The Institute of Family & Community Impact hosts event to boost paternal mental health

Photo by Humphrey Muleba on Unsplash

Several years ago, the American Psychological Association released a poignant video called Boys Don’t Cry  which briefly explores the negative impact of stereotypical expectations of masculinity.  

“There are so many things that shape each person’s idea of masculinity, from social norms to cultural influences,” as NICHQ Senior Project Director Kenn Harris explains in Promoting Fathers’ Mental Health During Children’s Early Childhood.

These forces have the potential to impact fathers’ mental health, and research shows that one in 10 fathers get Paternal Postpartum Depression (PPPD) and up to 16 percent of fathers suffer from an anxiety disorder during the perinatal period. 

Paternal mental health impacts their partners and their children and as NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP points out, fathers can be powerful allies for maternal child health

In an effort to address paternal mental health, Healthy Children Project faculty Eira Yates in partnership with OhioGuidestone developed the Yates Paternal Depression Screening Tool for male fathers, a first of its kind measurement which we reported on last summer

 

Photo by Picsea on Unsplash

Father’s Feelings research activity, which uses the depression screening tool, was suspended due to the COVID-19 pandemic. 

Yates reports that thanks to a recent grant, the team will be able to expand its pilot program. 

Brittany Pope, M.S., Director of Applied Clinical Sciences and Research at OhioGuidestone shares that The Institute of Family & Community Impact has been able to move forward with some other exciting events too. 

Namely, DaddYoga, a free virtual yoga class for fathers and their children led by Judge William Dawson, a yoga instructor, motivational speaker, and municipal court judge in East Cleveland.

Photo by Devon Divine on Unsplash

Beyond the yoga instruction, Judge Dawson will offer insight and encouragement to fathers about healthy living and other life goals. 

Participants will also have the opportunity to interact with people from the world of professional sports. For instance, on June 13, Major League Baseball agent Josh Yates will join DaddYoga to discuss his experiences as a single father while navigating the high-powered world of professional sports.

The event provides fathers an opportunity to destress while engaging with their children which  aligns with UNICEF’s suggestions on how to build babies’ and children’s mental health. 

Information for the DaddYoga event can be found here.

Considering evolving language in perinatal care and beyond

In the 90s, Diane Wiessinger, MS, IBCLC wrote Watch Your Language, an iconic piece that got us thinking about how we talk about infant feeding simultaneously, warning us of the dangers of “inverting reality” as it relates to breastfeeding and artificial feeding methods. 

Wiessinger writes, “When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food…the logical response is, ‘So what?’ Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy–and thus safety and adequacy–of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.”

Photo by Hanna Balan on Unsplash

“Health comparisons use a biological, not cultural, norm, whether the deviation is harmful or helpful…” she continues. “…We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.”

At present, infant feeding behavior has changed so greatly that the authors of The Meaning of “Breastfeeding” Is Changing and So Must Our Language About It  write “the term ‘breastfeeding’ is now so ambiguous that it is impossible to discuss contemporary breast milk feeding behaviors using this word.” 

To illustrate the diversity of infant feeding experiences, some of the ways infants and young children may receive milk include:

  • from their biological parent directly at the breast
  • human donor milk from a bottle or cup 
  • at the breast with a supplemental nursing system (SNS)
  • exclusively pumped milk via syringe 
  • wet nursing 
  • at the chest using an SNS with a combination of human donor milk and artificial milk 
  • feeding with purchased human milk 

Infant feeding is not black or white, nor one or the other. 

Given the multitude of ways that infants may be fed, the authors The Meaning of “Breastfeeding” Is Changing and So Must Our Language About It make several proposals for preferred language in order to develop clear communication around the feeding of breast milk to infants. 

They note:  “These terms are not intended to convey a value judgment about any of the behaviors described, but rather to provide an improved means of describing the wide variety of behaviors now encompassed by the word ‘breastfeeding.’” 

Language comes up often on Our Milky Way. We first explored it here, then went on to write about it here, featured transliteracy here and thought about language some more here and  here

This week, we’re adding to the ongoing discussion about terms that may be obsolete, using language to be more inclusive and evolving language to more accurately and positively describe certain behaviors and phenomena during the perinatal period and beyond. 

 

On-demand feeding or responsive feeding 

Photo by Nubelson Fernandes on Unsplash

Up first is the problematic term on-demand feeding

Caring for young humans is surely a massive responsibility, but to deem them demanding seems unfair and connotes negativity between the child and their caregiver.  

Instead, UNICEF suggests the term responsive feeding  which encourages relationship building through feeding responsively (regardless of feeding method) and recognition that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and caregiver. 

 

Sleep regression or sleep progression 

Many care providers have argued that the term sleep regression discredits what is actually happening: our babies’ brains are growing rapidly. 

Oasis Lactation Services posted, noting that #languagematters: “Sleep regression? It’s a sign of development and brain growth! Sleep shift is a better way to describe it. Your baby is gaining skills, not regressing.”

 

At risk or underserved 

The way that we communicate about barriers, inequities and populations that have inadequate access to health care services matters. Advocates warn us to use caution when speaking about barriers to breastfeeding and other behaviors. For instance, the increased mortality rates experienced by Black Indigenous People of Color (BIPOC) are not biologically-based; instead the systems of power and the oppressors create the risk. 

 

Foremilk and hindmilk or simply milk  

The foremilk/ hindmilk myth comes up often in lactation professional networks. 

Nancy Mohrbacher writes that “There are not “‘two kinds of milk.’ … Despite this common belief, there is no ‘magic moment’ when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.”

In fact, the concept is even more complicated than this. While more fat is transferred when milk flows well, due to circadian rhythms, foremilk from one feeding may be higher in fat than hindmilk from another feeding, as Healthy Children Project’s Cindy Turner-Maffei details.  

Mohrbacher and others point out that research indicates there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer. 

 

Breastfeeding and chestfeeding and  human milk feeding and bodyfeeding and

Photo by Sergiu Vălenaș on Unsplash

Serena Kalish, PA-C, CLC got interested in the various terms used for feeding babies during her Lactation Counselor Training Course (LCTC). It was the first time she had heard the term chestfeeding and it got her wondering how many other care providers are unaware of the term chestfeeding as well as when and where the term is being utilized. 

Kalish created a poll on a social media page curious to learn what terms lactation care providers are using and prefer. The majority of the respondents replied with breastfeeding, followed by nursing, followed by breastfeeding & chestfeeding. Respondents added feeding, lactation/lactating parent/lactation journey, bodyfeeding and chestfeeding (as a standalone from breastfeeding) to the options.

The results of the poll didn’t necessarily surprise her, she reports, but she says she found the added options interesting. 

Photo by Nathan Dumlao on Unsplash

Kalish shares that for a medically-minded person like herself, the term nursing sounds archaic.  She wonders if by using the term nursing that we are perhaps adding to the stigma of breastfeeding by not using a term that specifically identifies anatomy. 

Many respondents noted that inclusivity matters to them in their practice, so the terminology that they use is determined by whatever their clients prefer. 

This sentiment reflects ABM’s Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients which states that “Although the terms introduced previously may be unfamiliar to some providers, recognizing and affirming patients’ names, pronouns, and family members are a cornerstone of providing affirming care for patients who identify as LGBTQ+…  Affirming health care, including using affirming names and pronouns, and recognizing individual patients’ families and communities, can help to mitigate the effects of stigma and improve health.” 

 

FTM or FTM 

Kalish goes on to present an interesting anecdote. As a participant in many “mommy groups” on social media, she became familiar with FTM to stand for “first time mom”. At one point, she noticed that some individuals were confused by a post that mentioned FTM because in LGBTQ circles, FTM stands for “female to male”. 

“It was an interesting perspective to learn that there are other contexts where certain terms and phrases and abbreviations are used,” Kalish comments. “It helps you realize that you have to be more sensitive sometimes and learn other terminology.” 

 

Language of inclusion and compassion  

Language comes in many forms. Hand Waves Birth Services’ Childbirth Educators and Full Spectrum Doulas Ally Balsley (she/her) and Brittany Noschese (she/her) touched base with us about non-verbal language and how to better serve individuals who are deaf or hard of hearing in a blog post from earlier this year.  

La Leche League International recently released a statement that announces the organization’s plan to increase audio and visual resources to better support those with vision or hearing impairment as well as those living in communities where we have not yet identified translators.

The statement also refers to their Cultural Sensitivity in Publications Policy, a trend that has been adopted by many companies and organizations as the national conversation about race amplifies.

Photo by Solen Feyissa on Unsplash

Finally, while many of us may have grown up on the playground chanting that bit about sticks and stones– stick and stones may break my bones, but words will never hurt me— it’s time we reckon with that falsehood. The words we chose when addressing birthing people and the conversations we have with them are impactful and can influence a lifetime. 

The Practising Midwife Journal posted for Birth Trauma Awareness Week: “…What we say and how we say it – can make a woman’s birth experience either transforming or harrowing. We have that potential impact.”

CLC launches non-profit resource center

While much of the world came to a screeching halt when the COVID-19 pandemic was recognized, Danielle Villanueva, CLC took it as an opportunity to propel her work helping families.

Villanueva pictured with her daughter.

Villanueva completed the Lactation Counselor Training Course (LCTC) in February 2020 just before our lives started to change. 

Formerly a WIC peer counselor, she pursued the course in order to open a private practice and start her 501(c)(3) Latch & Love Lactation Support and Resource Center in Henderson, Texas. 

“There was so much unknown, it made me want to do it even more knowing the help was going to be needed even more,” she says of launching her non-profit during the pandemic. 

Latch & Love Lactation Support and Resource Center officially opened in January 2021 after taking the summer prior to fundraise. 

Latch & Love offers lactation services, home visits, classes, support groups, and a donation center for families in need in a town with no other local lactation and breastfeeding support beyond WIC services. 

“Whether it’s a single mom or dad, struggling family, foster or kinship placement, grandparents, etc., they are welcome here and we do whatever we can to help,” Villanueva explains.  

Villanueva’s daughter celebrates Latch & Love. 

Villanueva delved into this work after becoming unexpectedly pregnant at 18 with her daughter Esmè. Determined to breastfeed, she and her daughter were off to a solid start in the hospital.

“The second I got home, things started to go downhill,” Villanueva reports. 

The closest lactation care was 40 minutes away– back at the hospital she delivered in. 

“So there I was a young mom, postpartum still recovering from stitches and as you can imagine quite emotionally and physically exhausted,” Villanueva remembers. 

She second-guessed making the trek with her baby for help, but ultimately made the trip.

“My visit with [the lactation care provider] changed everything and after that I just knew that this was my true calling,” she says. 

Villanueva says Latch & Love is getting the conversation about healthy infant feeding started in her community.

“It’s really opened up a lot of people’s minds about [breastfeeding] and helped them to realize its importance,” she shares. 

Virtually, she hosts “Talk it Out Tuesday” on Facebook and offers a support group that generally meets during the lunch hour, so that working parents can pop in on their break. 

The local hospital now gives out Latch & Love’s information with their discharge information. 

Villaneuva sees about one to two moms per week through her private practice, although she reports helping others via phone and messaging very frequently. Latch & Love Donation Center serves roughly two to four families each week.

 

“I couldn’t imagine myself doing anything else and I can’t wait to further my education in this field…” Villanueva adds. “Latch & Love is making a big difference in our community and I would love for everyone to hear about it.” 

Celebrating the 40th Anniversary of the Code

The International Code of Marketing of Breast-milk Substitutes, now 40 years old, is as relevant as ever. 

Otherwise known as the Code, it was adopted by the 34th World Health Assembly (WHA) on May 21, 1981 in an effort to contribute to safe and adequate nutrition for infants by protecting breastfeeding and ensuring the proper use of breast-milk substitutes by restricting promotions that target the public, parents and health workers.

Formula milk companies– an industry worth 60 billion dollars and growing by about 10 percent annually– have done an incredibly successful job of positioning themselves as a trusted source for families, shaping infant feeding culture globally. They’ve achieved relationship-based marketing through digital avenues, shifted their target toward older children over the years, and used the COVID-19 pandemic to promote their brand undermining maternal child health. 

The baby food industry continues to use many of the promotional tactics they did in the 1970s but have become more sophisticated in pushing baby milk formulas through online social clubs, targeted ads, and hosting contests to be formula “influencers”.

This month, the United States Breastfeeding Committee (USBC) hosted its first webinar in its Unpacking Commercial Milk Formula Marketing: Communities, Contexts, and Impacts webinar series presented by World Health Organization (WHO) technical officer Laurence Grummer-Strawn, PhD and Senior Advisor Access to Nutrition Initiative (ATNI) Rachel Crossley, MSc.  

At the beginning of the webinar, USBC Deputy Director Amelia Psymthe Seger reviews what has led USBC to create the shared learning journey around the Code. In 2019, USBC conducted a survey of the knowledge of the Code among member organizations, which demonstrated “a fractured understanding of the Code”.  In 2020, member organizations expressed interest in active engagement around the Code, leading to an incubation conversation, testing the will and capacity of the interested organizations to take action on the Code. That conversation led to the creation of this 3-part webinar series as a platform for mutual learning to determine future actions.

Responding to ‘old tricks, new opportunities’ 

The marketing of formula milks impact mothers’ infant feeding decisions on a personal level, but Grummer-Strawn reviews how marketing tactics have impacted society in general, embedding corporate influence on many levels.

(Image credit: Alive & Thrive)

Formula milk companies have infiltrated the networks mothers find themselves in controlling the advice that they receive from friends and relatives. Companies have influenced health care providers’ messaging by sponsoring scientific meetings. What’s more, they’ve molded a culture that claims infant feeding to be a personal choice making it easy for employers and legislators to ignore investing in policies that affect healthy maternal child health outcomes. 

Since the adoption of the Code, Grummer-Strawn lists subsequent clarifications that have addressed loopholes, unclear resolutions and the ever-changing contexts families find themselves in like modifications to how to monitor the Code in emergency situations, conflicts of interest, recommendations for the duration of exclusive breastfeeding, labels, follow-up formulas, health care provisions and cross promotion. 

Grummer-Strawn goes on to highlight some of the most recent work around the Code:

  • research that looks at mothers’ experiences with formula milk marketing in eight countries
  • Review of how the industry uses digital marketing  
  • Understanding breastfeeding within the context of human rights as well as the right of the industry through free speech 
  • Consideration of standardized formula milk packaging 
  • Analysis of how countries are implementing the Code 

Over the next 18 months, we can anticipate another Lancet series on maternal child nutrition and a global summit on the commercial determinants of child health. 

Highlighting positive outcomes  

Since its inception and moving forward, the Code calls on many actors to implement the code; from manufacturers and distributors to national governments, to UN agencies, NGOs and professional groups to health care workers, media and creative industries.

(Image credit: UNICEF)

Crossley’s work at ATNI around private sector accountability on nutrition has documented equally crushing and hopeful reports. For instance, ATNI’s 2018 US Access to Nutrition Index found that “overall America’s ten largest food and beverage manufacturers lack comprehensive strategies, policies and action to effectively address the nation’s high levels of obesity and diet-related diseases.”  

However, she reports that one major formula milk company has made a “substantial, unilateral, voluntary commitment through the call to action process” to extend its policy by the end of 2022 in alignment with the Code. 

“It’s really quite a big step forward,” Crossley says in the webinar. 

Some of ATNI’s newest work includes its Responsible Lobbying Framework which assesses how companies’ lobbying aligns with the Code.

One country’s journey with the Code

In Sweden, Kristin Svensson of Karolinska Institutet and Elisabeth Kylberg of the University of Skövde have witnessed the effects of the Code over several decades.

(Image credit: UNICEF)

In the 1970s while breastfeeding rates in Sweden were on the rise, the National Board of Health and Welfare initiated breastfeeding promotion throughout the country by establishing an expert group and publishing a book to help train professionals working with families from pregnancy and beyond. In 1973, The Breastfeeding Mothers Association (Amningshjälpen) was formed. 

“It was a positive climate to promote breastfeeding,” Svensson and Kylberg share in an email interview with Our Milky Way

In this climate, applying the Code in 1983 was “one step further in an ongoing process to protect breastfeeding.”  

At this time, Kylberg and Svensson remember formula milk advertisements disappearing from pediatric health centers. 

“It was an incredibly positive change,” they write.  

It wasn’t until 2013 that Sweden adopted the Code into law (SFS 2013:1054) following the EU-directive. 

(Image credit: UNICEF)

Kylberg and Svensson point out that there are limitations in the law. The baby food industry is permitted to advertise formulas in papers for professionals and bottles and teats have been omitted from the law. But they report that the Code is still used as an important tool to report violations. 

Because there is no national monitoring in place though, whistleblowing falls on non-governmental and professional organizations as well as individuals working in the health sector, they explain. 

Promisingly, an initiative in the region of Skåne upholds the Code and urges all staff working in primary health care to follow it.

At the national level, a collaborative of different national agencies is working to find a solution on how to organize a holistic approach on breastfeeding and to revitalize the BFHI which now includes the Code, the duo shares. 

They add that the Code is now even more important in light of the COVID-19 pandemic.  

“We think that to monitor the Code is [continuous work] and to push the national agencies to do what they should do,” Svensson and Kylberg share. “That is the best honor of the Code.”

[This figure depicts the prevalence of exclusive breastfeeding in Sweden from 1964 until 2016. Note: no breastfeeding data collection occurred between 1975 and 1985. The upper line depicts breastfeeding at 2 months of age, middle at 4 months and the lower at 6 months.]

Onward 

Advancing the mission of the Code is an uphill battle, as Grummer-Strawn puts it.  

He details the many ways we can contribute to the cause.

(Image credit: UNICEF)

First, he encourages education. There are plenty of online opportunities offered including a health professinals’ guide from UNICEF, IBFAN’s resource page, as well as USBC’s upcoming webinars as part of their series Unpacking Commercial Milk Formula Marketing: Communities, Contexts, and Impacts. Up next is “Commercial Milk Formula Marketing: Communities and Emergencies” on Wednesday, June 2 from 2 to 3:30 p.m. ET. 

Documenting and publicizing the problem is paramount. 

“If we aren’t making noise so people understand what the problem is, it’s going to be very hard to get any action on it,” Grummer-Strawn explains during the webinar. 

For this piece, there are tools like the NetCode Toolkit and IBFAN’s Code Monitoring Toolkit.  

Crossley suggests writing directly to the entities at fault. You can report compliance concerns to one major company here. While some companies have a direct page to report complaints, you may be surprised to find the trail others lead you down. For example, in the U.S. one company takes you from here to here to here, making the whistleblowing process much more convoluted and distracting. 

(Image credit: UNICEF)

USBC webinar presenters emphasized the importance of lifting up the good actors, celebrating and amplifying the companies that are doing good things rather than solely focusing on companies’ wrongdoings. 

Honoring the Code, especially in the U.S., has to be a long term strategy, Grummer-Strawn says. Executing an incremental approach ultimately adds up to the goal of full Code implementation. 

In this light, Grummer-Strawn touches on U.S.-specific circumstances to consider: 

  • We have a shared understanding of the harms of tobacco and can restrict tobacco companies’ speech, but we don’t have that same understanding with formula milk.
  • Modifying procurement standards within organizations like WIC may improve the way infant formula is distributed in the U.S. For example, would it be feasible to use Code compliance as a factor used to determine how states, territories, and tribal organizations choose formula vendors for WIC contracts?
  • Addressing conflicts of interest between healthcare providers and pharmaceutical companies is a huge movement in healthcare; conflicts of interest with formula companies are in this same vein and voluntary action against this conflict should be taken. 
  • Educating and engaging retailers may be instrumental in changing the industry. 
  • Pressure from consumers and investors drives competition among companies to work ethically. 

Our nation’s health and global health are so deeply intertwined with the saturation of baby food industry’s influence. Without vilifying the use of baby milk formulas, companies must be held accountable for their exploitation of maternal child health outcomes.  The Global Breastfeeding Collective and its partners call on all governments and their actors to protect mothers and babies from commercial exploitation by enacting and enforcing strong national legislation. Put #BabiesBeforeProfits.

(Image credit: Alive & Thrive)

The 40th Anniversary of the #BMSCode is a powerful reminder of what happens when the world comes together to protect the youngest lives. This #NutritionYearOfAction, Governments can once again pledge to safeguard children’s lives by #ProtectingBreastfeeding + putting #BabiesBeforeBusiness. 

A recording of the Global Breastfeeding Collective’s celebration of the Code is available here in several languages. 

Additional resources and links from Global Breastfeeding Collective 

Event Landing page

The BMS Code resources from the Global Breastfeeding Collective

Capitalizing on fears, companies promote breastmilk substitutes during the pandemic | Alive & ThriveCode FAQs 

Marketing of breast milk substitutes: national implementation of the international code, status report 2020

https://www.llli.org/quick-guide-international-code-2/

Baby-Friendly in the Pandemic: Ingenuity, Flexibility, and Doing Whatever It Takes

Originally published last month,  we’re sharing with permission Baby-Friendly USA’s piece Baby-Friendly in the Pandemic: Ingenuity, Flexibility, and Doing Whatever It Takes this week on Our Milky Way. The article details the continued importance of the Baby-Friendly Hospital Initiative (BFHI) and how hard facilities are working to meet changing needs during the pandemic.

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Baby-Friendly in the Pandemic: Ingenuity, Flexibility, and Doing Whatever It Takes

Published On: April 30, 2021

Over the past year, BFUSA has engaged in a series of support calls with Baby-Friendly designated facilities to learn about how things have been going at the front line of care during the pandemic. We have been so very impressed by the ingenuity, flexibility and uncompromising commitment to do whatever it takes to best support mothers and babies during this challenging time. And many facilities even found that some good may have come out of the pandemic.

Here are some of their stories…

Going Virtual at NYU/Langone

“We’ve been Baby-Friendly for ten years now, so the Ten Steps have been ingrained in our culture,” says Francine Pasadino, RNC-OB, CNM, C-EFM, IBLCE, LCCE, MA, Nurse Manager of Perinatal Support Services at NYU Langone Health in New York City.

Francine Pasadino (left), along with Rachel Levine, IBCLC (middle), and Victoria Masterson, program coordinator for the Center for Perinatal Education and Lactation (right)

But when New York City emerged as the epicenter of the pandemic in the spring of 2020, the lactation services staff faced unprecedented challenges. By mid-March 2020, in response to local and federal government recommendations to minimize the spread of COVID-19, Langone leadership halted all in-person and support groups.

“Lactation is a hands-on profession,” says Pasadino. “When everything was suspended, we really had to think outside the box to see how we can best support women and maintain our compliance with the Ten Steps.”

Fortunately, as with many other things in our world, virtual communication platforms offered a solution.

“We didn’t have any online or virtual option prior to the pandemic,” Pasadino says.

Undaunted, the Langone lactation team quickly made the transition. They bought an on-demand education platform, converted all in-person classes to virtual platforms, and developed a new 1-hour virtual Q&A session with a lactation consultant called “Ask the Educator” to help address the confusion many families were feeling at the beginning of the pandemic. They also disseminated the latest evidence-based information through their Facebook page and invited families to submit questions directly to their team via a dedicated email account.

Post discharge, mothers needing additional support were invited to register for virtual lactation consultation or to join a virtual Breastfeeding Café. The team also started a virtual support group called “Café Grande” for mothers with babies six months and older, which has become very popular as well.

Pasadino and her colleagues, Gladys Vallespir Ellett and Kathleen DeMarco, wrote about their experience in an article published in the Clinical Lactation journal.

“We were particularly concerned about supporting mothers asymptomatic and positive for COVID-19 and those mothers with mild COVID illness on the Mother/Baby unit since, in an effort to preserve personal protective equipment particularly in the beginning of the pandemic, our in-person interactions with COVID-positive mothers had to be limited,” say the authors.

The authors conclude that, although “the energy from in-person sessions cannot be replicated” and there are some limitations, “a virtual technology format is a viable alternative means of providing lactation education and supporting optimal infant feeding.”

“I believe virtual support is here to stay,” says Pasadino. “It was a bit challenging at first, but it has actually become a very effective option for families. And best of all, the virtual format has allowed us to reach women we wouldn’t have been able to reach before because they couldn’t come in person.”

Moving the Unit (Twice!) at Woodland Memorial

The staff at Woodland Memorial Hospital, a 107-bed facility in a suburb of Sacramento, California, faced a different kind of challenge when COVID-19 hit.

Nova Fox (fourth from left), along with (L-R) Lindsey Lyon, RN, Lezlie Siminski, RN, Samuel Siegel, MD, Shannon Baker, RN, and Jennifer Wienecke-Friedman, IBCLC

“Last March as the pandemic was unfolding, our leadership got together to discuss how we would accommodate the potential COVID surge,” explains Nova Fox, manager of the Family Birth Center (FBC).  “We were looking at the population of our community and our county, utilizing equations to calculate how many COVID admissions we should expect to receive, and we were concerned that our ICU unit would not be able to accommodate those numbers.”

The ICU at Woodland Memorial was an 8-bed unit, not large enough to accommodate the potential surge. Leadership began exploring ideas and identified that FBC had the necessary medical gases to accommodate intensive care patients. FBC had 7 Labor, Delivery, Recovery and Postpartum rooms, plus three additional shared rooms used for overflow postpartum and an isolation room – the only true isolation room in the hospital.

“We decided that turning FBC into the COVID unit was the best solution because it could hold 20 ICU status patients,” says Fox.

In late March, the hospital decided to take action in preparing for the COVID surge. FBC was transformed into the COVID unit and Fox and her staff relocated to the Outpatient Surgery Center across the parking lot. There, temporary walls were constructed to create two negative pressure delivery rooms, and staff were required to don and doff the proper PPE when entering these designated COVID delivery rooms.

“Patients labored in pre-op, delivered in the OR, and recovered in post-op,” recalls Fox.

The greatest challenge in moving a whole unit, according to Fox was the IT component.

“The equipment, we just rolled across the parking lot and into the next building,” Fox says. “More critical was building the virtual units within the Electronic Medical Record to ensure all service departments knew where to find the patients when orders were placed.”

Laboring patients in the Outpatient Surgery Center was a little bumpy at first.

“We had to figure out our new flow and what worked best for our patients,” Fox says. “But our staff did an awesome job – and our Baby-Friendly practices were not affected at all.”

Fortunately, the surge they were prepared for in the hospital did not materialize and after six weeks in their new setting, Fox and her team were told they could move back into their previous location.

Then, in the middle of December, the hospital began experiencing the COVID surge they had feared and FBC was once again asked to move. This time, FBC was able to stay within the walls of the hospital, trading spaces with the ICU. The ICU space offers eight private rooms where FBC patients labor, deliver and recover.

“The second move was a really easy transition. We knew exactly what to do,” recalls Fox.

Today, FBC remains in its temporary location while the hospital watches its COVID numbers and carefully considers its options for the next few months. In the meantime, Fox says, the Center’s Baby-Friendly practices have continued unabated.

“We had our virtual Phase One assessment when we were back in our unit and we passed 39 of the 40 elements,” she says. “We are now gearing up for our Phase 2 assessment in the virtual setting, which seems appropriate given how mobile we’ve been.”

Converting Mom-Baby Rooms to Med-Surg at University Medical Center

Beginning this past August, University Medical Center in Lubbock, Texas, began experiencing a surge in COVID patients and decided to divert non-COVID patients to other floors in order to open up capacity. The Postpartum unit was among the units selected.

Malory Foster (second from right), along with (L-R) Lena Fuller MSN, RNC-OB, Jill Shanklin, MSN, RNC-OB, Tamarah Smith, MSN, RN, CLC, Jessie Alexander, MSN, RNC-OB, and Cindy Savage, BSN, RN

“At first, we had one ICU unit and one med-surg unit designated for our COVID patients,” said Malory Foster BSN, RN, CLC, Perinatal Quality Specialist at University Medical Center. “When the COVID units got overwhelmed, they started spilling over into other units and we had to convert some of the postpartum rooms to med-surg.”

“Our nurses had to take care of things they weren’t used to at that point.” For example…“men,” she says with a laugh. “We all had to adjust a little bit.”

The team also had to convert some regular rooms in the Mom/Baby units to negative pressure rooms to care for mothers who tested positive for COVID. And the hospital added a medical tent to accommodate the increased demand for beds. Through it all, they were able to stay on track with Baby-Friendly practices.

“It was disruptive for sure,” says Malory, “but not to where processes changed.”

The biggest challenge, according to Malory, was the fact that information changed from day to day.

“It felt like every day, possibly every shift, information was changing,” she remembers. “What are the current facts and how do we use that information to effect change?”

In addition, it was also challenging to keep staff focused on daily tasks against a backdrop of larger, global issues.

“Everyone was consumed with COVID, and the worry of transmission from provider to patient or patient to provider. I think the drive to do all the little things like charting felt secondary with everything else at the time,” says Malory. “So, it was a mindset issue we needed to overcome.”

But overcome they did.

“I have to give it to our staff,” says Malory. “They were willing to do what needed to be done. Looking back on it, I feel like it has gone fairly well for a pandemic.”

Supporting Native Culture at Tuba City Health Care

As reported in a November 2020 story on PBS News Hour, the Navajo Nation has been particularly hard hit by the pandemic and its healthcare system has been straining to keep up. This impact has certainly been felt at Tuba City Regional Health Care, a 73-bed facility in Northeast Arizona which serves as a referral center for the western part of the Navajo and Hopi Reservations.

Alberta Nez (third from right), along with (L-R) Trudy Begaye, CNA, Madeline Tecson, RN, Ashton Norris, CNA, Rantreva Peaches, RN, Euelda King, RN, Nicole Donager, CNM, Janessa Payano-Stark, CNM, and Dr. Lee Johnson, DO

The OB staff were dealing not only with a vulnerable population, but an aging facility as well.

“The structure of our hospital is old,” says Alberta Nez, RN, MSN, Director of Obstetrics for Tuba City. “When the pandemic started, we had to make do with what we had. Things couldn’t be created quickly enough, but we were trying to do things that would be best for our patients.”

Small-scale structural changes were all they could hope for, but they have meant big changes, including the creation of two makeshift negative pressure rooms.

“It wasn’t the best. It was too loud. It took up too much space. But we had to do what we had to do,” recalls Nez.

They also did what they had to do by continuing to support breastfeeding during this challenging time.

“Our Baby-Friendly staff were still committed to encouraging moms to breastfeed and providing the extra care and education that’s important for our breastfeeding mothers,” Nez says.

But what really makes Tuba City unique is the population they care for, the vast majority of which are Native American. The pandemic created some interesting challenges where COVID-19 safety practices clashed with traditional tribal practices.

For Navajo women, it is customary to bury a child’s placenta on the tribe’s reservation as a binder to ancestral land and people. However, it was deemed unsafe for the COVID positive patients to leave with the placenta for fear it might spread the virus. Most women understood the need for this change, according to Nez.

“COVID 19 instilled fear in people,” she says. “We didn’t know, even amongst us providers. It was a scary time.”

The other major cultural change for these women came from the fact that each mother was permitted to have only one support person with her during labor and recovery.

“In certain times, if a mother was having trouble with labor, they would request a medicine person come in and offer a prayer to help the childbirth process move along,” Nez recalls. “But we could no longer allow that because they could only have their one support person.”

The staff is also accustomed to having women labor with large numbers of family members in the room to give them support because the childbirth is seen as a family event. But that changed as well because of COVID.

“Sometimes we would have to turn away family members from the room because there was too many of them,” she recalls. “That was hard on the mother because they had to choose just one. How can you choose? And it was stressful for us too because we are the ones who had to tell them they had to choose.”

But all in all, as with the other facilities featured above, the staff at Tuba City made it work and focused on the positive.

“I’m hoping it will give the mothers that are on the fence about breastfeeding a nudge,” Nez says. “I hear some say, ‘This horrible thing is going on in the world, but this is something that I can at least do for my baby.’”