AABN was founded by Angelia Wilks-Tate and Dalvery Blackwell who set out to address breastfeeding disparities through a community-led organization. Blackwell now serves as the organization’s first executive director and Wilks-Tate serves as the President of the Board Directors.
Yesterday, the organization and its partners hosted their ninth annual Lift Up Every Baby! Celebration. Lift Up Every Baby “is all about the blissful happiness we experience when our community comes together to celebrate, securing our collective power to help create spaces of health and wellness!” the organization shared with their social media followers. Pregnant people and young families were invited to experience a community-drive and “family-centered afternoon of festivities, celebrations, good food and positive vibes.”
Guest post by Donna Walls, RN, BSN, CLC, ANLC with intro by jess fedenia, clc
Donna Walls’s, RN, BSN, ICCE, IBCLC, ANLC unmedicated births were sort of a fluke.
“I remember being horribly afraid of someone sticking a needle in my back,” she recalls.
The “glorious” feelings of confidence and joy were unexpected consequences, but thinking back, Donna says, “Boy, I am sure glad I [gave birth that way.]”
In all other aspects of parenting, Walls credits growing up in the 1960s for becoming a self-described Granola Mom.
“When everything went ‘back to nature’, that was a big influencer for me,” she says.
As a nurse, Walls was always drawn to maternity care and supporting breastfeeding as the natural progression after giving birth.
It felt thorny to her when babies were taken to the transition nursery immediately after birth and later given back to their mothers.
This ritual sent the message that “We (as in the staff) can take better care of your baby than you (as in the mother) can.” That never sat right with Walls.
Then, one pivotal moment in particular, Walls on duty in the transition nursery, walked by a baby only a couple of hours old.
“He was frightened,” Walls begins. “His lip was quivering and he was splayed out underneath the warmer. He was so frightened. It just affected me.”
After that, Walls galvanized to change the culture in this hospital. She worked very hard alongside a physician colleague to open a birth center within the hospital. In 1995, Family Beginnings at Miami Valley Hospital in Dayton, Ohio was unveiled, offering families an option where birth wasn’t pathologized and where mothers and babies were honored as dyads. (Birthing at Family Beginnings remains an option for those in the Dayton area today.)
The center was designed to look like a home. There was no nursery for babies to be separated from their parents. When mothers came in to labor, the staff would pop in bread to bake, a special touch of aromatherapy.
Freshly baked bread, though enticing, wasn’t the number one reason families signed up to birth here. Instead, they chose Family Beginnings because they didn’t want their babies taken away from them, Walls reports.
Walls has since retired from her work in the hospital, but respectful maternity care remains forward in her mind and in her advocacy.
She graces us with reflections on respectful maternity care in her guest post this week on Our Milky Way. Read on!
As a nurse in maternity for over 40 years, I have too often witnessed what I refer to as the “empty vessel theory”. Women are regarded as merely a container for the fetus and care providers merely the technician to remove it, usually as quickly as possible. I have often been saddened when the emotions and spirituality of birthing are disregarded or even mocked. This miraculous process is a rite of passage with all the inherent pain, joy, lessons and connections needed to begin the journey into parenting. My hope is that through discussions and activism, we can reach a point where the birthing family is honored and all newborns are brought into the world with love and respect.
Respect is “showing regard for the feelings, wishes, rights or traditions of others”. Concerningly, there is an abundance of anecdotes from patients and caregivers that demonstrate how maternity care practices are often disrespectful, sometimes even abusive.
Disrespectful care encompasses racial inequity, lack of confidentiality, physical and/or emotional abuse, denial of care or provision of substandard care, lack of informed consent or coercion or condescending communications. This type of care occurs in all countries around the world, to all demographics of women and their families. Fortunately, disrespectful care has drawn the attention of many health organizations, including the World Health Organization, and steps are being taken to stop disrespectful, abusive care practices.
Examining the intersection of maternity care and human rights has been a recent topic in many maternal and infant care advocacy groups as well. We cannot assume that hospital admission for an appendectomy is equal to admission for the birth of a baby. This is because the scope of the process of birthing impacts a person, a family, a community and a nation which is not so of a surgical procedure.
Most women and families expect they will receive safe, inclusive, compassionate care and trust their caregivers to provide prenatal, intrapartum and postnatal care with honest communication and respect for their needs and choices. Provision of safe care should look beyond the basics of preventing maternal, fetal or neonatal morbidity or mortality and consider how to support the family’s human rights– rights inherent to all people, without discrimination, regardless of age, nationality, place of residence, sex, national or ethnic origin, color, religion, language or any other status. (White Ribbon Alliance, 2020)
The first stated right is to be free from harm and mistreatment, yet we find continuing cases of physically and emotionally abusive treatment of pregnant and birthing women. Secondly is the right to competent, culturally sensitive care for both mother and newborn. Next is the right to companionship and support, and lastly the right to meet the basic life-sustaining needs of the dyad, including breastfeeding support for the newborn.
The first step toward respectful care is choosing healthcare providers who value open, honest communication and who will discuss options and listen to the family’s needs and concerns. WHO defines respectful communication as communication which “aims to put women at the centre of care, enhancing their experience of pregnancy and ensuring that babies have the best possible start in life.” (WHO, 2018)
Other components of respectful communication include the use of positive body language, active listening, the use of non-judgmental language, assuring patient privacy and honoring physical and emotional needs. Respectful communication can begin with simply referring to the person by the name they prefer. If it is not documented, ask.
Another important step is selecting the birthing place. (Niles, 2023) Most care providers practice at one to two hospitals or birth centers. Choosing the birthing environment is an important decision in creating a birth experience which is in line with the family’s expectations and goals. Research and discussions with childbirth educators, lactation care providers and other families can give insights into common or routine practices at that institution. Will the family’s requests be honored? Will questions be answered with open and honest informed consent? Will the birthing and breastfeeding practices support their goals? These are all questions that need to be answered before a birthing place decision is made.
Creating an environment of respectful care in the birthing place is foundational. It is care that assures women and their families will be regarded as capable of making decisions. Making decisions which respect the values and unique needs of the birthing woman can only be made when patient autonomy– the right of patients to make decisions about their medical care without their health care provider trying to influence the decision– is recognized.
Individuals often comment on birthing in the hospital as a time when you lose all modesty; however, it is possible to follow protocols that set a standard for assuring privacy and modesty which can positively impact the birth experience. Simple steps like not discussing patient history or current conditions in front of others (without the patient’s permission), being mindful of covering intimate body parts (or culturally sensitive covering) whenever possible, asking permission before touching or knocking (and waiting for a response) before entering the room are a huge part of maintaining patient dignity. It cannot be overstated that any cultural requirements for modesty must be respected at all times.
More on respect in health care on Our Milky Wayhere, here and here.
For those who couldn’t attend, there will be a recording sent to registrants. And if you missed registration, we’ve distilled the conversation in hopes that you’ll use it as a jumping-off point in your discovery or continued understanding of operationalizing Diversity, Equity, and Inclusion (DEI) or what is sometimes referred to as J.E.D.I. (Justice, Equity, Diversity, Inclusion).
First off, USBC Senior Engagement & Training Manager Denae Schmidt and Dr. James made the distinction between operationalizing DEI and advancing health equity. Simply put, the former is the practice and the latter is the outcome. Dr. James suggested participants think of the distinction as the difference between who is doing the work and who is being served.
So, what practices are philanthropists adopting in order to serve the advancement of health equity?
Funders are reevaluating what is truly needed from grantseekers. Many are making the application process less tedious, acknowledging that many small organizations do not have the resources to “jump through hoops.”
Some funders are forgoing reporting requirements, adopting the concept of trust-based philanthropy. Trust-based philanthropy embraces the idea that the community has a lot of expertise, as Dr. James puts it. In this relationship, there is trust in the collaboration, a power share. Dr. James nods to MacKenzie Scott who tends to vet organizations on the front end in order to understand their focus, and then give funding with no strings attached.
Over the past five or so years, there has been a shift in the field to recognize that there needs to be more capacity-building for grant seekers. Catchafire is a “network of volunteers, nonprofits, and funders working together to solve urgent problems and lift up communities” offering pro bono services. Find out how that works here: https://vimeo.com/462743914
Dr. James reports that more people are starting to recognize that policy is an important piece in health equity. She said that we need to get “upstream” to address health disparities which means that we need to address the structures that lead to poor outcomes in conjunction with providing resources to organizations.
What are some tips for grant seekers?
Grantseekers can check funders’ websites for statements on commitments to DEI to make sure it’s a good fit for them. Grantseekers might also research what other projects funders have supported to get a sense of what kind of work they invest in.
Grantseekers might consider inviting potential funders to their events in order to engage with the community. Dr. James suggests not approaching the first meeting with funders with an “ask”.
Work alongside and across spaces to pool resources like talent and time. Collaboration expands reach, and this is desirable to funders.
Don’t be afraid to reach out to funders to get more information about how proposals can align more with their commitment.
Schmidt and Dr. James closed with some thoughts on why good intentions just aren’t good enough. Mainly, good intentions don’t always lead to action, Dr. James pointed out. And sometimes, she added, they can lead to harmful action. She reminded us that we didn’t start talking about health equity in 2020. These discussions had been happening long before, and what has been missing are the resources and the support in leadership.
What leadership talks about in public and in private signals what they care about, Dr. James continued. Individuals leading DEI initiatives need to have the authority and the respect to make decisions.
So, generally speaking, what can we all do to help operationalize DEI?
Take the courageous stand to commit to DEI.
Facilitate the collection and evaluation of DEI initiatives, so that we can gain an understanding of what is happening in these spaces.
Enter spaces with cultural humility. Recognize who is already in the space and what you can learn from them.
Green Feeding practices should continue beyond exclusive breastfeeding. When complementary foods are introduced at six months of age, guidelines include:
foods which are naturally occurring foods (such as plants and animals),
minimizing processed (foods prepared with salt, sugar, oils such as canned fruits or vegetables or simple cheeses),
culturally appropriate, family foods which rarely contain concerning levels of sugar, salt, fats, and toxic additives,
and the avoidance of ultra processed foods (foods altered by processing and additives not normally found in foods like dyes, preservatives, stabilizers). Infant formulas fall into the category of ultra processed foods.
Human and planetary health interplay
Breastfeeding is a frequently ignored topic by global climate action leaders despite it being an almost cost-neutral intervention with a huge impact on human and planetary health.
“Recent studies have highlighted the environmental cost of decades of disinvestment in services to support breastfeeding,” the authors of Support for breastfeeding is an environmental imperative write. “When breastfeeding is encouraged and supported the associated infant and maternal health outcomes produce healthier populations that use fewer healthcare resources.”
By contrast, breastmilk substitutes leave an ecological footprint and require energy to manufacture, materials for packaging, fuel for transport distribution, and water, fuel, and cleaning agents for daily preparation and use, and numerous pollutants are generated across this pathway.
Human health is often sacrificed for business interests and profits; the “bottom line” is about dollars and not families’ precious health.
The Green Feeding advocacy document continues to spell out the interplay between human and planetary health through the lens of healthy infant and young child feeding (IYCF).
As a renewable natural food resource, mother’s milk contributes to local food and water security and biodiversity.
Differently, the run-off of waste from dairy farming used in artificial milk development, threatens our water supply with contamination by toxic chemicals, pesticides and harmful microorganisms.
Not breastfeeding poses the risk of multiple avenues for exposure to toxic heavy metals like contaminated foods and artificial baby milks and contaminated water. Municipal tap water, groundwater or well water is used to reconstitute powdered formulas and cereal foods and can contain high levels of toxic chemicals. This same water is used for cleaning feeding equipment and for drinking. The risk is increased because powdered formulas and foods prepared with water are the sole or the major source of food and drink at the most vulnerable stage of infant and young child development.
“Exposure to toxic heavy metals causes permanent decreases in IQ, diminished future economic productivity. Toxic heavy metals endanger infant neurological development and long-term brain function,” according to a 2021 IBFAN report.
Plastic pollution is a huge environmental concern made worse by the need for bottle feeding supplies and consumption of single-use articles.
Green Feeding contributes to the work of social justice and poverty reduction, offering protection to the most vulnerable infants and their families, creating a “level playing field” for family budgets. It challenges inequalities in marginalized households and communities that are most negatively impacted by climate change. The high cost of infant formula and ultra-processed baby foods can overwhelm low and middle income households.
Green Feeding begins prenatally
There’s a growing body of research connecting prenatal and early life toxic exposures to poor health outcomes.
Things like air pollution, heavy metals, phthalates, plasticizers (PCB) and per- and poly-fluoroalkyl acids (PFASs) which are produced during industrial manufacturing and are widely used in consumer items such as food packaging and non-stick cookware have been known to lead to childhood liver disease, development of diabetes and developmental delays in children.
Endocrine disruptor exposure prenatally and early in life also present a major concern to children. Dozens of these endocrine disrupting chemicals are found in pesticides, personal care products, flame retardants and are found in the air, water and foods. They mimic the female hormone estrogen and thus interfere with the action of the body’s natural hormones which influence reproduction, immunity, metabolism and behavior. More on endocrine disruptors can be found in Endocrine disrupting chemicals and the battle to ban them.
In studies from the University of Rochester Medical School, it was found that wistar rats exposed prenatally to environmental estrogens resulted in damage to the alveolar cells of the breast to the extent that the mother rats were unable to nourish their offspring, as documented in Dioxins In Food Chain Linked To Breastfeeding Ills.
Authors LaPlante and Vandenberg note reduced milk production in mice exposed to 17α-ethinyl estradiol, and less “mothering behaviors” in rats exposed to environmental estrogens, including reduced nesting behaviors and pup retrieval have also been documented. These, and other studies, show a concerning trend in the future care of offspring.
Eliciting change from the top down
UNICEF’s 2022 report Places and Spaces: Environments and Children’s Well-Being calls on national, regional, and local governments to make protection of children’s environmental health a priority. Clean air, water and food make up an essential foundation for infant and childhood health. Creating a cleaner, healthier environment begins with the cleanest first food, breastfeeding, and continues with toxic-free foods throughout childhood and adolescence. Taking these steps now reduces the risk of food-induced illnesses including childhood obesity, diabetes, hypertension, asthma, neurodevelopmental delays and immune dysfunction. While we continue to see the predatory marketing of altered foods claiming to offer health benefits, there is no evidence that any of these are superior in any way to clean, naturally occurring foods.
Eliciting change from the bottom up
Anthropologist Margaret Mead said, “Never doubt that a small thoughtful, committed group of citizens can change the world: indeed it is the only thing that ever has.”
Advocate for breastfeeding. Join local breastfeeding support groups and talk about the risks of not breastfeeding for mother, infant, and the environment. Connect with “breastfeeding adjacent” groups such as breast cancer advocates or prenatal and infant information groups or toddler play groups.
Talk with local stores selling maternity or infant care products about the opportunity to present this information to customers. Use social media to help spread the word.
Stay politically aware of legislation and contact your local, state or federal representatives and let them know why and how you support breastfeeding and climate-friendly actions. The United States Breastfeeding Committee (USBC) is a great launching pad for this type of activism.
If you, your family or friends need to use infant feeding bottles, teats and other products, find safer alternatives like non-plastic infant feeding bottles and plant-based food storage containers.
Connect with local health food or natural food stores, local organic farms or community assisted agriculture groups to brainstorm ways to distribute recipes and meal ideas for cleaner, healthier foods. Local food pantries can also be a great starting point to connect with community resources to encourage healthier family foods.
Local childbirth education and doula groups can also be a great resource for connecting with pregnant or new families to discuss feeding choices.
Many local gardening groups may have information on growing and preparing natural, organic foods.
Join food cooperatives wherever possible and offer education to families on breastfeeding, clean foods and safer food storage/preparing/serving utensils.
Join civic groups in starting community gardens in public spaces, schools, churches and housing complexes.
In Kimberly Jones’s 2020 viral video, How can we win, which comments on looting during the protests sparked by the death of George Floyd, she asks us to consider the why behind peoples’ actions. To explain, she delves into an economic history of Black people in America and the ways in which capitalism and racism are messily entangled.
Geraud Blanks, Chief Innovation Officer for Milwaukee Film and one of the organizers of the event, thanked all of the sponsors who showed up.
“Accessibility is the key to inclusion,” Blanks said. The Black Birth Symposium was completely free to participants including parking, lunch and the space.
Blanks went on to share feedback from a 2022 Black Birth Symposium participant, driving home the importance of investment. It read: “I really hope all the medical facilities get on board with this event. They say that this is the most important issue impacting Black women but I didn’t see everyone at the event. Our community watches to see who puts their money where their mouth is. This also helps build trust in our communities. We don’t need another billboard ad, we need your dollars to go to events like this that really make an impact in our communities. We are watching.”
The thread of capitalism held through the keynote conversation with Tiffany Green, PhD, Assistant Professor Population Health Sciences and Obstetrics & Gynecology at UW-Madison and Jeanette Kowalik, PhD, MPH, MCHES, president and owner of Jael Solutions Consulting Services, LLC.
Dr. Green urged Black and Brown individuals to understand their value.
The Center for American Progress’s piece Women of Color and the Wage Gap points out that, “When looking at women’s wages across broad racial and ethnic categories among full-time, year-round workers, Hispanic women experience the largest pay gap, having earned just 57 cents for every $1 earned by white, non-Hispanic men in 2020. Black women also experience wide pay gaps, with data on Black women alone revealing that—despite consistently having some of the highest labor force participation rates—they earned just 64 cents for every $1 earned by white, non-Hispanic men in 2020. This number dips slightly to 63 cents, reflecting a slightly larger wage gap, when data on multiracial Black women—meaning Black women who also identify with another racial category—are included in the analysis.”
With these inequities in mind, Dr. Green and Dr. Kowalik acknowledged the difficulty in accessing capital, for both individuals and grassroots organizations.
Dr. Green asked participants to consider not giving away their knowledge. You are a part of the community; how can you take care of the community if you’re not taking care of yourself, she posed. Ask for what you are worth, she further advised.
In the arena of maternal child health research, Dr. Green explained that it is well within reason to ask hard questions to funders and leaders like: What is the budget for this grant? What problems are you addressing? Are you stigmatizing the community? May I co-author or co-create?
An audience participant brought up the phenomena of large funding institutions being insular and wondered who holds them accountable. What is the metric? she wondered.
“Folks like us… with our boots on the ground… doing this work every day, have to fight and jockey to keep ourselves alive,” she pointed out.
Building upon her previous comment, the participant added that spirituality and emotional intelligence are not valued in science. She called on us to “restore ancient knowledge”, to “transform and decolonize what we consider competence”, and to “honor the people who brought their lived experiences.”
Dr. Kowalik applauded the work of The Birth Justice Fund – Rapid Response Fund (BJF-RRF), an organization addressing the challenges in accessing capital in under-resourced communities. BJF-RRF is a three- year opportunity to advance community power efforts led by Black, Indigenous, and People of Color (BIPOC) birth justice (BJ) organizations to address implicit bias and structural racism and their impact on maternal and infant morbidity and mortality. The second wave of funding opens this month. Apply here.
Dr. Greene said, “Black scholars need a seat at the table. When you have the lived experience, you ask the right questions. That’s what makes the science better.”
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