Make a Difference for Working Parents

Enabling Breastfeeding: Making a Difference for Working Parents is the theme for World Breastfeeding Week 2023.  Whether you are a primary care provider or lactation consultant, seeing patients prenatally or after delivery, we all have the potential to help families navigate this transition.  

Impact of Work on Breastfeeding

Did you know that workplace challenges remain one of the most common reasons that families quit breastfeeding earlier or never start? A woman's plan to return to work influences how long she intends to breastfeed. Given over 80% of families are initiating breastfeeding and approximately 60% of new mothers are working (with 23% of employed US mothers returning to work within 10 days postpartum), our responsibility to support families in reaching their breastfeeding goals includes navigating breastfeeding and returning to work.

How can we make a difference?

Consider a third-time breastfeeding parent with a goal of breastfeeding more than a year. Previously she did not go back to work until 9 months, and breastfed her first two until 1 and half years old. This time she returned to work at 10 weeks postpartum. Prior to returning to work, breastfeeding had been going well without difficulties. When she started working, her baby was gaining well, sleeping about 6 hours at night, and she was getting 18 ounces per day, pumping 3x/day at work and able to store some milk. Her infant is now 16 weeks old and she calls to say her milk supply has decreased. She is now pumping 12 ounces per day and needs to take 4 ounces from her freezer stash each day.  For about a month her baby had been sleeping about 10 hours at night, but in the last 10 days is now awakening 1 to 2 times at night. 

Returning to Work and Maintaining Milk Supply:

Low milk supply is one of the most common challenges families encounter upon going back to work. To better understand the specifics, our practice  conducted an online survey of families in our Facebook support group.  After returning to work, we asked those who reported concerns with low milk supply (approximately 50%), the reasons for decreased milk supply. Answers included:

• not enough break time (43%)
• milk supply better with direct breastfeeding (43%)
• tired and stressed (65%)
• trouble expressing (11%)
• don’t know (32%)

As healthcare providers, our ability to educate and discuss solutions for these concerns will help families maintain their milk supply. 

Educate

Break time:  According to the Federal Labor Standards Act (FLSA) businesses are legally required to accommodate protected time to express milk in a clean, private space that is not a bathroom.  In 2022, The Pump Act closed loopholes and the right was expanded to most working families including teachers, nurses, and agricultural workers who may not have had protection previously. Confirming families are aware of the federal laws protecting break time and then helping plan for logistics (i.e. number of times to pump while working) is a great beginning. 

Direct breastfeeding: For many, more frequent direct breastfeeding helps maintain supply. If this helps an individual, we can discuss planning their day so they can breastfeed before and after work. Perhaps looking for a breastfeeding supportive child care provider that encourages breastfeeding at drop off and/or pickup could help. Clear communication with childcare providers can ease transitions, which might look like childcare waiting on giving a bottle if pickup time is soon, or providing a smaller last bottle of the day so baby is interested in direct breastfeeding at pickup. And if the parent’s supply decreases as their baby sleeps longer stretches at night, consider a dream feeding before the breastfeeding parent goes to bed. 

Trouble expressing: Given the need to express when separated, it is important to support effective milk expression, including identifying an appropriate pump, assisting with correct flange sizing for optimal comfort and milk expression, reviewing hand expression, and teaching about pump use. Some parents may find having a picture of their baby or meditating may help with milk flow. Directing families to reliable resources, either at your practice or in your community, helps solve problems.

Tired and Stressed: This covers a lot of topics. It could be stress at work, stress with a partner, or concern for their milk supply.  Being able to support requires stopping, listening, and taking time to individualize the plan. Self-care is important for new parents and taking time to identify solutions that work for them is a priority.  Sometimes knowing there is flexibility on when to feed and express can be a good place to start. 

Advocate

Supporting a family may include advocating for workplace support with their employer through a letter highlighting the benefits to the business and the rights of the employee. The Business Case for Breastfeeding is a comprehensive program highlighting the benefits to businesses that support workplace lactation programs. Available through the Office on Women’s Health, there are toolkits for employees, employers, and health care providers, including a sample letter from the physician to an employer.

An opportunity for team-based care. 

The need for supporting breastfeeding families as they return to work highlights another benefit of team-based lactation consultant support. It takes time to obtain the needed information to individualize a plan. Having a lactation consultant in your clinic provides an available resource for families. They are available before returning to work to spend the time watching a feeding, checking the pump, measuring flange size, talking through the feeding routine, discussing breastfeeding-friendly childcare providers, and educating parents about their rights. After returning to work, lactation consultants can help problem-solve.

Circling back to our case scenario:

Around the time mom returned to work, her baby started sleeping longer at night. While she started pumping 3 times per day when she returned to work, she found that if the day was busy she would miss a pumping session.  Also, it was busy when she came home with the 2 older children so they often missed breastfeeding upon getting home and often just breastfed once before bed. Overall she had dropped 2 to 3 feedings/pumpings a day. A visit in the office also helped identify that with a different flange size, she could express the milk more efficiently, which made adding in another pumping session at work more feasible. Also, it helped to learn that her pumping sessions did not need to be exactly spaced out; if she missed a session because of a meeting she could pump two times closer together. She also talked to her family about the need to breastfeed the baby right after work in addition to before bed. These two changes added in 2 more feeds, and in follow-up 2 weeks later, she no longer needed to take milk from her freezer stash to meet baby's needs from one day to the next.  

Taking the time to discuss, explore, and educate helps families maintain milk supply and supports their goal of continued breastfeeding. Team-based Lactation Consultant/Primary Care visits help primary care offices have the time available at their clinics to  make a difference for working families. 

~ Ann M. Witt, MD, FABM, IBCLC