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Inside Appalachia

Breastfeeding is Natural, But for Many Appalachian Women, It’s Not ‘Easy’



Emma Pepper plays with her son at their home in Charleston. Pepper struggled to breastfeed for six weeks before switching to formula -- a decision she says she wishes she would have made "much sooner." Photo: Kara Lofton, West Virginia Public Broadcasting

Infants should be exclusively breastfed for the first six months after birth, says the American Academy of Pediatrics, citing research that says breastfeeding is healthy for infants. It protects against diseases, obesity and stomach issues, helps the mother lose weight and decreases the risk of some cancers. But although breastfeeding is “natural,” for many women, it’s not “easy.”

When Emma Pepper got pregnant, she was totally on board with breastfeeding — until her son was born.

“He could never quite latch properly,” she said. “And he was actually born on a weekend in the hospital and so the lactation consultants weren’t available to support me in the very beginning.”

Pepper lives in Charleston, West Virginia. West Virginia Public Radio reporters called 14 hospitals in the state and only two had breastfeeding consultants available around the clock, even though it’s common for women to struggle with breastfeeding after giving birth.

Unless doctors and nurses have undergone special training, they may not have the expertise to help new moms learn to breastfeed. Only four hospitals in West Virginia require formalized breastfeeding training for nurses and doctors on labor and delivery floors. These hospitals have a “baby friendly” designation from Baby Friendly USA, a World Health Organization and UNICEF program designed to improve the role of maternity services worldwide.

The hospital where Pepper gave birth is not one of the four. Pepper said she was told by a nurse to keep her son for more than an hour on each of her breasts to try to get him to latch. By the time she was discharged from the hospital, she said her nipples were raw.

“It ended up making my breastfeeding experience just more challenging overall,” she said.

A 2013 study published in the journal Pediatrics found that 60 percent of women don’t breastfeed as long as they intend to. This is because of latching problems, concerns about infant nutrition and weight, the need to return to work, or because they don’t have enough support as they try to figure out breastfeeding.

Kailey Littleton, a pediatrician and board-certified lactation consultant in Weirton, West Virginia, said a lot of women she sees have problems breastfeeding.

“Because the information is not great and a lot of the ‘help’ that women get is not the best for them, things tend to go awry,” she said.

Littleton said she hears stories from women about how friends and family or even doctors and nurses have encouraged them to supplement with formula. But supplementing with formula can impact breast milk supply, making it harder to breastfeed. She says many women are also told some pain is normal — but she says it’s not — and that pain is the sign of a bad latch.

When Pepper was discharged, her son still wasn’t latching properly. The doctor recommended she supplement with formula. Pepper was okay with that, but she still wanted to breastfeed. She worried that if she didn’t, her son would be sick more often.

In the meantime, she was being urged on by a lot of people. Her friends, her therapist, even her hairdresser, asked her if she was breastfeeding.

“And so I felt an extreme amount of just societal pressure to be able to live up to that,” she said. “And as a result of that, I made some pretty extreme demands on my body in order to be able to fulfill that wish that I had for him.”

Pepper said she spent hundreds of dollars on pumps to increase her milk supply. About a week after giving birth she also connected with a local lactation consultant who suggested a strict regimen: breastfeed, then supplement with formula, then pump to increase milk supply. But Pepper said she was either breastfeeding or pumping around the clock. It wasn’t sustainable.

“I felt such an enormous sadness that I was wearing this pump all of the time, and I couldn’t hold and bond with my baby while I was wearing it, and I only had a limited amount of time for maternity leave,” she said.

After about two months, Pepper would have to return to work. She struggled to breastfeed for six weeks, then the lactation consultant recommended she switch to formula.

“Receiving that advice from her was part of what gave me the confidence to go ahead and switch to formula feeding when I felt I had exhausted every single avenue available to me to make breastfeeding work,” said Pepper.

It’s a decision she said she wishes she had made earlier.

This article was originally published by West Virginia Public Broadcasting.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

Inside Appalachia

Mountain State Mead Makers Provide a Taste of Appalachia



Mountain Dragon Mazery makes nine varieties of mead. Photo: Larry Dowling, West Virginia Public Broadcasting

Mountain Dragon Mazery co-founders Ruthann Smith and Tom Maltby began making honey wine — or mead — more than two decades ago as a way to marry their love of old-world traditions with their love of honey. Five years ago, they opened a tasting room and custom-made micro-factory to produce and bottle nine varieties of mead on a commercial scale. They’re part of the fastest-growing sector of the alcoholic beverage industry in the U.S.

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“I’ve been a beekeeper since I was three and alcohol making has always interested me,” explains Maltby, who sports a long, grey-streaked beard and brown leather fedora with feathers.

At its core mead is simply water, honey and yeast, mixed together and left to ferment, but the beverage can take many forms. Fruit, spices, rose petals and more can be added to create different varieties. Mountain Dragon Mazery, for example, specializes in a style of mead that is dry, which makes for easy drinking.

Tom Maltby checks on fermenting mead. Photo: Larry Dowling, West Virginia Public Broadcasting

Historians have found evidence that honey wine was made by communities around the world thousands of years ago, something Smith and Maltby have embraced. Their blue glass bottles of mead are adorned with a dragon and red-haired maiden logo. Inside their tasting room and factory ⁠— an old neighborhood bar in Fairmont, West Virginia, that has been repurposed ⁠— a large black and orange dragon kite hangs near the bar.

“It’s been really neat to bring to the local community, and West Virginia in general, an old-world craft to the modern times,” Smith said.

In the decades since Smith and Maltby began experimenting with mead in their kitchen, the beverage, often associated with Vikings and medieval feasts, has experienced a modern-day revival. In 2000, there were less than 100 commercial meaderies nationwide, according to the American Mead Makers Association. Today, the trade group estimates a new meadery opens, on average, every three days.

“When we first opened the people would come in and say, ‘you’re making alcohol out of honey — are you sure that works?’” Maltby said. “And now we have people searching for us, sometimes driving from several cities away.”

Appalachia’s unique geography plays an especially important role in the mead crafted in West Virginia. That’s because honey, the core ingredient for mead, tastes different depending on what plants and flowers the bees had access to.

Honey, It’s Important

Maltby checks on a new hive. Photo: Brittany Patterson, West Virginia Public Broadcasting

At their farmhouse just a few miles away, Maltby tends to the hives of bees that make the honey used in Mountain Dragon Mazery’s mead. Each 60-gallon batch of mead requires 10 gallons of honey.

As their mead operation has grown, Smith and Maltby have moved most of their hives to the care of another beekeeper in the state. Four hives remain at the farmhouse.

“I believe that the Mountain State is making some of the best honey left in the world,” Maltby said. “Partly because we’re so far from primary sources of agriculture and chemical pollutants. Here we make forest honeys instead of agricultural honeys.”

Bees make honey by extracting sugary nectar from flowering plants and storing it inside a honeycomb. West Virginia’s diverse geography, mountainous terrain and relatively small farms mean that the nectar collected by bees here can be quite diverse. That changes the way honey tastes and one’s mead will taste, said Josh Bennett, owner and founder of Hawk Knob Cider and Mead.

“If you’re a beekeeper and trying to make meads from locally sourced honey you’re going to have the essence of your region in your mead,” he said. “That’s going to be dependent upon when that honey was harvested by the bees and the little microclimate that it was in, but specifically related to your local flora.”

Bennett said the types of tree and plant species in the local forest or region change the taste.

“Here in the mountains you’ve got bees away from large swathes of monoculture,” he said. “Appalachia has a lot to offer in that way and the diversity of the biosphere that we have here.”

Versatile Beverage

Hawk Knob’s barrel-aged cyser mead. Photo: Brittany Patterson, West Virginia Public Broadcasting

It’s also a diverse drink.

“You can have something herbal, something fruity, something sweet, something dry,” Bennett said. “You can hop it up like a beer, or you can age it like wine, and there’s just a lot of versatility. You can create a lot of different types of beverages within the realm of mead.”

Mead’s versatility is both a blessing and a curse for modern day mead makers, said Rowe, with the American Mead Makers Association.

On a regulatory front, the Alcohol and Tobacco Tax and Trade Bureau regulates mead as a wine, which Rowe argues is not broad enough to cover the variations on the beverage, which can range in alcohol by volume (more commonly known as ABV) from under 4 percent to upwards of 20 percent.

“We have a segment that aligns more accurately with what the cider people or what the craft beer people are doing, and yet we’re still clumped under wine,” she said.

Because meaderies aren’t individually tracked like cider and beer is by federal regulators, new mead makers face barriers in applying for loans with up-to-date growth numbers for the industry.

And the wide variation among mead often means mead makers, like Mountain Dragon Mazery, often find themselves educating patrons about the craft beverage.

On a recent weekday, Smith gives a full tasting to the Menjivar family who stopped into the tasting room while on vacation.

Smith pours a blush-colored liquid into a small plastic cup. This variety of mead is called a Rhodomel, which is fairly unique. It’s made with wild tea roses harvested at their home along the Monongahela River and fermented with wildflower honey.

Paty Menjivar, the family matriarch, said she wasn’t sure what to expect but was curious about honey wine. She takes a sip.

“It’s really good,” she said. “Really good.”

This story is part of an Inside Appalachia episode exploring the alcohol culture and industry in Appalachia. It was originally published by West Virginia Public Broadcasting.

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Inside Appalachia

Craft Brewers Work With Farmers For Unique Ingredients



Craft breweries are popping up all over the region. In West Virginia alone, there are 27 breweries and three quarters of them opened in the last five years.

Sam Fonda, from Weathered Ground Brewery in Raleigh County, West Virginia, has almost 3,000 gallons of soon-to-be-beer fermenting and another 1,000 gallons aging in oak barrels nearby at any given time. That may sound like a lot, but his typical batch is 220 gallons, and that gives him the chance to experiment.

In addition to the basics of water, malted grains, hops and yeast, small craft brewers all over the region are experimenting with locally sourced ingredients to give their beers a unique flavor. Today, you can find West Virginia beers that contain traces of coffee, berries — even tree branches.

Sam Fonda adding malt from North Carolina into a recent batch of beer. Photo: Janet Kunicki/West Virginia Public Broadcasting

Weathered Ground buys malted grains from the mountains of North Carolina, as well as hops, fruit, and flavorings from local farmers. Working with his neighbors is a source of pride for Sam.

“That’s why using local is so much fun. Because you can have this personal relationship with your suppliers. It’s almost always more expensive. Sometimes double really, but that’s just kind of the price you pay for doing what you want to do. So, we’re happy to pay a little more for the flavor we’re going to, as well as supporting local,” Fonda said.

One of Fonda’s suppliers is JR Ward, a hop farmer and full-time underground coal miner who lives just 20 miles or so down the road in Fairdale. JR loves the farm he has built, with 3,000 square feet of vegetable garden and a quarter acre of hops.

“Years ago, I couldn’t tell you what a hop was, didn’t even know they looked like, did not like craft beer. Then what really made me going forward was a few years ago we had layoffs in the mines and the hard times and I never want to leave here because this is just a piece of heaven to me. And it’s beautiful land, I just started looking into stuff and hops caught my attention,” Ward said.

He currently supplies Weathered Ground with enough hops for 440 gallons of beer in two batches. They are: “Lost Ridge Pale Ale,” named for JR’s farm, and the second is a nod to JR’s other job. It’s called “Hop Farmin’ Miner.”

JR Ward stands in front of his hop yard. Over the next few months, the hops will grow up the ropes behind him and will be ready for harvest. Photo: Eric Douglas/West Virginia Public Broadcasting

Starting next year, he plans to expand to five full acres of hop yard on his property and is working with a friend to plant an additional five acres on a nearby farm. That will make Lost Ridge Farms one of the largest hop growers in the state.

Besides hops, Weathered Ground sources local fruits and just about anything that tastes good according to Sam Fonda.

“We brewed an IPA a few weeks ago with birch branches, and then the flavor that comes from birch just unreal, so a lot of people don’t think about that kind of thing when they think about beer, but back in the day, that’s kind of what beer was, what materials do you have on hand,” Fonda said.There is a growing movement throughout Appalachia for beverage makers to use locally sourced ingredients. It may cost more, but brewers like Sam Fonda believe in the process and so far, they’ve been successful using that business model.

This article was originally published by West Virginia Public Broadcasting. It is part of an Inside Appalachia episode exploring the alcohol culture and industry in Appalachia. 

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Inside Appalachia

The Appalachian Home Brewers Who Brewed Craft Beer Before It Was Cool



Appalachian Brew Club members cheer to 10 years since the club formed. They meet every month to talk and taste beer. Photo: Caitlin Tan/WVPB

Peanut butter stouts, guava sours, hazy double IPAs, pomegranate ales – these are just a few experimental beers to come out of the craft beer craze in recent years.

According to the National Brewer’s Association, this expanding industry started in the 1990s but didn’t gain momentum until 2010, making it relatively new. Today there are more than 7,000 commercial breweries in the country.

In West Virginia, that growth came even later. In the state there are 30 craft breweries, but in 2011 there were just five.

A beer on tap at restaurant and bar El Gran Sabor in Elkins. Beer comes to be through six stages – milling, mashing, lautering, boiling, fermenting and conditioning. Photo: Caitlin Tan/WVPB

All the craft breweries started with a home brewer – someone who experiments in brewing at home, and usually it’s a person who genuinely loves the science and craft behind beer.

Homebrewers in West Virginia have been experimenting with beer for decades, and they have been collaborating in community-organized home brew clubs.

There are 13 clubs in the state, one of which is in Elkins. It formed in 2009, and they call themselves the ‘Appalachian Brew Club.’

“When you’re around other brewers, you pick up learning how to brew in a really short time. It’s a super-fast starter for people,” Jack Tribble, Appalachian Brew Club co-founder, says.

He has been brewing since the 90s. He and several other members like to get together at one another’s homes to brew.

On this day, they have met up to brew a New England IPA.

DIY Beer

In the kitchen, the stove is covered in giant, stainless steel pots, and the counters are filled with different yeast strains and a variety of grains. There is an oversized Gatorade cooler nearby for pouring beer into, which allows the liquid to steep in the grains.

Scott Biola lifting the grains out of the wort. After this step the liquid will be transferred to the giant pot on the stove. Photo: Caitlin Tan/WVPB

The room is filled with a distinct, yet polarizing smell. Jack gives his thoughts on the aromas.

“I think it has a sweet cereal smell that has a grainy backbone to it. It smells great,” he says.

But longtime club member Rick Newsome says it is an acquired scent.

“Brewers love the smell. Walk into a big brewery and they’re brewing a porter and it smells heavenly. Unless you’re my wife,” Newsome says.

While the club brews, they sample other regional beers.

A lot of people enjoy beer, but these guys love beer. For Rick Gauge, it is like a creative science.

“It’s a great bunch of people to hang out with and talk about beer and they, like me, nerd out about the specifics and the details and not just oh this tastes good, but why? What hops are used and what’s the malt bill like?” Gauge says.

There are six stages in the brewing process – milling, mashing, lautering, boiling, fermenting and conditioning.

The Elkins club is at the end of the mashing stage, where the enzymes from the grains are converting to sugar. At this point, it is not quite beer, but a sugary liquid called Wort.

They are trying to get the Wort to an exact temperature. Too hot or too cold and the beer changes type.

“How geeky do you want to be?” Newsome says. “There are two enzymes that convert those starches into sugars – alpha amylase and beta amylase. Beta works in a range from 140 to 150 degrees. Alpha works from 150-160.”

In simpler terms, he is saying in order to convert the yeast to sugar the liquid needs to be between 140 and 160 degrees Fahrenheit.

As a club, they get together several times a year to brew, but they meet up once a month just to talk beer. Clinton Hamrick, one of the members, says home brewers tend to be on the cutting edge of new styles.

Tammy and Clinton Hamrick enjoy a beer on the bar crawl. The Appalachian Brew Club members all say Tammy can “out-brew them all.” Photo: Caitlin Tan/WVPB

“The home brewers I think are a little more on the leading edge of what’s going to be popular this summer or the following year,” Clinton says.

It is a lifestyle. They even plan their vacations around beer, calling them “beercations.”

“We go with brewers and meet brewers over there and have a really good time, and all of a sudden they are pulling out stuff from the backs of their refrigerators and we have a really good time,” Jack says.

They also brew beers for competitions.

Homebrew Competitions 

Homebrewers recently competed in a competition in Morgantown, called the Coal Cup Homebrewer’s Competition, which featured stouts and porters from regional homebrewers.

Inside the hotel conference room where the competition was held, judges quietly sip beers. They are voting on several categories – most boozy, coolest growler and weirdest flavor. In another room, members of the public gather to taste beers for the people’s choice competition. 

Jason Croston, a homebrewer in the Morgantown club, is competing with a Christmas porter and Bourbon barrel porter. He says brewing beer is something that has been passed down in his family.

A beer entered in the People’s Choice at the Coal Cup Homebrewer’s competition. Some of the categories included most boozy, coolest growler and weirdest flavor. Photo: Caitlin Tan/WVPB

“My dad actually grew grapevines on the side of our house and used to make wine. And one of my grandfathers was a brewer way back. It’s in our family history and it’s in our blood,” he says.

There are two types of homebrewers – those who want to pursue opening a brewery and those who do not. Jason is the former. He hopes to open his own brewery one day, and even has a name picked out.

“I grew up in the backwaters in Cheat Lake, hence the name of my brewery when I do open –‘Backwaters Brewing,” Jason says.

But not all homebrewers want to take that path. Chris Eberlin from Cumberland, Maryland says brewers can lose their freedom with regulation. He gave an example of his friend who makes experimental beers.

“He’ll just grab roots off the ground and throw them in and maybe some bark off a tree, and sometimes you get duds and sometimes you get really good flavors,” Chris says. “The big challenge with commercial beer is you have to appease a big group of people. As a home brewer, I have the ability to go crazy because I’ve only brewed one to five gallons of beer. So I can make something horrendous and dump it and it’s only a little bit of time and money I wasted. But as a commercial brewer that could be the difference between life or death.”

All the home brewers spend the day tasting each other’s beers, waiting to hear how they placed in the competition.

Overall, the Appalachian Brew Club place second in the Coal Cup competition.

The Bar Crawl

The Appalachian Brew Club members during their bar crawl in Elkins. They like to try all kinds of beers to keep their palates up to date. Photo: Caitlin Tan/WVPB

Back in Elkins, the brewers club members go on a bar crawl to taste some of the local beers on tap. On this day, they start at a local restaurant and bar El Gran Sabor.

Clinton Hamrick tastes a new beer on tap.

Rick Newsome has brewed beer on and off since the 90s. Today’s burgeoning craft beer industry had yet to take off in the 90s. Photo: Caitlin Tan/WVPB

“It tastes like figs, little bit of raisin, woody, sweet, slight caramel – it’s good,” he says.

Whether it is making their own beer, trying other beer or taking part in competitions, home brewers simply love beer. Unlike commercial brewers, these guys are not in it for the money. They cannot legally sell you a beer, but they will try to excite your palate.  

“I genuinely believe there is a beer out there for everyone,” Rick Gauge says. “People who say they don’t like beer, I make it my personal mission to find them a beer they like. Beer can taste like anything. The people that say they don’t like beer just haven’t tried the right one.”

This article was originally published by West Virginia Public Broadcasting. It is part of an Inside Appalachia episode exploring the alcohol culture and industry in Appalachia. 

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