LCTC Archives - Our Milky Way

May 7, 2023

Field of lactation gains child psychologist

The field of lactation just gained another amazing care provider. Kenya Malcolm, PhD, CLC is a child psychologist, consultant, and trainer in Rochester, New York. Dr. Malcolm’s work focuses on programs and interventions in early childhood in mental health settings, preschools and pediatric offices. Among her many responsibilities, Dr. Malcolm is the HealthySteps program coordinator at a large pediatric practice.

Dr. Malcolm says, “The research is pretty clear that working with caregivers early to support children is the best way to promote optimal family and child health. So, that’s what I do!”

In fun, Dr. Malcolm is not only passionate about mental health, but she’s a self-described stationery nerd.

“I think that color coding is a great way to take notes and stay organized but I’ve been mocked for my pen collection!” she begins. When her LCTC instructor Dr. Anna Blair recommended using multiple ink colors on the Lactation Assessment & Comprehensive Intervention Tool (LAT), Dr. Malcolm says she felt validated.

She was again validated during the first few sessions of the course while learning about the benefits of breast/chest feeding not only for the baby but for lactating people.

“That’s when I knew I’d made the right decision to sign up for the course,” she reflects.

Because Dr. Malcolm is new to lactation counseling, she says that “every successful chest feeding story is my favorite right now.”

“All the moms have been so happy that they’re successful!” she explains. “I was not supported in breastfeeding my own kids when they were born and honestly, being a CLC is like an opportunity to be the superhero I wish I had 20 years ago.”

In becoming that superhero, Dr. Malcolm subscribes to reflective practice as a guiding principle in her work, and more specifically, in her leadership roles.

Dr. Malcolm remembers the words of one of the founding members of ZERO to THREE Jeree H. Pawl: “How you are is as important as what you do.”

Here’s more of what Dr. Malcolm had to say:

“Reflective supervision is a special kind of supervision that focuses on the practitioner’s own thoughts, feelings, and behaviors to support their ability to provide good care to the folks they are working with. Working with caregivers and children is tough work and usually includes navigating systems that are very siloed with rigid expectations. As humans, we often respond in ways that are just as much about ourselves as about the family in front of us. Reflective supervision is a necessary space for slowing down and looking at our actions to improve care, reduce bias and disparities, and improve the well-being of everyone involved. Reflective capacity is a skill and reflective supervision is considered a necessary component of support for people who are working with young children and families by most major organizations working toward the health of families.”

In Dr. Malcolm’s side gig with The Society for The Protection and Care of Children, participants introduce themselves with their baby pictures “as a way to hold in mine our own younger selves who continue to show up in our work.” The work focuses on training staff in Infant Mental Health (IMH) principles, Reflective Supervision, and infant/early childhood mental health conceptualization and diagnosis using the DC0-3 across New York state.

“One IMH principle is that we always hold the baby in mind,” Dr. Malcolm begins. “But it’s not just the baby in front of us. We also have to be aware of the baby whose needs are still present in our own selves. That’s why reflective spaces are so important. Our own biases and histories are present in all of our current interactions–another IMH tenant is that our early experiences matter– and we want to be mindful of how those are showing up in our work in both helpful and not so helpful ways.”

Dr. Malcolm tackles another big idea. Responding to an article on moral injury she wrote on social media, “I… think there’s a savior fantasy that many health professionals have that is sometimes traumatic to lose while in the field.” This phenomenon often rings true for lactation care providers. Dr. Malcolm advises doing the self- work it takes for true humility and reflection.

She shares this anecdote:

Source: United States Breastfeeding Committee (USBC)

“I was observing a lactation counseling visit last week and a mom came in with questions about a possible tongue tie and some nipple pain with feeding. Since the latch was poor, the LC provided some strategies for improving latch that helped to address some of the pain. Like, mom agreed that there was less pain with position changes. But mom was not actually interested in working on latch; she was focused on the possibility of the tongue tie. The LC did a great job of talking through her observations and assessment and providing next-step ideas to Mom. But the LC and I really wanted mom to want to improve her latch. It would be easy to feel like that was an unsuccessful visit because we didn’t save the day in the way we wanted. But mom left feeling heard and supported. Many of us go into human services work to be a hero (I actually used the words “being a superhero” two answers ago!! I’m tempted to change that answer now, but I’m not going to.) of our own design. Families don’t need that. They need support to be at their own best.”

You can connect with Dr. Malcolm here.

March 26, 2023March 24, 2023

Fatherhood advocate facilitates paternal involvement, positively affecting children’s and mothers’ lives

Doug Edwards, Director of Real Dads Forever, a Fatherhood Strategies Development organization, is a firestarter. Inside every father is something of value, an ember, as Edwards describes. Edwards sees it as his mission to clear away any ashes so that the embers can burst into flames, to become energy and atmosphere, to help fathers come into the space where they can truly radiate.

“I want to change the world!… More realistically and substantively I want to get dads to understand their unique and specific value and articulate it and change behavior so their relationship is meaningful to their child,” Edwards said in a 2013 interview.

Paternal involvement positively affects child development and wellness; further when fathers are positively involved in their infants’ lives, mothers’ stress decreases.

Edwards was propelled into this work nearly three decades ago when he volunteered with a development center working with teen parents.

Since then, he has worked with over 20,000 men.

When he started this work, Edwards says the national focus was on deficit and absent fathers; today, he sees more awareness and an understanding of the importance of fatherhood as it relates to the needs of the child.

Real Dads Forever boasts an impressive list of clients including Centering Pregnancy, UCONN, public school systems and departments of public health.

About a decade ago, Edwards found through a father-friendly site survey, that only 30 percent of programs enrolling new parents–whether that be at a school or through a maternity program, etc.– asked for the father’s name.

“We don’t encourage [fathers] to step up and then we wonder why they don’t show up,” Edwards commented in a 2013 interview.

In many cases, this continues to be the trend today.

Recently, Edwards conducted a Fatherhood Friendly Site Assessment with Connecticut WIC. He investigated: Were fathers included in their policies? If so, was this being translated into their practice? Was the physical environment welcoming to fathers? Were fathers pictured in their educational and promotional materials? Edwards found that fathers literally had no chair at the table. When consults were held, there was often no chair for the father to be included in the discussion.

Edwards helped the organization implement changes specifically through staff training and professional development. The training included sensitivity training on how to respectfully ask the question : “Where is the father?” when he is not present, taking into account many of the realities that families may be dealing with: death, incarceration, deployment, abuse, and absence under other circumstances.

Edwards suggests that those working with young families take stock of our biases as well as acknowledge and address any systemic barriers present.

Fathers are often forgotten in the experience of infant and young child death too. Through his work with the Fetal and Infant Mortality Review in Hartford, Conn., Edwards found that fathers were getting little to no support after the death of a child.

He recalls one father who shared that he listened to the heartbeat of his baby, felt his baby’s movements, sang to the baby, and attended all of the prenatal visits. Around eight months gestation, the family was involved in a car accident. The baby was born prematurely and ultimately died. The father shared with Edwards that he lost the ability to become the father he didn’t have. “My fetus knew her dad,” the father told Edwards.

It was this poignant story that led Edwards to create the curriculum, “Paternal Prenatal Early Attachment”. The program is designed for expecting couples with a focus on strengthening fathers’ capabilities to enhance their support of mothers and babies during pregnancy beyond. He has facilitated the program in Connecticut and with 17 different states for National Institute for Children’s Health Quality (NICHQ), which provides Technical Assistance for National Healthy Start.

Prenatal education offers the “biggest bang for your buck,” Edwards says of fatherhood advocacy.

“This is when [fathers] are keenly aware of something outside of themselves that’s going on,” Edwards comments. “They want to do a good job… Guys like jobs… I turn that into more than a job; I turn that into a relationship. I want them to fall in love with their unborn child and fall in love with [the mother of their child]. That’s a great setup for the child to thrive.”

Edwards’ work challenges fathers to explore and feel their own childhoods.

“This is an eye opening experience for them,” Edwards comments.

He calls it “backing into empathy.”

Edwards has watched the transformation of self described “thugs” and “black hearted” individuals to softened men when they go through the “magical epiphany” of becoming a father.

Edwards explains that fathers gain new insights and experience out-of-body sensations due to the flood of oxytocin during the birth of a child. Skin-to-skin contact deepens this bond between father and child. [More at Facilitating the bond between children and fathers or male-identifying partners]

Reflecting on the course of his work, Edwards says “It’s just getting better with time. We didn’t have these discussions years ago.”

He highlights fatherhood legislative work in Conn., the first state to pass legislation on fatherhood.

“The Connecticut Fatherhood Initiative (CFI) is a broad-based, statewide collaborative effort led by the Department of Social Services, focused on changing the systems that can improve fathers’ ability to be fully and positively involved in the lives of their children.

First implemented after the passage of legislation in 1999, state and local partners have been working together … to make changes to policy and practice in order to better meet the needs of fathers…” [Read more here: https://portal.ct.gov/Fatherhood/Core/The-Connecticut-Fatherhood-Initiative]

Edwards was previously featured on Our Milky Way in Unsung Sheros/Heros in maternal child health.

Edwards also recently completed the Lactation Counselor Training Course (LCTC).

March 19, 2023March 19, 2023

‘Full pandemic mama’ becomes full spectrum doula

Allysa Singer was, as she describes, a “full pandemic mama.” Singer became pregnant with her first child in the winter of 2019. As she became aware of the threats and the consequences of COVID-19, she started researching her options and her rights in the delivery room she’d find herself in August 2020.

What started as personal preparation– How many support people would she be allowed? Would she be allowed a support person at all? What restrictions would she encounter? How could she advocate for herself? What were her options?– propelled her into a world of birth support and autonomy advocacy.

“I was just dumbfounded by the disparities that exist in maternal health,” Singer begins.

In 2020, Alabama, where Singer and her family live, had the third-highest Maternal Mortality Rate in the nation, at 36.4 per 100,000 live births.

BIPOC families suffer from massive disparities in maternal and infant deaths. In a recent piece, Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds, Tiffany L. Green, an economist focused on public health and obstetrics at the University of Wisconsin-Madison is quoted: “It’s not race, it’s racism…The data are quite clear that this isn’t about biology. This is about the environments where we live, where we work, where we play, where we sleep.”

Still, unlike so many of her peers, Singer reports having had an amazing birth experience.

Inundated by birth horror stories, she decided to change care at 27 weeks in hopes that she would be better supported in her choices at a different institution.

Here, she was allowed a doula and support person to accompany her during her birth.

“Not a lot of women had that luxury,” Singer comments.

Knowing well that birth support is a right and not a luxury, she started her own doula practice in December 2021.

Singer shares that she experienced severe postpartum depression, but she was able to divert and ultimately reshape this energy into her doula work.

“My doula training was the lifeboat that saved me from drowning in my PPD,” she says.

And now her practice, Faith to Fruition, has become the lifeboat for many of the birthing people Singer supports.

She shares: “I don’t believe that a birther’s desire to have more children should be dictated by their birthing experience. I have heard so many stories from people who had one kid but say, ‘I would never do this again because my experience was so traumatic.’ One of my biggest missions and goals is to support birthers to feel empowered in their process; not as bystanders of their process.”

Singer also holds a full time position as an industrial psychologist where she channels her advocacy work, pushing for organizational change and understanding of proper maternal support.

In fact, as part of a public speaking course for a training curriculum, Singer presented on why it’s important to support breastfeeding. She reports that her audience of roughly 25 was engaged, especially as she pointed out the absurdities of infant feeding culture in our country: How would you feel if I asked you to eat your meal in the bathroom? How would you like to eat with a blanket tossed over your head? for instance.

Singer also points out the “insanely amazing public health outcomes” breastfeeding affords.

If 90 percent of U.S. babies were exclusively breastfed for six months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). [Bartick, Reinhold, 2010]

“Not only is there a personal investment, there is a public investment and value to understanding the larger implications,” Singer comments. “As a taxpayer, [breastfeeding] impacts you; as someone who utilizes our healthcare system, [breastfeeding] impacts you.”

With the recent passing of the PUMP Act and the Pregnant Workers Fairness Act coming soon, Singer says “We still have a long way to go.”

Organizational policy doesn’t support motherhood; instead it fuels detached parenting which goes against nature, Singer goes on.

“Mothers feel the brunt of that more than ever,” she says. “[We aren’t] supported to be able to care for our children the way that we want to.”

Singer says she sees it as her mission as an organizational psychologist to encourage change that supports parenthood, so that women don’t feel threatened to care for their children the way that they want to. This means ensuring that women are provided with ample space to pump their milk while away from their babies and empowering them to approach HR when there aren’t appropriate accommodations.

“Outside forces shouldn’t be able to dictate how you care for and feed your child. The end of one’s breastfeeding journey should be a personal decision.”

She continues, “It’s amazing that legislation is catching up. The thing that I fear with any law, there are still people behind those laws that have to enforce them and carry them out. Education and garnishing an understanding of what this looks like is a key component to implementation. The people behind those policies have to make them successful, but this is moving things into a very good direction, and I hope that more changes to legislation follow suit, especially with paid parental leave. It’s a catalyst for change; I am hopeful but cautiously optimistic.”

Singer says she owes her personal success continuing to breastfeed her two-and-a-half year old to Chocolate Milk Mommies, where she now serves as a board member.

Through Chocolate Milk Mommies, Singer started a subcommittee to focus on education for individuals within the breastfeeder’s support system.

“The people in the village need to be supportive. When you don’t know better, you can’t do better,” she explains.

Singer recently completed the Lactation Counselor Training Course (LCTC) as part of Chocolate Milk Mommies’ mission to best support their constituents and as a way to benefit her doula clients with more well-rounded support.

“I really loved the training because I already thought that our bodies are amazing, but learning more science was great. I would text my friends the ‘Boobie Fact of the Day’,” Singer shares. “[The science] allows me to really appreciate my journey that much more and how impactful I’m being with my daughter.”

You can follow Singer’s work here and here.

July 10, 2022July 5, 2022

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.”

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

May 15, 2022

Graduate student explores complexities of nutrition and health from cradle to grave

Originally from New Orleans, Erin Bannister, lab instructor and dietetic intern at Northern Illinois University, says that food is tied to her identity. Bannister was ten when she first learned to make a roux. Those early skills prepared her for her later work as a chef, which she describes as a kind of manual labor with long, hot hours.

Bannister shares with a laugh, that she started to wonder how she could work with food and continue to nourish people with weekends and holidays off. Eventually, she discovered the field of dietetics.

Currently in the thick of her Master’s thesis, Bannister is exploring the metabolic energy needs in adults and determining whether the default equations we use are accurate in the populations they’re used in.

For instance, it is widely accepted that an average allowance for a roughly 170 pound man is 2,300 kcal/day; for women, it is 1,900 kcal/day. We expect that pregnant and lactating people will have higher metabolic energy needs.

As Bannister spends a swath of her days compiling and extracting data, she says she’s discovering that some of the accepted equations need to be delineated.

“The real root of my thesis and the root of most of my studies and the goals that I have, is to use accurate evidence-based interventions in the populations that they are meant to be used in and to not remove ourselves from that evidence,” Bannister begins. “… Often times, things are taught and then they are believed because the person that taught it is an expert and the evidence gets lost on the way; don’t forget to review the evidence.”

As Bannister continues to pursue this idea that we can do better than sludging through the status quo, she sought out the Lactation Counselor Training Course (LCTC). Although Bannister has great interest in the complexities of nutrition and health from cradle to grave, she says that there is a solid argument that the health of a population is highly correlated with the health of its mothers.

“[I want] to be as helpful and effective as possible… to have the knowledge to be able to contribute meaningfully, and the certification adds credibility,” she explains. “The training was quite eye-opening, almost embarrassing to say how little I knew about breastfeeding.”

Bannister goes on that ultimately, she would like to work with nutrition intervention in low and middle income countries where the burden of improper nutrition is most severe. Currently, many countries worldwide face the double burden of malnutrition – characterized by the coexistence of undernutrition along with overweight, obesity or diet-related noncommunicable diseases (NCDs). In fact, nearly one in three people globally suffers from at least one form of malnutrition: wasting, stunting, vitamin and mineral deficiency, overweight or obesity and diet-related NCDs. (WHO 2017)

As Bannister buckles down at the end of the semester, she says, “I want to make sure I am utilizing all the forks I’ve got in the fire.”

You can learn more about Bannister’s work by exploring the various topics she has presented on, ranging from potatoes to prison to poop. Connect with Bannister on Linkedin and Instagram @calibrating_palates.

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