Note: This Q&A first published in Mississippi Today's InformHer newsletter. Subscribe to our free women and girls newsletter to read stories like this monthly.

Dr. Christina Glick is a retired neonatologist who runs Mississippi Lactation Services, one of the only free-standing breastfeeding clinics in the Jackson area. She is an advocate of family-centered care, a system of practice that incorporates the family in therapeutic, management and even diagnostic decision-making, and a proponent of breastfeeding as medicine.

Research around breastfeeding – which lowers the incidence of numerous diseases, infections and depression in both mother and baby – has made strides in the last few decades. Still, Glick says she sometimes encounters colleagues who joke that she “quit practicing real medicine” when she opened her clinic in 2015.

With the highest rate of preterm birth, Mississippi could stand to benefit from increasing its breastfeeding rate – one of the lowest in the country. Mississippi Today spoke with Glick about the science and stigma of breastfeeding, the multi-billion dollar infant formula industry, and what would be needed to eradicate unnecessary pharmaceutical intervention in baby feeding practices.

Editor's note: This Q&A has been edited for length and clarity.

Mississippi Today: How did you first get into breastfeeding research and, at the time, did you feel like it was a rather underappreciated or niche area?

Dr. Christina Glick: When I first did my training back in the early ‘80s, there was no breastfeeding training in medical school at all. It wasn't even mentioned. And one of the things we were regularly losing babies from was malnutrition. So, the smallest babies were the hardest ones to be able to feed. And so there was some early work in the late ‘80s that breast milk was maybe a solution for some of our malnutrition issues in the tiniest, sickest babies who had chronic lung disease and just weren't able to get enough nutrition. I got certified as a lactation consultant by the International Board of Certified Lactation Consultants, IBCLC, in the early 2000s. I started working with breastfeeding for my NICU patients at that time, and when I was in private practice I began to do a lot of breastfeeding medicine in the NICU.

When I opened my clinic, I thought ‘well I know a lot about breastfeeding and it's going to be a pretty easy adjustment from intensive care medicine to lactation,' and it was not – at all. I found that I knew very little about breastfeeding – and I've breastfed three children of my own. It's a very confusing thing: you think it's natural so it's going to be simple, but it's a very complex field of work. I have found that it's absolutely critical to be able to coordinate the teamwork between the provider and the family to be able to successfully advocate for breastfeeding.

It is an extremely underrepresented field, still to this day. It's getting more and more recognition but I still get people kidding me, ‘well, you quit practicing real medicine' and stuff like that.

MT: Tell us a little bit about the research around breast milk and how breastfeeding has been shown to be mutually beneficial for mother and baby.

CG: There are so many aspects of breastfeeding that are just, seemingly magical. There's the nutritional part of it – it's the perfect food for the baby. So it's exactly matched to the proteins that babies need. And we've found that breastfed babies actually need less volume, less protein, less calories when they're fed breast milk – because it's the perfect food.

Babies that are breastfed, we know, have a lower incidence of some of the diseases that are the most common causes of adult bad outcomes including cardiovascular disease, heart attack and stroke. So breastfed babies have less of that. And we always thought it was a nutritional thing but as we've been discovering, the human genome is actually affected by breastfeeding. So the epigenome, which is the part of our genetics that is changeable, is actually impacted greatly by breastfeeding. And so we think now that breastfeeding changes the likelihood of having heart attacks and strokes, based on the changes in the genome, not as a nutritional result – which I find pretty amazing. The breast milk actually turns off bad genes and turns on good genes.

And as we studied the microbiome, we found that breastfeeding dramatically changes the microbiome and probably has a really big effect on our overall long-term health as well as the epigenome. So breastfed babies have completely different colonies of bacteria in their gut and we think that affects their overall health and their immunological response to infections. So it's not just the nutritional benefit but also the microbiome that helps fight infections.

MT: Aside from all the benefits for the baby, what are some of the benefits for the mother? Can it help with things like postpartum depression?

CG: Yes. And one of the confusing things about breastfeeding is that the first couple of weeks are usually pretty stressful. We always paint it as a time of bonding and rainbows and unicorns or whatever but establishing breastfeeding in the first couple of weeks can be extremely stressful.

And sometimes the first few weeks are so stressful that people imagine that postpartum depression is increased by breastfeeding – but the data shows that it's actually protective. One of the best things that happens with breastfeeding is the hormonal changes that breastfeeding brings on are really unique. So, breastfeeding moms have really high levels of prolactin. And they have huge oxytocin surges which is what stimulates the transfer of milk to the baby. And it turns out that the oxytocin surges are pretty unique in breastfeeding mothers, and those oxytocin surges help reduce the incidence of cardiovascular disease long-term in the mother. So, we see less heart attacks and strokes in mothers who have breastfed for any significant time that is more than a matter of weeks.

In addition, breastfeeding helps reduce breast cancer. So breastfeeding mothers have a lower risk of developing breast cancer throughout the rest of their lives.

MT: Why do you think Mississippi has one of the lower rates of breastfeeding in the country?

CG: One of the things that gave formula such a strong foothold early on in the ‘50s and ‘60s was that it was called formula, so it was like the perfect scientific formulation of milk for a baby that was going to make babies healthier than breast milk. And so it became a socioeconomic incentive that well-off people can feed their babies with this new, special formulation of milk. So, it became a status symbol, if you will, that formula-fed babies are better off than breastfed babies. And that lingers in our culture today in America that it's considered an advantage to be able to formula feed babies.

And one of the things that has happened is that one of the programs that serves lower socioeconomic groups, particularly single women, is the WIC program – Women, Infants and Children Program – and that has really translated to a sort of formula chain. There are some lactation consultants who work on supporting breastfeeding, but it's not a perfect system and it tends to be sort of a knee-jerk to offer women formula instead of breastfeeding. It just seems easier, so if there's any bump in the road they tend to switch to formula.

Breastfeeding is a cultural thing. If your mother breastfed you and your sisters and your cousins and everyone is breastfeeding their babies, then there is a lot of community support. If you come from a culture where everyone is formula feeding, there's no one there who really understands. So when you hit problems, the answer is formula.

And unfortunately, the indigent population in Mississippi, and in the country as a whole, is still on the formula highway. There's not support in our culture by a long history of breastfeeding. So, if you're in a formula culture, you tend to formula feed and that is the case in Mississippi.

MT: Mississippi also has one of the highest rates of cesarean sections in the U.S. Are these two things, high rate of cesareans and high rate of formula use, connected?

CG: Right, great question. With a cesarean, there are a number of things that interfere with the initiation of breastfeeding. So, one of the big things is that a woman who has a C-section gets a big bolus of fluids, and that translates pretty quickly straight into the baby. So babies born of C-sections have higher water content in their bodies. And when we're water overloaded what we do is pee it all out pretty quickly. And so babies born by C-section tend to lose weight really quickly. And we have this 10% cutoff, based on a terrible study that said that babies who lose more than 10% of their birth weight are in danger, and immediately supplement them with formula. So, just the weight loss piece of surgical deliveries makes them be at higher risk of formula supplementation recommendation right off the bat.

And then the second thing that happens is that surgical delivery delays the milk coming in. So, there's breast milk and there's colostrum. And normally, we transition from colostrum to regular milk by the second or third day, but with surgical deliveries that's delayed to the fourth or fifth day. And oftentimes when a breastfed baby is only getting colostrum for four or five days, they're pretty darn hungry by the time the milk comes in. And they've lost a lot of weight. So you have a crying, fussing baby who is acting unsatisfied and the natural response is to give the baby supplementation, instead of saying ‘it's ok for that baby to cluster feed for 10 or 15 times a day to get that milk.' And the data is that if you use more than four ounces of formula in a 24-hour period in the first month, it dramatically interferes with sustainability of breastfeeding in the long term.

MT: In your view, do you think more Americans are using formula than need it? What would be needed to shift the paradigm?

CG: Absolutely. That is completely, absolutely true. And one of the unfortunate things that has happened as a result of the move toward formula is the companies who have produced formula are very powerful political forces in this country. So it's an economic incentive for hospitals and doctors to push formula. And that's become a real driver in the supplementation of formula in our country. And breastfeeding is not a powerful money-making industry, right? So it's very hard to fight the pharmaceutical intervention in infant feeding practices in our country.

We would need to strip the pharmaceutical power and make that not a factor anymore … Most mothers are given a sample of formula when they register at the prenatal clinic. So that's a huge tool to get formula in your front door by sending you free formula. That should be banned. It should be illegal to do that.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.