May 2010 Issue

Working Mothers’ Challenge — Finding a Way to Pump Throughout the Day
By Larissa Gedney, MS, RD, LD
Today’s Dietitian
Vol. 12 No. 5 P. 32

Since “breast is best,” mothers who return to work after giving birth need their employers’ support to continue providing nature’s ideal nourishment.

As the nurse wheeled me to the car, my sleeping newborn snuggled in my arms, she tucked yet another stack of brochures on the health benefits of breast-feeding into my hospital bag. Most how-to guides and educational resources on infant nutrition argue that breast-feeding is best, but after addressing potential obstacles of improper latching, discomfort, and any health issues, they often do not discuss the challenges of continuing to breast-feed after returning to the workforce.

For me, as an RD, breast-feeding my infant was a no-brainer, and it presented me with the opportunity to practice what I preach. I knew I would find a way to continue it after I returned to work from maternity leave, but I was baffled by the challenges that faced me.

Because of increased opportunities for women and a rapidly changing economy, full-time working mothers are the fastest-growing demographic in the U.S. labor force, with nearly all of these women returning to work within six months of giving birth.1 Programs to support this growing presence provide benefits to both the employee and the employer, but they are inconsistent from state to state and workplace to workplace. With the recent amendments and additions to healthcare and labor laws in support of breast-feeding employees, an increasing number of employers are choosing to provide supportive environments and lactation services. Yet in many places, both knowledge and the incentive to establish corporate policies to provide support to all breast-feeding women who choose to rejoin the workforce is still lacking. As a result, returning to work is one of the top reasons why women discontinue breast-feeding, usually before the infant reaches 3 months of age—far sooner than health and nutrition professionals recommend.

Nature’s Best Nutrition
The old adage “breast is best” summarizes the benefits of breast-feeding. Naturally, there are contraindications to breast-feeding, and some women decide against it. (Women with certain diseases such as HIV, untreated tuberculosis, and cancers requiring radiation or chemotherapy agents are advised against breast-feeding.2) The American Dietetic Association and the American Academy of Pediatrics, however, encourage exclusive breast-feeding for the first six months of an infant’s life, with continued breast-feeding until an infant reaches the age of 1 to achieve optimal health benefits, including immune system support, a decreased risk of developing certain conditions (eg, type 2 diabetes, heart disease), and better protection against allergies.

According to La Leche League International, mothers may also reap the benefits of breast-feeding, such as a decreased risk of breast and ovarian cancers, better iron profiles from less menstrual blood loss, and a potentially lower risk of developing osteoporosis later in life. Mothers who breast-feed also have a faster recovery postpartum and may return to their prepregnancy weight sooner than women who bottle-feed.

The health benefits for both mother and baby play an important role in women’s attendance at work. Breast-feeding employees may require fewer sick days and days off to care for an ill child. Most full-time working mothers require some form of child care while they are away from home, and several choose day care facilities, where exposure to germs and illness is high. Breast-fed infants benefit from the antibodies present in breast milk and may be less susceptible to catching germs from other children in a day care setting.3

Because most women are at least somewhat familiar with the health benefits of breast-feeding, the initiation rates have increased over the past 20 years. However, the rates of exclusive nursing have not changed, and mixed feedings (formula and breast milk) have increased, with factors such as insufficient family and societal support, maternal employment outside of the home, and improper interruption of breast-feeding among the reasons.2

Workplace Obstacles
One of the most common complaints shared by breast-feeding women working outside the home is a lack of privacy. Effie Akerlund, an RD from New Jersey who breast-fed her daughter for more than one year, recalls the inconvenience of finding a private place to express milk. “I shared an office with a man, so I’d have to lock him out of the office. But even then, people who had keys to it, like the housekeepers and department secretary, would walk right in while I was in the middle of pumping,” she says.

In addition to relieving discomfort from breast engorgement, many women must pump to provide milk for their child’s caregiver the following day. Akerlund advises mothers who plan to continue breast-feeding after returning to work to think ahead and start storing breast milk in the freezer while still on maternity leave. Knowing that she had a backup supply at home if she did not have time to pump at work on any particular day would have been comforting. But because she did not, Akerlund says, “One of the most stressful things was making sure I had time to pump during the day so that I could make enough bottles to send to day care with my baby.”

Although many states’ laws allow mothers breaks to express milk, most breaks must run concurrent with those these women already have—usually their lunch break—creating the need to multitask, as skipping meals can be detrimental. La Leche League International estimates that lactating women need an additional 200 to 500 kcal each day to support milk production, yet many breast-feeding employees use their break times to express milk when they otherwise may have been eating.

Akerlund describes how she would fit in time to breast-feed her baby during her breaks: “The day care was nearby, so I would grab a sandwich and eat it while I was walking over there. I never had time to actually sit and take a break for lunch and breast-feed my baby. It was one or the other, but as mothers we learn how to multitask quickly.”

A typical break schedule necessary for pumping for a full-time working mother may be 15 minutes midmorning, 30 minutes during lunch, and 15 minutes midafternoon. The length and frequency vary depending on the infant’s age and nutritional needs.

Lactation is a supply-and-demand system wherein the body naturally increases milk supply with more frequent feedings or pumping sessions. Conversely, milk supply decreases when this frequency declines.

Casey White, a full-time nurse in South Carolina, breast-fed her son for one year. Working 12- to 13-hour days in a high-volume acute care unit, she had difficulty finding time to pump. “I never had a set schedule with breaks, and some days I would go all day without pumping,” she says. White needed to supplement her baby’s diet sooner than she had planned because her milk production had decreased significantly. She also complained of a lack of privacy. Without her own office or specific lactation area, White found herself expressing milk in the nurses’ locker room, with traffic coming in and out, or “in an empty patient’s room if all the beds weren’t filled that day.”

Oftentimes, larger facilities have varying policies within their different departments. For example, the director of the human resources department may be supportive and accommodating of a breast-feeding employee, whereas the manager of the accounting department may be less understanding. Inconsistencies cause confusion and send mixed signals. They interfere with the process of educating other employees about the importance of supporting breast-feeding coworkers for the success of not only the mother but also the company as a whole.

White recalls fellow coworkers passing judgment on her even though her direct supervisor supported her need to express milk during the day. “Occasionally, someone would make a comment like, ‘Why does she get extra breaks just because she’s breast-feeding?’ making me feel guilty for something I knew I had a right to do and fit into my lunch break. I don’t think it would have been an issue if there was more of an understanding and education about full-time mothers breast-feeding.”

Workplace breast-feeding programs include criteria to minimize the obstacles that lactating employees face. This may include providing a private area with a locked door to express milk, a refrigerator or cold storage area, and a clock to keep track of the amount of time spent pumping. Other helpful items include a mirror so that an employee can check her appearance before returning to work (because partial undressing is usually necessary during the pumping session) and a computer or a phone if an employee wishes to multitask and continue working while pumping.

Lastly, employee support is a key component to overcoming workplace obstacles. Whether providing lactation consulting services or offering other support programs, having the employer on board with the breast-feeding program ultimately determines its success rate.

Supportive Legislation
Prior to President Obama signing the Health Care Reform Act at the end of March, less than one half of the states in America had specific laws related to breast-feeding in the workplace.4 As part of the Patient Protection and Affordable Care Act, amendments were made to the Fair Labor Standards Act of 1938 to require employers to provide break time and a private lactation area other than a restroom for women who choose to express milk.5  

But the details of the federal and state policies are often unclear or nonspecific. Many of the breast-feeding laws use the term reasonable in regard to their efforts to provide a private location to express milk and the amount of unpaid break time allowed to do so. What is considered reasonable is subjective and varies from workplace to workplace. In addition, employers exempt from the law include those with fewer than 50 employees or whose business may experience “hardships” if a breast-feeding employee uses break time to pump milk.5

Some states, however, have started taking a more progressive approach. According to the National Conference of State Legislatures, Indiana requires employers to provide not only a lactation area in facilities with at least 25 employees but also refrigeration for storing breast milk whenever possible. Oregon specifies that women be allowed 30-minute breaks for every four hours worked for the purpose of expressing milk.

Rep Carolyn B. Maloney (N.Y.) and Sen Jeff Merkley (Ore.) presented the Breastfeeding Promotion Act to Congress in June 2009. The bill is aimed at protecting and supporting breast-feeding women in the workplace and providing tax incentives to employers who establish private areas to express milk or offer their employees breast-feeding consultation.3

The Business Case for Breastfeeding is a program designed to encourage employers to support breast-feeding in the workplace by educating them on the benefits companies receive that contribute to their overall success. The Business Case lists some of the following as incentives and benefits to providing a supportive lactation program4:

• Decreased absenteeism: Breast-fed infants tend to be healthier than formula-fed infants; as a result, employees may take fewer leave days to tend to sick children.

• Fewer medical insurance claims: Breast-fed babies may spend less time at physicians’ offices and have fewer hospital visits than formula-fed babies, resulting in lower healthcare costs.

• Lower employee turnover rates: Employees are more likely to stay with their same employer after giving birth if the company supports lactation. This lowers the cost of hiring and training new staff to fill the position.

• Higher loyalty and productivity: A supportive workplace contributes to employee morale and desire to succeed. Women may have an easier transition from maternity leave to returning to work if they feel as though they will be returning to a supportive environment consistent with their breast-feeding goals.

• Positive public image: Some states with breast-feeding laws allow employers with lactation programs to market their company as infant friendly, which may recruit in-demand staff. In addition, employers may also gain local and/or national attention as a result of their program and improve their company image.

Make Pumping at Work Possible
More women are initiating breast-feeding and more mothers are present in the workforce, but those two facts do not go hand in hand. Returning to work, whether by choice or necessity, should not be a deterrent to breast-feeding. With all of the knowledge and studies available to promote the importance of nursing an infant for at least one year, employers need to take the initiative to support a mother’s right to provide her child with optimal nutrition.

Whether taking part in a structured breast-feeding-in-the-workplace program or offering individual support to their employees, companies that provide encouragement and aid to their breast-feeding workers contribute to the overall success and well-being of the employee, the infant, and the company as a whole. With the government support to provide consistent rights across the nation to breast-feeding employees, a mother’s decision to return to the workforce will no longer be a primary reason for discontinuing breast-feeding sooner than health professionals recommend or the mother desires.

— Larissa Gedney, MS, RD, LD, is a clinical nutrition manager at Conway Medical Center in Conway, S.C.

 

References
1. Shealy K, Li R, Benton-Davis S, Grummer-Strawn L. The CDC guide for breastfeeding interventions. 2005. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf

2. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496-506.

3. H.R. 2819: Breastfeeding Promotion Act of 2009. Available at: http://www.govtrack.us/congress/bill.xpd?bill=h111-2819

4. U.S. Department of Health and Human Services Maternal and Child Health Bureau. The business case for breastfeeding: Steps for creating a breastfeeding friendly worksite. 2008. Available at: http://www.womenshealth.gov/breastfeeding/programs/business-case/breastfeeding-businesscase-for-managers.pdf

5. National Conference of State Legislation. Breastfeeding laws. Updated March 2010. Available at: http://www.ncsl.org/issuesresearch/health/breastfeedinglaws/tabid/14389/default.aspx