There aren’t many states in the U.S. with lower breastfeeding rates than Alabama, but extraordinary efforts are being made by dedicated breastfeeding advocates to help change that.

This year, Baby Café Birmingham organizers Dr. Elizabeth Sahlie, MD, FAAP,  Dr. Jesanna Cooper, MD and Marcia Davis, IBCLC hosted The Lactation Counselor Training Program in Birmingham, Ala. to increase families’ access to lactation professionals.

The Baby Café Birmingham team was able to provide scholarships to community members to participate in the course thanks to a NACCHO grant. Scholarship recipients included anyone who was interested in volunteering at the Baby Café: mothers, current volunteers, labor, NICU and postpartum nurses, medical assistants, doulas, an operating room technician, a physics teacher and a high school student.

“In addition, we solicited medical students and offered them the training and a follow up summer internship in our office to help promote Baby Café and to help us develop ‘baby friendly’ office policies,” Dr. Sahlie says.

Thinking back on her medical training, Dr. Cooper reflects on the importance of lactation and breastfeeding training during medical school. She says that before she became a mother, she had no idea that her medical training and education had been so lacking.

“It is easy to become frustrated with nurses and physicians who – often

inadvertently­ sabotage breastfeeding mothers and babies, but I also sympathize,” she explains. “We are in a position where we are supposed to have answers, but no one has taught us the skills necessary to provide those answers.”

Becoming a CLC has allowed Dr. Cooper to “be more than a cheerleader” to her patients.

“I had hoped to recruit medical students and residents before they became busy physicians who don’t value breastfeeding because their education did not value breastfeeding,” she adds.

Baby Café Birmingham now has 21 more volunteers and will be able to open a second Baby Café on Birmingham’s East Side. Davis says the team is also looking into opening another Baby Café to accommodate working mothers.

The need

Baby Café Birmingham opened in February 2014 to address the infant feeding crisis in the south.

Dr. Cooper considers Alabama’s infant feeding challenges “extreme versions of everyone’s challenges.”

“Like the rest of the country, we have a medical community that is apathetic and, in some cases, hostile to the changes needed to support breastfeeding mothers and babies,” she explains. “Nursing in public is often shamed. Support is limited in most areas of our state, but in our particular community, access to support is almost non­- existent.”

“Our mothers return to work early and work in jobs where they are often too intimidated to ask for pumping accommodations,” she goes on. “Most of my patients don’t know anyone who has successfully breastfed and have only heard horror stories regarding breastfeeding.Our maternity and birth practices are high intervention and antagonistic to breast feeding. Alabama has some of the highest c-section rates in the country. We have high teen pregnancy rates and high rates of violence against women. All of this comes together in a perfect storm of maternal disempowerment, ripe for the marketing of breastmilk substitutes.”

After attending a ROSE conference with these challenges in mind, Drs. Sahlie and Cooper learned about Baby Cafés, a network of drop-in centers that provide mother-to-mother breastfeeding support.

“We were sensitive to the low breastfeeding rates among certain groups, especially African American women and low income women, and wanted to provide support targeted at these underserved groups,” Dr. Sahlie says.

Opening a Baby Café nearby also fulfills the need for an outpatient support group as their hospital pursues Baby-Friendly designation.

Networking

From the beginning, volunteers like Dr. Marquisha Jarmon and Marcia Davis, IBCLC were eager to help with the process. A local church agreed to donate space.

“It’s really been a whole village effort to get Baby Café going and to maintain it,” Dr. Sahlie says.

Before coming to Simon Williamson Clinic (SWC,) Dr. Cooper says she was unsuccessful trying to implement change toward breastfeeding friendly policies due to lack of collaboration.

“When I joined SWC,I had an ally and everything changed!” Dr. Cooper exclaims. “It is so hard to be a lone voice—one friend makes all the difference.”

Now Dr. Cooper serves on the Alabama State Breastfeeding Committee and the Regional Perinatal Council review committee. She is also on the board of Birthwell Partners and Mother’s Milk Bank of Alabama. (Check out their Facebook page here.)

“I hope that we will be able to offer banked donor milk in my hospital in the near future,” Dr. Cooper says. “The Milk Bank has been very supportive of Baby Café…We look forward to a long and positive collaboration with the Mothers Milk Bank of Alabama.”

Even more, Dr. Sahlie stays in touch with local pediatric offices and the WIC coordinator at the local health department to ensure community members are aware of Baby Café. ­

Continuity of Care

Drs. Sahlie and Cooper along with other members of their team create a continuum of care vital to mothers’ success with breastfeeding.

“It is really important that women are receiving good information and consistent information from early in the pregnancy on through to infancy and beyond,” Dr. Sahlie explains. “When I meet a mother in the delivery room or shortly thereafter, she has generally already made a decision about how she will feed her baby. That’s why the prenatal education is so important—so that each mother can make an informed decision. From there on out, it’s important that all the members of the medical care team are delivering a consistent message. If I’m telling the mother one thing, and she’s hearing different advice from the nurse and lactation professional, she is understandably confused and also gets the message that breastfeeding is complicated or difficult.”

Dr. Cooper also acknowledges the importance of continuity of care. Because she and Dr. Sahlie work in a multispeciality clinic together, coordination becomes easier, she says.

“We work together on hospital policies where in the past, pediatricians and OBGYNs have been pitted against each other,” Dr. Cooper says.

She gives this example:

I feel that our newborn glucose policy is insane and I know it works against breastfeeding. Beth knows the evidence on newborn glucose screening and can discuss that evidence intelligently in our department meetings. This is much more useful than me saying that the policy feels insane. I counsel and educate mothers during prenatal care and do my best to avoid birth practices that interfere with breastfeeding. Beth supports the mothers after birth in ways that I can’t, reassuring mothers that their baby is ‘getting enough’ and doing well. She and her partners do not assume that formula is the lowest risk solution to newborn feeding problems, and they provide close follow up after hospital discharge.

 

Success Stories

Thinking back to the Baby Café’s early meetings, Dr. Sahlie remembers one mother with a very sleepy one week old. The distressed mother was “on the brink of giving up,” she recalls.

“We quickly had the baby skin-­to­-skin and she was able to experience a successful feeding at the meeting that day,” Dr. Sahlie says. “She wound up being a regular attendee and breastfeeding for at least a year.”

“I think that she got some good advice at that meeting, but more than that she was able to form relationships with other mothers and see them successfully breastfeeding, and that made the difference for her,” she continues.

Dr. Cooper’s favorite success story is that of a mother who was concerned she wasn’t producing enough milk, so she stopped putting her baby to breast at four weeks.

Drs. Sahlie and Cooper encouraged her to come to Baby Café. She did.

“She was quiet, but seemed to enjoy listening to the other mothers,” Dr. Cooper remembers.

At a follow-up, she was exclusively breastfeeding again. Two weeks later when she returned to work, she received information to share with her employer and continued to breastfeed her baby for 10 months.

“My favorite memory is of a methadone mom who breast fed only to help lessen the withdrawal/ neonatal abstinence syndrome symptoms in her baby, who was small for gestational age, and a couple of weeks early,” Davis says. “Because the pediatrician knew this mom and had been her pediatrician, he allowed the baby to be discharged with her and follow up at his office and at Baby Café for weight checks.”

Davis recalls that even though this mother had to arrange rides to get herself and her baby to Baby Café, she continued to come for the weight checks until the pediatrician was satisfied with the baby’s progress.

“That mother struggled with a lot of things, but she worked hard at breastfeeding for her baby’s sake,” she says.

What’s next

Dr. Sahlie says she’d like to pursue promotion of lactation education in the medical school and/or residency Peds and OB/GYN curriculum.

Aware of the challenges that physician mothers face, Dr. Cooper says she’d like to become involved with a local Dr. Milk chapter.

She’s also interested in becoming more involved with family practice and rural medicine physicians addressing Alabama’s maternity care crisis.

“I see an opportunity to establish models of care more in line with family practice and midwifery models that support breastfeeding and can make a real and positive impact on the health in these communities,” she says. “I know that practice changes and access to maternity and infant care that focuses on low intervention and breastfeeding support can lower Alabama’s high maternal and infant mortality rates. I want to see this happen in my lifetime—dream big!”

You can find Baby Café Birmingham on Facebook.