Lives and legacies of late maternal child health advocates: Dr. Audrey Naylor

Photo by Alex Guillaume on Unsplash

The evening darkens early this time of year. There’s a crunch of blanketed autumn leaves when I walk the neighborhood trails; dormant, woody branches loom overhead. 

In my son’s school, student-made ofrendas welcome admiration and an opportunity to study Día de Muertos and the monarchs’ arrival.   

In my podcast feed– up next– a Bay Curious episode called “A Final Resting Spot for Furry Friends.”

In another, Wild Card, the host asks her contestant, “How often do you think about death?” 

I reflect on this myself. 

It’s been four years since I watched my grandma die, I realize. 

My step-dad, diagnosed with stage IV colorectal cancer in 2013 and then hit with two major strokes the following summer, announced last week that he will cease the invasive treatment he’s endured all of these years. All of these years, I have been bracing myself for his death.  We call him– in the most loving way– The Cockroach. This season, his death feels more present than ever. 

In the headlines, death tolls are also ever-present. 

So, how often do I think about death? It’s bombarding me as of late. 

I’m reminded of the saying: “Grief is a reminder of the depth of our love.” 

This month, that’s where Our Milky Way will take us. Each week, a commemoration revisiting publications about late maternal child health advocates. The World Alliance for Breastfeeding Action (WABA) houses a tribute page where you can learn about the lives and legacies of other advocates who we didn’t have the honor of featuring here. 

If you knew a maternal child health advocate you’d like to honor, please email us at info@ourmilkyway.org. 

We begin this series honoring Dr. Audrey Naylor. We featured Dr. Naylor’s work in 2013. 

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Dr. Naylor receives coin for her protection, promotion and support of breastfeeding at US Breastfeeding Committee meeting in August of 2010.

There are an estimated 300 billion stars in our galaxy. The collective twinkle of the thousands of stars visible to the human eye makes the night sky magnificent. But in a seemingly infinite galaxy, there are stars that always stand out. Polaris for example is famous for virtually standing still in the night sky. It serves as a celestial navigator in our endless sky.

Our Milky Way is made up of thousands of luminous stars working to promote, protect and support breastfeeding.  Like our night sky, the beauty of Our Milky Way is the collective, brilliant energy of all lactation professionals working toward a common goal. However, like Polaris our celestial guide, there are certain lactation professionals that serve to inspire upcoming lactation stars.

Dr. Audrey J. Naylor, MD is Clinical Professor of Pediatrics at the University of Vermont. Her distinguished career and humorist approach are both something to look up to.

While studying in San Diego, Naylor completed a clowning course with the local clown club.

“Somehow, when you get into clown make-up with a red nose it changes who you are!” she exclaims. “I have always carried a red nose with me. You never know when it will be useful.”

That clown nose is something remembered by lactivists everywhere, like Ryan Comfort of Milk for Thought.

With a lifetime interest in illness prevention, Naylor says she was quickly convinced of the power of breastfeeding after only attending a few hours of a breastfeeding seminar in 1976.

“Neither medical school nor pediatric residency taught me anything about breastfeeding,” Naylor says. Since then, Naylor has completed Healthy Children’s Certified Lactation Counselor training and agrees that there is always something more to learn.

On a mission to educate physicians and maternity care facilities around the world improve breastfeeding practice, Naylor and her colleague Ruth Wester founded Wellstart International in the 1980s.

In 15 years, Wellstart has educated 655 professionals from 55 countries including the U.S.

“They all did something significant,” Naylor says of the Wellstart Associates.

Colonel Roseanne Warner, US Air Force presents Dr. Naylor with medal.

Stressing the importance of collaboration between professionals, Naylor explains that the Wellstart program’s design brings multidisciplinary teams of healthcare providers together including obstetricians, pediatricians, family practitioners, nurses, nurse midwives and nutritionists.

While collaboration isn’t always easy, it’s essential when it comes to serving mothers and babies.

Naylor offers this advice to beginning lactation professionals on how to work with medical clinicians in the care of breastfeeding moms and babies: “Know that the medical clinicians are very interested in the wellbeing of the patient,” she says. “Many know nothing about lactation and breastfeeding but can’t admit it.”

Naylor suggests staff review Wellstart International Self-Study Modules Level I. She says this approach does not offend the medical clinician’s lack of basic knowledge.

Through its trainings and other involvement in the medical community, Wellstart has “changed the care given to mother-baby pairs in hundreds of hospitals, modified curriculum in a significant number of professional training programs, contributed to hundreds of thousands of secondary training events and contributed to the global expertise regarding lactation management.” [Retrieved from:http://www.wellstart.org/about.html]

Naylor’s activity in many groundbreaking breastfeeding events is equally inspiring.

She was present at the Innocenti Declaration, a WHO/UNICEF policymakers’ meeting that declared specific actions to be taken to protect, promote and support breastfeeding around the world.

She attended the 1984 Surgeon General’s Workshop on Breastfeeding and Human Lactation which described several infant feeding recommendations for our nation and resulted in various breastfeeding promotion activities.

Service women from Aviano Air Force Base (a US base in Italy) who breastfeed exclusively for a specified time period also receive this coin for their commitment.

She was also involved in the founding of the United States Breastfeeding Committee. After conducting an intensive needs assessment of breastfeeding activities in the U.S., the National Alliance for Breastfeeding Advocacy (NABA) and Healthy Children Project convened to satisfy one of the four operational targets set by the Innocenti Declaration “to establish a multi-sectoral national breastfeeding committee composed of representatives from relevant government departments, non-governmental organizations, and health professional associations in every country.” [Retreived from:http://www.usbreastfeeding.org/AboutUs/History/tabid/62/Default.aspx]

At the August 2010 meeting of the US Breastfeeding Committee, Colonel Roseanne Warner of the US Air Force awarded a coin to Dr. Naylor on behalf of Aviano Air Force Base in Italy in recognition of her ceaseless efforts to protect, promote and support of breastfeeding.

Among the many landmark events Naylor has been involved in, she’s unable to pinpoint one in which has influenced her most deeply.

“They have all had their place in the work that I have done,” she says.



The postpartum experience

Dr. Greer Kirshenbaum, PhD posed in an instagram post “What happened at your six week postpartum check up?”

Santana St. Remy and baby skin-to-skin after birth. https://www.ourmilkyway.org/accessing-the-milky-way-scholarship-recipient-inspires-positive-change-in-generations-to-come/

Some responses include:

I felt uncomfortable and like a guinea pig. 

I had my check up today and honestly it felt like a tick box exercise…. Like [my GP] was just asking me the questions to just get through it…

Well mine never happened! My [practitioner] decided not to do these anymore! When I called to enquire 13 weeks postpartum I was notified of this and was told that I’m welcome to book an appointment if I think there’s something wrong. It’s ridiculous….

My 6 week health check was shambolic. I was not asked one single question about my mental well-being (after an incredibly traumatic emergency c section) he didn’t even ask about my wound or stitches!? Just asked about contraception and did basic checks on baby…

My postpartum care differed according to care provider. After I gave birth to my first daughter in a hospital, I showed up to my six week check up with my baby. My OB looked at me like, “Why is she here?” and motioned for me to set her in the corner of the bleak exam room. Then, my legs spread, he exclaimed, “Wow! Your cervix! It’s as if you didn’t just have a baby!” It was kind of weird. 

After giving birth to my second and third babies at home, our postpartum care came to us. My midwives acknowledged us as the dyad, and even beyond that, included my older child(ren) and partner. They were thorough, interested in my physical, mental and emotional state, and didn’t make any strange comments about my insides.  

The postpartum experience in America is many things. Often, it’s despicable. 

For one, we offer no paid leave. In fact, one in four women return to work within two weeks of giving birth. The United States Breastfeeding Committee (USBC) is urging our decision-makers to establish national paid family leave. USBC offers a simple action tool to help individuals pressure Congress to pass the FAMILY Act. Find it here. 

Without a paid leave policy, it makes it easy to turn the postpartum experience into a money-maker. Concoctions touting increased milk supply and hair growth, programs tailored to bounce-back culture,  postpartum hotels, sleep training programs, commercial milk formula,  etc. etc. etc. are all marketed wildly. 

Care, when and if there is any, is generally siloed. Our system doesn’t consider the whole human or the dyad, so most moms are left chasing around to appointments specifically for baby (ies) and separately for herself. And because too many dyads experience traumatic births, often as the result of the medicalization of birth, that many more appointments pile up (if accessible) as a reactionary remedy.  

Fourth trimester care attempts to heal this disconnect and to shift our cultural (mis)conceptions about the postpartum experience, where breastfeeding is recognized as a natural progression of pregnancy and labor, where the mother-baby is cared for as one, and where the postpartum individual is regarded as both delicate and powerful.

Photo by Luiza Braun

One effort in particular, the 4th Trimester Project, part of the University of North Carolina at Chapel Hill Jordan Institute for Families (JIF) in the School of Social Work, the Collaborative for Maternal and Infant Health (UNC CMIH) within the School of Medicine, and the Carolina Global Breastfeeding Institute within Department of Maternal and Child Health at the Gillings School of Global Public Health offers a wealth of resources for both families and providers. Browse the database here. 

On The Breastfeeding Medicine Podcast, Dr. Eglash interviews Dr. Malasa Kahn who provides some practical advice for practitioners on how to integrate 4th trimester care into their efforts. 

Check out these individuals and projects previously featured on Our Milky Way working to improve and integrate postpartum care:

Integrating mental health services into primary care 

Therapist integrates lactation counseling into perinatal mood disorder work

Announcing the launch of the continuity of care in breastfeeding support 

OTs can help new parents adopt new habits, skills, and routines

BOMB doulas address disparities in care  

Tragically for too many, the postpartum experience and lack of care is deadly. [Read Forgotten Mothers of Arkansas: State With Worst Maternal Health Outcomes Fails To Support Postpartum Mothers, Maternity’s Most Dangerous Time: After New Mothers Come Home, Black Moms are Dying. What’s the Prescription?] 

MaryAnn Wilbur, M.D., M.P.H., M.H.S. wrote a gut-wrenching piece called Ms. Omega One about the death of a young, Black mother that went completely unpublicized. Ms. Omega One died just two days after giving birth to her daughter. The piece draws attention to important issues such as the coverage of gun violence and disparities in media reports which must be addressed from an anti-racism lens. Ms. Omega One’s story also reminds us why we continue to fight for policies and legislation that support families. It’s because policies and legislation shape the reality of families’ lives. Things like supporting healthy birth options, enabling paid leave, upholding breastfeeding rights, and so on, all support family bonding and mental health. By better supporting families, by honoring the beauty and messiness of motherhood, we might become a society marked by less stress, less divisiveness, less violence and fewer tragedies.

Photo by Mother of Wilde

Natasha VC of the Radical Moms Union recently wrote a piece called Let us Admire the Lactating Fountains of Italy: The most powerful representation of nature in art is a lactating woman. 

“The Fontana della Spinacorona is a marble representation of the mythological founder of Naples, the winged siren Parthenope. Legend has it that the siren shot her breast milk onto the flames of the volcano Vesuvius to extinguish the fire. The work bears the Latin inscription Dum Vesevi Syrena Incendia Mulcet: ‘while the siren of Vesuvius calms the flames’…I must point out how absolutely METAL that is!!??? BREASTMILK TO EXTINGUISH THE VOLCANIC FLAMES OF VESUVIUS!!!!”

The piece illuminates a time when lactating women were “thought to represent Nature at its most glorious and powerful.”

“Think about that for a minute,” Natasha VC urges.  “We typically think of a postpartum woman as weak, drained, struggling. Here, the nursing mother with fountains of milk shooting from her ample breasts, puts her on par with the gods of the sky and sea. PURE, RAW POWER, que bella!” 

 

More on the PP experience

Photo by Jonathan Borba

How does breastfeeding impact postpartum depression in pre and post covid 19 cohorts 

She was living but she wasn’t alive 

Finding the missing puzzle pieces in maternal support 

Lactation Counselor Training Course enhances PT’s practice 

‘Pandemic mama’ becomes full spectrum doula

Motherhood is beautiful 

Postpartum healing lodge– Michigan Breastfeeding Network  

Dark Side of the Moon documentary

Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review



Happy Asian American Pacific Islander (AANHPI) Breastfeeding Week 2024: Bridging the Gaps

National Breastfeeding Month is such a dynamic time of year on account of the weekly observances that honor unique cultures and voices within the wider realm of lactation and breastfeeding. 

This week, we celebrate Asian American Pacific Islander (AANHPI) Breastfeeding Week (August 15 to 21) with the theme Bridging the Gaps, in a call for advocacy around culturally tailored education and community-reflective lactation support. 

We’re revisiting a previous publication, as we did earlier this summer celebrating various national celebrations, in honor of AANHPI Breastfeeding Week. 

We hope you’ll enjoy this reworking of A collection of stories by and about those in the AANHPI community, which was originally published last summer. 

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The 2023 Asian American Native Hawaiian Pacific Islander (AANHPI) Breastfeeding Week Telling our own stories. Elevating our voices was rich with opportunities to engage, learn and celebrate. 

Gorgeous content from Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Social Media Toolkit 2023

As part of the observance, 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.

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.

It’s also become tradition to host the AANHPI Coloring Pages Contest. 

In an engaging discussion with Tonya Lang, MPH, CHES, IBCLC and Grace Yee in 2022, they 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.

More gorgeous content from Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Social Media Toolkit 2023

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 an effort to demonstrate the complexity and diversity of this population, we have collected several stories by and about those in the AANHPI community.

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.

And another beautiful collection from Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Social Media Toolkit 2023

In Spring 2023, 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.

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

  • Professionals who identify as AANHPI or work PRIMARILY with AANHPI communities in birthing or lactation, are invited to complete a 10 minute nationwide survey and share it with colleagues.

The AANHPI Lactation Collaborative seeks to compile and create a resource directory to share publicly on their website. Your answers will also help inform future projects focused on increasing access to lactation support and resources for AANHPI birthing people.

If you have completed this survey in the past, please only retake it if you need to update your responses.

Responses are confidential other than information voluntarily provided for the AANHPI resource directory.

To take the survey, go to: https://tinyurl.com/AANHPICollabSurvey

Happy World Breastfeeding Week and National Breastfeeding Month!

It’s World Breastfeeding Week (WBW) and National Breastfeeding Month (NBM)! This time of year, we come together to celebrate our successes, reflect on the challenges we’ve overcome and those that are still ahead, to continue our momentum and reignite passion and purpose.

The 2024 World Breastfeeding Week campaign’s focus is on survival, health and wellbeing. It showcases the need to improve breastfeeding support to reduce inequalities that exist in our society with a special focus on breastfeeding in times of emergencies and crises. There are so many ways to engage. Check out this interactive map here. 

And this year’s NBM theme, Nourish, Sustain, Thrive, shines a light on why protecting, promoting, and supporting lactation is so important for the human life cycle. This summer, we honor the incredible work that organizations are doing to make the world a little more friendly for new parents and families, and highlight how individuals, funders, and policymakers can contribute to a strong and sustainable lactation field. 

We are excited to kick off NBM sharing a short Q&A with U.S. Breastfeeding Committee’s Senior Collective Impact Coordinator  Erin Fortuna, IBCLC. Among her many amazing achievements, Fortuna designed the beautiful NBM logo.

Fortuna’s personal, adverse experiences with birth and breastfeeding in 2017 led her down the path of wanting to make a difference for people in her community, particularly in service to LGBTQIA+ families. As a queer parent, she became a peer-to-peer lactation counselor because she says she wanted to better support those who wished to feed their babies human milk. This ultimately led her to her journey toward becoming an IBCLC.  In 2022, when she came to the USBC, she was newly postpartum with her second child and “knee-deep in the throes of [on-cue] nursing a 3-month-old, constant diaper changes, and all the challenges that come along with new parenthood…at the same time navigating a career change.”

“The USBC was so incredibly accommodating, which enabled me to nurse on demand for an additional two-and-a-half years,” Fortuna continues. “I knew that my ‘luck’ in having this flexibility shouldn’t be luck at all – this should be the standard! From paid leave to equitable lactation support compensation, this journey is a long and winding road toward change, and I am grateful to be a part of such a hardworking team dedicated to a vision for thriving families and communities.” 

Q: What else makes you proud to be a part of USBC?

A: Honestly, so much work happens behind the scenes at the USBC, and this is exciting for me! I get to see organizations come together to collaboratively work on a common goal and knock down barriers that previously separated them. I get to learn from those in the field who are breaking barriers to get the work done and carving their own path to progress. I get to be there to support and celebrate legislative wins and learn how to navigate the disappointment when efforts become derailed or stalled. It’s pretty incredible to watch these building blocks get stacked at the USBC and built as a collective! 

Q: What are you most looking forward to this NBM?

A: I love seeing how many organizations and community-led initiatives create events and celebrations for National Breastfeeding Month. From cultural weekly celebrations to milk banks to hospitals to lactation support programs, every year, I look forward to seeing photos of celebrations and achievements shared with the USBC! It’s a really exciting time, and the momentum from all the awareness generated and the actions taken in support and celebration of NBM-related activities can continue to have an impact year-round.

 Q: You created the NBM logo to reflect “a special harmony and peace that aligns when a nursing dyad’s needs are met.”  Can you please describe your approach to creating the design? 

A: I have been exploring the possibilities of AI generation as it relates to people and faces. We have such limited access to stock images that it becomes challenging to not use the same parent-and-baby or breastfeeding-baby photo that the rest of the field is using. The USBC does have a photo gallery that organizations can use for non-commercial, educational purposes, but I was looking for a new face!  With the help of AI tools, I was able to generate a generic likeness of a dyad that harnessed feelings of harmony and togetherness. From that image, I creatively styled it to reflect a more illustrated and colorful feel. I really wanted it to feel vibrant and lively but also “close to home” for those partners and organizations that would ultimately use it. My hope is that even if the likeness of the dyad doesn’t resonate with folks, the warm embrace between the parent and baby will.

One of my favorite things about NBM is seeing the creativity behind each weekly observance logo and how each organization makes its celebration(s) unique. I like to collect things that support the efforts of these observances like stickers and t-shirts. I have a whole drawer full of them at home!

Q: What’s the best way for folks to get involved with USBC’s important work during NBM? 

A:  Be sure to subscribe to USBC communications! In each edition of our Weekly Wire newsletter, starting in mid-July and ending in mid-September, there is a special section related to National Breastfeeding Month activities. We have a searchable archive of past editions, a form to submit news and information for future issues, and an open call to the field asking for NBM-related activities that the USBC can amplify. Our team sends emails throughout NBM: offering opportunities to celebrate, learn, connect, and take action to help create a landscape of breastfeeding support for families across the U.S. We hope your readership will join us in making a difference this National Breastfeeding Month!

 

A few more suggestions from OMW on how to participate in WBW, NBM and beyond

Raise awareness by purchasing your NBM gear here. 

Healthy Children Project has released a new round of Accessing the Milky Way scholarships in celebration of WBW. Apply here.

Coffee and tea chats hosted by the Academy of Breastfeeding Medicine will be available throughout WBW.  

Watch the Global Breastfeeding Collective’s replay of Are we there yet? and register for Strength in Numbers. 

Acquaint yourself with corporate wrongdoing, the forces that seek to destroy the power of the mother baby dyad.  



Lactation Support in the Workplace: New and Improved Protections Guest Post by Donna Walls

Universal pumping icon by Fiona Jardine

When the PUMP Act was signed into law in late 2022, after I did my happy dance, I made sure to share the wonderful news with several of my friends. One of my pals shared my enthusiasm and then urged that advocates make sure that moms actually know about their rights. Years ago, when she worked in a daycare, she noticed that  so many of the moms she interacted with didn’t realize that they had any lactation rights (which were less than, but still existent). That’s what guest blogger Donna Walls’s mission is this week, to amplify the progress we’re making around lactation support in the workplace. Please enjoy and pass along her piece: Lactation Support in the Workplace: New and Improved Protections. 

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There have been great victories for lactation advocates and families but, unfortunately, we are not hearing much about them outside of the “inner circle”. It’s time we start talking about these important legislative victories!

Source: United States Breastfeeding Committee (USBC)

I am privileged to be a part of the United States Breastfeeding Committee’s (USBC) Workplace Support Constellation. The Workplace Support Constellation works to address the barriers to breastfeeding for lactating workers, with a specific focus on reducing disparities and inequities. The Constellation works together to advance the following priority strategies:

  • Increase understanding of employer responsibilities and employee rights under federal and state law through an education campaign emphasizing existing implementation resources.
  • Identify gaps in the current laws and work to expand protections for all employees. [Retrieved from: https://www.usbreastfeeding.org/ws-constellation.html] 

We work to support mothers returning to work or school in any way needed; practically, legally and educationally. While there is always work to be done, I am happy to report that much progress has been made. 

First, let’s impart a little history of lactation support in the workplace. In 2010, the US Department of Labor Wage and Hour Division amended Section 7 of the Fair Labor Standards Act (FLSA) to require employers to provide breastfeeding mothers with reasonable break time and a place (other than a bathroom) to express breast milk. This amendment became effective on March 23, 2010, when the Patient Protection and Affordable Care Act (ACA) was signed into law.

Over a decade later, the PUMP (Providing Urgent Maternal Protections) Act for Nursing Mothers was passed providing expanded protections, including legal recourse for those who have been denied these rights by their employer. 

Watch the PUMP Act Briefing here. 

Though the updated legislation filled many gaps, unfortunately, certain employees of airlines, railroads, and motorcoach carriers are exempt from nursing employee protections under the FLSA. However, employees who are not covered,  may be entitled to break and/or space protections under State or local laws.

More good news came in the summer of 2023 when the Pregnant Workers Fairness Act  (PWFA), through The Equal Employment Opportunity Commission, went into effect.

According to the government website, “Generally, PWFA  requires an employer to provide a ‘reasonable accommodation’ to a qualified employee’s or applicant’s known limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, unless the accommodation will cause the employer an ‘undue hardship’.  Reasonable accommodations may include extra breaks, flexible scheduling, being able to sit down or drink water, uniform changes, taking time off work or limiting exposure to hazardous chemicals.

Photo by João Paulo de Souza Oliveira: https://www.pexels.com/photo/gray-scale-photo-of-a-pregnant-woman-3737150/

The PWFA applies to all businesses private and public sector, including state and local governments federal agencies with more than 15 employees. 

Protections also include accommodations related to infertility, miscarriage, pregnancy loss, and abortion, childbirth and recovery, postpartum depression and lactation and conditions like mastitis, low milk supply and plugged ducts.  

Employers must:

  • make a reasonable accommodation for the known limitations of an employee
  • not deny a job or employment opportunities to a qualified employee based on the person’s need for a reasonable accommodation
  • not require an employee to take leave if another reasonable accommodation can be provided that would let the employee keep working
  • not punish or retaliate against an employee or applicant for requesting or using a reasonable accommodation
  • not coerce individuals who are exercising their rights or helping others exercise their rights under PWFA

Check out https://pregnantatwork.org/ for more detailed information. 

If employees are being denied these accommodations, they can file their complaints through the Equal Employment Opportunity Commission. Click here for more. A Better Balance also offers a  free and confidential legal helpline to help individuals understand their  rights in the workplace. The helpline number is 1-833-NEED-ABB (1-833-633-3222) or there is an online form available. 

You can also check  out https://pregnantatwork.org/ for more detailed information. 

One of the most recent victories are the new protections finalized under Title IX. 

Title IX prohibits discrimination on the basis of sex and pregnancy-related conditions and parental status. This includes sexual orientation of the parent, biological or adoptive parents, foster or stepparent, legal guardian or custodial parent, actively seeking legal guardianship, custody or visitation, adoption of a child under 18 years of age or a disabled person over 18 who is not capable of self-care.

Protections have expanded to include students, trainees and employees of schools K-12,

college, university, vocational school, other academic institution or government-funded training

programs. Exemptions may be granted to religious institutions if not discriminating violates their religious beliefs. More information on exemptions can be found here. 

For clarification and help with implementing these protections, the Workplace Lactation Accommodations: Employer Toolkit will be published soon through the USBC Workplace Support Constellation.

Example of a lactation space. Read more about this one here: https://www.ourmilkyway.org/colorado-pediatric-office-becomes-breastfeeding-friendly-employer/

Until then, here is a brief summation of the protections:

  • What is a “lactation space”?  These may look very different, but all spaces must be a clean, non-bathroom space free from viewing, preferably with a lock or security measure. The space may be multi-use with the provision that the mother expressing her milk is prioritized. Each designated lactation space will contain, at minimum, a chair, table or other flat surface for holding a pump, and electrical outlets (not required but strongly recommended). A sink or access to water for hand and equipment cleaning is also strongly recommended. A general guideline for establishing the number of lactation spaces needed is about six spaces per 1,000 female employees. Examples may be an exam room, conference room, office or clean, uncluttered storage room or closet.       

 

  • What is a “lactation break”? Time will be provided for employees to express milk as often as needed (as determined by the employee) during the workday and will

Include time to set up, express milk and clean up. Employees are expected to inform their supervisor of the expected schedule as soon as possible, and it is the responsibility of the supervisor to obtain any required coverage. Employees’ needs may change over time and they may request changes in this schedule as needed. Salaried employees will not find changes in their pay as a result of pumping breaks, but hourly employees’ lactation breaks will be unpaid except when they choose to work while pumping; are pumping during a break that is normally paid; are using paid time off. A general guideline is that the employee may need about 20 to 30 minutes, every two to three hours but this may vary depending on the child’s age and individual needs.

 

  • What about milk storage? The law requires a place to store milk safely but does not

Make any specific considerations. Human milk is not considered a safety concern and can be stored in any employer provided refrigerator or cold storage. All milk should bel labeled with the employee’s name and date expressed. The Center for Disease Control and Prevention provides milk storage guidelines here. 

Much work has been done, and we are now presented with the opportunity for all lactation advocates to help spread the word. Provide this information in your breastfeeding classes, share on all of your social media sites and talk with pregnant women whenever possible, including local childbirth education classes and postpartum support groups.

Check with the Human Resources Department in your workplace to make sure they are aware and can implement the needed protections. Find parallel advocacy fields– Adolescent Nutrition, Climate Change, Digital Health, Early Marriage/Pregnancies, Emergency Settings/Humanitarian Crises, Economics, Newborn and Child Health, Pediatrics, Sexual and Reproductive Health, Social and Behavioral Change, Women’s Health–  lactation and breastfeeding are almost always relevant somehow! Let’s celebrate these major strides. 

 

Other relevant resources

Pregnant Scholar toolkit on student legal protections

USBC list of local partners 

Sample outreach letter from lactation support orgs to local schools/colleges: https://thepregnantscholar.org/wp-content/uploads/Lactation-Support-Org-Letter.docx 

WorkLife Law’s Free Legal Helpline for pregnant, postpartum and lactating students and workers: (415)703-8276 and hotline@worklifelaw.org

HHS Employer guide to supporting nursing parents at work

Breastfeed LA accommodation ideas in different spaces, guides for employees/students and employers 

University of Northern Colorado Campus Lactation Toolkit (note, contains outdated legal information) 

Title IX BreastfeedLA website with reports on lactation and education

Lactation accommodation while incarcerated