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!” 



“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. 

Photo by Matthew Ball on Unsplash

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.