Doctoral student researches lived experiences of Black women after pregnancies complicated by gestational diabetes, breastfeeding, and later risk of Type 2 Diabetes

 Marked by a devastating entry into parenthood, Indiana State University doctoral student Teirra Riggs has turned tragedy into triumph,  manifesting a pay-it-forward attitude.

Riggs’ first pregnancy resulted in an unexplained stillbirth of her daughter at 20 weeks gestation. Days after the birth, Riggs remembers breastmilk leaking onto her computer while doing her doctoral work. 

“I didn’t have any education about what to do next,” Riggs says. “…Coming home with breasts full of milk and no baby, it was a very tumultuous time for me.” 

Even so, through the mental health upset and distress,  she remained committed to her doctoral program. 

Two years later, Riggs became pregnant again. At six weeks pregnant, she learned through an employer health program screening that her blood sugar level was dangerously high, resulting in a diagnosis of gestational diabetes.  

Riggs gave birth to her son at 37 weeks. Although her baby was born full term, over the next six months he would be diagnosed with failure to thrive– a set of words that became quite triggering for Riggs. 

“I knew I wanted to breastfeed,” she begins. “But I didn’t know what that would look like as a diabetic.” 

With the goal of increasing her baby’s weight, Riggs worked tirelessly with lactation care providers, all the while, the words “failure to thrive” playing over and over in her mind. She and her son went on to nurse for nine months. 

In many ways, Riggs felt the void of lactation and breastfeeding support as a Black woman, but she had some cheerleaders along the way. She and her dissertation committee chair Dr. Darleesa Doss were expecting their first babies at the same time and Riggs says she found comfort in that peer support.

“She was an immense support for me,” Riggs says. 

The department’s secretary, Ms. Susan Crist, would sometimes look after Riggs’ sleeping baby while she taught class. And when space wasn’t available for Riggs to pump, they made space for her in the women’s volleyball locker room. 

“Academia can be male-centered and male-led, so it was nice to have that nurturing support,” Riggs says. “It was an immeasurable experience.” 

The personal experiences of birthing and parenting as a diabetic quickly became inspiration and a vested interest in her professional life. 

Riggs currently serves as the Diabetes Prevention Coordinator at the Indiana State Department of Health. In this role, she works with employers encouraging them to adopt the CDC’s National Diabetes Prevention Network (DPP) Platform — a yearlong lifestyle training course for those at risk for diabetes. The platform is now offered on a virtual platform called Inspire Health. 

“Research has shown through this implementation, it works to get people off of their medication when they are aware of healthier lifestyles,” Riggs begins. “Prevention works. Promotion works.”  

Over the next nine months, Riggs’ doctoral research will look more specifically at the lived experiences of Black women after pregnancies complicated by gestational diabetes, breastfeeding, and later risk of Type 2 Diabetes. Although Black women are not most at risk for gestational diabetes, they have a 56 percent higher rate of developing Type 2 Diabetes five to seven years after delivery, Riggs explains. 

She says she hopes to explore and understand what happens during this time period: What are  Black women’s perception of risk of developing diabetes after a complicated pregnancy? What does access to care look like for Black women who receive this diagnosis? What are the psychological impacts on Black women during this time? 

Riggs also hopes to shed light on the importance of breastfeeding’s potential to mitigate the challenges of maternal diabetes and affect babies’ health outcomes

Most recently, Riggs completed the Lactation Counselor Training Course (LCTC) after learning about the course through the Indiana Black Breastfeeding Coalition

“[The class] was a great fit for my research endeavors,” Riggs explains. “[The LCTC] will help me pay it forward after working with the lactation care providers that embraced me.” 

She adds, “Even if you are diagnosed with a condition, breastfeeding is still possible when you have the right support system around. I want to change the narrative showing that Black women breastfeed.” 

 

In the future, Riggs hopes to present her experiences and findings through a TED Talk.

Uplifting transgender and non-binary parents

In a Hidden Brain episode, the podcast’s guest talks about how people have a difficult time accepting rules that have a lot of exceptions. The last day of March marked International Transgender Day of Visibility and while exploring some of the celebratory work of trans individuals, it got me thinking about how part of the essence of being a human is breaking rules; we ourselves are a compilation of rules with exceptions.

As with any individual, birth and lactation support should be tailored to address our uniqueness, but this mindfulness is especially important for transgender parents.

Source: The Gender Spectrum Collection

Danielle Downs Spradlin of Oasis Lactation Services shared on her social media a photo of a pronoun pin that she sports during her visits.  

“Look at this awesome pronoun pin…I share my pronouns so other[s] feel comfortable sharing theirs. I want to call all my patients and friends by the name they designate. That’s basic human to human respect. Trans parents feed their milk to their kids. We are mammals. It’s what we do. We can get those pronouns right too. #transparentsmatter #translivesmatter #pronouns #basicrespect #mammalsmakemilk #chestfeeding #breastfeeding,” Downs Spradlin writes. 

This is such a simple but effective and visible gesture toward inclusivity! 

U.S. Breastfeeding Committee’s (USBC) Diversity, Equity, and Inclusion page offers a compilation of gender and sexuality equity resources for those looking for ways to support the trans community: 

Personal Gender Pronouns 

Adapted from:

LGBTQ & Pride Month Resources

2019 NBCC Highlight:

Recommended Reading:  

La Leche League International ‘s Transgender and Non-Binary Parents 

GLAAD  

Transgender FAQ 

Tips for Allies of Transgender People 

Several years ago, Nikki Lee RN, BSN, MS, IBCLC, CCE, CIMI, ANLC, CKC conducted an interview with Diana West, BA, IBCLC on becoming transliterate. It remains relevant in the spirit of identity, acceptance, inclusion, and progress. Find it here.

Anne Eglash’s MD, IBCLC, FABM The Institute for the Advancement of Breastfeeding and Lactation Education, a USBC member, offers special considerations for LBGTQ+ individuals who desire lactation summarizing The Academy of Breastfeeding Medicine (ABM) Clinical Protocol #33

One should also note though that some trans parents desire to suppress lactation for various reasons. Those implications can be explored in one of Trevor MacDonald’s articles

Lactation care provider Aiden Farrow presented All Families Welcome: What Do We Mean By That? Creating a Culture of Support for Diverse Families at the 2019 International Breastfeeding Conference. Their references from the presentation include:

Farrow also wrote for the former Language of Inclusion: Embracing diversity in birth and breastfeeding! where they questioned the widely-used term ‘biologically normal’ in Are some parents not biologically normal?

“The desire to parent appears to be universal across the heterosexual and LGTBQ communities. In nature, difference is normal. Diversity is desirable for the survival of the species. Diversity in parenting is however, frequently not considered normal, and therefore access to care, support and legal recognition is not equal,” Farrow writes. 

In a recent article, Dr. Rachel Levine, the nation’s newly confirmed assistant secretary for health comments on care for transgender patients: “’I like to quote that sage Yoda from Star Wars. You know, ‘Fear is the path that leads to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.’ I think that people fear what they don’t understand,” she said.’”

The article also points out that “more Americans than ever oppose discrimination against transgender people.” Visibility leads to greater understanding, diminishing fear and hopefully halting suffering. 

Birth and lactation care providers are situated in a role serving families of all kinds during a pivotal point in parents’ lives. We have the responsibility to uplift transgender and non-binary people, empowering them to live openly and authentically, ultimately helping sculpt a respectful, vibrantly diverse and beautiful future.

Overcoming the challenges of living with low milk production

Lacy and her daughter

What’s in a name? For individuals challenged by Insufficient Glandular Tissue (IGT), the diagnosis can come to define their self efficacy and parental identity and confidence. It’s not uncommon for mental health to suffer in parents with IGT; for them to feel quite literally insufficient.

Insufficient education about the condition among care providers and limited research on supportive practices can often compound these feelings of failure in parents.    

Kaia Lacy, a mother of two toddlers, has surmounted the peaks and valleys of living with IGT, redefining what it means to live with the condition. 

A few months after her second child (now 19 months old) was born, she created a space on Instagram dedicated to IGT support, where there once was very little.  @lowsupplymom spreads “awareness about the experiences of low milk supply, and to remain a place where we can explore our journeys together, connect with others who understand them, find resources of support, and grow together in more confidence and knowledge, knowing we’re not alone.” 

Feelings of insufficiency 

Lacy’s early parenting experiences were marked by heartache and trauma.

While pregnant with her firstborn, Carl, Lacy set a goal to breastfeed her baby for four years. She hired a breastfeeding instructor at a local birthing center, read and researched about breastfeeding.

“I felt pretty confident going into it,” she reports. 

When her son was born, Lacy says she made sure to continue to “do everything right.” That meant Carl went skin-to-skin after birth and stayed there often, nursing many times throughout the day. Still, Carl’s weight gain was concerning. 

“We were checking all of the boxes and for some reason things just weren’t working,” Lacy remembers. 

In hindsight, Lacy says of her IGT, “A lot of red flag indicators went unnoticed.” 

Hoping for answers, Lacy hired lactation care providers who offered strategies to increase milk production. They told her “If you want it, it will work.” 

At one-month-old, Carl was diagnosed with failure to thrive. 

“He’d gone from 95 percent to two percent in his weight,” Lacy explains. “Seeing this lethargic and dehydrated baby, I felt so heartbroken.  It was a traumatic time for us. I felt insufficient as a mother, as a provider.” 

After Carl received treatment, Lacy continued to work with different lactation care providers attempting to boost her milk production. 

“I couldn’t get more than six ounces in 24 hours,” she reports. “It became so representative of this feeling of insufficiency.” 

Freed by information 

After four months, Lacy started feeding Carl formula exclusively. 

“Having distance from that experience helped me gain a lot of perspective,” she begins. “I had to grieve and process and understand what was going on in my body, and that’s when I started to learn about IGT.” 

That process of gathering information empowered Lacy. 

“It helped heal me and realize it wasn’t my fault,” she says. 

Released from guilt, Lacy went into her second pregnancy accepting that she might not be able to exclusively breastfeed. 

Extensive research alongside her lived experience helped her to realize that there are no opposites in infant feeding; instead, it’s a spectrum.

Graphic with variety of infant feeding options by @lowsupplymom

“I made it a part time job to pull information together and learn as much as I could about my condition,” Lacy begins. “I focused on the mental health aspect to manage my expectations and to be able to celebrate anything I could provide.”

It’s a sentiment she wants all parents struggling with low supply to embrace: it’s not all or nothing. Lacy’s Instagram page celebrates these variations in infant feeding and she acknowledges the worth in the decision to formula-feed. 

During her second pregnancy, Lacy harvested colostrum and went on to use an at-breast supplementer with her daughter Nora. 

“We became such pro-nursers,” she exclaims (as she and Nora nursed almost through the entirety of our phone call.) 

Lacy stresses that breastfeeding isn’t simply an “exchange of nutrients.”

“It’s something so beautiful. It’s such a sense of comfort. There are so many other functions.” 

Validating and uplifting others 

With a passion for helping people combat struggles similar to what she endured, Lacy hopes to guide them to a place of peace that she’s discovered. Scrolling through the comments on her Instagram page, one can sense the relief in many of her followers for having found a safe and refreshing space. Lowsupplymom offers uplifting encouragement, research and posts tinged with playful snark

Without dismissing this thriving community, Lacy says it’s frustrating that more medical professionals and care providers aren’t equipped with information about conditions like IGT, hypoplasia and other indicators for lactation failure. 

“I love supporting moms, but this should not be my job,” she says. “I’m just a mother on the internet with no accreditation, but I do it because I want to help move forward.” 

Having recently completed the Lactation Counselor Training Course (LCTC), Lacy brings a breadth of knowledge and compassion to the field of lactation. 

Her approach centers mothers and validates their experiences. 

She points out that a recent online poll she conducted revealed that the number one red flag for low supply  that was missed by providers was no breast changes in pregnancy or postpartum. 

“Everyone should be told that,” she says. “If there are signs of primary lactation failure, we need to engage in an emotionally sensitive way and support mothers’ goals, mental health and the safety of babies.” 

Addressing parents struggling with low supply, she continues, “You’re not alone. Your worth is not dependent on how much breastmilk you make. You deserve support and that’s the bottom line.”

Evidence-based safe-sleep practices to ensure that all babies and parents sleep safely

 As universal as sleep is, it’s amazing how taboo a subject it becomes when tiny humans are involved. New parents are often confronted with questions from friends, relatives, health care providers and even strangers wondering how well their baby sleeps. 

Image source: National Action Partnership to Promote Safe Sleep https://www.nichq.org/safe-sleep-and-breastfeeding-image-gallery

“Is she a good sleeper?” leaves much room for interpretation. Are babies considered good sleepers if they follow biological norms or if they adhere to the unrealistic, cultural sleep standards that we’ve forced upon them and their parents? 

It is uncommon for parents to receive solid, evidence-based sleep recommendations for their babies, and with roughly one third of adults in America sleep deprived,  it’s no wonder parents seek and find solutions on their own. 

Breastfeeding families might find that bed-sharing inadvertently happens, but might be hesitant to speak with their care providers about safe bed-sharing behavior since it is often but falsely prescribed as never acceptable

Some families discover a diverse collection of sleep training methods that promise sweet, sweet sleep despite the consequential effects of sleep training, which can be frustrating to lactation care providers as most sleep training methods are also detrimental to breastfeeding relationships.  

Amidst the taboo, the confusion and the desperation for good sleep, there is the tragedy of the approximately 3,500 infants who die from sleep-related causes every year in the U.S.

National Institute for Children’s Health Quality (NICHQ) just wrapped up its campaign advancing advocacy, protection, and promotion of evidence-based safe-sleep practices to ensure that all babies are sleeping safely in celebration of Sleep Awareness Week 2021.

Image source: National Action Partnership to Promote Safe Sleep https://www.nichq.org/safe-sleep-and-breastfeeding-image-gallery

The organization has compiled a wealth of evidence-based safe-sleep strategies and resources like their social media toolkit, conversation modules for health care providers, a literature review  and more. 

You can access all of their resources here including articles on health equity for safe sleep and breastfeeding outcomes. 

Challenged by omphalocele anomaly, mother builds resilience, calm and empowerment

Denise Bruno apologized for the background noise on our call; she was mixing her daughter’s drink, who, 29 years ago, was born with an omphalocele defect and spent just shy of one year in the NICU.

The Bruno family

Mariah wasn’t expected to live, Bruno tells me. Anticipating her baby’s birth in early summer 1991, she was put on bedrest in March. Mariah was born on May 29, 1991.  

“I didn’t hold her until she was a month old,” Bruno recalls. 

Without any kind of lactation support, Bruno pumped her milk which was given to Mariah through a gastric tube. No one on their health care team acknowledged Bruno’s efforts or the importance of human milk for her baby; and while Bruno credits her milk for seeding Mariah’s immune system and in part, her survival, she says that pumping her milk was terribly difficult. 

“It was a horrible feeling for me because I felt like I wasn’t a mom,” she explains, noting that she never experienced early bonding with skin-to-skin snuggles. 

Mariah endured severe complications from the surgery to relocate her organs into her abdominal cavity,  open heart surgery, a medically-induced coma, hip surgery, a serious infection, and more. 

When Mariah turned nine months old, Bruno became pregnant with her second baby. Later she had two more daughters. 

“I think, how did I ever get through all of that?” Bruno wonders. “If someone told me ahead of time, this is what your life is going to be like, I would have thought I couldn’t do it.  Mariah’s experience made me such a strong person.” 

With such resilience, Bruno’s greatest desire is to help others. 

Amidst severe medical challenges, welcoming new family members, and everything else life threw her way, Bruno started nursing school, became a certified yoga instructor, a massage therapist including infant massage, trained as a doula, and worked in a pediatric office and a women’s center. 

Ultimately, she decided to stay home to care for Mariah, although she’s still practicing massage therapy and using other modalities to help bring calm to people’s lives. 

“Infant massage and instructing yoga help me in helping others in this beautiful experience in bonding and making it calm and memorable,” Bruno adds. 

Most recently, Bruno completed the online Lactation Counselor Training Course (LCTC). Before the course went online, it was inaccessible because she couldn’t leave her daughter to travel to the locations that it was being hosted. 

“When I could do it online, I was like oh my god, I have to do this!” she exclaims. 

Bruno reports appreciating most the course’s emphasis on counseling and empowering mothers to feel like they are enough. 

Even through her most tumultuous times, Bruno says she harnessed the power of positive thought

“I would put music up to my belly and think positive thoughts,” Bruno recalls of being on bedrest during her pregnancy with Mariah. 

She hopes to impart this idea of mental strength on the new families she works with. 

Bruno offers a last bit of advice: Always keep an open mind and listen to what parents have to say. 

She stresses the importance of honoring parents’ instincts too and urges care providers to approach families holistically, rather than thinking compartmentally: “This is the problem; I have to fix it.” Most often, it’s more than that, she explains. 

“Listen and get the whole picture,” she advises. “Offer guidance and reassurance.” 

With this approach, parents and their babies have the best chance at building resilience, finding the connection we need to thrive, and cultivating the energy to pay it forward.