‘Strength-based approach’ increases breastfeeding rates

Like so many Certified Lactation Counselors (CLC), Joy L. Knapton, CD, CLC looks back on her training, laughing about how she looked forward to sitting in class all day.

“I sat on the edge of my chair completely fascinated by all the evidence-based information,” Knapton says. “I had been taught and told things over the years that I took as truth, but to hear new information that was backed up by evidence gave me the confidence to come back and tackle a population in our community that had not been reached with lactation support.”

With Healthy Children Project’s International Breastfeeding Conference just a few months away, Knapton looks forward to engaging and learning from other speakers.

“I am also excited to share what we are doing in our community and hopefully encourage others to reach out, tackle barriers, and promote breastfeeding in their community,” she adds.

Knapton, along with Ashley S. Graham, MSE, will present Integrating Lactation Counseling into Home Visiting Services to Decrease Racial and Socioeconomic Breastfeeding Disparities.

clc_care2In 2012, the Healthy Families Central Virginia Program integrated free lactation counseling into in home visiting services. This has increased the community’s breastfeeding rates among African-American women, teenage mothers, and families living in poverty. The relationship-based approach of home visiting programs provides a prime environment to overcome challenges and increase breastfeeding rates. [Retrieved from: http://www.healthychildren.cc/PDFs/2015_InternationalFlyer.pdf ]

Although in home lactation services are ideal, it is sometimes challenging for organizations to provide this care mostly due to financial restrictions. With the support of grants, Healthy Families is able to offer in home lactation support free of charge. Lactation services perfectly complement their in home childhood development support.

Still, Knapton says funding is one of their biggest challenges.

“…[In home] service is solely funded by grants and the generous support of our agency,” she explains. “This means I can only provide the service part-time, which is somewhat limiting to the impact we can make.”

Knapton’s journey with Healthy Families clients begins prenatally. At in home visits, she educates expectant mothers about breastfeeding, answers questions, dispels concerns, offers support and conducts assessments using a portable baby scale. Knapton also provides on-call assistance over the phone.

The challenges Knapton’s clients battle are enormous.

First off many of the women have never seen anyone breastfeed. Many of the new moms are concerned that breastfeeding will hurt. And the list goes on from here as Knapton reports: They worry that breastfeeding is weird. They worry about what others will think. They view breastfeeding as sexual which often triggers pasts wrought with sexual abuse. They wonder if breastfeeding will interfere with their smoking or drug use. Many of the mothers are depressed. With little self confidence, many don’t think they can do it. They wonder how they will breastfeed when they have to return to work or school.

With these forces working against them, Knapton says starting care prenatally is beneficial.

“One on one prenatal class allows them to ask any questions in a comfortable environment,” she continues.

CLC_Mom2A “strength-based approach” is respectful to mothers’ individual needs and gives them assurance that they’ll be supported in their journey.

Of many stories, each with “their unique challenges and amazing outcomes,” Knapton shares the following story of a young, single mother pregnant with her third child.

She had many challenges and had been in our program at Healthy Families for a couple of years. When I learned that she was pregnant with her third I was hoping to go out to see her and see what her thoughts on breastfeeding would be. She had told her family support worker that she was going to formula feed. I went out as a “feeding specialist” to talk about preparing formula and feeding it to baby in a safe way.

As we started to talk, I asked her when she hears the word breastfeeding what comes to her mind. She said, “weird.” I asked if she had ever breastfed before. She said, “No.” She said she had never seen anyone breastfeed before and no one in her family did. I asked her if she would want to try to breastfeed this baby. She said, “No…I can’t.” I asked her why should couldn’t. She said, “The doctor said I can’t.” I asked her why the doctor said that. She said, “Because I smoke.” I clarified with her about what she was smoking. She said, “Cigarettes.”

I let her know that it is always safer for mom and baby for her not to be smoking, but that she can still breastfeed. We talked about ways to make it safer for baby and about trying to quit smoking. I was then able to share information on benefits and help prepare her to breastfeed. She was open to trying. She said, “I want you to come to the hospital and help me.”

After she had the baby I met her at the hospital, she did skin to skin for the first hour and attached the baby. When I asked her how it felt feeding her baby at the breast she said, “Weird.” She explained that it felt weird in the way of being sexual. We talked about that and about the abuse she had experienced in her past. We talked about how our bodies are designed and how she could start looking at her body and feedings in a healthy way. I asked her if she was willing to give it another day or two. She said, “I guess.”

I talked with her nurse, letting her know she did an amazing job with the latch, the position was great, and that she just needed a lot of encouragement while being in the hospital. The nurse replied, “I don’t think she will be able to continue breastfeeding with her mental health issues.” I encouraged the nurse to talk with the doctor about discussing it with her first, and if she has to be on a medication if they could try to find one that is safe for baby. I called her the next day and she said the feedings were going well. She said that she was feeding frequently and that she really enjoyed the skin to skin contact.

I met the mom at her home on the 5th day postpartum. This is a mom that lives in the low income housing and usually greets her guests with a written note on the door filled with colorful language. This time the sign that greeted me was: please knock I am breastfeeding. You can imagine that gave me quite the smile.

I entered her home and much to my surprise this mom’s demeanor and mood was very different than I have ever seen before. She was softer, less abrasive, and she was attentive to her baby’s needs. She said that breastfeeding was going great and that she was telling everyone that they need to breastfeed their babies. She said that she was feeling better about life, was less depressed, and that she felt like she was feeling better physically. This mom’s overall health was improving. She stopped smoking, she was able to get to a healthy weight, she was able to bond with her baby, and use only breast milk and not have to supplement.

In the past she was also quick to go to the emergency room for ailments. She told me, “My breasts were hurting really bad and I almost called the ambulance. I remembered you talking about getting the milk out using a breast bath. I got in the tub and soaked my breasts and started to feel better.”

Overall this mom was able to do something that she did not think she could do, she was able to give her baby a healthy start, and her confidence and overall health was improved.

This year, Knapton served her 100th breastfeeding mother since the start of Healthy Families’ in home lactation services.

Learn more about Knapton’s work at the International Conference. Register here.

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