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 

LCTC participant rewrites cultural norms with “Afrofuturist healing modalities”

As you focus on clearing your generational trauma, do not forget to claim your generational strengths. Your ancestors gave you more than just wounds.” — Xavier Dagba

 

Audrey Gentry-Brown, Full Spectrum Birth Sista, Certified Blactation Educator (CBE), Student Midwife, and Medicine Woman in Loudoun County, Va. often found herself asking why?

While present at her sisters’ childbirth experiences, she couldn’t help but question the medical interventions imposed on their bodies. “Why aren’t these doctors allowing their bodies to do what they were designed to do?” she wondered. 

Audrey, hailing from a family with maternal origins in the Southern United States and paternal roots in Jamaica, noticed a stark difference in breastfeeding customs. In the U.S., it appeared that nobody from her maternal lineage embraced breastfeeding, while in Jamaica, it was a widespread tradition.The puzzle deepened when she observed the aversion of many Black women to breastfeeding. 

Just as she diligently tends to her garden, Audrey embarked on a quest for answers and is now sharing the abundance of knowledge she has cultivated.

In her own words, she is rewriting cultural norms within her community, introducing “Afrofuturist healing modalities” that reconnect to “ancestral magic.”

“I engage in this work to revive and reclaim the traditions that we have abandoned. I advocate for, educate, and guide our women through a system that often neglects our needs. My dream is for us to give birth as our foremothers did, within the comfort of our homes, surrounded by love,” Audrey passionately explains.

She says she sees a glimmer of hope in the growing trend of families choosing to reclaim their traditional birthing practices by opting for out-of-hospital births, which grants them greater control and the ability to curate their birth experience.

Having recently been awarded the Accessing the Milky Way scholarship, she is currently pursuing the Lactation Counselor Training Course (LCTC) and continually equipping herself with knowledge to assist her community in addressing deeply ingrained trauma related to infant feeding.

Audrey points out a concerning statistic: Black women are more likely to face in-hospital formula introduction (Echols, 2019), along with other marketing tactics targeting them.

“I’m here to tell you that there’s a better way,” she declares.

Moreover, she is dedicated to educating families about traditional practices like babywearing, which encourages breastfeeding and responsive parenting.

In her quest to preserve cultural traditions, Audrey invokes an African proverb: “When an elder dies, a library burns down.” She urges people to reach out to the matriarchs and patriarchs in their families, seeking knowledge of their ancestral customs, and ultimately, to revive, safeguard, and uphold those traditions.

To support Audrey’s mission, you can explore her apothecary or enlist her birthwork services to contribute to her efforts to gather supplies for her future midwifery practice.

Breastfeeding is food sovereignty. Breastfeeding is health equity. Breastfeeding is healing.

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

Breastfeeding is food sovereignty. Breastfeeding is health equity. Breastfeeding is healing.

Breastfeeding is a “weapon of mass construction”, a phrase coined by Camie Jae Goldhammer, MSW, LICSW, IBCLC, (Sisseton-Wahpeton).

In her Reclaiming the Tradition of Breastfeeding: the Foundation of a Nation webinar, Goldhammer describes how breastfeeding has the power to heal those suffering the effects of generational trauma, specifically through the release of oxytocin, subsequently allowing mothers and their babies to feel empowered and independent.

Photo by Luiza Braun

Kathleen Kendall Tackett’s work also illuminates how breastfeeding can heal trauma. Her videos, How Birth Trauma Affects Breastfeeding and Breastfeeding Can Heal Birth Trauma and Breastfeeding’s Healing Impact on Sexual Assault Trauma discuss the mechanisms behind why and how breastfeeding can be helpful for trauma survivors. Essentially, breastfeeding allows for the down regulation of stress responses, specifically adrenocorticotropic hormone (ACTH) and cortisol, and similar to exercise, improves maternal mood, decreases the risk of depression, decreases hostility, and improves the mother infant bond.

Jennie Toland, BSN, RN, CLC offers commentary on the role lactation care providers play in offering trauma-informed care in this piece.

This Invisibila episode, Therapy Ghostbusters, shares the incredible story of how a Cambodian practitioner worked to help heal an entire community from generational trauma. It took him over a year to simply earn individuals’ trust.

“…That’s pretty unique,” the podcast hosts point out and offers insight into how our nation approaches care for individuals with specific mental health needs and cultural considerations.

Goldhammer quotes Round Rock elder Annie Kahn:  “When a mother nurses her baby, she is giving that child her name, her story and her life’s song. A nursed baby will grow to be strong in body, mind and spirit.”

This connection to the past that Kahn refers to, also offers a form of healing. Breastfeeding is an example of Indigenous food sovereignty, “a part of living culture” and facilitates the revitalization of traditional knowledge. (Cidro, et al 2018)

The revitalization of breastfeeding spans the Black Indigenous People of Color (BIPOC) experience and is a channel to champion equity.

Ifeyinwa V. Asiodu,  Kimarie Bugg,  and Aunchalee E.L. Palmquist write in Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future:

“Breastfeeding is an especially important public health issue in Black communities, particularly given that Black families and communities continue to experience the highest burden related to poor maternal and infant health outcomes, including higher incidence of preterm birth, low birth weight, maternal mortality and morbidity, infant mortality, and lower breastfeeding rates. Owing to lifetime exposure of racism, bias, and stress, Black women experience higher rates of cardiovascular disease, type 2 diabetes, and aggressive breast cancer. Given that cardiovascular disease and postpartum hemorrhage are leading causes of maternal mortality and morbidity, increasing breastfeeding rates among Black women can potentially save lives.”

Photo by Emily Finch

More specifically, studies show that the experience of racial discrimination accelerates the shortening of telomeres (the repetitive sequences of DNA at the ends of chromosomes that protect the cell) and ultimately contributes to an increase in people’s risks of developing diseases.

It has been found that higher anxiety scores and inflammation are associated with shorter telomere length.

Because physical and psychological stressors trigger the inflammatory response system, one way to counter this reaction is by supporting ongoing breastfeeding relationships; when breastfeeding is going well, it protects mothers from stress. (Kendall-Tackett, 2007)

Another study found that early exclusive breastfeeding is associated with longer telomeres in children.

Photo by Luiza Braun

The authors of Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future continue, “Yet breastfeeding is rarely seen as a women’s health, reproductive health, or a public health strategy to address or reduce maternal mortality and morbidity in the U.S. Inequities in lactation support and breastfeeding education exacerbate health inequities experienced by Black women, specifically maternal mortality and morbidity, and thus a greater investment in perinatal lactation and breastfeeding education and resources is warranted. Breastfeeding is an essential part of women’s reproductive health.”

Journalist and maternal child health advocate Kimberly Seals Allers’ approach is one “For Black people, from Black people.”

“…The call to revive, restore and reclaim Black breastfeeding is an internal call to action,” Kimberly Seals Allers begins in Black Breastfeeding Is a Racial Equity Issue.  “… Breastfeeding is our social justice movement as we declare the health and vitality of our infants as critical to the health and vitality of our communities.”

Specifically through her work with Narrative Nation, Seals Allers and colleagues are promoting health equity “by democratizing how the story of health disparities is told,” centering BIPOC voices. Additionally, through her Birthright podcast, KSA uplifts stories of  joy and healing in Black birth.

Especially after the deaths of George Floyd, Breonna Taylor and Ahmaud Arbery, organizations made statements about their commitments to dismantling structural racism and focusing efforts on equity.

Equity has become a buzzword; in fact, one author brands the sentiment “Fakequity”. This year, United States Breastfeeding Committee (USBC) National Conference and Convening presenters expressed their fatigue with the word.

“We want to see action,” they said.

Nikki & Nikki LIVE offer their Allies, Advocates and Activists Equity in Lactation webinar which covers the meaning of equitable in lactation care, how to show up for the marginalized and how to make a lasting impact.

In other efforts, the CDC has identified breastfeeding as a priority area to address health inequities.

Photo by Luiza Braun

NICHQ’s Achieving Breastfeeding Equity campaign also focuses on closing breastfeeding disparity gaps, viewing their efforts through an equity lens.

Director of policy and partnerships at the National Women’s Health Network Denys Symonette Mitchell offers commentary on a way forward with key policies that will ensure investment in breastfeeding to ultimately advance health equity.

Watch Racism and the Colonial Roots of Gendered Language in Public Health and Biomedicine with Dr. Aunchalee Palmquist, PhD, IBCLC for more on these issues.  

 

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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, tell us about how you are contributing to working toward healthy equity.

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.

Firstfeeding coalition focuses on enriching Indigenous lives

Heidi Abed, Executive Director Ayllu Community Network, gave birth 20 years apart. With this spacing, Abed saw firsthand how mothers are treated according to their age and perceived experiences.

Photo Courtesy of IFCC

As a 17-year-old, medical professionals doubted her when she told them she was in labor. When she was sent away from the hospital, Abed almost gave birth at home alone.

“I had to call an ambulance,” she recollects.

At 37, Abed desired a water birth, but her insurance denied coverage for this natural option.

“Even 20 years later, I have not seen enough improvement in maternal support provided for any natural options during birth, postpartum and especially with lactation,” Abed shares.

What’s more, she says it was like pulling teeth to try to gain access to a lactation care provider in the hospital.

“They told me that they had lactation consultants, but a couple of days later, they never got the chance [to come see me.]”

Once she and her baby were discharged, it was hard to find lactation care too. When she did connect with one, the lactation specialist used language Abed didn’t understand, and she says she had to look it up on Google to try to make sense of it.

Established in 2018, Abed joined the Indigenous Firstfeeding Coalition Colorado (IFCC)– a coalition created to combat extremely low lactation rates in Indigenous communities due to generational and historical trauma— a few years after its launch. [More on addressing historical trauma here.]

“I am doing what I can to fill a gaping void for far too many,” Abed shares.

Abed’s comrade at IFCC, LJ, has been invested in supporting and educating parents about lactation since having a child in 2013. Being Native, enriching Native lives stays a priority for LJ.

Abed and LJ  have grown in their knowledge and ability to help support others by completing the Indigenous Lactation Counselor Training and Cornerstone Full Spectrum Doula Training.

The team has also embraced inclusivity leading to their name change from Indigenous Breastfeeding Coalition Colorado to its current name, along with their handle across social media: NativeNipples.

The coalition networks with many other community organizations promoting and engaging with their events. This summer has been full of opportunities to connect and more to come like the Breastival, the Indigenous Mind Body Gathering, the Healing Hoop veteran honoring event, Elephant Circle video contest, and the second part of Tewa Women United’s Lactation After Loss.

“Interconnectedness and networking is really everything since we are volunteers with no funding,” Abed begins. “Our aforementioned training was made available through other partnerships at no cost to us. Also, our communities are relatively small and spread out, so pooling together knowledge and resources across social media helps bridge geographic gaps. Bringing light to each other’s efforts makes us more effective, supported, and [helps] avoid redundancy.”

IFCC at the 9 Health Fair in 2019.

Abed also points out the links between Black maternal health and Indigenous maternal health and how they are working together with allied organizations to dismantle many shared experiences that impact maternal infant health.

With the 3rd Annual Indigenous Milk Medicine Week this week, honoring the theme “Strengthening Our Traditions From Birth and Beyond”, IFCC will host an Instagram Live event. Follow them on social media and stay tuned for more information throughout the week.

Knowing that Indigenous cultures are diverse and complex, the learning and honoring never ends! Check out the following to learn more and support these important efforts.