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!” 



Balancing family health and economic well-being in Kenya

Josephine (Josie) W. Munene is the Director of Community Engagement at Maziwa Breastfeeding, an organization that helps mothers balance their babies’ health and their families’ economic well-being in Kenya. Munene leads the lactation education training programs and the Community Breastfeeding Ambassador peer support initiatives.

Munene completed her graduate work in the UK with a focus on international development, and while she imagined she would spend her life working globally, and after spending some time working in the corporate world, she determined a need for helping moms in her home country. 

After her first son (now 14 years old) was born, she struggled to find breastfeeding support. Munene noticed that many of the resources and programs were established in the Global North and lacking for women in her community. So Munene switched gears and launched a business that sold breastfeeding supplies like breast pumps and nursing bras and nursing pads different from the “lumps” handed out by the hospital. She was looking to infuse dignity in the experience, she explains.  But Munene quickly realized that it wasn’t enough to sell products to women, so she pursued the Infant and Young Child Feeding Counselor Training in order to meld her lived experience with technical knowledge and offer evidence-based care to breastfeeding dyads.   

Kenya ranks quite well in the World Breastfeeding Trends Initiative (WBTi) coming in at number 10 worldwide. Still, Munene shares that in Kenya, lactation professionals are not widely accepted as competent nor essential care providers. Instead, they are often considered “quacks” or the profession is regarded as a “hobby”. Munene has therefore made it a priority to engage in policy change with a goal to establish a national accreditation curriculum in her country that will recognize lactation care as an essential part of the continuum of care. Munene sees engagement of social enterprises in public private partnerships as an important piece to this work; reliance on governments alone or donor partners alone has proven to be ineffective, she comments. Further, Munene emphasizes the importance of engaging the people who the policies are intended to benefit. 

She sees an opportunity to adapt well-established accreditation programs in the Global North to Sub-Saharan countries’ needs. Growing the membership of the Kenya Association of Breastfeeding would signal to the Kenyan government the need for a local accreditation, she proposes. 

Recently, Munene and her colleagues helped facilitate a  Kenya Association for Breastfeeding workshop during the Amref International University (AMIU) Public Health Care Congress. A range of participants including gynecologists, pediatricians, students were invited to learn about the fundamental principles of lactation and breastfeeding. They then participated in reflecting on case studies using Healthy Children Project’s (HCP) 8-Level Problem Solving Process by Karin Cadwell and Cindy Turner-Maffei as a framework. 

Munune reports that the most interesting finding from the interactions was the participants’ identification of the need for breastfeeding support early on to alleviate or to eliminate challenges. 

Another takeaway illuminated  the specialized care that breastfeeding can require. Munene explains that in Kenya, breastfeeding generally falls under the nutrition category which overgeneralizes the “benefits” of breastfeeding and ignores the need for practical support that is tailored and effective. 

Munene mentions that Kenya employs Community Health Promoters which are important players in preventive health care, but the program does not address the need for more targeted support for breastfeeding dyads. 

Overall, Munene sees a need for a more comprehensive approach to lactation and breastfeeding care in her country. She calls for policies that go beyond “paperwork and guidelines”. 

For instance, Kenya has established lactation laws for working mothers, but she finds implementation and enforcement is lacking. [Check out this qualitative study for interesting  perspectives from women, families and employers in Kenya.] 

In Breastfeeding challenges for working mothers and their families in different workplace settings, around 18 minutes into the webinar, Munene presents on maintaining exclusive breastfeeding for working mothers.

Munene also reflects on maternity cash benefits for those working in the informal sector. These interventions can only be effective if they come with proper education, she reports. Cash benefits have the potential to influence personal nutritional wellness, and if individuals use the money to purchase indigenous foods from their neighbors, they have the added potential to boost income for the community as a whole. 

You can learn more about these endeavors and connect with Munune here

You might also be interested in learning about The Cost of Not Breastfeeding in Kenya. Check it out here.

Happy World Breastfeeding Week 2023: Making a difference for working parents

Logo by WABA

We’re abuzz with excitement for World Breastfeeding Week: Making a difference for working parents! This year’s theme is especially relevant in the U.S. with the recent passing of the PUMP for Nursing Mothers Act and Pregnant Workers Fairness Act. Yet, we remain one of the only countries with no paid family leave.

In celebration of the triumphs and in hopes of a better future paved by the hard work and passion of countless advocates, we’re looking back on Our Milky Way stories in the workplace.

  • The 2015 World Breastfeeding Week theme, Breastfeeding and Work Let’s Make it Work!, inspired Alyssa Sheedlo’s, RD LDN, CLC sharing of her story about providing milk for her triplets. Her story was originally published by the World Alliance for Breastfeeding Action (WABA). Read it here.
  • In a male dominated field, Alameda County Sergeant Misty Carausu blazed  trails for mothers working in law enforcement. Carausu was granted an initial three thousand dollar budget to renovate an existing lactation closet at the county jail. Read that story here.
  • Laura Westover PA-C, CLC, a provider at Castle Rock Pediatrics, dove into helping transform her office into a Breastfeeding-Friendly Employer and ultimate Breastfeeding- Friendly Medical Office.Westover worked alongside a  breastfeeding policy specialist to create their policies and lactation spaces through a six-point plan which includes policy, staff and provider training, patient education, environment, evaluation and sustainability, and continuity of care. Read the whole story here.
  • Learn about Zambian Investment Management and Banking Professional Musa Imakando-Mzumara’s perspective on breastfeeding and how it fits into the solution of national challenges here.
  • Look back on efforts by Scott Behson, PhD, creator of the Fathers, Work and Family (FWF) blog, to shape work policies here.
  • Passionate about breastfeeding support from both a personal and social standpoint, clinical researcher at the University of Colorado Dr. Bridget Young, PhD, CLC volunteered her time redesigning three lactation rooms and adding four newly designated lactation rooms at the University of Colorado Anschutz Medical Campus. Read about her efforts here.

 

We’d be honored to share your story about balancing employment and breastfeeding on Our Milky Way! Please email us at info@ourmilkyway.org with interest.

Cheers to a Happy World Breastfeeding Week and National Breastfeeding Month! Follow the WBW social media channels to stay up to date on all of the festivities @waba.wbw, @wabasecretariat, @waba_global and @wabasecr!

 

Helpful resources from A Better Balance and WorkLife Law:

Talking to your boss about your pump (Spanish)

Talking to your boss about your “bump”