Supporting Black breastfeeding in Wichita Metro Area

Joyea Marshall-Crowley, CBS, Protect Yourself, Protect Your Baby Program Coordinator with the Kansas Breastfeeding Coalition (KBC) and coalition coordinator at the Wichita Black Breastfeeding Coalition (WBBC) had a wonderful perinatal experience in Dayton, Ohio. She shared her pregnancy and labor and delivery stories on social media, specifically advocating for midwifery care, sparking curiosities and starting conversations among her friends.

When she moved  back to her hometown of Wichita, Kansas though, she realized that the health options available were lacking. 

“Those options were not offered, spoken about, or supported,” Marshall-Crowley begins. “Since then, I pride myself on letting women know they have choices and are in control of their maternal healthcare.” 

Marshall-Crowley’s management of “Protect Yourself, Protect Your Baby” helps provide pregnant and breastfeeding mothers of color with accurate information about the COVID-19 vaccine. The focus of this project is to create a safe space to talk about vaccine hesitancies. The project includes healthcare experts of color who understand that these hesitancies come from trauma and historical incidents within the healthcare system, Marshall-Crowley explains.  You can find more information here: https://ksbreastfeeding.org/covid-19-vaccine-awareness/

 

WBBC formed relatively early on in the pandemic. With everything shut down, Marshall-Crowley noticed that people were in a state of being still and listening. On top of that, more babies were being born, and mothers were interested in finding ways to keep their babies safe from COVID which led them to research and take more interest in breastfeeding. 

WBBC is one of over 20 HealthConnect One’s First Food Equity project organizations supported in their efforts to rollout community-based projects by BIPOC leaders. [https://www.healthconnectone.org/feature-supporting-black-breastfeeding-in-wichita/

From this funding, the #LatchedLegacy project came about. 

Marshall-Crowley and other supporters uplift mothers with lactation and breastfeeding information and supplies.

“We are most proud of being a representation for women of color regarding breastfeeding support,” Marshall-Crowley shares. 

WBBC has engaged in many community events this summer like The Rudy Love Music Festival, Fiesta Mexicana of Topeka, Rock the Block, and Juneteenth celebrations just to name a few.  

Marshall-Crowley shares that they have received excellent feedback from the community and have been thanked many times for doing this work for the black and brown communities. 

She goes on, “Since the pandemic, social media has highlighted maternal healthcare for black and brown women, and breastfeeding has entered into those conversations. The culture is undoubtedly changing and starting to include breastfeeding as a first choice for infant feeding. For Wichita specifically, there have been changes like the formation of the coalition and the creation of the “Wichita Birth Justice Society,” which highlights maternal healthcare in a full circle. As a result, women of color in our community are feeling more supported and interested in owning their own maternal health experiences.” 

When WBBC started, there were no credentials in lactation within the group, Marshall-Crowley reports. Since spring though, they’ve added two certified breastfeeding specialists (CBS) working towards their IBCLC, three doula-trained workers, three Chocolate Milk Café trained facilitators, and two in the works of getting their midwifery license. 

“Our vision is to become the resource and information where Black women can seek help from the coalition, people who look like them and do not have to be outsourced because of ‘credentials,’” Marshall-Crowley stated in the coalition’s HealthConnect One feature

What’s more, the KBC accepted two of their members to the Color-Filled BF Clinical Lactation Program, so that list of credentials within the coalition will soon be updated further.

Marshall-Crowley was honored as one of USBC’s Cultural Changemaker awardees this year. 

You can follow WBBC’s activity on Facebook here

Helping families flourish in southeastern Alaska

As a young child, Jasmine Esmay, RNC-OB, CLC, now a nurse at a Baby-Friendly critical access hospital in southeastern Alaska, watched a mare birth her foal. 

Esmay was struck by the “reverent atmosphere”. The horse has fresh hay and water. Calm and quiet hushed over the scene. 

“I was in awe of the whole process,” she says, making the connection early on that we, too, are mammals.

Most young children play house at some point, but I was never interested in pretending to cook or playing house,” Esmay shares. “I wanted all my friends to pretend they were in labor and I was the midwife, much to the dismay, I think, of their parents.”

Then when Esmay was 17, she was invited to attend the hospital birth of a friend she babysat for. 

“Again, I was in awe of the power and strength and miracle of new life,” she says. 

Her personal birth stories further shaped her passion and work within maternal child health, fully realizing the importance of evidence-based practice. These stories were a sharp contrast to the gentle, supported births she had witnessed, and she began to understand that how women experience birth can influence outcomes such as bonding, breastfeeding rates and  postpartum depression occurrence. Early on in her work, she realized the significance of a calm, patient-centered approach. 

Latching babies or empowering parents 

Esmay eventually volunteered with WIC, making house calls and inviting others to her home to help with breastfeeding whenever she could. Since 2008, she’s been working solely as an OB nurse. 

“…It seemed wherever I was working in an obstetric unit people would always say “Go find Jasmine, she can get any baby to latch!’” she shares. 

In 2017, she completed the Lactation Counselor Training Course (LCTC)

“What [our instructors] taught me through that course was to put my hands in my pockets and take in the entire picture, and then to help the breastfeeding dyad to find their own ways to be comfortable and successful with breastfeeding,” she explains. 

“They really stressed starting newborns with laid back positions, to encourage instinctual feeding behaviors, and to help new parents be comfortable and confident in their ability to breastfeed,” Esmay continues. “It was so hard those first few months to trust the process. I had to learn that my method of so-called helping was really not helpful.”

Esmay found it helpful to remind herself of the words of Cindy Turner-Maffei: “You may be able to get a baby to latch, but is it teaching the parents or empowering the parents so that when they go home, breastfeeding is successful?” 

Over time, Esmay says she came to realize that confidence is half the battle.

“I’ve heard over and over ‘I didn’t think I could do it’ or ‘I couldn’t have done it without all the help and support’,” she reports. “It’s nice to know that we not only encourage breastfeeding, but that we give people the tools they need to really succeed at breastfeeding and enjoy it. I really hope that those feelings of success and empowerment reach into the rest of parenting and pass down into generations.”

She’s noticed too that parents prefer a hands-off approach most of the time. 

“As this approach was implemented, I began to see less parents coming back supplementing or with nipple pain or other breastfeeding issues,” she reports. “It is very rewarding to see the parents’ confidence grow, and see how that affects bonding and the integration of the newborn into the family.” 

Expanding lactation care support 

Esmay plans to take the IBCLC exam in April, a process she’s been working toward for five years. 

“I can honestly say that out of all the trainings and books and lectures and conferences I attended, the training I received through Healthy Children Project changed my practice the most,” she comments. 

Esmay was recently honored as a member of USLCA’s advisory board.

“My hope is that through knowledge and idea sharing we can think outside the box on ways to expand lactation support and education to marginalized populations,” she reflects on her new role. 

Esmay shares that she has conflicting thoughts regarding the exclusive use of IBCLC credentialing for “the gold standard” of lactation care. 

She explains: “It is important to recognize credentials, and licensing will help with getting lactation care reimbursed, but I also know from experience how expensive it is to obtain and maintain. The reality is that obtaining an IBCLC at this point is just not possible in many rural and marginalized populations. 

I think more focus should be on training all healthcare workers in normal breastfeeding support and the importance of breastfeeding. Statistically breastfeeding is just as important to overall health as teaching cardiac wellness and cancer screening. The focus should be on breastfeeding as a normal part of maternal child health, with referrals to experienced lactation care professionals when there are complicated feeding issues.” 

Barriers and triumphs 

In her work today at the critical access hospital, Esmay and her colleagues serve 15 remote communities. Their hospital was the first tribal affiliated hospital in the state to receive Baby-Friendly status. 

Esmay says their patients are plagued by many of the same barriers as those in the rest of the nation; namely, limited access to evidence-based breastfeeding support, physical distance and travel barriers for perinatal care, breastfeeding not being the socially acceptable norm, abysmal parental leave, little or no workplace pumping accommodations and/or childcare. 

“I think our biggest barrier though is in the current medical model of care where there is a lack of continued support throughout the postpartum period,” she says. “It doesn’t make sense to have 10 plus prenatal visits, and then only one postpartum follow up 4 to 6 weeks after a baby is born.” 

Adopting the midwifery model of care could offer many solutions in regard to postnatal care, she adds. 

Location lends itself to some challenges too. 

“It seems the very nature of where I live lends itself to always being a bit understaffed. Living on an island has its challenges and some of the community is transient by nature due to seasonal work or contract work.

 I think it is well known that healthcare in general is a very mentally and physically challenging calling. For obstetric care in general, I think that is why it is so important to get more feet on the ground for lactation support. If we can encourage routine breastfeeding education and training to all women and children’s nurses and providers, that will lessen the burden and improve access to breastfeeding support.

In my opinion, if you work anywhere in healthcare, but especially maternal child health, then basic breastfeeding knowledge should be the standard, not the exception. There are always those special feeding needs that will require a higher level of care, but every women’s and children’s healthcare provider should know what normal breastfeeding patterns look like, how to support a breastfeeding dyad and how to spot problems.”

Despite the aforementioned barriers, Esmay and her fellow colleagues are unrelenting in their service. The team offers a variety of breastfeeding support programs including:

    • Postpartum phone call 7 to 10 days after birth as a safety net between 3 to 5 day check and 2 week newborn follow up
    • Free lactation clinic 
    • Monthly peer breastfeeding support group 

Alaska scores quite well on their breastfeeding rates compared to U.S. national averages. Esmay attributes this in part to necessity. 

“Many of the communities in southeast Alaska are very remote and cannot always rely on shipments of food or formula to survive,” she explains. “I think it speaks to the importance of family-centered communities and the knowledge sharing that happens in extended families.”

Community is strong in her area, and there’s strong community awareness of the state of maternal child health in America. 

Esmay brings attention to community gatherings like that of a group called NEST (Nurture, Empower, Support, Transform). She recently partnered with the Alaska Breastfeeding Coalition and the hospital to implement a “Breastfeeding Welcome Here” campaign for area businesses.

Encouraging trauma informed care 

While Alaska is making a difference with small changes, Esmay sheds light on an area that needs improvement: trauma informed care.

“The statistics in Alaska for women experiencing trauma are astronomical,” she begins. “Thirty-seven percent of women in Alaska have been victims of sexual violence– that rate goes to 50 percent if you are an Alaskan Native Woman– and in some areas of the state that number can be more than 90 percent. 

When women who have survived sexual violence give birth, there are triggers. Often the traumatized person is not expecting these triggers. How care is given during prenatal visits and throughout the birth process can affect how a labor progresses, how parents bond and how they view themselves as new parents. 

It can make the difference between a healing and empowering experience or becoming a victim of violence once again. If care is taken adhering to the principles of trauma informed care, there will be better birth outcomes, like less postpartum depression and a higher rate of breastfeeding success. 

Ultimately it will lead to healthier families, and that’s really the long term goal of healthcare for women and children.” 

Esmay recommends When Survivors Give Birth by Penny Simkin and Phyllis Klaus to help us understand how to best care for the pregnant person who has experienced trauma. 

Esmay shares a few closing thoughts:

    • Approach breastfeeding from a preventative healthcare point of view. A study reported in the Surgeon General’s Call to Action found that if 90% of U.S. families followed guidelines to breastfeeding exclusively for six months, the United States would save $13 billion annually from reduced direct medical and indirect costs and the cost of premature death.  
    • Populations most affected by dangerous diseases have the least access to breastfeeding support and education. 
    • Breastfeeding is a global health issue of the highest importance. Corporate healthcare and governments need to invest as much money and energy as possible into promoting breastfeeding. 
    • We need human donor milk available in every hospital, we need equitable and affordable access to breastfeeding support, and we need the U.S. to uphold the WHO code of marketing to prevent formula companies from preying on vulnerable populations. We need the organizations that support breastfeeding to brainstorm new ways to improve education and access for all. 
    • Really the answer to world peace could be in breastfeeding, but that’s a topic for another day.