WBW 2016: Historical trauma, breastfeeding, and healing with Camie Jae Goldhammer

wbw2016-logo-textEditor’s note: Attachment Parenting International hopes you enjoy this throwback Thursday post, originally published August 7, 2015. It remains a great example of breastfeeding as part of sustainable development, the theme of World Breastfeeding Week this year:

It is often noted that part of what makes breastfeeding so challenging at times is that in our Western culture, we just don’t see breastfeeding happening on a regular basis.

Nursing in public is still a rare occurrence relatively, especially without a nursing cover. Breastfeeding mothers are still getting kicked out of restaurants and stores. A photo of a breastfeeding baby with more of the breast exposed than a tidbit between folds of fabric can result in an entire Facebook page being shut down. Children are still encouraged to feed their dolls with a bottle, rather than at the breast, in public places like childcare centers and preschool. Working mothers, at many places of employment, continue to be directed to broom closets and bathrooms to pump…if they are allowed adequate pump breaks at all. The working and breastfeeding law doesn’t cover everyone!

Even with all the advances our medical community has made in promoting and supporting breastfeeding, our culture remains woefully behind in some ways. What shame there is in strangers’ claims of indecency!

camieIn May of 2015, I attended a portion of the Standing Bear Symposium in Lincoln, Nebraska, USA, to hear Camie Jae Goldhammer, MSW, LICSW, IBCLC, present “Mitakuye Oyasin: Health and Healing through Motherhood.”

Camie is a clinical social worker and lactation consultant, the founder and chair of the Native American Breastfeeding Coalition of Washington, a founding member of the Collaborative for Breastfeeding Action and Justice, and a member of the Native American Women’s Dialogue on Infant Mortality.

As a Native American herself — Sisseton-Wahpeton — she is intimately aware of the challenges of breastfeeding women among Native Americans. It helps put non-Native American cultural challenges surrounding breastfeeding into perspective and can give us understanding of why culture can seem to be so slow to change on the view of breastfeeding. Let’s look at the very critical factor of historical trauma.

What is Historical Trauma?

We understand what trauma is: something horrific that happened, that has lasting, often debilitating, effects collectively known as Post-traumatic Stress Disorder (PTSD). Symptoms can include:

  • Flashbacks
  • Disturbing dreams of the traumatic event
  • Emotional distress
  • Avoidance of places, activities or people that remind of the traumatic event
  • Becoming emotionally numb or inability to feel happiness
  • Negativity toward self or others
  • Amnesia about the traumatic event
  • Difficulty in close relationships
  • Irritability and aggression
  • High anxiety, particularly a feeling to always be on guard for danger
  • A sense of overwhelming guilt or shame; and others.

Historical trauma is when the same traumatic event happens to an entire generation of people. Because it happened to the entire generation, there was no guidance within that generation as to how to heal from the trauma so that the PTSD behavior is transferred inter-generationally through the the parents’ thinking and behavior. And the same PTSD behavior continues to be passed down through the family tree, when healing has not occurred, with the trauma showing up generations later in certain stereotypical mannerisms attributed to that particular culture.

Camie shared an example of the Jewish people, in whom traits like high anxiety, overprotectiveness, and extreme frugality are seen as the stereotypical traits of this culture. These traits are also documented byproducts of the Holocaust among survivors. Without knowing it, Holocaust survivors passed these PTSD behaviors as family values to their children in how they coped with their trauma. And their children passed them to their children as part of their lifestyle, and so on and so on…to a point in their family tree where people with no firsthand exposure to the Holocaust continue to display the same PTSD-like behavior generations later.

That’s historical trauma.

Camie gave other examples of culture suffering from historical trauma: the peoples of Cambodia, Russia and India as well as the Native Americans.

How Does Historical Trauma Relate to Breastfeeding?

Among Native Americans living on a reservation, breastfeeding rates are extremely low. Statistics depend on the exact location, but here are the breastfeeding hurdles common to most reservation, to give you the big picture:

  • High teen pregnancy rates
  • No local obstetrician services so most women do not receive any prenatal care and therefore no breastfeeding education
  • Very few local lactation specialists, especially among peers
  • Low pump-at-work support from employers
  • Access to free formula through federal nutrition programs.

But these are surface symptoms of the real problem: The historical trauma of generations of oppression of native parenting, including breastfeeding.

Camie detailed 6 phases of unresolved grief through the generations of Native Americans:

  1. Colonization by white people – Besides introducing disease and alcohol, there was much death among native peoples at this time, including genocide.
  2. Economic competition – Native peoples began losing their ability to be self-sufficient, beginning to rely on trade with the white people for supplies.
  3. Invasion and war – White people begin exterminating native peoples, and those who don’t die become refugees.
  4. Subjugation through reservations – Native peoples are confined to locations often very different than their homelands and are forced to depend on their oppressors.
  5. Boarding schools – Native children are forcibly removed from their birth families to be educated in a foreign religion and customs, and were severely physically punished as they were forced to conform. This generation is called the “lost generation,” as 70% of native children were taken from their families and culture.
  6. Forced out of reservations – After the boarding schools were closed, white people resorted to forcing adolescent native youth to live off the reservations in what they called “red ghettos” in U.S. cities, away from their families and culture as an attempt to give them a better life than on the reservations.

From generation to generation — because each of these traumas were happening to all the peoples of each generation — there have been terrible, widespread effects on Native Americans, particularly those who live on reservations. The poorest areas in the United States — some without running water, even — are located on reservations. The generational response to this succession of historical trauma has resulted in:

  • Clinical PTSD
  • Depression
  • Unidentified/unsettled emotional trauma, which is displayed through mental illness, anxiety disorders and anger issues
  • High mortality rates, including suicide and murder
  • High rates of alcoholism, domestic violence and child abuse.

What’s more, there is also a prevalent discouragement from bettering oneself, because it feels like a betrayal of past generations that suffered and lost so much.

Women, specifically, have lost confidence in their bodies and their ability to mother, and have learned to defer their decision-making potential to a male-dominated culture. Native women see menstruation, childbirth and breastfeeding as shameful. The generational wounds of native women include:

  • Loss of empowerment in the mother role
  • Devaluation of native parenting, which embodies a feeling that parenting is a sacred responsibility, that children have wisdom, that children are the future of the Nation and therefore need to be raised with a sense of incredible value.

Because breastfeeding equals maternal power, how do we expect a native woman to breastfeed if this — disempowerment and devaluation — is what she feels like?

Breastfeeding Can Heal Generations

In her private practice, Camie works off the 7th Principle, meaning that whatever a person’s choices, that person’s actions have a ripple effect to the next 7 generations. Camie believes that breastfeeding can change everything…in how we view children, mothers, families, parenting, community, generations and humankind overall.

Breastfeeding is a statement: that a mother, family, community and culture is willing to give the best to their children. Breastfeeding is a protest to a culture that devalues children and families.

Breastfeeding is an act of power. The top causes of infant mortality among native peoples are Sudden Infant Death Syndrome (SIDS), respiratory infection and influenza. The risk of each can be lowered through breastfeeding.

Camie’s great-great-great-grandmother was the last generation since Camie to breastfeed her children. This relative had 5 sons and all were forcibly removed one day by the U.S. government to grow up in boarding schools. How they each coped with this separation and loss of culture rippled through the generations until it seemed that the knowledge and art of breastfeeding, and mothering, had been lost.

But it was not lost on Camie. She breastfed her oldest for 4 years, and is currently breastfeeding her 3 1/2 year old. Camie seemed to be born with the desire to always question the status quo.

Camie talked about how trauma, historical or individual, will always be passed down through each generation until someone is able to step back and question why their family does things a certain way and is willing to look deeply into that family’s trauma to heal.

Cultural Changes Helping Mothers to Breastfeed, Too

The culture has changed its attitude toward native mothers, too. Western culture has worked to help heal the emotional wounds of Native Americans, though there is still so much work to do. Camie identified these needs among native mothers to improve breastfeeding rates, which are not so different than what we all — Native American or not — need from Western society:

  • Support from peers, especially those trained as lactation specialists
  • Prenatal education specific to breastfeeding and emotional barriers, such as not wanting baby to be physically close, a sign of unidentified trauma
  • Targeted breastfeeding education to mother’s support persons, especially grandmothers, sisters, aunts and other women who the mother relies on for emotional support.

The Strength of a Breastfeeding Mother

After Camie’s talk ended, several native mothers shared their amazing stories of breastfeeding success against all odds. One woman told of how her boyfriend threatened to beat her if she continued to breastfeed past 6 months, so she would sneak the baby into the shower and other out-of-the-way places in the home to breastfeed until she was able to get out of that abusive relationship. It took months, but she is still breastfeeding — now tandem-nursing that older child alongside a newborn.

Another mom told of how she gave birth to her first child when she was still a high school student, but the school wouldn’t allow her to pump, so she hand-expressed breastmilk in the school bathroom. She talked about how she would leak breastmilk during the day and would have to put up with negative comments from peers and teachers about that.

The undercurrent through both of these and other stories is women finding their power as mothers, reclaiming their confidence as women.

White American Mothers, Historical Trauma and Breastfeeding

161052_1659While Camie’s presentation was directly related to the Native America culture and breastfeeding, I think it can be easily applied to any population of women living in a culture struggling with supporting breastfeeding.

I am not Native American, but as the typical white American, I can look back in my family tree and see the history of breastfeeding is much the same as it was for my white American friends: After World War II, formula really took hold as the “best” way to feed babies, so much that the medical community was recommending formula over breastfeeding. The only families that were breastfeeding for any length of time typically were the poorest families, those who couldn’t afford the cost of formula. Formula also gave mothers the choice to be able to work outside the home, a freedom of choice that coincided with the feminism movement. At the same time, however, our white American mothers were losing the significance of breastfeeding — that is central to not only infant and child health, but also the mother-infant bond and the beginnings of secure family attachments.

I was discouraged as a new mother to my first child, by a nurse at the hospital, to exclusively pump unless I didn’t qualify for free formula through the federal nutrition program. I chose to listen to my instinct instead: Breastmilk was something I could give to my baby that no one else could.

Breastfeeding empowered me to embrace the role of mother, despite strong discouragement at times from Western culture. For me, as a white American who is overcoming historical trauma placed on generations of white American mothers who were discouraged from breastfeeding and Attachment Parenting, breastfeeding is a statement: that I, as the mother, know what was best for me and my children.

The cost of denying employee accommodations for actual breastfeeding

Editor’s note: Because many parents come to Attachment Parenting by questioning the status quo, many members of Attachment Parenting International (API) become passionate advocates in their communities for this approach to parenting, such as through the API Leader and Support Group program. Some API members become parent educators, lactation consultants, birth doulas, babywearing consultants, infant massage educators, positive discipline educators or join another profession linked closely with Attachment Parenting.

kate frederickOthers, like Kate Frederick of New Hampshire, USA, find their voice in another way — advocating in the policy- and lawmaking process. Today, Kate introduces the piece of legislation that she wrote and that was debated during this year’s session of the New Hampshire Legislature. While this bill was not passed during this spring’s legislative session, its introduction and debate has made great headway in breastfeeding laws, particularly for working mothers. Thanks, Kate, for your advocacy!

If an employee requests workplace accommodations for breastfeeding, what is the financial risk for the employer if they deny the request? Simply put, it can cost more to deny the accommodation than to grant it.

With the employer’s costs incurred for unemployment insurance from the many health insurance companies that offers this service, an investigation by the Human Rights Commission, the Department of Labor and/or Equal Employment Opportunity Commission (EEOC), and the potential for a private cause of action, it’s just not cost effective to deny breastfeeding accommodations. This is something legislators, the employment sector, breastfeeding advocates and attorneys considered as they weighed in on the bipartisan New Hampshire State Senate Bill 219, relative to breastfeeding.

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New Hampshire SB 219, Relative to Breastfeeding

The 2015 bill was submitted to Prime Sponsor, Senator Martha Fuller Clark (Democrat), by myself and Kary Jencks with the New Hampshire Citizens Alliance. SB 219 was intended to address goals set for each state by the U.S. Surgeon General to achieve better breastfeeding support in the employment setting. So far, New Hampshire has not yet met those goals.

By addressing cultural obstacles to lactation, the bill also served to clarify already existing employer obligations, by putting the context of several Federal and State laws all into one place.

It also brought New Hampshire legislation up to the level that Vermont, Maine and most other states already have on the books.

Impressive savings and benefits to employers are already well documented in the U.S. Department of Health And Human Services’ Business Case for Breastfeeding. Savings on employee healthcare costs are cited. The longer a woman breastfeeds, the greater she can reduce her risk of breast and ovarian cancer as well as diabetes. Breastfed children tend to have less illness, so an employee has less absences due to childcare.

Breastmilk has proven superior over any other alternative. It is even being prescribed to chemotherapy patients to improve their immune systems, while extreme athletes are buying breastmilk online as a performance-improving, protein-packed energy drink.

Employers may value the benefits of breastmilk, but they need to think about paying salaries and serving their customers. The costs incurred for denying workplace breastfeeding accommodations is now causing employers to think even more about these issues, as a direct result of the Federal suit filed on my behalf: Kate Frederick vs The State of New Hampshire Department of Health and Human Services, which addresses the need for workplace pregnancy and breastfeeding accommodations.

Notice the irony of who published the Business Case for Breastfeeding and who is named in the suit.

Supporters of the Bill

The New Hampshire Senate passed the breastfeeding bill with amendments. The New Hampshire Business and Industry Association’s senior vice president Dave Juvet testified in support of SB 219 during the bill’s public hearing on March 31 in the House Commerce and Consumer Affairs Committee, along with the bill’s prime sponsor Senator Martha Fuller Clark (D), Senate Majority Leader Jeb Bradley (Republican) and Commerce Committee member Representative Ed Butler (Democrat). Sponsors Senator Molly Kelly (Democrat) and House Representative Karen Umberger (Republican) singed in for support. Additional testimony also in support came from the American Civil Liberties Union-New Hampshire, Civil Rights Attorney Benjamin King, The New Hampshire Citizens Alliance, the New Hampshire Breastfeeding Rights Coalition, the New Hampshire Departments of Labor and Public Health, the NHBTF, the Dartmouth-Hitchcock Medical Center and New Hampshire Voices for Health.

In her testimony, Senator Fuller Clark explained the distinction between using a breast pump and actual breastfeeding. This is significant for employers, because many of them are confused or misled by unclear language to think they are not already obligated to provide accommodations for breastfeeding.

Lactation as a Medical Condition Related to Pregnancy

The EEOC has been cracking down on the prevalence of unlawful sex discrimination experienced by breastfeeding employees, for needing to breastfeed as referenced in their 1979 and 2014 enforcement guidance:

“Lactation is a medical condition related to pregnancy, and it is illegal to discriminate against employees for breastfeeding activity during a workday.”

The EEOC 2014 Enforcement Guidance was referenced recently in the Supreme Court of the United States.

SB 219 would serve to clarify employer requirements and keep New Hampshire in compliance with current Federal laws and court decisions, including the March 25 Supreme Court ruling on Young vs United Parcel Service (UPS), which ruled in favor of Peggy Young to reverse the lower court’s decision and to have a trial, after she sued UPS under the federal Pregnancy Discrimination Act, for failure to provide pregnancy accommodations.

Young’s Supreme Court ruling directly affects SB-219 in that it makes clear the instances when employers are mandated to provide accommodations and when sex discrimination may be inferred if they don’t. If there are both Federal and State laws that exist, it is the law with the greater protection that applies. As the Pregnancy Discrimination Act includes protections to accommodate medical conditions related to pregnancy, such as lactation, employers are considering their vulnerabilities to liability.

Cost of Unemployment Insurance Benefits: $14, 500 (in New Hampshire)

It would be cautionary for an employer to consider the current federal laws, including the Fair Labor Standards Act, the Family and Medical Leave Act, Title VII of the Civil Rights Act: Pregnancy Discrimination Act, the Americans with Disabilities Act and state laws against pregnancy and disability discrimination, in order to avoid the expense of unemployment insurance benefits.

An employee who needs a medical accommodation, such as for lactation, may be eligible for New Hampshire unemployment even if the employer acted in compliance with current law when denying the employee’s request for accommodation and even if the employee quit, was fired or is still employed, but their hours were reduced. Employer costs for an employee receiving unemployment insurance in New Hampshire can be up to $555 per week for 26 weeks. This can increase to almost a year, if the employee is granted an extension of her unemployment insurance

In order to qualify for unemployment insurance benefits, a breastfeeding claimant must meet a number of requirements including, but not limited to, proper documentation from her medical provider and demonstrating that she is able and available to work with accommodations.

Employers should also factor in additional costs for their unemployment insurance rates going up, time spent on fact-finding interviews from adjudicators, potential hearings and a backlogged appeals process.

Cost of Replacing the Employee: $50,000

Another consideration for employers when it comes to the bottom line is the potential expenses to replace the employee. Costs for advertising, recruiting, interviewing, training and loss of production can amount to an average of $50,000, according to businessman and Patagonia Inc. founder Yvon Chouinard.

With government subsidies for on-site child care centers, tax deductions that mitigate costs incurred for lactation sites and employee retention, granting breastfeeding accommodations can even become a profit center.

Cost of Agency Investigations That Lead to Lawsuits: Thousands

What if the employee does in fact qualify for the accommodations under a State or Federal law, but the employer was unaware of their obligation or otherwise fails to comply? In this scenario, an employer can expect additional costs related to investigations and complaints under the U.S. Department of Labor, the EEOC and the Human Rights Commission. A lawsuit and a legal defense can take years to resolve, while back pay, damages and attorney’s fees accrue.

Moving Forward

With legislative bills like New Hampshire’s bipartisan SB 219 moving forward, even resistant employers are realizing that the bottom line is not just about good health for the employee and her family, but about the accounting of financial prudence.

To 3 and beyond: An interview with Janell Robisch on breastfeeding

to three and beyond coverI received a copy of To Three and Beyond: Stories of Breastfed Children and the Mothers Who Love Them at a critical point in my parenting journey.

At the time, I was breastfeeding my third child at 2-1/2 years old. The longest I had breastfed my other two children was 9 months, and my original goal with my third baby was 1 year. I was thrilled to make it to 1 year, and so changed my goal to 18 months. My breastfeeding journeys with my daughters had always been rocky, a struggle to make it month by month it seemed. So I was unsure how long my good luck would last with my third, my son.

At 18 months, I changed my goal to 2 years. And at 2 years, I made a firm decision in favor of child-led weaning. But about 6 months later, I was surprised by my feelings of feeling touched-out and tied-down. I felt ready to wean, but at the same time, I was very sad at the thought. It was evident that my son was not ready to wean. I never thought, in a million years, that I would be struggling with these feelings.

And then the book, To Three and Beyond, arrived in my mailbox. It was sent from Praeclarus Press, owned by Kathleen Kendall Tackett, member of API’s Resource Advisory Council and co-editor of API’s 2013 Journal of Attachment Parenting. What a Godsend! The book is a collection of stories by mothers who breastfed children to 3 years old and beyond, choosing to allow their children the full benefit of extended breastfeeding and child-led weaning.

The book was my main source of support and comfort during the rest of my breastfeeding journey with my third child. It was my “support group” on paper.

(Photo credit: Allison Profeta)Today, I share my interview with To Three and Beyond‘s editor, Janell Robisch, whose own breastfeeding story graces the pages of the book. A former La Leche League Leader, Janell breastfed her 3 children to the ages of 5, 4-1/2 and 3-1/2 years.

API: Janell, I do so love your book! Please begin by telling me what inspired you to write To Three and Beyond. How do you want your book to benefit families?

JANELL: My own experiences with breastfeeding a young child and the lack of resources for mothers nursing a child beyond toddlerhood inspired me to create such a resource.

During the writer’s process, which was fairly long — about 10 years — at least one other book on the topic was released, but I wanted something more personal, a book that mothers could curl up with and be able to empathize and connect with. I see this book as kind of a La Leche League group meeting for long-term breastfeeding mothers. It is a collection of stories, and there are all kinds of mothers with all kinds of experiences. They are ready to share their experiences and give their support to the reader through their words.

This book will give mothers a sense of belonging to a greater group of mothers doing what they feel is right for their families and maybe an idea of how things might go along their own journeys. It also provides some resources for getting more support and evidence about what science has to say about natural-term nursing.

API: How do you offer support to mothers breastfeeding a toddler or older child who feel isolated and unsupported in their choices, and who may be reconsidering those choices?

JANELL: Remember why you have made the choice to continue breastfeeding.

You are not alone, not by far. I feel comfortable saying that at this moment, there are thousands — if not more — mothers nursing beyond infancy and even toddlerhood.

One of the most important things to do is to find support. It means the world, even if it is only online or from one friend or family member in your life.

There is a list of resources in the back of To Three and Beyond, but parents can also join the “Breastfeeding to Three and Beyond” online discussion group on Facebook. It is a closed group that started out about the book but is now mostly a discussion group for mothers with questions, stories and things to share about nursing older children and breastfeeding in general.

API: How does your book fit within the mission statement and vision of Attachment Parenting International (API)? What are your views of API?

JANELL: I am happy that such an organization exists, and I believe that API’s tenets of parenting reflect a safe, nurturing and loving way for preparing for parenthood and raising our children.

The website is full of great resources for parents, especially those looking for ways to approach parenting in a way that respects not only their feelings and needs but their children’s feelings, needs and development.

While no two mothers’ experiences are the same, one of the main threads running through the stories in this book is that of individual mothers carefully considering their children and their families and making decisions about breastfeeding and parenting based on the family’s needs as a whole and the children’s needs in particular. There is compassion and respect here for children’s needs, even when they contrast with what society presents as the “right” way to do things, and there is balance as well.

API: Thank you, Janell, so much for you time and insights. Is there anything else you’d like to share?

JANELL: I just want to give a shout out to all the brave mamas out there who fly in the face of tradition, not to rebel but to parent in the best way they know how, those who are brave enough to question parenting practices that ignore the needs and developmental stages of children and do what feels right for their children and families.

(Photo credit: Allison Profeta)

Morning cuddles: a story of child-led weaning

Editor’s note: At some point in every breastfeeding relationship, the question of when and how to wean presents itself. Many parents breastfeed into the toddler years and beyond, choosing child-led weaning. Janell Robisch shares her weaning story below.

to three and beyond coverAttachment Parenting International (API) thanks Praeclarus Press for giving permission to reprint this except from To Three and Beyond: Stories of Breastfeeding Children and the Mothers Who Love Them, edited by Janell E. Robisch, published by Praeclarus Press, www.PraeclarusPress.com. Used with permission. Read more about the book through an upcoming API interview with Janell.

So, when I was feeling touched-out or just ready to quit nursing, I would test the waters, cut back a little or talk to [my son] A.J. about it, and see how he reacted. I felt that since I was the adult, I could be patient when I needed to. If his reaction was intense, I knew that he wasn’t ready, like the many short-lived occasions when I tried night weaning. If, however, he went on about his business without much reaction to what I was doing — or not doing — I knew that we could move forward.

The following excerpt from my personal journal, written in 2006, tells the rest of the story:

“When my son finally weaned in January 2006 at age 5 years 3 months, of course part of me wondered if I had done the right thing in nudging him along. I had been ready to end nursing for a while but was contented to let him continue to nurse until he was really ready to stop. To me, ‘ready to stop’ meant that he would not be traumatized by weaning and that, as a mother and child, we would be able to easily meet his needs in other ways.

About 4 months before he actually weaned, A.J. set a date for weaning. During the interval before that date, he continued to nurse in the same pattern, in the morning and before bed and sometimes in between. However, when the date actually came, he said that he was going to stop nursing for that day only. I smiled and waited a while longer to bring up the subject again. About a month later, he stopped nursing for six days but then went back to it.

It was the end of November when we talked about it again. He had just turned 5 in October. I suggested that it might be easier for him if he got used to the idea of weaning by slowing down a little at a time. He was amenable to the idea and set yet another date. This time, however, he did slow his nursing down right away; he suddenly went days without any nursies and showed no ill effects. In addition, prospects for a weaning party were suddenly more important than having milk.

The last day of nursies — January 1 — came and went, and we even took pictures of his last nurse. As things went, he came down with a stomach bug a few weeks later, and he did nurse one more time around January 18.

Now, as I write this, 5 months later in May 2006, I am confident that we did okay. He has not asked to nurse again since that day and has not shown any ill effects of weaning. We still have plenty of close cuddle time, especially every morning when he wakes up. If I am not nearby when he wakes, he seeks me out as he still likes to start his day with some close time with Mommy. Our bond is still there, still strong, even though our nursing relationship is over. I will be ever grateful for the bond that it created and am happy that we had that special time together.”

It has been 8 years since I wrote that journal entry. A.J. is now 13 years old and is still incredibly smart and exacting. He is not incredibly “touchy” with most people, but he always makes time for a hug for me when he first wakes up and before he goes to bed. Our relationship, like any mother-child relationship, is not perfect, but I feel that nursing — more than anything — laid down a foundation of love and connection for us that will last a lifetime.

Editor’s note: Thank you to the photographer, Allison Profeta, for the image of Janell E. Robisch included in this article.

WBW 2015: Breastmilk and baby’s gut health, the big picture

wbw2015-logo-mEditor’s note: Several scientific studies were published this year on the topic of breastmilk’s effect on the establishment of healthy gut flora. This World Breastfeeding Week, Attachment Parenting International (API) gives a special thank-you to API Editorial Review Board member Linda F. Palmer, DC, for this modified excerpt from her new book, Baby Poop: What Your Pediatrician May Not Tell YouPalmer2008, which gives an overview of how our choice to breastfeed or not — or to provide expressed breastmilk or donor breastmilk if breastfeeding is not an option — can affect our baby’s health not only through childhood but long into adulthood.

Born from an entirely protective environment where mother’s body tends to baby’s every immune and nutritional need, breastfeeding transitions the newborn safely into childhood. Nutrition is truly only a portion of breastfeeding’s role. Along with significant neurological and hormonal provisions, there are multitude immune-protective factors. A major, but seldom considered, portion of baby’s protection from illnesses, and the continued health of the child, comes from the early establishment of optimal gut flora.

Editor’s note: Watch this video from National Public Radio to learn more about what your gut has to do with your health.

In the Beginning

Beginning with the trip through the birth canal, every minute counts in the early effort to launch the healthiest-possible balance of gut microbes. The newborn digestive system is not ready at birth to handle much in the way of food, and the breasts know this. Immune protection is the first order of business and is greatly dependent upon the establishment of healthy flora. When uninhibited by antibiotics, formula supplements or delayed feedings, breastmilk can essentially seal the deal.

from linda 4It’s been shown that the health of the floral environment into which an infant is born can have positive or negative impact on the creation of his long-term microbiome. In turn, the child’s early risks for infectious diseases, and adult risks of non-infectious diseases, are highly dependent upon early gut health. Remember that some hospital germs are much tougher than community germs, and quite antibiotic resistant. Also, if mother has not been in the hospital herself for a few days, her immune system — and hence her breastmilk — will not contain antibodies to many of the threatening microbes floating around the hospital. Infants born into large hospitals are at greatest risk for colonization with unfriendly flora. Those born in a non-sterile home with healthy-gutted inhabitants — and with people or pets who go outside often — are shown to establish the healthiest array of florae.

Editor’s note: API does not take a stance on homebirth, but rather advocates that parents make an informed choice on childbirth decisions. Learn more through API’s First Principle of Parenting: Prepare for Pregnancy, Birth and Parenting.

from lindaIf only a magical concoction existed with which a newborn’s digestive membranes could be quickly coated immediately after birth and then, if repeatedly applied, it could possibly head off some less desirable environmental influences. Of course, there is one. A few drops of colostrum from mother’s breast is all it takes — the sooner, the better.

The newborn’s stomach acidity at birth is quite neutral, because it contains amniotic fluid. Acidity does not become higher for about a day, so either good flora provided in colostrum or bad flora from a hospital environment have an exceptionally high opportunity to establish themselves in the first many hours after birth.

The Broncho-Entero-Mammary Pathway

Interestingly, when birth occurs through a planned Cesarean section — meaning no labor has occurred — mother’s milk is found to contain less healthy flora to pass to her newborn. Apparently, labor is not only a signal for mother’s placenta to pump antibodies into the soon-to-be-born child, but also a signal for the conveyance of important flora to mother’s breasts to enhance her colostrum for added newborn protection.

In addition to antibody-producing cells making their way from mom’s lymph centers in her intestines and respiratory tissues to her breasts, flora also travel from these areas to mother’s milk. Clearly, mother’s own gut health will impact what flora are available. These immune system cells and healthy bacteria are found to travel — transported by dendritic cells — chiefly through the lymphatic system as well as through the bloodstream. These roadways — by which mother’s body provides such valuable factors to her milk — are referred to as the broncho-entero-mammary pathway.

Mother’s milk not only provides more than 700 different species of valuable bacteria and fungi to homestead in her infant’s gut, but also plenty of special fiber-like sugars — oligosaccharides — to perfectly feed the flora. Every breastmilk taste provides a nurturing boost to the child’s floral garden.

Microbes — good or bad — will generally enter a child’s system through the mouth, pass through the throat and enter the intestines; thus, the digestive system is a baby’s greatest vulnerability, by far, in terms of infections. Auspiciously, breastmilk travels this same course and has tremendous influence on the development, wellbeing and protective capacities of the digestive tract and its flora — and thus the child. Even microbes that enter through a child’s nose will meet with breastmilk-nurtured floral defenses in the throat. The floral balance, and thus the infection risks for the sinuses and ear canals, depend upon the mouth and throat flora, which are influenced by the gut flora and by the same factors that affect gut flora — mainly breastmilk. Even lung flora and function are strongly influenced by the gut microbiome. Via its passage through the baby, breastmilk powerfully protects against dental, sinus, ear, throat, lung, stomach and intestinal infections.

Lactoferrin, Iron and Infant Protection

from linda 2Lactoferrin is a breastmilk protein that binds with iron. Nutritional iron is provided by mother’s milk in this bound manner. The more challenging bacteria — found in the gut of formula or solid-food-fed infants — require free iron to survive and proliferate. Lactoferrin holds on to the iron in the exclusively breastfed intestine, making the iron unavailable to feed unwanted bacteria and providing safe haven for desirable lactobacilli, bifidobacteria and other friendly microbes to proliferate.

Once free iron is added to a breastfed child’s diet, it will saturate and overwhelm the lactoferrin, feeding the challenging bacteria and allowing them to flourish. Free iron exists in all formulas — even low-iron formulas — and pretty much in any solid food besides pure fats or refined sugars. It doesn’t take very much formula, juice or baby food to overtake the protective lactobacilli and bifidobacteria florae provided by exclusive breastmilk feeding and to allow for the growth of the more challenging types of bacteria, including enterococci, enterobacter, clostridia, streptococci and E. coli. In fact, baby’s flora has been shown to change within 24 hours after just one bottle of formula.

The picture, of course, isn’t quite as simple as this. Various proteins, such as isolated soy or cow milk proteins, are also known to interrupt the virgin flora of a previously exclusively breastfed gut. Once your infant’s stools begin to develop unpleasant odor and darken in color, you can tell that the floral transition from protective breastfed flora to more adult-like bacteria is taking place.

A final loss of the exceptionally protective flora that only exclusive breastmilk provides is inevitable with the eventual introduction of solid foods. The longer this event can be put off, however, the longer the child’s status of lower risk for infections can be maintained and the stronger his future protection becomes. Six or more months before introducing other foods is the recommended goal. Still, after this flora alteration occurs, breastfeeding continues to provide many, many nutritional, hormonal, neurological and immune protective advantages and continues to support the flora.

Final Thoughts

Many mothers have an ideal image of the way they want their baby’s beginnings to be. Often, things don’t go as intended. All is not lost. The good news is that recent studies are revealing that when all doesn’t go as planned, positive impacts can be made on baby’s flora and intestinal health with the use of probiotics and other healing measures, thereby reducing later risks of many chronic diseases.

Editor’s note: Citations and further information, including the impact of antibiotic use among infants, can be found in the book Baby Poop.

WBW 2015: Who is the woman in pink?

martha with viola from LLL and baby stephenWhen this photograph was taken, 26 years ago, there was no such thing as the Internet. Cameras were film only. There were no cell phones or laptops. If you wanted to make a phone call while on the road, you had to first find a pay phone booth. And if you wanted to make a phone call at home, you had to stretch the cord connecting you to the wall around the corner to get any privacy. Mainstream parenting advice wasn’t particularly warm, fueled by a widespread fear of spoiling children, but parents who wanted another perspective could get it through a print subscription of Mothering magazine.

And while more mothers were breastfeeding back then than a couple decades before, lactation consulting was still gaining a foothold in medical practice. The International Board of Lactation Consultant Examiners, which certifies lactation consultants, was still in its infancy, having been founded in 1985. Really, the only reliable source of breastfeeding education and support anywhere was La Leche League (LLL) with its expansive network of mother-to-mother support groups, many in small and rural communities.

This image was captured in 1989 at a LLL conference in Anaheim, California, USA. The young woman in this photograph — do you recognize her? (Keep reading to find out who this mystery mom is!) — was breastfeeding Stephen, the baby in the arms of Viola Lennon, one of LLL’s seven cofounders and coauthor of The Womanly Art of Breastfeeding.

The world said a sad goodbye to Viola in 2010 when she passed away at the age of 86. She was the mother of 10 children and had learned how to breastfeed from her own mother before attending the founding meeting for LLL in 1956. She went on to serve LLL in many ways, including Board chairman and Development Director. LLL quotes Viola saying:

“Breastfeeding…led me to self-discovery and to a greater appreciation of the full humanity of the babies who were entrusted to me. Each woman needs to trust her own instincts, her own feelings and her own sense of what will work for her with each baby. Women in the 1950s had forgotten the wisdom of previous generations in relation to breastfeeding. Mothers who tried to breastfeed on their own were almost always destined to fail. The neighbors sent their children to watch me breastfeed, because they knew the children would not see it anywhere else!”

LLL, from the beginning, nudged parents toward a gentler, more biological way of relating to their children. Breastfeeding itself is rooted in a secure parent-child attachment bond; breastfeeding cannot be successful in any other way. No doubt, the very beginnings of the Attachment Parenting movement are rooted in LLL. Very significantly,  Attachment Parenting International (API) credits LLL as part of our foundation. API’s cofounders Lysa Parker and Barbara Nicholson were LLL Leaders before they conceived the idea of API in 1994, most influenced by a speaker they heard at an LLL conference about the importance of secure attachment on child development: Dr. Elliott Barker of the Canadian Society for the Prevention of Cruelty to Children explained how every violent criminal he had encountered had a history of extreme separation and insecure attachment as a child. As LLL continued to focus primarily on breastfeeding as its mission, API was able to take up Attachment Parenting as its mission.

LLL influenced others apart from Lysa and Barbara to educate and support parents in Attachment Parenting, many who soon joined in encouraging API’s growth and development. Among them is pediatrician and API Advisory Board member Dr. William Sears and his wife, API Board of Directors member Martha Sears, a nurse and mother to their eight children. Bill and Martha Sears had first published The Baby Book — considered a parenting bible by families around the world — in 1992, and would go on to become two of the most recognized names in parenting.

MSears159Three years before, in 1989, a young Martha was sitting on a couch with Viola as they admired Stephen. I wonder if Martha had any idea at that point what her future would hold?

Thank you, Martha, for breastfeeding your babies…for becoming a LLL Leader…for coauthoring parenting books that questioned the status quo…and for going on to encourage mothers worldwide to reclaim the wisdom of previous generations in both breastfeeding and parenting in a sensitive, wbw2015-logo-mnurturing, gentle, attachment-minded way. You have made a difference in the world! And we recognize you this World Breastfeeding Week!

WBW 2015: The Big Latch On

wbw2015-logo-mWorld Breastfeeding Week is an exciting time for me every year. Not only do I greatly enjoy joining in the annual celebration through Attachment Parenting International‘s week-long observance on the APtly Said blog, but I also get to partake in fun, local events through my job as a WIC Breastfeeding Peer Counselor. Today, I kicked off World Breastfeeding Week by helping with a local Big Latch On event.

The Big Latch On originated in New Zealand, started by the Women’s Health Action as part of the 2005 World Breastfeeding Week. It is an organized opportunity to support breastfeeding families and promote breastfeeding by inviting breastfeeding women from the local community to come together and latch on their babies and toddlers at a set time. It’s similar to the Great Cloth Diaper Change, if you’ve ever been part of that.

PrintThe Big Latch On event I helped with was in Kearney, Nebraska, USA, and hosted by the Kearney Community Breastfeeding Initiative, Breastfeeding USA of Kearney, Community Action Partnership of Mid-Nebraska and Nebraska WIC Nutrition Program. Breastfeeding moms and their children began coming in to get signed up, settled in and comfortable at 10 a.m. Then, at 10:20 a.m., we announced that it was time to prepare to latch. At 10:30 a.m., every mom was supposed to latch and stay latched until at least 10:31 a.m. Accountability was provided by witnesses, like me, who assured the count was accurate. After 10:31 a.m., participants could leave whenever they wanted. We did have a drawing for breastfeeding T-shirts and a chance for moms to share why they chose breastfeeding, and most moms stayed to chat for an hour, as their babies finished breastfeeding. Then, the coordinator of the program tallied the number of attendees and number of moms who latched and submitted these statistics to the Global Big Latch On.

Big Latch On events have been going on July 31 and August 1 globally, and there is also a count through August 2 of selfies of moms with their babies and children latched on. So the total isn’t in yet, but as of 9 pm Central Time, there have been 13,000 latches. That’s a lot of moms and babies!

The count isn’t a Guinness Record Attempt, but rather a comparison to past years. The idea is beat last year’s record. Here are the records for the past five years:

  • 2010 – 2 countries – 147 local events – 2,045 latches
  • 2011 – 5 countries – 412 local events – 5,687 latches
  • 2012 – 22 countries – 626 local events – 8,862 latches
  • 2013 – 28 countries – 845 local events – 14,536 latches
  • 2014 – 31 countries – 826 local events – 13,798 latches

If you have participated in the Great Cloth Diaper Change, you know that this event is a Guinness Record Attempt. And Guinness World Records can certainly increase awareness, both during the attempt as well as in total numbers. So why is the Big Latch On different?

According to the organizers, the Big Latch On is designed to reflect reality in order to show how culture is changing. This means including communities where there aren’t large groups of breastfeeding women. To be a Guinness Record Attempt, each local event would have to have a minimum of 25 participants to be counted. Many of the Big Latch On events are in smaller communities where there aren’t 25 or more mother-child pairs to be had. At the Kearney event I helped with, we didn’t have 25 breastfeeding mothers. But the moms who came did — and should — count!

By the way, the Guinness World Record for simultaneous breastfeeding is 3,738 mothers at one location, and for multiple locations: 15,128 mothers across 295 sites. Both are held by the Philippines, and both are great awareness tools for breastfeeding. But this just isn’t the Big Latch On style.

Another not-so-obvious, but very good, reason why the Big Latch On is not a Guinness Record Attempt is that what the Big Latch On counts as a latch happens not only during the act of breastfeeding — of both singletons and multiples and tandem-nursings (each baby’s latch counts separately!) — but also active pumping by an exclusively pumping mom.

As I like to say when working with WIC clients, any amount of breastmilk is good. So moms don’t have to be exclusively breastfeeding to be included. One mom who attended the Big Latch On event at Kearney had 2-month-old twins, whom she breastfeeds but also gives pump-expressed milk and supplements with formula. Breastfeeding multiples is hard work, and kudos to her for sticking with it and continuing to work on boosting her milk supply.

Another mom is pump-dependent and actively working on latching her baby, but wasn’t successful at latching that day at 10:30 a.m. No problem, because breastfeeding mothers who are unable to latch are now recognized in their own count. It can be hard to hold off a feeding for a newborn baby who would otherwise be breastfeed on demand, whether at 10:30 a.m. or not.

161052_1659Probably the most impressionable conversation of the event was one I had with a grandmother who came to the Kearney event in support of breastfeeding. She was a breastfeeding mom 30 years ago and talked about how fortunate women today when there are so many opportunities for qualified support, whether from an International Board Certified Lactation Consultant (IBCLC) or another breastfeeding specialist, La Leche League or another local support group, or the Big Latch On or another awareness-raising activity.

This grandmother, who had been formula-fed only herself like so many others in her generation, decided to breastfeed her own children with literally no local breastfeeding support and of course the Internet didn’t exist back then. She remembered going to her doctor for a diagnosis of mastitis and even her doctor didn’t know what to say or how to help. All she could do was continue breastfeeding, despite severe pain, and hope it would get better. What a strong woman! She now has a daughter who is breastfeeding her third time and is an active breastfeeding advocate.

Thirty years can seem like eons ago, but at the same time, it really wasn’t that long ago when women who chose to breastfeed didn’t have any real options if they came upon a challenge, like poor latch, engorgement or low milk supply. Some communities had La Leche League groups, but the organization was still growing then. So many breastfeeding moms 30 years ago, especially in rural areas, who encountered a problem had only one option fully supported by the medical community and culture at the time: to wean to formula. And so many did.

For all the breastfeeding challenges we still have to face and overcome in our culture, we are very fortunate to be mothers at this time in history.

Ready for World Breastfeeding Week 2015?

wbw2015-logo-mAttachment Parenting International (API) is pleased to announce that we are taking part in World Breastfeeding Week, Aug. 1-7. Check daily for posts about how women are making breastfeeding work for them and supporting others in their motherhood journeys.

The 2015 theme of World Breastfeeding Week is “Breastfeeding and Work: Let’s Make It Work!” This annual observance is coordinated by the World Alliance for Breastfeeding Action (WABA), which has issued this statement:

This World Breastfeeding Week, WABA calls for concerted global action to support women to combine breastfeeding and work. Whether a woman is working in the formal, non-formal or home setting, it is necessary that she is empowered in claiming her and her baby’s right to breastfeed.

wbw2015-elementThe WBW 2015 theme on working women and breastfeeding revisits the 1993 World Breastfeeding Week campaign on the Mother-Friendly Workplace Initiative. Much has been achieved in 22 years of global action supporting women in combining breastfeeding and work, particularly the adoption of the revised International Labour Organization Convention 183 on Maternity Protection with much stronger maternity entitlements, and more country actions on improving national laws and practices. At the workplace level, we have also seen more actions taken to set up breastfeeding- or mother-friendly workplaces including awards for breastfeeding-friendly employers, as well as greater mass awareness on working women’s rights to breastfeed.

The Innocenti Declaration (1990) recognized that breastfeeding provides ideal nutrition for infants and contributes to their healthy growth and development. There is much that remains to be done despite 25 years of hard work, particularly on the fourth Innocenti target that calls on governments to ‘…enact imaginative legislation protecting the breastfeeding rights of working women and establish means for its enforcement.’

WABA calls for:

  1. Concerted global action to support women to combine breastfeeding and work, whether in the formal sector, non-formal sector, or at home
  2. Ratification and implementation of maternity protection laws and regulations by governments, in line with the ILO Maternity Protection Convention
  3. Inclusion of breastfeeding target indicators in the Sustainable Development Goals (SDGs)

wbw2015-objWith the World Breastfeeding Week 2015 campaign, WABA and its partners at global, regional and national levels aim to empower and support all women, working in both the formal and informal sectors, to adequately combine work with childrearing, particularly breastfeeding. We define work in its broadest form from paid employment, self-employment, seasonal and contract work to unpaid home and care work.

Various strategies exist to support women working in your country or community from long-term actions to short-term actions. Together, we can make it work!

This week, API’s celebration of World Breastfeeding Week will honor a collection of inspiring mothers who are dedicated to supporting mothers in breastfeeding no matter their lifestyle choices. A few of the upcoming posts to look forward to:

  • A tribute to Martha Sears, coauthor of many of the Sears parenting books
  • The role breastfeeding plays in baby’s gut health and what that means for overall health not only in childhood but adulthood
  • The role of historical trauma in breastfeeding rates among tribal women.

Check in tomorrow, Aug. 1, for our first installment of 2015 World Breastfeeding Week!