Black Breastfeeding Q&A: Overcoming the Challenges

[MUSIC PLAYING] We are celebrating Black Breastfeeding Week on this At the Forefront Live with UChicago Medicine Comer Children's Women's and Children's specialists. What are some of the barriers to overcome when starting breastfeeding? Why is breast milk healthier than formula? Who can breastfeed? And what types of support can Black women get for breastfeeding? Midwife Karie Stewart and lactation consultant Christina Billy will discuss breastfeeding for new moms and answer your questions. That's coming up right now on At the Forefront Live.




And as always, we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's start off with having each of you introduce yourselves and tell us what you do here at UChicago Medicine. And Christina, we're going to start with you this time.


Hi. I'm Christina Billy. I am a patient care manager here in the NICU. I also lead with our breastfeeding committee, chair our breastfeeding committee here in the Comer Children's NICU, where we help our moms to establish breastfeeding here in the NICU so that they can continue to do so at home.


And Karie?


Hi, I'm Karie Stewart. I'm one of the staff midwives here at the University of Chicago with the midwifery group.


And let's talk about breastfeeding. Karie, you were just on the program recently. And we discussed it a little bit. But this is Black Breastfeeding Week, if I'm not mistaken. And so there is certainly some great opportunity to spread some really good information. And you two are perfect for that.


I want to talk a little bit about breastfeeding in general, particularly with Black women. And there's an area that I think that maybe deserves a little bit of attention because maybe that's an area that a lot of Black women struggle. And I want to get your thoughts on that. And Karie, let's start with you. And just kind of give us your thoughts, and we'll go from there.


Yes, women have been breastfeeding for centuries. What we have to do in understanding the history from breastfeeding in the Black women's culture, in Black culture, is that during slave times, Black women were forced to stop feeding their own children and to feed the babies of white slave owners. So there is some stigma around breastfeeding that stems back from traditions that may hinder, or some moms may not even want to just because, you know, traditions in their family, what they've been taught, not having the support that they need to understand that breastfeeding is really the best thing and to really encourage them to do so with their baby.


And Karie, it's interesting because we had the opportunity to talk with three moms just recently about breastfeeding and some of the challenges that they've faced. And we also talked with them about cultural issues, as you just mentioned. And I want to see if we can go ahead and roll that little clip, John. And then we'll discuss what they said as we come out. So John, if we can roll that.


Well, around the time that I had my first daughter, a couple of my friends had recently had kids. And some of my family had also had kids. And I didn't really see too many of them actually breastfeeding.


My mom, my aunt, they're kind of-- I hate to say it, but they're from an older generation. So they didn't believe in having what they would say, your breast exposed in public. So when we went to public places, if we went to restaurants or things like that, they wanted me to go in the bathroom to breastfeed. If I went to church, you know, my mom would say, oh, you have to go in the bathroom to breastfeed. And to me, it was like the most disgusting thing. I'm like, I don't want to breastfeed in the bathroom where, you know-- that's not-- to me just is not the place to go to feed my child.


My mom was born in Mississippi. So she viewed it as, like, a country thing or something Southern, or even maybe something that poor women did for their children. She could afford the best for her child, and the best, she was told, was formula. So that disconnect saddens me because of the lack of access, choice, and education.


So Karie, as you see the comments there, and Christina-- I don't know. Do you think that times are changing and attitudes are changing in this area? And if so, hopefully in a positive way.


They are. We have to go back to education. And you can see in the clip that they are just carrying on some thoughts from their family members and things that they thought traditionally they were taught. Again, the sexualization of breasts and breastfeeding, hiding as if it's something to be afraid of or to be embarrassed by. The breasts are for feeding your baby. That's what they're for.


So if we continue to allow our moms not to be educated on the reasons for the breast and supporting them and encouraging them to do so, then the change won't happen. And we have to start with the education.


You know, Christina, one of the things we talked-- I'm sorry. Go ahead.


Hey, I'd like to piggyback off what Karie was saying. When formula came around, there was this big press for using formula. And then people started to realize that human milk was better. But at that time, in the '70s and '80s, when that realization happened, it was a time where Black women were not getting traditional care during their pregnancies. And so they didn't get that education. So they were still being taught to use formula. And so when you don't see your neighbor, or your sister, or your mother, or your aunt breastfeeding, or you're not-- and you're going to the doctor's office, and you're not being taught to breastfeed, then that's not something that they learn to do.


So now, as more Black women are educated and more Black women are going to traditional health care services during their pregnancies, they're starting to learn, and we're starting to learn. And it's a matter of changing that narrative now and teaching our moms and our aunts that no, we're not going to feed our babies formula. We're going to breastfeed.


You know, Karie, when we had you on the program-- was it a week ago? I believe it was. And we talked about health disparities, particular maternal health disparities for Black women. This one of the things that cascades out of that, I would imagine, because it is an education issue, a cultural issue that stems from all of that. And that's one of the real problems, one of the real challenges that I think we're facing. But again, there's a lot of work that's happening there that hopefully will be making this a little better. Do you see a shift in thought process here?


There is. Again, like Christine said, we have to educate not only just our patients, but we also have to educate their moms and their aunts. We also need to provide role models who have breastfed or are currently breastfeeding, and then provide support groups. And we're slowly but surely seeing the change. But all those behaviors are pretty much learned. And so if we demonstrate that, we can actually support our moms and get them to do the same.


We also have to be mindful of the care that we provide in the hospital as well, when patients are coming in. And if they don't know about breastfeeding, let's educate them and not just automatically offer them the formula. Or if they say they want to do formula, just asking them, had you thought about breastfeeding? Do you know about breastfeeding? And of course, if they choose not to, that's different. But sometimes, patients tend not to know about it or have some misconceptions about it. And we can definitely, like she said, change the narrative and educate patients on the things that they don't know.


You know, Christina, one of the things that I thought was really neat, when you put us in contact with the three moms that we just saw in that clip-- and we'll see more of them throughout the program. They're all acting as advocates for other moms. And again, it's what you two are talking about. It's that education.


And I think a lot of it also comes down to a stigma. And one of the moms said something that is kind of sad, in my opinion, that there is that embarrassment or stigma, and some people will go into the bathroom to do this. Well, you don't want to eat in the bathroom. You wouldn't want to do that to your child. So I think it's really positive, though, that there are folks out there that are leading the charge along with you all to help other moms. So that's pretty neat, I think.


So let's talk about some of the barriers to overcome, physical barriers, when breastfeeding. And Christine, I think you can help us with this one. Because it is a challenge, particularly if you're a brand-new mom.


yes. So there are some-- a few physical barriers for when it comes to the baby. As I'm sure Karie and Cynthia talked about when they were on last week, Black moms are more likely to have smaller, early babies. And so that often leads to separation. And when you separated from your baby, that means establishing breastfeeding a little bit more challenging.


But what we always tell moms in the NICU, you should mimic what the baby does. And when you are starting breastfeeding, you need to put the baby to breast within the first hour. Babies should breastfeed eight to 12 times in 24 hours, which is one of the stigmas and misconceptions that people have all the time. They think that formula is better because then the baby is going to sleep more, which they don't sleep. They're not supposed to sleep that long.


Some other physical challenges, some babies come out with lip ties and tongue ties, and that can be challenging to establish breastfeeding. Sometimes breastfeeding hurts. And it does. I'm going to be honest. But those are things that you can get through, and especially if you have the support.


There are lactation counselors, peer counselors. For instance, one of the moms that you interviewed, she's a peer counselor. They will go, and they will help other moms do this. There are doulas. There are support groups there. There are all these things that will help moms get through these challenges that babies can have.


And smaller babies, particularly those late, preterm babies that we don't often separate from their moms, so those babies that are 35 weeks gestational age when they come out to 37 weeks, they sometimes have a harder time learning to latch and learning to-- babies have to learn how to eat, suck, breathe, swallow all at the same time. And oftentimes, giving a baby a bottle of formula is easier because it just pours the milk right down their mouth, and they don't have to think about it. And for those babies, that's easier because they just swallow it, and they don't have to think about it. So those can be some of those physical challenges that present themselves early on. But in the long term, getting past those things, breastfeeding is so much more rewarding and can last long term.


I mean, I'm a mom that breastfed, and I did it for 18 months. And I did it with a late preterm. My son was born at 36 weeks. He had a lip tie. He had a tongue tie. I took him home at 5 pounds. And we made it to 18 months. So it's possible. Anything's possible.


Christina, I'm glad you brought that last point up too, because I imagine it's very, probably, frustrating and discouraging to the new mom when it's difficult. And when you're at that stage, and you've got a little baby, and they're crying, you want to do whatever you can just to make them happy. And so this is tough. And that's where you come in, though. And that's great that we have you because you can help the moms, and coach the, moms and give them some really good advice.


We had a couple of comments already from viewers that I want to pass along. And I think, Karie, this one goes to you. "This is very interesting. Thanks for sharing this history." So that was good. And then the other one is, "I tried breastfeeding my first child, but I wasn't able to produce enough milk for the baby. So it can't be discouraging. But I'm going to try it again if I have another child," which is fantastic. So that's good. And again, I think that's really important to know that there are folks like the two of you and the moms that we interviewed that can give advice and help.


I do want to play another clip from our moms. And John, let's play the one where the moms give advice for other moms. So let's do that one real quick.


Everything is going to come in stages. So just like your first trimester doesn't last the whole time, second trimester, third. So really be present, and don't worry about what's happening now happening for the entirety of your pregnancy. Really just stay focused and listen to what your body needs today. And if you're able to provide that through a nap, or through extra water, or proper nutrition, do that today. Don't get concerned that you're going to sleep your way through the rest of your pregnancy or that you going to be tired for 40 weeks. Just worry about today. And as you get through today, then tomorrow will come.


Take classes if they can. Learn about where they can get help for free because a lot of times, the hospitals where they're giving birth, they have free help that they can get and different things that they can go to. And just make sure they get as much information as possible before their baby gets here so they can be informed and know what to look out for. And it's just easier once you have some sort of background on breastfeeding before just trying to do it and not knowing anything.


Don't give up! Even if-- I made a post. I made a post during breastfeeding month last year on social media. And a number of women had shared with me their stories as a result of my post because with my first son, my milk didn't come up the right way, the way I wanted it to rather. And then with my second son, it was like an overflow of milk. And I shared that. And so many moms said, oh, with my first one, I had the same experience. And I just thought I would never be able to breastfeed again.


If that's you, if you had that experience with the first one, don't give up. I promise. Every baby is different. Your body may react differently with the second baby. Even if you are at the beginning stages of your journey, and you're feeling discouraged, or you're feeling like maybe it's not enough, just find that comfort zone.


For me, breastfeeding is all about-- it's kind of like a dance with the baby-- finding that special spot, getting them comfortable in there, getting yourself comfortable, and allowing your body to do what it's supposed to do naturally anyway.


So I love Ebonie's comment right there-- don't give up. And that goes back--


Don't give up.


Yeah, kind of what the one mom just said a moment ago, that she had a hard time with the first baby, but she's going to try it again. So that's fantastic.


Karie, another question from a viewer-- "what are some of the health benefits for the baby from breast milk?" And as you talk about this, can we also talk a little about COVID? Because I think that's another area where people are a little worried. I know the answer on this one, but I'll let you take it, Karie, if you will please.


You know.


Yeah, I do.


Yes. Yes, breast milk is the best milk, regardless pandemic, not pandemic. There's a lot of nutrients in breast milk-- fats, vitamins, very essential for baby's brain development and growth. And so that's also why we want to encourage mothers to do breastfeeding.


Yes, it takes a long time. The milk takes about three to four days to come in. But it's that first few hours to the first couple of days that that colostrum comes through. It's what we call the liquid gold. And it's full of wonderful things that the baby should get in those first couple of hours to days of life that will help the baby develop. And so the longer you can do it, the better. But any amount of time of breastfeeding is very essential and beneficial.


Well, you mentioned the colostrum, that also actually helps keep the baby healthy, correct, and protect the baby against various illnesses and that sort of thing.




So again, really, really important.


Right. So babies tend to have less ear infections, asthma issues, illnesses that most babies might experience younger in life. They have less of those experiences.


Christina, you mentioned some of the things that might be present when a baby is born, particularly if a baby is born prematurely, that can impact breastfeeding. Could you kind of describe some of that to us? Because you had a couple of terms in there that I wasn't familiar with. But talk to us a little bit about some of the challenges that newborns might have when it comes to breastfeeding and what can be done.


So for instance, a term I used was gestational age. Gestational age is how many weeks the baby is. So a term baby, typically, a pregnancy lasts 40 weeks. We call a term baby a baby that is born at 37 through 40 weeks. Then post-term would be after 41 weeks. A late preterm baby is a baby that's born between 35 and 36 week. And then a premature baby is born before 35 weeks.


And then I mentioned lip ties and tongue ties. So clearly, I'm running my mouth right now. So I have a lip tie. That's why I have a gap in between my teeth. I was born in the '80s. And at that time, they were not cutting lip ties, so I was not breastfed.


I can tell you that my son had a lip tie and a tongue tie. And it was not cut until a month ago. And he is six now. So we breastfed through the lip tie and the tongue tie.


So the lip tie, it connects the lip closer to lower in the gums. And the tongue tie connects the tongue too far to the teeth. And when babies latch on, they need to look like a fish, essentially, so it makes it hard for them to latch on to the breast. Because you can imagine, if you need to open their mouths up to look like a fish, if you're lip is connected too far down to your gums, and your tongue is connected too close to your teeth, you cannot open up like a fish.


Thing to go to overcome that without-- depending on your pediatrician, they might clip it. A lot of pediatricians clip it. My son's pediatrician did not believe in clipping it. So we used what is called a nipple shield. And that is something that you can get from a lactation consultant when you're first breastfeeding until the tie is clipped, or even if the tie is not clipped.


So that helps. It make the nipple seem more like a bottle nipple but still makes the baby do the work for breastfeeding, not like-- it does not pour out milk like a bottle would. They still have to work for the breast milk as if they were-- because they're still breastfeeding. It just makes it so they can latch onto the breast nipple easier.


So again, I think this just shows the value of having somebody like a lactation consultant like you--


It does.


Because a lot of moms probably wouldn't get that information, and again, would be very frustrated. And when you're frustrated, it just makes everything that much harder.


Karie, who can breastfeed? Are their moms out there that can't? Or is that something that basically all moms can do?


All moms can breastfeed. Some patients have had breast augmentation or surgeries. And of course, we talk to them about how the surgeries were done to address if they can still breastfeed. It just depends on the reconstruction and if the ducts were interrupted at any point during the surgery. But all moms should be able to breastfeed.


And we're playing the video right now. This is my favorite part of what we did. We talked about this before the show. Because the kids really wanted to be part of this too, which was awesome. And this was just so much fun when we did these interviews with the moms, and the kids decided to get involved. And happy, healthy little kids there. And it's just awesome. So I'm glad we're seeing this. This was fun.


So Christina, when a mom comes in, and they're having their child, and they think that they need some help to start breastfeeding, what's the process? Do they just ask for a lactation consultant? Or how does that all work?


So here at UChicago, so the processes in labor and delivery, the nurse should immediately put the baby to the breast. We do skin to skin immediately so long as the baby is not being brought to us in the NICU. So once the baby is cleared and is healthy, immediately skin to skin.


And then we don't bring them-- labor and delivery is another building from other babies, so they don't travel that way. Some hospitals do travel that way. And then, a mother-baby lactation consultant will see them. They will see every mom.


We arr a baby-friendly certified hospital. So the expectation is that every baby leaves out of here breastfeeding. We do not even offer formula. Moms have to ask for it. So that helps a lot here. But in most hospitals, yes, they have lactation consultants.


Here in the NICU, lactation consultants for mother-baby have dedicated time to come in the NICU and round. Our staff are also trained lactation counselors. We actually do have staff that are lactation consultants as well. But all of our nurses are trained to help latch. And they are trained to help our moms pump.


We have a saying here in the NICU-- eight or more in 24-- to help our moms remember to pump eight or more times in 24, even wake up at night time to pump because that is what your baby would do if it were with them. And to stay hydrated-- we give them really large cups to stay hydrate because that is very important when breastfeeding to make sure you


Let's talk about pumping for a second because that leads me to a question that came in on Facebook just a moment ago. And the question is, "is there a health difference between pumping milk and feeding directly from the breast?" And I don't know if they're talking specifically for the baby or maybe the baby and the mom. So if you could answer that, that'd be great.


Sure, a health difference? Is that the question? I'm sorry.


Yeah, from milk that you've pumped versus straight from the breast, I guess.


So yes and no. All human milk is good for the baby. The human body is an amazing thing. And it will give the baby an appetizer, and then a full meal, and then dessert when it is breastfeeding, if you put the baby to the breast. So it gives a little snackish in the beginning. And then it'll give a fuller milk in the middle. And then towards the end of the baby's feeding session, it'll give a heavy, sweet milk to indicate that the feeding is coming towards an end.


So when you're pumping, that does not happen. It's not a different health benefit. It's just what the body does because it's amazing. Pumping does not-- all the same nutrients go into the milk.


The only difference, I would say, is when we're talking about that colostrum compared to your mature milk is keeping those in separate containers because they are different. Or if the mom gets sick, keeping that milk separate from milk that she pumps when she's healthy. Because again, your body is very smart. So the antibodies that you create as a sick mom, your body will pass on to your baby to keep your baby from getting sick as well. So you need to keep that milk separate and label it if you're pumping so that your baby-- you know which milk you're giving to your baby, and therefore, passing on which antibodies to that baby.


Also, always label and date your milk because your milk changes as your baby gets older. Your body knows how old your baby is. And it gives your baby the milk that it needs for the age that it is.


And for those moms that pump for a long or breastfeed or pump for a long period of time, that's very important because if you have another baby and you get pregnant again, your body will start over when the second baby comes out, is born. So let's say you pump or breastfeed for 18 months. When baby number two is born, you don't continue to make mature milk. You start over at colostrum again. So it's important to label and date all of your milk because your body is very smart, and it keeps up with the baby.


So for instance, if you have a NICU baby and you're bringing milk from home, you want to make sure you're keeping up with the baby and you're bringing the right milk.


That's great advice. Karie, we have another question from a viewer. "For parents who are struggling with breastfeeding and who are feeling somewhat isolated because of COVID, are there online resources or communities that you would recommend where parents can look for support?" What do people do people do? Where do they turn at this point?


We're in the midst-- here at UChicago, we're getting ready to do a support group where we're going to be doing group prenatal care. And so we're going to have some support with that as well. But there are several organizations, Black doulas organizations, individual doulas that might be having online sessions collectively that they can tap into. And we definitely could get patients involved in those things so that they can feel supported and have conversations with other breastfeeding moms who might be having some of the same concerns.


And Karie, I know you do video visits, I believe, as a midwife, right?




And so Christina, do you do those as well?


Well, in the NICU, no, we don't. Well, for our families that are in the NICU, we do do family night virtually. I can tell you that mother-baby here does Baby Bistro. And they have switched to virtual, so that's a support group for moms that happens once a week on Wednesdays, I believe, from 10:11 to 12:00 via Zoom. And then there are tons of social media groups that use Instagram and Facebook to do virtual meetings as well to talk about breastfeeding.


I think this all comes back to just having that right support. And you all are doing a wonderful job providing that.


I do want to play one more clip before we go. We're about out of time. But let's play the support clip if we can, John. And then we'll come back and say goodbye here in a minute.


I first felt supported by my husband. And that was a conversation that I had to have with him, that I'm not going to leave the room to-- especially at my own house, I'm not going to leave the room to nurse. I'm not going to always cover up. I'm not going to be shunned away for something that's totally natural. By having his confidence and his support, that made me more comfortable in a bigger situation.


Also, I did extended breastfeeding. So every step that someone's like, oh, when they have teeth, that's enough. When they're able to walk, when they can ask for it. He's two. I know you're going to stop now. At those moments, we had to have those conversations in our household that my husband knew that I was doing the best for me and my baby, and we weren't ready to stop yet. So having his support really helped me in the family sense. But then once that happened, my parents were on board. His parents were on board. And I'm very proud to say that it has created a culture of breastfeeding now in our family.


That's fantastic. Well Karie and Christina, you guys were awesome. We really appreciate you being on. You provided, I think, some great advice. But unfortunately, we are out of time.


We will have another At the Forefront Live coming up in the next couple of weeks. Just remember to check out our Facebook page for our schedule of programs coming up in the future. Also, if you want more information about UChicago Medicine, take a look at our website at If you need an appointment, you can also give us a call at 888-824-0200. And remember, you can schedule your video visit by, of course, going to the website.


Thanks again for being with us today. And I hope you have a great week.



We're celebrating Black Breastfeeding Week with our women's and children's specialists at the University of Chicago Medicine and Comer Children's Hospital.

In our live Q&A session, Karie Stewart, APN, MSN, MPH, CNM, and NICU patient care manager Christina A. Billy, BSN, RNC-NIC, discuss the history and impact of health disparities that commonly affect Black breastfeeding moms, as well as ideas that may help to overcome these unique challenges.

Breastfeeding Support and Resources at the Family Birth Center

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Connect with a certified lactation consultant at the Family Birth Center.

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