Dr. Rebecca Dekker – 00:00:00:
Hi everyone. On today’s podcast, we’re going to talk about trauma-informed lactation care with Porsche Holland-Otunba. 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, and welcome to today’s episode of the Evidence Based Birth® Podcast. Did you know that the Evidence Based Birth® conference is coming up in March 2025? If you haven’t heard yet, the EBB conference this year is a virtual event for birth workers and healthcare workers from around the world. We have a line up of incredible speakers on topics ranging from RSV to Medicaid payment for doulas to infertility and the research on home birth. And today’s podcast expert, Porsche Holland-Otunba, is one of our speakers. So, today on the podcast she’s going to talk with us about lactation and at the conference she’s going to dive deep into advocacy for preeclampsia survivors and preeclampsia prevention. A few important dates for you to know if you’re interested in the conference. Today, Wednesday February 5th is the due date for people who would like to apply for equity or scholarship pricing. Next week, February 12th, is the last date to register and get invited to an exclusive post-conference bonus Q&A with Jen Kamel of VBAC Facts® about everything related to vaginal birth after cesarean. And then, two weeks from today, on February 19th is the final day of early bird registration. So if you already know you want to attend, I highly encourage you to go ahead and get your ticket before those due dates arrive. And, if you just want to learn more about the speakers or to go ahead and get your ticket, just visit evidencebasedbirth.com/conference.Â
And now I’m excited to introduce our guest expert for today’s podcast who is going to cover a wide range of topics with a focus on trauma-informed lactation care for Black families. Porsche Holland-Otunba is a Philadelphia native, wife and girl mom of two, a third generation preeclampsia survivor and birth trauma survivor, Cesarean birth giver, and exclusive pumping mom. Porsche has supported parents as a birth and postpartum doula, childbirth educator, and a lactation counselor. She is the CEO and lead consultant of Reclaim Black Motherhood, LLC, a firm dedicated to the growth and development of birth workers and contributing to program development, curriculum building, and research efforts in the birth, postpartum, perinatal mental health, and lactation spaces. Porsche is also an Evidence Based Birth® instructor. And Porsche we are so excited to welcome you to the Evidence Based Birth® Podcast.
Porsche Holland-Otunba – 00:01:29:
Thank you so much for having me. I’m excited to chat with you.
Dr. Rebecca Dekker – 00:01:32:
Yeah. Can you start off by telling us a little bit about your own birth story and how that shaped your approach to trauma-informed care?
Porsche Holland-Otunba – 00:01:41:
Yes, sure. So I always like to lead by saying my first pregnancy in 2017, it came out of just a traumatic space. I had experienced a significant loss of a sister, not by blood, but someone that was very close to me and shortly conceived after that. So was in a difficult space, wasn’t really thinking that I wanted to have a family, unplanned pregnancy. So one of those 50% of people and single at the time. And so I didn’t know what I now know. And my pursuit of care and even the folks that I surrounded myself with, they just didn’t have it. And they tried to do the best they could. So I was healthy, never had any issues, complaints in life. And so I’m expecting this healthy vaginal birth that we see people huffing and puffing and going through on TV. And so I ended up at just about 40 weeks having a slow leak. And so there was some amniotic fluid coming through. And instead of things really being explained to me, there was just a push to go to the PETU or to where folks go when they’re pregnant. That kind of emergency room space in the hospital in Philly and an induction started. And so going through that experience, having what I really frame as a traumatic birth experience, not being informed, not being aware, just feeling like such a weird out of body experience and which turned into an emergency Cesarean. And so it was at that point of healing, struggling with breastfeeding, nurses trying to put their hands on me and my baby. And it was just uncomfortable and didn’t feel right. That it really prompted me to rise up and say something. Now Philadelphia, we’re a city of advocates and fighters and justice seekers. So I’m thinking to myself, I’m not suffering for no reason and I’ve heard about Serena’s story and I knew things were going on. And even with my Master’s level educated self, I didn’t feel like I was valued even giving birth at a hospital very well known in Philadelphia, the nation’s first hospital, did not feel well cared for at all. And so that prompted me to start cold calling organizations, looking up maternal health initiatives, saying, what can I do to get involved? So my baby’s on my hip and I’m literally doing my breastfeeding peer counselor training while formula feeding because I was struggling and was also doing my doula training and started taking clients before my baby even turned one. And so that’s really just kind of how things started to spin after a traumatic birth turned, I need to fight, and find out what can I do to raise my voice because of what I went through.
Dr. Rebecca Dekker – 00:04:34:
It sounds like it really lit a fire underneath you. Like you’re like, how can this be happening in this day and age?
Porsche Holland-Otunba – 00:04:41:
Exactly. I’m like, it’s 2021. My mom told me about one of her beautiful experiences with me, with a midwife at our last birth center that we had truly in Philly, which is now gone and we’re fighting for them again. But it was just like, what is happening here? Why wasn’t anyone talking, explaining things to me? Why did it get to this point? And why wasn’t the childbirth education that they offered really comprehensive, really told me the truth? No, it was just policies and procedures for the hospital. And I now know that being a birth worker.
Dr. Rebecca Dekker – 00:05:14:
Did you have enough support when you’re going through that process, that birth?
Porsche Holland-Otunba – 00:05:20:
I believe so. I had a very supportive mother who did the best she could with what she had. My grandmother as well. Brother, great friends. I had a whole tribe of people building furniture for me, sending me food. I’m very organized and was doing postpartum work before I really knew what it was. So I had meal train lists and people coming over to clean and I’m ordering food while people are setting up my baby girl’s room. And so I had a great supportive community. And even engaged with a doula in my third trimester very late. So I wasn’t able to fully take advantage of that support and understood what it meant, but the hands were available to me.
Dr. Rebecca Dekker – 00:06:03:
So your community was kind of rallying around you. Then with how the birth went and became so traumatic, was it a system failure? Was it that particular hospital? Was it staff there? Like, what was it that was the most traumatic part for you?
Porsche Holland-Otunba – 00:06:19:
Yeah, I think the combination of not being informed throughout the process.
Dr. Rebecca Dekker – 00:06:24:
So they’re not explaining things to you.
Porsche Holland-Otunba – 00:06:27:
Correct. Correct. At least break this down for me. Listen, I have a biology degree. I can understand some things. But if you would have said something as opposed to we know how coercion and just leading happens. We’re doing this now. This is what’s happening now. This is this. This is that. And no explanation. No, is this what you would like, Porsche? Miss Holland, is this what you want?
Dr. Rebecca Dekker – 00:06:47:
Okay. So every step of the way, they were just telling you what they were going to do. And there was no choice involved for you.
Porsche Holland-Otunba – 00:06:52:
Correct. And I didn’t know. I was scared. You know, before my doula got there, I was scared. My mother was also just like, I want you and this baby to be well. Like, I need you to be well.
Dr. Rebecca Dekker – 00:07:02:
Right. Like the fear was paramount there.
Porsche Holland-Otunba – 00:07:06:
Correct.
Dr. Rebecca Dekker – 00:07:06:
Yeah.
Porsche Holland-Otunba – 00:07:08:
Yes, absolutely. I also felt that based on my insurance at the time that there was some prejudgment, right? Having state insurance, being this young black girl, no ring, no husband. Even though I had my mom with me, so I wasn’t by myself. But I did feel this prejudgment. And so it’s like, will you explain? Will you take time? Will you ask if this is what I want?
Dr. Rebecca Dekker – 00:07:31:
Right.
Porsche Holland-Otunba – 00:07:31:
And because nothing was being explained, I didn’t know the Pitocin was too much. I didn’t know that my body was going to respond in this way. I didn’t know how I should be sitting or what I should be doing. And so things just kind of spiraled. And I soon discovered my first, my eldest does not like inductions, did not like that process. And having someone come bedside and saying, sorry, this is now what we have to do and feeling like a failure, but also looking around. And no one looked like me. It was a very young staff of all white folks. And that was scary in and of itself. Just being like, what’s going on? What’s happening? I know some things. I went to an HBCU. I know about experimentation. I know about different things. And I’m like, all of these folks touching my body and not explaining it to me, but I can’t leave. I don’t know where else to go. So I have to go through this. And that also compounded along with just feeling the failure of not being able to give birth vaginally.
Dr. Rebecca Dekker – 00:08:35:
Yeah. So just a lot happening all at once and feeling out of control. Like you said, out of body experience. I can see how that would be really traumatic.
Porsche Holland-Otunba – 00:08:44:
Yes. Yes.
Dr. Rebecca Dekker – 00:08:46:
And then the lack of representation at a hospital in Philly seems just inexcusable, but it reminds me of an episode we did episode 156 with Nicole Deggins of Louisiana. She talks about the lack of representation, how difficult it is to, you know, for Black women and folks to be in labor and delivery nursing. And we’ve talked about that in obstetrics as well. So it’s a systemic problem and it has real life implications for people like you. Yeah.
Porsche Holland-Otunba – 00:09:20:
Correct. I definitely agree, especially if it’s a first timer, you’re generally healthy. So you’re not in the hospital all the time. You go for this life-giving event in a very try to save your life. Death is happening space was also, I went to hospitals to visit my grandmother who was sick or to see someone that had a surgery. And so it was like, why am I even here? So even just that the smells, the coldness, the lights, just different things were also just didn’t feel real and safe to me. So just taking time to process since then, it was a compounding effect of different things that really made me think, what is this? And then I later found words that trauma is a real thing and experiencing a traumatic birth is real, not just for me, but also for my baby.
Dr. Rebecca Dekker – 00:10:08:
Right. So you started really getting into advocacy with birth and doula work and more lactation, as you mentioned. What happened next? What did you do next?
Porsche Holland-Otunba – 00:10:20:
Yeah. So I go through this breastfeeding peer counselor training, which leads to a doula training with PALS, an organization associated with this hospital, which is so interesting. And I just immediately get plugged in. I start meeting the movers and shakers in Philly and South Jersey. So people like Brittany McCollum, a pelvic floor expert and childbirth educator. I’m hanging out and getting mentoring from folks that have developed curriculum and made waves in our work, like Naima Black, who took me on and first mentored me and became my colleague and now friend. And so opportunities just started coming out of nowhere. I’m telling my story publicly on social media. The clients are out the wazoo. Screaming on social media platforms and showing up at events because it was pre-COVID. And so income speaking opportunities, income, of course, you know what you’re doing. Yes, I was already a consultant in a different area, but I can help you build your program capacity now under the lens of maternal health. And so it just started spinning in terms of research opportunities, curriculum building, program development, and then using that to fuel further education, training with birthing advocacy to become a childbirth educator, later becoming an Evidence Based Birth® instructor. And then eventually the perinatal mental health certification with PSI, Postpartum Support International. It was really just organic. I just did a lot of running my mouth, showing up at events and pumping local folks their work that they were doing. And quickly people saw me as a trusted source and somebody worth working with. So it helped in that regard. And then parents also saw me out and about a lot. And the word continued to spread. And I continued to have clients and be able to engage with families at the same time.
Dr. Rebecca Dekker – 00:12:13:
You’ve talked a lot about being a third generation preeclampsia survivor. Can you share a little bit about that story as well?
Porsche Holland-Otunba – 00:12:20:
Yeah, it’s really powerful for me. And I like to say that because a lot of us don’t talk about our preeclampsia experiences, particularly in the Black community. And we know the numbers disproportionately impact us. And so when I finally sat down, my mom would tell me all the time about it. It was toxemia for me. So I was born in ’86. And she was on bed rest. She was 20 and still had great, beautiful midwifery support, beautiful vaginal birth with me, a successful breastfeeding experience. And she would always talk about it. And one day we roundtabled with my grandmom and she began to talk like, yeah, toxemia, the tox, they didn’t know in my day. So we’re talking about the 60s, late 50s. And she unfortunately lost a baby. And so we talked about that. I’ve processed around it. And so when I got pregnant with my second baby, I’m like, they had it with earlier pregnancies or the first, it’ll skip me, right? I didn’t know what I know now. And so then to get this diagnosis that I was fighting to avoid, it became surreal that, wow, there is this connection. I need to learn more about this. And so I was one of the ones that was able to catch early, had a very supportive midwife, knew different signs, told them about my family history and the care was proactive. So I didn’t have adverse outcomes except for me. My baby was SGA, small for gestational age, but other than that, fully thriving. And so I connected with the preeclampsia foundation, told them my story. They were intrigued because people aren’t talking about those generational pieces. Typically Black women aren’t sitting around talking about birth and the things that happen, especially for our elders that face like the twilight birth era. And so to me, it was just profound to be able to say, we have this story, we can capture it. And I want to lead with this. So folks know I’m not just advocating for preeclampsia because it’s something that’s cute. I’ve been there, done that. It’s in my bloodline. We’re pretty sure we can trace it back even further generations, but they didn’t have the language or the support that we do.
Dr. Rebecca Dekker – 00:14:33:
They didn’t have the ways to measure it.
Porsche Holland-Otunba – 00:14:34:
No.
Dr. Rebecca Dekker – 00:14:35:
Yeah.
Porsche Holland-Otunba – 00:14:36:
Unfortunately, the folks were losing babies and we were wondering why, or they were getting sick and we were wondering why. And the care and the support and the advancement of technology and understanding was just not there. And so I really pride myself on being able to say, one, the birther survived. We did lose a couple of babies in our family lines, but the birther survived and we have a story to tell and we are the face. And so what does that now do when we’re advocating for further research dollars and efforts? Because we still don’t have any reliable ways of actually treating. It’s just get the baby out. And so that needs to change. It’s 2024. And if I can stand on at least four generation shoulders of suffering at the hands of this condition, then we have to do better. So I use that also to help advocate and force people to listen around preeclampsia.
Dr. Rebecca Dekker – 00:15:34:
What do you see as some of like the future of preeclampsia care and prevention? Like what are your hopes for Black women in the future, you know, dealing with this, like you said, a generational traumatizing condition?
Porsche Holland-Otunba – 00:15:49:
Yeah, absolutely. Number one, I need everybody to have a blood pressure monitor. And I also feel like a glucose monitor as soon as your pregnancy is confirmed. It just needs to be standard in terms of normalizing. You can do this at home. You can get a family member or a friend to help you and to not rely solely on appointments for checking in around these things. That’s number one for me because the trends are just heavy and it seems like the numbers are continuing to grow. So taking some of that stigma away that it is solely a medical provider standpoint, no, I check my blood pressure. I’m the one that caught trends and was able to tell my midwife what was going on and check myself into the ER. Nobody else could have did that for me. And if you’re unfortunately at a practice that’s overbooked or in a rural area, you’re going to get less amount of care and touch points. So that’s one for me. Number two for me is a clearer road of prevention. Aspirin cannot be it. I just can’t tolerate that. We have to find a better way. Is there something else we can do? Another rock we can overturn.
Dr. Rebecca Dekker – 00:16:56:
It’s like instead of a band-aid on it, aspirin has been shown to improve outcomes, but it’s not getting to the root of the problem is what you’re saying.
Porsche Holland-Otunba – 00:17:06:
Absolutely correct.
Dr. Rebecca Dekker – 00:17:07:
It reminds me of, this is really funny, Porsche, because you’re talking about ways of, it’s like the primary prevention versus secondary prevention, which is like a public health concept. But one of the things I’ve found interesting is with the ARRIVE trial with 39-week inductions, they’re constantly talking about how it decreased preeclampsia. And I want to say, it’s not preventing the underlying condition. You’re just causing the delivery to happen before the preeclampsia reveals itself. So it’s not addressing the root cause. So that’s one thing I’ve been seeing a lot with the ARRIVE trial with inductions and talking about how it prevents preeclampsia. But it’s not really preventing the underlying problem.
Porsche Holland-Otunba – 00:17:50:
Correct. And then there’s even the postpartum issues that come after that. I am chronic hypertensive. My grandmother was. My great grandmother was. My mom is. There are significant impacts for our health beyond the postpartum. And we’re just now starting to scratch the surface on that. Shout out to some great researchers. And physicians that are doing work around that. But we were just sending people home. You made it through the birth. I know it was traumatic. At least you’re alive. Goodbye. Our heart health, our cardiovascular health going forward, the numbers are ridiculous, right, in terms of the things that we have to face. And so not only better detection and treatment and prevention options, but can it go beyond just prescription? I utilized many things that I really do think helped delay the onset. So I was like a 39 and 4 confirmed.
Dr. Rebecca Dekker – 00:18:43:
So you were able to carry your baby for longer that way?
Porsche Holland-Otunba – 00:18:46:
Yes. And I do believe the combination of things that I did, herbs, like different things, I really do believe it helped. And is there room for us to discuss those and to look at that more as opposed to I was being fussed at for not wanting to take blood pressure medicine. I was being told different things by people. And it was like, I have the right to look into evidence and to see what’s going to work for me and to try. I want to try to carry this baby full term. Give me a chance or work with me or give me some studies or something. And so I would love to see more of a holistic. What else could we be doing to support throughout the pregnancy for particularly for people that have had preeclampsia or HELP syndrome in the past? Or we’re seeing it in their generational lines.
Dr. Rebecca Dekker – 00:19:35:
And so you already know they kind of have this underlying predisposition that it could happen to them.
Porsche Holland-Otunba – 00:19:40:
Right. And so how do we engage with that parent? What do we do there? And that’s some of the work that the Preeclampsia Foundation, The Take 10 campaign is seeking to do around asking Black folks like, please take 10 minutes. Join this registry. Tell us about your story. We want to put links together around birth and preeclampsia occurrences. Use that to fuel research, but also to advocate for funding and dollars around advocacy and awareness. And so I have a whole group of Take 10 sisters. We’re all survivors and we are fighting hard to tell our stories, to advocate and to raise awareness around this campaign so that we can advance research efforts. Like folks want to do it, but they’re not getting the dollars. I’ve talked to researchers globally. They’re concerned. They see that this is an issue. Nobody wants to support it. And so that has to change. Like we need more robust efforts. If we don’t want to keep crying, I got another patient with preeclampsia. Well, then let’s do something about it.
Dr. Rebecca Dekker – 00:20:42:
Right. Like so many other women’s health issues, they’re chronically underfunded and exactly everything you’ve been saying. So this also leads me to kind of another issue that you’re really involved in is with lactation. So can you talk a little bit about how generational trauma and the current kind of status of lactation care is impacting Black families today?
Porsche Holland-Otunba – 00:21:06:
Yeah. So lactation is so interesting. Many things for me that I’ll share also came up personally in my own family line. There tends to be, and even some research that I’ve done around lactation support in folks in Philadelphia after they’ve given birth, there tends to be this understanding that generally breastfeeding is good. It’s great. It’s helpful for the baby, but right? So is it the family that’s not offering the support? They’re saying that’s doing too much. Why don’t you cover up and go in the corner? We didn’t do that. Look at all your aunts and uncles. They have formula. They just fine. Your uncle is a CEO. Your aunt is an astronaut. Okay, great. I’m not saying that they’re not smart because they had formula, but this is what I want to do for my baby. So again, some of those generational conversational pieces that do come from a place of trauma. Was time cut short because our grandmothers, great-grandmothers, aunties, and them wanted to work, had to work. There were no accommodations, right? Or they were shunned or told that it was nasty or too much because maybe their great-grandmother was actually a wet nurse, right? And so there’s trauma there that comes from that piece. The over-sexualization of the body, right? Black women being seen as voluptuous and your breasts are so big and just all of this, and how can you be doing this in public and not covering up? And just all of these things that I see in this cocktail or jambalaya of things that impact why people make the decisions that they make. But one of the biggest things, especially for immigrant communities, and I’ll say this as my husband is Nigerian, and I also do a lot of work with folks from the Caribbean and other places like the continent of Africa, and people come and they look and say, I want to be a part of American culture. And I’m not seeing you all breastfeed. I’m not seeing anyone else doing this. This is not what I’m going to do because I want to assimilate. And I’ve even heard this while interviewing parents doing a research study. And I’m just like, is that what we’re giving off? So that even if in Costa Rica or Guyana or Zimbabwe, where you were, everyone is breastfeeding, you will come here and say, no, I’m not because I’m not seeing it. And it’s not the cultural norm. And so that is disgusting and sad and terrible all at the same time when many people desire to, but either lack of education, awareness, support, or resources comes in the way. And we’re definitely seeing that nationwide. Some places are more blessed than others to have a plethora of support like Philly. I mean, there is so much support, so many support groups, free resources. I mean, it’s just ridiculous out the wazoo. But in the hospital space, there tends to be struggling around baby friendly designation. Those first few days, not enough lactation counselors or IBCLCs to support people. So we know within that first week or so, establishing a routine, establishing great lactation support, that’s going to impact the rest of the feeding journey. And so that’s where for us in Philly specifically, we’re seeing some breakdown happening in the hospital space. But in terms of the community support, other Black lactation folks rising up to support families, it’s there. But those are the nuanced pieces that are going to vary city by city and state by state.
Dr. Rebecca Dekker – 00:24:40:
Well, so much can happen in the hospital too, that can impact your infant feeding journey. Did you experience any of that your first time around?
Porsche Holland-Otunba – 00:24:48:
Yes. You come out the OR and I tell people, it’s like, I thought I was in a different world. If this is what being high is, I guess I was high because I don’t know what was happening. I’m literally falling asleep to the point that my mom had to watch me and make sure that my eldest Anya was okay. But because there’s a time clock in terms of weight and output and there’s not this gentle approach, sometimes we’re forcing. So I had a nurse. I’ll never forget this, ladies, coming in and forcing my F cup size breast into my little small baby’s mouth and trying to force her to eat, which I now know is not the way. I don’t touch my clients at all. And they have healthy latches. You don’t touch people. You don’t have to touch them. But just the confusion that happened, the fighting that happened to the point that now she’s starving. And so we’re expressing wasn’t introduced. The pump is immediately pulled out, which I know expressing can now be a great first tool. And so we’re getting the milk faster through a syringe or through a bottle. And so I’m already tired. I’m already trying to heal. What position do I do? I don’t know. Nobody came back in to teach me a healthy position, right? And so now we’re struggling. We’re struggling. And I see that you’re better satisfied and going to stop crying if I hurry up and express this milk and give it to you, right? Or for some people that didn’t even know that they could express someone’s coming in with a pack and with some formula to slide your baby. And so for me, exclusive pumping became the thing. Once I then got home, sat on my recliner and started Googling and I’m like, exclusive pumping is a community. It’s a website. It’s a whole thing. I can do this and feed my baby. But I really do believe that confusion, the stress on the body, the grieving that was happening. It didn’t impact my milk supply. The milk was there and the proof was in the pudding every time I pumped. But that connection, that latch, that education was disrupted and made it more difficult going forward because of those early intervention pieces that happened to hurry up and get her fed.
Dr. Rebecca Dekker – 00:27:01:
Yeah. Those first hours, the first couple of days were where you needed that support and help and knowledge and wisdom. And instead, like you said, it was forced on you and you were also not given the knowledge that you needed. And you did what you could and it worked. That’s I think the beauty of parenting is sometimes we find another way to take care of our babies. So that’s beautiful, but also sad because one of the things in our community and maybe similar in Philly is that sometimes there’s only one lactation consultant in the hospital for an entire unit of people who need support. And they usually don’t work nights. They’re often not scheduled on weekends. So there’s these giant gaps in being able to access the lactation support. And then there’s also prejudices and biases about who they think will want a lactation counselor or consultant.
Porsche Holland-Otunba – 00:28:01:
Right.
Dr. Rebecca Dekker – 00:28:02:
Do you see that in Philadelphia as well?
Porsche Holland-Otunba – 00:28:04:
Absolutely. You hear it from folks. I know folks that work the floors and are seeing it that are trying to take extra hours. But it’s always a money thing. Certain hospitals are yelling or they’re we’re seeing cross training, too. You tend to see a lot of L&D or postpartum nurses also trained in lactation. So that might help. But again, you’re not guaranteed that all 24 hours in a day are covered. And even if they are a new parent without any prenatal lactation education or support, it can take quite a few hours of following up, of sitting, of helping. Baby fell asleep. You can’t get-
Dr. Rebecca Dekker – 00:28:43:
Providing emotional support.
Porsche Holland-Otunba – 00:28:44:
Processing through the birth. They’re going to tell you everything. I’ve been there. They’re going to tell you everything. And there’s no way you can hit a whole entire floor. What if 10 people gave birth that night? You’re not going to hit everybody. So one or two people isn’t even enough to cut it. It’s just it’s just really not. And so that’s why we tend to see folks as soon as they leave calling in. They’re getting app support from Pacify. They’re hitting up one of our lactation providers. They’re jumping into one of the few support groups that we have locally immediately or they’re saying, forget it. Yeah, unfortunately.
Dr. Rebecca Dekker – 00:29:18:
And I think it’s one of those things, too, when a culture has kind of like lost a lot of that societal knowledge about how to lactate and breastfeed and chestfeed your baby, then there’s this huge knowledge gap. And then there’s only a few people that know how to help, right? Whereas if we lived in a society where everybody watched babies being fed and we all knew how it worked, it wouldn’t be as such a dire condition.
Porsche Holland-Otunba – 00:29:45:
Correct.
Dr. Rebecca Dekker – 00:29:46:
But we really need those experts right now because we lost a lot of that knowledge.
Porsche Holland-Otunba – 00:29:50:
Yes, I agree. And so it’s some of that normalizing and general education, right, that you do see a lot of peer counselors. You do see a lot of doulas that at least have some of that basic knowledge and can then phone for help to say, hey, are you now available? I know you’re overwhelmed, but can you now slide in and help my client? And that happens for me. A lot of the doulas that I mentor will then say, Porsche, I tried to do some of the basic things you taught or that you recommended, but now I need some more help. Can you do a consult? Or I’ll send them over to an IBCLC if I’m seeing it’s beyond my scope as a CLC. And that’s kind of what we do in Philly to help each other out, to help spread the load. But we know other cities are just not as fortunate with the number of hands and the amount of knowledge to share.
Dr. Rebecca Dekker – 00:30:38:
When you were talking about the lactation consultant listening as the birthing parent is sharing their story while they’re sitting there trying to breastfeed, you mentioned that often in these situations, they’re processing the trauma while they’re trying to feed their baby. Can you talk a little bit about advice you might have for healthcare workers or birth workers who want to integrate more trauma-informed practices into their lactation support?
Porsche Holland-Otunba – 00:31:06:
Yeah, absolutely. It’s so real being one that has been there and then offered it for others. One of the things that I always say is to just start with that person centering that person. It should be a whole lot more of them talking than you. And when you come into a space, you’re sitting down. I would do a lot of consults in folks homes. So I’m asking, where can I sit? Where can I be? I want to look at them, sit alongside them. I’m not touching baby or anything like that. I rarely ever touch a baby, even for my doula clients. And it’s a, tell me what’s going on. What’s your concerns? How was your birth? And just kind of letting them spill. Because there is this huge emotional, psychological thing that is also connecting to them physically. And you might find out there were blockages in birth. There was trauma. There was neglect. There was different things that were happening. And you just simply coming in to listen without this. I got 30 minutes. We got to hurry up and get this baby latched can really make a difference in building the trust, but also getting straight answers about what’s going on. You might find out there’s a violent situation. You might find out there’s housing insecurity that you can now go get other resources for. But if you are driven by the time clock, driven by just I got to check this list and get through these clients or make this coin, which I know is real, we need to get paid. You can now miss some very key things. And so that approach for me has helped me to find out the state of people’s relationship. If they needed food. I mean, like basic things that they were then willing to open up and share because I one ask for consent to be in their space, to sit where they wanted me to and to ask them what is going on and how they’re feeling. And if partner was there, I invited them into. If grandma was there, I invited them into. I introduced myself to everyone. Congratulations to the entire family. And what can I do to help? You all, tell me what is needed, because I realized that even though I was coming into that space as a lactation professional, my job went far beyond that. I might as well be a community health worker or health advocate. It went far beyond that. So that was one thing, that relational piece that took a place for me. And with that active listening. Okay, so what I’m hearing you saying is this. I just want to be sure I’m grasping this. Explaining what you’re doing, because oftentimes in the hospital space, it’s not being explained. I’m pulling out my pad so I can take a few notes, so I can better figure out what I’m going to do to help you. I have some things in my bag that I’m grabbing right now. This is what I’m doing. And you may say, Porsche, that’s doing too much. But you don’t know how just writing notes might trigger somebody or now they’re thinking you’re getting called DHS. They’re fearful. They’re wondering what notes you’re taking or what you’re going to reach in your bag to get, right? Violence is a real thing. And so I’m coming into your space or you’re meeting me in my office and I need to make sure you are centered and you are safe. And you know everything that’s happening along the way. And so those are just two things that really rise up for me in terms of trauma-informed. It’s really person centered, walking people through being sensitive and allowing them to guide the session. I wouldn’t care if it’s a doula visit, a lactation visit, a mental health visit or therapy session. They should be guiding what is actually going about. And that to me is just hugely impactful.
Dr. Rebecca Dekker – 00:34:29:
You really painted such a clear picture of what a beautiful trauma-informed initial approach would be. So I’m assuming as you’re building this relationship in the minutes that follow and they start opening up to you, sometimes it’s an overwhelming amount of concerns and issues. So how do you as a lactation worker, doula, community health worker, all your hats, like how do you prioritize what to do next?
Porsche Holland-Otunba – 00:34:59:
Yeah, that’s a good question because it can be a lot sometimes. My first thing is the basic needs. And so I’m trying to order the basic needs and that’s shelter, food, safety, right?
Dr. Rebecca Dekker – 00:35:10:
Okay.
Porsche Holland-Otunba – 00:35:10:
And of course, with their consent. And so I know a place where this food can happen. There’s a couple of places right near you. Would you like their information? Could I call them for you? Can we sit and do this? Can I go with you? When I’m in private practice, depending on the stipulations, can I take you? Can I meet you there to handle certain things? Housing is a lot more of a tricky situation because it’s just an issue in general in Philly. But there are places where I can drop information and birth workers, community health workers will round robin on what we can do, where a shelter might be, what is actually open right now for a family and for children. And so I’m but I’m asking those things. Like I’m saying, this is what I’m hearing. These are some of the concerns. Even asking what might be the biggest for them right now. If I literally say sit here, I’m going to go grab you something to eat. And I see the cabinets are bare. Everything’s dry. What’s going on? Someone bringing you something. Can we do DoorDash? Like, what can I handle in that moment versus what might need a warm handoff? So who do I know in one of these community organizations that can help me make that connection? And where can I maybe take you or ask somebody else to come in? And so the main things, and it’s normally some type of combination of that, it’s the housing, the safety, and the food. And I’m really just trying to see what’s the best in the midst of that. And, of course, things like pack and plays, cribs, strollers, car seats, we have tons of resources. I could get that for somebody in a matter of hours to make sure that they have that. But those pieces tend to be the ones that rise up as a priority. And we’ll do what we need to do to make sure the baby is fed for now. And we’ll work on that. But if you’re not stable, you’re not comfortable, you’re not safe, it impacts the lactation and bonding journey.
Dr. Rebecca Dekker – 00:37:04:
You can’t make milk if you’re not eating and sleeping and, yeah, being taken care of yourself.
Porsche Holland-Otunba – 00:37:10:
Right. And not safe. So I have to make sure you’re well. We have to deal with that first. And, again, that’s where it goes beyond. I’m just doing a job. I’m trying to get the baby here.
Dr. Rebecca Dekker – 00:37:20:
You’re not just dealing with the latch.
Porsche Holland-Otunba – 00:37:23:
It’s more than it goes beyond a breast. Like, seriously, it is. We are. It’s a whole person centered approach and a care. And I know that might sound like a lot for some people, but it’s what it is. You don’t work with robots. You don’t work with machines. You work with people. So if you can’t be fully person centered, this just may not be the space for you. Fund our work. Help us scholarship more people to train. But maybe this is not the lane for you. Develop programs and apps and send us resources. But don’t work directly with people because that’s what it takes in all honesty.
Dr. Rebecca Dekker – 00:37:58:
Porsche, I love hearing about your journey. Can you tell us a little bit about how you got connected with Evidence Based Birth® and how that connection grew?
Porsche Holland-Otunba – 00:38:06:
Oh, my gosh. I’m trying to think my initial. Maybe it was my Googling because I was hungry for information. So back in the day when I first got started, I was just Porsche the Doula on Instagram. And I know I got connected with EBB in Instagram. I immediately found out about the newsletter. I found out about becoming a professional member and I would just amplify whatever EBB was doing. That’s just what I existed to do was amplify resources. And so as I started coaching and mentoring birth workers, I’m like, you don’t know about EBB. And I’m talking to parents like you don’t know about EBB. And folks are looking at me like I’m crazy. And so I’ve become this spokesperson and I’m sure tons of people from Philly and just all these folks have come and gotten connected since then, but I’m like the premier like organization around evidence for all things related to birth, because I say Reclaim Black Motherhood is all things Black maternal health. So I’m like EBB is evidence, all things maternal health. And people are staring like, what is this? And so I can’t remember exactly how it started, but I was sold from day one. And like, what do I need to do to get involved? And so not only feeling like as a parent, because then later. I was doing this pregnancy thing again. I could digest and understand what was offered for parents. And it made sense. And I didn’t feel like I was being spoken over. But then also as a birth worker, truly tangible, applicable resources and tools that not only do I use, but again, I share with my community of people that I mentor and that I support. And so from there, I would just be on the hinges of what’s happening, what’s going on. Jumped at the opportunity to become an instructor. Jumped at the opportunity to be a member and to engage and to tell other people to engage as well. And just, I felt like even hearing from you, Rebecca, that I was like, this is a real person. And I would tell people that. People know that if Porsche sends you a resource, she vetted it. Like it’s not it’s not a game because there are some people in this work that take advantage. They’re not for the good of people. They’re not safe spaces for Black and Brown bodies. And I’ll tell people I know Rebecca, like she’s cool. She’s for us. And they’ll be like, you sure? And I’m like, yes. But that’s what we have to do in the Black community. Because unfortunately, things come our way and they are not for our benefit. And so getting integrated and finding out inner workings, talking to staff members, you have an amazing team of staff. That was the proof in the pudding for me to be like, not only can I rely on this as a birther, but I can tell my community you can. And so that is huge for me. I’m just grateful for however I got introduced. It might’ve been somebody’s post. And I would dig through people’s posts and go to the original person that posted and then say, I need to get on their email list. I need to follow them. And I’m pretty sure that’s how I found out about EBB. And the reason why I continue to amplify the work that is going on, because it literally was impactful for me and my life and my journey. And I know that it could do the same for others.
Dr. Rebecca Dekker – 00:41:15:
And we’re glad we can be of use and of service. And I know your people, Porsche, you know, the hunger for information, the wanting to give out accurate information, you know, you have that connection.
Porsche Holland-Otunba – 00:41:29:
Absolutely.
Dr. Rebecca Dekker – 00:41:29:
And providers too. Yeah, it was wonderful getting to meet you in Alabama.
Porsche Holland-Otunba – 00:41:34:
Yes.
Dr. Rebecca Dekker – 00:41:35:
See you on the stage talking about your work in Philadelphia. Is there anything else you want to share with our time that we have left? Anything on your heart or mind right now?
Porsche Holland-Otunba – 00:41:47:
Yeah, perinatal mental health is just so huge. I guess I would like to pull in just even based on that question you asked about the lactation support, that we are also equipped to help people through their mental health things. And if you feel like you want more information about that, I encourage people to train in perinatal mental health to learn. Because again, as we’re asking people about things, they’re going to tell us about their sexual relationship with their partner. They’re going to tell us about their housing. They’re going to tell us about their mother-in-law or their cousin that they just got in a fight with. I mean, you hear everything. And so one of the other ways that we can truly be equipped as like warriors going out to support families is to also be aware that mental health challenges present in pregnancy. And throughout the first two years postpartum, they need to be treated differently by people that actually specialize in those areas. And so a simple licensed social worker or marriage family therapist may not be the answer. And it does impact lactation. It does impact postpartum healing, it’s truly intersectional.
Dr. Rebecca Dekker – 00:42:58:
How does it impact lactation, mental health?
Porsche Holland-Otunba – 00:43:01:
Yeah. So I have seen for people based on whatever their concern is, the either the bonding piece around, around actually wanting to lactate or because of their diagnosis, medications that come to play, right? There is often this misconception on the obstetric side and on the mental health side that either people need to completely stop their medications or they cannot breastfeed, chestfeed, pump, give any of their milk to their baby with certain medications. And a lot of it is nuanced and they just don’t know. It’s the same as me saying, let me rely on my pediatrician to know things lactation. Let me go to a dermatologist when it’s actually the podiatrist I need for my foot. There is a specialty area for maternal perinatal mental health. And so I’ve seen a lot of people stop medications, stop treatment, say they can no longer breastfeed, got to dry up their milk. And I’m like, wait a minute, wait a minute. This person didn’t know. I’m pulling up the evidence right now. I’m going to show you why this is incorrect and what medications actually do work in alignment with your diagnosis, right? But I need you to not be walking around without your medication. If you literally need this to function, you’ll lock yourself in a room. You’ll not engage with your baby and nobody’s getting fed. And so I’ve seen it impact that feeding journey in that way. And just based on some of the feedback or the advice that is given in spaces where they just do not know. And so, it’s truly, truly, truly intersectional to at least know what PMADs are, perinatal mood and anxiety disorders. And at least to know in your area who are prescribers and who are people that are trained in this area. So if you’re seeing this present with your client, they’re not thinking they can’t use contraceptives. They can’t breastfeed, they’re not thinking all of these things without truly getting the advice and support from someone that knows.
Dr. Rebecca Dekker – 00:45:04:
Wow. Thank you for bringing that up. I don’t think we’ve talked about that on the podcast before, about the fear of how different medications might affect your milk and all of that with perinatal mental health. So that’s a really important topic and definitely encourage our listeners to check out Postpartum Support International. And we have the past board chair is on the podcast in January. And also Dr. Kimarie Bugg is an incredible IBCLC who’s also on the podcast in January talking about lactation. So thank you, Porsche, for tying those two topics together. I feel like you’ve given us such a nice holistic picture of trauma-informed care. Is there anything else?
Porsche Holland-Otunba – 00:45:45:
Yeah. If you don’t know, ask somebody. Literally, I think a lot of providers, a lot of birth workers, folks are just trying to do the trauma informed thing. And not doing it well because you don’t know. There are folks that can tell you there are melanin consultants and speakers and trainers that can inform you. If you need references, glad to give you some. But don’t go at it alone, trying to revamp policies and do new things and make your team and employees implement stuff that you don’t know about. Like, truly.
Dr. Rebecca Dekker – 00:46:18:
Don’t reinvent the wheel. There’s already people out there doing the work whose lead we can follow.
Porsche Holland-Otunba – 00:46:23:
Correct. So just ask us.
Dr. Rebecca Dekker – 00:46:26:
And what’s the best way to follow your work?
Porsche Holland-Otunba – 00:46:28:
Sure. Facebook, Instagram, Reclaim Black Motherhood, reclaimblackmotherhood.com, and also Porsche Holland-Otunba on LinkedIn. I’m shouting on all of those spaces. So glad to connect there.
Dr. Rebecca Dekker – 00:46:41:
Thank you, Portia, for always using your voice. We love hearing it. Thank you so much for being on the podcast.
Porsche Holland-Otunba – 00:46:47:
Absolutely. My pleasure.
Dr. Rebecca Dekker – 00:46:49:
This podcast episode was brought to you by the Evidence Based Birth® Childbirth Class. This is Rebecca speaking. When I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I’ve met countless parents who felt that they too were unprepared for the birth process and navigating the healthcare system. The next time I had a baby, I learned that in order to have the most empowering birth possible, I needed to learn the evidence on childbirth practices. We are now offering the Evidence Based Birth® Childbirth class totally online. In your class, you will work with an instructor who will skillfully mentor you and your partner in evidence-based care, comfort measures, and advocacy so that you can both embrace your birth and parenting experiences with courage and confidence. Get empowered with an interactive online childbirth class you and your partner will love. Visit evidencebasedbirth.com/childbirthclass to find your class now.
