Feeding Healthy Families: The Challenges of Breastfeeding in a Post-Pandemic World

Crystal Morgan has been a labor, delivery, recovery and postpartum, and NICU nurse for over 15 years. She shares with us a glimpse of her experiences and devotion to families in need throughout her healthcare journey.

Alexis: Tell me a little bit about your background in healthcare.

Crystal: I initially started as a nursing student on the pre-med track. My idea was to work as a labor and delivery nurse while in medical school with the hope of one day practicing as an OB/GYN. My plan quickly changed when I gave birth to my oldest daughter at the age of 18. After graduation in 2003, I returned home to work in a local hospital as a nurse in the Family Birthing Center. I grew up in this same neighborhood and a lot of my friends and family still lived there as well. This is where I have been for the last 18 years! In 2004, I spent a few months in the NICU at the University of Chicago. This was a great opportunity for me as it helped increase my skills and confidence in stabilizing premature babies as well as those needing a little extra assistance transitioning after birth. I became officially certified as a lactation specialist in 2016 and board-certified in 2018. I currently work as an IBCLC in the hospital and through Sonder Health as a telemedicine provider.

Alexis: Why is it important for a labor and delivery nurse to be specifically trained as a board-certified lactation consultant?

Crystal: I did not understand the importance of becoming board certified as a lactation consultant until I did! I always thought the knowledge I had as a nurse and breastfeeding mother was enough to provide mothers with the support and education they needed. Boy was I wrong! It was not until I learned just how in-depth the lactation process is that I decided to seek the breastfeeding gold standard as an IBCLC. I remember learning so much information during class. At one point, it seemed as if there was a constant light bulb going off as I was starting to piece together some of the difficulties I experienced and what caused them. As a labor and delivery nurse, you are often the first breastfeeding encounter a new mother has. Having the evidence-based knowledge to provide mothers with the education and support needed is key in making sure breastfeeding is off to a great start. Providing consistent messaging and support is directly correlated to how long a mother will continue to breastfeed. It is also the perfect opportunity to collaborate with the pediatrician, so everyone is on the same page.

Alexis: The pandemic caused many disruptive changes in prenatal and postnatal services. What changes did you see and what additional gaps in care were created by COVID-19?

Crystal: There have been so many changes in pre and postnatal services especially as it relates to breastfeeding. Before the pandemic, I was helping to grow the lactation program at our hospital with another IBCLC. We increased the breastfeeding rates in our hospital, had a decent number of mothers attending prenatal breastfeeding classes, and we were able to follow up outpatient with those that needed assistance after discharge and throughout the remainder of their breastfeeding journey. In April 2020, we were furloughed through the end of July. During that time, no lactation services were being offered at the hospital. It has been a struggle to increase those numbers since we have returned. There is a specific number of patients that are breastfeeding that need to be present on the unit for us to work. That means no longer are the days where we were able to come in no matter how many breastfeeding patients are there. We would normally use low census days to make follow-up phone calls, plan for our breastfeeding classes, focus on educating the staff, updating policies, and continuing education all of which is just not being done right now. Although we were brought back to the hospital, we could go two or three weeks without working! There have been months where we have only worked one day. Moms are coming in to deliver and being sent home 24 hours after delivery, some not breastfeeding well, and they are being instructed to supplement with formula. They are going home without being able to get a breast pump because no one is quite sure of how to do it or they just do not have the time. The nurses are also working short-staffed which leads to less time for them to assist moms with breastfeeding for an extended period. In my opinion, the worst part is there is very little to no follow-up available.

Alexis: Why is it important to have telemedicine as a part of a hospital or clinic’s solution to serving the prenatal and postpartum populations?

Crystal: Telemedicine has become extremely important during this time and should stay in place for the future. It is an easier option for mothers to have access to the services that they need. If a new mom has other children at home or healing from delivery, it can be hard to pack up everything and everyone for an outpatient appointment. Moms should have the opportunity to ask a simple question or get suggestions as it relates to breastfeeding before she makes a decision that can harm breastfeeding and milk supply. Most breastfeeding challenges can be worked through via telemedicine and just like any other aspect of healthcare if the challenge warrants an in-person assessment then one can be scheduled when able.

Alexis: How does a lack of insurance coverage, particularly within Medicaid, contribute to additional access issues for women across the country?

Crystal: Thankfully, Medicaid covers lactation services in the state of Indiana. One of the biggest problems is the coverage for outpatient services. Outpatient services for lactation are only covered when they are in person. This is incredibly difficult during a pandemic when a majority of health care services are offered via telemedicine. There were allowances made for primary care visits and specialties but not as it relates to breastfeeding. The lowest breastfeeding rates are among minorities. The population in the community where I work is mostly Hispanic and African American with African Americans having the lowest initiation and duration of breastfeeding rates. A lot of that is directly related to the type of support that they have or lack thereof. The communities that could benefit the most from breastfeeding are limited in their access to care, support, and education as it relates to breastfeeding.

Alexis: Tell us your favorite part about being an IBCLC.

Crystal: I love everything there is about being an IBCLC. As a society, we focus on the benefits of breastfeeding and promote it EXCLUSIVELY for 6 MONTHS for optimal benefits, but the reality is breastfeeding is DIFFICULT and the support systems must be in place to support parents and their babies. There are enough societal pressures for mothers, so I enjoy helping them achieve their breastfeeding goals. There is nothing more rewarding than helping a mother feel confident and supported in a non-judgmental way for how she chooses to feed her baby.

Alexis: You’ve recently become a Nurse Practitioner. What made you take the next step toward advancing your license? What are the benefits of having a dual license?

Crystal: I want people to know that I love being myself! I also love people and I mean all people from different races, cultures, and communities. I love to learn and share that education with others. I love to travel and spend time with my family and friends. I treat people the way I want to be treated if not better. As a healthcare provider, I have learned the true meaning of the quote “People do not care how much you know until they realize how much you care about them”. I live by this and want to be a change agent in all aspects of healthcare.