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!”

From Africa to Appalachia, improved relationships and communication through nutrition research

 From Africa to Appalachia, Stephanie L. Martin’s, PhD, CLC research on nutrition during pregnancy, lactation, and childhood, has gone beyond nutrition alone.

In a world where infant feeding is commonly reduced to input and output, “perfect” latches and weighted feeds, Martin’s work illuminates the added benefit of improved relationships and communication. 

In Zambia for instance, Martin and her colleagues have looked at how to engage family members to support nutrition in women living with HIV and their children. 

Twenty years ago, when antiretroviral therapy (ART) was less accessible, the risk of transmitting HIV through breastfeeding was high. Today though, with an increase in availability and access to ART, the World Health Organization (WHO) recommends the use of antiretroviral drugs as a safe way to prevent postnatal transmission of HIV through breastfeeding. 

Still, Martin has found that mothers talk about their fears of transmitting HIV to their infants the same way they did two decades ago. Mothers often use unfounded strategies like breastfeeding for shorter durations, breastfeeding less often or offering other liquids in an effort to limit the risk of transmission. So, Martin and her team have counseled mothers not to cut feedings short. Martin shares that her most recent Lactation Counselor Training has offered new insight.

“I’m going to change things in our counseling materials based on what we learned in the CLC training [in regard to] how we phrase things about breastfeeding for longer periods of time; if there is efficient milk transfer, we don’t need to focus on this longer length of time,” she explains.   

Additionally, in an effort to reduce caregivers offering infants under six months food or drink other than breastmilk, alternative soothing recommendations were offered. Martin remembers one mother who tried the suggestions to calm her crying baby. The mother reported that propping her infant onto a specific shoulder alleviated the baby’s discontent. “I don’t know what it was about that shoulder, but she stopped crying,” Martin quotes the mother, noting the importance of empowering mothers and caregivers through counseling. 

In Tanzania, Martin and partners at Kilimanjaro Christian Medical University College sought to identify  facilitators and barriers to exclusive breastfeeding among women working in the informal sector. And in Kenya, Martin and colleagues have worked to improve adolescent nutrition in informal settlements.

Martin pictured with colleagues from Kilimanjaro Christian Medical University College and Better Health for the African Mother and Child organization

Throughout all of her work in East and Southern Africa, Martin says they are reliant on community health workers to roll out their programs. 

“It’s so important to understand their experiences,” Martin says of hearing out the helpers. 

Through her research , Martin has explored the experiences of peer educators, community health workers, WIC breastfeeding peer counselors, health care providers, and program implementers.

Surveying global health professionals provides an opportunity to learn from their experiences and fill gaps in the peer-reviewed literature to strengthen intervention design and implementation as concluded in Martin, et al’s Experiences Engaging Family Members in Maternal, Child, and Adolescent Nutrition: A Survey of Global Health Professionals

Through Facilitators and Barriers to Providing Breastfeeding and Lactation Support to Families in Appalachia: A Mixed-Methods Study With Lactation Professionals and Supporters, Martin draws parallels in the challenges lactation care providers in Africa and Appalachia face, including compensation and availability of services. 

Specifically in Appalachia, the authors heard lactation care providers expressing the desire for additional training for providing support around mental health, chest feeding, drug use, etc. 

Martin says that she found the Lactation Counselor Training Course (LCTC) covered many of these topics. 

“[The course] seemed very intentional in all of the right ways,” she says. 

The Appalachian Breastfeeding Network (ABN) also offers an Advanced Current Concepts in Lactation Course which covers these desired topics with scholarship opportunities. 

When asked if she’s optimistic about the future of maternal child health, Martin answers with a slightly tense laugh: “I feel like I have to say yes.” Martin goes on to explain the inspiring work of ABN and all of the lactation care providers she’s interacted with.

“If they were in charge of the world, it would be such a better place,” she begins. 

“When I think about them, I feel optimistic. I’d like to see different laws that are supportive of women’s health and families. We have all the right people to make positive changes.”

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.

Photo by Keira Burton

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.

Photo by Anna Shvets

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.

Photo by Laura Garcia

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.

Photo by Ксения

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]

Photo courtesy of the Gaynor family

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).