BBy Lillian Scott, MS, CCC-SLP, IBCLC
Before diving into this post, please take a few minutes to close your eyes and reflect. Think back to how you and your siblings were fed during infancy. Were you breast/chestfed? Did you help feed your siblings or another baby? Did you pretend to breast/chestfed your dolls? Were you bottle fed formula? Maybe a hybrid of breast/chestfeeding and bottle feeding formula because your mother returned to work at six weeks post-partum and electric pumps were not readily available.
Now, fast forward to your teenage or young adult years. Think about the first time you noticed someone outside your family breast/chestfeeding. What were your feelings? Now, think about the beliefs you hold about different cultures/races’ breastfeeding practices. Why do you suspect their beliefs and practice for breast/chestfeeding may be the same or different from yours?
Implicit and Explicit Bias
These beliefs you hold are biases, prejudices in favor or against one thing. The bias was formed through both conscious and unconscious thoughts that begin taking shape in infancy and continue to evolve through life events, culture, education, and experiences. Explicit bias are attitudes or stereotypes that affect our understanding, actions, and decisions on a conscious level. Since we are generally aware of these, we will focus on implicit bias defined as the “attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. Implicit biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control. Residing deep in the subconscious, implicit biases are different from explicit/known biases that individuals may choose to conceal for the purposes of social and/or political correctness. Rather, implicit biases are not accessible through introspection.” (excerpt from the Kirwan Institute)
We all have biases, learn more by exploring this resource: Project Implicit
Speech-Language Pathology Bias
Now that we have explored bias, we may hold space to discuss how our bias for infant feeding may be impacting breast/chestfeeding. These biases may be impacting our practice but more importantly impacting our clients and their families in meeting their breast/chestfeeding goals.
We, as Speech-Language Pathologists (SLP) and medical professionals, need to be aware of how our implicit bias affect our recommendations for infant feeding. The SLP’s role is to assess, diagnose and provide treatment for infants and children who have swallowing and feeding disorders (Pediatric Dysphagia Practice Portal Pediatric Dysphagia Practice Portal). This includes considering culture as it pertains to food choices, perception of disabilities, and beliefs about intervention (Davis-McFarland, 2008).
SLP culture is biased to support artificial nipple feeding, also referred to as bottle feeding. Research by SLPs in the area of neonatal and infant feeding is typically on the use of artificial nipples (bottle feeding) and how to mimic breast/chestfeeding with these devices. SLP’s lack of training on breast/chestfeeding limits our knowledge and comfort level with the natural and normal method of nurturing the infant and toddler (Blake, 2014). New research supports that SLP students are learning about breast/chestfeeding (Mahurin-Smith, J. (2018) and social media discussion groups that focus on infant feeding frequently have clinicians inquiring about feeding difficulties and dysphagia in neonates, infants, and toddlers who are receiving human milk.
Are we, as SLPs, supporting the human lactation goals of our families or are our biases impeding our culture shift?
History of breast/chestfeeding in the United States
Watch this short video: Growing a First Food Movement Note: SLP’s involvement in the field of swallowing began as early as the 1950s but significantly increased with the pediatric population in the 1970s and 1980s.
Implicit Bias & Clinical Breastfeeding Care By Melanie Miller, MA, IBCLC
Hosted by Central Jersey Family Health Consortium
February 26, 2019 noon EST
Please explore these resources to learn cultural perspective for breast/chest feeding and how each organization is supporting, promoting, and protecting breast/chest feeding. This list is not extensive by any means. I encourage you to join your local or state breast/chest feeding coalition (USBC Directory).
Appalachian Breastfeeding Network
Breastfeeding Without Birthing (adoption, relactation, induced lactation)
Breastfeeding Without Birthing (book) by Alyssa Schnell
Camie Jae Goldhammer, MSW, LICSW, IBCLC (Sisseton-Wahpeton) and Kimberly Moore-Salas, IBCLC (Diné)
Latino Best Start
Where’s the Mother? (book) Trevor MacDonald
Native Breastfeeding Coalition of Wisconsin
ROSE (Reaching Our Sisters Everywhere)
Chestfeeding refers to transmasculine or gender non-conforming individuals and the act of feeding a baby or child at the chest with or without a supplementing tube (MacDonald, 2016). Parents who identify as female and who have a history of abuse may experience dysphoria regarding breasts thus prefer the term of chestfeeding. The intention of this term is to have inclusive language.
Blake, A. N. (2014). Breastfeeding knowledge and clinical management among speech-language pathologists (Master’s thesis). Retrieved from ProQuest Dissertations and Theses database (UMI No. 1557076).
Davis-McFarland, E. (2008). Family and cultural issues in a school swallowing and feeding program. Language, Speech, and Hearing Services in Schools, 39, 199–213.
MacDonald, T., Noel-Weiss, J., West, D., Walks, M., Bienwe, M., Kibbe, A., & Myler, E. (2016). Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study. BMC Pregnancy and Childbirth. 16:106 https://doi.org/10.1186/s12884-016-0907-y
Mahurin-Smith, J. (2018). Changes in Speech-Language Pathology Students’ Attitudes Toward Breastfeeding During a Pediatric Dysphagia Course. Journal of Human Lactation, 34(4), 721-727.
Mahurin-Smith, J. & Genna, C. W. (2018). Assisting the Breastfeeding Dyad: A Guide for Speech-Language Pathologists. Perspect ASHA SIGs, 3 (SIG 13), 47–57. doi: 10.1044/persp3.SIG13.47
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