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.

First ever Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes spurs multi-national project

Earlier this summer, the World Health Organization (WHO) hosted its first ever Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes.

INFACT USA’s Cadwell and Mulpeter ready for the Congress

INFACT USA Convener Karin Cadwell PhD, RN, FAAN and INFACT USA Program Coordinator Ellie Mulpeter, MPH, CLC were of the roughly 400 Congress participants.

The conference aimed to to increase knowledge and skills of national actors on strategies to end the unethical marketing of breast-milk substitutes, bottles, and teats, develop national roadmaps/work plans to strengthen legislation, monitoring and enforcement of the International Code of Marketing of Breast-milk Substitutes, and build regional networks to share information and support of national action on the Code.

Mulpeter says the overall energy was upbeat and eager.

“It was inspiring to see so many people from around the globe all dedicated to the same mission, and all passionate about implementation and enforcement of the Code to protect families across the world,” she reports.

Congress participants proudly pose

The Congress was intended to be as interactive as possible with breakout sessions organized by region. The U.S., Canada and the Caribbean were grouped together.

“The work being done in all of the Caribbean Islands is very impressive,” Mulpeter explains.  “They are all unique islands with their own unique policies and legislative processes, so it was fascinating to hear their representatives brainstorm together and discuss ways to work regionally in the future.”

Congress conveners created an industry influence grassroots monitoring simulation where participants had the opportunity to spot and record Code violations using the KoboToolbox platform.

Congress leaders also shared the the International Special Dietary Foods Industries (ISDI) statement released in response to being excluded from the Congress.

“It really drove home the point about how integrated the industry is when it comes to Code monitoring and enforcement,” Mulpeter comments.  “It’s a wild marketing tactic to blatantly lie about their dedication to breastfeeding families.”

As laid out by INFACT USA: “Here in the United States, there is an incredible amount of work to be done to advance the Code and its subsequent resolutions. To date, the U.S. is one of three countries in the world that did not sign onto the Code back in 1981. While that step may never come for the U.S., there are other options and avenues to implement protections against predatory marketing practices of these commercial baby-food product companies.”

Mulpeter points out that the Federal Trade Commission (FTC) already has an avenue to monitor false advertising and hold companies accountable for making claims that are not evidence-based.

“Additionally, the fact that the US is hyper-focused on data sharing and digital privacy at the moment may allow an opportunity to explore how targeted advertisements of formula companies are directed towards pregnant individuals and new parents,” she goes on.

Participants engaging at the Congress

What’s more, last week INFACT USA started the recruitment phase for a multi-national research project on the Code. The U.S., Canada, the UK and Australia are all participating in a Code monitoring project that will collect real-world violations from the general public.

Research participants are asked to download the Goose Chase Adventures application on their mobile device and participate in the missions outlined within the app. Submissions will help monitor Code adherence in several countries.

Individuals interested in learning more about this research study can visit: https://surveyswesternsydney.au1.qualtrics.com/jfe/form/SV_cN14ryUEZriqHL8

Should you have any questions about the project prior to or after signing up to participate, please contact Ellie Mulpeter at: info@infactusa.org or Jeni Stevens at: Jeni.Stevens@westernsydney.edu.au

Mulpeter explains: “We hope that the results from this study will not only allow us to assess what types of violations are happening most frequently in these four countries, but also to assess the frequency with which people see and recognize them as problematic at all. Pending the outcomes of the study, we hope that INFACT USA will be able to use the evidence gathered in this project to persuade legislators in the U.S. to implement stricter monitoring of predatory marketing practices of infant and young child feeding products. Ideally, Australia, Canada and the UK can use the results from this study to enforce stricter implementation and monitoring of the Code in their respective countries.”

Mulpeter and Cadwell applaud the efforts of the hosts of the first Global Code Congress: “It was a huge success!”

Monumental ‘Skin-to-skin contact after birth: Developing a research and practice guideline’ calls for immediate, continuous, uninterrupted skin-to-skin contact for all mothers and all babies from 1000 grams, after all modes of birth

In Western culture, we tend to trust the process of pregnancy and the capability of a human body to grow and nourish a fetus, but there’s a moment between then and the approaching birth of the baby and beyond when that confidence is lost. Among other reasons, loss of trust in the female body forces mostly unnecessary and often harmful interventions on the process of labor and birth. Thereafter, though the safest place for most newborns immediately after birth is skin-to-skin with their birthing parent, common maternity practices often strip the dyad of this sacred, critical transition diminishing the capability of the mother and the infant.

As the authors of The nine stages of skin‐to‐skin: practical guidelines and insights from four countries put it, alarmingly, “despite the research and compelling directives from world authorities, the implementation of immediate, continuous and uninterrupted SSC for all healthy mothers and newborns, regardless of feeding choice, has not become standard practice.”

Last month, Kajsa Brimdyr, et al published the monumental Skin-to-skin contact after birth: Developing a research and practice guideline.

Authors not in order of appearance: Kajsa Brimdyr, Jeni Stevens, Kristin Svensson, Anna Blair, Cindy Turner-Maffei, Julie Grady, Louise Bastarache, Abla al Alfy, Jeannette T. Crenshaw, Elsa Regina Justo Giugliani, Uwe Ewald, Rukhsana Haider, Wibke Jonas, Mike Kagawa, Siri Lilliesköld, Ragnhild Maastrup, Ravae Sinclair, Emma Swift, Yuki Takahashi, Karin Cadwell

It’s an “excellent overview of the huge quantity of evidence supporting skin-to-skin contact after birth and give evidence-based guidelines, endorsing the recommendations of the World Health Organisation, that ‘immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth,’” Andrew Whitelaw writes in this editorial.

Source: United States Breastfeeding Committee (USBC)

In the review, the expert panel– representing all continents but Antarctica– sifted through roughly 8,000 articles and ultimately pared down to only include those with a clear definition of immediate, continuous, uninterrupted skin-to-skin contact.

The panel concluded that “delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.”

The guideline includes the Pragmatic Implementation Guide for Skin-to-Skin Contact after Birth which serves as a how-to for staff, preparing them to facilitate skin-to-skin contact before and during the birth. The document is downloadable here: Appendix S1.

Brimdyr points out that none of the information presented is new; instead it’s consolidated in a way that hasn’t been done before.

“It takes the expertise of so many people and puts it in one place,” she explains.

Brimdyr says she believes it will give practitioners the confidence to make this practice work for moms and their infants.

“All of these babies, all of our mothers really deserve this opportunity,” Brimdyr advocates. “They deserve to have the best start.  This research is so well established… the fact that we’re not doing it everywhere is absolutely upsetting.”

Also last month, Brimdyr released a new film, The 9 Stages of Premature Infants, which documents  the nine stages as demonstrated by premature infants. The film brings to life the implementation of facilitating skin-to-skin for this population of infants and their parents.

“There is something absolutely magical seeing how capable babies are that really transforms any words on a page into reality,” Brimdyr says. “The research has been there to say premature babies can do this, but it’s so much more powerful to see premature infants do this.”

You can find a collection of skin-to-skin research here.

Centers for Disease Control and Prevention (CDC) changes their breastfeeding policy for HIV-infected mothers

Without major announcement, in February 2023,  the Centers for Disease Control and Prevention (CDC) changed their breastfeeding policy for HIV-infected mothers and no longer recommend advising against breastfeeding.

Photo by Paul Hanaoka

The new recommendation gets closer to the updated 2010 World Health Organization (WHO) guideline on HIV and infant feeding. Before 2010, “WHO guidance on HIV and infant feeding (UNICEF et al., 2003; WHO et al., 2006) recommended an individualized approach in which women living with HIV would be counselled on feeding options according to their household circumstances.”

The new CDC guideline acknowledges that, “For mothers on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero,” as determined in the PROMISE Study.

The guideline goes on to recommend “patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making.” Read the full document here.

Organizations like the National Institute of Health Office of AIDS Research, the Infectious Disease Society of America and National Association of County and City Health Officials announced the new guidance, but it has gone largely unacknowledged in the field of lactation.

“This change in HIV policy serves as a reminder to always check sources. New research findings and policy reconsiderations make it imperative that the most up-to-date information is available to the families we serve,” Healthy Children Project’s Karin Cadwell PhD, RN, FAAN, IBCLC, ANLC comments.

Photo by Wren Meinberg

In the U.S., HIV diagnoses among women have declined in recent years; still, nearly 7,000 women received an HIV diagnosis in 2019. (The CDC has commented on the effect of the COVID-19 pandemic: “Data for 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state and local jurisdictions. While 2020 data on HIV diagnoses and prevention and care outcomes are available, we are not updating this web content with data from these reports.”)

How does the U.S. compare in their recommendations to other high-income countries?

The British HIV Assocation’s 2018 guidelines for the management of HIV in pregnancy and postpartum states that “Women who are virologically suppressed on cART with good adherence and who choose to breastfeed should be supported to do so, but should be informed about the low risk of transmission of HIV through breastfeeding in this situation and the requirement for extra maternal and infant clinical monitoring” among other recommendations for helping manage lactation in HIV-positive mothers.

Photo by Laura Garcia

A National Health Service (NHS) Greater Glasgow and Clyde document Management of infants born to HIV positive mothers reads: “There is now evidence from developing countries that breast feeding while mum’s viral load is fully suppressed is safe, and BHIVA/CHIVA no longer regard a decision to breast feed as grounds for referral to child protection services. For HIV positive women who choose to breast feed, maternal HAART should be carefully monitored and continued until one week after all breastfeeding has ceased. The mother’s viral load should be tested monthly to ensure that HIV virus remains undetectable; this testing will be undertaken by the obstetric/ID team. It is recommended that breastfeeding be exclusive, and completed by the end of 6 months.”

You can learn more about Canada’s approach here and Switzerland’s here.

For more, check out  Lacted’s Clinical Question and the CDC’s Preventing Perinatal HIV Transmission.

Laughing matters

“… A proper ringing toast soothes the savage beast,” Karen Krizanovich writes. “Taste has a sound and it’s the thing with the ding that is the ding an sich of the memorable toast.” We teach our little ones civility and celebration and merriment at a young age; the clunk of a sippy cup meets a mug of coffee, toasting the adventures of a toddler. One mother shares that her 15 month old decided to start “cheers-ing” her breasts together before she nurses.

Closing out National Humor Month, this endearing anecdote is the inspiration for this week’s post.

Parenting is serious business, and those who support parents through their responsibilities undertake weighty duties too, but amidst the seriousness, there is hilarity and light.

In 2019, we published Cheap medicine: laughter, where you’ll find research on laughter as it relates to infants, development, breastfeeding, and prosocial behavior.

This week, we’ve compiled a collection of breastfeeding-related material to make you laugh. Interestingly, in our search for funnies, we found that many of these pieces are reactions to the absurdity of infant feeding culture in the U.S. For instance, there is a comic depicting a breastfeeding dyad in front of an ad of a buxom woman. Two men approach, shaming the dyad, “Nursing?! This is a shopping mall! We can’t allow women to brazenly display their breasts!” It makes you chuckle, but of course the undertone is depressing. Nikki Lee wrote commentary on the real-life manifestation of this absurdity. Find it here.

In another case,  humor is used as a coping and healing mechanism as well as commentary on the Pinkwashing of the breast cancer epidemic. Poet and performer Christine Rathbun Ernst’s delivery will make you laugh and ask you to consider some really raw, hard topics. Find her work here.

And, without further ado…

Hungry Toddler Tries To Feed On Bras

Sibling love

Todd Wolynn’s engaging presentation about human milk 

The nursing cover 

Breast Side Stories: 100 unusual breastfeeding stories

Could you not do that?

Lactation consult on livestock 

The breast crawl 

Put some breast milk on it 

Necklines 

The Milk of Hathor 

Seven alternatives to evidence based medicine

We’d love to hear your funny stories, as a professional or parent. You can email us at info@ourmilkyway.org, or share your story in the comments below.