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 

Where are they now? Catching up with Lucy Ellen Towbin, LCSW

Towbin admires her grandchild in this recent photo.

Many of Lucy Ellen Towbin’s, LCSW endeavors are defined by nourishment. By the time she was two, Towbin was producing art and as she has continued to make multimedia art into her 70s, she nourishes her Self. As the eldest of four children, Towbin helped provide for her
younger siblings in their childhood. In her 30s, as a new mother,  she nourished her children.  As a social worker and lactation care provider, she supported other dyads in their infant feeding efforts. Later, Towbin started a business (which has since been sold) that offers clean, dehydrated parrot pellets, so that she and other parrot-owners could escape reliance on industry-produced pet food which usually contains additives and food coloring that parrots are particularly sensitive to.

During the first wave of the COVID-19 pandemic, Towbin retired from the
Arkansas Health Department, and while she no longer holds her IBCLC
credential, she continues to assist new mothers informally. Towbin now
practices as a part-time therapist for a psychotherapy clinic in
Arkansas.

The last time Towbin graced Our Milky Way was back in 2017 when we
featured the breastfeeding art contest she facilitated through the
Arkansas Breastfeeding Coalition.

We’re pleased to have chatted with Towbin as part of our Where are they
now? series. Responses have been edited for brevity.

 

Towbin poses with Ruth Lawrence roughly a decade ago.

How did you become interested in maternal child health? 

The first job I had at the Department of Health was as the refugee health program coordinator. We worked with mostly refugees from Southeast Asia.  I was really interested in and intrigued  by the difference in how
they were taking care of their children. They slept with their babies, which I’m sure plenty of people in the U.S. still did quietly, but back then, no one was talking about it.
During a panel discussion we once held, a speaker from Laos shared
that his six children born in Laos were breastfed, and the five children
born in the States were bottle-fed. This is when I really became
interested in the cultural aspects that affect infant feeding, and I started
to try to figure out what was going on.

Is there a current trend, project or organization that excites you?

I’m really not that up-to-date about trends in lactation, but what does
excite me are the portable pumps that working moms can wear. A close
friend of my daughter’s is a nurse practitioner and she showed me her
pump that she wears under her white jacket as she walks around seeing
patients. It makes almost no noise and it’s amazing because you don’t
even know that it’s under there. That would’ve been so incredible for me
to have as a working breastfeeding mom.

When I was working outside of the home, it was really difficult; even La
Leche League wasn’t very supportive of working moms at the time. With
my first child, I had a manual pump and my own office, but the pump was
miserable.  It hurt and wasn’t that effective. With my second child, I
stayed home longer with him and then he wouldn’t take a bottle, so I
didn’t do that much pumping. When I went back to work, my mother took
care of him and she lived close to where I was working, so I would nurse
him before work, and then drive back and forth to her house to feed him
about every two hours. It was a lot of back and forth.

What is the most significant change you’ve noticed within maternal child
health?

I have a very small sample size to talk about significant changes. All I
know is from my daughter and her friends. I’ve noticed that there seems
to be less unmedicated births happening in the hospital. I know there are
still a lot of people choosing home birth. But of those having babies in
the hospital, I haven’t heard about anyone doing what I did and having
mine in the hospital, but with no pain medicine or IV or anything.   I was
lucky to find the physicians that I did who went along with my wishes.  I
would expect there would be more supportive physicians now and instead, I don’t hear about any. I do want to reiterate that my observations are based on just a small group.

What is your best piece of advice for the next generation of lactation
care providers?

The most helpful lesson combines my training as both a therapist and
lactation consultant. New mothers need so much emotional support.
They don’t need people to take care of the baby. Bringing food and running errands for them is helpful. But I think what gets overlooked is
how much they need to be told that they’re going to make it, that they will
survive this early period of no sleep, and not knowing if they are doing a
good job. They need reassurance that this difficult time is normal and
they need to be told they will get through this.

My best piece of advice for the next generation is to take a holistic
approach, don’t just emphasize the physical exam. Equally important is
how much sleep the mother is getting,  what she is eating, if she is
getting exercise, if she has family and friends supporting her, if she has a
plan for if she’s going to be working outside of the home. It’s important to
equip new moms with coping strategies like easy breathing exercises or
something when she is feeling stressed that are doable in short time
frames and at home.

Where do you envision yourself in the next decade?

Asking someone my age where I see myself in the next ten years is
basically just hoping I’m still healthy and active! I do all the right things
and have good genes, so I’m on the pathway to that, but you never
know. Appreciate good health and youthful energy if you still have it.

Where are they now? Checking in with Stephanie Hutchinson of the Appalachian Breastfeeding Network (ABN)

In May 2016, Stephanie Hutchinson (then Carroll), MBA, BS, IBCLC  and a few of her colleagues launched the Appalachian Breastfeeding Network (ABN), “dreaming that one day [Appalachian] parents would have the access to lactation care that they deserve.”

In just one year, the network grew to 11 states and 250 members. By the time the organization was five years-old, the network  grew “to over 600 members across all 13 states in Appalachia – and beyond!” Today, ABM “continues to grow in its membership, its capacity, and its visibility.” [Retrieved from: https://www.appalachianbreastfeedingnetwork.org/abn-board.html

 

Then

When Our Milky Way first featured Hutchinson in 2017, she said that the exponential growth was not expected, but also not surprising. 

“There was absolutely no organization that grouped Appalachia as a culture, together, to make an impact for change,” she said.

 

 

and now.

Almost a decade later, Hutchinson serves as the President of ABN and Administrator of their 24-Hour Breastfeeding Hotline. She also works in private practice as the owner of Rainbow Mountain Lactation, is an instructor and administrative assistant/media manager for Lactation Education Consultants

This year, ABN will host its first cohort of Appalachian LATCH (Lactation at the Center of Healthcare) Leaders which is their train-the trainer program. With grant funding provided by Gallia American Community Fund of the Foundation for Appalachian Ohio (FAO) and the I’m a Child of Appalachia Fund®, they will offer 20 scholarships for registration to the course. 

Many years ago, before the birth of her daughters, Hutchinson shared that she never anticipated doing the work she’s been engaged in, but as we often say, “All roads lead to breastfeeding.” Now, reflecting on the most significant change she’s noticed in maternal child health in the last decade, Hutchinson says, “As a member of the LGBTQ+ community, I have noticed more inclusivity in education and support for all families. I am happy to see such wonderful changes to include everyone who is lactating.” 

And the most helpful lesson she has learned along the way is to say ‘no’. 

“This has probably been my hardest lesson learned, but there is only one of me and I know I cannot do all the things,” she reflects. “It’s okay to refer out to someone else, say no to a speaking gig, not go to every conference possible, and take care of myself. Once I learned this hard lesson, I noticed I am able to give more to my clients and my own family…I know that I am not the lactation consultant for every person and humbling yourself to collaborate with others will help your practice tremendously.”

Photo by Elijah Mears on Unsplash

Looking forward, Hutchinson says: “In 10 years, I hope Appalachian Breastfeeding Network has been able to grow enough to fit more into our budget and reach more parents, especially in those areas with little to no lactation support. It is my vision to duplicate our hotline and make it sustainable and available to anyone, anytime, for as long as possible. On a personal front, I hope to see my kids happy and thriving as adults and live out our empty nester lives.” 



LCTC participant fueled by daughter’s poor experiences

Shipley pictured with her grandchild.

As Tanya Shipley, a recent Accessing the Milky Way scholarship awardee, shares her experience working through the Lactation Counselor Training Course (LCTC) thus far, I sense both enthusiasm and relief.

“I love it!” Shipley exclaims. “I am learning so much stuff, oh my gosh, I love it. I  am just in awe.”

She goes on to explain that while she has always been interested in women’s health and wellness, she only became interested in maternal child health after her 35-year-old daughter’s pregnancy and birth this year.

Not unlike many women, and especially BIPOC women, Shipley’s daughter did not receive competent lactation care in the hospital.

“She was really bummed about it,” Shipley begins. “When she got home, she was having issues because she thought that she wasn’t producing enough milk. She felt like she let the baby down.”

Shipley blames some of what was lacking on her “own ignorance” as the grandmother.

At one point Shipley recalls suggesting: “Why don’t you just [give the baby] a little formula right now because she’s hungry.”

“It bothers me today because everything I am learning now,” Shipley reflects.  “It didn’t have to be that way.”

Shipley circles back to how much she is learning through the LCTC. This is where I hear a sense of relief in her tone; she is now well-equipped to share the knowledge she gains with not only new families but women her age, so that they can help their children, as she explains. It’s well-known that grandmothers have the capacity to influence exclusive breastfeeding. [More here and here.]

“After I finish a module,  I will call my daughter and I will share with her some of the things I am learning,” Shipley says.

Shipley recently left the entertainment industry and started volunteering for the Happy Mama Health Baby Alliance and Joy in Birthing Foundation. She also completed a birth doula workshop and finds herself exploring where she can make the biggest impact. She’s considering starting her own non-profit and providing lactation care in the hospital setting, fueled by the lack of care that her daughter received.

You can read more about grandmothers’ influence on infant feeding in For many, grandmothers are the village.

VA Maternity Care Coordinator (MCC) program facilitates specialized care for military Veteran parents

For new families, healthy, evidence-based infant feeding education and support can be hard to come by, but among this often barren landscape of support, the VA Maternity Care Coordinator (MCC) program provides an oasis for military Veteran mothers.  

Retired USAF Lt Col Tammy Tenace BSN, MS, APRN-BC, now Women Veteran Education, Outreach and Research Coordinator  for James A. Haley Veterans Hospital in Tampa, Fla. says that the VA understands that pregnancy and parenthood often requires specialized care.

About a decade ago, as care providers started to notice that lactation and breastfeeding support was severely limited in civilian communities, they established the MCC role. MCCs maintain contact with Veteran families throughout the perinatal period, facilitating care that meets their specific needs. 

Because the VA does not provide obstetric care, the MCC acts as a liaison between the VA and the community obstetrical provider. MCCs follow Veterans through pregnancy and postpartum at one and six weeks postpartum. [https://link.springer.com/article/10.1007/s11606-019-04974-z]  The VA supplies Veterans with lactation supplies like breast pumps, nursing bras, nursing pads, storage bags, etc.

The MCC role has been established at every VA medical center, and Tenace has served as MCC at her hospital since 2016.  

Photo by George Pak : https://www.pexels.com/photo/family-sitting-on-sofa-beside-house-plant-near-the-windows-7983863/

Throughout the COVID-19 pandemic, what little perinatal support existed in civilian spaces, dwindled to almost nothing, Tenace points out. 

Hospital breastfeeding support groups, while only meeting a couple of times a week, stopped meeting altogether. Women weren’t allowed support people or their partners at appointments, and they began to feel isolated. 

“I realized I needed to do something; I couldn’t depend on the community,” Tenace says.  

Working through the Office on Women’s Health as a subject matter expert, VA National Consultant for Lactation Ashley M. Lauria, MA, RD, LDN, IBCLC helps establish standards of care in lactation programs at VA facilities nationwide. 

Tenace and Lauria both comment that among the hundreds of parents they have cared for, it is truly a rarity for an individual to express disinterest in lactation. Their experience reflects national numbers, where most dyads start out breastfeeding. 

Women Veterans are the fastest growing group among the Veteran population. In fact,  “by 2040, VA estimates they will comprise 18% of the Veteran population, versus just 4% in 2000,” according to a VA Pittsburgh press release.

In order to keep up with this demand, Tenace and her colleagues are in the process of curating a Certified Lactation Counselor (CLC) program. Made possible through funding from the Women’s Health Innovations and Staffing Enhancements (WHISE), ten of their staff members are completing the Lactation Counselor Training Course (LCTC), including Tenace, physicians, a health coach, advanced practice nurses, among others. 

“The most up-to-date information is really important,” Tenace begins. “[We are all] unlearning the things we thought we knew. The course has been instrumental to helping us feel like we are actually helping women, instead of relying on the knowledge that we thought we had. The course is detailed and professional, yet practical. The practicalness is what’s to our advantage. It’s how we actually help women breastfeed.”

Photo by Timothy Meinberg on Unsplash

Tenace and Lauria go on to explain that their efforts are Veteran-led. That is, their facilities host quarterly focus groups where they can learn about Veterans’ requests. 

“We want to know from women: what do they want?” Tenace comments. 

Because Veteran women often prefer support groups comprised of other Veterans, Lauria offers virtual lactation support groups that also act as social circles and a place for comradery. 

As James A. Haley Veterans’ Hospital designs new facilities, Tenace has been invited to offer input on the creation of lactation space for both employees and patients. Tenace applauds their leadership for focusing on improvement for the patient and employee experience. She also highlights that the newly designed main entrance will host a lactation pod. 

“I can’t think of a better way to show commitment,” she adds.  

Tenace and Lauria have embodied a passion for birth and lactation since their youth. Their work with the VA allows them to continue their mission to celebrate parents and their families and position themselves as life-long learners, evolving with the needs of Veteran mothers. 

 

Photo by Brianna Lisa Photography: https://www.pexels.com/photo/mother-breastfeeding-her-child-in-park-11620457/

For more on VA maternity care services visit https://www.womenshealth.va.gov/docs/WomensHealthReproductiveHealthBrochure508.pdf

More on Veteran Health https://www.commonwealthfund.org/blog/2021/birth-equity-Veterans-and-servicemembers  

Regulations and resources for all military branches https://www.mom2momglobal.org/bficb 

Coverage for pregnancy and lactation care in the military health system https://www.military.com/daily-news/2021/11/01/tricare-cover-doulas-lactation-consultants-some-starting-jan-1.html