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In this episode, I’m talking with Dr. Nastassia Harris, a registered nurse and international board-certified lactation consultant, to discuss her extensive experience in the field of maternal and infant health. Dr. Harris shares her journey into this vital profession, highlighting her passion for improving breastfeeding rates in the Black community and eliminating racial disparities in maternal and infant health. She sheds light on the work of the Perinatal Health Equity Initiative, a nonprofit organization she founded, and her newest venture, Ignite Maternal Health, aimed at providing essential education and support to mother-baby nurses. Dr. Harris offers valuable insights into the challenges faced by Black families and the critical role that education, culturally congruent care, and community resources play in saving lives and preventing adverse outcomes in the postpartum period. Tune in to learn more about the impactful work being done to enhance maternal health and support families during this crucial phase of life.  

 

Content Warning: racism, Black infant and maternal mortality, preeclampsia
Resources

Learn about Nastassia’s work, here:

  • Perinatal Health Equity Initiative website
  • Sistahs Who Breastfeed website
  • Ignite Maternal Health website

Follow Nastassia’s work:
Learn more about related efforts mentioned by Nastassia:
  • Black Mamas Matter Alliance, website
  • Black Breastfeeding Week, website
  • Black Maternal Health Week, website
  • Chocolate Milk Cafe, website
  • Center for Disease Control’s (CDC) Hear Her campaign, website
Read the book referenced, The 4-Hour Workweek by Tim Ferris, here

Listen to EBB episodes:

EBB 280 – Bringing Equity to Lactation Imagery with Nekisha Killings, IBCLC and Founder of the Melanated Mammary Atlas®

EBB 214 – Supporting Pumping Parents in Lactation with IBCLC, Nichelle Clark

Transcript

Dr. Rebecca Dekker – 00:00:00:

Hi everyone, on today’s podcast, we’re going to talk with Dr. Nastassia about the state of Black perinatal healthcare in the United States. Welcome to the Evidence-Based Birth® podcast. My name is Rebecca Dekker 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 ebbirth.com/disclaimer for more details. Hi everyone, my name is Dr. Rebecca Dekker, pronouns she/her, and I’ll be your host for today’s episode. If there are any detailed content or trigger warnings, we always post them in the description or show notes that go along with this episode. And now I’d like to introduce our honored guest, Dr. Nastassia Harris, pronouns she/her, is a registered nurse, international board-certified lactation consultant, mother of four, and a resident of West Orange, New Jersey. Dr. Harris has more than 19 years-experience working with birthing and lactating families. She is passionate about improving access to qualified lactation professionals and improving breastfeeding rates in the Black community. Nastassia founded the Perinatal Health Equity Initiative in 2018. This is a nonprofit advocacy and support organization dedicated to eliminating racial disparities in Black infant and maternal health. Her most recent venture, Ignite Maternal Health, is a consulting and education firm focused on postpartum and newborn nursing and care, where Dr. Harris will use her background in academia to provide education at the community level. A lifelong learner, Nastassia has a BSN, MSN, and Doctor in nursing practice in educational leadership, and she’s certified in maternal newborn nursing. Dr. Harris is active in several committees and organizations, including the Association of Women’s Health Obstetrics in Neonatal Nursing, the Black Mamas Matter Alliance, and Black Breastfeeding Week. Nastassia’s research and clinical interests include implicit bias in racism in healthcare, breastfeeding in the Black community, obstetric violence, high-risk obstetrics, and reproductive justice. We are so excited that Dr. Nastassia Harris is here. Welcome to the Evidence-Based Birth® Podcast.

Dr. Nastassia Harris – 00:02:21:

Hi, welcome. Thank you so much for having me. 

Dr. Rebecca Dekker – 00:02:24:

So, we’re so thrilled to have you on to talk with me and our listeners and we’ve been trying to bring you on for a while and I’m so grateful to Dr. Michelle Gabrielle Caldwell for putting us in touch. You are doing so much for families in New Jersey and beyond. Can you talk to me a little about how you found your niche in working with birthing and lactating families? Like where did you get into this field?

Dr. Nastassia Harris – 00:02:48:

So, I had actually attended a conference in Massachusetts with Dr. Amuta last year, actually no this year, and it triggered a memory for me. One of the nurses who was on a panel was talking about a baby story and that Lifetime show or TLC show that used to come on that kind of went through the birth experience and I was like, I do remember that and that was kind of like my introduction to newborn and mother baby care. I had decided in high school that I wanted to work with women and children, just wasn’t really sure where and then found newborn nursery nursing and decided that’s what I wanted to do. So, I went straight from high school into college, always worked in mother-baby, I did my time in Med-Surg, I did a year because I felt like I needed to do that. And then went right back to my love, which is mother-baby. And I’ve stayed in that field in various capacities, but it was really lactation for me. I was working at a hospital in the South Bronx and we had a very high Latinx population and they all wanted to breastfeed. And I had very little experience with breastfeeding, I had had a daughter that I did not breastfeed it was not something I was encouraged to do, did not have that as a family background. But there was this drive on the unit that they wanted to do it and I was like, well, what is this? Why is there such this high need to do it? And I felt very inadequate in my ability to assist them. I did not have the technical skills. I did not have the education. And so, I am the type of person that if I don’t know how to do something, I must know how to do it. And so, I kind of embarked on the journey of discovering what was it that could help someone to do this. And this was back in ‘07, we did not have an IBCLC on the floor and I didn’t even know what that was at the time. And so, I stumbled upon that as a different profession and started studying that. I went on to become an IBCLC actually while I was pregnant with my first son, I had a complicated pregnancy where I needed to be on bed rest and I couldn’t just lay in the bed and do nothing. So, I studied during that time and I actually went and sat for my IBCLC board and my maternal newborn board after that, because I had, you know, six months of bed rest to sit there and study. So that’s what I did during that time. And then once I came back from my delivery, my job did not have a lactation role and so I moved into a different position and became in charge of that lactation program. And that’s when I got exposed to kind of the inequities and Black breastfeeding. I used to always feel like I was a saleswoman, like I was selling this product of breastfeeding that nobody wanted and I could not understand why I myself hadn’t breastfed. But as I embarked on that journey with my son, I breastfed him. And then felt immediate regret that I did not have that experience with my daughter, that no one talked to me about it, that even nursing school did not address the importance of doing that. And the community that I was in was a predominantly Black community and most of those women were not interested in breastfeeding. And so, I began to learn the history of why that was, what the barriers were. And it wasn’t what I learned. And it wasn’t just I don’t want to do that. It was I don’t want to set myself up for a future failure. I don’t want to start something that I’m not going to be able to continue. I don’t have the support. There were a number of reasons why that wasn’t happening. And so, I made that kind of my work at that point to really focus on doing that. So that’s kind of how I got my introduction into the space.

Dr. Rebecca Dekker – 00:06:30:

So, it was life experiences and then also your professional experience of realizing how did it feel to know that there was this whole aspect of infant feeding that you as a nurse did not receive adequate training on how to help people.

Dr. Nastassia Harris – 00:06:44:

There was a lot, at the time I didn’t think, why is that, well maybe this is something I was supposed to learn on the floor but I know now that it really is something that should be part of nursing curriculum. We should be normalizing infant feeding and breastfeeding as chestfeeding and as the normalized way that we’re feeding babies. And then, obviously still continuing to support families who choose to formula feed, but the baseline in which we measure should be based on, on human milk. So, there was part of me that was a little despondent that I didn’t get that education, but very happy that I went and pursued it on my own and kind of created a whole different lane for myself outside of nursing. I think that is a gap in nursing that we don’t talk about other things that you can do other than going to work in a hospital, that’s kind of like the only place nursing directs you to. And there are so many other things that we could be doing.

Dr. Rebecca Dekker – 00:07:36:

Right. And that career path as an IBCLC is something you kind of fell in love with then.

Dr. Nastassia Harris – 00:07:42:

I did some time on the floor as a hospital-based IBCLC, from there, I moved into a perinatal educator role where I was in charge of the labor and delivery and mother-baby units, and I was the first IBCLC to hold that role. This happened to happen at a time in which our hospital regs were being changed to include the 10 steps for baby-friendly. Although they weren’t requiring the hospital to become designated, they were requiring the implementation of the 10 steps. So, I got to use a lot of my nursing education background, my lactation background to do that. And then that saved me when I left that position. I had a very, and I always tell this story, I had a very nice position. Being a perinatal educator was my dream job. And I had a dream team of people who were doing that with me. And then some of those people started to leave and their replacements weren’t as great as they were. And the unit completely shifted and changed, and I decided that’s no longer a place that made me happy and chose to leave but it was lactation that kept me afloat. I started private practice and started seeing families on my own and kind of discovered entrepreneurship that way. So, although I was sad to leave that role and not happy with the things that happened, that change in management actually sparked where I am today. So, I’m grateful for it in hindsight.

Dr. Rebecca Dekker – 00:09:05:

Yeah, and you left that kind of hospital position in 2016, correct? Yeah, which is around the same time I left my university position to do Evidence Based Birth®. So, it was interesting that we were kind of going through that transition to entrepreneurship at the same time.

Dr. Nastassia Harris – 00:09:22:

Yeah.

Dr. Rebecca Dekker – 00:09:23:

Tell us about the organization you started then, a perinatal health equity initiative, the nonprofit devoted to advocacy and eliminating racial disparities in Black infant and maternal health. Can you tell us what this organization looks like, what kind of work you’re doing?

Dr. Nastassia Harris – 00:09:38:

Sure. So, I am grateful that we are now a team. It started with just me and kind of this vision and goal of things that I wanted to accomplish but I’m so grateful for all the many, many people that help us to do that work. So, I transitioned into lactation practice and kind of had this dream that I was going to see this huge list of Black clientele and that did not happen. I was predominantly seeing white women. And so, the Black women that I was seeing, I started to kind of ask questions and I’m getting the birth stories and I’m hearing things that I know are just wildly inappropriate, shouldn’t be happening and I’m like, what is going on? And so, I kept hearing that repeatedly. And part of the lactation community, I joined a number of different mommy groups. And I’m seeing in these mommy groups, these conversations that are like only taking place on Facebook. There were infants that were dying. There were moms that were dying. And this is in my community and this is the only place this conversation is happening. And as a nurse, we are taught that a maternal death is a never event. And I was very confused as to why so many things that were never supposed to happen kept happening repeatedly in my community. And I then began to do my research. I discovered the Black Mamas Matter Alliance. I began to learn about the racism and that role in these outcomes. And so, I decided that from a business model, I wasn’t going to be able to do what I needed to do. And so, I shifted into a nonprofit from that point and we started in lactation work, I will say that I have always run in the sense that lactation has a stigma attached to it, I have definitely met funders who have said we will not fund anything breastfeeding related. And so, we’ve been very mindful and making sure that, you know, breastfeeding is a part of what we do, but we also do many other things. But breastfeeding has brought so many people to us. It has brought board members to us. And so, it’s a component that we’ve kept, but also expanding into looking at the direct service component of it. So providing education, going over advocacy skills, following up with providers who are providing poor care, writing complaints for families. And now we’re kind of in this redevelopment phase. We’ve done, you know, Black Maternal Health Week every year is always a big staple event. We’ve done Black Breastfeeding Week every year as a staple event. But we really this year wanted to look at what is our direct impact. We’ve provided resources, diapers, wipes, car seats. We’ve had community baby showers. We’ve done a lot of that stuff. We’ve done breastfeeding consults, but really wanted to make sure that we are growing our programs and growing our skillset of what we’re actually offering to the community. And this year we’re doing our strategic planning and trying to get those things in order.

Dr. Rebecca Dekker – 00:12:26:

I’m curious after doing this work for so many years with the Perinatal Health Equity Initiative, have you seen, like what kinds of changes have you seen? Because I get the feeling that 10, 20 years ago there was obviously work being done and there were advocates out there, but it seems like there’s a lot more resources now, so, are you seeing a difference or a change in outcomes in your community?

Dr. Nastassia Harris – 00:12:50:

I will say I’m hearing more conversation, which is always positive. I am seeing more people enter the space, but I’m also seeing a lot of performative action in that space, people who are doing the work because there’s funding attached to it and for no other reason. And our state of New Jersey, around the same time that I opened the organization, the Murphys came into office as governor and First Lady Murphy announced that Black infant mortality and maternal mortality were going to be kind of the things that she focused on and she developed the Nurture New Jersey Plan. I think what I have been most disappointed with is the lack of inclusion of Black-led organizations in a lot of this work. We are a consortia state, so there are three organizations that kind of run maternal health in our state. Any funding that happens comes through them and then we kind of get the trickle down effect. And I don’t think that’s the way things should work. Black led organizations should be able to freely do their work as needed and should also have access to state funding, it’s very difficult to do that in our particular state. So, while we were originally ranked 47th when I started the organization, we were one of the worst states in the nation. I believe the most recent report is that we are now 36th, which is an improvement, but Black women’s health is not improving and I believe that has a lot to do with the fact of who’s leading the work. We need allies in this space. We need people that can help us, but we don’t need anyone else to do the work. And I think that’s where we’ve had a lot of missteps in New Jersey is the forefront, the image, the face of this work is not Black women. And that’s disappointing.

Dr. Rebecca Dekker – 00:14:37:

With your nonprofit, I know you talked a lot about the resources you’re providing for Black families, but I know you’re also providing education and training to providers. Can you talk a little bit about what that looks like?

Dr. Nastassia Harris – 00:14:49:

Yeah, so that’s a newer space for us. I had started a curriculum back in 2019, which was Breastfeeding in Color, and that was designed to be a culturally congruent curriculum that focuses on human lactation. Since we’ve done that program, we’ve trained a couple of facilities. We’re right now working with a federally-qualified health center, but are also looking to build out our curriculum as it pertains to culturally congruent care, respectful care, and what that looks like. So, we haven’t fully started on that venture yet, we’re really building out what the curriculum will be. But as we’ve done this work, and my background is not nonprofit, it’s not public health. I’ve had to learn a lot of these things along the way, and there are funding opportunities that we’ve taken that maybe we shouldn’t have. So, we’re learning now about what this partnership looks like for our organization, and really setting the standards for this is what we need from organizations, and this is how we will give back training to those organizations to make sure there’s a mutually respectful relationship. If you’re referring people to us, we want to be able to send people back to you, and we don’t know that you’re gonna safely handle our families unless there’s evidence that you’ve been trained to be able to do that. So that’s something that we’re working on, hope to have released either by the end of this year or early next year, but not utilizing it as of yet.

Dr. Rebecca Dekker – 00:16:11:

And what’s the name of that program?

Dr. Nastassia Harris – 00:16:14:

Well, it doesn’t have a name yet.

Dr. Rebecca Dekker – 00:16:16:

This is because I want to keep my ears open for news of this.

Dr. Nastassia Harris – 00:16:20:

It doesn’t have a name yet. We’re working on building that out, but it’s definitely in the vein of birth equity and reproductive justice and culturally congruent care.

Dr. Rebecca Dekker – 00:16:29:

And is this something that hospitals could incorporate, like this kind of training with their staff?

Dr. Nastassia Harris – 00:16:34:

We would love for that to happen.

Dr. Rebecca Dekker – 00:16:36:

Yeah, and universities and places where people are in training?

Dr. Nastassia Harris – 00:16:40:

Yes, we would love for that to be the case. There is legislation in our state that says, like California, that all providers have to go through this implicit bias training. I have not seen the training myself, but it’s, you know, if you’re a healthcare provider and you’re taking curriculum on HealthStream, we know what the outcome of HealthStream is, you click through it, you’re not really paying attention, you’re not really getting any

Dr. Rebecca Dekker – 00:17:02:

It’s just a checkbox you’re checking off.

Dr. Nastassia Harris – 00:17:05:

Correct, correct. So, we can say, yes, we made this legislation and we required the training, but what is the outcome of that training? Have we improved care? And the data tells us no, we haven’t.

Dr. Rebecca Dekker – 00:17:14:

Yeah. And what are the stories? You know, like there’s data, but then there’s also the stories you’re hearing from families and from birth workers and our, you know, so much of this work isn’t just about spreading data, but it’s about changing hearts and minds, right? So, the people treat people differently, like humans, like family, you know? So.

Dr. Nastassia Harris – 00:17:37:

We haven’t gotten there yet. 

Dr. Rebecca Dekker – 00:17:38:

Yeah. What about Ignite Maternal Health? This is the other organization you founded. Can you talk about what that organization is doing?

Dr. Nastassia Harris – 00:17:48:

Sure, so this is my new baby, and there’s not a whole lot to tell, but it’s very new. But I left my faculty role to fully focus on the nonprofit. I became very discouraged with our lack of progress, and the lack of progress as our organization, if I’m being honest, I was working two jobs and couldn’t fully dedicate myself to the work and knew at some point I was going to have to make a choice. And so nonprofit isn’t the most lucrative space to work in. And so, I knew that for me to make that leap, I was going to have to generate multiple streams of income to be able to do that. And I looked at what skills do I have and what gaps could I fill. And I felt as a mother-baby nurse, we are often looked at as, you know, we do patient education, we babysit the patients and then we send them home. But the mother-baby role is very important, we’re the last step before someone goes home and really can make a significant impact in what those outcomes are. And so, I wanted to kind of create a space for mother-baby nurses so that we have access to the education that we need, the community for our families of other nurses who are doing that work. But then also, I was looking at certification rates and the rates for mother baby nurses, certification is something like 17,000 nurses, whereas for labor and delivery nurses, it’s something like 60,000 nurses. So, it’s a really significant difference in the certification rate and I really became curious as to why. And so, I started asking questions about certification and it was shocking to me that a lot of nurses did not know there was a specialty certification for mother-babies. So that really made me feel like there’s a lack of resources and education dedicated specifically to mother-baby nurses. And so that Ignite Maternal Health is designed to fill that particular gap.

Dr. Rebecca Dekker – 00:19:45:

Yeah, and that makes sense. I kind of remember, even just back to nursing school, your perceptions of labor and delivery and then mother-baby, like labor and delivery is the exciting, sexy place to work where there’s lots of adrenaline and excitement. And mother-baby is more kind of the sleepy, I don’t know. It’s slower, quieter, so there’s not as much attention paid to it, but that’s where so much important work goes, you know, happens. That educating of like, not only lactation, but just like helping facilitate bonding and healing and parenting.

Dr. Nastassia Harris – 00:20:24:

Yeah, and I would say, you know, that may have been true of mother-baby nursing, you know, 30 years ago when we had different patients who were coming in to deliver, but what our patients look like now don’t look like how they looked 30 years ago. And so, a different skill set is required to care for these patients, both in the labor and delivery setting and postpartum. And where we know postpartum heads is a lot of our deaths are happening in the postpartum period. Where is that gap being filled in? There are definitely doulas and community health workers in that space, but where is nursing in that space? And I feel like there needs to be room to kind of create other programs to fill in that gap where nurses can be a little bit more present in the home or virtually or whatever the case may be to support families after delivery. There are, I think there’s a numerous amount of skill sets that nurses have that aren’t being utilized when it comes to home visitation and not just from an education standpoint, but skilled nursing. I remember there used to be a program in New York that only did high risk home visitation and like I wanted to work for them forever and I just could never get a job. But they did high risk patients and it wasn’t education they were coming in to do. They did fetal monitoring. They did IVs. They took care of families who were on bed rest and I feel like we’ve lost a little bit of that. But then also, where is their space for education? When you’re a community-based nurse, where are you going to be educated? Because that A1 doesn’t necessarily cater to the community-based nursing field. There’s definitely stuff that is in there, but there’s really no specialty that’s dedicated to mother-baby from that spectrum. And so that to me was a gap that I wanted to fill. And so, while we are in our ramp up growth period, I hope to have something to share shortly.

Dr. Rebecca Dekker – 00:22:14:

You’re speaking of saving lives and preventing bad outcomes in the postpartum period made me think of what are some specific examples that nurses and doulas postpartum, what are some basic skills and educational strategies that they can use to help improve health outcomes, especially for Black families?

Dr. Nastassia Harris – 00:22:36:

So, I think knowing the statistics is very important and knowing the why behind those statistics. You know, one of my favorite quotes, and I’m not going to get the quote exactly right, but from Joia Crear Perry is it’s not race, it’s racism. And so, we need to understand that saying, I don’t see race or I don’t see color is actually harmful to our patients. You need to see those things but you also have to tailor your education to the families that you’re serving. So, for example, preeclampsia, when you look at the number one cause of death for Black women was cardiovascular disease. The media focused on maternal mental health, but that was why white women were dying. It was not the reason Black women were dying. And so, we have to cater our education based on what our family needs are. So, knowing about preeclampsia is going to be very, very important for our families, making sure that they have blood pressure cuffs at home, that there is a postpartum visit that’s scheduled, that’s not at six weeks postpartum. And the importance of cardiology involvement. No one talks to families about having a cardiologist involved in their care. And I think that was one shocking to me to learn that that was even supposed to be part of the intervention. But then in talking to people, how many other people did not know that either and so, where’s that gap in education that we can kind of fill to make sure that’s happening? That the information is not scary to people. I’ve heard that come back a number of times that nurses don’t want to tell patients all the things that can go wrong at home because they don’t want to scare them going home. Well, in our state maternal mortality review report, the number one thing that could have been done to stop deaths in Black women was patient education. And so, we are doing a disservice to our families by not telling them what to look for. They need to know what they have to look for, and they need to know where to go and get support for those things. So, there’s the maternal early warning signs that A1 made. That’s available. There are tons of there’s a Hear Her campaign that’s available, there are numerous, I’m sure you have things on your website that are available as well, there’s numerous resources. We just need to be able to point people to those resources so that they’re getting them into the hands of families. And then can we do a check in phone call after discharge? I know every hospital is not set up to do that, but it’s something to consider. Are you calling people after they’re home not to check on the quality of their care? Because that’s often what the phone call is. But actually, how are they doing? Are they experiencing any of these symptoms? And I found that for a number of our families, one of the biggest barriers for them getting care is actually child care. They’re so focused on themselves and don’t have anyone to take care of their babies that they’re sacrificing themselves at the expense of not having anywhere to send their children. So just thinking about what are the community resources that families need, because that’s the gap that we fill as well. We will provide 24-hour or find a facility that covers 24-hour access care. So, knowing your community, you can’t go and work in Newark or in the South Bronx and not know where any of the community resources are. You have to be able to point families to those resources and trusted resources. Please vet the resources that you’re sending people to.

Dr. Rebecca Dekker – 00:25:49:

Thank you so much for bringing up the blood pressure cuff. I think that’s something that a lot of families don’t think of and childbirth educators and doulas might not think to recommend, but postpartum preeclampsia causes more deaths than prenatal preeclampsia. And I’ve been shocked at the number of times I’ve read case studies in different scenarios where actual human lives are involved, where people did not receive appropriate follow-up care. Where healthcare workers were not concerned by what should be concerning. And it’s interesting you mentioned about people being scared about learning the warning signs because I did have that experience this year. I was teaching a group of mostly Black and Brown pregnant teenagers and we talked about the postpartum warning signs and it did scare them. And it was really hard to kind of handle that because they’re pregnant and I’m kind of the first person who’s bringing up the fact that these are warning signs and it’s really important you seek help because most pregnancy-related deaths happen after pregnancy and they were really scared and I did my best to reassure them, but how do you deal with those feelings of fear and anxiety when you’re teaching people?

Dr. Nastassia Harris – 00:27:04:

I think it’s letting people know that they’re not alone in this fight. Too many times people go home and they experience things and they don’t have anyone to call to explain what they’re experiencing. The doctor may not be hearing what’s being said. And so, we need to make sure that they know there’s a safe place that they can go to, to express those things, even if it’s something they think is silly or not a big deal, that they have a space. But then also, you know, sharing that data so that they know what to look for, but also the other side of that. Most births are not going to have those complications. Most births are going to go smooth. But when they don’t, we need to act quickly and just making sure they have that reassurance of not being alone in that process.

Dr. Rebecca Dekker – 00:27:45:

I think also educating other family members too, because you know, when you’re, after you’ve given birth, it seems like you’re in a little bit of a haze, you know, you’re recovering from this huge experience. And so not just educating the pregnant person, but their family and friends that they know the warning signs as well.

Dr. Nastassia Harris – 00:28:04:

Absolutely. In many of our cases, one, which unfortunately turned out in a death, it was the father or support person that identified the issue and was trying to seek help for their family. So, it’s definitely important to include fathers, support persons, grandmas, aunties, whoever’s going to be involved in that house that knows what to look for. And you know, with discharge teaching is a lot of education coming at you very quickly and it’s impossible to remember all of those things. So, if you have someone else who’s a second set of ears that’s listening, that can only add to a better outcome.

Dr. Rebecca Dekker – 00:28:40:

Let’s switch back to breastfeeding one more time. So, I know recording this, we’re kind of going to be close to honoring Black Breastfeeding Week. That’s not when this episode is coming out, but I know you’re very passionate about that week and you’re active in celebrating it and honoring it. Can you tell our listeners a little bit about the importance of Black Breastfeeding Week and what are some things we can do to help improve the stats?

Dr. Nastassia Harris – 00:29:04:

Sure. So Black Breastfeeding Week, and I hope I don’t get this question this year, but almost every year someone asks, you know, if we’ll post something about Black Breastfeeding Week, why are we being segregated? Why are we covering this, you know, this racial separation amongst these groups and that everyone should be celebrating this together? And it’s important to recognize that, yes, we do need to celebrate it together, but there are also our significant inequities in our community. We are currently embarking on a study, which, you know, is something that’s been shared. Black women don’t receive information about breastfeeding and chestfeeding the same way that other groups do. In our study in New Jersey, we found that many providers didn’t talk to them at all about their feeding choices. Many assumed that they were going to be formula feeding and so that’s a missed opportunity. The data shows that when a provider actually has that conversation with the patient early in their pregnancy, they’re more likely to choose to breastfeed. So many of our families struggled to find lactation support on their own, which means there was no referral system that was created. Black women are more likely to have preterm births. Preterm babies benefit the most from access to human milk, so being able to support families in that endeavor. One thing I always like to talk about, especially we go into October when we talk about breast cancer, there is a significant benefit to Black women in the prevention of premenopausal breast cancer. The longer you breastfeed, the more benefits you receive. In that prevention and Black women, when we do get these types of breast cancer, we’re more likely to be diagnosed later, have aggressive forms and die from it. And so, we view breastfeeding and chestfeeding as a public health decision, not as a feeding choice because it does so much more than that. Another thing I would add is, you know, most recently there was a study that came out about the cardiovascular protection that providing breast milk and human milk offers and that’s very important. We know that the leading cause of Black maternal mortality is cardiovascular disease. So, if there’s one thing that we can do to kind of help, it’s not going to fix the problem, but it’s not going to hurt the problem either. And so being able to provide access to support and help families to continue is only going to lead to better health outcomes. So, I think for us as an organization, we really try to frame the access to human milk as more than just a way that we’re choosing to feed our babies, but as a health benefit that’s going to last for that birthing person and that infant for the rest of their life. And when it comes to Black women, we are more likely to not have access to paid leave, you know, we’re fortunate to be in a state that has state mandated paid leave, but everyone does not live in such a state. And so, the ability to continue is compromised. While there are laws that say you should be able to pump and express milk at work for many Black women that can put their job at risk and so, they’re not willing to risk that. So, there are many barriers. There’s the whole sexualization of the Black body. There’s the slavery, ancestry component of it where, you know, we were watching our babies die while we were feeding the slave masters children that damaged breastfeeding significantly. So there’s a lot formula targeting that was specific towards Black families, which then disrupted the little work that got done in moving families back into breastfeeding. There’s a very long history of damage and that damage has created this notion that Black women don’t breastfeed or don’t want to breastfeed. And that is simply untrue. I have found more cases of Black women who were sabotaged in their decision making to breastfeed than people who have made that decision. I don’t want to provide any breast milk at all. So, I think we just need to look at this differently, provide access to resources when you’re sending people home, especially if they are providing human milk for their babies. Where is their community, IBCLC or CLC or support group, something to help them continue their journey so that they have access to support. And unfortunately, Black women are more likely to experience that access of lack of support and then one other thing I’ll mention is belonging. We have a culturally centered breastfeeding group, which is called Sistahs Who Breastfeed. Chocolate Milk Cafe is also a sister organization through Black Mamas Matter Alliance, those spaces matter. And having access to people who look like you, the images and the books that we’re using, the teaching tools that we’re using, that matters a lot. Having Black women who are in that same space of also going through that journey with you matters to improving outcomes and so, know where those spaces are in your communities, be able to move them forward. But when it comes to Black Breastfeeding Week, that was really designed to one, uplift those things, but then also talk about the joy in Black breastfeeding, that it’s not this horrible thing that is always filled with regret and barriers and damage, but that there are families who are breastfeeding successfully and doing really, really well and that we need to share those stories as well and have those images out there. And so, the theme for this year is ‘We Outside’ and we are doing local events that are going to be outside with various different community partners. And so, we’re excited to be able to continue that work, but very, very important week to kind of honor those inequities, but then also amplify joy.

Dr. Rebecca Dekker – 00:34:19:

Yeah. And I also want to amplify the work of Nikesha Killings, another IBCLC who has the Melanated Mammary Atlas® and that was a feature on episode 280. And then I think another, you mentioned pumping briefly, but IBCLC Nichelle Clark came on in 214 to talk about parents who choose to pump exclusively as a choice, not as like a medical necessity. And I think that was a really important episode as well, because there’s different families need different kinds of lactation support.

Dr. Nastassia Harris – 00:34:53:

I think where we make mistakes as healthcare professionals is thinking that things need to be done the one way that we were taught and not being open-minded to exploring other things. And I think that’s part of why Baby Friendly has gotten a bad reputation in some communities because Baby Friendly does not mean no one can have a pump. That’s not what Baby Friendly means, but that’s how people operationalize it. If someone asks for a pump, while we know that there’s not going to be a flow of milk when you give them that pump, you give them the pump, you teach them the hand expression, teach them what to expect because it’s the disappointment and the lack of milk flow that usually ends people’s journeys. But when we talk to them about the process and what to expect, we can empower these birthing people to continue that journey. So just listen and do what people are asking, I think is probably the simplest message.

Dr. Rebecca Dekker – 00:35:44:

Listen to Black women, especially, Black birth workers and IBCLCs. I think that’s a whole other rabbit hole we could go down with Baby Friendly because we have that in my hometown in Kentucky. There’s one Baby Friendly hospital and the other, sorry, the ones that are not Baby Friendly tend to, I hear rumors that the nurses there don’t want to be Baby Friendly because they think it makes more work for them and it’s worse for the patients and they have all these like mindset issues around breastfeeding which just goes, I think goes back to the stigma on breastfeeding and then there’s even more stigma placed on Black breastfeeding.

Dr. Nastassia Harris – 00:36:25:

Yeah, and I think in nursing too, the studies support that when you did not have a good breastfeeding experience yourself, you impart that experience on the families that you take care of. So having that own self-awareness is very important, but Baby Friendly is a tool just like anything else in the hands of who is implementing the tool will change what it looks like. Baby Friendly was never designed to stop people from getting formula, but that’s how some people have used it, so that’s what it looks like to other people. And it was really just meant to stop giving formula to the babies who have said, or the mothers and birthing people have said that they want to breastfeed. It’s not to stop people who wanted to formula feed from being able to do so. But unfortunately, it’s been weaponized that way by some people. And so, people don’t want it because of that.

Dr. Rebecca Dekker – 00:37:14:

Yeah, interesting. I feel like that’s a whole different episode we could go down. I know you are doing so much work. Dr. Harris, you’re doing the clinical side, you are an educator, you’re an activist, you have a nonprofit, and you also have your business as well. How do you balance these commitments and protect your own health?

Dr. Nastassia Harris – 00:37:38:

Well, I will admit that I didn’t. I did not balance these things well. I did a lot of professional things and my family life suffered in doing that. And those who know me know that I am very passionate about teaching it’s something that I loved so much and teaching is something I’ll always be able to do. And as a Black faculty member in a nursing program, which is also a rarity, I struggled with leaving that role because I knew that there would be a hole there. But had to make some decisions of what was most important to me and important to the work that I was doing. And so ultimately decided to resign from that role this year so that I could focus on growing the nonprofit and having the community impact that we desire to have and that was a hard choice to make. But you know, I’m not superwoman. I can’t do all things and you can’t do all things well. And so, I had to come to that conclusion, you know, on my own that I needed to say no to some things and step away from some things to make my life function. And I feel much happier in those decisions that I’ve made this year. So, I will say what I am learning to do is to say no to things that aren’t going to bring me joy and happiness or aren’t fulfilling. And we have a new member of our team, Jessica, who helps with our grant writing and development. And she’s always mindful of, is this on mission? And keeping me very much focused on, is this addressing your mission? Because if it’s not, the answer is no. And so, I’m like, all right, Jessica, I understand. Sometimes I do say yes to things that I really should not say yes to or overextending myself and I’ve had to learn not to do that. So, I will say that I am still in the process of learning to do that, but making sure that I say yes to things that are going to fulfill me and are going to have meaning to the person that I’m giving that to. So, I will say that it’s a work in progress.

Dr. Rebecca Dekker – 00:39:39:

Yeah, I can understand. And it’s true, you say no to things, but also when you say yes to some things, you’re saying no to other things, maybe your health or your family time. And you get to a point where your life is so full, you have to start taking things off the list.

Dr. Nastassia Harris – 00:39:56:

Yeah, absolutely. Yeah, I have four children and a lot of time has gone by. And I wanna make sure that I am here and available to meet their needs. And so that meant saying no to some things and having to step away from some things and that’s okay, I’m okay with doing that. But I think we all have to know our own personal limitations. And in this work, we are also more likely to have health complications and to experience burnout because it is an emotionally taxing space and you’re giving so much of yourself. So, it is the ability to learn how to do that. And with this summer, I started reading a book called The 4-Hour Workweek and really trying to learn what to do with your hours in the day, right? The point is really that you don’t need 40 hours in a week to do your job, that most of your time is being spent on stuff that’s either not important or could be delegated elsewhere. And so, we’re trying to work on making sure that we have email set to check at a certain time. We’re not spending hours in our inbox because that’s taking away from doing other stuff. So, it’s really just about learning how to better manage your time. So much time gets wasted on stuff that’s really not important. And so, it’s the process. So, we’re on a four-day work week. We work Monday through Thursday and that was important for not only me, but for our team. The summer is short, we don’t have a long time to enjoy the summer. And I wanted to be able to enjoy it with my kids. And I wanted our team to be able to do that as well.

Dr. Rebecca Dekker – 00:41:26:

Yeah, I don’t think that’s something we’ve talked about a lot. But here at EBB, we don’t do the four-day work week. But we do a 30 hour work week. So, 30 hours at EBB is considered full time. And we don’t expect anyone to work above that because people have lives. And they can get so much done. Clearly, our team is doing amazing work because I see it happening all the time. So, we don’t need to add those extra 10 hours and most of us, but not all, are parents. But we all have families and loved ones and hobbies and other jobs. Some people want to do doula work on the side. So, it’s important.

Dr. Nastassia Harris – 00:42:04:

You can’t do work in equity and then not be an equitable place to work. Those two things are in contradiction to me. And so many times I’ve seen places operate that way where their workers are not paid well, they don’t have any flexibility, but yet they’re expected to go out and serve and do that work. And that’s not fair.

Dr. Rebecca Dekker – 00:42:25:

Yeah, that’s true. One last question. Can you tell us how we can follow and support your work?

Dr. Nastassia Harris – 00:42:34:

Sure. So, we are on all social media platforms under Perinatal_Equity. We are on IG on Facebook. I think we have a TikTok, I don’t really use it, I don’t quite understand TikTok. I’m not good at it yet. We’re on LinkedIn. We do have a..it’s not Twitter anymore. I don’t know what you call it anymore. We’re, we don’t use that really. We’re around. And of course, on our website, www.perinatalequity.org, you can find us there and follow and support our work.

Dr. Rebecca Dekker – 00:43:05:

And I know you had your inaugural New Jersey Birth Equity Conference this year in 2023. Are there any plans to have more events that people can attend?

Dr. Nastassia Harris – 00:43:15:

Yes, we are beginning the process of planning for 2024, so look out for updates for that. And we hope to offer more educational opportunities in the future as well.

Dr. Rebecca Dekker – 00:43:27:

Yeah, it looked like a fantastic event with a lot of amazing speakers and attendees. More than just a state-like event.

Dr. Nastassia Harris – 00:43:35:

Yeah, it was beautiful and for it to have been our first one, I’m really proud with how it turned out and I was even more proud of the yeses that I received from every Black woman that I reached out to, was so willing to come in support and that I am very, very grateful for.

Dr. Rebecca Dekker – 00:43:54:

Well thank you so much Dr. Harris for talking with us about Black perinatal health and for supporting families from the pregnancy all the way through the lactation journey. We appreciate your work.

Dr. Nastassia Harris – 00:44:07:

Thank you. Thank you for having me.

Dr. Rebecca Dekker – 00:44:09:

This podcast episode was brought to you by the book, Babies Are Not Pizzas, They’re Born Not Delivered. Babies Are Not Pizzas, is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence-based care. In this book, you’ll learn about the history of childbirth in midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizzas is available on Amazon as a Kindle, paperback, hardcover and audible book. Get your copy today and make sure to email me after you read it to let me know your thoughts.

Listening to this podcast is an Australian College of Midwives CPD Recognised Activity.

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