A few weeks ago, I wrote about nursing my newborn at her well-child check up and our healthcare providers’ reactions.

While I express a glint of hope for our society, overall, it’s a rather angry post.

This week I’m happy to share with you a greater dose of hope for breastfeeding acceptance in our culture.

I recently came in contact with Jenny DeDecker, CLC, LMT a Kansas native who currently lives in a rural Michigan town. Having previously lived in California, she shares an interesting dichotomy between her California community and the one she currently resides in.

When I became pregnant in California, [my husband] and I had the option to interview multiple midwives. Their phone numbers were easy to come by and our friends and acquaintances had opinions and stories about their own midwife or their friend’s midwife. The one we chose to work with was also employed by the local medical clinic. We were encouraged to receive “parallel care”, meaning prenatal care from an M.D. as well as from a midwife. This type of care was very common and respected by both parties…The desired end result was the same for everyone: healthy mother and healthy baby.

When I moved to [Michigan], I knew that I wanted to have another child and that again I desired a home birth.  I had a very hard time finding a midwife and an even harder time finding a doctor who would offer parallel care. I was denied care by several doctors when they learned of my intention to have a homebirth with a midwife. Even though I began my search for care 12 months before I got pregnant, I was 18 weeks gestation before I finally received care from a medical professional.  In the same week, I met our midwife, and a Family Practice doctor who agreed to parallel care.

In California breastfeeding was so common that I rarely went a day without seeing a baby nursing in a public location, whether that be in an Ergo or Moby carrier, on a park bench, in a restaurant, at the beach, or in the grocery store.  Bottle fed babies were so few and far between, it was actually difficult to get advice from mothers on which brand or type of bottles were best. It seemed that most women with whom I interacted had little to no experience with bottles.

When we moved to Michigan, my daughter was 13 months old and still an avid nurser. When I nursed in public, I received so many stares that I actually started to believe that many of the residents here had never seen a breastfeeding dyad.

The perplexed expressions on their faces were similar to the ones I witnessed while visiting villages in Peru where the school children had never seen a person with light colored skin. I felt foreign in my new town. There seemed to be no other women nursing publicly. It was within this isolated state that my passion for breastfeeding blossomed. I had taken for granted the ease and normalcy of breastfeeding in California. Now I felt as though I stood alone, in a new community, with a toddler at my breast. I was motivated and affirmed by the sweet great-grandmother that approached me out at dinner one night, congratulating me on nursing my baby. My passion was driven deeper when the receptionist at the dentist office told me to cover up because there were “older men” scheduled to arrive shortly (I kindly refused).  I resolved then that I was not going to change for my community, but my community would change for natural, for healthy, and for right.

Discrepancies in breastfeeding acceptance occur for a variety of reasons; one outstanding reason being access to education, DeDecker comments. She makes an interesting observation that women are generally “given an opportunity to learn about breastfeeding, but it is offered when they are already pregnant.” Expectant parents may be offered breastfeeding pamphlets during prenatal visits and directed to classes but this is where the “support” ends in most communities throughout the States.

“This presents a major flaw in the system,” DeDecker says.

Maternity wards exhibit flaws that further discourage women from successfully breastfeeding. DeDecker, an aspiring doula, has attended births in both California and Michigan.

“…In California doulas are very common, so I had no hesitations being with friends through their labor, but I was a little nervous walking into the hospital for my first birth here [in Michigan],”  she explains.

But to DeDecker’s surprise, the medical staff was receptive to her requests as acting doula.

“The nurses seemed happy to have me there because the floor was packed with laboring women and they were stretched pretty thin,” she says.  “I think they appreciated knowing that someone was with this mother, helping and supporting her.”

While DeDecker says she believes women are generally given great care at Dickinson County Memorial Hospital, the local maternity hospital, she adds that it is apparent that natural, normal birth “is not what they normally see.”

“Women are still routinely hooked up to monitors and IVs. There is one birthing ball on the entire floor. There are showers but no bathtubs. Women are offered water, ice and popsicles only. VBACs are against hospital policy and the use of Pitocin is incredibly common,” she reports.

It isn’t breaking news that the overuse of intervention during labor and birth directly affects a mother and baby’s ability to breastfeed. Like too many other maternity hospitals, Dickinson Memorial offers extremely limited lactation support postnatally.

Families in DeDecker’s community are up against other challenges.

For instance, women have been formula and bottle-feeding for at least two or three generations.

“Many women having babies right now have never observed a baby feeding at the breast,” DeDecker explains. “It is hard to expect our new mothers to try something so different from their understanding of the way things are. People in this community are rooted deeply. This quality makes Upper Michigan special, but at the same time, makes change difficult.  ‘I was formula fed and I turned out fine’ is a difficult mindset to work with.”

Fortunately, DeDecker is anything but discouraged. As a massage therapist she says she in in a “constant state of wonder and amazement… as [she studies] and observe[s] the human body.”

“I will never stop being in awe of its innate power and ability,” she continues. “Considering the manner in which people so blindly trust their bodies on a day to day basis, it is bewildering how something as natural as breastfeeding became an issue of question.”

Because breastfeeding has become stigmatized, DeDecker completed Healthy Children Project’s The Lactation Counselor Training Course to become better equipped to change the breastfeeding dynamic in her community. Having been discouraged by the rigidity of the IBCLC program, DeDecker “was very excited to find the CLC training.”

Besides expressing excitement over learning about the growing number of Baby-Friendly facilities, DeDecker says it was energizing to be surrounded by so many people working toward a common goal.

“It has been easy for me to feel somewhat isolated in my community and before attending the training, my goals seemed difficult to attain,” she says. “I left the training with the motivation and support that I needed to return to my community with confidence that this paradigm shift is possible.”

DeDecker has started networking in her area since completing the training. So far she has met with a WIC breastfeeding peer counselor, a WIC nurse and family practice physician “who is extremely receptive and excited about any changes in the direction of normalizing breastfeeding.”

“What I seem to be finding is that there are a lot of health care providers who want this shift to happen, but they have been waiting for the spark to start the fire,” she says. “Maybe that’s what my purpose is?”

DeDecker offers  lactation counseling to clients at Dr. Kerry Niebrzydowski’s, ND Radiant Natural Health Clinic where she practices massage and bodywork as well as at a chiropractic office.

DeDecker offers lactation support and education, pre- and post-natal massage and infant massage through her own business, Full Moon Rising Maternal Health Services.

Eventually, DeDecker says she would like to operate as a natural maternal health center where clients can enjoy pre, peri and postnatal care. She has plans to create a community space for breastfeeding and childbirth education, yoga, meditation and retail space for natural products and therapies related to pregnancy and maternal care.

Meet Healthy Children faculty Jenny Spang, CPM, IBCLC, CLC! Jenny has worked with mothers and babies for over 20 years. She shares her story about how she became interested in maternal child health and her thoughts on the current birth and breastfeeding culture in our nation.

When Jenny was 15, her dog went into labor after dinner one night. Her parents stayed awake to see the first puppy born. Jenny, completely fascinated by the birth process, stayed awake the remainder of the night to witness the arrival of the entire litter.

“It was miraculous to me to that she knew just what to do,” Jenny says of her laboring dog.

At this moment, Jenny decided she would become a midwife. Her journey wasn’t as clear-cut as the intention though.

“It took lots of twists and turns,” she says.

Jenny started looking into what it would take for her to become a midwife. In the early 1980s, her options were very limited with only a few university-based nurse midwifery programs in the nation. Realizing the commitment to become a CNM she thought, “I might as well become an obstetrician. Then no one would tell me what to do.”

Once enrolled, she quickly realized that the very competitive nature of the other pre-med students wasn’t the right environment for her.

Eventually, Jenny graduated with an anthropology degree. During this time she fell in love and moved to northern Vermont where she and her partner built a log cabin and lived off the land. She became pregnant with her first son.

“I had a wonderful pregnancy and I was very confident about my ability to birth at home,” Jenny recalls. But after four hours of pushing, her midwife recommended they transfer to the hospital.

Jenny delivered her healthy baby just 45 minutes after being admitted into the hospital. She was discharged four hours later and continued her postpartum care in the privacy of her home.

“It ended up being a pretty darn good experience,” she says. “But it still took me a while to process and to grieve the loss of the ideal homebirth I had envisioned.”

Jenny’s birth experience resparked her interest in becoming a midwife. She studied independently and several years later became certified as a Professional Midwife.

Jenny took on other roles like WIC Breastfeeding Peer Counselor, Childbirth Educator, Doula, Family Planning Specialist, Community Health Educator and home visitor for pregnant and parenting teens.

While working as a home visitor, Jenny started her journey to become an IBCLC. She interned at a local hospital and took Healthy Children’s The Lactation Counselor Training Course.

All aboard

“I was so impressed with that class,” Jenny says. “I learned things…that I had never learned before, and I also got the evidence for things I had learned that I just always thought were common sense.”

After completing her CLC training, Jenny delved into Healthy Children’s “Train the Trainer” course to become more confident training other professionals.

Thanks to the CDC’s campaigns combatting our nation’s obesity epidemic and interest in breastfeeding as a preventative measure, “breastfeeding burst at the seam,” as Jenny puts it. More than ever, people are interested in the significance breastfeeding has on our nation’s health. Healthy Children serves as the largest national provider of lactation management education for health care providers.

“The CLC class trains tons of people all over the country,” Jenny says. “We need everybody to know this stuff.”

And the need is incontestable because our culture often ignores and invalidates the important bonds being formed during pregnancy, birth, breastfeeding and early childhood, doing families and our future a great disservice.

“I’m seeing that the beginning [of life] is a necessary foundation for how it ends,” says psychologist and author Dr. David Chamberlain, Ph.D. in a Peaceful Parenting interview excerpt.

Influencing our future 

Dr. T. Berry Brazelton, M.D. focuses on the parent child relationship through touchpoints. Pregnancy, birth and breastfeeding are all touchpoints that will influence the future health and wellness of families, Jenny comments.

“Birth is a huge touch point that sets the stage for how the mother feels about herself and her ability to parent,” she explains. “That’s why it is so important women have support through the labor and birth process.”

Jenny acknowledges, as she experienced firsthand, that birth can’t always go as planned. However having good emotional support through whatever the outcome preserves a mother’s positive feelings about herself and therefore offers her confidence in the way she will parent her child.

The same goes for feeding her baby; a mother must feel supported in whatever her infant feeding choice.

“We need to feel supported in our decision because it makes us feel capable for of providing that foundation for our children in a way we feel good about,” Jenny explains. “For so many women, if they don’t get support through their birth experience and desire to breastfeed, they end up feeling guilty, like they have failed and that’s just so wrong and devastating.”

The newborn period is yet another touchpoint.

“One really important thing that lactation professionals and doulas can do is to protect that sacred time after the birth when mothers and babies get to know each other, bond and begin their relationship with uninterrupted skin to skin contact,” Jenny says. “Even when the support that women get through pregnancy and birth is not ideal or when medical circumstances truly prevent the optimal birth plan, skin to skin in the first hour-or as soon as possible when mother and baby are medically stable- is tremendously healing. The research clearly shows that continuous skin to skin after the birth until after the first feeding mitigates the negative effects of labor interventions on successful initiation of breastfeeding.”

Even more, skin to skin has been shown to affect the relationship and interactions between the mother and child for the first several years of life and probably thereafter as well, Jenny goes on.

“After being disempowered through their birth experiences, is it any wonder we see such high rates of postpartum depression at the beginning of motherhood?” Jenny wonders. “The statistics about postpartum depression and post traumatic stress disorder as a consequence of childbirth are truly tragic. So many women start their relationships with their children suffering from trauma. This is a broken system that needs to be fixed.”

Fixing the system

Healthy Children’s CLC course raises questions about the impact of current maternal child health care practices and inspires participants to explore how they can change policies to support best practice.

“I’m always really inspired by all of the the different people that come to these classes,” Jenny says. “There are nurses, WIC staff, doctors, midwives, nurse practitioners, doulas, childbirth educators, speech/language pathologists and moms with no medical backgrounds. It’s really exciting that all of these people want to help make it easier for mothers to succeed with their breastfeeding goals and they all bring different skills.”

CLC participants are encouraged to consider health outcomes, Jenny continues.

The Joint Commission’s Core Measure Sets include increasing exclusive breastfeeding rates but also decreasing inductions and elective cesarean sections because of the negative health outcomes associated with unnecessary intervention.

“It’s about all of us recognizing the consequences of current practices and changing to evidence based best practices so that interventions are used only when medically appropriate,” Jenny explains.

Jenny sees the Baby-Friendly Hospital Initiative and its ten steps as having the potential to drive positive change, including allowing more mothers to have normal physiological births.

It is Jenny’s dream to see hospitals “go to the next step” to include Mother-Friendly hospital practices.

“It’s up to us to reinforce for the mother that she is strong and powerful,” Jenny says. “She is the most important person in [her] child’s life.”

If you need just one reason more to attend Healthy Children Project’s upcoming International Breastfeeding Conference, here she is: Christine Rathbun Ernst. The poet, playwright, performer, mother, wife, breast cancer survivor is sure to shake you to your inner core (or make you laugh at the very least) with readings from her latest book, Wild Fortune: Moving Pianos in Paradise, a collection of stories and monologues about family, motherhood, feeling fat, drinking wine, and dumb luck.

With unfettered confidence, she shares her intimate life moments making sense of the world and how she fits into it.

Rathbun Ernst performs “My Neighbor and Her Large Dog”- scene one of Fat Ass Cancer B!#&h.

“I need to find the humor in it. This is crucial,” Rathbun Ernst says. “…I need to share it with other folks to make sure it’s not just me; that this happens to everybody, right?”

Family loss, a failed marriage, and cancer provoke the rawest of emotions; she confronts and shares those deep struggles in an “extremely engaging, entertaining and, by turns, hilarious, riveting and deeply affecting” manner. [http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20130707/LIFE/307070324/-1/rss21]

In a 2009 MAMM article Rathbun Ernst is quoted: “Being on stage and performing some of the painful scenes … I’m catapulted back…and that fear and terror is quite visceral.”

Since then, Rathbun Ernst has performed some of her work dozens of times, reliving the hardship of being diagnosed with cancer over and over. Still, the act of sharing heals.

“It is simple: we suffer because we don’t share the story,” Rathbun Ernst explains. “We require connectedness. The reassurance of the universal experience.”

“I was helped so often when I was sick by the gift of someone else’s story,” she goes on. “It gave me perspective and context and somehow made the ordeal safer, less terrifying. And I have this sneaking suspicion that if I stop sharing my own story, I’ll get sick again. Some trick! I am sort of charged by my own health and good luck to pay it forward in this way.”

She hopes her storytelling inspires others to share theirs.

“…Maybe [the audience will] hear a version of their own story and share back.”

While Rathbun Ernst’s stories are told from the perspective of a “mid-menopausal not-skinny regular old middle-aged woman,” her commentary really translates to the human experience in general.

This “bad-ass, fat-ass, amazon, warrior, revolutionary and, loath as she may be to use the term, breast cancer survivor,” as writer Carol Panasci calls her, breastfed both of her daughters: daughter Marney before her single mastectomy and daughter Julia after.

Life with one breast is surprisingly like life with two breasts, Rathbun Ernst says.

“It turned out to be a matter of supply and demand,” she says of feeding Julia from one breast. “Turns out I possess the Little–seriously, little– Breast That Could.”

Julia just turned five-years-old, still nursing occasionally, and weighs 60 pounds.

“Imagine how big she’d be if I’d had two breasts,” Rathbun Ernst says.

Not only surviving but triumphing over the tragic illness, Rathbun Ernst reflects on the reality of health care in our nation and the importance of breast cancer prevention as opposed to treatment.

The general public should know that breast cancer is an epidemic and every teenager needs to know how to do a breast self exam, she says.

“…The ounce of prevention — exercise, diet, breast self exams, affordable genetic testing, meaningful research into chemical causes — is worth pounds and pounds and pounds of ‘cure’ – the effects of chemo and radiation, the Big Pharma wars, the cosmetic surgery industry (google TRAM flap and check out potential side effects), the wigs, the prosthetics, the Pink Ribbon industry,” she explains. “The ribbon generates lots of cash for research, but it generates exponentially more in corporate profit.”

Choose to Pink wisely, she advises.

Although her breast cancer coverage is essential, Rathbun Ernst’s upcoming performance will focus mainly on her mother monologues.

“I’m looking forward to hanging with a bunch of smart women who are doing good work in the world,” she says.

Rathbun Ernst performs her work regularly on stage and at open mics and has been featured in MAMM Magazine, The Cape Cod View, Cape Cod Magazine, and in the literary journal Ars Medica. Two of her plays have been named Massachusetts Cultural Council Grant Finalists.

Rathbun Ernst spends her summers performing as the Fat Ass Cancer B!#&h at Cotuit Center for the Arts, where she also teaches writing classes. She lives in Sandwich, Mass. with her husband sculptor Michael Ernst and their daughters. [Retrieved from: http://www.healthychildren.cc/conferences3.htm]

Join us for this unique and unforgettable performance Thursday, January 16 from 8 p.m. to 9:30 p.m.

Admission by donation to your choice of two breastfeeding charities. Drop your donation into the jug of your choice and help us fill the jugs.

Cash bar will be open!

To register, please click here.

To view more of Rathbun Ernst’s work, visit her YouTube channel at: http://www.youtube.com/user/fatasscancerbitch

My little Iris sounds a little like an exotic bird when she’s irritated. She squirms a bit, her face scrunches and she lets out one startling, little squawk. Thirty minutes early for her well child check up (don’t ask me how that happened), she and I found a seat in the waiting room across from the bubbling fish tank when I noticed her feathers starting to ruffle. I quickly offered her the breast. But before she could even get a few gulps down, a nurse came rushing over and escorted us into our exam room.

“I just figured it would be more comfortable for you in here,”  she explained.

Trying not to be overly skeptical, I thanked her and continued to feed Iris. But as she ate, I grew more and more dubious. It’s hard to know if the nurse’s intentions were pure. Nonetheless, I was insulted having been hidden away to feed my baby in private when I was perfectly comfortable nursing in the waiting room.

Things have admittedly changed since becoming a mother of two. Instead of hiding in my car to breastfeed, I’ve finally mustered up the confidence to feed my baby in public thanks to inspiring articles like Chantal Molnar’s Breastfeeding and Feminism:

“America has an uneasy relationship with breastfeeding and has a hard time facing the duality inherent in breast’s function. Sex versus nurture, or sex and nurture? We don’t seem to have any problem with the duality of our mouths, which can be for sex and for eating. We do not make people cover their heads with a blanket when they are eating in public simply because the mouth is frequently used sexually.”

Iris and I waited for the pediatrician as I glared at Abbott logos on patient handouts and warnings about the perceived dangers of bedsharing cluttering the walls. The doc entered. Measurements taken. Questions asked and answered. Goodbyes and see you next times.

Before packing up, Iris was ready to nurse again.

“I’ll put a flag up so people know you’re feeding,” the ped told me with a smile. “Just leave the door open on your way out,” closing it behind her.

A flag? Is that really necessary? I thought, rolling my eyes.

I resent the fact that our birth and breastfeeding culture has turned me, an otherwise benefit-of-the-doubt kind of gal, into an angry, cynic questioning the motives of potentially well-intentioned people.

Furthermore, I resent that we should even have to consider spending the time and money creating or designating special breastfeeding rooms (except for pumping mothers). Our culture has even forced us to devote time, money and energy into creating laws (with virtually no enforcement mind you) to protect a mother’s right to feed her baby and her baby’s right to eat. This is crazy.

And although nursing rooms are received well by many, the only benefit I see is that they offer containment for mothers with curious, wandering toddlers while their siblings feed. However, there’s a difference between choice of convenience and the expectation that nursing mothers tuck themselves away.

There’s more. Not only are we failing already breastfeeding moms with unsupportive breastfeeding behavior and policies, we’re setting up potential parents for failure when we expect discretion from breastfeeding moms. It’s rather simple: Breastfeeding begets breastfeeding, bottle-feeding begets bottle-feeding. (Here’s a great post about the problem with nursing covers: http://rixarixa.blogspot.com/2011/11/problem-with-nursing-covers.html)

If we really want our breastfeeding initiation and duration rates to continue to rise, if we really want  mothers to feel empowered by their choice to breastfeed, if we really want to produce a healthier future, we have to stop treating nursing dyads like lepers or at the very least, stop assuming that we want privacy.

When Iris and I returned home from her appointment, the girls and I took advantage of the balmy, 40- degree- Wisconsin weather. Willow admired her boot prints in the slushy snow and built “sand castles”. Iris nursed again through her bundles.

The neighborhood boy, enjoying the weather too, greeted Willow excitedly. He had just returned from his birthday party at the public museum and was thrilled about his dinosaur egg he’d scored. He also got a new bike. Maybe distracted by the delight of his party and fancy gifts, he didn’t even notice Iris feeding. In fact, he didn’t notice there was a baby there at all.

Or maybe it’s because breastfeeding isn’t a big deal. (Eat the Damn Cake blogger Kate Fridkis agrees: http://www.huffingtonpost.com/kate-fridkis/i-dont-care-what-you-think-of-me-breastfeeding-in-public_b_4173435.html) Still, our culture has perverted the simple act of feeding our children so that nursing mothers and babies are exiled to private areas wrapped in caution tape (or a flag). Beware. Do not enter. Feeding in session. Enter at your own risk.

If an eight-year-old boy, who normally giggles at butt jokes and flatulence, can respect a mother feeding her baby, I am hopeful that one day our society will too.

What do you think? What is your experience with nursing in public? Please share your comments below.

Healthy Children faculty Donna Ellis, RN, MSN, IBCLC has spent the past 30 years living and working in Germany with the U.S. military. For six years, she served on active duty in the Army Nurse Corps, working in general medicine until she and her husband started their family.

Much of Ellis’ nursing career was spent working in community health in the late 80s and early 90s.

“The community I served was composed of frontline soldiers, tankers and people from lower socioeconomic backgrounds,” Ellis says. “Domestic violence and poor knowledge of child rearing skills prompted me to look at the impact of breastfeeding and skin to skin contact.”

Observing a wide variety of parenting approaches and skills, Ellis asked herself, How do you get mothers and babies close to each other?

“I just wanted some way for mothers and babies to have closeness and to fall in love with one another,” she says.

At this time, WIC was not present in the U.S. military communities abroad and many individuals were struggling to put food in their babies’ mouths. While some fought for WIC services like artificial baby milk substitute aid, Ellis thought, This breastfeeding thing is a really reasonable way to do this.

Ellis’ personal infant feeding experiences influenced her professional ventures. She breastfed her eldest son but due to extensive traveling for work, she formula fed her second son. She acknowledges very different health outcomes between her children.

“There has to be a connection there,” she says.

After certifying as a lactation consultant, Ellis created a lactation professional position at the Heidelberg military hospital.

She was also instrumental in working with staff to become a Baby-Friendly (BFHI) certified birthing facility.

“It was painful at times and it was frustrating at times,” Ellis says of implementing BFHI. Becoming Baby-Friendly is never an effortless task, but Ellis explains the challenges unique to certifying a military hospital.

“Our staff turned over every three years; a third of our staff went away,” she says. “Our [hospital] CEO changed every two years.”

Staff training is often one the biggest concerns and challenges for hospitals, especially those with such high turnover rates. The online format of the 20 hour course made training simpler, more efficient and more accessible.

Heidelberg’s high turnover rate had an “up” side. New staff members had little say in their training so implementing changes in policy and practice was sometimes made less difficult.

“The Ten Steps are powerful and no matter what your resources are, [Baby-Friendly status] is possible,” she says.

Ellis also spent some time working at Landstuhl Regional Medical Center in Germany. Here, she encountered a “crusty obstetrician” who was very skeptical about taking The Lactation Counselor Training Course.

“He sat there with his arms crossed,” Ellis remembers. But after being presented the information, his mind quickly changed about the importance of skin to skin contact and breastfeeding. He has been highly influential in keeping babies delivered by cesarean skin to skin with their mothers immediately after birth.

Ellis sometimes finds other CLC participants in similar situations.

“You often start out with a group of individuals who aren’t sure they want to buy into this information and they come with feelings and judgements and uncertainties,” she explains. “But by mid-week you can just see the light switches go on; ‘Oh my gosh, I can do something about this.’ They’re ready to make a difference.”

Ellis is “very optimistic” about the future of maternal child health for these reasons.

“Healthy Children Project is a huge part of that because of the information they put forth and the lives that they touch,” she says. “I see them making a huge difference.”