When Senator Tammy Duckworth brought her infant onto the floor of the Senate in 2018, the realities of motherhood were thrust into the political spotlight. Some women state lawmakers in New York and Nebraska recently breastfed their babies on the floors of their state legislatures and the slogan “Legislate like a mom” began to gain traction. With all this positive momentum and renewed appreciation of motherhood, the time is ripe for an honest conversation about the challenges many working mothers face when trying to balance the desire to breastfeed their children with maintaining career momentum. And despite recent publicity, many scientific workplaces do not support breastfeeding mothers.
Breastfeeding can be immensely challenging for a variety of reasons, including physical, cultural and social barriers. In fact, it has only been since 2018 that it is legal to breastfeed in public in all 50 states and Washington, D.C. Despite this, only 28 states have workplace protections regarding breastfeeding. Student mothers may even have fewer protections by law, primarily those covered by Title IX. The lack of cultural acceptance and institutional support is especially apparent in academic settings and across scientific fields, where workplace protections are often not honored. In addition, there are many unique consequences of being in scientific fields that make it difficult to breastfeed, including: remote field sites, open laboratory spaces, working with potentially hazardous materials, unpredictable hours for experiments, teaching obligations, and many more.
Up to the day our children are born, we are focused on having healthy pregnancies. At the same time, many early career women scientists are concerned about the instability of living on year-to-year contracts or the challenge of getting tenure with children. Even when job concerns are alleviated, the pressures of science careers lead many new mothers to worry about leaving projects untended and wonder if we should really take any time off at all. It is not abnormal for new mothers to answer work e-mails from their hospital beds after delivering their babies. We feel pressure to hold our laptops open while we learn to nurse our infants in the early days, and the challenges of balancing professional demands and breastfeeding continue as we transition back into the workplace.
Returning to work can be challenging for many mothers for a number of reasons: inadequate maternity leave, postpartum depression/anxiety, guilt for wanting to return to work, desire to stay home with your child, physical recovery after birth, exhaustion, scarcity of time to express milk throughout the workday, and difficulties with milk production are just a few challenges. It’s also critical to acknowledge that the lack of mandated paid leave makes it harder to breastfeed. Working mothers without paid maternity leave are often forced to return to work shortly after birth and are often not able to establish the milk supply needed to feed their babies. Centers for Disease Control guidelines state that mothers need support from their co-workers and supervisors in order to successfully continue breastfeeding after they return to the workplace, yet that support is often lacking. Our goal as 500 Women Scientists is to advocate for every woman to be able to make the right choice for her and her baby and support that choice by reducing institutional barriers that make it harder for women to balance breastfeeding with full-time work.
Hormonal surges during milk production are linked with important bonding processes, and public health agencies recommend that infants be breastfed through the first year of life and beyond. Breastfeeding also offers multiple health benefits including decreased risk of asthma, obesity, diabetes, and ear or respiratory infections in children, and lower risk of high blood pressure, diabetes and ovarian and breast cancer in mothers. According to the CDC Breastfeeding Report Card 2018, although 83.2 percent of moms in the United States started to breastfeed, just over half (57.6 percent) were still breastfeeding at six months, and 35.9 percent were breastfeeding at 12 months.
When you look at exclusive breastfeeding rates (no formula used), these numbers drop to 24.9 percent exclusively breastfed through six months. Why is there such a dramatic drop in breastfeeding? The lack of institutional support is likely an important factor. According to the Society for Human Resource Management, less than half (49 percent) of employers provide a separate onsight lactation/mother’s room and the spaces provided by many employers are inadequate to meet the needs of nursing mothers. Additionally, many employers don’t allow for adequate time to express milk throughout the day. A research study showed that only 40 percent of working mothers are allotted both a private space AND enough time to express milk. This is critical because not pumping often enough will cause a drop in the milk supply, affecting the mother’s ability to produce enough milk for her child.
SOCIOECONOMIC STATUS, STIGMA AND MISINFORMATION
Research shows that the likelihood of breastfeeding depends on the age of the mother, her level of education, race and socioeconomic status, and social support from her family, medical providers, community and coworkers. Well-off and well-educated mothers are much more likely to start and continue breastfeeding because they have access to infrastructure and support, jobs that allow breaks for pumping, longer parental leave, and participation in a cultural community that promotes and encourages breastfeeding. Breastfeeding rates are lowest for low-income mothers and young mothers, in large part as a consequence of the lack of supportive community, job and family support, and lack of education about the benefits of breastfeeding.
Hispanic women and white women have the highest rates of breastfeeding. Black women have the lowest breastfeeding rates, in part because of generational trauma, lack of information, racism in support structures, and the social stigma of breastfeeding. Unlike white women, black women are not given the initial medical support and encouragement to breastfeed; one study found that black women were nine times more likely than white women to be given formula at the hospital, and hospitals in zip codes with a more than 12.2 percent black population are less likely to allow babies to stay with their mothers during the hospital stay and less likely to help mothers initiate early breastfeeding.
BUILDING BETTER LACTATION SPACES
Thanks to the Affordable Care Act, which mandates both time for pumping during the workday and health insurance coverage of breast pumps, access to lactation at work is improving for many women. However, while the spaces provided often meet basic law requirements, they are not adequate to meet the real needs of pumping mothers. The standards for considering a room in the workplace a lactation space are limited: the only requirements are that the room be private, safe and clean (bathrooms do not qualify). The requirement to create lactation spaces only applies to businesses of more than 50 employees and to non-exempt staff. Furthermore, employers are not obligated to designate permanent lactation spaces, forcing many women to have to advocate for themselves.
Research shows that comprehensive workplace lactation programs can improve breastfeeding rates. Dedicated, well-equipped and comfortable lactation rooms are optimal for efficient and comfortable expression of milk during the workday and would reduce involuntary early weaning. Here are some considerations when designing or creating lactation spaces:
- A space that is ADA accessible (ideally, seven feet by seven feet for a single user).
- Sufficient spaces for all pumping employees based on rate of maternity leave. The general rule of thumb is one room per every 100 employees. Consider multi-user space in buildings with a large capacity and based on user demand/preferences.
- At least one lactation space per building and/or accessible with five to seven minutes from the users’ primary work area.
- A directory of spaces, signage, and a reservation system so users know when rooms are available.
- A lock on the door/restricted access to the room/indicator when room is “in use” on the door. Locked rooms need clear access policies for all potential users and barriers to use should be minimized (e.g., users should not be required to request a room key for every use).
- Consideration of need for access to lactation space for all occupants of the workspace, including all levels of staff, visitors and any other users.
- Good temperature control (warm temperature) and internal light control.
- Sound privacy.
Mechanicals and appliances:
- Outlets near chairs where women will be sitting, preferably at counter height.
- A flat surface for the breast pump and bottle preparation (ideally 24-inch-deep counter).
- Flooring materials that can easily be cleaned.
- A refrigerator that can be accessed at any time for storage of milk (even when others are using the room).
- A sink for washing pump parts.
- Storage space for pump/clothing between sessions that can be accessed at any time.
- A microwave for sanitizing pump parts .
Furniture and amenities:
- Comfortable, sanitizable chairs.
- Multi-user, hospital grade pumps should be considered in certain environments.
- Trash can.
- Cleaning supplies for spills.
- Hand sanitizer.
- Artwork/design features that make the room less sterile and more welcoming.
- A mirror to adjust clothing after pumping.
- Coat rack or hooks.
For more information see these posts about designing an ideal lactation space/awesome lactation rooms (https://www.architectmagazine.com/practice/priming-the-pump-lactation-room-design-guidelines_o, https://www.elle.com/culture/career-politics/g28143/the-best-lactation-rooms-across-america/, https://www.workingmother.com/most-impressive-company-lactation-lounges-in-us#page-3, https://www.fastcompany.com/90163920/what-happens-when-moms-design-a-lactation-room).
WHAT CAN WE DO?
Know your rights.
Depending on your institution and whether you are an employee and/or a student and the state where you live/work, your rights vary when it comes to breastfeeding and pumping on a campus. Title IX provides some protection for lactating students, and the Fair Labor Standards Act provides protections for workers, but these may not apply to everyone because of individual titles or support from employers. Seek out information from both internal sources (HR, dean of students) and external sources like the Center for Worklife Law during your pregnancy, if possible. Being able to anticipate your institution’s policies may help you navigate barriers around accessing these spaces such as reservation systems and card access that needs to be granted in advance of the request. When planning your maternity leave, talk to your supervisor/HR about planning ahead for when you know you will be in an environment that is not your everyday workspace, such as visiting another campus for a conference, talk, seminar, job interview, etc.
Many universities and companies are trying to improve their lactation spaces and policies. Some have a lactation policy that clearly states your rights on that campus as a pumping mom. One great example is the University of California Davis, which was on the vanguard of having a comprehensive lactation support program. They have a clear lactation policy, but also includes lactation support on campus, almost 50 lactation spaces, pump kits and hospital-grade pumps. If you find that your university does not have a policy for staff or students, now is a great time to advocate for one and recruit decision-makers as co-advocates. It is truly the only way to ensure that the proper protections for lactation will be in place for yourself and your colleagues.
Find or create support groups.
After frustrations with not finding adequate lactation spaces, Liz and Whitney formed a group called Milk and Cookies that provides a lunch time support group and shared pumping space for any parents who wanted to join. In addition, the bimonthly meetings often involve lactation support, advocacy groups, local politicians, and university officials to help promote lactation issues on campus and at the state level. If you aren’t sure about how to create your own safe space for support, check out this post about how to create your own Milk and Cookies. Other lactation support groups also exist specifically for women in certain careers. For example, Dr. Milk is a support and advocacy group for physician mothers with a national and local presence. Some hospitals and other local resources also have breastfeeding support listservs where new moms can support each other. Social support is a key factor in achieving breastfeeding goals; find where you are comfortable and connect.
If formal space cannot be found, advocate for “flex” space.
Space is a limited resource at many institutions, and they may be reluctant to dedicate coveted space for lactation accommodations. Sometimes the only way to find an adequate solution for yourself is to request a temporary space to pump, such as a currently unused office, conference room (with blinds) or really anywhere where you would feel comfortable that is NOT a bathroom. Another alternative is to advocate for multi-user rooms, which can be used by multiple women. Some women may be comfortable pumping in front of others, but see if your institution will invest in room dividers or curtains, so that everyone is comfortable (or bring a drape for yourself). Lastly, some campuses are purchasing portable spaces such as a Mamava pod that can be accessed by people through an app and may be relocated if demand for space changes.
When planning meetings and conferences, consider lactating moms.
Many conferences are now providing spaces for lactation, which is a great step forward. However, few convention centers have invested in making dedicated lactation space standard and often the accommodations conferences provide are inadequate or inappropriate, e.g., they are far from common areas or do not provide enough space for the needs of attendees. One other consideration is the time that women have to take while pumping, which means they are missing out on critical networking or talks that may be relevant to their research. One way to deal with this issue is for smaller conferences to provide a “livestream” of the talks to the lactation room so that women who are pumping are not excluded. For in depth coverage of how to make your conference more parent-friendly, see the recent article in PNAS by Calisi, et al.
Normalize breastfeeding and lactation.
Colleagues, and supervisors are critical allies for breastfeeding women to meet their goals for lactation after they return to work. If you work with others, supervise others, interview people, teach, make decisions in your lab, or have other areas of influence, consider how you can contribute to making lactation at your institution a little easier for the next person. Maybe that means identifying space that could be made into a lactation room; maybe it means offering to show a pregnant colleague where the closest existing lactation room is and how to access it; maybe it means just talking to your co-workers about challenges you’ve faced.
Many institutions are looking at their approaches to wellness, diversity, and inclusion. Bring up lactation support early and often if you are involved in these conversations. Look for wellness and diversity committees at your institution and share your story and ideas with them. Be humble and don’t assume that everyone’s experience or struggle is the same as yours: ask decision-makers to improve efforts with feedback from other mothers in the workplace.
Assume people might need access to lactation space. Put a link to the lactation policy for students on your syllabus. Share the directory of lactation spaces with job candidates. If you are planning a conference or meeting, or inviting people to your campus or workplace for any reason, identify appropriate lactation space for guests and clearly communicate how to access accommodations up front, just like you would with parking. Sharing this information with people who don’t need it contributes to normalization and relieves those who do from having to go through gatekeepers to continually request accommodation.
Normalizing breastfeeding in all spaces where women are, which includes the workplace and school, is an essential step to gender equity. Women make up almost half the workforce and academy. We can’t continue to exist there on the condition that we act like we don’t have families. The prioritization of other people’s discomfort with the normal physiological functions of a mother feeding her infant is detrimental to women, children and society as a whole.
Discomfort with lactation can come from both men and women, and since women are directly affected by a lack of lactation accommodation and support, we are often the ones who have to advocate for better policies and space. However, we need others to stand up and support women in the workplace and for everyone to understand that mother’s issues are societal issues.
ARE YOU STRUGGLING WITH BREASTFEEDING/LACTATION?
Again, our goal is to promote a workplace that is supportive of working moms. Regardless of whether you have work support in your infant feeding choices, being a mother is hard work and we are here to support you.
We are stronger together, and by sharing our experiences and holding space for each other, we can support each other as we rise. 500 Women Scientists has created a resource page highlighting different resources that may be helpful to you. In addition we hope to build awareness of working mom issues, including breastfeeding, through our new initiative “Sci Mom Journey.” To contribute your story please visit https://500womenscientists.org/share-your-story.
“As a working mother and graduate student, I have experienced multiple barriers in breastfeeding my children. I experienced challenges with my first child related to establishing breastfeeding due to latching issues, so I thought breastfeeding my second would be much easier because I was more prepared. While this was true in the first few weeks, I experienced multiple challenges at work and school that were based on false assumptions and biases about breastfeeding. These false assumptions and biases lead to discrimination against breastfeeding students and workers, and these need to be challenged and changed to work towards gender equity.
After many difficulties with finding adequate lactation spaces for me to pump while at work or school, I then experienced an even more shocking barrier. I was enrolled in a master's level course on campus, and at one class I was unable to secure childcare for my infant daughter. My instructor and I had discussed that it would be a possibility for me to bring her to class. I brought her and she remained quiet and was not disruptive to class. I breastfed her during class, which is the best and most natural way for a mother to calm her child. I later received an e-mail from the program director saying ‘people’ were uncomfortable with me breastfeeding my child during class, and that it calls into question the ‘professionalism’ of the students, and she asked me to leave the classroom if I brought and breastfed her again. It turned out to only be one person who complained: the instructor.
Since Colorado law states that ‘a mother may breastfeed in any place she has a right to be,’ I felt that someone telling me not to breastfeed was a violation of law. I was furious that someone was judging not only my way of feeding and comforting my baby, but also my body and my breasts. Since women's bodies, including breasts, have been sexualized in our society, it's extremely difficult to breastfeed, especially in public. I filed a Title IX complaint, because being asked to leave a space because of breastfeeding reasonably seemed related to sex. However, the extremely painful and difficult investigation led to findings that no law was violated, and that there was no discrimination based on sex.”
“My daughter was born nine weeks premature. I had a condition called placenta previa where it was very unlikely I could carry her to term, and would result in a c-section. She was born at 3 lbs, 7 oz. Due to my position as a postdoc, I had only eight weeks of disability leave, seven of which my daughter was in the NICU. I tried desperately to get her to latch, but many preemies have difficulty with the breath, suck reflex and there is a lot of pressure to get your baby to eat from either the bottle or breast, often with the bottle winning out. I was determined though to follow guidelines regarding breastfeeding and wanted to make sure that my daughter was getting breast milk (in this case supplemented with formula) for the first six months. This means pumping. A lot. Since we were not feeding from the breast, I had to be at the pump as often as the baby was supposed to be feeding, which in the NICU was every three hours for 24 hours a day. I would wake up in the middle of night desperately pumping while feeding my baby a bottle in my lap hoping I could provide enough milk for her next feeding. This was all before I returned to work.
I work in an open-lab space with no private office. My workplace has lactation facilities, but the nearest one was in the next building and only provided two spaces. I would often go down to pump toting all of my equipment to find the room occupied. Not only was this difficult to manage with a busy experimental schedule, but also a huge waste of my time since I would only have to come back in half an hour to maintain my supply and schedule. I was able to pump enough for my baby until she was six months adjusted (or eight months total), but this was by far one of the most difficult work-life balance experiences of my life and it would have been much more difficult if not for support groups such as Milk and Cookies.”
“As a graduate student in 2009, I was very unusual in having a baby during my graduate career. My advisor said, ‘you’re not going to bring him to the lab, right?’ The only place to pump when I was on campus was not anywhere near my lab. I used to pump on my car (a five minute walk from lab) until it got too cold. I finally found a server room that had no windows. I used to pump in the dark so that no one could see the light through the door. I always felt sneaky and like I was doing something wrong. It was very stressful.”
“My journey wasn't an easy one. My daughter was born with shoulder dystocia and needed to have her arm broken in order to get her out during labor. We spent one week in the NICU recovering. During this time her blood sugars were all over the place. Since my milk had not come in yet, we had to substitute with formula. We went back and forth between trying to breastfeed and formula. Breastfeeding just wasn't working until I met with a lactation consultant and started using a nipple shield. The shield worked and my daughter started latching. We used the nipple shield until she was four months old when one day she just grabbed it, threw it off me, and latched without it. We have been breastfeeding without a nipple shield ever since!
Since the beginning I have been pumping, and we started giving her bottles right away with formula so we continued when we got home. We knew that eventually she would be in daycare while I went back to work, and she would need to take a bottle. Luckily my daughter adjusted well with bottles, but pumping was more of a challenge for me. When I started working again I became very stressed out, and my supply decreased. I had to work one on one with a lactation consultant and after a few weeks I got my supply back up.This was extremely stressful and I felt like a failure. Also because of the nature of my work, it's sometimes difficult or awkward to pump in the car in between my clients for ABA therapy. I don't know how many times I just wanted to give up. I am so happy I stuck with it and kept up with it. I am personally proud that my daughter and I have been able to breastfeed now for 13 months and continuing.”
“I had twins during my postdoc and struggled to produce enough milk for both of them. I was nursing and pumping every two hours round the clock to build and maintain my milk supply and that schedule didn’t stop when I returned to work. During a typical day I pumped for 30 min every two hours. However, my university only had a few lactation spaces and the closest was a 20 min walk from my office. Due to the demand for the space, mothers could only reserve a space twice a day for 15 min at a time. I worked in an open office space with no privacy so I contacted my building administrator to ask about getting a private space for pumping. He suggested that I use the handicapped bathroom as it only had one stall and could lock. I told him I would do that if he ate his lunch in there every day. Eventually my department provided a small office that I was able to use for pumping. By the time I finished my postdoc there were at least two other women utilizing that space for pumping. The room also had a desk so I was able to work while pumping which helped me maintain my professional productivity.”
“I’ve had very different experiences pumping at scientific conferences. The first time, the conference hotel was booked so I got the next closest hotel which was a 15 min walk to the conference. The conference had a pumping room but it didn’t include a fridge and they said they couldn’t provide a cooler (even though it was attached to a hotel which I assume has both fridges and ice). This made it essentially useless for me since I needed to be at the conference all day and recommendations are not to keep the milk at room temperature that long.
As a result, I walked back and forth to my hotel every three hours and thus missing large parts of the conference. My hotel also did not have fridges in the rooms so I gave it to the front desk to store and they were supposed to put it in the freezer. When I picked up all the milk at the end of my trip only half the milk was frozen. Since I didn’t know if it had been kept cold for the week I ended up dumping most of it. More recently, I went to the American Geophysical Union Fall Meeting 2018 and had the opposite experience. The pumping room was large, conveniently located, with a fridge, several chairs, storage areas and lots of support from other women pumping at the conference. It made a big difference in my ability to fully participate at the conference.”
“Breastfeeding started well, as my son latched in the surgical recovery room and seemed to get the hang of nursing quickly. His weight gain was acceptable, and for the first three weeks this pattern continued. I was able to work on manuscript revisions while I recovered from surgery and he took restful naps during the days. Then his digestive issues emerged: he screamed in discomfort and his belly was distended with gas. He clawed at me in pain. With medical consultation and a lactation support group, I discovered that my son had sensitivity to cow’s milk protein. When I eliminated all milk products, cheese and butter from my diet, he was much calmer. I am glad that I did not have to discover this by trial and error or an old wives’ tale. The scientific research is emerging on the topic, but some infants may be sensitive to the proteins from cow’s milk in a maternal diet that passes through to breast milk. I only found this out by being able to access medical care through insurance provided to me by my university employer.”