I wrote this in 2019. I am re-posting because it reflects this year’s World Breastfeeding Week focus of “Prioritize Breastfeeding: Create Sustainable Support Systems”.

A Soft Place to Land

Introduction

According to the Mirror, Mirror, 2024 report, the United States has the worst health outcomes of all resource rich nations studied. (Blumenthal et al., 2024) To close this health disparity gap will require many interventions, including increased access to healthcare coverage, better preventative care, and addressing social determinants of health. (Blumenthal et al., 2024) Within the U.S. there are additional health disparities, with racially/ethnically marginalized populations suffering even poorer health outcomes. (Blumenthal et al., 2024)

To reduce health outcome disparities, it is important to focus on early childhood health, especially birth to three years. One intervention that directly targets both preventative healthcare and social determinants of health, is providing human milk for infants. Human milk feeding is shown to protect against many negative health outcomes for infants and their parents, while supporting food justice and security. (Asiodu et al., 2021)

However, lack of paid family leave is a significant barrier to establishing lactation after childbirth, and the United States is the only high-income country without a national paid family leave policy. (Rosenberg et al., 2024; Rosin-Slater, 2018) Returning to work before 12 weeks, especially full-time work, is common in the U.S. and is associated with less intention to exclusively breast/chestfeed. (Beauregard, 2019)

Therefore, a national policy of paid family leave (PFL) is proposed to support more optimal and equitable human milk feeding and reduce health outcome disparities within the U.S., and in comparison, to other nations.

Research Overview

Human milk feeding has been shown to protect infants from diarrhea, iron deficiency anemia, respiratory infections, obesity, and to promote full intellectual potential. (Asiodu et al., 2021) Completing the lactational phase after gestation and birth, provides protection for the parent from postpartum hemorrhage, postpartum depression, breast, uterine, and ovarian cancers, metabolic disease, and cardiovascular disease. (Asiodu et al., 2021) The U.S. Surgeon General recommends exclusive breast/chestfeeding for the first 6 months and afterward for at least one year with complementary foods provided as the optimal human milk feeding goal. (General (US) et al., 2011)

Longer workplace leave after childbirth is associated with higher rates of breast/chestfeeding globally. (Steurer, 2017) However, only 56% of U.S. workers qualify for unpaid family leave and only 15% have access to paid family leave. States in the U.S. with paid family leave policies are shown to have higher rates of any breastfeeding, longer breastfeeding duration, and higher rates of exclusive breastfeeding, suggesting that nationwide paid family leave could improve breastfeeding rates in the U.S. for all families. (Rosenberg et al., 2024)

While breast/chestfeeding rates in the United States are improving, there are significant disparities, especially regarding Black and Indigenous populations. (Asiodu et al., 2021) Black infants in the United States who are at highest risk for poor health outcomes are also those who are least likely to receive human milk. (Chiang, 2021; Hill et al., 2024) Black infants and their birthing parents also experience inequities in peripartum care due to structural barriers related to systemic racism. (Asiodu et al., 2021)

Pregnancy and peripartum mortality rates for Indigenous and Black birthing parents in the U.S. are more than 3 times the rates for their White counterparts, 63.4 and 55.9 vs. 18.1 per 100,000, respectively. (Hill et al., 2024) These Black and Indigenous parents also are more likely to have inadequate prenatal care, while their infants suffer higher rates of low birth-weight, preterm birth, and perinatal mortality. (Hill et al., 2024) Black birthing parents are also at significant risk for postpartum hemorrhage and other negative birth and postpartum outcomes that can be ameliorated by breast/chestfeeding. (Asiodu et al., 2021)

Formula is more frequently offered to Black infants in hospitals than non-Black infants, further sabotaging optimal breast/chestfeeding. (Asiodu et al., 2021) Indigenous infants also receive less human milk due to racial inequities in breast/chestfeeding support. (Asiodu et al., 2021)

Black women, birthing people, and their families may have negative views about breast/chestfeeding due to abusive practices during chattel slavery and directed predatory marketing from the commercial milk formula industry. Grassroots organizations such as Reaching our Sisters Everywhere (ROSE) and Black Mammas Matter Alliance (BMMA) support Black parents and infants by normalizing breast/chestfeeding in their communities and advocating for representation and culturally competent care in the field of birth and lactation. (BMMA, n.d.; ROSE, 2018) Similarly, there are Indigenous led lactation support organizations such as Indigenous Milk Medicine Collective and projects such as Indigenous Breastfeeding, Birthworks, and First Foods, that support the traditional practice of breast/chestfeeding disrupted by colonization. (IMMC, 2025; Longmont et al., n.d.)

Even with support, there remain significant barriers to Black and Indigenous birthing parents establishing and fully experiencing an optimal course of breast/chestfeeding. This is due in part to racial/ethnic inequities for access to adequate leave from employment after childbirth. (Goodman et al., 2021) Returning to work is self-reported as a significant breast/chestfeeding barrier to Black parents who are more likely to return to work early and have unsupportive work environments than other ethnic groups. (Johnson et al., 2015) Indigenous families also have inequitable access to paid family leave, even in states with PFL policies. (University of Washington, 2023)

Challenges, Barriers, and Solutions

There are legislative barriers to enacting universal paid family leave policies. The commercial milk formula industry uses predatory marketing tactics to promote their replacement for human milk, and actively lobbies against paid family leave to protect revenues which amount to $55 billion annually, with a marketing budget of about $3 billion. (Lancet, 2023) This industry pressure on government has kept the United States from aligning with the World Health Assembly’s International Code of Marketing of Breast-milk Substitutes, which sets standards to prevent predatory marketing practices. (Lancet, 2023) Unfortunately, the United States is not among the 32 countries that have already enacted legislation supporting this code. (Lancet, 2023)

KConnect, an equity collective from Kent County Michigan, along with the Michigan League for Public Policy, has partnered with Mothering Justice to build a coalition for promoting paid family leave in Michigan. (Young & Vosovic, 2024) They are championing the Michigan Family Leave Optimal Coverage (MI-FLOC) bills which are currently in legislature and are supported by 71% of Michigan residents. (Young & Vosovic, 2024) Additionally, these bills are promoted by small business organizations as providing competitive advantage. These efforts provide an advocacy blueprint that can be used to build coalition around promotion of national paid family leave.

It is critical to educate legislators regarding the benefits to society and the economy of paid family leave. While there may be some initial opposition from employers to PFL, evidence shows that it supports career continuity, positively affects employee productivity and morale, and has minimal or no impact on employer costs. (Rosin-Slater, 2018) According to the People First Economy, the programs supported by the MI-Floc bills would cost nothing for businesses of fewer than 20 employees. (Young & Vosovic, 2024)

Discussion

Breast/chestfeeding is lifesaving and health protecting. Increasing optimal breast/chestfeeding supports both preventative health efforts and addresses social determinants of health by protecting the health of marginalized populations and supporting food security. Increasing optimal breast/chestfeeding rates would help to close the disparity gap between U.S. health outcomes and those of other resource rich nations, while also promoting health justice within the United States. Research supports that a national paid family leave policy would contribute to increased levels of optimal breast/chestfeeding in the United States and increase equitable access for marginalized communities to the lifesaving and health promoting benefits of human milk feeding.

While challenges remain to enacting a national PFL policy, there are trailblazers creating a base of support for policy implementation. It is important to build coalitions with existing community partners to amplify their efforts and bring more support and resources for paid family leave. This policy is good for birthing parents, infants, caretakers, and small business owners. Joining their efforts and promoting breast/chestfeeding justice as an additional advantage for paid family leave, strengthens the case for implementation nationwide. Each success builds a base for national enactment of policy that supports all U.S. citizens to have the necessary paid time off from employment to establish lactation after childbirth.

Conclusion

The United States is at a public health crossroads. With the highest spending on healthcare of all resource rich nations, alongside the poorest health outcomes, solutions must be pursued with urgency. (Blumenthal et al., 2024) Increasing optimal breast/chestfeeding is a proven health promoting policy. While paid family leave will not remove all barriers to optimal breast/chestfeeding, it will support grassroots lactation organizations’ efforts to improve the health of all infants and birthing people though increased and equitable access to this lifesaving, health promoting, human birthright.

Paid family leave policies work for nations, states, communities, and families. We must work alongside grassroots stakeholders to build the political will to implement national paid family leave in the United States

© Laura Spitzfaden, BSPH, IBCLC

References

Asiodu, I. V., Bugg, K., & Palmquist, A. E. L. (2021). Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future. Breastfeeding Medicine, 16(6), 447–451. https://doi.org/10.1089/bfm.2020.0314

Beauregard, J. L. (2019). Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015. MMWR. Morbidity and Mortality Weekly Report, 68. https://doi.org/10.15585/mmwr.mm6834a3

Blumenthal, D., Gumas, E. D., Shah, A., Gunja, M. Z., & Williams II, R. D. (2024). Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System — Comparing Health System Performance in 10 Nations. https://doi.org/10.26099/TA0G-ZP66

BMMA. (n.d.). Black Mamas Matter Alliance—Advancing Black Maternal Health, Rights & Justice. Black Mamas Matter Alliance. Retrieved April 10, 2025, from https://blackmamasmatter.org/

Chiang, K. V. (2021). Racial and Ethnic Disparities in Breastfeeding Initiation ─ United States, 2019. MMWR. Morbidity and Mortality Weekly Report, 70. https://doi.org/10.15585/mmwr.mm7021a1

General (US), O. of the S., Prevention (US), C. for D. C. and, & Health (US), O. on W. (2011). The Importance of Breastfeeding. In The Surgeon General’s Call to Action to Support Breastfeeding. Office of the Surgeon General (US). https://www.ncbi.nlm.nih.gov/books/NBK52687/

Goodman, J. M., Williams, C., & Dow, W. H. (2021). Racial/Ethnic Inequities in Paid Parental Leave Access. Health Equity, 5(1), 738–749. https://doi.org/10.1089/heq.2021.0001

Hill, L., Rao, A., Artiga, S., & Published, U. R. (2024, October 25). Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

Indigenous Milk Medicine Collective. (2025). Indigenous Milk Medicine Collective. https://www.indigenousmilkmedicinecollective.org

Johnson, A. M., Kirk, R., & Muzik, M. (2015). Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers’ Needs for Workplace Breastfeeding Support. Journal of Human Lactation : Official Journal of International Lactation Consultant Association, 31(3), 425–433. https://doi.org/10.1177/0890334415573001

Lancet, T. (2023). Unveiling the predatory tactics of the formula milk industry. The Lancet, 401(10375), 409. https://doi.org/10.1016/S0140-6736(23)00118-6

Longmont, N. H. F. N. D. I. 2432 M. S., Albuquerque, N. E., & Pasadena, S. 222. (n.d.). Indigenous Breastfeeding, Birth Work, and First Foods | First Nations Development Institute. Retrieved April 10, 2025, from https://www.firstnations.org/projects/indigenous-breastfeeding-birth-work-and-first-foods/

Roghair, R. (2024). Breastfeeding: Benefits to Infant and Mother. Nutrients, 16(19), 3251. https://doi.org/10.3390/nu16193251

ROSE. (2018, June 7). Home—Reaching Our Sisters Everywhere. https://breastfeedingrose.org/

Rosenberg, J., Nardella, D., & Shabanova, V. (2024). State paid family leave policies and breastfeeding duration: Cross-sectional analysis of 2021 national immunization survey-child. International Breastfeeding Journal, 19(1), 37. https://doi.org/10.1186/s13006-024-00646-9

Rosin-Slater, M. (2018, February). Easing the Burden: Why Paid Family Leave Policies are Gaining Steam | Stanford Institute for Economic Policy Research (SIEPR). https://siepr.stanford.edu/publications/policy-brief/easing-burden-why-paid-family-leave-policies-are-gaining-steam

Steurer, L. M. (2017). Maternity Leave Length and Workplace Policies’ Impact on the Sustainment of Breastfeeding: Global Perspectives. Public Health Nursing, 34(3), 286–294. https://doi.org/10.1111/phn.12321

University of Washington. (2023, May 18). Pilot project explores equitable access to state’s paid family leave policy for AIAN families. Population Health. https://www.washington.edu/populationhealth/2023/05/18/pilot-project-explores-equitable-access-to-states-paid-family-leave-policy-for-aian-families/

Young, S., & Vosovic, J. (2024, December 5). Partnering for paid family and medical leave in Michigan. MLPP. https://mlpp.org/partnering-for-paid-family-and-medical-leave-in-michigan/

I am a lactation consultant. I help parents to chest or breastfeed their babies. That is my passion, to feed the baby.

It has been estimated that exclusive and continued breastfeeding could save 823,000 children’s lives each year worldwide. (Lancet, 2016) My training informs me that during war, displacement, and famine, providing infants with human milk is even more important. Infants and young children are extremely vulnerable in emergencies; babies who do not receive human milk in emergency situations are more susceptible to infection, malnutrition, and death. (Bilgin & Karabayır, 2024)

Under the circumstances faced in Gaza, where there is limited access to clean water for safe formula preparation, and for cleaning of feeding supplies, human milk is critical for survival. International guidance for infant and young children feeding in emergencies promotes human milk feeding as a first choice for infants in emergency situations. (Bilgin & Karabayır, 2024)

I wondered how parents in Gaza were feeding their babies in the middle of a genocide. While being bombed by Israel. While being starved by Israel. I wondered where they were receiving support for breastfeeding or if they were on their own. I learned of an organization in Palestine called GINA, the Gaza Infant Nutrition Alliance. The nurses who work with GINA help new parents to nourish their babies through breastfeeding, despite a severe lack of resources. They are delivering food packages to lactating parents, and providing guidance and support for initiating and continuing breastfeeding in Nasser, Al Awdeh, Al Helou, and Al aqsa hospitals, and in the Mwasi Clinic. (GINA, n.d.)

Starving parents can produce milk but they do so at the expense of their own physical well-being. Their bodies prioritize lactation, removing nutritional reserves from blood and bone. The Gaza Infant Nutrition Alliance nurses and physicians have had to educate lactating parents that even though they are starving, their breastmilk is still good enough to feed their babies. One nurse from GINA named Shaheda, who is supporting new mothers and parents in the hospital, has had to them, “Please do not let your lack of food or water stop you from breastfeeding.” (GINA, 2025)

As their starvation progressed, GINA lactation consultants counseled parents that they would not be expecting to produce enough milk to support growth of their infants and only to sustain their survival. We are hearing from the GINA lactation consultants that some birthing parents do not want to breastfeed their babies because they fear that their infants will refuse to accept substitutes if they die.  At a time that should be joyous, new parents are preparing for their own deaths. This is horrifying.

The Gaza Nutrition Infant Alliance is fighting an uphill battle. The food packages they provide to lactating parents are becoming more difficult to prepare as food supplies become scarce. Hospitals have run out of commercial infant formula to feed fragile babies in neonatal intensive care. Infants in incubators are starving while food and formula sits in trucks only miles away.

According to a report developed by Defense for Children International – Palestine, in collaboration with Doctors Against Genocide, “Israeli authorities have deliberately weaponized starvation as a method of genocide, resulting in the preventable deaths and suffering of Palestinian children in Gaza, that will carry negative impacts for generations to come.” (DCIP, 2025)

Key Findings:

1. Famine has been present in the Gaza Strip since at least early 2024, when the first Palestinian children died of starvation due to Israel’s closure of north Gaza.
2. Starvation of children is a key mechanism in Israel’s campaign of genocide and has been from the beginning, targeting existing and future generations of Palestinian children and families.
3. Refusal by the international community to declare famine, acknowledge Israeli officials’ genocidal intent, and break Israel’s siege has paved the way for the starvation of more children.
4. Palestinian newborns, infants, and children with chronic illnesses are among the most vulnerable to the effects of malnutrition and dehydration.
5. Starvation occurring in Gaza now will negatively impact Palestinian children and families for generations to come. (DCIP, 2025)

Doctors Against Genocide explains in the report that there are long-term and often irreversible effects of starvation of children, including stunted growth, neurological damage, weakened immune systems, and permanent cognitive impairment. (DCIP, 2025) And of course, the potential for death. Along with these medical and developmental effects, there exist deep psychological consequences of unrelenting hunger. (DCIP, 2025)

The report brings attention to U.S. complicity in the replacement of international aid with private security contractors that are operating deadly “distribution hubs” in Gaza where hundreds of Palestinians have been shot or killed while attempting to access food. (DCIP, 2025) “The report’s legal analysis concludes that Israel’s starvation policies constitute war crimes, crimes against humanity, and acts of genocide” (DCIP, 2025).

We must do everything in our power to break the siege, allow food and medicine to reach starving Palestinians, and feed all of the babies. We must facilitate an arms embargo such that Israel can no longer continue the bombing, genocide, and ethnic cleansing of Palestinian babies, children, their parents, and all Palestinian people.

It is our obligation under international law. It is our obligation as human beings.

Free Palestine!

References:

Bilgin, D. D., & Karabayır, N. (2024). Infant and Young Child Feeding in Emergencies: A Narrative Review. Turkish Archives of Pediatrics, 59(2), 135–143. https://doi.org/10.5152/TurkArchPediatr.2024.23184

DCIP. (2025, June 24). “Starving a Generation” report indicts Israel for weaponizing starvation as a tool of genocide. Defense for Children International Palestine. https://www.dci palestine.org/starving_a_generation_report_indicts_israel_for_weaponizing_starvation_as_a_tool_of_genocide

GINA. (n.d.). Gaza Infant Nutrition Alliance. Gaza Infant Nutrition Alliance. Retrieved July 3, 2025, from https://www.gina.org.uk

I am adding links to references for this essay. I am not finished but will continue to add links as I am able.

I am trying so hard to write with love and understanding but I am demoralized and enraged. As a white, non-religious, queer, autistic lactation consultant who lives on Turtle Island, I have been witnessing the genocide perpetrated by the Israeli government with the support of the U.S. government on the people of Palestine, with horror over my own complicity and culpability. I am appalled that many of you believe in Israel’s right to exist and defend itself when it is actively and openly perpetrating a genocide. How does any state have a “right to exist”? Only people have the right to exist. Why don’t Palestinians have the right to exist and defend themselves?

Jewish people have the unalienable right to exist. But the lie that Jewish people require a Jewish state for safety harms Jewish people and makes them less safe. It is incontestable that Jewish people have experienced historical atrocities and current ongoing antisemitism. But calling out the Israeli genocide of Palestinian people is not antisemitism. Some of my Jewish colleagues are attempting to shut down discourse of Israeli genocidal actions with accusations of blood libel. I had to look up this term. I am disgusted that blood libel has been used against Jewish people to promote antisemitism. I am so sorry. But your attestations in this instance are careless and lazy and wrong.

Calling out the Israeli government for their genocide of the Palestinian people is not blood libel. The Israeli military does intentionally kill babies and children and adults, not for their blood, but to erase Palestinians. The Israeli government, themselves, claim that no Palestinian is innocent, and that even the children must be exterminated. They blame Hamas, whom the Israeli government funded and established as the only resistance force in Palestine. Every accusation made by the Israeli government against Hamas is a confession of their own brutal actions. Even Israeli soldiers confirm Israeli military atrocities. Should the Palestinians agree to lie down and die or do they have a right to resist murder and forced displacement?

I am trying to understand how some Jewish people I admire for their kindness and lactation expertise can support such atrocities and joyously celebrate the terrorism of Israel and their benefactors in the U.S. I have come to believe you are biased by your own trauma. My understanding is that many Jewish people receive education in childhood that their very survival requires an Israeli State. You did not deserve this. Your trauma is being exploited by a colonizing force.

I have read one pro-Palestinian Jewish individual’s account of summer camps where Jewish children are exposed to activities where they must endure camp counselors assaulting and terrorizing them on their “journey” to find their way to Israel (a location at the camp) to be safe. Along the way they are yelled at, forced to perform physical feats of strength, and frightened until they make it to “safety.” This indoctrination of a lack of safety is a common experience in Jewish childhood education. Real Jewish trauma is weaponized to make Jewish children feel unsafe. Traumatized Jewish children grow into adults who may be oblivious to Israeli atrocity. But adults are responsible for recognizing their own trauma and not perpetuating it on others.

Israel does not = Judaism. Operationally, Israel is an illegal, racist, colonial project. Judaism is a religion. Jewish, Muslim, and Christian people lived together in peace in Palestine for generations until the Nakba in 1948 when the Israeli government claimed this land and forced Palestinians to leave. Yes, there are accounts of atrocities against and displacement of Jewish people in the 1500s. This does not give modern day European Jewish people the right to steal land from Indigenous Palestinians whose families lived on their land for centuries. You cannot point to land theft in the 14^th century to justify land theft, forced displacement, and murder in the 20^th and 21st centuries.

The Nakba forced Palestinians from their land owned by generations, killed 15,000, and displaced approximately 750,000 Palestinians. Palestinians in the diaspora still have keys to their own homes that are occupied by Israeli settlers. There are currently living displaced Palestinians from the Nakba. Israeli settlers are still stealing land from Palestinians, right now, today during a genocide. Imagine waking up and finding that an official has “given ownership” of your land to a colonizer and you are forced by authorities to leave your ancestral home. This happens daily in Palestine. If you are Indigenous to Turtle Island, you don’t even have to imagine, as this is also your history.

Palestinians have been living under apartheid since the Nakba in 1948. They do not have the same rights as Jewish citizens. Many Palestinian birthing people give birth at checkpoints in apartheid Israel because they are prevented from timely travel to hospitals by Israeli government officials. They are not allowed to travel freely through their own country. This is femicide and infanticide as well as apartheid. This was occurring decades before October 7.

Palestinian lactating parents and their infants are starving due to lack of nutrition. Starving parents are unable to fully sustain breast/chestfeeding. Commercial milk formula is unavailable in hospitals or homes to feed the babies who have no access to human milk. This is not a natural disaster. It is a deliberate and diabolical withholding of food from Palestinian people. This is happening while aid trucks, which are blocked by Israeli military, have food ready for delivery just a few miles away. Food that could sustain birthing parents so that they can provide human milk for their babies. Commercial milk formula for those infants in NICUs who do not have access to human milk.

Babies are starving to death while people debate the value of their lives. As supporters of birthing and lactating people, we are obligated to denounce this. Our counterparts in Gaza are crying out to us to help them access food to feed birthing parents so they can feed their babies. My colleagues, where is your moral outrage? How are you not standing up for Palestinians every single day? In every way you can? Some of you speak up for queer people and Black people and Brown people and immigrants and Indigenous people of Turtle Island but most fall silent for Palestinians. You wrap yourselves in your ostentatious progressive righteousness as long as it is socially and fiscally acceptable. You know this is wrong, but you place your own livelihood above your morality. Gross. Shame! Speak up. Your silence is complicity. Every voice can make a difference. It is almost too late.

The Israeli government has destroyed hospitals, homes, and schools, has intentionally targeted journalists and health care workers, has deliberately killed innocent civilians, has taken Palestinians hostage for decades, and has kept aid from reaching starving Palestinians. There is no justification for this. This is ethnic cleansing. This is genocide. This is evil. There are no words to fully describe this horror. Please colleagues, reevaluate your rhetoric or your silence and wake up to the actual circumstances. Find your moral courage. Let us all work together to feed all of the babies. Now.

Free Palestine, love the Jewish people, fuck colonialism, fuck Israeli government apartheid and genocide, and as always, Free Palestine.

Laura Spitzfaden, BSPH, IBCLC

Feed the Baby LLC

Today is IBCLC Day. As an International Board Certified Lactation Consultant, this has a lot of meaning for me. I am remembering all the families I have supported and feeling warm and fuzzy and proud. I scroll through Facebook and see fellow IBCLCs posting positive messages about our profession. I love my job! I love breastfeeding! Human milk is so much more than nutrition. I want all the babies to have it. I am reflecting on ways I can improve my care of families and parents who want to provide human milk for their infants and….wait!

On my Facebook news feed, I saw that a friend has shared a new message (just in time for IBCLC Day) from an organization that works to directly undermine breastfeeding. My first reaction was to feel angry and frustrated. Why can’t my friends see that this organization is wrong and I am right? I wanted to rush in and share all the reasons why they should not provide a signal boost for this organization.

And then I decided to sit with it and step back a little. The real questions are: Why does this organization own the message that exclusive breastfeeding does not always work? What are breastfeeding supporters doing to push parents into the arms of this organization? FIB is providing a soft space to land for those parents who did not receive adequate breastfeeding support. How can we do better?

We need to understand that parents already know that breastfeeding is important for their health and the health of their infants. “Of the approximately 4 million babies born in 2015, most (83.2 percent) started out breastfeeding – but many stop earlier than recommended…”- CDC Releases 2018 Breastfeeding Report Card If 83.2% of US parents are initiating breastfeeding, the message that breastfeeding is critical for infant and parent health is getting through loud and clear. However, without adequate support, this message also serves to create stress and anxiety in parents who do not reach their own breastfeeding goals.

Exclusive breastfeeding for the first 6 months of an infant’s life is a very important universal health goal. In trying to promote this message in a society that does not support parents, we are placing parents between a rock and a hard place. No wonder they are running from our message. Parents who find themselves unable to exclusively breastfeed or to breastfeed at all, feel as if they are failing. But parents do not fail at breastfeeding. We are failing parents.

New parents are sent home from U.S. hospitals with no idea how to tell if their infant is breastfeeding well and no idea of when or how to appropriately supplement their infant if needed. “Fed is Best” steps in to fill this vacuum but they are not a friend to parents. They are a predatory organization that is exploiting parent and health care provider’s fears in order to undermine policies that support exclusive breastfeeding. They have shown by their lack of cooperation with recognized health organizations that they do not care about infant well-being.

In order to get the most human milk into the most human babies, the focus must shift from promotion to support. While breastfeeding is “natural” it isn’t usually easy. Most parents struggle somewhat in initiating breastfeeding. Some struggle more than others. Some experience severe pain and physical and emotional trauma. Some do not make enough milk to completely sustain their infants and we need to acknowledge that without undermining each parent’s potential to exclusively breastfeed.

Lactation is a robust system but it can be compromised. Just like any other organ in the body, the breasts can fail to work optimally for so many different reasons, including reasons outside the control of the parent. Most of the time, with excellent support, a parent can exclusively breastfeed if they choose to do so, but many of them do not get this support. If they are fortunate enough to initiate exclusive breastfeeding, most will still struggle to continue to provide breastmilk to their infants if they must return to employment outside their homes.

The United States fails parents and children with a lack of universal health care and with profoundly, criminally, inadequate parental leave policies. Parents need high quality, timely breastfeeding support that they can afford in order to reach their own breastfeeding goals. They need universal health care that pays for this high quality breastfeeding support. They need paid leave in order to spend uninterrupted time with their newborns and young children in order to establish and maintain breastfeeding for as long as they choose.

We need to provide more families with the services of the highly trained IBCLC. All the IBCLCs I know want infants to be fed. Feeding an infant is a minimum goal, not a thing that is “best.” IBCLCs do not encourage parents to risk their infants’ health in pursuit of exclusive breastfeeding. They have the expertise to help parents determine if their infants are receiving enough nutrition through breastfeeding and how to appropriately supplement if needed. They help parents meet their own goals whether it be to exclusively breastfeed, bottle-feed expressed breastmilk, inclusively breastfeed, combination feed, or wean.

In order to fully support breastfeeding, we need to support families. We do not need to tell parents that they should breastfeed; we need to remove obstacles so they can breastfeed. This is the work of the IBCLC. We can be their soft place to land.

#happyIBCLCday #fedisnormal #paidparentalleave #medicareforall

Many people who pump breastmilk do not own a hand pump and rely on electricity for milk expression. If you are an exclusive pumper or just pump when you are separated from your baby, you know how important your breast pump is for your well-being and that of your baby. If your pump has ever malfunctioned, you have forgotten important parts, or if you have lost power, you may have experienced the inability to express milk when you needed to. There are alternatives to using an electric pump that may be helpful in these circumstances.

Hand Expression:

Learning to hand express is a valuable skill. Your hands are always available, so you can express milk even if you have no other equipment. The following video is one of my favorites for demonstrating hand expression. https://vimeo.com/65196007

Warm Jar Method:

Have you heard of the new silicon manual hand pumps? These use consistent rather than intermittent vacuum to remove milk from the breast. They work well for many who are lactating but if you do not own one, the warm jar method can also work. This method has been used for generations to express milk. First pour very warm water to fill a wide mouth canning jar. Pour slowly to avoid cracking the jar. Pour out the water and cool the rim so that the breast will not be burned. Center the jar over the nipple and hold it there. As the jar cools, a vacuum will form and milk will be drawn from the breast. Once the milk is flowing, you may try combining this method with hand expression.

Using Pump Supplies to Make a Hand Pump:

If you gave birth in the hospital, you may have been sent home with various pumping supplies that you didn’t use. Some of these supplies are used for hospital rental pumps and are not needed for personal use pumps. These supplies can also be used to make a hand pump! The following video shows how.

https://www.youtube.com/watch?v=u-vyb8Y5uBI

I am a big fan of therapeutic breast massage as taught by Maya Bolman, and shared on the website for Breastfeeding Medicine of Northeast Ohio, so I was very excited to discover that the website has a new video on latching. It shows how important it is to help your baby achieve chin contact before latching in order to stimulate a wide deep latch.

Video from Breastfeeding Medicine of Northeast Ohio

https://vimeo.com/204112635

Babies and breasts come in different shapes and sizes. This may be a very obvious statement but it bears consideration when we bring babies and breasts together. Suzanne Colson, Nancy Mohrbacher, and Christina Smillie teach us to lie back to achieve good positioning. This often works very well but not for everyone. If a parent lies back and the nipple points downward, the baby cannot get in a position where the chin contacts the breast under the nipple.

In the past, breastfeeding helpers taught the tickle (the lips with the nipple) wait for a wide open mouth, and RAM (rapid arm movement) method. Some providers suggest aiming the nipple toward the palate or brushing the upper lip with the breast and waiting for a wide open mouth. But what comes next? Often the baby’s head is pushed onto the breast and the baby can’t breathe and becomes frustrated. Or the baby is brought to the breast but closes their mouth on the way causing a shallow latch. Why is it so hard?

Again, breasts and babies come in different shapes. Some babies have very receding chins. Some breasts are very round and some are flatter or softer or smaller or larger or…

The best positioning for a particular parent and baby is to be sure that the baby’s chin contacts the breast before latching. Chin contact below the nipple allows a baby to achieve a deeper latch. There are many techniques that can help achieve this positioning (try Googling “laid-back breastfeeding” or “flipple” or “deep latch technique”) but the technique needs to match the shape of the baby and the breast so they come together in harmony.

I absolutely love the following photo for showing how to position your baby.

http://www.cwgenna.com/quickhelp.html (click on “Latching Your Baby 101”)

Whatever your shape or your baby’s shape, if you can achieve chin contact before latching, you may have a more comfortable latch. If not, you might just need more help from an International Board Certified Lactation Consultant.

Parents who are struggling with breastfeeding need high-quality, timely support in order to ensure they meet their breastfeeding goals. Because optimal breastfeeding is critical for the health of Baby and Parent, it is important that they receive the best help available.

There are many knowledgeable volunteer breastfeeding supporters that can help parents to breastfeed. Often this peer-to-peer help is all that is needed to resolve a breastfeeding difficulty. For more complicated problems such as low milk-supply, painful breastfeeding, babies who have difficulty latching, and slow weight-gain, it is important to get timely professional help in order to get back on track quickly.

I frequently see parents who have tried many other professional breastfeeding helpers and did not receive the help they needed. Time, energy, and resources may have been wasted. Delays in following the best interventions often result in parents not meeting their breastfeeding goals and babies missing out on optimal breastfeeding. High quality professional breastfeeding support may seem expensive but it saves time, effort, and financial resources in the the long run. Additionally, lactation help from an IBCLC is usually reimbursable by insurance.

Parents are often confused about the many different kinds of professional breastfeeding support providers available in the community. It is critical that parents have access to information regarding these differences so that they can make informed decisions about whom to hire for help. The following links explain the different types of breastfeeding supporters and the training required for each. Be aware that the term “Lactation Consultant” can be used by anyone, no matter what training or experience they have with breastfeeding.

http://uslca.org/wp-content/uploads/2015/05/Whos-Who-Short1.pdf

http://massbreastfeeding.org/wp-content/uploads/2013/06/Landscape-of-Breastfeeding-Support-03-31-14.pdf

The following article explains why I chose to become an International Board Certified Lactation Consultant.

http://feedthebabyllc.comwhy-i-became-an-international-board-certified-lactation-consultant/

This site  is dedicated to helping parents find answers to their breastfeeding concerns and to provide a platform for posts regarding current breastfeeding topics. It has recently been optimized to be smartphone friendly. Breastfeeding information is easily accessible by clicking on the Menu link or Search box located at the top of the site.

None of the information on this site is intended to replace medical advice. Please consult your health care provider for medical advice. If you are not able to solve your breastfeeding difficulties, please contact a Board Certified Lactation Consultant (IBCLC) or breastfeeding peer helper for more assistance.

Find a Lactation Consultant

Find a La Leche League Leader

Other Breastfeeding Support

The contents of this site are the property of Laura Spitzfaden. Please do not reproduce anything without permission. You are welcome to link to my site if you wish to share any of the material you find here.

Contact me: laura@feedthebabyllc.com

In honor of IBCLC Day 2014, I am linking to the article I wrote last year on IBCLC Day.

http://feedthebabyllc.comwhy-i-became-an-international-board-certified-lactation-consultant/