Alameda sergeant improves lactation space and support in county

In a male dominated field, Alameda County Sergeant Misty Carausu is blazing trails for mothers working in law enforcement. 

“A lot of women in this workforce always put our own desires on the back burner,” Carausu begins.

Often, those who are not mothers working in the agency, express distaste for their lactating and mothering counterparts. For instance, there’s a sense that lactating employees are an inconvenience when break time is required, Carausu explains. 

What’s more, women are often afraid to stand up for themselves and their needs for fear of “causing ripples” and ruining their careers, she goes on to explain. 

“I’m at a point in my career where I am comfortable speaking my mind,” Carausu says. “If I don’t support these women, it’s never going to change.” 

Advantageously, Alameda County Human Resources Department has a zero tolerance policy for hostile work environments. Carausu uses this to combat blatant discrimination and microaggressions (like sighing and eye rolling) against lactating people. 

 

Reflecting on teen motherhood 

Carausu’s breastfeeding advocacy story began in 1997 when she was 15 years old and gave birth to her son by c-section. 

Aside from reading What to expect when you’re expecting, Carausu reports that she wasn’t provided with any breastfeeding education or support.

“My mother did the best she could to help me, but she also struggled with breastfeeding so she didn’t know how to help me,” she remembers. 

Nonetheless, Carausu continued to breastfeed through engorgement, the pain of her healing c-section, little support from her baby’s father and his family, nipple shield frustrations and undiagnosed postpartum depression. 

Although her son was gaining weight well, Carausu says their pediatrician still insisted on supplementing with formula. By the time her baby was three months old, the formula supplementation had affected her milk production and she transitioned him to exclusive formula feeding. Her mother supported this move; she would be taking care of Carausu’s son while she went back to highschool. Formula feeding was “easier”.

 

Unexpectedly becoming an older mother  

Through her entire adult life, Carausu shares that she was told by medical professionals that she could no longer become pregnant because of obstructive uterine syndrome and other reproductive conditions.

Having met her husband in 2014, they’d come to terms with the idea that they would never have children together. Carausu focused on her career working as a detective. She specialized in major crimes involving sexual assaults and took the exam to become a sergeant in 2018. 

“I became engulfed in my work,” she comments. 

Then, at 38 years old, not long after she and her family celebrated her son’s 21st birthday, Carausu gazed upon a positive pregnancy test. 

“I cried,” she shares. “I thought my career was over.” 

Once the initial shock wore off, Carausu started pouring herself into research about healthy birth and breastfeeding, joining support groups on social media and taking prenatal classes. 

“I was full in on breastfeeding,” she says.

It was a major shift from her feelings about breastfeeding prior to this pregnancy. 

Carausu explains: “When I was a detective, my colleague had a baby and she was pumping in the bathroom. I would say, Ew, gross you’re milking. It was weird to me.”

Still, Carausu didn’t think it was appropriate for her colleague to be forced to pump in the bathroom, so she offered her her office instead.

Carausu’s daughter was born by emergency c-section. Their breastfeeding journey was off to a good start. While building a “stash” of milk for her return to work though, Carausu dealt with oversupply, mastitis and raw nipples from a poor flange fit. 

“I can’t do this anymore; I’m in so much pain,” Carausu remembers thinking, so she reached out to a local lactation care provider, Stacey, whom she affectionately calls “Fairy Breast Mother”. 

“She was my saving grace,” Carausu says. “I get teary-eyed and emotional just thinking about her.”

Carausu breastfed her daughter until she was 16 months old when she became pregnant with her second daughter. Born during the early months of the pandemic, Carausu held her baby skin-to-skin immediately after her c-section and during recovery. Without visitor interruptions, Carausu says she was able to keep her baby on her chest for almost the entirety of their hospital stay. 

 

Transforming lactation space 

While on maternity leave, Carausu learned about the jail’s “nightmarish” lactation room. 

“A lot of moms were like, No one uses it because it’s disgusting,” she says.

Carausu describes the space: “It was a big closet with a cabinet filled with car flares, hazardous materials and other office supplies. A rod hung from wall to wall with a curtain. Behind the curtain was a poor, dilapidated table on its last leg and an old leather chair. There were photos of random babies on the table. The floor was moldy.”

She goes on, “I told my partners, I am pumping in my office. If you have a problem, you can leave.” 

Carausu pumped in her office without conflict, but wasn’t satisfied because there was little privacy. 

She approached her captain. 

“We need to set the standard for law enforcement and change this,” she remembers proposing. 

Carausu was granted an initial three thousand dollar budget to renovate the existing lactation closet.

Conveniently, the jail is equipped with onsite tradespeople, so Carausu worked with each specialty to create a luxury space for pumping employees. 

They replaced flooring and baseboards, added a refrigerator and glider, stocked cabinets with snacks and extra milk bags and installed lockers. Carausu added decorative flair with rugs and paintings. 

She says that the carpenter exclaimed that he had “the best time” planning this project with her.

Their graphic designer created a sign with a breastfeeding symbol in their county-issued colors to be displayed on the door. The room is equipped with a lock that only lactating employees have access to. 

With roughly 2,000 people working at the jail, Carausu recalls about six other mothers using the new space generating demand to create yet another space. 

 

The project became such a success that HR revamped their lactation policy for the whole county. Now, every Alameda county-owned or county-leased agency must have a lactation-specific room with, at the very least, running water and a fridge. 

 

 

Implementing lactation counseling services 

Carausu isn’t stopping here. She recently completed the Lactation Counselor Training Course (LCTC)

“I already gave advice,” Carausu says. “But I wanted to be able to back it up.” 

Carausu plans to implement mother-specific counseling services with HR. 

“How can we give them a smooth transition? Are they prepared to come back? Are they pumping? What do they need? How can we help?” Carausu brainstorms. 

Carausu adds that she hopes to expand her work to provide services to other law enforcement agencies.

Cleft and Craniofacial Center Team Coordinator enhances counseling skills through Lactation Counselor Training Course

 In the past eight years, Melisande Ploutz, C-PNP Team Coordinator at the Cleft and Craniofacial Center Golisano Children’s Hospital has noticed a major shift in the way health care providers approach infant feeding with babies born with cleft abnormalities.

Years ago, she says, there was no consideration of breastfeeding for a baby born with any classification of cleft lip or palate. 

“We have come a long way,” Ploutz says. 

Ploutz currently serves as a liaison between patients, families, and the craniofacial team, assisting families in understanding, coordinating, and implementing their treatment plans.

Recently inspired by her own breastfeeding experience, Ploutz completed the Lactation Counselor Training Course (LCTC).

“The course helped me become more knowledgeable about breastfeeding and lactation, but ultimately helped me become much more competent in my counseling,” she shares. “It helped me to instill that same confidence in [mothers’] ability to breastfeed.” 

She goes on to explain that the course has shaped the way she helps families manage their expectations around breastfeeding a baby with medical complexities. 

Overall, she hopes to increase the consumption of human milk for babies with cleft abnormalities.

Because cleft lips are almost always caught on anatomic ultrasounds, Ploutz says she can start education about healthy infant feeding prenatally.

“I provide reassurance [to the family] that we have the capability of taking care of their baby no matter what the diagnosis is,” she says. “We talk about infant feeding and all of the possibilities.” 

Differently, isolated cleft palates are not detected on prenatal ultrasounds, so education and support for these families begins at birth. Ploutz and her colleagues most commonly encounter babies born with unilateral cleft lips and palates. 

“The families I meet prenatally are much more confident during the newborn period, because they were much better prepared,” Ploutz comments. 

Overwhelmingly so, Ploutz finds that the parents of babies born with cleft lip and/ or palates plan to breastfeed. 

She helps them realize what breastfeeding may look like for their special care babies. There is no reason that a baby born with an isolated cleft lip cannot breastfeed, she says. Experimenting with different positions can help to mould the breast tissue to form a seal so that the baby can breastfeed successfully, for instance. 

Differently, Ploutz explains that it is unlikely that a baby born with a cleft palate will be able to exclusively feed at the breast. 

“Our number one goal is for the baby to thrive and be healthy for surgery,” she says. “We really reinforce pumping and providing breastmilk for babies.” 

Mothers’ milk can be fed to babies with cleft palates through an assistive bottle. Ploutz reports that families may also have access to pasteurized donor human milk (PDHM) through their hospital. 

Ploutz emphasizes that breastfeeding a baby with cleft abnormalities requires careful monitoring including frequent weight checks and strong support from primary care providers. 

Cleft lip surgery generally occurs around four months of age. Corrective palate surgery happens, on average, before the baby’s first birthday. Ploutz says she especially encourages mothers to feed their babies their pumped milk around the time of the baby’s surgery because its protective properties are profound. 

About four years ago, Ploutz, the lactation care team and occupational therapists at their hospital, created a breastfeeding friendly protocol for babies born with clefts. The protocol clearly lays out what can be expected for a baby born with cleft lip and/or palate, Ploutz explains. The protocol describes first feeding the baby mother’s pumped milk from an assistive bottle to meet nutritional needs and then recommends the mother put her baby to breast for “bonus” milk and hormone stimulation. Skin-to-skin is highly encouraged to facilitate bonding and regulation. 

Ploutz points out that limited data shows that overall, babies born with clefts are less likely to receive breastmilk.

She says that in terms of her counseling skills, the LCTC “changed everything” for her, and she encourages other care providers to obtain this education and sharpen their counseling skills in order to better support breastfeeding in this population. 

“I want to spread the word,” she comments. “Wouldn’t it be amazing if more nurses and team coordinators in the cleft community took this course?” 

Ploutz and Healthy Children Project are in the very early stages of brainstorming the creation of a video about breastfeeding babies with clefts. Ploutz says she sees a video as an opportunity to facilitate consistent messaging, clear up misconceptions and help families to feel more confident.

Catching up with the authors of ‘Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties—Spatial Analysis of the Lactation Support Landscape’

Art by Ken Tackett Praeclarus Press

Earlier this fall, in Parts One and Two of National Childhood Obesity Month: the links between infant feeding and obesity, we zeroed in on what obesity looks like in the U.S. and how infant and young child feeding (IYCF) and other perinatal factors influence the obesity epidemic. This week, Our Milky Way caught up with the authors of ​​Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties—Spatial Analysis of the Lactation Support Landscape. Anna Blair, Ellie MacGregor and Nikki Lee’s work explores the inverse relationship between geographic access to professional Lactation support providers (LSPs) and childhood obesity in Pa. counties.

Their analysis recognizes that interventions to reduce childhood obesity are multi-faceted and must include several components. The authors share that they looked through the lens of breastfeeding support because of the empirical evidence suggesting that exclusive breastfeeding for six months and continuing for at least one to two years, can be a contributing factor to lower rates of childhood obesity. 

“We then became interested in exploring the relationship between access to qualified lactation support professionals and childhood obesity rates with the hopes of seeing a positive correlation between access to more professionals and lower rates of childhood obesity,” the authors share. “We hypothesized that, if an area has greater access to qualified lactation support providers, then breastfeeding rates would be higher, and, through the transitive property, childhood obesity rates would also be lower in those areas. This research is merely correlational, but we feel that it supports the overwhelming body of research suggesting that we need more qualified lactation support providers in order to support healthier generations moving forward.”

Photo Credit: United States Breastfeeding Committee

Their work pinpointed the least amount of CLCs in northwest Pa. counties, excluding Erie county. 

“This is, at least in part, due to the rural nature of the area geographically,” the authors comment. “The Healthy Children Project’s Center for Breastfeeding has historically targeted and traveled to rural areas with the goal of increasing lactation support in those areas most in need.”

They go on to explain that due to the COVID-19 pandemic, all in-person training courses and ALPP CLC examinations have been halted. 

In 2019 when the paper was written, there were 617 CLCs in Pa. As of Fall 2021, there are 662 CLCs in Pa. 

“Albeit a small change, we see this as a positive externality of the pandemic in the sense that access may have increased by offering the Lactation Counselor Training Course through the Center for Breastfeeding and the ALPP CLC examination online,” the authors offer. “It is the hope of the Center for Breastfeeding and ALPP to be able to travel to rural Pennsylvania in the future to assist in increasing the number of qualified lactation support providers in that area.”

Blair, MacGregor and Lee also report that the Pennsylvania Chapter of the American Academy of Pediatrics includes the Northwest counties as a target region to encourage and offer breastfeeding education to staff in pediatric offices and hospitals. Although folks enrolled in those educational programs will not receive a credential, they will become more knowledgeable and more confident in their ability to provide accurate and timely breastfeeding support to families.

The authors end on an important note: “Our intent with this paper was to shed light on the fact that all lactation support providers are valuable members in the lactation landscape, and we desperately need more providers working, and being paid for their work, in the field. All efforts to increase reimbursement for lactation support services and to incentivize lactation support as a career path should be equitable and inclusive to all qualified types of lactation support providers.” 

Breastfeeding with Hemiplegia by Scarlett Murray

Breastfeeding with Hemiplegia by Scarlett Murray was originally published on October 21, 2021 on her blog which can be found here. We are pleased to share this piece on Our Milky Way with permission from the author. 

 

Tentatively, the student midwife tries to reposition my left hand so that it is holding the baby. My left hand fails to flatten against the baby’s body, it remains at its distinctive bend. She looks mystified by my hand. She doesn’t understand why my hand can’t hold a baby – wait, that word – normally.

We are speaking two separate languages and we need each other’s language. I need the language of breastfeeding, so that I can breastfeed my baby. She needs the language of my body, so that she can navigate through its limitations and find a way for it to breastfeed.

I sigh.

My baby has been alive for less than 24 hours.

She is an absolutely tiny red-purple skinned creature with dark hair that stops at her eyebrows and goes all down her back. She smells of the earth and of familiarity when she is delivered on to my chest. She nestles for breast, finds it, latches. My hands precariously holding her in place. The latch feels odd: slightly painful, it is like tiny vibrations from a mini vacuum on my nipple. However, I can physically feel the bonding that I’ve read so much about pre-birth.

Still, it’s a struggle for my disabled body to know how to hold her in place to feed. Part of it is a lack of faith. I perceive of my body, and my left hand in particular, as frail and insecure. But my baby finds great security in my disabled body. She does not care that one of my arms is weak, limp, thin – she just thinks: Mummy. She places all of her confidence into it. Her confidence gives me a confidence in my adaptability.

I want to breastfeed for all the usual reasons people want to breastfeed.[2] For the health benefits for baby and mother. For the bonding. For the ease – you are walking food supply. But I also want to breastfeed because I find lids fiddly. I can’t imagine myself at 2 o’clock in the morning screwing and unscrewing lids. I won’t be able to screw them tight enough for the milk not to leak. If someone screws the lid on for me, then there is a good chance that I won’t be able to unscrew the lid. I’m right about this. By the time my daughter is old enough to drink water, it takes me four different brands to find a bottle that I can screw the lid on tight enough so that she won’t spill it, but not so tight that I cannot unscrew it. Yes, other people could help. But my hormones are raging at me to feed her. My breasts are huge, constantly leaking, ready to feed at even the slightest squeak from any baby on the ward.

My body twists uncomfortably to achieve the classic cradle hold. The midwives are propping us up with pillows. Someone else holds her body in place, as my left hand fails to. She is feeding. Just this method is unsustainable.

I long to feed her easily and independent of help.

Then, one of the student midwives rushes in. She explains that I should lie down and my baby should lie down beside me, a little below but facing my nipple. This is called the side-lying position. It takes the emphasis off my left arm and its holding capabilities. It is the least physically demanding breastfeeding position. And it works! Wonderfully.

At the first midwife home visit, I show her the side-lying position. This is exclusively how we breastfeed. I feel embarrassed, like we should be doing the cradle hold, because that’s the pervading image of breastfeeding that I have in my head. I call my left hand pathetic. The midwife tells me that my left hand is not pathetic, and that we have mastered the side-lying position. Still, she arranges for a lactation consultant to help me feed my child without the full use of my left hand.

The lactation consultant is brilliant. She is forward, bossy, but a great believer in my body and its ability to care for my baby. She shows me different positions, props us up with pillows. We take photographs.

After she’s gone, I try the other positions, but keep falling back to the side-lying position. It’s okay. We’re not going very far with a new-born.

My confidence in my body is slowly building.

Then, a pub lunch. I feed her before. I plan to feed her afterwards. She won’t need a feed in that time. But then, she cries: my body is her greatest comfort. Necessity drives me. The practice I’d previously deemed futile enables me. Her confidence, and my newfound confidence, secures us. I breastfeed her in the cradle hold. And she is soothed. And I get to eat my lunch.

I have not written this to get into debates about breast vs bottle feeding.[3] You are definitely not a less worthy parent if you cannot or do not want to breastfeed. Parents striking holier-than-thou wars are not my thing.

Disabled people live lives of constant adaption. When you have a baby, there is no real way that you can know how equipped your body will be for parenting. There is scant information out there for disabled parents or parents-to-be. Hence, I wrote this piece in the hopes that it will fall in front of the eyes of at least one disabled person who is about to become or is thinking about becoming a parent. I would like this to serve as an example of what is possible. Reading this would have been a great relief for me when I was pregnant, so with any luck, it will be that for others.

 

Resource:

The Positive Breastfeeding Book: Everything you need to feed your baby with confidence – Amy Brown (2018) – a hugely useful and insightful book on all things breastfeeding.

 

[1] My other post, ‘Cerebral Palsy’ has a more detailed description of my disability. [2] I should say, forthrightly and clearly, that I harbour no ill-judgement to those that formula feed their children. Happy babies are not hungry babies. [3] Furthermore, I have referred to this as “breastfeeding” because I am a cisgender woman and have always identified with and felt comfortable having breasts. I do not mean to exclude anyone who prefers the term “chest-feeding”; I refer to it as “breastfeeding” in relation to my experience alone.

A’nowa:ra Owira (Baby Turtle) Doulas serve Indigenous families at a uniquely situated point on the map

In a matrilineal society, ancestral descent is traced through maternal lines. Indigenous Full-Spectrum Doula Skaniehtiiohstha Kasokeo of A’nowa:ra Owira Doulas— serving those on the borderlands of Canada and the U.S.– points out that of the hundreds of Native American tribes across North America, many of them are matrilineal and this framework contributes to the interconnectedness of life.

Sign reads: “My Mom, Sisters, Aunties + Grandmas are Sacred” Photo by Dulcey Lima on Unsplash

But because of the devastation of colonization and forced assimilation, many of the birth and infant feeding traditions passed down through clans by mothers have been disturbed. Kasokeo and her colleagues are working to empower Indigenous families through birth, restoring these traditions. 

“A lot of things were taken,” Kasokeo says of the effects of colonization. “We all have bits and pieces of that big picture; we’re healing from historical trauma. We can use this time of birth to bring healing to [families].” 

She shares that an elder once told her that through the messages we tell our children, we send messages to our future. 

Skaniehtiiohstha Kasokeo

“I personally relate that back to the birth experience,”Kasokeo begins. “The messages we send about our bodies, our connection to each other and the strength of women, in my mind happens through breastfeeding. Especially in the first hours after birth, the first messages we relate are about our bodies and the connection to babies’ matrilineal line through breastfeeding.”

Kasokeo emphasizes that this path will look different for every person. 

“It doesn’t have to look a certain way,” she says. 

Another doula featured in Reclaiming Birthing Traditions: Indigenous Advocates Talk Maternal Health by Daisy Sprenger echoes this distinction. 

“There is a problematic tendency… to generalize within dialogues about Indigenous communities,” Sprenger writes. “It’s critical to remember that ‘Indigenous’ is a very broad term, and that each community has different practices and traditions. Within these communities …  each mother and family will have different outlooks, personal histories, and levels of comfort and desires.” 

Kasokeo and her colleagues embrace this approach with the overarching theme to give power to women, instilling in them the confidence that their bodies will help their babies to thrive.

Photo by Luiza Braun on Unsplash

The doulas in their group lean on one another, strengthening their collective as support people.  Kasokeo talks about how she, in part, pursued doula work in order to become what she needed.

When Kasokeo became pregnant at 19, she immediately sought out the very limited midwifery care where she was living in Saskatchewan (Treaty 6 Territory). With only 12 midwives in her entire province, she sent in her application as early as possible, but was denied due to the sheer number of parents seeking out midwifery care. 

Author Amanda Short details that “Jessica Bailey, President of the Midwives Association of Saskatchewan, said that her team of six at Saskatoon City Hospital turns away anywhere from 40 to 50 percent of people asking for care monthly. Across the province, it’s somewhere from 20 to 50 percent.” 

During this time though, she learned about doulas, connected with one in her area and says she “fell in love with everything about it.” 

As a survivor of sexual abuse, Kasokeo says it was important to her to know what procedures were going to be done to her perinatally and to be equipped with as much knowledge as possible. Having a doula by her side helped her achieve that.

Despite laboring for over 20 hours and ultimately deciding on pain medication not originally planned, Kasokeo reports having had an orgasmic birth. She says she thought, “Everybody should have this!” 

During her second birth, Kasokeo hemorrhaged and was later forced to navigate an unjust healthcare system with retained placental fragments eight weeks postpartum. 

Having endured the challenges she found herself in, Kasokeo says she sees herself as well-situated to meet other women where they’re at. 

In 2017, she and her colleagues formed A’nowa:ra Owira (Baby Turtle) Doulas serving those in Akwesasne, Canada and surrounding areas.

Akwesasne is a uniquely situated point on the map. Joshua Keating writes in The Nation That Sits Astride the U.S.-Canada Border: “This Mohawk community is home to around 13,000 people and sits astride the world’s longest border (three hours’ drive northeast of Syracuse or two hours’ travel southwest from Montreal), not quite a part of either country, but not quite independent either…The town has three different governments: one elected council recognized by Canada, one by the United States and a traditional government affiliated with the Iroquois Confederacy, of which the Mohawk are one of the six constituent nations, or tribes. All told, including the United States, Canada, the state of New York and the provinces of Quebec and Ontario, there are eight governments with some level of jurisdiction over a territory with an area of less than 40 square miles…” 

Kasokeo explains that this means not everyone has access to the same health care systems, so she and her colleagues work to fill in the voids that many families face when in need of maternal child health care. 

As the world learns to manage life amidst a pandemic, she and her group are beginning to open up more meetings and social gatherings in hopes of reaching more birthing and lactating individuals. 

Recently, Kasokeo completed the online Lactation Counselor Training Course (LCTC)

“I loved the training!” she exclaims. The myth busting and the counseling skills were notable, and she says she appreciated the convenience of being able to simultaneously learn and stay at home with her children. 

Kasokeo admits that covering the counseling skills stalled her at times throughout the course; she says she felt guilty reflecting back on past clients and how she might have interacted with them differently and better served them.

Photo by Gustavo Cultivo on Unsplash

“I needed to find the confidence in myself,” she adds. “It was really scary for me, but the course has given me the tools to be confident in my ability to become a lactation care provider. Moving forward, the number one thing will be not making assumptions and asking people to clarify things.” 

Kasokeo’s fascination with and passion for maternal child health persist, and she says she would love to network with others. She is particularly interested in learning about how to nurture a homegrown organization with limited funds. You can reach Kasokeo directly at skasokeo@anowaraowiradoulas.org  or connect with A’nowa:ra Owira Doulas here and here.