Suggestions for white lactation care providers on a path toward antiracism

One of the tenets of practicing as a Certified Lactation Counselor (CLC) is active listening. It’s the first step to humbly entering a relationship between ourselves and the parents we serve. Listening is one of the most effective, if not the most effective, skills a CLC can use to help families address their concerns and celebrate their triumphs. 

Active listening serves us well outside of the client-counselor relationship too. When we truly listen, we can learn to respect and celebrate humanity in the spaces where our differences collide. 

Photo by James Eades on Unsplash

For centuries, Black, Indigenous, People of Color (BIPOC) have had their experiences ignored and dismissed by those who don’t care to listen. Stories have been silenced altogether in fear of reprisal. 

Ancient Song Doula Services (ASDS) has launched their Listen To Me Now campaign, a safe space “to tell the truth about what parents, providers, family members, and communities are experiencing.” 

Active listening cues when it’s time to speak up. The current, global energy surrounding systemic racism calls upon us with privileged identities to seek individual awakening and to actively participate in the dismantling of unjust, inequitable systems. 

When the protests disperse and Race fades from the limelight, the work will continue. 

At this crucial time, we are all called to the work of dismantling injustice. (I would like to note here that my original sentence read: “Maybe– hopefully– you have already started this work.” until my editor pointed out that this assumes the reader is white. It is amazing how deeply woven and how subtle white supremacy can be, how easily overlooked it can be when you’re of privileged identity. I wrote those original words with pure intentions, but centered myself and my racial identity dismissing the entire population we’re rallying for.) 

In the words of ASDS Founder and CEO Chanel L Porchia-Albert:

“Now we are at a juncture of great awakening for some. A call to action to understand one’s own moral compass within the human dynamic.  A defining moment of choice.  A choice between doing good, a choice to promote justice and equity, a choice to reckon with understanding the power and privilege afforded to some at the expense of others.  

A choice to actively work towards dismantling intergenerational racism and the trauma it has caused over generations of Black people…

Now more than ever we need our collective community to drive equity, accountability, and sustainability to families. Because the privilege of some to sit and wait is not afforded to others and what we can do must be done now!… Onward Ever, Backward Never!!” 

Porchia-Albert suggests ways to engage:

  1. Share our Listen to Me Now Campaign centering the voices of Black pregnant people, providers, and community members in sharing their stories that will inform health policy, accountability, and collective change.
  2. Share and Donate to our Equity, Continuity & Hope GoFundMe created to support the community during this pandemic.  Help us to reach our goal! and let’s go beyondbirthwork!!
  3. Become a monthly donor your contribution will allow us to create sustainable change for our immediate community and beyond. 

One ally posted in a private lactation professional Facebook group wondering what her white CLC colleagues are doing to fight against injustice in healthcare. 

Photo by James Eades on Unsplash

Several care providers offered suggestions on how they’re working toward justice and equity including: 

Healthy Children Project Faculty Felisha Floyd, BS, CLC, IBCLC, RLC created a post calling for the investment in Black communities and Black businesses. There is a thread of Black birth workers’ Cash Apps for those compelled to contribute to their work. Find it here

NICHQ CEO Scott D. Berns reminds us in a message that “Everything we do should be viewed through a racial lens.”

Berns goes on to write, “Mr. Floyd, a 46-year-old Black man, along with concerned and outraged onlookers, called for help – but their voices were ignored, and a man died. Systemic racism is unacceptable. Let’s not continue to allow the voices for change fall on deaf ears.”  

Change is not easy, and this work is not easy. 

Melissa DePino, the white woman who shared the Starbucks video and co-founded the @privtoprog movement with Michelle Saahene acknowledges that in her piece A Love Letter to All the Overwhelmed White People Who Are Trying

Change takes time. DePino writes that it also takes a sincere desire to push through guilt and shame. It takes humility and an effort to get to know the parts of ourselves that we may not like. 

She concludes, “So my advice to you, having been where you are, is to sit back and listen. Don’t talk unless in white spaces to interrupt racism and to tell others you are on the path to antiracism…” 

Progress through podcast: Care provider supports families through relevant lactation education

When Tangela L. Boyd, MA, IBCLC, CLC, CLE, CCCE, CPD, a Union Institute & University affiliated faculty member and owner of Mommy Milk  & Me, Inc., had her twin boys 14 years ago becoming a mother of four, she simultaneously entered a space of advocacy.

“I had a very adventurous time with those guys in the NICU,” Boyd remembers. “It changed the way I thought about breastfeeding.” 

As a young Black mother, Boyd says she feels fortunate to have had support from hospital staff to feed her twins (which she went on to do for three years), acknowledging that this is not often the case for BIPOC families

“That support in turn gave me the desire to help other mommies,” she says.

Boyd’s passion lies in uplifting underserved communities, particularly families living in the rural regions of the Southeast U.S. where she lived for nearly 20 years. 

Now located in Florida, Boyd’s newly released podcast, The Early Postpartum Period, offers a way to stay connected and reach underserved mothers with basic, relevant breastfeeding information. 

Boyd admits that the technology was something new to her and it required much patience to bring the project to fruition. Still, she says, it’s something that she wants to commit to for a long time to come, connecting with families especially in the time after they’ve left the hospital. Boyd hopes to soon host focus groups to get a better understanding of what kind of information families would like her to cover in the episodes. 

In the meantime, she plans to release more episodes over the summer. Her practice emphasizes the importance of organization, so she’s planning a podcast featuring organizational skills and time management tips. 

“There is a lot of lactation education out there and I don’t want to be repetitive,” Boyd begins. “I want to hit areas that will really be relevant and give [parents] something they can use, not just something they can listen to.”  

Boyd explains that learning organizational skills can bring a sense of calmness which allows parents the energy to move forward with daily tasks, rather than getting engulfed by an often chaotic world. She suggests things like preparation, avoiding procrastination and working up endurance through taking a breath and stepping away when necessary. 

Especially as our country examines our foundations and current events have brought race to the forefront, Boyd emphasizes the urgency to address high Black maternal mortality rates.

The pandemic has illuminated ways in which to address these rates, Boyd explains, like out of hospital birth and doula support. 

“We have to move forward,” Boyd encourages. 

You can connect with Boyd on Twitter here and find her website here

Boyd has been featured on Ifeyinwa Asiodu’s PhD, RN, IBCLC Blacktation Diaires for her work on increasing breastfeeding and perinatal education rates among BIPOC. She has also written for Kimberly Seals Aller’s Mocha Manual.

Accessing the Milky Way scholarship opportunity

Recently, Healthy Children Project put out a statement about our stance on the current events. “These are incredibly trying and painful times. As we negotiate the very current multiple impacts of the COVID-19 pandemic, recent events remind us that systemic racism and social injustice are longstanding national plagues…For too long families of Black and Brown babies have lived in fear for their children, themselves and their loved ones. The Healthy Children Project and the Center for Breastfeeding will not tolerate injustice, hate, bigotry and racism in any form.”

We expressed our solidarity with birthing families, our staff, our participants, our families, our communities, and our friends and hold Black, Indigenous , Mothers of Color in our hearts, our mission and our vision and reiterated that we will not tolerate injustice, hate, bigotry and racism in any form. We especially remember the words of Dr. Martin Luther King, Jr. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Our mission and focus is all about supporting mothers and their breastfeeding journeys. We know that Black women experience maternal mortality and morbidity at three to four times the rates of white women and infant mortality is twice as high for babies born to Black mothers when compared to babies born to white mothers. We also know that breastfeeding can help mitigate both of these unacceptable disparities. 

We are taking steps to help Black mothers and Black communities while staying focused on what we do best; train people to assist with breastfeeding. 

Healthy Children Project and the Center for Breastfeeding has always been committed to making lactation care community diverse and equitable. We have worked to make the Lactation Counselor Training Course (LCTC) accessible by giving scholarships each year to organizations such as ROSE and HealthConnect One.

But we realized that we could do even more. Towards that end, we announce that we have started an initiative called Accessing the Milky Way. This initiative will send Black, Indigenous , People of Color to the online LCTC by offering scholarships that range from partial to full. 

The first phase of this initiative will provide full tuition for the online LCTC on full scholarship for 25 BIPOC. This Accessing the Milky Way scholarship will pay the entire tuition for the course. 

In addition, we have started a fund to pay for the required text book and the testing fee for each of the 25 recipients to further eliminate barriers to becoming a Certified Lactation Counselor. 

We invite you to nominate a person that you know who wants and deserves the opportunity to take the LCTC in order to better serve and support the mothers in their community. We will be accepting nominations now through July 10, 2020. If you would like to nominate an individual, please send an email to info@centerforbreastfeeding.org and include the nominee’s name, phone number, email address, city and state, and a short description of the work they are doing and the benefit to their community by them becoming a Certified Lactation Counselor. Self-nominations are welcome. 

There are two fixed costs that cannot be covered by the scholarship. The cost of the text book is $75.75 and the fee to take the exam after the class (administered by the Academy of Lactation Policy and Practice) is $120.  This additional $195.95 is another barrier to BIPOC getting training that will support the families in their communities. Healthy Children Project faculty is working to raise a total of $4900 which would cover these fixed costs for all 25 recipients of the scholarship. Those interested in growing this fund may visit the GoFundMe page here.

Paternal mental health and engagement

Humans are born connected. Separation is a learned behavior and in Western society, is often an accelerated process beginning just moments after birth

Photo by Kreated Media on Unsplash

If we can learn to separate, then we can unlearn those practices too. We can learn to reconnect. 

In recent time, skin-to-skin contact immediately after birth and beyond has been widely embraced as a tool to keep mothers and babies connected and to promote bonding. Skin-to-skin contact is encouraged to facilitate bonding between baby and father and other care providers too. 

As NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP points out in Fathers: Powerful Allies for Maternal and Child Health, “father engagement and involvement is a critical opportunity to improve children’s health outcomes in the decades to come”… beginning in the prenatal period. 

Despite overwhelming evidence demonstrating the importance of paternal involvement, fathers are up against significant barriers “including systemic obstacles related to employment, and a lack of confidence stemming from social stereotypes about the expected role of a father—namely that their role is somehow secondary to the mother’s.” [https://www.nichq.org/insight/fathers-powerful-allies-maternal-and-child-health

Fathers BJ (left) and Frankie (right) embrace their seconds-old-newborn boy Milo. Milo’s umbilical cord is still attached to the surrogate in this image. Photo by Ontario artist Lindsay Foster. Formerly published in: http://www.ourmilkyway.org/skin-to-skin-image-goes-viral/

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. 

The tool is reminiscent of the Edinburgh Postpartum Depression Scale (EPDS) developed to screen for depression in women during and after pregnancy and childbirth, but different in that it is sensitive to fatherhood and “not retrofitted and adapted from tools developed to capture unique characteristics of depression in women and mothers.” 

Photo by Kelly Sikkema on Unsplash

The Yates tool can screen male fathers during the perinatal period (prenatal or before birth up to 12 months after birth) for signs of depression with questions related to Mood/Loss of Interest and Motivation, Aggression/Irritability, Self-Concept/Feelings of Worth, Social System Deficits and Drug/alcohol use.  

“We believe that a culturally sensitive, carefully designed tool can give insight into the particular ways depression manifests in male fathers, identify men at risk for perinatal depression, and highlight the need to tailor treatment and services to the unique experiences of male fathers,” Brittany Pope, M.S., Director of Applied Clinical Sciences and Research at OhioGuidestone explains. “Furthermore, we hope to spur opportunities to explore potential programming, treatment and policy changes, both to raise awareness of the need to screen male fathers and to offer efficient and effective services and programs to meet their clinical and parenting needs.” 

The tool isn’t yet published and due to COVID-19,  research activity has been suspended, however the team plans to reopen the study using remote telehealth videoconferencing in August/September. This method will allow for even higher recruitment and screening. 

You can learn more about the screening tool at The Institute of Family & Community Impact’s website here

Photo by Chris on unsplash

In another effort to include fathers in the conversation around birth practice, separation and support,  Lactation Specialist Lydia O. Boyd, CLE is conducting a survey to capture the experiences of Black males through the Covid-19 pandemic. The survey can be found here

Reaching Our Brothers Everywhere (ROBE), an organization dedicated to educating, equipping, and empowering men to impact an increase in breastfeeding rates and a decrease infant mortality rates within the African-American communities, is hosting its 2020 Virtual Summit June 23 & 25 featuring speakers Dr. Saturu Ned, former Black Panther, Dr. Brian McGregor, Dr. Torian Easterling, Kenn Harris from National Healthy Start and the entire ROBE team. Register here.

On Becoming Transliterate: An Interview with Diana West, BA, IBCLC

June is Pride Month, a time to commemorate the 1969 Stonewall riots and celebrate the LGBTQIA+ community. Originally published in 2016, this piece by Guest Blogger, Nikki Lee RN, BSN, MS, IBCLC, CCE, CIMI, ANLC, CKC remains relevant in the spirit of identity, acceptance, inclusion, and progress.

From dianawest.com
Diana West BA, IBCLC       From dianawest.com

Diana West BA, IBCLC, LLL, is a co-author of many important works, (the 8th edition of the Womanly Art of Breastfeeding, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family,  Breastfeeding after Breast and Nipple Procedures, The Clinician’s  Breastfeeding Triage Tool, and The Breastfeeding Mother’s Guide to Making More Milk) , as well as the sole author of Defining your Own Success: Breastfeeding after Breast Reduction Surgery and editor of her father’s autobiography, In the Line of Duty.   In addition to her websites, she is well known as an educated, lively, and passionate public speaker. Our Milky Way blog is grateful for the chance to interview Diana about her research article, “Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study,” co-authored with Trevor MacDonald, Joy Noel-Weiss, Michelle Walks, MaryLynne Biener, Alanna Kibbe and Elizabeth Myler.

The universe works in wonderful and mysterious ways. Several years ago, Diana received an email from a would-be author asking her to read a book that he had written. There was something special about this letter that captured her attention. In it, Trevor MacDonald, a trans man wrote of reading her book Defining Your Own Success: Breastfeeding After Breast Reduction Surgery, and then of being inspired to chestfeed his own child.

As the right of all people to their own identity is one of her core values, Diana entered into a relationship with Mr. MacDonald, first as a mentor guiding him towards publication, and then as a friend, sharing a room with him at an ILCA conference, and then as a collaborator, working together.

He was appreciative of and patient with her respectful approach; he taught about this new world, where an untold number of people struggle without help, staying underground as they fear the judgments of the helping professions.

They thought of publishing a case study but changed their minds to do a research study instead. While they initially envisioned a quantitative study, after consulting with others, including Canadian Professor Joy Noel-Weiss, they decided to do a qualitative study.  Dr. Noel-Weiss helped them to see that the data in a qualitative study would be richer, giving insight into the motivations behind lived experience; this would be far more valuable than evaluating numbers.

After developing research questions and obtaining clearance from an ethics committee, the merry band applied for a modest CHID (the Canadian version of the US’s National Institutes of Health) grant.  In an amazing affirmation of the value of this research, they received $100,000, far more than they had requested, because the agency was so impressed with the topic!

The 3 goals of their study were: to understand the lived experience of the transgender men who chose to birth and to chestfeed, to understand the barriers they encounter, and to provide guidance to healthcare providers.

Many breastfeeding helpers came of age and into their avocations in the 1970s, when women were fighting for autonomy and rights to freedom in birth and breastfeeding. Today, some feel that trans men are encroaching on women and their feminist perspectives. This is why trans women were banned from a women’s festival in Michigan. Instead of saying, “These are more women who have been denied dignity” they were seen as men who were encroaching on a woman’s needs for equality of choice. However, gender identity is not binary, i.e., only male or female.

A cisgender person, one who identifies as the gender manifested by their genitalia may not be absolutely and always female or male.  Gender identity is fluid. We may feel more male on some days, more female on others, and there are days when we feel neuter. There are mutational variations of hormones that create variations on gender. Babies are born with ambiguous genitalia. There are cultures where people can be recognized as 2-spirited. Gender, identity, and sexual preference are complex traits, there is a wide range of variation, and consequently, people don’t all fit into a neat “either/or” category.

Thirty-three years ago, I met a great fiddler named Gary. Gary was the most crass and obnoxious man that I ever met. It was impossible to have a conversation with him without his making some gross joke or sexually slanted comment. I didn’t like to be with him, because he was such a cad. He lived in the South; I lived in the North and didn’t have contact with him very often.

Fast-forward 25 years, when I run into Gary at a fiddler’s convention. Only now Gary has breasts, is wearing a dress, earrings and make-up and wants to be known as Marie. We had an amazingly open discussion, where I got to ask all the questions I wanted to ask and she answered them all. She told me that all the deeply difficult work, all the family disruption (before transitioning, she had married and had 2 children), and all the medical and surgical interventions were worth it, as now she felt complete and comfortable in her own skin for the first time in her life.  All was well except for one thing, family and friends continued to use the wrong pronoun; myself included. I got annoyed with her for being annoyed with me when I kept using male pronouns; I said to her, “Gary, I’ve known you for 33 years as a male and it is hard for me to switch gears quickly enough for you.”

After hearing this story, Diana gently suggested,

 “Oh yes you can, and here is why. For a trans person to come out to the world as someone who is a different sex than the world has known them before, is one of the most difficult situations imaginable. It is difficult to be brave enough to be one’s true self out in the world. Acceptance is what is craved, in order to have dignity. When we who are cisgender do not recognize that change, we are denying that person their dignity. We can make the effort to honor the pronoun they choose.  Everybody has the right to the pronoun of their choice. It is simply a matter of respectfully asking them what pronoun they prefer.” (This means adding new terms, understanding, and words to our vocabulary.)

Diana goes on to say, “We don’t know people’s paths, and we don’t know their hurts. When we accept people choosing the path that meets their needs, we recognize their right to be who they are. “

She paraphrases Mr. MacDonald in saying that many people find the concept of being transgender disturbing because they picture themselves having to act and dress differently than their true selves. But really, it is the trans folks that have had to act differently to who they really are until they transition. Putting it another way, was there a day that you consciously chose to be cisgender? Or, do your feelings about your gender identity flow from a place inside you, where the truth of who you are has always lived?

Society is presently a challenge, as there is anger about trans gender.  Some people believe that sexuality is a choice and manifest their fear in attacks that fill our feeds and screens. The rudeness and brutality of the Internet and the rhetoric of today’s political debates is painful to those struggling for recognition.  It behooves us all to post and tweet with courtesy and respect.

Science and technology have made possibilities real that were hitherto unimaginable. Think of the suffering that has gone on for millennia, where differently gendered folk could only dream of the pharmacy and the surgery that would enable them to have their physical bodies match their inside spirits. Today, these dreams can come true; now, everyone in society needs new skills and new understanding to catch up to the new reality.

Another barrier is the public attitude about children who are being parented by trans men.  Diana responds,

Children raised with love and respect and healthy growing environments, have the best chance to be wonderful adults. We don’t have to be perfect parents; the only ideal for a parent is deeply loving a child and taking care of them.  There is NOTHING about being transgender that precludes them from being a good parent. In fact, they may have more understanding to teach about the importance of treating everyone with dignity.”

Most trans people are not activists as they are too busy living their lives. The trans experience is really about self-actualization, a concept younger folks may not yet appreciate.

So far, what is most helpful is social support from family and friends. (This is true for breastfeeding too!) The people who donated a lot of the milk that Mr MacDonald used to chestfeed were Mennonites and Mormons. Although they knew who he was, their priority was on feeding the child human milk, and they didn’t judge him nor withheld their gift.

As healthcare professionals, we need to become transliterate, so that we can be helpful and respectful to anyone that we care for. This means educating ourselves so that our clients don’t have to explain everything over and over again with each one of us. The new research article has great information about how healthcare professionals can help transgender clients more effectively.  Diana also has a FAQ on her website to aid the transgender person in finding the help they need for birth and breastfeeding, and for healthcare professionals to educate themselves.

Ask about preferred pronouns and “what would you like your child to call you?” There is no need to apologize for what we don’t know; “I want to be helpful, how can I help?” is a lovely way to start a discussion.  People make mistakes; those who are transgender understand this. Our responsibility is not to be stuck on our mistakes, and to make the transition to helping and not to impose our own struggles.  We also want to avoid overcompensating to prove how cool and current we are.

If transgender issues aren’t comfortable for you, remember that as healthcare professionals, we are ethically bound to take care of people that we may not like. We have an obligation to provide best care; this requires only an intention of respect. We need to treat people in a humane way, as we should be treating ourselves.

Grammar is another stumbling block, as language locks old societal attitudes into our unconscious, where they are negative influence on our interactions with others.  Diana says, “ ‘They’ has been a plural noun; we have to let go of old grammar rules and use ‘they’ as a singular noun.”  (Facebook is doing this.) This will get rid of the gender binary view, and bring us forward into the 21st century. Language is a dynamic, changing thing; language change fuels our intention and is manifested in our actions.

A mistake that I made in this interview was to talk about the “transgendered” This noun is similar to the term “colored”, it is a subtle way of expressing the terrible attitudes towards “those people who are different to and inferior than us.”  Diana encourages the use of the word “transgender”.

Diana reminds us that of the need for acceptance, dialogue and welcoming all points of view; she is collaborating with transgender speakers to introduce her talks on that topic. Her goal is to be a cisgender Ally; the capital ‘A’ is intentional and reflects the importance of a new social advocacy role in supporting human rights. Her dream is for all people to become self-actualized and lead the best and healthiest lives possible.

We applaud Diana for breaching this barrier, and educating us about human rights. We can use this information in our own communities, and together, build an inclusive and respectful world.