who can chew regular, whole foods… we both cocked our heads– our heads formed with great influence by the foods we eat– in bewilderment at this silicone product.
In the era of the International Breastfeeding Conference, Cindy Turner-Maffei and Karin Cadwell would present their beloved Weird Findings segment on the last day of the conference. I always found it delightful and now wistfully reminisce about the session sometimes.
One year, we learned about pink yak milk, spider milk, goat wet nurses and donkeys with “good moral reputations” with the alleged ability to cure distemper and poisoning. That year, I was also introduced to the jaunty tune “I’m a Mammal”. It was all great fun; entertaining and educational.
So, this week’s post is my attempt at a Weird Findings collection, a nod to all that is quirky. I landed on quirky as the best word applicable to most of the items below, but quirky and weird are really just umbrella terms for those things that might also be totally awesome, maddening, perplexing and all of the things in between and just outside of these descriptors.
The artificial womb
My high school biology teacher once asked our class to contemplate a riddle about the Nacirema people. Part of it contained a description of their reproduction which read like an excerpt from a science-fiction novel. Really, it described Americans.
Reading about the development of an artificial womb to support premature birth had me thinking back to this exercise.
Like any technology, great promise and great unknown surround “advancements”. Because this womb is not available to humans yet and because of my overall skepticism, I thought it necessary to point out that we have a means to help very premature babies right this very moment…our bodies.
Be inspired, maddened, saddened, weirded out by the remainder of the comments here.
Exercise and breastfeeding
This study found that adiponectin concentrations increased in breast milk after high intensity interval training (HIIT). “It has been postulated that higher breast milk adiponectin concentrations may prevent rapid weight gain in infancy,” the authors write. The real-life implications of this discovery? South China Morning Post’s coverage on the study points out how exercise has physical and mental benefits for mom and baby.
Tomatoes and erectile dysfunction
Around three minutes into this amazing video, Katie Hinde points out: “When we zoom in on the number of articles just investigating breast milk, we see that we know much more about coffee, wine and tomatoes…We know over twice as much about erectile dysfunction.
I’m not saying we shouldn’t know about those things — I’m a scientist, I think we should know about everything. But that we know so much less about breast milk — the first fluid a young mammal is adapted to consume — should make us angry.”
The disgraceful CMF industry
As sophisticated as the commercial milk formula industry’s insidious marketing tactics are, they are truly a disgrace in the event of pregnancy loss or stillbirth. The authors of an ABM blog post share the perspectives of mothers who endured pregnancy loss and stillbirth and subsequently received infant formula samples.
“‘It feels like a slap in the face, a punch to the gut,’ Caitlin C. says, after discovering formula samples at her door following two second-trimester losses. ‘If [the formula company] somehow knew I was pregnant, couldn’t they also know I’m not anymore?’”
Amphibian milk
It wouldn’t be a proper Weird Findings collection without the inclusion of a creature that challenges our Linnaean classification system. NPR reported that “a species of worm-like amphibian has been caught on camera feeding milk to its young…The creature, known as a caecilian, lives underground. Researchers believe that the animal developed the ability to produce a milk-like substance independently of mammals…” Weird.
Milk composition
There’s weird and then there’s WEIRD: Western, educated, industrialized, rich, and democratic.
Klein’s, et al work found variations in milk composition across populations classified by four subsistence patterns: urban-industrialism, rural-shop, horticulturalist-forager or agro-pastoralism. The authors synthesize: “Populations living in closer geographic proximity or having similar subsistence strategies (e.g. agro-pastoralists from Nepal and Namibia) had more similar milk immune protein compositions. Agro-pastoralists had different milk innate immune protein composition from horticulturalist-foragers and urban-industrialists. Acquired immune protein composition differed among all subsistence strategies except horticulturist-foragers and rural-shop.”
It was found that “When compared with western populations, some of these groups have genetic profiles that favor… immune responses and elevated levels of immune molecules throughout life…”
Microbiome and breast cancer
Other examples of the microbiome and immune connection come from Nikki Lee’s ponderings. “This new world of research is astounding!” she shares.
In Microbiome and Breast Cancer: New Role for an Ancient Population, the authors show “a significant difference in the microbiome composition of nipple aspirate fluid between healthy individuals and patients with BC suggested the potential role of the ductal microbiome in BC incidence.”
The final element of a Weird Findings segment is song and dance!
This video is a public health announcement rolled into song by Rodah Amakal, a gospel musician from West Pokot County for the Pokot community in Kenya. Enjoy!
The red bud in my yard is bursting with magenta. The remnants of nighttime thunderstorms, gems of rain dangle from its branches glistening under late morning sun. There’s a lot of anticipation in our backyard woods; a buzzing of green that will soon become too dense to see the railroad tracks that curve through the neighborhood.
When I open the grill on one of these beautiful spring days, I’m confronted by a mother mouse perched in her nest. Her black, beady eyes send me shrieking, foolishly and frantically flailing into my house.
My partner, much less ruffled by the tiny animal, uses the grill utensils to relocate the mother mouse and her nest. Upon removal, he notices that her tiny, pink babies, nearly translucent, are attached to her teats.
“Oh my god!” he exclaims. “Oh my god, they’re nursing! They’re just hanging on!” And then, minus the flailing, proceeds to freak out, because he is so affected by the fact that he has disturbed a nursing mother and her babies. Despite the assault of grill tongs and humans giant relative to their size, the mother and her babies remain together, in an act of survival.
A few days later, at my daughters’ soccer game, my son finds an empty field to kick around his soccer ball. His location and the girls’ game are separated by a small parking lot. I want to finish watching the girls’ game, so my son and I establish a meeting spot. When I go to check on him the first and second time, he is happily occupied, working on what looks like some fancy footwork and big boots. The next time I go to check on him, I scan the landscape, but he is not there. There’s a berm, so I swiftly walk over to see if he’s hidden behind the mound. Still, I don’t see him, so I panic, shouting for him, over and over with no response.
Perhaps I will reveal too much about my character here…I start to conjure up all of the possibilities: he’s been abducted by a stranger, driven away in a van and I’ll never see him again; he’s been swallowed by the marsh on the other side of the road; he’s wandered off into the woods on the perimeter of the field and wolves will eat him; he’s been coerced by someone in the stands and they’ve snuck off with him somewhere.
At this point, my heart is beating in my forehead. Blood drains from my arms and legs and they begin to tingle. It feels like I could be staggering from light-headedness, but I manage to make my way over to recheck our meeting spot; he is not there either. I walk up into the bleachers and ask a familiar face if she has seen my son.
“Yep, he’s right there; I’ve been keeping my eye on him,” she points to the other end of the bleachers… not our meeting spot.
I exhale, thank her quickly, rush to him, embrace him, scold him through trembles. He holds my hand as we make our way to the top of the bleacher seating. He curls his arm around my waist and we sit side-by-side this way watching the reminder of the game together.
My son is no longer a nursling, but my point in sharing these vignettes is that the connection we have to our children, the instinct to be with them, near them, is mammalian, primal. It’s beautiful and powerful.
From the start, our infants’ survival depends on proximity. Of the many things that Karin Cadwell and Kajsa Brimdyr have taught me and that have stuck with me is how babies instinctively crawl to the breast, so even when infant feeding hasn’t been a part of the prenatal conversation, or even if a mom has been on the fence about “committing” to breastfeeding, the baby often makes that initial decision, questing to the breast when given the opportunity in uninterrupted skin-to-skin contact after birth.
“[Babies] are 10,000 years old when they are born,” Nikki Lee has said. “If they’re not next to a heart beat, they are saber-toothed tiger lunch.”
Yet, we find ourselves in a culture that has stripped us of these sacred experiences through marketing and medicalization. We have been acculturated to believe that separation is normal, acculturated to believe that tending to our babies’ basic needs will spoil them, acculturated to believe the only way we can be rested and sane is by separation from our babies, acculturated to believe that we require gadgets to properly raise our children, because somewhere along the line, we started to believe the marketing that nature must be flawed. We fell into the corporate trap, succumbed to their greed, allowed it to dim our instincts.
Now, the language we use refers to the “benefits” of our mammalian behavior: the benefits of physiological birth, the benefits of skin-to-skin contact, the benefits of breastfeeding. Max Ramirez of IBFAN & MOH Panama has said that “Talking about the advantages of breastfeeding versus the risks of not breastfeeding is like talking about the advantages of breathing instead of the consequences of smoking.”
In this Leadership Pittsburgh presentation about “Milk Money,” Todd Wolynn goes as far as to say, “Economics dismantled us as a species.” (He’s referring to formula companies.)
All is not lost. In fact, Camie Jae Golhammer has said of Indigenous traditions, that they’ve gone dormant rather than have completely died off.
Like the boasting red bud in my yard, these sacred moments during our reproductive years will not always lay dormant and there are bright spots to celebrate.
Programs like the Baby-Friendly Hospital Initiative empower families with practices and messaging like: “Every mother has the right to evidence-based information, free from commercial interests to help her decide how to feed her baby and should be equally supported and treated with dignity and respect for her infant feeding decision.”
Global recognition of the importance of midwifery care came to the forefront late last year when midwifery was inscribed on the Representative List of the Intangible Cultural Heritage of Humanity. This recognition is not only well-deserved by the many, many generations of midwives who have supported and continue to support healthy families, but essential in order to safeguard those in the practice of protecting fundamental human rights and these sacred moments.
Another ray shines as the people at the United States Breastfeeding Committee (USBC) do lots and lots of hard work to advance policies that actually allow people to be with their babies. The organization offers a hub for policy action that makes it incredibly simple for citizens to engage and influence change.
The Hidden Pregnancy Experiment which explores anxieties around surveillance. “As a general rule, these devices don’t lead to better outcomes for the babies they monitor. More often—like social media, which promises connection as a salve for the loneliness created by social media—parenting tech exacerbates, even calls into existence, the parental anxieties that it pledges to soothe.”
A white-presenting lactation professional working with a black mother and her baby shortly after birth exclaimed something along the lines of, “Awww, look at him, he looks just like a little thug!” commenting on the slight sag in his newborn hospital cap.
“Little thug”– a heavily loaded term generally carrying negative connotations– was understandably a trigger for the mother. She shut down no longer feeling safe in the space and asked to be discharged early. Most likely, the lactation professional did not intend to offend, but the impact of this short exchange has much further reaching consequences than the intention itself.
We have explored the impact of language to a relatively great extent here on Our Milky Way. You can check out these pieces for examples:
In a recent exchange, Nikki Lee added to this ongoing conversation about language in maternal child health. She shared an observation about how “the media rarely misses a chance to plant negative seeds in the public’s mind about breastfeeding”.
Citing an example from a PubMed alert that morning– Sudden Death in a Breastfeeding Woman with Arrhythmogenic Mitral Valve Prolapse— Lee commented “I ask you, how in the world does the infant feeding method have to do with the death of this mother? She had some kind of cardiac defect; pregnancy and labor place huge stresses on the cardiovascular system. What would you think and how would you feel if you saw a headline ‘Sudden death in a formula feeding woman with arrhythmogenic mitral valve prolapse’?”
In her own reflection on the use of language in perinatal support, Donna Walls, RN, BSN, ANLC shares her guest post Our words need to send a supportive message- how can we do it? this week on Our Milky Way.
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As a child I often repeated “sticks and stones can break my bones, but words can never hurt me”. As an adult, I know this is not true. Words are powerful. In our breastfeeding advocacy world, words can be used to build a new mother’s confidence, or they can be used to undermine it. Below, I offer you some of my pet peeves, words and phrases we commonly use without thinking about their impact.
Source: United States Breastfeeding Committee
First, maybe the most common and certainly one of the most harmful is talking about “milk coming in”. We know that the number one fear of new moms, especially first-time moms, is not having enough milk. In the first days after birth, there aren’t often visible signs of milk production. New parents have often heard about engorgement and how breasts get so full, they look like they are ready to explode. But, they see no signs of exploding breasts in the first one to two days after birth. They may be able to express drops which is encouraging but no big reassurance that there is plenty for their baby.
We often see at about two days of age the occurrence of “cluster feeding” when their quiet, precious newborn seems ravenous and so, so hungry. Many moms think, or unfortunately are told, that this is a sign of not having enough milk. This is not even slightly, vaguely true but rather a normal newborn feeding pattern. We dutifully tell this anxious mother not to worry; her “milk will come in” in a day or two. The not-so-subtle message is that there is no need to worry about not having milk now, that it soon will come in.
What has happened is that we have reinforced her biggest worry about not being able to adequately feed her baby. I don’t believe for a minute that this is intentional on our part, really just one of those things we have always said and never really examined the consequences.
I sometimes feel sorry for underappreciated, often ignored colostrum. Maybe it’s time we change the language. So instead of saying “your milk will come in”, might I suggest we instead say “the milk you’ve been making for your baby while you were pregnant is there for the first feeds. It is newborn milk, sometimes called colostrum, and this small volume is all your baby needs in the first hours and days. When you nurse frequently in these first days the newborn milk will change over to mature milk and you will see an increase in the amount as your breasts will become fuller, firmer and heavier.” You can of course come up with your own wording just as long as new parents get the message that there is milk NOW- not “coming in” later!
Source: United States Breastfeeding Committee
My second pet peeve is judgey diagnoses of flat nipples. Way too often when prenatal breast assessments are done, there is a diagnosis of flat nipples, usually based only on the appearance with no regard to assessing function. Once these misunderstood nipples are labeled, the mother is deemed not quite right for feeding. Silly exercises and gadgets are recommended to make already elastic skin behave appropriately. First point: nipples are erectile by nature, some stand up a lot, some a little. Sadly most new mothers have seen artificial nipples and think they should look like these, not ever recognizing that we have the real nipples so why aren’t bottle nipples more like ours?! When counseling mothers, ask the mom if she notices her nipple erecting in cold weather or with sexual/manual stimulation.
As a clinical lactation care provider for many years, I would often be saddened by the words used to make a mother feel her nipples weren’t quite right, not good enough. I have seen too often women struggling with breastfeeding because they were told even before the baby’s birth that the chances were slim for successful breastfeeding; bad nipples would certainly cause problems.
I am quite sure males are not discouraged about the abilities of their erectile tissue at the onset of sexual activity. This is not to say that there may not be challenges with inverted nipples; they may cause challenges when they are retracted enough to not ever be stimulated or stretched for hormonal release, but flat nipples will evert. They just want to do it their way. We need to remind moms that the nipple their baby will prefer is attached to their favorite person.
Third, let’s talk about the term engorgement. By definition, engorgement is not normal. It is a state brought on by interruptions in the expected initiation of lactation [Source]. Unfortunately, the term is used by professionals and families to mean a fullness in the breasts. Signs of engorgement include hot, reddened, uncomfortably swollen breasts which can be hard for a newborn to correctly latch to the breast. This needs to be distinguished from normal signs of lactation when breasts become rounder, fuller, firmer and heavier. Too often a mother may complain about her breast “engorgement” and interventions are recommended to help reduce the discomfort and swelling when in reality she just needs to be reassured that what she is feeling is normal and actually a good sign that she is producing milk. So, my request is that when a mother talks about her concerns about engorgement, our response needs to be to ask something along the lines of “what exactly are you feeling?” as well as the usual questions of frequency of feedings, adequate output and signs of comfortable latch.
Source: United States Breastfeeding Committee
Our words can have a profound effect on the success or failure of breastfeeding. A huge part of our job, our responsibility to our patients and their families is to build confidence in their ability to nourish and nurture their newborns. Be aware of the message that is being sent and choose words that will build confidence, be generous with realistic praise and couch our intervention suggestions with success in mind. Ask for parents’ input; we want them to know their thoughts are important to the process!
Reference Cadwell, K. and Turner-Maffei, C. Pocket Guide for Lactation Management. 2022. Jones and Bartlett. Burlington, MA.
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