Meet HCP’s newest faculty member!

unnamedMeet Healthy Children Project’s (HCP) newest faculty member Cindy Francisco, RN, MA, IBCLC, RLC! Since beginning teaching with HCP three months ago, Francisco finds herself most struck by the reciprocal learning relationship between herself and The Lactation Counselor Training Course participants.

“I’ve learned from the students’ experiences; they all come from different backgrounds,” she says. “They are so excited to learn from us and so appreciative of the information we give them– the week goes so fast and we develop quite a bond with the attendees.”

Francisco has over four decades of experience in maternal child health. She became interested in the mother baby dyad right out of nursing school when she began her career as a labor and delivery nurse.

“A lot of the interest sparked around the beautiful, magical part of the woman’s body,” Francisco begins. “The pregnancy and being able to feed her baby… that whole aspect that influenced me.”

Reflecting on her forty plus years working in maternal child health, Francisco says: “We have a huge way ahead of us, yet I really see that we have changed.”

Specifically, she remembers laboring mothers being routinely strapped to the delivery table. She recalls when partners started being invited into the delivery rooms to support the laboring mother, sometime around the mid 1970s.

Today, she notices a trend toward a family centered birthing experience.

Francisco has also become aware of the importance of skin-to-skin contact immediately after birth, especially since completing her Master’s degree with Union Institute and University.

Her thesis led to the implementation of skin-to-skin in the hospital where she worked as a nurse and lactation professional.

“After [we] implemented [skin-to-skin,] I saw an increase in our breastfeeding rates,” Francisco reports.

Not only has Francisco witnessed the physiological effects of skin-to-skin contact, she’s aware of its emotional effect on parents.

She tells the story of an expecting couple who specifically chose the hospital Francisco worked at because of its implementation of skin-to-skin.

“It was so important for them not to miss that opportunity,” she says.

Francisco continues, “As nurses in the medical field, we take [these experiences] for granted. This isn’t our experience. This is the mother, baby, family, their experience.”

Francisco is sure to inspire many in her new capacity with HCP.
“I have to pinch myself a lot,” she says. “This is the highlight of my career. I’m just so pleased to have this position.”

Museum responds creatively to NIP discrimination

Last month, a mother was discriminated against for breastfeeding in public at the Cleveland History Center by some of its staff members. The museum has taken a proactive approach in their response.

Western Reserve Historical Society (WRHS) President and CEO Kelly Falcone-Hall made this statement which was posted to their Facebook page:

“We were made aware that, last weekend, a breastfeeding mother was asked to move to a private space by members of our Cleveland History Center staff. This reflects poor judgment on our part, for which we are truly sorry. We have formally apologized to the mother, and are immediately implementing additional training for our entire team in order to ensure that an incident like this does not happen in the future. The Western Reserve Historical Society strives to be an inclusive, family-friendly organization that provides a welcoming environment for all our of patrons, including breastfeeding mothers. We did not live up to that goal in this instance.”

We do not nor have we ever had a policy that prohibits a mother from feeding her child. We have contacted the mother directly and issued an apology which she has accepted. We do not condone the incident and are taking steps to retrain our entire staff.

Several lactation professionals from the Ohio Breastfeeding Alliance recently led a training with the entire Cleveland History Center staff followed by a Q&A, reports Patty Edmonson, Cleveland History Center/ WRHS Museum Advisory Council Curator of Costume and Textiles. Staff from other museums in the area were also invited to attend the training.  Edmonson says that this training will integrate into their human resources program going forward.

The earliest dress featured in "Dressing for Two," from about 1775.
The earliest dress featured in “Dressing for Two,” from about 1775.

But that’s not all. The Cleveland History Center also creatively responded to the NIP incident by featuring a pop-up exhibit of historical maternity and nursing garments. The exhibit was received well, some saying it was a beautiful way to honor women and others commending the center for its efforts to extend breastfeeding education to the public.

The dresses featured in the pop-up exhibit come from a 2003 exhibit called Dressing for Two which featured maternity wear and birth and childhood related objects spanning from the late 18th century to the 1970s.

Some of the artifacts included were children’s clothing, obstetrical forceps, breast pumps, bottles, teething rings, baby vanity sets, safety pins, and rattles, explains Edmonson.

An example of a wrapper.
An example of a wrapper.

From this exhibit, Edmonson says she is particularly fond of a 19th century garment called a wrapper which she says was essentially a “really fancy” robe.

Women, especially wealthy women, wore the wrapper toward the end of their pregnancy for comfort and style. The buttons down the front of the garment also made it comfortable to nurse in.

“The biggest difference between then and now is the desire to hide what was going on,” Edmonson says of this historical nursing wear.  She pays special attention to the pink and green plaid dress, noting that the slits for nursing are located under a fold in the garment. (See pictures below.)

“That’s not to say maternity and nursing clothes today are putting everything out there…People have so many more choices and options. In the 19th century it was about editing the clothes that you had.”

Because cloth was expensive to make, people owned less clothing prior to the 20th century, Edmonson explains.

Maternity dressing gown from about 1900.
Maternity dressing gown from about 1900.

Some of the garments could have seen their owner through twenty years of childbearing.

Edmonson’s next exhibit will feature political clothing where one of the dresses featured in Dressing for Two will be shown again. The reform dress, complete with an adjustable front, freed women from the corset.

You can visit WRHS’s website here.
To read more about the fascinating history of infant feeding, check out A History of Infant Feeding and Baby Food.  

Images courtesy of the Cleveland History Center, a museum of the Western Reserve Historical Society, Cleveland, Ohio.

In the moment

I have been a major jerk to my kids lately. Between selling our home, building a new one, growing another baby, and anticipating Willow going to kindergarten, I’m overwhelmed with my responsibilities. My poor children are stuck with me acting like a crazy lady day in and day out.

When I take time to appreciate that these changes are simply wonderful, it makes me feel worse for having such a short fuse and getting worked up over menial things like spilled milk (literally.)

92e40d1b-ec6d-4a37-89e1-96c112f46e93Our lives are so abundant! Still, I spend so little time celebrating our privilege, luxury, and happiness and most of it huffing and puffing about petty, little things.

But the other night, I reveled in a beautiful 45 minutes with my girls, dancing in front of a toothpaste-splattered, bathroom mirror. Confronting my reflection was an invitation to step out of my curmudgeonly self. I saw what other people see; my sweet, sweet Willow, my sweet, sweet Iris and I, all three of us smiling together, moving uninhibitedly to our eclectic playlist.

Willow’s lanky limbs swayed high and low. Her scraggly, red locks caught in her lips. She swiftly brushed them away, then flapped her arms like a frantic bird. She twisted her face and cocked her head while she gyrated. She looked just like me.

Iris looped her arms through mine as I spun her round and round. Her body felt so small and squishy, but her legs draped and hung far passed my pregnant belly. We fit together like puzzle pieces, and even though her weight strained me, I didn’t put her down.

My shirt bunched under Iris’s bottom exposing much of my stretching abdomen. The veining through my skin appeared so vibrant, twisting this way and that, turquoise against my pale, reddish hue. Day-old mascara smudged my eyelids and my bun was falling out. Even so, I felt stunning and happy and full. I took note of what seemed like such a unique moment.
Holding onto this memory, I realize that there was nothing uncommon about it at all. I am forever surrounded by this splendor.  

Exploring the challenges associated with internship placement

Many of us discover our passion for breastfeeding through our personal experiences. It certainly seems to be the trend here at Our Milky Way. Many of the breastfeeding advocates we’ve featured decide they want to be the change they seek after overcoming a slew of barriers. Others find inspiration from those who helped them to be successful with their infant feeding goals.

Whatever the impetus, the journey to securing a profession in the field of lactation can be overwhelming and challenging. For those seeking to qualify for the International Board of Lactation Consultant Examiners (IBLCE) exam, obtaining the required hours of lactation practice can pose difficulties.

Some are able to qualify through IBLCE Pathway 1, with 1,000 practice hours completed over the past five years during paid or volunteer work in obstetric, maternity or pediatric care settings (e.g. nurses, physicians), as breastfeeding counselors in WIC and other community settings, or as mother support counselors in voluntary organizations such as La Leche League, Baby Cafe USA, Breastfeeding USA, or other recognized breastfeeding support organizations.

For those who don’t have the experience to qualify for this 1,000 hour route, IBLCE Pathways 2 (academic) and 3 (mentorship) are also a possibility. However, regardless of the pathway chosen, the demand for such placements appear to exceed supply in the experience of many seekers. Lactation consultants are often inundated with requests for placement for practice, academic internship or mentorship hours. Thus, seekers often receive many “No” responses.

This post was a collaborative effort between Healthy Children Project faculty member and affiliated professor at Union Institute & University (UI&U) Cindy Turner-Maffei and I to weigh-in on the challenges that UI&U students and others face when trying to locate internship sites. UI&U is one of 6 academic institutions offering Pathway 2 options to graduates.

UI&U students who choose to complete requirements to sit for the IBLCE exam under the academic pathway (Pathway 2) must complete an internship consisting of 300 hours under an IBCLC mentor as part of their Bachelor’s degree in Maternal Child Health or Master’s in Health and Wellness.

Turner-Maffei notes that not all UI&U students pursue the IBLCE Pathway 2; some are not currently working toward the IBCLC credential, others are already IBCLCs.

Because the students in the UI&U degree programs are located all over the US, internship sites have not been pre-arranged, and students must take an active role in identifying internship placement  with the help of the university staff.  

Some Pathway 2 programs are offered only on a traditional campus and have created partnerships with area hospitals, which makes internship placement less challenging, Turner-Maffei explains.

“As an online program with a national scope, it’s not possible for us to proactively have agreements with hospitals [or other facilities] all over the country,” Turner-Maffei says.  

She goes on, internship sites are limited because students are required to work with an IBCLC mentor. Especially in hospital settings, there may be concern about liability of having interns providing patient care.

To address this concern, an affiliation agreement is developed between the facility providing internship site and the university. These documents delineate responsibilities and rights of the parties involved, and lay out requirements for interns such as background checks, tuberculosis testing, immunizations, CPR training, universal precautions, etc.

Liz Chang, B.Sc.,CLC is an IBCLC candidate pursuing IBLCE Pathway 3. She reports that this process took about two months before she could begin her internship at a local hospital.

It’s seems to be even more difficult for students living in states with the lowest breastfeeding rates to find clinical mentors, Turner-Maffei says. People of color may also experience challenges in finding internship and mentorship placements. She mentions that organizations including ROSE, NAPPLSC, ILCA, and IBLCE are working on initiatives to improve and broaden access to all interested student LCs.

She has found though, that with the push for Baby-Friendly Hospitals, some students are able to find an internship opportunity because of their willingness to help prepare for Baby-Friendly assessment in exchange for and as part of their internship.

Turner-Maffei explains that establishing relationships before requesting internships is vital. She reports that lactation consultants want to help grow the field, but they’re inundated with internship requests from strangers on top of their already hectic schedules.

Some students have found internship placements with hospitals, pediatric practices, WIC programs, and other settings in which they have received care themselves.

Chang reports having a challenging time networking with lactation professionals in her community. Eventually, connecting with a maternity director at her church helped Chang score her most recent opportunity at a university hospital in New Jersey.

Chang also got lucky when she directly contacted the medical director at her first internship site.

“She was in awe that I had the guts to request an internship,” Chang remembers. She recalls the director being impressed with her passion to help moms and babies.

Chang’s first internship was cut short when she left due to personality differences and her disagreement with hospital policy and practices.

Ultimately, when UI&U students can’t find an internship site, it postpones their graduation date and/or they opt out of the Pathway 2 program into a different one.  

“It’s a tricky time in breastfeeding,” Turner-Maffei says. “Everyone is talking about it, rates are increasing, but lactation hours in most facilities are limited. The thing I would focus on as a seeker of internship hours is be a good citizen in the lactation community. Once people know you and trust you, doors are much more likely to open.”

Tell us, what strategies do you use when searching for practice hours?

Inquisitive, insightful kids

The other day, Willow handed me a note in an envelope sealed with a hot air balloon sticker. She instructed me to open it and read it, so I skimmed the colorful zigzags.

“Wow, this is really interesting! What does it say?” I asked.

“It says I am really excited to have a baby brother or sister, and I hope that I can cut the umbilical cord,” she told me.

I have to tell you, I think it is so cool that my four-year-old wants to cut an umbilical cord again, like she did for her little sister Iris.

Willow first learned about the umbilical cord in Hello Baby by Jenni Overend, which we often read to prepare her for her sister’s home birth.

We also read What Makes a Baby by Cory Silverberg which helped us start conversations about conception, pregnancy and birth. It’s a fabulous book that helps generate discussions at any comfort level.

With another baby on the way, watching Kajsa Brimdyr’s Happy Birth Day series with my young daughters allowed us to talk about how babies sometimes enter the world. It was a wonderful opportunity for them to ask questions and for us to discuss how the births in the series might be the same or different from our anticipated home birth.

It’s extremely important to my husband and me to facilitate conversations about pregnancy, birth, infant feeding and beyond with our children. I’m endlessly fascinated by their inquisitiveness and insightfulness. While they work to make sense of their world, their perceptions help us make sense of our world, especially when they ask really tough questions.

For instance, Willow recently asked me if moms die when babies are “cut out of them.” (Silverberg’s book depicts a cartoonish cesarean birth.) I told her, yes, sometimes they do.

Another time, Willow paged through her baby book when she came upon a photo of herself newly born, on a warming table with gloved hands around her.

“Why was I sick?” she asked.

At first perplexed, I soon realized that she associates hospitals with illness, not a place where babies can be born.

Most recently, Willow has told me that she doesn’t want to have kids, because it hurts. She often asks me why I wanted to have her.

She wonders so many other things too! At three-years-old, she asked me, “How do you get the sperm out?”

Another time, she asked me if I was going to birth a boy baby, but before I could answer she replied, “Oh! That’s right, you get what you get and you don’t throw a fit.”

And before bed one night while we discussed age she announced, “A one month old baby in a shell is smaller than a two-year-old…Wait a minute… a baby in a shell… that doesn’t make sense! We’re humans!” We proceeded to chuckle.

My two-year-old is on track to boggle my mind too. Just last night she announced matter-of-factly, “Mommy big vulva. Iris little vulva.”

This week, I’d like to share a compilation of stories about children’s insight shared by friends and colleagues. I’m struck by the hilarity and adorableness, the sagacity and thought-provoking nature of their stories. Thank you to everyone who was willing to share!

Ashlee Wells Jackson of 4th Trimester Bodies shares her recent Facebook post about an exchange she had with her young daughter Nova.

N- “Make me a photo like the boys and girls mama.”

Me – “Honey we have [a] photo. Remember, baby Nova on the book?”

N – “Yeah. Make me a photo like the ladies, then mama. Our friends. I stand on the box. I a strong woman. I beautiful too.”

I often say that I can’t wait to talk to her, years from now, about what she recollects from these early years on the road with me. Around the world, city to city, she has met hundreds of woman, thousands of children and had a front row seat to stories of vulnerability and sorrow, triumph and celebration. She has seen so many humans and their bodies, delivered tissues to tears and caught on to infectious laughter.

It is true that I can’t wait to hear what future Nova has taken away from all of this but I adore what present Nova sees – friends, strength, beauty…inspiration.

Kristin B., mother of Paisley(5), Peyton(4), Paxton (14 months)

Pais had always wanted Pax to be a girl. Once he was born, she said, ‘Well, Mom, now that he is out of your belly, we can get a sister now!’

A recollection from Nikki Lee, RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, CKC.

My youngest daughter had her umbilical cord wrapped twice around her neck. The cord was tight enough to hold her back even as the contractions pushed her forward, causing Clelia to poop. Copious amounts of fresh baby poop came out when my water broke, causing in a transfer from home to the hospital.   So much fresh poop also made the midwife rush the birth a little. She cut the cord before my daughter was fully born, as it was too tight to be lifted over the head. She also cut an episiotomy instead of waiting for the natural pushing to stretch me. Clelia was taken immediately after she was born so the pediatrician could put a tube down her throat to see if any poop had gotten into her trachea.

Fortunately, there was no poop below her vocal cords, and after being suctioned anyway (a move that I will always question)  I got to have my sweet baby on my chest. We went home six hours after her birth.

Four days later, my sweet baby slept on a sheepskin rug by the fire, while I sat and stared at her, marveling in her tiny perfection. Suddenly she startled in her sleep, uttered a pathetic little cry, and put both hands up to her throat, holding an imaginary cord in an unmistakable grasping motion. She was having a dream about her birth; there is no other explanation.

Noreen O., mother of Lennon almost 3

Lennon and I have been talking a lot about a baby growing inside me and then the conversation always turns into one about mama milk…I do want to tandem nurse, so I am trying to prepare him for that.  He has nursed only on my left breast for the last year and he lovingly refers to that breast as ‘big ol’ mama’.  When he nursed on both sides, he would always choose big ol’ mama and then he just stopped nursing on the right side.  So when we talk about the baby growing inside of me and ask him if he thinks the baby is going to love mama milk as much as him, his whole face lights up and says yes.  I then ask him if the baby will like big ol’ mama or little mama (my right breast) and he territoriality replies the baby will have little mama and he will get big ol’ mama.


Poem by writer-poet-performer Christine Rathbun Ernst for her elder daughter

A Poem for Margaret, because she bought me a Milky Way when I was sad.  And

because I never took my mother’s breath away.                                                                        

splendid girl

laughing mouse

piles of laundry in our house


also my demanding:

Dishes done! Cat-box cleaned!

I can be a bitchy queen


you are like the Buddha’s smile

a wise and kindly changeling child

possessed of sense, a calm beyond your age

born to teach me joy, undo my rage

I am undeserving and frankly bewildered as your mother

surely I was meant to be parent to some other

more colicky, cranky progeny

(apples of course fall not far from the tree)

despite our ironic role reversal (my dumb luck)

I will keep you safe and cherished, baby duck

you are

my heart

my home, my sense

my first and best

sweet bean you are a skein a stream a spool of light a star

and I, your befuddled mother, breathless, blessed.

Rathbun Ernst recites another one of her poems, Peanuts and Bujugu, in this video.

Jenny Spang, CPM, IBCLC, CLC recalls what one of her sons said about remembering before he was born.

I asked him, “Really?! What was it like inside Mommy’s tummy?” He said, “Dark!!!”

And one time when I was at a birth in which the mom was doing a lot of vocalizing during labor, sort of something between a moan and a chant,  “Ohmmmmm! Ahhhhhhhh!”
Her husband was rubbing her back and rocking with her and vocalizing along with her to help her keep breathing.  Their little daughter who was also around three, said,
“What are you guys doing?”
That was it!

My son who was then four had come to play with little Ella during that labor. There was a friend of Mom’s there to watch the kids and they mostly were playing outside. But when Mom was ready to push, sitting on a birthing stool, the kids just sat right down in front of her because they wanted to see the baby come out. No big deal. I have since asked my son if he remembers it and he does not so I guess it didn’t make a big impression!