Reflections from a volunteer CLC working on naval base

Many of our Our Milky Way interviewees launch into their advocacy for
healthy infant feeding after they’ve endured personal situations with their
own babies. This is not Crystal Grask’s, CLC origin story into the world
of breastfeeding though.  Now the mother of a darling little one, Grask
serves as a Red Cross volunteer lactation counselor at Naval Base Rota
in Spain, but her road to breastfeeding started before becoming a
mother.

We’re pumped to feature this interview with Grask this week on Our
Milky Way.

On discovering her passion for maternal child health…

I had really no insight into maternal child health until I found myself
interviewing for the Communications Coordinator position with the Rocky
Mountain Children’s Health Foundation and Mothers’ Milk Bank. Once I
obtained the role, I started working directly with Laraine Lockhart-
Borman, the then director of the milk bank…her staff… Donor Relations
Coordinators, Certified Lactation Educators, Doulas and more. I found
myself immersed in a totally new world and was soaking up the
knowledge like a sponge. Everyday I learned something new about
breastfeeding, donating human milk, or lactation and the impact these
things have on the mother-baby dyads and the families we served.
As I learned…I found myself becoming more and more passionate about
helping moms, babies and families have successful happy starts in life.
Through the RMCHF and MMB I learned about the the Lactation
Counselor Training Course (LCTC), learned about the importance of
breastfeeding, saw firsthand the impact donating and receiving donor
human milk had on mother-baby dyads and families, and was able to
observe and glean insight into dozens of parents’ feeding journeys
through the Foundation’s  programming and milk bank’s weekly Baby
Cafe pregnancy and postpartum moms groups.

On completing the LCTC…

… Life happened, and I was unable to take the course during my tenure
at the [RMCHF], but the passion didn’t go away. It continued to blossom. I moved to Washington State where the course wasn’t offered,
but I remained passionate and steadfast in my desires using my
previous knowledge about breastfeeding/lactation to help providers (OBs
and Pediatricians) communicate with their patients about breastfeeding. I
knew I still wanted to work in this realm, and decided that once I was
able to obtain my CLC certification, I would like to pursue a private
practice.

In 2020, the course became virtual, which allowed me to start my
training! I started in December of 2020, and soon after, we moved to
Spain with the Navy. It was there I finished my training, in June of 2021. I
loved the virtual nature of the training and found – even when I was an
ocean away – I could tune in, interact during office hours, and complete
the course with ease. I really appreciated that!

On her own breastfeeding journey…

Flash forward five years… I found myself breastfeeding my daughter,
Julieanne, and having a rough journey. We started off feeding well,
resolving minor latch issues right off the bat. However, despite having a
small but adequate supply, she struggled to gain weight. Our pediatrician
immediately suggested formula supplementation, and I struggled with
that suggestion. My husband was a huge supporter of breastfeeding,
and also felt like there wasn’t a huge need to supplement. I was able to
reach out to prior colleagues… for observations, but neither of them
could find anything truly amiss. My daughter latches well and has always
been very healthy, but didn’t gain weight well no matter how much or
what we were feeding her. We discovered she has a very high
metabolism and strong passion for eating, so I found myself feeding
round the clock, triple feeding for a few weeks, and eventually settling
into a combo-feeding routine. While it wasn’t my picture perfect image of
how our breastfeeding journey would go, I am proud to say we’re still
largely breastfeeding and she’s gained a significant amount of weight.

Photo by Taylor Marie Photography

I hope to help moms receive the support I lacked in the immediate
postpartum. With consistent help and follow-up observations, perhaps
we wouldn’t have needed to supplement. I want to be that resource for other moms, to help them feel validated, encouraged to meet their goals,
and support them no matter what their feeding choices are.

On landing her volunteer CLC position at the naval base…

One of the first things I noticed after arriving at Naval Base Rota was the
multitude of pregnant women around. We were still living in COVID
times, and I quickly learned while there was support for moms to
breastfeed from a command standpoint, there were not many staff or
programs available to support the station’s breastfeeding dyads either in
hospital or at home postpartum. I knew I could help bridge this gap.
After exploring a few different avenues, I found I was able to sign up with
the Red Cross as a volunteer CLC at the Navy Medicine Readiness and
Training Command Rota (Naval Hospital Rota) Maternal Child Infant
ward! This role gives me the unique opportunity to help moms within
hours after delivering her baby, and help these dyads and families start
their feeding journeys feeling confident and supported.

On a typical day in this role…

I come in, check in with the nurse on duty or head nurse for a rundown
of our patients to learn about their delivery(ies), their baby, their current
health situation, and how feeding has been going thus far. I also ask if
mom/family has presented them with any concerns/questions about
feeding thus far, so I can be as prepared as possible when I first meet
with a mom.
After ensuring I have all the information/resources ready, I go meet with
the mom/baby dyad/ family. While in their room, we talk about how mom
is doing, I meet their new little one, and we go over how their feeling
about feeding thus far. I often provide latch assessments, and observe
feedings while in the room as well. Sometimes, during this, we’ll be in a
more relaxed setting, and mom will ask questions about any concerns
she has for when she goes home, which I answer or refer her to her
provider or the base’s Visiting Nurse if it’s a subject outside of my scope.

Once my initial visit is over, I will make a follow up plan with mom if
desired, then input notes and do any supplemental research for her. At
my follow up visit (usually that day or the next) I will give her any
resources we discussed and provide answers to her questions.
In the LCTC, we focused a lot on listening to mom, hearing her story and
using that, her experience and her health history to guide our
counseling. I think I use that often to meet moms where they are and
give them the care they deserve. I also find I’m teaching the asymmetric
latch often, even to second and third time moms! I also cover hand
expression and storage guidelines often. We get a lot of questions
around pumping and building a stash of milk for returning to work,
especially for active duty moms.

I have also started seeing postpartum patients in the hospital’s OBGYN clinic.

On unique challenges…
Grask at Rota Breastfeeding Week 2023 presenting topics like skin-to-skin and hand expression 

I think there is a strong desire to help breastfeeding moms here, but
there is an apparent lack of resources, especially for postpartum moms.
The community has one Visiting Nurse who is a rockstar seeing many
moms daily, but she’s unfortunately the only one able to do so at the
moment. To help bridge this gap, I’ve gained approval to have a small
business, Asbury Breastfeeding Counseling, and am offering my
services to moms in the community in addition to my work as a
volunteer. I’m also working with the Visiting Nurse and hospital MCI
leads to host monthly breastfeeding courses at the hospital, promote the
existing pregnancy and postpartum support groups, and soon will be
offering a BYOBB (Bring Your Own Baby and Breastfeed) class at the
hospital for new moms to learn the various positions they can breastfeed
their babies in and be available to answer any questions/troubleshoot
any feeding/latch issues in person.
We also hosted Rota Breastfeeding Week helping educate the
community here on what is available for new moms and showcasing the
various lactation spaces. We also had a latch on nursing event.

On goals for next year…

 

Over the next year, I hope to reach more moms and families to help
them feed successfully… I know this community’s resources are slim. I hope to establish these classes and have imparted education to staff so
when I ultimately transition out of this station, I know I am leaving moms
with supportive providers who can help her achieve her goals.

Some favorite breastfeeding stories…

While working at the Mothers’ Milk Bank, I was able to sit in on several
Baby Cafe postpartum support groups. During a few of these groups, I
met a parenting duo and their little one. No matter what they did, this
mom struggled to make enough for her little one, but desperately wanted
to make breastfeeding work. I listened and observed them for weeks,
learning from their interactions as a couple, parents and individuals and
gleaning insights from the [lactation care provider]  helping them.
Ultimately, I believe they began to feed with donor milk and formula, but
it was their journey and the persevering passion to help their baby and
family thrive that left an impression on me.
Here in Rota, I have been lucky enough to see a few of the moms I’ve
helped in early days several months postpartum. Two such dyads come
to mind. One was a new mom, baby born a couple weeks early had had
an ample supply of milk. Due to her baby’s early arrival, the baby was
transferred to a Spanish hospital where they received formula instead of
her breast milk. I saw her about five days postpartum and her milk
supply had fully come in but the baby was fussy and struggled to latch.
We worked on several techniques, including skin-to-skin care, cross-
cradle and football holds, asymmetric latch and also discussed ways to
pump/store milk. I was worried as this mom seemed to be ready to give
up quickly, but I ran into her six months postpartum and her once small
baby was now thriving on breast milk! It was a beautiful thing to see and
she is still breastfeeding.
In January, I served the family who had the first baby of the year. The
parents were first time parents, and had no idea what to expect or how
to navigate breastfeeding now their arrival had made her debut. Mom
and I worked on recognizing feeding cues, latching, promoting skin-to-
skin care, using dad for support, and discussed various ways to pump– hand express, manual, double-electric, wearables, to help her build a
supply later on. Soon after I had my own baby, I ran into this mom at a
moms group and found breastfeeding was going well for her! Her little
one was steadily gaining weight and she felt confident in her feeding
routine and encouraged by the support she had received early on. I was
elated at this update and so happy to see them thrive.
Personally, breastfeeding hasn’t been as easy as I’d like, but when I feed
it is the most wonderful, almost indescribable feeling. One of my favorite
stories I have is from my early postpartum days. I had been hanging out
skin-to-skin with her on the couch and accidentally fallen asleep. A little
while later I awoke — to a baby suckling on my breast! I had heard and
known about a baby’s natural instinct to find the breast, but I hadn’t expected her to seek it out and find it on her own when she was so new
to the world. Now she giggles whenever she sees my breast and is
especially excited for boob food time!

Changing the culture of mother baby separation in one Northeastern hospital

“I got to touch him once and they took him right away from me,” Northern Light Eastern Maine Medical Center labor and delivery nurse Jennifer Wickett says, remembering the birth of her first child 19 years ago.

Wickett desired non-medicated births, but her three children ended up being born via cesarean sections for various reasons. Wickett’s personal birth experiences coincided with her early professional life, working at a hospital in Massachusetts as a labor and delivery nurse.

At the time, she explains, the process was this: the baby was born,  taken to the warmer, vitals and weight were recorded. The baby was wrapped in a blanket and held next to mom’s face for five to ten minutes and then taken to the newborn nursery.

Skin-to-skin in the OR, Healthy Children Project

“I hated that for my patients and I hated that for me,” Wickett says.

So Wickett singularly started changing that culture of mother baby separation.
Now, at Northern Light Eastern Maine Medical Center, Wickett attends about 95 percent of the c-sections, and she says she was able to “take control.”

“[Initially] I wasn’t tucking baby in skin-to-skin, but I was putting baby on top of mom with the support person helping hold the baby,” Wickett explains.
She deemed it the Wickett hold: baby placed chest down on mom with knees tucked under the left breast and baby’s head on the right breast.

Attending a Kangaroo Mother Care Conference in Cleveland galvanized her efforts: the evidence clearly supported skin-to-skin contact immediately after birth and beyond.  Fellow nurses, anesthesiologists and other team members were resistant, but Wickett and a few other fellow nurses who created the Kangaroo Care Committee kept at it, always leading with kindness and communication. Rather than approaching the process with an “I have to do this” agenda, Wickett involves and acknowledges all of the participants in the room.

For instance, to the mother, she asks permission while also explaining the importance of skin-to-skin contact.

“They’re in hook line and sinker when I explain that their body regulates their baby’s temperature,” Wickett explains. “They don’t want to give that baby up; they are not letting that baby go.”

To the anesthesiologist, she facilitates open communication. Wickett lets them know that she assumes responsibility for the baby. “Are you good?” she often checks in with the anesthesiologist, while minding their space to work safely and efficiently.

Wickett  makes certain to involve the partner in their baby’s care, asking them to keep a watchful eye over mom and baby.

Photo by Jonathan Borba

Just about half of the babies she sees begin breastfeeding in the OR, she reports. From the OR, babies are kept on their mothers’ chests as they’re transferred to the recovery room, continuing the opportunity to breastfeed. All in all, Wickett says that babies born by c-section at her hospital spend more time skin-to-skin than those who are born vaginally.

After a vaginal birth, eager nurses often disturb skin-to-skin contact to complete their screenings and documentation. Excited partners wanting to hold their baby tend to do the same.

In the OR though, Wickett says there are at least 30 minutes without these disruptions.  Once mother and baby are transferred to the PACU, mothers report decreased pain when skin-to-skin is practiced.

What’s more, Wickett reports hearing often “This baby is such a good breastfeeder!” because the babies have an opportunity to initiate breastfeeding within the first two hours of life.

The World Health Organization (WHO) recommends that immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. The recent Skin-to-skin contact after birth: Developing a research and practice guideline synthesizes the evidence. [Read more here.]

Skin-to-skin, Healthy Children Project

Wickett and seven other colleagues had the opportunity to complete the Lactation Counselor Training Course (LCTC) last year.
While she says she would have loved to have been able to take the course in-person, Wickett still found the material and resources “fabulous.”

For the past four years, there’s been a vacancy in the perinatal coordinator position at her hospital, so Wickett hopes that her new credentials will allow her to fill the need.  In the meantime, Northern Light Eastern Maine Medical Center offers outpatient lactation visits. The center’s breastfeeding support groups halted during the height of COVID and have yet to resume; Wickett reports that they are trying to bring those back virtually.

Additionally, Maine residents have access to the CradleME Program which
offers home-based services to anyone pregnant up to one year postpartum.
In partnership with the Mothers’ Milk Bank Northeast , Northern Light Eastern Maine Medical Center became the first milk depot in the Bangor area.

You can read more Our Milky Way coverage on skin-to-skin after cesarean birth in  Skin-to-skin in the operating room after cesarean birth , The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth , and Skin to skin in the OR.

Also check out Skin to Skin in the First Hour After Birth; Practical Advice for Staff after Vaginal and Cesarean Birth Skin to Skin.

Find some beautiful KMC imagery here.

African American Breastfeeding Network (AABN) is outside and celebrating connection and community

Photo by Criativa Pix Fotografia

For 15 years, the African American Breastfeeding Network (AABN) has been leading and immersed in integral work to improve maternal child health outcomes in the Greater Milwaukee area.

AABN was founded by Angelia Wilks-Tate and Dalvery Blackwell who set out to  address breastfeeding disparities through a community-led organization. Blackwell now serves as the organization’s first executive director and Wilks-Tate serves as the President of the Board Directors.

Photo by julio andres rosario ortiz

AABN hosts healing spaces for birth workers, facilitates doula trainings including the HealthConnect One community doula training and WeRISE Community Doula Program, celebrates father involvement, holds space for bereaved parents, fights for birth and reproductive justice, and more and more and more. Simply visit their Facebook page and you’ll catch a glimpse of the passion, the wisdom, comradery, fun, and the dedication. You can also read about their 2020 impact here.

Yesterday, the organization and its partners hosted their ninth annual  Lift Up Every Baby! Celebration.  Lift Up Every Baby “is all about the blissful happiness we experience when our community comes together to celebrate, securing our collective power to help create spaces of health and wellness!” the organization shared with their social media followers. Pregnant people and young families were invited to experience a community-drive and  “family-centered afternoon of festivities, celebrations, good food and positive vibes.”

The event fit perfectly into Black Breastfeeding Week’s (BBW) 2023 theme: We Outside! Celebrating Connection & Our Communities.

https://blackbreastfeedingweek.org/

Perhaps one of the most touching moments of each year’s event is the opening ceremony made possible by Zakiya Courtney celebrating participants’ cultural heritage and values.

You can check out footage from last year’s event here and stay tuned for reports from this year’s celebration here.

A collection of stories by and about those in the AANHPI community

Asian American Native Hawaiian Pacific Islander (AANHPI) Breastfeeding WeekTelling our own stories. Elevating our voices— is coming to a close.

On Friday, the U.S. Breastfeeding Committee AANHPI Caucus presented the AANHPI Lactation Community Forum, an open panel discussion where AANHPI community members shared about their journeys to becoming lactation support professionals as well as provided guidance on how we can further build community capacity to support AANHPI families.

Photo by Samrat Khadka on Unsplash

Other opportunities as part of the celebration included visiting the Asian American, Pacific Islander, and Native Hawaiian Breastfeeding Week Facebook page and engaging with activities like the AANHPI Coloring Pages Contest. The Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce AANHPI Social Media Toolkit produced shareable social media content including messages and captions in the toolkit which have been translated into 11 different AANHPI languages: Chinese (both traditional and simplified), Farsi, Hindi, Hmong, Japanese, Korean, Native Hawaiian, Samoan, Tagalog, and Vietnamese.

In an engaging discussion from last summer, Tonya Lang, MPH, CHES, IBCLC and Grace Yee, described the diversity that exists under the AANHPI umbrella, shaking away the stereotypical idea that Asian culture is monolithic.

The Asian Pacific Institute on Gender-Based Violence begins to describe the complexity of AAPNHPI groupings and the forces that shape identity in Census Date & API Identities. AAPI DATA, which provides demographic data and policy research on Asian Americans and Pacific Islanders, compiled some wonderful visuals to help shape the numbers.

The overgeneralization of the API community has led to some misleading data about breastfeeding rates. On an aggregate level, initiation and duration rates are relatively high, but the statistics don’t account for stark disparities within these population groups. This piece covers this phenomenon in more depth and offers strategies for tailoring infant feeding support in the Chinese American population.

As Dr. Magda Peck has pointed out, numbers and data are important because they drive decisions and policies, but they also have the potential to sanitize humanity. That’s where stories come in. Not only do they humanize the numbers, they can also help us make sense of the data.

In celebration of AANHPI Week and in hopes of demonstrating the complexity and diversity of this population, we have collected several stories by and about those in the AANHPI community.

Photo by Dragon Pan on Unsplash

First up, is To-wen Tseng and her contributions to the San Diego County Breastfeeding Coalition’s blog. Tseng wrote most recently about her ‘why’ reflecting on National Breastfeeding Month. Read that piece here.

Joanne Datangel-Gallardo, MD, DPPS of the National Children’s Hospital, Philippines has worked extensively with relactation efforts. Read about Dr. Datangel-Gallardo’s work here.

Also out of the Philippines is a piece by Micaela Papa detailing how breastfeeding saved one baby’s  life and helped her mother recover from the stress of Typhoon Odette.

Not far south from this archipelago, is the island nation of Timor Leste. Here, emergency response efforts to protect breastfeeding have saved the lives of many. Community members manage and intercept artificial baby milk and other ultra-processed food product donations among other components of the nurturing care model. Read about these efforts here.

In Indonesia, efforts are also underway to combat commercial milk formula companies. Find a simple model for reporting Code violations here.

Jenny Lei Ravelo writes about the tangle of infant feeding complexities on Indonesia’s remote islands complete with stunning photos in partnership with the 1000 Days Fund.

In India, the Foundation for Mother & Child Health (FMCH) works to empower families from vulnerable communities with actionable information and services, resulting in health seeking behavior and nutritious food choices in order to tackle maternal child malnutrition, ultimately breaking the cycle of poverty. Read about the organization’s impact here.

In the spring, the Asian Pacific Islander Breastfeeding Task Force (APIBTF) a part of Breastfeed LA, tailored the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities, a project that augments APIBTF’s sister organization Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Continuity of Care (CoC) Blueprint Project Prenatal Toolkit for AANHPI families. You can find out more about the efforts to center culture in health here.

Elisabeth Millay/BreastfeedLA and API Breastfeeding Task Force

Also exemplifying culture centered in health is the Hmong Breastfeeding Initiative (HBI). With funding from Reducing Disparities in Breastfeeding through Continuity of Care Identifying Care Gaps grant from National Association of County and City Health Officials (NACCHO), the Hmong Breastfeeding Coalition (HBC) conducted an environmental scan of the Twin Cities (Minneapolis and Saint Paul, Minn.) on breastfeeding promotion and support for child-bearing age Hmong women and families. Read more here.

Tiffany Pao Yang has played a crucial role in this work. The daughter of Hmong refugees, she is especially invested in helping change the narrative around infant feeding in the Hmong population. Read part of her story here.

 

More to explore

 

Breastfeeding in Emergencies: The Struggles of New Mothers in the World’s Largest Refugee Camp

A Journal of Aboriginal and Indigenous Community Health: Community Influences on Breastfeeding Described by Native Hawaiian Mothers

Breastfeed LA’s Current APIBTF Projects

API Breastfeeding Task Force Video Library

AANHPI Lactation Collab 

The Cost of Not Breastfeeding from Alive & Thrive Downloadable PDFs for several Asian countries

Educator and leadership team member shares breastfeeding experiences, supports lactating colleagues

When the PUMP Act was signed into law last year, it expanded the legal rights of some 9 million more lactating individuals, including teachers, who had been previously excluded from the 2010 Break Time for Nursing Mothers law as it only applied to hourly workers.

But even with the revamped legislation, teachers are in a unique position.

In Jill Inderstrodt’s I Study Breastfeeding Behavior. Here’s Why Nursing Teachers Have It So Tough, she explains: “…The bill’s prescriptions are often at odds with the day-to-day logistics of jobs.”

Inderstrodt goes on, “In many cases, teachers have to choose between finding coverage for their classroom or forgoing pumping. With one or two pumping sessions per day, this could mean finding coverage 40 times a month.”

Stacy Synold is an educator and part of the leadership team at a small, private school in the Midwest. She breastfed all three of her biological children, now 25, 22, and 19, beyond their second birthdays.

“I never thought I would breastfeed as long as I did but I followed their lead and found it to be supportive of my parenting choices,” Synold shares.

She continues, “Breastfeeding was so important for my kids, who all had asthma and allergy issues.  I shudder to think of what their health may have been without nursing. What started as a nutritional imperative for me became some of the most treasured [moments] in my life.  Given that I nursed toddlers and even a near preschooler, they were all very verbal and verbally loving about breastfeeding, and I remember all the little names and words they had for breastfeeding.”

There was “sie-sie” for nursies and “noonies” and “nonnies”.

“One time… my son said, ‘I give hugs to the nurse and hugs to the other nurse,” in reference to breastfeeding, Synold remembers.

As it sometimes is, weaning was a momentous event for Synold’s family. When her daughter was about to turn three, she hosted a weaning party.

“We had pink cupcakes and the whole family celebrated.  She had stopped nursing except for once every few weeks so we decided to support her into her next phase.  We gave her a baby doll to nurse if she wanted to and that was her favorite doll for a long time.”

Besides feeding her own children, Synold pumped her milk for the adopted newborn of a local woman who endured the death of her biological baby a year earlier.

“She had high hopes of relactating, but I very much wanted to help her in the short-term,” Synold says.  For eight weeks, she pumped on a three to four hour schedule.

“It was almost like having a newborn again, and my 18-month-old daughter loved my increased production,” Synold remembers. “I would do it all again to see the smile on that mom’s face each time I delivered the milk!”

Synold served as a La Leche League Leader for nearly a decade under the mentorship of Kay Batt, who has been a LLL leader since 1967.  Batt invited Synold to an evening meeting which turned out to be a meeting with an emphasis of supporting mothers and families who worked outside the home.

“She helped me become a better mom and shared so much knowledge, especially about how to support the unique needs of working families who breastfeed,” Synold reflects.

Since breastfeeding her own babies, Synold has witnessed a shift in infant feeding culture.

She cites being appreciative of the laws passed in protection of breastfeeding and the increase in designated places for mothers to breastfeed in public.

“I wasn’t bashful, but my children were easily distracted and needed a quiet place to nurse],” she begins. “I was kicked out of a restaurant in Mayfair Mall once in 2001 for breastfeeding at the table.  Apparently, men and boys ate there…who knew! I said to the woman who was kicking me out when she stated about men and boys, ‘I know, I am feeding a little boy right now!’”

Because of the nature of her work outside of the home while she was breastfeeding, Synold didn’t find herself in the position of needing workplace accommodations. For instance, as a nanny at one point, she says she was easily able to nurse her son without special accommodation. In a different position, her daughter was two, so she was able to withstand longer stretches without emptying her breasts. Her toddler  would then nurse throughout the night as they coslept.

In her recent leadership roles, Synold facilitates safe lactation spaces for her colleagues.

“I always have a comfy area in my office, I offer flexible schedules and plentiful breaks if needed, and seek better locations,” Synold explains.  “One year, I had seven teachers give birth and my office was the only office with a lock.  I ended up out of my office most of that year, so we gave a locking large closet a makeover for pumping.  I did realize I sometimes needed an office!”

Like Inderstrodt concludes, “If we are going to recruit and retain our teaching workforce under such circumstances, teachers need all the accommodations we can give them. That means that legislation such as the PUMP Act must be accompanied by scheduling accommodations at both the school and district levels so that the legislation for lactating mothers transcends paper.” Even before it was signed into law, Synold has exemplified this support.