VA Maternity Care Coordinator (MCC) program facilitates specialized care for military Veteran parents

For new families, healthy, evidence-based infant feeding education and support can be hard to come by, but among this often barren landscape of support, the VA Maternity Care Coordinator (MCC) program provides an oasis for military Veteran mothers.  

Retired USAF Lt Col Tammy Tenace BSN, MS, APRN-BC, now Women Veteran Education, Outreach and Research Coordinator  for James A. Haley Veterans Hospital in Tampa, Fla. says that the VA understands that pregnancy and parenthood often requires specialized care.

About a decade ago, as care providers started to notice that lactation and breastfeeding support was severely limited in civilian communities, they established the MCC role. MCCs maintain contact with Veteran families throughout the perinatal period, facilitating care that meets their specific needs. 

Because the VA does not provide obstetric care, the MCC acts as a liaison between the VA and the community obstetrical provider. MCCs follow Veterans through pregnancy and postpartum at one and six weeks postpartum. [https://link.springer.com/article/10.1007/s11606-019-04974-z]  The VA supplies Veterans with lactation supplies like breast pumps, nursing bras, nursing pads, storage bags, etc.

The MCC role has been established at every VA medical center, and Tenace has served as MCC at her hospital since 2016.  

Photo by George Pak : https://www.pexels.com/photo/family-sitting-on-sofa-beside-house-plant-near-the-windows-7983863/

Throughout the COVID-19 pandemic, what little perinatal support existed in civilian spaces, dwindled to almost nothing, Tenace points out. 

Hospital breastfeeding support groups, while only meeting a couple of times a week, stopped meeting altogether. Women weren’t allowed support people or their partners at appointments, and they began to feel isolated. 

“I realized I needed to do something; I couldn’t depend on the community,” Tenace says.  

Working through the Office on Women’s Health as a subject matter expert, VA National Consultant for Lactation Ashley M. Lauria, MA, RD, LDN, IBCLC helps establish standards of care in lactation programs at VA facilities nationwide. 

Tenace and Lauria both comment that among the hundreds of parents they have cared for, it is truly a rarity for an individual to express disinterest in lactation. Their experience reflects national numbers, where most dyads start out breastfeeding. 

Women Veterans are the fastest growing group among the Veteran population. In fact,  “by 2040, VA estimates they will comprise 18% of the Veteran population, versus just 4% in 2000,” according to a VA Pittsburgh press release.

In order to keep up with this demand, Tenace and her colleagues are in the process of curating a Certified Lactation Counselor (CLC) program. Made possible through funding from the Women’s Health Innovations and Staffing Enhancements (WHISE), ten of their staff members are completing the Lactation Counselor Training Course (LCTC), including Tenace, physicians, a health coach, advanced practice nurses, among others. 

“The most up-to-date information is really important,” Tenace begins. “[We are all] unlearning the things we thought we knew. The course has been instrumental to helping us feel like we are actually helping women, instead of relying on the knowledge that we thought we had. The course is detailed and professional, yet practical. The practicalness is what’s to our advantage. It’s how we actually help women breastfeed.”

Photo by Timothy Meinberg on Unsplash

Tenace and Lauria go on to explain that their efforts are Veteran-led. That is, their facilities host quarterly focus groups where they can learn about Veterans’ requests. 

“We want to know from women: what do they want?” Tenace comments. 

Because Veteran women often prefer support groups comprised of other Veterans, Lauria offers virtual lactation support groups that also act as social circles and a place for comradery. 

As James A. Haley Veterans’ Hospital designs new facilities, Tenace has been invited to offer input on the creation of lactation space for both employees and patients. Tenace applauds their leadership for focusing on improvement for the patient and employee experience. She also highlights that the newly designed main entrance will host a lactation pod. 

“I can’t think of a better way to show commitment,” she adds.  

Tenace and Lauria have embodied a passion for birth and lactation since their youth. Their work with the VA allows them to continue their mission to celebrate parents and their families and position themselves as life-long learners, evolving with the needs of Veteran mothers. 

 

Photo by Brianna Lisa Photography: https://www.pexels.com/photo/mother-breastfeeding-her-child-in-park-11620457/

For more on VA maternity care services visit https://www.womenshealth.va.gov/docs/WomensHealthReproductiveHealthBrochure508.pdf

More on Veteran Health https://www.commonwealthfund.org/blog/2021/birth-equity-Veterans-and-servicemembers  

Regulations and resources for all military branches https://www.mom2momglobal.org/bficb 

Coverage for pregnancy and lactation care in the military health system https://www.military.com/daily-news/2021/11/01/tricare-cover-doulas-lactation-consultants-some-starting-jan-1.html 

Lactation Counselor Training Course (LCTC) offered completely online for first time ever

In this uncertain time, it can be helpful to remember that we have control over the way we respond to the things we don’t have control over. Healthy Children Project joins individuals, businesses and organizations that have had to adapt to this strange, challenging Covid-19 situation. 

“When you face challenges, we have two choices: Let it stop you or find a way to grow and make a difference, even during challenging times. Now, more than ever, lactation counselors are needed to promote, protect and support breastfeeding families, even though we temporarily find ourselves in a place where face-to-face courses can’t happen,” says Karin Cadwell, Healthy Children Project’s executive director. 

Since social distancing and safer-at-home policies have been implemented, Healthy Children Project (HCP) was propelled to use this as an opportunity to offer the Lactation Counselor Training Course (LCTC) completely online for the first time ever. 

“While we still strongly believe that the experience of being together for the LCTC course has provided wonderful opportunities for meeting new friends and colleagues and networking, the changing times have propelled us to revisit the course delivery options,” Cadwell says. 

ALPP will offer an online, remotely-proctored CLC exam starting this week

The LCTC course combines up-to-date high level evidence, counseling training, policy and practice.

“I have learned so much already that medical school, 20 years of practicing and nursing four babies never taught me. (I am only in the second section!)” one participant shares. 

Another participant shares: “I was extremely happy with this course, as it was taught in a way that was inclusive, free of bias, and with much knowledge. In addition, the evidence that was provided was exceptional. Though I was not able to do this course in person, the instructors created a course that was not only highly educational, but also enjoyable. Thank you again to all that made this course happen.”

Photo by Charles Deluvio on Unsplash

The online LCTC is a self-paced online course presented in an engaging and energetic format through videos, self-check questions and competency verification and twice-weekly office hours with faculty to answer additional questions for online participants. 

“I am truly enjoying the format of this course and it definitely helps that you are all so entertaining and fun! I feel like I am sitting in your living room and you are telling me everything you know and it is quite lovely!” on participant exclaims.

The course should take 52 hours to complete (just like the in-person version).

“I’m so impressed with our participants. They are working on the course when they get back from a long day working in the hospital or in between their kids online school zoom meetings. They are finding ways to grow and learn, even with this new ‘normal’ we are all experiencing,” according to Healthy Children Project faculty Kajsa Brimdyr.

Offering the LCTC online has produced some unexpected benefits like accessibility. 

“I love that we are able to offer this to those who need the flexibility of online learning, those who may not be able to get five days off in a row can take this course on their own time, in a way that works for busy lives and schedules,” says Brimdyr.

“I enjoyed the teaching methods utilized and enjoyed the ability to work on training while having the ability to pause and do other duties for my employment as well,” another participant attests.

What’s more, faculty has gotten creative about how to best replicate the face-to-face experience. 

“The office hours are a popular aspect of the new online class,” says Healthy Children Project’s Anna Blair. “Karin and I have had a great time getting to know the participants and help them think about how to integrate the new information into their practice. It’s really fun. My dog, Sandy, occasionally joins us and I love seeing all the faces (and participants’ babies and dogs) on the screen during the office hours.” 

Blair continues, “It is so nice to connect with the participants who are going through this journey.” 

Participants have also shared that one of their favorite parts of the course is  the virtual office hours with faculty. 

“It is really helpful hearing some of the questions and answers people are asking/getting,” one explains. 

Participants can email questions in advance or ask questions during the office hours in the chat feature of the program. In the absence of in-person learning, this feature replicates the value of hearing others’ questions. Each office hour section is logged and labeled by topic so that students can revisit and review the questions at their convenience. 

Photo by Richard Jaimes on Unsplash

“We kept thinking about the phrase ‘Laurus crescit in arduis’ –Laurel grows in steep and difficult places,” Cadwell begins. “Not only have we seen amazing stories of resilience in the news and with our friends, our team at Healthy Children has been focused on making a difference in the world. We all have, and need, the opportunity to bloom. Learning together, we can share our experiences and knowledge. We have loved hearing from our participants during the course – their ideas, experiences and future plans. We all can work together to make a difference for breastfeeding families.”


To register for the Online Lactation Counselor Training, please click here.

Never underestimate a mother

This photograph brings the kind of smile to my face that lifts my ears up several millimeters and presses the tops of my cheeks into my bottom lashes. The athletes are so expressive, I almost squeal in excitement as if I’ve just witnessed their victory. 

The story behind the photo is summarized by Ann-Derrick Gaillot in 10 Women’s Sports Stories That Would Make Great Films:

“When the winners of the women’s 4x100m relay at the 1992 Summer Olympics in Barcelona were announced, no one was more thrilled to win than the bronze medalist team from Nigeria. Teammates Beatrice Utondu, Christy Opara-Thompson, Mary Onyali, and Faith Idehen were relative outsiders in the international running scene and were not expected to stack up against powerhouses like France and the United States. Though injury and traditional cultural gender norms would threaten their chances of competing in those Olympics at all, they would leave Barcelona that summer as the first Nigerian women to win Olympic medals. Onyali eventually went on to become one of Nigeria’s most successful runners, appearing at the Olympics four more times.”  

Underdog stories are always inspiring, and they’re happening every day when a woman becomes a mother. 

That’s Nurse-Family Partnership supervisor in Buffalo, N.Y. Daynell Rowell-Stephens’s MS, RN message.

“Stay open no matter what the circumstances the mother may be going through,” Rowell-Stephens offers. “[Mothers] have the ability and the capability to be the best moms, to flourish. Never underestimate a mother because motherhood drives women to be the best.”

Photo by Sai De Silva on Unsplash

She continues, “Support moms no matter what; whether it’s drug use or homelessness– I’ve seen it– motherhood really launches them into directions they never imagined they could go into.” 

Rowell-Stephens and her colleague’s agency is just over a year old, and in that short time, they’ve managed to make a great impact on the lives of mothers and their new families. 

“We are so excited about all that we are doing,” Rowell-Stephens says. 

It’s well-documented that people of color have less access to health care resources and are faced with structural barriers that inhibit good health outcomes. Amani Echols points out some of those barriers in The Challenges of Breastfeeding as a Black Person:

  • “Many Black people work, and breastfeeding at work is hard…
  • Black neighborhoods are also lacking in hospital practices supporting breastfeeding…
  • The societal stigma of breastfeeding is heightened for Black and brown people.” 

These are big gaps to fill, but Rowell-Stephens and her team readily take on the challenge.

They make sure their clients receive proper prenatal care by connecting them with various health care providers including midwives and doulas. They provide nutrition counseling. They help them secure housing and jobs and continued education. They impact decisions about cigarette and drug use. They support them through mental health crises. They educate on how to navigate different stressors. They support healthy infant feeding and bonding.

“All of the nurses on the team are very passionate about breastfeeding  so we love to see so many of our moms interested in learning to be successful at breastfeeding,” Rowell-Stephens comments. 

She’s the most recent member on her team to complete the Lactation Counselor Training Course (LCTC). She says the experience was “quite eye-opening.” 

“It is really going to change my practice overall,” she says. 

Maybe most importantly, the team teaches their clients how to healthfully engage with their children. 

“It makes me so excited to see these girls change their whole outlook on life,” Rowell-Stephens says of her clients when they become mothers. 

She celebrates the story of one of her clients who set a personal goal to complete a rehabilitation program and acquire a living place before the birth of her baby. 

“She accomplished that!” Rowell-Stephens reports.

Not long after, the mother’s roommate was using drugs in the home. 

“Her motherly instinct kicked in and she knew she needed to get out of that environment,” Rowell-Stephens begins. “She recently found another apartment and she’s providing for her child.”

Rowell-Stephens goes on, “She’s taken what might seem like very small steps, but for her, as we look back at just this past 9 months, she has done so many things. She has changed the world around her.” 

Toxic Stress, Resilience Building, COVID-19 and Breastfeeding

As I write this, I’ve logged exactly two weeks at home in self-quarantine due to Covid-19 with my husband and three children. Technically, we’ve only made it through the kids’ scheduled spring break, but they’ll start an indefinite distance learning journey on Monday.

Our socially-distanced days have been filled with laughter of a couple kinds. The pandemic has offered us the opportunity to connect without the distraction of our robotic, go-through-the-motion schedules. We find simple entertainment: puzzles, charades, tiptoeing along sidewalk cracks. The situation has helped me rediscover how to be playful, and I’ve surprised myself and  kids with genuine laughter (or maybe it’s because I’m utterly deranged) over things that might have otherwise made me blister in anger. 

When I look outside my household, I laugh in discomfort. It’s this disturbed kind of cackle; a psychological response to the panic, the destruction, the trauma, the unknown that this pandemic has burdened the globe with. 

My most recent interviews with Nikki Lee about breastfeeding policy in shelters and Healthy Children Project’s Anna Blair and Karin Cadwell about their upcoming webinar on Covid-19, breastfeeding and resilience went this way: we seemed to laugh more than in interviews before the pandemic hit our country. 

Photo by Toa Heftiba on Unsplash

For me, I laughed because it was a simple joy to hear my friends’ and colleagues’ voices, to connect with those outside my immediate family. But even when the conversations turned dark, still I laughed. I laughed until I actually started sweating. What is the matter with me?

Blair and Cadwell pointed out something about the status of the crisis we’re currently in. When a hurricane tears through a community, we know there’ll be an end to the devastation. With Covid-19, we have no idea when this ends, and that’s sure to threaten mental health

Cadwell shares that while she does not consider herself a joyful person, she often thinks about joyful things in the future. 

“One of the things this has done for me is it has taken away my anticipation of joy,” she says. 

Some will argue that we’ve gained something through the shared experience; we’re together by being apart. “Rediscovered humanity,” in the words of the head of my children’s school.

We’ve lost a lot though too. Lives most importantly and second to that, control. 

In Hidden Brain’s episode An Unfinished Lesson: What The 1918 Flu Tells Us About Human Nature guest Historian Nancy Bristow recounts, “To remember the flu would be to admit to the lack of control that people had had over their own health. It would be to admit that the U.S. was not necessarily all powerful but was like everywhere else in the world subject as victims to something beyond their control.”

Almost a century later, these words ring true. Where there was opportunity for control, or a fair degree of preparedness at least, our nation failed. 

Cadwell has pointed out time and time again that our country has better emergency preparedness plans for our pets than we do for our moms and babies. 

“The unfortunate reality of the coronavirus pandemic is that it has shown how unprepared and underfunded the public health infrastructure in the U.S. is to address the basic needs of our citizens,” Monica R. McLemore begins in her piece COVID-19 Is No Reason to Abandon Pregnant People. 

Now we’re in what feels like an impossible place. 

Kimberly Seals Allers exposes the fact that infant formula quantities are scarce.  

“There, I said it! Cue swarm… I have time,” KSA begins in a Facebook post. “Everybody is talking about ‘choice’ & blasting #breastfeeding advocates until there’s a global pandemic, a panic-induced international run on infant formula & quantities are scarce. Now the ‘just give a bottle’ folks want to teach you how to re-lactate.” 

Doulas have been deemed non-essential, partners of birthing people considered visitors. (Refer to McLemore’s piece above.)

“We are taking so many steps backward,” Blair comments.

She continues: “We have heard so many times, not just locally, but colleagues around the country that there has been a misunderstanding about what the protocols are for babies being born now.  Babies are being automatically separated from their mothers for two weeks in some cases, even if the mother is Covid-19 negative. That is not best for the baby and that is not best for the family. Story after story. It worries us tremendously.” 

A member of the Certified Lactation Counselor (CLC) from ALPP Facebook group shared this account: 

“Mom had baby yesterday and was forced to wear a mask and gloves for all of labor and delivery. She had low o2 sat(91%) when coming into the hospital. No other symptoms. She is now separated from baby. Baby with dad in postpartum room and she in ICU pending covid test. She has not seen baby since and they will not let her until she gets a negative (test pends for 5 days apparently. They gave her a pump but didn’t show her how to use it. She’s a young first time mom and has now pretty much given up breastfeeding and seems highly depressed. She claims the hospital told her the CDC said to quarantine moms away from baby.” 

Later, the member provided an update.

“She’s with him now and he is currently latched <3 she’s still mentally in a dark place but things are looking up now that she’s finally got to hold him skin to skin without gloves or a mask.” 

Another participant suggested that this mother might need timely birth trauma therapy. 

The original poster replied: “I completely agree. She is very flippant and now seemingly unbothered and lacking emotion. Dad is worried and said he’s never seen her like this before.” 

Dr. Amy Gilliland of Doulaing the Doula is raising questions about mother baby separation on her social media outlets.

In one post Gilliland describes the effects of separation after birth: “The infant experiences loss and has a grief response – that’s the only interpretation – Where did my mother go? And it’s a loss they never recover from because their initial impression is abandonment and isolation. We are screwing up their capacity to trust and creating insecurity. We know this from research and therapy with young children, older children and adults. www.birthpsychology.com (also the Alliance for Infant Mental Health)…” 

Photo by Gift Habeshaw on Unsplash

Toxic stress is bubbling up in mothers, babies, families and equally their care providers.

What’s worse, Cadwell explains, is that many of us have accumulated toxic stress over our lifetime and in the current situation, many of our regular stress relief outlets have been stripped from us.   

Gutted by the situation, Cadwell and Blair put together Toxic Stress, Resilience Building, COVID-19 and Breastfeeding, a webinar that focuses on how to build resilience in ourselves and in others. 

“How can we find a resilient future?” Cadwell wonders. 

The webinar refers to Dr. Kenneth Ginsburg’s The 7 Cs: The Essential Building Blocks of Resilience

Healthy Children Project and Health Education Associates are offering the webinar at no cost. Continuing education credits for nurses, lactation consultants and lactation counselors are available.

You can request the free module here

In closing, I offer you this PSA:

“Unless you have prior experience navigating the emotional, psychological, and financial implications of a global pandemic- all while suddenly becoming a homeschool teacher to kids with cabin fever and unlimited snack requests… give yourself some grace.”  

Photo by Miguel Bruna on Unsplash

And one of my favorite quotes, quite applicable when the entire world is becoming unglued, “As long as there is breath, there is hope.”