From MDGs to SDGs

Time does not stand still when you have two spunky, young children and another on the way. As I loaded our family calendar this month I thought, “Holy buckets! March already?!” And then I thought, “Holy buckets! Is it really 2016?!” Sure enough.

Dr. Cristiano Boccolini
Dr. Cristiano Boccolini

With the end of 2015, came the end of the Millennium Development Goals (MDGs) era. Back in January at the 22nd Annual International Breastfeeding Conference, Cristiano Boccolini, PhD, MS presented Moving Beyond the Millennium Development Goals: Research challenges in breastfeeding.

Dr. Boccolini pointed out that breastfeeding fit into all eight of the MDGs. Here are some examples of what conference participants came up with:

  1. Eradicate extreme poverty and hunger.

  • Breastfeeding is essentially free.
  • Children who are not breastfed are sick more often forcing families to miss more work and spend resources on medical care.
  1. Achieve universal primary education.

  • Breastfeeding promotes optimal interpregnancy intervals. When families have less children, they can invest more in them.
  • Children who are not breastfed have lower IQs.
  1. Promote gender equality and empower women.

  • The act of breastfeeding itself empowers women.
  • Women who do not breastfeed are forced to spend money on artificial feeding methods leaving them with less money to spend on other things like education.
  • Breastfeeding mothers have a better chance to educate themselves and/or work because their children are sick less.
  1. Reduce child mortality.

  1. Improve maternal health.

  • Women who do not breastfeed bleed more postpartum.
  • Breastfeeding mothers suffer from less anemia because they experience fewer menstrual cycles.
  • Breastfeeding reduces the risk of PPD.
  1. Combat HIV/AIDS, malaria and other diseases.

  • Breastfeeding provides improved response to injectable vaccines.
  1. Ensure environmental sustainability.

  1. Global partnership for development.

The 2015 MDG Report covers the progress we made and what challenges and inequalities we still need to tackle. Spoiler: We have a lot of work to do.

The Sustainable Development Goals (SDGs) pick up where the MDGs left off. They are “an even more ambitious set of goals” comprised of 17 goals and 169 targets to wipe out poverty, fight inequality and tackle climate change over the next 15 years. [http://www.un.org/sustainabledevelopment/blog/2015/12/sustainable-development-goals-kick-off-with-start-of-new-year/]

Dr. Boccolini shared his concern over the sheer number of goals and targets.

“Where are we in the global agenda?” he asked.

The SDG targets are certainly not as straightforward as the MDGs.

Dr. Boccolini also expressed his concern regarding measurement of the goals. How do we define conservation? How do we define restoration? he wondered.

A Council on Foreign Relations article covers SDG criticism reporting that they’ve been called “too broad” and “absolutist.”

“The SDGs are also expected to be more costly [than the MDGs,]” the author writes.

The same article quotes Sarah Hearn, associate director and senior fellow at New York University’s Center on International Cooperation.:“The MDGs were about resource transfer from rich countries. The SDGs are universal—they’re supposed to apply to all countries and try to overcome the ‘West lecturing the rest’ dynamic.”

Dr. Boccolini questioned if the SDGs were the product of a “Since-we-are-effect.” Since we are doing this, let’s do this…

He left us with this:

ODG (17 targets)=> SDG (169 targets)…. OMG!

“When you do everything, you don’t do anything at all,” he said. “I hope I am wrong. I hope we can find our way in the new global agenda.”

Happy Birth Day, a new project by Dr. Kajsa Brimdyr

I just finished watching the Happy Birth Day series, a vignette of real birth experiences produced and filmed by Healthy Children Project’s Dr. Kajsa Brimdyr, PhD, CLC and Emmy nominated producer Judy Blatchford with my two- and four- year-old-daughters… I am so excited to give birth again!

For me, watching these mothers, their partners and their babies reaffirms how remarkable normal birth can be.  Birth in its realness and rawness. Not some glammed-up, sensationalist reality birth show, like the ones I grew up watching obsessively.

“When you watch those other TV shows, it’s like you’re an anthropologist,” Brimdyr comments. “You’re learning, ‘In my culture, this is how we do it.’”

My first birth followed suit. Supine, legs spread, as I wailed in horror.

Then thanks to normal birth advocates like Brimdyr, I learned what birth can be. My second daughter was born differently. After Iris came earthside, I wanted to parade my new family around our neighborhood. I was so proud, so triumphant

The idea that a healthy baby is not all that matters during childbirth is beginning to take hold in our country. Google “A healthy baby is not all that matters” and you’ll find several great articles. But what does a respectful, family-centered, empowering birth actually look like? Happy Birth Day gives moms something tangible, something attainable.

“We learn so much from watching,” Brimdyr says. “And so much of natural childbirth doesn’t show up in our TV shows, in our movies, in our YouTube videos.”

Unlike their reality TV counterparts, the Happy Birth Day vignettes “entice through compassion and empathy rather than enticing through drama.”

“You fall in love with every one of these couples,” Brimdyr says. “You watch their experience and you’re drawn in. It’s amazing. Birth doesn’t need extra drama.”

Brimdyr and Blatchford filmed the births at Tobey Hospital in Wareham, Mass., a Baby-Friendly designated facility that offers nurse-midwifery care.

When I talked to Brimdyr for this article, I argued that the majority of moms aren’t birthing in Baby-Friendly facilities nor with midwives, but she reminded me of the prevalence of midwives in our country and of our increase in Baby-Friendly designated facilities. Currently, 12.8 percent of births occur at Baby-Friendly Hospitals, which exceeds our 2020 goal.

Brimdyr’s inspiration for Happy Birth Day stems from her most recently published research The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth (available here.) The research shows the negative impact of common labor drugs on breastfeeding and babies’ behavior immediately after birth. What’s more, most primiparas mothers who give birth in the U.S. will get some sort of epidural concoction. A 2011 National Vital Statistics Report concludes that “overall, 61 percent of women who had a singleton birth in a vaginal delivery in [the 27-state reporting area] in 2008 received epidural or spinal anesthesia…”

Saddened by the results of her study, Brimdyr says that ethically she needed to offer mothers an option as to what is possible when birthing their babies.

“If I’m giving a worry, I want to give a hope at the same time,” she says. “This is what’s possible.”

The Happy Birth Day project offers a unique setup of short videos that can be rented or purchased individually.

“We want to make sure that they’re really accessible to moms, dads, grandmas and anyone who is thinking about getting pregnant,” Brimdyr explains.

The setup also makes it easy for childbirth educators to incorporate the videos into their classes. Likewise, the Birth Strategies portion of the project is a great tool for educators. The videos include much of the same footage as the Birth Stories, but it’s reorganized to showcase key concepts like movement and massage.

While I see Happy Birth Day as a great tool for parents, I also think it is invaluable to healthcare providers who have never seen normal birth.

“Sometimes you are only familiar with what is happening in your institution,” Brimdyr comments. “It’s fun to be able to see a glimpse of what’s happening in other areas.”

When Brimdyr first presented her project to Tobey’s primary midwife Louise Bastarache, CNM, NP, MS, Bastarache didn’t understand Brimdyr’s interest.

She said that because birthing mothers typically go through the same stages, natural childbirth wouldn’t make compelling enough television.

“But every mother’s experience is slightly different and every mother’s experience is amazing and life-affirming and magic,” Brimdyr explains. “To get a glimpse into this time of a woman’s life is such an honor.”

Happy Birth Day documents how partners are transformed too. It is so refreshing to see fathers as active participants during their babies’ births.

Brimdyr specifically recalls one of the participating partners.

“He was unprepared for how profound it was going to be for him,” she explains. As he retells their birth story, Brimdyr goes on, you hear his passion of realizing how important it is for him to become a father.

“That authentic passion is so important,” Brimdyr comments.

Happy Birth Day oozes with “authentic passion.” There’s no doubt you’ll be struck by one mother’s exclamation, “That’s the best feeling in the world!” after she births her baby.

Another mother describes birth as “bliss.”

“Everybody deserves this feeling,” Brimdyr says.

Watching each blissful, Happy Birth Day with my young daughters was both special and enlightening. They had so many comments and questions! Is it going to be a girl or a boy baby? What is that bucket? What’s on her arm? Where are her feet? That baby needs some milk. What is she eating? Is that the midwife? She needs a pillow. Boobie!

I’m so pleased that there is a resource like this available, so that each new potential parent has the opportunity to explore the beauty of birth.

Find out more about Happy Birth Day here!

Improving relationships between parents and health care providers

I’ve been on a quest for the “perfect” pediatrician since before my first baby was born. Over four years later, I have yet to find him or her. Thankfully, I think we’ve come close with our current pediatrician. I’m not thrilled with her infant feeding suggestions, I despise the “ABCs (Always Alone, on Back, in a Crib) of Safe Sleep” message that scrolls across the computer screen in her exam rooms, and the office receptionist is sort of cranky. Even so, our current pediatrician is the first one to respect my husband and me as our children’s health authorities. She has created a space where we can have conversations about our choices, and she is committed to working as a team. That’s what makes her practically perfect.

d4f77497-2801-4d5c-9833-180a2957a4e8Over one month has passed since the 22nd Annual International Breastfeeding Conference, and I am still sifting through my notes. One of the themes that has struck me most recently is this idea of parental empowerment; it comes up in nearly all of the speakers’ presentations. I think it’s safe to say that the majority of conference participants believe that parents are the experts on their children and thus should be treated as their health authorities.

But how exactly does this play out in practice? How can parents and health care providers work hand in hand for the best possible health outcomes? How can an effective and respectful relationship be cultivated when many health care providers have worked in a landscape where they are regarded as the professionals and often assume the primary caretaker role?

As we discussed some of these conundrums, Healthy Children Project’s Elyse Blair RN, BSN, ANLC, IBCLC, a former NICU nurse and lactation consultant, shared how difficult it can be for nurses to relinquish control, even when it’s to the baby’s own parents.  

“These are our babies too,” she said, mentioning the bonds nurses often develop with babies in the NICU.

Conference speakers and participants soaking in the sun!
Dr. Maastrup and friends soaking in the sun at the International Conference!

Dr. Ragnhild Maastrup, RN, IBCLC, PhD  acknowledged this challenge.

“They (health care providers) are just as important as before, but they should use their knowledge to help the parents,” she commented.

Healthy Children Project’s Cindy Turner-Maffei,  MA, ALC, IBCLC directed us to the work of Anette Ekström. Ekström and colleagues’ research shows that process-oriented training is an effective way to improve professionals’ attitudes toward parental support. (Check out A Process-Oriented Breastfeeding Training Program for Healthcare Professionals to Promote Breastfeeding: An Intervention Study and Nurses and midwives professional support increases with improved attitudes – design and effects of a longitudinal randomized controlled process-oriented intervention.)

Health care providers need to be equipped with the proper tools in order to effectively interact with and teach parents, which will in turn equip parents with the proper tools to function as an empowered family.

During another discussion, Turner-Maffei shared that many care providers feel like they need to make all people breastfeed. She likened this mentality to cracking open someone’s skull and pouring in information. (What a gory and awesome analogy!)

This is not what it’s about, Turner-Maffei continued.

“It should be a dialogue!” she exclaimed. Of course this applies to any health-related decision.  

Certainly when policies and practices shift, like when facilities work toward Baby-Friendly designation, there is a learning curve for staff. Turner-Maffei suggested that change can be most difficult for mid-career professionals. Care providers who find themselves in this situation should evaluate their goals. Ask themselves, “What does success look like for me?” Turner-Maffei said.

Linda Smith, MPH, FACCE, IBCLC, FILCA added that people who see success in others as opposed to those who thrive on individual success tend to more easily welcome changes that empower parents.

I always believed that change was never easy, no matter what kind of person you are. But Cathy Holland, RN, BS, IBCLC, FACCE so brilliantly pointed out that change can be easy during her conference presentation Energy medicine and breastfeeding.

You too can try the simple exercise she shared with us. Clasp your hands together. Note which thumb is on top. Now clasp your hands so that the other thumb is on top. How does it feel? Reclasp your hands alternating which thumb is on top for one minute. Make sure to completely unclasp your hands at each rotation. Now reclasp your hands with the thumb on top that you initially began with. How does it feel?

Dr. Flacking speaks at the International Conference.
Dr. Flacking speaks at the International Conference.

Initially, many people report that when they change the placement of the top thumb, it feels severely uncomfortable, but after several alternating clasps, the placement of the thumb is no longer an issue.

“New experiences may feel strange at the beginning, but give them a chance,” Holland said. “New and great opportunities are at our ‘fingertips!’”
Finally, Dr. Renée Flacking, RN, PhD declared that parents are the driving force for change. We have the power to put pressure on policymakers and administrators. We have the right to demand respectful, family-centered care.

The power of positive stories

The other night at prenatal yoga, my teacher, classmate and I talked birth and breastfeeding. (Of course we did!) I was appalled and saddened to hear their stories and the tragic stories of their friends that they shared. My heart stays heavy remembering their experiences; what an impact they’ve had on me. I wonder what kind of influence those stories might have had if I were a first time mom; if I didn’t have the positive birth experience I had to show me what becoming a mom can really be like.

Horror stories seem to be the norm. Doesn’t it seem like most pregnant moms are welcomed into motherhood with stories of fear, shame and defeat?

Bankston and her mother nursing their children together. Bankston reports it is one of her favorite pictures.
Bankston and her mother nursing their children together. Bankston reports it is one of her favorite pictures.

I love Katie Bankston’s CMA, CLC story because it demonstrates the power of positive birth and breastfeeding experiences.

Bankston was attending phlebotomy class one day when she overheard a conversation between a mature student with grown children and a pregnant peer.

She remembers the mature student talking about how wonderful breastfeeding is and how it helps your uterus contract back to pre-pregnancy size.

Up until this point, Bankston reports that she didn’t even know what breastfeeding was. She says it was well before she even thought about having children of her own.

Bankston is now the mother of a preschooler and a toddler.

Throughout her prenatal care and the birth of her first son, Bankston developed a strong relationship with her nurse.

She was my support system when my family was hundreds of miles away,” she says. “She saved me. Had I not had her support and encouragement, I wouldn’t have talked to my doctor about my depression during my pregnancy.”

Bankston’s nurse also served as her breastfeeding advocate.

“This is where I was inspired to become ‘that support’ for someone else,” she says.

Not long after Bankston’s first son was born, she moved back to her hometown. During this time, Bankston’s little brother was born.

“My first lactation ‘client’ was my mother, who had not nursed me or my brother,” Bankston says. “I encouraged her to nurse my second brother. After a rocky start she went on to nurse him until he was three years old.”  

Bankston currently works full time as a Certified Lactation Counselor and a Certified Medical Assistant in an OBGYN practice.

Recalling her Lactation Counselor Training, Bankston says the most valuable thing she learned was how people receive information differently. She says it has helped her to understand that her interactions with each mother will be unique, and that she will have to adapt to address each mother’s concerns in different ways.

Bankston also acknowledges the importance of helping a mother take ownership of her relationship with her baby.

Bankston and her colleagues serve the entire Big Bend area of Tallahassee, Fla. at the OBGYN practice. Their practice delivers between 1,500 and 2,000 babies a year; about half of the babies born each year in the area. The hospital is currently working toward Baby-Friendly designation.

“I get the chance to see a lot of different families with different backgrounds,” Bankston says. “It’s amazing.”

Bankston is the only lactation counselor within her practice.

“It’s a good start,” she comments. “I would love for them to one day have more CLCs.”

Bankston is confident in the breastfeeding support an OBGYN clinic can offer to mothers.

“We’ve developed this relationship over their entire pregnancy,” she explains. “Sometimes an obstetric office is the first time these women are learning what their body is capable of.”

Bankston recently attended the 2016 International Breastfeeding Conference.

“It was amazing. I want to see and do everything now!” she exclaims. “I can’t wait to go next year.”

Specifically, Bankston was struck by Dr. Cristiano Boccolini’s, PhD, M.S. presentations and his discussion of Brazil’s Breastfeeding Friendly Primary Care Initiative (IUBAAM.)

“I’d love for something like that to be here,” she says.

Bankston is working to apply for a grant that would allow physicians and nursing staff to become better educated about lactation and breastfeeding support.

I want to make it easier for obstetric offices to implement lactation education into their care,” she says.

Some of Bankston’s other goals include starting a non-profit for further lactation education and advocacy research in the prenatal and postpartum settings, finishing her DONA postpartum doula certification, and becoming a midwife.

Bankston has also been in touch with the IT department at the OBGYN office so that she can begin to track their breastfeeding outcomes.

“The IT guys tells me about computers,” Bankston begins. “And I tell him about areolas and montgomery gland secretion. He finds it fascinating.”
Check out Bankston’s blog at http://lovecraftedlactation.com/.

Fitting in, standing out: Acknowledging stigmas and biases

Parents attend MommyCon, a “boutique style,” natural-parenting convention for many different reasons.  

Last year, my dear friend and I traveled over 100 miles with four children under four to attend the convention out of curiosity.

We arrived after a tumultuous two hour drive. Immediately upon entering, I was struck by the sea of women who looked exactly like me. Sure, our baby carriers were different brands and styles, but overall there was a tremendous lack of individuality. I was so freaked out. What an odd sensation drowning in the ordinary!

(A quick side note: I vow never to return to Mommycon after learning that the breastfeeding presentation was sponsored by a bottle manufacturer. The Boob Geek wrote a great post about that sponsorship: Mommycon is not for me.)

Dealing with stigmas

Anna Blair, PhD, IBCLC, CLC presented Motherhood: Identity, social stigmas and resilience at the 22nd Annual International Breastfeeding Conference last month. Unknowingly, Blair’s presentation perfectly complimented Karin Cadwell’s presentation from earlier that morning.

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During Blair’s presentation, we talked about the challenges we face as “others” trying to fit in, and how we react to those different from us. She asked participants to reflect on things that we feel stigmatized for and to reflect on things that we stigmatize others for.

Blair discussed visible stigmas like race and invisible stigmas like being HIV positive or suffering from mental health disorders.

She pointed out Katz, Nilsson and Rasmussen’s study Danish health care providers’ perception of breastfeeding difficulty experienced by women who are obese, have large breasts, or both. which looked at how health professionals who support lactating women perceive visible maternal characteristics as obstacles to breastfeeding.   

Their findings “indicate the importance of recognizing and treating large breasts and maternal obesity as separate obstacles to successful breastfeeding and that interventions to reduce these obstacles should be designed to account for characteristics of the person providing them.”

In Stigma of visible and invisible chronic conditions, authors Joachim and Acorn present a “beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility.”

d4f77497-2801-4d5c-9833-180a2957a4e8Blair revealed that through our interactions with others, we engage in the social comparison theory. Part of the social comparison theory involves the downward comparison theory which brings ourselves up and puts others down.  

The perceiver is more disdainful if the person is assumed to have control over the issue– like weight, Blair pointed out.

The power of thought also influences our interactions with others, presenter Cathy Holland explained. A participant asked how to help children with down syndrome breastfeed better. Holland replied that approaching the mother and child with an “Oh, no that poor child” attitude will likely negatively influence their feeding experience. Surely, babies with down syndrome should be provided with appropriate care, but they should never be expected to fail. The power of positive thought can be applied to any “other.”

Judging others, important conversations  

Throughout Blair’s presentation, I couldn’t get Abby Theuring, MSW, The Badass Breastfeeder’s I Judge You piece out of my mind.

She writes: “The ‘mommy wars’ are imaginary. They do not exist. People judge. It’s normal and it’s natural. It’s not a human flaw.”

“Oh goodie, justification for bullying,” someone commented on her blog.

Theuring is not an advocate for bullies. She’s simply acknowledging judgement as something that happens. Consequently, she encourages us to have conversations about our differences.

She continues: “The ‘mommy wars’ is a silencer. It keeps us from being able to have important conversations. It makes it so that whoever expresses an opinion, whoever discusses breastfeeding (or maternity leave or daycare or whatever) or whoever shares their experiences is seen as a bully. It’s not in corporation’s best interest for us to become informed, make our own choices and create alliances with each other.”

In her presentation, Blair challenged us to practice active-noticing versus intentional blindness. Look for the unexpected, be serendipitous, she said.

Acknowledging bias

During another conference presentation, Mona Liza Hamlin of the National Association of Professional and Peer Lactation Supporters of Color (NAPPLSC) asked us to be honest about our biases and stigmas.

A report from the University of Illinois at Urbana-Champaign shows that being honest about our biases, specifically racial bias, might be more complicated than we think. The analysis shows how racial bias affects pulling the trigger of a gun.

“‘People were quicker to shoot black targets with a gun, relative to white targets with a gun. And … people were more trigger-happy when shooting black targets compared to shooting white targets,’” Mekawi told NPR.

What’s more, Gabrielle Canon writes in a Mother Jones article: “‘What this highlights,” Mekawi told NPR, ‘is that even though a person might say, ‘I’m not racist’ or ‘I’m not prejudiced,’ it doesn’t necessarily mean that race doesn’t influence their split-second decisions.’”

Canon continues: “Racism, it turns out, can actually be hardwired into our brains.” She goes on to include information from an Inquiring Minds podcast with neuroscientist David Amodio on why we discriminate even if we don’t want to. Find more here.

486d7d71-2727-4653-a1bd-5b6aa0a41f30This is all so much to process! When I’m overwhelmed with information, I try to synthesize it into something that I could explain to my brilliant four-year-old. Here it goes: Some days we will struggle to showcase our uniqueness. Some days we will struggle to fit into “normal.” It’s important to embrace and celebrate our differences. It’s just as important to acknowledge how we feel about and treat people who are different from us.

As health care providers, lactation professionals, breastfeeding advocates, I urge you to reflect on these important pieces and consider how your biases affect the mothers, babies and families you interact with. Are you honest about your biases? Are you able to provide unprejudiced care? Can you recognize your limitations? Asking ourselves and exploring these difficult questions will only help us to provide better, woman-centered care.