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!”

Empathy in architecture

A friend of mine works in a healthcare building; her office, windowless. Stark white walls frame the shiny tiled floors in the also windowless laboratory that surrounds her office. Rectangular fluorescent lighting looms eerily overhead. Working in this space for the majority of her waking hours amounts to constant longing for sunshine and an overall agitated demeanor. I imagine the architect of this space wasn’t much of an empath.

Photo by Robert Katzki on Unsplash

This effect is being documented in a growing body of research demonstrating how color, texture and patterns affect human emotions.

Generally, humans are quite robot-like, performing our daily duties without a great deal of attention paid to the building structures, layouts or designs that we move through. 

“When we don’t notice the built environment, it’s silently affirming our right to be there, our value to society. When we do, too often it is because it’s telling us we don’t belong. Those messages can be so subtle that we don’t recognize them for what they are,” Kim Tingley writes, later quoting architect Joel Sanders: “‘We sleepwalk our way through the world…Unless a building interior is strikingly different or lavish or unusual, we are unaware of it.’” 

The first time I saw a lactation pod at an airport– unusual at the time– I had mixed emotions. Part of me became excited that this was an option for traveling, lactating, pumping, and breastfeeding people, but most of me scoffed, annoyed, thinking something along the lines of: “Of course breastfeeding moms would be given this messaging to go hide themselves away from the public eye.” 

What Tingley wrote, that our built environment affirms our right to be in a space, affirms our value to society, is certainly a powerful concept. 

The COVID pandemic has forced us to think more about the built spaces we move through, adding layers to this idea of how and what and who we value.  

In a recent episode of Uniquely Milwaukee Salam Fatayer of 88Nine Radio Milwaukee poses the question: “What could our city, neighborhoods and community spaces look like if they were created based on people’s emotional, psychological and social needs?”

Photo by Coasted Media on Unsplash

Local architects and scholars answer with ideas about how they’re supporting the users of the spaces they create, with the goal of making sure people feel safe, at peace and nurtured by those built environments. 

On Our Milky Way, we’ve had the honor of highlighting the work of those thinking about how built spaces affect birth, lactation and beyond. 

For example, in conjunction with the Institute of Patient-Centered Design, Inc., The MomFriendly Network created The Lactation Design program which consists of research and outreach projects to enable the Institute to contribute design resources that  improve accommodations to support breastfeeding. Read more about this project here: https://www.ourmilkyway.org/physical-environment-influences-breastfeeding-outcomes/ 

Renée Flacking and her colleagues’ work, Closeness and separation in neonatal intensive care, explores how architecture influences outcomes in neonatal units. Single-family room designs are increasingly replacing traditional open-bay units for reasons documented in their paper.

Source: United States Breastfeeding Committee (USBC)

“This architectural structure provides the family with an opportunity to be with their child in the neonatal intensive care unit day and night providing facilities for parents’ basic needs including the need for privacy. This design has been suggested to be associated with a lower rate of hospital-acquired infections, similar to single patient rooms in adult intensive care (48), earlier full enteral nutrition, higher breastfeeding rates and a more soothing environment with, for example, lower ambient sound levels (49). As this design has been shown to reduce the length of stay in hospital significantly, for example, by 10 days in preterm infant below 30 weeks of gestation in a Swedish study (50), it shortens the time of separation for the infant from the home and family. Parents have reported that they felt that a single family room design in a NICU facilitated their presence with their infant (51), but the increase in parent–infant closeness gained by a single family room model during hospital care is not well documented in scientific literature.”

Read Our Milky Way’s coverage on this concept here

In stark contrast, attorney Leah Margulies recently shared in Protecting Breastfeeding in the United States: Time for Action on The Code that formula companies provide architectural designs to maternity care facilities in a deliberate attempt to separate dyads, making bonding and breastfeeding difficult and consequently,  families more likely to become reliant on their artificial products. It’s a sickening example of how the industry saturates our systems, down to the skeletons of our buildings.

Photo credit: Henrico County Public Library

Venturing beyond the very early postpartum period, it’s exciting to explore how community spaces are supporting young families. The Henrico County Public Library – Fairfield Area Library is accommodating families with their Computer Work + Play Stations which were conceptualized by library staff and materialized by architects at Quinn Evans and TMC Furniture staff. Read more about that inspiration and process here

Supporting lactation and breastfeeding in the workplace is a vital part of ensuring that lactating individuals feel valued. Setting up lactation spaces sometimes calls for innovation and creativity. You can explore our collection of stories about workplace accommodations in the stories below: 

CLC advances breastfeeding protection and support in the workplace

Workplace supports breastfeeding mother of triplets

Making Breastfeeding the Norm through The Breastfeeding Family-Friendly Community Designation (BFCD)

Alameda sergeant improves lactation space and support in county

Artist celebrates working mothers with ‘Liquid Gold’ project

Worksite program caters to nursing moms

Photo credit: Meredith W. Gonçalves

 

Pulling back the lens further, the architecture of communities themselves influences well-being too. One of the effects of redlining is poor health outcomes. Part of this equation involves the placement of industrial buildings and factories. Vann R. Newkirk II points out in Trump’s EPA Concludes Environmental Racism Is Real that The National Center for Environmental Assessment released a study indicating that BIPOC are much more likely to live near polluters and breathe polluted air. “Specifically, the study finds that people in poverty are exposed to more fine particulate matter than people living above poverty,” he writes.  

NICHQ hosts a webinar The Residual Impact of Historical Structural Inequities: Connecting Residential Segregation and Mortgage Discrimination to Current Infant Mortality and Breastfeeding Rates where maternal child health experts including speakers Jaye Clement, MPH, MPP, Brittney Francis, MPH, Kiddada Green, MAT, Arthur James, MD and Jessica Roach, LPN, BA, MPH share examples for supporting efforts to reduce infant mortality and improve maternal and infant health. 

Circling back to Tingley’s piece, the article raises the concern that although we’re equipped with knowledge about how under-resourced populations are being affected by current structures and practices,  “funding earmarked for expanding inclusivity [may] be diverted toward making existing facilities safer for those they already privilege.” 

Drawing on Sanders’ work, Tingley writes,  “Throughout history… the built environment has reflected and reinforced inequality by physically separating one group from another, often in the presumed interests of health or safety. Women-only bathrooms, so designated by men, supposedly preserved their innocence and chastity; white-only bathrooms separated their users from supposedly less ‘clean’ black people. It’s no coincidence that Covid-19 has disproportionately sickened and killed members of demographic groups — people who are black, Indigenous and Latino; who are homeless; who are immigrants — that have been targets of systemic segregation that increased their vulnerability. It’s also not hard to imagine the pandemic, and a person’s relative risk of infection, being used to justify new versions of these discriminatory practices.”

Art by Liz Richter, Photo by Leslie Rodriguez
Find more of Richter’s art here: https://www.lizrichterart.com/public-art

In this vein, Glenn Gamboa details where some funding gets funneled in a piece published this spring. 

“Twelve national environmental grant makers awarded $1.34 billion to organizations in the Gulf and Midwest regions in 2016 and 2017, according to a 2020 study by The New School’s Tishman Environment and Design Center. But only about 1% of it — roughly $18 million — was awarded to groups that are dedicated to environmental justice.” 

The climate crisis is an accelerating threat that is both affected by and affects architecture. 

“Architecture has to mediate between the perceived needs of the moment versus the unknowable needs of the future; between the immediate needs of our bodies and the desire to create something that will outlast generations,” Tingley goes on to write. 

Across the globe, architects push to be “mindful of their projects’ environmental impacts and resilience, including an emphasis on upcycling, the use of solar power, better building practices, and, of course, structural longevity,” Alyssa Giacobbe writes.  [More on ecological design here.] 

Alongside resilience and sustainability, there must be a focus on design that specifically serves mothers and their children. Mothers are too often left out, unseen, underserved despite there being about two billion of us worldwide, with an increasing likelihood of women becoming mothers

Photo by Dimitry Anikin on Unsplash

Lisa Wong Macabasco puts it this way: “Although the experience of human reproduction touches all of us at least once in our lives, its effects remain taboo, under-researched and excluded from exhibitions and publications covering architecture and design history and practice. In these spheres, maternity is treated furtively or as unimportant, even as it defines the everyday experiences of many – some 6 million Americans are pregnant at any given time.” 

It isn’t surprising that “design for children, design for healthy spaces, design for those with disabilities, care of and for their colleagues – these discussions and follow through are happening largely through female-led firms and initiatives,”  Julia Gamolina comments in The Unspoken Burden on Women in Architecture

In an exciting development, Wong Macabasco describes design historians Amber Winick and Michelle Millar Fisher’s Designing Motherhood, “a first-of-its-kind exploration of the arc of human reproduction through the lens of design. Their endeavor encompasses a book, a series of exhibitions and public programs in Philadelphia, and a design curriculum taught at the University of Pennsylvania.” 

This is exciting, and it’s progress. But as Wong Macabasco quotes Juliana Rowen Barton– architecture and design historian and curator who also helped organize Designing Motherhood– “Progress is not the fact that this show happened – progress is these conversations continuing to happen.” 

Designing Motherhood is on view at the Mutter Museum in Philadelphia through this month of May 2022.