System-based approach reduces racial disparities in breastfeeding

Despite efforts to reduce racial disparities in maternal child heath care, Black women die during pregnancy, childbirth, and the first year postpartum at nearly four times the rate of White women. Black babies are more than twice as likely as White babies to die before they turn one. And breastfeeding rates among Black women are lower than those in White.

Since 2014, the CHAMPS (Communities and Hospitals Advancing Maternity Practices) initiative has been doing something about that.

The W.K. Kellogg Foundation awarded Boston Medical Center (BMC) a $2,125,000 three-year grant for the program which improves maternal child health outcomes through the promotion of Baby-Friendly practices in Mississippi, New Orleans, Texas, and Southern Tennessee. In 2017, CHAMPS secured three more years of funding from the Kellogg Foundation and the Bower Foundation to increase the number of Baby-Friendly hospitals in Mississippi.

CHAMPS Project Director Anne Merewood, PhD, MPH, IBCLC worked mainly as a researcher in breastfeeding for 15 years.

“Eventually, I got fed up doing one more research project to prove that breastfeeding is good for babies,” she says. Instead, she now focuses on “action and implementation.”

In 2017, Dr. Merewood launched CHEER, the Center for Health Equity, Education and Research at BMC which oversees the Baby-Friendly projects as well as a growing body of work in Indian Country.

Dr. Merewood points out that it takes an average of 17 years before research integrates into policy and practice. CHAMPS has made tremendous progress around reducing racial inequities in just three years.

Breastfeeding initiation in the U.S. rose from 80% to 81% between 2012 and 2013, but Mississippi’s rate fell from 59% to 52%, Dr. Merewood notes in her 2016 American Public Health Association (APHA) Annual Meeting presentation CHAMPS Initiative and Improved Compliance with the Ten Steps to Successful Breastfeeding in the South.

In 2013, Mississippi had the lowest breastfeeding rates in the nation, the lowest mPINC score and ranked last on the CDC’s breastfeeding report card.

Also in CHAMPS Initiative and Improved Compliance with the Ten Steps to Successful Breastfeeding in the South, Dr. Merewood reports that prior to CHAMPS enrollment, none of the hospitals reported data by race or correctly defined or charted skin-to-skin or rooming-in.

But between January and December 2015, twenty five of 31 CHAMPS hospitals in Mississippi, Louisiana, Texas, and Tennessee collected and submitted data. The results:

  •         “Average breastfeeding initiation rose from 64% to 72% (all races), and from 50% to 61% (blacks).
  •         Exclusive breastfeeding rose from 32% to 36% (all) and from 10% to 23% (blacks).
  •         Skin-to-skin rose from 42% to 50% in vaginal births, and from 8% to 35% post-cesarean.
  •         In Mississippi CHAMPS-enrolled hospitals, breastfeeding initiation rates rose from 49% to 62%; from 69% to 77% among white individuals, and from 33% to 45% among black individuals.”

Rigorous data collection has allowed institutions to recognize and address racism, although there’s still a lot of progress to be made.

“There’s an awful lot of institutional racism and it needs to be figured out,” says Dr. Merewood.

All this activity has led to tremendous momentum in Mississippi; now 80% of Mississippi’s 43 birthing hospitals are on the Baby-Friendly Hospital Initiative’s 4D pathway to designation.

In December 2015, Mississippi’s first Baby-Friendly Hospital was designated. That same month, Mississippi opened a human milk bank. In February 2016, the first Lactation Counselor Training Course in the state took place. In April 2016, the first Baby Café opened. Since its infancy, CHAMPS has trained over 40 Reaching Our Sisters Everywhere (ROSE) Community Transformers.

CHAMPS also works in Indian Country where hospitals are generally severely under resourced; they lack federal funding, they suffer from remoteness and high staff turnover and they serve high-risk populations. Dr. Merewood served as Baby-Friendly consultant to the Indian Health Service (IHS), and 100% of federally funded IHS birthing hospitals are now Baby-Friendly designated.

IHS accomplishments are “an example for the nation,” Dr. Merewood states in a WKKF article.

Through its American Indian and Alaska Native Communities and Hospitals Advancing Maternity Practices (AI/AN CHAMPS) project, the group has helped four out of five tribally run birthing hospitals become Baby-Friendly designated and is now working with all Alaska Native hospitals to implement the Ten Steps.

“We found a winning solution with CHAMPS and the same with Indian Country,” Dr. Merewood says. “The way to go is regional. Once you get momentum going, everyone gets on board and things move much more quickly.”

A geographic or system-based focus has proven effective along with the formation of partnerships. CHAMPS team members and participants have collaborated with state health departments, WIC, the Mississippi Perinatal Quality Collaborative and Blue Cross & Blue Shield of Mississippi for example.

In fact, Blue Cross Blue Shield’s Quality Model requires all delivering network hospitals across Mississippi to gain Baby-Friendly designation as part of criteria for achieving Blue Distinction for maternity care. [More here: https://www.bcbsms.com/2015-healthy-mothers.html]

With the launch of CHEER, the team is now working on a broad range of projects: drug abuse prevention, Community Health Assessments in tribal communities, enhancement of prenatal care, domestic violence prevention, suicide prevention and technical assistance especially in tribal communities. CHEER partners with the Indian Health Service (Billings area), the Rocky Mountain Tribal Epidemiology Center in Billings, Montana and the Blackfeet, Northern Cheyenne and Chippewa Cree tribes.

Learn more at www.cheerequity.org.

Non-profit Julia’s Way proves babies with Down syndrome can breastfeed

Against the backdrop of a misty ocean and watercolor sky, ten mother baby couplets and their families gathered for a photoshoot to prove that babies with Down syndrome can indeed breastfeed, a truth not widely accepted especially among medical professions.  

The photoshoot is part of phase one of a breastfeeding project by Ella Gray Cullen, founder of the non-profit Julia’s Way, after her daughter Julia Grace. Nicole Starr Photography captured the celebratory nature of Cullen’s overall mission to “reimagine life with Down syndrome.”

The darling stars of the Julia’s Way photoshoot– Julia Grace, Emily, Mae, Oliver, Lewis, Harper, Rian, Cate, Rory, and Cayden– have been shared widely on social media pages including La Leche League, Occupy Breastfeeding and Nationwide Nurse-In Facebook pages as well as Love What Matters Facebook page which has seven million followers.

Making it known that breastfeeding is possible for babies with Down syndrome is ever important as the negative effects of not providing human milk and breastfeeding on babies born with Down syndrome are robust. Even so, Cullen reports that 20 to 30 percent of women are told that their babies with this diagnosis are not as capable of breastfeeding as other children.

Nicole Starr Photography

Her research comes from an infant feeding survey she conducted of over 500 mothers of children with Down syndrome, which will eventually be converted into an academic paper. Cullen anticipates the paper will help identify what helps mothers of babies with Down syndrome achieve their infant feeding goals.

Next on Cullen’s schedule is the release of a video which will feature the infant feeding stories of the mothers who participated in the photoshoot. The video is set for release during World Breastfeeding Week. Currently, Cullen features the “Breastfeeding Superstars’” stories on the Julia’s Way blog.

A book and accompanying website that will serve as a comprehensive resource for new mothers seeking information on how to help their babies with Down syndrome breastfeed successfully is also part of phase one. The book will be available as a free download and a print version will be available for a nominal fee to cover printing costs and shipping.

Julia’s Way is currently working to establish a database of lactation professionals who specialize in working with babies with Down syndrome.

The second phase of the project focuses on developing resources for medical professionals so they may properly support women to breastfeed their babies with Down syndrome. Last week on Our Milky Way, we featured the story of Ashley Albright, a mother of a child with Down syndrome, which exposes the dangerous deficit of infant feeding support to those with children who are medically complex.

Cullen’s breastfeeding advocacy dates back to before Julia Grace was born while Cullen worked in the medical field.

“I have been a huge proponent of breastfeeding for years,” she writes on her blog. “As a former labor and delivery nurse and a one-time midwifery student I believe the benefits cannot be overstated and have always encouraged people to consider it. I find it comical how little understanding I had of breastfeeding when I was instructing my patients and now that I have personal experience I understand how challenging it can be in those early weeks and how much persistence it can take.”

Cullen’s infant feeding story is atypical in that she received feeding support during their hospital stay and at home.

While Cullen says she was internally determined to breastfeed, she writes on her blog: “I know I would not have had the ability to be successful without [lactation professionals] and am grateful that they believed in me and in Julia Grace’s ability to nurse eventually.”

Julia Grace breastfed directly for the first time at 11 weeks. That meant that Cullen pumped exclusively for those 11 weeks, ten to 12 times each day which amounted to at least 40 hours per week of the pumping routine (cleaning equipment and bottles, storing, etc.)

“It was exhausting and tough,” Cullen remembers.

Her experience allows her to remain realistic about the challenges of providing milk for a medically complex child. She includes this project “disclaimer:”

“Our project has always been about supporting mamas who want to and can pump or breastfeed. We understand that babies with Down syndrome can have medical complexities that may be overwhelming at times and there may be other priorities for the family and the medical team. Our intention is not to add a layer of difficulty to what can be a stressful time. However, no mama should ever be told that she shouldn’t even bother to breastfeed her baby just because of a diagnosis of Down syndrome and for those mamas who want to attempt breastfeeding but just need support or encouragement, we are here for them.”

Cullen will attend this year’s Down Syndrome Diagnosis Network – DSDN Rockin’ Moms Retreat in Chicago where she will woman a table to share her vision for reimagining life with Down syndrome.

Get involved with Cullen’s mission:

  • Share your stories.
  • Share your professional infant feeding photographs to be included in her upcoming book.
  • Donate to the cause. There are several ways to support Julia’s Way which can be found on the Julia’s Way Facebook page.

You can get in touch with Cullen here.

Turning regret into advocacy

When Ashley Albright’s baby Marcus Jr. (MJ) was diagnosed with Down syndrome, she was “crushed.”

I felt what I thought was my heart shattering. I could not believe it,” she writes on her blog Just the Albrights.

It was her husband who helped change her perspective. After a conversation with him, she no longer felt defeated by the diagnosis; she felt hopeful and enthusiastic about her son’s future.

While Albright has embraced the diagnosis, she still has regrets about her infant feeding story.

We had a very rocky breastfeeding journey and stopping at three months is still one of my biggest regrets!” she exclaims.

Although Albright planned to exclusively breastfeed, she reports that the hospital offered “absolutely no support.” During her son’s eight-day stay in the NICU, no one encouraged her to provide breastmilk for her baby; actually, no one had a conversation with her about breastfeeding at all. Still, determined Albright pumped milk for MJ.

“I grew tired of pumping though…Because of his Down syndrome, we were terribly busy with doctor appointments, therapy sessions, [and so on.]”

Albright has since had another son and a daughter. She breastfed her second child for 34 months and continues to exclusively breastfeed her eight month old daughter.  She points out that she birthed her daughter at a different hospital than her sons and acknowledges that the breastfeeding support was “out of this world amazing.” She also utilized the Tennessee Breastfeeding Hotline, staffed by CLCs and IBCLCs.

“Out of all of my children, MJ needed [my milk] the most,” Albright says. “I regret that I did not supply him with the best.”

“Months later, I would pump whenever I was engorged with my second son,” she goes on.  “I would offer that milk to MJ, but he would refuse it.”

Now that Albright has several years of breastfeeding experience, she says that friends, family and co-workers come to her for breastfeeding advice.

“Plus, I absolutely love breastfeeding” she adds. “I want to be there to encourage and educate other moms.”

Accordingly, Albright recently completed The Lactation Counselor Training Course.  

“I loved the course…I learned so much,” she says. “If I had money to dispose of, I’d take the class again because it was so fun and interesting!”

Albright plans to volunteer her new skills at the Down Syndrome Association of Memphis and the Mid South.

“[People] need to know the endless benefits that they can offer their children through breastmilk,” she says.

Albright also practices her breastfeeding advocacy through breastfeeding groups on Facebook, by creating breastfeeding videos on her YouTube channel and offering breastfeeding encouragement through Instagram.

#FactsNotFear

“What do you think of that Fed Is Best movement?” my dear friend wondered when it became prominent on social media.

“Um, I don’t really like it,” I replied so inarticulately. Since then, I’ve reflected on the movement and continue to struggle to express anything coherent.

Kimberly Seals Allers and me (and George!) at the International Breastfeeding Conference 2017 after presenting on her book ‘The Big Let Down.’
[Find it here: http://www.kimberlysealsallers.com/book/]
Just last week though, the remarkable Kimberly Seals Allers, published My Struggle To Find My Voice & Raising A Collective One to Protect Mothers to introduce the launch of the #FactsNotFear campaign which advocates for FACTS, not fear-mongering. Seals Allers and 1,000 Days shared a new blog Facts Not Fear: Protecting the One Place Where Fear Does Not Belong and developed suggested social media posts and graphics for both Facebook and Twitter so that we can easily support the cause.

We are publishing Seals Allers’ guest post here on Our Milky Way in support of the #FactsNotFear campaign.

————

We live in a world of fear. From the recent terrorist attacks in England to last year’s Orlando nightclub massacre. We have seen how the fear of outsiders has sparked powerful political movements around the world. As a frequent business traveler I sense my own anxiety as I sit on planes and trains, and as a mother I know the feeling that sweeps over me whenever I receive an incoming phone call from my children’s school.

Yes, we live in times of fear and anxiety—much of which is beyond our control.

But there is one place where fear should not exist. There is one area, where, as women and mothers, that we should insist that fear not enter—that is in the precious act of feeding our babies. From the time they are first placed in our arms, we are anxious that we will do our best. Yes, we are nervous that we will make mistakes. But we should not be made to dread our ability to mother—particularly when it comes to feeding our infants—one of our very first tasks.

That’s why a recent spate of fear-based marketing, particularly from the Fed Is Best Foundation, stoking fears that exclusive breastfeeding kills babies is both erroneous and irresponsible. But it is also the type of insidious marketing that preys on a mother’s existing insecurities that should make all women concerned. If the only way Fed Is Best can make its point is by sensationalizing infant deaths and undermining our confidence in our bodies—then maybe their point needs to be carefully considered.

Or, as women, we insist that they make it with valid facts and sans the fear mongering.

Let’s face it, women are sold fear and anxiety as a marketing tool every day. In fact, the strategy, officially known in business circles as FUD—fear, uncertainty and doubt—was designed by an IBM executive decades ago to persuade buyers to feel “safe” with IBM products rather than risk a crash, virus or server disruption. By the early 90’s it was generalized to refer to any kind of misinformation used as a competitive weapon.

Today, weaponizing fear takes many forms. We fear our faces aren’t pretty enough, so we buy cosmetics. We worry that our body isn’t the right “type” so we are sold diet plans and surgical procedures. We are told our hair isn’t shiny, bouncy or thick enough so we are sold multitudinous hair products. And then we are told to fear that our bodies may not properly do what they are biologically made to do, and we are sold infant formula.

The truth is, our bodies were uniquely made to feed the infants we create. Decades of scientific research proves that formula is nutritionally inferior to breastmilk. Admittedly, societal pressures, structural barriers such as a lack of paid maternity leave, and physicians who receive little to no training in lactation science in medical school, make it very difficult for some women to fulfill their biological norm. Many women who want to breastfeed find undereducated physicians and nurses and limited post-natal support—particularly in the early days after discharge. We have much to overcome.

To be clear, infant formula is necessary. When a mother’s own breastmilk or human donor milk is not available, then infant formula is an important third option that can, at times, save lives. However, women should come to that decision fully informed, not because of marketing efforts designed to incite distrust in their own bodies or threatened with the fear of the death of their infant.

It’s no secret that, especially in the Western world, women already fear they will have insufficient milk. For some, this fear can become a self-fulfilling prophecy because fear and anxiety can literally limit lactation by stifling the letdown reflux that stimulates the milk glands. Feeding into this insecurity by promoting early formula supplementation “just in case” has been a go-to move by the formula industry for years.

As far back as the 1940s, the manufacturers of Borden KLIM evaporated milk ran a radio jingle in the Congo that stoked mother’s fears over insufficient milk. The song went:

The Child is going to die

Because the mother’s milk has given out

Mama o Mama the child cries

If you want your child to get well

Give it KLIM milk

So when Fed Is Best frequently promotes eerily similar headlines claiming, “One bottle would have saved my baby”—it seems to make early supplementation innocuous, while deploying a similar tactic used to spur sales of infant formula. The insidious message is that your breast cannot be trusted but a bottle can—this type of marketing should concern all women.

Instead of fear, we should demand the facts about why physicians and nurses don’t have more education to properly identify lactation dysfunction or failure. We should demand knowledge about other options to increase milk output such as hand expression, which can extract more milk than a pump. If formula must be used, it should be administered as a temporary bridge until a mother’s supply is established, not a breastfeeding killer for mothers who want to nurse. And we should demand standard home visitation immediately after discharge, as is the practice in the UK and other European countries.

Ultimately, women deserve facts not fear. Women have a right to guilt-free, confidence-building information and support. And it’s time that we demand it of everyone—including, and especially, from those claiming to support mothers. We cannot stand by while Fed Is Best insists that fear is best.

Kimberly Seals Allers is an award-winning journalist and nationally recognized infant health advocate. Her fifth book, The Big Letdown—How Medicine, Big Business and Feminism Undermine Breastfeeding was released in January by St. Martin’s Press. Learn more at www.KimberlySealsAllers.com and follow her on Twitter @iamKSealsAllers.

Breast milk for their ‘Nemo’

After three years of IVF treatments, Elizabeth (Elizabeth has asked that we keep her last name private,) MSN, ARNP, PNP-BC, CLC, CPN learned that her baby, her last frozen embryo, would be born with at least a bilateral cleft lip. 

“My husband, the entire pregnancy after we found out about the cleft lip, was hoping it would go away, that the ultrasounds were wrong or it would fix itself,” Elizabeth remembers. “He was in complete denial.”

But after their son was born, Elizabeth overheard her husband compare him to the popular Disney character Nemo; He is our Nemo. Nemo had a gimpy fin and our son has a birth defect, she recalls him saying.  

“For him to have that pride and comparison to Nemo is breathtaking,” she goes on. 

Elizabeth, a pediatric nurse practitioner and doctoral student at the University of Florida, currently teaches undergraduate nursing students at the local children’s hospital.  

Her first job as a registered nurse was in the NICU which strengthened her support for human milk and breastfeeding.

“I saw first-hand the benefits of breast milk for those tiny little babies, not only for the children but for the moms as well,” she says.

It was after the birth of her son that she became especially determined to earn lactation credentials so she could help families achieve their infant feeding goals.

In May, Elizabeth completed The Lactation Counselor Training Course.  

‘Not this month’

Elizabeth says she always thought she would have four children, but several years of IVF treatments proved to be exhausting.

“It was one of the most difficult times of my life,” she says.  

In the beginning, Elizabeth shared her IVF journey with friends and family in search of support. But when treatments failed, it became too draining.  

“I would be curled in the fetal position crying hysterically while my poor husband had to be the one to tell everyone ‘not this month,’” she remembers. “I got tired of everyone feeling sorry for us…”

She acknowledges that people’s remarks like “It’ll just take time,” were intended to be encouraging, but they weren’t. 

“Unless you have lived the agony of wanting to be pregnant and month after month not getting pregnant, you have no idea,” Elizabeth explains.

Co-workers were unaware of the heartache Elizabeth endured those years of trying to conceive, but she remembers crying the entirety of her drive to work, washing her face inside and proceeding to her duties. 

“Going to work I felt like a stranger. A separate person,” she recalls.   

It was on Mother’s Day 2014 when Elizabeth and her husband publicly announced their pregnancy.  

Two years of breast milk

Elizabeth always planned to breastfeed her baby. Breastfeeding was one of the things she looked forward to most as a mother. And after learning of her baby’s bilateral cleft lip, she had only one question: “May I still breastfeed?” 

In preparation to feed her baby with special needs, Elizabeth contacted lactation counselors, met with a cranio-facial surgeon, made spread sheets with pumping times, and talked to everyone she knew in the medical field about cleft disorders. 

Despite avid preparation, Elizabeth wonders if the feeding support she received immediately following the (frank breech, unmedicated, vaginal) birth of her baby could have been better.

“We did not get skin to skin after delivery which still makes me sad,” she says.  A lactation specialist helped Elizabeth to pump her milk, but her baby wasn’t even in the room when the specialist came to visit her. 

Presently, the hospital where Elizabeth birthed is Baby-Friendly. Looking back, she wishes this had been the case during her stay.

“I know it would have truly made a difference,” she says.

While Elizabeth eventually learned that her son’s latch and transfer would not allow him to breastfeed directly exclusively, lactation specialists from the hospital’s Mother Baby Tea and their occupational therapist, helped her use the supplemental nursing system (SNS) and Haberman feeder. Elizabeth provided breast milk for her son for two years!

“There is absolutely nothing better in this world than feeding the son you love and smelling him and holding him close,” she reminisces.

Breastfeeding her baby also gave her the gift of feeling connected to other women. While nursing her baby at a doctor’s office, she looked up to the smile of another woman.

“It was one of those knowing smiles only women who breastfeed can share,” she says. 

Ongoing challenges

When he isn’t busy at weekly occupational and speech therapies for feeding difficulties and a speech delay, Elizabeth’s son, now two years old, loves to swim and read books about Nemo.

There’s a lot to anticipate throughout Elizabeth’s family’s journey; A child with cleft disorders will undergo an average of nine surgeries before she/he is 21 years old, she reports. She asks that we all remain sensitive to the ongoing challenges cleft disorders present, especially after watching videos by adolescents affected by cleft disorders.

“I cried and cried hearing about all the teasing these young people endured,” she says.

Reflecting on her own journey, Elizabeth says: “Motherhood, breast feeding, cleft disorders are all hard. If I can help or make a difference for just one mom and baby, that is all I can ask.”