Making an Informed Decision on Vitamin K Prophylaxis

By Donna Walls, RN, BSN, IBCLC, ANLC
With introduction and contributions by Jess Fedenia 

Source: United States Breastfeeding Committee.

The concept of shared decision making is based on the tenets that patient autonomy is an ethical imperative, and several important outcomes of care are improved when individuals feel involved in their own health care decisions. 2,3 However, shared decision making can be misconstrued and therefore misused.

I bought cream for the first time in my three decades on Earth in an attempt to calm the bulging bags under my eyes. I slabbed on the ointment, wondering why in the world I felt and looked so tired. 

Soon after, I learned about a phenomenon called decision fatigue and it all started to make sense. 

Annie Reneau explains it this way in her Scary Mommy piece:

“There is a commonly overlooked stressor in childrearing…It’s a well-known psychological phenomenon, and I’m not sure why we don’t talk about it more in parenting circles… We usually think of having choices as a good thing, but making decisions zaps our mental and emotional energy. Even small decisions, such as what to wear or what to have for dinner, require our conscious attention and thought. Every time we make a choice, we go through a process of weighing pros and cons, risks and benefits, costs and rewards. Our brains go through that process even if we aren’t cognizant of it, and the energy expenditure occurs whether we want it to or not. More decisions mean more drained energy and lowered willpower.” 

Adding to parents’ choices, COVID-times have exasperated the fatigue . On top of the normal slew, now we wonder about things like if it’s safe to leave the house, if we should send our kids to in-person classes, if we should get the vaccine, and so on. 

Healthy Children Project’s Donna Walls, RN, BSN, IBCLC, ANLC has prepared an article about making an informed decision on vitamin K prophylaxis providing us with historical and scientific context. To add personal perspective, I’ve peppered in my experience on choosing the vitamin k injection for my three children.

Historical insight into vitamin K administration 

Photo by Jonelle Yankovich on Unsplash

In 1961 the American Academy of Pediatrics (AAP) began recommending all newborns receive a vitamin K injection as part of routine newborn care. The recommendation was made after review of research which confirmed the administration of vitamin K as an effective preventative treatment for the condition called vitamin K deficiency bleeding (VKDB). 

Historically, in 1894 Dr. Townsend of Boston first described 50 cases of bleeding in newborns which he called “Haemorrhagic Disease of the Newborn (HDN).” Then, in 1930, a Danish biochemist, Carl Peter Henrik Dam, discovered that vitamin K deficiency was the cause of unexpected bleeding in baby chicks, for which he won a Nobel Prize. In 1944 Jorge Lehmann, a Swedish researcher studied 13,000 infants who were given 0.5 mg of vitamin K (either oral or injection) on the first day of life. The published research confirmed that infants who received vitamin K experienced a 5-fold reduction in the risk of bleeding to death during the first week of life. It was estimated that for every 100,000 full-term infants, vitamin K would save the lives of 160 infants per year (Lehmann 1944).

Vitamin K is a co-factor which plays an important role in the formation of coagulation (blood clotting) factors, reducing the risk of abnormal or excessive bleeding. Infants are at increased risk for VKDB until they are regularly eating vitamin K-containing foods (e.g. dark green leafy vegetables, broccoli, brussel sprouts, cashews, kidney beans), usually at 6 months of age, and until their intestinal bacteria start producing vitamin K.  At birth, babies have only a small amount of vitamin K stored in their bodies as very little passes to the fetus from the mother during pregnancy, and breastmilk contains low amounts of the vitamin. Formula provides more vitamin K than breastmilk, making VKDB risk greater in  exclusively breastfed infants than for formula fed infants. 

Exclusive breastfeeding is considered the gold standard of infant feeding, so how can we make sense of this apparent deficiency?  It is theorized that similar to the digestive and immune systems, the coagulation mechanisms will naturally mature during the first months of life. (Dekker, 2019)

Breaking down Vitamin K Deficiency Bleeding

VKDB presents as early, classical or late.  

Early VKDB:

  • occurs in 1 in 60 to 1 in 250 newborns.
  • presents in the first 24 hours of life.
  • is severe and found more frequently in mothers requiring anti-seizure medications, some antibiotics, anticoagulants or isoniazid for tuberculosis treatment.

Late VKDB:

  • is rarer occurring in 1 in 14,000 to 1 in 25,000 infants.
  • occurs within two to 12 weeks and presents as bleeding in the brain or intestines.

Classical VKBD:

  • presents in one to 7 days as bruising and bleeding from the umbilical cord or the circumcision incision. 

Infants who do not receive a vitamin K injection at birth are 81 times more likely to develop late VKDB.  (CDC Fact Sheet)

Infants may develop any of the following signs of VKDB: bruises, especially around the baby’s head and face, bleeding from the nose or umbilical cord, skin color that is paler than before.  InBabies of Color, gums may appear pale.

After the first three weeks of life, the sclera (white part of the baby’s eyes) may turn yellow.

Stool may have blood in it or appear black or dark and sticky (also called ‘tarry’). Babies may also vomit blood.  

Irritability, seizures, excessive sleepiness, or a lot of vomiting may also all be signs of bleeding in the brain.

If or when any of these symptoms are recognized, parents should call their infant’s healthcare provider immediately.

The AAP provides their policy statement on vitamin K injection which reads as follows:

“Because parenteral vitamin K has been shown to prevent VKDB of the newborn and young infant and the risks of cancer have been unproven, the American Academy of Pediatrics recommends the following:

  1. Vitamin K1 should be given to all newborns as a single, intramuscular dose of 0.5 to 1 mg.
  2. Additional research should be conducted on the efficacy, safety, and bioavailability of oral formulations and optimal dosing regimens of vitamin K

to prevent late VKDB.

  1. Health care professionals should promote awareness among families of the risks of late VKDB associated with inadequate vitamin K prophylaxis

from current oral dosage regimens, particularly for newborns who are breastfed exclusively.” (AAP, 2003)

Jess’s experience:

Like many of the decisions I made with my first child, we opted for the vitamin K injection, because that’s “what ya do.” Willow was born in a large hospital, and while I was very firm on wanting a non-medicated, vaginal birth and breastfeeding soon after, the other choices I left up to whatever the hospital’s norm was. That meant Willow got the vitamin K injection, Hep B vaccine, and antibiotic eye ointment by default. Looking back, I wonder if my non-decisions had something to do with decision fatigue. 

“The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts…the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice,” author John Tierney writes in this piece.

I was a young mom, fresh out of an undergraduate program and internship. My decision-making capacity may have been maxed out.  

Rejection of and concerns over vitamin K injections in newborns 

Photo by Sergiu Vălenaș on Unsplash

There have been some controversies surrounding the routine administration of newborn vitamin K. 

A growing number of parents in the United States refuse the vitamin K injection for their newborns raising concerns among care providers.  (Loyal, 2017

Reasons for refusal include:

  1. Concern about causing pain in their newborn
  2. Concerns about the ingredients in the vitamin K injection solution (preservatives and other additives)
  3. Concerns about possible allergic reactions. 
  4. Perception that vitamin K injection may cause childhood cancers (Golding, et al, 1992)  There is ample research to quell parents concerns. For instance, research  does not support any correlation between the vitamin K shot and the development of childhood cancers including leukemia or solid tumors. 

Only one case of allergic reaction has been reported and that was with an intravenous injection. 

Additives have been minimized ( e.g. propylene glycol was reduced by 30X the previously used dose) or removed from the injection solution. A “preservative-free” formulation is also available upon request. In order to diminish pain during the time of the injection, cuddling, skin-to-skin, and breastfeeding before, during and after the injection are all effective ways to manage the infant’s pain. If the mother is unavailable, a cloth with the maternal skin and milk aroma can be made available for the newborn to inhale.   There are some reported cases of redness or irritation at the injection site but these have been shown to be mild and temporary.

Jess’s experience:

When I became pregnant with my second child, I opted for a home birth with midwifery care. I felt in charge of my perinatal care and therefore more involved in every aspect of decision-making.

Before I found out the sex of my baby, my husband and I debated vehemently over circumcising our potenitally-male child. 

Researching male circumcision led me to research the vitamin K injection. Dekker’s Evidence Based Birth website was an awesome resource, and although we didn’t need to make a decision about male circumcision because Iris was born with female parts, I could make an informed decision to opt for the vitamin K injection. 

I had considered oral administration (more on that later) for my second baby to avoid an injection, but worried that with a toddler and a new baby,  I wouldn’t be able to keep up with the demand of multiple doses. I also worried about the efficacy if spit up. 

Ultimately, the injection didn’t seem to cause any discomfort; Iris and I laid skin-to-skin and she breastfed while our midwife administered the injection. 

When my son was born, we also opted for the vitamin K injection, mostly because I knew I would breastfeed him leaving him at risk for developing VKDB.   

Increasing Vitamin K through maternal diet 

Source: United States Breastfeeding Committee.

Can eating more vitamin K-containing foods or supplements during pregnancy or breastfeeding increase vitamin K levels in the newborn? In a 2018 systematic review and meta-analysis, researchers pooled six randomized trials (over 21,000 pregnant people) from the US, the United Kingdom (UK), the Netherlands, and Japan. This review found no difference in newborn bleeding with vitamin K supplementation, but there was improvement in maternal vitamin K levels, including in breast milk, and levels in newborn cord blood. (Shahrook et al. 2018)

Injection vs. oral administration 

Many parents who have voiced concern about causing pain in the newborn have opted for the oral route of administration. 

The 3-dose, 2 mg regimen of oral Vitamin K1 does lower the chance of VKDB to less than 1 in 100,000 births, but does not eliminate it as effectively as the injection (Mihatsch et al. 2016). If the weekly oral vitamin K regimen is used, because it is a fat- soluble vitamin, it should be given with a feeding and must not be spit up in order to be effective .

Sankar found that “Between the two routes of administration of vitamin K, [intramuscular](IM) route was found to be more beneficial than the oral route in the two studies from Germany and the United Kingdom. The reported RRs for IM and oral routes were 0.03 and 0.2, respectively, in the former study and 0.01 and 0.35, respectively, in the latter study. The disadvantage of oral vitamin K may possibly be due to poor absorption and a shorter duration of effect. Indeed, multiple oral doses of vitamin K seemed to offer an advantage over a single oral dose”. (2016) 

There has been improved efficacy demonstrated with multiple doses of vitamin K, but it does require repeated doses. Worldwide, the process of tracking and contacting discharged parents for completion of the multi dose regimen is of concern. (Sutor, 1999)

Weighing the risk and benefit 

As healthcare providers and parents, we all must consider the risks and benefits of any and all treatments and care protocols for our children. From an evidence-based approach, it appears  that the risks of VKDB  are greater than the risks of the intramuscular vitamin K injection. For those parents who prefer the multi dose oral prophylaxis, a system that assures completion of the regimen must be in place.  Effective, open and honest communication between parents and their infant’s care provider is essential for all informed decision-making and the vitamin K decision is no exception.

 

References

Afanasjeva, J. Administration of Injectable Vitamin K Orally. Hosp Pharm. 2017 Oct; 52(9): 645–649.

Published online 2017 Sep 8. doi: 10.1177/0018578717729663

Ardell, S. et al. Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates. Cochrane Database of Systematic Reviews. 2018;https://doi.org/10.1002/14651858.CD008342.pub2

CDC National Center on Birth Defects and Developmental Disabilities.  Protect Babies from Life-Threatening Bleeding — Talk to Expectant Parents about the Benefits of Vitamin K Shot for Newborns. n.d. https://www.cdc.gov/ncbddd/blooddisorders/documents/Vitamin-K-Provider-p.pdf

Committee on Fetus and Newborn Controversies concerning vitamin K and the newborn. Pediatrics. 2003; 112: 191-192 

Dekker, R. Evidence on: The Vitamin K Shot in Newborns. 2019. https://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/

Golding, J. et al.  Childhood cancer, intramuscular vitamin K, and pethidine given during labor. BMJ.1992; 305:341-346.

Lehmann, J. Vitamin K as a Prophylactic in 13,000 infants. Lancet. 1944. 243(6294): 493-494.  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)74175-4/fulltext

Lowensteyn, Y. Increasing the dose of oral vitamin K prophylaxis and its effect on bleeding risk. European Journal of Pediatrics. 2019; 178: 1033-1042 https://doi.org/10.1007/s00431-019-03391-y

Loyal, J. Factors associated with refusal of intramuscular vitamin K in normal newborns. Pediatrics. 2018; 142: 1-6

Mihatsch WA,  ESPGHAN Committee on Nutrition, et al. Prevention of Vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2016 Jul;63(1):123–9. https://doi.org/10.1097/MPG.0000000000001232.

National Center on Birth Defects and Developmental Disabilities, CDC. Vitamin K deficiency bleeding. December, 2019

https://www.cdc.gov/ncbddd/vitamink/facts.html

Sankar, M.J. et al. Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review. J Perinatol. 2016 May; 36(Suppl 1): S29–S35.Published online 2016 Apr 25. doi: 10.1038/jp.2016.30

Simes, D.C, Vitamin K as a Diet Supplement with Impact in Human Health: Current Evidence in Age-Related Diseases Nutrients. 2020 Jan; 12(1): 138. Published online 2020 Jan 3. doi: 10.3390/nu12010138

Stachowiak, A.  and Furman, L. Vitamin K Is Necessary for Newborns. Pediatrics in Review June 2020, 41 (6) 305-306; DOI: https://doi.org/10.1542/pir.2019-0146

Sutor AH, von Kries R, Cornelissen EA, McNinch AW, Andrew M. Vitamin K deficiency bleeding (VKDB) in infancy. ISTH Pediatric/Perinatal Subcommittee. International Society on Thrombosis and Haemostasis. Thromb Haemost 1999; 81(3): 456–461.

How to better serve birthing individuals who are deaf or hard of hearing

American Sign Language (ASL) has been in the news recently. Hand Waves Birth Services’ Childbirth Educators and Full Spectrum Doulas Ally Balsley (she/her) and Brittany Noschese (she/her), say that they are hopeful that this move will influence our nation’s overall effort to be more inclusive and accessible. 

“This is only the beginning of more to come,” they write in an email interview.  “This move should be inspiring to all the health workers and for them to recognize the great need of accessibility for everyone.”

Ally Balsley and Brittany Noschese of Hand Waves Birth Services

Individuals who are deaf are challenged by a chronic lack of access to healthcare information. Balsley and Noschese explain that those who are deaf often struggle with improper translation and communication with their care providers.

Recent research shows that individuals who are deaf and hard of hearing have a higher risk for pregnancy and birth complications and that the infants of individuals who are deaf and hard of hearing are more likely to be born preterm, have low birth weight, and receive a low Apgar score. Authors note that causes of these disparities have not been determined, but they believe that health care providers’ shortcomings in communication may play a large role. 

Alicia Pittman is a clinical coordinator at an acute care hospital working as a Speech-Language Pathologist and she says that language access is crucial to appropriate healthcare. 

“…Lack of information impacts patient outcomes,” Pittman begins.  “In this study, it was found that Deaf patients reported fear, mistrust, and frustration during healthcare visits. It was reported that having a medically trained ASL Interpreter present, reduced these concerns and caused the patient to have a more positive experience.”

Mitra and colleagues add that individuals who are deaf or hard of hearing are at a higher risk for stress, depression, anxiety, and interpersonal violence, which all can influence pregnancy and birth outcomes of course. 

The Hand Waves team suggests that care providers can better nurture the mental health of those in  the deaf community by providing resources and therapy primarily from those who know ASL and have experience with deaf culture. 

“Deaf community is their culture and it plays a big factor in their lifestyle so having professionals who are experts with knowledge in this culture helps greatly,” they explain. “The healthcare providers should have a list of proper referrals ready if needed to best serve the deaf community, and with that, they would be able to ensure that they would be able to receive and ask for the information and support they need.”

Photo by Jonathan Borba on Unsplash

Video Relay Interpreter (VRI) services can be effective, but the Hand Waves team explains that these services are faulted for having poor connections sometimes. They add that deaf individuals don’t always receive transparent information from their medical providers.

“It is pretty common for deaf individuals to receive basic selective information from the providers,” they explain. “Due to the lack of details, the families are limited in making informed decisions.”

Abigail Shipp, CBD(CBI), CBE(CBI), SBD, CLC  is a Certified Birth Doula and Childbirth Educator, Certified Bereavement Doula, Certified Lactation Counselor (CLC) and Certified ASL interpreter practicing in the Omaha metro, Papillion, Bellevue, and Southwest Iowa areas. Shipp echoes many of the barriers Balsley and Noschese describe. 

“Access to information is extremely limited,” she says. “[Deaf individuals] are limited to the providers they can choose from, due to lack of interpreters, and the ability for smaller, private practice providers to provide interpreting services. So right off the bat, they are immediately penalized due to their deafness in not getting the provider of choice.”

In an article by Angela Skujins about growing up with deaf parents, the author explores the role of CODA, an acronym for the “Children of Deaf Adults” stating  that “many CODAs act as interpreters for their parents from a young age, and this can mean taking on responsibilities generally reserved for adults.”

The Hand Waves team writes to this point, “It is unethical for health providers to use family members, especially children, to interpret for their families.  It is incredibly important to have a certified interpreter to do that role as a neutral person in the conversation.” 

Shipp brings up another barrier: effective translation even when a hired interpreter is present. 

“…Interpreters may not be skilled in the language of birth, postpartum, or lactation,” she explains. “They may not be comfortable interpreting these topics, thus interfering with a smooth interpretation of the information.”

Photo by Walaa Khaleel on Unsplash

The Hand Waves team adds: “Currently, there is not a specific place where you can learn the signs for certain words related to the birthing world. We would encourage reaching out to those who teach ASL, possibly take classes on general signs in ASL, and immerse yourself in the deaf community by going to deaf events.” 

They continue that the deaf community’s primary language is usually ASL rather than written English.

“So when they don’t receive the information in ASL, they are not receiving the information in the language where they can fully comprehend and receive full access to the information,” they write. “It is legally and ethically your right to have an ASL interpreter on site or VRI depending on the deaf individuals’ preference.” 

Shipp shares one of her experiences in a role where she was asked to fill in as an interpreter instead of the doula role in which she was intended.

“I was attending a birth [but] because the mother was not yet six centimeters dilated, the interpreter was not allowed to stay and be compensated for their time. Think of all of the communication that happens during labor: the questions from nursing staff, the responses from the laboring mother… that information could not be conveyed, simply because the mother was not yet six centimeters in labor. So then that put the family, the staff and myself in an awkward situation where they relied on me to interpret for this family, when I was there in a support role. Imagine if I hadn’t been there, how would communication have happened?” 

Balsley, Noschese and Shipp all break down how maternal child health professionals can better advocate for the deaf community: 

  • Ensure a proper referral system with those who specialize in serving the deaf community.
  • Make sure patients are comfortable with provided interpreters; be sure they have a choice in what kind of interpreting services they prefer.  
  • Allow time for the interpreting process and give the patient time to express themselves.
  • Provide scholarships for members of the deaf community to become certified in birth and lactation work.  Find a volunteer-based resource list of deaf/signing birth workers here
  • During in-person classes, set up seats in a circle or semi-circle so vision is not obstructed.
  • Check in often to ensure the individual follows what is being taught or explained. 
  • Include videos, props, pictures and hands-on performances to help communicate. 

    Photo by Luiza Braun on Unsplash

Pittman recalls many infant feeding success stories and shares that they all have one thing in common: collaboration with a lactation care provider who can help parents with their infant feeding goals.

There are several ongoing efforts to gather the experiences of the deaf community to better serve birthing people. Find them here and here

“Every birthing person’s experience matters,” The Hand Waves team writes. 

You can connect with Shipp here:

www.bellylovebirthdoula.com

www.omahachildbirtheducation.com

www.facebook.com/bellylovebirthdoula

www.facebook.com/omahachildbirtheducation 

And Balsley and Noschese here.

During Black History Month and beyond, celebrate positive stories of Black people’s ongoing legacy

I received an email from my fourth grader’s teachers updating parents on some of the topics they’ve been covering in class: World War II and Black History. In the message was a heads-up that students may be coming home with “big questions” about some of the sometimes difficult details they’d discussed. 

My grade school memories fade, but I can say with near certainty that none of the history lessons covered in my elementary education (and beyond) required any kind of warning from my teachers. The history that we covered was diluted to become palatable, white-washed, white-centered, and one-dimensional. 

At the same time, there was little to no celebration of the Black individuals who have shaped American history and propelled us forward. 

Photo by Prince Akachi on Unsplash

The National Institute for Children’s Health Quality (NICHQ) Black History Month Celebration statement puts it this way: “Too often, the mainstream narrative around the Black experience is one of violence, heartbreak, and pain. The importance of understanding our nation’s exploitative history and its impact on modern-day inequities cannot be overstated.”

It goes on,  “However, leaning into collective learning about the contributions of Black thinkers, doers, and visionaries is imperative to creating a world equitable for all. As journalist John Blake and countless others highlight the need for more ‘trauma-free Blackness,’ NICHQ joins the call to highlight and share positive stories and messages about Black people’s ongoing legacy. ” 

Nichelle Clark’s piece  Breastfeeding As An Act Of Resistance For The Black Mother seconds this sentiment.

“Black History Month in the breastfeeding community is normally littered with posts and articles about the dark history of African American Breastfeeding in this country,” Clark writes. “I firmly believe that in order to understand where you are going, you must first understand where you have been. However, Black Mothers in today’s society face a very different dilemma: actually being Black History.”

Photo by Kiana Bosman on Unsplash

And again, Jamarah Amani, LM, executive producer of the documentary Legacy•Power•Voice— a three-part documentary that explores the evolution of Black birthing traditions in America–advises, “You have to look back to go forward.” 

As a white woman with white children educated by white people, in honor of  Black History Month– but of course extending beyond the month of February– I’m looking back on my education (and looking inward) in an effort to evolve my learning and re-learn with my kids.  

We have subscribed to the idea that “If Black children are ‘old enough’ to experience racism then white children are ‘old enough’ to learn about it” as educator Blair Amadeus Imani has said. This is a piece of the critical process of dismantling systemic racism in America.

Thanks to Kimberly Seals Allers’ (KSA) Irth Wind & Fire Facebook episodes, I’ve started digging into the rich history of Black midwifery in my effort to relearn and gain new perspective. 

Black midwifery is part of history that has been hijacked by white men who thought birth should be medicalized and white women who turned it into something “crunchy,” KSA explains.  These influences eventually led to the criminalization of midwives and ultimately influenced low breastfeeding rates and high maternal infant mortality rates in BIPOC.

Photo by Mustafa Omar on Unsplash

Midwifery worked before these forces disturbed the process. Actually, midwifery still works, and KSA shouts out the Black organizations and individuals who are helping families birth safely: 

National Black Midwives Alliance, Southern Birth Justice Network, the Granny Midwives, and community-centered missions and birth centers like those in Detroit and New Jersey for example.     

KSA urges us to honor the systems that have worked for generations, rather than grasping for flimsy and phony solutions. Speak up about midwifery care and to find ways to put time, money and energy into the solutions that we know work, she says in her Irth Wind & Fire episode.

Reflecting on NICHQ’s statement, I realized that Our Milky Way is in part, a collection of “positive stories and messages about Black people’s ongoing legacy.” 

The people we’ve featured– Anihhya Trumbo, Tytina Sanders-Bey, Crystal Lovett, Brittany Isler, Rose Hurd, Kayla Bitten, Evelyn Rhodes, Monica Haywood, Joy R. Gibson, Tangela L. Boyd, Dr. Carolyn Turner, Chanel Porchia-Albert, Dr. Byron Whyte, Tammy Thompson, Ngozi Walker-Tibbs, Acquanda Stanford, Ravae Sinclair, Sering A.L. Sosseh, Charles Clayton Daniels, Jr., Shirley Payne, Patricia Officer, Ashley Albright, and many others–  are the changemakers, the “Black thinkers, doers, and visionaries… creating a world equitable for all.”

Photo by Humphrey Muleba on Unsplash

Racial discrimination is morally wrong and often deadly to Black Indigenous People of Color (BIPOC). If that’s not enough to inspire people with privilege to create positive change, Sum of Us Author Heather McGhee draws “on a wealth of economic data… [and] argues that when laws and practices have discriminated against African Americans, whites have also been harmed… thus we all have an interest in fighting…”  [Read more or listen about the cost of racism for everyone here.]

Along with an understanding of our nation’s exploitative history and acknowledgement of the systemic racism embedded in our country, let’s also celebrate that “… Black lives should matter outside of trauma.”

John Blake writes, “Any true racial reckoning should acknowledge all of our humanity — not just when we’re dying.”

Photo by Eye for Ebony on Unsplash

More resources to consider:

  • The International Confederation of Midwives (ICM) and Council of International Neonatal Nurses (COINN) are surveying nurses and midwives asking for what they might need to better support breastfeeding. The UNICEF-WHO Global Breastfeeding Collective will incorporate the results into an Advocacy brief that highlights the important role of nurses and midwives in supporting, protecting and promoting breastfeeding. Nursing and midwifery organizations and individual nurses and midwives are encouraged to participate in this survey before the end of February. 
  • Teasers and behind the scenes footage of Legacy•Power•Voice here
  • Celebrate BHM with NICHQ’s Weekly Social Media Themes and follow them on Facebook, Twitter, and LinkedIn for posts and resources.
  • Tune into KSA’s Irth, Wind and Fire episodes.
  • Get free access to Breastfeeding Medicine research and articles about Black experiences. 

Tailoring infant feeding support to better serve Chinese American families

On Friday evening, many Chinese American families’ tables were filled with Kao Nian Gao, Tang Yuan, Jiaozi, Jujube, fish, noodles, oranges and other traditional dishes in celebration of the Lunar New Year. 

Asian culture is incredibly diverse, encompassing approximately 52 different countries with about 800 different languages and dialects. The Asian and Pacific Islander (API) population is also the fastest growing group of people, yet they are often overgeneralized or overlooked in health messaging and support.

Jeanne Kettles, MA, IBCLC, Tonya Lang, MPH, Grace Yee IBCLC, presenters of Effective Collaborations and Breastfeeding Promotion Strategies for Asian, Southeast Asian and Pacific Islander Communities, part of the USBC Racial Equity webinar series, point out that on an aggregate level, the API community looks like they’re doing very well in terms of breastfeeding initiation and duration rates.

But the statistics don’t cover the full story, they add, stating that “there are stark disparities within these population groups.”   

Photo by Taiying Lu on Unsplash

Heading into the Year of the Ox, let’s celebrate Chinese American culture– the largest Asian American group– by looking at some of the ways maternal child health advocates can better serve new families by building on cultural practices and by uplifting the organizations that are designed to serve these families. 

Discovered in part through their work with the Asian Southeast Asian Pacific Islander (ASAP!) Taskforce,  Alameda County Breastfeeding Coalition and other community engagement,  Kettles, Lang and Yee outline some strategies for tailoring infant feeding support in the Chinese American population. 

  • Include grandmothers in breastfeeding education and infant feeding plans. Grandmothers are influential elders that often assume responsibility of care for the new mother and infant during the postpartum period.  
  • Incorporate peer counseling into the traditional postpartum confinement period. Whether  mothers stay in the home or in a confinement center during this period, they should have access to proper lactation care. This study shows the importance of targeted training to support better breastfeeding outcomes. 
  • Establish a referral system for appropriate lactation care. 
  • Educate employers on lactation space provisions. 
  • Increase representation of Asian mothers in breastfeeding promotion. 
  • Increase representation of Asian lactation care providers. 
  • Ensure counseling strategies align with cultural practices. 

A major barrier to Chinese American families’ healthy infant feeding practices is linguistic isolation. ASAP! collaborated with Global Health Media to translate some of their videos into Chinese.  La Leche League Canada provides some of their information sheets in simplified Chinese and traditional Chinese. To-wen Tseng’s blog And I’d rather be breastfeeding is available in English and Chinese.  

Photo by Reynardo Etenia Wongso on Unsplash

Moving into a new year, the Asian & Pacific Islander Breastfeeding Task Force celebrates some of their accomplishments as shared on their Facebook page

Photo by Macau Photo Agency on Unsplash

“The ox, in Chinese culture, is a hardworking zodiac sign. It usually signifies movements so, hopefully, the world will be less static than last year and get moving again in the second half of the year,” Thierry Chow, a Hong Kong-based feng shui master is quoted in this article offering predictions on the year ahead.

For more on API culture, resources and materials, visit USBC’s page here

‘Accessing the Milky Way’ scholarship recipient advances equitable care

 

Lovett nurses her 4 month old at a family reunion.

Crystal Lovett, RN, CLS loves telling her breastfeeding stories. The first one goes like this:

My breastfeeding story began February 13, 2006, the day my son was born at WomenCare BirthCenter in Hurricane, W.Va.  Due to possible aspiration of meconium in my amniotic fluid, he was transferred to the hospital where he spent his first week of life.  I expressed breast milk using a hospital-grade breast pump in addition to attempting to feed him at the breast.  After spending the first couple of nights in the hospital with him, the staff urged me to go home and rest.  Though leaving the hospital without him is one of the most difficult things I have ever done, I went home, rested, and continued pumping around the clock to provide him with as much breast milk as possible.  We had some difficulty getting a good latch during his hospital stay and thankfully had the opportunity to work with a lactation professional before he was discharged home.  We ended up having a 15-month breastfeeding journey!

Years later, on March 22, 2019, Lovett gave birth to her daughter at 35 weeks by an unplanned cesarean section. She continues recounting her journey: 

The evening of her birth remains a blur as it took several hours for the medications I received during surgery to wear off.  Though she weighed 4 lbs 15 oz, had an initial low blood sugar, and low body temperature, she did not require a stay in the NICU and we were able to room together the majority of our time there.  I attempted nursing for each feeding before supplementing with formula and pumped after each feeding.  We had some difficulty with latching in the beginning resulting in lots of pain on my end.  We were fortunate to see the lactation consultant before discharge and she showed us some helpful techniques, including how to use a supplemental nursing system (SNS), so that my daughter could receive her supplement while nursing at the breast.  The lactation consultant was the first person to identify a possible tongue restriction, which was diagnosed and revised, along with an upper lip tie, at two weeks of age.  We went back to see the lactation consultant for three outpatient visits.  Eventually, with much work and continuous support, my daughter and I got the hang of breastfeeding.  We were able to stop supplementing around day five and she was back to birth weight by one week!  Now here we are at 22 months still going strong.

Lovett takes a work selfie on dress down day, 3 months postpartum.

From a young age, Lovett says she knew she wanted to make her career in maternal child health, but it was after receiving “such amazing support” from hospital lactation specialists that she zeroed in on wanting to help families navigate new parenthood. 

COVID-19 has challenged Lovett’s newest role as a WIC Peer Counselor, but she says she’s part of a supportive team that has helped her learn the ropes. While the majority of their work is currently done remotely, Lovett reports that they have been able to see some clients in-person with proper PPE and cleaning and sanitizing procedures to ensure a safe experience for everyone. WIC clients have been encouraged to use a lactation support app which offers 24/7 support complete with video chat capabilities.

“I love talking with participants, listening to their stories, providing prenatal breastfeeding education, and counseling for concerns and questions,” Lovett says.   

Her accomplishments have been honored in her feature in the Future of Nursing WV’s Courage to Care Campaign.  She plans to participate as an Ambassador RN and work with the Diversity Team at Future of Nursing West Virginia. 

As an Accessing the Milky Way Scholarship recipient, Lovett completed the Lactation Counselor Training Course (LCTC) last month. 

Not only [will] this help broaden my knowledge base and in turn better equip me to help families, but it…also provide[d] me with a portion of the 90 lactation specific education hours required to become an International Board Certified Lactation Consultant,” Lovett explains. 

Lovett will sit for the September 2021 IBCLC exam.

Mocha Milk in the Mountains, Lovett’s developing business, was born out of her passion to help families and focuses on families of color through pregnancy, birth, breastfeeding/chestfeeding, and beyond. 

Lovett poses in celebration of Black Breastfeeding Week 2020.

“My hope for our community is that all families, regardless or race, ethnicity, or gender, will receive the equitable care and support needed to have healthy and safe pregnancies, deliveries, and parenting experiences,” Lovett says.  

She continues,  “This care includes not only the medical aspect, but also the mental, emotional, and spiritual well-being of the families.  Our need for this support does not go away in the midst of a pandemic; therefore, now more than ever it is important to reach our communities…Our communities need us and I look forward to being one of hopefully many that help normalize breastfeeding in our culture and lead us to better outcomes for families.”