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

Find Clear Light Holistic Midwifery on Facebook.

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.

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