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!”

Recent happenings linking maternal child health and planetary health

Late this autumn, I went for a hike with my family that moved me to tears. As I looked over the rolling foothills cascading in green, its beauty, while simultaneously reflecting on the horrors in this world, provoked a surge of emotion like the swell of ocean waves just over the mountain range we perched upon. 

I shared this experience with one of my dearest mentors and she replied: “I also find nature a powerful midwife and teacher about life. I remember being moved to tears by redwoods standing firm bearing deep gouges and gaping wounds from lightning strikes and subsequent fires… yet continuing to grow and foster another generation.” 

Photo by Tatiana Syrikova: https://www.pexels.com/photo/anonymous-little-kid-touching-tree-with-hand-3932861/

When I returned to my neglected inbox after this respite hiking and exploring new-to-me land, I came across the juxtaposed images of a human fingerprint and the dissection of a tree trunk suggesting that ‘we are nature’. 

With my mentor’s poetry in mind and the concept of “human nature,” I’d like to invite you to explore the following happenings, documents and projects as they all pertain to the inextricable connection between planetary and human health and the influence of infant and young child feeding practices on greater population health, a concept coined One Health

First up, the 46th Session of the Codex Alimentarius Commission (CAC46) came to a close this month. The CAC is a UN body established by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) in 1963 with a mission to protect consumer health and promote fair practices in food trade.

The International Baby Food Action Network (IBFAN) participated in the session, and as the organization reports:  “After more than a decade of challenging negotiations within the industry-dominant Nutrition Committee, the Revision of the 1987 Follow-up Formula Standard has been officially adopted this week – now renamed the Standard for Follow-up Formula for Older Infants and Product for Young Children.

Thanks to the relentless advocacy efforts of IBFAN, WHO, UNICEF, public interest NGOs, Brazil, Ecuador, Nigeria, and numerous [other] countries, the new standard now makes specific references to the International Code of Marketing of Breastmilk Substitutes and relevant WHA Resolutions in a Preamble. Despite sustained opposition from the USA, these safeguards were retained during CAC, although some of IBFAN’s warnings were removed from the CAC46 report.” 

You can find more detailed coverage at the Baby Milk Action blog here

Also this month, WHO hosted a webinar covering the release of the new WHO guideline for complementary feeding of infants and young children 6-23 months of age

Dr. Francesco Branca began by pointing out some hopeful news.

“The past decade we have seen important gains in improving maternal and child nutrition, including a one-third decline in the proportion of children suffering from stunting, and a tend point increase in exclusive breastfeeding on the way to reaching the 2025 World Health Assembly nutrition target of 50 percent of infants below six months exclusively breastfed. Yet multiple forms of malnutrition, poor growth, micronutrient deficiencies and overweight continue to jeopardize children’s ability to survive and thrive…” 

Dr. Larry Grummer-Strawn summarized that while some of what is in the report is repetitive, there are several key updates. 

For instance:

  • “Milks 6–11 months: for infants 6–11 months of age who are fed milks other than breast milk, either milk formula or animal milk can be fed… Milks 12–23 months: for young children 12–23 months of age who are fed milks other than breast milk, animal milk should be fed. Follow-up formulas are not recommended… (p. 15)
  • “Starchy staple foods should be minimized. They commonly comprise a large component of complementary feeding diets, particularly in low resource settings, and do not provide proteins of the same quality as those found in animal source foods and are not good sources of critical nutrients such as iron, zinc and Vitamin B12. Many also include anti-nutrients that reduce nutrient absorption. (p. 24) 
  • “Foods high in sugar, salt and trans fats should not be consumed… Sugar-sweetened beverages should not be consumed… Non-sugar sweeteners should not be consumed…Consumption of 100% fruit juice should be limited…” (p.32) 

There is also an emphasis on responsive feeding (pages 43 to 47). 

Around 38 minutes into the recording of the webinar, Grummer-Strawn recognizes the reality of consumption of unhealthy food and beverages, the convenience of UPFs and calls on the need for broad policy actions to protect child health. 

Finally, Conference of Parties (COP) 28 wrapped up this month. At COP27, Healthy Children Project’s (HCP) Karin Cadwell presented research on the environmental impact of powdered baby formula milks in North America and HCP’s Kajsa Brimdyr on skin-to-skin contact (SSC) in the first hour after birth as a simple and easy, inexpensive, appropriate for all dyads with countless benefits intervention. (Read more coverage here.) 

Notable from this year’s session, among other important endeavors, includes work by the London School of Hygiene and Tropical Medicine (LSHTM) like the Children, Cities and Climate Action Lab and a partnership to understand how floods and heat driven by climate change affect the delivery of maternal and child health care in Brazil and Zambia

For further reading on climate action, check out Hidden Brain’s newsletter blurb:

“Psychologists have studied how to raise awareness about climate change and get people to take action on the issue. The answer can vary depending on a range of factors, like culture, age, gender, political ideology — the list goes on. An international team of scientists behind a recent paper has created a tool that shows which messages and interventions are most effective with different demographics. ‘To maximize their impact, policymakers and advocates can assess which messaging is most promising for their publics,’ said study co-author Kimberly Doell, who also helped lead the project. Check out the tool for yourself here.

Children’s book celebrates the joy of natural-term breastfeeding

Monica Haywood is a researcher by nature. When she became pregnant with her daughter, she read all of the baby books. 

She read about prenatal vitamins, proper nutrition, prenatal appointments, etc., etc., etc. 

“I wanted to do everything right,” Haywood says. 

Sometime during her second trimester, her focus narrowed in on breastfeeding. She was familiar with the stories her mother told about breastfeeding her, but she wanted to know more. Haywood attended La Leche League of Louisville meetings and scoured websites for infant feeding information. 

She felt prepared and laid out a plan to breastfeed her baby for three months. 

“Little did I know, the journey was slightly different,” she laughs. “You can read, read, read, but be prepared to pivot on things that you may have read about.”

Baby Noelle was born in 2017 and instead of breastfeeding for the planned three months, Noelle and Haywood nursed for 34 months. 

Haywood says that while exclusive, natural-term breastfeeding was sometimes challenging like balancing her baby’s needs and self-care and managing other people’s perceptions mostly, breastfeeding created a sense of empowerment and bonding. 

Haywood shared another connection with Noelle through her love of books early on. 

“She was only a couple months old and my husband and I were reading books to her,” she shares. 

“[Reading] helps with language development, and we also thought it was important to find books that she could relate to… characters that look like her and that can relate to her experience,” Haywood continues.  

She found that most children’s breastfeeding books were geared toward weaning, but she was looking for something that celebrates the breastfeeding journey, something that could capture what she and Noelle were doing. 

And when she couldn’t find it, she created it. Haywood wrote Noey Loves Nursing, a colorful book that commemorates her nursing journey, celebrates a diverse character,  and educates and brings awareness to extended breastfeeding. 

“I wish I could get it in the hands of every breastfeeding mother!” Haywood exclaims. 

The book is highly admired by younger readers including her daughter who Haywood says is really excited by the book. 

Another young reader, Blake, shares his reading of Noey Loves Nursing @readingwith_blake

“When I saw [the video],  it literally brought me to tears,” Haywood says. “It’s just awesome.” 

Before COVID-19, Haywood enjoyed sharing Noey Loves Nursing at in-person gatherings like LLL Louisville’s Live Love Latch during National Breastfeeding Month and Healthy Children Project’s International Breastfeeding Conference. She’s also shared her story with local WIC offices.

This summer, Haywood adapted to Zoom and Facebook Live events to celebrate Black Breastfeeding Week and National Breastfeeding Month with her book. 

Haywood looks forward to the United States Breastfeeding Committee’s (USBC) National Conference in 2021 where she hopes to bring her mother and Noelle– three generations sharing their breastfeeding journeys. 

The second edition of Noey Loves Nursing will be released later this year or in early 2021. Get connected with Haywood on social media @noeylovesnursing, @monicareneeinc and on Facebook.

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.