Trauma-informed care

More awesome graphics at: https://stores.praeclaruspress.com/free-posters-and-graphics/

Johanna Sargeant’s BA, BEd, IBCLC Mastering Lactation Conversations: Creating Successful and Achievable Care Plans is an excellent reminder of compassionate and effective counseling. Early in her presentation, Sargeant unpacks the perception that lactation care providers (LCP) can sometimes desire breastfeeding “success” more than the clients themselves.

As LCPs, it can be easy to get wrapped up in checklists and targets and “perfect” latches, forgetting about the complexity of the human experience and how infant feeding is inextricably influenced by parents’ lived experiences. Parents must be allowed to define their own terms of success, and as LCPs, we must honor the complexity of their lives. 

April is Sexual Assault Awareness Month which is as good a time as any to focus on trauma-informed care, which should be the standard of care for all perinatal services.  

Sexual trauma is common and affects approximately 20 to 25 percent of women, according to  Kathleen Kendall-Tackett, Ph.D., IBCLC. 

Image by Nadezhda Moryak

“Abuse survivors can experience a full range of responses to breastfeeding: from really disliking it to finding it tremendously healing, “ she writes in an Uppity Science Chick publication.

All of those many years ago that I completed the Lactation Counselor Training Course (LCTC), one of the most striking bits I took away was learning about the “hands off” approach. I was perplexed that this even needed to be emphasized( though I had experienced a “handsy” LCP after the birth of my first daughter and have so many friends who share similar experiences.)

These cloth breasts are a solution to demonstration without touching people’s bodies. (It is advised to exercise care when dealing with breast models in childbirth and breastfeeding education as the symbolic dismembering of the female body can carry powerful negative messages.)

Jennie Toland’s BSN, RN, CLC article on trauma-informed care reminds us that acknowledging the existence of trauma and its effects is the first step LCPs can take to providing proper care.

“Recognizing signs such as anxiety or emotional numbing can prompt further discussion that builds trust and fosters collaboration and engagement,” Toland writes. “…It can be as simple as asking if someone would prefer the door shut for privacy, positioning ourselves so we are not standing over another person when performing assessments, or verbalizing next steps and asking for consent to move forward…. It can happen within just a few seconds as we ask, ‘What is your preference?’ to provide someone with control over their care.”

[Here’s an older piece that explains how the simple prompt “May I?…” changed the way I view healthcare.]  

Toland writes that trauma-informed care does not need to be complicated, and the approaches she suggests aren’t specific to any one kind of trauma. 

While birth and breastfeeding can be remedial and healing for trauma survivors, these experiences can also be the source of abuse and trauma. 

Dr. Gill Thomson’s work describes this phenomenon. 

Dr. Karen Scott’s work through Birthing Cultural Rigor challenges the reality of maternity care for Black Indigenous People of Color (BIPOC). Indeed,  “We cannot fix the maternal mortality problem without fixing the human rights problem at its core.

There are so many others acknowledging trauma and incorporating compassionate care. In Milwaukee, BOMB Doulas are providing wrap-around care services, thorough screenings like the Adverse Childhood Experiences (ACES) and sensitive, respectful care.

Photo by Mateusz Dach: https://www.pexels.com/photo/photo-of-baby-on-mother-s-arm-4504005/

The White Ribbon Alliance UK offers programming like Safer Beginnings which includes Free From Harm for maternity workers which works to address obstetric violence.  

There are those like Audrey Gentry-Brown, Full Spectrum Birth Sista, Certified Blactation Educator (CBE), Student Midwife, and Medicine Woman in Loudoun County, Va. working to  rewrite cultural norms within her community, introducing “Afrofuturist healing modalities” that reconnect to “ancestral magic.” 

Xavier Dagba’s words embody her work well: “As you focus on clearing your generational trauma, do not forget to claim your generational strengths. Your ancestors gave you more than just wounds.” 

Photo by Serdi Nam: https://www.pexels.com/photo/close-up-of-mother-breastfeeding-baby-19178588/

Shawn Ginwright, a Black clinician, shares a similar ethos in a piece that challenges traditional approaches to trauma-informed care by exploring the distinction between simple ‘treatment’ and true healing.

“A healing centered approach to addressing trauma requires a different question that moves beyond ‘what happened to you’ to ‘what’s right with you’ and views those exposed to trauma as agents in the creation of their own well-being rather than victims of traumatic events,” Ginwright writes. “Healing centered engagement is akin to the South African term ‘Ubuntu’ meaning that humanness is found through our interdependence, collective engagement and service to others. Additionally, healing centered engagement offers an asset driven approach aimed at the holistic restoration of young peoples’ well-being. The healing centered approach comes from the idea that people are not harmed in a vacuum, and well-being comes from participating in transforming the root causes of the harm within institutions.” Essential reading! 

Other relevant resources and articles 

School Age Parenting Program nurses complete Lactation Counselor Training Course enhancing support for students

Spring can be an especially busy time for pregnant and parenting teens. There’s prom, Easter egg hunts, Eid al-Fitr, Holi, Passover and other festivities,  the summer school enrollment process, all alongside their typical school responsibilities. Then there’s the excitement of pending graduation for some. 

Nurse Michelle and Nurse Ashlee

Michelle Alkinburgh, BSN, RN and Ashlee Anzalone, RN, health care coordinators at the Racine Unified School District’s School Age Parenting Program (SAPAR), recently completed the Lactation Counselor Training Course (LCTC) in an effort to further support their students who are managing the multiplicity of being pregnant or parenting in high school. 

The duo is proud to report that many of their young parents choose to breastfeed even while juggling all of their other demands.

“We have many moms who breastfeed the first few weeks and have had three moms who breastfed for a year!” they exclaim.  

In the U.S., one estimation suggests that of the  “approximately 425,000 infants born to adolescents… only 43 percent will initiate breastfeeding, in contrast to 75 percent of mothers of adult age…” [Kanhadilok, et al, 2015]

Over 30 years ago, the state of Wisconsin required school districts to provide programming and services to school-age parents. As such, SAPAR  programming has been in place since the requirement was established.  

SAPAR is intended to retain pregnant and parenting students in school, promote academic progress, increase knowledge of child development and parenting skills, improve, decision-making regarding healthy choices, prevent subsequent teen pregnancies and child abuse and neglect, including that of the teen mother, and assist in post-secondary education and/or employment.  The program is open to all students under the age of 21 years who are not high school graduates and are parents, expectant parents or have been pregnant during the last 120 days. [Retrieved from https://rusd.org/academics/alternative-programs/pregnant-parenting-teens

Alkinburgh and Anzalone report that they average around 100 enrolled students each year.  During the 2022/23 school year, they served 104 students.

Healthy Children Project’s Carin Richter notes that programs like SAPAR aren’t often sustained for as long as Racine’s programming; instead,  they’re often met with a lot of opposition and are frequently cut from school budgets, she observes.

“I am impressed with the school district that promotes her program and the school board, PTA, and school staff that encourage this type of program,” Richter offers. 

The team comments on their strength and sustainability: 

“[Our program] has two nurse case managers with extensive knowledge and experience in maternal and child health, allowing us to help when medical issues arise, not just for our parents but also their children.  We provide health education, childbirth and parenting classes, and assist with community resources and academic needs.  We work together as a team with our students, families, school staff, medical providers and community partners.  

The national average graduation rate for teen parents is about 50 percent,  but our program changes that!  Last year 94 percent  of our eligible Seniors graduated providing more job opportunities, financial stability and college or apprenticeship options. Teens 15 to 19 years old also have higher rates of infant mortality and maternal complications. We had zero percent.”

Students Anika Moreno and Gregory Sanders Jr. pictured with their child.

Each work day is different for the duo. There are no defined hours and they often work with students for several years.  

“Our work requires a lot of flexibility and patience, but it is so rewarding to see our students succeed,” they begin. “We provide school visits throughout the district, and also phone, virtual, home and community visits to meet the individual needs. You may find us busy helping students get health insurance, find a medical provider, manage pregnancy symptoms to stay in school, check a blood pressure, obtain a medical excuse, meet with support staff, talk to a parent, help enroll in community programs, get a crib or car seat, find diapers, etc.  We may be assisting with childcare, nutrition, housing, employment or transportation needs.  We also do a lot of health teaching and use evidenced-based curriculum specifically designed for young parents to help them learn and have an opportunity to earn additional credit toward graduation. Our goal is that our students stay in school, graduate high school and have healthy babies.”

Teenage dads can get a bad rap, but Alkinburgh and Anzalone note that “they really want to be great dads.” The nurses offer individual, joint and group meetings for young fathers and cover topics like infant care, co-parenting, child support, etc.  

“We try to make learning fun and engaging,” the duo says. “For example, we may have a diaper changing race or have them practice giving a baby a bath with our infant model and newborn care kit.” 

To add to their skill-base, the team needed to do some unlearning about breastfeeding myths through the LCTC.  

“Now that we know the newest research-based facts, we can best educate our students,” they say. “We already started using the awesome counseling skills they taught us in the training and it has really helped us ask more open- ended questions to address students’ concerns and goals.” 

Overall, the nurses have experienced a positive attitude for breastfeeding in their community at large. For instance, the district offers private lactation rooms in each of their schools for staff and students to use when needed. 

For those interested in supporting the program’s mission, the team offers: “Be kind, supportive and share with others how truly valuable a program like ours really is!” They also suggest donating, volunteering or partnering with community organizations that help support their students  like the Racine Diaper Ministry, Salvation Army, Cribs for Kids, Parent Life, Halo, and United Way. 

Find the program on Facebook here.

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!”

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.



Medical librarian to perinatal services manager, LCTC participant strives to improve Black maternal health

Christian Minter, MSLIS is the eldest of twelve siblings. Her mother gave birth both at home and in the hospital, and she breastfed all of her children, so Minter says she was accustomed to seeing the full range of options when it comes to maternity care.

About ten years ago, Minter became interested in maternal and child health after hearing friends share their often less than ideal birth experiences. She discovered that informed choice was a rarity in their care. As Minter learned more about the disparities in birth outcomes among Black women and babies, she became passionate about working to improve Black maternal health.

At the time, Minter worked as a medical librarian supporting families with access to health information. 

“There was only so much I could do as a librarian to support maternal and child health,” Minter reflects. 

Her work evolved and in 2019, Minter began her public health graduate studies. As a project for the course Introduction to Health Disparities and Health Equity at University of Nebraska Medical Center College of Public Health, Minter created a beautiful mini-documentary about doula care for Black women. 

Minter also served as the manager of maternal infant health initiatives for March of Dimes Nebraska, Black maternal health organizer for I Be Black Girl and collaborated on the Omaha Reproductive Well-being Project

Now, Minter works as the perinatal services manager at Community of Hope in Washington, D.C. She is currently on maternity leave with her first baby who is three months old and cooed sweetly during our phone call. 

“Breastfeeding him has been an eye opening experience,” Minter shares.  “It’s one thing to talk about maternal and child health, and another to experience it firsthand. It’s giving me a greater appreciation of the breastfeeding journey of families.  It’s  increased my passion to support other families.” 

Minter shares that she had her eye on the Lactation Counselor Training Course (LCTC) for quite some time, but could never sacrifice the time away from work for the week-long, in-person training. As one of the most recent awardees of the Accessing the Milky Way scholarship, Minter says she’s enjoying the online, self-paced format and learning about the physiology of breastfeeding. 

Minter plans to use her training to support their patient population at Community of Hope. Additionally, she says she’d like to make lactation education and support more accessible to those living in Prince George County, Md., as families often need to travel outside the county for community-based support. 

Minter encourages readers to follow Community of Hope on social media. Their breastfeeding classes are open to the general public. The organization also accepts donations of supplies for families like diapers, maternity clothing and books. Check out their wishlist here and learn about other ways to support their work here.