Baby Steps

The Milky Way is off to a galactic start this year thanks to Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences, a study recently released by the Centers for Disease Control and Prevention (CDC).
The study highlights that more women are breastfeeding for longer periods and that the gap between black and white breastfeeding initiation rates narrowed in recent years.

This is all great news. Celebrate!

But the study also found that only 23.4 percent of women breastfed for 12 months, the recommended duration. Twenty three point four percent is a miserable number.

Contributing author Jessica Allen, MPH, MSW
Contributing author Jessica Allen, MPH, MSW

“It depends on which way you look at,” Contributing author Jessica Allen, MPH, MSW says. She reminds me that trends are on the rise.

Still, there’s that enormous number of women not meeting recommended breastfeeding durations. Additionally, she says many mothers aren’t satisfying their personal breastfeeding goals.

That’s where support comes in.

The authors of the study place a huge emphasis on support in order to boost breastfeeding rates and duration and to further close the gap between black and white breastfeeding rates.

“We have to make sure women who want to breastfeed are receiving the support they need,” Allen says. “We need to continue to look at things that we know work.”

For instance, the CDC has compiled a Guide to Breastfeeding Interventions. The guide features information for state and local community members to choose a breastfeeding intervention strategy that best meets their needs.

“Hopefully people become familiar with [women’s] goals and the impact they have,” Allen says. She says she hopes all community sectors do their part to help women in whatever feeding choices they make.

CDC Director Tom Frieden, M.D., M.P.H. comments on Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences in a clip featured on the CDC’s website: “Hospitals can make a big difference by becoming Baby Friendly and insuring that every woman has the best possible chance of starting breastfeeding.”

The Baby-Friendly Hospital Initiative backed by a government official. Incredible news for moms and babies everywhere.

Even more, the report cites the Surgeon General’s Call to Action to Support Breastfeeding which outlines a number of actions aimed at increasing support for breastfeeding women.

Best Fed Beginnings, a project supported by the CDC, provides support to close to 90 hospitals to improve maternity care practices that support breastfeeding. The project aims increase the number of Baby-Friendly hospitals in the U.S.

In an effort to establish better support systems for mothers, the CDC “awarded funds to six state health departments to develop community breastfeeding support systems in minority populations.”

Because African American women struggle with breastfeeding more so than other populations, the authors of the report suggest increasing the number of lactation consultants in these communities.

However, just because lactation services are available does not mean that they are accessible. Services need to be covered by insurance. The Affordable Care Act helps to make lactation services affordable for families.

Services also need to be physically accessible to mothers. That is, bring the help into the home like the efforts at Maternity Care Coalition.

Limiting credentials and/or “claiming that one set of credentials is worthy of health insurance reimbursement and not others will severely limit mothers’ and babies’ access to quality care,” as stated in Healthy Children Project’s A RENEWED CALL FOR COLLABORATION AMONG LACTATION PROFESSIONALS.

Award-winning journalist Kimberly Seals Allers recently launched the Be First Food Friendly Movement which serves to transform communities, especially those with extremely low breastfeeding rates, into First Food Friendly environments. Be First Food Friendly is a great example of increased support in all facets of the community so that moms and babies can be successful at breastfeeding.

Multifaceted support is especially important for African American mothers: “…Even when accounting for factors such as socioeconomic status and maternal education, racial/ethnic differences in breastfeeding persist. This persistent gap in breastfeeding rates between black women and women of other races…might indicate that black women are more likely to encounter unsupportive cultural norms, perceptions that breastfeeding is inferior to formula feeding, lack of partner support, and an unsupportive work environment,” the CDC report states.

While some communities suffer from depressingly low breastfeeding rates, initiation rates in the Hispanic population did not increase significantly from 2000 to 2008.

“They started so high,” Allen says. “It’s like taking an A student to an A+.”

My hope for the moms who aren’t meeting breastfeeding recommendations or personal feeding goals is that with increased recognition for support, national breastfeeding rates will continue to creep upward.

Even while we make baby steps, I remain skeptical.

In the study’s full report we learn that “Breastfeeding initiation was assessed by asking, ‘Was [the child] ever breastfed or fed breast milk ?’ Breastfeeding duration was assessed by asking, ‘How long was [the child] breastfed or fed breast milk ?’ The wording of the breastfeeding duration question changed slightly in 2006 to ‘How old was [the child] when [the child] completely stopped breastfeeding or being fed breast milk ?’”

This Pediatrics’ study discusses characteristics of breastfeeding practices among U.S. mothers: http://pediatrics.aappublications.org/content/122/Supplement_2/S50.full.pdf+html.

Allen says that Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences’ questioning didn’t allow researchers to decipher whether baby consumed breast milk straight from the source or from another vehicle. The study includes baby’s consumption of breastmilk in any form. One may assume then that breastfeeding and breastmilk feeding are created as equal in the scope of the study.

We must remember though that breastfeeding and breastmilk feeding are not the same. For instance, babies fed from a bottle are less likely to self-regulate milk intake.

Will increased awareness for breastfeeding support help more mothers breastfeed or breastmilk feed?

We know that any amount of breastmilk given to baby is beneficial but nothing compares to the biological norm of mother feeding baby at the breast.

“We are really encouraged to see some of these increases, but at the same time there is a long road ahead of us,” Allen says.

For more information on how support affects breastfeeding rates please visit: http://summaries.cochrane.org/CD001141/support-for-breastfeeding-mothers

To hear more from CDC Director Tom Frieden, M.D., M.P.H. please visit http://www.cdc.gov/breastfeeding/resources/breastfeeding-trends.htm and scroll down to “MMWR News Synopsis.”

Collaboration promotes Baby-Friendly Hospital Initiative

Tobey Hospital staff at its press event announcing Baby Friendly designation.

A laminated sign hung on the nursing staff’s entrance at Tobey Hospital announcing the newest Baby-Friendly designated medical facility in early summer 2011.

Nurse Manager of Family Centered Unit at Tobey Hospital Southcoast Hospitals Group Mary Ellen Boisvert, RN, MSN, CLC, CCE reports ecstatic squeals as employees read the exciting award.

“We were so elated,” Boisvert says of receiving Baby-Friendly designation.

Working together  

Baby-Friendly USA recently designated its 150th facility. The prestigious award is most certainly something to celebrate; “Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity” according to a 2005 Pediatrics publication.

As a mother who did not deliver in a Baby-Friendly Hospital and initially struggled with breastfeeding because of that, I find Tobey’s dedication to normal birth and breastfeeding exciting and inspiring. The hospital’s Baby-Friendly appointment separates it from other medical facilities, but its collaboration with other medical facilities to inform and assist them in their Baby-Friendly journey is what really deserves applause. Since its designation, Tobey participates in breastfeeding collaboratives like the Massachusetts MotherBaby Summit to inform and assist others in their journeys to become Baby-Friendly.

Tobey Hospital is part of Southcoast Health System, a not-for-profit community based health delivery system which offers an integrated continuum of health services throughout Southeastern Massachusetts and Rhode Island. Southcoast Hospitals Group also includes Charlton Memorial Hospital and St. Luke’s Hospital. The group recently developed a system-wide task force that focuses on promoting things like skin-to-skin immediately after birth to improve breastfeeding rates and duration.

Boisvert says she thinks most medical facilities are excited about the Baby-Friendly Hospital Initiative. In order to make the task manageable though she suggests promoting relationships between hospitals as Tobey has done. Working among colleagues allows for painless execution of plans of action she says.

“That way you don’t have to reinvent the wheel,” Boisvert explains. “We have to work together to promote the best start for mom and baby. That’s where we all want to be.”

CLC led team

Boisvert tells me about the nursing team at Tobey; they are just as inspirational as she. They seem nothing like the impatient, uninterested and uneducated nurses who interfered with my daughter’s breastfeeding initiation. Instead, Boisvert’s team of nurses express interest in lactation counselor certification (CLC) because they genuinely want to help their patients.

“It became something [we] saw as valuable,” Boisvert says of the CLC training. “We want to be able to give full care, whatever needs our moms and babies have.”

Currently, nearly 30 percent of Tobey’s nursing staff are CLCs and several more express interest in coordinating near future training.

“Breastfeeding is part of the whole package of a mom and baby,” Boisvert says. “And in order to give complete care to that couplet, before delivery, you have to be setting them up for success.”

Boisvert stresses the importance of creating an environment that encourages breastfeeding and she says that her CLC training has helped her put that into practice.

Somewhat simple tasks

Tobey has always been committed to natural birth; the least amount of intervention provides the best outcome for mother and baby. This ideology made for a relatively simple Baby-Friendly assessmentbecause many of the requirements were already well ingrained in Tobey’s culture, Boisvert explains.

Tobey Hospital’s press event announcing the Baby Friendly designation back in August 2011.

Tobey eliminated its free formula giveaways nearly five years ago. As of July 2012, all Massachusetts maternity facilities are bag-free. To find out about the status of hospitals in other states, visit banthebags.org.

Several years ago Tobey also stopped accepting pens, measuring tapes, due date wheels, crib cards and other vendor promoting materials. Tobey now advertises itself on crib cards. Boisvert says ceasing to accept free products did not set them back financially. She also explains that the hospital no longer sends mixed messages to its patients.

Uninterrupted skin-to-skin contact immediately after birth was a fairly simple qualification for Tobey to meet as well.

“It was so much easier than we expected it to be and it’s because the benefits showed themselves,” Boisvert says.

As for the no-pacifier requirement, Tobey staff simply picked a date and removed them all from the facility. When medically indicated, pacifiers are used, for example with premature infants. Tobey staff provide education to parents who request pacifiers when not medically indicated.

It is so refreshing when evidence-based research is actually practiced. When my daughter and I were in the hospital, one of the nurses advised I give her a pacifier so she wouldn’t “tear my nipples up” with her constant desire to suck “for no reason.” I’m hopeful that, with Tobey’s and others’ dedication to promoting BFHI, maternity facilities everywhere will adopt its guidelines so that all moms and babies can reap the initiative’s benefits.

Minimal challenges

Tobey’s Baby-Friendly journey was not travelled challenge-free. Boisvert says that while they have always promoted rooming in with mom and baby most of the time, their biggest challenge was keeping mom and baby together all of the time. She says the nurses believed they were doing mothers a favor by taking babies to the nursery.

“One of our leadership nurses who didn’t see how [rooming in] was going to work, became one of the biggest supporters,” Boisvert says.

Practicing rooming-in around the clock allows for more efficient procedures like PKU and hearing tests to be completed Boisvert explains. Even the small population of bottle-fed babies at Tobey remain close to mom during these procedures.

When considering Baby-Friendly designation, it’s always important to consider these promising stories of success especially when the initial task seems daunting or impossible.

Collaboration with facilities already awarded the designation can be a vital resource when embarking on the Baby-Friendly voyage.

For more information about the Baby-Friendly Hospital Initiative, visit http://www.babyfriendlyusa.org/ or Baby-Friendly USA on Facebook.
More information about Southcoast Health System is available at www.southcoast.org.
Connect to Southcoast through social media at www.southcoast.org/connect/.
Southcoast™ is a trademark of Southcoast Health System Inc.

Health coaching organization focuses on breastfeeding

52368633_scaled_173x216Have you ever met someone for the first time but felt like you’ve known that person all your life? A while back, I had the pleasure of speaking with founder and executive director of Femtique Associates Incorporated Judith Beaulieu, RN, BSN, MIS, CHC, RYI and I instantly fell in love. Her bubbly manner is so inviting; I could have chatted with her for hours like with an old friend.

Beaulieu’s organization provides health coaching for women with a special focus on breastfeeding support. It secured its articles of incorporation in July 2011.

I am astonished by Beaulieu’s capacity to understand and appreciate the needs of mothers and babies; she doesn’t have any children of her own.

Funding

Beaulieu says her ideas for Femtique are never-ending so she keeps a journal nearby for jotting down her 3 a.m. visions.

“How can we increase breastfeeding rates through awareness?” Beaulieu asks herself. “Well, I got this idea that we could commission an artist that would put a picture to what breastfeeding looks like. In today’s society you don’t really see it.”

'Hearts Full Of Hope' by Katie Berggren
‘Hearts Full Of Hope’ by Katie Berggren

Beaulieu became acquainted with motherhood artist Katie Berggren after browsing her images online and later through a project with the Pennsylvania Breastfeeding Coalition. Beaulieu serves on its grant committee.

“She took to the idea like a duck takes to water,” Beaulieu says of Berggren. Soon after Berggren created Hearts Full Of Hope.

Berggren says it was hard not to feel motivated about “the opportunity to create a piece that would speak of Femtique’s urge to educate mothers and the community as to the value of breastfeeding at least through the child’s first 6 months”. She says the image for Hearts Full Of Hope materialized almost immediately.

Beaulieu plans to dedicate the commissioned, promotional, original painting to Surgeon General Regina M. Benjamin for her dedication to breastfeeding. The painting will also be sold as prints and charms to raise money to fund Pennsylvania nurses’ Certified Lactation Counselor training.

“My hope is that Hearts Full Of Hope can help to serve as a visual vehicle for Judith on her journey,” Berggren says. “An image that can help to get a message across when there isn’t time or space for words.”

Femtique also offers quilted art, Baby Fats’ Quarter Quilts, as another form of fundraising.

In the late 18th century, quilting was a creative conduit for the stifled voices of women. Quilts served to tell and exhibit the stories of their makers.

To Beaulieu, the quilt perfectly parallels the important bond created between mother and infant during skin-to-skin contact.

“We need to put those hugs and skin to skin positions back into our lives instead of putting babies in strollers and handing them bottles,” Beaulieu says. “We need our babies to be with us.”

Goals to satisfy

Eventually, Beaulieu would like all Femtique associates certified as lactation counselors. She explains that health coaches with nursing backgrounds and professional lactation certifications allow for a holistic experience for the client.

She uses the example of a mother who undergoes cesarean section also needing breastfeeding support and explains that she will benefit from a caretaker with multifaceted training.

Through Berggren’s artwork and other fundraising endeavors, Beaulieu plans to sponsor as many nurses’ CLC trainings as funds offer.

“Nurses just don’t have the money to pay for the credentialing,” she says. “When they are ready to leave the clinical setting and go to community work, the job change just doesn’t afford them the extra credentials.”

Beaulieu explains that Femtique’s clients seek help for a variety of reasons, but she says continued breastfeeding support is of popular concern.

She emphasizes the importance of creating safe, public areas for women to breastfeed their babies.

Beaulieu recalls an outing to a Barnes and Noble cafe with a colleague a couple of years ago. A group of mothers engaged in a book discussion while nursing their children. Her uncomfortable co-worker suggested they sit elsewhere so not to disturb the nursing mothers.

Looking back on the situation, Beaulieu called Barnes and Noble to ask what kind of protection they provide for nursing moms. The store manager cited discreet nooks and crannies between shelves where mothers are welcome to nurse their children.

“It’s one small little goal just for that one big need,” Beaulieu says of creating public areas for breastfeeding dyads.

Beaulieu Yoga and Health Coach Studio
Beaulieu Yoga and Health Coach Studio

Of Beaulieu’s other goals is the creation of a yoga camp for teenage girls. She hopes it will allow them to bring awareness to their bodies. She says teens need some kind of outlet so unwanted pregnancies can be reduced.

“It’s so obvious that yoga is the craze,” Beaulieu says. “But no studio is like Beaulieu Yoga and Health Coach Studio because it is run and overseen by a nurse.”

And instead of her instructors simply looking to make a living, Beaulieu says Femtique associates are looking to make a difference in the world.

Femtique backs the Baby-Friendly Hospital Initiative (BFHI). Supporting the initiative is a great way to “put those hugs back into our lives” as Beaulieu suggests.

A change in health services

Beaulieu feels a change in the health care paradigm.

“I would like to align our services with the reform bill so that we will be in the forefront of healthcare,” she says. “We will be able to get people to stay healthy.”

Technology and prescription drugs, rise in chronic diseases and administrative costs drove United States’ health care spending close to $2.6 trillion in 2010. [Retrieved from http://www.kaiseredu.org/issue-modules/us-health-care-costs/background-brief.aspx]

“The writing is on the wall,” Beaulieu says. “”There is not going to be money for hospital care. Everyone knows something has to be done differently.”

She suggests a preventative approach and what better way than to protect, promote and support breastfeeding.

“We’ve got to make noise and I think this is the way to do it,” Beaulieu says. “We need the world to be more friendly to our children so they can grow up healthy.”

Transformational travels through the Milky Way

I recently had the opportunity to travel to Orlando, Fla. for Healthy Children’s 17th Annual International Breastfeeding Conference. As a trained journalist, I am ashamed to admit that I cannot find the words to explain how phenomenal an experience it was.
The gathering of speakers including Ann-Marie Widström, Kristin Svensson, Nikki Lee, Katja Pigur, Elizabeth Brendle Froh, Dianne Cassidy, Ricardo Herbert Jones, Linda Smith, Julie Mennella, Kimberly Seals Allers and Healthy Children faculty and attendees created a warm energy that surely renewed and transformed participants.

The lovely Tippy snags me for an interview!
The lovely Tippy snags me for an interview!

Because I am new to the field of lactation and because I have not worked in a clinical setting, I was especially privileged to be surrounded by such an experienced, concerned group of lactation care givers.

When we weren’t engaged in remarkable presentations and discussions, us conference participants were forced to have a lot of fun. (Wink, wink) During group activities, I laughed myself to tears. We enjoyed entertainment from a special guest called Tippy, we raced milk ducks for a great cause and attendees viewed the premiere of Healthy Children’s newest film The Lost Secret of the Throne. Early in the week, we visited Sea World to learn about aquatic mammalian lactation- our Sisters of the Sea.

Milk ducks await the race! Five-bucks-a-duck fundraiser raises money for breast cancer prevention through breastfeeding.
Milk ducks await the race! Five-bucks-a-duck fundraiser raises money for breast cancer prevention through breastfeeding.

Between Monday and Friday, Healthy Children presented breastfeeding education that surpasses the idea that Breast is Best. Although accurate education is still crucial for breastfeeding success, we can begin to focus on the many dimensions breastfeeding connects to: economy, environment, public health, human development, perception of women, ethics, and the list goes on and on.

Below, I reflect on some of the overarching themes discussed at the conference.

Women are not powerless.
Why is it that most birth stories are stories of horror and pain and violence?

For one, today’s women are generally not exposed to the beauty that birth can be. Instead we’re inundated with dramatized, inaccurate versions of birth in the media and our own experiences reflect those.

Second and perhaps more significantly, the medical industry has seized women’s power.

Homebirth and hospital-attending obstetrician/ gynecologist and homeopath Ricardo Herbert Jones, MD explains the many reasons why there is a divide between evidence-based birth and current obstetric practice.

First, he spells out physicians’ fear of litigation. A doctor who performs a caesarean section will not face potential charges because he or she used available technology. People simply no longer believe in the safety of normal birth; instead, we glorify technology.

Intervention is convenient for physicians. Scheduling or calling for an “emergency” c-section allows doctors to make it home in time for dinner. One conference participant calls it the “five-o’clock cut.”

Dr. Jones also explains that intervention supports commercial interest. The more c-sections performed, the less time wasted and the less time mother and baby spend in the OB ward.

“Birthing is a factory process; there is no emotion,” Speaker Nikki Lee, RN, MSN, IBCLC, ANLC, CIMI, CCE, CKC observes.

Dr. Ric Jones presents about birth in Brazil.
Dr. Ric Jones presents about birth in Brazil.

Society does not believe in women’s innate ability to birth our children. We’ve been made to believe that our bodies are defective and untrustworthy and so, we must relinquish power.

Common practices including shaving women’s pubic hair transforms her into a child, a girl who exercises no choice, Dr. Jones explains. He also uses the chilling metaphor that by hooking women to IVs during labor, we become fused to the medical system.

When women are permitted to experience birth fully, the way we choose, it has the potential to empower and transform us.

“Birth mirrors everything that happens in society,” Dr. Jones says.

Babies are not incompetent.

Kimberly Seals Allers speaks about her innovative project Be First Food Friendly.
Kimberly Seals Allers speaks about her innovative project Be First Food Friendly.

Why do we assume neonates are vacuous, otherworldly creatures?

Common medical practices wrap infants like a popular Mexican delicacy (the infamous baby burrito), separate them from their mothers and disregard their distinctive language.

When a baby is placed skin to skin with her mother immediately after birth, she performs nine instinctive stages that ultimately allows for flawless latching to mother’s breast. The nine instictive stages were originally identified by Ann-Marie Widström, RN, MTD, Doctor of Medical Science and colleagues. Skin to skin also counters the stress of being born, regulates baby’s body temperature, allows oxytocin to flow freely and has profound self regulatory skill implications later in life. It is common medical practice which demonstrates incompetency when it interrupts this seamless, delicate system.

Healthy Children faculty Kajsa Brimdyr points to one study that indicates neonates’ brilliancy. When a mother’s labor gown was given to a crying baby, the baby stopped crying. So we know scent is a highly developed sense that plays a significant role in newborns’ inclination to survive.

Further, Brimdyr explains that when an infant is placed skin to skin after a vaginal birth, his knees and legs push on mother’s abdomen forcing delivery of the placenta. Another incredible accomplishment baby arranges when allowed to do so.   mail-3

During the nine stages toward the breast, babies often rest. Speaker Ann-Marie Widström says that the relaxation stage is yet another sign of an early survival instinct; keep still and quiet so not to draw attention from predators.

Conference participants explain that it seems nearly impossible for medical staff to remain onlookers during this process and usually allow their impatience to interfere with babies’ instincts.

Healthy Children faculty Dr. Karin Cadwell and Carin Richter sarcastically joke about the contrast between the way we treat infants and other patients:
Why don’t we have the same respect for babies?
It would be absurd to say to the cardiac patient: “Oh, you’re just having chest pain, oh you’re just blue…”
Babies have needs too. Why do we disregard or respond mistakenly to the way they communicate?

Karin Cadwell presents our galaxy, Our Milky Way.
Karin Cadwell presents our galaxy, Our Milky Way.

Birth, breastfeeding and parenthood are a continuum.
Fragmented specialty care in America makes it difficult to provide consistent, clear information for patients.

“Our system divides the nursing mother and baby into two specialty care divisions, peds and OB/Gyn,” Healthy Children faculty Cindy Turner-Maffei explains. “That would be considered ridiculous to do in pregnancy.”

It’s ridiculous too, to expect mothers and babies to be successful at breastfeeding when their birthing experience involves scalpels and suctions when not medically indicated.

And when mother and baby are not given the opportunity to organically bond through skin to skin and breastfeeding, parenting can become an increasingly difficult, unpleasant endeavor with long-lasting effects.

We must remember that birth has everlasting consequences.

When we disregard excuses, we will make change.
How many reasons can you think of why you cannot go on vacation? Brimdyr asks us to brainstorm reasons and the group creates a rather lengthy list.mail-6

“But you always find a way…” Brimdyr concludes.

Applying this idea to the humanization of birth and breastfeeding allows for less intimidating models of change.

Brimdyr, Widström and Kristin Svensson, RN, Midwife, Doctor of Medical Science offer several suggestions to initiate change within our medical system:

Breastfeeding is not a personal or private issue.
Long-time, maternal infant caregiver Nikki Lee, RN, MSN, IBCLC, ANLC, CIMI, CCE, CKC recently wrote The dollar value of human milk. which has an incredible, fresh perspective on the value of breastfeeding. She shares an ingenious equation that calculates the monetary value of breast milk per state. Her post is a must-read. Find it here: http://www.breastfeedingalwaysbest.com/what-the-world-needs-to-know-about-human-milk/.

Specificity is key.

mail-1When The Joint Commission (TJC) expanded its performance measure requirements, many lactation care workers performed their happiest happy dances. Beginning in 2014, all hospitals delivering  greater than 1,100 babies annually will be required to implement the Perinatal Core Measure Set which includes exclusive breastfeeding targets. Hurrah! But wait, TJC’s core set measures exclusive breast milk feeding. Breast milk feeding is not the same as breastfeeding, all of us conference-goers agree.

Cadwell and Turner-Maffei created an activity that opened conversation to define breast milk feeding. It was a challenging task! Our groups considered donor milk, wet nursing, cross nursing, shared human milk feeding… There is much room for interpretation. And while indirect human milk provision is still superior to artificial baby milk concoctions, breastfeeding between biological mother and baby is number one on the World Health Organization’s hierarchy of infant feeding.

A call for specificity can be applied to issues surrounding Step 4 of BFHI as well:  Help mothers initiate breastfeeding within one hour of birth. An accurate interpretation of Step 4 is the implementation of skin to skin immediately, continuously and uninterrupted until completion of the first successful breastfeeding. We are getting closer, but what is skin to skin comprised of? Proper skin to skin implementation is a fully naked infant, only diapered, placed stomach down on its mother’s fully naked upper body. So you see when we fail to deliver specifics, moms, medical staff and supporters can get lost in translation.

Linda Smith, BSE, FACCE, IBCLC discusses Lyme disease implications and related tick-borne infections during pregnancy and lactation.
Linda Smith, BSE, FACCE, IBCLC discusses Lyme disease implications and related tick-borne infections during pregnancy and lactation.

A personal thank you to all of the conference participants for enlightening me and for furthering my passion for healthy children, healthy women, healthy families and healthy communities!

Congratulations to Dr. Julie Mennella for receiving Healthy Children’s prestigious Milk Shake award for shaking up lactation-based research. And congratulations to Kristin Svensson who was also awarded a prestigious Healthy Children award for her contribution to advancements in maternal infant health.

For more information about upcoming Healthy Children conferences, cruises and other educational opportunities please visit http://www.centerforbreastfeeding.org/.

Visualizing change

Two tables across from my husband, daughter and me, a woman pulled a fuzzy green nursing cover from her Petunia Pickle Bottom diaper bag and positioned her infant to nurse. Since I have begun paying attention, this is the first breastfeeding dyad I’ve seen in public.

My initial reaction was to hug and kiss the woman and thank her profusely for making such an important choice for her child.

When I calmed down, I remembered that the way she feeds her child is normal. I wouldn’t congratulate her for sending her child to school, nor would I congratulate her for changing its soiled diaper.

As we continued eating our meals, my husband said to me, “You should nurse Willow too so that woman doesn’t feel uncomfortable.”

A simple stop at Red Robin (cringe) turned into something so much more. I was elated to finally watch a mother other than myself breastfeed her child, but I was reminded of how much more progress our society needs to make to support breastfeeding families.

Why do moms bother with fuzzy green nursing covers? Why have I only witnessed one nursing mother in years? Why do we automatically assume mothers are uncomfortable nursing in public?

mailNot long after this experience, I had the opportunity to speak with Nurse Manager and Maternal-Child-Health Coordinator for Penobscot Nation Health Department and Clear Light Holistic Midwife Andrea Mietkiewicz, RN, CPM, CLC.

Because of her enthusiasm and passion for maternal infant health and the projects she immerses herself in, I am optimistic about future breastfeeding outcomes in our nation. But until I see floods of nursing dyads instead of floods of bottle-fed babies, I’m not convinced we are where we need to be.

Mietkiewicz and filmmaker Nicolle Littrell of  Woman in the Moon Films recently released Mothers, Grandparents, Fathers: Breastfeeding, Support, Tradition and the Penobscot Nation, a film documenting a program launched in June 2012 that facilitates and supports breastfeeding in Penobscot Indian Nation on Indian Island, Maine. It’s simply referred to as The Breastfeeding Program.

Breastfeeding 101

The film was funded as part of a grant awarded to United South and Eastern Tribes (USET) by the National Library of Medicine. Because of its previous breastfeeding work, Penobscot Nation Health Department was chosen to implement trainings addressing gaps within breastfeeding education, Mietkiewicz says.

Simultaneously, Littrell worked on her masters thesis on midwifery care and homebirth and suggested capturing the trainings on film.

Andrea and Evelyn at the first training.
Andrea and Evelyn at the first training.

The first training called Passing on Healthy Tradition Through Breastfeeding taught by Clear Light Holistic Midwifery Midwife Apprentice Evelyn Conrad, ICCE, CD DONA, HBCE, CLC, CH, targeted uninformed generations, ones that may have a significant influence on breastfeeding families.

The film calls this generation Wisdom Keepers. The training taught Wisdom Keepers things like the marble-size of an infant’s stomach, the dangers of supplementation and natural infant behavior.

The second training also taught by Conrad included information on natural weaning and general safety training.

Dr. Karin Cadwell of Healthy Children Project taught a third training: How to Help a New Mom be Successful at Breastfeeding.

Addressing barriers

Initially, the film showed within the Penobscot Community but was forwarded to Midwives Alliance of North America (MANA) so that it could be used within necessitous communities.

Mietkiewicz says hospital workers are an important audience.

She specifically cites employees at Eastern Maine Medical Center so they’re able to see the changes being made within maternal infant care in their area.

Mietkiewicz boldly says that anyone in the formal healthcare setting should be ashamed of the gaps in breastfeeding care.

She has a 98 percent breastfeeding success rate in her practice.

“I don’t feel like it’s difficult to obtain,” she says.

Esther nurses baby Aven.
Esther nurses baby Aven.

She explains that in general, hospitals are women’s biggest barrier when it comes to successful breastfeeding by inhibiting skin to skin, promoting supplementation, keeping baby from mother and cutting lactation care workers.

“Breastfeeding is on the bottom of their list,” she says. “You cannot expect to catch up later.”

Mietkiewicz says change needs to come from outside of the hospital.

“We need to show a different picture,” she says.

Painting the picture

In an attempt to normalize breastfeeding, a Penobscot Community art teacher took pictures of Naya and Esther Mitchell, two sisters showcased in Mothers, Grandparents, Fathers: Breastfeeding, Support, Tradition and the Penobscot Nation, nursing their exquisite infants. The artist projected the images on plywood and created large cutouts to display in the community’s walk-in clinic.

Andrea poses with Naya (left) and Esther (right) Mitchell walk-in clinic cut-outs.
Andrea poses with Naya (left) and Esther (right) Mitchell walk-in clinic cut-outs.

“The first thing you see are women breastfeeding,” Mietkiewicz says. “That’s what needs to happen all over the place.”

Amen!

“If we want to attach people to the project, the best way is to personalize it,” Mietkiewicz says. Including images of the community’s mothers and babies is an effective way to get others connected to and excited about the project she adds.

CLCs role in community care

While peer mentoring is an important part of the Penobscot Nation’s breastfeeding efforts, Mietkiewicz says certifying peer counselors as lactation counselors will further strengthen their community care model. She is currently arranging for Healthy Children Project to bring the Certified Lactation Counselor (CLC) training to Penobscot Nation.

Mietkiewicz tells me about a potential breastfeeding challenge unique to a large portion of the Native American population: milk protein allergies. She says a lot of breastfeeding moms report fussy, colicky babies, so they switch to formula thinking this will solve their baby’s condition.

Alexandra nurses Silas.
Alexandra nurses Silas.

Milk protein allergies can usually be eliminated within the first year of baby’s life when a breastfeeding mother restricts all milk proteins like casein and whey from her diet. It sounds awful, but it can be done- I gave up curdy delicacies when my daughter was diagnosed with the allergy.

A CLC can offer unequaled support when surmounting a challenge like this. While I sometimes wish I had encouragement from a fellow CLC, I’m happy to report that Willow is now free and clear of her allergy. Victory.

Mietkiewicz also tells me her community faces extremely high diabetes rates. In fact, many Native American peoples are at greater risk for diabetes. A specific study of the Pima Indians can be found here: http://www.ncbi.nlm.nih.gov/pubmed/9704241. Mietkiewicz cites this as another potential breastfeeding challenge unique to Penobscot Nation. It’s important to remember that “breastfeeding may be particularly important in tribal communities because of its ability to alleviate health problems, such as infant mortality and diabetes…

Saving resources and lives

Mietkiewicz is determined to establish a milk dispensary in her community to assist mothers and babies in uncommon circumstances because donated human milk saves lives.

With money leftover from the USET grant, Mietkiewicz purchased two locked freezers and a pasteurizer. Mietkiewicz says the milk would be offered free of charge. She calls it “native milk for native babies” and stresses the importance of providing live, genetic material for infants in need.

Contented baby Silas.
Contented baby Silas.

Mietkiewicz also says she is pushing for implementation of milk banking at the community’s hospital but has run into a financial obstacle.

“The milk is not a cost hospitals are willing to assume,” she says. “A hospital is a business.”

Spelling out her confusion, she wonders why the businesses won’t swallow the milk’s four-dollars-per-ounce processing fee when not providing human milk to babies in need will incur hundreds of thousands of dollars in future healthcare costs.

“We can save so many resources with just this one simple thing,” she explains.

Requesting assistance with her milk banking efforts, Mietkiewicz recently wrote to First Lady Michelle Obama.

Naya nurses baby Bennally.
Naya nurses baby Bennally.

“There’s never an end to the problem,” she says. “I’m going logistically from one to the next to the next.”

While the fix-it list seems never-ending, Mietkiewicz remains optimistic.

“The whole government is even changing its feeling about the importance of breastfeeding,” she says. “That is a huge step for the government to acknowledge the importance.”

Watch Mothers, Grandparents, Fathers: Breastfeeding, Support, Tradition and the Penobscot Nation here: http://vimeo.com/53639153

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For more information about Nicolle Littrell’s work click here. She is currently working on a project for Midwives Alliance of North America (MANA) called I am a Midwife.