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

notwithstanding

also my demanding:

Dishes done! Cat-box cleaned!

I can be a bitchy queen

but:

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?”
“Singing.”
“Oh.”
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!

 

Moms can and do have dignified conversations about touchy subjects

The notion of ‘The Mommy Wars’ is incessantly covered in the media. Some of it good, some of it repulsive. Most recently, I saw ‘The Mommy Wars’ come up in the Analytical Armadillo’s An Open Letter to Jamie Oliver about Breastfeeding.

“I’m a tad unimpressed with the whole situation too to be honest, particularly the newest trend to try and silence all discussion surrounding infant feeding for fear of offending, well, everyone,” the author writes. “Honestly if I hear the words “mummy wars” one more time, I fear I may lose it entirely.”

The letter brought to mind exchanges between two different friends.

The first was with a friend who feels very judged and stigmatized for her decision to breastfeed beyond infancy. During our latest exchange, I shared my inspiration from Anna Blair’s International Breastfeeding Conference presentation Motherhood: Identity, social stigmas and resilience. Blair’s insight allowed us the opportunity to not only acknowledge my friend’s feelings of being judged, but to talk about how and why we judge others.

I told her about Abby Theuring, MSW, The Badass Breastfeeder’s I Judge You piece, and how it’s helped me to own my own judgement of others. It also helped me to be cognizant about what I do with that judgement. My friend and I made an agreement that we would try to be more open to learning from our judgement. We agreed that instead of passing judgement and leaving it at that, we would attempt to ask respectful questions to learn more about the choices people make different from our own.

Several days later, another friend and I chatted while our kids played together. We talked about my upcoming anatomy scan, and learned that the OB I was going to see was the same OB who performed one of her son’s circumcisions. She told me she would recommend him if we end up with a boy.  

Instantly I remembered my earlier conversation with my other friend.

“We won’t be circumcising,” I told her. Then I took a deep breath– because I was afraid of what my question might turn into– and said, “May I ask why you chose to circumcise your boys?”  

She told me, and then she asked why I will not circumcise if I have a son.

I gave her a very honest answer. We are still friends.

I wanted to share this exchange, not to start a debate about genital cutting (which it inevitably will, right?) but to demonstrate that mothers can and do have dignified conversations about our parenting choices, even when it comes to something as sensitive and controversial as circumcision.

My friend and I might not see eye-to-eye when it comes to genital cutting, but I respect that her decision was not mine to make. She reciprocates with the same respect.

The Analytical Armadillo’s letter continues: “The great infant formula marketing machine (protecting its multi billion pounds profits), has done a great job of shutting down dialogue by suggesting mothers should feel guilty or are being judged…”

As I continue to reflect upon this experience, I wonder if it is too bold to think that companies not only have a hold on our conversations involving infant feeding, but that they have infiltrated and influence nearly every parenting choice that we make. 

The exchange of ideas is a debilitating thing to those that profit from our silence. Cindy Turner-Maffei reminded me of the Crucial Conversations approach (find the book here,) a technique developed to start conversations about touchy subjects like circumcision. Cindy explains that “the approach trains one to think of the other as reasonable, and to inquire about their rationale for holding belief/opinion from that position (rather than just ‘othering’ people with differing opinions.)”
What a powerful tool this could be for parents! (Alison Stuebe, MD, MSc also recommends Crucial Conversations for lactation professionals to help them establish mutual purpose and mutual respect with physicians and other colleagues.)

Please tell us about your respectful conversations about tricky subjects in the comments below!

Absurd and awesome products

Last year I wrote a post, Commercial products marketed at breastfeeding families, to call attention to the variety of companies and products that prey on mothers and babies. Many of the products are expensive, some of them are completely useless and several of them totally disregard how lactation and breastfeeding work, undermining mothers’ desire to breastfeed. The products ranged from for-profit donor milk to breastmilk enhancers to alcohol testing strips.

I’ve compiled two more lists of products to share with you today. The first list contains the most absurd baby products EVER (and one to use only when medically necessary.) The second is a compilation of awesome, innovative, helpful products that empower families. Sadly, you’ll notice that The Absurd list is much longer than The Awesome. If you have suggestions for The Awesome list, please let us know!

The Absurd

  • This one takes the cake. A vagina boombox for pregnant women. No joke. Pregnant mothers can insert a pink device into their vaginas, hook it up to their smartphones and play music for their unborn babies. The gadget costs over $100. So. Weird. So. Useless. As a friend of mine puts it, “babies can hear without being plugged in.”
  • Unlike vagina boomboxes, there’s nothing seriously wrong with fancy barf bags, except for the fact that I can think of 100 better ways to spend my money. On the bright side, they’re biodegradable!
  • Fetal keepsake imaging and heartbeat monitors used for creating fetal keepsake images and videos are strongly discouraged by the FDA.  In a consumer update, an FDA biomedical engineer Shahram Vaezy, Ph.D. is quoted saying: “Ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles (cavitation) in some tissues.” The long-term effects of tissue heating and cavitation are not known, the report goes on.
  • A gadget that tweets when baby kicks has been praised for being “a great way to keep dads in on the action by notifying them when mom is feeling little jabs from within.” I worry that products like this might completely wipe out face-to-face communication.
  • Baby perfume. Whhhyyyy?!! Why would you mask that naturally intoxicating human baby smell?!
  • This article reports that milk resembling human breast milk has been produced by genetically engineered cows.  “Chinese researchers announced in the journal PLoS ONE…that they had engineered cows to secrete milk containing lysozyme, a protein found in human breastmilk that boosts the immunity of breastfed babies,” the author writes. Gross! The article includes Professor Peter Hartmann’s response: “This is an interesting scientific achievement but it really has little relevance to feeding babies,” said Peter Hartmann, a professor at the University of Western Australia. He said lysozyme is only one of 279 proteins in human milk that provide protection to babies. Babies are also protected by antibodies circulating in the breastfeeding mother, said Hartmann, who is president of the International Society for Research in Human Milk and Lactation. “Breastfeeding is not just pouring breastmilk down the baby’s throat. It involves a very complex interaction between mother and infant,” he says. “Claims of producing cows that secrete breastmilk are naïve to the extreme,” he said, adding lysozyme would be largely destroyed during pasteurisation of cow’s milk.
  • This vest allows caregivers to attach a baby bottle to it. In one advertisement, the product is shown attached to a child sitting in his/her carseat. First off, aftermarket products are not safe to use in or on car seats. Secondly, regardless of infant feeding method, feedings provide the opportunity for a loving, intimate interaction. This product touts ending parents’ frustration with “the dropped bottle,” but I worry that it will only encourage solitary, disconnected feedings. Although this device isn’t exactly bottle propping, I also worry that it may pose some of the same risks. I have similar concerns with this bottle holder.
  • Complementary feeding devices like this, this and this aren’t only odd, they are completely unnecessary. Read more here, here and here in regards to Baby-Led Weaning.
  • This product analyzes a baby’s cry which “teaches parents to distinguish the different types of cries of their baby.” Parents have the capacity to learn their babies’ needs before they start crying, because babies communicate in many ways!

The Awesome

  • These pregnancy bands for expectant couples replicate any movement felt by the mother on a matching band for the partner so that he or she can “feel” the baby’s kicks. This product could be a great tool for surrogacy and adoption. Unfortunately, these bands are not actually for sale. 
  • This system allows bereaved families to spend more time with their babies.
  • PATH program officer Kimberly Amundson and colleagues with the University of Washington and the Human Milk Banking Association of South Africa developed a smartphone app to guide flash-heat pasteurization of human milk from donors. The mobile-phone app directs and monitors a simple heat-flash pasteurization process and transmits data to quality assurance supervisors.
  • Back in 2014, over 100 parents, engineers, designers and healthcare givers gathered at the MIT Media Lab for the “Make the Breast Pump Not Suck” Hackathon. Erin Freeburger and Robyn Churchill and their team created the Mighty Mom utility belt, “a fashionable, discrete, hands-free wearable pump that automatically logs and analyses your personal data.” Find out more about the Hackathon here, including other winning designs and a research paper and documentary about the Hackathon.
  • This Mashable article highlights eight apps and mobile-based services that revolutionize maternal child health care in developing nations.

What would you add to the list and why? Please add your comments below!