Centrul ProMama’s Magia Maternity facilitates skin-to-skin in Romanian hospitals

Romania suffers from one of the highest infant mortality rates in Europe.

The simple and inexpensive practice of “skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality,” as articulated by the authors of Skin-to-skin contact after birth: Developing a research and practice guideline.

Photo courtesy of Centrul ProMama
https://www.facebook.com/promama.ro/posts/pfbid02N5nf5CJk47SbEkDFFoQnSB29SuxvHQuTLRCJCBiZ8HDSMBks9ucDgErH4JqeQDHAl

One Romanian organization, Centrul ProMama led by Sorana Muresan and Andreea Manea and their colleagues are working to implement immediate, continuous, uninterrupted skin-to-skin contact as the standard of care for all mothers and all babies across the country through their Magia Maternity Program.

The program provides medical staff  with about five hours of theoretical training, consulting on the practical implementation of The Magical Hour in the delivery or operating room, and a four-hour breastfeeding course. The program also includes six months of follow-up consultation.

Officially established in 2019, much of their work began in 2012, when Muresan and Manea facilitated a partnership with Healthy Children Project. As a result, the team helped implement The Magical Hour in two public and two private hospitals.

“We still remember the impact that we had during this time together!” the duo exclaims. “We learned and observed extraordinary things about skin-to-skin between the baby and the mother in the first hour after birth!”

The team goes on to report: “It took us six years to launch our programme. That was after hard work, offering antenatal classes where we constantly talked about the importance of skin-to-skin contact, organizing conferences and other events on the subject and lobbying to the Minister of Health. We even launched campaigns on social-media and television.”

Photo courtesy of Centrul ProMama
https://www.facebook.com/photo?fbid=665390452405066&set=pcb.665390772405034

During this time and sometimes today still, medical staff show(ed) less enthusiasm than Muresan and Manea.

“Many doors closed before our eyes, some brutally, others with a smile,” they remember the reluctance.

Over the years, facilitating skin-to-skin after birth has gained traction in their country though.

In the autumn of 2023, the ProMama team shared a Facebook post reporting an empty newborn nursery. Instead, all of the babies were with their mothers, a testament to the growth and effectiveness of the Magia Maternity Program.

“Some [staff] practice this routinely, but others in the public hospitals still have rigid bureaucratic procedures, which stands in their way of practicing the Magical Hour,” the ProMama team explains.

Romania is up against some of the highest c-section rates in Europe, around 40 percent.

“We believe that it is because we are not properly or only superficially informed about pregnancy, even though we have information about childbirth everywhere. In addition, mothers are anxious, some of them are over 35 years old and also have some medical problems,” the team suggests.

Learn about this little guy and his mom here: https://www.facebook.com/promama.ro/posts/pfbid034h1hChHFS6aQm8Pi189FtzTUGov5NXdtAaXNzoM1rvQ4dikoVCZHNPMKPM21BuoEl

Though high c-section rates are cause for concern, difficulty implementing skin-to-skin after a surgical birth is only a perception. Check out the following pieces to learn about how maternal child health advocates are changing the culture of mother baby separation after c-section here, here, here and here.

Muresan and Manea explain: “The Magical Hour and the immediate initiation of breastfeeding can compensate a lot in case of c- section and it is one of our goals as prenatal educators to promote the physiology of birth and the postpartum period.”

As humans have adopted more and more technological advances, the Magic Hour is often described as a “new” concept, when the practice is actually ancient. Muresan and Manea reflect on the phenomenon of how our modern lives often interfere with the natural, physiological processes of our reproductive experiences.

“We …feel that this is a kind of paradox,” they begin. “Something so natural, so physiological and instinctive shouldn’t need so many scientific arguments. Despite this, doctors still have doubts in practicing the procedure…It’s a great step that science has come so far and that medicine can now save more lives! The problem is that it interferes very much with nature and we can no longer or no longer want to trust our instincts.”

Closing out 2023, the Magia Maternity Program had reached its seventh maternity hospital.

The team is happy to report that with the support of Dr. Vaso Edvin “…amazing things are happening.”

In an effort to continue to spread knowledge about the importance of skin-to-skin contact, the team gathered a group of influential individuals from different sectors including Karin Cadwell and Kajsa Brimdyr of Healthy Children Project at the CONFERINȚA MAGIA MATERNITĂȚII – Ora Magică în România.

“We wanted to approach the topic from different angles – medical, maternal and social,” the team shares. “It was also important for everyone to listen to the specialists from Healthy Children Project to learn what meaningful studies they have so they can understand how a single hour right after birth can improve a child’s health and development in all areas.”

The team emphasizes the life-long impact skin-to-skin offers.

As such, Muresan and Manea say that the Magia Maternity Program is their most important project.

“Our wish is for the MAgic of MAternity program to become a national program because we strongly believe that this is the natural path to healthier children, generations and society…To achieve this, we need to enable mother and child to be together and fall in love with each other after birth. This way, mothers feel comfortable, are encouraged to breastfeed and have a beautiful relationship with their children in the future. Of course, the medical staff should be there to observe, protect and preserve mother and child…The emotions we experience at every birth when we see the face of the new mother with the newborn at her breast cannot be put into words! It is moving to tears!”

Where are they now? An update from Nicole Bridges PhD, B Comm (Hons), SFHEA, MPRIA

Then

Amidst trolls who lurk, misinformation that muddies, and insidious marketing,  Nicole Bridges’s PhD, B Comm (Hons), SFHEA, MPRIA (she/her) work illuminates the helpful spaces on the internet. Almost a decade ago, her publication The faces of breastfeeding support: experiences of mothers seeking breastfeeding support online, found that “social networking sites (SNSs) provide support from the trusted community” that is “immediate…practical and valuable…”

In our 2017 coverage, Dr. Bridges pointed out how social media can compliment face-to-face interaction between breastfeeding dyads and lactation care providers, how it can offer moms “access to the collective wisdom of the whole tribe” as opposed to the perspective of one lactation professional, and how it can facilitate social interaction offline.

and now.

Dr. Bridges now serves as the Director of Academic Program for Communication, Creative Industries and Screen Media and is a Senior Lecturer in Public Relations in the School of Humanities and Communication Arts at Western Sydney University. For over two decades, she has been a volunteer breastfeeding counselor with the Australian Breastfeeding Association.

We’re pleased to have caught up with Dr. Bridges as she reflects on the past and future.

Q: What is the most significant change you’ve noticed in maternal child health in the last decade?

A: The increased use and evolution of social media tools to support breastfeeding. The COVID-19 pandemic amplified this and demonstrated how useful social media and online communities can be to supporting families in times of need.

Q: What is the most helpful/profound lesson you have learned about maternal child health in the last decade?

A: That (unfortunately) there is still so much more work to be done and that volunteer peer support organisations like the Australian Breastfeeding Association are needed more than ever before.

Q: Is there a current project, organization, initiative, endeavor or trend in lactation and breastfeeding that excites you most?

A: It will be interesting to see how the introduction and evolution of AI tools can be used to support breastfeeding into the future.

Q: What’s your best piece of advice for the next generation of maternal child health advocates?

A: Always place the parents and children at the centre of everything you do.

Q: Where do you envision yourself in the next 10 years?

A: I do hope that I am still a volunteer peer counsellor 10 years from now and that I can still continue to support breastfeeding families in this role and as a researcher in this area.

Check out Dr. Bridges’ publications since her work was last featured on Our Milky Way:

  • Rowbotham, S., Marks, L., Tawia, S., Woolley, E., Rooney, J., Kiggins, E., Healey, D., Wardle, K., Campbell, V., Bridges, N. and Hawe, P. (2022), ‘Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia’, Health Promotion Journal of Australia, vol 33, no 1 , pp 151 – 161.

  • Bridges, N., Howell, G. and Schmied, V. (2019), ‘Creating online communities to build positive relationships and increase engagement in not-for-profit organisations’, Asia Pacific Public Relations Journal, vol 20 .

  • Bridges, N., Howell, G. and Schmied, V. (2018), ‘Breastfeeding peer support on social networking sites’, Breastfeeding Review, vol 26, no 2 , pp 17 – 27.

Brenda Hwang’s, MA, CCC-SLP, CLC, CDP light bulb moment: “My colostrum is in fact enough…”

[Photo by Andrea Piacquadio]
We consider ourselves life-long learners here at Healthy Children Project. Sometimes learning occurs gradually, and sometimes there are the ‘light bulb’ moments.

We put a call out to our followers to share “Aha!” moments with us. Maybe it was a myth busted during the Lactation Counselor Training Course (LCTC) or maybe it happened during a visit with a dyad.

We also called for stories about your babies’ and children’s ‘light bulb’ moments. When have you seen your little ones’ faces light up in discovery and understanding?

The call for stories is still open! Please send your reflections to info@ourmilkyway.org with “Light Bulb” in the subject line. 

This is Brenda L. Hwang’s, MA, CCC-SLP, CLC, CDP illuminating moment. 

******

Myth – You have to feed formula in the beginning until your milk “comes in.”

FACT – You do not have to feed formula if you do not want to and your colostrum IS ENOUGH. 

I had an incredible breastfeeding journey with my first born that lasted a little over two years. It was difficult for me to think about other moms not having a positive breastfeeding experience. 

That is when I decided to become a lactation counselor. During my training, I remember learning about helping mothers feel confident about their milk supply (when there are no medical reasons to be concerned about). I remember being fascinated with the Baby-Friendly Hospital Initiative and researching if there were any near me for when I deliver again or to recommend my patients to go to for the most pro-breastfeeding support. Unfortunately, there wasn’t one. 

When I gave birth to my second born, I remember feeling overwhelmed by so many emotions following childbirth. I remember trying to remind myself that this was typical as our hormones are off the charts after experiencing what the amazing body just went through to bring new life into the world. I felt like there were so many things that I had little or no control over, but what I did have control over was advocating for immediate skin-to-skin and the opportunity to breastfeed my daughter. That made me feel grounded and confident. 

However, that night came and my daughter wouldn’t stop crying. The nurse would come in and out of our room always looking angry, telling me that my supply was not enough, and that I needed to give my daughter formula for her to stop crying. I kept advocating for myself and reminded my husband that –

  1. Formula was not what we planned for or want, 
  2. I have colostrum and,
  3. My colostrum is in fact enough and the best thing that we can give to our daughter right now. 

Although I knew this was true, the sad little cries broke my heart and the nurse’s comments and facial expressions made me feel uneasy. 

Even with the breastfeeding education that I had, she eventually made me believe that perhaps I was wrong and what I had was not enough for my daughter. I dozed off crying quietly to myself, feeling like a failure as a mom. This was my Ah-Ha moment. I thought, “Wow, that was terrible and unfortunately too common of an event that mothers often experience in the hospital.” I would never wish for any mom to feel that way – to feel like she is not enough, or a failure as a mom.

I am now dedicated to providing breastfeeding education during pregnancy… to help moms feel prepared for the first few moments after baby is born. I strive to find a role in the hospital in order to advocate for parents who wish to breastfeed and to provide timely interventions so that they too can have a positive breastfeeding experience. 

Thank you for reading my story.



Involution

*This piece contains curse words.

Image by Nadezhda Moryak

It’s early in the New Year. Every evening, I work out on my beloved stationary bike, not because of some expected resolution or disillusioned intentions, but because it’s where I am forced to breathe, and therefore it’s become a necessary part of my existence. After each workout, I move through a ritual, so absurd, before stepping into the shower.

Confronting my naked self in the mirror, my head cocks slightly, my eyes narrow, and I admire the tone I’ve achieved in my upper abs and the muscles that grip my ribs.

Simultaneously, I grimace at the places I obsess over sculpting but that which won’t respond to calorie deficits, macro-calculating, crunches, four minute planks, cardio, endurance training, barre, yoga, weight-lifting, mindfulness, willing myself into a satisfying form.

In an exasperated sigh, I roll my shoulders back, scowling at the beefy traps I’ve acquired.  The scowl accentuates the crease between my eyes, a fissure carved by contemplation.

I “draw my navel to my spine.” This is the more sensitive version I’ve learned to replace “suck it in.”

I squint at the flakey, smudged mascara under my eyes, the substance I brush on my blonde eyelashes each morning to avoid people thinking I’m sick. (A former co-worker once insisted I must be sick when I arrived at work without it. “No, really, you do not look good,” she said, recoiling as if it were painful to look at me.)

I prop my hands on my hips, smoothing out the bulge so that it’s easier to envision myself at least one pant size smaller, just out of reach of kid sizing, a disgusting delusion I recognize.

When I prop my hands this way, it also makes my arms look thinner by avoiding the offensive spread when they’re at rest.

And then I clench my fingers around my waist, squeezing enough to whiten my knuckles, wishing there were somewhere else for my organs to go, wondering if maybe they are the reason I appear so wide.

My scrutiny moves next to the sinewy dangles suspended from my chest wall. They’re pruned, though more full than the year my husband begged me to see a doctor for the weight I had (intentionally) lost.

Shiny stretch marks radiate from auburn areolas punctuated by cylindrical nipples topped with depleted pigment, like tiny little snow-capped mountains.  They’re cock-eyed yet knowing and they hold my attention offering me something like: “‘Fuck the patriarchy and boob idolatry!…’”

They demand respect.

I cup my hands around them. The flesh spills into the spaces between my fingers. They’re soft, not like how my former boyfriends would express; soft, not like how they felt after my babies had fed; soft, more like the powdery skin that hung from my grandmother’s triceps.

I pull them up toward my face, and the stretch marks wrinkle into themselves. A fold forms under my thick collarbones. I lift my arms above my head and my boobs fall to gravity. The muscle near my armpits lift the edges of my breasts into a mischievous smile. The bottoms hang pendulous. Each breast morphs into an elongated structure, like the way an octopus maneuvers and slips gracefully, awe-inducingly into secret crevices and caves.

My breasts don’t respond to the tricks I experiment with on other parts of my body: the pressing, sucking, tensing, flexing, tucking.

They’re rebellious.

Still needing a shower, I cup my breasts again as if hand expressing milk.  On other nights, I’ve envisioned thick, golden colostrum beading at my pores or milk like that that nourished my children sprinkling onto the bathroom floor, but as biology would have it, these substances don’t come.

When I draw my fingers down toward the nipples on this night, in a festive but discreet explosion, like the poof of a dainty flatulent, confetti detonates from my nipples. Beautiful colors and sparkle blast toward the mirror in a nebulous, celebratory swirl toward my reflection which distorts into an expression of utter disbelief.

The remnants drift gracefully onto the counter, into the sink, onto the tiled floor littered with my sweaty clothing. The confetti speckles the tile where I birthed my son, catching him with my own hands in a triumphant act that propelled me into my next evolution of motherhood.

I gather some confetti into a pile and examine the sheen of some pieces, the crepey texture of others, the dusty glitter that I dread will take me forever to clean.

Then I peek out of the bathroom door into my bedroom where my husband still lay asleep, undisrupted by this commotion. His gentle snore reverberates from under the sheets.

I tend to the remaining mess of confetti and dispose of the projectiles in the trash next to our toilet.

“What the fuck,” I mutter, finally stepping into the shower.

I wash myself, dry myself and settle into bed like any other night.

The clock nears midnight. I toss and turn. I sleep some. Numbness in my extremities wakes me to moonlight, mostly snuffed out by thick winter clouds, glowing just enough though to reveal a panorama of slouching silhouettes, snow-laden willows, pines, junipers and oaks that surround me.

The next day happens, and soon I’m brined in sweat standing in front of my mirror again. On this evening, I skip the self-loathing and move straight to the breast-fondling, because if my breasts can produce confetti, the possibilities seem endless. Perhaps tonight it’ll be that beautiful new mixing bowl I’ve had my eye on… a fancy pair of boots…all of the words of the Croatian language I’ve been trying to learn… assurance that my kids will enjoy a well-adjusted life… world peace.

There’s a lurching in my stomach, the one that comes with anticipation as I attempt to express the unknown. Then, lights.

My breasts are projectors beaming stories in some sort of visual diary of my memories. The picture is dream-like, bleeding and blended around the edges. At first the shapes sway like shadows in dappled sunlight.

Then there’s focus. I watch my seven-year-old self walking around my childhood home in soccer shorts, otherwise topless. I ask my mom if I look like a boy, and she tells me no. I ask her again and she confirms that no, she does not think I look like a boy.

I watch my fifth grade self sporting my new three quarter-length, hot pink top. It has glitter embedded in its purely synthetic fabric, and I absolutely love it. Walking to my desk, a boy shouts, “Put a bra on!” My cheeks ignite into a shade that’s between red and purple. I relive the combustion of embarrassment, shame and anger. I try to keep this potion from seeping out, but I hate this boy for a good portion of my life. It’s when I realize that he is someone’s misguided son that hatred dissipates, and then I pity him.

The clips keep playing.

I watch myself in ballet class. I’m “sucking it in” and constantly adjusting my leotard so that what little fabric is there will cover up as much of my growing breasts as possible. I see myself wishing that they were detachable, so that I’d be flat-chested in ballet class, but have the option to use them to my benefit outside of the studio.

The next clip shows my dear friend and I during our study abroad on a long train ride in Morocco. My eyes scan, hardly keeping up with the passing landscape, tumbling plastic bags, dusty cracked soil, and as we slow to a stop I notice a woman draped in textiles but her face and her breast. An older baby is positioned to feed, his lower body dangles on a diagonal. She holds his weight in one cradled arm. She’s striking. I’m saddened when the train’s speed picks up again, pulling me away from her captivating strength.

In another flicker, I’m approaching my grandma’s house. She greets me with her beautiful, comforting face. She embraces me and kisses me many, many times like she’s going to devour me, and then attempts to wipe off the lipstick she’s smudged on my skin. She holds my shoulders, looks directly at me, and tells me, “I just love you!” and while I was once perplexed by her unending-enthusiasm to see me, I now understand since becoming a mother. Now I kiss my children, devouring them, the way she used to kiss me. The clip continues to the part where my grandma tells me that she’s going to get breast implants. She says she wants others to feel what she feels when she hugs me. She’s felt insecure about her breasts for as long as she knows, I learn, and so at 70-something, she does something about it.

The reel transitions to depict me discovering colostrum leaking from my breasts while pregnant with my first daughter. My mind is absolutely blown. I call to my then fiance to share my fascination, but he’s seemingly less entertained by my body’s ability.

The reel reveals me riding this wave of fascination.  My areolas have darkened and expanded after the birth of my first child, a target intended to guide her to survival outside of my body,  and I show them to my friends, because seriously, how crazy is this?! My breasts have ballooned to a size much bigger than my baby’s head. Tingly let downs spray milk in spectacular fountains soaking my infant and all of our surroundings.

The projection pans to my toes curled. Like clenching fists, they channel discomfort as I breastfeed through a pregnancy, and then the overwhelm of breastfeeding a toddler and a newborn and ultimately the fatigue of having breastfed for a combined nine and a half years.

There’s a clip that shows the blossoming of one of my most treasured friendships. I am watching her breastfeed her young infant in the middle of a mom-and-me music class, and my face brightens for I feel instant connection and admiration.

Another clip of the woman who flashes me a smile and a thumbs up while I breastfeed my baby in a restaurant. I smile back and it’s a beautiful, unspoken exchange of understanding and pride.

The projections remind me of each of my children’s darling little bodies weighted across my lap feeding from my left breast, where my heart beat is most detectable. My rhythm and nourishment pulsing into them; their energy surges back into me.

In a final clip, I watch my husband administer a syringe of Lupron into my lower abdomen, the artificial hormone that will propel me into a menopausal state. The drug is part of the protocol that will attempt to trick my body into welcoming a frozen embryo, so that I can gestate and birth another couple’s baby. I look forward to lactating again and I visualize abundance, enough to express for their baby, enough to donate to others. The clip starts to fade, but of course I already know what happens. I do not birth their baby, and I do not make milk anymore.

There is a part of this story where I am supposed to be a gestational carrier that feels unresolved. A section of my heart withers into little bits of confetti, just like the other stuff, and drifts to the floor like snowflakes tumbling through the slow-moving molecules of a bitterly cold night.

The projections dim with a final flicker.

So I step into the shower again. I sleep again. I wake again. I sweat again. And this happens over and over.

And every night, there’s something oozing, spewing, dribbling, emitting from my breasts.

One night, a substance I can best describe as lava.  Another it’s spider silk, then soil, the wafting scent of cedar.

“Each week on our program, we choose a theme….” It’s Ira Glass broadcasting not from WBEZ Chicago, but from my breasts.

Throughout this inconceivable sorcery, I question my sanity, but I’ve been worried about being crazy long before my breasts started blasting party paraphernalia and sound and other things.

Mostly, I am amused by the unpredictability.

There is no purpose to these substances I’m producing. It’s completely unlike the milk I made for my children. And it’s not like the perceived uselessness of say, foreskin, which holds a cultural misconception of being futile.

My breasts now truly perform no other function than amusement, dynamic works of art, in all their expressions, like eroding sea glass tumbled by the elements.

Where are they now? Checking in with Stephanie Hutchinson of the Appalachian Breastfeeding Network (ABN)

In May 2016, Stephanie Hutchinson (then Carroll), MBA, BS, IBCLC  and a few of her colleagues launched the Appalachian Breastfeeding Network (ABN), “dreaming that one day [Appalachian] parents would have the access to lactation care that they deserve.”

In just one year, the network grew to 11 states and 250 members. By the time the organization was five years-old, the network  grew “to over 600 members across all 13 states in Appalachia – and beyond!” Today, ABM “continues to grow in its membership, its capacity, and its visibility.” [Retrieved from: https://www.appalachianbreastfeedingnetwork.org/abn-board.html

 

Then

When Our Milky Way first featured Hutchinson in 2017, she said that the exponential growth was not expected, but also not surprising. 

“There was absolutely no organization that grouped Appalachia as a culture, together, to make an impact for change,” she said.

 

 

and now.

Almost a decade later, Hutchinson serves as the President of ABN and Administrator of their 24-Hour Breastfeeding Hotline. She also works in private practice as the owner of Rainbow Mountain Lactation, is an instructor and administrative assistant/media manager for Lactation Education Consultants

This year, ABN will host its first cohort of Appalachian LATCH (Lactation at the Center of Healthcare) Leaders which is their train-the trainer program. With grant funding provided by Gallia American Community Fund of the Foundation for Appalachian Ohio (FAO) and the I’m a Child of Appalachia Fund®, they will offer 20 scholarships for registration to the course. 

Many years ago, before the birth of her daughters, Hutchinson shared that she never anticipated doing the work she’s been engaged in, but as we often say, “All roads lead to breastfeeding.” Now, reflecting on the most significant change she’s noticed in maternal child health in the last decade, Hutchinson says, “As a member of the LGBTQ+ community, I have noticed more inclusivity in education and support for all families. I am happy to see such wonderful changes to include everyone who is lactating.” 

And the most helpful lesson she has learned along the way is to say ‘no’. 

“This has probably been my hardest lesson learned, but there is only one of me and I know I cannot do all the things,” she reflects. “It’s okay to refer out to someone else, say no to a speaking gig, not go to every conference possible, and take care of myself. Once I learned this hard lesson, I noticed I am able to give more to my clients and my own family…I know that I am not the lactation consultant for every person and humbling yourself to collaborate with others will help your practice tremendously.”

Photo by Elijah Mears on Unsplash

Looking forward, Hutchinson says: “In 10 years, I hope Appalachian Breastfeeding Network has been able to grow enough to fit more into our budget and reach more parents, especially in those areas with little to no lactation support. It is my vision to duplicate our hotline and make it sustainable and available to anyone, anytime, for as long as possible. On a personal front, I hope to see my kids happy and thriving as adults and live out our empty nester lives.”