How to better serve birthing individuals who are deaf or hard of hearing

American Sign Language (ASL) has been in the news recently. Hand Waves Birth Services’ Childbirth Educators and Full Spectrum Doulas Ally Balsley (she/her) and Brittany Noschese (she/her), say that they are hopeful that this move will influence our nation’s overall effort to be more inclusive and accessible. 

“This is only the beginning of more to come,” they write in an email interview.  “This move should be inspiring to all the health workers and for them to recognize the great need of accessibility for everyone.”

Ally Balsley and Brittany Noschese of Hand Waves Birth Services

Individuals who are deaf are challenged by a chronic lack of access to healthcare information. Balsley and Noschese explain that those who are deaf often struggle with improper translation and communication with their care providers.

Recent research shows that individuals who are deaf and hard of hearing have a higher risk for pregnancy and birth complications and that the infants of individuals who are deaf and hard of hearing are more likely to be born preterm, have low birth weight, and receive a low Apgar score. Authors note that causes of these disparities have not been determined, but they believe that health care providers’ shortcomings in communication may play a large role. 

Alicia Pittman is a clinical coordinator at an acute care hospital working as a Speech-Language Pathologist and she says that language access is crucial to appropriate healthcare. 

“…Lack of information impacts patient outcomes,” Pittman begins.  “In this study, it was found that Deaf patients reported fear, mistrust, and frustration during healthcare visits. It was reported that having a medically trained ASL Interpreter present, reduced these concerns and caused the patient to have a more positive experience.”

Mitra and colleagues add that individuals who are deaf or hard of hearing are at a higher risk for stress, depression, anxiety, and interpersonal violence, which all can influence pregnancy and birth outcomes of course. 

The Hand Waves team suggests that care providers can better nurture the mental health of those in  the deaf community by providing resources and therapy primarily from those who know ASL and have experience with deaf culture. 

“Deaf community is their culture and it plays a big factor in their lifestyle so having professionals who are experts with knowledge in this culture helps greatly,” they explain. “The healthcare providers should have a list of proper referrals ready if needed to best serve the deaf community, and with that, they would be able to ensure that they would be able to receive and ask for the information and support they need.”

Photo by Jonathan Borba on Unsplash

Video Relay Interpreter (VRI) services can be effective, but the Hand Waves team explains that these services are faulted for having poor connections sometimes. They add that deaf individuals don’t always receive transparent information from their medical providers.

“It is pretty common for deaf individuals to receive basic selective information from the providers,” they explain. “Due to the lack of details, the families are limited in making informed decisions.”

Abigail Shipp, CBD(CBI), CBE(CBI), SBD, CLC  is a Certified Birth Doula and Childbirth Educator, Certified Bereavement Doula, Certified Lactation Counselor (CLC) and Certified ASL interpreter practicing in the Omaha metro, Papillion, Bellevue, and Southwest Iowa areas. Shipp echoes many of the barriers Balsley and Noschese describe. 

“Access to information is extremely limited,” she says. “[Deaf individuals] are limited to the providers they can choose from, due to lack of interpreters, and the ability for smaller, private practice providers to provide interpreting services. So right off the bat, they are immediately penalized due to their deafness in not getting the provider of choice.”

In an article by Angela Skujins about growing up with deaf parents, the author explores the role of CODA, an acronym for the “Children of Deaf Adults” stating  that “many CODAs act as interpreters for their parents from a young age, and this can mean taking on responsibilities generally reserved for adults.”

The Hand Waves team writes to this point, “It is unethical for health providers to use family members, especially children, to interpret for their families.  It is incredibly important to have a certified interpreter to do that role as a neutral person in the conversation.” 

Shipp brings up another barrier: effective translation even when a hired interpreter is present. 

“…Interpreters may not be skilled in the language of birth, postpartum, or lactation,” she explains. “They may not be comfortable interpreting these topics, thus interfering with a smooth interpretation of the information.”

Photo by Walaa Khaleel on Unsplash

The Hand Waves team adds: “Currently, there is not a specific place where you can learn the signs for certain words related to the birthing world. We would encourage reaching out to those who teach ASL, possibly take classes on general signs in ASL, and immerse yourself in the deaf community by going to deaf events.” 

They continue that the deaf community’s primary language is usually ASL rather than written English.

“So when they don’t receive the information in ASL, they are not receiving the information in the language where they can fully comprehend and receive full access to the information,” they write. “It is legally and ethically your right to have an ASL interpreter on site or VRI depending on the deaf individuals’ preference.” 

Shipp shares one of her experiences in a role where she was asked to fill in as an interpreter instead of the doula role in which she was intended.

“I was attending a birth [but] because the mother was not yet six centimeters dilated, the interpreter was not allowed to stay and be compensated for their time. Think of all of the communication that happens during labor: the questions from nursing staff, the responses from the laboring mother… that information could not be conveyed, simply because the mother was not yet six centimeters in labor. So then that put the family, the staff and myself in an awkward situation where they relied on me to interpret for this family, when I was there in a support role. Imagine if I hadn’t been there, how would communication have happened?” 

Balsley, Noschese and Shipp all break down how maternal child health professionals can better advocate for the deaf community: 

  • Ensure a proper referral system with those who specialize in serving the deaf community.
  • Make sure patients are comfortable with provided interpreters; be sure they have a choice in what kind of interpreting services they prefer.  
  • Allow time for the interpreting process and give the patient time to express themselves.
  • Provide scholarships for members of the deaf community to become certified in birth and lactation work.  Find a volunteer-based resource list of deaf/signing birth workers here
  • During in-person classes, set up seats in a circle or semi-circle so vision is not obstructed.
  • Check in often to ensure the individual follows what is being taught or explained. 
  • Include videos, props, pictures and hands-on performances to help communicate. 

    Photo by Luiza Braun on Unsplash

Pittman recalls many infant feeding success stories and shares that they all have one thing in common: collaboration with a lactation care provider who can help parents with their infant feeding goals.

There are several ongoing efforts to gather the experiences of the deaf community to better serve birthing people. Find them here and here

“Every birthing person’s experience matters,” The Hand Waves team writes. 

You can connect with Shipp here: 

And Balsley and Noschese here.

During Black History Month and beyond, celebrate positive stories of Black people’s ongoing legacy

I received an email from my fourth grader’s teachers updating parents on some of the topics they’ve been covering in class: World War II and Black History. In the message was a heads-up that students may be coming home with “big questions” about some of the sometimes difficult details they’d discussed. 

My grade school memories fade, but I can say with near certainty that none of the history lessons covered in my elementary education (and beyond) required any kind of warning from my teachers. The history that we covered was diluted to become palatable, white-washed, white-centered, and one-dimensional. 

At the same time, there was little to no celebration of the Black individuals who have shaped American history and propelled us forward. 

Photo by Prince Akachi on Unsplash

The National Institute for Children’s Health Quality (NICHQ) Black History Month Celebration statement puts it this way: “Too often, the mainstream narrative around the Black experience is one of violence, heartbreak, and pain. The importance of understanding our nation’s exploitative history and its impact on modern-day inequities cannot be overstated.”

It goes on,  “However, leaning into collective learning about the contributions of Black thinkers, doers, and visionaries is imperative to creating a world equitable for all. As journalist John Blake and countless others highlight the need for more ‘trauma-free Blackness,’ NICHQ joins the call to highlight and share positive stories and messages about Black people’s ongoing legacy. ” 

Nichelle Clark’s piece  Breastfeeding As An Act Of Resistance For The Black Mother seconds this sentiment.

“Black History Month in the breastfeeding community is normally littered with posts and articles about the dark history of African American Breastfeeding in this country,” Clark writes. “I firmly believe that in order to understand where you are going, you must first understand where you have been. However, Black Mothers in today’s society face a very different dilemma: actually being Black History.”

Photo by Kiana Bosman on Unsplash

And again, Jamarah Amani, LM, executive producer of the documentary Legacy•Power•Voice— a three-part documentary that explores the evolution of Black birthing traditions in America–advises, “You have to look back to go forward.” 

As a white woman with white children educated by white people, in honor of  Black History Month– but of course extending beyond the month of February– I’m looking back on my education (and looking inward) in an effort to evolve my learning and re-learn with my kids.  

We have subscribed to the idea that “If Black children are ‘old enough’ to experience racism then white children are ‘old enough’ to learn about it” as educator Blair Amadeus Imani has said. This is a piece of the critical process of dismantling systemic racism in America.

Thanks to Kimberly Seals Allers’ (KSA) Irth Wind & Fire Facebook episodes, I’ve started digging into the rich history of Black midwifery in my effort to relearn and gain new perspective. 

Black midwifery is part of history that has been hijacked by white men who thought birth should be medicalized and white women who turned it into something “crunchy,” KSA explains.  These influences eventually led to the criminalization of midwives and ultimately influenced low breastfeeding rates and high maternal infant mortality rates in BIPOC.

Photo by Mustafa Omar on Unsplash

Midwifery worked before these forces disturbed the process. Actually, midwifery still works, and KSA shouts out the Black organizations and individuals who are helping families birth safely: 

National Black Midwives Alliance, Southern Birth Justice Network, the Granny Midwives, and community-centered missions and birth centers like those in Detroit and New Jersey for example.     

KSA urges us to honor the systems that have worked for generations, rather than grasping for flimsy and phony solutions. Speak up about midwifery care and to find ways to put time, money and energy into the solutions that we know work, she says in her Irth Wind & Fire episode.

Reflecting on NICHQ’s statement, I realized that Our Milky Way is in part, a collection of “positive stories and messages about Black people’s ongoing legacy.” 

The people we’ve featured– Anihhya Trumbo, Tytina Sanders-Bey, Crystal Lovett, Brittany Isler, Rose Hurd, Kayla Bitten, Evelyn Rhodes, Monica Haywood, Joy R. Gibson, Tangela L. Boyd, Dr. Carolyn Turner, Chanel Porchia-Albert, Dr. Byron Whyte, Tammy Thompson, Ngozi Walker-Tibbs, Acquanda Stanford, Ravae Sinclair, Sering A.L. Sosseh, Charles Clayton Daniels, Jr., Shirley Payne, Patricia Officer, Ashley Albright, and many others–  are the changemakers, the “Black thinkers, doers, and visionaries… creating a world equitable for all.”

Photo by Humphrey Muleba on Unsplash

Racial discrimination is morally wrong and often deadly to Black Indigenous People of Color (BIPOC). If that’s not enough to inspire people with privilege to create positive change, Sum of Us Author Heather McGhee draws “on a wealth of economic data… [and] argues that when laws and practices have discriminated against African Americans, whites have also been harmed… thus we all have an interest in fighting…”  [Read more or listen about the cost of racism for everyone here.]

Along with an understanding of our nation’s exploitative history and acknowledgement of the systemic racism embedded in our country, let’s also celebrate that “… Black lives should matter outside of trauma.”

John Blake writes, “Any true racial reckoning should acknowledge all of our humanity — not just when we’re dying.”

Photo by Eye for Ebony on Unsplash

More resources to consider:

  • The International Confederation of Midwives (ICM) and Council of International Neonatal Nurses (COINN) are surveying nurses and midwives asking for what they might need to better support breastfeeding. The UNICEF-WHO Global Breastfeeding Collective will incorporate the results into an Advocacy brief that highlights the important role of nurses and midwives in supporting, protecting and promoting breastfeeding. Nursing and midwifery organizations and individual nurses and midwives are encouraged to participate in this survey before the end of February. 
  • Teasers and behind the scenes footage of Legacy•Power•Voice here
  • Celebrate BHM with NICHQ’s Weekly Social Media Themes and follow them on Facebook, Twitter, and LinkedIn for posts and resources.
  • Tune into KSA’s Irth, Wind and Fire episodes.
  • Get free access to Breastfeeding Medicine research and articles about Black experiences. 

Tailoring infant feeding support to better serve Chinese American families

On Friday evening, many Chinese American families’ tables were filled with Kao Nian Gao, Tang Yuan, Jiaozi, Jujube, fish, noodles, oranges and other traditional dishes in celebration of the Lunar New Year. 

Asian culture is incredibly diverse, encompassing approximately 52 different countries with about 800 different languages and dialects. The Asian and Pacific Islander (API) population is also the fastest growing group of people, yet they are often overgeneralized or overlooked in health messaging and support.

Jeanne Kettles, MA, IBCLC, Tonya Lang, MPH, Grace Yee IBCLC, presenters of Effective Collaborations and Breastfeeding Promotion Strategies for Asian, Southeast Asian and Pacific Islander Communities, part of the USBC Racial Equity webinar series, point out that on an aggregate level, the API community looks like they’re doing very well in terms of breastfeeding initiation and duration rates.

But the statistics don’t cover the full story, they add, stating that “there are stark disparities within these population groups.”   

Photo by Taiying Lu on Unsplash

Heading into the Year of the Ox, let’s celebrate Chinese American culture– the largest Asian American group– by looking at some of the ways maternal child health advocates can better serve new families by building on cultural practices and by uplifting the organizations that are designed to serve these families. 

Discovered in part through their work with the Asian Southeast Asian Pacific Islander (ASAP!) Taskforce,  Alameda County Breastfeeding Coalition and other community engagement,  Kettles, Lang and Yee outline some strategies for tailoring infant feeding support in the Chinese American population. 

  • Include grandmothers in breastfeeding education and infant feeding plans. Grandmothers are influential elders that often assume responsibility of care for the new mother and infant during the postpartum period.  
  • Incorporate peer counseling into the traditional postpartum confinement period. Whether  mothers stay in the home or in a confinement center during this period, they should have access to proper lactation care. This study shows the importance of targeted training to support better breastfeeding outcomes. 
  • Establish a referral system for appropriate lactation care. 
  • Educate employers on lactation space provisions. 
  • Increase representation of Asian mothers in breastfeeding promotion. 
  • Increase representation of Asian lactation care providers. 
  • Ensure counseling strategies align with cultural practices. 

A major barrier to Chinese American families’ healthy infant feeding practices is linguistic isolation. ASAP! collaborated with Global Health Media to translate some of their videos into Chinese.  La Leche League Canada provides some of their information sheets in simplified Chinese and traditional Chinese. To-wen Tseng’s blog And I’d rather be breastfeeding is available in English and Chinese.  

Photo by Reynardo Etenia Wongso on Unsplash

Moving into a new year, the Asian & Pacific Islander Breastfeeding Task Force celebrates some of their accomplishments as shared on their Facebook page

Photo by Macau Photo Agency on Unsplash

“The ox, in Chinese culture, is a hardworking zodiac sign. It usually signifies movements so, hopefully, the world will be less static than last year and get moving again in the second half of the year,” Thierry Chow, a Hong Kong-based feng shui master is quoted in this article offering predictions on the year ahead.

For more on API culture, resources and materials, visit USBC’s page here

‘Accessing the Milky Way’ scholarship recipient advances equitable care


Lovett nurses her 4 month old at a family reunion.

Crystal Lovett, RN, CLS loves telling her breastfeeding stories. The first one goes like this:

My breastfeeding story began February 13, 2006, the day my son was born at WomenCare BirthCenter in Hurricane, W.Va.  Due to possible aspiration of meconium in my amniotic fluid, he was transferred to the hospital where he spent his first week of life.  I expressed breast milk using a hospital-grade breast pump in addition to attempting to feed him at the breast.  After spending the first couple of nights in the hospital with him, the staff urged me to go home and rest.  Though leaving the hospital without him is one of the most difficult things I have ever done, I went home, rested, and continued pumping around the clock to provide him with as much breast milk as possible.  We had some difficulty getting a good latch during his hospital stay and thankfully had the opportunity to work with a lactation professional before he was discharged home.  We ended up having a 15-month breastfeeding journey!

Years later, on March 22, 2019, Lovett gave birth to her daughter at 35 weeks by an unplanned cesarean section. She continues recounting her journey: 

The evening of her birth remains a blur as it took several hours for the medications I received during surgery to wear off.  Though she weighed 4 lbs 15 oz, had an initial low blood sugar, and low body temperature, she did not require a stay in the NICU and we were able to room together the majority of our time there.  I attempted nursing for each feeding before supplementing with formula and pumped after each feeding.  We had some difficulty with latching in the beginning resulting in lots of pain on my end.  We were fortunate to see the lactation consultant before discharge and she showed us some helpful techniques, including how to use a supplemental nursing system (SNS), so that my daughter could receive her supplement while nursing at the breast.  The lactation consultant was the first person to identify a possible tongue restriction, which was diagnosed and revised, along with an upper lip tie, at two weeks of age.  We went back to see the lactation consultant for three outpatient visits.  Eventually, with much work and continuous support, my daughter and I got the hang of breastfeeding.  We were able to stop supplementing around day five and she was back to birth weight by one week!  Now here we are at 22 months still going strong.

Lovett takes a work selfie on dress down day, 3 months postpartum.

From a young age, Lovett says she knew she wanted to make her career in maternal child health, but it was after receiving “such amazing support” from hospital lactation specialists that she zeroed in on wanting to help families navigate new parenthood. 

COVID-19 has challenged Lovett’s newest role as a WIC Peer Counselor, but she says she’s part of a supportive team that has helped her learn the ropes. While the majority of their work is currently done remotely, Lovett reports that they have been able to see some clients in-person with proper PPE and cleaning and sanitizing procedures to ensure a safe experience for everyone. WIC clients have been encouraged to use a lactation support app which offers 24/7 support complete with video chat capabilities.

“I love talking with participants, listening to their stories, providing prenatal breastfeeding education, and counseling for concerns and questions,” Lovett says.   

Her accomplishments have been honored in her feature in the Future of Nursing WV’s Courage to Care Campaign.  She plans to participate as an Ambassador RN and work with the Diversity Team at Future of Nursing West Virginia. 

As an Accessing the Milky Way Scholarship recipient, Lovett completed the Lactation Counselor Training Course (LCTC) last month. 

Not only [will] this help broaden my knowledge base and in turn better equip me to help families, but it…also provide[d] me with a portion of the 90 lactation specific education hours required to become an International Board Certified Lactation Consultant,” Lovett explains. 

Lovett will sit for the September 2021 IBCLC exam.

Mocha Milk in the Mountains, Lovett’s developing business, was born out of her passion to help families and focuses on families of color through pregnancy, birth, breastfeeding/chestfeeding, and beyond. 

Lovett poses in celebration of Black Breastfeeding Week 2020.

“My hope for our community is that all families, regardless or race, ethnicity, or gender, will receive the equitable care and support needed to have healthy and safe pregnancies, deliveries, and parenting experiences,” Lovett says.  

She continues,  “This care includes not only the medical aspect, but also the mental, emotional, and spiritual well-being of the families.  Our need for this support does not go away in the midst of a pandemic; therefore, now more than ever it is important to reach our communities…Our communities need us and I look forward to being one of hopefully many that help normalize breastfeeding in our culture and lead us to better outcomes for families.”

Southern Oregon cohort of maternal child health professionals complete LCTC

Photo by Raj Rana on Unsplash

While families, communities and nations continue to suffer through the COVID-19 pandemic, good things occasionally glimmer amidst the devastation and tragedy. Early in the pandemic, we reported on the positive environmental impact of decreased transportation. In Fostering connection through technology, we touched on the creation of new technology to foster meaningful connection while we physically distance from other humans. We also learned that charitable human milk donations have increased dramatically during the pandemic.

Now, there’s more good news out of Oregon. A group of 24 maternal child health advocates have completed the Lactation Counselor Training Course (LCTC) on scholarship made possible by Health Care Coalition of Southern Oregon (HCCSO)

The organization had initially intended to send a limited-sized group to the in-person LCTC in Springfield, Ore. which required travel costs, HCCSO Healthy Start Program Manager Lee Ann Grogan, CLC reports.

Lee Ann Grogan

But when the course became available online, they reassessed costs and realized they could support more scholarships. 

“With the expansion, we have been able to support professionals from many different fields: pediatric providers, home visiting nurses, doulas, WIC staff, alcohol and drug counselors, homeless shelter staff, teen parent program staff, and all Healthy Start staff,” Grogan explains. “We are thrilled to support this network of professionals and know that having this level of knowledge and expertise in so many potential touch points will be a benefit to many families.” 

Rachel, one course participant, offers praise, “This course was inspiring in and of itself. I really enjoyed the course material and how the information was shared. It was one of my favorite training experiences to date. I also wanted to complete that course because I could see how the information that I was learning could be used in my everyday job and I could pass the knowledge to my patients.” 

Another participant, Kerri Anne, shares, “ The instructors are amazing and easy to follow… I am one who needs to see something multiple times before it really sinks in so having the ability to watch a module more than once before testing is extremely helpful. The quizzes after each module are also helpful. If I happen to misunderstand a question or get it wrong I love being able to see why my answer was incorrect.”


Course participants in the cohort are connected through a project management and team communication platform where they can build relationships with one another, share resources, and network with other lactation professionals.  

Along with ongoing lactation education training opportunities, the cohort will be invited to participate in a Perinatal Task Force panel discussion about their training, Grogan adds. 

She explains that the Perinatal Task Force is a collective impact group dedicated to overall community health, working together towards a shared goal, leveraging funds, and aligning priorities to be most effective.

Photo by Larry Crayton on Unsplash

“I would encourage other organizations interested in supporting wide-spread lactation education to do some dreaming and problem-solving with any organization that works with families,” Grogan advises. “We did not anticipate the interest from so many different fields of infant and family services, but are very pleased with the results!  Our organization was able to provide the financial support to our partner organizations for this opportunity, but we know that our partnerships are stronger and the investment will help ensure that the voices of lactation professionals are heard across our region. That will have a lasting impact when we look to future training needs, advocacy opportunities, and events.” 

While the circumstances brought forth by the pandemic have broadened some opportunities, a shift to remote support models for families has proven challenging.  

Southern Oregon is burdened by higher maternal infant mortality rates than the rest of the state. 

Grogan points out key areas of health challenges:

  • “Food Insecurity– Over 15 percent of all residents in Douglas and Josephine Counties are food insecure, but this rate is higher for children with one in four children in our region being food insecure. 
  • Unemployment– Our area’s unemployment rate continues to regularly exceed the state rate. 
  • Poverty Status– Both Douglas and Josephine counties have higher poverty rates than Oregon and the U.S. Over one in four children in the region live in poverty.
  • Maternal Smoking– Our region has alarmingly high rates of maternal tobacco use, with over 20 percent of women smoking during pregnancy.”

She goes on to explain, “Our rural communities lack access to reliable internet and cellphone services… The majority of our clients experience the crisis of poverty and do not have the financial means for smartphones, tablets, or computers.  Beyond access to the required technology, tech literacy is generally low for our population.”

Photo by Luiza Braun on Unsplash

Because of these limitations, Grogan says most of their services are provided over the phone.

Catrina, a cohort member, says that even telephone communication can be difficult because of poor reception in rural areas. Without being able to observe a feeding, she says she and her colleagues have had to tap into their listening skills.  

“We’ve been using our knowledge gained from our CLC training and  listening to what our parents are telling us to help them solve the challenges they have faced,” she says.   

For those with internet access, HCCSO transitioned their most recent Community Baby Shower to social media.  Lactation care providers addressed the importance of early literacy and gave out hundreds of books, addressed safe sleep education and gave away more than 50 cribettes and breastfeeding supplies like breast pads, easy-to-read breastfeeding guidebooks and hand pumps.

“We reached hundreds more families with our social media outreach than we had planned to with our in-person event, so that is definitely a silver lining!” Grogan exclaims.  

Kerri Anne and other LCTC participants in the cohort share that COVID-19 has presented the opportunity to change their perspective, embrace frequent change, and exercise flexibility.  

Photo by Juan Jose Porta on Unsplash

“Covid also accelerated our services and encouraged us to change what we do and how we offer assistance to meet the needs of our patients and their support systems and care teams,” Kerri Anne explains. “… We want them to feel supported and remind them that social distancing shouldn’t mean isolation. We want our families to lean on us … during these uncertain times. Covid has brought us closer to the families we work with and we now check in with them weekly just to see how they are doing rather than wait for them to contact us with a need or concern.” 

Follow HCCSO here, here and here