Healthy Living in the North

Breastfeeding: It can look different!

(Co-authored with Randi Parsons, Regional Nursing Lead – Maternal, Infant, Child & Youth, and Lise Luppens, Population Health Dietitian)

Woman holding two babies with t-shirt that reads "sometimes breastfeeding looks like this."Tailor-made to meet the nutritional needs of her baby, a mother’s milk supplies unique immune factors, stem cells, hormones, and enzymes. The composition of her milk changes depending on the needs of her baby. How incredible is that!?

Breastfeeding is recommended where possible, as it supports:

Yet, in situations where feeding directly at the breast is not possible, many moms can continue to offer their milk to their babies.

  • To relieve full breasts
  • To collect breast milk if they will be away from babies for more than a few hours
  • To increase milk supply*
  • To maintain milk supply during times when feeding at the breast is not possible*
  • To collect milk for feeding via an alternative feeding method, such as a syringe, supplemental nursing system, cup, or bottle*

For families interested in providing expressed milk by bottle, it’s best to wait to introduce a bottle until breastfeeding is well established (usually after four to six weeks).

*Families who need to express breast milk, for reasons other than feeding by bottle, would likely benefit from the support of a lactation consultant, or other knowledgeable health professional or breastfeeding support person.

Helpful tips for families

Just like breastfeeding, expressing breast milk involves a learning curve for families. It’s helpful for families to receive support and information about:

Exclusive pumping and combination feeding

Some families make an informed decision not to feed at the breast. Instead, they express breast milk and feed this to their baby as their sole source of nutrition. This approach is sometimes referred to as “exclusive pumping.” Other families choose a different approach called “combination feeding,” where they alternate between feeding at the breast and feeding breast milk by bottle.

Regardless of the feeding approach, it’s vital for mother’s support systems, including friends, family, and health care providers, to have an awareness about milk expression, exclusive pumping, and combination feeding. This awareness ensures that mothers are well care for, and feel understood and supported.

The bottom line

There are reasons why a mother may not feed her baby at the breast. In these situations, we all have an important role to play in supporting women who wish to provide their own milk to their babies.

To learn more, consider these resources:

Theresa Healy

About Theresa Healy

Theresa is the regional manager for healthy community development with Northern Health’s population health team and is passionate about the capacity of individuals, families and communities across northern B.C. to be partners in health and wellness. As part of her own health and wellness plan, she has taken up running and, more recently, weight lifting. She is also a “new-bee” bee-keeper and a devoted new grandmother. Theresa is an avid historian, writer and researcher who also holds an adjunct appointment at UNBC that allows her to pursue her other passionate love - teaching.

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Tandem breastfeeding: Strengthening family connections

Young girl wearing a big sis t-shirt.

Expecting a second child can raise many questions, including how to breastfeed both of them at the same time, an approach called “tandem breastfeeding.”

Baby news! Our family is growing, and soon, we’ll be welcoming our second baby. This special news has our preschooler very excited – this is the same little girl, Jovie, who helped me to learn about the many joys (and challenges) of breastfeeding.

With our new bundle on the way, I’ve been wondering about breastfeeding both children, at the same time. This approach is called “tandem breastfeeding.” As a mom and a nurse, this topic fascinates me. Until recently, I knew very little about the topic, and today I’m sharing what I’ve learned so far.

Making an informed decision

Choosing to breastfeed is a personal decision, and breastfeeding looks different for every family. Some families consider the option of breastfeeding an older child during pregnancy, as well as after the arrival of a new baby. Here’s some information that might be helpful.

Is it safe?

  • In most pregnancies, it’s safe for women to continue breastfeeding an older child. La Leche League explains more in Nursing Through Pregnancy.
  • In some situations, caution may be advised.
  • Women can share their questions and concerns with their health care team.

Bonding time

  • Some mothers feel that breastfeeding during pregnancy can promote bonding with the older child as they prepare to be a “big sister” or “big brother.”
  • This definitely resonates for me as Jovie loves to “nuggle” more often lately. She wants to keep close to me and even talks (and sings) to baby – so cute!

…and then there were two (or more)!

  • When the new baby finally arrives, continuing to breastfeed an older child can help them to feel connected as their parents tend to the newborn’s unique needs.
  • Tandem breastfeeding also supports bonding between siblings. How special is that!?
  • An experienced nursling can also help their mother to manage breastfeeding challenges after the new baby arrives, such as engorgement, a plugged duct, or a forceful letdown.

Helpful tips to consider

It surprised me to learn so many interesting tidbits about tandem breastfeeding. I’ve also discovered that:

  • Pregnancy hormones may decrease the supply of breast milk. Jovie noticed this and announced “there’s no more milk, mama.” I assured her it would return, especially when the new baby arrives!
  • Mothers can feed both children at the same time, or feed each of them in turn. Families can do what works best for them.
  • Newborns should generally be breastfed first. Breast milk is their only food source, while older children are already enjoying a more varied diet.
  • Sharing the breast can be an adjustment for the older child. Engaging them in age-appropriate activities can help, as can trying different breastfeeding positions that allow mom to have a free hand. This sounds like juggling at its best! (HealthyFamilies BC shares some general tips about how to prepare an older child for a sibling).

Tick tock…

As we prepare for our newborn, I find myself feeling giddy about the new experiences we’re going to have as a family. There’s so much to learn, and I plan to consult my support circle as the pregnancy progresses. La Leche League has mother-to-mother support groups, so this would be a helpful place for me to ask about others’ experiences with tandem breastfeeding.

Interested in learning more, too? There are other resources to explore:

Randi Parsons

About Randi Parsons

Randi has lived in northern BC since 2010 after graduating from the University of Alberta with her Bachelor of Science in Nursing. Since her graduation, Randi has held different nursing positions with a focus in maternal-child health. Her career as a nurse started on Pediatrics in Prince George before transitioning into Public Health Nursing in the Omineca area. For 5 years, Randi worked as a generalist Public Health Nurse, finding her passion in perinatal wellness, early child development and community collaboration. With her husband, daughter and two Chihuahuas, Randi lives in Fraser Lake, currently working as the Regional Nursing Lead for Maternal, Infant, Child, Youth with Public Health Practice. When she is not nursing, Randi enjoys crafting, practicing yoga, learning to garden and being a mom! She is passionate about raising awareness for mental health and advocating for women, children and families.

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Human milk banking: Getting breast milk to the babies that need it most

(Co-authored with Katherine Schemenauer, Clinical Practice Lead at the University Hospital of Northern BC’s Neonatal Intensive Care Unit)

A poster promoting the donation of breast milk.Did you know that there are four human milk banks in Canada? We are lucky to have one in BC: the BC Women’s Provincial Milk Bank, in Vancouver. This milk bank provides screened, pasteurized donor breast milk to hundreds of tiny, sick, or at-risk babies every year. Babies in the Neonatal Intensive Care Unit (NICU) at the University Hospital of Northern BC (UHNBC) in Prince George are amongst these recipients.

Why is donor human milk important?

The gift of donor milk is life-changing for the smallest, sickest, and most vulnerable babies. When mothers are unwell, deliver their babies prematurely, or their babies are born sick, they may not have enough of their own milk in the first few days to provide for their own babies. The processed donor milk provides a safe, easy to digest first milk for their babies until they can grow stronger, and their mothers can provide enough of their own milk for their babies.

Human milk has been shown to reduce the incidence of Necrotizing Enterocolitis (NEC) in newborns. NEC can be life threatening to an already at-risk baby. Human milk is easy to digest, making it the best option for premature digestive systems.

What is a donor milk collection depot?

A milk depot is a place where eligible donors can drop off their breast milk donations, once they have gone through a screening process. These depots then send the milk to the provincial milk bank in Vancouver for processing. Currently, there are 24 donor milk collection depots in BC, based out of hospitals and health units. Northern Health has one depot in Prince George, at UHNBC, in the NICU.

Northern Health uses donor milk in the NICU

The NICU at UHNBC uses up to 3 litres of human donor milk for up to 15 babies a month. Most babies in the NICU need between 12ml (less than a tablespoon) to 500ml (2 cups) of donor milk a day.

Got milk?

Women who are interested in donating their milk are welcome to contact the BC Provincial Milk Bank to learn more.

Additional resources:

Jeanne Hagreen

About Jeanne Hagreen

Jeanne has been a Lactation Consultant since 1993. She worked for Northern Health for 38 years, first as a nurse on the Maternal-Child Units, then 20.5 years as a Lactation Consultant. During this time, she also returned to school and earned her BSN from UNBC. Following her retirement at the end of September 2015, Jeanne has remained an active member of local, regional & provincial perinatal committees. She is also co-president of the BC Lactation Consultant Association. Jeanne was born in Whitehorse, Yukon and also lived in Campbell River, Victoria, Toronto and Vancouver. In 1975, she moved to Prince George with her husband and two small sons. In addition to her volunteer work, she is an avid knitter and reader. She enjoys living in the rural community of Salmon Valley with a small menagerie of animals, along with the wildlife that passes through her yard.

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Nutrition and breastfeeding: Are we sending the right message?

As a dietitian, I aim to stay abreast of up-to-date nutrition information. Some topics surprise me, and cause me to rethink my approach. I am realizing that information about nutrition and breastfeeding can send the wrong message, even though it might be well intentioned.

breastfeeding mom on picnic bench

There is no need for a special or restrictive “breastfeeding diet.”

Does breastfeeding require a special diet?

Online, we can find suggestions for foods that moms should or shouldn’t eat when they are breastfeeding. Mothers probably hear this advice from family, friends, and others, too. Unfortunately, this suggests that moms need to follow a special diet in order for their milk to meet their babies’ needs. Not only is this untrue, this myth can cause stress for mothers and families. It can also create a barrier to breastfeeding. Mothers want the best for their babies, and this informs the choices they make. And some mothers wonder, “Is there is enough nutrition in my breast milk?”

Mothers’ milk is amazing

I am happy to share good news. Even if she isn’t always eating well, a mother’s milk will generally be nutritious and the best choice for her baby. Did you know that the level of many nutrients in a mother’s milk are not affected by what she eats? What’s in her milk primarily comes from her body’s nutrient stores. As a result, her milk is a reliable source of calories, protein, fat, carbohydrate, and other nutrients, despite day-to-day variability in her diet. Her milk also offers so much more than just nutrients. It also supplies unique immune factors, stem cells, hormones, and enzymes – and her baby can’t get that from any other food. Amazing!

What guidance can we offer breastfeeding mothers?

There aren’t a lot of dietary do’s and don’ts for breastfeeding mothers; no special diet is required. As with other women of childbearing age, with the goal of supporting their own health, breastfeeding moms are encouraged to:

  • Choose foods from each of the food groups of Canada’s Food Guide.
  • Aim for two servings per week of fatty fish that is low in mercury, such as salmon, herring, and sardines. Canned fish can be a nutritious and economical choice.
  • Continue to take a multivitamin supplement, such as a prenatal vitamin.
  • Follow cues of thirst, hunger, and fullness to decide how much to eat and drink.

Some breast milk nutrient levels do fluctuate with mom’s food intake, namely certain vitamins and fatty acids. This is where the multivitamin and attention to fish intake can be helpful. Also, because we live in the north, we recommend a vitamin D supplement for breastfed children.

Other things that might be helpful to know:

  • You don’t have to drink milk to make milk.
  • A cup or two of coffee or tea each day is just fine.
  • Teas made from food products or the following herbs are generally safe: bitter orange/orange peel, echinacea, peppermint, red raspberry leaf, rose hip, and rosemary.
  • There’s no need to avoid spicy foods, garlic, broccoli, cabbage, citrus fruit, fish, sushi, soft cheeses, or other dairy products.
  • Avoiding specific foods for the purpose of preventing allergies in infants is not advised. For more information, see HealthLink BC’s resource: Reducing Risk of Food Allergy in Your Baby.
  • In cases where mothers or babies have unique nutritional concerns, a dietitian or other knowledgeable health care provider may be able to help.
  • Some families may benefit from additional supports to access food (see General & Health Supplements or BC211).

The bottom line

Breastfeeding moms can feel confident that their babies are getting great nutrition, and there is no need for a special or restrictive “breastfeeding diet.”

Lise Luppens

About Lise Luppens

Lise is a registered dietitian with Northern Health's regional Population Health team, where her work focuses on nutrition in the early years. She is passionate about supporting children's innate eating capabilities and the development of lifelong eating competence. Her passion for food extends beyond her work, and her young family enjoys cooking, local foods, and lazy gardening. In her free time, you might also find her exploring beautiful northwest BC by foot, ski, kayak or kite.

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Welcome to 2018 Breastfeeding Week

An infographic featuring the 10 steps to successful breastfeeding, from the World Health Organization.

The 10 Steps to Successful Breastfeeding, from the World Health Organization (WHO). Original: http://www.who.int/nutrition/bfhi/bfhi-poster-A2.pdf

Happy Breastfeeding Week! This week is celebrated annually in Canada from October 1-7 to promote the importance of breastfeeding, and it’s an opportune time to highlight breastfeeding as the foundation of lifelong good health for babies and mothers.

Northern Health is committed to supporting facilities and communities to adopt the Baby Friendly Initiative (BFI) 10 Steps recommended by the World Health Organization (WHO). The BFI is a world-wide effort to implement practices that protect, promote, and support breastfeeding.

As a registered nurse and mother of two breastfed children, I find Breastfeeding Week to be a great time to reflect on my breastfeeding experience – even from 15 years ago! As a parent, the BFI provides a framework that reassures me that hospitals and communities are making efforts to achieve standardization of these internationally endorsed 10 steps. Parents may use these 10 steps to help guide their decisions regarding infant feeding and breastfeeding and the supports they may expect from their care providers.

Here are some highlights of how hospitals and communities support mothers to breastfeed (adapted from the WHO’s Ten Steps to Successful Breastfeeding):

  1. Hospital Policies – not promoting infant formulas, bottles or teats; making breastfeeding care standard practice; keeping track of support for breastfeeding.
  2. Staff Education – training staff on supporting mothers to breastfeed; assessing health workers’ knowledge and skills.
  3. Prenatal Care – discussing the importance of breastfeeding for babies and mothers; preparing women in how to feed their baby.
  4. Care Right After Birth – encouraging skin-to-skin contact between mother and baby soon after birth; helping mothers to put their baby to the breast right away.
  5. Support Mothers With Breastfeeding – checking positioning, attachment and suckling; giving practical breastfeeding support; helping mothers with common breastfeeding problems.
  6. Supplementing – giving only breastmilk unless there are medical reasons; prioritizing donor human milk when a supplement is needed; helping mothers who want to formula feed do so safely.
  7. Rooming-In – letting mothers and their babies stay together day and night; making sure that mothers of sick babies can stay near their baby.
  8. Responsive Feeding – Helping mothers know when their baby is hungry; not limiting breastfeeding times.
  9. Bottles, Teats and Pacifiers – counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
  10. Discharge – referring mothers to community resources for breastfeeding support; working with communities to improve breastfeeding support services.

As we celebrate breastfeeding this week, I invite you to look forward to additional posts throughout Breastfeeding Week 2018!

Vanessa Salmons

About Vanessa Salmons

Vanessa is a registered nurse and Northern Health’s Early Childhood Development lead for preventive public health. Located in Quesnel, Vanessa supports prenatal, postpartum and family health services across the north. She is married with two children and is always busy with the family’s many activities. Work/life balance is important to Vanessa. When she is not at work, she enjoys spending time with family and friends entertaining and cooking. Vanessa stays active through walking or running with her dog Maggie, spinning and circuit training. A good game of golf or a good book is always a bonus!

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Why skin-to-skin care is important for your baby’s well-being

Have you ever thought about having your baby skin-to-skin with you after birth and in the first few weeks after birth? Many parents have never thought about holding their baby skin-to-skin until they are pregnant and skin-to-skin is mentioned as an option right after birth. Often the reaction at that time is “Yuck. Can you at least dry the baby off first?”

Most of us don’t think about the millions and millions of bugs (flora) that are on and in our body until we are asked about skin-to-skin. However, this flora, making up our own unique ecosystems, is absolutely essential for health and well-being. So how does a baby acquire flora?

mother holding breastfeeding baby

Babies need repeated doses of skin-to-skin to help develop a healthy body ecosystem.

Babies come out of a relatively sterile environment so they need to be colonized by healthy bugs, rather than ones that can cause them to get sick. Most babies delivered vaginally get a healthy dose of good bugs during the delivery process, although this is just some of the flora they need. Babies born via caesarean section are less likely to get these bugs and more likely to pick up other ones from their surroundings.

Developing a healthy range of good bugs is important for all babies. One of the easiest ways for babies to get a range of healthy flora is from being skin-to-skin with a parent right after birth. If parents are not available, then other family members work almost as well, as families share many bugs in common. Spending time skin-to-skin right after birth is important but it is also important in the days and weeks after birth as babies need repeated doses of skin-to-skin to help develop a healthy body ecosystem.

Spending time skin-to-skin is not just about introduction to healthy bugs; here are some other benefits:

  • Skin-to-skin helps babies maintain their temperature.
  • Skin-to-skin helps maintain adequate sugar levels in their bloodstream.
  • Skin-to-skin helps develop normal breathing patterns quicker after birth.
  • Babies cry less often if they spend time skin-to-skin.
  • Babies often breastfeed better if they spend time skin-to-skin. For babies who are not breastfeeding, spending time skin-to-skin is particularly helpful because they cannot pick up a parent’s flora as easily as they are usually not right against a parent’s skin like babies who breastfeed.

We encourage you to think about spending time skin-to-skin with your baby so your baby can develop a healthy body ecosystem at the same time as you get to know your baby.

About Jane Ritchey

Jane Ritchey was previously the Interim Executive Lead for the Perinatal Program. (Jane has recently retired from Northern Health, we wish her all the best.)

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What is MILK? It’s time to protect, promote, and support maternal & child health!

(Note: co-authored by Sarah Gray, Primary Care Nurse)

As a Lactation Consultant with Northern Health and a new mother, I am deeply passionate about maternal and child health. It’s an honour to support families along their desired feeding journey. I strive to provide evidence-based information that empowers women and their families to make the best decisions. In my work, I keep my personal birthing and feeding journey close to mind. I find it important to connect with families as a fellow parent, as this provides another level of support.

Through an intimate and artistic lens, MILK brings a universal perspective on the politics, commercialization, and controversies surrounding birth and infant feeding over the canvas of stunningly beautiful visuals and poignant voices from around the globe.” (www.milkhood.com, 2017)

The communities of Prince George and Smithers are hosting an exciting opportunity to broaden the exposure of birthing and infant feeding on a global level. I encourage the public to take advantage of the free screenings of MILK: Born into this World. Following the screening, there will be a panel discussion with key community stakeholders to highlight the challenges and opportunities that exist within our communities.

Prince George Screening
Location: Prince George Public Library (Bob Harkins Branch)
Address: 888 Canada Games Way, Prince George, BC V2L 5T6
Date: Thursday, September 21st, 2017
Time: 10:00 am to 1:00 pm
Registration: Drop-in. Limited seating (maximum 100 people)
Facebook event: https://www.facebook.com/events/836744646495537

Smithers Screening
Location: Smithers Public Library
Address: 3817 Alfred Avenue, Smithers, BC V0J 2N0
Date: Thursday, September 21st, 2017
Time: 9:00 am to 12:00 pm
Registration: Drop-in. Limited seating (maximum 50 people)
Facebook event: https://www.facebook.com/events/1401529189924722

This documentary has caught the eye of leaders around the world; our own Mm. Sophie Gregoire Trudeau shares her passion for the MILK documentary and the education it provides. This documentary is not focused solely on the personal stories of mothers; rather it highlights the important roles within the community to support each birthing and feeding journey.

Reflect on your personal experiences of birthing and infant feeding. What challenges come to mind, and how can we come together as a community to provide support to families? With the World Health Organization (WHO) recommendations on breastfeeding, as a community, we need to continue to promote the normalcy and importance of breastfeeding.

It’s time to get involved! Attend a screening of MILK and follow MILK on social media!

Facebook: facebook.com/MilkTheFilm
Twitter: @MilkTheFilm
Instagram: @MilkTheFilm

Brittney McCullough

About Brittney McCullough

Brittney, born and raised in Prince George, graduated as a registered nurse in 2012 from UNBC. She completed her Perinatal Specialty Certificate in 2013, and IBCLC in 2017, and maternal and child health has always been her passion. She has recently taken a new role as a Lactation Consultant for Northern Health. She enjoys the northern outdoors and all that it offers, especially spending weekends at the cabin. With her first child born in 2016, her daily life is all about making memories with family and friends.

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Beware the noisy toy

Baby with toy

Do you know how loud your kids’ toys are? A few simple steps can help protect their hearing health!

I have seen many an adult with hearing loss due to excessive noise exposure. In my current role as a pediatric audiologist, I am more likely to see hearing problems due to an ear infection than to noise damage. That doesn’t mean it’s not possible, though.

The Canada Consumer Product Safety Act has a section on Toy Regulations. In it, they suggest that: “A toy must not make or emit noise of more than 100 decibels (dB) when measured at the distance that the toy would ordinarily be from the ear of the child who is using it.” One hundred decibels, though, is pretty darn loud!

Worksafe BC counsels, as do many safe workplace organizations, that at noise levels of 85 dB, an employer needs to provide proper hearing protection for their staff. Audiologists in both Canada and the US would agree this should also apply to toys. Granted, children may not play with that same toy for 8 hours (the length of an average workday); it’s more than likely that after about 10 minutes their parent tends to direct them to another, quieter, activity. But even these short playtimes with loud toys can be unsafe: Worksafe BC also counsels that workers can only be exposed to 100 dB for a period of 15 minutes before that noise becomes hazardous to hearing health.

Toy manufacturers are not required to specify the decibel output of their product, so how would a parent or well-meaning relative know? To put it into perspective: a gas-powered lawn mower is about 100 dB. So is a subway train entering the station. However, in neither case is the listener’s head as close to the sound as a child’s ear can be to a toy, or a teenager’s to an iPod. It stands to reason: the closer a sound is to our ears, the louder it is.

As parents don’t usually have sound level meters in their homes, what can they do?

Here are a few pointers:

  • Try before you buy. Listen to the toy, keeping in mind how close children will hold it to their ears. If you find it uncomfortably loud, it’s too loud for your child.
  • Is there a volume limiter, off switch, or battery compartment? You can always shut it off or remove the batteries. In the case of an iPod, iPhone, and/or iPad, a parent can access the volume limiter, reduce it, and lock it. Your teen may not be impressed, but their hearing health is protected – at least from the iDevice.
  • Depending on the size of the toy, put clear tape over the speaker. It will still make noise, but not as loud. If you’re crafty enough, your child may not even realize it’s there.

Interested in more information?

The Sight & Hearing Association, based out of Minnesota, provides an Annual Noisy Toys List. They use 85 dB as their upper limit, and a list can be provided to anyone who requests it!

Laura Curran

About Laura Curran

An audiologist at the Terrace Health Unit, Laura was born and raised in Nova Scotia but has made the trek to Terrace twice in her career - most recently in 2014, as she found she missed the beauty of the area. She started out in private practice for a national hearing aid dispenser and then moved into research before finding her main passion: Clinical Pediatric Audiology. When not working, Laura enjoys crafting, quilting, and camping with her husband.

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World Breastfeeding Week: One mom’s story

Child at breast.

With the support of a daycare, one Prince George mom has been able to keep up breastfeeding while balancing work demands. How can you support breastfeeding in your community?

October 1-7 is World Breastfeeding Week in Canada. The theme for the week this year is Breastfeeding and Work: Let’s make it work. We all have a role to play in supporting mothers to balance work and family demands. For me, this story of a working mom in Prince George is a great example of how we can support breastfeeding and strike this balance. Many thanks to the mom who shared this story and photo with me:

When I returned to work after my maternity leave, I was committed to finding ways to spend as much time with my son as possible, and to keeping up breastfeeding. So, as I interviewed and visited daycares, one of the most important questions I asked was whether the care provider was open to me visiting on my lunch hour to nurse my son. Both my previous and current daycares were very accommodating by providing us with a quiet and comfortable place to nurse. I’m proud to say that I’ve been spending lunch hours with my son for a full year now! Not only is it best for his healthy physical development, it’s also best to foster our attachment. And it’s a lovely midday break from the stresses and worries of work!

How can you support breastfeeding at home, at work, and in your community?

Stacy Hake

About Stacy Hake

Stacy is the Administrative Assistant for the Perinatal Program. She started with Northern Health at Mental Health & Addiction Services before moving over to the Northeast Medical Health Officer’s office and then onto the Perinatal Program. She lives and works in Fort St. John with her husband, two children and mother-in-law. When not working, she volunteers with her children’s dance/theatre productions and cheers during swimming lessons. (Stacey no longer works with Northern Health, we wish her all the best.)

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