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2014 Legislative Session Week Three – Breastfeeding Friendly Washington

Promoting breastfeeding has been a part of the work we do at WithinReach since the beginning.
Breastmilk is a baby’s perfect first food. It has special nutrients a baby needs that are not found in formula and changes to meet the needs of a growing child, including giving your baby protection against illness and infection.  As a result, breastfed babies have fewer earaches, colds, and allergies and are less likely to experience Sudden Infant Death Syndrome. Besides the many health benefits, breastfeeding also helps build a special bond between a mother and her baby.
Most mothers know that breastfeeding is the best choice, too.  Nine out of ten babies in Washington begin life breastfeeding!
But breastfeeding isn’t easy, and unfortunately only 34% of babies are still breastfeeding at one year. New mothers are dealing with sleep deprivation, recovering from giving birth, getting into doctor’s appointments, etc.  So when a baby isn’t latching on and the mother doesn’t have support or resources to help her, changing over to formula is far too easy to do.
Through the Evidence-Based Hospital Breastfeeding Support Learning Collaborative (EBBS), WithinReach has worked with the Department of Health to identify and implement steps that hospitals can take to be more breastfeeding friendly.  We want mothers to be set up for breastfeeding success!
We were very excited to see two bills introduced into the state legislature this year that, if passed, would create a voluntary program to encourage and recognize institutions that take steps to promote breastfeeding.
The Senate version (Senate Bill 6298) would create a designation system for hospitals that take steps to promote breastfeeding.  This bill had a hearing last Monday in the Senate Health Care Committee where WithinReach Executive Director, Alison Carl-White, testified about the great work that has been done by WithinReach and our Breastfeeding Coalition of Washington.  The Senate Bill passed out of the Health Care Committee on January 30th and now sits in the Rules Committee, who will decide if the bill will be sent to the Senate floor for debate and possible vote.
The House version (House Bill 2329) would also create a designation system, but in addition to hospitals this one would also include health care providers, workplaces, and child daycare centers that take steps to promote breastfeeding.  This bill also had a hearing last week.  The hearing was in the House Health Care Committee and Alison testified again in support of the bill.  Alison’s testimony at this hearing can be watched at TVW.  We expect the House Health committee to vote on the bill within the next couple of days.
While there are some differences between the two bills, either would be a great step forward in encouraging hospitals and other institutions to provide more support and resources to help women be successful with breastfeeding. The sponsor of the Senate Bill, Senator Randi Becker, was interviewed on TVW’s The Impact about the breastfeeding friendly bill.  The piece also included some of Alison’s testimony!
The legislature is only in session for 60 days this year, so there is a short period of time to pass this important legislation.  Take a minute to contact your legislators and ask them to support House Bill 2329 and Senate Bill 6298 so we can make more places breastfeeding friendly.  If you don’t know who your legislator is, you can find that out here by putting in your information.

Tags: Breastfeeding   Breastfeeding Coalition of Washington   Evidence-Based Hospital Breastfeeding Support Learning Collaborative   

Moving Upstream. . . One Training at a Time

544 providers. More specifically: 296 nurses, 147 doctors, 24 dieticians, 19 nurse practitioners, 4 midwives, (and a partridge in a pear tree!) What do all these people have in common?

They all provide care for Washington families and they’ve all recently gone through a breastfeeding education training organized by WithinReach.

Recent studies show that provider lactation education has a statistically significant increase on breastfeeding outcomes. In other words, the more that doctors, nurses and other support staff learn about and support breastfeeding, the more likely the women in their care will meet their own breastfeeding goals, and we know that longer breastfeeding leads to better maternal child health.

Health care providers play a critical role in supporting breastfeeding women. The recently published CDC Guide to Breastfeeding Interventions affirms that “health care professionals need in-depth knowledge and skills directly related to breastfeeding and lactation management because 86% of Americans still turn to a health professional as their primary source of health information”.  Lack of adequate support is the main reason we hear about for why women discontinue breastfeeding. Here at WithinReach, we’re working to change this. One training at a time, we’re working to ensure that Washington State health care providers are equipped with the knowledge and skills to support moms and babies with breastfeeding.

In the field of public health, we often talk about ‘upstream’ and ‘downstream’ approaches to improving community health, preventing disease and eliminating disparities. Watch this quick video for a brief overview. To sum it up: “Investing upstream in prevention, rather than downstream in intervention, is often wiser and more effective, and is the essence of public health.”  Many challenges with breastfeeding could be prevented before they turn into substantial concerns. Ensuring moms are appropriately supported, from prenatal breastfeeding education to support at the hospital bedside and beyond, is a key way to do this. For another analogy about the impact of public health prevention strategies and the social determinants of health, see the fabulous Dr. Camara Jones’ well known talk about the Cliff of Good Health.

While we could choose to focus our efforts to promote breastfeeding on direct support for mothers and babies, that work is really best done by IBCLCs (Lactation Consultants), peer counselors, community programs and other perinatal support professionals. This is indeed a critical element of a broader community that supports breastfeeding. WithinReach and the Breastfeeding Coalition of Washington’s work is primarily focused on providing tools and information directly to health care providers. Moving further upstream and taking a public health approach allows us, with a relatively small amount of resources, to facilitate training for the providers that care for mothers and families and to impact organizational policies and practices. With this approach, we are able to reach tens of thousands of breastfeeding moms and babies. By working with nineteen hospitals around the state through our Evidence-Based Hospital Breastfeeding Support (EBBS) Learning Collaborative, in 2013 we have positively impacted the care received by over 40% of babies born in Washington.

With support from the Washington State Department of Health, Public Health- Seattle & King County and SeaMar Community Health Centers, and a partnership with Molly Pessl, BSN, IBCLC (owner and lactation education trainer) from Evergreen Perinatal Education, WithinReach has coordinated five trainings over the past several months that have reached well over 500 health care providers. We’re helping support breastfeeding throughout the state, one training at a time. Thank you for supporting us in this work!

Tags: Breastfeeding   Breastfeeding support   health care providers   

Community Clinics Prioritize Breastfeeding

Written by Camie Goldhammer and Rachel Schwartz

Nearly 10 months ago we began our Community Health Center Breastfeeding Promotion Project. The goal of this project is to address breastfeeding support at the primary care level. Although nine out of ten Washington babies begin life breastfeeding, we see a steady decrease in breastfeeding rates the moment mothers leave the hospital. Research shows that the support of the primary care provider is an essential part of a mother reaching her breastfeeding goals. During this project, clinics have been provided technical assistance from WithinReach as well as monetary funds from the Department of Health to help implement programmatic changes. A comprehensive evaluation of this project has been conducted by the UW Center for Public Health Nutrition’s Erica Lamson (Skagit Breastfeeding Coalition member!).

Some highlights from our eight clinics were:

  • Six of the eight clinics now have Infant Feeding Policies stating that breastfeeding is the preferred method of feeding infants.
  • Nearly 80 clinic employees received 8 hours of clinical lactation education hosted by WithinReach and taught by Evergreen Perinatal Education, while several more staff attended the Simkin Center’s 45 hour Foundations for Best Practice in Lactation Care and are not Certified Lactation Eductors.
  • Seven clinics are now formula free.
  • Seven clinics have designated space for both patients and employees who need to express their milk or nurse their babies in private (if they prefer).
  • All of the clinics have prioritized prenatal one-on-one breastfeeding education with patients.
  • Half of our clinics have begun or are planning on offering breastfeeding classes for prenatal patients.
  • Six clinics have adopted policies to ensure that all babies are seen in the clinic within 5-7 days post birth.
  • All clinics have begun tracking or are in the process of tracking breastfeeding rates.

As this project comes to a close we want to give a huge congratulations to the Roger Saux Health Center (Quinault Tribe), SeaMar Community Health Center-South Park, Port Gamble S’Klallam Health Clinic (Port Gamble S’Klallam Tribe), North Bend Family Clinic/Tolt Community Clinic (Snoqualmie Tribe), Community Health Centers of Central Washington-Ellensburg, Tri-Cities Community Health Center-Pasco, Yakima Valley Farm Workers Clinic and the David C. Wynecoop Memorial Clinic (Spokane Tribe) for all your great work. The work accomplished by these clinics has been inspiring and the mothers and babies of Washington State will benefit for years to come!

We also want to thank these clinics for helping us pilot test the materials for the Washington Steps Up for Breastfeeding Success initiative. Once finalized, the clinic self-assessment, resource toolkit and provider reference card will be available to all clinics and providers in Washington State so they too can step up in support of breastfeeding.

Tags: Breastfeeding   Community Health Center   Lactation education   Washington Department of Health   

Washington Steps Up to Support Breastfeeding Moms

We recently hosted a visit with two Centers for Disease Control (CDC) staff members – Rosanne Farris and Carol McGowan, who oversee a CDC breastfeeding grant WithinReach was awarded.  It was a great opportunity to talk about the work we are facilitating around the state to create breastfeeding supportive communities.
Parenting is hard.  Right from the start parents are faced with choices at every turn.  Hospital or birthing center? Obstetrician or midwife? Breastmilk or Formula?  Home-based , center-based, or family and friend childcare?  For most, these questions aren’t simple either -or-decisions.  They are complicated and nuanced; based on one’s life experience, culture, capacity, resources and current situation.  Unfortunately, in our quest to provide the best for our children, these decisions often get framed as “right” or “wrong” choices.   And with this perspective, we can be quick to judge ourselves, and each other.
Years ago, in my first days at WithinReach (then Healthy Mothers, Healthy Babies), we hosted a Seattle visit by T. Berry Brazelton, Professor Emeritus at Harvard Medical School and his Touchpoints team.  I will never forget the response one of his staff gave during a lunch panel at the event,  in response to two attendees who had both posed questions related to the type of childcare they had chosen for their children (In my mind, both hoping for confirmation that they had made the “right” choice).
She quickly defused the tension in the room by commending both parents for caring so deeply about their children’s health and development. She went on to say that she felt we could do so much more for kids and parents if we focused our energy on supporting one another, as opposed to judging each other in an attempt to confirm the value of our own decisions.
Even though it was basically a reminder that there is more than one road to healthy child development, it brought huge relief to me as a new, uncertain mom, who was constantly worried about making the “right” choices for her baby.   Clearly, even though there are many paths to health and wellness for kids, all roads are not equal.  We do know what fosters good health and development for babies and children.
Breastfeeding, in fact, is one of the things we know a great deal about.  The evidence is clear, moms and babies receive huge benefits from breastfeeding and the benefits are life-long.  Making the decision to breastfeed is not a one-time decision.  It occurs over and over in different venues as parents navigate the early days of childhood.
First, at the hospital, where a new Mom may be supported to initiate breastfeeding, or she may be given formula and the subtle message that it may be easier for her to use.  Next, during early visits to a new baby’s primary care provider, where the care and support a Mom receives will either encourage or discourage her decision to breastfeed exclusively for the recommended 6 months.  We also know that most moms return to work at some point, many early in their baby’s life.  Will a mom’s employer support her decision to continue breastfeeding by providing a comfortable place to pump breastmilk and a culture supportive of doing so?  Further, can a working mom find a quality childcare facility that supports her decision to breastfeed by willingly storing and providing her baby the breastmilk she has worked so hard to provide?
At every turn, a moms decision to breastfeed is made easier or harder depending on the support she does or does not receive.  That’s what our work on the new Washington Steps Up for Breastfeeding Success initiative is all about. Over the next 3 years, by working with hospitals, health clinics, employers and childcare facilities, our goal is to help 10 communities become fully supportive of breastfeeding.  Through the Washington Steps Up 5-star quality rating system, families will quickly and reliably be able to identify places that will support their decision to breastfeed. Watch for announcements about the launch of the Washington Steps Up website in late 2013.
In partnership with the Department of Health, this work will make the connections thousands of moms and babies need to be healthy.  But even more importantly, it will offer on-going support, as families navigate the never ending storm of parenting decisions that face them!

Tags: Breastfeeding   Breastfeeding support   Washington Department of Health   Washington Steps Up   

I Want You to Support Breastfeeding

Yup, that’s right. You. I want you to support breastfeeding.
Over the years, as a breastfeeding educator, lactation consultant, and chair of the Native American Breastfeeding Coalition of Washington, I have done community breastfeeding outreach at events all over the state. At many of these events, I have breastfeeding promotional materials and a comfy chair for mothers to nurse their babies in. Usually, I have a many mothers stop by and tell me that they “are happy to see me,” several elders give me a thumbs up and shout out that they breastfed all four of their children, and many others just walk by without looking up.
But an overwhelming majority of people don’t fit in any of those categories. Most people (men and women) walk by, look at my sign and throw up their arms as if I just threw a punch, take a step back and say “Whew, I nursed my two. I’m done with that” or “Ew, that’s not my thing” or “Yeah, I don’t need to worry about that.”
Studies and surveys have shown that time and time again  the number one reason mothers stop breastfeeding before they wanted to (60% of women do not reach their personal goal) is a lack of support. Everyday, those of us in the lactation field hear stories of mothers being asked to cover up or move by restaurant managers, mothers getting disapproving looks at the local park and mothers having to choose between keeping their job or providing breastmilk for their babies. The fact is that a majority of people do not support breastfeeding because, just like the people that I meet at every event, they don’t think they need to. Most people think that because they are not a breastfeeding mother, that breastfeeding is not their responsibility. And, that is a problem.
Breastfeeding is important and it does affect you. Did you know:
  • If your daughter does not breastfeed your grandbaby, her risk of breast and ovarian cancer goes up.
  • If your employee does not breastfeed her child, she will take more time off taking care of a sick child.
  • If your sister does not breastfeed, your niece or nephew will have a higher chance for diabetes and respiratory infections.
  • If your baby is not exclusively breastfed, his or her risk of dying from SIDS goes up 73%.
  • If your neighbor does not breastfeed, her risk of post-partum depression goes up.
  • And did you know that if 80% of mothers breastfed for just 6 months that the US would save $13 billion dollars and nearly 1000 lives?

Breastfeeding is your business. It is our responsibility. It is your role as a grandmother, uncle, friend, boss, neighbor and citizen to support the breastfeeding mother in your life. That mother is doing something profound for her child and, in turn, your community. Let’s make sure she knows she’s supported. Visit our breastfeeding section for more information and resources to help provide moms and babies with the best breastfeeding support possible.

Breastfeeding Support: Close to Mothers

Babies were born to breastfeed. We say it all the time, yet there are a lot of factors in our society that impede a baby’s access to her mother’s breast (and all the good that comes with that). If you look at breastfeeding rates 60 years ago, you’d be amazed to see how uncommon breastfeeding was.  With the rise of manufactured infant formula and several other factors, by around 1970, just 25% of babies were ever breastfed (p. 17) and only about 5% of babies were breastfeeding at 6 months.  Today in Washington State, 9 out of 10 babies begin life breastfeeding. We’ve certainly come a long way! Mothers, health care providers, employers, the public health system and the larger community have rallied to make breastfeeding the norm in our state- at least as far as initiation is concerned. A key component of this breastfeeding support network is peer counselors, also known as mom-to-mom supporters.
August 1-7 is World Breastfeeding Week (WBW), where over 170 countries come together to jointly acknowledge and celebrate the role and importance of breastfeeding in humanity. Indeed, we often forget that for the vast majority of human existence, all babies from all cultures were exclusively breastfed.
This year’s World Breastfeeding Week  theme, ‘Breastfeeding Support: Close To Mothers’, highlights Breastfeeding Peer Counseling. Even when mothers get off to a good start, all too often in the weeks or months after delivery there is a sharp decline in breastfeeding rates, particularly exclusive breastfeeding. The period when mothers do not visit a healthcare facility is the time when a community support system for mothers is essential. Continued support to sustain breastfeeding can be provided in a variety of ways. Traditionally, support is provided by the family. As societies change, however, in particular with urbanization and geographic distancing between family members, support for mothers from a wider circle is needed, whether it is provided by trained health workers, lactation consultants, community leaders, partners or from friends who are also mothers. WA State is lucky to have a strong WIC peer counseling program. These mothers, and the WIC staff behind them, work tirelessly to support women in their community, so moms can meet their own breastfeeding goals… and it’s making a difference in the lives of families.
From naval bases, to community picnics and walks, to Big Latch On events, to the Tribal Canoe Journey, Washington is turning out this week to celebrate breastfeeding. For a list of events led by breastfeeding coalitions across the state, visit the WithinReach website.  To learn more about this year’s WBW theme, visit
World Breastfeeding Week signals to me a yearly chance for us to come together. Celebrations of motherhood and of community are what this week is all about- the relationships we have and how we support each other. It sounds cliché, but together we have truly turned the tide… from 25% to 90%. How awesome is that?!

Tags: breastfeeding peer counseling   WIC   world breastfeeding week. breastfeeding support   

From inquiry to impact to action: The Inequity in Breastfeeding Support Summit

Inquiry: What is inequity in breastfeeding support and why does it matter?

Breastfeeding is a cornerstone of public health. Mothers know breastfeeding is important, yet the care and support provided to all women is not the same (like educational opportunities or job access), setting some mothers up for success and creating barriers for others. In short, white women tend to experience a more supportive mainstream healthcare system, with greater breastfeeding resources made available to them, than women of color. This inequity in support leads to long-term disparities in care and health. Breastfeeding significantly predicts health outcomes for mothers and babies for things like Sudden Infant Death Syndrome, breast and ovarian cancer, diabetes, asthma and more- all things experienced disproportionately by people of color. This is a huge gap in care, and entities ranging from community grassroots organizations up to the Surgeon General are increasingly acknowledging and working to address this.

While disparities in breastfeeding rates are often cited by medical organizations and in the media, rarely do we discuss the root causes of these differential health outcomes born by women and their families. Dr. James Collins and colleagues have shown the impact of racism on maternal child health outcomes, specifically low-birth weight and pre-term babies in the African American community. Institutional racism and white privilege impact the breastfeeding care that women and their babies receive as well. Institutional racism is a term first coined by Stokely Carmichael to refer to the “collective failure of an organization or system to provide an appropriate and professional service to people because of their color, culture, or ethnic origin.” Solid Ground, one of WithinReach’s community partners, defines institutional racism as:

The systematic distribution of resources, power and opportunity in our
society to the benefit of people who are white and the exclusion of people
of color. Present-day racism was built on a long history of racially distributed
resources and ideas that shape our view of ourselves and others. It is a
hierarchical system that comes with a broad range of policies and institutions
that keep it in place.

White privilege refers to the [perhaps unspoken or unacknowledged] privileges that white people have in a racist society that affords more value to white people than people of color- it is the flip side of racism. While we often hear about ‘underserved’, ‘underprivileged’ or ‘disadvantaged’ communities, the flipside is rarely acknowledged: that other communities (namely white, middle and upper class) are over-served, over-privileged and over-advantaged.

Impact: The 2013 Inequity in Breastfeeding Support Summit

In 2012, community breastfeeding activists, including representatives from the Native American Breastfeeding Coalition of Washington, Mahogany Moms Breastfeeding Coalition and WithinReach’s Breastfeeding Coalition of Washington, got together in an effort to address the institutional barriers faced by women of color seeking breastfeeding support. Out of these conversations, the Inequity in Breastfeeding Support Summit was born. The purpose of this Summit was threefold: to collaborate, educate and act together as a community of breastfeeding supporters to counter institutional racism in support services for new families, that are significantly centered on the needs and experiences of white women. Our long-term aims as a result of this Summit are to increase the cultural competence of breastfeeding supporters, increase the proportion of breastfeeding counselors who are women of color, and increase the organizations that provide culturally relevant breastfeeding support to women of color.

Cynthia Good-Mojab, a Summit planning committee member and speaker, acknowledged that “this Summit has been a yearlong, collaborative labor of love. We stand on the shoulders of giants. Long before and concurrent with our efforts to create this Summit, others have made far more significant contributions to the ongoing movement to dismantle racism and other forms of oppression.”

On June 21-22, over 200 people came together from across Washington State and the country- mothers and babies, community members, breastfeeding peer counselors, public health professionals, health care providers and more. The day started out with a blessing from Emma Medicine White Crow honoring the Duwamish people for their land that the city of Seattle and the Summit were held on. Day one was focused on what systemic racism looks like and how it impacts families. Leaders in maternal child health such as Dr. Maxine Hayes, Kathi Barber and Sheila Capestany, laid the historical groundwork for disparities in breastfeeding rates and the access to breastfeeding support that mothers have. Kathi Barber led us through a history of the African American experience starting with women’s treatment during slavery, how many women were removed from their children and unable to nurse them and bringing us to present day, showing how this collective history has contributed to where our society is today with regard to breastfeeding.

Day two was focused on solutions that prioritize supporting moms and babies of color. Six breakout sessions focused on topics ranging from grassroots community breastfeeding support programs to heterosexist language in breastfeeding support to the role of social media in creating ally communities. A three-hour action planning session got participants discussing solutions and the role they can play in ensuring all mothers and babies are receiving quality care. The end result: the synopsis of dozens and dozens of voices answering one question: What key actions can we take to advance racial equity in breastfeeding support at the individual, family, community and societal level? The two days ended with each participant, speaker and planning committee member saying just one word about how they were feeling or what they were left with. Comments ranged from uplifted, humbled and doubtful to motivated, skeptical and inspired. The Summit likely didn’t meet the needs of all participants, but it did build upon the groundswell of work happening around the country to name and address institutional factors that create unequal care for mothers and children. To read one student midwife’s reflection of her experience at the Summit, visit Robin Gray-Reed’s post from her blog The Mindful [Student] Midwife.

Action: Next steps in moving forward

This Summer, WithinReach intern Rebecca Allen and the Summit planning committee will drive the development of a Community Action Report. We hope this document will serve as a blueprint of steps to take for all communities interested to work in achieving equity in breastfeeding support and maternal child health outcomes. To learn more or get involved visit the Inequity in Breastfeeding Support Summit Facebook page.

Tags: Camie Goldhammer   equity in breastfeeding   institutionalized racism   maternal and child health   Rachel Schwartz   racism   white privilege   

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