Removing Barriers to Breastfeeding in Niagara County

istock_000000346530_mediumBy Elaine Roman, MA, BSN, RN, IBCLC, ANLC Director, Division of Public Health Planning and Emergency Preparedness, Public Information Officer & Elise Pignatora, MS, CLC Public Health Resource & SNS Support Officer, Niagara County Department of Health

For the past three years, Niagara County (NY) Medical Reserve Corps (MRC) has received the MRC Challenge Award from the National Association of County and City Health Officials (NACCHO) for their breastfeeding initiative, “Energizing Partnerships to Advance Support Networks for Breastfeeding Mothers.” Director of the Division of Public Health Planning in the Niagara County Department of Health Elaine Roman, MA, BSN, RN, IBCLC, ANLC and Public Health Resource and SNS Support Officer Elise Pignatora, MS, CLC led the lactation initiative. The Niagara County Department of Health’s inspiration for this intervention to the 215,000 population community came from the 2011 Surgeon General’s Call to Action to Support Breastfeeding.  “We also looked at the Healthy People 2020 numbers and realized our county was not performing the way we would like it to be in regards to initiation, duration, and exclusivity of breastfeeding in our county,” Roman said.

The project targeted women of childbearing age; specifically women aged 15-44 as well as high risk populations including African American women. The first year of the project brought a breastfeeding and baby care station to the Niagara County Fair, an event that new mothers have avoided in the past because of the lack of clean spaces to breastfeed and change their infants. An air-conditioned trailer, complete with a refrigerator, power outlets, privacy screens, changing pads, sink and restroom is offered to families for the purpose of breastfeeding and changing their babies. “We offer the mothers a private breastfeeding area,” Roman said. “We have dividers for privacy but often several of them will choose to sit together and share in friendly discussion while they are nursing their babies.”

For mothers who choose to pump, there is a refrigerator where they can store milk during the day. In addition to serving as a breastfeeding station, the county and the MRC use the opportunity to provide education to the visitors and to gather data. Women who visit take part in a community survey on breastfeeding. All visitors are invited to take the Breastfeeding Fun Quiz which Roman designed as a fun and simple way to engage the community and gather data on breastfeeding knowledge of community members of all ages and genders. The fun quiz also serves as a teaching tool. “Over the weekend I had a family of eight with two adults and six children,” Roman said. “The youngest family member, a nine year old boy received the highest score of 100%.  Issuing this quiz to a group or to a couple most often breeds a very competitive and fun learning environment.” Roman added. Afterwards, quiz-takers are offered unbreakable reusable pocket thermometers printed with handwashing instructions as tokens of appreciation.

A diverse set of volunteers help staff the breastfeeding station, including Medical Resident/MPH candidates from the State University of New York at Buffalo (SUNYAB), Niagara Falls Memorial Medical Center Community Health Workers and IBCLC; MRC nurses and pharmacists, and functionally challenged young adult volunteers from Opportunities Unlimited.

To further serve as a resource to the community, Roman and Pignatora received certification in lactation consulting in 2015. Roman is an International Board Certified Lactation Consultant (IBCLC) as well as an Advanced Nurse Lactation Consultant (ANLC) and Certified Lactation Counselor (CLC). Pignatora is also a CLC. With this expertise, Pignatora and Roman provide consultation at the fair on issues such as initiating and sustaining breastfeeding/ability to express milk in any setting, medications and human milk, human milk and immunity, vaccinations, nutrition, and family planning. Consultation is also provided via the Niagara County Department of Health Lactation Program 24/7 “Breastfeeding Support Line.”

“This “warm” line is dedicated to lactation issues,” Pignatora said. “Mothers and families can call any time on the Support Line to address any issues or concerns they have in regards to our breastfeeding initiative.”

The project also focuses on changing the environment towards breastfeeding in the workplace, with Public Health Director Daniel Stapleton, MBA serving as a champion for the cause through the establishment of a lactation room for multiple Niagara County Departments, their staff members and their visitors. A hospital grade breast pump and accessory kits, in addition to a dedicated refrigerator and sink for washing hands and supplies is available in the lactation room. Both Pignatora and Roman provide consult to women on overcoming barriers to breastfeeding in the workplace as well as child care sites. In 2015, the initiative began an ongoing effort of designating daycares and employers as breastfeeding friendly.

“We go to interested businesses that have returned our survey form and conduct a site visit. Together with their business leadership, we look at their existing space and capabilities. Then we discuss options and work with them on how they can make the best breastfeeding friendly environment in that space,” Roman said.  In a final site visit, businesses that are designated Breastfeeding Friendly receive framed and signed Certificate of Designation and a framed and signed Promise of Support from the Niagara County Department of Health Director. A County Legislator also participates in this important visit. The site visits to issue the Certificate and Promise with the two Lactation Program managers, Public Health Director and Legislator are always photo-journaled and highlighted in press releases and other media.

The future of the lactation program will focus on stress reduction for pregnant and postpartum women. “We know that one out of seven women that give birth get postpartum depression or anxiety,” Pignatora said. “To address this we created a mommy mindfulness initiative and we are in the process of training 15 volunteers in mindfulness-based stress reduction.”

The program relies on a train-the-trainer model where volunteers are trained in Mindfulness Based Stress Reduction and then teach the skills to community organizations and families engaged through program activities. Mommy mindfulness meetings will also be offered for women interested in reducing stress during pregnancy and throughout motherhood.

The lactation program has received extensive media coverage and Roman recently presented at the NACCHO Annual Preparedness Summit. They both attribute the success of the initiative to forming real connections with community partners, a strong volunteer force, the strong science-based materials they provide, and the support of leadership at the Niagara County Department of Health.

“Our main goal is optimal public health and health equity for infants and children,” Roman said. “We understand the short and long-term benefits of breastfeeding, and promote breast milk as the first food and the first vaccine a baby receives for optimal nutrition and immune protection.  Our motto for this breastfeeding initiative is “Feed and Protect.” It is also our public health mission,” Roman added.

Roman and Pignatora are dedicated to working towards achieving optimal public health by growing and expanding the breastfeeding initiative in Niagara County.

Learn more about NACCHO’s MRC Challenge Awards at