VA Maternity Care Coordinator (MCC) program facilitates specialized care for military Veteran parents

For new families, healthy, evidence-based infant feeding education and support can be hard to come by, but among this often barren landscape of support, the VA Maternity Care Coordinator (MCC) program provides an oasis for military Veteran mothers.  

Retired USAF Lt Col Tammy Tenace BSN, MS, APRN-BC, now Women Veteran Education, Outreach and Research Coordinator  for James A. Haley Veterans Hospital in Tampa, Fla. says that the VA understands that pregnancy and parenthood often requires specialized care.

About a decade ago, as care providers started to notice that lactation and breastfeeding support was severely limited in civilian communities, they established the MCC role. MCCs maintain contact with Veteran families throughout the perinatal period, facilitating care that meets their specific needs. 

Because the VA does not provide obstetric care, the MCC acts as a liaison between the VA and the community obstetrical provider. MCCs follow Veterans through pregnancy and postpartum at one and six weeks postpartum. [https://link.springer.com/article/10.1007/s11606-019-04974-z]  The VA supplies Veterans with lactation supplies like breast pumps, nursing bras, nursing pads, storage bags, etc.

The MCC role has been established at every VA medical center, and Tenace has served as MCC at her hospital since 2016.  

Photo by George Pak : https://www.pexels.com/photo/family-sitting-on-sofa-beside-house-plant-near-the-windows-7983863/

Throughout the COVID-19 pandemic, what little perinatal support existed in civilian spaces, dwindled to almost nothing, Tenace points out. 

Hospital breastfeeding support groups, while only meeting a couple of times a week, stopped meeting altogether. Women weren’t allowed support people or their partners at appointments, and they began to feel isolated. 

“I realized I needed to do something; I couldn’t depend on the community,” Tenace says.  

Working through the Office on Women’s Health as a subject matter expert, VA National Consultant for Lactation Ashley M. Lauria, MA, RD, LDN, IBCLC helps establish standards of care in lactation programs at VA facilities nationwide. 

Tenace and Lauria both comment that among the hundreds of parents they have cared for, it is truly a rarity for an individual to express disinterest in lactation. Their experience reflects national numbers, where most dyads start out breastfeeding. 

Women Veterans are the fastest growing group among the Veteran population. In fact,  “by 2040, VA estimates they will comprise 18% of the Veteran population, versus just 4% in 2000,” according to a VA Pittsburgh press release.

In order to keep up with this demand, Tenace and her colleagues are in the process of curating a Certified Lactation Counselor (CLC) program. Made possible through funding from the Women’s Health Innovations and Staffing Enhancements (WHISE), ten of their staff members are completing the Lactation Counselor Training Course (LCTC), including Tenace, physicians, a health coach, advanced practice nurses, among others. 

“The most up-to-date information is really important,” Tenace begins. “[We are all] unlearning the things we thought we knew. The course has been instrumental to helping us feel like we are actually helping women, instead of relying on the knowledge that we thought we had. The course is detailed and professional, yet practical. The practicalness is what’s to our advantage. It’s how we actually help women breastfeed.”

Photo by Timothy Meinberg on Unsplash

Tenace and Lauria go on to explain that their efforts are Veteran-led. That is, their facilities host quarterly focus groups where they can learn about Veterans’ requests. 

“We want to know from women: what do they want?” Tenace comments. 

Because Veteran women often prefer support groups comprised of other Veterans, Lauria offers virtual lactation support groups that also act as social circles and a place for comradery. 

As James A. Haley Veterans’ Hospital designs new facilities, Tenace has been invited to offer input on the creation of lactation space for both employees and patients. Tenace applauds their leadership for focusing on improvement for the patient and employee experience. She also highlights that the newly designed main entrance will host a lactation pod. 

“I can’t think of a better way to show commitment,” she adds.  

Tenace and Lauria have embodied a passion for birth and lactation since their youth. Their work with the VA allows them to continue their mission to celebrate parents and their families and position themselves as life-long learners, evolving with the needs of Veteran mothers. 

 

Photo by Brianna Lisa Photography: https://www.pexels.com/photo/mother-breastfeeding-her-child-in-park-11620457/

For more on VA maternity care services visit https://www.womenshealth.va.gov/docs/WomensHealthReproductiveHealthBrochure508.pdf

More on Veteran Health https://www.commonwealthfund.org/blog/2021/birth-equity-Veterans-and-servicemembers  

Regulations and resources for all military branches https://www.mom2momglobal.org/bficb 

Coverage for pregnancy and lactation care in the military health system https://www.military.com/daily-news/2021/11/01/tricare-cover-doulas-lactation-consultants-some-starting-jan-1.html 

Accessing the Milky Way scholarship opportunity

Recently, Healthy Children Project put out a statement about our stance on the current events. “These are incredibly trying and painful times. As we negotiate the very current multiple impacts of the COVID-19 pandemic, recent events remind us that systemic racism and social injustice are longstanding national plagues…For too long families of Black and Brown babies have lived in fear for their children, themselves and their loved ones. The Healthy Children Project and the Center for Breastfeeding will not tolerate injustice, hate, bigotry and racism in any form.”

We expressed our solidarity with birthing families, our staff, our participants, our families, our communities, and our friends and hold Black, Indigenous , Mothers of Color in our hearts, our mission and our vision and reiterated that we will not tolerate injustice, hate, bigotry and racism in any form. We especially remember the words of Dr. Martin Luther King, Jr. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Our mission and focus is all about supporting mothers and their breastfeeding journeys. We know that Black women experience maternal mortality and morbidity at three to four times the rates of white women and infant mortality is twice as high for babies born to Black mothers when compared to babies born to white mothers. We also know that breastfeeding can help mitigate both of these unacceptable disparities. 

We are taking steps to help Black mothers and Black communities while staying focused on what we do best; train people to assist with breastfeeding. 

Healthy Children Project and the Center for Breastfeeding has always been committed to making lactation care community diverse and equitable. We have worked to make the Lactation Counselor Training Course (LCTC) accessible by giving scholarships each year to organizations such as ROSE and HealthConnect One.

But we realized that we could do even more. Towards that end, we announce that we have started an initiative called Accessing the Milky Way. This initiative will send Black, Indigenous , People of Color to the online LCTC by offering scholarships that range from partial to full. 

The first phase of this initiative will provide full tuition for the online LCTC on full scholarship for 25 BIPOC. This Accessing the Milky Way scholarship will pay the entire tuition for the course. 

In addition, we have started a fund to pay for the required text book and the testing fee for each of the 25 recipients to further eliminate barriers to becoming a Certified Lactation Counselor. 

We invite you to nominate a person that you know who wants and deserves the opportunity to take the LCTC in order to better serve and support the mothers in their community. We will be accepting nominations now through July 10, 2020. If you would like to nominate an individual, please send an email to info@centerforbreastfeeding.org and include the nominee’s name, phone number, email address, city and state, and a short description of the work they are doing and the benefit to their community by them becoming a Certified Lactation Counselor. Self-nominations are welcome. 

There are two fixed costs that cannot be covered by the scholarship. The cost of the text book is $75.75 and the fee to take the exam after the class (administered by the Academy of Lactation Policy and Practice) is $120.  This additional $195.95 is another barrier to BIPOC getting training that will support the families in their communities. Healthy Children Project faculty is working to raise a total of $4900 which would cover these fixed costs for all 25 recipients of the scholarship. Those interested in growing this fund may visit the GoFundMe page here.

Suggested Covid-19 resources for pregnancy and lactation

Lactation care and breastfeeding support are always essential, but perhaps even more so during crises like the one we’re facing today, dazed by social isolation.

Photo by Sasha Freemind on Unsplash

Like many states responding to the Covid-19 pandemic, The Academy of Lactation Policy and Practice (ALPP) is required to comply with Massachusetts Governor Baker’s emergency order and stop in-person operations. Healthy Children Project, Inc. has also been required to halt in-person operations, including the Lactation Counselor Training Courses (LCTC) for the time being. ALPP is continuing to process Certified Lactation Counselor (CLC) recertification requests remotely.  

Despite the current situation, the spirit of CLCs shines. In the CLC Facebook Group, lactation care providers are engaging in conversations about telemedicine, HIPAA compliance, and protective equipment and how to best serve families amidst the unknown. 

ALPP Executive Director Ellie MacGregor, MPH, CLC mentions that there are other important exchanges happening in  ALPP’s Community of Practice portal like current research and practice recommendations.

“We’re doing our best to share all of the evidence-based information although it’s changing every day,” MacGregor says.  

Photo by Luiza Braun on Unsplash

Healthy Children Project’s Cindy Turner-Maffei, MA, ALC, IBCLC has compiled resources for maternal child health care providers to reference when helping their clients navigate life during a pandemic. 

General Statements and Resources

For formula-feeding families

For expectant parents 

  •  Ready Set Baby curriculum produced by The Connecticut Department of Public Health (CT-DPH) in partnership with the Carolina Global Breastfeeding Institute (CGBI)

For personal sanity 

  • The meditation app, Ten Percent Happier, has made a set of meditations entitled “Coronavirus Sanity Guide” available to the general public.  In addition, they are making their full app available at no charge to healthcare workers who are responding to the virus outbreak. They invite health workers to email them for instructions at care@tenpercent.com. 
  • Yale’s Dr. Laurie Santos will host a Coursera Live Q&A event featuring ways to cope and process our emotions during the Covid-19 pandemic.
Photo by Greg Rakozy on Unsplash

Going forward, the United States Breastfeeding Committee (USBC) and MomsRising are inviting health care providers, pregnant and breastfeeding families, and all public health stakeholders to share how the pandemic is impacting the infant feeding experience. MomsRising points out that with the situation constantly evolving, personal experiences can make an impact on decision-making and help elected leaders understand how to best meet the needs of families.