School Age Parenting Program nurses complete Lactation Counselor Training Course enhancing support for students

Spring can be an especially busy time for pregnant and parenting teens. There’s prom, Easter egg hunts, Eid al-Fitr, Holi, Passover and other festivities,  the summer school enrollment process, all alongside their typical school responsibilities. Then there’s the excitement of pending graduation for some. 

Nurse Michelle and Nurse Ashlee

Michelle Alkinburgh, BSN, RN and Ashlee Anzalone, RN, health care coordinators at the Racine Unified School District’s School Age Parenting Program (SAPAR), recently completed the Lactation Counselor Training Course (LCTC) in an effort to further support their students who are managing the multiplicity of being pregnant or parenting in high school. 

The duo is proud to report that many of their young parents choose to breastfeed even while juggling all of their other demands.

“We have many moms who breastfeed the first few weeks and have had three moms who breastfed for a year!” they exclaim.  

In the U.S., one estimation suggests that of the  “approximately 425,000 infants born to adolescents… only 43 percent will initiate breastfeeding, in contrast to 75 percent of mothers of adult age…” [Kanhadilok, et al, 2015]

Over 30 years ago, the state of Wisconsin required school districts to provide programming and services to school-age parents. As such, SAPAR  programming has been in place since the requirement was established.  

SAPAR is intended to retain pregnant and parenting students in school, promote academic progress, increase knowledge of child development and parenting skills, improve, decision-making regarding healthy choices, prevent subsequent teen pregnancies and child abuse and neglect, including that of the teen mother, and assist in post-secondary education and/or employment.  The program is open to all students under the age of 21 years who are not high school graduates and are parents, expectant parents or have been pregnant during the last 120 days. [Retrieved from https://rusd.org/academics/alternative-programs/pregnant-parenting-teens

Alkinburgh and Anzalone report that they average around 100 enrolled students each year.  During the 2022/23 school year, they served 104 students.

Healthy Children Project’s Carin Richter notes that programs like SAPAR aren’t often sustained for as long as Racine’s programming; instead,  they’re often met with a lot of opposition and are frequently cut from school budgets, she observes.

“I am impressed with the school district that promotes her program and the school board, PTA, and school staff that encourage this type of program,” Richter offers. 

The team comments on their strength and sustainability: 

“[Our program] has two nurse case managers with extensive knowledge and experience in maternal and child health, allowing us to help when medical issues arise, not just for our parents but also their children.  We provide health education, childbirth and parenting classes, and assist with community resources and academic needs.  We work together as a team with our students, families, school staff, medical providers and community partners.  

The national average graduation rate for teen parents is about 50 percent,  but our program changes that!  Last year 94 percent  of our eligible Seniors graduated providing more job opportunities, financial stability and college or apprenticeship options. Teens 15 to 19 years old also have higher rates of infant mortality and maternal complications. We had zero percent.”

Students Anika Moreno and Gregory Sanders Jr. pictured with their child.

Each work day is different for the duo. There are no defined hours and they often work with students for several years.  

“Our work requires a lot of flexibility and patience, but it is so rewarding to see our students succeed,” they begin. “We provide school visits throughout the district, and also phone, virtual, home and community visits to meet the individual needs. You may find us busy helping students get health insurance, find a medical provider, manage pregnancy symptoms to stay in school, check a blood pressure, obtain a medical excuse, meet with support staff, talk to a parent, help enroll in community programs, get a crib or car seat, find diapers, etc.  We may be assisting with childcare, nutrition, housing, employment or transportation needs.  We also do a lot of health teaching and use evidenced-based curriculum specifically designed for young parents to help them learn and have an opportunity to earn additional credit toward graduation. Our goal is that our students stay in school, graduate high school and have healthy babies.”

Teenage dads can get a bad rap, but Alkinburgh and Anzalone note that “they really want to be great dads.” The nurses offer individual, joint and group meetings for young fathers and cover topics like infant care, co-parenting, child support, etc.  

“We try to make learning fun and engaging,” the duo says. “For example, we may have a diaper changing race or have them practice giving a baby a bath with our infant model and newborn care kit.” 

To add to their skill-base, the team needed to do some unlearning about breastfeeding myths through the LCTC.  

“Now that we know the newest research-based facts, we can best educate our students,” they say. “We already started using the awesome counseling skills they taught us in the training and it has really helped us ask more open- ended questions to address students’ concerns and goals.” 

Overall, the nurses have experienced a positive attitude for breastfeeding in their community at large. For instance, the district offers private lactation rooms in each of their schools for staff and students to use when needed. 

For those interested in supporting the program’s mission, the team offers: “Be kind, supportive and share with others how truly valuable a program like ours really is!” They also suggest donating, volunteering or partnering with community organizations that help support their students  like the Racine Diaper Ministry, Salvation Army, Cribs for Kids, Parent Life, Halo, and United Way. 

Find the program on Facebook here.

Where are they now? Lessons from ruins with Carin Richter RN, MSN, APN-BC, IBCLC, CCBE

Photo by Aykut Eke on Unsplash

The peafowl is a bird known for attracting attention. Whether flaunting their colorful, unfurled plumage or delivering a resounding cry, peafowl are undoubtedly expressive, insistent creatures.

Occasionally, when Healthy Children Project’s Carin Richter, RN, MSN, APN-BC, IBCLC, CCBE hosts Lactation Counselor Training Course (LCTC) competencies from her Florida home, a curious peacock will poke its head into the frame of the video call demanding attention from her and the participants. 

“The big inquisitive bird insists on being part of the session on breastfeeding!” Richter exclaims.  

Since we featured her last, Richter has fully retired from her responsibilities at St. Anthony’s Medical Center in Rockford, Ill. and now helps facilitate the online LCTC once a week.

Our Milky Way caught up with Richter this winter as part of our Where are they now? series. 

Now 70 years old, Richter shares with a stirring of anger, worry and dismay in her tone: “Women’s health… We are in crisis mode. I’m personally struggling with any kind of optimism.”

She cites a few culprits: a political climate that tolerates division and disrespect, the marginalization of maternal child health issues, and the stripping of rights as marked by the reversal of Roe v. Wade. 

From these ruins, Richter has constructed several lessons. For one, she implores us to become politically involved. 

“Keep women’s issues right smack dab in the conversation,” she advises. “Look around. Search out areas where you can sit at that decision making table.” 

Political involvement, Richter suggests, can come in the form of participating on a shared governance board, community advisory boards, church councils, and rotary clubs. Engagement doesn’t need to look like shaking hands with the mayor. 

She continues, “My friends always say, ‘Oh Carin, you never have one conversation without the word breast coming through.’ We need to live that! Because if we don’t we’re going to lose what we have.”

Photo by Nicole Arango Lang on Unsplash

In other words, be a peafowl. Demand attention. 

Richter lays out what happens when we don’t. 

During her nursing career, Richter and her colleagues’ involvement with the Baby-Friendly Hospital Initiative (BFHI) eventually gave rise to seven hospitals in her area being designated by 2013. As of 2022, only one of those hospitals had retained their designation. 

“Because there was no one sitting at the decision making table speaking for the initiative,  administration lost sight of it and breastfeeding took a back seat or perhaps didn’t have a seat at all,” Richter reflects. “No one spoke of keeping breastfeeding issues in the forefront. It’s an experience that brings me to tears.”

Another insight she’s gained is the difficulty in beginning and sustaining a community-based lactation business. She watched friends with solid business plans, well-researched proposals, and passionate ambitions to help dyads get crushed by lack of insurance reimbursement, lack of mentorship and lack of collaboration.

“We need a lot of work on that front,” Richter comments. 

She suggests a reimagination of the way lactation services are viewed where insurances and companies recognize the importance of breastfeeding and elevate lactation support to a professional state. 

For instance, while working at the hospital, Richter brainstormed ways to give value to and justify the services of in-house lactation care providers. She found that postpartum breastfeeding support offered in-hospital  resulted in a marked increase in patient satisfaction scores. A creative solution suggested that  initial lactation and breast care be embedded in the room rate available for all patients, not billed as a separate line item, allowing for a higher reimbursement rate, Richter explains.  

Photo by Hannah Barata: https://www.pexels.com/photo/woman-having-skin-to-skin-contact-with-her-newborn-baby-19782322/

After retirement from the clinical setting, Richter cared for her aging parents. She says she felt the pinch many women of today experience as they juggle personal, familial and work responsibilities.

As she lived the struggle to find workable solutions for the care of her elder parents, she says she was surprised to find that barriers were similar to those she encountered while working for change in the community surrounding breastfeeding. For both, breastfeeding and elder care, resources are often limited, frequently expensive, and often inaccessible or unavailable.

Her focus now has broadened from maternal child health advocacy to the broader realm of family care issues. She finds herself
advocating for maternal child health and family care issues like pay equity and affordable child care.

“The struggle continues across the continuum, in arenas frequently dominated by women who bear the majority of responsibility,” Richter reflects. 

Despite a sometimes discouraging climate, Richter says she sees “little bright spots” here and there. 

“Not a week goes by that I don’t have a [medical professional] seeking lactation credentialing… I am thrilled with this,” she begins.  The practitioners seeking lactation credentials are not only specializing in women’s health; instead they’re an interdisciplinary group of folks, a sign that breastfeeding and lactation care is breaking free from siloed confines.  

“This is what keeps me excited,” Richter says. “More knowledgeable, eager voices speaking for mothers and babies.” 

Looking back, Richter remembers when it caused a fight to require lactation credentialing for OB nurses. 

“We got so much backlash not only from administration but from OB nurses themselves,”  Richter recounts. “Some OB nurses took no ownership of lactation. ‘That’s the lactation counselors’ job,’ they would claim.”

In this culture, Richter pointed out that trauma nurses are required to be trauma certified, oncology nurses  are required to be oncology certified; why were OB nurses not required to be certified in lactation when it’s such a large portion of their work?

“It was a bit of an eye opener,” Richter says. 

Retrieved from ALPP. Used with permission.

Now almost all hospital OB nurses need to be certified within the first one to two years of hire, and Richter says she’s encouraged by the ever-increasing number of OB nurses she speaks with weekly who are seeking breastfeeding certification and are supported by their department managers.

As for physicians certified in lactation, an already developed template existed. The state of Illinois had issued a Perinatal state wide initiative to mandate that all anesthesiologists caring  for pregnant patients were to be certified in Neonatal Resuscitation Program (NRP). All obstetricians soon followed. Richter says her wish would be that the template could extend to mandating lactation credentials to all professionals caring for pregnant and breastfeeding families.

Another bright spot Richter’s noticed are the larger, private sector industry and private employers in the Midwest offering adequate workplace lactation accommodations and services  that go beyond what is mandated by law. 

Moreover, Richter continues to be  impressed by the work that the United States Breastfeeding Committee (USBC) is doing, namely increasing momentum for workplace protections across the nation.

Though she adds, “The spirit is really strong, but the body is really weak. Getting the body to make the decisions and the policies is difficult.” 

Retrieved from ALPP. Used with permission.

Yet another area of encouragement is the inroad made into the recognition of perinatal mood disorders (PMD). Acknowledging that there is always room for improvement, Richter extols the improvements in detection, treatment and the lightened stigma around PMDs.  

Richter shares on a final note that while maternal child health issues have been largely well promoted and mostly supported in the last decade, she hopes to see more emphasis and energy put into the protection leg of the triad. That will require involvement in the work of policy change at the institution, community, state and national level. Policy development and change is the first stepping stone, she advises. 

“Do not be afraid of policies, because policies have power,” Richter states.  “Get involved and find your place at the decision making table.That’s your homework assignment for the year!” 



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!”

Where are they now? An update from Nicole Bridges PhD, B Comm (Hons), SFHEA, MPRIA

Then

Amidst trolls who lurk, misinformation that muddies, and insidious marketing,  Nicole Bridges’s PhD, B Comm (Hons), SFHEA, MPRIA (she/her) work illuminates the helpful spaces on the internet. Almost a decade ago, her publication The faces of breastfeeding support: experiences of mothers seeking breastfeeding support online, found that “social networking sites (SNSs) provide support from the trusted community” that is “immediate…practical and valuable…”

In our 2017 coverage, Dr. Bridges pointed out how social media can compliment face-to-face interaction between breastfeeding dyads and lactation care providers, how it can offer moms “access to the collective wisdom of the whole tribe” as opposed to the perspective of one lactation professional, and how it can facilitate social interaction offline.

and now.

Dr. Bridges now serves as the Director of Academic Program for Communication, Creative Industries and Screen Media and is a Senior Lecturer in Public Relations in the School of Humanities and Communication Arts at Western Sydney University. For over two decades, she has been a volunteer breastfeeding counselor with the Australian Breastfeeding Association.

We’re pleased to have caught up with Dr. Bridges as she reflects on the past and future.

Q: What is the most significant change you’ve noticed in maternal child health in the last decade?

A: The increased use and evolution of social media tools to support breastfeeding. The COVID-19 pandemic amplified this and demonstrated how useful social media and online communities can be to supporting families in times of need.

Q: What is the most helpful/profound lesson you have learned about maternal child health in the last decade?

A: That (unfortunately) there is still so much more work to be done and that volunteer peer support organisations like the Australian Breastfeeding Association are needed more than ever before.

Q: Is there a current project, organization, initiative, endeavor or trend in lactation and breastfeeding that excites you most?

A: It will be interesting to see how the introduction and evolution of AI tools can be used to support breastfeeding into the future.

Q: What’s your best piece of advice for the next generation of maternal child health advocates?

A: Always place the parents and children at the centre of everything you do.

Q: Where do you envision yourself in the next 10 years?

A: I do hope that I am still a volunteer peer counsellor 10 years from now and that I can still continue to support breastfeeding families in this role and as a researcher in this area.

Check out Dr. Bridges’ publications since her work was last featured on Our Milky Way:

  • Rowbotham, S., Marks, L., Tawia, S., Woolley, E., Rooney, J., Kiggins, E., Healey, D., Wardle, K., Campbell, V., Bridges, N. and Hawe, P. (2022), ‘Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia’, Health Promotion Journal of Australia, vol 33, no 1 , pp 151 – 161.

  • Bridges, N., Howell, G. and Schmied, V. (2019), ‘Creating online communities to build positive relationships and increase engagement in not-for-profit organisations’, Asia Pacific Public Relations Journal, vol 20 .

  • Bridges, N., Howell, G. and Schmied, V. (2018), ‘Breastfeeding peer support on social networking sites’, Breastfeeding Review, vol 26, no 2 , pp 17 – 27.

Louisiana doula protects BIPOC women from abuse through birth work and beyond

Having endured the trauma of a lost pregnancy at the hands of her obstetrician during her teenagehood, Angelica Rideaux vowed that she would work to protect BIPOC women from emotional and physical abuse.

In 2021, she enrolled in Community Birth Companion, a non-profit doula training program serving those in Southwest Louisiana. 

“During the training, I was loved on by women who looked like me, and had the same purpose of ending racial bias in maternal child health care,” Rideaux recalls.

She now serves as a doula for BIPOC families around Louisiana  with the ultimate goal of becoming a Certified Professional Midwife (CPM). Currently, there are only three Black CPMs in Louisiana, according to Rideaux. In 2021 Baby Catcher Birth Center, the state’s first Black-owned, CABC accredited free-standing birth center opened.  

Most recently, Rideaux was accepted as a member of the Power Coalition for Equity and Justice’s She Leads: Community Activist Fellowship 2023 cohort: a “network of women activists who are disrupting the current power structures and realizing change in their communities.”

Rideaux’s accomplishments go on. She earned one of the most recent Accessing the Milky Way scholarships to support her completion of the Lactation Counselor Training Course (LCTC)

Because Rideaux is a hands-on learner, she reports the online format of the LCTC challenging. Even so, Rideaux says she likes challenges. 

“So I am going to push past that,” she states. 

She says she has found the office hours helpful; they make the experience of online learning feel less isolating. 

Working her way through the course, Rideaux has been surprised by how many myths have been put to rest. Specifically, she says it was “mind-blowing” to learn that water consumption is not solely responsible for milk production. She plans to share the knowledge she continues to gain among her colleagues and the families she supports.    

Rideaux sees the LCTC as an important piece in making her future in midwifery more well-rounded, effective and supportive. 

As Rideaux continues on her journey to know more to better serve her community, she reminds us of some important concepts to reflect on as we move through our own work to improve maternal child health outcomes. 

First is that discomfort is necessary for change, and sitting in discomfort, having those difficult  conversations is part of bringing an end to racial inequity.

Secondly, creating healthy environments for women and children, especially those in BIPOC communities,  is not a trend. Rideaux comments that while she wants everyone to be culturally aware and competent, she hopes that the impetus comes from “hearts to get the situation resolved” rather than for “the dollars” or for “the accolades” or for an illusion of doing good.  

In Equity is more than a buzzword, the author writes: “Those committed to equity should understand that the harm of racism cannot simply be ‘undone’. The ramifications of colonization, enslavement and segregation penetrate almost every aspect of our society, including our education systems. Merely boosting representation is not an effective way to increase equity in predominantly white institutions.”  (Paytner, 2023)

It’s a reminder that improving maternal child health outcomes for the BIPOC community is part of a revolution, as Rideaux describes it. 

A lot of us are on the ground getting this work done, never receiving any kind of media coverage,” she begins. “We are soldiers in this war, and the goal is to get everybody on the same path for equity and justice. We  want everybody to feel like they are humans because that’s what we are first and foremost.”  

Learn about ending obstetric racism by visiting Birthing Cultural Rigor, founded by Dr. Karen A. Scott, MD, MPH, FACOG.