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 

Graduate student explores complexities of nutrition and health from cradle to grave

Originally from New Orleans, Erin Bannister, lab instructor and dietetic intern at Northern Illinois University, says that food is tied to her identity.  Bannister was ten when she first learned to make a roux. Those early skills prepared her for her later work as a chef, which she describes as a kind of manual labor with long, hot hours. 

Bannister shares with a laugh, that she started to wonder how she could work with food and continue to nourish people with weekends and holidays off. Eventually, she discovered the field of dietetics.

Photo by ja ma on Unsplash

Currently in the thick of her Master’s thesis, Bannister is exploring the metabolic energy needs in adults and determining whether the default equations we use are accurate in the populations they’re used in. 

For instance, it is widely accepted that an average allowance for a roughly 170 pound man is  2,300 kcal/day; for women, it is 1,900 kcal/day. We expect that pregnant and lactating people will have higher metabolic energy needs. 

As Bannister spends a swath of her days compiling and extracting data, she says she’s discovering that some of the accepted equations need to be delineated. 

“The real root of my thesis and the root of most of my studies and the goals that I have, is to use accurate evidence-based interventions in the populations that they are meant to be used in and to not remove ourselves from that evidence,” Bannister begins. “… Often times, things are taught and then they are believed because the person that taught it is an expert and the evidence gets lost on the way; don’t forget to review the evidence.” 

As Bannister continues to pursue this idea that we can do better than sludging through the status quo, she sought out the Lactation Counselor Training Course (LCTC). Although Bannister has great interest in the complexities of nutrition and health from cradle to grave, she says that there is a solid argument that the health of a population is highly correlated with the health of its mothers. 

Source: United States Breastfeeding Committee (USBC)

“[I want] to be as helpful and effective as possible… to have the knowledge to be able to contribute meaningfully, and the certification adds credibility,” she explains. “The training was quite eye-opening, almost embarrassing to say how little I knew about breastfeeding.” 

Bannister goes on that ultimately, she would like to work with nutrition intervention in low and middle income countries where the burden of improper nutrition is most severe. Currently, many countries worldwide face the double burden of malnutrition – characterized by the coexistence of undernutrition along with overweight, obesity or diet-related noncommunicable diseases (NCDs). In fact, nearly one in three people globally suffers from at least one form of malnutrition: wasting, stunting, vitamin and mineral deficiency, overweight or obesity and diet-related NCDs. (WHO 2017)

As Bannister buckles down at the end of the semester, she says, “I want to make sure I am utilizing all the forks I’ve got in the fire.” 

You can learn more about Bannister’s work by exploring the various topics she has presented on, ranging from potatoes to prison to poop. Connect with Bannister on Linkedin and Instagram @calibrating_palates.