In December, 2020, Mariana Gambande, a student of the Douglas College Breastfeeding course for Health Practitioners, asked me for an interview and sent me the following questions. I appreciate the breadth of the questions, and am publishing the interview here as an introduction. 

Question: You are a holistic lactation consultant, how did you end up studying that and what motivated you? Did this information lead you to the use of galactagogues? Where did you study?

Hilary Jacobson: I discovered herbal and dietary galactagogues in 1988 while living in Switzerland. This was a time when doctors and lactation consultants were legally not permitted, per their certifying medical boards, to talk about such “unscientific” things with mothers. 

My personal success with galactagogues and a lactogenic diet motivated me to dive into the research, using the Swiss University Library system as my main resource. 

As I learned more, I resolved to write a book, Mother Food. Coincidentally, the first school of Holistic Lactation formed in 1999 in a Swiss town called Rapperswil, and I was one of the first certifying students. The founder, Christiane Husi-Simoniis, helped me understand herbology, TCM, Ayurvedic medicine, acupressure, and mind-body connection. Those insights were incorporated into my book Mother Food.

The website for the Swiss school of Holistic Lactation Consulting ( Ganzheitliche Stillberatung CH.HU.SI.®)  is: www.stillberaterin.com 

Question: You are also a trained Hypnotherapist, what was your motivation to start that journey?

Hilary Jacobson: Over the years I listened to probably hundreds of mothers talk about the emotional toll of their breastfeeding struggles. For my part, a feeling of sadness and helplessness also grew because I did not know how to help them heal from these emotional wounds. I had figured out the herbs and foods part of the puzzle, but I couldn’t help them in this area. 

I believe that every day a mother is stuck in feelings of loss and grief due to breastfeeding or birth trauma is a day that is lost, or reduced, in multiple ways, for the development of that baby and the development of that relationship. 

We can’t just shake off trauma or grief. A mother can’t decide: “Today I’m just going to feel better,” as much as she might try. She can talk to her doctor about medication of course, but it typically takes a month for medication to unfold its effect – that is lost time – and it does change the personality. 

Many mothers start their mothering journey feeling trapped in negative, crushing emotions. They absolutely do need specialized help. The good news is that trauma actually can be moved through and healed, and that this process is accelerated with hypnosis.

In summer 2013,  I took a 3-month certification course in hypnotherapy. It might surprise you to learn that I did not actually intend to become a practicing hypnotherapist. The school had just opened up in the town where I lived, and I thought that learning about hypnosis might be interesting and a fun way to spend the summer. As a writer, I was curious to experience how words and images can evoke deep relaxation and a state of trance. I have meditated since my teens, and I wanted to see if and how meditation and hypnosis overlap. 

I found the training fascinating, but also surprisingly very healing, physically and emotionally. During the last days of the training it finally hit me that I had unwittingly acquired a therapeutic skillset that I could actually use to help mothers. It felt to me as though my wish had been answered.

I began to practice hypnotherapy with volunteers from mothering forums. With time, I developed techniques that are well-suited to mothers in the postpartum. Presently, I offer one-on-one sessions, but I am also preparing mentoring classes for mothers in basic mindfulness and self-hypnosis techniques–a kind of soft introduction to this form of healing.

Question: Based on your historical research, would you state that breastfeeding has become more or less challenging in our modern culture compared to ancient times? Why do you believe so? What aspects  of our culture are influencing this phenomenon?

Hilary Jacobson: I am fascinated by lactation in early hominids and primates. We know that first-time chimpanzee mothers sometimes fail at milk production. I wonder: is there a sub-set of female primates who struggle more than others?

Studies on primates living in their natural environment reveal a breastfeeding hierarchy: mothers who are stronger and able to access more food have a calmer, more secure personality. Mothers who are weaker and who have access to less food are more nervous. These two types have different patterns of milk production, and their offspring have different patterns of growth and temperament. I think this is a really interesting line of thought. Ayurvedic medicine divides us into types, and the vatta type (nervous, mental, creative) is more prone to lactation problems, per this theory.

If we look at early historic times, we see that in early Western civilizations, mothers quickly lost the basic skills of breastfeeding. In Roman times, books written by a doctor named Soranos carefully outline remedies for the breastfeeding challenges of the upper class. Those recommendations would apply to city-living women today, too.

There is no question however that today’s breastfeeding challenges are unique to our times. Fifteen years of research into lactation difficulties, both on a mother’s and her baby’s side, confirm that our challenges are new.  

On the mothers’ side, many women have hormonal imbalances that affect lactation, especially insulin resistance. Today, half of the world’s the adult population is pre-diabetic. Easy weight gain, obesity, gestational diabetes and type two diabetes and PCOS are all associated with some degree of lactation difficulty. Not every woman with insulin resistance will have lactation problems, but many will.

This is new–and it is a tragedy. We know that many of these women, if given proper support, will overcome these difficulties and go on to breastfeed well. But proper support is both subtle and complicated, and must be tailored to each individual mother and baby. This requires highly trained, devoted and intuitive lactation consultants – in a world in which the skills of the highly trained lactation consultant are hardly recognized or valued. And because health insurance rarely covers this kind of care, it is denied to women of lower socioeconomic levels. 

This is where the the “lactogenic diet” gains relevance, as this diet consists of foods and herbs that improve insulin function while also supporting the major organs of digestion, detoxification and elimination – and this improvement is available to anyone willing to change their food choices. What I am saying is that in addition to improving the mother’s supply, the lactogenic diet may help correct the underlying metabolic imbalances from insulin resistance, and prevent the progression to serious disease.

On the babies’ side, we see more babies with severe “oral tethering,” in which the tongue, lips and even the inner cheek tissue are “tied” together in ways that prevent free and complete movement of the tongue. As well as oral tethering, we see more narrowing of the jaws. While these problems are not new, their prevalence has increased. In the 1970s, Swiss doctors wrote that the narrower jaws were the result of zinc deficiency in the mother’s or grandmother’s diet. This was the first I heard of nutritional lacks having cross-generational consequences. The sheer numbers of children today with structural changes in their mouths and skulls is most likely the cumulative effect of two or three generations who have now lived immersed in the full western, industrial lifestyle (food, medicine, substance abuse, exposure to toxins and stress). 

For a demonstration of such changes, see the documentation of Weston A. Price from the 1920s:  photographs of the facial and dental structures of tribal peoples before and after eating the western diet.

C-sections  also take a toll: they deprive mothers of natural oxytocin and opiate surges, which prepare the pituitary for the production of prolactin and also prime the mothers’ and baby’s brain for bonding. Also, a baby born with C-Section is deprived of an important dose of microbiome from the mother’s vagina, increasing the risk of infant colic and intestinal disease later in life.

And more babies born today have torticollis – that is, their bodies are stuck in a state of tension, so they cannot relax into their mother’s arms to nurse. Mothers in most cultures learn to massage our babies every day, to release the muscular tension. Today, we must take our baby to a skilled physical therapist, a so-called bodyworker, who is specially trained in infants.

Question: Why do you believe it is so difficult for mothers to overcome the sadness of not being able to meet their breastfeeding goals? 

Hilary Jacobson: Mothers frequently say that breastfeeding grief is the worst experience of their lives, comparable to the loss of a loved one. I believe that is because it relates so directly to the core and heart of ourselves as a mother.

One reason it is hard to heal is the loneliness that accompanies the experience. Mothers don’t feel understood and so they do not talk about their feelings. The emotions they feel are complex and intense. Not being able to share these feelings only compounds their intensity.

For mothers to overcome these feelings, and to rediscover and embody their mothering confidence and joy, specialized help is needed. I have developed a method that yields wonderful results. I hope more hypnotherapists will learn these skills and that the essential elements of this approach will one day be wrapped into mainstream postpartum care.

One last thing: not all mothers experience these intense feelings. Many can move through the experience of breastfeeding disappointment feeling sad, of course, but not traumatized, and they are soon able to feel well and be present with their baby.

Question: What do you think of the use of galactagogues during pregnancy? Is it possible that they help to stimulate lactogenesis in your experience?

Hilary Jacobson: This subject is close to my heart. No mother or baby should have to wait a full week for the milk to arrive. Multiple studies show that lactogenic meals and beverages the week after childbirth bring the milk in earlier and more fully. This option should be available at all birth clinics and from postpartum doulas. We should avoid the powerful galactagogue herbs, as they can cause engorgement and oversupply, but instead serve gentle lactogenic ingredients and teas that support the transition to milk production.

To your question, over the years, I have seen stark improvement in mammary gland tissue during a second or third pregnancy when certain herbs are used with regularity. I know of three cultures that recommend specific foods during late pregnancy to help with lactogenesis. This really needs to be studied.

I personally advocate for eating a lactogenic diet during pregnancy and enjoying gentle lactogenic meals and beverages after childbirth, and I believe this will lead to a more timely and comfortable launch of lactation and to a more optimal milk production long-term. 

Question: Many times, for the sake of avoiding anxiousness in the mother, it is not indicated to prepare for any eventual breastfeeding problems. However, parents are usually prepared for eventual birth issues, reflected in the vast majority of births taking place in hospitals nowadays. What is your opinion about this phenomenon?

Hilary Jacobson: It’s a conundrum. Mothers who struggle to nurse often say they dearly wished someone would have told them about the possible problems beforehand, and saved them a lot of hardship. But mothers who receive this information before or during pregnancy sometimes say they wish they had not been told, because it caused them unnecessary concern and worry.

This conundrum is just one example of the “uncomfortable spaces” that parents and healthcare providers occupy.

I see it this way: our medical system has a legally binding contract with US citizens to inform us about what we might encounter, what we might prepare for, and what we might prevent through lifestyle choices and behavior. To a great extent, this is not happening.

Our healthcare system is a “divided house,” meaning, it has divided loyalties. Actually, it has many divergent loyalties. And the first rule of medicine, “Do no harm,” gets lost in the process.

For instance, a higher-up at the WHO told me in the early 1990s that, “We say “all women can nurse” not because it is true, but because it will remove doctors’ excuses to push formula feeding instead. You think we are aiming this slogan at mothers in the United States, but really we are aiming it at doctors all around the world. We are insisting that they motivate mothers.”

I replied, “But what about the multitude of mothers who take it literally, and when they cannot produce a full supply, feel like failures.”

He said that was sad, surely, but their priority was to influence the behavior of doctors and women around the world. I later understood what he meant: if mothers in the United States cannot produce a full supply, it is sad but not fatal. But when women in impoverished areas of the world are not encouraged to nurse, and if they then have to resort to formula, it can drive the family into deeper poverty, and also cause long lasting health problems or death for the baby, because often the formula was mixed with unhygienic water, and also stretched, to last longer.

This was how I learned about the “individual vs the population” problem. Help the individual, hurt the population. Help the population, hurt the individual. Examples I often hear around breastfeeding are: 

“If we tell all mothers that nursing can be challenging, fewer of them will try to nurse.”  

“If we tell all mothers that their diet impacts the quality of their breastmilk, fewer will try to nurse because they wouldn’t want to change their diet.” 

But for many mothers, and perhaps the majority of healthy women, being told about potential problems and also learning tools to prevent or ameliorate the problems, or being encouraged to accept the problem and not blame themselves if it cannot be improved, will not de-motivate them. Just the opposite. They will take the information and run with it. And that can mean better mental and physical health for the entire family, and possibly for further generations of that family.

Our medical industry has divided loyalties. Research into nutrition is lacking. Education in nutrition is minimal at best for doctors and nurses. This helps explain why there is so much push-back on the idea that diet could resolve some of our lactaiton problems.

In my ideal world – a fantasy, admittedly – we would teach young people about cross-generational health loss, due to the western diet and the rise of insulin resistance. We would start in fifth grade, provide more info in sixth grade and Jr. High School, invite parents to learn along, and add more details in High School, including the fact that with insulin resistance, fertility problems and breastfeeding problems are more likely.

We might motivate them with examples of how dietary and lifestyle changes that will most probably improve their own health for the longterm and possibly make breastfeeding easier — but that in the short run, will probably improve their concentration abilities and memory for their school work. 

My daughter was shocked to see documentaries about the sixties, and to note that none of the teenagers and young college students were overweight. What happened? How did we get here? How can we turn the trend around?

Bottom line, if a Great Depression were to come again — a time when many families survived with a small backyard garden, by eating simple food and salad made with dandelion greens from their garden — it is good to know that some important lactogenic herbs grow abundantly as weeds in every patch of soil across the country, and indeed the world. They are free for the taking and can be easily transplanted and cultivated in backyards and community gardens–even on window-sills, balconies or fire-escape platforms. 

In my new book about growing lactogenic foods and herbs, indoors and outdoors, I devote a chapter to describing modern lactation problems. I describe what we can do to correct them, as much as possible anyway. And I show ways to grow lactation-supporting  herbs no matter if you live in a small apartment or a farm.

Question:  Have you found any differences between Switzerland and the US regarding breastfeeding practices?

Hilary Jacobson: When I lived in Switzerland, the people were healthier than here in the US. One example: fungal infection of the nipple called “thrush” was unknown. We in the US are more prone to fungal infection because our diet is processed and heavy on carbs,  our doctors over prescribe antibiotics, and more mothers have C-Sections and routinely are given antibiotics at that time. 

Swiss mothers aim to exclusively breastfeed for six months – and most do. There are milk supply problems but not as many as in the US. Lactation teas, non-alcoholic beer, lactogenic vegetables and foods such as oatmeal, fennel root, malt and whey are routinely used by mothers to support their supply.

Question: What advice would you give to a pregnant woman, to a mother who is experiencing low milk supply, and to one that is experiencing breastfeeding grief?

Hilary Jacobson: Read my books. Grow a galactagogue garden. Stay hydrated. Take yourself seriously and treat yourself kindly. Create a network of holistically trained mother-baby healthcare providers, and reach out for support when needed.

Also, please know that breastfeeding is not the end-all of mothering. There are many things you can do to achieve secure bonding and good neurological and immunological development for your baby. I talk about these in Part Three of my book Healing Breastfeeding Grief, but this really needs to be discussed and taught in childbirth and breastfeeding preparation classes: what besides breastfeeding promotes best development and good bonding. 

We need to have a larger discussion. We are truly all in this together. There is no race or area of society that is not affected. We are all experiencing profound cross-generational losses. But we can improve the health of individuals and the population as a whole over the next few generations by learning new self-healing skills, learning new (and inexpensive) approaches to diet, and refusing to go along with the poor food and lifestyle as it is offered to us today.