Editor's note: This story is part of Southwest Michigan Second Wave's On the Ground Battle Creek series.
Rickeshia Williams and Stephanie Freeman are in the minority personally and professionally as the only Black lactation professionals in Calhoun County and among less than 10 percent of African American women within the United States who are in this profession.
The two women, both Battle Creek residents, say the lack of racial diversity in their field is among the reasons that Black and Brown women are less likely than their White counterparts to breastfeed. This disparity in the profession was pointed out in a 2019 Lactation Care Provider Demographic Survey done by the United States Lactation Consultants Association
and was highlighted during Black Breastfeeding Week, which began on Aug. 25 and ends today (Aug. 31) and is part of National Breastfeeding Awareness Month.
Stepanie Freeman, left, and Rickeshia Williams together founded Milk Like Mine to help women of color with their lactation questions.
Freeman, a Certified Lactation Counselor with Grace Health, sees anywhere from five to six women each week in the clinic setting, the majority of whom are African American or women of color who represent all income and education levels.
“Most moms we are seeing in the clinic are also seeing a white provider and I see them and it’s almost as if their entire body language changes. We are a community because of the way we grew up or the color of our skin and this creates an instant connection,” Freeman says. “It’s like she knows us versus an outsider who she doesn’t think will understand, which makes it difficult to share her concerns.”
Williams says it was not unusual for new mothers, who are women of color, to tell their healthcare providers during initial follow-up appointments that everything is going well with regard to breastfeeding or bottle-feeding their babies with breast milk, even if it's not.
“They were telling the providers everything was going great or that they’d be feeding every two hours but numbers on the scale when their babies were being weighed were saying something completely different and we would go in and get a completely different story,” says Williams, a Certified Lactation Specialist and co-founder with Freeman of Milk Like Mine
, a breastfeeding coalition for women of color in Calhoun County.
“They would tell us that things were not going well at all. There was this visible moment when you just saw them relax and talk openly about what was really going on.”
If the numbers look great, Williams says that also presents a problem because the provider may not call in a lactation representative who can connect the women to other resources the provider may not make them aware of.
In her 20-plus years in the nursing profession, Sekeita Lewis-Johnson, a co-founder of the Southeast Michigan IBCLC’s (International Board-Certified Lactation Consultants) of Color from the Detroit area, says she remembers one incident early when she saw a nurse bottle-feeding a baby in a hospital nursery even though the mother wanted to breastfeed.
“One thing that’s always bothered me is that women are asked in the hospital if they are going to bottle or breastfeed. Healthcare professionals have the opportunity to see everyone’s feeding choices and very few times do you have someone who says they only want to formula feed,” she says. “The bottle doesn’t necessarily equate to formula because women can pump their breast milk to put in a bottle.”
This is when the role of a lactation counselor or specialist becomes necessary because they can share this information and present different options. Freeman says too often providers don’t ask a new mother why they may be choosing formula over breast milk and don’t discuss the feeding options until the baby is born.
“They are trying to do our job before we even enter the room,” she says. “By the time I go in there I have to do all that and have to reassure the mom that breastfeeding is OK. We are reassuring, not promoting, breastfeeding.”
“It’s our responsibility to let them know that lactation support is a resource, but also has representation that looks like you,” she says. “We have to hit the ground kind of hard to let providers and hospitals know that we are out there and willing to help as soon as the hospital discharge to do virtual visits.”
There is a lot of research that discusses how implicit bias and racially discordant relationships impact the way that a lactation professional interacts with and delivers care to women of color, particularly African American women, Lewis-Johnson says.
“I’ve seen it and I’ve witnessed it as a person who works alongside nurse practitioners and pediatricians,” says Lewis-Johnson, who earned her Doctorate degree in Nursing last year. “I would say that a lot of it is about race and the inability to treat a person as a person.”
After reading a patient’s chart, she tries to erase everything from prior consultations and go in with an open mind. She calls this a cultural humility of care model.
“I don’t know if they lack support at home, have been displaced from their home, or what kinds of other challenges they may have,” Lewis-Johnson says.
Williams, who works fulltime with Milk Like Mine, has been conducting virtual visits and could see upwards of five women during the week. She and Freeman are both on call and it is not unusual for either of them to answer a call for assistance in the late night or early morning hours.
Meeting virtually has its pros and cons, Freeman says, “because there are certain things you can’t really see over video, so it makes it hard to assess latching on. Most of what I deal with is supply and I ask her to plug in the pump and see how much she can pump. I can share the screen and put a video on and show good latching so I’m making sure I’m giving the correct information and solving the problem.”
The silver lining of the virtual capability is immediate accessibility, Williams says. She has gotten calls from women who don’t have transportation and are experiencing breast pain and she has been able to talk them through their concerns even at one in the morning.
Their work also includes ensuring that women have necessary equipment and supplies such as breast pumps. Milk Like Mine has what Williams terms a “modest budget” and works through partnerships with other groups in Michigan, including the Michigan Breastfeeding Network and Sisters Across Michigan in Lactation, to access supplies. She says Milk Like Mine is planning a fundraising event focused on raising money to cover the cost of supplies. MLM also is part of Mi Milk Collective, a statewide group led by lactation groups that represent many races and ethnicities throughout the state of Michigan dedicated to serving Black and Brown families.
The profession takes off
Lewis-Johnson says lactation counseling as a profession didn’t take off until the 1980s. When it did, she says, it was a predominantly white-led profession similar to breastfeeding support organizations at the time such as La Leche clubs.
She says the real turning point came when then-Surgeon General Regina Benjamin issued a call to action in 2011 to increase support for breastfeeding that included women of color and those who support their efforts.
Among the barriers for African Americans and people of color who wanted to break through that white ceiling was the cost of earning the necessary certifications and credentials.
“You do not have to have to a (Registered Nurse) certification to be an IBCLC (International Board-Certified Lactation Consultant), I was an RN before I became IBCLC but most of my colleagues are not and what that leaves them with is trying to be creative and find positions in the community so they can make a livable wage,” Lewis-Johnson says. “They either start doing it on their own as consultants or form an LLC company of some sort.
“This is a national concern. If you’re not licensed, it leaves the IBCLC trying to see how they can make ends meet.”
The words “International Board Certified” are the gold standard for lactation professionals and what is needed to be able to say that you’re credentialed and skilled to provide lactation support.
When the lactation profession became more racially diversified additional obstacles were put in place, including the preference for an RN license. Prior to this, Lewis-Johnson says lactation consultants working in hospitals did not have to have an RN license.
Organizing for change
Freeman and Williams first got to know each other while working for Calhoun County’s WIC program beginning in 2011. They say the lack of support they encountered as breastfeeding mothers is what prompted their decision to form Milk Like Mine in August 2019.
Earlier that year, Williams attended a national conference on breastfeeding and says she had an epiphany while listening to women from all walks of life – some who were peer counselors and lactation specialists. She says Freeman’s passion mirrored hers while they were working in the clinic.
“We were working in the clinic and seeing these disparities in the infant mortality rates and seeing the differences with Black and Brown women and we wanted to improve things for these women in our community,” Williams says.
“All of the statistics still show that infants born to Black and Brown mothers have a higher mortality rate than those born to white mothers.”
The Southeast Michigan International Board-Certified Lactation Consultants became an official group in 2018 for similar reasons, Lewis-Johnson says.
“As I started to advocate for non-licensed IBCLCs what I noticed was that there was some professional growth necessary and opportunities for me to be a mentor to new lactation specialists and also create and offer some fellowship,” she says. “Our mission is to be a collective to support one another and support professional growth. If there’s a clinical issue or a case study, we want to be the go-to people for that for anyone who wants to be a lactation specialist.”
The 14-member organization is working towards establishing nonprofit status. They partner with the Michigan Breastfeeding Network which provides some financial support and acts as their fiduciary when they have fundraisers. What isn’t covered through these sources comes out of their own individual pockets.
Members of the Southeast Michigan International Board-Certified Lactation Consultants are all in private practice and cover for each other if a client outside of their normal practice needs to be seen. They also do pro bono work and will not turn anyone away based on their ability to pay for services. Lewis-Johnson recently drove from her home in Farmington Hills to Flushing to provide services to a low-income client who needed help.
During the pandemic, they have been the only lactation professionals in southeast Michigan providing in-home services while adhering to strict social distancing guidelines. They have been distributing donated supplies of hospital-grade breast pumps and nipple shields throughout their community and recently began a program to transport breast milk from mothers to their babies who are in Neonatal Intensive Care units or in foster care.
“When we see needs in the community, we pretty much act,” Lewis-Johnson says.
Providing care and support
In addition to many of the visible challenges being dealt with, lactation professionals also are dealing with hidden cultural and societal differences that impact women of color to a greater degree than white women.
“We are seen as we’re supposed to have it all together. We’re more of a private community that’s encouraged to ‘fix it on your own and don’t ask for help,’” Freeman says.
Williams says there is the sexualization of the female breast that comes into play in the Black and Hispanic cultures.
“I’m part Latina and we are taught to be modest,” she says. “In the Black culture, if you’re showing too much you are ‘fast’, meaning that you’re out there trying to get attention from boys. America is such a sexualized place. If you’re in public and breastfeeding, that’s seen as immodest and you need to cover up.”
Some women who breastfeed in more private locations, such as their homes or a family member’s home, are made to feel like they’re doing something wrong because people see a breast without stopping to think about the nourishment it is providing to the baby, Williams says. So, in addition to supporting the new mom, lactation consultants and specialists also work to educate the whole family or whomever a woman’s breastfeeding supporter may be about the importance and advantages of breastfeeding.
The critical nature of this support is underscored by a Milk Like Mine’s Sistah to Sistah Breastfeeding Club that meets at 6 p.m. on the fourth Thursday of each month. The club had been meeting in-person and switched to virtual gatherings to comply with state mandates to stay home to slow the spread of the coronavirus. Club members also engage in a collaborative support group, also being done virtually, with the Southeast Michigan IBCLC’s every Saturday.
Numerous studies have shown the benefits of breastfeeding for both the mother and the baby. In remarks Benjamin made during her call to action she said breastfeeding is “one of the most highly effective preventive measures a mother can take to protect her child and her own self.”
Research has shown that breastfed babies are less likely to develop asthma. Breastfeeding also has been shown to reduce the risk of sudden infant death syndrome and the risk of obesity later in life.
Benjamin said, “For mothers, breastfeeding reduces the risk of both ovarian and breast cancer
Williams refers to the colostrum, the first form of milk produced after giving birth, as “liquid gold” because of the antibodies it contains which protect newborns from disease. This has become especially important given the pandemic.
For those women who aren’t able to breastfeed, Williams says it’s the job of the lactation professional to “meet them where they are and allow them to make an informed decision. Sometimes it’s anatomy and personal circumstances that are an issue. You don’t mom-shame them or their personal choices. We have a mom who never breastfed who is a member of MLM because she wants the other women to know that while she was not given education about breastfeeding, she thinks it’s important and wants to be part of the change.
“We do the work we do because we want everyone to know that women of color in Battle Creek breastfeed too and we want them to know that there is support available for them on their breastfeeding journey. And we want people to know that we are a resource. We know that our babies can be stronger, be healthier, and live longer with this support.”
Members of the Southeast Michigan International Board-Certified Lactation Consultants, pictured from left: Sekeita Lewis-Johnson, DNP, FNP-BC, IBCLC; Shonte Terhune, BS, IBCLC; Tameka Jackson-Dyer, IBCLC, CHW; Renee Pearson, IBCLC, CHW; Jennifer Day, IBCLC; Mia Roetherford, BS, IBCLC. Not pictured: Micia Eddins, IBCLC, CLS and Keana Wright, MPH, RN, IBCLC