Southern Oregon cohort of maternal child health professionals complete LCTC

Photo by Raj Rana on Unsplash

While families, communities and nations continue to suffer through the COVID-19 pandemic, good things occasionally glimmer amidst the devastation and tragedy. Early in the pandemic, we reported on the positive environmental impact of decreased transportation. In Fostering connection through technology, we touched on the creation of new technology to foster meaningful connection while we physically distance from other humans. We also learned that charitable human milk donations have increased dramatically during the pandemic.

Now, there’s more good news out of Oregon. A group of 24 maternal child health advocates have completed the Lactation Counselor Training Course (LCTC) on scholarship made possible by Health Care Coalition of Southern Oregon (HCCSO)

The organization had initially intended to send a limited-sized group to the in-person LCTC in Springfield, Ore. which required travel costs, HCCSO Healthy Start Program Manager Lee Ann Grogan, CLC reports.

Lee Ann Grogan

But when the course became available online, they reassessed costs and realized they could support more scholarships. 

“With the expansion, we have been able to support professionals from many different fields: pediatric providers, home visiting nurses, doulas, WIC staff, alcohol and drug counselors, homeless shelter staff, teen parent program staff, and all Healthy Start staff,” Grogan explains. “We are thrilled to support this network of professionals and know that having this level of knowledge and expertise in so many potential touch points will be a benefit to many families.” 

Rachel, one course participant, offers praise, “This course was inspiring in and of itself. I really enjoyed the course material and how the information was shared. It was one of my favorite training experiences to date. I also wanted to complete that course because I could see how the information that I was learning could be used in my everyday job and I could pass the knowledge to my patients.” 

Another participant, Kerri Anne, shares, “ The instructors are amazing and easy to follow… I am one who needs to see something multiple times before it really sinks in so having the ability to watch a module more than once before testing is extremely helpful. The quizzes after each module are also helpful. If I happen to misunderstand a question or get it wrong I love being able to see why my answer was incorrect.”

 

Course participants in the cohort are connected through a project management and team communication platform where they can build relationships with one another, share resources, and network with other lactation professionals.  

Along with ongoing lactation education training opportunities, the cohort will be invited to participate in a Perinatal Task Force panel discussion about their training, Grogan adds. 

She explains that the Perinatal Task Force is a collective impact group dedicated to overall community health, working together towards a shared goal, leveraging funds, and aligning priorities to be most effective.

Photo by Larry Crayton on Unsplash

“I would encourage other organizations interested in supporting wide-spread lactation education to do some dreaming and problem-solving with any organization that works with families,” Grogan advises. “We did not anticipate the interest from so many different fields of infant and family services, but are very pleased with the results!  Our organization was able to provide the financial support to our partner organizations for this opportunity, but we know that our partnerships are stronger and the investment will help ensure that the voices of lactation professionals are heard across our region. That will have a lasting impact when we look to future training needs, advocacy opportunities, and events.” 

While the circumstances brought forth by the pandemic have broadened some opportunities, a shift to remote support models for families has proven challenging.  

Southern Oregon is burdened by higher maternal infant mortality rates than the rest of the state. 

Grogan points out key areas of health challenges:

  • “Food Insecurity– Over 15 percent of all residents in Douglas and Josephine Counties are food insecure, but this rate is higher for children with one in four children in our region being food insecure. 
  • Unemployment– Our area’s unemployment rate continues to regularly exceed the state rate. 
  • Poverty Status– Both Douglas and Josephine counties have higher poverty rates than Oregon and the U.S. Over one in four children in the region live in poverty.
  • Maternal Smoking– Our region has alarmingly high rates of maternal tobacco use, with over 20 percent of women smoking during pregnancy.”

She goes on to explain, “Our rural communities lack access to reliable internet and cellphone services… The majority of our clients experience the crisis of poverty and do not have the financial means for smartphones, tablets, or computers.  Beyond access to the required technology, tech literacy is generally low for our population.”

Photo by Luiza Braun on Unsplash

Because of these limitations, Grogan says most of their services are provided over the phone.

Catrina, a cohort member, says that even telephone communication can be difficult because of poor reception in rural areas. Without being able to observe a feeding, she says she and her colleagues have had to tap into their listening skills.  

“We’ve been using our knowledge gained from our CLC training and  listening to what our parents are telling us to help them solve the challenges they have faced,” she says.   

For those with internet access, HCCSO transitioned their most recent Community Baby Shower to social media.  Lactation care providers addressed the importance of early literacy and gave out hundreds of books, addressed safe sleep education and gave away more than 50 cribettes and breastfeeding supplies like breast pads, easy-to-read breastfeeding guidebooks and hand pumps.

“We reached hundreds more families with our social media outreach than we had planned to with our in-person event, so that is definitely a silver lining!” Grogan exclaims.  

Kerri Anne and other LCTC participants in the cohort share that COVID-19 has presented the opportunity to change their perspective, embrace frequent change, and exercise flexibility.  

Photo by Juan Jose Porta on Unsplash

“Covid also accelerated our services and encouraged us to change what we do and how we offer assistance to meet the needs of our patients and their support systems and care teams,” Kerri Anne explains. “… We want them to feel supported and remind them that social distancing shouldn’t mean isolation. We want our families to lean on us … during these uncertain times. Covid has brought us closer to the families we work with and we now check in with them weekly just to see how they are doing rather than wait for them to contact us with a need or concern.” 

Follow HCCSO here, here and here

Finding missing puzzle pieces in maternal support

Creighton University School of Pharmacy and Health Professions Assistant Professor Kailey Snyder, PhD noticed early in her career that the experience and needs of mothers are often missing from conversations when developing health messaging and policy, and this is leading to substantial gaps in support.

For instance, during her graduate work focusing on early childhood physical activity, she realized that a focus on the mother’s physical activity could lead to an increase in her child’s activity, rather than solely focusing on enhancing the child’s experience. Only one in five pregnant/postpartum mothers meet physical activity recommendations however. Snyder states this is due, in large part, to a lack of effective education, resources, and support to help mothers know how to safely engage in prenatal/postpartum physical activity.

“If we can provide a mother with the tools to engage in healthy behaviors, like physical activity, during pregnancy and postpartum, we can enhance the health of her child,” Snyder begins. “A healthy mother is not only a role model, but a primary proponent of her child’s health behaviors. I [hold] strongly to the belief that if we can support mom during that pivotal transition to motherhood, we can make really substantial change…To improve the next generations’ health and well-being, it starts with mom.”  

Until recently, Snyder says she has focused a lot of her work on identifying maternal needs, specifically in Nebraska.  

Some of her most recent publications related to breastfeeding include Social Support During COVID-19: Perspectives of Breastfeeding Mothers, Healthy eating and physical activity among breastfeeding women: the role of misinformation, Workplace Breastfeeding Support Varies by Employment Type: The Service Workplace Disadvantage and Perceptions of Physical Activity While Breastfeeding Using the Self-determination Theory

Through this work, she and her colleagues came to conclusions such as:

  • “Mother’s ability to obtain breastfeeding support has been negatively impacted by the pandemic due to the inability to engage with individuals in-person and the lack of access to childcare.
  • Women need greater access to education and resources regarding healthy eating and physical activity while breastfeeding… [and] breastfeeding women may need additional support for engaging in physical activity…
  • There is a need for more breastfeeding support programs to be developed that target specific workplace characteristics.”

Snyder and her colleagues are currently working on a project to improve self-management of pelvic health among mothers living in rural Nebraska in conjunction with breastfeeding education.

One in four women suffer from pelvic floor dysfunction (PFD). It’s estimated that surgery related to PFD will increase by 47 percent by 2050, driving up health care spending and suffering, Snyder reports. She reminds us that just because a condition is common, it doesn’t make it normal (think nipple pain during breastfeeding). 

Older theories blamed common breastfeeding issues like engorgement and other breast discomfort for high rates of inactivity among mothers, but Snyder says that her new research to be published this spring shows that a large population of mothers are experiencing urinary incontinence too. Because breastfeeding is a low estrogen state, breastfeeding parents are at risk for incontinence. 

“This is a piece of the puzzle that hasn’t gotten a lot of attention,” Snyder comments.  

Because PFD is a risk factor for postpartum depression (PPD) and PPD is a risk factor for early cessation of breastfeeding, it is Snyder and her colleagues’ hope to help moms better self-manage their pelvic health. Not only this, but educating mothers to safely engage in pelvic floor muscle exercises, identify distressing symptoms, and seek additional care that may reduce PFD, all of which can positively influence a mother’s health and well-being.  

In her effort to move beyond identifying the problems that new parents are up against, Snyder completed the Lactation Counselor Training Course (LCTC) to enhance her breastfeeding knowledge and broaden her scope, she explains. 

“For someone in the weeds of maternal/child health research, it can be easy to get tunnel vision, and I think it’s crucial to continue to find ways to increase your knowledge and understanding of the population you are working with,” Snyder says.   

She goes on, “Where we are in 2021, people know that breastfeeding is a good thing. However, despite the consistent and widespread evidence on the benefits of breastfeeding, we continue to have suboptimal breastfeeding durations. Our interventions need to go beyond just breastfeeding education and support and also consider the mother’s mental and physical health.  Considering factors such as pelvic health and physical activity equips a mom with additional tools to support her own health in her breastfeeding journey.” 

The next phase of Snyder and her colleague’s work hones in on which health education models are most cost-effective and sustainable. They’ll pilot different education pieces like offering mothers a webinar coupled with weekly follow up text messages or a follow-up appointment with a specialist, for example. With time, she and her colleagues will be able to assess which models and services mothers can access and utilize best.  

“We are taking things piece by piece when we go to develop these interventions and using the voices of moms to guide us,” Snyder explains. “…We want everything we do to not only be evidence-based but to resonate with moms. There’s an old saying, The best medication is the one the patient will take. It’s not just about having the right information but disseminating it in the right way as well.” 

You can find an exhaustive list of Snyder’s publications here

To learn more about emerging research on PFD, click here

Lactation counselor pumps for 29 months and counting after surrogate births

Juli Velasquez’s, CLC first son, now 10 years old, was born by emergency c-section.

“It was pretty frightening,” she remembers. “I was completely put under [anesthesia]. Everyone saw the baby before I did.” 

Despite a challenging birth, Velasquez and her son went on to breastfeed for 13 months. During this time, she planned the birth of her second child with 18 month spacing, hoping to replicate the sibling-closeness that she enjoyed with her sister.  

Having moved from Florida to New York (then later back to Florida), Velasquez had a successful vaginal birth after cesarean (VBAC) at 40 weeks and 2 days with her second son. 

“It was the most amazing experience ever,” Velasquez reports. “I told my husband, ‘I could do this a million more times.’”

Shy of a million, Velasquez did go on to carry four more babies as a gestational surrogate (GS):  a baby born in May 2015, twins born in January 2017 and a baby born in July 2020. Velasquez pumped after her first surrogacy birth for eight months, the second for 15 months, and has currently been pumping and for six months and counting. 

Screenshot of Velasquez’s and her sister’s plan to become surrogates together.

Velasquez says surrogacy was something that she always wanted to do. Initially, she and her sister planned to become surrogates together after they had completed their own families, but when her sister ended up becoming pregnant again with her own child, Velasquez started her surrogacy journey solo in 2014.

About 750 babies were born via gestational surrogacy in the U.S. in 2019. [https://www.webmd.com/infertility-and-reproduction/guide/using-surrogate-mother#1

Thinking back to her pregnancy with the twins, Velasquez reports that she and the parents have become like family. In fact, she says that while her surrogacy journey is over, she would make an exception for this couple if they chose to grow their family. 

“They are raising their twins knowing of me and how I carried them in my belly. It’s the sweetest thing!” she exclaims. 

Like the birth of her second son, Velasquez describes her first surrogacy birth as an amazing experience too. 

“I became friends with the parents,” she explains. “It was really great.” 

The intended parents (IPs) did not make the birth of their baby, but they listened in on Velasquez’s labor via speakerphone. After their baby was born, the mother asked Velasquez if she would nurse the baby until she arrived at the hospital. 

“I never even considered it, but I wasn’t against it,” Velasquez says. So she went on to feed the baby until her parents arrived.  

Velasquez explains that contracts between the GS and IPs typically cover pumping breast milk after the baby is born.

“The wording in the contract says that no one is held to it, but that if both parties agree, they’ll continue as long as it’s good for everyone,” she offers the Cliff’s Notes version. 

For the following eight months, Velasquez pumped her milk, shipping the breastmilk to the family for about half of that time. For the remainder, she donated to milk bank.

Velasquez describes the demands of exclusively pumping (EP) for a surrogate baby: 

“You don’t have a baby, but you are tied to a pump every three hours around the clock. I wake up at four in the morning, and pump eight times a day. It is a huge commitment, not just for me, but for my entire family. It is… so time-consuming.”

But it’s not just the pumping, she adds. 

“I have to wash and sanitize, bag and label, freeze, box and ship. My hands are so raw from so much washing that is happening.”  

Still, Velasquez continues to provide and donate her milk. 

“I’ve always been fascinated with milk,” she begins. “It’s been super important to me.”

Even if the process is grueling, Velasquez says that providing milk to babies is equally satisfying. 

“I don’t have tons of money or tons of time to help people, but this is something that I can do,” she explains. 

Some GS provide their milk free of charge, but Velasquez says that most charge between 10 cents and one dollar an ounce. In comparison, pasteurized donor human milk (PDHM) comes in at about three to five dollars per ounce and formula feeding costs families between $900 and $3,000 over the first 12 months

Velasquez estimates that roughly 85 percent of surrogates attempt to EP after birth for various reasons which sometimes include their own mental health and for the purpose of donating.

In the midst of the pandemic, Velasquez says that her most recent surrogacy experience was relatively unaffected aside from having to stay home much of the latter half of her pregnancy.

“It wasn’t the funnest pregnancy, but everyone felt that same heaviness,” she says. 

Differently, she assumes the unknowns brought forth by COVID-19 changed the IPs’ experience. 

“I feel like it made their journey less enjoyable and more stressful,” she begins. “If I were to get sick, what would happen to the baby? I’m sure it was way less enjoyable having Covid hang over their entire pregnancy.”

Labor and delivery was stressful for everyone though, Velasquez recalls. 

Multiple people involved in the process– the IPs, Velasquez and her husband– and ever-changing hospital policies due to COVID-19 made planning stressful and a bit of a logistical nightmare. Ultimately, the hospital was able to accommodate the mother with her own room to await the arrival of her baby. 

“During this journey, [the mother] made it very clear that breastmilk was not a priority for them, but I pumped in the hospital and sent them one big shipment of milk,” Velasquez reports. 

She goes on to share that the family received faulty information from their pediatrician about the risk of human milk and COVID-19 infection. For up-to-date, evidence-based information on human milk, breastfeeding and COVID-19 click here.   In fact, fellow CLC Dr. Rebecca Powell, assistant professor of medicine, Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai, is studying human milk as a possible treatment for the COVID-19 coronavirus

Regardless, “it was another Covid issue that [the IPs] didn’t want to take the assumed risk,” she explains.

Last year, just before we became aware of the pandemic, Velasquez became a CLC herself. 

“In September 2019, my sister had a baby and she was having trouble latching, so here I am a pump expert– I can map everything out– but my own sister, I don’t know how to help,” Velasquez sighs. 

“I brought her to a WIC breastfeeding class hosted at our local hospital by an IBCLC and a WIC peer counselor CLC,” she continues. “I fell in love in that second. ‘I want to be you… how do I be you?’” 

Velasquez pictured with the twins that she carried. They received her milk for the first year of their lives.

Velasquez returned to the class, without a baby, every Thursday for the next six months “just watching in awe.” The lactation professional who led the class mentored her, and when the Lactation Counselor Training Course (LCTC) came to her town in Hernando County, Fla. she jumped on the opportunity. 

“It was awesome. It was perfect,” she says. 

Velasquez runs a private lactation practice now, but is currently working with a large obstetric office to offer in-house lactation and breastfeeding support. 

Through it all, Velasquez gives her husband a shout out, saying he has been her biggest fan.

“None of this– surrogacy, extended pumping, my CLC– would be possible without my husband’s support,” Velasquez shares.  

Velasquez offers her email address for families and individuals interested in learning more about surrogacy: velasquez_09@icloud.com. You can also find her on IG @velasquez09. Her vlog can be found here.

 Reviewing Breastfeeding Employee’s Rights in the Workplace During Covid

By Guest Blogger Donna Walls, RN, BSN, IBCLC, ANLC

Over a decade ago, the Department of Labor released the Fair Labor Standards Act – Break Time for Nursing Mothers Provision. It requires employers to provide nursing mothers reasonable break time to express breast milk and a place, other than a bathroom, that is shielded from view and free from any intrusion from co-workers and the public.

Source: United States Breastfeeding Committee (USBC)

The law does not quantify the duration allowed for expressing milk, but suggests the amount of time needed to express milk for an infant under one year of age. Time used to express milk is not required to be compensated. Remote work situations are included in this law.  (dol.gov, 2010)

Then in July 2019, Congress passed the Fairness for Breastfeeding Mothers Act of 2019. This law requires public buildings to “provide a shielded, hygienic space other than a bathroom, that contains a chair, working surface and an electrical outlet for use by members of the public to express milk.” 

Lactating people in the workplace are also protected under the Pregnancy Discrimination Act of 1978.

While work situations have changed drastically for many amidst the pandemic, these laws still apply during COVID-19. 

Healthy Children Project, Inc., in partnership with the University of California Hastings College of the Law and the Workplace Support Constellation of the United States Breastfeeding Committee, have created a Your COVID-19 Workplace Rights: Breastfeeding and Lactation handout which details employee rights during the pandemic and links to helpful resources.   

Source: United States Breastfeeding Committee (USBC)

Lactation laws vary by state, but all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands have laws that specifically allow women to breastfeed in any public or private location. Most states exempt breastfeeding from public indecency laws and many have specific workplace protections for breastfeeding employees. 

In some situations, lactating people may be able to negotiate accommodations like requesting a sabbatical, using accrued paid time off, parental or family medical leave options or other time away programs. There may also be options available for working from home, reducing hours or requesting a change of job temporarily or permanently. There may also be benefits such as the “Pandemic Unemployment Assistance” or another state benefit available. Apply through the agency that provides unemployment insurance at the Career One Stop website

In order to protect against the spread of COVID-19, employers may need to do more to ensure safe expression of milk. For instance, more time may be needed for pump cleaning and disinfecting surrounding surfaces. If milk expression occurs in an area shared by other employees, frequently touched surfaces like tabletops or door handles should be cleaned with a solution of 70% isopropyl alcohol, 0.05% dilution of hydrogen peroxide, bleach containing 5.25%–8.25% sodium hypochlorite, quaternary ammonium or Lysol after each use. (WHO, 2020)

The Centers for Disease Control and Prevention (CDC) recommends three different methods for cleaning and disinfecting a breast pump kit:

  1.  thoroughly washing with warm water and soap including scrubbing with a stiff bristle bottle brush 
  2.  using a dishwasher set on the sanitizing cycle
  3.  boiling pump parts for at least five to10 minutes and removing with clean tongs (CDC.gov, 2019)

    Source: United States Breastfeeding Committee (USBC)

No matter the method, begin by thoroughly removing all traces of milk and rinsing. Do not use sinks used for other cleaning purposes and set aside a basin to be used only for pump cleaning.  Clean well after each use. Scrub and clean pump equipment well with hot soapy water after each use. Dry all equipment thoroughly on a clean cloth, dish towel or paper towel.

Lactating individuals may prefer to hand express rather than using a manual or electric breast pump. Employers might consider having instructions available on how to hand express. Hand expression requires no equipment, therefore saving time and reducing the risk of virus transmission through potentially contaminated equipment. Employees must have access to hand washing stations, but may not need to have availability to electrical outlets. (Stanford, 2006)

Source: United States Breastfeeding Committee (USBC)

Special considerations may need to be assessed in  healthcare facilities. Prior to any milk expression, gowns, gloves, caps or masks should be removed to limit the spread of COVID-19. Breastfeeding employees might also consider wearing a clean facial covering or mask during milk expression and bringing their own cooling/storage system rather than using refrigerators provided by the employer. (CDC, 2019)

Milk storage at work requires no further preparations other than routine cleaning of milk storage containers. If using single-use storage bags, there is no need to pre-clean the bag. If using glass or plastic bottles or other containers, wash with hot soapy water and scrub with a bottle brush or use the sanitizing dishwasher cycle. It is not advisable to clean milk storage containers with antibacterial soaps or chemical disinfectants as they may leave a residue of chemicals not meant for ingestion by infants or children.  (HMBANA, 2020)

It is well established that breastfeeding is the healthiest choice for feeding infants and children. When the COVID-19 pandemic hit,  there were concerns regarding the safety of keeping mothers and babies together and the transmissibility of the virus through breastmilk. Research, policies and protocols have shown the safety of continuing breastfeeding and breastmilk feeding.  Practices that ensure safe lactation in the workplace should continue to be implemented and breastfeeding employees should be supported in their infant feeding goals.

For further information, contact the Center for WorkLife Law’s free COVID-19 legal helpline at 415-851-3308 or  COVID19Helpline@worklifelaw.org. 

 

References

ABM STATEMENT ON CORONAVIRUS 2019 (COVID-19).” Academy of Breastfeeding Medicine, 10 Mar. 2020, www.bfmed.org/abm-statement-coronavirus. 

Care for Breastfeeding Women.” Centers for Disease Control and Prevention, 3 Dec. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/care-for-breastfeeding-women.html.

CGBI COVID-19 Resources.” UNC Gillings School of Global Public Health, 24 Apr. 2020, sph.unc.edu/cgbi/cgbi-covid-19-resources.  

Cleaning and Disinfecting Your Facility.” Centers for Disease Control and Prevention, 28 Dec. 2020, www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html. 

Clinical Management of COVID-19.” World Health Organization, 27 May 2020, www.who.int/publications/i/item/clinical-management-of-covid-19. 

FREQUENTLY ASKED QUESTIONS: Breastfeeding and COVID-19 For Health Care Workers.” World Health Organization (WHO), 12 May 2020, www.who.int/docs/default-source/reproductive-health/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_5. 

Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting. Human Milk Banking Association of North America (HMBANA), 14 Apr. 2020, www.hmbana.org/file_download/inline/a593dd72-be78-471e-ae5e-6490309108fd. 

Morton , Jane. “Hand Expressing Milk.” Hand Expression of Breastmilk, Stanford Medicine , 2006, med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html. 

Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA. 2020. Epub 2020/03/05. 7. 

Workplace Lactation Laws – Pregnant@Work.” Pregnant@Work, 2020, www.pregnantatwork.org/workplace-lactation-laws/. 

Your COVID-19 Workplace Rights: Breastfeeding and Lactation.” Worklife Law , University of California Hastings College of the Law , 2021, www.pregnantatwork.org/wp-content/uploads/Rights-of-Breastfeeding-Workers-in-the-Context-of-COVID-19.pdf.

Therapist integrates lactation counseling into perinatal mood disorder work

Too many of us know that many breastfeeding parents have poor experiences with lactation professionals which are often tied to “lactation professionals’ agenda”.

Others though feel heard and supported and find empowerment through their interactions with lactation care providers (LCPs). Of course there are experiences outside of and in between those too. 

In any case, new parents’ birth and breastfeeding experiences often inspire their own careers and life work, developing into a “pay-it-forward” kind of mission. 

Ericka Davis is a social worker at Centerstone’s Early Childhood Services (ECS) in Columbia, Tenn. who recently completed the Lactation Counselor Training Course (LCTC).

Maternal and infant attachment and mental and physical health have “always been this lifelong knowing and passion,” as Davis describes it.  

“I think my own childhood adversity has always led me into wanting to work with moms and children and led me to social work,” she explains. 

As a new mother, Davis shares that she struggled with breastfeeding but managed through the challenges with the help of a CLC.

Her early breastfeeding experience starts like a lot of others: when her son did not latch in the hospital, the nurse told Davis that he needed to eat and gave them formula.    

I left the hospital with a bag full of sample formula bottles,” Davis says. 

Along with the formula, she had some familial support, but no support specific to breastfeeding.

“I often heard, ‘If it’s too hard or if you are in that much pain just give him the bottle,’” Davis goes on to explain. “I know it was coming from a good place;  they didn’t want to see me struggle and were worried about the baby. But I really wanted to nurse my son, I wanted to give him the best start.”

Davis soon found a La Leche League lactation café.

“I was able to go super early in the morning to this serene space full of rocking chairs, water, bowls of candy, other moms with their babies and get support from a CLC,” she reports.  “It made all the difference, to have someone who was trained in breastfeeding support me. I was able to successfully nurse my son after that and with my second child I was more confident in myself and nursed him longer. I credit my success to that café, that CLC.”  

Davis adds, “This experience is just another that has led me into this field. I see the value in CLCs and nursing, and I am happy I can give back in a small way.” 

In her work with ECS at Centerstone, a not-for-profit health system providing services designed specifically for those in the perinatal period, Davis and her colleagues aim to strengthen families’ physical, mental and emotional health primarily through in-home services. 

Davis works as a therapist on the team and networks with other dedicated professionals like a psychiatric nurse who provides medication management, for example. 

She and her colleagues recognize that the most effective approach to reaching their goal of strengthening families is by addressing their basic needs as well as addressing their mental health through therapy; therapy alone is not effective if families don’t have their basic needs met, so they provide wrap-around services. 

As CLCs, Davis, along with the majority of her clinic’s early childhood staff, are able to integrate lactation counseling into their perinatal mood disorder work.  

“It’s such an amazing tool to have as a provider to be able to understand and recognize that moms are struggling with something that you can really provide help and support with,” Davis says of becoming a CLC. “It’s another technique in my therapeutic modalities, another tool that I can really implement that alleviates some of those feelings surrounding breastfeeding and help someone be successful.”  

Failed lactation and perinatal depression often go hand in hand, but perinatal mood disorders (PMDs) go beyond this box. There can be a layering effect too, Davis explains. 

In her own experience, she shares that challenges associated with PMD coupled with breastfeeding challenges “added constant pressure and the thought  ‘I am failing.’” 

The work that Davis and her colleagues are doing through Centerstone is a sort of microcosm of an ideal world where families’ mental health is nurtured. 

“It comes from a comprehensive approach,” she begins. “We are talking about a complete cultural shift and policy change where businesses get on board with the importance of maternal infant health, where we can provide moms very safe spaces, and enough time [with their babies], destigmatizing what breastfeeding looks like out in public and normalizing it in society. Policy has to back up ideology.”  

Davis goes on to say that good support looks different for every family, echoing an article she recommends by University of Alberta’s Stephanie Liu’s commentary Breastfeeding struggles linked to postpartum depression in mothers

Liu writes: 

“As parents, we intend to provide the best for our babies, so difficulty breastfeeding may lead to significant amounts of stress.

As a family doctor, I know that breast milk is the optimal feeding choice for health benefits, but as a mom, I know the extreme pressures that we are placed under as women to produce milk every time our baby needs it.

This is why I always support the idea to breastfeed if you can, to reach out for support, and if you are struggling, there are other safe and healthy options to ensure your baby is well fed.”

In her practice, Davis is acutely aware of the health benefits of breastfeeding for mom, baby and public health, but she says she acknowledges that it’s not always the best option for everybody. 

“While we want to support people in their goals, we have to make sure that they are personal goals… I can’t push my agenda [as a LCP],” Davis comments. 

When LCPs want their clients to breastfeed more than they actually want to, it adds pressure, even if well-intentioned. 

“It can go so extreme that it ends up not being helpful and productive and sometimes even becomes harmful,” Davis adds, circling back to earlier mentioned poor experiences with LCPs. 

Recently, Davis has been able to help a young mother achieve her breastfeeding goal of six months, despite pressure from her family to give up. 

“We took it week by week,” Davis explains. “She got to her goal and it was perfect for her.”

Click here for Centerstone’s ECS Program Flyer —>TN Early Childhood Services – English