This summer, while health advocates across the globe celebrated World Breastfeeding Week and the U.S. celebrated National Breastfeeding Month, Egypt commemorated the launch of their initiative “1,000 Golden Days for the Development of the Egyptian Family.” This work is situated under the umbrella project 100-Million Healthy Lives Presidential Initiative.
In collaboration with Egyptian Members Association (EMA) of the Royal College of Paediatrics and Child Health (RCPCH), the comprehensive 1,000 Golden Days project provides free-of- charge access to competent midwifery care, “develop[s] family and parental awareness” and employs medical and psychological examinations for the parent and child within the first 1,000 days (spanning from conception through the second year).
Dr. Abla Al-Alfi presented an honorary plaque to Dr. Khaled Abdul Ghaffar, Minister of Health and Population, in recognition of his efforts in supporting the initiative. Photo courtesy of Kajsa Brimdyr.
The initiative ensures the “right of the child to be raised in a sound family environment and the right of the mother [and father] to enjoy a healthy life,” as stated by Dr. Khaled Abdul Ghaffar, Minister of Health and Population, during a commemoration speech over the summer.
Healthy Children Project extols the achievements of their long-time partner Dr. Abla Al-Alfi and colleagues.
Dr. Abla explains that 85 percent of children’s physical, mental and psychological capabilities develop within the first 1,000 days; when proper development isn’t nurtured, the lasting health impacts and challenges often become insurmountable and irreversible.
Healthy Children Project and Egyptian colleagues Back row: Dr. Kajsa Brimdyr, Dr. Anna Blair, Dr. Karin Cadwell, Barbara O’Connor, Cindy Turner-Maffei, Dr. Amal El Taweel, Dr. Abla Alalfy Front row: Amira Saber el Sayed, Dr. Farida Mahgoub, Mohamed Akkad
“Although Egypt has made significant progress in reducing infant and child mortality, the World Bank Group reports that Egypt was expected to lose US$1.3 billion to chronic disease by 2015, with more than US$800 million lost in GDP each year due to vitamin and mineral deficiencies,” as noted by Turner-Maffei and Cadwell.
Read more about the startling and unacceptable health outcomes in their 2019 coverage here.
Targeting these shortcomings, the 1,000 Golden Days initiative specifically aims to support healthy pregnancies including ideal conception spacing, decrease c-section rates, implement skin-to-skin in the first hours and establish exclusive breastfeeding and responsive feeding practices including cue-based feeding, support continued breastfeeding through six months, with the addition of adequate, timely, safe and appropriate complementary foods at six months, and continued breastfeeding through at least two years, as laid out here.
The experimental phase of the project began in July 2022 in three provinces. The first phase of the initiative will be carried out in ten provinces through June 2024, extending to December 2025 during the second phase, serving 17 governorates.
I never considered myself much of a car person; that is until I discovered a vehicle with a personality and a vital mission.
This vehicle is decorated in “vibrant…indigo and white…featuring the components of human milk…[and] a snowdrop, known as the milk flower,” as described in this piece.
What’s more, the EV was “sustainably wrapped using water-based resin ink and PVC-free media.”
I first learned about the car on Amy Brown’s Breastfeeding Uncovered page. The EV is the product of a partnership between Swansea University and the Human Milk Foundation which set up a donor milk hub in Wales. The car runs donor milk deliveries and pickups across south and west Wales, expanding the reach of the charity Blood Bikes Wales, an organization that provides a free courier service to the NHS, as explained by Brown here.
Samantha Hoskins has been a breastfeeding peer counselor for 13 years, and since having a baby a year ago, she has donated over 15 liters of her milk to the mission. Hoskins is one of more than 100 women who have donated more than 250 liters of milk since the launch of the donor milk hub.
Photo courtesy of Hoskins
“I’ve always had a keen passion for breastfeeding; there isn’t enough done in our local health board to promote and help the new mums with breastfeeding so I always try to do what I can, help when I can…,” Hoskins says.
She continues, “I don’t think enough is known about breast milk donation. I know there are mixed views about it, so I try and promote it when I have a collection to try and normalise it. To show people that it is something that does go on, to show there is a need for it, to show that it’s something good, to increase knowledge, for realisation that it’s human milk for human babies…
not cow’s milk for human babies.”
Hoskins aims to express her milk once a day.
“I don’t stress about it,” she shares. “Whether it feeds one baby or two, it’s better than none is how I look at it.”
Hoskins goes on to explain the process of preparing milk for transportation which says is very easy: “I express into a bottle that the milk bank provides that also fits my electric pump. When I’ve finished, it goes straight into my freezer. I take a temperature check every day and document it in the paperwork they send. When I have enough for collection – at least two litres, I email the milk bank, they inform Blood Bikes Wales, who then contact me to arrange a
collection day and time. When they turn up, the milk is taken out of the freezer, the time is noted and put into the blood boxes that fit on the motorbikes. [It’s] then taken straight to Singleton hospital where it gets pasteurised and ready for babies.”
Many of our Our Milky Way interviewees launch into their advocacy for
healthy infant feeding after they’ve endured personal situations with their
own babies. This is not Crystal Grask’s, CLC origin story into the world
of breastfeeding though. Now the mother of a darling little one, Grask
serves as a Red Cross volunteer lactation counselor at Naval Base Rota
in Spain, but her road to breastfeeding started before becoming a
mother.
We’re pumped to feature this interview with Grask this week on Our Milky Way.
On discovering her passion for maternal child health…
I had really no insight into maternal child health until I found myself
interviewing for the Communications Coordinator position with the Rocky
Mountain Children’s Health Foundation and Mothers’ Milk Bank. Once I
obtained the role, I started working directly with Laraine Lockhart-
Borman, the then director of the milk bank…her staff… Donor Relations
Coordinators, Certified Lactation Educators, Doulas and more. I found
myself immersed in a totally new world and was soaking up the
knowledge like a sponge. Everyday I learned something new about
breastfeeding, donating human milk, or lactation and the impact these
things have on the mother-baby dyads and the families we served.
As I learned…I found myself becoming more and more passionate about
helping moms, babies and families have successful happy starts in life.
Through the RMCHF and MMB I learned about the the Lactation
Counselor Training Course (LCTC), learned about the importance of
breastfeeding, saw firsthand the impact donating and receiving donor
human milk had on mother-baby dyads and families, and was able to
observe and glean insight into dozens of parents’ feeding journeys
through the Foundation’s programming and milk bank’s weekly Baby
Cafe pregnancy and postpartum moms groups.
On completing the LCTC…
… Life happened, and I was unable to take the course during my tenure
at the [RMCHF], but the passion didn’t go away. It continued to blossom. I moved to Washington State where the course wasn’t offered,
but I remained passionate and steadfast in my desires using my
previous knowledge about breastfeeding/lactation to help providers (OBs
and Pediatricians) communicate with their patients about breastfeeding. I
knew I still wanted to work in this realm, and decided that once I was
able to obtain my CLC certification, I would like to pursue a private
practice.
In 2020, the course became virtual, which allowed me to start my
training! I started in December of 2020, and soon after, we moved to
Spain with the Navy. It was there I finished my training, in June of 2021. I
loved the virtual nature of the training and found – even when I was an
ocean away – I could tune in, interact during office hours, and complete
the course with ease. I really appreciated that!
On her own breastfeeding journey…
Flash forward five years… I found myself breastfeeding my daughter,
Julieanne, and having a rough journey. We started off feeding well,
resolving minor latch issues right off the bat. However, despite having a
small but adequate supply, she struggled to gain weight. Our pediatrician
immediately suggested formula supplementation, and I struggled with
that suggestion. My husband was a huge supporter of breastfeeding,
and also felt like there wasn’t a huge need to supplement. I was able to
reach out to prior colleagues… for observations, but neither of them
could find anything truly amiss. My daughter latches well and has always
been very healthy, but didn’t gain weight well no matter how much or
what we were feeding her. We discovered she has a very high
metabolism and strong passion for eating, so I found myself feeding
round the clock, triple feeding for a few weeks, and eventually settling
into a combo-feeding routine. While it wasn’t my picture perfect image of
how our breastfeeding journey would go, I am proud to say we’re still
largely breastfeeding and she’s gained a significant amount of weight.
Photo by Taylor Marie Photography
I hope to help moms receive the support I lacked in the immediate
postpartum. With consistent help and follow-up observations, perhaps
we wouldn’t have needed to supplement. I want to be that resource for other moms, to help them feel validated, encouraged to meet their goals,
and support them no matter what their feeding choices are.
On landing her volunteer CLC position at the naval base…
One of the first things I noticed after arriving at Naval Base Rota was the
multitude of pregnant women around. We were still living in COVID
times, and I quickly learned while there was support for moms to
breastfeed from a command standpoint, there were not many staff or
programs available to support the station’s breastfeeding dyads either in
hospital or at home postpartum. I knew I could help bridge this gap.
After exploring a few different avenues, I found I was able to sign up with
the Red Cross as a volunteer CLC at the Navy Medicine Readiness and
Training Command Rota (Naval Hospital Rota) Maternal Child Infant
ward! This role gives me the unique opportunity to help moms within
hours after delivering her baby, and help these dyads and families start
their feeding journeys feeling confident and supported.
On a typical day in this role…
I come in, check in with the nurse on duty or head nurse for a rundown
of our patients to learn about their delivery(ies), their baby, their current
health situation, and how feeding has been going thus far. I also ask if
mom/family has presented them with any concerns/questions about
feeding thus far, so I can be as prepared as possible when I first meet
with a mom.
After ensuring I have all the information/resources ready, I go meet with
the mom/baby dyad/ family. While in their room, we talk about how mom
is doing, I meet their new little one, and we go over how their feeling
about feeding thus far. I often provide latch assessments, and observe
feedings while in the room as well. Sometimes, during this, we’ll be in a
more relaxed setting, and mom will ask questions about any concerns
she has for when she goes home, which I answer or refer her to her
provider or the base’s Visiting Nurse if it’s a subject outside of my scope.
Once my initial visit is over, I will make a follow up plan with mom if
desired, then input notes and do any supplemental research for her. At
my follow up visit (usually that day or the next) I will give her any
resources we discussed and provide answers to her questions.
In the LCTC, we focused a lot on listening to mom, hearing her story and
using that, her experience and her health history to guide our
counseling. I think I use that often to meet moms where they are and
give them the care they deserve. I also find I’m teaching the asymmetric
latch often, even to second and third time moms! I also cover hand
expression and storage guidelines often. We get a lot of questions
around pumping and building a stash of milk for returning to work,
especially for active duty moms.
I have also started seeing postpartum patients in the hospital’s OBGYN clinic.
On unique challenges…
Grask at Rota Breastfeeding Week 2023 presenting topics like skin-to-skin and hand expression
I think there is a strong desire to help breastfeeding moms here, but
there is an apparent lack of resources, especially for postpartum moms.
The community has one Visiting Nurse who is a rockstar seeing many
moms daily, but she’s unfortunately the only one able to do so at the
moment. To help bridge this gap, I’ve gained approval to have a small
business, Asbury Breastfeeding Counseling, and am offering my
services to moms in the community in addition to my work as a
volunteer. I’m also working with the Visiting Nurse and hospital MCI
leads to host monthly breastfeeding courses at the hospital, promote the
existing pregnancy and postpartum support groups, and soon will be
offering a BYOBB (Bring Your Own Baby and Breastfeed) class at the
hospital for new moms to learn the various positions they can breastfeed
their babies in and be available to answer any questions/troubleshoot
any feeding/latch issues in person.
We also hosted Rota Breastfeeding Week helping educate the
community here on what is available for new moms and showcasing the
various lactation spaces. We also had a latch on nursing event.
On goals for next year…
Over the next year, I hope to reach more moms and families to help
them feed successfully… I know this community’s resources are slim. I hope to establish these classes and have imparted education to staff so
when I ultimately transition out of this station, I know I am leaving moms
with supportive providers who can help her achieve her goals.
Some favorite breastfeeding stories…
While working at the Mothers’ Milk Bank, I was able to sit in on several
Baby Cafe postpartum support groups. During a few of these groups, I
met a parenting duo and their little one. No matter what they did, this
mom struggled to make enough for her little one, but desperately wanted
to make breastfeeding work. I listened and observed them for weeks,
learning from their interactions as a couple, parents and individuals and
gleaning insights from the [lactation care provider] helping them.
Ultimately, I believe they began to feed with donor milk and formula, but
it was their journey and the persevering passion to help their baby and
family thrive that left an impression on me.
Here in Rota, I have been lucky enough to see a few of the moms I’ve
helped in early days several months postpartum. Two such dyads come
to mind. One was a new mom, baby born a couple weeks early had had
an ample supply of milk. Due to her baby’s early arrival, the baby was
transferred to a Spanish hospital where they received formula instead of
her breast milk. I saw her about five days postpartum and her milk
supply had fully come in but the baby was fussy and struggled to latch.
We worked on several techniques, including skin-to-skin care, cross-
cradle and football holds, asymmetric latch and also discussed ways to
pump/store milk. I was worried as this mom seemed to be ready to give
up quickly, but I ran into her six months postpartum and her once small
baby was now thriving on breast milk! It was a beautiful thing to see and
she is still breastfeeding.
In January, I served the family who had the first baby of the year. The
parents were first time parents, and had no idea what to expect or how
to navigate breastfeeding now their arrival had made her debut. Mom
and I worked on recognizing feeding cues, latching, promoting skin-to-
skin care, using dad for support, and discussed various ways to pump– hand express, manual, double-electric, wearables, to help her build a
supply later on. Soon after I had my own baby, I ran into this mom at a
moms group and found breastfeeding was going well for her! Her little
one was steadily gaining weight and she felt confident in her feeding
routine and encouraged by the support she had received early on. I was
elated at this update and so happy to see them thrive.
Personally, breastfeeding hasn’t been as easy as I’d like, but when I feed
it is the most wonderful, almost indescribable feeling. One of my favorite
stories I have is from my early postpartum days. I had been hanging out
skin-to-skin with her on the couch and accidentally fallen asleep. A little
while later I awoke — to a baby suckling on my breast! I had heard and
known about a baby’s natural instinct to find the breast, but I hadn’t expected her to seek it out and find it on her own when she was so new
to the world. Now she giggles whenever she sees my breast and is
especially excited for boob food time!
“I got to touch him once and they took him right away from me,” Northern Light Eastern Maine Medical Center labor and delivery nurse Jennifer Wickett says, remembering the birth of her first child 19 years ago.
Wickett desired non-medicated births, but her three children ended up being born via cesarean sections for various reasons. Wickett’s personal birth experiences coincided with her early professional life, working at a hospital in Massachusetts as a labor and delivery nurse.
At the time, she explains, the process was this: the baby was born, taken to the warmer, vitals and weight were recorded. The baby was wrapped in a blanket and held next to mom’s face for five to ten minutes and then taken to the newborn nursery.
Skin-to-skin in the OR, Healthy Children Project
“I hated that for my patients and I hated that for me,” Wickett says.
So Wickett singularly started changing that culture of mother baby separation.
Now, at Northern Light Eastern Maine Medical Center, Wickett attends about 95 percent of the c-sections, and she says she was able to “take control.”
“[Initially] I wasn’t tucking baby in skin-to-skin, but I was putting baby on top of mom with the support person helping hold the baby,” Wickett explains.
She deemed it the Wickett hold: baby placed chest down on mom with knees tucked under the left breast and baby’s head on the right breast.
Attending a Kangaroo Mother Care Conference in Cleveland galvanized her efforts: the evidence clearly supported skin-to-skin contact immediately after birth and beyond. Fellow nurses, anesthesiologists and other team members were resistant, but Wickett and a few other fellow nurses who created the Kangaroo Care Committee kept at it, always leading with kindness and communication. Rather than approaching the process with an “I have to do this” agenda, Wickett involves and acknowledges all of the participants in the room.
For instance, to the mother, she asks permission while also explaining the importance of skin-to-skin contact.
“They’re in hook line and sinker when I explain that their body regulates their baby’s temperature,” Wickett explains. “They don’t want to give that baby up; they are not letting that baby go.”
To the anesthesiologist, she facilitates open communication. Wickett lets them know that she assumes responsibility for the baby. “Are you good?” she often checks in with the anesthesiologist, while minding their space to work safely and efficiently.
Wickett makes certain to involve the partner in their baby’s care, asking them to keep a watchful eye over mom and baby.
Photo by Jonathan Borba
Just about half of the babies she sees begin breastfeeding in the OR, she reports. From the OR, babies are kept on their mothers’ chests as they’re transferred to the recovery room, continuing the opportunity to breastfeed. All in all, Wickett says that babies born by c-section at her hospital spend more time skin-to-skin than those who are born vaginally.
After a vaginal birth, eager nurses often disturb skin-to-skin contact to complete their screenings and documentation. Excited partners wanting to hold their baby tend to do the same.
In the OR though, Wickett says there are at least 30 minutes without these disruptions. Once mother and baby are transferred to the PACU, mothers report decreased pain when skin-to-skin is practiced.
What’s more, Wickett reports hearing often “This baby is such a good breastfeeder!” because the babies have an opportunity to initiate breastfeeding within the first two hours of life.
The World Health Organization (WHO) recommends that immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. The recent Skin-to-skin contact after birth: Developing a research and practice guideline synthesizes the evidence. [Read more here.]
Skin-to-skin, Healthy Children Project
Wickett and seven other colleagues had the opportunity to complete the Lactation Counselor Training Course (LCTC) last year.
While she says she would have loved to have been able to take the course in-person, Wickett still found the material and resources “fabulous.”
For the past four years, there’s been a vacancy in the perinatal coordinator position at her hospital, so Wickett hopes that her new credentials will allow her to fill the need. In the meantime, Northern Light Eastern Maine Medical Center offers outpatient lactation visits. The center’s breastfeeding support groups halted during the height of COVID and have yet to resume; Wickett reports that they are trying to bring those back virtually.
Additionally, Maine residents have access to the CradleME Program which
offers home-based services to anyone pregnant up to one year postpartum.
In partnership with the Mothers’ Milk Bank Northeast , Northern Light Eastern Maine Medical Center became the first milk depot in the Bangor area.
Residents and visitors of Southwest Kansas have the delight of enjoying the efforts of the Lactancia Latina en el Suroeste de Kansas, an organization formed in late 2018 with the nurturing of the Kansas Breastfeeding Coalition and Ford County Breastfeeding Coalition.
Photo by Rosalba Ruiz, used with permission from Latina/x Breastfeeding Week/ https://www.facebook.com/Latinxbreastfeedingweek
This week, with the help of Carmen Valverde, CLC, Local Coordinator at the Lactancia Latina en el Suroeste de Kansas and 2022 USBC Cultural Changemaker Awardee, we highlight the organization’s projects in honor of Semana de La Lactancia Latina.
At the age of seven, Valverde was an immigrant to the United States. Her passion to help the Latin community comes from not having the support she needed while raising her young children.
“I totally relate to the struggles the families in Southwestern Kansas face,” Valverde comments.
In partnership with Vigness Welding, NACCHO, UnitedHealthCare, Western Kansas Community Foundation, the Kansas Breastfeeding Coalition, and the City of Dodge City, Lactancia Latina en el Suroeste de Kansas coordinated the placement of several lactation benches throughout the Southwest communities.
The first bench was placed in Garden City because they have the largest zoo in the rural region. Each bench has a QR code with the Kansas Breastfeeding Coalition directory so that families can find the support they need based on their zip code, Valverde explains.
Photo source Lactancia Latina en el Suroeste de Kansas
Additionally, billboards were installed in high traffic areas. The billboards have information about where to find infant feeding support on social media and information about lactation in the workplace.
Alongside breastfeeding, soccer is Valverde’s other passion; Lactancia Latina en el Suroeste de Kansas is a proud sponsor of the Dodge City Toros and Atletico Liberal. Sponsorship was made possible by HealthConnect One.
Valverde has made it a point not to “reinvent the wheel” in the coalition’s efforts to support breastfeeding and become more visible.
“… I like to work and partner with other organizations and events so that we can both have the best outcome,” Valverde begins. “It just works out better that way… So far the public has received it very well. We’ve had more moms… get involved with our local coalitions as a result of it and the [local] newspaper has done a piece on [the sponsorship].”
During one of the most trying times during the pandemic, the coalition was able to accomplish the recording of a PSA with a local meat packing plant in Dodge City. Valverde says the plant, Cargill, does a marvelous job investing in their employees. Watch the video here.
Lactancia Latina en el Suroeste de Kansas provided scholarships to an all-Spanish breastfeeding training made possible through a NACCHO grant and partnership with Lactation Education Resources’s certified breastfeeding specialist training. Valverde reports that the coalition is currently planning an in-person skills day training so that the online training material can be reinforced.
Source: United States Breastfeeding Committee
You can learn more about these projects and Lactancia Latina en el Suroeste de Kansas’s future endeavors on Facebook.
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