You’ve just seen a new breastfeeding family for their first visit. You analyzed the situation and gave research-driven advice. You left them with a care plan you feel good about and a schedule for following up. You covered all your bases. 

Or did you? 

Did you happen to ask what the infant feeding history is in the family, going back one or more generations? 

A study by Alexis Woods-Barr, presenter at the upcoming International Lactation Consultant Association National Conference, suggests that understanding a family’s infant feeding history is a critical piece of the puzzle. And failing to understand that dynamic can seriously undermine the effectiveness of your help.

At a time when listening to voices of Black families and communities is being increasingly recognized, Woods-Barr’s research feels especially critical. Particularly in Black families, which are the focus of her research, knowing the multi-generational picture for each family is critical, Woods-Barr says. 

“You can say to a mother, ‘Breast is best,’” she explains. “And that may not matter at all, if she is hearing another message from her mother or grandmother or aunt. The older generations are respected, whether they are giving out the latest information or not. What grandma says gets listened to, and she is in close, constant contact with the mom.”

A recent PhD graduate from the University of South Florida, Woods-Barr recently worked with 15 Black families in the United States across two or three generations in a study that explored infant feeding stories, messages, and experiences shared between generations. 

Woods-Barr will discuss her research during a plenary talk at the #ILCA2020 Virtual Conference. She will focus on the infant feeding conversations revealed in her study. “I wanted to know, what Black families were talking about as it relates to feeding babies? ” Woods-Barr explains.

Intergenerational messages about infant feeding start in adolescence or even early childhood, and have a huge impact on beliefs and behaviors–usually without the older generation even realizing they are transmitting messages, Woods-Barr says. And it’s not just the messages given to girls that matter. “What are grandfathers and dads saying to their boys?” she asks. “What are moms saying to their sons, and what are dads saying to their daughters? The entire big picture–the whole family dynamic–matters when it comes to infant feeding.” 

We are all being called on now to ask, listen, and act in deeper and more thoughtful ways, whether with patients from backgrounds similar or different to our own. IBCLCs who attend the conference will leave Woods-Barr’s presentations with new understanding and tools they can apply immediately to their practices. 

“My goal is to help those who work with lactating families understand that there is a role that each generation plays, and that they can leverage the wisdom and knowledge of the older generations,” she explains. “I’m hoping the take-away is that it’s really important to get the mother’s mother, or aunt, or whoever is important in her life on board. Invite the older generation into appointments, see where she stands on the idea of breastfeeding.

“If you don’t know where the family stands, it’s going to be very hard to be effective. The family history of infant feeding determines what advice the older generation gives the younger generation, the reservations that are presented, and the affirmations that are given.” 

The good news, according to Woods-Barr, is that when the older generation is invited into the conversation, and their experience and wisdom is acknowledged and respected, they are almost always willing to hear out ideas that are different from theirs. “The beauty of it was that the older generations were open to learning new things,” she says. “That’s something you can pretty much bank on. But you have to teach them. They don’t know what they don’t know.” 

Woods-Barr believes her research is broadly applicable, inside and outside the United States where it occurred. “From my experience, in other cultures, respecting elders is supreme,” she says. “I believe what I learned can help in many contexts.” 

As both #ILCA2020 and the ILCA Annual General Meeting (AGM) goes all-virtual this year for everyone’s safety, we are thinking creatively about how to honor and celebrate our members and attendees in new ways! As an international organization, we have traditionally opened our conference with a Parade of Flags, where attendees from all over the world represent their countries.

This year we hope to see a record number of attendees from around the globe, and want to celebrate accordingly with a virtual Parade of Flags! 

If you are a member or an attendee at #ILCA2020, we invite you to submit a picture or very short video of yourself with your country’s flag. The flag you pose with may be made of fabric, printed out or drawn on paper, or even a digital background!

We asked some of our board members to share videos of their flags to inspire your photo or video:

Please submit your photo or video here by 24 July 20 (deadline extended).

We will compile the images into a Parade of Flags that will be shared during both the AGM and at #ILCA2020. (Not yet registered for the virtual conference? Click here to sign up today.

This year is a time of crisis and change worldwide: both the COVID-19 pandemic and ongoing human rights uprisings across the globe have highlighted the gaps and failings in our current systems. Babies and families have always needed us. Now more than ever, we are called on to learn and grow so we may best support their needs. #ILCA2020 is going all-virtual to provide vital information and support, wherever you may be. We invite you to join us at #ILCA2020.  

Our speakers are addressing urgent questions including:

• Health disparities
• Clinical skills
• Emergency planning
• Ethical issues
• Access to care

Who are you most excited to hear at #ILCA2020?

Check out the full schedule and then leave a comment here on the blog telling us which speaker or topic YOU are most excited by at the #ILCA2020 Virtual Conference.

We will pick one person to receive a FREE #ILCA2020 Virtual Conference registration!

Bonus entry if you also leave your comment in this thread on Facebook or this thread on Instagram. 

Our winner will be chosen on 16 July 2020.

Early Bird discount ends 17 July 2020!

Get details on our equity pricing HERE.

Yesterday, George Floyd was laid to rest in Texas, United States, next to his mother. 

I, like so many around the world, mourn his passing, and send my deepest condolences to his family, including his six-year-old daughter Gianna.

His death is holding so much that it can feel hard to bear. From the pain of centuries of racism and oppression, to anger at the injustice of police violence, to sorrow at the inequities in health care, George Floyd’s untimely death at the hands of police has become the prism that has concentrated our collective outrage and focused it into a clear call for action.

As we all take a hard look at the ways we can answer this call in our communities, we must look to the inequities that are experienced in lactation. Nearly two years ago, when I took office as ILCA’s president, I committed to “setting the table” in a way that “created a space where all voices are truly welcomed and truly heard.”

During my tenure, I, along with the ILCA board and staff, have worked hard to set that table and hear your voice. ILCA has done much to name the barriers faced by Black people in the United States, both for entering the lactation profession and for accessing breastfeeding and chestfeeding support. Unacceptably, barriers exist too for other non-dominant cultures, both in the US and around the globe, and we have worked to name those as well. 

Building on the work of the Lactation Summits, we have shared with our community some of the tools we need to do the work of dismantling oppression. (Here’s one important resource: strategies for having challenging conversations in the lactation field.) 

We asked our community to help us get an even deeper understanding of the barriers, and with the help of Dr. Adrienne Coleman and Traci D. Ellis, JD, SHRM-SCP, experts in diversity, equity and inclusion (DEI), developed an action plan for moving towards equity in the profession, both in the United States and globally.

Our board and our equity committee are tackling the important work of making that plan a reality. I am truly honored to see this critical work take place.

**

Today, while I mourn, I also celebrate George Floyd’s life and his legacy. In the past few days, many important policy changes have been proposed or enacted in some US states, aiming to reduce police violence against Black people. While these changes are critical, and I am grateful for them, they are not enough. We all must do more to dismantle oppression in the US and globally.

And while I am deeply proud of the work we have done at ILCA, I also know that this, too, is not enough. 

I, along with the board, commit to continuing the work I set out to do when I took office: we must do all that ILCA can do to clear a path to the profession. Culturally-matched care for families is critical to the well-being of families and an equitable start at life. To do so, we must continue to ensure that our commitment to diversity and equity is not just in name, but woven into every aspect of our work. We must increase our support for these efforts, and at every turn, ask ourselves the hard question: are we doing enough? Families deserve nothing less from us.

George Floyd, an unarmed Black man, died face down and handcuffed, after being pinned down by a police officer in Minneapolis, Minnesota, United States.

Among his last words were a call to his mother.

As mothers, and as those that support mothers and breastfeeding and chestfeeding families, we at ILCA join in mourning his death and this tragic loss. And we join in raising our voices against the systems of oppression in the United States that led to the loss of his life and so many others.

Starting with pregnancy and birth care and continuing throughout the lifespan of Black Americans, systemic racism affects every aspect of life, from housing to health care to criminal justice to education to employment.

We believe that access to maternal and infant health care, including lactation care – and opportunities to enter the profession – are fundamental to a just start in life. As Michael Lu, physician and Associate Administrator of Maternal and Child Health at the United States Department of Health and Human Services, says: “We can’t all be created equal if we can’t get an equal start in life.”

ILCA stands in support of efforts to dismantle systems of oppression in the United States. 

ILCA stands in support of Black mothers and birthing people in the United States and celebrates their deep and loving care for their families, despite inadequate systems of support.

ILCA stands in support of Black lactation consultants in the United States, and celebrates their tireless care for their communities, despite inadequate systems of support.

ILCA calls on our members and partners to join us in standing in support of our community, and to advocate now for the change needed to ensure a just start in life for Black families.

Join in support of Black families

Would you or your organization like to sign on in support of Black families in the US and this statement? Complete the form here and your organization or name will be added.

Organizations

A Family Affair, United States
Alaska Breastfeeding Coalition, United States
Amy Chatburn-Stevens: Lactation Consultant, United States
Annie Frisbie IBCLC Inc., United States
Australasian Lactation Courses, Australia
Baby Beloved, Inc, United States
Baby Cafe Bakersfield, United States
Baby Cafe USA, United States
Baby Sips In-Home Lactation Consulting, United States
Baby’s Best Beginning, United States
Bayou Region Baby Cafe, United States
Beyond the Breast, United States
BFF – Breast Feeding Friend LLC, United States
Bonding With Baby Lactation, LLC, United States
Breastfeeding Coalition of Solano County, United States
Breastfeeding Resources, Manhasset, NY, United States
Breastfeeding Rocks!, United States
Breastfeeding Success Company, United States
Breast Is Best Lactation Services, United States
Breastfeeding USA, Inc., United States
Bronx Breastfeeding Coalition, United States
BVL (Belgian Association of Lactation Consultants), Belgium
California Breastfeeding Coalition, United States
Clark Memorial Health, United States
Coalition of Oklahoma Breastfeeding Advocates (COBA), United States
Community Lactation and Parenting, United States
Confidence In Birth, United States
Cuddles Lactation Services, Pakistan
Elevation Lactation, United States
Every Mother, Inc., United States
Fairhaven Lactation, United States
First Candle, United States
Great Start Lactation, United States
Happy Milk Lactation Support, United States
Hazelbaker Lactation Institute, LLC, United States
Healthy Horizons Breastfeeding Centers, Inc., United States
Healthy Mothers Healthy Babies Coalition of Hawaii, United States
Human Milk Banking Association of North America, United States
iLactation, Hong Kong
ImaniLia Fashions, LLC, United States
International Board of Lactation Consultant Examiners
International Childbirth Education Association (ICEA), United States
Institute for Family Health, United States
Janine’s Baby and childcare Consultancy, South Africa
JM Lactation Services, Australia
Lactation Associates of Montana, United States
Lactation Education Accreditation and Approval Review Committee
(LEAARC), United States
Lactation Education Resources, United States
Lakewood Ranch Lactation, United States
La Leche League Alliance, United States
La Leche League International
Luna Lactation, United States
Mahmee, United States
Mama Bear Lactation Care, United States
Mama Bee Lactation, United States
Mary Rutan Hospital, United States
Minnesota Breastfeeding Coalition, United States
Morning Star Moms, Inc, United States
Morrisania WIC Program, United States
Mother’s Milk Alliance, United States
Mothers’ Milk Bank Colorado, United States
My Village: Lactation, United States
North Carolina Breastfeeding Coalition, United States
Nourish Holistic Lactation Support, United States
Nurture By Nature Holistic Lactation, United States
Nurturing Generations, United States
Nutrition and Nurture, United Kingdom
NYC Breastfeeding Leadership Council, Inc., United States
Ohio Lactation Consultant Association, United States
Pennsylvania Resource Organization for Lactation Consultants, Faroe Islands
Phenomenal African Woman Foundation, Nigeria
Riverdale Lactation Center, United States
Sacred Good Medicine, United States
Space Coast Lactation, United States
Successfully Raised Kids Project, United States
Tarrant County Breastfeeding Coalition, United States
The Baby Whisperer, United States
The Lactation Training Lab, United States
The Milk Bank, United States
The New York Milk Bank, United States
The Young Masters Inc., United States
United States Lactation Consultant Association, United States
University of Nairobi, Kenya
UWMC, United States
Virginia Breastfeeding Coalition, United States
Willow Family Medicine, Canada
Wisconsin Association of Lactation Consultants (WALC), United States

Individuals

A recent controversy regarding an article about the handling of human milk containers during the COVID-19 pandemic has raised important concerns from readers of the Journal of Human Lactation.

We hope that the following helps answer some of your questions and guide your next steps as a skilled lactation provider.

What is the article about?

The Journal of Human Lactation recently published a series of articles related to COVID-19, including the “Insights into Practice and Policy” article Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic, by Kathleen A. Marinelli, MD, IBCLC, FABM, FAAP and Robert M Lawrence, MD, FABM, FAAP.

This article highlights that, at the time of publication, there is no evidence of the COVID-19 virus in human milk. It also notes that, at the time of publication, no guidance had been published concerning the disinfection of the outer surfaces of containers of expressed milk during the COVID-19 pandemic. [editor’s note: since the time of publication, the Human Milk Bank of North America (HMBANA) has released a set of guidelines, which can be found here.]

The article makes recommendations for milk expression and for the disinfection of containers of expressed milk.

What is the concern?

Following publication of the article, HMBANA shared concerns that the recommendations were “created and published without the involvement of milk banking and food safety experts.” In particular, HMBANA’s statement expressed objections to the author’s recommendations for disinfection that they describe as exceeding “FDA’s legal limit for food manufacturers.” HMBANA called for the retraction of the article.

How has ILCA addressed this concern?

First, some background: in order to ensure that scientific journals can operate as freely as possible from non-scientific concerns, they typically operate separately from their professional organization. The Journal of Human Lactation (JHL) is no exception. ILCA provides operating support to the JHL and extends subscriptions to JHL to its members. ILCA does not oversee JHL staff and exerts no influence over the content of the articles.

That being said, ILCA heard HMBANA’s concerns and took them seriously. ILCA reached out to both JHL and JHL’s publisher, not to influence the content, but with the goal of ensuring a thorough and transparent review of HMBANA’s concerns.

How has the Journal of Human Lactation addressed these concerns?

Discussions and disputes about scientific research and commentaries are not uncommon. The discussion that result are, in fact, a part of the process that brings us the best possible thinking in lactation research.

However, when there is a concern that there may be a risk to human health, or a dispute in a time of emergency such as the COVID-19 pandemic, sharing information quickly about the difference of opinion is paramount. Scientific journals, including JHL, have a process in place for moments such as these.

The JHL editor-in-chief has released an Editor’s note, which alerts the scientific community to the presence of a concern. The JHL has published two letters outlining some of the concerns, which can be found here and here. The article authors have also been given the opportunity to respond here. (Note that the articles and the responses either are or will be open source as soon as possible.)

What resources are available to my health care facility for decision-making about our policy regarding the handling of human milk?

First and foremost, it is important to note that there continues to be no evidence of the COVID-19 virus in breastmilk. 

ILCA has made available on our COVID-19 page the milk-banking guidelines from HMBANA as well as a statement from the European Milk Bank Association. In addition to the robust conversation referenced in this post, JHL has also made available a letter sharing the experience of an Italian donor milk program, which can be found here.

In the face of the rapidly changing information regarding COVID-19, ILCA will continue to share guidelines, resources, and information here. We welcome your suggestions of additional resources to share with the ILCA community. Please share updates to media@Ilca.org.

Every day, new information is released about the COVID-19 virus. New statistics refute earlier assumptions, new data challenges current protocols, and just-released guidelines are revised and replaced.

As a professional helping lactating families, how do you wade through the flood of information? And how do you translate it to action steps for your practice?

In a recent webinar Cecília Tomori, PhD, MA, Director of Global Public Health and Community Health at Johns Hopkins University School of Nursing, offered guidance on understanding COVID-19 data. Tomori weaves together a thoughtful and fresh multi-disciplinary discussion of the basics of the virus, how to digest and evaluate information and guidelines, and how to translate it all into practical action.

Below is a summary of the key take-aways from Tomori’s webinar.

Keep following emerging evidence. As a lactation professional, make sure you are staying up to date—and also make sure the sources you use are credible. Tomori herself relies heavily on the World Health Organization for information. (She includes a list at the end of her webinar of other reliable sources.)

Think critically. Be prepared to analyze and question what you hear and read. “Whatever level it is—locally or nationally—we can’t just read information uncritically,” Tomori says. “In a time of uncertainty and limited evidence with these … kinds of complexities, we really need to think very carefully.” Thinking critically means staying aware of your own biases, according to Tomori. “These are going to be deeply embedded and related to the cultural context that [you] come from,” she notes. “So this is going to take some deconstructing.”

Understand the limitations. When evaluating today’s newest COVID-19 information, Tomori says it is important to remember that we are living in an environment of constant change, and that new information is simply the best current understanding, not a definitive answer. “None of us knows everything, and tomorrow, there may be evidence that may change our minds,” she says.

Examine the implications for equity. “Health and illness is always shaped by structural and social inequities,” Tomori notes. “Epidemics are not equalizers. Just because the virus is not aware of social divides, the way in which it moves directly builds upon inequities. [The effect of the virus is to] heighten and reveal profound inequities, and to do so both globally and locally.” When evaluating a piece of COVID-19 guidance or information, Tomori urges practitioners to train themselves to ask, “How will this affect different people differently?”

Remain an advocate. When you see new COVID-19 policies or guidance affecting birthing or lactating families, Tomori advises reading it through a lens of advocacy for families. “Look for opportunities to support parents’ and infants’ rights,” she says. While some settings may offer less option for shared decision making than others, Tomori urges practitioners to work within their own settings to maximize the ability of parents to engage in understanding risk-benefit analysis and making choices.

Evaluate guidance on separation. One of the key questions during COVID-19 relates to the separation of birthing parents and infants. Tomori urges practitioners to understand that guidance is frequently rooted in a deep cultural bias toward seeing separation as neutral or default. “The mother and neonate are [seen as] completely separate individuals,” she says. “ …. These kinds of assumptions have to do with the socio-historical changes we have seen in the past 200 years … [mother-baby togetherness] is not considered something that is the default, but rather as a potential threat—in this case, a vector of transmission.”

In fact, the harms related to separation are extensive. “It takes the infant out of its normal niche, prevents co-regulation, disrupts breastfeeding, and presents a significant stress for mother, infant, and family.” Breastfeeding is especially important in offering protection from infectious disease, both from other illnesses and potentially mitigating COVID-19.

Seeing separation as inherently protective can also be misleading. “[The assumption is that] separating an infant from a COVID-19 positive [birthing] parent will achieve a neutral environment without the virus,” Tomori says. “But it actually exposes the infant to new exposures. Each health care worker or care handling the infant is a [potential] new exposure … the result is that the infant has a high likelihood of exposure but fewer benefits from proximity and breastfeeding.”

Transmission and clinical course in infants. The risk and clinical course of COVID-19 in infants has been the subject of a lot of interest, but data is still limited or incomplete. Evidence suggests a milder clinical course for COVID-19 in children overall, but the possibility of severe disease in infants, due to immune system immaturity and other factors. With regard to vertical transmission/in utero transmission, Tomori points out that a new study suggests it is possible but this finding remains unconfirmed. She says, “[This] may change in the coming weeks, but as of today, we do not have evidence of it.” There is no evidence of virus in breastmilk at this time either. The risk of transmission after birth can be minimized with good respiratory hygiene (e.g. wearing a mask) and handwashing.

Look for opportunities to collaborate. When trying to understand and apply COVID-19 information and guidance, do not go it alone, Tomori advises. Instead, connect with colleagues, learn from their expertise, and share your own. “Reach out to experts and ask for information,” she says. “This is a great opportunity for collaboration. We all need to be looking for opportunities to work together so we can support families the very best we can.”

The challenge of figuring out how to interpret new data and guidance during COVID-19, and how to provide answers to the families who rely on you, can feel overwhelming. But there are ways to work with the overwhelm, according to Tomori.

“Whenever we feel like there is overwhelming despair, I think it’s best to move toward action,” she says. “Work together. Communicate to address concerns, to raise questions, to relay information to colleagues, and to provide leadership in the environments where we operate.

“We are in this for the long haul,” she continues. “So we really need to be thinking very carefully about how we support families, because while it’s an emergency and many of us are dealing with very acute circumstances, we’re going to be dealing with some of these issues for many months to come. So we’re going to need to figure out how to build the best possible support that we can for families around the world.”

Want to learn more? Watch this free webinar here.

The International Lactation Consultant Association (ILCA) and the United States Lactation Consultant Association (USLCA) stand firmly in support of the World Health Organization (WHO) and their critical work helping “mothers and children survive and thrive,” particularly during the COVID-19 pandemic.

The care plans and policies that are established during COVID-19 for the care of new families are essential to the wellbeing of parents and babies, now and throughout the life course of the family.

ILCA and USLCA offer deep appreciation and support for WHO’s significant efforts to provide evidence-based research, guidance, and support to individuals, organizations, and countries to guide those decisions. 

Their guidelines provide much needed support for keeping breastfeeding and chestfeeding parents and infants together, and offer recommendations to safely breastfeed; they also provide information on protecting milk production and providing human milk to babies if there is separation.

This role is critical across the entire globe, as breastfeeding and chestfeeding is demonstrated to save lives, reduce burdens on the health care system, and increase food security now and into the future. These protections for families — which are felt regardless of the economic development status of the country — are critical now more than ever. WHO’s work in supporting these aims is indispensable.

ILCA and USLCA strongly urge the United States, and all countries, to continue their funding to the World Health Organization, especially at this critical time.

Join in support of WHO during COVID-19

Would you or your organization like to sign on in support of WHO and this statement? Complete the form here and your organization or name will be added.

Endorsements

Organizations

Adelante Network
Anna Sumner, Australia
Athena Lactation, LLC
The Baby’s Voice
BPNI Maharashtra, India
California Advanced Lactation Institute, USA
Cheryl Patel, RN, LNC, IBCLC
Chinese Lactation Consultant Association (CLCA), Taiwan
Christine’s Care & Compassion, USA
Colorado Breastfeeding Coalition, USA
Early Dawn Doula and Lactation Services, USA
Egyptian Ministry of Health and Population, Egypt
ELACTA, Austria
ELCA, Egypt
Every Mother, Inc., USA
Galactablog, Ireland
Hanen Association for Breastfeeding Promotion, Tunisia
Janette Brooke, Australia
Joy MacTavish, IBCLC / Sound Beginnings LLC, USA
Kawartha Birth and Lactation, Canada
KellyMom.com
La Leche League USA
Lactation Consultant At Home, LLC
Lactation Consultants of Great Britain, UK
Latch In Color
Lisa Staggs, BSN, RN, IBCLC
Lucile Packard Children’s Hospital Stanford, USA
The Milk Collective, USA
The Milky Mermaid LLC, USA
The Milky Way LLCA, USA
Mina Ognjanovic Jasovic IBCLC
Mom & Baby by Gaby Uribe, Mexico
Mother’s Own Milk Matters, USA
NHS, UK
Nurturing Traditions, LLC
Pretty Mama Breastfeeding LLC
Sarah Wydner RN, IBCLC, USA
Senecca Kirkhart, CPNP, IBCLC, USA
Somerset West Community Health Centre, Canada
St Georges University Foundations Trust, UK
Successful Breastfeeding LLC
Terra Nova Midwifery, Canada
Westchester Lactation Consultants
Women’s and Children’s Health Network, Australia
Your Baby Butler, USA
Zdravo Bebe-Centar za majki, Macedonia

Individuals

Khansa Abd Halim, Malaysia
Michelle Angelini, Canada
Jasna Apostolski-Nikolov IBCLC, Macedonia
Magdalena Arciszewska, Canada
Eya Belkhir, Tunisia
Andrea Blanco, USA
Kelly Bonyata
Janette Brooke, Australia
Elizabeth Brooks JD IBCLC FILCA, USA
Decalie Brown, Australia
Anna Cannon, UK
Colleen Carney, USA
Tiziana Catanzani, Italy
Rebecca Costello, IBCLC, MPH, USA
Paulina Erices, USA
Pauline Garcia, USA
April Grady, USA
Michele Griswold, USA
Margaret Haines, USA
Trish Islam, UK
Jessica Jolley, USA
Molly Jonas, USA
Nut. Karen, Mexico
Charnise Littles
Bonnie Logsdon
Suzanne Mackinnon IBCLC, Canada
Sonia Mathisson
Josefa Martinez, USA
Karen Cecilia Mejía Espinoza, Mexico
Jocelyn Milanes
Nor Kamariah Mohamad Alwi, Malaysia
Daniela Nicolin, Italy
Amanda Nutkins, UK
Aunchalee Palmquist, USA
Inge Sofia Pena, USA
Lauren Pitts, USA
Chelesa Presley, USA
Milagro Raffo, Peru
Amanda Russell, USA
Dawn Russell, USA
Leah Segura, USA
Eve Schein, USA
Kati Smith, USA
Christine Staricka, USA
Anna Summer, Australia
Lynn Tauss, USA
Cecilia Tomori, USA
Shu-Fang Wang, Taiwan
Natalie Ward, USA
Allyson Wessells, USA
Jorhdyn White
Kelly Yanuri

New York City, New York, United States currently has more COVID-19 cases than any other place in the world—and one borough, Queens, has had more deaths than any other place in New York City.

Annie Frisbie, IBCLC, has run a private practice from her home in Queens since 2011, and she has helped hundreds of families in and around her New York City borough. In 2018, she was given the United States Lactation Consultant Association for extraordinary service to the profession, and she’s the author of several books about private lactation practice. Nothing, however, could have prepared her for the challenges her practice is facing now.

In this interview, Frisbie shares her experiences living and working at the current epicenter of the pandemic.

What is life like for you right now? 

The [New York City] hospital experiencing the greatest surge is a mile and a half from my house. It’s the hospital where, if we called 911, that’s where they would take us.

We have been staying home for quite a while now. My children are two weeks into virtual schooling. They have not really left the house except for short walks, and my husband is also only leaving the house for short walks or bike rides. 

So we’ve gone from living in New York City where we have everything available 24 hours a day to having just what’s in our house, and we’re grateful for what we have. There is just a lot of uncertainty.

 What effects are you seeing for the families you work with?

New parents are under extreme stress. They have partners who’ve lost their jobs, or they’ve lost their job. None of them know whether they have a job to go back to. They are living with so much uncertainty. Can they pay their bills?

And then add to that being trapped at home all day. Some of them were planning to have family fly in when the baby was born, and their family can’t come. I spoke to one woman who said, “I am by myself for the entire day.” She’s having to do a lot of things to keep breastfeeding going, and she said, “How am I supposed to do it?”

 And there is just no answer.

It’s heartbreaking.

With over-crowded hospitals and restrictions on who can accompany people in labor, what is the situation like for families preparing to give birth?

What I am hearing is that the pregnant families are so scared.

Every day, there is a new story about what pregnant parents are going through. One of the big hospitals here just announced that they are going to be testing every parent who comes in in labor, and if you have your baby before they get the test results back, they are separating you, routinely. Some hospitals are not allowing doulas and partners. 

There are so many competing factors. We can all see that slowing down [the spread of the virus] is so important, but we also know the effects of separation on babies, and we know the risk factors for parents when their babies are separated from them and the negative effect of stress in the postpartum period. What kind of short- and long-term effects are we going to see from that?

[eds notes: some of these policies have changed in New York since the time of this interview, find details here, paywall may be in effect. Find international guidelines, which recommend keeping birthing parents and babies together – with appropriate protection – regardless of COVID-19 status here]

What conversations are you having with families to help them navigate the situation?

When I talk to them, I acknowledge that this situation is hard, and it might be really hard. But I also try to help them go in with a plan. I tell them, “The more frequently you remove milk, the more milk your body makes. If it’s rough in the hospital, just start hand expressing and give your baby your colostrum and then get home. And then we’ll talk and we’ll figure it out when you get home. Just get out of the hospital and we’ll work on the rest of it.”

I have also been recommending that people learn to do hand expression of colostrum while they’re still home, because that is a really tangible thing that families can do. They know they are going into a very potentially isolating and scary experience, but they also know, “I’m already familiar with my breasts.” If somebody says, “Your baby needs to be supplemented,” you can say, “Great, I brought it with me.” You already know what your beasts can do.

You are currently doing all your consults virtually. How did you work through the decision to suspend home visits?

 I did my last home visit a week ago. At the beginning of last week, [my plan was to continue to] do home visits on a case by case basis. I planned to screen everybody and sanitize everything.

And then, the very last one I did was a uniquely terrifying experience. Not because of what was happening inside the parents’ home, because that was lovely. There was a baby, and a new family, and all the beautiful things that mean so much to all of us that work in lactation. It was great. And I washed my hands, I sprayed down my scale.

But to get in and out, I had to go through a large, open lobby that was full of people working from home in a big apartment building. I had to get into an elevator. I had to touch buttons. As I was about to get into an elevator, somebody stepped in and said, “Here, there is room for you, too.” And I thought, “The last thing I am going to do is get into an elevator with you.”

I had my husband drop me off and pick me up, because I would have had to use valet parking. I don’t want someone else inside my car right now.

There was so much fear. What am I bringing into this family’s home? And what am I taking out, because I am passing through so many public spaces?

I had to make the decision to stop home visits. The density is such a big factor in my decision.

And I do recognize that there is a harm to that—things are going to be lost for these families because they can’t have us in their homes. I lost a lot of sleep over that decision, and I know I’m not the only one. It’s not something I came to lightly, and I am very concerned about the families that don’t have access to [in-person] care. But at the same time, it’s just very frightening here.

At this point, I think it’s very important not going to judge anyone’s choice to do home visits or not to do home visits. No one should be shaming people who are still doing home visits. We need to trust our colleagues that they are making good clinical decisions, and if they are still providing home care, we should just thank them for it. And for people who have said, “I can’t do home visits right now,” we need to thank them for recognizing their limitations and for doing their part to keep families safe. We need to make sure everyone in our community feels like we are supporting each other, because that is how we’re going to support families.

This is not something to police anybody about. Nobody knows anything right now, and we do know that babies need help. So let’s just trust that the people who are still doing home visits are not behaving cavalierly.

Many IBCLCs are working with telehealth for the first time. What have you learned about how to provide a great consult when you’re working through a video screen?

We’ve all been dropped in feet first! I did a record number of consults this week, and they were all virtual. I went in with a little fear. I was thinking, “Do I really have the skills for this? I’m not a movie director.”

[When it comes to the details of using video], there are good resources out there to help you. For example, to [help you figure out] the sort of pictures you might want to get if you are trying to assess oral anatomy. Dr. Bobby Ghaheri has a blog post that gives advice for things like where to put the camera, how to take a burst, how to take a video. I share this post with my clients.

But in a big-picture sense, I have been getting a lot of questions like, “Do you chart differently for virtual consults?” People have been telling me, “I need all new things to do virtual.”

My advice is, you don’t need all new things. You are still the same lactation consultant you were when you were sitting on your client’s couch or when they were sitting in your office. We have to remember that the basics still apply. What do we do? We ask questions. We listen. We observe. We ask more questions. We take a history. Those are still the same things you will be doing.

[As I was starting to do virtual consults], I was thinking—there are things I do with my hands and I have so much knowledge in them. And now I can’t touch anyone. So I started to ask myself, what do I usually feel for? And how can I convey that to the parent?

So that means saying to the parent, “Can you put your finger into your baby’s mouth? Here is how I would do it.” And then physically demonstrating to them what I would do. And then not saying, “Do you feel this, this, or this?” But saying instead, “What does it feel like to you?” And then really listening to what the parent is saying and using your imagination to try to feel what the parent is saying they feel. And that’s different from putting your finger in the baby’s mouth and knowing what you feel. It’s a different way of interpreting data. But you still know what you’re trying to find out. You still have all those clinical skills.

I have also been recommending that my families that are concerned about weight gain get a scale to use at home, because we really don’t want them going to the pediatrician and there are no drop-in breastfeeding groups. So ordinarily, I would say, “Wait, we’ll keep and eye on it, and I’ll come back and weigh your baby.” Now, we’re not weighing babies, but families can weigh babies.

I’ve always believed that parents truly are the expert on their own baby. I tell them, “We’re just going to keep talking. And I’m going to listen to what you’re telling me.” One wonderful thing that’s happening is that we’re showing parents their own resilience. [We’re saying], “I am not there, but you are, and there are things that you know and can do. And I can teach you and counsel you and help you step into your own authority as a parent.” We are coming back to the foundations here.

That’s beautiful, because that’s what the best consult does anyway.

Exactly. So in some ways, not being able to be the expert with the magic hands could be good. There could be benefits that come out of that. I think I will personally grow as a clinician through having to do virtual consults. I might even keep them in the mix after this is all over, because I feel like they might be really helpful for certain things. Like if I don’t really want to drive 30 minutes to do a 30-minute pumping consult and look for parking, I could definitely do that virtually.

For IBCLCs who are feeling scared about virtual consults and wondering if you have what it takes to do it, you might not know that until you just jump in and start doing it. There are great trainings out there about how to do virtual consults. It would be a good idea to seek that out, and then you’re supporting another IBCLC who has skills to share. I am a big fan of learning from others.

What are you doing to take care of yourself and get support?

As care providers, we’re all under a lot of stress, and it’s crucial that we get our own support for that. Sometimes my clients tell me they are scared of something, and I think, “I’m scared of that, too!” But I can’t bring that into our clinical relationship. But then I have to walk away and I have their problems and my problems now. With the empathy that we naturally have as lactation consultants, everything is triggering right now.

The main thing I did was immediately find a therapist. I recognized that it was a critical need, as important as food and water and shelter. I need someone I can talk to and process this with, because it’s not going to work otherwise. This is too big. It’s not like, “Oh, you’re a little stressed. Do some deep breathing and self-care. Take some time for yourself.” No. This is huge, and it’s okay to reach out for professional help. It doesn’t mean you’re weak or there is something wrong with you. It might be the most important thing you do for your clients, if not for yourself.

You’ve been reminding your clients that birthing families have always been strong.

Yes. Right now, we can just do our best with what we have, and I think we have a lot more than we realize. We as clinicians have a lot of resources, and our families have a lot.

I loved an article that came out this week in The Cut, a New York magazine, with a midwife named Robina Khalid. I have been sending it to my clients. She reminds families that there is always going to be hardship, and there has always been hardship. But there have also always been parents and babies, and at the end of the day, babies don’t know there’s hardship. They just know you. And you can do this. That is the message I want to amplify to families right now.  

Are you a skilled lactation provider serving families during the COVID-19 pandemic? ILCA wants to hear your stories. Email at media@ilca.org.

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How to Add a Profile Frame on Desktop 

1. Navigate to your profile page by clicking your name on top blue bar 
2. Hover over your profile picture 
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4. Click “Add Frame” 
5. In the search box, type “ILCA Telehealth” 
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