Guidance for Breastfeeding in an Unsupportive Culture
About the Interview
In this interview, Lisa Reagan, Kindred’s editor, talks with Kathleen Kendall-Tackett about the responses to the Kindred’s video series featuring the latest science and research supporting the healing powers of breastfeeding. Kendall-Tackett says that the science is there in spades, but the cultural support for breastfeeding is not. Despite the lack of basic social support, like family leave, and institutional support, like hospitals who are baby-friendly, Kendall-Tackett says from her vantage point things are improving. She shares her insights in the audio interview above and encourages parents to make the right choice for their family, skip the guilt, but don’t be afraid to talk about the truth of breastfeeding science.
Watch the video series here. Enjoy the free audio interview download above.
Watch the entire series, The Healing Power of Breastfeeding:
Breastfeeding Reduces Child Abuse/Neglect VIDEO
Answering the Critics: Breastmilk Separate of Breastfeeding Does Not Produce the Same Results VIDEO and Article
Why Sleep Training Is Bad for Moms and Babies: Breastfeeding Moms Get More and Better Sleep VIDEO and Article
New Research Shows Breastfeeding’s Healing Impact on Sexual Assault Trauma VIDEO and Article
The Psychoneuroimmunology of Breastfeeding: Evidence That Nature Knew “We Did Not Lead Perfect Lives”
Lisa: I am amazed at what we have done for the last month here at Kindred with your video series and articles. I have to tell everyone that we filmed those interviews out of a 37 minute run through in February at the LATCH conference in Virginia as a winter storm was bearing down on us and everyone was fleeing the hotel. So the video series was a little miracle and I am so grateful to you for being game to do them.
Kathy: You are welcome.
Lisa: Not everyone has heard this side of breastfeeding, how it benefits the mother. And a part of the reason for that is our culture wants to believe that breastfeeding is about the product of breastmilk that is nutritional for the child. A holistic culture, or worldview, recognizes breastfeeding as a process. When we bring out your insights and research in these videos, about how breastfeeding is protective and supportive of the mother’s health, the wholeness of breastfeeding’s power becomes more evident.
Just to recap, we covered in the videos, how breastfeeding protects maternal mental health, can aid sexual assault recover, decreases child neglect/abuse, improves sleep and can heal birth trauma. So help us to understand what is the common variable in all of these amazing healing capacities of breastfeeding.
Kathy: What you really have to look at is the physiology of breastfeeding. You’re right in that people want to look at breastfeeding as breastmilk, but this misses that crucial piece of mother and baby together and what happens especially coming into post partum. In the last trimester of pregnancy, a lot of women in our culture are vulnerable to depression, especially when you start adding things that women are susceptible to in our culture: a lot of stress, lack of support, trauma history, history of affective disorders, and all of these kinds of issues. From the physiological point of view, from the field of psychoneuroimmunology, you can actually see the ramping up of the stress system and particularly one aspect of it which is the inflammatory response system. When that is active, when that is high, the risk of depression increases.
Normally when the inflammatory system is ramped up it is not a problem, but when you add all of the extra stuff to it that it pushes it into the depression range. That’a adaptive because what that is supposed to be doing it getting ready to fight infection and heal wounds, but what we need to think about is, would Nature leave women vulnerable to depression without a way to ramp that response back down so that they are not so vulnerable? And that is where breastfeeding can come in.
Breastfeeding can turn that system off. When you understand that piece, then all of sudden all of the findings about how mothers have lower rates of depression makes sense. Now, this doesn’t mean that breastfeeding mothers can’t get depression, what it is doing is reducing the risk. When you down regulate the stress response system, you are up-regulating the oxytocin response system. And this is keeping the mother and baby together as a system.
Now, we have a lot of moms in situations where breastfeeding is extraordinarily difficult. I think that is a system failure, that is not anything that the mom is doing wrong. When you start hearing about moms toughing it out, especially on social media, mothers talking about how much it hurt or the baby is on all the time or the baby isn’t gaining weight – those are problems. They are all problems, but they are solvable problems. But the fact that we leave our moms alone to tough those things out is just ridiculous. And in that situation, the mother certainly can get depressed. But when it is going well, physiologically it makes a huge difference.
This is what was so exciting with our sexual trauma data, is to see that very clear difference that happens when that mom was exclusively breastfeeding. She looked better to me on every single measure we looked at, and that to me is really exciting because it is kind of what you would hope to find, but to get the findings we got as clearly as we did was amazing. We had a very large sample of mothers – 6,410 moms and almost 1,000 moms had been sexually assaulted. So we had a really good number to work with and they were really very striking findings.
The Inflammation, Stress and Depression Trap
Lisa: I’d like to talk further about inflammation and exactly what that is. We hear a lot about inflammation and its relationship to chronic disease these days.
Kathy: Inflammation is a response to the immune system and what we’re finding is that inflammation underlies a lot of disease processes through the chronic turning on of that inflammatory response system. It is related to cardio-vascular diseases, metabolic syndrome and diabetes, all of these diseases, we are finding, have inflammation as the underlying factor.
In the field of psychoneuroimmunology, the PNI researchers are looking at where does the mental health piece fit into that? With depression it is a two-way relationship. Depression can cause that inflammation and inflammation can cause depression. So they reinforce each other. So when you think about something like depression, or someone under chronic stress, or with an anxiety disorder, all of these things are related to that ramped up inflammation system. So what the PNI researchers are trying to get out there is that depression can cause that inflammatory response, so can chronic stress, and that actually leads to disease.
This explains the relationship that we have observed for a long time, which is that depression can cause heart disease; it is a risk factor for heart disease. We didn’t understand why until PNI came along and said, it is because depression ramps up that inflammation system which gets in there and damages the vasculator and causes clotting, and can lead to cardio-vascular incidents.
It is also related to insulin resistance, and this is when you start to see the relationship between metabolic syndrome and depression and how they reinforce each other. I have a webinar that I am presenting called, Trauma Makes You Fat, that talks about some of the undiscussed issues in obesity. We think obesity creates the disease, but it is usually the underlying process that causes obesity, which also causes disease. So it is not this simple thing like exercise more and eat less, but dealing with the depression, trauma and sleep problems that often go along with those and how they all fit together.
Skip the Guilt, Keep the Science, Do Your Best
Lisa: What we’re recognizing here is that parents who are trying to follow the ideals of wellness, like breastfeeding, in an outer world that does not offer support, also need to be aware of their inner world processes. Until we have intentionally created a holistic orientation in ourselves, it is a seems like, sometimes, it could be cruel to set these great expectations for parents who have no family leave, no social support, no recognition of the stress these exterior variables have on our efforts. How different would we feel and act if we realized what we are asking of ourselves and others? I think this is the real challenge of “conscious” parenting.
Our feedback to the video series certainly DID reflect some of the anger and sadness some mothers feel over their efforts to breastfeed. I feel compassion for these parents who are struggling, and was really grateful for your responses to some of them. For example, one mother say, “Are you saying I just pumped for a year and wasted my time?”
Another mother refused to believe that exclusive breastfeeding contributed significantly to a reduction in child neglect and abuse and called the claim, “Bullock!”
It seems like these responses go back to our cultural misunderstanding of breastfeeding as a product and the benefits of breastfeeding as a process.
Can you address those mothers again? Both their anger and their disbelief?
Kathy: First of all, it was in no way my intent to in anyway diminish the work of the moms who are exclusively pumping. I have to had it to them for doing it. It is really tough to do. I have worked with mothers who were pumping and it is really hard to do. Sometimes mothers have to do this for a variety of reasons. It is absolutely not a waste. They did the absolute best thing that they could for their baby and I salute them for doing it. It’s about triple the work of breastfeeding, so in no way am I diminishing that.
What I am saying is that they may not have gotten all of the health benefits if their baby was not at the breast. You are still getting some, you have to because by pumping you are up-regulating that oxytocin. The babies were definitely getting the benefits and it is so much better than the alternative of not providing milk at all, but they didn’t necessarily get the full benefits. Part of that reason is because they have added the stress of pumping. So, the definitely go some of the health benefits, and it is never a waste. I salute mothers who pump because I know the tremendous amount of work and dedication it takes.
As far as the mother who thought the study showing breastfeeding decreases child neglect and abuse significantly was “bullocks” that is not true. That study appeared in Pediatrics in 2009 and was a huge study and very well done. He has 5,700 mother-infant pairs that they followed for 15 years. What they found is that breastfeeding did make a difference in rates of abuse. They had 512 cases of maternal perpetrated child maltreatment and what they found was double the risk of physical abuse for mothers who did not breastfeed and four times the risk of child neglect for mothers who did not breastfeed. They also found the longer you breastfed the lower the effect. The difference between the two groups of babies who had never breastfed and babies who were is where you saw the greatest effect.
In our own study of the sexual assault survivors, the one that that was really impacted, especially for exclusive breastfeeding mothers, was anger and irritability. There was a big spike in that for moms who had a history of sexual assault and were not exclusively breastfeeding. As I said, this is really consistent in the literature, it wasn’t just something we found.
Breastfeeding provides that stress reduction; mothers are reporting better sleep, they have more energy during the day, they have better physical health. This is not to say that they are not tired, but are they tired or are they more tired? It seems to be protecting mothers from more tired. All of us listening to this know when you don’t get enough sleep you get more irritable and snappish. So it’s not a stretch to see that in certain situations, maybe where there is not a lot of support or a history of trauma, become a situation where there is maternal perpetrated abuse. So, like I said, I believe that study, it was very well done, and I believe the findings.
“We Don’t Even Know What Support Looks Like”
Lisa: In one of the film series videos you talk about the lack of support in our culture and you say, we don’t even know what support looks like. And then it was our experience that some of the reactions to the film series and this fairly new information about breastfeeding was met with resentment, like, just don’t give me one more reason to feel guilty or bad that I didn’t make this choice or couldn’t make this choice. How can we help parents to understand the context of the trap they are caught in right now and not take the science, which is great news, personally or negatively?
Kathy: Well, I am going to add my voice to a lot of other parenting experts and weigh in on this. We are getting a lot of information from fields like neuroscience and lifetime health effects of childhood adversities, and what we are seeing is that our culture is doing an extremely poor job of supporting moms. What does that mean for an individual parent? It is definitely not my intention to try to pile any guilt as we are all doing the best we can do.
But I feel we have to talk honestly about what the science is showing. Individual families may decide to make different choices based upon the science. The good news is, kids don’t need perfect parents. That is good news because none of us are perfect. We all look back and think about how we would have done things differently as a parent. I know I do.
On the other hand, there is this movement and I think we are seeing it come from some unexpected places. I’ve seen more and more psychologists and particularly neuropsychologists getting on board with the idea that we need more responsive parenting. It can be that there are other caretakers, but the baby or child needs to be attached to them. Again, I am seeing this acknowledgement come from places that didn’t used to talk about this and they are not warm, touchy-feely people. They are not baby-wearers and co-sleepers. But we are seeing more neuroscientists saying that responsive parenting is important. But we find ourselves in a culture where we expect moms to be back at work at six weeks. Parents will need to do what they need to do, but the science is very clear on things like breastfeeding and responsive parenting.
So, while it is not my goal to make people feel guilty, on the other hand, don’t you want to know the truth? As I said, we are seeing the science coming from different quarters now. Like I said, these are choices that each individual family must make. It is not up to me and it is not up to Lisa to decide what makes a good parent. That is up to the parent to decide. But I think if we had a culture that supported families, some of these other decisions would naturally flow out of that.
Lisa: Didn’t mean to put you on the defensive by the way! I am like you, I am so fascinated by the innate intelligence of our bodies, and like you, I try to trot it out there into a system that does not support wellness choices much less allow for public policy to be written around the science and research insights.
Kathy: We do need to be faithful in reporting what the science is saying.
Lisa: If listeners are interested in supporting family leave policy in the US, the Moms Rising group is doing this. I have to say, that one of the reasons I do this work is because I see parents, myself included, living and reacting in a bubble, unaware that the US is at the bottom of child and mother wellness indexes and is the only developed country not supporting mothers and families for a paid leave act.
What are the cultural differences that we don’t see, that we are missing out on?
Kathy: There are a number of them. There are cultures all over the world where mothers don’t even get depression or the baby blues. There is a book about this that was written years ago that showed that the post-partum period is unique. We don’t do that in our culture. We expect mothers to step right back into their lives. This can really wallop some mothers. That expectation is absurd in other cultures. There is time set aside where moms are not expected to be a part of normal life.
In other cultures you would have people come into the home to take care of children, for example.
Another way cultures support mothers is the social recognition of her new status. Again, not something we do at all. There is no ritual or mechanism that shows what she went through. I have this story that I read when I present on this issue and it is a story about a certain tribe in Uganda that talks about how the mother emerges from her hut after about three months and as she is walking toward her village they sing songs to her like songs sung to warriors returning from battle. Yeah, it’s amazing.
We have a book that we published called The Gentle Art of Newborn Family Care, and it is written by this doula who talks about the level of care that she provides for families, which is so different from what most mothers experience. She gets stopped on the street and gets cards for Mothers Day fifteen years later because people remember what it was like to have that level of care. Really basic things, like she would pop in and say, have you had lunch yet? Why don’t you take a shower, and then she would change the bed sheets for them.
That kind of mentality is so lacking, but most of the times moms don’t think they should ask. They don’t know what to ask for. We’re trying to get some educational materials so we can help moms start advocating for themselves.
“Why I Believe Cultural Support for Breastfeeding is Improving.”
Lisa: Despite the cultural obstacles to breastfeeding, you have said that you are very optimistic about the breastfeeding movement. What do you see from your vantage point that is encouraging?
Kathy: One of the things is that I am starting to see some cultural pieces coming into place to support breastfeeding. I am seeing more activism to support mothers, but I am also seeing changes higher up at the policy level. You know, for a long time, the United States had very few hospitals with baby-friendly designation. And now all of a sudden there is a national push for hospitals to become baby-friendly.
We’re also seeing some changes in the policy stuff coming down, where organizations like ACOG, are coming out with policy statements against elective inductions because they are causing problems. The March of Dimes has recognized the dangers to babies from these. And once you have problems you torpedo breastfeeding. So we are seeing hospitals being held accountable for their birthing practices.
California’s WIC program issued a report not too long ago and named hospitals and asked, how can this hospital have ten times the amount of cesareans than this other one? So we’re starting to see at the policy level some things that I think are going to be really good news for breastfeeding. Much more of a national push than I have seen in the last ten years. It is an exciting time to be in the field.
Hospitals Who Become Baby-Friendly Will Have to Give Up The Formula Company Carrots
Lisa: What do you think is going to happen with the hospital culture? I talk with lactation consultants in my state who tell me that the hospital settings are run by the formula companies. At the LATCH conference, I talked with a lactation professor about the obstacles lactation consultants face when trying to support mothers. Our Kindred listeners can go to our video page and watch my interview with Glenda Adams who talks with me about this. I ask her about the formula companies running the CEU training programs for breastfeeding in hospitals, and while the training programs and presenters are not supposed to mention formula, they often do at the end or there are materials close by.
What Glenda says is that the formula companies hold all of the carrots. They pay for the training programs, give out free food and gifts, provide free formula, and it is too much for the hospitals to turn down.
Kathy: I think from a national stand point, that is changing. For example, Dartmouth won’t let even a pen with a formula company name. Some of the bigger hospitals are getting on board with that. I think there is movement against this, but some of the hospitals are going to be slower to change than others. But that is where the baby-friendly policy comes in, that policy will remove some of the carrots.
I think what Glenda was describing is something you used to see much more broadly than you do now. Once these baby-friendly policies are put into place, I think you will see the elimination of that.
This is where the policy part comes into play. Some of these hospitals could make a huge difference in the culture by making these top down decisions. And then having everyone have education and support to come on with the same goal. That’s how you do it. That is how you create a culture change within a hospital.