Breastfeeding and the Workplace

***When I wrote my piece on community support and its effect on breastfeeding, we had a huge request for a follow up piece about breastfeeding and the workplace. So mamas – here it is!***

Breastfeeding in today’s social climate is sometimes an uphill battle. Not only do we encounter booby traps from the media and cultural cues but we also have to avoid traps set by our care providers and hospitals and even from our loved ones and friends. Now, if we avoid all those negative influences, have proper educational sources, and hopefully some positive social support we have a decent chance of reaching our breastfeeding goals. But then the majority of us need to return to work. What is a mom to do? What are our rights?

Simply put, breastfeeding works easiest (usually) when the baby can be at the breast on demand and without interruption. That is how nature designed the system to work. Nature never expected us to live in a society where it takes two people working 40+ hours a week just to make a decent living. Our breasts simply don’t have that sort of knowledge, expectation, or wiring. Luckily the invention of the breast pump came into our lives.

Mothers who work and continue to breastfeed, be it directly (baby comes to work or comes to visit) or through pumping, deserve major respect and kudos. I know as a stay-at-home-mom that I have it easier in many respects when it comes to maintaining my breastfeeding relationship. A working mother has to figure out not only the logistics of making sure her supply is maintained, but also the logistics of making sure her rights as a breastfeeding mother are respected.

Because of the many changes to the law, varying laws in some states, and the newest changes to insurance and breastfeeding coverage, I wanted to create one easy resource with all the information in one place. After all, you are a new mom and you have a baby on your breast (a lot) and you only have two hands and so many hours in the day. So let me do the leg (or rather mouse) work for you.

Starting at the federal level, I am going to look at the United States Department of Labor and what they say about nursing/pumping and the workplace. The basis of the federal law has to do with changes from the Affordable Care Act:

The Patient Protection and Affordable Care Act (“Affordable Care Act”) amended section 7 of the Fair Labor Standards Act (“FLSA”) to require employers to provide reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk. Employers are also required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk. The break time requirement became effective when the Affordable Care Act was signed into law on March 23, 2010.

To break this down a bit further, there is a specific fact sheet HERE. Some highlights include a note that the number of breaks, duration, and frequency will likely vary from mother to mother. The location made available to the mother must NOT be a bathroom and must be private with some security from coworkers walking in. It does not have to be a dedicated space just for pumping, but needs to be available to the mother when she needs to pump. [As an example, some businesses will offer an office to use that has a lock.]

Now the cravat (and where many businesses fall through the loophole) is that if a business has less than 50 employees they are not required to provide pumping time or space if it would cause “undue hardship” to the employer. [Never mind undue hardship to the mother and baby I suppose.] They do have to demonstrate to the Labor Department that it would cause the hardship to the business. You are also not covered by this if you are exempt from Section 7 protection (however, State laws could cover you). The break time also does not have to compensated (unpaid breaks). These federal standards do not override any higher protection given by states in which the woman lives.

They provide a PDF of a handy card to carry with your rights on it HERE, and if you need a file a complaint you can do so HERE.

Looking at the state level, additional rights vary. An overview of state laws and links can be found HERE at the National Conference of State Legislators. While 45 states have laws ensuring mothers can breastfeed in public and 28 further protect that public feeding from indecency laws, only 24 states have laws related to breastfeeding and the workplace (along with D.C and Puerto Rico). Those states are Arkansas, California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine, Minnesota, Mississippi, Montana, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming, [As an authors note: I am happy to say that my states protects breastfeeding mothers in public, from indecency laws, and at work!]

I wanted to see which states go above and beyond the current federal protections, since some of the states listed above simply reiterate the federal standards. Those states include:

• Colorado: the federal standards are extended to TWO years after the birth of the child, and the Department of Labor in that state provides a list of ways for employers to accommodate nursing mothers.
• Hawaii: specifically prohibits an employer from denying employment, withholding pay, demoting, or in any other way discriminating against a lactating employee. Another plus for Hawaii: they also give any mother who is discriminated against at work or in any public place the right to a private cause of action against the person or business who infringes on her rights. This actually gives the public breastfeeding law there some “teeth” to protect the mother with more than words.
• Indiana: any state or political places of employment must provide PAID breaks for the expression of milk. Any employer with more than 25 employees must make every effort of accommodate a mother to federal standards and also to provide a refrigerator for storage of milk.
• Louisiana: state-owned buildings, educational institutions, and certain office buildings must all provide suitable areas for breastfeeding and lactation. (While not specific, this seems to imply that a lactation room is needed in these locations)
• Maine: provides for a mother to provide milk for her child at work for THREE years after the birth of her child. They also specify they the mother cannot be discriminated against in the workplace for her choice to pump milk.
• Montana: specifies that a storage location (fridge) must be available to mothers who express milk.
• North Dakota: creates the term “infant friendly” that can be used on employment information if an employer complies with certain policies such as adequate break times and work patterns for expression of milk, safe and convenient space to express milk, and a fridge to store milk in within the work place.
• Oregon: allows for a 30 minute break every 4 hour shift for the expression of milk (though some businesses can be exempt).
• Puerto Rico: allows for women to have the opportunity to nurse their baby directly for 30 minutes during each full-time work day for up to one year.
• Texas: creates the designation of “mother friendly” for businesses to use if they make efforts to accommodate working nursing mothers.
• Vermont: provides protection of pumping right for up to THREE years after the birth of the child and creates a task force to encourage and improve workplace pumping policies.
• Washington: also uses the designation “infant friendly” for employers, similar to North Dakota (above).

Any states not listed above all must still follow the federal guidelines. These above states simply have specific laws giving extra protections.

Now this next bit is where I will admit, I get confused. You might too. Insurance issues are swampy in this country (well, for American readers) due to the massive variety of coverage levels, copays, etc, etc, etc. Health insurance is enough to give me a headache. However, I am going to try to pry what I can from the changes at the federal level (though from what I have heard from mothers, some insurance plans or providers can still wiggle around; for instance plans that were “grandfathered” in).

On this fact sheet we see that breastfeeding and lactation services and products are mentioned. It states that pregnant and postpartum women be given access to coverage for lactation consultants and counselors from trained providers and have coverage for breast pumps and related supplies. They state that non-grandfathered plans must do this, but that they still have the freedom to decide at what level they will provide coverage and what they will cover. This leaves things very murky.

The HealthCare.gov page doesn’t really clear things up much either. The pump can be covered before or after baby gets here, at the insurance companies discretion. The pump covered can be rented (for a certain period) or yours to keep. It can cover a manual or electric pump, single or double. Again, this is all up to the insurance, not on you and your needs. Sometimes a recommendation from your doctor can override the basic coverage of a policy. For instance, many women report that a “prescription” from their doctor for a pump or pump rental allowed the insurance company to cover what they needed. Medela*** provides a helpful little list of list for figuring out your coverage. One thing that does seem to be clear is that for non-grandfathered plans, a lactation consultant should be covered with no co-pay.

The bottom line with insurance coverage for pumps and lactation help is to be proactive and get on the phone with your insurance company. Don’t take “no” for an answer – talk to as many people as you need to. Sometimes the person you first connect with won’t know the answers but might not admit that – they may just give a generic answer and hope to satisfy you enough to get you off the phone. One thing I have learned from my mom (an insurance-company-phone-talking whiz) is to write down each call you make. Write down the person’s name and extension, what you ask and what they say. That way if you call back you know everything you were told and don’t get flustered. It is also a good idea to write down your questions before hand.

The bottom line for navigating the workplace and breastfeeding and pumping rights is to know your rights and be prepared. Your employer may not have dealt with this before, so you don’t necessarily have to go in with guns blazing. But be ready to stand up and help educate them not only on the law, but also on the benefits for the workplace that come with your baby getting breastmilk. Working on preparing both your workplace for postpartum and pumping and navigating your insurance before the birth of your baby will make the start of your breastfeeding relationship smooth and less stressful.

Breastfeeding and Benefits for the Employer (further reading):

• The Economic Benefits of Breastfeeding
• Investing in Workplace Breastfeeding Programs and Policies: An Employers Toolkit (PDF)
• The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies, 2013 (started at page 23 specifically) (PDF)
• The Business Case for Breastfeeding

 Pumping Tips from the Pros (aka, other mamas!):

• Having a picture or video of baby is helpful for letdown. You can focus on your little one and let the oxytocin flow.
• Get a good pump. This will vary from mom to mom, but generally a double electric pump is the fastest way to get the most milk. However, some moms have better luck with single pumps, manual pumps, or hand expression.
• Consider two pumps – one for work and one for home, that way you don’t ever forget your pump.
• If your job means you are mobile, keep a manual pump with you in your purse or consider a battery operated pump or car adapter.
• Relax for a minute or two before pumping. Take that time to have a drink of water, think about baby, and just unwind. Tension makes letdown harder.
• A hands-free pumping bra can be a life saver. You can also “diy” one, just check out pinterest/google for ideas.
• Try to pump at the same times each day if you can, it will help your body regulate and prepare for a good letdown.
• Know what your employers breastfeeding/pumping set up and rules are before you have baby. You want time to negotiate for what you need.
• Nursing at night can help bolster supply. Night feedings give the strongest cue to make more milk and provide the most fatty milk of the day.
• Never hesitate to seek help or guidance if you feel supply is low or you need help with your pump.
• Pay attention to flange size – if the flange is too large or too small it will not get milk out as well.
• A little olive or coconut oil around the inside of the flange can help with soreness.
• Be sure your child’s care provider is not over-feeding. This is a common problem for breastfed babies who also take bottles and will kill your freezer stash. Kellymom has a great guide HERE. (there is a PDF link as well)
• There is a handy milk calculator to see how much your baby should need while you are gone HERE.

***Birth Without Fear is not affiliated with Medela or any breastpump/breastfeeding supply company, nor do we promote any one company. This list was just a helpful source found for this article.