Two Iñupiaq women work to become village-based lactation counselors to better support mothers in Northwest Alaska

When Jessica Snyder gave birth to her first child, her grandmother, a traditional midwife, was by her side to answer questions about feeding the baby. Now Snyder wants to provide that support to other women in her village.

“I have no more grandmothers now,” she said, “so we need to fill that void.”

A Noorvik resident, Snyder is among several women in Northwest Alaska who are part of the Village-Based Lactation Counselors project, spearheaded by a subsidiary of the Nondalton village’s Kijik Corporation, International Data Systems.

“The women in the region, they prefer to go to someone they actually know instead of someone they don’t know,” said another participant in the project, Frances Williams. “I think that more women should come forward and do it.”

In January, two lactation experts — Camie Jae Goldhammer and Kimberly Moore-Salas — held an Indigenous-specific lactation counselors training in Kotzebue. The training included such core knowledge as the importance of hydration, frequency of breastfeeding and how to get a good latch. It also addressed the role that historical trauma and colonization have played in interrupting this traditional practice.

“It discusses colonization and the relationship between historical trauma and declining breastfeeding rates, utilizing traditional food and traditional practices and how to reclaim those,” said Laura Norton-Cruz, project manager with International Data Systems. “How to offer care in a culturally appropriate way and how to address barriers that people might experience to seeking help for breastfeeding.”

[From 2022: With rituals, knowledge and care, Alaska Native birthworkers support families through the birthing process]

Creating the Lactation Counselors project in Northwest Alaska

Breastfeeding is a great way to provide healthy nutrition for the baby, said Marcel Hollis, clinical dietitian at Maniilaq Health Center. It can also be an economic decision for rural Alaska residents, he said.

“There are proven benefits for breastfeeding ... it supports immune function for a baby, decreases the risk of obesity and cardiovascular diseases, and it’s free,” Hollis said. “With formula being already so expensive, the village prices and the community prices of the formula are even higher — you know, you’re talking about almost $30 a can.”

Maniilaq Association serves 12 villages in Northwest Alaska but isn’t able to provide direct care at all times in some of those communities, Hollis said.

“Trying to explain over the phone how to breastfeed can be quite complicated because you’re not able to see what’s going on with the baby,” he said. That’s why the January lactation counselor training and increasing lactation support overall in Northwest Alaska are important, Hollis said.

“If mom’s choosing to breastfeed initially, she should be able to do so, and we should be able to help them the best way we can,” he said.

Before creating the Lactation Counselors project in Northwest Alaska, Norton-Cruz and her project partners traveled to several villages to gauge the needs around infant feeding and what kinds of support mothers in the region needed. After holding focus groups and one-on-one interviews with over 40 parents, the majority of them Iñupiaq, they learned that what mothers wanted the most was someone in their village who already breastfed her own kids and who could be trained to help them.

“The idea for this project came directly from Iñupiaq mothers,” said Norton-Cruz, who has worked on various child care and nutrition projects. “They wanted someone they knew and trusted, someone who understood their diet, someone who understood their life, who spoke like them, who wouldn’t judge them, who could help them and meet them where they’re at ... and be close to them.”

Finding the right women for the project was easy, Norton-Cruz said. Mothers pointed out their peers whom they already reached out to for help. Williams was one of them.

An Ambler resident and a mother of four, Williams breastfed for 11 years and has been sharing her experience with other women in her community.

“I basically went through it all: I had the cracked nipples, I had the mastitis ... any problem — I had it,” she said. “My firstborn didn’t latch good.”

Williams said she wants to become a lactation specialist to help more women in Ambler. She also hopes to be able to help women in neighboring villages, Shungnak and Kobuk, in the future.

The funding for the project came from a Centers for Disease Control and Prevention program, State Physical Activity and Nutrition, which is administered by the state of Alaska’s Division of Public Health. International Data Systems has been working with the Maniilaq Association to figure out details of the counselor position, such as payment and supervision, as well as potential expansion of the program, Norton-Cruz said. Until then, women can provide lactation counselor services independently and be paid an honorarium, she said.

To Williams, the details don’t matter as much, she said.

“Money is not that important to me,” she said. “It’s more about helping moms and the babies.”

Infant feeding support around Alaska

Breastfeeding peer support programs exist in other places around the state.

In the Norton Sound area, two local women, trained in breastfeeding support and education, provide services by phone, email and text to families who are expecting or currently breastfeeding. The Norton Sound Health Foundation this week also held a Certified Lactation Educator Training for residents in the region.

Farther south, the Kodiak Kindness program for about 18 years has been helping families in Kodiak and surrounding villages with infant feeding, said executive director Heather Preece. Four counselors and two volunteers check in with families from the day their baby is born to when they are a year old, offering help with breastfeeding, formula feeding and introducing solid food. Since 2006, the project has helped 2,575 families.

Parents can contact counselors at any time of day with questions and concerns. Additionally, counselors reach out to the families themselves at several points during the baby’s feeding journey. During those calls, parents often ask whether their baby is getting enough food, whether it’s normal to have breast milk come in late, or how to help the baby latch better, said one of the counselors, Danya Rios.

“We’re just there to reassure the mothers, they’re doing a great job,” Rios said.

The counselors in the Kodiak Kindness represent diverse residents of Kodiak. One of the counselors speaks Tagalog and works with an expansive Filipino population. A volunteer who is the partner through the Cama’i Home Visiting Program travels to remote villages around Kodiak to provide culturally appropriate care to Alaska Native families.

“We want to cover everybody,” Preece said. “We only have a hundred babies born a year, but when the parent needs help, they need help. It makes a huge difference to be able to get help in that moment.”

Rios is a Spanish speaker from Mexico and focuses on the Hispanic population in Kodiak, many of whom work in the fish canneries. She said having a similar cultural background allows her to help families better. For example, she understands it might be hard for Hispanic women to reach out for help and she is aware of the common beliefs they might have.

“It’s really helpful to have people here with the same background as me that I know how they’re gonna feel, or like, what are the little superstitions that they have, or their moms can give them, and they’re gonna believe it, and they’re gonna do it,” she said.

Overall, she is happy she can help residents who might be separated from their support network and family.

“We have a lot of people here in Kodiak that come for work, or they come with work visas, and they need to stay here for a longer period of time. For example, we have a few of Ukrainians,” she said. “You don’t even know if your family is going to be with you or if they won’t be able to fly here.

“Mothers need support,” she said.

Rising need for peer support

In Northwest Alaska, the need for breastfeeding peer support has risen, said Noorvik resident Snyder.

In her home village, as well as in other villages, many traditional knowledge holders died during the COVID-19 pandemic, she said.

“Our Elders are very rare now,” she said.

Without them, when women have questions about feeding their babies, they either ask health aides for advice or turn to Facebook and Google, Snyder said. She said that several women in Noorvik tried breastfeeding but gave up and switched over to bottled formula, which doesn’t always have as many nutrients as breast milk.

Snyder lost her grandmother and other Elder relatives as well, but she’s glad she had a chance to learn from them about breastfeeding practices and the importance of Indigenous food and subsistence.

“My grandmother, she’s very hard on making sure we live the traditional lifestyle and wanted us to make sure that we use what we have ... share and help one another,” Snyder said. Her Elders taught her that following a subsistence lifestyle and having a diet rich in Indigenous foods is one of the most important things for the health of a mother and a baby, Snyder said.

A mother of six, Snyder also has extensive personal experience with feeding babies: She has been breastfeeding since 1997 and is breastfeeding her youngest child now.

Snyder wasn’t able to attend the in-person training in Kotzebue, but she is determined to complete the online certified lactation counselor training. By becoming a village-based lactation counselor, Snyder said she hopes to deepen her expertise around breastfeeding and better serve women in her village.

“It would be good to have someone there already available,” she said. “We don’t have any other counselors besides our local peers. It would not only provide information, it would help broaden, you know, the workforce in our community and strengthen our mothers and fathers.”