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!” 



Infant feeding and planetary health go hand in hand

I recently woke up to a headline with the words “climate” and “hope” strung together. As author Jeff Brady points out, it’s “…something you don’t hear much when it comes to climate change: hope.” 

Brady goes on to illuminate a recent International Energy Agency (IEA) report that shows “countries are setting records in deploying climate-friendly technologies…” 

There’s more: “While greenhouse gas emissions keep rising, the IEA finds that there’s still a path to reaching net-zero emissions by 2050 and limit global warming to 1.5 degrees Celsius, or 2.7 degrees Fahrenheit. That’s what’s needed to avoid the worst effects of climate change, such as catastrophic flooding and deadly heatwaves,” he writes.

Photo by Mika Baumeister on Unsplash

It’s hard to imagine that we’re in a place where there’s still the potential for “the worst effects.” Are we not already there? 

Not long ago, when extreme weather occurred, we were told it wasn’t possible to link specific events to the climate crisis. Now though, scientists have figured out a model to represent how the climate crisis produces specific weather events like hurricanes and extreme heat.

Extreme weather events and other disasters and emergencies will continue to occur, so it’s imperative that we develop infant and young child feeding in emergencies (IYCF-E) preparedness in the U.S., something we are seriously bad at.  

Jennifer Russell’s, MSN, RN, IBCLC, NHDP-BC, Ph.D. Candidate in Nursing Science from the University of Tennessee Health Science Center co-authored Domestic Preparedness Journal article “Challenges with pediatric mass care feeding,”(p 27-31) details the importance of and how state, local, tribal, and territorial organizations’ (SLTTs) can “safely, effectively, equitably, and quickly provide pediatric feeding support” in emergencies. 

Namely, the authors state: “SLTTs must estimate and plan for the logistical distribution and cost of breastfeeding and re-lactation supplies along with safe alternatives to mothers’ breastmilk and other pediatric feeding items.” The authors bust some common misconceptions about emergency response and offer ways in which we can improve existing guidance. 

Photo by Dave Clubb on Unsplash

In her most recent guest post on Our Milky Way, “Nourishing Children and the Planet”,  Healthy Children Project’s Donna Walls considers the critical weather events of late and highlights the urgency of education, legislation and action.

Walls points out that lactation care providers (LCPs) and health advocates can and should take a leading role in the fight for the health of our planet.  LCPs are important actors within the greater need for national-level policy development, and LCPs’ work helps to mitigate the more grandiose challenges of the climate crisis.  

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The first best food for infants is mother’s own milk. We all know about the benefits for mothers and babies, but we don’t often discuss the benefits for the health of the planet.

https://www.gifa.org/en/international-2/green-feeding/

This is a win-win situation. By providing our infants and children with cleaner, “greener” foods, we also create a cleaner, safer environment for our families, our communities and the world. 

By contrast, commercial milk formulas (CMFs) are harmful to the planet because they require procurement of ingredients and manufacturing and transport of the product. All of these processes use resources and contribute to the increasing burden of greenhouse emissions. Read Powdered Baby Formula Sold in North America: Assessing the Environmental Impact for a detailed look at the environmental and Greenhouse Gas impact of powdered baby formula, which as the authors note, “should be considered when developing and funding infant and young child feeding policies and supportive programs.”

Water resources are scarce in many countries around the world, and yet “about 5000 litres of water are used for every kilogram of milk powder, including producing the milk, then processing the powdered milk, preparing the feeds, and sterilising feeding equipment.” (Linnecar, van Esterik, 2023).  Unnecessary use of precious water resources threatens the very survival of children across the globe.

It’s true that “the few extra litres of water required by a breastfeeding mother are negligible compared to the amounts of water for formula production and preparation.” (Linnecar, van Esterik, 2023

Destruction of natural resources, such as the rainforest for harvesting ingredients as well as ever-mounting pollution from plastics is creating a negative impact on the environment ultimately contributing to rapid climate change. 

By supporting breastfeeding families,  LCPs can be the first line of defense by reducing pollution and minimizing the powerful effects of the climate crisis. Breastfeeding  is, without doubt, the cleanest, “greenest” form of infant nutrition. 

Ultra processed foods (UPFs) impact on  health

What’s more, we have evidence that breastfed infants consume less ultra processed foods (UPFs) as they get older (Paharia, 2023). 

UPFs not only strain our resources but have been shown to increase rates of type 2 diabetes, obesity, hypertension, cardiovascular disease and dementia further straining resources as communities struggle to care for sick individuals. Shockingly, research shows “67% of children’s calories come from empty ultra processed foods” in the U.S. (Berg, 2022).

Food additives– “any substance not normally consumed as the food itself and not normally used as a typical ingredient of the food, whether or not it has nutritive value” (FAO, Codex Alimentarius, 2021)– frequently found in UPFs, present a myriad of concerns including central nervous system disruptions, hyperactivity or other behavioral or neurological issues in children. (Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children, 2021

Predatory marketing lulls families into believing that these convenient food sources are not harmful. Information and research about the toxicities and harm is usually assigned to the small print or not disclosed at all. 

The Environmental Working Group (EWG) has published information on several food additives that are especially troubling. These include:

  • Nitrates and nitrites- meat preservatives  linked to stomach cancer, esophageal cancer, and possibly brain and thyroid cancers
  • Propyl paraben- a preservative in pastries shown to cause developmental and reproductive harm.
  • Food dyes (especially red and yellow dyes) linked to cancers
  • Potassium bromate- carcinogen found in baked goods
  • BHT and BHA- preservatives in foods are possible carcinogens
  • Titanium dioxide- color additive implicated in DNA damage
  • PFAS- known as forever chemicals used in food packaging which has been shown to leach into foods. These are known to increase the risk of cancer, damage to the immune system and hormone disruption. 
Food additives’ impact on environmental health 

According to Lempart-Rapacewicz, et al, the latest literature classifies food additives as one of the groups of so-called Contaminants of Emerging Concern (CECs), defined by the United States Environmental Protection Agency (USEPA) and United States Geological Survey (USGS).

These chemicals are not naturally occurring, and so require manufacturing resources ie; water, energy, systems for disposal of by-products and waste and packaging materials, to either develop or alter the final product.  Pollution of our air and water are well documented consequences of this type of manufacturing. 

These  substances are also found in sewage where current processes are unable to remove them from the systems, leading to concerns of the micropollutants in the ground and water tables. 

Additives such as ascorbic acid might sound harmless, but when found in large quantities,  alters the pH of water and soil, affecting the basic growing medium for plants and crops. Ongoing research investigates the long-term consequences on plant and crop properties and the effects on biodiversity. Some studies have found mutagenic and teratogenic effects on fish and aquatic vegetation after exposure to food additives. ( Lempart-Rapacewicz, et al, 2023)

Plastic ingestion

Infants and children can be especially susceptible to  exposure to micro or nano plastics–plastics so small they are measured in micrometers or nanometers (microplastics are plastic particles under 5 millimeters in size, and nanoplastics are under 0.001 millimeters in size). They’ve been detected in many of the foods we eat,  in the air we breathe and the water we drink. Micro and nanoplastics are absorbed into our bodies through food packaging or in infants and children through feeding bottles and teats, baby food containers and pouches. Significantly more particles are released when the food containers are heated in the microwave (Hussain, et al, 2023).

Photo by Zeesy Grossbaum on Unsplash

The health effects of ingesting plastics are not completely understood yet, but early research implicates micro and nano plastics in imbalances in the microbiome, altered lipid metabolism, reproductive system, brain and lung dysfunctions. 

More on environmental degradation

In 1962,  Rachel Carson wrote the groundbreaking book Silent Spring, sounding the alarm about the use of pesticides and herbicides. Concerningly, as a nation, we have yet to heed her warnings. 

Use of these powerful chemicals is negatively impacting plants by causing them to produce less phytonutrients– the vitamins and minerals we need to stay healthy. 

Scientists are finding “dead zones” in bodies of water, areas that are so polluted they can no longer sustain aquatic animals and plants on account of run off of these toxins. Disruptions in the ecosystems have led to the rapidly changing climate and instability of our weather patterns.

Since the publishing of Carson’s book, micro and nano plastics have been found to inhibit the growth of healthy microbiota in aquatic animals and have also been shown to obstruct the digestive system of marine organisms such as mussels and oysters. 

Scientists note increasing contamination of agricultural soils with these particles, reducing plant growth and overall productivity (Amboyne, et al, 2021). Soil contamination negatively affects inhabitants such as earthworms and nematodes resulting in changes in the soil microbiome.

Learning to live in balance
Photo by Derek Owens on Unsplash

On an individual level, tackling the catastrophic challenges spurred by the way we produce and consume food, is insurmountable and requires system-level action;  however, there are resources for families to consult when working to make the healthiest choices for their families. Beyond breastfeeding,  families can check out theEWG’s  “Dirty Dozen” and “Clean 15” listing of foods to find the most budget-friendly way to provide cleaner, organic foods. There is no question that organic foods are the healthiest. 

When we learn to live in balance with the natural world, the health of both flourishes.  It can sometimes seem an uphill battle to create a cleaner, greener world but as individuals, and collectively, it is our privilege and responsibility to do whatever we can. One person at a time, one family at a time, one community at a time. One of my life-long favorite quotes is from Margaret Mead, and it is as important now as when she wrote it in 1978: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has”. This seems to be the time for those committed to caring for mothers and babies to also commit to caring for Mother Earth as well.

More resources to consult

Global Nutrition Report 

Green Feeding Tool

IBFAN’s Health and Environmental Impacts

Report on CARBON FOOTPRINT DUE TO MILK FORMULA: A study from selected countries of the Asia-Pacific region

Register to attend  Infant and Young Child Feeding in Emergencies: Preparedness Systems for Communities to Keep Our Babies Safe webinar hosted by U.S. Breastfeeding Committee (USBC) and the National Association of County and City Health Officials (NACCHO) on November 1 from 2:00 – 3:30 pm ET. The session will provide an overview of the Centers for Disease Control and Prevention’s (CDC) infant and young child feeding in emergencies (IYCF-E) toolkit, share current research exploring personal experiences and disaster-related factors that influence breastfeeding, describe how NACCHO has supported communities in emergency preparedness for maternal and child population.



Celebrating Semana de La Lactancia Latina and the efforts of Lactancia Latina en el Suroeste de Kansas

It’s almost Semana de La Lactancia Latina (September 5- 11)! New this year to National Breastfeeding Month, we celebrate Latina/x families and raise awareness about infant feeding barriers specific to Latin communities.

Residents and visitors of Southwest Kansas have the delight of enjoying the efforts of the Lactancia Latina en el Suroeste de Kansas, an organization formed in late 2018 with the nurturing of the Kansas Breastfeeding Coalition and Ford County Breastfeeding Coalition.

Photo by Rosalba Ruiz, used with permission from Latina/x Breastfeeding Week/ https://www.facebook.com/Latinxbreastfeedingweek

This week, with the help of Carmen Valverde, CLC, Local Coordinator at the Lactancia Latina en el Suroeste de Kansas and 2022 USBC Cultural Changemaker Awardee, we highlight the organization’s projects in honor of Semana de La Lactancia Latina.

At the age of seven, Valverde was an immigrant to the United States. Her passion to help the Latin community comes from not having the support she needed while raising her young children.

“I totally relate to the struggles the families in Southwestern Kansas face,” Valverde comments.

In partnership with Vigness Welding, NACCHO, UnitedHealthCare, Western Kansas Community Foundation, the Kansas Breastfeeding Coalition,  and the City of Dodge City,  Lactancia Latina en el Suroeste de Kansas coordinated the placement of several lactation benches throughout the Southwest communities.

The first bench was placed in Garden City because they have the largest zoo in the rural region. Each bench has a QR code with the Kansas Breastfeeding Coalition directory so that families can find the support they need based on their zip code, Valverde explains.

Photo source Lactancia Latina en el Suroeste de Kansas

Additionally, billboards were installed in high traffic areas. The billboards have information about where to find infant feeding support on social media and information about lactation in the workplace.

Alongside breastfeeding, soccer is Valverde’s other passion; Lactancia Latina en el Suroeste de Kansas is a proud sponsor of the Dodge City Toros and Atletico Liberal. Sponsorship was made possible by HealthConnect One.

Valverde has made it a point not to “reinvent the wheel” in the coalition’s efforts to support breastfeeding and become more visible.

“… I like to work and partner with other organizations and events so that we can both have the best outcome,” Valverde begins. “It just works out better that way… So far the public has received it very well. We’ve had more moms… get involved with our local coalitions as a result of it and the [local] newspaper has done a piece on [the sponsorship].”

During one of the most trying times during the pandemic, the coalition was able to accomplish the recording of a PSA with a local meat packing plant in Dodge City. Valverde says the plant, Cargill, does a marvelous job investing in their employees. Watch the video here.

Lactancia Latina en el Suroeste de Kansas provided scholarships to an all-Spanish breastfeeding training made possible through a NACCHO grant and partnership with Lactation Education Resources’s certified breastfeeding specialist training. Valverde reports that the coalition is currently planning an  in-person skills day training so that the online training material can be reinforced.

Source: United States Breastfeeding Committee

You can learn more about these projects and Lactancia Latina en el Suroeste de Kansas’s future endeavors on Facebook.

Opportunity to submit comments on the most recent World Breastfeeding Trends Initiative’s (WBTi) report for the United States and territories

The amount of work that needs to be done to improve families’ lives can sometimes feel paralyzing. Over the next few weeks though, individuals and organizations will have the opportunity to engage with an important endeavor: submitting comments on the most recent World Breastfeeding Trends Initiative’s (WBTi) report for the United States and territories.

The WBTi report assesses the status of benchmarks on the progress of implementation of the Global Strategy for Infant and Young Child Feeding.

The first national assessment in the U.S. was completed in 2016 with an update made in the spring of 2019.

The U.S. as a nation scores consistently low in most indicators.

In 2017, Healthy Children Project also released a national report based on the WBTi criteria that monitors the progress of infant and young child feeding (IYCF) in each of the 50 U.S. states plus six  territories.

This year, the subject matter expert panel is calling on any individual with an interest in maternal child health to submit their comments on the next update by June 30. In order to include any initiative on the report, the information must be documented on a publicly available source.

Healthy Children Project presented the preliminary reports at the United States Breastfeeding Committee’s National Conference and Convening June 8- 10 to gain feedback from state coalitions.

What we measure as a nation is what we value, thus the report helps guide lactation policy by gauging the success of current practices and determining where improvement is needed.

On a state, organizational or individual level, the reports can help channel opportunities to engage in areas where states are lacking.

Find the preliminary reports and submit comments here: www.wbtiusa.org

You will need to enter your email address to receive a password, which will allow you to suggest changes and additions.

The Details

WHO: Individuals vested in maternal child health in the U.S. and territories

WHAT: 2023 World Breastfeeding Trends Initiative’s (WBTi) report for the United States and territories

WHEN: Now until June 30

HOW: www.wbtiusa.org

WHY: To help guide and improve maternal child health policy