mental health 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.

February 26, 2023

Learning self care through active practice

The same principles apply to supporting self care as the business case for breastfeeding: employees who are more satisfied and loyal and cost savings realized in the retention of experienced employees, the reduction in sick time taken, and lower health care and insurance costs.

Nearly a decade ago, Healthy Children Project’s Donna Walls, RN, BSN, ICCE, IBCLC, ANLC helped establish a meditation room in the maternity care wing of the hospital she worked at. With soft lighting, comfy chairs and the option for aromatherapy and calming music, the room was well-received, or necessary as Walls would argue.

Photo by Karolina Grabowska: https://www.pexels.com/photo/woman-kneeling-on-a-yoga-mat-4498216/

Now, Walls co-teaches an overview of holistic health as part of the Allied Health program at Sinclair College in Ohio.

Walls and colleague Jeri Layer recently presented a compressed version of the course, “Learning Self Care Through Active Practice”, to Sinclair faculty.

In their course, they ask participants to consider what they do on a daily basis to maintain physical and mental health. Participants are also asked to consider: what are their stress triggers and what are the sensations associated in those times of stress?

Typically, as a nation, we have been taught to be reactionary with our health, but Walls says that even before the COVID-19 pandemic struck, she started to notice people paying attention to mental health and self-care.

“The pandemic put a really bright light on it,” Walls says.

Walls and Layer have broken down self-care into very specific strategies and offer a variety of modalities for humans to promote emotional, mental and physical health.

Photo by Valeria Boltneva: https://www.pexels.com/photo/closeup-photo-of-white-petaled-flowers-965982/

For instance, aromatherapy can come in the form of simple awareness of the scents around us like freshly baked bread, the air after a rain, or the scent of roses. Essential oils can be used therapeutically as they have “a direct effect on the brain and trigger emotions and hormonal responses.”

The duo advise how to use essential oils along with methods of administering like steam inhalation, direct application to the skin with carrier oils, or used in diffusers like lamp rings or cotton balls for example. Oral ingestion is NOT recommended, they warn.

Tapping, or the Emotional Freedom Technique (EFT), is another modality proposed.

“Tapping is a self-help technique that involves tapping with fingertips on points of ‘energy meridians’ located around the body,” Walls explains. “It is based on the theory used for acupuncture, but without the use of needles, to stimulate energy points on the body which create a balance both emotionally and physically.”

Affirmations can be coupled with tapping.

Walls and Layer share these:

“Even though I feel this anxiety, I deeply and completely accept myself.”

“Even though I panic when I think about ______, I am strong enough to deal with this.”

“Even though I’m having pain, I can see myself relaxing and releasing this pain.”

Other self-care techniques include the Havening Technique which is a method that uses sensory input to alter thought, mood, and behavior through a process called synaptic depotentiation, mindful breathing, 4-7-8 breathing, box breathing, and three-part breathing, and mediation.

The majority of these practices are inexpensive and accessible making them good options for whenever the need arises.

Walls and Layer emphasize the importance of building the immune system as a self-care tool. Part of building a healthy gut, a major component of the immune system, is minimizing the use of antibacterials and instead, washing hands with toxin-free soaps.

Using appropriate herbs, ensuring proper micronutrients through whole foods and prioritizing sleep are all vital components in caring for ourselves holistically, the duo teach in their course.

Photo by Nathan Cowley: https://www.pexels.com/photo/woman-slicing-gourd-1153369/

Walls acknowledges that it’s often most difficult to carve out time for self-care when we need it the most.

Reminiscing about when her children were young, Walls says, “I look back on those really busy times in my life and wonder ‘How did I get through those crazy times?’ I think I learned early on how to do a lot of these self care techniques… and I am really glad because I can see the benefits as the years have gone on… I am reaping the benefits now at my age from [practicing self-care] back then.”

When we practice self-care, we’re setting examples for the next generation, too. Walls points out that her adult daughter now uses many of techniques she observed as a child with her own children and with the children she works with at an elementary school.

Walls likens this to a concept Dalai Lama is credited with: “Just as ripples spread out when a single pebble is dropped into water, the actions of individuals can have far-reaching effects.”

Photo by Felix Mittermeier: https://www.pexels.com/photo/closeup-photography-of-water-drop-355724/

Check out another Our Milky Way piece Self-care strategies for lactation care providers for more thoughts on providing sustainable care.

October 9, 2022October 14, 2022

Self-care strategies for lactation care providers

Tomorrow is World Mental Health Day. Read on about self-care strategies for lactation care providers.

When a gas-powered vehicle is low on fuel, it’ll often show signs of fuel starvation like a sputtering engine and intermittent power surges. Eventually, when the engine dies completely, the hydraulic power to the brakes and steering lose power too. Steering and stopping is still possible at this point, but it requires greater effort.

Perinatal professional Sara BhaduriHauck, CLC of Mandala Motherhood analogizes the vehicle and the human body and how self-care and nurturing mental health is crucial to providing sustainable care.

“It feels good to give,” she begins, speaking from the perspective of lactation care provider. “But you can only give so much.”

Learning to sense the feelings and sensations that warn us of burnout, is like filling up the gas tank when it hits a quarter tank.

“Keep an eye on your gas tank,” BhaduriHauck advises.

This wisdom of self-discipline, knowing when to stop giving to others so that one can give to themselves, allows for a healthy care provider/client relationship.

Liba Chaya Golman, CLC with lev lactation shared her struggle after a particular session: “I just met with a dyad dealing with weight loss and low supply and while we have a short term plan and pediatrician involvement, I am feeling so emotionally spent after the consultation. I’m empathetic by nature and became a CLC after my own difficult breastfeeding experience. I feel capable of managing the situation and have people to refer to and rely on, but came home and cried after the visit.” Soliciting tips for lactation provider self-care, BhaduriHauck offered up some suggestions.

“I find therapy to be an amazing self-care tool, especially when client situations trigger my own traumas,” she shared. “The situations that hit us the hardest shed light on the areas inside of ourselves that need some tender attention.”

BhaduriHauck endured traumatic birth experiences herself, like so many maternal child health care providers who are drawn to this work because of personal challenges that they endured.

After slogging through our mental health system, BhaduriHauck eventually connected with a trauma-informed therapist specializing in EMDR and a perinatal mental health specialist. Later, BhaduriHauck pursued training as a postpartum doula.

“Doing that work and learning how to help other people also helped me help myself,” she explains. “You have to have healed enough of your own emotional stuff to put it down and to pick up someone else’s, but in learning to help others, I was also learning how to support myself.”

She continues that journaling allows care providers to give their feelings space and “attention to be seen and articulated.”

“Sometimes I just need the space to express them before I can let them go,” she shares.

Affirmations are another avenue of self-care for care providers to explore.

BhaduriHauck uses this one most often: This work isn’t about its outcomes. It’s about making a difference.

“Over-giving/over-investing is something I fall into naturally, and I have to work at creating distance between a client’s situation and my responsibility to it,” she explains. “Reminding myself that me just doing my job, makes a world of difference to the client [and] helps me release some of the big feelings I’m holding onto about the client’s situation.”

BhaduriHauck acknowledges two types of processing: active and passive.

Going to therapy, having someone who is trained in validating and providing empathy, is an example of active processing. When our feelings are “infused with empathy,” as BhaduriHauck puts it, “we can put them away inside ourselves softer.” The opposite of this can happen if we have not chosen the listener appropriately, she warns.

Passive processing sometimes comes in the form of slowing our pace and down regulating our nervous systems. For BhaduriHauck, she finds a calmer state of being by going for a walk, snuggling her dog, or taking a hot bath. In these scenarios, she might not be actively processing trauma or emotions, but she’s giving her body space.

Intentionality in practice can help preserve mental health, and allow a care provider to be a more effective support person too. BhaduriHauck suggests checking in with oneself, “Am I doing this in service of the client, or in service to myself?” If it’s the latter, there are better avenues to pursue the boost of “feeling good by doing good” and/or getting the assurance that “my knowledge is valuable”.

BhaduriHauck shares some final thoughts on mental health as a lactation care provider. “The emotional learning I’ve done in becoming a care provider and overcoming my own struggles, they’ve gone hand in hand. My experiences help other people and others’ experiences have helped me in learning emotional management techniques. When I talk to parents… I can listen without it triggering past traumas.”

She goes on, effective care requires the provider to have trained themselves to embrace the emotional component of the work in ways that are in service to their clients.

In 2021, the CDC issued a call to action to protect health care workers’ mental health. You can find that information here.

The National Alliance on Mental Illness (NAMI) offers resources for Health Care Professionals including peer and professional support options. Find those resources listed here.

Praeclarus Press offers Burnout, Secondary Traumatic Stress, and Moral Injury in Maternity Care Providers, an opportunity to learn about the stresses of maternity care and how to care for yourself on the job. Learn about the course here.

May 1, 2022April 26, 2022

“She was living, but she wasn’t alive”: May 4th marks World Maternal Mental Health Day

“‘I have too much mental health and breastfeeding support,’ says no family EVER!” Felisha Floyd of The B.L.A.C.K. Course has accurately asserted. Around the world, as many as 1 in 5 new mothers experience some type of perinatal mood and anxiety disorder (PMADs). Often, PMADs go unnoticed and/or untreated and can have tragic and long-term consequences to families and subsequently societies.

The World Maternal Mental Health (MMH) Campaign’s blog features the sometimes harrowing, sometimes triumphant stories of those enduring PMADs.

“It didn’t look anything like what the brochures told me it would look like….For me, PPD/PPA was a sneaky vixen that tricked my mind into thinking that every new mom felt like this,” one contributor writes. “That I was living in a cruel joke of a world where no one tells you that as soon as that baby pops out, you will never feel the same way again. The sneaky vixen told me that we’d made a huge mistake. We weren’t supposed to have a baby. That what I thought I wanted more than anything my whole life, was something that just wasn’t for me. I didn’t feel like this baby I was holding was mine. It belonged to the universe but I wasn’t his mom.”

Another shares, “I would look into the mirror and wonder who was the person looking back at me. She looked like me, but did not feel like me. There was no spark in her eyes. She was living, but she wasn’t alive.”

May 4 marks World Maternal Mental Health Day, time to reflect on why we need to pay attention to maternal mental health, influence policy and drive social change, reducing the stigma of maternal mental health.

The MMH Taskforce has curated a hub for individuals and organizations to find information about MMH and suggest a variety of ways to get involved including a social media toolkit with simple actions.

Last year, the Maternal Mental Health Leadership Alliance (MMHLA) compiled the Perinatal Mental Health Advocacy Toolkit, “designed to help perinatal mental health (PMH) advocates understand the importance of their voices in raising awareness and influencing public policy to better support the mental health of women and other birthing people during the perinatal timeframe. Recognizing that advocacy and lobbying may sound scary or feel overwhelming, this Toolkit provides information and tools to empower advocates to tell their stories effectively, to build an advocacy network, and to put advocacy into action.” The document is complete with worksheets so that participants can build their own Toolkits with items like talking points, scripts for telephone calls, sample emails and letters, and more.

This work is of critical importance as we know that the health of mothers influences the health of the entire family.

Dr. Beryl Watnick, PhD has pointed out that the “mother infant bond is of profound importance. The brain patterns in babies can mirror the brain patterns in depressed mothers, but when women with depression are taught how to engage their babies in spite of their depression, their children’s depressed brain patterns can reverse themselves. This is the power of parenting.”

Although it is true that there is a vast amount of work to do in order to de-stigmatize maternal mental health and better support mothers and their families, there are also simultaneously a great deal of successes to celebrate. There are effective and well-researched treatment options available to help women recover, like breastfeeding. Individuals can connect with knowledgeable providers using Postpartum Support International’s database.

One such provider is Jabina Coleman, LSW, MSW, CLC, IBCLC aka The Lactation Therapist, providing clinical support, resources and tools for the start of a successful breastfeeding journey and adjustment into parenthood.

“Everybody Wants to Hold the Baby, Who Will Hold the Mother?” Coleman’s poignant credo. On her website, she lays out how to effectively hold mothers, with an emphasis on addressing the maternal mortality crisis that affects Black women who are dying three to four times the rate of their white counterparts.

In addition to the resources provided by the MMH Taskforce, MMHLA, and The Lactation Therapist, there are a variety of other opportunities to learn about and support MMH.

The Michigan Breastfeeding Network is hosting “Human Lactation and Mental Health: Best Practices” with presenters Tameka Jackson-Dyer, BASc, IBCLC, CHW, Rosa Gardiner, RN, IBCLC, Mistel de Varona, IBCLC, and Kara Smith, BSN, RN, CLC, PMH-C. You can register for the webinar here.

Kathleen Kendall Tackett’s, PhD, IBCLC, FAPA presentation Does Breastfeeding Protect Maternal Mental Health? The Role of Oxytocin and Stress is available here.

The American Heart Association, with funding support from the Center for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health program, is hosting a webinar titled “Mixing Milk + Meds: Assessing Infant Risk during Breastfeeding” on Wednesday, June 15, at 2 p.m. ET. Speakers from the Infant Risk Center will discuss how to evaluate which medications are safe for breastfeeding patients.

March 29, 2020March 29, 2020

Toxic Stress, Resilience Building, COVID-19 and Breastfeeding

As I write this, I’ve logged exactly two weeks at home in self-quarantine due to Covid-19 with my husband and three children. Technically, we’ve only made it through the kids’ scheduled spring break, but they’ll start an indefinite distance learning journey on Monday.

Our socially-distanced days have been filled with laughter of a couple kinds. The pandemic has offered us the opportunity to connect without the distraction of our robotic, go-through-the-motion schedules. We find simple entertainment: puzzles, charades, tiptoeing along sidewalk cracks. The situation has helped me rediscover how to be playful, and I’ve surprised myself and kids with genuine laughter (or maybe it’s because I’m utterly deranged) over things that might have otherwise made me blister in anger.

When I look outside my household, I laugh in discomfort. It’s this disturbed kind of cackle; a psychological response to the panic, the destruction, the trauma, the unknown that this pandemic has burdened the globe with.

My most recent interviews with Nikki Lee about breastfeeding policy in shelters and Healthy Children Project’s Anna Blair and Karin Cadwell about their upcoming webinar on Covid-19, breastfeeding and resilience went this way: we seemed to laugh more than in interviews before the pandemic hit our country.

For me, I laughed because it was a simple joy to hear my friends’ and colleagues’ voices, to connect with those outside my immediate family. But even when the conversations turned dark, still I laughed. I laughed until I actually started sweating. What is the matter with me?

Blair and Cadwell pointed out something about the status of the crisis we’re currently in. When a hurricane tears through a community, we know there’ll be an end to the devastation. With Covid-19, we have no idea when this ends, and that’s sure to threaten mental health.

Cadwell shares that while she does not consider herself a joyful person, she often thinks about joyful things in the future.

“One of the things this has done for me is it has taken away my anticipation of joy,” she says.

Some will argue that we’ve gained something through the shared experience; we’re together by being apart. “Rediscovered humanity,” in the words of the head of my children’s school.

We’ve lost a lot though too. Lives most importantly and second to that, control.

In Hidden Brain’s episode An Unfinished Lesson: What The 1918 Flu Tells Us About Human Nature guest Historian Nancy Bristow recounts, “To remember the flu would be to admit to the lack of control that people had had over their own health. It would be to admit that the U.S. was not necessarily all powerful but was like everywhere else in the world subject as victims to something beyond their control.”

Almost a century later, these words ring true. Where there was opportunity for control, or a fair degree of preparedness at least, our nation failed.

Cadwell has pointed out time and time again that our country has better emergency preparedness plans for our pets than we do for our moms and babies.

“The unfortunate reality of the coronavirus pandemic is that it has shown how unprepared and underfunded the public health infrastructure in the U.S. is to address the basic needs of our citizens,” Monica R. McLemore begins in her piece COVID-19 Is No Reason to Abandon Pregnant People.

Now we’re in what feels like an impossible place.

Kimberly Seals Allers exposes the fact that infant formula quantities are scarce.

“There, I said it! Cue swarm… I have time,” KSA begins in a Facebook post. “Everybody is talking about ‘choice’ & blasting #breastfeeding advocates until there’s a global pandemic, a panic-induced international run on infant formula & quantities are scarce. Now the ‘just give a bottle’ folks want to teach you how to re-lactate.”

Doulas have been deemed non-essential, partners of birthing people considered visitors. (Refer to McLemore’s piece above.)

“We are taking so many steps backward,” Blair comments.

She continues: “We have heard so many times, not just locally, but colleagues around the country that there has been a misunderstanding about what the protocols are for babies being born now. Babies are being automatically separated from their mothers for two weeks in some cases, even if the mother is Covid-19 negative. That is not best for the baby and that is not best for the family. Story after story. It worries us tremendously.”

A member of the Certified Lactation Counselor (CLC) from ALPP Facebook group shared this account:

“Mom had baby yesterday and was forced to wear a mask and gloves for all of labor and delivery. She had low o2 sat(91%) when coming into the hospital. No other symptoms. She is now separated from baby. Baby with dad in postpartum room and she in ICU pending covid test. She has not seen baby since and they will not let her until she gets a negative (test pends for 5 days apparently. They gave her a pump but didn’t show her how to use it. She’s a young first time mom and has now pretty much given up breastfeeding and seems highly depressed. She claims the hospital told her the CDC said to quarantine moms away from baby.”

Later, the member provided an update.

“She’s with him now and he is currently latched <3 she’s still mentally in a dark place but things are looking up now that she’s finally got to hold him skin to skin without gloves or a mask.”

Another participant suggested that this mother might need timely birth trauma therapy.

The original poster replied: “I completely agree. She is very flippant and now seemingly unbothered and lacking emotion. Dad is worried and said he’s never seen her like this before.”

Dr. Amy Gilliland of Doulaing the Doula is raising questions about mother baby separation on her social media outlets.

In one post Gilliland describes the effects of separation after birth: “The infant experiences loss and has a grief response – that’s the only interpretation – Where did my mother go? And it’s a loss they never recover from because their initial impression is abandonment and isolation. We are screwing up their capacity to trust and creating insecurity. We know this from research and therapy with young children, older children and adults. www.birthpsychology.com (also the Alliance for Infant Mental Health)…”

Toxic stress is bubbling up in mothers, babies, families and equally their care providers.

What’s worse, Cadwell explains, is that many of us have accumulated toxic stress over our lifetime and in the current situation, many of our regular stress relief outlets have been stripped from us.

Gutted by the situation, Cadwell and Blair put together Toxic Stress, Resilience Building, COVID-19 and Breastfeeding, a webinar that focuses on how to build resilience in ourselves and in others.

“How can we find a resilient future?” Cadwell wonders.

The webinar refers to Dr. Kenneth Ginsburg’s The 7 Cs: The Essential Building Blocks of Resilience.

Healthy Children Project and Health Education Associates are offering the webinar at no cost. Continuing education credits for nurses, lactation consultants and lactation counselors are available.

You can request the free module here.

In closing, I offer you this PSA:

“Unless you have prior experience navigating the emotional, psychological, and financial implications of a global pandemic- all while suddenly becoming a homeschool teacher to kids with cabin fever and unlimited snack requests… give yourself some grace.”

And one of my favorite quotes, quite applicable when the entire world is becoming unglued, “As long as there is breath, there is hope.”

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