Azul looked peaceful on an August afternoon in Sunland Park. The baby girl, less than a year old, nestled against her mother Bella Luna’s bosom. Luna had gathered with other families at The Border Latch, an annual event that supports breastfeeding in the Paso del Norte region.
The El Paso mother gave birth via C-section to her first child in early 2022. After three miscarriages and a high-risk pregnancy, Luna thought the hard part was finally behind her.
But she faced another emotional hurdle when she struggled to breastfeed, something she assumed would be simple after watching her younger sister breastfeed her three children with relative ease. Instead, out of necessity, Luna turned to formula to nourish her crying baby.
It wasn’t until Azul was about four months old, that Luna met a lactation consultant from the state’s Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC. The free, one-on-one consultations helped her understand she was capable of breastfeeding alongside formula feeding.
The challenges of breastfeeding can cause distress in the early postpartum experience. The American Academy of Pediatrics recommends exclusively breastfeeding infants in the first six months of life, but many mothers don’t feel equipped with the knowledge they need by the time they’re discharged from the hospital.
A gap between the expectation and reality of breastfeeding can lead to confusion, stress and in some cases, self-blame. In response, support groups in El Paso are working to fill that gap, through lactation consultations, baby cafes and guides to safe infant feeding.
“I thought I got to do everything by myself and figure out everything by myself, but that’s not the way women should be,” Luna said. “Sometimes your milk doesn’t come in until later, so I think it was just a mixture of not having the right support, then me not knowing a lot about breastfeeding.”
Lactation consultations can cost more than $100 per session, but the WIC program is one of the few ways low-income parents in El Paso can access free services. Another is El Jardín Birth & Family Resource Center in central El Paso, which is funded by donations.
Lactation consultants in El Paso fill a need
Every Friday parents can find Lizabeth “Libby” Berkeley at a baby cafe she organizes at El Jardín, located in a nondescript building at 901 Arizona Ave. Down the hall from a vegan restaurant, in a room with couches and newly added portable air conditioning units, mothers come to breastfeed, get lactation tips and bond with other parents.
Berkeley holds a master’s degree in public health from Columbia University and an IBCLC certification, which means she completed her training through the International Board of Lactation Consultant Examiners. The IBCLC is the highest certification and the only internationally recognized credential in the field of lactation. She’s one of at least a dozen certified lactation consultants and counselors in El Paso who provide services outside of the hospital setting.
She started the baby cafe at El Jardín in 2017 so breastfeeding mothers could have a place to receive additional support after they leave the hospital. It’s one of just a couple drop-in sites in the city, apart from the Lactation Center at Las Palmas Women’s Center.
Since most WIC lactation consultations are virtual, baby cafes offer a way for parents to get hands-on support and socialize with other families in-person.
Texas has a breastfeeding initiation rate of 89%, according to a 2019 report by the U.S. Centers for Disease Control and Prevention. Once babies reach six months old, the breastfeeding rate drops to 54%. At one year old, the rate slips further down to 35%.
Nationally, low-income parents and Black parents breastfeed at lower rates. Studies that look at barriers to breastfeeding on the border also suggest that breastfeeding rates in El Paso are lower than the U.S. average.
There are a variety of reasons why mothers abandon breastfeeding, including stress and postpartum depression. Then there are practical lifestyle reasons, such as going back to work, Berkeley said.
In her experience as a lactation consultant, Berkeley has found that pain and not producing enough milk are the two most common reasons people struggle to breastfeed. A shallow latch, when the baby doesn’t get a big enough mouthful of breast, can cause excruciating pain. Factors such as a C-section, which can cause swelling in the breasts from IV fluids, can delay milk production.
Yvette Schmitz, who volunteers at El Jardín, said she took the Certified Lactation Specialist Course because she didn’t want mothers to go through the same breastfeeding stress she experienced. After 36 hours of labor, she gave birth to her first child on a Saturday in El Paso in 2019, but no lactation consultants worked on the weekends and hospital staff said she could wait until Monday to see one.
At the hospital she started with formula to bring her infant’s glucose level up. Once she could bring her baby home, she did a mix of everything — breastfeeding, bottle feeding with pumped breast milk, formula feeding — because she felt insecure about whether her child was getting enough food.
“I even read tons of books, watched so many videos online, but when you actually have a baby it’s really hard. You don’t know the cues, you don’t know the signs if baby’s hungry,” she said.
Seeing a lactation consultant — first at the baby cafe at Del Sol Medical Center and later a private consultation with Berkeley — helped ease Schmitz’s fears so she could become a confident breastfeeder.
Berkeley said if there’s any advice she can impart on pregnant people, whether it’s their first child or not, it’s to seek a lactation consultant before they have a baby so they can get realistic expectations. Most women have the physical ability to breastfeed, but just need help, she said.
She would also like to see nurse midwives and OB-GYNs do a breast exam in the last trimester “with an eye for breastfeeding.”
“They might see things like scarring from breast surgery, an incised area of her breast that might have a huge impact on breastfeeding,” Berkeley said. “Or she has inverted nipples, or extremely asymmetric breasts. Where her breasts are placed could be seen prenatally and she would have been prepared to know she’s never going to make enough milk, but can still get advantages — and calories — by supplementing with formula.”
Why these mothers turned to breastfeeding
Angie Ortega was interested in breastfeeding as a way to bond with her son and give him the health benefits.
In the first couple days after giving birth, the mammary glands can produce colostrum, a highly concentrated, early form of breast milk that’s rich in nutrients, antibodies and antioxidants to build a newborn’s immune system. Studies, including a randomized trial of more than 17,000 infant-mother pairs, also show that breastfeeding can protect babies against gastrointestinal infections that cause vomiting and diarrhea.
Ortega, who lives in Ciudad Juárez, gave birth to her son in May 2021, right before the surge of the delta variant of COVID-19. While her boyfriend was supportive of her choice to breastfeed, he worked during the day and Ortega felt isolated at home. Pressure from her relatives to switch to formula deepened her anxiety. She turned to social media to feel less alone, and found further support from Luna Tierra Casa de Partos, a birth center in El Paso that also provides postpartum services.
It’s important for breastfeeding education to extend beyond the mother to partners and family too, said Rosalba Ruiz Reyes de Holguín, outreach coordinator for the Binational Breastfeeding Coalition. Ruiz Reyes de Holguín holds a master’s degree in public health from Universidad Autónoma de Ciudad Juárez.
“Statistically, they say that if a man supports his wife breastfeeding, the likelihood she will continue breastfeeding goes up,” she said. “If he’s possessive, very machista and jealous, and doesn’t support it, she will not breastfeed.”
The Binational Breastfeeding Coalition holds events like The Border Latch, or La Gran Tetada Fronteriza, in El Paso, Juárez and Sunland Park to normalize breastfeeding in public places and at work. The event is typically held every August during Breastfeeding Awareness Month, a campaign promoted by the U.S. Department of Health and Human Services.
The organization, which celebrates its 10th anniversary this year, provides stickers to local businesses where the owners welcome breastfeeding. People can also go to the organization’s website for links to additional lactation resources, such as milk bank locations in the region.
Bella Luna and her younger sister Blanca Luna, who have both participated in The Border Latch, said they want health care policies that make it easier for parents to access lactation resources. While Bella’s health insurance covered the cost of a breast pump, it took about a month for the pump to get approved and shipped, so she ended up purchasing one out of pocket because she couldn’t wait that long.
The Affordable Care Act mandates that individual and employer-based health insurance plans cover breastfeeding support. But if the lactation consultant is not in-network, the parent has to eat the cost.
Navigating health insurance is just another stress factor on top of the stress of caring for a newborn, Bella said. Outside of the WIC program, Bella also paid for a private, in-person lactation consultation because at the time, the need was urgent, and she didn’t want to go through the hassle of determining whether her insurance would cover it.
El Paso breastfeeding advocates praised TRICARE, the health insurance plan for U.S. military members and their beneficiaries, for covering six lactation consultations.
The Luna sisters acknowledged that their lifestyles are conducive for breastfeeding — Bella has a remote job that allows her to work from home, and Blanca is a stay-at-home mom. Every breastfeeding experience is different, and can even vary between a mother’s first, second and third child, Blanca said.
Mothers need time to figure out how to breastfeed, which is why Bella believes paid family leave should become a federal or at least municipal requirement. Unlike other industrialized countries, the United States does not mandate paid family or sick leave.
Besides her sister and lactation consultants, Bella said local Facebook groups like the Badass Breastfeeders of El Paso were another major source of guidance. She and Blanca are considering starting a group for breastfeeding mothers to meet up in person. And Bella is training to become a doula for underprivileged families in El Paso who otherwise can’t afford this one-on-one service.
Ultimately, they believe, El Paso parents just need to know they’re not alone.
“If I just had the right support, it would have been much much different,” Bella said of her breastfeeding journey. “It would have released the pressure on me. I didn’t think it would be this important, or this hard, during pregnancy.”
Free breastfeeding support in El Paso
El Jardín Birth & Family Resource Center: Breastfeeding support group meets Fridays, 10:30 a.m. to 12:30 p.m. at 901 Arizona Ave. For more information visit eljardinbirthandfamily.org. To schedule a private, donation-based consultation, contact Breastfeeding.Garden@gmail.com or 915-257-8844.
Las Palmas Women’s Center: Breastfeeding class conducted once a month on Saturdays. Register online at laspalmasdelsolhealthcare.com.
The Lactation Center is open Tuesdays and Thursdays, 10 a.m. to 2 p.m., and Wednesdays, 12 p.m. to 4 p.m. at 1801 N. Oregon St., Building B, Floor 3. For more information contact firstname.lastname@example.org or 915-264-7171.
Del Sol Medical Center: Prenatal classes and virtual baby cafe sessions take place Wednesdays, 1:30 p.m. to 3:30 p.m. Email email@example.com or call 915-263-5487 to register.
Hospitals of Providence: Breastfeeding classes are available in English and Spanish once a month at the Memorial campus, 2001 N. Oregon St. Register online at thehospitalsofprovidence.com.
People can also get a hold of a lactation specialist on the Memorial, Transmountain and East campuses by calling 915-577-6011.
Women, Infants & Children (WIC): Offers virtual sessions with local breastfeeding counselors or lactation consultants. Eligible people must register for WIC online or over the phone. Live, online classes are also offered at texaswic.org.