Carry a Baby, Change the World

by Uncategorized

Sometimes the most globally-appropriate and cost-effective innovation requires looking at the simple tools of our past rather than creating a new solution for a problem that has already been solved. 

Sometimes the most globally-appropriate and cost-effective innovation requires looking at the simple tools of our past rather than creating a new solution for a problem that has already been solved. 

Low rates of lactation and high rates of postpartum depression contribute to perinatal mortality and morbidity globally and are exacerbated by underlying social and structural factors. Black, Indigenous and global majority communities face a disproportionate burden of these postpartum disparities. Yet most interventions to support lactation and postpartum mental health are based on models of care that are unrepresentative of the traditional and cultural practices of Black, Indigenous, and global majority communities. 

Earlier this fall, I went to a conference highlighting the newest technology-based innovations in women’s health, to talk about quite possibly the OLDEST technology developed for the period after birth: baby carriers. Keeping a baby strapped to a caregiver’s body with a textile device, known as “babywearing,” “backing,” or simply “infant carrying” has likely existed since the beginning of human history and is still practiced around the world. 

Despite how long this tool has shaped human childrearing and postpartum health, it has been completely neglected by mainstream postpartum care systems. One reason that traditional and cultural postpartum practices have been left out of the medical standard of care is that these practices are largely neglected in the scientific literature, leading to a dearth of clinical understanding of the potential benefits of such practices. Let’s not forget that the other primary reason that practices like infant carrying have been left out of mainstream medical models is the white supremacy culture that undermines and erases many traditional practices.

This lack of cultural understanding or humility creates tension between biomedical systems of care and traditional systems of care.

This lack of cultural understanding or humility creates tension between biomedical systems of care and traditional systems of care. As an infant carrying researcher, it feels like there is an urgent need to accurately document the risks and benefits of this practice. Thus far, our scientific examination of this practice has shown nothing but benefits for physical and mental health, parental responsiveness. Next step is to keep shedding a light on the evidence-based benefits and clinical applications of this practice and work to make it equitably accessible.

Which is exactly what our team has been working on this year. 

The randomized controlled intervention that we published this year showed a *significant decrease in symptoms of postpartum depression* with only just ~2 hours of carrying per day. This new research, published this summer in Journal of Affective Disorders, shows a PREVENTATIVE solution for the #1 complication of childbirth, and one of the biggest causes of preventable maternal mortality. 

It is also the basis for a project that earned us a place as a finalist in the NIH IMPROVE Initiative’s Connecting the Community for Maternal Health Challenge. This honor came with one year of coaching and support to build our organization’s research capacity. Even after 5 years in a rigorous PhD program at UCSD, I can honestly say this is the most comprehensive research mentorship I have received. Program Director Aver Yakubu and I meet weekly with the NICHD team to develop and launch the next phase of our carrying research in partnership with Global Communities and Healthy Birth Initiatives. 

But the purpose of Nurturely is not just to conduct research, it is to connect the research to the community and use it as a tool, alongside lived experience and cultural wisdom, to eliminate disparities in postpartum and infant health. 

In early 2024, we are launching our self-paced infant carrying course for birthworker, educators, healthcare providers, and anyone who wants to support parents. Using a human rights framework, the course will support any type of professional that works with parents in being able to share the evidence-based results of baby carrying with their networks. Sign up here to be the first to know. 

Nurturely Statement Against Genocide

by Position StatementsUncategorized

Content warning: The following statement contains disturbing statistics, information, and imagery. While we encourage connection to our global community in an effort to motivate collective action to end genocide, secondary trauma has real, lasting effects especially during pregnancy, and therefore especially discourage pregnant people from reading any further. 

Women, birthing people, and infants disproportionately feel the impacts of violence, war, and atrocity crimes like genocide. The more we know from epigenetics, the more we know that this is not only the acute devastation of death, disease, and the direct trauma of living in a warzone, but that these effects – even of secondary trauma of simply witnessing this devastation – persist across the lifetime and across multiple future generations. Nurturely, as an organization committed to equity in perinatal wellness, recognizes that local perinatal equity will not be achieved without a global end to human rights abuses. 

The Nurturely team feels the devastation echoing around the world as the global community has witnessed the recent loss of life and severe human rights violations against civilians – many of whom are women and infants – of Palestine, The Democratic Republic of Congo, Ethiopia, Haiti, Sudan, and Ukraine. These recent atrocities add to the long list of international human rights abuses during the past century including to Tutsis and moderate Hutus in Rwanda, the people of Cambodia, the Herero and Namaqua people of Namibia, the Rohingya of Burma/Myanmar, the Jewish population of Europe, the people of Armenia, and Bosniak Muslims of Srebrenica. These global human rights violations, genocidal attacks, and acts of atrocious violence are felt disproportionately by pregnant people and infants both locally and globally.  

Here in the US we still live, despite our collective failure to acknowledge it, with the consequences our history of genocide and enslavement. So much of the work Nurturely and our partners do everyday is in response to the lasting harms in perinatal health from these unaddressed massive crimes against humanity. Just last week the CDC announced that the neonatal mortality rate has increased, with the rate of mortality for Black and African Americans still significantly higher than all other groups and with the mortality rate increasing significantly (21%) for Indigenous Americans. 

These global human rights violations are felt disproportionately by pregnant people and infants both locally and globally.  

Death & Devastation

In Ethiopia, recent reports document that entire families have been killed and relatives have been forced to watch horrific crimes against their loved ones. Since November, this escalated violence in Ethiopia has included mass killings, rape, starvation. In Gaza, as one example, Ministry of Health Data reported by the World Health Organization confirms that the majority of deaths have been women and children, representing 67% of the casualties as of November 3rd.  Photos have circulated of newborn infants dying as they are removed from incubators that have lost power are just one particularly grim example of the many ways that living in a warzone affects reproduction and perinatal health. In Sudan, independent military group Rapid Support Forces has reached El Fasher, the only major city in the Darfur region still outside its control. Civilians in El Fasher fear for the worst as the RSF and allied Arab militias have deliberately executed civilians, raped women, looted and burned towns, and targeted hospitals. The Economist reports on the genocide in Sudan: “When they saw her 15-month-old son strapped to her, they shot him dead as he clung to her. The bullet burst through his tiny body and into hers, where it remains lodged.”

Displacement

Almost 780,000 individuals and families fleeing war are being hosted by UNRWA, seeking protection and safety, although more than 60 of the 150 United Nations facilities have been impacted by attacks and 10 have been directly hit. Early assessments from UNRWA estimate 12,000 cases of diarrhea and 22,500 cases of acute respiratory infection among infants displaced as war victims. As both of these can be prevented with exclusive human milk feeding directly from the body, the importance of global, preventative, systemic support for lactation is one critically supportive mechanism in an overall dire situation. In Ethiopia, whole communities have been displaced or expelled from their homes and have been separated from resources due to the destruction of schools and medical facilities and arbitrary detention. Often displacement camps are the target of further attacks, which has been the case in Sudan where the killing and raping of many internally displaced people has been rampant. 

Transgenerational Trauma

Even before the current attacks,  infants, children, and families were at the center of ongoing attacks and human rights violations, with the majority of children experiencing both personal trauma, as well as experiencing secondary trauma by witnessing the trauma of others. In pregnancy, no matter how far away the direct trauma is being felt, the stressful experience of witnessing or imagining such trauma can have irreversible effects. Through epigenetic mechanisms of gene expression that are shaped by the environment, these effects of war are transgenerational, being felt for generations to come. 

The question is demanded of us: what could solidarity across borders and across the walls of violence thrown up by governments and armed forces look like? 

Global <> Local Connection

Pregnancy, birth, and postpartum are global, universal, and deeply cultural human experiences. Achieving perinatal health equity requires not only local activism and change, but a feeling of deep connectedness to places directly impacted by country-wide war and genocide.  Genocide is a reproductive justice issue and will not end without global demands for action. 

Healthcare & Birthworkers 

Living in a warzone with the effects of displacement, lack of clean water, blackouts, and lack of access to food and medicine, perinatal care is disrupted if not completely nonexistent. The estimated 50,000 pregnant people in Gaza are forced to deal with not only the psychological trauma of living in fear and rubble but also must deal with the physical complications of this lack of access. In Gaza, it is estimated that 180+ parents give birth every day, turning childbirth into a life or death scenario. The few hospitals that are open are operating in fear, as some hospitals have been directly targeted by attacks.  The toll of this warzone on birthworkers and all people providing services to infants, parents, and families cannot be overestimated. Birthworkers and healthcare providers have a long history of the heroic labor of providing direct support in situations where their own lives and livelihoods are directly compromised. 

As an organization committed to tackling global oppression as a root cause of perinatal health inequities, and providing training and support to birthworkers and healthcare providers locally, we stand in solidarity with the service providers working in warzones, and our heart goes out to the expectant and new mothers living through this nightmarish reality. 

Culture, Choice, & Policies

by Human Milk is a Human Right

The “Choice” to Breastfeed

There is often still confusion about lactation advocacy. Some things I often hear are: Are you anti-formula? Are you anti-choice? The idea that breastmilk vs formula is a “choice” is wildly misleading. In fact, only those who have the most privilege (with regard to racism, culture, family structure, income, ability, geography, etc) actually get to make the choice between human milk and formula. Most often, both in the US and around the world, parents become dependent on formula due to predatory marketing, lack of culturally relevant support and education, racism in perinatal care, historical trauma that impedes breastfeeding, lack of proximity to or knowledge of donor milk, and/or having to return to work too soon.

Among families who have the privilege of avoiding these barriers and others, it may actually be a personal choice between formula and breastmilk. But are those families truly informed of the risks associated with infant formula? The health risks of formula are so great and so well-established that researchers cannot ethically do a controlled study comparing breastmilk vs formula. Yet this understanding of the qualitative and indisputable differences between human milk and formula often don’t reach parents.

Our goal at Nurturely is to make it common knowledge that human milk access should be a human right. With this framing, it becomes more clear that this is a fight that everyone has a role in, regardless of how you personally feed your own baby or whether you even have babies at all. Join the conversation on this human rights issue that connects humans around the world. 

Policies x Culture

Policies supporting lactation have been slowly increasing, which is of course fantastic and very needed. And as much as I want to celebrate and support these policy advances, they’re falling support of 1) being equitably implemented, and 2) getting at the cultural change that needs to happen to be truly effective.. At its core, lactation is a cultural practice and so the solutions that aim to increase equitable access to lactation and human milk must shift culture, not just change rules or structures. 

As one example, corporate, state, and federal policies now support milk expression in the workplace (e.g., ACA, PUMP Act) and are associated with increased lactation duration (Kim et al., 2019), yet structural racism has created disparities where Black lactating parents are more likely to work in the service or transportation industry in jobs with less flexibility in comparison with white parents who are more likely to be in management positions (United States Bureau of Labor Statistics, 2018). This results in an unequal benefit from these policies, making education about and equitable enforcement of milk-friendly workplaces critical to health equity and racial equity (Johnson, Kirk, & Muzik, 2015). Among birthworkers and healthcare professionals who provide the majority of care to perinatal patients, almost none are required to obtain – or are routinely provided with – any training in lactation in general, much less milk expression specifically. Due to lack of expertise plus a lack of continuity between these providers, parents often receive conflicting messages and guidance about milk expression, a lack of coordination that threatens lactation and human milk access (NACCHO, 2021). 

Another example is the legislation and structural change of providing lactation rooms in airports. The Friendly Airports for Mothers Act was signed into law in 2020, requiring airports to have a private space for pumping and breast/chestfeeding. The easy-to-implement and compliant solution came in the form of a lactation pod, now seen widely across most US airports. Though structurally and systemically, this law and the corresponding solution are creating infrastructure to benefit lactating and pumping parents, let’s also look at the cultural message these pods are sending: 

– lactation/pumping should be shut away, out of public view

– lactation/pumping should be done alone

– lactation/pumping is a thing that happens at a specified and time

These messages are neither accurate nor supportive of the biology, psychology, and culture of how humans feed babies. 

– Is this law a win for parents and health equity advocates? YES!

– Is the lactation pod an easy and affordable solution for airports to stay compliant? YES. 

– Is it true that many parents would prefer feeding/pumping alone in the privacy of a pod? Of course. 

The long term goal should be cultural change, building a society that welcomes and supports feeding and pumping anywhere, anytime, and we all have a role to play.

Reach out to us to brainstorm how you can support a culture of lactation at your workplace, community group, or other public space. 

Relational Culture

by Research

cancel culture: the act of damaging someone’s life or career because they made human error

 

–   urban dictionary

 

In this day-and-age, it would be nearly impossible to have not witnessed firsthand the modern phenomenon of cancel culture. Cancel culture operates under the guise of accountability, yet the process by which cancel culture occurs lacks enough integrity to actually be supportive of any sort of true accountability. When a person or institution is “cancelled” due to a past or current mistake or even intentional harm, they are boycotted and publicly humiliated. But at Nurturely, we align more with the goals of accountability culture. Accountability culture, according to Urban Dictionary (which to be clear, is a crowdsourced – not a peer reviewed – source of evidence) means: “when a person is held accountable for their words or deeds by losing privileges such as jobs, book deals, social media followers, etc.” We love the concept of accountability culture because it supports growth through the enforcement of consequences. Consequences are necessary! Focusing on accountability does not demand perfection, it just acknowledges that when mistakes are made, people and institutions MUST admit their wrongdoings and take steps toward future mitigation of such transgressions or wrongdoings. In this way, accountability culture supports the creation of positive change – while cancel culture does not.  

 

Nurturely’s values are built on a foundation of accountability. Every policy in our team handbook references the culture of accountability on the first page. Every volunteer, intern, employee, or board member who is interested in getting involved at Nurturely goes through an equity and accountability screening. Every collaboration we start articulates clear shared goals and shared understanding of values before we move forward. These screenings and standards don’t demand perfection (from either side!), they just require a set of shared values and a desire to learn and be accountable when mistakes are made. When this shared understanding of values has been breached by either party, we go back to the drawing board to reassess where accountability was lost and whether values are in fact still in alignment. Although we have strict values of active antiracism and intersectional inclusion, we also support growth in these areas and deny the requirement of perfection. Accountability culture, but not cancel culture, allows for this.

 

But let’s take it a step further. What both cancel culture and even accountability culture are lacking is one thing: relationships, and direct honest communication. Cancel culture operates, pretty specifically, in the very anonymous (and often outraged!) spheres of the internet. Accountability may manifest publicly, or it may be confined within the structures or social networks that are most impacted. This can be both good or bad, given that public accountability can be important and relates to transparency, which is a critical component of accountability.

 

What relational culture adds is the nuance between public and private, the important factor of human connection, as emphasized by Nurturely Equity Lead Ayisha Elliott and outlined beautifully by Relational Uprising. Whether the process of accountability is completely private or completely public, these both can occur without an actual, face-to-face exchange. We are omitting the human connection in the process of accountability. At it’s core, this negates the humanity that is required for the work of antiracism and intersectional inclusion. Relational culture demands that the human connection is centered and prioritized.

 

Recently, a well-respected leader in the field of birth equity was put under the fire of cancel culture for posting an incendiary article on public social media. The article proclaimed a rejection of transgender inclusion, with the purported motivation that transgender inclusion goes against the protection of Black women and that policies such as genderless bathrooms cause harm for Black women by perpetuating the culture of rape and sexual violence against all women, but in particular Black women. While we absolutely acknowledge and take very seriously our current culture of sexual violence, and acknowledge that Black women are in fact disproportionately impacted by rape and sexual assault of all types, this article was misinformed at best and violent and exclusionary at worst. However, our approach is to lead with curiosity, and practice transparency, human connection, and direct communication. These approaches led to a 2+ hour face-to-face conversation between myself and this leader, followed a few weeks later by a 3+ hour conversation between Nurturely Equity Lead and this leader. Through a relational approach, we sought to understand the purpose behind this posting, the actual beliefs held by this person on this issue, and the specific implications for both the thousands of birthworkers (many of whom are transgender and nonbinary) who have trained under her as well as the much smaller but still important partnership that we had in place for training and supporting a multicultural cohort of birthworkers at the Nurturely Lounge in Oregon. Through our conversations, both Ayisha and myself learned that: 1) she had not actually read the article and posted it without understanding where it had come from or what it actually meant, 2) she has a deep love for all people who are committing to birthwork and especially those training with her, and 3) there was accountability to the fact that generational, religious, and cultural perspectives have shaped some misunderstandings regarding the modern conversation on gender expansion and inclusion, and most importantly 4) there was a clear desire to learn and expand her knowledge on this topic.

 

Through these conversations, we not only took into account a misplaced and ill-informed article, but considered the breadth of culture and experience that was represented in the work of this leader, elder, and tireless advocate for birth equity in Oregon and across the world.

 

Relational Uprising shares that the framework of relational culture allows us to “explore identity as both an important site of inclusion and justice, and as a complex reality rooted in a long history of social construction and division, exploring how we can reclaim and honor together the stories that make up each of our lives, lineages, legacies and organizations.” This resonates. While cancel culture would have immediately turned to boycott and rejection, a relational approach led to accountability and resource-sharing for learning. We have decided to move forward with a continued partnership for these reasons.

 

To be clear, sometimes “cancelling” is warranted, especially when accountability is incomplete and relationships are unprioritized. But at Nurturely, we will always make sure that before cancelling, a relational conversation, an opportunity for accountability, and a space for shared humanity and intentional growth are co-created. Only then, can we make progress toward these massive goals of an antiracist and inclusive society.

Recent Research Summary: High Temperatures and Perinatal Health

by Planetary HealthResearch

Learn about the connect between climate change and perinatal health through a summary of a recent article titled “Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis” by Chersich et. al.

A recent study from Chersich et. al found that heat exposure can affect perinatal health and possibly children’s health especially for those birthing people who are of lower socioeconomic status. This is particularly concerning given the temperature rises due to the ever-increasing threat of global warming.

Previous research has found that changes that inhibit a birth person’s ability to regulate their temperature, known as thermoregulation, can raise the risks of adverse pregnancy outcomes. Vulnerable groups are unable to limit their exposure to extreme heat, making them particularly vulnerable to the increasing temperatures due to global warming.

The systematic review or metanalysis study published in September 2020 titled “Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis” by Chersich et. al added to the previous research by finding that “exposure to high temperature is associated with an increase in adverse pregnancy outcomes, especially preterm birth and stillbirth, and among women in lower socioeconomic groups”.

The study’s authors looked at 14,880 records and 175 full text articles including 70 studies in 27 countries, seven of which were low- or middle-income countries. Using this method, the researchers found that:

  • In 40 of 47 studies examined, preterm births were more common at higher temperatures.
  • For every 1°C increase, the odds of a preterm birth and stillbirths rose 1.05-fold.
  • Associations between temperature and outcomes were most evident among those in lower socioeconomic groups and those birthing people of relatively old and young age.
  • In 18 of 28 studies examined, higher temperatures were associated with smaller birth weight.

In conclusion, this study adds yet another negative affect of the global climate emergency; perinatal health and indicates that children’s health may also be affected by the heat exposure during the pregnancy of their birth parent.

To read the full paper, visit https://www.bmj.com/content/371/bmj.m3811.

Nurturely recently hosted a panel discussion on the intersection of perinatal health, planetary health, and racial and social justice. To learn more about this session and receive a recording, visit nurturely.org/planet/ and register.

Racism, Birth, & Supporting Black Midwives

by Equity in Perinatal Wellness

In the United States, African-American, Native American and Alaska Native women are about three times more likely to die from pregnancy-related causes compared to white women, according to the Centers for Disease Control and Prevention (CDC), yet sixty percent of all pregnancy-related deaths could be prevented (Rabin, 2019). These statistics hold even when controlling for other factors including income level (Watson, 2019).

The youngest baby separated from family at the US-Mexico border was four months old

Nurturely’s Position on Families at the US-Mexico Border

by Position Statements

During 2019, Americans watched in horror as children of all ages were forcibly separated from their parents at the U.S.-Mexico border. While much of the early 2020 news coverage has now turned away from this abhorrent treatment of families along our southern border, Nurturely is committed to ensuring that ALL babies have the ability to thrive. Therefore, Nurturely will continue to call attention to the ongoing humanitarian crisis at our border detention facilities. Nurturely strongly condemns the cruel family separations at the U.S.-Mexico border as well as the intolerable conditions of migrant detention camps.

The youngest baby separated from family at the US-Mexico border was four months old

Decades of research show that childhood trauma, especially in infancy, can create lasting long term physiological and psychological damage. The trauma of separation, as well as detention with congregate care (24-hour residential facilities for groups of children), does not the support healthy brain development. Congregate care prevents the child from bonding with caregivers. There have been reports of harsh conditions without basic provisions at border detention facilities. Children in these centers have already been screened to display “developmental delays and signs of emotional disturbance such as a short attention span, aggression, withdrawal, difficulty coping, and learning difficulties” (Zero to Three). The detrimental effects of stress cannot be buffered by familial connections in these detention settings; the only safe placement is in a family-like setting.

Short term effects on children of forced parental separation and placement in incarceration-like settings include:

  • Anxiety
  • Depression
  • Self-regulatory issues (such as sleeplessness or eating issues).

Longer-term consequences of these traumatic experiences include:

  • Behavior and cognition regression
  • Symptoms of post-traumatic stress disorder (PTSD).
  • When not addressed by a medical professional, these childhood traumas can lead to:
  • Increased risk for learning difficulties
  • Problems forming relationships
  • Adult health issues.

Given this compelling research, Nurturely actively advocates for the following policy changes:

  •  Families who have been separated should be reunified immediately and the practice of separation stopped. While the Executive claims that this practice has stopped, it is unclear if this is true.
  • Young children who have been held in detention and/or separated from families should immediately receive mental health services and support. It should be presumed that children who have experienced detention and/or separation have experienced life- changing trauma and are treated accordingly.’

About the author: India Olchefske, MPH, has a Master’s in Public Health from George Washington University and a Bachelor’s from the University of Chicago. Her graduate thesis focused on how the opioid epidemic affects rural pregnant women. She has worked at a variety of direct service, research and policy organizations with a focus on women’s and maternal health. She is currently pursuing a career as a ballet dancer in addition to public health.