Podcast: Breastfeeding Equity with Kimberly Seals Allers
Hear from Kimberly Seals Allers, author and advocate for breastfeeding health equity, about the challenges breastfeeding moms face in the United States. It’s not just an issue of support in and outside of the hospital, but a more complex issue of big business, equity, and cultural norms on this episode of the WithinReach Podcast.
Building a Breastfeeding Friendly King County
World Breastfeeding Week Podcast
Stand up for breastfeeding moms
As a physician who provides obstetrical and newborn care, I have some control over the messages that my new mothers hear while in the hospital. Fortunately, I also have the ability to write orders which limit formula use for medical reasons only. Nurses can call me, and as a lactation consultant I can also stage appropriate and baby-friendly interventions.
However, many dietitians, community-based healthcare staff, and breast-feeding advocates do not routinely provide in-hospital care. I can only imagine how difficult it is to know that your patients and clients, whom you have worked so hard to educate and prepare for motherhood, may be exposed to contradictory messages about breastfeeding at such a vulnerable time.
As breast-feeding advocates, we hear messages about the potential consequences of just a single bottle of formula, but we have little ability to stop that single feeding at the times when that influence is most needed. However, I do think that there are many important points to remember with regard to breast-feeding promotion in the outpatient setting.
First, in the age of social media, it is important to remember that our clients and patients often turn to the Internet for guidance. Therefore, I would strongly recommend that as breast-feeding advocates we identify hospitals, physicians, midwives, internet groups, and web sites which consistently provide (and demand) baby friendly neonatal care, and make those comments in those places where our patients will see them. For example, does a medical clinic or hospital have a Facebook page? Make comments EVERY TIME you hear of a patient who had a good breastfeeding experience. We can help our patients select providers and hospitals which align with their goals, and OUR goals. Get the word out where our clients are looking.
In addition, as outside-hospital providers, I encourage you to put pressure on in-hospital staff to provide the quality of care that we expect. Perhaps it may be a phone call to a physician or midwife, or the director of the birth center at a hospital, to inquire as to why a patient, or several patients, may have received formula. The specific answer may not be available, or may be limited by HIPPA compliance, but it does demonstrate a vested interest in the well-being of our most vulnerable. Perhaps it may be an annual visit to a local medical clinic to explain the outsides services available to physicians that YOU provide. Consider also giving physicians, midwives, nurses, and in-hospital staff the appreciation that they deserve in very public ways. Never underestimate the value of personal contact. Market breastfeeding. Be deliberate and methodical.
Finally, I would encourage outside providers to discuss with their clients and patients the consequences of registering on various pregnancy and baby related websites and on in-store gift registries. The formula industry, as we all know, aggressively markets to our audience. We need to prepare our mothers for an inundation of formula-related material and samples. We need to tell them that it is OKAY to throw those samples and coupons away. They do not need to maintain a supply “just in case.” We need them to know that formula companies are unfairly playing to their insecurities at a time when they are most vulnerable. We need them to know that WE believe they can nurse their babies, and that they WILL make enough milk. We need to restore their confidence in themselves.
Dr. Jody Cousins is a family medicine and obstetric care physician at Fidalgo Medical Associates in Anacortes, WA. She is a member of the Skagit Breastfeeding Coalition and the recipient of the 2015 Breastfeeding Coalition of Washington MaryAnn O’Hara, MD Physician Leadership Award.
A response to KUOW’s “Why Seattle Moms Still Pump In Bathrooms”
By Chris Gray, Member- Breastfeeding Coalition of Washington
Finding appropriate accommodations for women to pump at work that are suitable for both mothers and employers continues to be a challenge. Though there are no state laws to support breastfeeding in the work place, Federal Law entitles hourly employees to reasonable break times and to a private, non-bathroom space to pump. And it is important to recognize that the Department of Labor encourages employers to provide breaks to all nursing mothers regardless of their status under the Fair Labor Standards Act (FLSA). Yet even with these laws in place, there is still a lot of room for employer interpretation and too often mothers find themselves with inadequate or inconvenient options. As we continue our efforts to normalize breastfeeding in our communities, how do we help employers–especially those with limited resources and space–normalize breastfeeding in their work place?
KUOW released an article on October 12th titled, “Why Seattle Moms Still Pump In Bathrooms” that brings to light some of the issues mothers face when trying to pump at work. Thank you to the companies and employers who have found a solution that supports their breastfeeding mothers’ need to pump at work. Thank you, KUOW, for prioritizing the creation of a new lactation room and supporting a mother’s desire to continue to breastfeed while at work. It is not impossible to find an appropriate space for pumping that works for both mother and employer; with a little creativity and determination, all employers can create private and secure spaces for their mothers to pump.
Here are a few resources that can help employers create quality spaces or improve the existing lactation spaces to better support their employees.
- Office on Women’s Health “Supporting Nursing Moms at Work: Employer Solutions”: Offers cost effective tips and solutions for any industry setting. It offers creative solutions to meet the time and space restrictions that some businesses face.
- The Business Case for Breastfeeding: Demonstrates how creating a nursing-friendly environment can actually support your business!
- Pregnancy Guidance: A resource page with fact-sheets for small businesses, Q&A from the EEOC, and best practices for employers.
- Employer Best Practices for Workers with Caregiving Responsibilities: Provides employers with information on how to create efficient workplaces that support employees with caregiving responsibilities.
- Local Chamber of Commerce in WA State: Federal and local breastfeeding resources have been shared with Chambers of Commerce to increase awareness of existing resources to support breastfeeding mothers in the workplace.
- Breastfeeding Coalition of Washington: Please join the BCW at our quarterly meetings as we focus on various issues in and around Washington, including normalizing breastfeeding in the workplace.
Breastfeeding: Your rights in the workplace
A couple of months ago I got a call on our Family Health Hotline from a woman who was approaching the end of her maternity leave and was trying to better understand her rights in going back to work as a breastfeeding mother. She was returning to work at a large tech company and her expectations were low that her employer would be accommodating of a flexible schedule that would allow her to breast-pump. As I scrambled to locate and articulate the legal jargon around this topic, I was glad to discover that the law does protect women in this situation, but I also craved more detail to better guide callers in the future and provide women with confidence to advocate for themselves in the workplace.
It’s recommended by the American Academy of Pediatrics that mothers give their babies nothing but breastmilk for the first six months of life, and continue giving breastmilk for at least one year or longer. The reasoning behind this is worth celebrating! Breastfeeding provides significant cost-savings and strengthens the trusting, loving bond between a mother and her baby by increasing levels of oxytocin, also known as the “love hormone.” The cells, hormones, and antibodies in breastmilk make it easier for babies to digest than formula and reduce their incidence of developing respiratory infections, asthma, diabetes, and obesity, among other health conditions. From a mother’s perspective, breastfeeding has also been shown to reduce the risk of breast and ovarian cancer as well as postpartum depression. Employers also have reason to encourage breastfeeding as research supports it contributes to lower health care costs and absences from work due to caring for a sick child. For more information on the benefits of breastfeeding as well as tips for making the transition back to work while breastfeeding, please visit our “Work and Breastfeeding” resource.
The Affordable Care Act (ACA) advanced the rights of mothers in the workplace and the benefits that breastfeeding mothers are required to receive. New health insurance plans (since March 2010) are now mandated to offer women full coverage of a breast pump as well as a range of preventative services and lactation counseling. Breastfeeding is now more accessible to a majority of employed women as most employers are required to provide a space and “reasonable break time” for women to express breast milk or pump during the workday. The space provided must be “shielded from view and free from intrusion from coworkers and the public.” A bathroom, even if private, is not considered an acceptable location under the Act. Employers can find cost-effective tips on providing time and space to support nursing mothers in a variety of work settings on the Office of Women’s Health Website.
While the Affordable Care Act established a new and improved standard for the affordability and accessibility of breastfeeding, there are still barriers to breastfeeding supplies and support that need to be addressed. For example, while most women can now receive full coverage of a breast pump and lactation consulting through their insurance, this may not apply to Medicaid-recipients in certain states, mothers who are most in need of extra assistance. In this case, it’s likely that the Women, Infants, and Children (WIC) program can pick up where the law left off and provide women with these resources. Increasing awareness of how the law protects nursing women and how to navigate health and legal systems can help bring our workplaces and communities forward in recognizing the importance of breastfeeding in fostering healthy, happy mothers and babies.
Here are a few additional resources to learn more about breastfeeding and how to access WIC and other food and health programs:
Breastfeeding: The Power of Courage
Breastfeeding Coalition of WA Program Coordinator
Breastfeeding Promotion Program
American Academy of Family Physicians
Academy of Breastfeeding Medicine
American Academy of Pediatrics
American College of Obstetrician and Gynecologist
American College of Nurse-Midwives
Academy of Nutrition and Dietetics
American Public Health Association
Academy of Breastfeeding Medicine
American Academy of Pediatrics
Center for Disease Control & Prevention- Breastfeeding
International Lactation Consultant Association (ILCA)
La Leche League International
Special Supplemental Nutrition Program for Women, Infants & Children, (WIC) USDA
Womenshealth.gov, OWH, HHS
World Alliance for Breastfeeding Action
The Revolutionaries Wore Pearls —about seven women who challenged society, changed the culture, and taught the world that babies were born to be breastfed.
Link Between Breastfeeding and Strong Child Development
• Breastfeeding improves children’s cognitive development.
• Maternal responsiveness and attachment security are increased by breastfeeding.
• Breastfed children are less likely to suffer from abuse or neglect.
• Children who are breastfed are more accepting of new foods.
World Breastfeeding Week 2014
By Alessandra DeMarchis, WithinReach Breastfeeding Promotion Intern
Last fall, I started the Master in Public Health program at the University of Washington with a focus on nutritional science. I have been interested in nutrition and food since before I can remember, but this fall I learned about the world’s most perfect food: breast milk. Breast milk is amazing! As a young woman, it is incredible to know that my body has the capacity to create the most nutritious food for a baby. Not only can my body produce enough of this food to sustain even twins, it also changes in composition, synchronized to the changing needs of the baby. Breast milk is a baby’s first vaccine and only food source for six months. Did I mention it is free? Breast milk is so powerful that it can actually reduce my future baby’s risk of obesity, high blood pressure, and type 2 diabetes, while at the same time reducing my risk of certain cancers.
So why did the CDC Breastfeeding Report Card from 2013 show that only 76.5% of babies in the United States have ever breastfed, and a mere 49.0% of babies are breastfeeding at 6 months? Washington State is not doing much better, with only 87.9% of babies ever being breastfed and 60.2% being breastfed at 6 months. If breast milk is free and the most perfect food source for a baby, than why are so many babies receiving artificial formulas? Until the 19th century, women throughout history exclusively breastfed their babies. Why did formula become the new normal and breastfeeding an activity done in secluded places? The truth is that breastfeeding can be especially difficult when mothers do not have emotional, informational, and logistical support of their family, friends, co-workers, employers, medical providers, community, and government.
World Breastfeeding Week, held every year from August 1 – 7, creates the opportunity for groups and organizations around the world to take action for raising awareness and support for breastfeeding. World Breastfeeding Week 2014 highlights the role of breastfeeding in achieving the Millennium Development Goals (MDG). The eight MDGs were set in 1990 to promote sustainable development and health and eradicate poverty and hunger. Breastfeeding is linked to each of the MDGs. In terms of the first goal, to eradicate extreme poverty and hunger, breast milk is a cost effective way of feeding babies, packed with high quality nutrients and energy. For the goal to ensure environmental sustainability, breastfeeding creates less waste from pharmaceuticals, plastic, aluminum, as well as firewood and fossil fuels. To achieve the post-2015 development agenda, organizations around the world must acknowledge and emphasize the value of increasing and maintaining the protection, promotion, and support of breastfeeding.
World Breastfeeding Week is a time for organizations to take action toward a world where breastfeeding is once again the societal norm. Every child should have a fair start at life, and that means ensuring all mothers have the support they need to provide their babies with breast milk.
Click here to see how Within Reach is promoting World Breastfeeding week. To learn more about World Breastfeeding Week and this year’s theme, visit http://worldbreastfeedingweek.org/.
One Moms Story of Why Breastfeeding Support Matters
Written by Seattle area mom, birth doula and breastfeeding activist, Julia Lacy
There is a piece of legislation (House Bill 2329) working its way through the policy-making process this week, hopefully on its way to becoming law. This bill would create a designation system for hospitals that take steps to supporting and promoting breastfeeding.
This piqued my interest for two reasons. 1) As a birth doula and breastfeeding cheerleader/activist, I believe deeply in the multitude of reasons why breastfeeding is important to both mothers and babies, and support anything that could help a woman achieve success breastfeeding–however she personally defines it; and 2) As a breastfeeding mother for most of the past 34 months, I’ve experienced my own ups and downs and have had firsthand experience with how said institutions can make or break success. As such, the importance of this type of legislation, which keeps businesses motivated and holds them accountable in their support (or lack thereof) for breastfeeding, is crystal clear to me.
Here in the United States, many women already have an uphill battle when it comes to establishing and succeeding at breastfeeding. With no mandated maternity leave, and many employers providing dismal (at best) accommodations for pumping (i.e., the bathroom stall), it’s no wonder that the rate of mothers exclusively breastfeeding at 6 months (the WHO recommendation) is less than 17%. When the myriad of other obstacles a mother might face are taken into consideration (pain, lack of familial support, dietary concerns, postpartum hormones, exhaustion, etc.), it becomes evident that finding support in her community is a clear method to help a breastfeeding mother succeed.
I feel very fortunate to live in the Seattle area, where breastfeeding resources are at my fingertips and where breastfeeding is widely accepted and normalized; but I also know that my experiences are unique and fortunate.
I’ve been breastfeeding since May 2011 when my daughter was born. After a three month maternity leave, I returned to work for six months until I chose to turn in my badge to stay home with her. I continued to breastfeed her until she was about 20 months old, when she could no longer share my lap with my 7 month-pregnant belly. Since last April, I’ve been nursing my son (some days, nonstop it seems!) and pumping on occasion, mostly for his big sister, who still loves her “mama milk.” My original goal was simply to breastfeed my baby girl for maybe a year or so, but as time went on, I became uncomfortable with the idea of weaning her. My goal shifted to letting her, and any future nurslings, self-wean. Although her weaning was more circumstantial (my milk was mostly gone by then anyway), I feel that my plan was successful. My hope for my son is that he breastfeeds until he decides he is done. Ten and a half months in, we are well on our way.
Over the course of my two journeys, I’ve had two experiences with institutions which I am certain either helped save, or fully saved, my breastfeeding relationships. The first experience was after I went back to work after having my daughter. My employer was incredibly accommodating. Now, I certainly recognize that part of my success in pumping 2 or 3 times a day was also due to an individual manager who fully supported my breastfeeding, as well as a job title in which I had the flexibility of setting my own schedule. If these things hadn’t been true, I’m not sure I would have succeeded at dedicating enough time to pumping, which in turn could certainly have sabotaged my breastfeeding goals. As it was, my employer had set up dozens of pumping rooms in our building – each equipped with everything from individual stalls and comfortable chairs, to miniature kitchenettes with sinks, cabinets and refrigerators, and even a hospital grade pump you could use if you had compatible parts. There were also stacks of magazines to flip through while pumping, and bulletin boards where mamas would proudly display pictures of their babies. Questions weren’t asked of women who went in to these rooms and I never saw any of these women express frustration over an unsupportive work environment. I am positive that thousands of breastfeeding relationships have been saved by this particularly accommodating employer. And it certainly makes sense for employers to provide mothers with these sorts of accommodations—happy employees are more productive employees, and research has shown that breastfeeding mothers are less likely to take time off from work, as their babies are less likely to be sick. I give full credit to my former employer for their support of my breastfeeding relationship, and can say with certainty that if I’d not had that support, my long term goals would not have been met.
My second crucial experience with institutionalized support happened after the premature birth of my son. When he was admitted to the NICU on enough respiratory support that I was unable to even hold him during the first three days of his life, my jumbled thoughts eventually came around to breastfeeding. Being aware of how critical the first days can be in establishing a good breastfeeding relationship, I knew that by not having skin-to-skin contact or establishing nursing within the first hour of his life, we would already have some early obstacles to overcome. I was concerned about everything: my milk coming in, him learning how to suck, maintaining a pumping schedule, etc. It turned out that I needn’t have been so concerned–our hospital went above and beyond in ensuring that they did everything in their power to help me reach my goals.
Whereas some hospitals fall short of providing proper breastfeeding support to new mothers – even sabotaging breastfeeding by unnecessarily providing formula or other such efforts – my experience was the opposite. I had a stream of visits from lactation consultants on staff. They helped me work through severe pain and clogged ducts and brought me everything from vials of olive oil to soothe me and help heal, to the correct-sized pumping flanges. I had nurses work with me to determine his feeding schedule so that I could be present at almost every single one. I had nurses wake me when it was time to nurse and help me with all the necessary adjustments and measurements so that my only focus could be feeding my boy. I will always remember the sound of nurses cheering for us in the hallway after a particularly voluminous feed.
I was lucky to have the experiences that I had breastfeeding my two kids. I knew it then, and I especially know it now. Not everyone has the support that I had, which is why almost unilaterally, breastfeeding bills such as the one currently in discussion should be passed and supported.
2014 Legislative Session Week Three – Breastfeeding Friendly Washington
Breastmilk is a baby’s perfect first food. It has special nutrients a baby needs that are not found in formula and changes to meet the needs of a growing child, including giving your baby protection against illness and infection. As a result, breastfed babies have fewer earaches, colds, and allergies and are less likely to experience Sudden Infant Death Syndrome. Besides the many health benefits, breastfeeding also helps build a special bond between a mother and her baby.
Moving Upstream. . . One Training at a Time
544 providers. More specifically: 296 nurses, 147 doctors, 24 dieticians, 19 nurse practitioners, 4 midwives, (and a partridge in a pear tree!) What do all these people have in common?
They all provide care for Washington families and they’ve all recently gone through a breastfeeding education training organized by WithinReach.
Recent studies show that provider lactation education has a statistically significant increase on breastfeeding outcomes. In other words, the more that doctors, nurses and other support staff learn about and support breastfeeding, the more likely the women in their care will meet their own breastfeeding goals, and we know that longer breastfeeding leads to better maternal child health.
Health care providers play a critical role in supporting breastfeeding women. The recently published CDC Guide to Breastfeeding Interventions affirms that “health care professionals need in-depth knowledge and skills directly related to breastfeeding and lactation management because 86% of Americans still turn to a health professional as their primary source of health information”. Lack of adequate support is the main reason we hear about for why women discontinue breastfeeding. Here at WithinReach, we’re working to change this. One training at a time, we’re working to ensure that Washington State health care providers are equipped with the knowledge and skills to support moms and babies with breastfeeding.
In the field of public health, we often talk about ‘upstream’ and ‘downstream’ approaches to improving community health, preventing disease and eliminating disparities. Watch this quick video for a brief overview. To sum it up: “Investing upstream in prevention, rather than downstream in intervention, is often wiser and more effective, and is the essence of public health.” Many challenges with breastfeeding could be prevented before they turn into substantial concerns. Ensuring moms are appropriately supported, from prenatal breastfeeding education to support at the hospital bedside and beyond, is a key way to do this. For another analogy about the impact of public health prevention strategies and the social determinants of health, see the fabulous Dr. Camara Jones’ well known talk about the Cliff of Good Health.
While we could choose to focus our efforts to promote breastfeeding on direct support for mothers and babies, that work is really best done by IBCLCs (Lactation Consultants), peer counselors, community programs and other perinatal support professionals. This is indeed a critical element of a broader community that supports breastfeeding. WithinReach and the Breastfeeding Coalition of Washington’s work is primarily focused on providing tools and information directly to health care providers. Moving further upstream and taking a public health approach allows us, with a relatively small amount of resources, to facilitate training for the providers that care for mothers and families and to impact organizational policies and practices. With this approach, we are able to reach tens of thousands of breastfeeding moms and babies. By working with nineteen hospitals around the state through our Evidence-Based Hospital Breastfeeding Support (EBBS) Learning Collaborative, in 2013 we have positively impacted the care received by over 40% of babies born in Washington.
With support from the Washington State Department of Health, Public Health- Seattle & King County and SeaMar Community Health Centers, and a partnership with Molly Pessl, BSN, IBCLC (owner and lactation education trainer) from Evergreen Perinatal Education, WithinReach has coordinated five trainings over the past several months that have reached well over 500 health care providers. We’re helping support breastfeeding throughout the state, one training at a time. Thank you for supporting us in this work!