From the WBWC Blog:

Breastfeeding / MILC Moment

WBWC Welcomes New Director of Lactation, Jacquana Smith

WBWC is happy to announce Jacquana Smith as its new Director of Lactation. Jacquana brings both her knowledge (degrees in psychology and public health) and her “latched-on personal experience” to Chapel Hill. A 29-year-old mother of four children — ages 7, 5, 3, 1 — Jacquana has been nursing babies nonstop since her first child was born. “I have literally been lactating since May 2012,” Jacquana said. “I hit seven years nursing this month!” Born in New York City, and raised in a small town in Ohio. Jacquana’s focus on families grew while earning her B.A. degree in psychology at the University of Cincinnati and continued while obtaining a master’s degree in public health. Jacquana’s passion is deeply rooted in research, education, and planning. An International Board Certified Lactation Consultant (IBCLC), she is passionate about lactation and the need for equality and dismantling systemic issues that prevent babies from access to human milk. She has a passion for fighting for inclusion of all families and dedication to infant feeding and birth justice. Jacquana serves as the Conference Program Coordinator 2020 for the International Lactation Consultant Association (ILCA). She has served as a La Leche League leader on the USA council, and Director of La Leche League USA Breastfeeding Helpline. Jacquana and her husband, Myrell, met at the sweet age of 16 and enjoy exploring museums, homeschooling, and trying new foods with their four kids, Malia, Olivia, Laila, and Mattias. Jacquana sees not just WBWC patients, but can see any mom in the community who needs help with breastfeeding support through WBWC’s Mother Infant Lactation Center (MILC). Jacquana is very interested in community building, bridging the gap in outcomes and making sure all families have the support they need to meet their own breastfeeding goals via an evidence-based care approach. Jacquana is also teaching community educational classes including “Breastfeeding Basics” and “Express Yourself”, a class on pumping and returning to work. She will also be training IBCLC students going through the Mary Rose Tully Training Initiative at UNC. She wants to increase support and education of those in marginalized and underserved communities, when it comes to human milk feeding. “My aim is to support the bigger initiative to dismantle inequalities and reproductive oppression, so that families can feel empowered to make healthy decisions for themselves and their children.” Jacquana’s public health studies included a focus in maternal and child health. She … Read More

Fond Farewell to Rebecca Costello

By Rebecca Costello, IBCLC, MPH As many of you already know, I am leaving WBWC in mid-May. I’m both so sad to leave such a special place, but also happy to moving closer to family in upstate New York. When I started at WBWC, I had been a lactation consultant for several years already, but all of that experience was in a hospital setting. I felt confident about supporting families days 0-4 after birth, but what about day 5, or day 365, or day 723? I had so much to learn when I started working here, and every single family I have worked with has taught me something. So while patients often thank me for help, really it should be turned around. So THANK YOU to the families who have been so generous in sharing their lives and their struggles, and putting their trust in us here.  I am proud that our lactation team has not only provided excellent care to our patients, but also participates in lactation advocacy, research, and leadership. We have grown so much in the past five and a half years. I am thrilled about my successor, Jacquana Smith – she is bringing so much passion and energy to this role, and I know she is going to do great things here and that you will love getting to know her.  My colleagues here at WBWC – LCs, midwives, nurses, lab, front desk, boutique, everyone! – have also taught me volumes, and have also been the most supportive and dedicated and funny group of co-workers I could imagine. I wish I could take WBWC with me when I move, and a piece of my heart will always be here!  

It’s Not Always Easy…

By Ashley Gatling “It’s easy,” they say….”it’s natural,” they say…”you have big breasts, that’ll make everything so much better!”  From the moment I found out I was pregnant, I knew I was going to breastfeed.  I imagined giving birth, my baby laying on my stomach and crawling towards my breast, latching like a champ and just thriving for the next 24 months with no issues! Then reality hit. Thanksgiving Day 2017, we welcomed Ashton Luke into the world. It was the most amazing labor: peaceful and quick, totally unlike what is said to be the “normal” labor for first time moms. But what came after labor, that was the true beast.  I hemorrhaged pretty badly, causing me to lose 1.5 liters of blood, which resulted in me needing lots of fluids. The fluids caused me to swell, which made latching extremely difficult for baby boy, but he did it!  We left WBWC with him latching pretty well!  Day two, I’m thinking we are going strong. He hadn’t lost too much weight at our home visit.  He had been sleeping pretty well. I figured it was safe to say that I was killing it at this mom thing…. Until Day 5. I knew that everyone said all we needed to do was Sleep, Pee, Eat, Nurse and Drink, but that was LITERALLY ALL I did!  HE NEVER STOPPED NURSING, and if he wasn’t nursing he was screaming! It was torture, but I thought it was normal, babies cry, this was of course the 4th trimester.  But I started to feel as though I was losing my mind. My son would nurse for forty-five minutes to an hour, fall asleep, then wake up thirty minutes later wanting to nurse again. It was a never ending cycle of dread and pain.  I was constantly told that breastfeeding shouldn’t hurt, but every time we nursed I sat on the edge of my chair, clenching my teeth.    I finally realized that I couldn’t do this alone. I decided to pay a visit to the amazing Rebecca Costello!  Luckily, we were able to be seen the next day. I explained what was going on, how nursing hurt and seemed to never end.  Rebecca checked us both out and did a weighted feed. Ashton wasn’t transferring much milk while nursing; after nursing over 40 minutes he was moving barely an ounce. We went home with new … Read More

MILC Moment

In 2019, we will be sharing some stories of breastfeeding from our MILC mamas. Just like birth stories, every breastfeeding story is a little different, with its own challenges and triumphs. We believe sharing these stories helps normalize breastfeeding – all of breastfeeding, including the hard parts! Thank you so much to Melody for sharing her story this month – she navigated various obstacles on the way to reaching her breastfeeding goals. By Melody Walker I don’t often reflect on my journey with labor, delivery and breastfeeding, because it’s taken a long time to come to a place of peace with how things went. One of my good friends had both of her boys at home, and struggled to finally get to a good place with breastfeeding. She was one of my biggest influences. I didn’t think my husband would be OK with a home birth, so I decided on the birth center as a compromise. I didn’t have any other face-to-face friends to talk with about this, but I joined every Facebook group and reached out to those ladies I knew had similar values/goals, even if they were far away. I labored at home/running errands for about 6 hours before my water broke. I didn’t rush in, but headed that way to check where I was. The aforementioned friend served as my doula, and I also had a photographer – they were so amazing and exactly what I needed. I labored all over the place in and around WBWC! I was there 30ish hours before I transferred. There’s so much I would say about this point in labor but ultimately it was a dark place. My doula and photographer left. My husband refused to allow my mom in the room. I was given the epidural and was able to sleep for about 2 hours. I woke up and was ready to have this baby. She still wasn’t earthside for a few more hours (over 40 hours of labor). I had several nurses and lactation consultants visit me and try to help me nurse. The doctors talked me out of revising her tongue tie. I had a healthy baby, but it was a far cry from the dream I wanted! I become more determined that no one, and I do mean no one, was going to take breastfeeding from me! I didn’t realize at the time how hard I was struggling with … Read More

MILC Moment

In the new year, we wanted to share some stories of breastfeeding from our MILC mamas. Just like birth stories, every breastfeeding story is a little different, with its own challenges and triumphs. We believe sharing these stories helps normalize breastfeeding – all of breastfeeding, including the hard parts! A big thanks to Morgan for kicking off our series with her honesty and beautiful writing. By Morgan Taylor Callahan December 26, 2017: After 19 months of trying to conceive, 39 LONG weeks of pregnancy, extreme pregnancy anxiety resulting in full body rashes and itching, and 12 hours of labor, our sweet Saoirse Kate had finally arrived. Saoirse was born with her cord wrapped around her neck and meconium in her fluid. She spent her first 15 minutes (the longest 15 minutes of my life) across the hospital room with the respiratory/NICU team before she was deemed fit for me to hold. A nurse helped her latch onto my breast, and it was… the start of a painful, challenging, frustrating experience that would take months and months to feel normal, let alone natural. Saoirse immediately began sucking vigorously – you could hear her across the room. “Good, this is good,” I thought, as my toes curled in pain and I fought the urge to rip her from my body and back away from her in horror. “Is this supposed to hurt?” I asked, knowing from my breastfeeding class with Rebecca a few months earlier that it probably wasn’t supposed to hurt quite this badly. But I was a first time mom, and no one in my family had ever breastfed before, so my knowledge of breastfeeding was conceptual at best. After about one minute of this excruciating first session, I stuck my pinky in the corner of her mouth like I learned in class to adjust her latch. I was horrified to discover a quarter sized bruise on my nipple. The nurse noticed, too, and said we should try the other breast. Five minutes later, I was sporting matching bruises on both nipples with bleeding to top it off. Our first visit with the hospital lactation consultant made me feel somewhat better, but didn’t actually improve anything. I asked several times if Saoirse had a tongue tie. I knew that there was something wrong. “No, she’s got a strong suck, she’s doing great, here’s a nipple shield to protect your nipples … Read More

MILC Moment – Holiday Mastitis

Calls about mastitis tend to increase over the holidays. Changes in routine, travel, sleep disruptions, stress, and missed feedings can all contribute to getting engorged, getting a plugged duct, and/or getting mastitis. When you get a plugged duct, it may start as a little lump in the breast. It may feel a little tender, and the skin over it might look more pink or red. If it doesn’t get better, it may get bigger and the congestion may start to spread to other areas of your breast. More of the skin might look red. You might feel body aches or chills, or get a low grade fever. If the congestion still doesn’t go away, you might start feeling worse – like you have the flu, with a high fever. At that point, you should definitely be calling WBWC (or your OB care provider) – “Help! I think I have mastitis!” A round of antibiotics will usually clear up mastitis pretty quickly. But we like to avoid antibiotics if we can, and of course we like to avoid you getting sick! Could we prevent a bad case of mastitis? Sometimes, we can! The first step in prevention is to take care of yourself over the holidays. Mastitis loves stress! Keep nursing your baby frequently, don’t skimp on sleep, and do whatever you can to minimize the stress that can come along with the holiday season. If you do start to have issues, it’s good to know that very frequent nursing or pumping often does the trick. If you have a really stubborn spot that won’t clear, all you need may be just your hands – massaging to clear out those congested areas before they get worse. Check out this video for techniques on how to massage and hand express: https://vimeo.com/65196007 . The Boutique also sells a “Happy Ducts” herbal tincture to help in clearing breast congestion. If you’re not able to clear the plug yourself, all the WBWC LCs, and many of the midwives and nurses, have been trained on how to do breast massage to help clear plugged ducts and breast congestion. If you feel like a plugged duct is getting worse, and you’re not able to clear it yourself, you can call for an appointment to get some hands-on help. If you believe you are getting mastitis, or have mastitis, you should always call WBWC (or your OB care provider) for care. If … Read More

WBWC Celebrates World Breastfeeding Month!

By Rebecca Costello, IBCLC MPH   Our first celebration was for World Breastfeeding Week with a “Milk and Cookies” theme. Honeysuckle Tea House hosted our party and even made a special lactation tea blend for us! We had a great time drinking milk (babies), eating cookies (the rest of us), and jamming to music with Erica from Jammin Baby, LLC. It was a hot day, but we had a great time! Click here for the link to the Facebook album. Thank you so much to Sunshine Scoville for the beautiful photography!   Our second celebration was for Black Breastfeeding Week. Tracey, who you all know well from your visits in the lab, did an awesome job of coordinating this! Moms and their families made nursing necklaces, got gorgeous henna tattoos, enjoyed tasty snacks, and had breastfeeding portraits taken by the wonderful Sarah Stanley from Love at First Sight Photography. Check out our group shot above, and there are more photos to come – stay tuned to our Facebook page.   Thank you to everyone who helped with and attended these events – we had a great time celebrating with you and your sweet babies! We’re already looking forward to next year.  

MILC Moment

We are excited that this month, our own Ellen Chetwynd is presenting at two conferences: the International Lactation Consultant Association (ILCA) and the International Consortium of Oral Ankylofrenula Providers (ICAP). At ILCA, Ellen is presenting specifically on research on mastitis and therapeutic breast massage done here at WBWC – a project that many of you have contributed to by volunteering for training sessions!   Mastitis is a common complication occurring in approximately 3-22% of breastfeeding women postpartum. Standard treatment includes prescription antibiotics once fever develops, making mastitis the most common reason for antibiotic use in the postpartum period. However, both providers and patients prefer to avoid the use of antibiotics unless necessary.   In September of 2014, all WBWC lactation consultants attended a workshop or staff training on Therapeutic Breast Massage in Lactation (TBML) for mastitis and plugged ducts. In November of that year, we taught the midwives, nurse practitioners, and nurses what we had learned. We have repeated the training several times since so new staff receive the same education. Recently, we reviewed charts from two years before and two years after the initial training to see if the training had made a difference. We looked at a number of factors including whether antibiotics were prescribed, and if the patient ended up taking them.   We found that while many patients still needed antibiotics to treat mastitis, the odds of receiving a prescription for antibiotics were significantly lower after the training, and the odds of patients actually needing to start taking antibiotics were also significantly lower. WBWC providers, nurses, and IBCLCs continue to frequently provide TBML for patients with plugged ducts or symptoms of mastitis – sometimes avoiding the need for antibiotics, and sometimes working alongside antibiotics to help relieve pain and engorgement, and speed healing. We have seen that patients feel more empowered when they learn that a treatment for plugged ducts and mastitis can be literally in their own hands!   **If you think you have mastitis, never hesitate to page your WBWC midwives or your own obstetric care providers to be seen for care ASAP.**

Peer Counseling Breastfeeding Support Program

By Dzidzai Muyengwa We have some exciting new changes coming to WBWC this summer and we wanted to take this opportunity to give you some information about our new Peer Counseling Breastfeeding Support Program. This program is being offered to provide birth center breastfeeding parents with some extra support during pregnancy and for the length of their breastfeeding journey.   What is a peer counselor? A peer counselor is a parent who breastfed at least one child, who then completes specialized training to learn about supporting other breastfeeding parents. The peer counselor is trained to support typical challenges in breastfeeding, and can also help you decide when it may be time to seek support from a Lactation Consultant. There is a strong evidence base for the effects of peer counselors on improving breastfeeding outcomes.   Our peer counselor is someone you all know and love – Tracey Jones, who you see in the lab at almost every visit! We will begin enrolling interested patients starting in the coming weeks, with a special focus on those who may not otherwise have easy access to breastfeeding support or education.  We are excited about this new opportunity to better serve WBWC families!

MILC Moment: Resources for Helping Your Workplace Become More Breastfeeding-Friendly

By Rebecca Costello, IBCLC There’s something we notice about WBWC patients – they don’t do things just because “that’s the way it’s always been done” – they ask questions and check to see whether there are better options out there! So we aren’t surprised when we hear from our patients who want to improve the way their workplace deals with moms who return to work while still breastfeeding/pumping milk for their babies. Many of them also know that the Affordable Care Act provides protections for nursing mothers. Employers are required to give mothers time to pump, AND a private space that is NOT a bathroom. To help you advocate for yourself and others, we’ve put together a list of resources that may be useful: 1)  U.S. Department of Labor information on the Break Time for Nursing Mothers requirement: https://www.dol.gov/whd/nursingmothers/ Includes Frequently Asked Questions, an Employee Rights Card, and How to File a Complaint. There is also information in Spanish. 2) U.S. Office of Women’s Health information for employers: https://www.womenshealth.gov/breastfeeding/employer-solutions/ An excellent set of resources for employers who are not sure how to structure pumping breaks and space. There are videos and illustrated guides, broken down by type of industry (for example, retail, education, agriculture, manufacturing, food service, even mining!) Each category has examples of real business who are successfully supporting their employees. 3) The Business Case for Breastfeeding: https://www.womenshealth.gov/breastfeeding/breastfeeding-home-work-and-public/breastfeeding-and-going-back-work/business-case More resources for employers and employees, including information for employers on the benefits and importance of supporting breastfeeding. 4) Carolina Global Breastfeeding Institute’s Breastfeeding Friendly Child Care project: https://sph.unc.edu/cgbi/breastfeeding-friendly-child-care-job-aids/ It’s not just about the mom pumping – it’s also about how the baby is fed while they are away from mom! Here are resources for helping your child’s daycare become more breastfeeding-friendly. Of course, you can always call on your WBWC lactation consultants for help and advice. We are here for you any time!  

MILC Moment: Who Are the Students You See at MILC?

By Rebecca Costello, IBCLC If you come to our breastfeeding classes, lactation visits, or breastfeeding cafes, you may notice we often have students shadowing our work and occasionally even helping with visits. (Although students are never present in a visit without receiving the patient’s permission first!) We are proud to participate in WBWC’s tradition of training the next generation of care providers – but where do our students come from? The main group of students you see with us are participating in the Mary Rose Tully Training Initiative through UNC-Chapel Hill. This program trains students and prepares them to sit for the exam to become International Board Certified Lactation Consultants (IBCLCs). As part of their training, they must complete hundreds of clinical training hours. WBWC is one of the sites where they learn from IBCLC mentors. Our staff also provides occasional lectures or teaching workshops as part of the students’ classroom learning. (The program is named after one of its founders, Mary Rose Tully, who was the first director of lactation services at UNC Hospitals and was a local and national leader in breastfeeding support.) We also have shadowers from a variety of clinical fields. A number of medical students and residents ask to do elective rotations with us, because they want more dedicated time to focus on lactation than they typically get in medical school and residency. And several pediatricians and family medicine physicians have spent time with us to hone their breastfeeding support skills and to prepare for the IBCLC exam. Speech language pathologists, nursing students, and doulas have also all spent time with us to supplement their training – they interact with breastfeeding in different ways, but all have a desire to learn more. Finally, we have shadowers from inside WBWC! Many of the nurse-midwifery and nurse-practitioner students who train here ask to spend time with the IBCLCs, to get a better sense of our work. And of course, all of our newly hired nurses, nurse-midwives, and nurse practitioners shadow our IBCLCs as part of their orientation. We work in a team here, so spending time getting to know each other and how we work is very important! Keep in mind that there is never an obligation to have a student at your visit. On the contrary, if you don’t feel comfortable with a student at your visit, we WANT you to decline so that you can … Read More

MILC Moments: Are You Breastfeeding in Combat Boots?

by Rebecca Costello, IBCLC   Over the years, WBWC has served many military families. Some drive multiple hours from bases elsewhere in NC to be able to enjoy access to a birth center! But once baby arrives, military duty can provide special barriers to breastfeeding – especially if you are breastfeeding and needing to return to active duty. You may find yourself confronting questions that you feel no one around you can answers for, like: o Can I breastfeed while I’m in uniform? o Can I pump while in the desert for training exercises? o Is my pump allowed onboard ship? o Do I need to pump and dump if I’ve been exposed to particular types of HAZMAT? Happily, there are resources out there for you! The website and associated book Breastfeeding in Combat Boots has a wealth of information and tips. For peer support, Mom2Mom Global is a breastfeeding support organization specifically for military families, with chapters on military bases around the world – including one here in NC at Fort Bragg! All these resources can reassure and empower you that yes, you CAN breastfeed even while you and/or your spouse is active duty. Finally, you have the resources here at WBWC here to support you! Our midwives, nurses, and lactation consultants are always available for support, encouragement, and advice – no matter where you are in the world. Give us a call any time!