Posts regarding the Women’s March on Saturday, January 21, 2017 are making its rounds on social media. As thousands march in support of their sisters, their mothers, their best friends, their daughters, and their daughter’s daughters; I’d like give thanks for those who gave their time to give the rest of us voices. In the words of the 2016 US Democratic presidential nominee: “Thanks for standing, speaking & marching for our values“. In turn, I’d like to contribute my two cent’s here – in the best way I can: in nutrition terms; and to take this opportuniy to talk about some of the things we do not talk about often enough when discussing women’s rights and nutrition: mental health. Afterall, “Mental health is an integral part of health; indeed, there is no health without mental health” (World Health Organization, 2010).
I am a Taiwanese-Canadian. In otherwords, my heritage is deeply rooted in Chinese traditions that distinctly distinguishes the role of women and men, but that I’ve also been brought up in a place that prides itself in celebrating diversity. However even in our so called progressive time, we may catch ourselves walking backwards rather than forwards. I wish to remind everyone the importance of diversity and rights as an individual, so that we can step away from stigma and shame, and step into support instead.
Recently, my local community has been greiving the loss of a beloved friend, wife and mother to post partum depression. Postpartum Blues – feelings of restlessness, irritation, tearfulness, discouragement, sadness and helplessness are experienced by up to 80% of women from within a few days of birth up till a year post-partum (1). Hence the title of this entry: to touch on maternal mental health, infant nutrition and individual rights. Because if we can become a stronger community, perhaps these “baby blues” can be preventable. And because if we are adding to the anxiety and stress a new family faces instead of providing a new mother with the support she needs, we are stepping in the wrong direction and clearly need to rethink the healthcare system and culture we hope to live in.
“You are Not alone. You are Not a bad mother. Do not EVER feel bad or guilty about not being able to “exclusively breastfeed”, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes. Apparently the hospitals are designated “baby-friendly” only if they promote exclusive-breastfeeding. I still remember reading a handout upon Flo’s discharge from hospital with the line “Breast Milk Should Be the Exclusive Food For the Baby for the First Six Months,” I also remember posters on the maternity unit “Breast is Best.” While agreeing to the benefits of breast milk, there NEED [sic] to be an understanding that it is OK to supplement with formula, and that formula is a completely viable option. I will talk more about this in the future.”
– Husband, Kim Chen writes in his Facebook group “Remembering Mother Florence Leung“
Without doubt, nutrition research repeatedly suggests that breastfeeding has advantages over infant formula both for mom and the newborn. It provides all energy and nutrient needs for the infant’s first months of life, promotes sensory and cognitive development and protects against infectious and chronic diseases. In fact, the WHO along with a multitude of nutrition experts suggest exclusive breastfeeding for the first six months of life, followed by continued breastfeeding with appropriate complimentary foods for up to two years and beyond (2).
The historical evolution of infant feeding consists of wet nursing, the feeding bottle, and formula use. Parallel to the changes in lifestyle through time, new infant feeding practices were adopted: with improvements of the feeding bottle and availability of animal’s milk and advances in formula development, we’ve gradually addopted artificial feeding for wet nursing. Along with these changes, stigma and society’s negative views on wet nursing. It is important for us to remember that while breastfeeding is a natural act, it is also learnt behavior; that all families require active support for establishing and sustaining appropriate breastfeeding practices. Even looking back in history, as early as 2000 BC, from Israel to ancient Egypt, there has been documentaiton that lactation failure was a challenge resolved by alternative feeding methods such as wet nursing, where a woman would breastfeed anothers’ child (3). In fact, it became a well organized profession with contracts and laws designed to regulate its practice (3). Even then, vessels of all shapes and sizes suggesting use of feeding bottles have been found, dating thousands of years back to the Roman Era, Middle Ages and the Renaissance -evidence that although wet nursing was the prefered method of choice, there were alternatives. With the onset of the Industrial Revolution, poor wages and increased cost of living pushed women into employment, changing the family role of women, making it extremely difficult to breastfeed and attend to their young (3). Hence, the refined, hygenic feeding bottle became available and since have been perfected. Throughout the ages until the end of the 19th Century, animal’s milk such as goat, sheep, donkey, camel, pig, horses and cow, were the most common source of artificial feeding.As science and medicine improved, other products such as evaporated milk, Nestle’s Food®, Horlick’s Malted Milk®, and other products were hitting the market. With time, they were altered, improved and supplemented with vitamins and minerals to improve nutritional profiles in attempt to mimic human breastmilk. However, synthetic formulas are generic, simplified and static. Human breastmilk is live, in other words, it is a process where bonding may occur for mother and infant, where there is an exchange of bacteria and antibodies, and human milk is responsive to a growing infant’s nutritional needs.
All this while, we’ve collected data and assimilated our medical knowledge to determine best practices for infants health. We’ve learnt that breastfeeding has the least risk for infectious related diseases in comparison to alternative feeding practices, concerns regarding safe water for formula use or hygenic standards of bottles. We know that it is the education around breastfeeding is the most cost-effective nutrition intervention for improved infant health. We’ve gone from Nestle boycott to Baby-Friendly Hospital Initiatives in attempt to strengthen practices to support breastfeeding. However, on the same line, have we gone too far with the “Breast is Best” campaign? With the best of intentions, we’ve beautifully woven a tapestry around infant and nutrition care network and are just coming to realize the gaping hole in the middle. We’ve fixated on infants and have fallen behind in the support we provide mothers and have failed to address the challenges and emotional support mothers need when initiating the breastfeeding process. Because healthy mothers raise healthy infants, and without mental health, there is no health; we cannot address infant nutrition without supporting the mental health of new and old mothers in this stage of life.
Perhaps it is time to re-evaluate the word choices we use when setting new moms up for success before leaving the hospital doors. To be more aware of the mental and physical challenges during this vulnerable time post-partum. To do a better job at educating prospective families about the spectrum of breastfeeding, ensuring their rights to make informed decisions about their preferred mode of feeding is respected without judgement, and support for executing their choice is in place. I say “spectrum of breastfeeding”, because it is not an all-or-nothing deal. Throughout history, there’s been a spectrum of feeding practices, and today it is the same. Breastfeeding is more than just the nutrition provided, now lactation consultants are becoming more aware of the benefits of skin-on-skin contact between a mother and her infant; so even if it puts a mother at ease, focusing on the act rather than the amount of milk produced may be more appropriate. The Pacific Post Partum Support Society told BC Almanac that “if breastfeeding is causing undue stress, the mother might be better off stopping or supplementing with formula…There’s so much pressure on new moms to be doing a perfect job, and so we want to see how we can really support moms and have a bit of gentleness around all of that. If we keep saying ‘breast is best’ then people are going to feel terrible if that doesn’t work out”. How are we in educating mothers what to do in case of mastitis, or pain when breastfeeding, and difficulties producing milk? What about addressing the social challenges at home with juggling work, household chores, and infant care? What we need is better support around breastfeeding trouble shooting, and to address the extreme culture and stigma we have around breastfeeding. Who wouldn’t agree that the messages we are hearing from our community confusing? One minute it’s shaming for breastfeeding in public on a flight, another it is being guilted into thinking one is not a good mother if choosing alternative modes of feeding.
I do not think I can phrase this any better than Nora Harren, a 17 year old girl from Boise and founder of the political action group “People for Unity”, so I will leave you with a few of her words: “We celebrate diversity and understand that there is strength in diversity. We, together will protect and progress on LGBTQ rights, women’s rights, minority rights, and reproductive rights. We will support those around us who may be feeling uneasy… We are strong alone, but we are stronger together“.
I hope that no matter the parent’s choice may be, we can all be supportive of each other for the well-being and health of our tomorrow. To families and friends and healthcare workers: more conscientious and aware of the vulnerability of a post-partum mother, be a better listener and provide support in the way she wants to be supported, and respect diversity. Take the load off her shoulders, even if it means that she can get a few more minutes of sleep, her mental and physical well-being directly affects the baby and the wellbeing of the family. To new, old and mothers-to-be: remember the spectrum, and that alternatives do exist, be kind and teach each other, because only you’ve experienced it; most of all, seek support because there’s a wealth of people who are willing to offer but likely do not know how.
Perhaps, it is time for a new movement…. How about “Best Mom= Best Fed“? And getting dad more involved in the picture! There has been buzz in scientific journals lately indicating that paternal nutrition has a lasting impact of child’s health outcomes as well.
- BC Children’s Hospital, 2014. Reproductive Mental Health, https://reproductivementalhealth.ca/
- WHO, 2017. Maternal Child Adolescent Health: Breastfeeding. http://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/en/
- Emily E Stevens, Thelma E Patrick and Rita Pickler, 2009. Jounral of Perinatal Education; 18 (2): 32-39. A History on Infant Feeding. doi: 10.1624/105812409X426314