22 Actions in 2022

“Nothing will work unless you do.” — Maya Angelou

Inspired by Life Kit’s 22 Tips for 2022, we’ve compiled 22 Actions in 2022 for maternal child health advocates to continue this important work.

Photo by Tim Mossholder on Unsplash

 1. Sign up for MomsRising alerts (enter your email in the top right) to learn about legislation in support of parental leave

2. Sign up for news and action alerts from U.S. Breastfeeding Committee (USBC). You can also use their Take Action tools to support active legislation and policies that support healthy families. 

3. Get really local. Talk to local parents about challenges and successes they are encountering. Are there restaurants and public places you might celebrate for their support of breastfeeding families? Check to see if your state has a “Breastfeeding Welcome Here” campaign implemented. Some examples include Kansas Breastfeeding Coalition, Nevada Breastfeeds, and Vanderbilt University.

4. If you are in the U.S., check out your state’s report by USBC. What’s going well in your state? How can you help “move the needle” on areas that need improvement?

5. Plan a COVID-contagion-free World Breastfeeding Week/National Breastfeeding Month celebration.

Photo by Timothy Meinberg on Unsplash

6. Learn how to play March Mammal Madness. Get your bracket ready for 2022!

7. Watch UC Davis’s Savor: Our First Superfood and the Infant Microbiome with participants Bruce German, Katie Hinde and Jennifer Smilowitz.

8. Learn about the status of the International Code in your country and your neighborhood. There is a forthcoming report from UNICEF/WHO

9. Explore Hollie McNish’s breastfeeding poetry

10. Read Baby Milk Action’s Patti Rundall’s news blog to learn about infant and young child feeding (IYCF) feeding policy and conflict of interest. 

11. Learn about the World Breastfeeding Trends Initiative (WBTi). If you are in the U.S., how does your state compare to the national results? Where is your state the strongest? Where are the greatest challenges? If you are outside the U.S., how does your country compare to others

12. Attend an equity training. USBC has several opportunities to explore here. Other opportunities include FACTUALITY and  Me and White Supremacy by Layla Saad accountability group (link to sign up in Google Document).  

13. Watch and share Global Health Media teaching videos. 

14. Show your support for a BIPOC-owned birth or lactation care service or organization near you. Some examples include Jamaa Birth Village, Southern Birth Justice Network, Reaching Our Sisters Everywhere (ROSE), A’nowa:ra Owira Doulas, Birth & Milk Co.Sankofa Lactation Services, Blactavist, Mommy Milk and Me Inc. Who else would you list here? 

15. Check out self-care resources like those on White Ribbon Alliance’s Self Care page or Kathleen Kendall-Tackett’s Burnout, Compassion Fatigue and Self-Care for Members of the Perinatal Team webinar.   

16. Explore how you can get involved with the National Institute for Children’s Health Quality’s (NICHQ) National Network of Perinatal Quality Collaborative Initiative

17. Donate milk, time, money or participate in research to support the Human Milk Banking Association of North America (HMBANA)

18. Complete the Building on Campaigns with Conversations learning module series to learn how to most effectively interact with families on topics of safe sleep and breastfeeding. 

19. Listen to The Breastfeeding Medicine Podcast, The Evidence Based Birth Podcast, and/or The History of BLW with Its Founding Philosopher Gill Rapley, PhD.

Photo by Emily Finch on Unsplash

20. Explore the new U.S. Dietary Guidelines for Pregnancy, Lactation and Infancy. What are the highlights in this new document? Lowlights? What resources presented can be helpful to you? 

21. Read the latest open access journals from Mary Ann Liebert, Inc. publishers.

22. Watch the Maternal Health Call to Action Summit and/or read through the Fact Sheet.  Urge your senators to support the provisions set forth in the Maternal CARE Act and the Black Maternal Health Momnibus Act. 

Tell us, what other actionable items will you be crossing off of your list in 2022? We’d love to hear from you! Comment below or email info@ourmilkyway.org.

How does breastfeeding impact postpartum depression in pre-and post- COVID-19 cohorts?

By now you may know that Healthy Children Project made the very difficult decision to cancel the 27th Annual International Breastfeeding Conference in Deerfield Beach, Fla. because of the growing concerns around COVID-19.  Still, we remain enthusiastic about the scheduled presenters’ incredible work and are excited to be able to share some of their findings here on Our Milky Way

A few weeks ago, we shared about Malaika Ludman, MPH, CLC and colleagues’ work titled Infant and Young Child Feeding in Emergencies in Louisiana: Lessons Learned from a Post-Hurricane Laura Response During the COVID-19 Pandemic

The Vozzola Duo

This week we are pleased to highlight work by Amanda Vozzola, BS, David Vozzola, PhD, Johanna McCracken, BS and Dikea Roussos-Ross, MD:   How Does Breastfeeding Impact Postpartum Depression in Pre-and Post- COVID-19 Cohorts?

Amanda Vozzola is a fourth-year medical student at the University of Florida College of Medicine and is applying for an Obstetrics and Gynecology residency position. Amanda shares that her passion for women’s health shaped much of her research and teaching initiatives, which led to work involving maternal morbidity and mortality in the US and transgender reproductive health considerations. 

While women’s health is her primary passion, she has also studied how chemotherapy impacts neural stem cell growth, created an individualized tobacco cessation protocol, and received an NIH-T35 grant for her research in pediatric cardiac imaging modalities. She says her goal as a future physician is to use her diverse background to provide high-quality, compassionate healthcare for her patients.

“Maternal medicine is complex, the patient population is wonderful, and it’s a field where healthcare professionals and researchers can make a tangible difference,” Amanda shares. “As a nation, our maternal morbidity and mortality outcomes and newborn health outcomes are unacceptable. I am interested in helping decrease the disparity gap through research, clinical practice, and education.”

Dr. David Vozzola (admiringly referred to as Dr. Dad by Ms. Vozzola) is the Director of the Information Technology Institute for Advanced Study (ITIAS) which  funds research in health technology, human technology, transportation, logistics, virtual reality, artificial intelligence, and machine learning.

Amanda says she got curious about postpartum depression (PPD) as she continued to see patients with mental health concerns postpartum.

Many blame themselves for ‘feeling down’ or say they do not feel like a good mom because they don’t feel happy,” Amanda explains. “Postpartum women often face an amplified stigma of mental health, and I believe a lack of research, knowledge, and awareness contributes to the amplification.”

Photo by David Veksler on Unsplash

Conversing with her roommate and co-author on this project, Amanda says they discussed how the pandemic impacted many of their patients, friends, and family members during pregnancy and postpartum. 

“Between hospital regulations allowing one (sometimes none) person to be in the room, the anxiety of an unknown virus and worldwide pandemic, isolation, etc.,” she reflects. “We hypothesized that postpartum depression and anxiety would increase in a post-pandemic cohort. We are strong advocates for breastfeeding and wanted to test its protective effect for mothers before and after the pandemic.” 

The authors share their results: 

  • “Both pre-and post-COVID-19 cohorts showed that breastfeeding resulted in lower levels of postpartum depression (PPD) based on the Edinburgh Postnatal Depression Scale (EPDS) scoring than their non-breastfeeding counterparts.
  • The protective effect of breastfeeding from PPD was significant in the pre and post-COVID-19 cohort. However, the pre- cohort exhibited a higher level of protection.
  • In the pre-COVID-19 cohort, 33% of non-breastfeeding patients exhibited PPD (EPDS >= 9) and 17% exhibited severe PPD (EDPS >= 15).  In contrast, only 14% of the breastfeeding patients exhibited PPD, and 4% exhibited severe PPD.
  • In the post-COVID-19 cohort, 45% of non-breastfeeding patients exhibited PPD (EPDS >= 9) and 24% exhibited severe PPD (EDPS >= 15).  In contrast, only 32% of the breastfeeding patients exhibited PPD, and 12% exhibited severe PPD.
  • A significant difference in PPD existed between breastfeeding and non-breastfeeding in the pre-and post-COVID-19 cohorts showing that breastfeeding had significantly lower PPD, based on EPDS scores.” 

Amanda says she hopes these findings will provide a foundation for further research. 

What are other factors protective against PPD? Are there specific factors about breastfeeding that influence EPDS scores, such as duration, exclusivity, and difficulty? Why was breastfeeding less protective in the post-pandemic cohort? she wonders. 

“Ultimately, I hope this research contributes to the knowledge of PPD that helps mothers feel understood and that they are not alone,” she adds. 

Photo by Brytny.com on Unsplash

The Vozzolas are currently working on a few other projects from the same data collection set regarding how insurance type, gestational age, patient demographics, and previous psychiatric diagnoses impact PPD, anxiety, and specific responses on the EPDS survey. 

They have submitted two abstracts to the American College of Obstetricians and Gynecologists (ACOGs) in hopes of presenting their research at an upcoming conference. One abstract looks at the association of COVID-19 and EPDS scores. The second abstract looks at the impact of psychiatric disorders’ history on EPDS scores.

They are also preparing two journal submissions. The first submission looks at COVID-19’s impact on PPD in women with a prior psychiatric history. The second submission looks at developing and validating a model of predictors and outcomes of COVID-19 and postpartum depression.

Capable and Strong After Pregnancy Loss: Dana’s Milk Donation Story

Capable and Strong After Pregnancy Loss: Dana’s Milk Donation Story was originally published by Mothers’ Milk Bank Northeast on October 18, 2021. We are honored to share Dana’s story here on Our Milky Way with permission.

Photo credit to the author and Mothers’ Milk Bank Northeast. Enjoy!

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Dana shares her story of pregnancy loss, subsequent birth complications, and healing through milk donation.

My name is Dana Scarantino, and my husband Domenic Salvemini and I have been together for eight years, married for four.

Two years ago this month we finally got the happy news we’d been hoping for for almost a year, a positive pregnancy test. We were elated, and dreamed about our future as a family, and how we’d tell everyone over the holidays about the baby we were due with in June. In mid-December, I had a missed miscarriage at 12 weeks, and a D&C the very next day. We were heartbroken to say the least, and had to wait a few months to be physically and emotionally ready to try again. Then came COVID, and when things were still looking like a lockdown would be short-lived, we made the call to try to conceive again. In April 2020, we got another positive pregnancy test.

A new start after pregnancy loss

Pregnancy after loss, compounded with the pandemic, was so anxiety riddled and stressful, but luckily our babe was healthy, growing perfectly, and was due January 1, 2021, a beautiful start to a new year. But this babe had other plans! Ten days after her due date, after trying everything possible to kickstart labor naturally, my OB/GYN team scheduled me for an induction. I had already begun to mourn the birth preferences I’d envisioned, but came to realize that “here and healthy” had been the goal the whole time, especially after the loss of our first.

Getting induced, more preferences went out the window. I was very slow to dilate, got an infection with a 104 fever from my water breaking, and the team found the baby’s first stool in my amniotic fluid, so off to surgery we went, with the NICU team on standby. Lydia Michele Salvemini was born via C-section, 13 days late on January 14, and came out perfect. But because she’d spent so much time on the inside, we were too slow to get a dirty diaper, and the doctors told us we had to supplement with formula. I was so disappointed; my body kept “failing” me with everything not going according to plan, and now my milk wasn’t enough to sustain little Lydia.

Building milk supply

So I kicked into determined-mom-mode and tried every tip and trick: I power pumped, had her skin-to-skin and latching every chance I could, and got my supply to a place where it was great, only having to use formula a handful of times. My supply was then so abundant I was able to start to freeze a stockpile so I could keep her on breast milk for as long as possible. It was a few months before I realized Lydia was a milk snob, and did not like my milk once it was thawed.

From there, I knew I had to do something with all this milk. Determined-mom-mode kicked in once again, and I found Mothers’ Milk Bank Northeast to donate to. While the screening was definitely a process, the team there was so grateful for all the information I shared, and how quickly I wanted to get the ball rolling, which made me really feel like I was making a difference.

Donating milk to help other moms

I wanted to donate for those moms like me whose plans got thrown off the rails, in hopes that it stings a little less when your milk doesn’t catch up to the needs of your baby. There’s no shame in formula, but breast milk is magical, and should be offered as an option in all hospitals to new moms in their emotional state. My husband wanted to donate to get back the freezer space! But really, I know that Domenic is genuinely proud of me, and we can’t wait to be able to share with Lydia one day what we did together.

After baby loss, pregnancy after loss, a late-term birth that ended in a C-section, and nothing going according to my birth preferences, it’s incredibly empowering to know that my body is capable and strong, and is providing milk for not only my baby, but other babies, too—NICU babies at that.

Screening to become a breast milk donor is an easy four-step process. Once accepted for donation, milk can be shipped for free door-to-door or through one of our donor milk depots throughout the Northeast.

 

Infant and Young Child Feeding in Emergencies in Louisiana: Lessons Learned from a Post-Hurricane Laura Response During the COVID-19 Pandemic

Deerfield Beach, Fla.

 Every year, we look forward to connecting with those in the field of maternal child health and human lactation, sharing our experiences and knowledge to better support families. But given the growing concerns around COVID-19 and new variants, we’ve made the difficult decision to cancel the long-awaited 27th Annual International Breastfeeding Conference in Deerfield Beach, Fla.

This was a very tough call to make and while we wish circumstances were different, we are so grateful for your enthusiasm for this conference.

Although we won’t have the opportunity to connect with conference presenters in person, we are still excited to share with you some of their incredible work here on Our Milky Way

Malaika Ludman, MPH, CLC is a Doula and Program Coordinator at Birthmark Doula Collective & New Orleans Breastfeeding Center. Her work in maternal child health was heavily influenced by her mother’s work. In the 1980s,  she founded a socio medical center in Lome, Togo that offered OB/GYN services, prenatal care, pediatric care, vaccinations, and social services.

Ludman went on to draw inspiration and wisdom from a clinic midwife who she met during a summer in Kaolack, Senegal. As part of her graduate studies, she provided  logistical support to staff at a community-based socio medical center, and that partnership sparked her interest in becoming a doula upon return to the states. 

Ludman was scheduled to present work titled Infant and Young Child Feeding in Emergencies in Louisiana: Lessons Learned from a Post-Hurricane Laura Response During the COVID-19 Pandemic at the conference.

Photo Credit: CDC https://www.cdc.gov/nccdphp/dnpao/features/disasters-infant-feeding/index.html

The World Breastfeeding Trends Initiative (WBTi) scored the United States zero out of 10 for Infant feeding during Emergencies.  Based on their experiences and observations providing infant feeding support after Hurricane Laura, Ludman and her colleagues developed specific recommendations for their state and local health departments and emergency response agencies for making infant and young child feeding during emergencies (IYCFE) and perinatal emergency preparedness a priority in the United States.

Ludman describes what it’s like to live through a multifaceted crisis– natural disasters exasperated by the climate crisis, a pandemic, and racial health inequities:  

“[It’s] heavy and overwhelming. Observing firsthand the lack of resources, practical assistance, and awareness of the needs of infants and young children and their parents during emergencies is upsetting. While there is an abundance of evidence to support the fact that human milk is the safest feeding option for infants in emergencies, structures that protect, promote, and support breastfeeding are not well integrated into emergency preparedness plans. The US model of disaster response is to request, accept, and distribute donations of infant formula far and wide, without assessing individual need, providing the resources needed to safely prepare formula, or offering follow-up, all of which make infants more vulnerable. 

To make matters more difficult, intense fear of COVID transmission in the early days of the pandemic made parents worry about whether it was safe to even breastfeed their babies. This jeopardized the health of a lot of breastfeeding dyads, and was a worrisome shift ahead of hurricane season. There were healthcare policies and practices that disrupted lactation, in particular separating infants from their parents immediately after birth. Also, social distancing influenced the type of support that families could receive; families were more isolated and support was less ‘hands-on’. This new and uncertain reality compounded with the anxiety of hurricane season was a recipe for stress. 

We also know that emergencies (whether natural disasters or pandemics), affect communities of color differently. In non-emergency situations, communities of color have inequitable access to infant and young child feeding support services and high quality medical care. In emergency situations, this divide becomes even greater. Breastfeeding rates are generally lower in communities of color, and infants that are not breastfed are more susceptible to infection in emergencies. When a disaster disrupts basic services, damages infrastructure, and leads to food and fuel shortages, parents of formula-fed babies become increasingly dependent on external resources.”

©UNICEF/UNI198206/Takyo

Looking into next year, a Birthmark Doula Collective and Xavier University’s collaboration will  conduct community-based participatory research exploring how to support IYCFE in populations with low breastfeeding rates. 

Ludman also shares that Birthmark is partnering with the Louisiana Department of Health’s Bureau of Family Health on a project funded by the National Association of County and City Health Officials. 

She explains: “The goal of the grant is to build relationships between emergency preparedness programs and other stakeholders to identify strategies for improving emergency response plans related to the needs of perinatal people and infants and young children under two years old. A large part of this project is delivering trainings on perinatal emergency preparedness to close to 500 emergency response people in the state of Louisiana by the Spring of 2022. We are currently about halfway through that training goal.” 

You can visit https://www.nolabreastfeedingcenter.org/infant-ready to learn more about Birthmark Doula Collective’s emergency preparedness program.   

 

Economist sees breastfeeding support as part of solution to national challenges

Photo by Mike Erskine on Unsplash

 It’s been three weeks since rain has fallen in much of Zambia. In what would normally be considered the rainy season, farmers should be planting their crops, but the national weather unit has advised holding off due to the severe dry spell.

Musa Imakando-Mzumara is an Investment Management and Banking Professional in Zambia, and she points out that people in her country are feeling the effects of the climate crisis and subsequent extreme weather conditions.

Inspired by her own challenges breastfeeding her now 18-month-old son, Imakando-Mzumara recently completed the Lactation Counselor Training Course (LCTC)

Musa Imakando-Mzumara

“[Breastfeeding] didn’t come so easily for us; it was a difficult thing for me,” she begins. “I was conditioned to think it happens automatically. I got so much confusing guidance… With everyone’s good intentions, some of the words may have been harsh and affected me negatively. I felt like I was failing.”

As an economist, she says studying lactation was something completely new to her, but she sees breastfeeding as a way to establish roots for a flourishing future in her country. 

 

Imakando-Mzumara initially sought out the LCTC to become a supportive resource for her peers, but she hopes to see these efforts grow into larger scale solutions. 

For instance, addressing the environmental impact of artificial baby milks is appealing to young, professional, millennial parents in Zambia. Breastfeeding’s appeal from an environmentally-friendly standpoint extends beyond millennial parents though, especially as the entire country feels the effects of extreme weather.

For perspective, “Droughts and floods over the last 30 years have cost Zambia more than $13.8b according to recent estimates, which is equivalent to approximately 4 percent of annual GDP,” according to a report by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).    

Interestingly, according to the latest WBTi report (2008), Zambia achieves high scores in their exclusive breastfeeding rate and many other arenas. Today, the country’s exclusive breastfeeding rate remains relatively high, and Imakando-Mzumara predicts it will continue to hold strong. 

That’s because a large part of the population falls into informal and rural work spaces, where mothers generally carry their babies with them all day making breastfeeding more convenient, she explains. What’s more, she says there’s a lot of outreach by medical personnel to ensure high breastfeeding success in rural spaces too.

Of course, these anchors don’t diminish the challenges that these mothers still face. Formula companies’ influence is perverse, like an invasive species that chokes out everything in its path. Because many families working in informal spaces cannot afford artificial milks for supplementation, Imakando-Mzumara reports that some supplement their infant feeding with sour milk (similar to kefir) which is not designed to properly nourish human babies. 

In urban areas, like the capital city of Lusaka where Imakando-Mzumara lives, families grapple with barriers to breastfeeding like non-compliance with the International code of marketing breast-milk substitutes, no Baby-Friendly Hospital Initiative (BFHI) accredited maternity facilities, very few lactation specialists, no specific breastfeeding education integrated into perinatal care and limited workplace lactation accommodations.

Source: United States Breastfeeding Committee (USBC)

Zambia’s Ministry of Labor states that a “female employee who is nursing a newly born baby is entitled to:

  1. Two nursing breaks of thirty minutes each;
  2. One nursing break of one hour in a day;

Provided that the nursing breaks are for a maximum period of six months from the birth of the child. These breaks should not be deducted from her normal working hours. Furthermore, the employee is still entitled to lunch break.” 

Without many breast pump retailers in Zambia, only some of the population having access to online shopping, and very limited lactation-specific education about how to properly pump or hand express, moms are left virtually alone to navigate getting their milk to their babies.   

Imakando-Mzumara shares that because her mother-in-law is a midwife equipped with lactation training, she was able to “stick it out” with her help. 

In Zambia, it is typical for new mothers to move in with their own mothers or for their mothers to come live with their daughter and new grandchild(ren). Imakando-Mzumara says that the familial support is wonderful, but that it can become detrimental when you consider their elders’ generation’s infant feeding beliefs.

Source: United States Breastfeeding Committee.

“Our moms come from the generation that was taught that formula is better for children,” she explains. “They will pass on information that they think is useful.” 

Imakando-Mzumara recognizes that these deeply held beliefs will take time to debunk. 

In the interim, she says she hopes to be someone who can encourage those without health and science backgrounds to become invested in lactation and breastfeeding promotion and support. 

“If they knew this opportunity (to support families) was out there, a good number of people would take it,” she comments. 

While in the beginning of her lactation counseling journey, Imakando-Mzumara plans to make herself available to parent groups in her network. 

She says, “A lot of moms make certain decisions because they just don’t have the knowledge or support to make other decisions.”