Guest Post: The Midwife as a Storyteller and Teacher by Patricia Harman

Oct18

The use of old-fashioned narrative to influence, and inform patients about health practices

As an author of memoirs, historical fiction and children’s literature, I am a storyteller, but I’m also a nurse-midwife, and I use storytelling as one of my primary teaching tools.

Storytelling is uniquely human. Anthropologists have argued that storytelling is pre-verbal, that pictographs on the inside of caves are in fact stories. Form the earliest days humankind has used narrative to record history, to entertain, to convey experience and to transfer information.

To convey information in narrative form is something no other species can do. It’s an evolutionary advantage and allows each individual to harbor more information than personal experience would allow.

Using stories to teach patients is not unique to midwives. All good providers use stories to illustrate how individuals can make better health choices.

We all know that many patients are non-traditional learners and even those in higher education love a good story. Research and statistics are boring for most people and easy to forget . Many patients, even if given a handout drop it in the trash as they leave our office. They don’t have time to read it or are non-readers.

On the other hand, if I tell a tale, in an amusing way, about a young woman who refused to take her birth control pills because she was worried they would make her fat…and now she’s pregnant…that’s a cautionary tale and brings a smile and a knowing nod from the fifteen-year-old here to discuss birth control: That’s not going to happen to her!

Using self-disclosure about your own life can humanize a professional relationship and help patients be more honest with you about their lives. For example, I might say with a smile, that I’ve gone to Weight Watchers for so long I could teach the class, even though I’ve never reached goal weight. The patient and I share a good laugh and now she feels comfortable telling me she can’t stand to look in the mirror, has tried four different TV diets and is terribly discouraged. A door for real communication has opened. She no longer feels alone and she knows she has me as a non-judgmental advocate.

Stories can accomplish what no other form of communication can do; they can get through to hearts with a message. I might tell a very stressed-out college student, sitting on the end of the exam table, about a patient of mine who had two jobs and was studying nursing full time. Last year she started getting a series of illnesses. Next thing she knew, she flunked two courses, lost her boyfriend and had a motor vehicle accident. The moral is clear: don’t take on more than is humanly possible. And the tale is more likely to induce lifestyle change than a lecture.

All health care providers, surgeons, nurses, physical therapists, family doctors or midwives must be teachers. If you missed that part in school, it’s not too late. With humor and love we can become part of the human story that will bring health and hope to our patients.

For the past twenty years, Patricia Harman has been a nurse-midwife on the faculty of The Ohio State University, Case Western Reserve University and most recently West Virginia University. In 1998 she went into private practice with her husband, Tom, an OB/Gyn, in Morgantown, West Virginia. Here they devoted their lives to caring for women and bringing babies into the world in a gentle way. Patricia Harman still lives with her husband, Thomas Harman, in Morgantown, West Virginia. She recently retired from her thirty-five years of midwifery so she could write more books for people like you!

My past reviews of Patsy’s books:

Past blog posts on the subject of story power:

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Free Mini Course: Womanspirit Wisdom

Jan14

I’ve developed three new free mini courses to offer this year. The first is ready to roll and begins on February 1!

Here are the details…

Womanspirit Wisdom

This three-week ecourse is designed to offer you a gently nourishing daily “sacred pause.” Beginning February 1, each day for 21 days, take a moment and simply receive. There is nothing to do, just enjoy taking a daily minute to connect with yourself.

Includes:

Daily inspirational quotes and food for thought
Song and poem recordings
Optional journal and photo prompts
$25 discount on Red Tent Initiation course or on the Womanspirit Initiation course, both beginning March 21
Creative Spirit Circle membership + weekly Brigid’s Grove email newsletter subscription

Join the Womanspirit Mini Class!

Sixmonthababy!

May8

So…THIS BABY! Somehow, he is six months old already. Somehow, he acts more like a ten month old! One of the things that is different about being a fourth baby than a first baby, is that you accept being zoomed around on a tiny car as a normal part of your morning…

Speaking of mornings, I’d like to comment that whomever said, “the days are long, but the years are short,” was totally wrong. Both the days AND the years are short. So, so short. I mentioned before that I am definitely feeling maxed out in my caregiving powers in an average day (and, one can only reduce household tasks so far without becoming disgusting). It is unbelievable to me how many things I DON’T get to do in a day and that I have to release or let go of. At the same time it is amazing how many things I actually do, but the number of important things that slip through my fingers is feeling rough to accept lately. It feels like much of my relationship work is being sacrificed. Activism, local events, friendships, relationships in general, doing things with my other kids, going places, self-care basics—these are all getting pared away, reduced, or feel like they are suffering, untended, or neglected. As one small example, I didn’t read most of or reply to hardly any of the birthday greetings I had on Facebook last week, I can’t respond to simple midwifery activism action alerts, and so forth. What I have been having time for is time to work next to my sleeping baby, since I have to sit in a quiet room with him and actively keep him asleep for naps. This is handy for blog posts, newsletters, etsy work, class preparation, and writing projects!

Okay, enough whining, and back to this baby. He is mobile! Very mobile. He crawls—mostly army style, but also on knees and then launch forward and then knees again and launch forward (sort of inch-worm style). He pulls to standing on everything. He gets himself back to a seated position after being flat on his belly. He lets go while standing and holds on with only one hand. He does some transferring between surfaces, but not cruising yet…that is coming any day now I think. He practices getting down from bed and chair by sliding off the edge (with help) over and over again—slide down, reach to be lifted back up, slide down again. You can see the practiced concentration. He does things like get canned goods out of the cabinet while standing there holding on with one hand (that’s what I mean about feeling like I have a ten month old). He’s only six months old! By the same token I feel like he bonks his head or hurts himself more often than he should as only a six month old baby—he tries things that are just a little out of his actual capacity. (Such as holding on to the laundry basket with one hand and leaning over and swiping other hand toward the couch trying to transfer surfaces even though he isn’t quite close enough to reach.)

Loves being outside!

Blondie boy!

Nursing at Laumeier Sculpture Park

Tanner’s long-lost twin!

At the zoo…

Jilly’s Cupcake Bar for mama’s birthday!

Little sister Lily!

Along with this mobility comes some struggling with our nursing relationship. He clearly feels “bored” or held down by needing to stop for “nonnies.” Some day, despite lots of offering and two minute long nursing sessions, it feels like he is only really, truly nursing at naptimes and then all night long (to make up for the busyness during the day). I pretty much have to shut myself up in the bedroom with him to nurse him very well at all. Along with this, he is eating a ton of solid food. Way more than any of my kids have ever done at the same age and he started doing so with no real fanfare or lead-in or episodes of gagging over textures and spitting things out. He grabs, he chomps, he gobbles, he has a specific “desperate” (horrible!) sound he makes when he wants a snack or something from our meals. Despite having a pile of other kids, until this month with Tanner, I have been pretty judgey towards other parents about their solid food choices with their babies. Since my other three were only passingly interested at this age and would gag and spit out almost everything, I assumed other parents who said their six month old loved to eat, were exaggerating or almost “forcing” the babies to have solids when they weren’t really ready. Apparently, no matter how many years you parent, there is always room to be humbled yet again!

He still weighs about 18 pounds (maybe 19. We get varying results.) The other thing he does that is different than my other kids is suddenly degenerate into extreme crying fits when it is time to go to sleep, usually when we’re changing his clothes/diaper and I’m brushing my teeth to get in bed. It is an abrupt shift into crying hard and he shrieks in a desperate, agitated, really over-the-top manner. He also continues with the car crying horror to the extent that we only actually leave the house once or twice a week! Oh, that said though, he as started to make some visits over to my parents’ house when the other kids go to visit during the day. The first time he left with them, I cried three times! Now, I’m seeing the advantage. Mark and I really benefit from focused time to work together instead of shouting to each other over the tops of people’s heads (not ideal for running a collaborative business). I’ve also left Tanner with Mark twice while I teach, instead of dragging them with me to sit in the hall. I’m almost to another session break and I also got it arranged to do my next two classes partially online, meaning I won’t be gone for the entire time and can get home to my baby in a timely fashion, instead of having to bring him + Mark along with me. While I do enjoy “grinding my corn” with my baby and having him close by while I teach, I do have to admit that I do a better job and feel much more satisfied when I am on my own at class and not worrying about them out in the hallway waiting for me!

He also got to visit with his great grandma last month!

Something Tanner does do that all of our co-sleeping babies have done is touch our faces in the night to ID who he’s got—since Mark has a beard, when he reaches up and feels Mark’s scratchy face, he knows to roll away and back towards me! In the night, I’ll feel a little hand patting at my cheek…checking in…right person? And, then snuggling up to nurse. He still sleeps on my arm all night long, but he rolls to face different directions while still being on my arm.

Despite the maxing and the chaos and the juggling and the paring away, I literally cannot believe I ever worried about not loving him. He is the baby I didn’t know I needed. The member of the family that was missing. He totally belongs and is so much a part of me and our lives that I can barely remember him not being here and can certainly not imagine that we might never have had him!

Thursday Tidbits: The Return

Jan15

Two months after Tanner’s birth, I still feel like I’m “coming back” from this trip.

And, speaking of returning, last night I went back to teaching my in-seat class. I am grateful to have a husband who accompanied me to keep the baby close on site for nursing as well as for helpful parents who rearranged their schedules/lives to take care of our other kids while we were gone.

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At class last night.

As I mentioned in a recent post, I’d mentally prepared to be “off” until January and now that it is January, I have a feeling of being sped up in an unpleasant way. So, I appreciated reading this essay and the reminder: you just had a baby.

You just had a baby.

So, let’s stop pretending like that didn’t just happen.

And let’s give you some grace and permission.

You don’t have to answer every email, every text or every invitation that comes your way. You don’t have to keep your house clean or make fancy dinners this week or plan your family vacation for the year. You don’t have to take your toddler to the dentist or figure out how to save for college right now…

You Just Had a Baby | Ashlee Gadd.

While I do keep up with a large variety of projects, ideas, communication, and relationships, there is not a single day that passes that I don’t drop a ball, forget something, let something go (intentionally or not), or let someone down. There are emails I don’t answer, calls I don’t take, and text messages I don’t respond to as well as laundry I don’t fold and piles of clutter than don’t get put away, not to mention all the blog posts I don’t write. This simply has to be okay. I’ve joked with friends and with Mark that my “word of the year” should actually be “ruthless,” meaning that I must be ruthlessly assessing of how I spend my time, ruthless about cutting out non-essentials. Every day involves a pile of choices and some of them are hard to choose between, or to not choose. I must be ruthless in my discernment—choosing wisely, choosing carefully, choosing mindfully. My real word of the year is “grow,” while at the same time the message I’ve frequently been picking up in moments of synchronicity and surprising overlap is “let go.” So, maybe I’ve actually got a trifecta of words this year!

I already wrote about the breastfeeding brain in a recent past post, but it appears that there are permanent changes to the maternal brain as well:

The artist Sarah Walker once told me that becoming a mother is like discovering the existence of a strange new room in the house where you already live. I always liked Walker’s description because it’s more precise than the shorthand most people use for life with a newborn: Everything changes…

The greatest brain changes occur with a mother’s first child, though it’s not clear whether a mother’s brain ever goes back to what it was like before childbirth, several neurologists told me. And yet brain changes aren’t limited to new moms…

via What Happens to a Woman’s Brain When She Becomes a Mother – The Atlantic.

And, speaking of mothers and their childbearing brains, Childbirth Connection has produced two phenomenal new resources. There is a report by Sarah Buckley on the Hormonal Physiology of Childbearing and a companion booklet for mothers that simplifies the research into a user-friendly booklet on the role of hormones in a healthy birth. Great resources for childbirth educators and doulas.

For more see: Hormonal Physiology of Childbearing | Transforming Maternity Care.

Tuesday Tidbits: Human Rights and Birth

Jul22

“It takes force, mighty force, to restrain an instinctual animal in the moment of performing a bodily function, especially birth. Have we successfully used intellectual fear to overpower the instinctual fear of a birthing human, so she will now submit to actions that otherwise would make her bite and kick and run for the hills?”

–Sister Morningstar (in Midwifery Today)

When I end my introduction to human services class and then again when I begin my social policy class, I ask my students to consider the above: What would happen if everyone cared? What would happen if our first reaction was compassion? What would happen if we focused on what matters? What would happen if we assumed everyone had inherent worth and value and deserves humane care and compassion?

I have said for a long time that women’s rights in birth represent a human rights issue, so I was very interested to receive word of a Human Rights in Childbirth campaign:

Women do not lose their basic human rights once they become pregnant. And yet, across the globe, women’s human rights are compromised and violated around childbirth. Examinations, interventions and procedures that pose risks to both mothers and their babies are routinely performed without informed consent, or through coerced compliance via threats or fear. When women come out of childbirth with post-partum PTSD from disrespect, abuse, or obstetric violence, the goal of a “healthy mother and healthy baby” has not been met.

via Home | Human Rights in Childbirth.

Childbirth IS a women’s rights issue and a reproductive issue:

Childbirth is a women’s rights issue and a reproductive justice issue. The United States maternity system is one of the costliest in the developed world, yet our birth outcomes compare poorly to those of other industrialized nations. Among industrialized countries, we consistently rank last or second to last in perinatal and maternal mortality rates. Moreover, birth is depicted in mainstream media with fear, medical intervention, and crisis…

via Business of Being Born: Classroom Edition | Talk Birth.

But, childbirth is also, quite simply, a human issue:

This is the whole point—women’s rights aren’t about “taking” rights from anyone else OR about demanding “special treatment,” they are important for a HUMANE WORLD for all people. I think it is hilariously awful that “women’s rights” are considered a political issue and that there is a section about “women’s rights” in the “opposing viewpoints” database for my social policy class. As long as women’s rights are considered a political issue or as something about which an opposing viewpoint can be held, rather than as self-evident, we are in continued, desperate need of revolution.

via Women’s Power & Self-Authority | Talk Birth.

Human rights in childbirth include access to the provider of one’s own free choice, so on a related note check out this set of consumer-oriented materials about the midwives model of care offered by collaborative effort of several midwifery organizations and endorsed by several others:

“Normal Healthy Childbirth for Women & Families: What You Need to Know” clearly explains and advocates the benefits of normal, physiologic birth for the average health care consumer. This helpful tool was created from a 2012 consensus statement developed by ACNM, the Midwives Alliance of North America, and the National Association of Certified Professional Midwives.

via OMOT Normal Birth Document Feature Page.

The below quote may seem obvious to birth advocates, but it is revolutionary in terms of health care. When Citizens for Midwifery shared this quote, they noted that, “One the KEY findings of the Lancet Special Series on Midwifery affirms the importance of women and their families participating in planning of health care.” For more from this special series on midwifery, go here: TheLancet.com.

And, in case we get so caught up in theorizing about appropriate care that we forget the lived experiences of the women who need it, read this tough, sobering article about why “going in pushing” does not a VBAC birth plan make:

Karen’s story is not uncommon and nor is the advice she was given about “going in pushing” but when we tell women they can not be cut unless they consent are we telling the truth? Whilst it’s true that legally the hospital can not physically force you into an operating theatre without your consent, they are not afraid to gain consent using underhand methods…

via Go In Pushing – It’s not a VBAC Birth Plan – Whole Woman.

And, of course, some relevant quotes to remember:

“If women lose the right to say where and how they birth their children, then they will have lost something that is as dear to life as breathing.” –Ami McKay

“Mothers need to know that their care and their choices won’t be compromised by birth politics.” – Jennifer Rosenberg

via As dear as breathing… | Talk Birth.

Is there anything that can be done, or are we facing an insurmountable struggle? I think we can remember that our “small stone” birth activism does matter:

While reading the book The Mother Trip by Ariel Gore, I came across this quote from civil rights activist Alice Walker: “It has become a common feeling, I believe, as we have watched our heroes failing over the years, that our own small stone of activism, which might not seem to measure up to the rugged boulders of heroism we have so admired, is a paltry offering toward the building of an edifice of hope. Many who believe this choose to withhold their offerings out of shame. This is the tragedy of our world.” Ariel adds her own thoughts to this: “Remember: as women, as mothers, we cannot not work. Put aside your ideas that your work should be something different or grander than it is. In each area of your life—in work, art, child-rearing, gardening, friendships, politics, love, and spirituality—do what you can do. That’s enough. Your small stone is enough.”

These quotes caused me to reflect on the myriad methods of “small stone” birth activism that can be engaged in as a passionate birth activist mother embroiled in a season of her life in which the needs of her own young family take precedence over “changing the world”…

via Small Stone Birth Activism | Talk Birth.

And, on a fun note, you might enjoy this lovely homebirth treasury on etsy: Home Birth by Kayleigh on Etsy. 🙂

“Thousands of women today have had their babies born under modern humanitarian conditions–they are the first to disclaim any knowledge of the beauties of childbirth…” –Grantly Dick Read, Childbirth without Fear

“I am not free while any woman is unfree, even when her shackles are very different from my own.” –Audre Lorde

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner

LLL of Missouri Annual Conference

Jun16

This past week Mark and I went to the La Leche League of MO conference. It was the first time we’ve gone anywhere together without any kids for TEN years! (And, technically we did have one with us, but he’s still in utero!) We were very grateful for my parents who hosted our kids for overnight fun. The conference schedule was packed and very tight. We got there at 8:30 on Thursday morning and didn’t leave until 10:30 Friday night. (The first day was scheduled from 11-10 [vendor set up is why we were earlier] and the second from 9 a.m.-10 p.m. These LLL conference organizers don’t mess around!)

We set up our Brigid’s Grove vendor’s booth first and Mark spent the majority of twelve hours two days in a row sitting at that booth!

Traveling bead shop section.

Pewter jewelry section.

After getting our booth set up, I set up our LLL Group’s boutique table. We always have a pretty good table, if I do say so myself. I’m not sure if we sold much though, since the sales are handled by the conference and a percentage of the profits comes later on (based on everything I had to pack back up to go home, I’m thinking it was not much).

We then had lunch and some introductory presentations and then a keynote presentation about making medical decisions which was given by a wonderful physician I’ve known since before I had Lann. I then went to her breakout session on “vaccinations and other controversial topics.” Due to the tight schedule, the next session began immediately and I enjoyed listening to a very informative session on Pumping in the NICU, for moms establishing a milk supply while expecting to be pump-dependent on a long-term basis. At dinner, I got to sit with LLL founding mother Marian Tompson (this was a perk of early registration) and got a picture with her. (Not the most flattering picture of me, but oh well.) I’m so inspired by these seven founders and what they contributed to the world. (I reviewed Marian’s book a couple of years ago here.) In the picture she’s holding her copy of the Amazing Year workbook that we distributed (with permission) in preparation for my own session the following day.

After dinner, I went to a session on Slow Weight Gain. Even though I’d signed up for another session after that, I took a little break and sat with Mark instead before going to an Area meeting for my Group’s area. We then packed up the booth and took our wares to our room where we FaceTimed with the kids for a little while before bed.

The next morning began early with re-setting up our booth and getting some breakfast and then going to my first session which was called the Proficient Pumper and was about helping mothers achieve their breastfeeding goals while expressing milk. This was followed by a helpful session on assessment of tongue tie and then lunch. The conference organizers bought two of our nursing mama goddess pendants as thank you gifts for the two primary speakers and I was delighted to see Marian Tompson wearing our little nursing mama while giving her lunchtime presentation (which was about self-compassion).

After lunch, I got my Womanly Art book autographed and a fresh picture with Marian, both of us sporting our mama goddess pendants from Brigid’s Grove. 🙂

I opted to skip the next session, since I’d signed up for another one about pumping and I’d already been to two other pumping presentations by that time. I wanted to have a little down time to focus on my own upcoming presentations and make sure I felt centered and prepared for them. It was hard to focus though as I was nervous as well as distracted by everything else going on.

I sat in for a while during the alumni presentation where different anecdotes from LLL history were shared by Marian and other LLL “lifers.” Then, I got set up for my own first presentation: Create Your Amazing Year, using Leonie Dawson’s workbooks and my own experiences. I started out pretty nervous, particularly because there were people I’ve known for a long time in the audience and somehow it is easier to present in front of “strangers” than to friends! I warmed up though and surprised myself by sharing more little snippets about my students than I originally meant to. I was worried about sounding like “commercial”–either for the workbooks (for which I make no money!) or for my own business, since my experience of the Amazing Year workbooks is integrally tied to the jewelry business Mark and I have co-created—but it didn’t feel that way at all. I’d worked really hard on making a little slide show presentation that was a good visually accompaniment to my ideas and had all kinds of happy, useful little pictures and quotes and inspiration in it. I finished my hour with exactly four minutes to spare, which was pretty good since I certainly had never rehearsed it verbally to make sure my timing was right! I learned from birth class work though that one page of notes gives me one hour of material and that held true for this work as well.

After this session was dinner and a nice presentation by Marian about LLL Leaders changing the world. Following dinner was my final session, Active Birth and Pelvic Mobility. Since my session was scheduled from 7:30-9:30 p.m., I anticipated that people would do “conference math” and decide to go home early and skip my session. I was right. I had 12 people signed up, but only three actually came and none of them were actually registered for the session! We had a really great time together anyway and they seemed appreciative of the information and excited about what they learned. I finished early on purpose to make sure to get back for the close of the silent auction, but ended up having to wait around then for the other speaker’s session to finish before the auction actually closed. I got outbid on the lovely breastfeeding mermaid picture I wanted, but I did win a nice new, red BumGenius diaper and some Soft Star Shoes for new baby boy.

While our Brigid’s Grove booth was never exactly hopping with activity, we did double the (very modest) sales goal we’d set before leaving. I told Mark not to expect many pewter sales, because lots of people don’t have tons of extra money they bring to conferences, and to expect lots of small bead and charm sales from people wanting to bring little, affordable gifts home to people. I was totally wrong and most people skimmed right past the traveling bead shop (I think because it was too much to look at for the tight conference scheduling) and headed straight for the pewter. We sold completely out of our breastfeeding mama goddess pendant! We were invited to have a booth at an upcoming LLL mini conference in St. Louis in August and we’re strongly leaning towards going.

…She’s just feeding her baby. Is she? Or is she healing the planet at the very same time?

Milky smile, fluttering eyes, smooth cheeks, soft hair. Snuggle up, dear one. Draw close. Nestle feet to thighs, head to elbow. And know that you are encircled by something so powerful that it has carried the entire human race across continents and through time for thousands upon thousands of years on its river of milky, white devotion.

via Pewter Breastfeeding Mama Goddess

The most beautiful thing about conferences like this is the sense of continuity with work that has been going on for 60 years, as well as a sense of connection with the many, many women present and past who have served other women. The face-to-face time with Leaders scattered around the state is invaluable and I am surprised by how connected I feel with these friends I only see at most once a year. I’m not sure what my role in LLL will be in the years to come, as I feel myself moving further and further away from my original interest in one-on-one helping, but I’m pretty sure I can’t help but be a “lifer.”

Breastfeeding as an Ecofeminist Issue: Collage Project

May15

Since January I’ve been working with an independent study student from Prescott College on a self-designed course called Breastfeeding and Ecofeminism. Her class ended this month and her final project was a collage making the connection between the world body and the female body and reflecting the idea that how we treat women and their bodies as a culture is mirrored by our global treatment of the planet (and, conversely, if we change how women’s bodies our treated, our treatment of the planet will also change). As she worked on her collage, she also made a series of digital collage images for use on social media (see above), using quotes from her reading for the course.

“Governments and commercial companies will ‘invest’ billions in expensive new technology: roads, bridges, airports, dams or power generation plants, ‘for the good of society’. They may even ‘invest’ in schools and hospitals, but the crucial primary investment in the emotional, physical and mental health of all humans, which breastfeeding and mothering provide, is invisible.”

—Gabrielle Palmer (The Politics of Breastfeeding, p. 333)

As my student remarked, this is an atrocity. AND, it is one that is largely “invisible” to the average person.

I also find this quote relevant from The Politics of Women’s Spirituality:

“Human life is valuable and sacred when it is the freely given gift of the Mother—through the human mother. To bear new life is a grave responsibility, requiring a deep commitment—one which no one can force on another. To coerce a woman by force or fear or guilt or law or economic pressure to bear an unwanted child is the height of immorality…If they were genuinely concerned with life, they would be protesting the spraying of our forests and fields with pesticides known to cause birth defects. They would be working to shut down nuclear power plants and dismantle nuclear weapons, to avert the threat of widespread genetic damage which may plague wanted children for generations to come…” (p. 420).

For one of her digital images, she chose one of my favorite quotes from Reweaving the World in an article that touches on birth as an ecofeminist issue:

Here are some photos of her final collage project:

“Knowledge serves no purpose if it is not spread around. As the poor get poorer and the rich get richer, an entrenched ignorance is kept in place through a culture created and maintained by commercial interests.” – Gabrielle Palmer, The Politics of Breastfeeding