Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model

Photo by Luiza Braun

Over half of the Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program peer counselors were once served by the program as mothers enduring mastitis or going back to work early or other barriers to healthy infant feeding. Yet, some of these mothers still managed to breastfeed into toddlerhood.

“They took the knowledge to not only be able to succeed but [brought] it back into their community,”  BHP program manager and lactation consultant Cody Cuni, IBCLC, BS says. “This is a success story.”

BHP is a person-centered, peer support counseling program intended to increase breastfeeding initiation, duration, and exclusivity among low-income, minority women in the greater Hartford, Connecticut area. For over 20 years, the program has existed in some form. In 2000, an official review of the program was completed and solidified the peer-counseling model.

The program’s name was born out of community feedback, mainly from Puerto Rican families. Cuni explains that as community Puerto Ricans were heavily targeted by formula marketing,  the name ‘Breastfeeding Heritage and Pride’ grew from the idea of reclaiming breastfeeding as part of their heritage.

Photo credit: United States Breastfeeding Committee (USBC)

Often, the lactation model of care is rooted in colonization, but Cuni says that their program  strives to respect and celebrate diversity.

“Our program seeks to empower…” she begins. “[Breastfeeding] is something that is yours, and something that has always been yours,” she says, speaking to the people they serve.

As program manager, Cuni trains the peer counselors through a 40-hour comprehensive lactation training. She approaches the training through a lens of diversity and cultural competence, helping peer counselors learn to have respectful conversations and teaching them how to be an advocate.

She explains, “Our peer counselors are working with mothers who do face a lot of bias in their health care and in lactation, so we have whole trainings on how to communicate with a provider, how to approach hospital staff who say things like ‘Don’t waste your time on that mother…’”

Peer counselors embark on visits with senior peer counselors and other lactation care providers as part of their mentorship model.

Photo by Felipe Balduino

The program also provides continuing education to stay relevant and weekly meetings to complete case reviews.

As part of their grant funding, BHP is required to track their breastfeeding rates, but Cuni says that what she finds more compelling than these numbers, is the documentation of the lactating person’s individual goals.

Empowering mothers to seek their own goals is our ultimate goal, Cuni says.

BHP is nestled in the Hispanic Health Council’s Parent and Family Learning department which offers other supports throughout the “cycle of learning throughout a family’s lifespan”.

Photo by Omar Lopez

“A holistic approach of care is vital especially for maternal child health care,” Cuni explains. “The first 1,000 days of life are critical to laying a healthy foundation.”

Practicing on a continuum of care gives Cuni and her colleagues the ability to gain a deep understanding of the families they serve, she says.

“Because we work so closely with the families, we establish trust and are able to refer in a way that they might not be open with [other providers].”

The clients that BHP serves are up against every breastfeeding challenge that every family faces in our country, but the issues are compounded and amplified by the stress of living in communities steeped in systemic racism and lack of resources, Cuni explains.

Their clients are managing intergenerational trauma and all of the symptoms associated with trauma, at a cellular level and beyond. For instance, BHP clients have a higher propensity of birthing babies with complex medical needs because of higher rates of preterm labor, gestational diabetes and other health concerns.

Cuni points out other challenges like those associated with being an undoumented immigrant. Gaining access to basic tools like breast pumps can be nearly impossible. Some of their clients return to work at two weeks postpartum after a cesarean section, not by choice of course, but for fear of losing their work as part-time employees.

And although Connecticut has workplace lactation laws in place, mothers will find that if they make noise about those protections, they might not see their name on the schedule any longer.

Photo source: United States Breastfeeding Committee (USBC)

Yet, despite all of these obstacles, Cuni says, “There is a sense of resiliency. They’re overcoming so much and they’re not even sitting in that; they’re just living their lives and wanting to do the best for their baby. That resiliency is really inspiring.”

Cuni shares about a mother who lost her baby late in her pregnancy and decided to pump and donate her milk for six months.

“This mom, her experience, her unimaginable tragedy…she still wanted to do something with her milk, and it was really a privilege for our peer counselors to support her.”

Another client they served, after struggling to assert her workplace lactation rights, had a position created for her by their HR department as “breastfeeding liaison”. Now, she is an advocate for any breastfeeding or lactating mother at her workplace.

“Not only did she win for herself, she left it better,” Cuni comments.

Cuni came to this work as a stay-at-home mom with ten years of breastfeeding experience. She was a single mother, returning to the workforce after leaving an abusive marriage.

“My breastfeeding experience was valued as an asset,” Cuni remembers. “My lived experience counted.”

She goes on, “As women, and especially as mothers, we’re always caring for someone else. The pressures that we face make wellness difficult. Our society needs to do more to recognize the value that women have and the support they need to succeed. I want to …. amplify the voices, because if we listen, the answers that we need to solve the maternal mortality crisis, the answers are there if we listen to the women and families we are working with.”

For those interested in supporting the work of the Hispanic Health Council’s BHP, they are looking for donated breastfeeding supplies. You can get in touch at  codyc@hispanichealthcouncil.org.

Colorado pediatric office becomes breastfeeding friendly employer

Castle Rock Pediatrics (CRP) made a splash this summer at the Douglas County Fair Parade where they displayed their incredible Under the Sea themed float. Patients and families created a colorful array of paper plate fish that “swam” through pool noodle crafted seaweed.

CRP also attended the  Renaissance Expeditionary Magnet School Back to School Carnival and the Downtown Castle Rock Concert Under the Lights where they set up a lactation station.

After breastfeeding her own young children and later completing the Lactation Counselor Training Course (LCTC), Laura Westover PA-C, CLC, one of the providers at CRP, dove into helping transform her office into a Breastfeeding-Friendly Employer and soon-to-be Breastfeeding- Friendly Medical Office.

Their work is supported by a grant through the Tri-County Health Department. Westover has been working alongside Susan Howk, a breastfeeding policy specialist, to create their policies and lactation spaces through a six-point plan which includes policy, staff and provider training, patient education, environment, evaluation and sustainability, and continuity of care.

The grant has funded things like a chair, end tables, a hospital-grade multi user breast pump and kits, a stuffed animal nursing dog with her puppies for siblings to play with, and a lactation scale for weighted feeds.

Westover displays the breastfeeding friendly employer certificate in March 2022 standing in their first lactation space.

Their lactation space started in one of their smallest exam rooms, but has recently graduated to one of their larger exam rooms, which is now near the end of its renovation. Westover notes that the space also functions for newborn and young baby visits.

Westover reports that CRP owners since November 2021 Drs. Anderson and Bouchillon have been highly supportive of the breastfeeding-friendly changes.

Prior to the implementation of their lactation policies, Westover says their office “was not lactation friendly at all.” She describes stacks of formula in plain view.

“It gave the impression that we were promoting formula,” she comments.

Gift bags for patients were also riddled with formula-promotions, so the team phased out the branded materials and replaced them for non-branded, breastfeeding-friendly items.

Now, Westover and her colleague Sydney Gruenhaupt RN-BSN, CLC  see breastfeeding dyads weekly for office visits; whereas they once had to refer out. Of mothers’ main concerns are poor weight gain and uncomfortable or painful latch.

Westover points out that Colorado has very high breastfeeding initiation rates, but like the national trend, tapers dramatically at 6 months and beyond. While Westover and her colleagues are not currently tracking their office’s breastfeeding rates, it’s part of the plan in hopes that their numbers will hold steady beyond initiation rates. Westover explains since they’ve switched over to a larger electronic medical records system, there should be potential for a simple, infant feeding tracking system. A 2016 project by the County of San Diego Healthy Works program, implemented by UC San Diego Center for Community Health with funding from First 5 San Diego extensively explores current practices and future possibilities of  breastfeeding measurement in the outpatient electronic health record.

Westover and her colleagues will be out and about again this fall where they’ll craft their  lactation tent at events like Oktoberfest and the town of Castle Rock Spooktacular Halloween celebration.

“[It’s] really wonderful because we are able to promote [to] the whole community,” Westover shares.

For more about CRP’s lactation services visit https://castlerockpediatrics.com/Services/Additional-Services .

Helping families flourish in southeastern Alaska

As a young child, Jasmine Esmay, RNC-OB, CLC, now a nurse at a Baby-Friendly critical access hospital in southeastern Alaska, watched a mare birth her foal. 

Esmay was struck by the “reverent atmosphere”. The horse has fresh hay and water. Calm and quiet hushed over the scene. 

“I was in awe of the whole process,” she says, making the connection early on that we, too, are mammals.

Most young children play house at some point, but I was never interested in pretending to cook or playing house,” Esmay shares. “I wanted all my friends to pretend they were in labor and I was the midwife, much to the dismay, I think, of their parents.”

Then when Esmay was 17, she was invited to attend the hospital birth of a friend she babysat for. 

“Again, I was in awe of the power and strength and miracle of new life,” she says. 

Her personal birth stories further shaped her passion and work within maternal child health, fully realizing the importance of evidence-based practice. These stories were a sharp contrast to the gentle, supported births she had witnessed, and she began to understand that how women experience birth can influence outcomes such as bonding, breastfeeding rates and  postpartum depression occurrence. Early on in her work, she realized the significance of a calm, patient-centered approach. 

Latching babies or empowering parents 

Esmay eventually volunteered with WIC, making house calls and inviting others to her home to help with breastfeeding whenever she could. Since 2008, she’s been working solely as an OB nurse. 

“…It seemed wherever I was working in an obstetric unit people would always say “Go find Jasmine, she can get any baby to latch!’” she shares. 

In 2017, she completed the Lactation Counselor Training Course (LCTC)

“What [our instructors] taught me through that course was to put my hands in my pockets and take in the entire picture, and then to help the breastfeeding dyad to find their own ways to be comfortable and successful with breastfeeding,” she explains. 

“They really stressed starting newborns with laid back positions, to encourage instinctual feeding behaviors, and to help new parents be comfortable and confident in their ability to breastfeed,” Esmay continues. “It was so hard those first few months to trust the process. I had to learn that my method of so-called helping was really not helpful.”

Esmay found it helpful to remind herself of the words of Cindy Turner-Maffei: “You may be able to get a baby to latch, but is it teaching the parents or empowering the parents so that when they go home, breastfeeding is successful?” 

Over time, Esmay says she came to realize that confidence is half the battle.

“I’ve heard over and over ‘I didn’t think I could do it’ or ‘I couldn’t have done it without all the help and support’,” she reports. “It’s nice to know that we not only encourage breastfeeding, but that we give people the tools they need to really succeed at breastfeeding and enjoy it. I really hope that those feelings of success and empowerment reach into the rest of parenting and pass down into generations.”

She’s noticed too that parents prefer a hands-off approach most of the time. 

“As this approach was implemented, I began to see less parents coming back supplementing or with nipple pain or other breastfeeding issues,” she reports. “It is very rewarding to see the parents’ confidence grow, and see how that affects bonding and the integration of the newborn into the family.” 

Expanding lactation care support 

Esmay plans to take the IBCLC exam in April, a process she’s been working toward for five years. 

“I can honestly say that out of all the trainings and books and lectures and conferences I attended, the training I received through Healthy Children Project changed my practice the most,” she comments. 

Esmay was recently honored as a member of USLCA’s advisory board.

“My hope is that through knowledge and idea sharing we can think outside the box on ways to expand lactation support and education to marginalized populations,” she reflects on her new role. 

Esmay shares that she has conflicting thoughts regarding the exclusive use of IBCLC credentialing for “the gold standard” of lactation care. 

She explains: “It is important to recognize credentials, and licensing will help with getting lactation care reimbursed, but I also know from experience how expensive it is to obtain and maintain. The reality is that obtaining an IBCLC at this point is just not possible in many rural and marginalized populations. 

I think more focus should be on training all healthcare workers in normal breastfeeding support and the importance of breastfeeding. Statistically breastfeeding is just as important to overall health as teaching cardiac wellness and cancer screening. The focus should be on breastfeeding as a normal part of maternal child health, with referrals to experienced lactation care professionals when there are complicated feeding issues.” 

Barriers and triumphs 

In her work today at the critical access hospital, Esmay and her colleagues serve 15 remote communities. Their hospital was the first tribal affiliated hospital in the state to receive Baby-Friendly status. 

Esmay says their patients are plagued by many of the same barriers as those in the rest of the nation; namely, limited access to evidence-based breastfeeding support, physical distance and travel barriers for perinatal care, breastfeeding not being the socially acceptable norm, abysmal parental leave, little or no workplace pumping accommodations and/or childcare. 

“I think our biggest barrier though is in the current medical model of care where there is a lack of continued support throughout the postpartum period,” she says. “It doesn’t make sense to have 10 plus prenatal visits, and then only one postpartum follow up 4 to 6 weeks after a baby is born.” 

Adopting the midwifery model of care could offer many solutions in regard to postnatal care, she adds. 

Location lends itself to some challenges too. 

“It seems the very nature of where I live lends itself to always being a bit understaffed. Living on an island has its challenges and some of the community is transient by nature due to seasonal work or contract work.

 I think it is well known that healthcare in general is a very mentally and physically challenging calling. For obstetric care in general, I think that is why it is so important to get more feet on the ground for lactation support. If we can encourage routine breastfeeding education and training to all women and children’s nurses and providers, that will lessen the burden and improve access to breastfeeding support.

In my opinion, if you work anywhere in healthcare, but especially maternal child health, then basic breastfeeding knowledge should be the standard, not the exception. There are always those special feeding needs that will require a higher level of care, but every women’s and children’s healthcare provider should know what normal breastfeeding patterns look like, how to support a breastfeeding dyad and how to spot problems.”

Despite the aforementioned barriers, Esmay and her fellow colleagues are unrelenting in their service. The team offers a variety of breastfeeding support programs including:

    • Postpartum phone call 7 to 10 days after birth as a safety net between 3 to 5 day check and 2 week newborn follow up
    • Free lactation clinic 
    • Monthly peer breastfeeding support group 

Alaska scores quite well on their breastfeeding rates compared to U.S. national averages. Esmay attributes this in part to necessity. 

“Many of the communities in southeast Alaska are very remote and cannot always rely on shipments of food or formula to survive,” she explains. “I think it speaks to the importance of family-centered communities and the knowledge sharing that happens in extended families.”

Community is strong in her area, and there’s strong community awareness of the state of maternal child health in America. 

Esmay brings attention to community gatherings like that of a group called NEST (Nurture, Empower, Support, Transform). She recently partnered with the Alaska Breastfeeding Coalition and the hospital to implement a “Breastfeeding Welcome Here” campaign for area businesses.

Encouraging trauma informed care 

While Alaska is making a difference with small changes, Esmay sheds light on an area that needs improvement: trauma informed care.

“The statistics in Alaska for women experiencing trauma are astronomical,” she begins. “Thirty-seven percent of women in Alaska have been victims of sexual violence– that rate goes to 50 percent if you are an Alaskan Native Woman– and in some areas of the state that number can be more than 90 percent. 

When women who have survived sexual violence give birth, there are triggers. Often the traumatized person is not expecting these triggers. How care is given during prenatal visits and throughout the birth process can affect how a labor progresses, how parents bond and how they view themselves as new parents. 

It can make the difference between a healing and empowering experience or becoming a victim of violence once again. If care is taken adhering to the principles of trauma informed care, there will be better birth outcomes, like less postpartum depression and a higher rate of breastfeeding success. 

Ultimately it will lead to healthier families, and that’s really the long term goal of healthcare for women and children.” 

Esmay recommends When Survivors Give Birth by Penny Simkin and Phyllis Klaus to help us understand how to best care for the pregnant person who has experienced trauma. 

Esmay shares a few closing thoughts:

    • Approach breastfeeding from a preventative healthcare point of view. A study reported in the Surgeon General’s Call to Action found that if 90% of U.S. families followed guidelines to breastfeeding exclusively for six months, the United States would save $13 billion annually from reduced direct medical and indirect costs and the cost of premature death.  
    • Populations most affected by dangerous diseases have the least access to breastfeeding support and education. 
    • Breastfeeding is a global health issue of the highest importance. Corporate healthcare and governments need to invest as much money and energy as possible into promoting breastfeeding. 
    • We need human donor milk available in every hospital, we need equitable and affordable access to breastfeeding support, and we need the U.S. to uphold the WHO code of marketing to prevent formula companies from preying on vulnerable populations. We need the organizations that support breastfeeding to brainstorm new ways to improve education and access for all. 
    • Really the answer to world peace could be in breastfeeding, but that’s a topic for another day.