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Marianne Neifert: Find a need and fill it

Marianne Neifert, Colorado Women's Hall of Fame
Posted at 3:38 PM, Mar 15, 2020
and last updated 2020-03-15 17:38:38-04

This is one of a series of stories about the ten women being inducted into the Colorado Women's Hall of Fame. Click here to learn more about this year's honorees and the women being inducted.

Tell us a little bit about your upbringing and family. How did your childhood shape who you are today?

I was the middle of five children--a boy, three girls, and a boy. People often talk about the middle child syndrome. However, I thought I was the luckiest one in the family, since I was the only child who had both an older brother and sister and a younger brother and sister. My middle position age-wise also helped me to be closer to each sibling, which was another bonus.

I was born at Bethesda Naval Hospital and grew up in a military family. My father was a WWII veteran and a Navy JAG officer. We didn’t move as often as many military families do, although we re-located every 2-4 years during my childhood. When I was 9, while we were living in Northern Virginia outside Washington DC, my Dad was reassigned to the island of Guam in the Western Pacific for 2 years. I cherished that unique experience…the local customs, diverse ethnicities, breathtaking setting, and recent WWII history. Even as a young child, I was keenly aware how fortunate I was to have such a unique cultural experience.

Education was a very high priority in my family. My mother not only was a college graduate, she earned a Master’s Degree in 1941 from the University of Michigan – at a time when very few women achieved such educational milestones. She was a high school English teacher, and could teach other subjects, as needed. My father was the youngest of five surviving boys, born to immigrant parents. His mother was widowed when he was 9 months old and struggled to provide for her 5 sons, 10 years and younger. Like my mom, my dad placed a high value on education and was the only one of his brothers who graduated college, and then earned a law degree.

As a middle child, I carved out a unique identity by striving to excel academically, with strong support from my parents. I have many fond memories of my father reviewing my homework, helping me find a show-and-tell item, and reassuring me that I could achieve any academic goal that I set. Although transferring to a new school can be challenging for children, I actually enjoyed the adventure of moving, crossing the country from coast to coast for our trips to Guam and later to Hawaii, which was the last place my father was stationed.

I completed the last two years of high school in Hawaii, where I loved being exposed to the diverse ethnicities, as well as living with other military families on a Naval base. After high school, I enrolled as a premedical student at University of Hawaii and had completed the first year of college when my father retired from military service. This was a decisive moment for me, since I had become engaged to another military dependent, Larry, during my first year of college. We met through the Navy base’s chapter of DeMolay, where I had been selected as their Chapter Sweetheart. Larry, who was both Master Councilor of the chapter and Hawaii State Master Councilor, was my escort for the State Sweetheart Ball. That evening I was selected as State Sweetheart, based on the speech I had written and delivered on my chosen topic, How DeMolay Builds Self-Esteem in Boys.

Larry and I hit it off right away. You just know when it’s the right match. We met in July, and by Christmas Eve we were engaged. My family moved back to the Washington D.C. area the next Summer and Larry’s family relocated to California. With only each other, we decided to get married on the anniversary of our engagement. I was just 18. By this time, Larry had joined the Navy Reserves, and his unit was being activated during the Vietnam War.

Meanwhile, I continued my pre-med studies at University of Hawaii in earnest. I began taking a very heavy course load so that I could graduate a year early and start medical school. As long as I can remember I had wanted to be a physician. Whenever I saw others who were dealing with disabilities, illness, or loss, I felt profound empathy. I wished I could somehow enter into their lives, appreciate what they were experiencing, and learn how I might alleviate their suffering. However, attending medical school on the mainland was no longer realistic, due to Larry’s enlistment and our extremely limited financial resources. Miraculously, University of Hawaii opened a brand new, 2-year medical school the year before I graduated college.

Not long after marrying, my maternal instinct intensified, and I longed to become a mother. However, shortly after I became pregnant, Larry was deployed to the West Pacific aboard a Navy destroyer, and I was left alone. We had moved to a new neighborhood 3 days before he departed, and I felt more alone than I had ever been. I didn’t yet have a driver’s license and took public transportation everywhere, including to the University. It was a really low point in my life.

While Larry was deployed, I continued my studies and applied to the new U.H. Medical School. I was visibly pregnant for my interviews--all with male physicians. As my pre-med friends began receiving letters of admission, I received no response. When I inquired about my application status, I was told that the admissions committee was uncertain how to handle my application due to my pregnancy and that they preferred to defer my application until next year. I petitioned to address the committee members, and at this meeting, I explained that I had met all of the academic requirements to date and felt that I deserved to be admitted. I reasoned that if I could give birth in the middle of the semester, complete my courses, and attend Summer school to fulfill the final requirements to graduate early, that I deserved the right to start medical school in the Fall. Furthermore, if I failed to do all that, I knew there was a lengthy waiting list of applicants to fill my spot, and thus, the committee had nothing to lose by betting on me. A couple days later, I found a letter of acceptance in my mail box!

I learned several lessons that day: never underestimate the power of appeal; when you really want something, perseverance and dogged determination are required; and youthful exuberance can be a powerful asset! Fortunately, Larry returned home shortly before Peter was born. I got my driver’s license two weeks later, attended summer school, graduated from U.H., and started medical school a month later.

I LOVED being a mom, and our second baby was born early in my second year of medical school. I had her induced after class on a Friday, and was back in class on Monday. This irrational birth plan was the result of a professor’s insensitive comment to me days earlier: “When I was in medical school, pregnant women were expelled.” I decided that it was imprudent to ask for time off and that I would have my baby without missing a beat. However, I am not proud of that decision today.

Since U.H. medical school did not yet have the clinical years of training, I transferred to University of Colorado School of Medicine (UC SOM) for the 3rd and 4th years of medical school. I chose UC SOM due to its strong reputation in pediatrics and because of the many Neifert extended family members who had lived here for several generations. I gave birth to our 3rd child during the 4th year of medical school, and our 4th child was born late in my Internship year. Our 5th baby arrived on the final day of my pediatric residency training.

The privilege of attending medical school at a time when women comprised only 10% of medical students nationwide was the fulfillment of a lifelong dream. To this day, I remain deeply grateful to have been awarded a Bernice Piilani Irwin (a friend of Hawaiian Queen Lili‘u‘okalani) Scholarship after high school that paid my tuition for University of Hawaii and U.H. Medical School, and also helped offset the cost of my UC SOM tuition for the 3rd and 4th clinical years. We each owe a great debt to all those who smoothed life’s paths for us.

Early in your career you developed an interest in lactation challenges and breastfeeding education. What inspired that?

I knew that my mother had been breastfed, so I always imagined that I would breastfeed my own babies. However, breastfeeding in the US was relatively uncommon during the 1940s, 50s, and ‘60s, due to a combination of influences, including: the development of infant formulas, the influx of women into the workforce, and the belief that bottle-feeding of formula was convenient, scientific, and modern. By 1968, when my first baby was born, only 18% of US infants were being solely breastfed at hospital discharge. By the 1970s, when US breastfeeding rates began to rise, a generation of unsupportive hospital maternity practices kept women from getting an optimal start breastfeeding after giving birth. Furthermore, health professionals received little to no training in the art of breastfeeding or the physiology of lactation so they were not equipped to knowledgeably counsel breastfeeding mothers or manage their lactation challenges. As a 3rd year medical student, I was expected to know about various specialty formulas, but was taught almost nothing about breastfeeding.

I was deeply committed to breastfeeding all of my children. However, I was unable to sustain breastfeeding as long as I would have liked, due to inadequate maternity leave; long separations from my babies, including overnight call; the lack of effective breast pumps or break times; and essentially no workplace support or knowledge about maintaining lactation when separated from an infant. Although I was grateful for the months of breastfeeding I was able to achieve with each of my first four babies, I experienced the intense disappointment and loss of untimely weaning. My 5th baby was born on the last day of my pediatric residency training, and I finally was able to make breastfeeding my high priority. By this time, I had already been helping mothers maintain lactation for their premature and sick infants in the Neonatal Intensive Care Units (NICUs) at University Hospital and Children’s Hospital. I had immersed myself in learning about the physiology of lactation and the management of breastfeeding challenges and had read countless books and articles about breastfeeding and lactation published in medical journals.

A 2012 CWHF inductee, Mary Ann Kerwin, was one of the founding mothers of La Leche League, International (LLLI) in 1956, and she had moved to Colorado shortly thereafter. Mary Ann was a powerful and inspirational role model for me and helped advance my career by recommending me to speak at national LLLI conferences, thereby launching my educational and thought leadership. During this era, LLLI was the preeminent source of breastfeeding information and support, and I rapidly became part of their movement to empower women to trust their own bodies and restore breastfeeding as a community norm.

Your nomination states that you were the first physician to identify and widely publicize examples of women who are unable to produce enough milk and newborns who may be at-risk for ineffective breastfeeding. This seems like a big deal. What do you think made other physicians miss, or dismiss, these observations?

As breastfeeding was making a comeback in the 1970s after 3 decades of a formula-feeding norm, breastfeeding proponents emphasized that “every woman can breastfeed” and “every nursing baby will get exactly what s/he needs.” If a breastfed baby wasn’t thriving, it was believed that nursing more often would solve the problem (“the more you nurse, the more you make.”) This overly simplistic dogma was helpful in building women’s confidence in their ability to nurse their baby. However, it contributed to baseless guilt among many disappointed women, who for legitimate medical reasons, were unable to produce enough milk. Furthermore, it placed babies in peril when they were unable to obtain sufficient milk by breastfeeding.

Early in my pediatric career, as I began helping breastfeeding mothers struggling with low milk supply, I conducted in-depth interviews and began examining women’s breasts. I learned so much from my detailed conversations with mothers and by following their breastfeeding experience over time. One of the first key observations I made was the link between breast surgeries, marked breast asymmetry, and other breast variations and an increased risk of insufficient milk.

When my close colleague, Joy Seacat, and I co-founded the first center for comprehensive breastfeeding services in 1985, our learning curve increased dramatically. We had begun using highly accurate infant scales to measure an underweight baby’s milk intake when breastfeeding. The results were startling, as some babies who appeared to be nursing effectively actually transferred very little milk. The rule of “supply and demand” translates to “the more milk that is removed, the more a mother makes.” The converse also is true: If milk is not removed, the supply will dwindle. Thus, when a newborn is unable to remove milk effectively, mother’s milk supply declines, making it even harder for the baby to obtain enough milk.

When the highly accurate infant scales showed that infants were not effectively removing milk, we began advising mothers to express any remaining milk with an effective electric breast pump to help maintain, and even increase, their milk supply. Plus, the extra milk expressed could be used to supplement the baby, thereby minimizing the use of essential formula.

Initially, many breastfeeding proponents argued that using accurate infant scales to measure an at-risk infant’s milk intake while breastfeeding would be intimidating for mothers. However, today the infant “test-weighing procedure” is standard practice in many settings, including in NICUs to monitor premature infants’ progress transferring milk as they gradually learn to breastfeed. It is now commonly recognized that many newborns are at risk for ineffective breastfeeding, such as late-preterm infants born at 34-36 weeks of gestation, early term newborns born at 37-38 weeks of gestation, newborns with even moderate jaundice, or smaller newborns, weighing less than 6 or 6 ½ lbs. at birth.

Perhaps what I have enjoyed most in my career is sharing what I have learned about breastfeeding with diverse lactation care providers throughout Colorado and nationwide. I have been privileged to educate health professionals about breastfeeding management across Colorado and in all 50 states at diverse venues, ranging from presenting Grand Rounds at prestigious medical schools and lecturing to large audiences at national meetings of professional associations to speaking to staff at community hospitals in rural areas and health care workers on Native American reservations. I have been inspired and informed by dedicated “breastfeeding champions” and devoted nursing mothers wherever my travels have taken me.

When I first got involved in helping women overcome their breastfeeding challenges, breastfeeding was considered an individual woman’s “personal choice.” Today, I am proud to say that the maternal and infant health benefits of breastfeeding are so widely recognized that breastfeeding has been elevated to a public health priority, warranting society-wide support! In Colorado 90% of mothers begin breastfeeding their newborns, and more than 60% are still breastfeeding by 6 months. Early in my career, breastfeeding was not considered a legitimate topic in medical academia. Today, breastfeeding medicine increasingly is taught in medical schools, and physician experts in breastfeeding medicine are commonly represented on prestigious medical school faculties.
When I first got involved in helping women overcome their breastfeeding challenges, breastfeeding was considered an individual woman’s “personal choice.” Today, I am proud to say that the maternal and infant health benefits of breastfeeding are so widely recognized that breastfeeding has been elevated to a public health priority, warranting society-wide support! In Colorado 90% of mothers begin breastfeeding their newborns, and more than 60% are still breastfeeding by 6 months. Early in my career, breastfeeding was not considered a legitimate topic in medical academia. Today, breastfeeding medicine increasingly is taught in medical schools, and physician experts in breastfeeding medicine are commonly represented on prestigious medical school faculties.
You co-founded the Denver Mothers’ Milk Bank (MMB) in 1984. How did you come up with the idea, and what challenges did you have getting it started?

Well, like so much of my career, this was a very collaborative effort and another “find a need and fill it” story. In the early 1980s, a Denver mother, Joyce Ann, had given birth to a premature infant at a major local maternity hospital. She was unable to produce sufficient milk for her sick newborn. However, she knew human milk was superior to formula and had heard of donor human milk banks, so she asked the hospital staff about using donor milk. When she learned there was no MMB in Colorado, she met with me to inquire about starting one. I learned that the nearest MMB was in San Jose, CA, so we contacted staff there and began collaborating with them. My close colleague and I enlisted experts in infectious diseases, neonatology, and pathology, and we began meeting at Joyce Ann’s house to develop safe milk banking protocols.

When the Denver MMB opened its doors in 1984, I was the first Medical Director, and I continue to serve on the Advisory Committee. Today, the Denver MMB is the largest non-profit human milk bank in North American, and has distributed more than 6 million ounces of human milk from more than 14,000 donors who have come from every state, and has served hospitals in 33 states. As their vulnerable babies are helped by receiving donor human milk, mothers of recipient infants gain peace of mind and a sense of kinship with an unseen community of selfless women. When donor mothers express and share their surplus milk, they help ensure that they continue to produce more than enough for their own baby, making donation a “win for everyone.”
When the Denver MMB opened its doors in 1984, I was the first Medical Director, and I continue to serve on the Advisory Committee. Today, the Denver MMB is the largest non-profit human milk bank in North American, and has distributed more than 6 million ounces of human milk from more than 14,000 donors who have come from every state, and has served hospitals in 33 states. As their vulnerable babies are helped by receiving donor human milk, mothers of recipient infants gain peace of mind and a sense of kinship with an unseen community of selfless women. When donor mothers express and share their surplus milk, they help ensure that they continue to produce more than enough for their own baby, making donation a “win for everyone.”
What do you see as the biggest challenge for today’s generation of breastfeeding mothers?

Women today not only want to breastfeed their babies, many experience intense pressure to do so in order to “be a good mother.” Ideal infant feeding recommendations include an emphasis on achieving exclusive breastfeeding until solid foods are introduced around 6 months and continuing breastfeeding for at least a year. Enthusiastic promotion of breastfeeding is often coupled with the maligning of infant formulas and a campaign to promote “the risks of feeding artificial baby milk.” Yet, insufficient breastmilk remains an all-too-common lactation challenge, and less than a quarter of mothers actually achieve the 6-month exclusive breastfeeding ideal. This dilemma for mothers has led to a dramatic rise in informal milk sharing, whereby mothers who have a surplus of milk share (or sell) their milk among mothers who don’t produce enough. Although the FDA discourages the use of unscreened, unprocessed milk from another mother, the practice appears to be growing.

Our modern electric breast pumps with dual collection kits allow mothers to express milk from both breasts faster than they can nurse their baby. For a variety of personal reasons, at least 5% of women exclusively pump and feed expressed milk. Since employed mothers are separated from their infants for many hours each day, expressed milk is often fed by another caretaker. The dramatic rise in feeding expressed breast milk and informal milk sharing suggest that our society values the product, human milk, more than the relational process of breastfeeding. I want to remind mothers that breastfeeding is both a source of nutrition and an intimate relationship. Even moms who are unable to supply all of their babies’ nutritional needs by nursing, and thus need to offer supplements to their infant, can reap the significant mutual rewards of the cherished, intimate breastfeeding relationship.

I fear that breastfeeding has become one more source of pressure on women, many of whom still fall victim to the Superwoman Syndrome—the unrealistic expectation that we must achieve perfection in every life arena, and that “anything less than perfection is equated with failure.” The widespread use of social media further exacerbates the pressure many women experience to be viewed as perfect. A new term, Breastfeeding Guilt, has been coined to described the profound sense of loss, sadness, and even shame that can result from a disappointing breastfeeding experience. Rather than increasing the pressure on women to breastfeed, we need to further increase society-wide breastfeeding support and services to enable women to reach their personal breastfeeding goals.

Is there a message you want to make sure we are sharing with others?

When I was young, I thought I had to do everything at once. Now, I have learned the value of doing things more sequentially, and I recognize that there are different seasons of life. Being a mom is an awesome, indeed a sacred, privilege. If I could go back, I would take more time to integrate each baby into our family. I would work part-time, instead of full-time, when my children were young. I would savor more precious moments, and say “no” to the requests of others more often in order to say “yes” to my own priorities. I want to make sure other women are encouraged to live authentically within their personal value system.

Each one of us has unique signature strengths, and it’s important to get in touch with those special, individual attributes. We are richly blessed when we find a way to use those signature strengths in as many life arenas as possible (family, career, community), and in service to something greater than ourselves. In my own journey, it has been an immense privilege to “find a need and fill it” and to be fulfilled in the process. I consider my work with breastfeeding mothers to be integrally linked with “launching families,” with helping new parents navigate such a precarious transition…in a way, giving other mothers what I would have loved to receive as an, often overwhelmed, new mother myself. Looking back, I can say with immense satisfaction, “Hasn’t it been great!?”