Babywearing as a public health initiative

Picture this: A Detroit mother with five children under the age of seven has no car and needs to go to the corner store for groceries. She must either choose to lug her infant in the hospital-provided car seat while she walks to the store and only purchase half of the groceries she needs so that she can manage carrying her load; or leave the infant at home with its older siblings. If she leaves her baby at home, she knows it could be unsafe, but she’d be doing it for her family’s survival.

Access to a baby carrier changes all of that, explains Rebecca Morse CLC, CBE, CPST, CKC recalling one of her client’s realities that strongly influenced her.

“The first picture I get on my phone when I wake up the day after leaving her house is her [wearing] her baby and holding all the groceries,” Morse remembers.

Morse is an infant care and breastfeeding instructor at St. Joseph’s Hospital in Ann Arbor, Michigan. Most recently, she started conducting postpartum discharge surveys as St. Joe’s works toward Baby-Friendly designation​.

Through her private practice, ​Close at Hand Baby Service​, Morse provides infant care education and home-visiting services with a focus on breastfeeding and baby carrier use and safety. The clients featured on her blog include many sets of multiples, and families on journeys with various, unique challenges.

Fellow Lactation Counselor Training Course participant and head of the Wayne County Fatherhood Initiative, wears another participant’s daughter at lunch break study group. More about the initiative here:

She’s also founder of Baby Carriers Provided (BCP)​, an organization that seeks to​ create access to baby carriers for caregivers enrolled in the ​WIC program​ as well as other family service organizations, hospitals, and family/legal interfacing systems.

It was after completing the ​Lactation Counselor Training Course​ this February that Morse “kicked into high gear” writing and creating the website for BCP with help from her team.

“I…gained a massive amount of inspiration,” she says.”I thought to myself, My​ dreams of growing an organization with a large reach and impact could be real.”

Babywearing as a public health initiative

The function of baby carriers in public health are many, Morse says.

Baby Carriers Provided (BCP) Staff

It keeps babies in their natural habitats (close to their caregivers) and simultaneously allows caregivers to integrate into and participate in modern society.

Morse addresses babywearing as a public health intervention through BCP​, in that​ the practice increases breastfeeding success, decreases child abuse, increases​ general safety and health of the family unit and potentially lowers maternal/infant mortality.

In her private lactation practice, Morse says ​Kangaroo Care​– carrying or holding baby while skin to skin– is her number one breastfeeding tool.

But Kangaroo Care and babywearing aren’t only for the breastfeeding dyad.

“When we breastfeed, we get natural oxytocin shots,” Morse explains. “We also get fairly good sized natural oxytocin shots during Kangaroo Care. Kangaroo Care does scientifically replace some of those hormones when the breastfeeding relationship is lost.”

One of Morse’s clients wearing her twins. She started wearing her babies around the time they turned five months old. Babywearing “lifted her mood,” Morse reports.

Morse theorizes that the connection between Kangaroo Care and baby carrier use is strong pointing out that “babywearing is just kangaroo care while walking around.”

She says she hopes to show this through the work of BCP.

Baby carriers can play an integral role in child abuse prevention too. Morse reports that 89 to 94 percent (range based on variation of data state to state) of parents who abused their babies did so because the baby wouldn’t stop crying.

“Baby carriers reduce crying,” Morse points out., referring to research published in Pediatrics..

It’s why baby carriers could also be an important tool for incarcerated mothers and pregnant women or families going through the Child Protective Services system.

Morse’s husband teaches at a Nurse Family Partnership event.

“The facilitation of attachment and the transfer of infant parenting skills by providing baby carriers in these systems could be effective in improving family preservation rates,” Morse explains.

Babywearing to prevent accidents

Babywearing has the potential to prevent infant-related accidents too.

Upright, on-body infant carriers have one of the lowest incident profiles of all baby products on the market. Infant bucket-seat/car-seat carriers on the other hand are often used outside of automobiles​, like on top of shopping carts, which can cause serious injury and death.

In fact, a 2010 AAP study​ found that about 10,000 infants​ in the U.S. are injured each year in their infant car seats while using the seat outside of an automobile.

Helping refugees – Baby Carriers and Breastfeeding in Displaced Populations

In June and November of last year, Morse traveled to Greece on a pair of refugee​ relief trips with ​Carry the Future​, a grassroots effort dedicated to delivering baby​ carriers, baby beds, and diapers and other needed supplies to refugee camps.

Carry the Future provides training and resources to volunteers without babywearing credentials to ensure families are properly and safely fitted.

One of Morse’s clients, Jennifer Canvasser, M.S.W., founder of NEC Society pictured with her son Micah.
“If I can help people connect and feel physically close with their babies no matter what the journey, it can be a source of healing and strength,” Morse says. “[Jennifer’s] story drives me.”
More here:
During her travels, Morse also encountered volunteers from Nurture​ Project International, an organization that sets up breastfeeding tents and supports​ refugee mothers and babies.

Morse says she believes it is a “perfect place” for CLCs to consider volunteering their time and expertise to the Syrian humanitarian crises.

“This is real good we can do with the knowledge we have,” she says.

You can read more about Morse’s experience with Carry the Future on her blog​.

Learn more about babywearing as a public health intervention here​. Connect with BCP on Facebook here.

Additional reading about babywearing:

Natural Parenting ― Back to Basics in Infant Care

Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment

Babywearing: The Benefits and Beauty of this Ancient Tradition



Breastfeeding in the healthiest county in Virginia

Janine A. Rethy, MD, MPH, FAAP, FABM, IBCLC is a general pediatrician in Loudoun County, Va. dedicated to improving breastfeeding outcomes in her community. She currently leads the Obesity and Chronic Disease Prevention team at the Loudoun County Health Department where she and her colleagues focus on a community-based approach to reduce disparities in obesity and chronic disease, with a focus on breastfeeding and healthy food access. 

Dr. Rethy also serves as the American Academy of Pediatrics’ Childhood Obesity Advisor for Continuing Health and says she’s pleased to have been appointed as Virginia Chapter of the American Academy of Pediatrics’ Co-Chair for Breastfeeding.  She also serves on the Virginia Breastfeeding Advisory Committee, as the physician advisor on the Loudoun County Head Start Health and Mental Health Advisory Committee and on the Loudoun County Public Schools Wellness Policy Committee.

In February, The Loudoun County Health Department hosted The Lactation Counselor Training Course as part of an effort to increase knowledge about best practice in their community.

“The training was successful by every measure,” Dr. Rethy says.

Of the 65 participants, present were six out of seven Loudoun WIC staff, nineteen other Virginia WIC staff, physician assistants, nurses, occupational therapists and doulas from around the region, and a participant who came in from a US military base in Japan, Dr. Rethy reports.

“After the course, many people from our community attended our quarterly Loudoun Breastfeeding Coalition meeting with additional pride at their accomplishment and increased knowledge,” she says.  

With an understanding that our medical system often strips mothers’ confidence to feed their own babies, she says she finds it most rewarding to demystify breastfeeding and help mothers feel confident.

“My favorite stories are the ones where we can peel away the complications we have often created on the mother-baby feeding process, and go back to the basics of skin-to-skin, mother and baby enjoying each other and often just facilitating and reassuring the re-emergence of the feeding instincts of the dyad,” she explains.

Below, Dr. Rethy shares fascinating insights into the state of breastfeeding in her community including results from a summer 2016 WIC survey, and the pivotal work she and her colleagues are doing to ensure healthy outcomes for all families.

Q: Loudoun County ranks highest in mean household income in the U.S. How does this affect maternal child health outcomes in your community? What else is unique about Loudoun county? 

A: Loudoun County does have the highest mean income in the US and is the healthiest county in Virginia.  What those numbers do not reveal is the more difficult situations for our lower-income families:  We have seen more than a four-fold increase in immigrants over the last 15 years and we have significant pockets of poverty in the county.  These communities are particularly struggling because the cost of living is very high and the infrastructure for services is less available since the demographic change happened so fast.  We have seen the pediatric obesity rates in our community health center, which serves the lower income community double that of the rest of the county.  In our recent WIC study, we found very high rates of early introduction of formula and poor access to lactation services.

Q: Please tell us more about the 2016 WIC survey you conducted with Dr. Sina Gallo of George Mason University.

A: This study was conducted at our two WIC clinics in Loudoun County in the summer of 2016.  The study looked at infant feeding patterns, Vitamin D, healthy food access, and utilization of assistance programs and community resources.  The study was funded as a part of a National WIC Association and the Centers for Disease Control Community Partnerships for Healthy Mothers and Children (CPHMC) grant we received at the Loudoun County Health Department. The grants larger goals are to develop policy, system and environmental changes to decrease obesity and promote health.

In regards to the breastfeeding piece of our study, we found fairly high rates of breastfeeding compared to HP2020 goals and recent US and Virginia scorecards with 84% ever breastfed and 58% still breastfeeding at 6 months.  However, looking more closely, 91% of mothers gave formula at some time. It turns out that 43% gave formula before they ever left the hospital, 17% at the first feed!  This tells us a lot of things and opens the door for some positive solutions.  Half of women intended to breastfeed exclusively, and only 9% never gave formula.  We as a health care system and community can do better to help women reach their goals and protect their infants from the harm that early introduction of formula can do.  We know that exposure to exclusive breastmilk in the first few days of life is critical for immune priming and development as well as intestinal maturation, the effects of which last a lifetime. Not to mention the improved chances of for successful lactogenesis 2 and overall success at reaching breastfeeding goals.  Interestingly we saw an increase in exclusive breastfeeding at 6 months compared to 3 months which corresponds with the time that the WIC package is greatly expanded for mother and infant if they are exclusively breastfeeding.   Our results lead us to believe that the non-exclusive breastfeeding we are seeing is likely modifiable with good counseling, especially in the prenatal period and right after birth.

Another result worth mentioning is the low rate of Vitamin D – only 27% of infants ever received Vitamin D, only 14% of exclusively breastfed infants received daily Vitamin D as recommended.  We found that less than half of mothers knew about the recommendations, those who did not give Vitamin D cited the fact that their pediatrician had not recommended Vitamin D as the primary reason they didn’t give it. Only 39% said that a pediatrician had recommended Vitamin D.  In response to this, we created a Vitamin D educational handout targeted in language and content to both the families and the physicians.  This document was recently approved and accepted by Virginia WIC to be distributed to all WIC offices in the Virginia.

Q: You and your colleagues have produced many amazing breastfeeding resources like the Breastfeeding Friendly Workplace document and the Breastfeeding Support Implementation Guide for the Outpatient Setting (which includes information on how to bill insurance for lactation services.) Please tell us more about these documents.

A: The Breastfeeding Support Implementation Guide for the Outpatient Setting was created in response to a study we did in 2015 of primary care providers in our county.  We looked at knowledge, attitude and practice in the area of infant feeding and found several gaps we wanted to address.  The Breastfeeding Friendly Workplace toolkit we created as a local adaptation of the HHS Business Case for Breastfeeding. We presented the toolkit at local Chamber of Commerce and Society for Human Resources events.  We worked with several businesses and agencies to take them through the process of implementing a Lactation Support Program.  Our biggest success was the Loudoun County Government, which has about 3,000 employees.  We worked with their HR department and health insurance company (Cigna) and helped them develop a comprehensive employee policy, HR systems and training to create a process for mothers returning to work, and educational materials including how to access support and equipment benefits afforded under the ACA. We also helped them open two permanent breastfeeding rooms.   We have recently expanded our toolkit to include information on the Virginia law which protects breastfeeding in public.

Q: What’s next?

A: We are currently partnered with the Loudoun County Chamber of Commerce (LCCC) and the Virginia Department of Health (VDH) to recognize businesses as Breastfeeding Friendly Businesses.  We have incorporated elements of breastfeeding friendly businesses into the annual LCCC Healthy Business Challenge.  Those businesses that complete all the elements, including educating employees on the recent Virginia law protecting breastfeeding in public, will receive a Breastfeeding Welcome Here decal for their businesses.

Dr. Gallo and I would like to continue our work at WIC and have recently applied for a grant to conduct a randomized controlled study looking at the effect of shared-decision making prenatal counseling on the early introduction of formula in the WIC population.

Q: Anything else you’d like to highlight about the work you’re doing? 
A: The Loudoun Breastfeeding Coalition was founded in 2012 and includes active participation from WIC, our local hospital system, La Leche League, doulas, and local health care providers.  It has become an important referral and information sharing network both for providers and for people in the community through the Facebook page.  We have also created and regularly  update a printed resources guide for our community. We were accepted to be represented on the Virginia Breastfeeding Advisory Committee, a body which advises the VDH.

Standing up as an ally

When I found out that my midwife Erin O’Day, CPM, LM was traveling to Oceti Sakowin Camp, a camp close by Standing Rock Indian Reservation, I thought I’d indulge in her tremendous birth stories, the birth junkie I am. Instead, upon her return, there were no birth stories; our conversation turned to Race. Simultaneously, I worked on a piece about what I had learned about Race at the International Breastfeeding Conference, and where I fit in the movement toward equity. Speaking with Erin helped me to process the complexities surrounding Race. She sets an example of what it’s like to be an ally to People of Color.

Erin traveled to the camp for about two weeks in the middle of December 2016 shortly after the water cannon incidence.   

“Things were relatively tense,” she recalls.

There wasn’t any particular connection that drew Erin to Standing Rock except that she said it was something she thinks is “right.” She felt the need to “stand in solidarity with Indigenous People for a fight that could potentially affect all of us.”

At the same time, it’s a fight that doesn’t necessarily affect us all, but the people who have been oppressed for more than 500 years, Erin reminds us.

She’s dedicated to owning her role in ending racism, even if it’s uncomfortable.

“We need to feel the guilt, the weight, the stuff that’s uncomfortable, so that we can do everything we can to step back and allow other cultures in our country to step forward and take the lead…” she said.

In this light, while Erin offered her midwifery services she makes clear her trip was not a volunteer mission and that she didn’t arrive with a rescue mentality. Instead, she went as someone humbled; someone ready to follow the leadership of the Indigenous People.

Erin’s main role during her stay was to simply stoke the fire in the midwife yurt. She and other women’s health advocates handed out yeast infection and UTI treatment, condoms and pregnancy tests. While she did provide some perinatal counseling, she says most of the women at the camp preferred care from the Indigenous Midwife.

“There was a lot of tea pouring, warming people up, and inviting people to sit and process whatever they needed to process through,” Erin remembers.

As an ally, that’s where she felt she fit in: creating and holding safe spaces for others.

Erin also collected and delivered winter camping supplies including a face cord of kiln dried firewood, a four season tent with wood stove, about 40 long john underlayers, bulk food items like beans, rice, honey and coffee and hand and foot warmers.

It was evident to Erin that most other visitors were ill-equipped to withstand the sub-zero conditions at the reservation. This is what struck her most, that people arrived with a “Burning Man” mentality of which Erin’s experience was nothing like.

“It’s a war zone,” she said. “You are subjecting yourself to potential trauma.”

What’s more, sometimes helping hurts; perceived help was more a burden in that Standing Rock leadership became responsible for the well-being of their guests.

Erin’s stay overlapped with that of about 2,000 U.S. military veterans which pushed the total population at the camp to about 10,000.

“Port-o-potties were overflowing, almost to a crises point,” Erin said.

Not long after, a snowstorm hit and many people left. Erin called the “ebb and flow” of protesters “interesting”; perhaps an illustration of taking on the ally role when conditions are convenient and walking away when they’re not.

During her stay, an Indigenous friend Erin met at the camp had a disagreeable encounter with a visiting man. The encounter amounted to this man declaring that “He doesn’t see Race” which further upset her friend.  

Erin wondered how she could help and offered to talk to the man. Unsure of the result, her friend ultimately accepted reporting that no one has ever offered to do that.

Erin approached the man and explained that his intention meant nothing, it was his impact that mattered.

She reflects on this encounter:
“The example it sets in my mind is that we all have the power to speak out if we see racism happening. We all have the power to show we are capable of shifting perspective and standing in a place that educates each other versus the constant need of education coming from people of color, letting us know what it is that offends them. We should know already. We should be changing our rhetoric and recognizing what it is that we say that has a negative impact. We should allow that uncomfortable feeling to set in to give us perspective and admit when we are wrong in our choice of words… It’s a story of what it looks like to speak out as an ally.”

Breastfeeding Latinas group offers scholarship for lactation training

Ileana Berrios, CLC is a mother, doula and Philadelphia WIC Breastfeeding Manager. Berrios praises Philadelphia as a breastfeeding-friendly city with Baby-Friendly Hospitals, organizations dedicated to maternal child health like Maternity Care Coalition, and a sisterhood among women of color.

“Women in the community are now breastfeeding openly in public, engage more on social media, serve as mentors for one another, and proudly promote breastfeeding,” she explains.

Still, Berrios recognizes racial disparities among lactation professionals in her area. She created the group Breastfeeding Latinas to address these disparities, call for culturally appropriate and culturally safe care, and to provide a resource to women of color in her community.

Inspired by the National First Food Racial Equity Cohort, Berrios, through her group, created a scholarship program that will award one person from a network of community doulas tuition to attend the Lactation Counselor Training Course.

Members of the community doula network have been provided with instructions on how to apply for the scholarship.  At present, a board of current CLCs is being established who will ultimately review the applications and choose a winner together. The scholarship recipient will be announced at The Global BIG Latch On in Philadelphia on August 5, 2017.

“[Members of] the Community Doula Network have expressed their excitement towards this opportunity,” Berrios says. “Many doulas have already shared their interest and desire to become a CLC or breastfeeding peer counselor. Doulas are beginning to see this opportunity as a way to engage with more women in the community.”

Next year, Breastfeeding Latinas will extend multiple scholarship opportunities to other networks of women who work with the mother baby dyad, Berrios reports.

Berrios completed the Lactation Counselor Training Course in 2013 while working with WIC.

“I was amazed at the amount of clinical information the CLC training provided,” she says. “I consider this training to be the necessary step towards any human lactation profession.”

Because the information was “entirely new” to her, Berrios admits feeling overwhelmed during her training. Not discouraged though, Berrios continues her journey as an IBCLC candidate.

Going forward, Berrios hopes to see the emergence of accessible, culturally appropriate maternity and lactation care and less restrictive insurance policies.

Healthy People 2020 has high expectations for breastfeeding rates and Breastfeeding Latinas wishes to add fuel to the fire when it comes to improving initiation and duration rates,” Berrios begins. “But we first must start by providing high-quality support which can be accessible to any woman of any color from all socioeconomic backgrounds.”

Finally, she sees the need for insurance companies to cover doula care and care provided by CLCs.
In her community, she has found that more CLCs provide support than IBCLCs, but only IBCLCs can bill insurance. It’s vital that the work of CLCs is recognized and rewarded for improving maternal child health outcomes, she says.

Happy thoughts

The following post is dedicated to those of you who crave restored hope in humanity! Too often, I find myself defeated by the state of maternal child health, but as I reviewed notes from this year’s International Breastfeeding Conference, I was reminded of the progress we’re making. Below, I am sharing unique findings,“big happenings,” and other highlights from the conference.

Little George and myself enjoying our time at the International Breastfeeding Conference.

Help us add to this list! Please share your “happy thoughts” in the comments below.