Prioritizing infant and young child feeding in emergencies during National Preparedness Month and beyond

September is National Preparedness Month. We’ve spent a lot of bandwidth covering our country’s deficiencies in handling healthy infant feeding in emergency situations. There was National Preparedness Month: the U.S.’s deficit in Infant and Young Child Feeding preparedness during emergencies, Guiding resources for infant and young child feeding during emergencies, Spotlight on Infant and Young Child Feeding in Emergencies during National Breastfeeding Month, Toxic Stress, Resilience Building, COVID-19 and Breastfeeding, and Underdeveloped plans for infant and young child feeding during emergencies.

In preparation for Hurricane Katrina– which the Federal Emergency Management Agency (FEMA) called “the single most catastrophic natural disaster in US history”– the government organized an alternate site for the Super Bowl but failed to employ an infant feeding in emergencies (IFE) plan. In the aftermath of the catastrophe, pets and exotic animals were accounted for, but mothers and infants were separated from one another as hospitals were evacuated. If you haven’t the time to sift through our coverage on emergency preparedness and response, those accounts pretty much sum up where our priorities lie.

Photo by João Henrique do Carmo: https://www.pexels.com/photo/child-breastfeeds-from-her-mother-5839104/

With the deficit clearly illuminated, we’re glad to report solutions and resources for infant and young child feeding in emergencies (IYCF-E) that have begun to emerge as emergent situations increase in frequency and severity.

During World Breastfeeding Week, we shared work being done in Timor Leste as reported by Dr. Magdalena Whoolery in Strategies for Infant and Young Child Feeding in Climate-Related Emergencies.

We covered Doula and Program Coordinator at Birthmark Doula Collective & New Orleans Breastfeeding Center Malaika Ludman’s, MPH, CLC work in Infant and Young Child Feeding in Emergencies in Louisiana: Lessons Learned from a Post-Hurricane Laura Response During the COVID-19 Pandemic.

Julia-Lorraine Mercedez Moore, a WIC peer counselor in Pickens County, S.C., talks about supporting breastfeeding through the pandemic in South Carolina WIC peer counselors help families through COVID and beyond.  

In New Mexico Breastfeeding Task Force’s efforts to support human milk feeding in alternative housing environments, task force members describe how to best support families in crisis.

Beyond Our Milky Way coverage, there’s fantastic work and opportunities for action to amplify.

CHEERing is an ISO certified, Greek-registered NGO dedicated to improving maternal child health and promoting preventive health in refugee populations. They provide direct support in refugee camps and shelters; training for agencies, including medical professionals and volunteers who work daily with refugee populations, and evaluation and monitoring.

The Global Breastfeeding Collective created an advocacy brief, Breastfeeding in Emergency Situations, which details a call to action that focuses on establishing proactive versus reactive feeding systems.

Photo by Mehmet Turgut Kirkgoz : https://www.pexels.com/photo/a-woman-breastfeeding-her-child-11779231/

The IFE Core Group by the Johns Hopkins Center for Humanitarian Health at Johns Hopkins Bloomberg School of Public Health, the Friedman School of Nutrition Science and Policy at Tufts University and the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill has compiled a repository that provides peer-reviewed journal articles that cover emerging evidence in emergency settings such as natural disasters, conflicts, displacement including refugee settings. Access the repository here.

This summer, the CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) released a toolkit with information and resources for emergency preparedness and response personnel, families, and the public to ensure that children are fed safely when disaster strikes. You can access the toolkit here.

Image credit: United States Breastfeeding Committee

The United States Breastfeeding Committee (USBC) is a leader in helping pass legislation that would better protect young families in emergencies. USBC’s Take Action Center offers an easy way to engage in formalizing legislation. You can contact your legislators about the DEMAND Act (S. 3601/H.R. 6555) here.

Read other USBC coverage on IYCF-E in Disasters Don’t Wait: We Must Make Babies a Priority in Emergencies and The Four Pillars of Infant Nutrition Security in the United States.

Wives co-breastfeed son for two-and-a-half years

The lactation care provider glanced at her breasts and claimed, “You’re not going to be able to produce much milk.” Glenis Decuir, CBS, a young mother at the time, had just given birth to her first baby (now 17 years old), and while she intended to breastfeed her daughter, without explanation, without proper consultation and counseling, without a shred of compassion, the lactation consultant disparaged her intentions so tragically that Decuir not only did not breastfeed her daughter, she remained discouraged through the birth of her second child (now 14 years old) and did not breastfeed him either.

Decuir eventually learned that she has Insufficient Glandular Tissue (IGT) disorder.

“I knew my breasts looked different, but my mom’s looked the same as mine; I didn’t think anything was abnormal,” Decuir explains. “ I was young and wasn’t resourceful; no one explained anything.”

Though Decuir’s introduction to infant feeding was shrouded in the unknown and total neglect from care providers, her story takes a turn, epitomizing self-determination, advocacy and education, perseverance, resilience and empowerment.

In 2018, Decuir’s wife became pregnant with their third child. Because she would not grow and birth this baby, Decuir wondered how she would form a bond with him.

“It was very difficult for me to wrap my head around that,” Decuir shares.

Plunging into self-guided research, Decuir landed on the potential to induce lactation.

When she decided to embark on this path, Decuir reached out for guidance, but found herself in a void.

“Unfortunately, I received the most pushback from doctors, many of whom didn’t even know that inducing lactation was possible,” Decuir documents her road to co-breastfeeding. “I had to see four different doctors before I could find one willing to work with me. Being under the doctor’s care was very important because I had never done this before, and I knew I would be taking medications. After exploring several options, we chose the Newman Goldfarb Protocol as our method of induced lactation.”

For well over 20 weeks, Decuir delved into the protocol.

“Because I had really poor experiences with my first two and poor experiences with seeking help with breastfeeding professionals… I became an advocate… I had overcome so much adversity,” Decuir begins.

Laws state that we can pump anywhere, Decuir continues. And that’s what she did.

“I was pumping in every location imaginable! At my desk, in the car, the movie theater, Six Flags, and much more!” she writes.

Decuir goes on, “I decided to be very public about my entire journey on Instagram. One, I have the right to and I exercise every right, but it also opened a gateway to educating others.”

Prior to inducing lactation, Decuir reports that her children had never been exposed to anyone breastfeeding, “not even at a playground or anything,” she elucidates.

“This is how behind closed doors moms are with breastfeeding,” she says.

But Decuir and her wife’s approach is different; they are open-books with their children, she explains.

“They were old enough to understand scientifically, biologically, physically what my body was going to go through,” Decuir starts. “I educated them through a scientific standpoint, but also talked about normalizing breastfeeding. We talked about my daughter breastfeeding in the future, and my son and his role as a man in a household and how he can support his future wife to breastfeed.”

Decuir recalls the emotional and practical support her older children offered: “I cried in front of them, I pumped in front of them, I laughed in front of them; they helped wash bottles and Spectra parts…”

In sharing her journey with others though, Decuir wasn’t always met with such maturity and acceptance.

“I got everything under the sun,” Decuir remembers. Some told her it was disgusting, some found it weird, and some even went as far as to claim it child abuse.

Orion was born on September 2, 2018. At the time of his birth, Decuir was producing 16 ounces a day– quite close to what is considered full production– and had stored over 1,000 of her milk in a deep freezer.

Decuir says that she didn’t set forth focusing on the quantity though. “I wasn’t thinking about achieving full supply; I was thinking about producing anything. Even if it was only five ounces a day, I thought, I can at least do one feeding a day and that to me was worth it on its own.”

She continues: “Every time that I would latch Orion on, I just thanked Mother Nature and how amazing our bodies are. Maybe if I had birthed Orion, if I  had just latched him on, it wouldn’t have been a second thought, but because of what I went through–I worked real, real hard– every time I was able to latch my son, I literally thanked the universe. I was so grateful.”

Decuir and her wife went on to co-breastfeed Orion until he was two-and-a-half.

Throughout her breastfeeding relationship, Decuir remained visible in her efforts. “Having the power to go through that experience breastfeeding anywhere and everywhere in public, it became almost liberating and very freeing to be able to exercise my right, and in doing so I came across a lot of people. I took them as opportunities to talk more about breastfeeding and breastfeeding in public.”

At the start of her journey, in order to create her village, Decuir started a private Facebook support group. Today it has over two and a half thousand members.

Locally, Decuir serves as a breastfeeding support person through ZipMilk and is a ROSE Community Transformer, all on a volunteer basis. She has presented at the ROSE Summit in years’ past and is currently working on a book.

You can read Decuir’s former publications about her co-breastfeeding journey at https://aeroflowbreastpumps.com/blog/the-road-to-co-breastfeeding

https://www.baby-chick.com/what-is-co-breastfeeding/ and

https://www.huffpost.com/entry/co-breastfeeding_n_5c13eaf8e4b049efa75213e6.

For many, grandmothers are the village

Reflecting on her experience as a first-time grandmother, one of my colleagues and mentors expressed that, for most of us, “grandmothers are the closest thing to a village that we have.”

This colleague, a lactation care provider herself,  described the intricacies, sweetness and sacredness of watching her daughter step into motherhood. My colleague’s notes described her thoughtful presence without overbearance, leaving space for her daughter and her new family to learn and to bond. For instance, she cleans the house, prepares their bed with sun-dried sheets, and sits at the foot of the bed while her daughter and granddaughter nurse. In this dreamy scenario, grandma, baby and parents are all met with challenges, however those challenges haven’t become insurmountable thanks in part to this level of grandmotherly support and care.

This week we bring to you some work that details grandmothers’ powerful influence on the perinatal experience and beyond. A 2016 systematic review found that “a grandmother’s positive breastfeeding opinion had the potential to influence a mother up to 12 % more likely to initiate breastfeeding. Conversely a negative opinion has the capacity to decrease the likelihood of breastfeeding by up to 70 %.”

Healthy Children Project’s own Barbara O’Connor, RN, BSN, IBCLC, ANLC – Faculty Emerita designed and authored the Grandmothers’ Tea Project for the Illinois State Breastfeeding Task Force (2011).

Through O’Connor’s interactive curriculum, grandmothers are invited to learn about breastfeeding through three activities that pose breastfeeding scenarios:

“The Grandmothers’ Apron activity updates grandmothers’ knowledge about the importance of breastfeeding.

During the Grandmothers’ Cell Phone activity, grandmothers talk about breastfeeding myths and barriers.

In the Grandmothers’ Necklace activity, participants create a beaded necklace to remind them of ways they can offer support through loving encouragement, updating their breastfeeding knowledge, and being helpful.” (As described in A Grandmothers’ Tea: Evaluation of a Breastfeeding Support Intervention)

Source: United States Breastfeeding Committee.

Author Jane S. Grassley, RN, PhD, IBCLC and colleagues encourage perinatal educators to explore the curriculum for A Grandmothers’ Tea as they found that grandmothers and mothers who attended the teas in their study enjoyed their interactions with one another and with the class content.

Their work also unearthed a phenomenon of defensiveness in grandmothers who did not breastfeed their own children. The authors explain  “Grandmothers who did not breastfeed may feel defensive about their infant-feeding decisions because of the current emphasis on the health benefits of breastfeeding (Grassley & Eschiti, 2007)”  and advise that “perinatal educators can invite grandmothers to share their experiences and validate the cultural context in which these experiences took place.”

In this realm of validation and healing, Midwife Andrea Ruizquez of Partera Midwifery explores the implications of the Mother Wound. On Partera Midwifery’s Instagram page, Ruizquez writes:

“Props to all the people navigating complicated mother child relationships as adults. Now that I am in my 40’s I find myself reconnecting with my own mother in a deeper way. There was a time when we were estranged from each other. I learned how to recognize that I needed boundaries and practiced maintaining them. I am learning not to get triggered by my mother’s ways, and have compassion for her reasons behind them. I extend this sentiment to all of my grandmas ancestors who are in my lineage.

I am having more compassion for myself, and the ways I am like her my mom. I am learning to love myself deeper and become a more conscious mama to my children. I am still learning to love my child self that did not get all of her needs met, and I reparent myself with love. I feel myself heal.”

Source: United States Breastfeeding Committee.

Cultural beliefs held by grandmothers have the potential to influence healthy infant feeding practices. In Grace Yee, Retired IBCLC and Tonya Lang’s, MPH, CHES, IBCLC  Cultural Dimensions in Promoting, Protecting, and Supporting Lactation in East Asian Communities, they explained the prominent roles of aunties and grandmothers in the early postpartum. One example includes how colostrum is sometimes regarded in older generations as impure or unhealthy. Yee and Lang suggest that instead of positioning tradition and culture as a hindrance, to reframe barriers to breastfeeding into potential strengths. Respect of elders’ traditions and cultural practices will establish trust and foster positive relationships, as noted in Monique Sims-Harper, DrPH, MPH, RD, IBCLC, Jeanette Panchula, RN PHN, BA-SW, and Patt Young’s, Health Educator, CLE work entitled It Takes A Village: Empowering Grandmothers as Breastfeeding Supporters.

The physiological imprint of breastfeeding withstands generations and the sensations of milk production may surface decades later as mothers become grandmothers. Grandmothers who have previously breastfed have reported the tingling sensation of a phantom milk release when holding their grandchildren.

In South Sudan, grandmothers are relactating to help manage severe acute malnutrition. This practice has been documented elsewhere like Natal, South Africa and Vietnam for example.

Barry Hewlett and Steve Winn’s study on allomaternal nursing indicates that while this practice occurs in many cultures, “it is normative in relatively few cultures; biological kin, especially grandmothers, frequently provide allomaternal nursing and that infant age, mother’s condition, and culture (e.g., cultural models about if and when women other than the mother can nurse an infant or colostrum taboos) impact the nature and frequency of allomaternal nursing.”

Photo by Наталия Игоревна from Pexels

For an illuminating anthropological perspective, read A Biocultural Study of Grandmothering During the Perinatal Period by Brooke A. Scelza and  Katie Hinde. Their “findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being” and “show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants.”

We would love to learn about your perinatal and infant feeding experiences as grandmothers or with grandmothers. If you’d like to share, please email us at info@ourmilkyway.org.

Colorado pediatric office becomes breastfeeding friendly employer

Castle Rock Pediatrics (CRP) made a splash this summer at the Douglas County Fair Parade where they displayed their incredible Under the Sea themed float. Patients and families created a colorful array of paper plate fish that “swam” through pool noodle crafted seaweed.

CRP also attended the  Renaissance Expeditionary Magnet School Back to School Carnival and the Downtown Castle Rock Concert Under the Lights where they set up a lactation station.

After breastfeeding her own young children and later completing the Lactation Counselor Training Course (LCTC), Laura Westover PA-C, CLC, one of the providers at CRP, dove into helping transform her office into a Breastfeeding-Friendly Employer and soon-to-be Breastfeeding- Friendly Medical Office.

Their work is supported by a grant through the Tri-County Health Department. Westover has been working alongside Susan Howk, a breastfeeding policy specialist, to create their policies and lactation spaces through a six-point plan which includes policy, staff and provider training, patient education, environment, evaluation and sustainability, and continuity of care.

The grant has funded things like a chair, end tables, a hospital-grade multi user breast pump and kits, a stuffed animal nursing dog with her puppies for siblings to play with, and a lactation scale for weighted feeds.

Westover displays the breastfeeding friendly employer certificate in March 2022 standing in their first lactation space.

Their lactation space started in one of their smallest exam rooms, but has recently graduated to one of their larger exam rooms, which is now near the end of its renovation. Westover notes that the space also functions for newborn and young baby visits.

Westover reports that CRP owners since November 2021 Drs. Anderson and Bouchillon have been highly supportive of the breastfeeding-friendly changes.

Prior to the implementation of their lactation policies, Westover says their office “was not lactation friendly at all.” She describes stacks of formula in plain view.

“It gave the impression that we were promoting formula,” she comments.

Gift bags for patients were also riddled with formula-promotions, so the team phased out the branded materials and replaced them for non-branded, breastfeeding-friendly items.

Now, Westover and her colleague Sydney Gruenhaupt RN-BSN, CLC  see breastfeeding dyads weekly for office visits; whereas they once had to refer out. Of mothers’ main concerns are poor weight gain and uncomfortable or painful latch.

Westover points out that Colorado has very high breastfeeding initiation rates, but like the national trend, tapers dramatically at 6 months and beyond. While Westover and her colleagues are not currently tracking their office’s breastfeeding rates, it’s part of the plan in hopes that their numbers will hold steady beyond initiation rates. Westover explains since they’ve switched over to a larger electronic medical records system, there should be potential for a simple, infant feeding tracking system. A 2016 project by the County of San Diego Healthy Works program, implemented by UC San Diego Center for Community Health with funding from First 5 San Diego extensively explores current practices and future possibilities of  breastfeeding measurement in the outpatient electronic health record.

Westover and her colleagues will be out and about again this fall where they’ll craft their  lactation tent at events like Oktoberfest and the town of Castle Rock Spooktacular Halloween celebration.

“[It’s] really wonderful because we are able to promote [to] the whole community,” Westover shares.

For more about CRP’s lactation services visit https://castlerockpediatrics.com/Services/Additional-Services .

Supporting Black breastfeeding in Wichita Metro Area

Joyea Marshall-Crowley, CBS, Protect Yourself, Protect Your Baby Program Coordinator with the Kansas Breastfeeding Coalition (KBC) and coalition coordinator at the Wichita Black Breastfeeding Coalition (WBBC) had a wonderful perinatal experience in Dayton, Ohio. She shared her pregnancy and labor and delivery stories on social media, specifically advocating for midwifery care, sparking curiosities and starting conversations among her friends.

When she moved  back to her hometown of Wichita, Kansas though, she realized that the health options available were lacking. 

“Those options were not offered, spoken about, or supported,” Marshall-Crowley begins. “Since then, I pride myself on letting women know they have choices and are in control of their maternal healthcare.” 

Marshall-Crowley’s management of “Protect Yourself, Protect Your Baby” helps provide pregnant and breastfeeding mothers of color with accurate information about the COVID-19 vaccine. The focus of this project is to create a safe space to talk about vaccine hesitancies. The project includes healthcare experts of color who understand that these hesitancies come from trauma and historical incidents within the healthcare system, Marshall-Crowley explains.  You can find more information here: https://ksbreastfeeding.org/covid-19-vaccine-awareness/

 

WBBC formed relatively early on in the pandemic. With everything shut down, Marshall-Crowley noticed that people were in a state of being still and listening. On top of that, more babies were being born, and mothers were interested in finding ways to keep their babies safe from COVID which led them to research and take more interest in breastfeeding. 

WBBC is one of over 20 HealthConnect One’s First Food Equity project organizations supported in their efforts to rollout community-based projects by BIPOC leaders. [https://www.healthconnectone.org/feature-supporting-black-breastfeeding-in-wichita/

From this funding, the #LatchedLegacy project came about. 

Marshall-Crowley and other supporters uplift mothers with lactation and breastfeeding information and supplies.

“We are most proud of being a representation for women of color regarding breastfeeding support,” Marshall-Crowley shares. 

WBBC has engaged in many community events this summer like The Rudy Love Music Festival, Fiesta Mexicana of Topeka, Rock the Block, and Juneteenth celebrations just to name a few.  

Marshall-Crowley shares that they have received excellent feedback from the community and have been thanked many times for doing this work for the black and brown communities. 

She goes on, “Since the pandemic, social media has highlighted maternal healthcare for black and brown women, and breastfeeding has entered into those conversations. The culture is undoubtedly changing and starting to include breastfeeding as a first choice for infant feeding. For Wichita specifically, there have been changes like the formation of the coalition and the creation of the “Wichita Birth Justice Society,” which highlights maternal healthcare in a full circle. As a result, women of color in our community are feeling more supported and interested in owning their own maternal health experiences.” 

When WBBC started, there were no credentials in lactation within the group, Marshall-Crowley reports. Since spring though, they’ve added two certified breastfeeding specialists (CBS) working towards their IBCLC, three doula-trained workers, three Chocolate Milk Café trained facilitators, and two in the works of getting their midwifery license. 

“Our vision is to become the resource and information where Black women can seek help from the coalition, people who look like them and do not have to be outsourced because of ‘credentials,’” Marshall-Crowley stated in the coalition’s HealthConnect One feature

What’s more, the KBC accepted two of their members to the Color-Filled BF Clinical Lactation Program, so that list of credentials within the coalition will soon be updated further.

Marshall-Crowley was honored as one of USBC’s Cultural Changemaker awardees this year. 

You can follow WBBC’s activity on Facebook here