Where are they now? Lessons from ruins with Carin Richter RN, MSN, APN-BC, IBCLC, CCBE

Photo by Aykut Eke on Unsplash

The peafowl is a bird known for attracting attention. Whether flaunting their colorful, unfurled plumage or delivering a resounding cry, peafowl are undoubtedly expressive, insistent creatures.

Occasionally, when Healthy Children Project’s Carin Richter, RN, MSN, APN-BC, IBCLC, CCBE hosts Lactation Counselor Training Course (LCTC) competencies from her Florida home, a curious peacock will poke its head into the frame of the video call demanding attention from her and the participants. 

“The big inquisitive bird insists on being part of the session on breastfeeding!” Richter exclaims.  

Since we featured her last, Richter has fully retired from her responsibilities at St. Anthony’s Medical Center in Rockford, Ill. and now helps facilitate the online LCTC once a week.

Our Milky Way caught up with Richter this winter as part of our Where are they now? series. 

Now 70 years old, Richter shares with a stirring of anger, worry and dismay in her tone: “Women’s health… We are in crisis mode. I’m personally struggling with any kind of optimism.”

She cites a few culprits: a political climate that tolerates division and disrespect, the marginalization of maternal child health issues, and the stripping of rights as marked by the reversal of Roe v. Wade. 

From these ruins, Richter has constructed several lessons. For one, she implores us to become politically involved. 

“Keep women’s issues right smack dab in the conversation,” she advises. “Look around. Search out areas where you can sit at that decision making table.” 

Political involvement, Richter suggests, can come in the form of participating on a shared governance board, community advisory boards, church councils, and rotary clubs. Engagement doesn’t need to look like shaking hands with the mayor. 

She continues, “My friends always say, ‘Oh Carin, you never have one conversation without the word breast coming through.’ We need to live that! Because if we don’t we’re going to lose what we have.”

Photo by Nicole Arango Lang on Unsplash

In other words, be a peafowl. Demand attention. 

Richter lays out what happens when we don’t. 

During her nursing career, Richter and her colleagues’ involvement with the Baby-Friendly Hospital Initiative (BFHI) eventually gave rise to seven hospitals in her area being designated by 2013. As of 2022, only one of those hospitals had retained their designation. 

“Because there was no one sitting at the decision making table speaking for the initiative,  administration lost sight of it and breastfeeding took a back seat or perhaps didn’t have a seat at all,” Richter reflects. “No one spoke of keeping breastfeeding issues in the forefront. It’s an experience that brings me to tears.”

Another insight she’s gained is the difficulty in beginning and sustaining a community-based lactation business. She watched friends with solid business plans, well-researched proposals, and passionate ambitions to help dyads get crushed by lack of insurance reimbursement, lack of mentorship and lack of collaboration.

“We need a lot of work on that front,” Richter comments. 

She suggests a reimagination of the way lactation services are viewed where insurances and companies recognize the importance of breastfeeding and elevate lactation support to a professional state. 

For instance, while working at the hospital, Richter brainstormed ways to give value to and justify the services of in-house lactation care providers. She found that postpartum breastfeeding support offered in-hospital  resulted in a marked increase in patient satisfaction scores. A creative solution suggested that  initial lactation and breast care be embedded in the room rate available for all patients, not billed as a separate line item, allowing for a higher reimbursement rate, Richter explains.  

Photo by Hannah Barata: https://www.pexels.com/photo/woman-having-skin-to-skin-contact-with-her-newborn-baby-19782322/

After retirement from the clinical setting, Richter cared for her aging parents. She says she felt the pinch many women of today experience as they juggle personal, familial and work responsibilities.

As she lived the struggle to find workable solutions for the care of her elder parents, she says she was surprised to find that barriers were similar to those she encountered while working for change in the community surrounding breastfeeding. For both, breastfeeding and elder care, resources are often limited, frequently expensive, and often inaccessible or unavailable.

Her focus now has broadened from maternal child health advocacy to the broader realm of family care issues. She finds herself
advocating for maternal child health and family care issues like pay equity and affordable child care.

“The struggle continues across the continuum, in arenas frequently dominated by women who bear the majority of responsibility,” Richter reflects. 

Despite a sometimes discouraging climate, Richter says she sees “little bright spots” here and there. 

“Not a week goes by that I don’t have a [medical professional] seeking lactation credentialing… I am thrilled with this,” she begins.  The practitioners seeking lactation credentials are not only specializing in women’s health; instead they’re an interdisciplinary group of folks, a sign that breastfeeding and lactation care is breaking free from siloed confines.  

“This is what keeps me excited,” Richter says. “More knowledgeable, eager voices speaking for mothers and babies.” 

Looking back, Richter remembers when it caused a fight to require lactation credentialing for OB nurses. 

“We got so much backlash not only from administration but from OB nurses themselves,”  Richter recounts. “Some OB nurses took no ownership of lactation. ‘That’s the lactation counselors’ job,’ they would claim.”

In this culture, Richter pointed out that trauma nurses are required to be trauma certified, oncology nurses  are required to be oncology certified; why were OB nurses not required to be certified in lactation when it’s such a large portion of their work?

“It was a bit of an eye opener,” Richter says. 

Retrieved from ALPP. Used with permission.

Now almost all hospital OB nurses need to be certified within the first one to two years of hire, and Richter says she’s encouraged by the ever-increasing number of OB nurses she speaks with weekly who are seeking breastfeeding certification and are supported by their department managers.

As for physicians certified in lactation, an already developed template existed. The state of Illinois had issued a Perinatal state wide initiative to mandate that all anesthesiologists caring  for pregnant patients were to be certified in Neonatal Resuscitation Program (NRP). All obstetricians soon followed. Richter says her wish would be that the template could extend to mandating lactation credentials to all professionals caring for pregnant and breastfeeding families.

Another bright spot Richter’s noticed are the larger, private sector industry and private employers in the Midwest offering adequate workplace lactation accommodations and services  that go beyond what is mandated by law. 

Moreover, Richter continues to be  impressed by the work that the United States Breastfeeding Committee (USBC) is doing, namely increasing momentum for workplace protections across the nation.

Though she adds, “The spirit is really strong, but the body is really weak. Getting the body to make the decisions and the policies is difficult.” 

Retrieved from ALPP. Used with permission.

Yet another area of encouragement is the inroad made into the recognition of perinatal mood disorders (PMD). Acknowledging that there is always room for improvement, Richter extols the improvements in detection, treatment and the lightened stigma around PMDs.  

Richter shares on a final note that while maternal child health issues have been largely well promoted and mostly supported in the last decade, she hopes to see more emphasis and energy put into the protection leg of the triad. That will require involvement in the work of policy change at the institution, community, state and national level. Policy development and change is the first stepping stone, she advises. 

“Do not be afraid of policies, because policies have power,” Richter states.  “Get involved and find your place at the decision making table.That’s your homework assignment for the year!” 



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.



Breastfeeding is sacred. 

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is sacred.

Photo by Anna B

Breastfeeding shows up in a myriad of religious texts, and across most religions, breastfeeding is encouraged and revered as a sacred act.

In Rabbinic texts “…nursing is more than food—it plays a key role in transmitting religion, values and culture,” BJ Woodstein BFC, IBCLC writes in her piece on breastfeeding and Judaism.

Photo by Kampus Production

Breastfeeding and the Baha ́ ’ı ́ Faith documents that “Baha ́’ı ́ Writings clearly endorse breast-feeding…the frequent use of the language of human lactation in positive symbolic terms identifies breastfeeding as a practice that is both dignified and worthy of juxtaposition with the sacred.”

In Chinese religious and philosophical culture, which includes the syncretism of Buddhism, Confucianism, Taoism and the theory of Yin and Yang, this is also true. In Taoism for example, it has been written that “the conditions of oceanic ecstasy correspond to the experience of symbiotic unity of a baby and its mother during the period of foetal development and of breast feeding.” [Tortchinov, 1996, p. 20]

Art by: Khou Vue
Courtesy of the Hmong Breastfeeding Coalition

Across most Native American groups, breastfeeding is revered as the first sacred food; their traditions have been largely passed down orally instead of documented in sacred texts.

Religious dietary rules and their potential nutritional and health consequences further details how most major religions encourage prolonged breastfeeding and other feeding indications.

In Islam, “a woman who breastfeeds more than five times a day a child who is not hers before the age of 2 years becomes a ‘milk mother’ for this child, who is then acknowledged as a full sibling to the foster-mother’s other children. This prohibits any possibility of subsequent marriage between them (sura 4: ayat 23).” The authors note that these rules have implications for human milk banking in Islamic countries.

Photo by Fatima Yusuf

Sucharita Sarkar’s article Pregnancy, Birthing, Breastfeeding and Mothering: Hindu Perspectives from Scriptures and Practices looks at the regulations of pregnancy, birthing, and breastfeeding in Ayurvedic treatises, and at representations of mothering in Vedic and Puranic texts.

Sarkar begins “Vedic and Ayurvedic texts glorify breastfeeding and project it as a natural attribute and sacred duty of good mothers. The Atharva Veda compares lactating breasts to pitchers full of divine nectar. Ayurvedic treatises like the Sushruta Samhita eulogise the nourishing powers of breastmilk and, by extension, of the lactating vessels, that is, the mother:

May the four oceans of the earth contribute to the secretion of milk in thy breasts for the purpose of improving the bodily strength of the child. O, thou with a beautiful face, may the child, reared on your milk, attain a long life, like the gods made immortal with drinks of ambrosia.”

Photo by Smadar Bergman

Where fasting is relevant, there are special considerations for individuals who are pregnant and/or lactating. Ramadan Mubarak: Breastfeeding in Islam and Religious Fasting and Breastfeeding cover many of those distinctions.

Author Beatriz shares about her initiation into Santeria– an amalgamation of Yoruba beliefs and Catholicism– as a nursing mother in this Brown Girls Out Loud piece.

Photo by Luiza Braun

With more than half of the world’s population practicing some kind of religion, religious interventions can be an effective way to support breastfeeding.

One study found that Catholic women are more at risk to intend and practice exclusive formula feeding than women of other religious affiliations.

In partnership, the SC Department of Health and Environmental Control Bureau of Community Health and Chronic Disease Prevention, Eat Smart Move More South Carolina, Palmetto Health Richland Hospital, and the South Carolina Breastfeeding Coalition created a toolkit entitled Creating a Mother-Friendly Environment for your Faith-Based Organization.

Buddhist nuns on the move: an innovative approach to improving breastfeeding practices in Cambodia assessed the impact of Buddhist nuns and wat grannies on breastfeeding behavior in rural Cambodia and found an 11 percent increase in breastfeeding initiation in the first hour after birth when mothers interacted with the nuns.

——–

Photo by Mehmet Turgut Kirkgoz

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share any experiences that you have had with infant feeding in a religious context.

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

For many, grandmothers are the village

Reflecting on her experience as a first-time grandmother, one of my colleagues and mentors expressed that, for most of us, “grandmothers are the closest thing to a village that we have.”

This colleague, a lactation care provider herself,  described the intricacies, sweetness and sacredness of watching her daughter step into motherhood. My colleague’s notes described her thoughtful presence without overbearance, leaving space for her daughter and her new family to learn and to bond. For instance, she cleans the house, prepares their bed with sun-dried sheets, and sits at the foot of the bed while her daughter and granddaughter nurse. In this dreamy scenario, grandma, baby and parents are all met with challenges, however those challenges haven’t become insurmountable thanks in part to this level of grandmotherly support and care.

This week we bring to you some work that details grandmothers’ powerful influence on the perinatal experience and beyond. A 2016 systematic review found that “a grandmother’s positive breastfeeding opinion had the potential to influence a mother up to 12 % more likely to initiate breastfeeding. Conversely a negative opinion has the capacity to decrease the likelihood of breastfeeding by up to 70 %.”

Healthy Children Project’s own Barbara O’Connor, RN, BSN, IBCLC, ANLC – Faculty Emerita designed and authored the Grandmothers’ Tea Project for the Illinois State Breastfeeding Task Force (2011).

Through O’Connor’s interactive curriculum, grandmothers are invited to learn about breastfeeding through three activities that pose breastfeeding scenarios:

“The Grandmothers’ Apron activity updates grandmothers’ knowledge about the importance of breastfeeding.

During the Grandmothers’ Cell Phone activity, grandmothers talk about breastfeeding myths and barriers.

In the Grandmothers’ Necklace activity, participants create a beaded necklace to remind them of ways they can offer support through loving encouragement, updating their breastfeeding knowledge, and being helpful.” (As described in A Grandmothers’ Tea: Evaluation of a Breastfeeding Support Intervention)

Source: United States Breastfeeding Committee.

Author Jane S. Grassley, RN, PhD, IBCLC and colleagues encourage perinatal educators to explore the curriculum for A Grandmothers’ Tea as they found that grandmothers and mothers who attended the teas in their study enjoyed their interactions with one another and with the class content.

Their work also unearthed a phenomenon of defensiveness in grandmothers who did not breastfeed their own children. The authors explain  “Grandmothers who did not breastfeed may feel defensive about their infant-feeding decisions because of the current emphasis on the health benefits of breastfeeding (Grassley & Eschiti, 2007)”  and advise that “perinatal educators can invite grandmothers to share their experiences and validate the cultural context in which these experiences took place.”

In this realm of validation and healing, Midwife Andrea Ruizquez of Partera Midwifery explores the implications of the Mother Wound. On Partera Midwifery’s Instagram page, Ruizquez writes:

“Props to all the people navigating complicated mother child relationships as adults. Now that I am in my 40’s I find myself reconnecting with my own mother in a deeper way. There was a time when we were estranged from each other. I learned how to recognize that I needed boundaries and practiced maintaining them. I am learning not to get triggered by my mother’s ways, and have compassion for her reasons behind them. I extend this sentiment to all of my grandmas ancestors who are in my lineage.

I am having more compassion for myself, and the ways I am like her my mom. I am learning to love myself deeper and become a more conscious mama to my children. I am still learning to love my child self that did not get all of her needs met, and I reparent myself with love. I feel myself heal.”

Source: United States Breastfeeding Committee.

Cultural beliefs held by grandmothers have the potential to influence healthy infant feeding practices. In Grace Yee, Retired IBCLC and Tonya Lang’s, MPH, CHES, IBCLC  Cultural Dimensions in Promoting, Protecting, and Supporting Lactation in East Asian Communities, they explained the prominent roles of aunties and grandmothers in the early postpartum. One example includes how colostrum is sometimes regarded in older generations as impure or unhealthy. Yee and Lang suggest that instead of positioning tradition and culture as a hindrance, to reframe barriers to breastfeeding into potential strengths. Respect of elders’ traditions and cultural practices will establish trust and foster positive relationships, as noted in Monique Sims-Harper, DrPH, MPH, RD, IBCLC, Jeanette Panchula, RN PHN, BA-SW, and Patt Young’s, Health Educator, CLE work entitled It Takes A Village: Empowering Grandmothers as Breastfeeding Supporters.

The physiological imprint of breastfeeding withstands generations and the sensations of milk production may surface decades later as mothers become grandmothers. Grandmothers who have previously breastfed have reported the tingling sensation of a phantom milk release when holding their grandchildren.

In South Sudan, grandmothers are relactating to help manage severe acute malnutrition. This practice has been documented elsewhere like Natal, South Africa and Vietnam for example.

Barry Hewlett and Steve Winn’s study on allomaternal nursing indicates that while this practice occurs in many cultures, “it is normative in relatively few cultures; biological kin, especially grandmothers, frequently provide allomaternal nursing and that infant age, mother’s condition, and culture (e.g., cultural models about if and when women other than the mother can nurse an infant or colostrum taboos) impact the nature and frequency of allomaternal nursing.”

Photo by Наталия Игоревна from Pexels

For an illuminating anthropological perspective, read A Biocultural Study of Grandmothering During the Perinatal Period by Brooke A. Scelza and  Katie Hinde. Their “findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being” and “show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants.”

We would love to learn about your perinatal and infant feeding experiences as grandmothers or with grandmothers. If you’d like to share, please email us at info@ourmilkyway.org.