Lactation counselor pumps for 29 months and counting after surrogate births

Juli Velasquez’s, CLC first son, now 10 years old, was born by emergency c-section.

“It was pretty frightening,” she remembers. “I was completely put under [anesthesia]. Everyone saw the baby before I did.” 

Despite a challenging birth, Velasquez and her son went on to breastfeed for 13 months. During this time, she planned the birth of her second child with 18 month spacing, hoping to replicate the sibling-closeness that she enjoyed with her sister.  

Having moved from Florida to New York (then later back to Florida), Velasquez had a successful vaginal birth after cesarean (VBAC) at 40 weeks and 2 days with her second son. 

“It was the most amazing experience ever,” Velasquez reports. “I told my husband, ‘I could do this a million more times.’”

Shy of a million, Velasquez did go on to carry four more babies as a gestational surrogate (GS):  a baby born in May 2015, twins born in January 2017 and a baby born in July 2020. Velasquez pumped after her first surrogacy birth for eight months, the second for 15 months, and has currently been pumping and for six months and counting. 

Screenshot of Velasquez’s and her sister’s plan to become surrogates together.

Velasquez says surrogacy was something that she always wanted to do. Initially, she and her sister planned to become surrogates together after they had completed their own families, but when her sister ended up becoming pregnant again with her own child, Velasquez started her surrogacy journey solo in 2014.

About 750 babies were born via gestational surrogacy in the U.S. in 2019. [

Thinking back to her pregnancy with the twins, Velasquez reports that she and the parents have become like family. In fact, she says that while her surrogacy journey is over, she would make an exception for this couple if they chose to grow their family. 

“They are raising their twins knowing of me and how I carried them in my belly. It’s the sweetest thing!” she exclaims. 

Like the birth of her second son, Velasquez describes her first surrogacy birth as an amazing experience too. 

“I became friends with the parents,” she explains. “It was really great.” 

The intended parents (IPs) did not make the birth of their baby, but they listened in on Velasquez’s labor via speakerphone. After their baby was born, the mother asked Velasquez if she would nurse the baby until she arrived at the hospital. 

“I never even considered it, but I wasn’t against it,” Velasquez says. So she went on to feed the baby until her parents arrived.  

Velasquez explains that contracts between the GS and IPs typically cover pumping breast milk after the baby is born.

“The wording in the contract says that no one is held to it, but that if both parties agree, they’ll continue as long as it’s good for everyone,” she offers the Cliff’s Notes version. 

For the following eight months, Velasquez pumped her milk, shipping the breastmilk to the family for about half of that time. For the remainder, she donated to milk bank.

Velasquez describes the demands of exclusively pumping (EP) for a surrogate baby: 

“You don’t have a baby, but you are tied to a pump every three hours around the clock. I wake up at four in the morning, and pump eight times a day. It is a huge commitment, not just for me, but for my entire family. It is… so time-consuming.”

But it’s not just the pumping, she adds. 

“I have to wash and sanitize, bag and label, freeze, box and ship. My hands are so raw from so much washing that is happening.”  

Still, Velasquez continues to provide and donate her milk. 

“I’ve always been fascinated with milk,” she begins. “It’s been super important to me.”

Even if the process is grueling, Velasquez says that providing milk to babies is equally satisfying. 

“I don’t have tons of money or tons of time to help people, but this is something that I can do,” she explains. 

Some GS provide their milk free of charge, but Velasquez says that most charge between 10 cents and one dollar an ounce. In comparison, pasteurized donor human milk (PDHM) comes in at about three to five dollars per ounce and formula feeding costs families between $900 and $3,000 over the first 12 months

Velasquez estimates that roughly 85 percent of surrogates attempt to EP after birth for various reasons which sometimes include their own mental health and for the purpose of donating.

In the midst of the pandemic, Velasquez says that her most recent surrogacy experience was relatively unaffected aside from having to stay home much of the latter half of her pregnancy.

“It wasn’t the funnest pregnancy, but everyone felt that same heaviness,” she says. 

Differently, she assumes the unknowns brought forth by COVID-19 changed the IPs’ experience. 

“I feel like it made their journey less enjoyable and more stressful,” she begins. “If I were to get sick, what would happen to the baby? I’m sure it was way less enjoyable having Covid hang over their entire pregnancy.”

Labor and delivery was stressful for everyone though, Velasquez recalls. 

Multiple people involved in the process– the IPs, Velasquez and her husband– and ever-changing hospital policies due to COVID-19 made planning stressful and a bit of a logistical nightmare. Ultimately, the hospital was able to accommodate the mother with her own room to await the arrival of her baby. 

“During this journey, [the mother] made it very clear that breastmilk was not a priority for them, but I pumped in the hospital and sent them one big shipment of milk,” Velasquez reports. 

She goes on to share that the family received faulty information from their pediatrician about the risk of human milk and COVID-19 infection. For up-to-date, evidence-based information on human milk, breastfeeding and COVID-19 click here.   In fact, fellow CLC Dr. Rebecca Powell, assistant professor of medicine, Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai, is studying human milk as a possible treatment for the COVID-19 coronavirus

Regardless, “it was another Covid issue that [the IPs] didn’t want to take the assumed risk,” she explains.

Last year, just before we became aware of the pandemic, Velasquez became a CLC herself. 

“In September 2019, my sister had a baby and she was having trouble latching, so here I am a pump expert– I can map everything out– but my own sister, I don’t know how to help,” Velasquez sighs. 

“I brought her to a WIC breastfeeding class hosted at our local hospital by an IBCLC and a WIC peer counselor CLC,” she continues. “I fell in love in that second. ‘I want to be you… how do I be you?’” 

Velasquez pictured with the twins that she carried. They received her milk for the first year of their lives.

Velasquez returned to the class, without a baby, every Thursday for the next six months “just watching in awe.” The lactation professional who led the class mentored her, and when the Lactation Counselor Training Course (LCTC) came to her town in Hernando County, Fla. she jumped on the opportunity. 

“It was awesome. It was perfect,” she says. 

Velasquez runs a private lactation practice now, but is currently working with a large obstetric office to offer in-house lactation and breastfeeding support. 

Through it all, Velasquez gives her husband a shout out, saying he has been her biggest fan.

“None of this– surrogacy, extended pumping, my CLC– would be possible without my husband’s support,” Velasquez shares.  

Velasquez offers her email address for families and individuals interested in learning more about surrogacy: You can also find her on IG @velasquez09. Her vlog can be found here.

 Reviewing Breastfeeding Employee’s Rights in the Workplace During Covid

By Guest Blogger Donna Walls, RN, BSN, IBCLC, ANLC

Over a decade ago, the Department of Labor released the Fair Labor Standards Act – Break Time for Nursing Mothers Provision. It requires employers to provide nursing mothers reasonable break time to express breast milk and a place, other than a bathroom, that is shielded from view and free from any intrusion from co-workers and the public.

Source: United States Breastfeeding Committee (USBC)

The law does not quantify the duration allowed for expressing milk, but suggests the amount of time needed to express milk for an infant under one year of age. Time used to express milk is not required to be compensated. Remote work situations are included in this law.  (, 2010)

Then in July 2019, Congress passed the Fairness for Breastfeeding Mothers Act of 2019. This law requires public buildings to “provide a shielded, hygienic space other than a bathroom, that contains a chair, working surface and an electrical outlet for use by members of the public to express milk.” 

Lactating people in the workplace are also protected under the Pregnancy Discrimination Act of 1978.

While work situations have changed drastically for many amidst the pandemic, these laws still apply during COVID-19. 

Healthy Children Project, Inc., in partnership with the University of California Hastings College of the Law and the Workplace Support Constellation of the United States Breastfeeding Committee, have created a Your COVID-19 Workplace Rights: Breastfeeding and Lactation handout which details employee rights during the pandemic and links to helpful resources.   

Source: United States Breastfeeding Committee (USBC)

Lactation laws vary by state, but all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands have laws that specifically allow women to breastfeed in any public or private location. Most states exempt breastfeeding from public indecency laws and many have specific workplace protections for breastfeeding employees. 

In some situations, lactating people may be able to negotiate accommodations like requesting a sabbatical, using accrued paid time off, parental or family medical leave options or other time away programs. There may also be options available for working from home, reducing hours or requesting a change of job temporarily or permanently. There may also be benefits such as the “Pandemic Unemployment Assistance” or another state benefit available. Apply through the agency that provides unemployment insurance at the Career One Stop website

In order to protect against the spread of COVID-19, employers may need to do more to ensure safe expression of milk. For instance, more time may be needed for pump cleaning and disinfecting surrounding surfaces. If milk expression occurs in an area shared by other employees, frequently touched surfaces like tabletops or door handles should be cleaned with a solution of 70% isopropyl alcohol, 0.05% dilution of hydrogen peroxide, bleach containing 5.25%–8.25% sodium hypochlorite, quaternary ammonium or Lysol after each use. (WHO, 2020)

The Centers for Disease Control and Prevention (CDC) recommends three different methods for cleaning and disinfecting a breast pump kit:

  1.  thoroughly washing with warm water and soap including scrubbing with a stiff bristle bottle brush 
  2.  using a dishwasher set on the sanitizing cycle
  3.  boiling pump parts for at least five to10 minutes and removing with clean tongs (, 2019)

    Source: United States Breastfeeding Committee (USBC)

No matter the method, begin by thoroughly removing all traces of milk and rinsing. Do not use sinks used for other cleaning purposes and set aside a basin to be used only for pump cleaning.  Clean well after each use. Scrub and clean pump equipment well with hot soapy water after each use. Dry all equipment thoroughly on a clean cloth, dish towel or paper towel.

Lactating individuals may prefer to hand express rather than using a manual or electric breast pump. Employers might consider having instructions available on how to hand express. Hand expression requires no equipment, therefore saving time and reducing the risk of virus transmission through potentially contaminated equipment. Employees must have access to hand washing stations, but may not need to have availability to electrical outlets. (Stanford, 2006)

Source: United States Breastfeeding Committee (USBC)

Special considerations may need to be assessed in  healthcare facilities. Prior to any milk expression, gowns, gloves, caps or masks should be removed to limit the spread of COVID-19. Breastfeeding employees might also consider wearing a clean facial covering or mask during milk expression and bringing their own cooling/storage system rather than using refrigerators provided by the employer. (CDC, 2019)

Milk storage at work requires no further preparations other than routine cleaning of milk storage containers. If using single-use storage bags, there is no need to pre-clean the bag. If using glass or plastic bottles or other containers, wash with hot soapy water and scrub with a bottle brush or use the sanitizing dishwasher cycle. It is not advisable to clean milk storage containers with antibacterial soaps or chemical disinfectants as they may leave a residue of chemicals not meant for ingestion by infants or children.  (HMBANA, 2020)

It is well established that breastfeeding is the healthiest choice for feeding infants and children. When the COVID-19 pandemic hit,  there were concerns regarding the safety of keeping mothers and babies together and the transmissibility of the virus through breastmilk. Research, policies and protocols have shown the safety of continuing breastfeeding and breastmilk feeding.  Practices that ensure safe lactation in the workplace should continue to be implemented and breastfeeding employees should be supported in their infant feeding goals.

For further information, contact the Center for WorkLife Law’s free COVID-19 legal helpline at 415-851-3308 or 



ABM STATEMENT ON CORONAVIRUS 2019 (COVID-19).” Academy of Breastfeeding Medicine, 10 Mar. 2020, 

Care for Breastfeeding Women.” Centers for Disease Control and Prevention, 3 Dec. 2020,

CGBI COVID-19 Resources.” UNC Gillings School of Global Public Health, 24 Apr. 2020,  

Cleaning and Disinfecting Your Facility.” Centers for Disease Control and Prevention, 28 Dec. 2020, 

Clinical Management of COVID-19.” World Health Organization, 27 May 2020, 

FREQUENTLY ASKED QUESTIONS: Breastfeeding and COVID-19 For Health Care Workers.” World Health Organization (WHO), 12 May 2020, 

Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting. Human Milk Banking Association of North America (HMBANA), 14 Apr. 2020, 

Morton , Jane. “Hand Expressing Milk.” Hand Expression of Breastmilk, Stanford Medicine , 2006, 

Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA. 2020. Epub 2020/03/05. 7. 

Workplace Lactation Laws – Pregnant@Work.” Pregnant@Work, 2020, 

Your COVID-19 Workplace Rights: Breastfeeding and Lactation.” Worklife Law , University of California Hastings College of the Law , 2021,

Therapist integrates lactation counseling into perinatal mood disorder work

Too many of us know that many breastfeeding parents have poor experiences with lactation professionals which are often tied to “lactation professionals’ agenda”.

Others though feel heard and supported and find empowerment through their interactions with lactation care providers (LCPs). Of course there are experiences outside of and in between those too. 

In any case, new parents’ birth and breastfeeding experiences often inspire their own careers and life work, developing into a “pay-it-forward” kind of mission. 

Ericka Davis is a social worker at Centerstone’s Early Childhood Services (ECS) in Columbia, Tenn. who recently completed the Lactation Counselor Training Course (LCTC).

Maternal and infant attachment and mental and physical health have “always been this lifelong knowing and passion,” as Davis describes it.  

“I think my own childhood adversity has always led me into wanting to work with moms and children and led me to social work,” she explains. 

As a new mother, Davis shares that she struggled with breastfeeding but managed through the challenges with the help of a CLC.

Her early breastfeeding experience starts like a lot of others: when her son did not latch in the hospital, the nurse told Davis that he needed to eat and gave them formula.    

I left the hospital with a bag full of sample formula bottles,” Davis says. 

Along with the formula, she had some familial support, but no support specific to breastfeeding.

“I often heard, ‘If it’s too hard or if you are in that much pain just give him the bottle,’” Davis goes on to explain. “I know it was coming from a good place;  they didn’t want to see me struggle and were worried about the baby. But I really wanted to nurse my son, I wanted to give him the best start.”

Davis soon found a La Leche League lactation café.

“I was able to go super early in the morning to this serene space full of rocking chairs, water, bowls of candy, other moms with their babies and get support from a CLC,” she reports.  “It made all the difference, to have someone who was trained in breastfeeding support me. I was able to successfully nurse my son after that and with my second child I was more confident in myself and nursed him longer. I credit my success to that café, that CLC.”  

Davis adds, “This experience is just another that has led me into this field. I see the value in CLCs and nursing, and I am happy I can give back in a small way.” 

In her work with ECS at Centerstone, a not-for-profit health system providing services designed specifically for those in the perinatal period, Davis and her colleagues aim to strengthen families’ physical, mental and emotional health primarily through in-home services. 

Davis works as a therapist on the team and networks with other dedicated professionals like a psychiatric nurse who provides medication management, for example. 

She and her colleagues recognize that the most effective approach to reaching their goal of strengthening families is by addressing their basic needs as well as addressing their mental health through therapy; therapy alone is not effective if families don’t have their basic needs met, so they provide wrap-around services. 

As CLCs, Davis, along with the majority of her clinic’s early childhood staff, are able to integrate lactation counseling into their perinatal mood disorder work.  

“It’s such an amazing tool to have as a provider to be able to understand and recognize that moms are struggling with something that you can really provide help and support with,” Davis says of becoming a CLC. “It’s another technique in my therapeutic modalities, another tool that I can really implement that alleviates some of those feelings surrounding breastfeeding and help someone be successful.”  

Failed lactation and perinatal depression often go hand in hand, but perinatal mood disorders (PMDs) go beyond this box. There can be a layering effect too, Davis explains. 

In her own experience, she shares that challenges associated with PMD coupled with breastfeeding challenges “added constant pressure and the thought  ‘I am failing.’” 

The work that Davis and her colleagues are doing through Centerstone is a sort of microcosm of an ideal world where families’ mental health is nurtured. 

“It comes from a comprehensive approach,” she begins. “We are talking about a complete cultural shift and policy change where businesses get on board with the importance of maternal infant health, where we can provide moms very safe spaces, and enough time [with their babies], destigmatizing what breastfeeding looks like out in public and normalizing it in society. Policy has to back up ideology.”  

Davis goes on to say that good support looks different for every family, echoing an article she recommends by University of Alberta’s Stephanie Liu’s commentary Breastfeeding struggles linked to postpartum depression in mothers

Liu writes: 

“As parents, we intend to provide the best for our babies, so difficulty breastfeeding may lead to significant amounts of stress.

As a family doctor, I know that breast milk is the optimal feeding choice for health benefits, but as a mom, I know the extreme pressures that we are placed under as women to produce milk every time our baby needs it.

This is why I always support the idea to breastfeed if you can, to reach out for support, and if you are struggling, there are other safe and healthy options to ensure your baby is well fed.”

In her practice, Davis is acutely aware of the health benefits of breastfeeding for mom, baby and public health, but she says she acknowledges that it’s not always the best option for everybody. 

“While we want to support people in their goals, we have to make sure that they are personal goals… I can’t push my agenda [as a LCP],” Davis comments. 

When LCPs want their clients to breastfeed more than they actually want to, it adds pressure, even if well-intentioned. 

“It can go so extreme that it ends up not being helpful and productive and sometimes even becomes harmful,” Davis adds, circling back to earlier mentioned poor experiences with LCPs. 

Recently, Davis has been able to help a young mother achieve her breastfeeding goal of six months, despite pressure from her family to give up. 

“We took it week by week,” Davis explains. “She got to her goal and it was perfect for her.”

Click here for Centerstone’s ECS Program Flyer —>TN Early Childhood Services – English

Lactation counselor expands access to pasteurized donor human milk

If you google Tytina Sanders-Bey, CLC, you will learn that she is a full circle doula, a lactation counselor, a GOLD Lactation presenter, and a mother. You’ll learn that she has worked alongside various organizations like the Chicago Region Breastfeeding Taskforce, Illinois Public Health Institute (ISPAN), Molina Healthcare, African American Breastfeeding Network (AABN), and Fathers, Families and Healthy Communities, most recently serving as a Human Milk Banking Association of North America’s (HMBANA) Mothers’ Milk Bank of the Western Great Lakes (MMBWGL) Education and Outreach Specialist. If you keep digging, you might learn that she was a teenage mother, she considers maternal child health advocacy her calling, and she loves nature. 

What you won’t find on Google, and what I’d like to share with you today, is that Sanders-Bey’s spirit is fierce, her presence inviting and her heart immense and self-less, brimming with compassion. She is a change-maker. 

Earlier this year, after participating as a panelist at the Chicago Area Breastfeeding Coalition, Sanders-Bey connected with program coordinator at MMBWGL Susan Urbanski, CLS

“That was the first time I had heard anything about the option of Pasteurized Donor Human Milk (PDHM),” Sanders-Bey says.  “It was like a lightbulb went off.”

“After Susan discussed the value and importance of PDHM, I went on to disclose that PDHM was not an option for communities of color,” she continues.  “I had this testimony as I was a community mother who had no idea that PDHM could be offered in NICUs or on an outpatient basis. Furthermore, I was a breastfeeding helper for countless families and never knew to encourage them to advocate for donor milk.”  (This study explores disparities in hospital-reported use of PDHM in NICUs.)

Soon after, Sanders-Bey says she was “welcomed with open arms” to MMBWGL as education and outreach specialist and later appointed community engagement program manager.

“PDHM is important to me because I care about public health,” Sanders-Bey begins. “It gives babies a fighting chance. That is something that infant formula simply cannot do. In my experience birthing people get a self-esteem boost when feeding human milk versus infant formula. PDHM reduces infant mortality, necrotizing enterocolitis (NEC), and other feeding intolerance.”

Sanders-Bey role is simple, but not necessarily easy.    

“Basically I educate the public on the option of donor milk,” she explains.

Sanders-Bey engages with hospital staff, community partners, community members, families, case managers, insurance representatives and religious leaders to name a few,  letting them know about MMBWGL’s services including donating and receiving milk and bereavement services. Much of her work has transitioned to virtual platforms because of COVID-19.   

“People, not just families, that I work with are in awe when they find out about donor milk,” Sanders-Bey reports.  “… I try to sum it up into layman terms with statements like ‘You’ve heard about blood banks, right? Well there are milk banks. Blood banks have blood, and milk banks have PDHM.’” 

Sanders-Bey occasionally encounters resistance from professionals who worry about mothers with HIV and with drug and alcohol addictions, but she’s equipped with information that proves donor milk safety.

At the community level, she says families’ concerns fall under accessibility. Sanders-Bey is there to connect them with the resources they need to secure healthy infant feeding methods for their littles ones. 

Surprisingly, human milk donations are surging during the pandemic. Sanders-Bey hopes that this will allow her to expand her work across the Midwest. 

More specifically, she says, “I am hoping that bereaved families are offered donor milk in more scenarios, such as domestic violence and violence overall. I hope more providers open their hearts to the wonders of donor milk and increase access. I’m hoping that if mothers’ own milk is not available, donor milk is offered before infant formula or glucose water.” 

While there’s been an increase in human milk donations, Sanders-Bey points out the overwhelming challenges families are still up against, and the ones that have been magnified by the pandemic. 

For instance, critical health services in Chicago medical centers are vanishing from predominantly Black neighborhoods, as reported here and here.

Sanders-Bey says these closures are the most alarming change that she’s witnessed during her decades of work within maternal child health. 

“That really hurts the communities that are being mostly affected by COVID-19 and systemic racism,” she comments.  “There are no NICUs in certain communities, no trauma units. When I became a mother each time I didn’t have to worry about where I was gonna go to deliver. The fact that I have been doing this work for more than 20 years and have never witnessed such injustice lets me know I need to put in another 20 years to advocate for positive change and improving community health.” 

Sanders-Bey told me, “I’ll always do birth and breastfeeding support paid or not. The payment is seeing the birthing person and baby smile.”

Lovely Offerings Doula strives to make perinatal services accessible and visible

If you’re reading this, you will likely appreciate this humor originally posted by Doula Nadia Smith: “If your partner can purchase a PS5 he can pay for a Doula!”

Of course there is truth in the statement. 

“Shall we talk economics of hiring a doula? Decreased risk of preterm birth, decreased risk of cesarean, decreased risk of perineal and pelvic floor damage… your total cost of healthcare is lower when you have a doula. And why are we putting a price on maternal wellbeing when we are in the most dangerous developed country for birthing?” Danielle Downs Spradlin, IBCLC, CLC of Oasis Lactation Services writes. 

Doula Anihhya Trumbo of Lovely Offerings Doula Service in Lexington, Ky. says it’s time we get our priorities together.

Trumbo offers her services on a sliding scale so that doula service is available to all families no matter their financial situation. As an independent doula, she doesn’t name a price; instead she simply asks families to pay for what they can afford. She also volunteers through Hope’s Embrace, an income-based perinatal support organization. 

Trumbo’s areas of interest include Pregnancy and Infant Loss and Fertility advocacy. 

As an Accessing the Milky Way scholarship recipient, she is also eager to become a Certified Lactation Counselor (CLC) currently working through the Lactation Counselor Training Course (LCTC).  

“I can’t wait till I complete my training,” Trumbo shares. “I’m learning so much already…”

Trumbo has been documenting some of her training and revelations on social media. 

Currently, Trumbo refers her clients out to lactation professionals, but she says, “I want to be able to provide that support within myself; they already know who I am. We have already built this strong bond.” 

Trumbo is passionate about not only making doula and breastfeeding services more accessible, but more visible. 

Pat Hoddinott’s and colleagues’ research into how vicarious experiences relate to breastfeeding intention and behavior shows that “The most important predictor of intending to breastfeed was the woman’s attitude to her most recent experience of seeing breastfeeding.”

The research echoes Trumbo’s thoughts: “… if we had more families supporting and being open about [breastfeeding] that may give expecting families at least the thought that they can do it.” 

Of course representation matters here too, not the insubstantial, rallying cry that author Lauren Michele Jackson writes about in this Vulture piece:  “Representation matters. A mighty yet modest observation — that the art and culture around us, consumed and therefore inside of us, which expands and contracts our capacity to imagine living in the world — has gone tinny in its rallying cry, hollowed by the market’s appropriative appetites.”  

Much like Kimberly Seals Allers writes about in The Black Maternal Mortality Crisis Is Not For Sale, “In this crisis, Black women must be the solution creators…,” Trumbo is a force driving positive impact on Black maternal child health outcomes. 

Connect with Trumbo @TheLovelyDoula.