Full spectrum doula facilitates multilateral programming to support BIPOC breastfeeding

When Meah El, SFW, TCP, CBE, a Full-Spectrum Doula, Education Specialist, Doula Team Leader and Cribs for Kids Coordinator at The Foundation for Delaware County, was just eight years old, she landed her first job. On summer trips to New England, El would help her aunt in her in-home daycare.  When her aunt gave birth to a premature baby in her late forties, El was the only one her aunt trusted in helping out with the baby.

“I always say that my career found me,” El reflects.

She stayed on this early education career path, later working with Maternity Care Coalition as an Early Head Start advocate. Through this work, she became trained as the first doula at their site.

“I loved it ever since,” she says. “Birth work is the crème de la crème.”

El remembers one of her first clients, a 15-year-old mother, and struggles to put into words just how amazing it felt to help a birthing mother.

To enhance her ability to support lactating and breastfeeding clients, El took a breastfeeding course with Nikki Lee  and now, she is one of the latest recipients to earn the Accessing the Milky Way scholarship which covers the Lactation Counselor Training Course (LCTC). A colleague of hers is also working through the LCTC, so they have scheduled a weekly meet up to review the course material together.

El is dedicated to helping BIPOC families reach their breastfeeding goals and dedicated to improving overall health within BIPOC communities through healthy infant feeding.

While Chester and Delaware counties have relatively high breastfeeding initiation rates, the overall infant feeding culture “hushes” breastfeeding, and BIPOC families are up against barriers to breastfeeding like lack of education, familial support, and skilled lactation care, as El explains.

During Black Breastfeeding Week (BBW) 2023, El facilitated a celebration complete with henna artists, reiki sessions, infant foot massage, aromatouch hand massages for parents, brunch and a breastfeeding photo shoot. El will curate the images from the photo shoot into an art installation during next year’s BBW celebration.

Moreover, El is working to establish a lactation cafe, a peer breastfeeding support group run by breastfeeding champions in the community, and mini trainings for staff at The Foundation.

Logo by Meah El

In order to combat breastfeeding misinformation on social media, El will create social media “shorts” with practical breastfeeding information that will be disseminated through the organizations channels. El is also in the process of working with the Pennsylvania Chapter of the American Academy of Pediatrics (AAP) to recognize breastfeeding-friendly businesses.

All of these efforts are part of El’s goal to create a supportive environment around breastfeeding.

“If there’s no community support and no support at home, [the system] is built to fail,” El begins. “I want everyone to win.”

El encourages Our Milky Way readers to share their breastfeeding photos on social media and tag #delcobreastfeeds in order to normalize breastfeeding. She also reminds readers to explore the multitude of programs available at The Foundation for Delaware County. You can contact El directly for direction.

Boston Public School teacher works to extend support to other lactating educators

Porshai Z. is a third grade teacher in the Boston Public School system, currently on maternity leave with her three-month-old son who cooed during our phone call on an early October morning.

Photo courtesy of Porshai Z.

“I absolutely love it,” Porshai says of teaching. “My [students] are at the most tender age where they’re still aiming to please adults, but they have a little sass and personality.” 

After the birth of her first son, Porshai returned to work just four months postpartum, and she says it’s one of her biggest regrets. For one, it took away from her role as a teacher. She found herself pumping in a bathroom,  stressing each and every time she needed to leave her full-of-personality third graders. Returning to work so soon after the birth of her baby also took away from the joy of feeding her first son, Porshai shares. 

Though Porshai poured herself into research about unmedicated birth and how to breastfeed as soon as she became pregnant, she found herself unprepared for the physical demand of feeding her little human. There was one evening in particular where she felt enticed to open the commercial milk formula package sent by the formula company, but she ultimately persevered. 

“I don’t know what quieted that voice,” Porshai reflects. Perhaps it was the investment she made learning and preparing for this relationship and her realization even through the challenge: “Wow, this is really special.”  

This time, Porshai will remain at home with her new baby for a year. Simultaneously, she is completing the Lactation Counselor Training Course (LCTC). Porshai earned one of the most recent rounds of the Accessing the Milky Way Scholarships

“I have really been enjoying [the course],” Porshai shares. “ There is so much I wish I knew the first time I was nursing.” 

She says she appreciates that the course grounds breastfeeding as a public health issue and that she was surprised to learn about the composition of human milk. Learning about milk’s dynamic nature has allowed her to better understand her own infant’s behavior. More generally, she was fascinated to consider how our society has adopted nesting caregiving behavior though we are truly carriers.  

“This is mind-blowing,” she says. “So many more women need to hear that.” 

As a highschooler, Porshai was always fascinated by reproductive health. She’d watch documentaries on birth and her favorite science museum exhibit was one that depicted the stages of life. It wasn’t until later that she became aware of the option to become a lactation care provider. 

Through Boston Medical Center’s Curbside Care for Moms and Babies, a mobile unit that provides “comprehensive mother-infant dyadic care during the first six weeks of life”– Porshai met her first duo of Certified Lactation Counselors (CLCs). 

“I really do think the power of that training is what allowed me to continue [breastfeeding]  in the first place,” Porshai reflects. 

This wrap-around care was particularly influential as it ‘met her where she was at.’ 

Porshai goes on to say, “I hope to work in that way as well. I hope to be that visibility.” 

More specifically, Porshai says she has been thinking a lot about how elementary education is a female-dominated industry; with many friends and colleagues growing their families, Porshai hopes to be a resource and support for them as they learn to feed their babies. She plans to create a network of breastfeeding mothers within the Boston Public Schools so that there is a designated space for parents navigating infant feeding and the unique challenges of teaching. 

In addition, Porshai is considering becoming a postpartum nurse. 

“[The LCTC] could very well be the thing that catapults me to go back to school.” 

For more on teaching and lactation, check out this article. The PUMP Act now extends federal lactation rights and protections to all employees in K-12 schools.

Changing the culture of mother baby separation in one Northeastern hospital

“I got to touch him once and they took him right away from me,” Northern Light Eastern Maine Medical Center labor and delivery nurse Jennifer Wickett says, remembering the birth of her first child 19 years ago.

Wickett desired non-medicated births, but her three children ended up being born via cesarean sections for various reasons. Wickett’s personal birth experiences coincided with her early professional life, working at a hospital in Massachusetts as a labor and delivery nurse.

At the time, she explains, the process was this: the baby was born,  taken to the warmer, vitals and weight were recorded. The baby was wrapped in a blanket and held next to mom’s face for five to ten minutes and then taken to the newborn nursery.

Skin-to-skin in the OR, Healthy Children Project

“I hated that for my patients and I hated that for me,” Wickett says.

So Wickett singularly started changing that culture of mother baby separation.
Now, at Northern Light Eastern Maine Medical Center, Wickett attends about 95 percent of the c-sections, and she says she was able to “take control.”

“[Initially] I wasn’t tucking baby in skin-to-skin, but I was putting baby on top of mom with the support person helping hold the baby,” Wickett explains.
She deemed it the Wickett hold: baby placed chest down on mom with knees tucked under the left breast and baby’s head on the right breast.

Attending a Kangaroo Mother Care Conference in Cleveland galvanized her efforts: the evidence clearly supported skin-to-skin contact immediately after birth and beyond.  Fellow nurses, anesthesiologists and other team members were resistant, but Wickett and a few other fellow nurses who created the Kangaroo Care Committee kept at it, always leading with kindness and communication. Rather than approaching the process with an “I have to do this” agenda, Wickett involves and acknowledges all of the participants in the room.

For instance, to the mother, she asks permission while also explaining the importance of skin-to-skin contact.

“They’re in hook line and sinker when I explain that their body regulates their baby’s temperature,” Wickett explains. “They don’t want to give that baby up; they are not letting that baby go.”

To the anesthesiologist, she facilitates open communication. Wickett lets them know that she assumes responsibility for the baby. “Are you good?” she often checks in with the anesthesiologist, while minding their space to work safely and efficiently.

Wickett  makes certain to involve the partner in their baby’s care, asking them to keep a watchful eye over mom and baby.

Photo by Jonathan Borba

Just about half of the babies she sees begin breastfeeding in the OR, she reports. From the OR, babies are kept on their mothers’ chests as they’re transferred to the recovery room, continuing the opportunity to breastfeed. All in all, Wickett says that babies born by c-section at her hospital spend more time skin-to-skin than those who are born vaginally.

After a vaginal birth, eager nurses often disturb skin-to-skin contact to complete their screenings and documentation. Excited partners wanting to hold their baby tend to do the same.

In the OR though, Wickett says there are at least 30 minutes without these disruptions.  Once mother and baby are transferred to the PACU, mothers report decreased pain when skin-to-skin is practiced.

What’s more, Wickett reports hearing often “This baby is such a good breastfeeder!” because the babies have an opportunity to initiate breastfeeding within the first two hours of life.

The World Health Organization (WHO) recommends that immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. The recent Skin-to-skin contact after birth: Developing a research and practice guideline synthesizes the evidence. [Read more here.]

Skin-to-skin, Healthy Children Project

Wickett and seven other colleagues had the opportunity to complete the Lactation Counselor Training Course (LCTC) last year.
While she says she would have loved to have been able to take the course in-person, Wickett still found the material and resources “fabulous.”

For the past four years, there’s been a vacancy in the perinatal coordinator position at her hospital, so Wickett hopes that her new credentials will allow her to fill the need.  In the meantime, Northern Light Eastern Maine Medical Center offers outpatient lactation visits. The center’s breastfeeding support groups halted during the height of COVID and have yet to resume; Wickett reports that they are trying to bring those back virtually.

Additionally, Maine residents have access to the CradleME Program which
offers home-based services to anyone pregnant up to one year postpartum.
In partnership with the Mothers’ Milk Bank Northeast , Northern Light Eastern Maine Medical Center became the first milk depot in the Bangor area.

You can read more Our Milky Way coverage on skin-to-skin after cesarean birth in  Skin-to-skin in the operating room after cesarean birth , The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth , and Skin to skin in the OR.

Also check out Skin to Skin in the First Hour After Birth; Practical Advice for Staff after Vaginal and Cesarean Birth Skin to Skin.

Find some beautiful KMC imagery here.

A collection of stories by and about those in the AANHPI community

Asian American Native Hawaiian Pacific Islander (AANHPI) Breastfeeding WeekTelling our own stories. Elevating our voices— is coming to a close.

On Friday, the U.S. Breastfeeding Committee AANHPI Caucus presented the AANHPI Lactation Community Forum, an open panel discussion where AANHPI community members shared about their journeys to becoming lactation support professionals as well as provided guidance on how we can further build community capacity to support AANHPI families.

Photo by Samrat Khadka on Unsplash

Other opportunities as part of the celebration included visiting the Asian American, Pacific Islander, and Native Hawaiian Breastfeeding Week Facebook page and engaging with activities like the AANHPI Coloring Pages Contest. The Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce AANHPI Social Media Toolkit produced shareable social media content including messages and captions in the toolkit which have been translated into 11 different AANHPI languages: Chinese (both traditional and simplified), Farsi, Hindi, Hmong, Japanese, Korean, Native Hawaiian, Samoan, Tagalog, and Vietnamese.

In an engaging discussion from last summer, Tonya Lang, MPH, CHES, IBCLC and Grace Yee, described the diversity that exists under the AANHPI umbrella, shaking away the stereotypical idea that Asian culture is monolithic.

The Asian Pacific Institute on Gender-Based Violence begins to describe the complexity of AAPNHPI groupings and the forces that shape identity in Census Date & API Identities. AAPI DATA, which provides demographic data and policy research on Asian Americans and Pacific Islanders, compiled some wonderful visuals to help shape the numbers.

The overgeneralization of the API community has led to some misleading data about breastfeeding rates. On an aggregate level, initiation and duration rates are relatively high, but the statistics don’t account for stark disparities within these population groups. This piece covers this phenomenon in more depth and offers strategies for tailoring infant feeding support in the Chinese American population.

As Dr. Magda Peck has pointed out, numbers and data are important because they drive decisions and policies, but they also have the potential to sanitize humanity. That’s where stories come in. Not only do they humanize the numbers, they can also help us make sense of the data.

In celebration of AANHPI Week and in hopes of demonstrating the complexity and diversity of this population, we have collected several stories by and about those in the AANHPI community.

Photo by Dragon Pan on Unsplash

First up, is To-wen Tseng and her contributions to the San Diego County Breastfeeding Coalition’s blog. Tseng wrote most recently about her ‘why’ reflecting on National Breastfeeding Month. Read that piece here.

Joanne Datangel-Gallardo, MD, DPPS of the National Children’s Hospital, Philippines has worked extensively with relactation efforts. Read about Dr. Datangel-Gallardo’s work here.

Also out of the Philippines is a piece by Micaela Papa detailing how breastfeeding saved one baby’s  life and helped her mother recover from the stress of Typhoon Odette.

Not far south from this archipelago, is the island nation of Timor Leste. Here, emergency response efforts to protect breastfeeding have saved the lives of many. Community members manage and intercept artificial baby milk and other ultra-processed food product donations among other components of the nurturing care model. Read about these efforts here.

In Indonesia, efforts are also underway to combat commercial milk formula companies. Find a simple model for reporting Code violations here.

Jenny Lei Ravelo writes about the tangle of infant feeding complexities on Indonesia’s remote islands complete with stunning photos in partnership with the 1000 Days Fund.

In India, the Foundation for Mother & Child Health (FMCH) works to empower families from vulnerable communities with actionable information and services, resulting in health seeking behavior and nutritious food choices in order to tackle maternal child malnutrition, ultimately breaking the cycle of poverty. Read about the organization’s impact here.

In the spring, the Asian Pacific Islander Breastfeeding Task Force (APIBTF) a part of Breastfeed LA, tailored the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities, a project that augments APIBTF’s sister organization Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Continuity of Care (CoC) Blueprint Project Prenatal Toolkit for AANHPI families. You can find out more about the efforts to center culture in health here.

Elisabeth Millay/BreastfeedLA and API Breastfeeding Task Force

Also exemplifying culture centered in health is the Hmong Breastfeeding Initiative (HBI). With funding from Reducing Disparities in Breastfeeding through Continuity of Care Identifying Care Gaps grant from National Association of County and City Health Officials (NACCHO), the Hmong Breastfeeding Coalition (HBC) conducted an environmental scan of the Twin Cities (Minneapolis and Saint Paul, Minn.) on breastfeeding promotion and support for child-bearing age Hmong women and families. Read more here.

Tiffany Pao Yang has played a crucial role in this work. The daughter of Hmong refugees, she is especially invested in helping change the narrative around infant feeding in the Hmong population. Read part of her story here.

 

More to explore

 

Breastfeeding in Emergencies: The Struggles of New Mothers in the World’s Largest Refugee Camp

A Journal of Aboriginal and Indigenous Community Health: Community Influences on Breastfeeding Described by Native Hawaiian Mothers

Breastfeed LA’s Current APIBTF Projects

API Breastfeeding Task Force Video Library

AANHPI Lactation Collab 

The Cost of Not Breastfeeding from Alive & Thrive Downloadable PDFs for several Asian countries

Gestational carrier provides milk for babies born via surrogacy

Erin Graham suffered six bouts of mastitis and a subsequent antibiotic allergy while breastfeeding her firstborn. Moreover, when her daughter was just five weeks old, Graham required emergency surgery for gallstones she’d developed. The care team reported that she would need to pump and dump her milk on account of the anesthesia, but Graham made a point to connect with a lactation care provider who dispelled this misinformation.

Photo courtesy of Erin Graham

Despite it all, Graham persevered and went on to breastfeed her daughter for a year.

When her son came along, breastfeeding proved much easier.

“Breastfeeding my son was a piece of cake,” she recalls.

Becoming a mother was the most transformative and defining experience of her life, Graham goes on to say. So, when she witnessed friends and family members struggling to create and grow their own families, she felt especially touched and inspired. That’s when she applied to become a gestational carrier (surrogate). Graham has given birth to three babies as a gestational carrier since then and has pumped milk after each pregnancy.

The decision to pump milk for her surrogate babies started with a simple conversation early on in the surrogacy process, during match meetings where prospective surrogates and intended parents connect. Graham says there was never any pressure from any parties.

“It was all just gratitude and positivity,” she remembers. The first intended mother she worked with would even make her snacks to help keep her energy up while pumping around the clock.

During her first two experiences, the families were local, so they would coordinate meet ups to drop off the milk. She and her family became quite close to both of the families, so she found herself sometimes pumping at their houses during get togethers.

After her final surrogacy, Graham and the family coordinated shipping through FedEx, and while Graham says she’s  heard horror stories of lost and thawed milk upon arrival, she never experienced any of these misfortunes.

When one of the families decided that they no longer needed Graham’s milk, she was connected to another family whose surrogate was unable to provide milk. Graham wasn’t ready to wean, so she provided milk for this infant instead. It’s one of her favorite infant feeding stories.

Graham shares how her experiences breastfeeding and pumping were so different. While breastfeeding, Graham says she never thought about how many ounces of milk she produced; instead, she focused on her babies’ cues. While pumping, she didn’t have the babies’ cues to prompt her, so she’d rely on an alarm and found that she became quite focused on her output. Pumping also required her to hone in on her organizational skills, making sure the freezer bags laid just right so that she could store and package them most efficiently.

Graham has remained deeply connected to the infertility and surrogacy space and has worked for a surrogacy agency and fertility marketplace where she helped both intended parents and surrogates find the agencies and clinics that fit their particular needs and desires.

In order to best serve her clients, Graham recently completed the Lactation Counselor Training Course (LCTC).

Having had the vastly different experiences of directly breastfeeding her own babies and pumping milk for her surrogate babies, now coupled with the LCTC training, Graham offers a unique perspective to her clients.

Graham has been featured in a GoStork Q&A where she offers more of her experience as a surrogate and fertility care advisor. You can find that here.