EBB 237 – Infant Feeding and Meeting your Community where they’re at with Family Nurse Practitioner and IBCLC Nikki Hunter-Greenaway

• Nikki’s FNP and IBCLC practice: Nurse Niki NP
• Cafe au Lait in New Orleans
• Follow Nikki on Instagram @nursenikkinp and on YouTube at “Nurse Nikki NP” 
• EBB 189 – Why Black Lactation Matters and the Importance of Black Breastfeeding Week with IBCLC, Janiya Mitnaul Williams 
• WHO International Code of Marketing of Breast – Milk Substitutes 
• Go to our YouTube channel to see video versions of YouTube episodes you listed above!!

Rebecca Dekker:

Hi, everyone. On today’s podcast we’re going to talk with board certified family nurse practitioner and IBCLC, Nikki Hunter-Greenaway about the formula shortage this year and meeting your community at where they’re at. Welcome.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Decker and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See evbirth.com/disclaimer for more details.

Hi, everyone. My name is Rebecca Decker pronouns she/her and I’ll be your host for today’s episode. Today we are so excited to welcome board certified family nurse practitioner and IBCLC Nikki Hunter-Greenaway, also known as Nurse Nikki. Before we interview Nikki, I want to let you know that if there are any detailed content or trigger warnings, we’ll post them in the description or show notes that go along with this episode.

And now I’d like to introduce our honored guest, Nikki Hunter-Greenaway, pronouns she/her, AKA Nurse Nikki, is a board-certified family nurse practitioner and International Board Certified Lactation Consultant. Nikki is the proud owner of Bloom Maternal Health, which provides Telehealth and house calls to pregnant and postpartum families in both Texas and Louisiana.

She’s the co-founder of the New Orleans Breastfeeding Center and Café au Lait Breastfeeding Circle for families of color. In 2018 she co-founded Nikki and Nikki Lactation Career Consultants to help Black, Indigenous, and People of Color demystify the path to becoming an IBCLC.

Her goal is to improve maternal health outcomes through community education, peer mentorship, and patient-centered care. I’m so thrilled that Nikki is here to talk with us. Welcome, Nikki, to the Evidence Based Birth podcast.

Nikki Hunter-Greenaway:

Thank you so much for having me. I’m so excited to be here.

Rebecca Dekker:

We are so excited to learn from you today. And I know I first heard of you and started following you knowing you as a fellow nurse. So I wondered if you could kind of start by talking about your nursing journey first and then we’ll get into the lactation consultant training that you did. What led you into nursing as a field and then becoming a family nurse practitioner?

Nikki Hunter-Greenaway:

Yeah, so actually this year I celebrate 15 years of being a registered nurse. And then I celebrate 10 years of being a nurse practitioner. So it’s a pivotal year for me in the world of nursing. But I started my nursing career as my second career.

So, I was originally a case manager at a homeless shelter for women and children. That is my background. That’s what I came out of college doing. I had a degree in sociology from Northwestern and Chicago. And even before then in high school, I worked with unhoused under-resourced families at homeless shelters. And I can’t even tell you exactly how I got into that work, but it’s something that fed my soul, even as a high school student. I started a summer reading program and all these things, and I really have dove into maternal child health.

Fast forwarded to through college I, again, worked with mothers and babies through volunteering and things like that. So I guess I kind of knew that it would be something in my, just to stay it with me in my DNA, and I was, like some nurses, was supposed to be a pediatrician. And I actually did a study abroad program at the University of Sussex in Brighton. And it was a premed program and I was there and I only worked with nurse practitioners.

And I said, “Wait, just a minute. Y’all are doing some of the same things that doctors do.” And so from there, I went back to school at Northwestern, they didn’t have a nursing program, which they had dissolved years before. And I said, “Well, I want to be a nurse practitioner.” I like the community aspect of it. I like the nursing model mixed with the medical model, that really spoke to me and my personality.

So, I left there and went to, I graduated from Northwestern with my sociology, and I went to Loyola in Chicago and got my nursing degree in one year. I did a accelerated program. And in that program, I dove more into the maternal health part because I understood child health, but I dove more into the maternal health part of C-sections, tons of C-sections, tons of C-sections, maternal mortality, the infant feeding piece of how we’re not feeding our babies. We’re not even encouraging that. We’re just automatically doing.

This was before baby friendly and things like that. And so when I left nursing school, I had an opportunity to come to Louisiana because I’m originally from Dallas, Texas, but I had this opportunity to come to Louisiana to New Orleans a year, no, it was two years after Hurricane Katrina, and it was still struggling.

So going into this space of a children’s hospital, I worked in the pediatric ICU, there was tons of mixed feeding, tons of just formula feeding. And I felt like I had an upper hand of knowing a little bit more than the community because for those that don’t know, Louisiana is number 50th in breastfeeding this year.

Rebecca Dekker:

And that means 50th in terms of the worst?

Nikki Hunter-Greenaway:

Yeah, the worst. Not in any way the best. And we go back and forth with Mississippi. We kind of traded on that. So Mississippi was for 50th a couple years ago. But just going into that and just learning a lot, being in the trenches. For the folks that are over 35, the show MASH about them working in this hospital and things like that. And they’re making stuff that is exactly what we did.

I learned a lot about improvising and helping the community where they are as opposed to having all the fancy things.

Rebecca Dekker:

Working as a pediatric ICU nurse then?

Nikki Hunter-Greenaway:

Yes.

Rebecca Dekker:

And seeing that the babies and kids who needed human milk the most were not getting it? Is that what you were seeing?

Nikki Hunter-Greenaway:

Yes. They weren’t getting it, but they also just weren’t getting the care that they needed. I think the pivotal part for me that moved me out of the hospital was a family, her baby one, was not receiving the human milk that the mama wanted to give, but her baby had down syndrome and he had had just had open heart surgery and the mom was pregnant again. And she said, “Well, I’m about,” we were talking at the bedside and she’s like, “I’m about to go outside and smoke a cigarette.” And I was like, “Oh,” and I said, “Well,” I said, “You know, I don’t think that’s the best idea.” As we had gotten comfortable so I was instructing her about, I was like, “Well, that could be hurtful to the baby and to this baby here.” Secondhand smoke. And she’s like, “No one ever told me that.” I was like, “Wow, really?” I said, “Well, I hope this helps you.” I gave her some facts, shared some information.

Rebecca Dekker:

And you’re talking more about even I think third hand smoke, where when you come back and the smoke is on the clothing, et cetera, that can be really harmful for other people?

Nikki Hunter-Greenaway:

Right. Mm-hmm. And she went on and she went outside and then my nurse manager came to me and she said, “That’s not your job.” I was like, “Really? How?” And she’s like, and I got written up for it. I got written up for talking to and educating the mother. And that’s when I knew that my role was outside in preventative care and community care, which is where my heart had been. But they tell you all the time, you have to start in the hospital. That’s where it is. But I felt like our infant feeding practices were all backwards.

We weren’t providing for the whole family. So I needed to go back into the community. And that’s when I really dove. And that’s when I started my NP as well and really started doing more community care. And that led me all the way to here.

My practice started because I had postpartum depression, and I didn’t have anyone in my community that could help me. There was no one coming to the house. I was struggling breastfeeding because of this depression. I had milk, but it’s just, I couldn’t make it all work for me. So my brother challenged me to be the change that I wanted to see. And so that’s when I started helping families in their homes, going to where they were, literally meeting them where they are, and started bringing up all the experiences that I’ve had throughout my career of working at the homeless shelter, helping the mothers in the hospital, once their medically fragile babies came home, all of that started to culminate into Bloom Maternal Health.  

So, I actually, with Bloom, we actually go into homeless shelters and provide care to pregnant and postpartum families, helping them with infant feeding, connecting them to resources, and all those things. So it really is a culmination of all my experiences over the years.

Rebecca Dekker:

Wow. That just gives me chills, everything that led up to that. Can you talk a little bit about the home visits and the power of that? Because I know in the United States, we don’t really tend to value that, or it’s not even part of normal practice. So did you start doing that as a family nurse practitioner or after you got your IBCLC, when did you start going into people’s homes and actually helping them with infant feeding and infant care?

Nikki Hunter-Greenaway:

Yeah, I did that at the beginning, off the bat as a nurse practitioner. So 10 years ago that’s how we started our practice. That’s how we function now.

Rebecca Dekker:

So, people don’t come to you in the clinic, you go to them at home?

Nikki Hunter-Greenaway:

No. I go to wherever their house is. We’ve been to hotel rooms. We’ve been to shelters. We’ve been, “Meet me over here,” wherever. We go to them because that’s where they’re most comfortable. They chose that place because that’s where they feel most comfort. And that’s where effective care happens when the patient is comfortable and the client is comfortable.

But we started that model because in England, that’s what worked. I spent a whole year there and I was like, “You mean people come to your house?” And they’re like, “Yeah.” And they taught me about the model and how rich it was and really honed in on the concept of meeting the client where they are. So when I came back and doing pediatric ICU and all of those things and then going into NP, some of the part of my community care nursing in nursing school was doing home visits, but to elderly.

And that’s where we kind of… We’ve used that model before, but we hadn’t ever used it in the perinatal setting. Nurse, family partnership, yes. Started to build momentum in the early 2000s but it really hadn’t come to where we came to them all the time and we did it for everyone, it was universal. It was just a part of your care.

Also, we have concierge medicine where people do and they charge an arm, a leg, and a spleen to be seen, but everyone should get that level of care. And that’s what my goal is to give everyone concierge care, you don’t have to have, and we don’t actually accept insurance either. That is billed through the shelter, whichever organization we’re working with, they need to pay for that because that’s the care that’s the standard.

Rebecca Dekker:

Yeah. I was going to say, how does that work financially? Can you bill for a home visit just as you would a clinic visit with the same diagnosis codes, if you were going to be billing insurance?

Nikki Hunter-Greenaway:

Yes. We do for private insurance, like we deal with Blue Cross Blue Shield, all those jazz and we get reimbursed pretty well. But for the folks that can’t afford it or that fit in fall into this gap, period, we either apply for grants as a fiscally sponsored institution, entity, and/or we bill through the organization.

So, we’ve had contracts with the Health Department, and we’ve had contracts with homeless shelters. We’ve had contracts with Healthy Start and with Head Start, they have a prenatal program in Louisiana. So we’ve contracted, they’ve come to us and said, “Hey, we have a grant to do some maternal health stuff. We don’t really know where to start. Can you develop a program for us?” And we develop a program for them where we provide maternal care to them.

Now with that, I got a lot of criticism from people within my space because they say you’re doing lactation work and you’re not even an IBCLC. And that hurt. It really did because I’m like, “How dare you? How dare you challenge me?” Because I felt like I was given evidence based information. I was always going to the source. I wasn’t just pulling stuff out of my butt to…

Rebecca Dekker:

And it’s part of the nursing. It’s about the whole person and health prevention and promotion and infant feeding practices is definitely something that a nurse can do. The problem is most nurses don’t know how to do breastfeeding counseling.

Nikki Hunter-Greenaway:

I had to learn that piece. It’s not something that they teach in nursing school or NP school or anything they just said, “Oh, give your baby breast milk, because it’s really good for them. These are the benefits to them. Go forth and help someone breastfeed.” It’s kind of what they do in medical school also where they like, “Just go forth, help them.” And you’re like, “How?”

I took the extra steps. I had taken all the steps to get the information. It’s just this credential. People really wanted you to have this credential, even within the IBCLC circles of, “You’re not an IBCLC. You shouldn’t be doing that work.” And I’m like, “But I’m trained to do this work.”

I came to a crossroads that either I’m going to get the credential or I’m going to keep telling these people to F off at some point. So my brother, once again, my older brother, he’s like, “This isn’t about you. It’s about the community in which you serve.” And he said, “I feel like this credential is going to add a layer that you’re not even expecting. It’s going to take you and catapult you into a space that you have no idea what it’s going to do for you and your community.”

And so, he was right. He was right. In this space I’m a Black nurse practitioner, IBCLC, I’m probably one, there are less than 50 of us in the world, Black nurse practitioner, IBCLC’s and I feel like the places where it’s allowed me to go to create a breastfeeding center in New Orleans, I felt like I needed that to be in certain spaces of offering lactation support and curriculum support.

I do curriculum development for the Louisiana Department of Health. So it has offered things where I have a broader reach now and are creating Nikki and Nikki IBCLC Lactation Career Consultants with Nekisha Killings.

So, to help more Black IBCLC’s, to create more, to help them along their journey. It’s created some interesting opportunity.

Rebecca Dekker:

Can you talk then a little bit about what you had to do to move from a nurse and nurse practitioner to becoming an IBCLC? How many years of study or practice or paperwork, what all did that involve for you?

Nikki Hunter-Greenaway:

I think it was more paperwork than anything. It was more mental block than anything. It was more mental because I had to convince myself that I needed another credential.

Rebecca Dekker:

You’d already been through how many degrees, like three?

Nikki Hunter-Greenaway:

Three. And…

Rebecca Dekker:

Well, and I think I want to pause there because I think that it’s not necessarily okay that we require people to jump through all these hoops and all the money and the years and the time, and it takes, and that’s kind of a pretty classist assumption that we can just expect people to get three degrees plus another credential in order to help families.

Nikki Hunter-Greenaway:

Right. And here’s the thing. Our families do not care. They do not care.

Rebecca Dekker:

They just want someone to help them.

Nikki Hunter-Greenaway:

Can you help me with my bleeding nipple? Are you qualified to do that? Have you done that before? Yes, I have. But here’s the thing. And as a nurse practitioner, IBCLC before we had entities that will help you bill insurance for your IBCLC, I was the only person in my city that could bill insurance for a lactation visit.

The Breastfeeding Center needed me in order to function. Because if I miss a day, they can’t bill insurance because there’s no provider there because nurse IBCLC’s could not build insurance. And that was just, it didn’t even make sense to me, but my journey into becoming IBCLC was actually because I had all these classes already. I had all the health sciences things done and done over.

It was really the lactation education classes, which I had already a lot of, because I took those, I’m a lifetime learner. So I’m always taking a continuing education somewhere and just keeping it. For me it was really just making sure I had calculated my hours correctly and they took my word for it. I’m a healthcare provider and they don’t really question the situation. You do have to just making to cover yourself. The organizations that I worked with, they would say, “Well, we’ll write letters to help you,” if they say, “Oh, did this person really work these hours?” Of course she did. That’s all she does all day is help clients with breastfeeding. So that was the thing for me.

It was really, and I’m not a great test taker. And I had to… That was, I think, a big hurdle for me, “Do I really need to take another three hour test to say that I’m doing something that I’m already doing?” But I got through it. Because I’m not a great test taker. I kind of have to psych myself into doing stuff like that. And I did not study. And I said, “It would be better for me if I didn’t, I’m going to go for what I know.” And that’s what I did. And I wouldn’t recommend that to anybody and I passed.

Rebecca Dekker:

You passed, but you don’t recommend it.

Nikki Hunter-Greenaway:

I don’t recommend it, but that’s the way my anxiety was set up at the time. I was like, “Either you’re going to spend hours and hours studying and being anxious over the studying, that you’re not studying enough or studying too little, or you just going to dive into it and say, if this is for me is for me.” And that’s where I had to lean on my faith. And I know that’s not the situation for everyone, but I really had to lean on my faith.

I’ve been doing this for years. I have been keeping up with the evidence. I have been doing all of those things. You going to have to rely on what you know. So it was really a test of all the years of my work and all the years of my sweat equity and going into the test and seeing, “How much do you really know?”

Rebecca Dekker:

So, you achieved this goal of becoming an IBCLC and now you’re family practitioner provider, a nurse, and an IBCLC, can you talk a little bit about the challenges you faced as you started doing this practice in Louisiana and Texas? What are some of the barriers you faced or some of the issues you came up with against, in your community?

Nikki Hunter-Greenaway:

Louisiana presented, New Orleans in particular, presented, because I started there, I’ve been there for 15 years it created a situation where I didn’t have… I had to convince people that they should get lactation help. Remember we’re number 50th, or 49th or 50th, we’re at the bottom. So we know people are doing formula. That is the norm. So I had to convince them otherwise. “Growing arose from concrete,” that’s essentially what I had to do in New Orleans, in Louisiana, is because they just didn’t know what they didn’t know. And I’m in here trying to tell them the good news and they’re like, “Uh-huh formulas working.”

So, it really was a hard sale. The other thing was a hard sale, was getting Black and Brown people to buy into what I was saying. Why do I need you to come into my home and take care of me? I have my family. And that is just a cultural response of that’s what we do. We take care of each other. And to have this stranger come in, “What? How is that helping me?” And I was like, “But I have information. I can teach you things.” And sometimes the family doesn’t always give the right information. And that’s just had to been years and years of conditioning saying, “Here’s what the research shows. Here’s trial and error of Oh, you don’t have to give your baby rice cereals. Breast milk is enough. Your baby is going to cluster feed. Your baby is getting enough. That yellow stool does not mean that your baby has an infection.” Constantly putting the information out there.

It helped that it started to become a little bit more mainstream and that we started to see that, and that WIC got on board and all of those things. And we had to have campaigns around it, but it really was a hard sale to my community because we’re at the bottom and they didn’t know what they didn’t know this. It felt very new, even though in our field, we’d been preaching that breast milk was a good option. It was the best option. It should be your number one option, but it wasn’t presented as such anywhere else. Because at that time, Baby Friendly was kind of coming out but people were upset. You know how upset parents were in Louisiana when Baby Friendly started coming? “What do you mean?”

Rebecca Dekker:

And nurses were upset. Here in Kentucky. Oh, my gosh.

Nikki Hunter-Greenaway:

Yes. They were irate. They’re like, “First doula now Baby Friendly, what are you trying to do?” So it really was a hard sell, in the community in general, but to get Black and Brown, I didn’t get… I had been in practice five years and I got my first Black client, my first one, and that I was excited, but then it hurt. I was like, “Dang, what am I doing wrong where I can’t even connect with my community?”

Because that’s all I know. I know my community best and yet I’m not… But I had to change how and just continue and be consistent with the information. And that was what I needed to do, the consistency. And now I would say 95% of my clients are Black and Brown.

Rebecca Dekker:

So you’re seeing if that shift happen…

Nikki Hunter-Greenaway:

Yes.

Rebecca Dekker:

In real time?

Nikki Hunter-Greenaway:

For sure. For sure. And it really is about who you know. If someone had a great experience, they’re going to spread the word. I don’t care how much advertising you do or anything. It’s about how you made them feel and you made them feel, you listened to them, you provided care for them.

But then also, as we started reporting more of our maternal mortality statistics and our infant mortality statistics and morbidity statistics and folks like, “It’s not that the hospital is against you it’s they don’t know what they’re doing sometimes.” And they don’t fully do it. So I am kind of a liaison between hospital and community care, making sure that they’re getting the care they need so there’s no readmission rates, but also communicating back to the hospital, or their provider, “Hey, this is what’s happening in the home. How do you want to address this? Because I can address it on my own or we can work on this collaboratively.”

So that’s kind of how I work through things. Now, Texas, as many know, is a different beast, Texas…

Rebecca Dekker:

They’re close. They’re located near each other, Louisiana, Texas, but you’ve had different experiences there?

Nikki Hunter-Greenaway:

I’ve had different experiences, Texas is, yeah. Maybe that should be our trigger warning, Texas something. But in moving there, I just moved there last year, last July. So still COVID was a thing everywhere else in the United States. And Texas was like, “Nah, it’s not really.” And then we have this whole detention center thing and it was just so many things. And when I got in the abortion situation, so when I got there I’m like, “What is happening here exactly? Who are we really caring for?”

And it’s not the baby. I mean it’s not the mother, it is the baby. That is the care that received in Texas. A report just came out that Texas is the lowest, is at the bottom for maternal care and education and access to care, and I see that, but they take care of the babies, but they don’t take care of the mothers.

And while we see huge, all the breastfeeding information, they’re the gold standard. And as far as their website and the information they give, but it’s who’s getting? And that’s where it really taught me that breastfeeding is a privilege. If you have the information, if you have the support, if you have those things, then you have access to it, but they’re not creating access to people that don’t have it. And that’s what makes it one of the places where it’s the hardest to get Medicaid. The process is just almost impossible and some people just give up.    

So, there’s so many more people in Texas walking around with no insurance, with no access to care. I’m like, “Your numbers are skewed. Something’s going on with the numbers.” We’re not giving good information because we think of Texas as bigger, it’s better. That’s not necessarily the case. And Louisiana’s always been compared to Texas “We need to be more like Texas.” Actually, we need to be more like Louisiana and take care of our folks. We see a problem, we recognize it, we work very hard to resolve the problem the best we can, and put steps in place.

We have a lot of grassroots organizations that on the ground doing the work. And I know that to be a fact in Texas, it’s just that the powers that be above, the non-grassroots organizations, the governmental organizations, man, they really do not listen. They really do not listen. And I see it in how our families are treated in Texas and the care that they receive. It’s a harder system to infiltrate, for me personally, as my practice is being a good troublemaker, it’s very hard for me to infiltrate the Texas system.

It was hard to become a nurse practitioner in Texas. It’s hard to transfer my license from it. I just got it done. They’re very restrictive of anything other than the doctor model, that hierarchy, they’re very restrictive for anyone else to get in there and to provide care.

Rebecca Dekker:

It makes me think about how the hometown can be the hardest place to make change. You said you’re from Dallas. You went to Chicago for school, went back to Louisiana, and really got your practice going there and then went back to Texas.

Nikki Hunter-Greenaway:

I’m like, “What are y’all doing here? You’ve made a mess of everything.” And then for them to be the voice of all the things wrong with women’s health, I’m like, “What is wrong with y’all? Y’all are on the wrong side of history here.” So yeah, that really hurt for that to be your hometown and for them to be acting so ignorant of so many things that could really help the help our communities out.

Rebecca Dekker:

Encourage our listeners, I know you talked about some of the disparities related to Black breastfeeding and I’d encourage you go back and listen to episode 189. We talked with IBCLC Janiya Mitnaul William about historical trauma and the cause of those disparities, because we don’t like to talk about disparities without reinforcing that racism is the cause of those disparities. So we cover that in detail in episode 189. So I encourage you all to go back and listen, if you’re not familiar with that history of oppression and race.

But Nikki, moving on another event that happened in 2022 was the formula shortage, which may or may not be resolved by the time we post this interview and may or may not happen again because it exposed a lot of the weaknesses and the missing links in our systems for perinatal health. So could you talk about what was your experience this spring and summer and how the formula shortage affected you and the families you work with?

Nikki Hunter-Greenaway:

Yeah. It posed a big problem because when you live in a state, in Louisiana, where formula is the first option and the number one option for most people, you kind of trying to, “Okay, let me get this breastfeeding information in here. Let me tell you about it.” But it came across wrong. The message did, even as gentle as you can put it. I think lactation support in these past few months has been hitting a bad note, not any fault to ours, but that’s the way the system is set up. That is the way they’ve created the system to be is that it always pushed formula as a thing.   

Even if we have Baby Friendly, even if we have it, the doctors and all the government, clearly, I feel it hasn’t been a level playing field. Formula and breastfeeding hasn’t been put as equal things or even breastfeeding being the number one thing, it’s always been formula. They’ve created it where it felt like it was superior to breastfeeding.

So now while I’m out here trying to educate people in the midst of a formula shortage, I look like I’m the bad person I look like I don’t care.

Rebecca Dekker:

You look like you’re being judgmental, you think?

Nikki Hunter-Greenaway:

Right.

Rebecca Dekker:

Because people are like, “You’re judging me for choosing formula.”

Nikki Hunter-Greenaway:

I’m like, “I’m not. I’m not. I’m trying to help you with this option that is from your body that you can totally do with support.” Because I always preach that supported families thrive. If you’re supported in your decision, you will thrive because you have all the people around you, positive affirmation around you, that you can do it. But I felt like we were pitted against folks that just, we were not seen in a good light. We are not seen in a good light at this moment. And some of us have kind of retreated a little bit and said, “Do I really want to do this work? I’m fighting up against all these things and our own government doesn’t support us.” Support the work that we do and the information that we’re trying to share. Yes, we have the CDC, but the CDC has lost some credit with this whole COVID thing.

So, we’re trying, I feel like we’re backtracking a little bit and we’re losing a little of our grounding because now we’re seen as unsupportive and judgmental and all these negative things. So even myself, I’ve kind of calmed down. I haven’t done lactation support in a minute just because I’m like, it doesn’t feel good. It does make me feel kind of weird and, not dirty, but just, I don’t know. I’m like, “Am I judging people?”

It made me have to check myself, check my biased, and where I’m coming from. And I’ve used formula. That was my other option having postpartum depression and not being able to breastfeed, pick my baby up to breastfeed, the baby had to get formula from another parent. So I’m not against it at all. It is a part of my community, being number 50th in breastfeeding. So I can’t be against it. I’m just trying to help people in this moment when it may not be available, what your option is, what are your options? This right here. It’s not making formula. It is using your body to feed your baby.  

So, I feel like that’s been a struggle for me and a lot of other, specifically Black lactation specialists, that has been a struggle for us. So it hasn’t been an easy season.

Rebecca Dekker:

It reminds me of some kind of trap that families were almost entrapped into believing that most people should formula feed and not all parts of the United States, but in a major portion of which I live as well and became dependent on it and the structures built up. So that’s what the pediatricians know. That’s what all the stores sell, they’re not selling lactation services. I can tell you that. All the grocery stores and pharmacies and we got to this point where we’ve been made by commercial resources to become largely dependent on formula. And then they just take it away and it’s like it’s your fault. It’s blaming the victim in a way.

Nikki Hunter-Greenaway:

Right. And then we come and try and help. We come out and try to help. And they’re like, “No.” I’m like, “I’m not judging you, friend. I’m just trying to help. I’m just trying to help.”

Rebecca Dekker:

So, what did families in your community do? How severe did the shortage get by you?

Nikki Hunter-Greenaway:

In the two areas that I service New Orleans and Houston. Houston, it was pretty, it’s pretty bad. There’s nothing really out there on the shelves. And in Louisiana it’s dire because a lot of people get formula from WIC and things like that. And even their shortage is low. So what do Southern people do when they don’t have formula? They feed their babies. They feed them. They feed them pot likker, they feed them grits, they feed them rice cereal with whole milk. That’s what they do. And they’re starting to do that. And a friend of mine, was saying, “We’re seeing some babies come through here that are not well.” Because folks have started to feed their babies.

And my thing… I’ve really wanted to, it’s also put me in a space of like, “What do I want to share on social media? Will it come across right” I really want to put out there, “Hey, I know y’all are feeding your babies. Here’s the tea. I know you’re feeding your babies. Here let me help you do it safely.” And talking to them about how to know if a baby is ready to feed, eat table food, and things like that. But I’m like, “Oh, I know some people are going to be in my DMs.” And I don’t want the criticism. I don’t want that energy.

So, I haven’t said anything, but in not saying anything, you’re like, “Are you really a lactation consultant? What are you here for?” So I’ve found myself not posting really at all about it and I feel like I’m just kind of stagnant and don’t want to be judged as a bully, but don’t want to be judged as not the educator that I know that I am, a community health educator. So it’s kind of a weird place to be.

Rebecca Dekker:

Yeah. I would imagine a lot of lactation consultants listening can agree with that feeling of being between a rock and a hard place. And again, it’s not your fault. It’s not our fault. It’s definitely the system’s fault, an oppressive system. But, I think, to me as well, the transportation issue and in this being also a class issue, because working with teens who don’t have transportation, they can’t drive around from town to town trying to find a store that might have something on the shelves.

And I was also talking with a parent who was fostering two premature twins and try imagining, trying to feed twins formula and trying to get enough formula for two babies at once who are medically fragile. And they said they went to nine stores before they finally found something. It’s super stressful for everyone. So our heart go out to everybody who’s been living through this.

And then I also have friends who have not been affected because they either have sources to get support with breastfeeding or formula feeding. Perhaps their formula is imported through their pediatrician who serves higher class or higher income clients. So it’s been a hard season for sure. And I do appreciate the work you and the other IBCLCs do to make breastfeeding, chestfeeding, an option for people who are interested in that option.

Nikki Hunter-Greenaway:

Thank you. Thank you. It really has been a season for us. And I feel there is a access issue of, in Louisiana and New Orleans particular, well, Louisiana always, there’s a lot of rural areas and people already had access issue of getting to certain places, getting to their doctor’s appointments on time, getting their kids to school on time if there’s no transportation buses and stuff. But then in Houston, there’s an access issue because it’s so big, getting from one place to another and then gas is $18 million a gallon.

So, it really does pose another problem in that, “Okay. I need to go find my baby food. Gas is expensive right now. I have so many barriers that are fighting against me. Who is for me?” And then when I show I’m like, “I’m for you. I’m here to help.” “No, you’re against me doing formula,” because of the way in which the media has portrayed the situation.

Rebecca Dekker:

You mentioned before we started the interview, something about the World Health Organization, the WHO, and their code. How does that relate to the formula shortage in the United States? Can you talk a little bit about that?

Nikki Hunter-Greenaway:

Yeah. So the WHO, the World Health Organization has a international code of marketing of breast milk substitutes, #formula. And it’s always been a little conflict for me because as IBCLC’s we’re supposed to uphold the code, we’re supposed to be led by the code, and adhere to it at all times. I don’t think the code is for areas that, I think it’s for areas that are predominantly breastfeeding. I think it’s for areas that have high breastfeeding rates, it is not for Louisiana.

We cannot adhere to all areas of it, right because we’re not helping the clients where they are. Do you know how many lactation consultants have become a lactation consultant and do not know how to help a family that is formula feeding?

Rebecca Dekker:

What percentage would you guess?

Nikki Hunter-Greenaway:

I guess about 80% of lactation consultants do not know how to help a family with formula feeding, because just based off of the Facebook groups.

Rebecca Dekker:

Unless they’ve done it themselves with their own babies?

Nikki Hunter-Greenaway:

Unless they’ve done it themselves. And even sometimes they’ve done it themselves they’re so zoned in on formula, “This is the way to feed your baby.” Friend, we have to help families where they are. And that is the epitome of helping families, where they are. If in Louisiana, our breastfeeding rate is number 50, that means people are formula feeding. They’re mixed feeding. They’re doing the things. We need to be able to help them where they are. We need to be able to mix formula. We need to be able to guide them in some way, not telling them which formula, but at least helping them look through it. And like, “These are my baby’s nutritional deficits. Does this look like a good resource?”  

We need to be able to do that. We need to be able to like, “Hey, I don’t have enough nipples for my baby. Do you know where I can get nipples for my baby?” Even the code monitors that and criticize. And I’m like, “For exclusive pumping families they have to use nipples.” They have to use some of these things that are included in this co feeding bottles. You mean to tell me I can’t advocate for bottles? I can’t help a family with bottles?

It just blows my mind and that’s not helpful. That’s not helpful. And I think it’s outdated. I think it needs to be revised for areas where this may be an issue where, like in Louisiana, like in under resourced areas, where they are doing formula feeding. I’m going to have to say in a positive light about formula, okay. In this space, I’m going to have to help her mix this bottle, because I had a family that I was helping and she wasn’t making enough milk.

And I was like, “Well, you have your formula that you’ve received from WIC,” I said, “how are you making it?” And she told me she was mixing whole milk with the powder. And I said, I said, “Well, who taught you that?” She’s like, “Well, that’s how you make milk. Don’t you?” And she said, “The powder was just the vitamins.” And she said, “You have to use milk to make milk.” And I said, “No, it’s powdered milk.” She said, “I’ve never heard of that in my life.”

And we have to ask the questions, even if you may not know the answer to it, but you are more in a position to find the answer than they are. So you have to have those of resources available. You have to know where to be able to send them to get help or where they can find that actual resource. So that’s why I’m glad…

Rebecca Dekker:

That makes sense that’s how you would build trust with your community, as a community health worker, is to meet them where they’re at.

Nikki Hunter-Greenaway:

And I think lactation consultants help them how they see them themselves as community health workers. You’re a community health worker. That’s what you are. I can’t, just as a lactation consultant, I never go into a home and do a lactation visit without taking a blood pressure. That’s me, because I can’t help you with your breast milk if you’re sitting here hypertensive, and I know maternal hypertension, postpartum hypertension is the number one killer of women. I wouldn’t feel good about myself. I am a community health worker, and that’s why to me it’s more than breastfeeding. I’m going to take care of the whole person.

I know not everybody in this space to do that, but you can get some information. You can make sure that you’re not just going in there so laser focused, you asking other questions, getting, I’d like to tell people, I’m getting in their business and you may think that’s prying, but sometimes we have to pry in order to help them, because it may not be an issue of breastfeeding and they may come up with it. It may be a small thing, but it could be like, “Does this mother have food?” You asked them, “Oh, did you have your snacks today?” And we always asking about that. Do they have access to food? Do they have access to food? Talking about these granola bars, you know how much granola bars cost? Goodness. Talking about fresh food. Do you know how much that costs these lactation cookies? She can’t make lactation cookies if she doesn’t have enough money for flour.

Are we asking those questions? Are we delving in a little bit more outside of the lactation intake? Is it a perinatal intake? Talk to them about their birth experience and the social determinants of health, what socially around them is happening that can move them to having a great breastfeeding experience?

Rebecca Dekker:

Nikki, I feel like your clients are so lucky to have you. And you’re just so inspiring.

Nikki Hunter-Greenaway:

Thank you.

Rebecca Dekker:

I love hearing how this whole health approach and really reminds me that the term healer has been stripped away from many different professions, but it really feels like what you’re doing is healing people, healing communities, promoting health. And I just appreciate all the work you’re doing and you have been doing, and I would love for our listeners to know how they can follow you and your work. Do you have any projects you want to share? How can we support you?

Nikki Hunter-Greenaway:

You can follow our Instagram page, which is @NurseNiki. Nurse, N-I-K-K-I, N-P on Instagram. I’m on Facebook. I have a YouTube channel where we do some education. It’s Women’s Health Wednesday, it’s a variety of videos. I was talking to Rebecca about one in particular that we’ve kind of exploded a little bit and become a big thing. It is…

Rebecca Dekker:

Truly went viral.

Nikki Hunter-Greenaway:

Truly went viral, of how to clean your vagina. It’s at, I think, now 1.5 million views, and I get emails all the time about, even from postpartum families, I would say the bulk of our folks that’s watched this video are not in the United States. And it just blows my mind the comments. I have 3000 comments. I’ve gone through 300 and answered them, but I don’t know how I could, I really want to respond to everybody, but how it is something that it just wasn’t taught.

And I think if we looked at breastfeeding in the same way, you assume everybody know how to clean their vagina, they don’t. Everyone knows how to breastfeed. They don’t. So meeting the client where they are and starting with the basics, as opposed to all the crazy clinical things that we do with breastfeeding, go to the basics first and work your way.

So how I educate my clients. The way I’m talking to you now is the way I talk to my client, “Hey friend, how are you doing today? What is going on? How are you healing? How can I help you in this moment with anything that you’re going through?” And I promise you, it will help their breastfeeding because supportive families thrive.

Rebecca Dekker:

And with that, thank you everyone for listening into Nurse Nikki because her words are so powerful. And I hope you’ve enjoyed this interview. Thank you so much, Nikki.

Nikki Hunter-Greenaway:

Thank you so much for having me. I appreciate it.

Rebecca Dekker:

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