Blue Cross Blue Shield of Tennessee team advances lactation care

A few years ago, Blue Cross Blue Shield of Tennessee (BCBST)’s Supervisor of Maternity Case Management Amy Griffin RN, BSN, CCM, CLC completed the Lactation Counselor Training Course (LCTC) in an effort to bring more lactation support capability to her team. Having been a nurse for 25 years, she says she found herself blown away by the comprehensiveness of the course. 

“It was just so impactful to me,” Griffin begins. “It totally changed the way that I taught our members.” 

Griffin goes on to say that she felt very strongly about getting as many of their nurses certified as possible, to better serve their members.

Photo by Sergey Zolkin on Unsplash

Set to host in March 2020, the LCTC was cancelled due to COVID-19. 

“Truthfully I was devastated at the missed opportunity for our staff,” Griffin shares. 

Not long after though, Healthy Children Project launched the online LCTC for the first time ever. 

Griffin calls it their “wonderful silver lining” as they were able to enroll the majority of their team.

With three nurse case managers previously certified, seven additional maternity nurse case managers have enrolled in the LCTC or completed the course to date. Seven NICU nurse case managers have enrolled as well. 

Of those nurses is BCBST Nurse Case Manager Rebecca Provine, RN who says that she has been able to implement her education immediately into practice. Most notably, Provine shares that the course has allowed her to weed out “old wives’ tales” for her members and practice purely on an evidence-based agenda.

In January 2020, BCBST launched their maternity care digital platform where members have access to perinatal support including breastfeeding care.  

“It’s been amazing being able to connect better to our members,” Provine shares. 

Especially in light of the COVID-19 pandemic, it keeps care providers and their members connected through an otherwise isolating experience. 

Provine points out that sometimes the support she offers feels small and intimate, but that it has lasting impacts. 

Photo by Reynardo Etenia Wongso

“Ultimately, we want people to live their best lives,” she says. “This is a great way to start.” 

Provine also notes that the LCTC offers a great launching pad for working toward national and global efforts like the Baby-Friendly Hospital Initiative (BFHI) and obtaining goals like those detailed in the UN’s Sustainable Development Goals (SDGs).

BCBS Tennessee made a specific commitment to expecting families in 2016 when they launched their Healthy Maternity program  and continue to enhance their commitment to their members.

Griffin highlights BCBST’s mission statement: “Peace of mind through better health.”

“I feel like we live up to that,” she says. 

While she notes the benefit of the online LCTC platform, Griffin says it’s still a big goal of hers to host the in-person course in the future.

Support the Providing Urgent Maternal Protections (PUMP) For Nursing Mothers Act


Source: United States Breastfeeding Committee.

Among 41 nations, the U.S. is the only country that does not mandate any paid leave for new parents. So, as long as we accept this structural agreement where parents and their infants/young children are separated for extended periods, it is imperative — both biologically and morally — that we make workplace accommodations for lactating people, explains U.S. Breastfeeding Committee (USBC) Deputy Director Amelia Psmythe Seger.

Accommodating lactating employees requires only simple arrangements, and decades of experience show that it is possible to support the expression of breastmilk in a wide range of workplaces.  

In 1998, Minnesota enacted the first state workplace lactation accommodation law, and since then, different states have been working on various approaches. Among these, in 2005 and 2007, members of the Nursing Mothers Counsel of Oregon, including Psmythe Seger and other passionate advocates, alongside then State Representative Jeff Merkley, worked to pass legislation that requires workplace accommodations for nursing mothers in Oregon.

Source: United States Breastfeeding Committee.

Then in 2010, when Merkley was a brand new U.S. Senator, he proposed the Break Time for Nursing Mothers provision, which passed unanimously out of a bipartisan committee.

USBC Senior Advocacy & Communications Manager Cheryl Lebedevitch says that it’s been rewarding to work on legislation built from the community level and up to a national framework.   

The Break Time provision was the first time federal law addressed breastfeeding workers.

Tempering the celebration, however, Psmythe Seger recalls that because of the placement of the provision within the Fair Labor Standards Act, the legislation unintentionally excluded nearly 9 million workers, including teachers and many registered nurses. 

“It was pretty devastating,” she recalls. “What we thought was a giant step forward was going to be inadequate, so we went right back to work.” 

Currently, USBC is working with partners at ACLU, A Better Balance, Center for WorkLife Law, and passionate advocates across the country to pass the Providing Urgent Maternal Protections (PUMP) For Nursing Mothers Act. This bipartisan bill would close this coverage gap and strengthen enforcement of the Break Time law. 

Source: United States Breastfeeding Committee.

Each year, Lebedevitch says, advocates build and strengthen congressional relationships while listening to parents and employers about what is working and what could be improved. These insights have allowed us to strengthen the bill language and associated advocacy materials each congressional session. 

All of that work is paying off. The bill has been advanced by the House and Senate committees, clearing it for a vote. Now, USBC urges advocates to raise their voices so that Congressional leaders will bring the bill to the House and Senate floor for a vote. Getting involved and showing support is easy, thanks to USBC online tools and suggestions.

Both Psmythe Seger and Lebedevitch emphasize the importance of storytelling to move this legislation forward.

Source: United States Breastfeeding Committee.

“Stories from families are so powerful,” Lebedevitch begins. “They can make the difference between a bill becoming a law or not.” 

Local breastfeeding coalitions can make a big impact with their own story tools, Psmythe Seger goes on to point out. Coalitions provide insights and compelling connections for legislators about the constituents they serve, she explains. Parents’ and employers’ stories alike help demonstrate where and how lactation accommodations are working.  

In all of their iterations, workplace laws were intended to have flexibility built into them, Psmythe Seger says. The Office on Women’s Health provides an online resource that breaks down potential lactation space solutions in all industry sectors. 

Source: United States Breastfeeding Committee.

Lactation accommodation can look like a screen partition set up in a warehouse, a pop-up tent in a field, an empty cubicle space in a library, and even butcher paper taped up over a window for privacy. 

 There are also businesses that go above and beyond existing laws, knowing well that there is a strong Business Case for Breastfeeding 

For instance, Psmythe Seger describes a company that provides employees with a stipend to bring along their infant and child care provider while traveling for work or covers the cost of shipping milk back home. 

Lebedevitch points out that Breastfeeding-Friendly awards, often offered through health departments and breastfeeding coalitions, can be a great way to lift up breastfeeding support. 

“The awards can really dig in and see who is doing this right and for [individuals or other businesses] to find examples,” she says.  

Source: United States Breastfeeding Committee.

The Missouri Breastfeeding Coalition’s Breastfeeding Friendly Worksite Program, the Michigan Breastfeeding Network’s tool pages list Breastfeeding Anytime- Anywhere sites, and the South Carolina Program for Infant/Toddler Care’s (SCPITC) Breastfeeding Friendly Child Care designation program are all great examples of lifting up the businesses supporting families. 

Because the challenges families face are ever-evolving, Lebedevitch explains that break time for nursing parents is just one piece of the larger puzzle

“PUMP is a big priority for us,” she begins. “But it’s not the only priority.” 

The lactation field has identified several important policy priorities for this congressional session, including federal funding for breastfeeding, infant and young child feeding in emergencies, paid family and medical leave, access to lactation support and supplies, and maternity care practices. Together, these policy changes can create the critically needed structures that support an equitable and healthy nation.

“Infants who have optimal nutrition and warm and healthy attachments do better across the lifespan, and everyone has a stake in that,” Psmythe Seger concludes. “The connection and harmony within families ultimately become communities that are mutually supportive and [influences] public health outcomes.”

It’s Pride Month! Working to close the gaps in LGBTQ+ Care

Breastfeeding Family Friendly Communities of Durham (Breastfeed Durham) is a health equity advocacy group that formed in November 2018. 

Amber Crews, chair of LGBTQ+ Human Milk Feeding with Breastfeeding Family Friendly Communities of Durham (BFFC), started as a  “backseat” member of the team in the organization’s infancy while she parented her one-year-old. 

“From the beginning, I provided a voice as a lactating member of the LGBTQ+ community,” she explains. 

Then, a few months after the COVID-19 pandemic was recognized, Crews became chair of the equity committee.

“… I channeled some of my pent-up energy by chairing an official equity committee dedicated to representing the LGBTQ+ lens regarding human milk feeding,” she says.  

Crews explains that the committee’s early accomplishments included compiling resources in a user-friendly format so that LGBTQ+ folx and those supporting them could have a centralized platform to reach inclusive information and established/vetted providers who are affirming, LGBTQ+ friendly, and knowledgeable.

So far, the resource list includes the Directory of Local Support , National Lactation Support Resources for LGBTQ+ Families, and National Lactation Support Resources for Medical Providers  and they continue to welcome and research additions. 

“It was really cool to get some national inquiries/re-posting our resource lists shortly after publishing them on our website,” Crews highlights. “Even with all the advances in equity work right now, when it comes to a centralized resource list for chestfeeding/human milk that is truly inclusive to all the varied LGBTQ+ families out there, pickings are slim. The fact that our very small team of volunteers put together something that caught people’s attention in the wider-internet world is saying something. There is a need, and we have only begun to address it.”

In addition to Breastfeed Durham’s lactation support for LGBTQ+ families and medical providers, the organization created 10 steps that detail what it is to be a Breastfeeding Family Friendly community complete with a proclamation by the mayor supporting human milk feeding. Without diminishing these successes, there remains room for growth and improvement in regard to supporting LGBTQ families.  

For instance, Crews explains that “there is still so much work to be done in educating providers working with LGBTQ+ families, educating family members and other support people, and getting all the information that’s out there to individuals about the benefits of chest feeding, the possibilities for situations like induced lactating, all the different ways to give our babies human milk and how important it is.” 

In an effort to fill support voids, Crews held several months worth of virtual Milky Pride & Play gatherings and hopes to continue the meetups once more families feel safe convening in-person again.   

Breastfeed Durham held a  community-wide “Gaps in LGBTQ+ Care” meeting this month which started to explore just that– gaps in care for LGBTQ+ families.

“Among other things, having a more centralized place for LGBTQ+ families to meet and socialize seemed a priority,” Crews reports.

Crews completed her La Leche League Leader certification last year making her the only lesbian leader in her community. 

“I’m hoping with time and word of mouth, more and more lactating folx will learn that there are options for support that they can trust. . . and that Milky Pride & Play can become a peer-to-peer support group that more know about and attend,” she shares. 

Crews continues, “I’m excited to see this work grow and help more babies get more human milk!” 

The Institute of Family & Community Impact hosts event to boost paternal mental health

Photo by Humphrey Muleba on Unsplash

Several years ago, the American Psychological Association released a poignant video called Boys Don’t Cry  which briefly explores the negative impact of stereotypical expectations of masculinity.  

“There are so many things that shape each person’s idea of masculinity, from social norms to cultural influences,” as NICHQ Senior Project Director Kenn Harris explains in Promoting Fathers’ Mental Health During Children’s Early Childhood.

These forces have the potential to impact fathers’ mental health, and research shows that one in 10 fathers get Paternal Postpartum Depression (PPPD) and up to 16 percent of fathers suffer from an anxiety disorder during the perinatal period. 

Paternal mental health impacts their partners and their children and as NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP points out, fathers can be powerful allies for maternal child health

In an effort to address paternal mental health, Healthy Children Project faculty Eira Yates in partnership with OhioGuidestone developed the Yates Paternal Depression Screening Tool for male fathers, a first of its kind measurement which we reported on last summer


Photo by Picsea on Unsplash

Father’s Feelings research activity, which uses the depression screening tool, was suspended due to the COVID-19 pandemic. 

Yates reports that thanks to a recent grant, the team will be able to expand its pilot program. 

Brittany Pope, M.S., Director of Applied Clinical Sciences and Research at OhioGuidestone shares that The Institute of Family & Community Impact has been able to move forward with some other exciting events too. 

Namely, DaddYoga, a free virtual yoga class for fathers and their children led by Judge William Dawson, a yoga instructor, motivational speaker, and municipal court judge in East Cleveland.

Photo by Devon Divine on Unsplash

Beyond the yoga instruction, Judge Dawson will offer insight and encouragement to fathers about healthy living and other life goals. 

Participants will also have the opportunity to interact with people from the world of professional sports. For instance, on June 13, Major League Baseball agent Josh Yates will join DaddYoga to discuss his experiences as a single father while navigating the high-powered world of professional sports.

The event provides fathers an opportunity to destress while engaging with their children which  aligns with UNICEF’s suggestions on how to build babies’ and children’s mental health. 

Information for the DaddYoga event can be found here.

Considering evolving language in perinatal care and beyond

In the 90s, Diane Wiessinger, MS, IBCLC wrote Watch Your Language, an iconic piece that got us thinking about how we talk about infant feeding simultaneously, warning us of the dangers of “inverting reality” as it relates to breastfeeding and artificial feeding methods. 

Wiessinger writes, “When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food…the logical response is, ‘So what?’ Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy–and thus safety and adequacy–of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.”

Photo by Hanna Balan on Unsplash

“Health comparisons use a biological, not cultural, norm, whether the deviation is harmful or helpful…” she continues. “…We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.”

At present, infant feeding behavior has changed so greatly that the authors of The Meaning of “Breastfeeding” Is Changing and So Must Our Language About It  write “the term ‘breastfeeding’ is now so ambiguous that it is impossible to discuss contemporary breast milk feeding behaviors using this word.” 

To illustrate the diversity of infant feeding experiences, some of the ways infants and young children may receive milk include:

  • from their biological parent directly at the breast
  • human donor milk from a bottle or cup 
  • at the breast with a supplemental nursing system (SNS)
  • exclusively pumped milk via syringe 
  • wet nursing 
  • at the chest using an SNS with a combination of human donor milk and artificial milk 
  • feeding with purchased human milk 

Infant feeding is not black or white, nor one or the other. 

Given the multitude of ways that infants may be fed, the authors The Meaning of “Breastfeeding” Is Changing and So Must Our Language About It make several proposals for preferred language in order to develop clear communication around the feeding of breast milk to infants. 

They note:  “These terms are not intended to convey a value judgment about any of the behaviors described, but rather to provide an improved means of describing the wide variety of behaviors now encompassed by the word ‘breastfeeding.’” 

Language comes up often on Our Milky Way. We first explored it here, then went on to write about it here, featured transliteracy here and thought about language some more here and  here

This week, we’re adding to the ongoing discussion about terms that may be obsolete, using language to be more inclusive and evolving language to more accurately and positively describe certain behaviors and phenomena during the perinatal period and beyond. 


On-demand feeding or responsive feeding 

Photo by Nubelson Fernandes on Unsplash

Up first is the problematic term on-demand feeding

Caring for young humans is surely a massive responsibility, but to deem them demanding seems unfair and connotes negativity between the child and their caregiver.  

Instead, UNICEF suggests the term responsive feeding  which encourages relationship building through feeding responsively (regardless of feeding method) and recognition that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and caregiver. 


Sleep regression or sleep progression 

Many care providers have argued that the term sleep regression discredits what is actually happening: our babies’ brains are growing rapidly. 

Oasis Lactation Services posted, noting that #languagematters: “Sleep regression? It’s a sign of development and brain growth! Sleep shift is a better way to describe it. Your baby is gaining skills, not regressing.”


At risk or underserved 

The way that we communicate about barriers, inequities and populations that have inadequate access to health care services matters. Advocates warn us to use caution when speaking about barriers to breastfeeding and other behaviors. For instance, the increased mortality rates experienced by Black Indigenous People of Color (BIPOC) are not biologically-based; instead the systems of power and the oppressors create the risk. 


Foremilk and hindmilk or simply milk  

The foremilk/ hindmilk myth comes up often in lactation professional networks. 

Nancy Mohrbacher writes that “There are not “‘two kinds of milk.’ … Despite this common belief, there is no ‘magic moment’ when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.”

In fact, the concept is even more complicated than this. While more fat is transferred when milk flows well, due to circadian rhythms, foremilk from one feeding may be higher in fat than hindmilk from another feeding, as Healthy Children Project’s Cindy Turner-Maffei details.  

Mohrbacher and others point out that research indicates there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer. 


Breastfeeding and chestfeeding and  human milk feeding and bodyfeeding and

Photo by Sergiu Vălenaș on Unsplash

Serena Kalish, PA-C, CLC got interested in the various terms used for feeding babies during her Lactation Counselor Training Course (LCTC). It was the first time she had heard the term chestfeeding and it got her wondering how many other care providers are unaware of the term chestfeeding as well as when and where the term is being utilized. 

Kalish created a poll on a social media page curious to learn what terms lactation care providers are using and prefer. The majority of the respondents replied with breastfeeding, followed by nursing, followed by breastfeeding & chestfeeding. Respondents added feeding, lactation/lactating parent/lactation journey, bodyfeeding and chestfeeding (as a standalone from breastfeeding) to the options.

The results of the poll didn’t necessarily surprise her, she reports, but she says she found the added options interesting. 

Photo by Nathan Dumlao on Unsplash

Kalish shares that for a medically-minded person like herself, the term nursing sounds archaic.  She wonders if by using the term nursing that we are perhaps adding to the stigma of breastfeeding by not using a term that specifically identifies anatomy. 

Many respondents noted that inclusivity matters to them in their practice, so the terminology that they use is determined by whatever their clients prefer. 

This sentiment reflects ABM’s Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients which states that “Although the terms introduced previously may be unfamiliar to some providers, recognizing and affirming patients’ names, pronouns, and family members are a cornerstone of providing affirming care for patients who identify as LGBTQ+…  Affirming health care, including using affirming names and pronouns, and recognizing individual patients’ families and communities, can help to mitigate the effects of stigma and improve health.” 



Kalish goes on to present an interesting anecdote. As a participant in many “mommy groups” on social media, she became familiar with FTM to stand for “first time mom”. At one point, she noticed that some individuals were confused by a post that mentioned FTM because in LGBTQ circles, FTM stands for “female to male”. 

“It was an interesting perspective to learn that there are other contexts where certain terms and phrases and abbreviations are used,” Kalish comments. “It helps you realize that you have to be more sensitive sometimes and learn other terminology.” 


Language of inclusion and compassion  

Language comes in many forms. Hand Waves Birth Services’ Childbirth Educators and Full Spectrum Doulas Ally Balsley (she/her) and Brittany Noschese (she/her) touched base with us about non-verbal language and how to better serve individuals who are deaf or hard of hearing in a blog post from earlier this year.  

La Leche League International recently released a statement that announces the organization’s plan to increase audio and visual resources to better support those with vision or hearing impairment as well as those living in communities where we have not yet identified translators.

The statement also refers to their Cultural Sensitivity in Publications Policy, a trend that has been adopted by many companies and organizations as the national conversation about race amplifies.

Photo by Solen Feyissa on Unsplash

Finally, while many of us may have grown up on the playground chanting that bit about sticks and stones– stick and stones may break my bones, but words will never hurt me— it’s time we reckon with that falsehood. The words we chose when addressing birthing people and the conversations we have with them are impactful and can influence a lifetime. 

The Practising Midwife Journal posted for Birth Trauma Awareness Week: “…What we say and how we say it – can make a woman’s birth experience either transforming or harrowing. We have that potential impact.”