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Ep. 72- Black Breastfeeding Equity and Opportunity for Change: an interview with Dr. DeVane-Johnson

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This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

Maureen: Hey everybody. Welcome back to the Milk Minute. Today we have the absolute pleasure of speaking with Dr. Stephanie, Devane-Johnson. But before we do that, we’re going to answer a listener question and then stick around to the end for an award. We have a special bonus thing we’re going to do. Yeah.

Heather: The bonus thing. You need it. All right. Today’s question is from Natasha Thomas and I could not help but laugh at this question. She says, point me in the direction of the facts. Happy to do it. My husband is convinced that the one cup of Trader Joe’s instant coffee is why our two-month-old is gassy.

I don’t eat dairy except for small amounts of cheese, maybe two times a week. And when we spoke to the pediatrician, he said, her being gassy was just a normal part of this age, but yes, she farts. And when she farts, she startles herself. And if she’s struggling to fart, she’s extremely fussy until it comes out. We help with various carrying positions and leg moves.

Natasha, let me just tell you full disclosure. I also startled myself awake during a massage the other day with a fart. And I thought that might actually be a low point in my life, but I’m not giving up coffee and your husband needs to probably step off because I’m sure he also farts and is not doing anything different to change his diet.

Maureen: And you know what? Yeah, your pediatrician’s right. To an extent that stuff is really normal. You know, if, if your baby is so gassy that they’re never content and they’re hard to settle, then we’re going to be looking at stuff like supporting their microbiome. Right. Before we look at stuff that would involve you changing your diet, because while it’s possible that’s impacting your baby’s, you know, gut and all of that, it’s not the most likely scenario.

Heather: Right. And you know, some kind of cruciferous vegetables like broccoli and brussel sprouts and cauliflower do cause a little extra gas in you and potentially in your baby, but it’s really okay because gas is kind of just a normal part of being alive. You know, everything’s functioning properly. It’s when the gas won’t come out or you can’t poop that you have problems. Yup.

Maureen: All right.

Heather: So anyway, go drink your cup of coffee. Tell your husband to calm down, take some Lexapro if he needs it. Everyone just chill and maybe think about getting some Evivo. That’s a really good probiotic that we like to recommend for breastfed babies.

And you can check out our information on that with Episode 47, where we talk all about the infant gut microbiome and the scientists that are working to fix it. So I hope that helps Natasha.

Maureen: Yeah,

Heather: Let’s take a quick break to thank our sponsor Aeroflow. Aeroflow is your one-stop shop to get the most popular breast pumps and accessories through your insurance. Yeah. So don’t let your insurance go to waste. Why don’t you let Aeroflow do all the dirty work for you? You never have to call your insurance when you use Aeroflow and they remind you when you’re eligible for free replacement parts.

Yep. So when you’re tired in your postpartum period, and you’re wondering why your pump isn’t working as well, you might get a text that says, did you know you need replacement parts? And you say, I did not know that. You push a button and boom. They show up at your door. Thanks, Aeroflow. Thank you so much. Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.

Maureen: All right. Today on the podcast, we would like to welcome Stephanie Devane-Johnson. She is a PhD in CNM and associate professor in the midwifery specialty at Vanderbilt University School of Nursing. Her passion and program of research are breastfeeding and health disparities in African Americans. She’s written and published on the impact that cultural and socio historical influences have on African American infant feeding decisions. And bonus. She was just on good morning, America. That was super cool. And we feel extremely privileged to have you today here, Stephanie we’re I I’m blown away that you’re on the podcast.

Dr. Devane-Johnson: Thank you. Thank you for the invite. I greatly appreciate it.

Heather: Well, you know, we have some questions here and I know a lot of people, you know, we have all these different holidays that we celebrate and different days of remembrance in the United States. Awareness weeks.

Maureen: I feel like every, every single day is a different thing. And we often, we personally miss them. We’re like, oh no, that was last week. So this year we wanted to make sure that for Black Breastfeeding Awareness Week, we had an episode of the podcast that was on topic and that helped us continue learning about this.

Heather: Right. So, you know, you’re the expert and you have talked to multiple groups of people. You have sought out communities of people. I’ve read your papers and I just can’t imagine not promoting this information, especially during this week, but really every day. But for the listeners that might not know why we’re even doing a Black Breastfeeding Week.

Why is it important that we have a Black Breastfeeding Week? And would you mind giving our listeners just a bit of a history lesson so we can understand how we got to where we are today?

Dr. Devane-Johnson: I would love to, and that is such a fabulous question. And thank you for asking it. I believe that we need to promote and highlight Black Breastfeeding Week to publicly recognize the ongoing health disparities that stem from misinformation, non-representation, and lack of education about the benefits of breastfeeding and human milk in the black community.

Being a 1. Black, African American woman, 2. Mother 3. And nurse/ midwife I tend to have a little bit of firsthand experience. And when I would see patients, cause I still actively see patients prenatally. And when I would ask, you know, how are you going to feed your baby? African American black women decide how they’re going to feed their babies differently. And when I would try to probe and get to the root of it, I could never do, I just don’t want to. And like a roadblock would come up and so I would fall back. And that’s where my PhD interests came from. I was like, there’s something deeper.

What is the root cause to some, not all, please do not get me wrong. I am not saying all black or African American deal with this at all, but there are some African American women who, where there’s negative stigmas in the black community about breastfeeding. That breastfeeding is a white thing. Some of the negative stigma stem from as far back as slavery with wet nursing.

And if your viewers aren’t familiar with wet nursing, that’s when another person feeds, breastfeeds another person’s child. So in the black African American history, it is in captive slaves, forced to breastfeed their captors kids at the demise of their own children. And so that, the mammy caricature, targeted formula marketing with the Fultz quadruplets in North Carolina, where it was a target at African Americans to get more people to formula feed.

And at that time in the forties and fifties, breastfeeding, if you were, if you had money, you formula fed, if you were poor, you breastfed. So there was a monetary incentive in some people’s mind to do one or the other. So to me, it’s fascinating because I do believe history does influence present day health decision-making processes.

Heather: Oh, absolutely. No doubt. And it runs so deep. I mean, that’s why, when you’re questioning your patients, it’s like they shut down because they, they might not have the answer. I find that with my patients too, where, you know, there’s, it’s almost like you have to ask the question, but why? Seven times, but why, but why until you can really get to the bottom and by the time you get to the bottom, everyone’s crying cause it’s just that deep. Oh my well, so this history of breastfeeding in the American black community, specifically because of the history of slavery, how do you see that still impacting our society and culture today?

Dr. Devane-Johnson: Oh huge. Even though, I mean, I’ve got, I wouldn’t get a lot of flak from, not going to say a lot of flak. I graduated from a predominantly white institution with my PhD. And so this topic did not go over very well. And I was told by other researchers, you’re barking up the wrong tree. That had been so long ago. That can’t possibly be why black women don’t breastfeed. And these were coming from white researchers.

And I was just like, well, how do you know? You never been black a day in your life and two, maybe the right questions have not been asked. And that’s what it was. Nobody had really sat and asked, you know, how do you decide you’re going to feed your baby? What is grandmama say, what is grandmama do? Like who are the influential players in your infant feeding decisions.

And once I did my qualitative work, I did focus groups with African American women who had to make the conscious decision, whether to formula feed or breastfeed. I stratified them by age 18 to 29, 30 to 50 and over 51. So I put them all in generational groups together and it was riveting. They could co-sign on something.

Oh yeah, I remember that. And that was around about the same time that I was doing, you know, X, Y, and Z. And it did bubble to the top. You know, one time, one of my participants, and this is published so I’m not saying anything that’s not already out there, was just like, you know, a white man said to her, tell your Mammy I said, Hey. While she was just walking down the street. And mammy is a very derogatory word in the African American community. And she was just like that and she was in her sixties and she was just like, I still remember that to this day. And that, that was one of the influential things that happened to me when I was growing up.

Heather: Can I just ask a follow-up question? When you were getting this pushback from other researchers at your university was like, in their mind, what is the alternative to asking people directly what their experience is? Is it just a bunch of white people sitting around a table speculating why black people aren’t breastfeeding as much, or aren’t seeking out support as much? What was happening that, you know, in real time that they were fine with?

Dr. Devane-Johnson: You’re speaking my language now. So what I have found, being a black researcher in a white research world is if it does not directly affect them or you, it’s not a thing. So they was just like, really right now? That can’t be it, let’s move on. I’ve been in the black community, doing this research for a long time and I would have heard that.

And I was like, no, In the black community, we, you know, and I’m sure in your, like when you go outside the house, your mom was just like, don’t tell all our business. Don’t go out here running your mouth. I’m sure that goes across all racial and ethnic groups, but probably more so in the black community. And a white researcher, granted, you’re coming in and you’re doing fabulous things, but you can’t infiltrate like that.

And then like somebody who probably potentially has the same lived experiences and that looks like them, we can infiltrate at a deeper level and get to the root cause. And being a student at the time and I was just like, you know, I just want to graduate. Like, I just want graduate! I’m not trying to ruffle any feathers. I’m not trying to make anybody mad, but I believed in this work because I knew after combing the literature, doing a lit review, that variables such as social economic status, education, marital status, things like that.

Those were variables that were out there. But that was not, that’s not it. That’s not the whole driving force because white women, similarly, positioned white women, still tended to breastfeed higher than black women.

Maureen: Yeah. And I mean, you’re at a double disadvantage researching that because also, nobody wants to fund research for like physiological, normal breastfeeding, because they can’t make money any off of it.

So I’m just saying kudos to you. Cause you got through it and you did it and you’re still doing it. And you know, from what I’m hearing and what, you know, we already know, there’s a lot of epigenetic trauma that’s playing into it. There’s generational knowledge that’s playing into this. So you know, with that in mind, can you tell us a little bit more about the barriers that still exist when it comes to getting proper breastfeeding education and assistance and support for black parents?

Dr. Devane-Johnson: One is representation. So I was on a board of directors and still am, of a pathway to program in North Carolina at a historically black college called North Carolina A & T University. And what the issue is becoming an IBCLC, as I’m sure you all know is not easy. It’s a lot of money. It’s finding somebody to proctor you, somebody to for you to apprenticeship under so that you can get your hours.

And they’re not a lot of black CLCs. So there, women and individuals, because there’s some black men who are IBCLCs, it was a barrier and they just couldn’t do it. And so we at Carolina, I was at Carolina at the time, the Carolina Breastfeeding Institute, partnered with North Carolina, A & T and Dr. I’m not doctor, but Genea McNall Williams and started this program.

And that is to put more peer counselors and IBCLCs of color in the community to mimic the population for which they serve. And that is huge. I’ve heard, I’ve had not heard horror stories, but I have heard uncomfortable stories from black patients, new to a specific area and go to a la leche, potentially meeting and being the only black person.

And that’s one disconcerting and two, she felt as though they couldn’t understand. So getting more mahogany milks and mocha moms, and there are a lot of virtual platform, breastfeeding support groups for women of color builds a community and a sense of comradery.

Heather: So tell us about the project that you’re most proud of in your career so far.

Dr. Devane-Johnson: The project then I’m most proud of in my career so far was my dissertation work. Which found, and it’s now published and it’s in the literature that social historical factors, cultural factors, the mammy caricature, force formula marketing, things like that does influence infant feeding decisions for some black African American women.

And I just have to put a, give a nod to Dr. Miriam Labbok. She has passed on, but she was the founder of the Carolina Breastfeeding Institute at UNC Chapel Hill. And she was on my dissertation committee. And when I first started this work, like you can’t do breastfeeding work in North Carolina without Miriam Labbok.

You shoot yourself in the foot if you try. So who do I link up with? I link up with Miriam Labbok. And she believed in my work and she wrote my dissertation into one of her grants and funded it for me. Wow. And paid for the whole, I would still be at Carolina right now if it hadn’t been for that, because you can’t get, you can’t pay out of your own pocket to do research. That’s, you know, unethical and against the laws, really. And she believed in me and paid for or funded the transcription, the, you know, the incentives, the food that I had for my focus group participants. And when I tell you I’m indebted and whenever I give a presentation, I show her picture and I give a nod to her in gratitude because how thankful and grateful that I am.

I didn’t get to where I am by myself. And once I graduated, I wanted to give a whole bunch of little degrees with everybody’s initials at the end, who helped me get to where I am. I’m not ignorant to that. I’m not that smart. Like I just have a great village and support that encouraged me and supported me to, to continue to move forward.

Heather: That’s great that you had that kind of support and you did use your PhD to disrupt the system, which is exactly what a PhD is for. So anybody that comes at you and is like, oh, you shouldn’t do research in that. Everything’s fine. Well, it’s fine until I disrupt it. And you know, that just reminded me. So you’re a Vanderbilt grad and you’ve precepted students from Frontier, so thank you very much cause that’s where I graduated from. And I know that’s not easy. We can be huge pains in the butt as students, but you know, when with your research that you’ve done and I’ve seen our professional organizations that are really kind of pushing this awareness.

Which is great, then people I’ve heard, don’t know what to do with it. Okay. I’m aware, I’m now upset and I have nowhere to put it and I don’t know what to do next. So do you have any advice for people who are in the birth work community on where we can go with this?

Dr. Devane-Johnson: Yes. I’m glad you asked. What I tell my birth workers, anybody in the birth world, GYN, women’s health, infant heath, colleagues about being an advocate, an ally or alibi. And sometimes your skin color affords you opportunities to be at certain tables that a lot of us aren’t invited to. And so if you’re invited to a particular webinar or a panel, bringing on somebody who has that expertise, you know, expertise that needs to be out there to come along. One of my colleagues at Chapel Hill Dr. Eric Hodges, he is a fellow of this breastfeeding committee panel.

And he was just like, I have a seat around the table and I want to invite you around the table. And I was just like, thank you. That’s, that’s all sometimes that we need, like, sometimes we just need one foot up, like somebody to reach down and kind of pull up. There’s not a lot of generational wealth in research, much less in the breastfeeding world.

And so whenever opportunities come up to and that, you know that you have a lactation consultant, midwife of color or brown person that is interested in that same thing. It’s like, come on, come with me. And that opens them up to that, just opens up new way, opens the door to networking, and then they can get on the list and can get invited to more things or, oh yeah. I need to talk to you about, and just getting our names and places out there.

I’ve had so many colleagues whenever I would public speak and they’d be like, “I’m a nice white person and I really want to help!” and I’d be like, we know it! You are, but you can’t, you know, you gotta just roll right into communities like the white savior and try to fix everything. That’s not the way it works. And that’s, I think sometimes what they think. We’re going to go in here and we gonna fix this community and all of this going to be right with the world. Wrong.

I’ve had a lot of researchers who tried to do the work in ethnic and minority groups, just not black, even Hispanic with no Hispanic or black researchers on their team. Hmm, that’s true. How did that work out for you? Right. Exactly. Like that. It’s not that. There have been so many atrocities, Tuskegee’s, Henrietta Lacks, like black people are fuel for old research studies.

Like. Nah, I don’t want them, you know, we’re not signing up for that. And so you have to go in and shake hands and kiss babies. And that’s what I did when I first got to Tuskegee. I talked to my Dean and I was like, look, I’m a black researcher but I can’t expect just because I’m black for the black community to embrace me. I got to go out and shake hands and kiss babies.

And I’m a nice person. And you know, that y’all can trust me. And as soon as I got here, I started it with the black churches and everything, and COVID hit. Well, how much community engagement can you do when a pandemic hits? And so it’s a continuous thing, but you can’t just walk in, set up a table and a tent and expect people to come.

You got to go in, like, what are you going to give back to the community? You can’t go into a community and take, take, take, take, take, and not give anything back, which is historically what research has done.

Maureen: Yeah. I mean, you have to build trust after all of the ways that people have fucked up in the past. It doesn’t, it doesn’t just come out of nowhere.

Heather: Yeah, but for some of, I mean, I am sure a lot of our listeners are unaware of that. Completely unaware of that, which is sad. But also, would you mind talking a little bit about some of those studies that you just referred to. Studies, I have like, oh, those atrocities. Yeah. Research atrocities that have been committed. Yeah, historically, just for some context.

Maureen: You know, some people are coming out this podcast and they’ve read it and they know, and some people will be like, wait, what do you mean Tuskegee? I’ve never heard of it. So yeah.

Dr. Devane-Johnson: Yeah, in the south, they knew that these black men had syphilis and we had penicillin at the time to treat the syphilis, but their, the researchers’ bright idea was, well, what if we don’t treat it? What, what will happen? Let’s see what will happen to these individuals if we don’t treat their syphilis.

And which again, unethical. You had the medication and you let these men become demented, crazy, pass it on to their offspring, and totally disrupted hundreds of lives all in the name of science, you know, and because they wanted to see what it looked like.

And so, again, it was these men, they didn’t necessarily inject them with syphilis, but the men had syphilis. There was penicillin. They were not given the medication that could cure them.

Maureen: And they weren’t told they had syphilis. Right.

Dr. Devane-Johnson: They had, no, they were told they had a blood disorder, like something like anemia or something like that. Right.

Heather: And I think a lot of people when they think about studies that are also atrocities, they think of like Nazi Germany, they think of concentration camps. And what they don’t think of is that it’s still happening today in the country that they live in. And we touched a little bit on this in what episode was that?

Maureen: Was it the formula one or the Prolacta thing?

Heather: Yeah, it was, it was, yes, it was the one about Prolacta where they targeted an urban community and they decided that they were going to pay black women who are postpartum for their milk. And they were going to quote unquote, help improve the black breastfeeding rate. And that is not a proven method. And it was basically just a bunch of white people sitting around a table, exploiting people with a smile on their face. And that was not that long ago. It wasn’t even 10 years ago.

Dr. Devane-Johnson: It wasn’t. I remember. It was the, we called it mammy 2.0. That’s what it was.

Heather: Yeah. Yeah. So just, listeners listen up because this is not something that happened 50 years ago. This is something that is real and it’s happening today and that’s why research ethics exist. And that’s why you need to become aware during awareness weeks of what’s going on, because I think a lot of people would be like, why do we even need this?

Like, of course black people should breastfeed. And it’s like, no, none of that, whatever you just said, no.

Dr. Devane-Johnson: I have, you know, there’s certain things about society that burns my biscuits. You know, the black lives matter. No, all lives matter. You’re right. But it’s not all lives are getting killed in broad daylight, on camera, like, come on.

There’s so much defensiveness and angry, like for no reasons. Like what, how was, why are you so upset about this? What is it? That it’s and I had to stop it. Like that’s a them issue, Stephanie, not a you issue. And it speaks to whatever it is, demons potentially that they’re fighting, but we’re not saying that all lives don’t matter, but it’s not all lives that are being killed at astronomical numbers by police, by, you know, other.

So that’s why we, you know, to highlight it and shine a light on it is not to diminish other races. We’re not trying to say y’all don’t matter. But y’all not getting killed by the police like everybody else. Give us a break. Just like how, why is this affecting you so much? Is how is this affecting you? Is it affecting how you’re going to feed your family?

How you’re going to, you know, your job? Why is the mantra of black lives matter so offensive?

Heather: I’ve asked myself that same question.

Maureen: I mean, and we, well, and we’re in West Virginia, you know, you’re, I’m sure you’re familiar with this, we’re still arguing about the Confederate flag and Confederate monuments where people are like, oh no, no, that’s our heritage. That’s not about racism or like, yeah. I don’t think you know about your heritage, actually, if you think it’s not about racism. Like what the fuck.

Heather: Yeah. Well, you know, the other thing is in regards to breastfeeding for those of you that don’t know, just a little over 80% of white people initiate breastfeeding, and in the black community, it hovers around 64% that initiate. That is a huge difference for human beings that are genetically the same. It is cultural and it is something that definitely fits into an awareness week initiative. And that’s what we’re doing here. It’s and that’s what Dr. Stephanie is doing here. She’s getting to the bottom of this.

I would love to know where your research has taken you next. What are we going to be looking into in your future?

Dr. Devane-Johnson: Oh, I, I have a lot out there. Let’s see. As you all know, from the Good Morning America piece, that I’ve teamed with colleagues at Carolina and Duke and getting grants, we’ve gotten grant funding and trying to get more to educate more perinatal, black perinatal doulas, which there will be peer counselors. They will have lactation support as well as labor support. Trying to do the same thing here in Tennessee. And our goal is to, the black maternal mortality rate and the black infant maternal mortality rate is very high.

And if we could get more representation again in the birth world with black doulas to be advocates and helping black patients navigate the healthcare system, because I have heard firsthand from black patients, I don’t want to go back to the hospital. I feel like I’m bothering them. And I was like, you’re going back.

Your blood pressure’s sky high, you look like crap. She’s postpartum and tears just flowing. And I was just like, I am so sorry that they made you feel as though you weren’t worthy or that you were bothering them, but you’re going back. you get ready for them to throw the kitchen sink at you and make sure that you’re okay.

And I had to take a moment and go out to my car and cry. I was just like, this is 2021. Nobody should feel as though they’re not worthy of good healthcare or not being listened to or being poo-pooed or dismissed in some type of way. So I’ve been trying to get some funding here in Tennessee. What next? It sounds pretty much the exact same grant and North Carolina. Flip it here in Tennessee and it got declined.

We are not in Kansas anymore and I’m working, hopefully not hopefully, but I am working with some researchers at Rush doing a diversity supplement, looking at black NICU moms and the moms’ desire to give human milk to their preterm babies.

Heather: That’s excellent. And I cannot wait to read that. And I have a follow-up statement slash question for you, because what you just touched on is very, very important.

And if we just take it one step deeper, I think it will help people really wrap their head around why someone might be afraid to go to the hospital. So it’s yes, it’s not believing when someone’s in pain, it’s not believing symptoms. It’s brushing people off, but what people really don’t understand and what I tell my nursing students at West Virginia University, I always sneak this into any lesson really.

I’m like, oh, by the way, this has nothing to do with this, but you definitely need to know. If you are a black woman in a higher socioeconomic status, you are more likely to die in childbirth. And they, their heads just kind of spin around and I say, yeah, okay. Let that settle for a minute because all your preconceived notions about people not accessing health care, because they’re not educated or whatever other biases that you came here with, the reason they are more likely to die in childbirth, if they are higher socioeconomic status is because they’re more likely to live in a white neighborhood and deliver at a white hospital with a white staff. And they just kind of, their face just drops every time. And I’m like, now that I want you to go home and marinade on.

Dr. Devane-Johnson: And allostatic load and weathering is a thing. And when you’re at a certain level as a black person, the amount of stress that your body has endured over years, our expectancy, you can cut off about two to three years. And that’s real and black women like residents, physicians, corporate have higher incidences of preterm labor and miscarriages as well. And I think it’s all stemmed to the amount of stress that they’re under. Absolutely. Definitely. Not necessarily. I mean, I think if you know better, you do better, but they, you know, they been making a decent amount of money.

They go on there, they’re seeking out the best. They feel healthcare and everything like that. But then they get into that system and nobody respects them or listens to them. And doulas can help mitigate that and helping them navigate, not be their mouthpiece, but sometimes, and I’m totally, I totally do this.

Sometimes we talk up here as providers and the patients are down here and I was just like, well, you didn’t understand anything I just said, did you? Okay, let me back up. And so the doulas can be like, okay, what they’re trying to say is X, Y, and Z, and you know, and help them formulate questions to make sure they have informed consent.

They’re so vulnerable when you’re the only person potentially that looks like you. And I always have a running joke with people. I was like, I’m a black midwife 1. I’m a unicorn 2. I’m a black midwife with a doctorate. I’m a double unicorn. So I’m usually the only one or one of very few in a room. Gotten used to feeling like that. Gotten used to playing that game.

Maureen: Right. And I wish more providers saw doulas in that role. You know, you just described a translator, right? Somebody who can sit there and say, Hey, I, you know, I saw that your healthcare provider just said something you don’t understand. And I’m going to stop the conversation and we’re going to go back to you, the patient, that this is really all about.

It’s not about your doctors, not about your midwife. We’re going to make sure you understand using words you understand. Asking questions that you might have in your mind, but just not, you’re not able to say for whatever reason. You know, I, I just get so annoyed when, when providers are so dismissive of doulas, like whatever, they’re just in the way.

Absolutely not. Sorry. They made you just slow down and take 15 minutes with a patient instead of 10, but that’s your job and they’re helping you do it better.

Heather: Yeah. And also consent. You know, you’re, it’s a vulnerable position anyway. You go in there and your legs are spread apart at some point during the process.

And that is a vulnerable feeling. And so if you’re already feeling like weird or that you’re in positioning anybody or that they’re not going to believe the words coming out of your mouth, consent, which is a fluid relationship. It’s not like, well, you gave me consent in the beginning, so that means I have consent to do whatever I want the rest of the time.

Maureen: Now that is what they make you sign at the hospital.

Heather: Oh, that’s what it feels like, but that’s not what it actually is. You know, having a doula there to be like, who has a relationship with you, who knows you over the course of your pregnancy, to say, I feel as though you are uncomfortable now in this moment.

Are you okay with a cervical exam now? Not 15 minutes ago, right now. And making sure that that relationship is still important and that the patient knows that they have every right in the world to withdraw that consent at any point in time. So important. So thank you for bringing that up.

Dr. Devane-Johnson: And I, I mean, I teach the new generation of nurse midwives, which I absolutely love.

And I got to give a plug, Vanderbilt is the number one nursing school in the country. But anyway I’m a product and now I teach there, but what I challenged my first-year students to doing, I was like, I don’t know how many of you all in this room have ever being the one or only person in a room that either looked like you, identified as you, was the same sex as you or anything like that.

But I challenge you to put yourself in that situation, at least once. Seek out a community where you would be the only one or, you know, an event where you could potentially be the only one that looks like you and sit with that and see what that feels like. And know that depending on where you go to work and the communities in which you serve, the patients that you, that you are taking care of could potentially be one or very few.

And it’s unnerving. It’s unnerving to walk in and whenever I go to conferences or whatever, I see somebody black, I was like, hey! How are you!

Heather: Oh my gosh.

Dr. Devane-Johnson: All right. I’m not in here by myself. There’s somebody that, you know, has felt the microaggressions. Whether they be, you know, subtle, implicit explicit or whatever. And I have male midwifery students in my class and when we go to the office and teaching them how to put patients in stirrups, I get the guys up there.

I was like, you need to feel the burn.

Heather: Jump in the saddle.

Dr. Devane-Johnson: And. I feel so vulnerable and exposed. Do you? Exactly! And never forget it. If more people would step outside of their norm and then just because it doesn’t affect them and pooh-poohing what other people are potentially going through. Like you go and try that.

You know, shed off all the layers of who you are and all the privilege that you might have, just because of your skin color, whether you are privileged or not. And I get a lot, I get that from a lot of white colleagues as well. It’s just like, well, no, I’m first-generation frat and I, you know, just all these things too like they’re not privileged. I was just like, yes, but your skin color did not, was one of the things that do not keep you from getting where you are. Yeah. People of color.

Maureen: And it’s really different too, like, yes, I can relate as a member of the LGBTQ plus community, but also I can pass whenever I want to. Yeah. You know what? I can go out there with my kids and nobody knows, and nobody has to know unless I say something about it. And that’s a really different experience.

Dr. Devane-Johnson: It is cause we can’t shed the skin color. We can’t like, race, and I had a colleague say to me one time, take race off the table. And I was just like, that’s what that’s like personal one-on-one you don’t never say that to a black person. I can never not take race off the table. Race beats me in the door. Yeah. Beats me in there before I get there.

Maureen: I mean, yeah, of course. You know, we’re like trying to prepare for this episode, I’m looking at the Vanderbilt website and I’m like, yep. I think she’s the only black woman on this page, you know? I mean shocker, but, and of course it’s like the, that’s always going to proceed you. Yep. And, and that, and you can’t, you can’t ever pretend it’s not going to.

Dr. Devane-Johnson: And my colleague did not mean that maliciously. And she was just like, you’re right. Thank you for saying something. And I was just like, you know what, I’m 50 and I’m proud to be 50. And I’ve lived the first half of my life fearful of losing my job potentially, or, or, or whatever. And I was like, I can’t live the second half of my life being scared. So you can’t make wrong, right. And I’ll call out wrong every time.

Heather: Oh, my. She’s going to blow up, you guys. I cannot wait. She’s going to get that grant funding. Don’t you worry about it.

Dr. Devane-Johnson: And, and I’m an unapologetically. I’m like, sorry, not sorry. And sometimes people don’t know, and that’s what I encourage more black researchers, just people, black people in general. If somebody says something that grates your nerves, circle back around. What is circle back around you, something that you said that didn’t quite sit very well with me.

Maureen: And especially in the lactation world, you don’t get shit done if you’re not like that. You know, you can’t, you can’t sit back and wait for someone to tell you it’s your turn. I’m very thankful for people like you that are unafraid to, to call it out as you see it. I’m very thankful for people in my life like that.

It’s, we’re super privileged to have a member of our midwifery group who continually, you know, to the greater white population is like, well, let’s back it up. Are you feeling unsafe or just uncomfortable? And, and then we talk about it again and we get through it or we’re trying to get through it. And yeah, it, it sucks to go through that, but it’s not going to suck any less next year, the year after, in a hundred years, you know, it’s only, it’s only going to get better if we just do it now,

Dr. Devane-Johnson: It sucks that it to do that, but how about feeling that way daily? Hourly? Every minute? Every second? And again, speaks to the weathering and the allostatic load. Like we’re tired, I’m tired. And it’s constant. And me, as you know, as a black nurse midwife, having been a midwife 23 years, having functioned at high levels of high risk, low risk, and still getting questioned about my management. Really? Right now. Hm. Yeah.

Heather: And as a woman too. And in addition to that, you know, we’re still trying to dig our way out of obstetricians that are all men who want to, you know, Twilight sleep us. Like that wasn’t that long ago.

Maureen: Oh no. I, I just met somebody yesterday who told me about all her twilight sleepers and I was like, oh.

Heather: Yeah, sorry about your non-consensual, but you bring up another good point. You know, if you have one black person on your staff and you hear this podcast and you’re like, oh, we really got to get into this. Like, let’s have a conversation. Maybe it’s not in that person’s interest at that time. And maybe they don’t want to do it for free because it is exhausting and it’s not actually their job just because they’re black to help you understand it.

Dr. Devane-Johnson: We are not the black Jesus! We are not the black Jesus!

Maureen: Gonna wake the baby.

Heather: Oh my God. You’re so funny. I mean, thank you for coming. We would love to donate to an organization or a charity in honor of you coming to speak to us today. So thank you so much. Where should we send our donation?

Dr. Devane-Johnson: I would love, in recognition of Kira Johnson, The March for Mom Organization with Ginger Breedlove and Ebony Renee, who’s a fabulous black nurse midwife. And of course, you know Ginger, she used to be at ACNM president. Because we’re lobbying, not necessarily lobbying, but you know, the mom, the bus act this out. One of them is because of Kira Johnson and I would love for any donations to go towards that organization.

Maureen: Okay. Yeah. And that’s a good call to action for listeners. If you know, it’s okay if you don’t have a lot of time, maybe have a little extra money, you can donate there and we will be super happy if we could rally some donations for that.

Heather: We’ll start, we’ll start. And we’ll put a link in the show notes. So if you’re feeling moved today and you don’t know what to do, but you want to do something, that’s a great place to start. So what is the one thing you want our listeners to take away from our conversation today?

Dr. Devane-Johnson: Oh, that wasn’t on the list.

Heather: Oh, sorry.

Maureen: Or 10 things. I don’t know, whatever you want to do.

Dr. Devane-Johnson: If the one thing that I want to challenge your listeners, that if you are in the position and you see something that inherently, you know is wrong, that is not necessarily being done to you, but potentially being done to a colleague or just somebody out in the streets, just say something. Because being silent means that you’re co-signing and like, oh, if it happened to them, it didn’t happen to me. And I think that’s, we turning a blind eye and ear to a lot of stuff because it does not affect us personally. And I’m tired of that. And that’s where I think, you don’t have funds and you know, with the pandemic, you know, everything everybody’s stressed, everybody’s strapped.

Everybody is everything but being kind and standing up for your fellow person, regardless of whether they look like you are not, cost nothing. It costs nothing to be kind and to advocate for somebody and to say, you know, I would like, especially in a meeting or something, I just don’t feel comfortable with that.

We need to press pause or something. I don’t know what we need to do, but we’re not moving forward. And that sometimes is a wakeup call to others. Like, oh, shoot. And you don’t have to be a bull in a China shop. You can just, I don’t feel comfortable with that sorry, not sorry. Thanks for coming to my Ted talk.

Like, I don’t know, but you got to find it in dig deep. Strap on a couple of gonads I don’t know. Whatever it is that you feel as though you need to do and be brave because that’s bravery.

Maureen: Absolutely. I like that. And I think, you know, I’ve, I’ve been, I’ve been thinking about our professional spaces a lot during this conversation. And I want to add to listeners, you know, if you are a professional in a space that’s mostly white and somebody calls out something you say or did, or says there’s racism in this space or whatever, because there is, if it’s mostly white, I, I want to challenge y’all to not get defensive, even if, even if you really disagree, it’s really not your call.

And it is okay to just take a step back and say, yep, I’m going to think about it. Thank you for pointing that out to me. And just, don’t try to defend yourself. Don’t try to pick apart everything that happened and analyze every single bit of it. Go think about it and sit in your discomfort a little bit and and see what you figured out from there.

And, you know, definitely like Heather said, you know, in those professional spaces, if y’all need help with a racism problem, don’t just ask the nearest black person to do it for free. There are people who do that professionally. And if the, you know, if the one or two black people who work with you want to do it, great. Fucking pay them.

Dr. Devane-Johnson: Because it, it is traumatic and I have, you know, a lot of colleagues are just like, if I have to be vulnerable and open myself up to that then I needed to be paid. And I was like, you darn, Skippy.

Maureen: Heck yeah. And really like, even just with your friends, ask consent before you have conversations like that. Say, Hey, you know, I really want to talk about X, Y, and Z. Do you have the emotional capacity for that today?

Heather: Yeah, I like this. I think we’re setting some really good groundwork for people to start these conversations. There might be people out there I’m sure who’ve been wanting to have these conversations for quite a while and they just don’t know where to start.

So, thank you so much, Dr. Stephanie Devane-Johnson for coming and talking with us today. Lyra is mad.

Dr. Devane-Johnson: Pleasure. She was just like, y’all talk long enough!

Heather: She’s had two boobs, three farts, and I’m ready for a nap. Get out of here.

Maureen: She hasn’t pooped yet. So the episode’s not over. That’s usually when we,

Dr. Devane-Johnson: I want you to, I want you all to know that I don’t take this lightly that you reached out to me and for allowing me to have a voice in a space. Is huge. And I want to let you all know how grateful I am and thank you.

Heather: Thank you. All right. Well, we’ll let you get on with your day, but we appreciate you and everybody don’t forget to go to the show notes, even $1, you know, just something. Something in the right direction is a good way to go.

So thank you so much, everybody, and have a great day.

Dr. Devane-Johnson: Thank you.

Heather: Hey guys, Heather here with a very special message for you. I wanted to let you know that if you’ve attempted to breastfeed your baby, even once or began pumping after an unexpected postpartum complication, you’ve taken the first step to a beautiful journey. I also want to let you know that you can breastfeed no matter what kind of labor you had, no matter what kind of baby you have, no matter what kind of job you have. There is a way to breastfeed that can work for you.

The thing that I really want to get across here is that the fear of what if I don’t have what it takes to breastfeed? What if people think I can’t do this? What if I fail? What if I can’t do my job? What if I’m not enough? Here’s the truth. Everyone has those thoughts, but some people push through and succeed at breastfeeding anyway.

So what’s the difference? Consistent support. Yeah. Consistent support is the linchpin in the breastfeeding plan. Having support available to help you through the natural hiccups of feeding your baby is essential to decreasing that anxiety and making those doubtful voices in your head disappear.

Throughout the pandemic I’ve been accepting virtual private lactation clients to meet people where they are. Despite the crazy circumstances with at first, I honestly wasn’t sure how it would go, but as it turns out, it was better than ever. I’ve decided to continue doing virtual consults and help people all over the world. As an IB CLC, I hold an international certification and breastfeeding is a universal language.

If you find yourself needing that personal support and would like to work with me, one-on-one you can schedule at your convenience at my link in the show notes, or by going to Let’s get you to where you want to be with breastfeeding and start asking new questions.

What if I succeed? What if I can breastfeed and do my job? What if you are enough? What if it works? We got this.

 It’s time for our award in the alcove, Maureen.

Maureen: I’m excited today to give an award to Maddie Looney. Maddie’s win is that her 34 weeker who was born last week has begun latching with the help of a nipple shield. It’s so exciting!

Heather: Yeah. That’s really exciting. And she’s got probably a lot of people helping her in the NICU, I hope. Because that can be a tricky scenario where their jaw muscles and their facial muscles just aren’t strong enough. And it’s also, they’re trying to mature their reflexes enough to even coordinate that suck, swallow and breathe.

So it’s probably been an uphill battle for you and we wanted to let you know that we appreciate that work that you’ve clearly put in and we are celebrating for you over here in the alcove. Woo. So what award are we going to give her today?

Maureen: Let’s give you the little engine that could. That one’s cute.

Heather: You are clearly, and your baby is actually, I would say the baby is the little engine that could.

Maureen: We’re kinda giving the baby the award, but your award is for your perseverance, Maddie. Cause I know that that takes work and honestly it takes bravery to take this tiny, tiny baby and see if they can latch.

Heather: Yeah. The perseverance award, coupled with the little engine that could award.

Maureen: I think I can. I think I can.

Heather: I think I can. Good job Maddie. We’re here for it and we are super pumped about it.

Maureen: All right, guys, bonus is that this week we received a couple of really wonderful emails from fans and I just wanted to read a lactation love letter and we’re just going to do that whenever we get them.

Heather: Yeah. This one tickled me pink and I had to send it directly to Maureen and tell her to read it because it really made my whole day.

Maureen: Okay. So this is from Rachel Friess. I’m not totally sure that’s how you say your last name, Rachel, but I’m sorry if it’s not. So Rachel says, hi ladies, I’m a first-time mom living in Ballarat, Australia and I wanted to share what a difference your podcast has made for me all the way across the other side of the world.

Going into it I knew I wanted to try breastfeeding and although I’ve had a fairly easy run with it, I’ve also been fighting the urge to give in and give up. I honestly feel like I would’ve given up months ago, had it not been for your podcast and your advocacy for the joys, benefits and truth about breastfeeding. As a pharmacist, I’m a strong proponent for evidence-based education.

And I was starved for accessible evidence-based information in those early weeks. I spent a lot of late hours on Instagram being persuaded into thinking I needed all the gadgets and cookies and nonsense. Thankfully, I found your podcast and I have been nonstop listening ever since. I’m slightly concerned my son’s first words will be milk minute. Yeah. As your theme song is stuck in my head constantly. Not only have you empowered me to continue through these tough times, you’ve inspired me to share your podcast with my mum friends, and you will have changed the way I practice as a pharmacist consulting with lactating parents when I returned to work. Oh my gosh. Thank you, Rachel.

Heather: Okay, now do it one more time, but with an Australian accent.

Maureen: You don’t want to hear it.

Heather: Rachel, that made me so happy on so many levels. You pretty much just. You assured me that all of the major tenets that we built this podcast on are coming through.

Maureen: Yeah. Yes. That’s exactly what it is. We read these emails and messages on Instagram and stuff, and we’re like, oh God, we’re doing it.

Heather: Yeah. I mean, when we first sat down to do this, we were like, okay. So what are the main things that we want to build this on? It has to be evidence-based. We want it to be a little bit funny and we want people to be inspired. And also we want people to put change into practice wherever they are practicing. You know, telling other people around you, that you might have some power over as a pharmacist, as a different lactation consultant in a, maybe in a community area, maybe in a hospital, maybe you’re the leader of a mom’s group.

You know, wherever you find yourself in a leadership position, you can help people get this evidence-based information. And we hope it’s fun.

Maureen: Hmm, I hope so. And before we go today, I also wanted to give a shout out to Holly Fitzwater, who I ran into at patina in Lewisburg at the end of July. And she recognized me before I walked out of the store and said, hi, and I will just let you know guys, if you recognize me from the podcast, please tell me and say, hi, I love meeting listeners. I’m really happy to, you know, start adding faces to, to this massive mystery that you guys are to us. Yes.

Heather: Did you know that? That you’re a massive mystery?

Maureen: So anyway, Hey Holly, it was wonderful to meet you and your sweet baby, and I hope we see each other again.

Alright everybody. It’s been an awesome episode. Thank you so much for listening to the end. All right. Bye-bye.

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