Six-day-old Michaela Hart naps during the first breastfeeding peer support meeting that she and her mother Ethel attended at St. John Hospital in Detroit.
Detroit Hospital Redesigns Maternal Care
DETROIT (WOMENSENEWS)–“Gimme this baby!” laughed Monica Washington as she threw her arms wide to hug Edwin, age 1, and his mother, Jasmine Kidd.
As Edwin joined the other giggling infants on the playroom floor of the Mother Nurture Project breastfeeding support group at Detroit’s St. John Hospital and Medical Center, Washington and Kidd reminisced about the trouble he’d had with nursing.
“It took him three months to latch on,” said Kidd, a frown crossing her dimpled face. “But Monica, my peer counselor, coaxed me through my frustration, texting me with helpful advice and taking my calls late at night.”
Listening attentively was newcomer Ethel Hart, who had delivered her fourth child at St. John six days earlier. Hart had just joined this group at the urging of a lactation counselor she met at the hospital.
“Though I gave formula to my other kids, I’ve decided to breastfeed little Michaela,” she said, reaching down to caress her sleeping infant’s face. “It will prevent her from getting sick. And already, it’s helping me bounce back and feel healthier than I did right after my other pregnancies.”
Hart leaned forward and tuned in as Kidd finished her story about the “eureka” moment when Edwin latched on. Cheers erupted from the half dozen other black mothers who were sharing sandwiches and snacks at this regular Tuesday afternoon meeting. They were celebrating Edwin’s victory–and that of their own children–in beating the odds and breastfeeding for better health.
African American women have the lowest breastfeeding rate of any ethnic group in the United States, which contributes to high incidences of obesity, diabetes and other health problems in their communities. By fostering solidarity among black women, Mother Nurture’s peer counseling program has helped boost breastfeeding rates among its obstetrics patients–the majority of whom are African American–from 46 percent in 2011, when Mother Nurture first launched, to 64 percent today.
Health experts say Mother Nurture’s culturally sensitive, community oriented approach is one that could serve as a model for improving black women’s breastfeeding rates across the United States. And grant providers agree: this spring, Mother Nurture received $500,000 from the W.K. Kellogg Foundation to fund its work for another two years and to allow it to continue building support for breastfeeding in the black community. (Disclosure: The Kellogg Foundation contributes to Women’s eNews.)
Lower Breastfeeding Rates
The U.S. Centers for Disease Control and Prevention reports that only 59 percent of African American mothers initiate breastfeeding, compared to 75 percent of white mothers and 80 percent of Hispanic ones. Only 30 percent of black women (compared to 47 percent of white ones and 45 percent of Hispanic ones) breastfeed exclusively for an infant’s first six months–the target recommended by the American Pediatric Association, the World Health Organization and other medical authorities.
Among black women, barriers to nursing include African Americans’ cultural scorn for breastfeeding (which harkens back to slave times, when black women were forced to serve as wet nurses) and a lack of support for nursing at work (black women are more likely than other women to have part-time or low-paying jobs that do not afford them time to pump breast milk and store it for their babies for later).
Also problematic is the black community’s long-standing practice of using breast milk substitutes. “Slave women were forced to feed their young regular food much too soon,” writes health activist Katherine Barber in her 2005 book “The Black Woman’s Guide to Breastfeeding.” “Infants were given cow’s milk, corn bread, molasses and the liquid from cooked greens…And [today], even those of us who initiate breastfeeding often do so with the inclusion of infant formula.”
Only a small number of African American celebrities–including First Lady Michelle Obama; actresses Jada Pinkett Smith and Halle Berry; and singers Alicia Keys, Beyoncé, and Lauren Hill–have publicly championed breastfeeding, which could contribute to a cultural shift.
“Some of the other black women with whom I work fear that if their babies are breastfed, those babies will become spoiled and too attached,” said Stacy Davis, a certified lactation consultant at Providence Hospital in Southfield, Mich., who worked for a year as a Mother Nurture lactation intern. “Others relate breastfeeding to a sexual act. Still others say it’s unclean or ‘just nasty.'”
Last year, the black women’s magazine Essence surveyed its readers and found 58 percent of them opposed visible breastfeeding in public and 9 percent “didn’t ever want to see” other women breastfeeding at all.
Peer Support Push
Can peer support convince reluctant black women to breastfeed? “Absolutely!” exclaimed Renee Pearson, one of Mother Nurture’s three breastfeeding peer counselors.
Two decades ago, when Pearson gave birth to her daughter, her grandmother told her to bind her breasts to stop milk from flowing–and scrounge up cash for infant formula.
“Like most black women, I didn’t have friends or family who breastfed, so I didn’t think to do it myself,” Pearson said. “I didn’t even realize breastfeeding was healthier than formula until I was pregnant again and a peer counselor I met while getting food through WIC [the U.S. government’s Special Supplemental Nutrition Program for Women, Infants, and Children] convinced me to give it a try.”
While caring for her second baby, a son, Pearson learned from her breastfeeding peer counselor that nursing lowers the risk of diabetes for mothers and the risk of asthma, infection and respiratory problems for babies. It reduces infant mortality, which is higher among African Americans than other ethnic groups and stands at double the national rate in Detroit. It also helps promote family harmony: a 2009 study in the journal Pediatrics found that mothers who breastfeed are four times less likely to abuse their children than mothers who rely solely on infant formula.
Impressed by breastfeeding’s many benefits, Pearson started to urge friends and family members to try it. When she’d grown so enthusiastic that she found herself marching up to pregnant strangers and encouraging them to nurse, Pearson realized being a breastfeeding advocate was her vocation and took the two-day training to become a breastfeeding peer counselor for WIC.
A year later, in 2011, she landed a full-time job as a lactation educator and peer counselor at the newly launched Mother Nurture program at St. John–one of only 248 U.S. hospitals that have met stringent World Health Organization breastfeeding standards and been deemed “Baby Friendly,” and the only public hospital in Michigan to ever attain this designation. (Women’s eNews has found that Baby Friendly Hospitals are rare in urban areas and are most often in suburban communities, such as Michigan’s Grosse Point, which shares a border with Detroit yet has a population that’s only 3 percent African American).
Circle of Sisterhood
Pearson said that just as her connection with her black WIC counselor helped convince her to try breastfeeding, the rapport she has with Mother Nurture’s black clients influences their decision making, too.
“My counselor was someone I could relate to using the same slang and shared sense of identity,” she said. “And today, when I pull back the curtain in a patient’s room and she sees that my face looks like hers, I see her smile and visibly relax. I ask, ‘Hey sugar, how you doin’ today?’ and we laugh and our conversation flows from there.”
Pearson said that as a black mother, she can sympathize with the problems her patients face, such as friends who buy them bags of formula as baby gifts and aunts who wrinkle up their noses at the mere mention of breastfeeding.
“Many black women who do want to breastfeed say they can’t because they don’t have any quiet time to themselves,” Pearson said. “So I ask, ‘What’s going on with you? How might you change things to make time in your schedule?’ I try to get women to see the possibilities so they’re proactive and learn to fix their own problems on their own.”
Problem-solving–and personal empowerment–is integral not only to Mother Nurture’s one-on-one counseling, but to its peer support groups, too.
As they joke and laugh with each other, the women at the Tuesday afternoon group also swap advice: “Do not buy formula just because you found coupons for it.” “To get her to latch on, hold her here, skin to skin.” “When you introduce him to solid foods, try mashing up a cooked yam and feeding it to him in little pieces.”
Kiddada Green, founder and director of the Detroit-based Black Mothers’ Breastfeeding Association, said this approach helps create a “circle of sisterhood.”
“The peer counselors at Mother Nurture–and the more experienced mothers in the group–have made breastfeeding work for them,” she said. “And through their example, they show others it can work for them, too.”
Linda Goler Blount, president of the Black Women’s Health Imperative in Washington, D.C., said she approves of peer counseling but sees potential obstacles to its wider implementation. Finding, training and deploying black breastfeeding peer counselors may work well in Detroit, where 83 percent of residents are black, but since African Americans comprise only 12 percent of the U.S. population, this approach may not reach black mothers in areas where they are an isolated minority.
“This needs to be small scale because you can’t forge the intimate connections on which it’s based via email or Skype,” said Blount. “But at the same time, you can’t have too much intimacy. To effectively help their clients, peer counselors need to be well trained so they create healthy boundaries and make sure they don’t overshare.”
Training also needs to be updated regularly, said Nekisha Killings, an African American mother of three who lives in Alexandria, Va., and serves on the Equity, Diversity and Inclusion Committee for La Leche League USA. “Breastfeeding medicine is ever changing,” she said. “And peer counseling will only succeed if the information the counselors convey is accurate and evidence-based.”
Every six months, Mother Nurture’s peer educators receive two days of updated training through WIC (which provided initial training for them all). And thus far, they are not only boosting breastfeeding initiation among the 10,000 obstetrics patients who have passed through their program, but inspiring patients to breastfeed an average of seven months–longer than the recommended six months.
The peer educators are also having a positive ripple effect on Detroit’s larger African American community.
“I brought one of my girlfriends to Mother Nurture,” said Kidd, running her honey-brown fingers through Edwin’s unruly hair and easing him onto her lap. “And with help from this group of ladies, more mothers will be joining us soon.”