Boni Katz and I had the privilege of attending the United Nations Commission on the Status of Women, March 14 – 16 and representing ICEA. This was a huge opportunity afforded us by IMBCO (International MotherBaby Childbirth Organization) through sharing of their passes and we were extremely grateful. The theme for 2018 was “Achieving Gender Equality and the Empowerment of Rural Women and Girls.” We were excited about the theme as this fits in with one of ICEA’s core values: Practicing a culture of collaboration based on the knowledge that mindful engagement with diverse groups advances positive, family-centered maternity care.
Prior to attending, Boni poured herself over the schedule to help lay out a plan that would allow us to attend as many sessions, representing other countries as possible. As we attended sessions representing countries like India, Nepal, Zambia, Arab, Merico, Tunisia Egypt, Turkey and the U.S., we learned about the challenges that face rural women around the world. We learned they do not have the resources for the basic needs let alone education and health care. Many of those sharing about the challenges in these countries shared what they are doing to meet these challenges and how other organizations could help. This is when ideas began forming of how ICEA could be a part of supporting rural childbearing women across the world!
We also had the opportunity to network with unique people representing a variety of organizations. These included International Mother Baby Childbirth Organization, Every Mother Counts, Circle of Health International, Zonta International and American Association of University Women, and Big Ocean – Women for Faith, Family, Motherhood. Our conversations left us excited about the possibilities of partnering with these and other organizations to provide education that supports family-centered maternity and newborn care. This has motivated us to share not only with the Board but with the entire membership of ICEA so that all can see the great needs that exist…and help to meet those needs.
ICEA has already been a part of educating others for certifications in CBE, Birth Doula, and Postpartum Doula in China, Taiwan, Costa Rica, Guatemala, and South Africa. We are looking at how we can take these programs to other countries and continue to help support family-centered maternity and newborn care.
Flourishing for ICEA,
Debra Tolson, RN, BSN, ICCE, IBCLC, CPST ICEA President
by Kathleen Kendall-Tackett, PhD, IBCLC, RLC, FAPA
We are at a critical junction in the U.S. in our conversations about race and ethnicity. People are being shot by police, and others rise up to protest those shooting. We grieve those losses and hope that changes in our system will result. In the face of these violent events, is breastfeeding even relevant? The short answer is Yes. Breastfeeding can’t stop racism and discrimination, nor can it stop trauma and adversity, but it can protect new mothers from their effects. To understand why breastfeeding helps, I’ll use discrimination as an example. What happens physiologically when people are discriminated against? We happen to have some good science on this.
The Biology of Discrimination
A fascinating book called Social Pain summarizes many studies, and describes the neurobiology of social exclusion (Dickerson, 2011; Eisenberger, 2011). The basic premise is this: we are designed to be in relationships with others. It’s important for our survival. When we are not–when we are excluded–our stress response is triggered, including the inflammatory response system. These are our survival mechanisms. Social exclusion activates the same part of our brains as physical pain—the anterior cingulate cortex (ACC). The ACC is the same part that is activated for other mammals in the separation-distress response. The response to social exclusion is a hard-wired for all mammals, including human beings.
The act of discrimination says to the recipient, “You are not one of us. You are not part of our group.” These behaviors can be in the form threats of overt violence, or they can be in the form of microagressions. Some people dismiss microaggressions, saying that people are “too sensitive.” Sometimes, that can be the case. There could be misunderstandings. But what we need to keep in mind is how it affects the people who experience them. These often careless utterances still have a physiological effect on the person who hears them. Microaggressions tell people that they are being excluded from the group, and that is why it is important to be aware of them.
So what happens when people experience discrimination on an ongoing basis? You get a chronic activation of the stress response system, which increases chronic inflammation and disturbed sleep. Many researchers have studied this effect. One study asked a series of questions, such as “you get poorer service in restaurants or stores,” or “people think you are not smart.” The more of these questions that people said yes to, the higher their levels of inflammation (Lewis, Aiello, Leurgans, Kelly, & Barnes, 2010).
Inflammation and disturbed sleep are physiological time bombs and increase rates of heart disease, diabetes, and BMI >30—in other words, the exact pattern you see in many of our minority populations (Suarez & Goforth, 2010). The obesity statistics are particularly relevant. Consistently, what you see across countries, that marginalized populations tend to have higher BMIs. The more marginalized they are, the higher the percentage of people with a BMI >30. In the U.S. and UK, women of African descent have the highest rates. But other groups, such as American Indians and people from Southeast Asia, tend to also have a higher percentage of people with BMIs >30 than Whites. In the UK, Irish are split out as a separate group from British Whites. Interestingly, a similar pattern of higher BMIs emerges. Given the long history of marginalization of Irish people, this effect is consistent with other research. You also see a similar pattern for people who have lower-incomes (Goodman, McEwen, Huang, Dolan, & Adler, 2005).
The Critical Role of Breastfeeding
Exclusive breastfeeding acts as a powerful counter to these physiological effects (Groer & Kendall-Tackett, 2011). It is one of the mechanisms that downregulates, or turns off, the stress response. Baby at the breast actually lowers two important stress hormones in the short term: ACTH and cortisol. Further, when the researchers tried to stress the mothers in their study, they couldn’t because of the lovely little cloud floating around them (Heinrichs et al., 2001). In other words, it was a short-term lessening of the stress response. When mothers experience that day after day, it lowers lifetime risk of the Number One killers of women in the U.S.–heart disease and diabetes—in a study of 139,000 women with a mean age of 63 (Schwartz et al., 2009).
There is an important caveat to these findings: in most of these studies, exclusive breastfeeding lowered risk, partial breastfeeding did not. In our study of 6,410 new mothers, we found that exclusive breastfeeding improved mothers’ sleep, lowered their risk of depression, and had a dramatic effect on self-reported anxiety and anger (Kendall-Tackett, Cong, & Hale, 2011). This was even true when women had a history of sexual assault, which puts them at high risk for both sleep problems and depression. There was still an effect of the sexual assault, but it was significantly lower (Kendall-Tackett, Cong, & Hale, 2013).
I was honestly surprised that we found no significant difference between partial breastfeeding and exclusive formula-feeding. I thought we would see a dose-response effect: the more they breastfed, the better the response. Instead, we found a threshold effect: that exclusive breastfeeding is a very different physiological experience than partial breastfeeding. It is one more reason to continue to support exclusive breastfeeding wherever possible.
How Shall We Then Treat?
As individuals, and as a culture, we must continue to eliminate discrimination. One way for you to do that locally is to foster trust, and then have open discussions with the population you serve. How do they describe themselves? Is there any terminology that they find offensive? A Jewish friend once told me that the term “Nipple Nazi” was high offensive to her and asked that I not ever use it. I hate that expression too, so I was happy to comply with her request. Other terms may seem more benign to you, and you don’t understand why they are problems. The best strategy is to ask.
As a woman with a disability, I’ve been on the receiving end of many microaggressions. For example, I have a hard time with stairs, so a conference organizer once volunteered to “carry” me up the stairs—a very demeaning way to speak to me. I’m sure she was trying to help and had no idea how offensive that was. It took me a long time before I started speaking up, and it was only after I was actually injured at a conference because the organizers ignored my requests.
Sometimes these conversations can be uncomfortable and really tense. I’ve seen some ugly ones that were not at all productive. So it’s important to set some ground rules about communicating respectfully, even if frustrated. And you’ll probably make some mistakes along the way. But having these conversations will deepen your relationships within the community, and will make you even more effective in helping the women you serve.
In summary, breastfeeding can be a radical act that helps women who experience discrimination take back their health. American Indian lactation consultant and social worker, Camie Goldhammer, describes breastfeeding as “food sovereignty,” a powerful way to take back your culture. You can help women overcome the physical effects of discrimination, one woman at a time. By doing so, these women can become powerful agents for change the broader culture.
Thanks for all you do for mothers and babies. You make a radical difference.
Dickerson, S. S. (2011). Physiological responses to experiences of social pain. In G. MacDonald & L. A. Jensen-Campbell (Eds.), Social pain: Neuropsychological and health implications of social loss and exclusion (pp. 79-94). Washington, DC: American Psychological Association
Eisenberger, N. I. (2011). The neural basis of social pain: Findings and implications. In G. MacDonald & L. A. Jensen-Campbell (Eds.), Social pain: Neuropsychological and health implications of loss and exclusions (pp. 53-78). Washington, DC: American Psychological Association.
Goodman, E., McEwen, B. S., Huang, B., Dolan, L. M., & Adler, N. E. (2005). Social inequalities in biomarkers of cardiovascular risk in adolescence. Psychosomatic Medicine, 67, 9-15.
Groer, M. W., & Kendall-Tackett, K. A. (2011). How breastfeeding protects women’s health throughout the lifespan: The psychoneuroimmunology of human lactation. Amarillo, TX: Hale Publishing.
Heinrichs, M., Meinlschmidt, G., Neumann, I., Wagner, S., Kirschbaum, C., Ehlert, U., & Hellhammer, D. H. (2001). Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology & Metabolism, 86, 4798-4804.
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22-26.
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine, 8 (1), 16-22.
Lewis, T. T., Aiello, A. E., Leurgans, S., Kelly, J., & Barnes, L. L. (2010). Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults. Brain, Behavior & Immunity, 24(3), 438-443.
Schwartz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., & Cauley, J. A. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics & Gynecology, 113(5), 974-982.
Suarez, E. C., & Goforth, H. (2010). Sleep and inflammation: A potential link to chronic diseases. In K. A. Kendall-Tackett (Ed.), The psychoneuroimmunology of chronic disease (pp. 53-75). Washington, DC: American Psychological Association.
A newly expecting military family might be thousands of miles away from any close friends and/or family, they don’t have a typical support structure in place for this physically and emotionally momentous occasion.
The armed services do offer military families a vast amount of information on topics surrounding childbirth and there are some wonderful assistance programs to take advantage of. However, military families need more than just handouts, online reading, discount goods, and care packages. They need in-depth childbirth education series—they need educational support from the prenatal period through the first few, crucial months of being a new parent.
Listeners will understand the physical and emotional needs of newly expectant military couples and how they can offer childbirth education, doula services, and parenting preparation classes in support of these families’ distinctive needs.
The dual military couple, the Lieutenants Riffle, will be presenting this topic on Friday afternoon! LT Jimmie Riffle is an active duty Navy Nurse Corps officer and currently a DNP student at the Uniformed Services Health University in Bethesda, MD. Jimmie has been serving our great country for over 16 years boat side and bedside. Liz Riffle recently chose to leave active duty service in order to pursue more maternal/child management and consulting opportunities, as well as to start their own family very soon. Liz was an active duty Navy Nurse Corps officer for six years, and is currently still in the Reserves.
Register now to come dialogue with us regarding the opportunities surrounding this distinguished population on Friday afternoon at the conference!
As a student in maternity health, you are the future of family-centered care. We want to invest in your future, so ICEA is now offering a special student daily rate of $100!
So grab some fellow students, hop in the car, and take a road trip to Louisville, Kentucky!
This conference will allow you to focus on the evidence-based information and research most relevant for birthing and breastfeeding practices, education, and support. Here are just six of the many reasons you should join us in Louisville, Kentucky, USA on 19-21 April:
I’ll bet you know someone who you have always thought should be recognized for their excellence and contributions to childbirth education, doula and/or breastfeeding work and support. Someone who exhibits the ICEA Core Values of Compassion, Collaboration and Choice.
Now is the time to shine a light on your exceptional colleague.
The ICEA board has reinvigorated our awards and you’ll want to be a part of this exciting celebration.
The nomination process begins now! And we want to hear about your amazing colleagues.
The honorees will be announced at the Louisville, Kentucky Conference, April 19-21, 2018 during the General Sessions. Register now so you can be part of these exciting and inspirational honors.
Please nominate someone you know for the following awards:
The Circle C Award A member who demonstrates the ICEA core values by approaching maternity care with:
Compassion: nurturing spirit improves birth outcomes for all families.
Collaboration: based on the knowledge that mindful engagement with diverse groups advances positive, family-centered maternity care. Examples would be with working collaboratively with broad and varied members in the workplace and health care setting, community and professional organizations.
Choice: practicing and promoting a culture of freedom of choice by of empowering expectant families through informed decision-making. An example of this would be a member stepping outside of their personal values and encouraging informed choice through broader decision making.
Childbirth Educator For the ICEA certified childbirth educator who demonstrates excellence, enthusiasm and innovation.
Doula For the ICEA certified doula who demonstrates excellence, enthusiasm and innovation.
Breastfeeding For the ICEA member who demonstrates excellence, enthusiasm and innovation in breastfeeding and support of the WHO code.
Sister Circle For a public persona or figure who supports and promotes ICEA core values.
See you in Louisville,
Colleen Weeks LCCE, FACCE, CLE, CSE, RTS
ICEA Director of Marketing
About a year ago, I decided that I wanted to work more closely with families in my home town of Lexington, Kentucky. So I developed a curriculum, and then scheduled independent childbirth classes in my hometown. I reached out to all the providers and doulas that I knew. I mailed flyers, posted flyers, and used social media to try and advertise my class. Even with my name recognition (Rebecca Dekker of Evidence Based Birth®), nobody signed up to take my 5-week childbirth class series. Which seemed odd to me. What was going on? Was it the fact that local hospitals offered free classes? Or was something else going on?
In 2013, the Listening to Mothers III survey found that only 1 in 3 mothers giving birth in U.S. hospitals that year had taken a childbirth class. And yet, these people are walking into a flawed health care system, where non-evidence based care is routine. They could use all the education and help they can get! Why aren’t they getting educated by a certified childbirth educator?
A few years ago, one of my mentors gave me advice when I was struggling with an issue in terms of how I could best serve my audience. She said, “Stop trying to guess what people are thinking. Ask them!” “Ah. You’re right!” I answered! “Why didn’t I think of that before?” Ever since that time, my policy is to ASK people what they want at Evidence Based Birth®, before I create anything!
So, I decided to hold a couple of online focus groups to find out what was happening. I sent out an invitation, specifically looking for people in their twenties, who were either pregnant, recently had a baby, or were planning on having a baby in the next five years. We had a great group of about 18 people in their twenties who video-chatted with me and told me their thoughts about childbirth. Another 34 people, who couldn’t make it, let me know their thoughts by email.
I’m not going to reveal all of their answers—I’m saving the bulk of what I found for the ICEA conference—but here 3 of the 9 themes that I found:
I can learn everything I need to know from the internet or from watching YouTube videos
I plan on just showing up and having the doctor and nurses tell me what to do
I’m too busy—I don’t have the time or money, and I don’t want to leave my home
Basically, what they told me, is that today’s young people would much, much rather stay at home in their fuzzy slippers than attend a live, in-person class. I totally understand—I’m exhausted at the end of the day, too! I can also see why casual online learning is so much more appealing young people. And yet… most online courses have DISMAL completion rates. Planning to offer a completely online childbirth class? Chances are only 5% of people who sign up will actually watch every video and complete the entire class.
So, what’s the solution? How do we reach today’s generation of birthing people? How do we entice them to leave their homes? Should we be making changes to how we teach? If so, what kind of changes should we be making?
And even if we do somehow figure out a way to get people to our classes, how do we handle the dilemma that nearly every childbirth educator I meet struggles with? That dilemma is, how do you help them get evidence based care, when evidence based care is extremely difficult to get in your community? For example, what if you teach childbirth classes at a hospital, and you encourage your clients to move around as much as possible during labor? But in the back of your mind, you know that once they arrive, they’ll most likely be hooked up to a continuous electronic fetal monitor that restricts their movement? What if you are encouraging your students to use a tub during labor, and they’re SO excited about that, but in the back of your mind you know that there’s only one room with a tub, and the nurses aren’t likely to fill it up?
Basically, I see the future of childbirth education as facing two critical issues:
How do we get millennials into our childbirth classes?
How do we help millennials get evidence based care, when it isn’t the norm?
I’ve spent the past few months brainstorming solutions to the first problem, and the past five years brainstorming solutions to the second problem. After talking with parents and educators from across the country, I’m excited to share some potential solutions with you.
To learn about those potential solutions, make sure you register for the 2018 ICEA Conference in Louisville, Kentucky. When you arrive, make sure you come to my session about “Childbirth Education and Birth Plans” to hear my solutions for the future of childbirth educators. Also, feel free to stop by my booth afterwards for photo ops and to chat some more! I can’t wait to meet many of you in person.
by Cynthia Billiar BSN, RN, IBCLC, ICCE, ICD, ANLC
Research suggests that we carry genetic memories of our ancestors that can affect our health. These genetic memories are called epigenetic tags. Epigenetics literally means on top of the gene, (Wilson, n.d.). Epigenetics encompass all the processes that lead to inherited changes in gene expression during development and across generations, (Epigenetics, n.d.).
Animal research shows that some epigenetic tags are passed through up to 10 generations out. During the Dutch Hunger Winter in 1944-1945 people suffered very difficult conditions, including stress and hunger. Researchers have been able to study the human epigenetic tags of the subsequent generations of the survivors of the Dutch Hunger Winter up to 60 years later. They found that the babies born to these survivors and several generations forward were more likely to have heart disease, diabetes, obesity and a wide variety of brain related conditions such as bipolar disease and schizophrenia, (Wilson, n.d.). Another study reported that descendants of the people who survived the Holocaust have different stress hormone profiles than that of their peers, possibly predisposing them to anxiety disorders, (Rodriquez, 2015).
The genetic information we inherit from our parents is called the genome, it is the complete assembly of our DNA. The epigenome is a multitude of chemical compounds that attach to the genome/DNA and modify its function, in other words, turning genes on or off; when this change happens, it is said to have “marked” the genome. This does not change the sequence of the DNA but it changes the way cells use the DNA’s instructions, (Epigenomics, 2016). The epigenome can be altered by environmental and lifestyle factors such as nutrition, chemicals, stress, and emotional experiences. Although our epigenome can potentially be altered throughout our lifetime, from in utero to age three is the most critical period of development in terms of the epigenome in humans. This is the time that our DNA is most receptive to epigenetic changes and alters the way our organs and predisposition to certain diseases develop. Maternal environment during pregnancy and the infant’s first received nutrition impacts the epigenome significantly, (Wilson, n.d.). Breastmilk can potentially change the epigenome to affect the lifelong health of the infant, (Wilson, n.d.). Just because you may carry a gene that is known to be associated with a disease does not mean it will ever develop, (Tow, 2014).
We have extensive evidence that those of us who have been breastfed or received breastmilk show lower risks of developing some non-communicable diseases. We know that breastfeeding can decrease the risk of developing type 1 diabetes and childhood cancers in children who are genetically susceptible to these diseases. We know that breastfed children born to families that are susceptible to cow’s milk allergies, if given just one bottle of infant formula, can become sensitized, (Walker, 2014). There are many components in human milk that can change gene expression and can decrease diseases such as childhood obesity, immune disorders, liver disease, and cholesterol issues, (Wilson, n.d.). Breastfeeding also benefits the mother, as we know it can decrease breast cancer, ovarian cancer and osteoporosis later in life.
We cannot begin to know all of the epigenetic tags we carry or pass on from our ancestors that can affect our health and the health of future generations. We can however, make a difference with what we do know, and that is our choices do affect others. Remember that nutrition plays a key role in whether some of those epigenetic tags from our ancestors are turned off or on. Keep in mind that from in utero to age three is the most critical period of development in terms of the epigenome in humans, and that breastmilk can potentially change the epigenome to affect the lifelong health of a child. Take care of yourself because we now know what you do today can affect not only your health but the health of many generations to come.