During a clinical nursing rotation, I observed that a woman with a “real job” – I had taught college biology classes when I was birthing and breastfeeding my children – could pump breastmilk handsfree and without leaving the patient’s bedside. My solution for breastfeeding and working had been to teach my students while my suckling child was secured by sling to my breast. My job was only part-time, so I had not yet allowed myself to see the same awe directed at me that I was bestowing upon this RN. Fast-forward two years and I’m working my first nursing job in a hospital LDRP (labor, delivery, recovery, and postpartum) unit.
“Why am I not getting assigned more laboring patients? Does the charge nurse not trust me?” The response I received was unexpected. “You are assigned postpartum couplets because most nurses here are afraid of breastfeeding.” I would continue to be disproportionately assigned mothers and their newborns while working at this hospital, but as a consequence I would be asked by management to train as a lactation consultant. And the time I had spent providing this support would allow me to sit for the board certification exam. I have been practicing as an IBCLC (International Board Certified Lactation Consultant) since 2011.
When I began my new role as a hospital RN-IBCLC in Michigan, I had already served my home state of West Virginia as a nurse in the Newborn ICU, LDRP, and the Right From The Start (RFTS) home-visiting program for all Medicaid-eligible expectant women and newborns. “You are going to do what in Flint?” was the initial response from my coworkers – most of whom commuted into the city for work but were otherwise disconnected from its crime and impoverished citizens – upon hearing of my business plan for With Woman. Unlike Colorado, Michigan provides a program equivalent of RFTS. By the time I was notified of my contract award with the Maternal Infant Health Program in 2013, I had staffed my office with a handful of these coworkers who were ready to become part of the effort to improve health outcomes of at-risk women and children while reducing the cost of healthcare for all citizens.
A contract with the State did not guarantee clients. Because women did not necessarily understand the program and newborns were not automatically enrolled even when their mothers had already participated, I had competition from other contractors to minimally attract the less than half of those eligible who were actively seeking enrollment. I was aware that national breastfeeding rates were improving only up until the time many women go back to work. And my postpartum hospital clinic was a success due to my understanding that, for most mothers, the confidence to feed one’s baby is about an individualized, realistic plan that is full of awe-sharing. The support is critical, empowering, and synergistic. It was a gift shared with me by my midwife – hence the business name that I had chosen – and one that I was passionate about sharing. My niche became the incorporation of lactation consulting into the program.
“Can you admit one of our new transfer patients?” I arrived at a prenatal clinic to find an unclean, hungry, and homeless soon-to-be mother who had used her only resources to pay for a bus ride to receive care. I did not hide my awe of this woman. During the process of feeding her and holding the space for her to cry, I learned that she was not allowed to return that night to the home of her unborn child’s father because she had not given him enough money. After arrangements had been made for overnight accommodations, I told her I would be honored to help with breastfeeding if she chose to do so. Prenatal visits with my staff were difficult to schedule and at varying locations, but she called me from home the evening she left the hospital with her newborn. She was guarded but happy to see me when I arrived. There were multiple women living there – one pregnant, another with an infant. The father of the child did not participate other than making his presence known in the next room. Her story had entirely changed as we chatted.
“I thought this was a lactation consult!” he said as his forceful energy ended our visit.
“Your baby and her mother are now breastfeeding well! Thank you for your time!”
I left and never heard from her again. I received a transfer request from another contractor the following week.
Rachel Bell RN-IBCLC, MBA, JD has practiced nursing for 12 years. After being blessed to have raised her children with the assistance of many outstanding public welfare programs and the individuals who implement them, she strives to set an example for her clients by following her dreams as a new attorney in Colorado this year.
While in law school she was inducted into the American Society of Legal Writers for her research and writing in human trafficking, which was inspired by the story shared here. She is new to SCL Health, where she works as a contingent nurse while developing her roots in the greater Denver area. Her goal is to transition into legal practice by next year, providing her advocacy skills to women and children of Colorado. She is always happy to serve and can be contacted at rachelbellrnjd@gmail.com.