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Helping Families in Alaska Access Virtual Breastfeeding Support

By lactationmatters on 28 May 2013 in IBCLCs around the globe, Mother to Mother Support, WIC

By Jessica Harper, IBCLC

Photo by jeff.snodgrass via Flickr

In this day and age, Google can be a new mother’s best friend. It can also be their worst enemy.

I’m an IBCLC in Fairbanks Alaska and I run a successful virtual breastfeeding support group (through Facebook) for our local WIC clinic. The group started about a year ago and now has over 300 mothers. It’s a great alternative to Google as it’s filled with real live mothers at various stages in lactation, all of whom have encountered their own challenges.

Mothers participate in our closed group multiple times per day and throughout what can be the lonely midnight and morning hours. Here in the interior of Alaska, winter time temperatures can often dip to -50 below zero. Who wants to take their newborn out in that? The group provides a way for mothers to get critical breastfeeding support from their own homes. This is especially important for those who may have transportation issues. Some mothers hide behind our online Facebook group, never attending an in person breastfeeding support meeting. However for others, the group helps them feel connected and actually encourages them to venture out and meet these moms that they interact with daily. This provides for in-person peer support and often helps encourage relationships.

Subjects range widely. Is my baby getting enough to eat? My baby is biting me, what can I do? Can I use birth control? I need help with breastfeeding, who can I call? Mothers supporting mothers is what keeps the group going. They are able to link one another to online articles, to share information and even videos.

Our WIC clinic has 4 breastfeeding peer counselors that help monitor the group and ensure accurate evidence based information is being provided. One of our peer counselors took a video of her nursing in public in a baby carrier and shared it in our group for all to see. Nursing in public can be intimidating for some, and being able to share that fear with others and explore options for conquering that fear can be helpful. It’s awesome to read when a mom posts about how she nursed in public for the first time that day and just wanted to share with us.

Fairbanks is a big military town. The moms here often have no family living nearby and when they have visitors, or they go home to visit, they can experience anxiety with breastfeeding and what their family is going to think. With smart phones on the rise, the group is available at the touch of a finger. The online group provides a constant source of stable support. A core of other mothers facing similar situations. When partners deploy or spend 12-14 hours a day in the field the mothers have each other.

This group has by far exceeded my expectations. Often, we get moms in the clinic who decline our breastfeeding services but later request to join our Facebook group. While some may not want the phone calls that our breastfeeding peer counselors provide or an in office consultation with me, they are still receiving support.

Since starting this online group our breastfeeding rates have increased! More moms are reaching out, feeling comfortable and getting the support they need. We have flyers posted all over our town promoting our group. While our group is mainly composed of WIC mothers, it is not limited. I feel having a wide range of mothers truly helps the support dynamic amidst the array of challenges a nursing mother can face. It has been rewarding running this group and I look forward to seeing it and others like it grow!

The kind of support that we provide online isn’t unique to Alaska. Just a few weeks ago, Lara Audelo released a book called The Virtual Breastfeeding Culture: Seeking Mother-to-Mother Support in the Digital Age. In it, she shares stories from more than 30 mothers who have found what they needed to be successful at breastfeeding online. As more and more mothers are seeking information and support on the internet, I encourage more of you to explore whether an online support group is what the women in your community seek.

Jessica Harper currently works for WIC as an IBCLC. She is a LLL Leader & mother to 3 in Fairbanks, Alaska. After experiencing her own breastfeeding challenges, she became a strong advocate in her community. When she’s not supporting breastfeeding mothers, she enjoys gardening, sewing and running.

A Day in the Life of Breastfeeding Support and Promotion in Public Health

By lactationmatters on 1 November 2012 in Breastfeeding, Breastfeeding Advocacy, Public Health, WIC

By Lisa Akers, MS, RD, IBCLC, RLC

I have worked in public health for over a decade and it never ceases to amaze me the number of people who truly do not understand public health or the work that public health officials seek to accomplish. Public health by nature is preventative medicine. Public Health can better be described as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” (1920, C.E.A. Winslow). According the World Health Organization, public health is “an organized effort by society, primarily through its public institutions, to improve, promote, protect and restore the health of the population through collective action.” Public health seeks to prevent disease and is not in the business, necessarily, of treating disease. Breastfeeding, by nature, is disease prevention and by this fact alone, is positioned high on the national public health agenda.

It is important to understand these facts before understanding my role in breastfeeding promotion and support in public health. I am, in fact, the State Breastfeeding Coordinator for the Commonwealth of Virginia. My job is to manage breastfeeding support and promotion endeavors for the state. My responsibilities vary from day-to-day, but they typically includes such things as the development of public policy, media campaigns, curricula, publications and training; oversight of the Virginia WIC Breastfeeding and WIC Breastfeeding Peer Counselor Program; collaboration with numerous non-profit and academic entities, and service as the Virginia Department of Health liaison to the Virginia Breastfeeding Advisory Committee. This is by no means a comprehensive list, but simply a taste of the many things that I do from day-to-day.

Our emphasis in public health is on educating the practitioner as well as educating the general public in the support and promotion of breastfeeding. Since this article seeks to give readers an idea of what a typical day looks like in the field of public health, let me first start by painting a vivid picture for you.

You are a new breastfeeding mother, who has just given birth two weeks ago to a baby girl. You are a single mother, who receives no financial support from family or friends. You are concerned about making ends meet and providing for your daughter, so you plan to return to work within the next week. You currently work two part-time jobs at a retail establishment and a local restaurant. You make too much money to qualify for federal aid or entitlement programs, but luckily do quality financially to receive WIC benefits. Your biggest concern at the moment is continuing to breastfeed while returning to work and also being able to afford quality childcare that is supportive of breastfeeding for your daughter.

This is a typical scenario that is seen day-in and day-out both internationally and nationally. From the time that I start work every day, this is the scenario that continually plays in my mind. On a typical day, I am managing several million dollar budgets to ensure that this breastfeeding dyad is both supported and protected. These budgets help to run the breastfeeding support endeavors for the WIC program (including the WIC Breastfeeding Peer Counselor Program), support statewide policy initiatives related to breastfeeding, provide training opportunities and curricula to both clinicians and childcare providers, provide technical assistance to businesses and employers seeking to better understand and comply with the Patient Protection and Affordable Care Act, and provide training opportunities to public health personnel seeking to improve their knowledge of lactation management. On any given day, I handle correspondence from constituents, WIC participants, employers, childcare providers, clinicians, colleagues, and many others. A day in the life of public health breastfeeding support and promotion is ever-changing and never dull!

Public health gives me the autonomy and utilizes my creativity in many ways. One such way is in the development of numerous educational initiatives for clinicians and public health personnel. Most recently, this came to fruition in the development of two web-based educational opportunities for clinicians. The first is a web-based learning initiative, www.BreastfeedingTraining.org, which seeks to expand clinician’s knowledge of lactation management. The second web-based performance improvement initiative, www.BreastfeedingPI.org, seeks to improve the individual practice of clinicians. Both offer continuing education units and were developed in collaboration between the public and private sector in an effort to increase the knowledge base of healthcare professionals. Yet another avenue of education was in the development of an internship opportunity for WIC personnel. Most recently, we created an IBCLC internship for WIC personnel seeking to become IBCLCs with the ultimate goal of having at least one IBCLC in each WIC clinic site. This, not only, will help support the new breastfeeding mother in the above mentioned scenario, but will also aid in increasing the morale of WIC staff and WIC breastfeeding peer counselors, who seek job advancement and satisfaction.

Whether it be through education, policy, financial management of programs, or other avenues, my satisfaction in working to support and promote breastfeeding in public health comes from seeing the mother pictured in the scenario above reach her full potential.

Lisa Akers is a Registered Dietitian (RD) and an International Board Certified Lactation Consultant (IBCLC). She completed her Bachelor and Master of Science Degrees in Clinical Dietetics from James Madison University. Lisa has been working in the field of public health and human lactation for over 12 years. Her current position as the State Breastfeeding Coordinator. In addition, Lisa serves as the List Serve Coordinator for the Women’s Health Dietetic Practice Group (DPG) and is the Academy of Nutrition and Dietetics’ delegate to the United States Breastfeeding Committee. She also served as an Expert Workgroup member for the Academy’s Evidence Analysis Library, as a reviewer for the Academy’s most current position paper on the Promotion and Support of Breastfeeding, and as a reviewer for the reproductive section of the Nutrition Care Manual. Lisa is also the current 2012 World Breastfeeding Week Coordinator for the International Lactation Consultant Association.

In her spare time, Lisa enjoys sewing, quilting, and taking long motorcycle rides with her
husband in the Blue Ridge Mountains of Virginia where she currently resides.

World Breastfeeding Week: Supporting Hmong Women in Sacramento, CA

By lactationmatters on 4 August 2012 in Clinician in the Trenches, Hmong Culture, WIC, World Breastfeeding Week

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

At Lactation Matters, celebrating World Breastfeeding Week means not only highlighting breastfeeding in the many countries on earth, but also in the individual cultures in each country. One size does not fit all! Today, we share an interview with Yang Her, an IBCLC working with the Community Resource Project WIC program in Sacramento, CA. She has worked tirelessly for many years to encourage and support the Hmong mothers in the community to breastfeed.

Photo by United Nations Photo via Flickr Creative Commons

The Hmong people are a group of Asian people, originally from mountainous regions of China, Vietnam, Laos, and Thailand. Many came to the United States as refugees following the communist takeover of Laos, settling primarily in Wisconsin, Minnesota and California with Sacramento being home to one of the largest populations. Breastfeeding support that focuses on the unique cultural needs of a mother is always important.

How did you come to be an IBCLC? What personal and/or professional experiences led you down the path?

I had my first child, Leo, in June 1989 and was not able to breastfeed him because I didn’t have any breastfeeding education. While I was pregnant with him, there were a number of controversial of breast cancer commercials on television. 3 days after our birth, I woke up with body aches, as well as very painful and lumpy breasts. All I could remember was what I had watched on TV and wondered if I was at risk for breast cancer! I was scared and called my doctor right away. When I got to the doctor’s office that morning, he said not to worry and explained a bit about engorgement. He gave me a tiny white pill (I had no clue what it was called) and told me to give Leo formula. That same day and through the night, the pain in my breasts went away slowly. By day 4, I resumed breastfeeding but Leo was fussy and pulled away from my breasts. By day 5, my breasts are soft and from that day on, my milk dried up. Leo was on formula and he didn’t tolerate it well. He would vomit with one formula or gets diarrhea or constipation with the other. I also had to return to work after 6 weeks but had to quit shortly after my return because my son was sick so often. When I was pregnant with my 2^nd child, Allen, I was determined to breastfeed and learned as much as I can about breastfeeding. I breastfed Allen for 3 1/2yrs and loved the experience and went on breastfeeding my 3^rd and 4^th child.

Several years later, in 994, I was a WIC participant and was recruited as a Hmong breastfeeding peer counselor. I worked in that capacity for a year and learned that I was not the only mother that didn’t know much about breastfeeding. My passion to advocate, educate, promote, and support breastfeeding mothers grew. I continued working with WIC as a nutrition counselor as well as a breastfeeding educator. It was so rewarding that I went on to pursue my CLE in 1999 and became an IBCLC in 2005.

What are the cultural norms of breastfeeding in the Hmong culture? What specific challenges are there in working with this population of mothers and babies?

Photo by nikkodem via Flickr Creative Commons

Back in our homeland, almost every Hmong mother breastfeds. The child and mother hardly separates from each other and if they do, the time is brief and the baby is fully fed before the mom goes anywhere. Mothers always carry their babies either on her chest or her back with a baby carrier. Whenever the baby shows hunger cues, the mother would remove the baby from the carrier and breastfed, and then once the baby is content, she carries the baby again. This is how she continues to do her daily tasks whether it’s cooking, sewing, cleaning, or farming. Hmong mothers are very creative in caring for their infants while maintaining their roles as a wife, mother, and daughter in-law. A mother can wear 20 different hats and would still be able to breastfeed her infant. There was no such thing as pumping and storing for separation periods.

Here in the USA, their roles may still be the same, however, breastfeeding their infants on demand has shifted by the fact that they are not always with their infants. There are a number of strict cultural beliefs about pumping and milk storage that effect the ease with which breastfeeding can continue in these circumstances such as:

Food and breastmilk cannot be stored in one place. This means, a breastfeeding mother who works or in school will need to buy a new refrigerator or freezer just to store her pumped breastmilk.

Breastmilk cannot be leaked anywhere. Culturally, there is a significant risk if anyone other than her infant accidently ingests or touches her breastmilk. The in-laws may discourage a mother from breastfeeding by telling her that if she breastfeeds, she would need to stay home because they will not take the risk of touching her pumped breastmilk.

What I have witnessed is Hmong mothers who are married to Hmong men are more likely to not breastfeed. On the flip side, Hmong mothers who are married outside of the race are more likely to breastfeed. When I asked for their reasons, almost always, it’s the Hmong belief that prevents the mothers from breastfeeding. The cultural beliefs is often not discussed with the mother until she decides to breastfeed. I look forward to sharing more about these beliefs in my upcoming book.

Can a Hmong LC like me make a difference providing breastfeeding education? It is possible if I can find a solution to the Hmong belief and restriction of human milk. I know I have a long way to go but I also believe that where there’s a well, there’s a way. It’s a matter of time.

What is one of your most rewarding experiences as a breastfeeding professional?

One of my most rewarding moments is when a breastfeeding mother comes to her appointment feeling discouraged, sad, and in pain and walks out of my office at the end of a consult feeling confident, understood, and knows that she’s not alone in her journey to successfully breastfeeding.

Thank you, Yang Her, for the work you are doing among Hmong women!

Using Text Messaging to Support Breastfeeding in WIC

By lactationmatters on 3 April 2012 in Breastfeeding News

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer

Recently, we talked to a private practice IBCLC and several of her clients about using mobile* phone based text messaging to support breastfeeding. We’re continuing the exploration of this innovative topic by talking to IBCLCs within the Women, Infants and Children (WIC) program about how they use text messaging to help low-income mothers succeed with breastfeeding. (NOTE: WIC provides nutritional support to over 50% of infants born each year in theUnited States which means that this federally funded program has a unique opportunity to play a significant role in promoting and supporting breastfeeding.)

The American Red Cross WIC office inSan Diego,California and the Shasta County WIC office in Redding,California both recently began using text messaging within their Breastfeeding Peer Counselor (PC) programs. Jennifer Nolan, Peer Counselor Supervisor and IBCLC (American Red Cross), and Sara Stone, Lead Peer Counselor and IBCLC (ShastaCounty), shared their stories with us…

Getting Started

Shasta County WIC PCs

Both WIC offices received federal grant funding which they used to purchase mobile phones for their Peer counselors (PCs). American Red Cross has 3 people on the peer counseling team and Shasta County has 8. When a new mother enrolls in the peer counselor service, each office asks the mother about her communication preferences and no one ever initiates text messaging without first receiving the mother’s approval (depending on an individual’s phone plan, they could potentially incur additional expenses for receiving unwanted text messages).

ShastaCounty also had to request a modification to the contacts database so that “text messaging” was an option for tracking contacts. (Note: they only count the text message as a contact if they get a reply from the mother; unreturned texts are not counted.) Once the database modifications were made, they became available to other California WIC agencies as well, allowing them to track text messaging use.

A lesson learned in Shasta County was the importance of having an effective phone for text messaging. Initially they got very basic phones for their PCs, but soon upgraded to phones with full keyboards so that the PCs could be efficient in sending texts.

How Text Messaging Is Used

Both Jennifer and Sara stressed that text messaging is never a starting point for building a relationship with a client, but instead a complementary communication method they use after first establishing face-to-face or phone contact. “We get better participation in our program by using a communication mode that is most comfortable for mothers,” says Jennifer. Sara echoed this sentiment, describing text messaging as a cultural shift that allows WIC PCs to stay better connected with their clients. Examples of the types of messages exchanged between PC and mother include:

Prenatal contacts that involve inviting the mother to classes or scheduling/confirming appointments
Sharing tips about baby’s development and checking in during pregnancy to help build rapport
Receiving texts from mother while she is in the hospital to learn about baby’s arrival
Asking and answering simple breastfeeding questions or scheduling calls to follow-up on more complicated breastfeeding issues
Checking in on postpartum status and sending encourage messages

Why Use Text Messaging?

San Diego WIC office

Text messaging is portable (mobile phones are typically with mothers at home, at work, and in the hospital) and also non-invasive (won’t wake a sleeping baby or interrupt someone during an important meeting at work). One WIC mother, upon receiving a call from her PC, whispered into the phone, “I’m at work, can you please text me?”

Jennifer says that the majority of their clients use text messaging, and she thinks it has the potential to prolong breastfeeding because it keeps mothers engaged and gets them the information they need (a critical mass of WIC data should allow future analysis of this). ForShastaCounty, “It’s taken off like wildfire,” says Sara. Text messaging has grown from 7% of their non face-to-face contacts (phone, email or text) in July 2011, to almost 25% as of February 2012. Sara’s words of advice to other WIC agencies – “Just jump in and do it!”

Are you using text messaging or alternative technologies in creative ways to promote and support breastfeeding within WIC or other settings (e.g. third-world countries)? If so, we’d love to hear your story!

* Other terms used around the world including cell phone, cellular phone, and hand phone.

By Maryanne Perrin

MBA, Graduate student in Nutrition Science, and ILCA volunteer

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