Breast-feeding her son, Mateo, was painful and difficult for Becky Alcala. The baby had a tongue-tie, limiting his ability to nurse. A specialist confirmed the condition and snipped the baby’s short frenulum – the piece of tissue that connects the tongue to the bottom of the mouth – but the long learning curve continued for both mom and son. Alcala stocked up on creams and cabbage leaves to soothe her sore breasts.
Then, when Mateo was 9 weeks old, Alcala returned to her full-time job as an aquatics manager at Fairchild Air Force Base. And – as happens for many working women who want to continue to breast-feed their babies – there arose a whole new set of challenges.
The hardest part was using a breast pump to express her milk, she said.
“Pumping in general doesn’t do anything for a woman, certainly not me,” Alcala said. “And having to do it at work was really uncomfortable.”
While breast-feeding rates are high in Spokane County and throughout Idaho right after babies are born, they’re dramatically lower by the time babies are a few months old – partly because many women share Alcala’s experience: There’s a lot about going back to work that makes it difficult to breast-feed babies.
“Going back to work really is one of the two biggest reasons moms give up breast-feeding,” said Rachel Schwartz, who runs the Breastfeeding Coalition of Washington. “The other one is just a general lack of support from the community and health care providers. Employers recognizing that and recognizing they can take some small steps really makes a difference.”
Under the Affordable Care Act, many employees have legal rights to time and space to express their milk at work. But for some mothers, logistical hurdles to pumping milk and saving it for baby’s consumption later can seem insurmountable, leading them to give up.
Compared with some other working mothers, Alcala said, she was fortunate. She could close her office door and pull the window blinds. She had a refrigerator to store milk, and Alcala’s husband, who works an opposite schedule, brought the baby to her once a workday to nurse.
But hooking herself up to a machine and letting it pump away, as her staff worked nearby, wasn’t fun.
“From four months on, it was tempting every day to quit,” said Alcala, 32, of Airway Heights. “What kept me going was knowing the benefits for him,” as well as the connection she felt with the baby through nursing.
What also kept her going, she said: her boss, who backed her up the whole time, including when pumping and nursing took time from her workday. When she got behind, she went to work on weekends to catch up.
“Honestly, I don’t think I could have continued to do it if I didn’t have the boss that I have,” she said, “where he is really supportive and willing to let me do that.”
‘A huge barrier’
Other workers – especially those working minimum-wage jobs – lack lactation-support services, said Tiffany Schamber, who runs the health district’s WIC program, which provides peer counselors, breast pumps and support groups to help promote and extend breast-feeding among clients.
“They don’t have a private room for the moms to pump in, they don’t have anybody to give them a break so they can go pump,” Schamber said. “Many moms have reported having to pump in bathroom stalls or out in their car, or that there simply is no private place for them to go to express their milk. That’s a huge barrier.”
In 2011, 91.3 percent of mothers in Spokane County started to breast-feed their newborns, according to data from the Spokane Regional Health District.
But despite that high initiation rate, many women stopped nursing their babies soon after giving birth, according to a survey conducted from 2007 to 2011. Slightly less than 59 percent of Spokane County mothers were still breast-feeding their 2- to 4-month-old infants. Rates continue to decline after babies turn 6 months old, Schamber said.
In Idaho, 91.8 percent of women initiated breast-feeding after their babies were born, according to data from the Centers for Disease Prevention and Control. By 3 months, 60.3 percent were breast-feeding exclusively.
The American Academy of Pediatrics recommends exclusive breast-feeding until babies are 6 months old, followed by breast-feeding in combination with other foods until they’re at least 12 months and continuing as long as the mother and baby want to continue.
The business case
Yet employers who make it easier for women to pump can cut health care costs, time workers spend away from work with sick children, and boost employees’ productivity and morale, Schamber said.
“There is a ton of research and data out there that shows that (breast-fed) kids are healthier,” she said. “They suffer less ear infections. They have less upper respiratory illnesses and things like that, so mom is not going to have to stay home as often with her baby because her baby isn’t as sick. That speaks to the business’s bottom line – and it’s using less health care dollars.”
The U.S. Department of Health and Human Services agrees there’s a case to be made for creating nursing-friendly worksites.
Its Business Case for Breastfeeding program is designed to educate employers about the benefits of supporting nursing mothers. Businesses stand to gain happier, more loyal workers, it says – but also bottom-line savings as they’re better able to keep experienced employees on the job, cut sick time parents take to care for ill kids, and reduce health care costs.
The program offers free online resources for helping employers provide lactation support for workers.
In many cases, they’re legally required to do so.
Under the Affordable Care Act, employers have to provide break time for pumping until the baby turns 1 and a private place, besides a restroom, to do it.
The law, which took effect in 2010, leaves it up to workers to decide when and how long the breaks should be, said Schwartz, of the Breastfeeding Coalition of Washington. The group is a program of WithinReach, a statewide organization that works to promote family health.
But while the law applies to hourly employees, salaried workers are exempt, Schwartz said. That leaves out some big groups, including teachers, for whom it’s often difficult to schedule time for pumping and who are left with no legal protection, she said. Also, employers with fewer than 50 workers can apply for exemption if accommodating breast-feeding women would cause “undue hardship.”At Inland Northwest Health Services, there’s no formal policy on supporting nursing mothers at work, said Nicole Stewart, director of marketing and communications. But INHS maintains comfortable, private and clean rooms where mothers can pump, she said.
As a manager, Stewart said, she can see productivity gains offered by the on-site rooms, if the alternative for employees was to leave work to nurse.
“Overall, I think the most important thing is that as an employer you’re embracing their choice and making it easier and more comfortable for them to (breast-feed),” Stewart said. “And ultimately that makes for a happier employee.”
As the Affordable Care Act took effect, Eastern Washington University officials informed employees in 2010 it would provide breaks and space for employees to express their milk until their babies turned 1, said Caren Lincoln, EWU’s human resources supervisor.
That formalized a process that workers and supervisors likely worked out on their own, she said.
“The individuals that I’m aware of have been thankful for having a private place to go do that,” Lincoln said, “and I think that will automatically translate into a morale booster.”
For other employers, the benefits – and the path toward creating a nursing-friendly worksite – are less clear.
As the Breastfeeding Coalition of Washington reaches out to employers around the state to make them aware of the federal law, it’s found supportive workplaces as well as bosses reluctant to make changes, Schwartz said.
“One of the biggest issues, frankly, is that we have a sexualized concept of the breast in this country, right?” she said. “That’s just the way it is. We hear from a lot of managers that they’re just uncomfortable to even talk about this.”
That’s one reason to have a formal policy in place, Schwartz said. When lactation support is just another on-the-books employee benefit, the burden on managers eases: “It’s just part of what you do for the wellness of your employees.”
Finding a space where women can express their milk is another frequent concern, she said. But while designated lactation rooms with couches and bulletin boards for babies’ photos are nice, she said, they’re not necessary. They might be impossible in a fast-food restaurant or a retail store.
The breastfeeding coalition works to find creative ways to create private spaces, Schwartz said. In a clothing store, a changing room will do. In spots with no closed-off spaces, employers have used pipes and drapes or cubicle walls to create makeshift rooms. Closets can be converted, managers’ offices borrowed.
“There’s some great work in the central area of our state with women that work in fruit-packing plants, and the rooms they’ve adapted,” Schwartz said. “It’s really just taking a closet space and making it work. You don’t need a big space to be able to be compliant with the law.”
‘Can we talk?’
Even under the best circumstances, breast-feeding can be challenging for working mothers, and quitting in favor of formula is a temptation even for those who’d set a goal of breast-feeding for longer.
“Pumping is not nearly as fun as breast-feeding a baby,” said Xylina Weaver, a birth and family educator at Providence Sacred Heart Medical Center who leads its weekly breast-feeding support group.
Weaver, also a certified lactation consultant who has her own business, helps women prepare themselves and their babies for the transition, suggesting that babies start learning to use a bottle before their mothers return to work.
To help women who want to stick with it, peer counselors at the health district’s WIC program help brainstorm ways to make breast-feeding on the job work better. Maybe a long extension cord, connecting an electrical outlet in a public place to a pump in a private place, can do the trick. Sometimes WIC can help clients get car adapters for their breast pumps, when there’s nowhere else to use it, said Schamber, the program manager.
Schwartz said she encourages workers to, “as much as possible, be proactive about it before they go out on maternity leave – talk about it as their right. Say, ‘I’m going to come back to work, and I’m going to be pumping. Can we talk about what that will look like?’ ”
That’s what Dana Stroud did, and it worked.
Stroud, a fisheries research biologist at EWU, knew before she was pregnant she’d breast-feed her baby. Her mother and her husband’s mother had nursed their babies. And Stroud didn’t want to have to heat up bottles for overnight feedings.
“Plus, as a biologist, I knew there were a lot of reasons for my health as well as for my daughter’s health, for the best possible immune system,” she said.
But Stroud also knew her own mother lost her milk supply after returning to work, partly because breast pumps worked less efficiently then and partly because her mother’s employer didn’t provide adequate breaks or a suitable place to pump.
As she neared her third trimester of pregnancy, Stroud talked with staff at EWU’s human resources department.
“I told them I planned on breast-feeding and I would need a place to pump that was discreet, ideally with a sink in close proximity to my workplace,” Stroud said. It was in place before she left on maternity leave. Her pumping room is across a hall from her office.
Stroud has been working and breast-feeding since Makea was 12 weeks old, with the goal of continuing until the baby turns 1, which is on Monday.
“Now that I’ve reached my original goal, I kind of feel like as long as it’s comfortable for me and it’s comfortable for her, we’ll continue,” she said.
Stroud said she feels lucky to have a flexible and encouraging employer. She urged other women to learn about how breast- feeding laws affect them.
“We do have a right to breast-feed, and we have a right to pump when we’re not in close proximity to our kids,” Stroud said. “And it’s important to know your rights if you want to continue breast-feeding.”