Alternatively, a small cooler with blue-ice packs (about 15°C) will work well. Stored this way, your milk will be fine for up to 24 hours.

If you forget your blue-ice packs, your milk can even be stored at room temperature (about 25°C or 77°F) for five hours.

Here are a few additional tips for storing your milk at work:

• Collect your milk in food-grade containers free of bisphenol A (BPA). (Most bottle makers have removed BPA from their products, but if you’re using a plastic bottle, check that the packaging is clearly labeled as “BPA-free.”)
• Label the container with the date, time and—if necessary—your name or your child’s name.
• Store your milk in single-serving portions. Two-ounce servings are a good size for young babies, and your caregiver can combine servings as needed. This allows some flexibility in preparing the milk, while minimizing waste.
• Milk expands as it freezes, so don’t forget to leave some space at the top of the container, if you plan to freeze your milk.

Leading health organizations recommend exclusive breastfeeding for a full six months, and continued breastfeeding for at least one year, but maternity leave typically ends at—or often before—12 weeks. This legislation recognizes that a mother’s ability to express her milk at work is a necessity for breastfeeding mothers who must balance their own need to re-enter the workforce with caring for their babies.

According to the relevant portion of the bill:

• Employers must ensure that women in the workforce have access to the time and space they need to express their milk for their babies.
• This must be provided for one year after the child’s birth.
• The place employers provide must not be a bathroom. It must be shielded from view and free from intrusion by coworkers and the public.
• Employers are not required to pay their employees for the time they spend expressing their milk.
• Employers with fewer than 50 workers are exempt from these requirements if they would pose an undue hardship by causing the employer significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the business.

These provisions do not preempt state laws from providing more protection for breastfeeding workers so it may be a good idea to check with your state labor department too.

As soon as possible, talk with your supervisor and co-workers about your plans to breastfeed, so that they can be supportive and won’t feel inconvenienced by the need to accommodate you upon your return. The Business Case for Breastfeeding may prove to be a useful resource as you have these discussions.

Additional resources include: Support for Breastfeeding in the Workplace from the Centers for Disease Control and Prevention (CDC) and Worksite Lactation Support Directory from the International Lactation Consultant Association (ILCA).

Unfortunately, the USDA’s provisions are under fire by Congress.

Although it has been 15 years since school lunch standards were updated, buying school lunch is as popular as ever. The USDA estimates that the proposed changes would reach approximately 32 million children every school day. Given that school lunch can provide half of the daily calories for many children and that nearly 32 percent of children ages 6 to 19 years are overweight or obese, the school lunchroom seems like an obvious opportunity for change.

The proposed changes to the school meal program regulations were based on research by the Institute of Medicine (IOM), found in its 252-page report, School Meals: Building Blocks for Healthy Children, the Dietary Guidelines for Americans, and Dietary Reference Intakes.

The changes aim to bring the Nutrition Standards and Meal Requirements into line with what’s been learned about nutrition science in the years since the requirements were last updated. They also strive to increase the availability of key food groups in the school meal program, including fruits and vegetables, whole grains, and fat-free or low-fat milk, and to set limits on saturated fat and sodium.

Fifteen years ago, a cost-cutting measure by the USDA threatened to allow condiments such as ketchup and pickle relish to be classified as vegetables under the school meals program. That was overturned, but recent action by Congress has allowed pizza sauce and French fries to maintain their vegetable status in lunchrooms across the country.

Is tomato paste a vegetable?
Under the guise of tight budgets, Congress has prevented the USDA from adopting its newer, more rigorous nutritional standards. Saying that schools shouldn’t be telling children what to eat—and ignoring the fact that schools will still be doing that, just with fewer healthy options—members of the House Appropriations Committee determined that the USDA’s new rules would “provide greater flexibility for local school districts to improve the nutritional quality of meals.”

Many school districts chafed at the cost of meeting the new requirements, and Congress also felt pressure from the food industry, including ConAgra, Coca-Cola, Del Monte Foods, and makers of French fries and frozen pizza, like Schwan. These companies spent more than $5.6 million lobbying against the USDA’s proposed changes.

Not everyone is thrilled with Congress’ decision. Margo G. Wooten, director of nutrition policy at the Center for Science in the Public Interest, a nonprofit research group, notes that child nutrition and childhood obesity are “national health concerns,” arguing that Congress “should be supporting USDA and school efforts to serve healthier school meals, not undermining them.”

According to the USDA, the proposed changes would have cost about 14 cents more per meal. That would have raised the annual budget for the school nutrition program from about $70 billion per year to about $71.4 billion per year. However, by bringing more fruits and vegetables into the school lunch program, and making standbys like pizza healthier with whole grain crusts and lower levels of sodium, the revised lunch program would have exerted an important influence on America’s schoolchildren.

Not only could school lunch changes have improved children’s health, but it would have provided a vivid, daily example of good nutrition. It’s hard to understand the importance of “2 ½ cups of veggies a day” in the classroom when the veggies in the cafeteria are tablespoons of sodium-laden pizza sauce under the cover of cheese.

Sojourner Marable Grimmett—an Atlanta mother, blogger at Married With Two Boys, and author of a study about balancing work and motherhood—is known for her breastfeeding advocacy. So when she posted a question on Facebook (Did her friends think it was appropriate to ask if companies have a lactation room during a job interview?), friends were eager to chime in. One left a comment mentioning that the Hartsfield-Jackson Atlanta International Airport had no designated lactation rooms for customers or employees. And with that, her next project was born.

“That really sparked something inside me,” says Grimmett, who works as a program administrator at the Southern Regional Educational Board.

Reflecting on her own breastfeeding experiences, she recalls being unable to pump at her former job. Without the ability to pump breast milk five days each week, she was unable to maintain her milk supply. Ultimately, she stopped breastfeeding her older son at just over 4 months of age—well before she was ready. “That was really hard for me,” she says. When she was pregnant with her second son, she helped establish a lactation room at work and was able to breastfeed him for 15 months. That lactation room, she says, made a huge difference.

Grimmett thought of not only airline employees wanting to pump, but of the 89 million passengers that pass through the airport each year. Far less busy airports have established lactation rooms. Perhaps Atlanta could look to the example of the Hong Kong International Airport, which boasts over 30 rooms with changing and feeding facilities.

Travelers need an easily accessible room to breastfeed or pump milk. Yet at the moment, Atlanta’s airport offers only use a private room at the airport that must be reserved in advance.

(As an aside, finding that “private room” is near to impossible. A search for “private rooms” on the Hartsfield website yields only a list of 12 approved smoking areas. Besides that, the notion of reserving a private room before traveling is ludicrous to breastfeeding mothers, who know that “babies feed on demand,” says Grimmett. “Sometimes, you don’t know if you’ll need a private room ahead of time.”)

Grimmett decided to do two things: contact the airport directly to encourage them to create lactation rooms, and build online support for the idea. She does both with Table for Two, a  campaign which “seeks to make the lifestyles of breastfeeding mothers seamless and build public accommodation for lactating mommies,” says the website.

“We deserve a safe, clean, and private area to express milk,” says Grimmett.

Table For Two campaign
Grimmett’s campaign focuses on the common comeback to all breastfeeding-in-public-naysayers: “Would you eat in the bathroom? Then why would you expect a baby to?” Her website features attention-getting photos of adults and children dining in bathrooms: a man eats pizza by a line of urinals; a couple enjoys a “romantic meal” while another man uses the facilities beside them.

“I wish this campaign would go viral, like planking!” she says, laughing. She’d love nothing more than to see other people eating in the bathroom and encourages people to send in photos of themselves doing so in support of the campaign. (More information on how to do that is below.)

The models themselves are primarily African-American, which was intentional as breastfeeding literature and promotional materials often lack an African-American presence thus ignoring an audience whose breastfeeding rates lag behind their white and Hispanic counterparts. But let’s face it—breastfeeding rates amongst all women need to be improved. Currently only 1 in 3 U.S. babies are breastfed exclusively for three months.

Breastfeeding advocates agree that in order for breastfeeding rates to rise, breastfeeding must be seen as a normal part of life. In other words, it needs to be part of the public scene. Grimmett says that she isn’t encouraging lactation rooms so that breastfeeding and pumping will be hidden away, behind closed doors. She just wants to provide a comfortable place for those mothers who prefer privacy when breastfeeding or pumping.

“I believe that women should nurse wherever they please…but I’m also about inclusiveness,” she says. “Some women don’t mind breastfeeding in public. Some women also pump in public…but for those women who don’t feel comfortable with that, [a lactation room] is another option.”

“I feel very optimistic about the possibilities of designated lactation rooms being established at Atlanta’s airport,” says Grimmett.

The airport officials she has contacted have been receptive, if not exactly forthcoming with information. Grimmett has asked for a timeline on when a lactation room might be created, but has not yet heard back. She hopes that Table for Two will create enough momentum in social media to encourage the airport to act quickly—and in the meantime, get people thinking about establishing lactation rooms everywhere.

“I’m such an optimistic person,” says Grimmett. “My dad always said, ‘Always speak truth to power’—speak up for what you believe in. That’s what I’m doing.”

Grimmett encourages supporters to post images of themselves eating in a bathroom on the Support Table For Two Facebook page, and to sign the petition calling for lactation rooms at Hartsfield.

Mary Jessica Hammes is an Athens, Georgia-based writer, trapeze instructor, knitter, gardener, comic book enthusiast, and hula hooper. She is mom to Tommy.

Breastfeeding is nudity?

Shocking news to anyone who has actually seen a woman breastfeed—even if a woman completely removed her shirt, the child’s head would still cover up far more than most bikini tops.

Georgia mothers are organizing a public “nurse-in” on May 23, 10 a.m.–noon, at Forest Park’s City Hall to protest the ordinance. (Check back with us next week to find out what happened.)

Why is this city ordinance a problem?

For one thing, it violates Georgia’s state law giving mothers the right to breastfeed their children—no limitation of age given—anywhere they are otherwise authorized to be.

But there is a host of other reasons why this ordinance is a terrible, pointless, and completely ignorant idea:

• The ordinance goes against the World Health Organization and the American Academy of Pediatrics recommendation to make the age of 2 a breastfeeding goal, not finish line. WHO’s language is specific—“age of 2 and beyond.” (Emphasis ours.) For breastfeeding to be accepted as the normal way to feed a baby, it has to be visible.

• There are nutritional and immunological benefits that are associated specifically with “extended breastfeeding.” That said, it’s safe to say that toddlers are getting most of their nutrition from the meals they eat and are still breastfeeding largely for comfort reasons—and what’s wrong with that? The fact is, regardless of whether we choose to use them, mothers were born with nature’s pacifier long before humans figured out how to make one out of rubber.

• The ordinance, born out of concern for “public indecency,” fosters the notion of shaming breasts and sexualizing breastfeeding. The topic of non-sexual nudity is pretty fraught, but there is a persistent notion in our nation that a woman’s breasts are sexual objects. I recently heard a young woman (not a mother) express her distaste for extended breastfeeding: “After a certain point, I’d just be like, ‘These are mine,’ okay?” she said, indicating her breasts. During the conversation, her point was clear: the breastfeeding mother was somehow losing a part of herself, surrendering her sexuality to a leechish-child. However, here is a truth that is impossible to fully understand unless one is, in fact, a mother: breasts don’t magically stop belonging to the woman attached to them just because they are serving a biological function. I have never met a breastfeeding woman who has had trouble with this concept. Breasts can and do make food! A law like this reinforces the idea that human breasts are, at an arbitrary point in a child’s life, solely sexual and, somehow, offensive.

What on earth prompted this ordinance, anyway? A rash of complaints about breastfeeding toddlers? Given our country’s breastfeeding statistics and the fact that only 17.9 percent of women in Georgia are still breastfeeding at 12 months, it is highly unlikely that Forest Park is flooded with moms making it a habit to breastfeed their 2-and-olds at all, let alone in public. Those moms who do breastfeed their children into toddlerhood—as I, a former breastfeeding mother from Athens, Ga., did—know that breastfeeding at this age is most likely occurring at home, usually during those prime times for bonding and comfort: in the morning and/or at bedtime. But that doesn’t mean it has to happen at home.

Public breastfeeding is not reviled everywhere in Georgia. Just two hours away from Forest Park, Athens takes a fairly progressive stance on public breastfeeding—thanks, in part, to a laidback atmosphere emanating from the local arts community, but no doubt encouraged by a thriving community of midwives, doulas, and childbirth educators like Alexa Clay. Inspired by the Forest Park ordinance, she had a candid chat her two young sons; here is an excerpt:

Alexa: Abram, what do you think breasts are for?

Abram (age 3, still nursing): Nursing, nurses, and nurse machines.

Alexa: What would you think about if you saw me walking down the street with no shirt on?

Abram: Nursing.

Alexa: How old do you think kids should be when they stop?

Abram: Oh…4.

Alexa: When’s your favorite time to nurse?

Abram: This day.

Alexa: What time of this day? At morning? At night?

Abram: Both.

Alexa: Elie, when do you think kids should stop nursing?

Elie (age 7, who weaned at age 4): Three, no, 4, no, 6. Yeah, 6.

Alexa: Elie, what would you think if you saw me or another woman walking down the street with no shirt on?

Elie: That would be a little weird, but if I saw a woman with her shirt pulled up the way you pull up your shirt to nurse [he demonstrates nursing, exposing a bit of skin but no nipple], then I wouldn’t think anything about it.

Parker didn’t respond to my request for an interview. If he had, I would have asked him, among other things, what he thinks breasts are for. Why does he feel such a breastfeeding-specific ordinance is necessary? I would have asked whether it was true that he responded to one parent’s complaints with dismissive laughter and the statement, “We don’t want children that can walk around to be breastfeeding in public”—and, if so, to identify this “we” (as if the threat of mass breastfeeding terrorizes every Georgian).

I would have asked him that if the ability to walk negates a child’s right to breastfeed, then why not lower the age limit of the ordinance to 9 or 10 months, because heaven forbid early walkers be permitted to breastfeed in public.

Actually, Mr. Parker, please don’t lower the age limit. The city ordinance is idiotic enough as is.

Editor’s Note—May 23, 2011
More than 100 women gathered at Forest Park City Hall Monday morning, children in tow, to protest the ordinance.

City officials offered coolers full of bottled water and protestors were able to use bathrooms inside City Hall. “It was all pretty cordial,” one mother reports.

She notes that at least some news media were there looking for a sensational story, but didn’t find one.

“A photographer asked to take a picture of my friend with her sign and asked if she would wave it frantically,” says Natasha Cummings, who traveled from Athens with her 2-year-old son, Emmett, who is still breastfeeding. “There was also a reporter…who wanted to take a picture of a 5-year-old boy sitting in a stroller. The reporter was disappointed to find that the stroller belonged to the boy’s little sister. I think both the photographer and the reporter were looking for extreme clichés.”

What they found instead was just another day at the park—albeit with signs and images reminding us all that breastfeeding (yes, even in public) is every woman and child’s fundamental right. “The mood was calm,” says Cummings. “It could have been an outing at the park—moms with kids, snacks, sippy cups, toys, sitting on blankets.”

City Manager John Parker has reportedly said that the ordinance will be revisited at the next council meeting, which is scheduled for June 6.

Editor’s Note—June 7, 2011
After a “nurse in” at City Hall in Forest Park sparked widespread media attention, the Forest Park City Council voted to amend its ordinance banning public breastfeeding of children over the age of 2. In accordance with Georgia state law, the new ordinance allows breastfeeding in public at any age.

Working mothers and the obstacles they face
Overall, women comprise half of all U.S. workers, according to a 2010 Congressional report prepared by the Majority Staff of the Joint Economic Committee.

The U.S. Bureau of Labor Statistics (BLS) also reports that as of 2009, only a few countries, notably Canada and Sweden, had female labor force participation rates that were higher than the U.S. Meanwhile, the agency projects that by 2018 the women’s civilian-labor force will increase by 9 percent, to roughly 6.5 million.

More specifically, the BLS reveals labor force participation rates of mothers with children under age 18 surged from 47 percent in 1975 to 71 percent in 2008. Not surprisingly the agency notes that mothers with children older than 6 years are more likely to participate in the labor force than mothers with younger children. Nevertheless, in 2010 the BLS announced the labor force participation rate of mothers with children under 6 years old was 64 percent and a whopping 57 percent for mothers with infants under a year old.

The Congressional report concludes the role of women in the U.S. economy is critical, stating, “The future of the American economy depends on women’s work, both inside and outside the home.” Will real change come from such strong rhetoric?

Despite the documented growth and rising importance of women in the U.S. labor market, pregnant women and working mothers still face a number of obstacles in balancing their dual roles as professional and mother.

The February 2011 report from Human Rights Watch, which analyzed 190 countries, found that 178 guaranteed paid leave for new mothers. Nine were unclear about their maternity policies, and only three clearly offer no legal guarantee of paid maternity leave: Papua New Guinea, Swaziland, and the U.S. What is the glaring difference between the U.S. and these other two nations? America has the largest and most technologically powerful economy in the world, with a per capita Gross Domestic Product (GDP) of $47,400, according to the Central Intelligence Agency (CIA) factbook.

Among the other findings of the Human Rights Watch report:

• Overall, the lack of paid maternity leave forced mothers to give up breastfeeding early.
• Parents in the U.S. report that having scarce or no paid leave contributed to delaying babies’ immunizations, postpartum depression, and other health problems.
• Many parents who took unpaid leave went into debt and some were forced to seek public assistance.
• American women reported that employer bias against working mothers derailed their careers.
• Many same-sex parents were often denied even unpaid leave.

In the U.S. the federal statute, the Family Medical Leave Act of 1993 (FMLA), does entitle workers of covered employers up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons, including the birth and care of a newborn child within one year of birth and the adoption or foster care of a child, according to the U.S. Department of Labor (DOL). To be eligible for leave under the law, however, an employee must have worked for their employer for a total of 12 months and must also have worked for a total of 1,250 hours or more in the previous 12 months. The employee also must work at a U.S. location where at least 50 other employees are based within 75 miles.

Due to the exclusion of small employers and short-tenure workers, about 40 percent of U.S. workers are not eligible for protection under the FMLA, according to the Center for Economic and Policy Research (CEPR). The Center believes American employers have not stepped in to fill the gap and finds that while about 60 percent of workers are eligible for FMLA-related leave, only about 25 percent of U.S. employers offer fully paid “maternity-related leave” of any duration, and 1 out of 5 U.S. employers offers no maternity-related leave of any kind, paid or unpaid. CEPR further argues that for many low- and middle-income families, unpaid leave is simply not an option; these families cannot afford the time away from work and are forced to take no leave at all.

In a 2009 report assessing parental leave policies in 21 countries, the group cites a 2000 Department of Labor survey over a 22-month period in 1999 and 2000 in which 3.5 million people in the U.S. needed leave for family or medical reasons but did not take it; almost 80 percent of those who did not take the leave said they just could not afford to do so.

How does the U.S. measure up?
The CEPR report identified four countries with leave policies that are strongest on both generosity and gender equality. These countries include Finland, Norway, Sweden, and Greece. Several others also offer parents generous options for paid family leave. Here is a rundown:

Trailing behind the countries listed above, Switzerland offers just 14 weeks of maternity leave to care for a new child. Unlike the U.S. however, even Switzerland provides 11 weeks of paid leave.

After consulting with lactation experts including those at the Centers for Disease Control and Prevention (CDC), the U.S. Department of Labor (DOL), has issued preliminary guidance. Before it releases the final guidance, the DOL has made an official “Request for Information” and wants to hear from the real experts in managing working and pumping—nursing mothers who are most affected by this new law.

The DOL recognizes that every mother’s situation is different with respect to milk expression needs—the mother of a 6-week-old exclusively breastfed baby will need to express more often than the mother of a 6-month-old baby who is eating solid foods; a mother using a hospital-grade pump may require less time than a mother using a hand pump; and some mothers may require extra time to get to the designated nursing station, depending on its location. All of these factors should be taken into account in deciding how much break time a mother needs. Mothers need to understand that this break time is unpaid, unless the mother is using paid break time afforded to all employees.

Not for everyone
Not all businesses and employees are covered by FLSA and the new break time law. First, there must be “enterprise coverage” or “individual coverage.” Enterprises are those employers with annual dollar volume of sales of at least $500,000, hospitals, businesses providing residential medical or nursing care, schools and preschools, and government agencies. Individuals are covered if their work regularly involves interstate commerce such as the sales of goods across state lines, regular phone calls out of state, travel, or handling of interstate transaction records.

Some state laws provide similar coverage even when the FLSA law does not apply, and the DOL encourages all employers to provide this break time regardless of whether the law specifically applies to them.

The law also recognizes that providing this break time might cause “undue hardship” to small businesses with less than 50 employees. Employers claiming “undue hardship” are required to show that compliance with the law would cause them “significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer’s business.”

Setting an example at the top
President Obama has taken the spirit of this new law seriously and recently issued a Presidential Memorandum for the Director of the Office of Personnel Management to provide “appropriate workplace accommodations for executive branch civilian employees who are nursing mothers,” regardless of whether they are covered by the law. This builds on policies already in place for congressional staffers. House Speaker Nancy Pelosi created special nursing rooms in 2007, and the Senate is also required to make accommodations for breastfeeding staffers.

How you can help
The DOL is asking for public comment in creating official guidelines that employers and employees will use in implementing the break time law. Some of the issues the DOL has specifically asked for input on include:

• The law specifies that bathrooms are not appropriate places for pumping, but lounge areas connected to the bathroom might be sufficient. Under what conditions—if any—should these lounge areas be considered compliant under the law?
• What about locker rooms? Could they be appropriate nursing stations?
• The nursing station is not required to be a space designated solely for this purpose. What conditions might spaces such as managers’ offices, storage rooms, or utility closets be considered acceptable?
• What about workers who don’t have a fixed work setting—such as bus drivers, delivery workers, law enforcement officers, etc.? The DOL recognizes that creative thinking will be needed to make sure these workers have the opportunity and space for the nursing breaks required under the law.
• If an employee works offsite, what is the best way to ensure a time and space for her pumping needs?
• The DOL has created a website of resources for employers and employees. What kinds of information and resources would be most helpful to ensure compliance with the new law?

Send your comments…
Some businesses are already offering flexible work hours and private lactation rooms (read more about it here). Unfortunately, this is not the reality at every company. All working mothers deserve the time and space needed to pump and provide breast milk to their babies. So take a few minutes and make your voice be heard. You can share your comments on these and any other issues related to the new law one of two ways:

1. Federal eRulemaking Portal. Follow the directions provided for submitting comments.
2. Mail comments to:

Montaniel Navarro
U.S. Department of Labor
200 Constitution Avenue, NW
Room S-3502
Washington, DC 20210

Note that all comments received will be posted without change (including any personal information provided) to http://www.regulations.gov. Comments must be received by February 22, 2011.

One of my dearest friends, another mother who worked full-time outside the home, sent me a bouquet of flowers that morning. She knew what it was like.

What was it like? Not great.

I liked my co-workers, but my extremely regimented work environment frowned on flexible schedules, telecommuting, and even scheduling doctor’s appointments during the workday. There was no particular understanding of how breastfeeding worked or interest in providing guaranteed access to pumping times, and I often struggled to eke out time for just one pumping session a day. I didn’t mind the pumping itself, because it meant I could keep breastfeeding. (In fact, racing home to nurse my son was the highlight of every day.) But when I did pump in my office, people would knock on my door or call loudly for me when I didn’t answer right away. I was lucky to have an office with a door that locked—otherwise, I would have had to pump in a bathroom stall! Everyday, I stored my pumped milk in an insulated bag next to other people’s refrigerated lunches.

Generally, my return to work felt very isolating. Five months later, I quit my job to become a freelance writer and stay-at-home mom to Tommy. We continued breastfeeding for three years. It was the best decision for me—one I have never regretted.

Tommy is 4 years old now. In that short amount of time, things have changed—lactation or “mother’s rooms” have become the buzzword in large companies that want to be viewed as family-friendly. And with a major component of the Breastfeeding Promotion Act rolled into the newly-passed health care reform bill, breastfeeding mothers can celebrate the possibility of even more change in the workplace.

The Breastfeeding Promotion Act is meant to ensure a working mother’s right to express breast milk at work. After all, maternity leave in the U.S. usually ends at 12 weeks or before. If mothers aren’t given the time and space to pump milk, then it’s practically impossible to maintain a supply long enough to breastfeed for a year or more, let alone exclusively for six months, as recommended by the American Academy of Pediatrics and the World Health Organization.

An amendment of the Fair Labor Standards Act (FLSA) now requires employers to give women access to the time and space needed to pump for at least one year after their child’s birth. The pumping room must not be a bathroom, and it must be private. Lest anyone complain about burdens to small businesses, employers are not required to pay the women during these pump breaks, and employers with less than 50 workers are exempt from the requirements if they pose “undue hardship.”

Check out Working Mother’s 2010 list of 100 Best Companies and you’ll see businesses that offer flexible work hours and private lactation rooms. We know that’s not the reality of every company. But after talking to some mothers about their post-maternity leave work experiences, I have renewed hope that change is in the air.

Pamela Ferrill, public relations manager for CISCO (one of Working Mother’s 100 Best Companies), San Ramon, California
When Pamela returned to work four months after her 8-month-old daughter was born, she became part of a breastfeeding-friendly community of parents.

Her boss has two young children. A co-worker had twins on the same day Pamela had Megan. Another co-worker had a baby a week and a half after Megan was born. All of them are happy to share their experiences in parenting and breastfeeding. Pamela calls it “networking” and wonders whether it happens because they all work in public relations. Probably, she says, it’s because Cisco “is really a family-type company.”

When she works from home, she pumps in her home office. “I’ve got my breast pump next to my laptop,” she says. “It’s my second tool, so to speak.”

When she’s at work, she uses a mother’s room to pump, something found in every Cisco building. “They really do try to make it feel like home,” she says. And, “you feel like you have the privacy you need.”

On her way into the mother’s room, she’ll pass co-workers with smiles on their faces.  “They know what you’re doing,” she says. “It’s a supportive smile.”

And adds, “We all work very hard, but we know what’s important to us—our families.”

Robyn Booth, online project manager for HomeDepot.com, Atlanta, Georgia
Robyn was able to pump breast milk for nine months—quite a feat, considering that it’s very common for pumping mothers to experience a decrease in their supply at around six months. Now, her son takes formula and solid foods, but Robyn says that she owes her breastfeeding success in part to the “seamless transition” back to work after her 12 weeks of maternity leave.

It helps that she was one of four women who were all pregnant at the same time.

“We were all due a month apart from each other,” says Robyn, mother to 10-month-old Braxton. “Since we have all returned back to work, it has been nice to share experiences and milestones.  We all utilized the lactation facilities and felt nothing but support from our co-workers.  A few of the other moms have to leave by 5:30 to pick up their kids from day care and they have not had any problems in doing so.”

While Robyn was still pumping, her managers and colleagues were very accommodating. Says Robyn, “I have felt very supported as a working parent.”

She knew that her company supported breastfeeding because it offers onsite lactation  and other parenting classes, as well as two designated lactation rooms, each with a mini-fridge for storing breast milk, sink for washing pump parts, and magazines. It was no problem for her to schedule 2-3 pumping sessions each day.

“I have never felt any awkwardness from co-workers around pumping,” she says. “I have felt very supported…in my choice to breastfeed.”

Kathy Dixon, promotion marketer at General Mills (one of Working Mother’s 100 Best Companies), Minneapolis, Minnesota
“General Mills hired me when I was 37 weeks pregnant,” says Kathy. “It was amazing and kind of unheard of in corporate America.”

Kathy, mother to Jacob, 2, and Aubrey, 6 months and still breastfeeding, works at corporate headquarters, where there is onsite child care. That means she can drop in for quick visits throughout the day or to breastfeed, although she typically chooses to pump in one of several mother’s rooms, all of which feature hospital-grade pumps (employees simply bring their own attachments). There’s even room to display baby photos. Scheduling a pumping session is as easy as logging onto Outlook, selecting the lactation room closest to your office, and then picking up a key.

She also has flexible work hours. Right now, she’s working at 70 percent, meaning she goes to work Monday, Tuesday, and Wednesday and works from home on Thursday. Sometimes she leaves work at 3 p.m. and then gets back online at night.

“Everyone’s really supportive,” says Kathy. “Almost everyone on my team has kids, as well as my managers and director. The work culture is ‘as long as your work is getting done, do what you have to do.’”

Kathy’s access to pumping means that Aubrey has never had any formula. Kathy knows mothers who have breastfed their children for years, weeks, or not at all. “All of them are awesome, great moms,” she says. “[Breastfeeding] is what works for me and I’m lucky I work for a company that supports what I want to do.”

What if you aren’t so lucky?
For many women, Pamela’s, Robyn’s, and Kathy’s experiences are enviable. However, even if you don’t enjoy flexible work hours or access to a designated lactation room, you can still pump milk and breastfeed your child.

• Plan ahead. Before your child is born, get everyone around you (as much as possible) onboard for the reality that you are going to breastfeed, knowing that there might be challenges and you could use their encouragement. Take a breastfeeding class specifically aimed at mothers going back to work.

• Buy or rent a good quality double electric pump, especially if you are returning to work full-time and will be pumping regularly (and have limited time to do so). By pumping both breasts at once, you get more milk in a shorter amount of time. If you choose to rent a pump, the official word from the FDA is that only hospital-grade pumps may be used for more than one person. In other words, avoid using second-hand pumps that might be a source of infection. Plus, from a practical standpoint, the pump might not work as well the second time around. However, full disclosure: My sister gave me her barely used electric pump (seriously, I think she used it once, maybe twice). I sterilized what I could and purchased new attachments. I was intimately familiar with both the machine’s history as well as my sister’s squeaky-clean health, and it was a perfect arrangement that also saved me some money.

• Give yourself time. Learn the settings on the pump and figure out what works best for you. You’ll need to use enough suction to cause a let-down (the oxytocin-triggered release of milk from your breast). Pump until the flow of milk slows down, take a break for a few minutes, then pump again. Continued pumping will usually trigger an additional let-down or two.

• Consider investing in a pumping bra. These hands-free bras hold the milk collection bottles in place, so that you can go about your non-pumping business while pumping!

• Find support. For tips, information, and message boards flooded with moms like you, look for websites like Work and Pump and seek out co-workers who are also working mothers—camaraderie and knowledge are key components in breastfeeding success.

• Be honest. Be candid with management and co-workers about your pumping schedule and needs. And don’t forget to block out pumping sessions on your work calendar—those breaks are earned and need to be respected.

Mary Jessica Hammes is an Athens, Georgia-based writer, trapeze instructor, knitter, gardener, comic book enthusiast, and hula hooper. She is mom to Tommy.

A recent report in The New York Times explains that, despite the well-documented preventive nature of breastfeeding for both babies and their mothers, the IRS refuses to consider the cost of breast pumps and accessories as eligible for payment through the Flexible Spending Accounts (FSA) unless medically necessary. FSAs allow employees to set aside pre-tax income to pay for medical expenses not reimbursed by insurance. New rules for FSAs will go into effect in January 2011; unfortunately, the status of breast pumps will not change. As the Times article points out, “While breastfeeding supplies weren’t allowed under the old regulations either, one major goal of the health care overhaul was to control medical costs by encouraging preventive procedures like immunizations and screenings.” Apparently the IRS puts breast milk in the same category as eating healthy foods, such as oranges to prevent scurvy. No one disputes the value of healthy eating, but the IRS draws the line at subsidizing healthy eating with tax breaks.

According to the article, the American Academy of Pediatrics requested that breastfeeding-related costs be reclassified as “[a] medical care expense.” So far, the IRS has denied requests to change these regulations, stating that it would take an act of Congress to change the tax law.

United States Lactation Consultant Association (USLCA) sent a letter in March 2009 stressing the preventive care aspect of breastfeeding. These two approaches represent an interesting dichotomy perhaps lying at the heart of the IRS’s reluctance to change. Breastfeeding is normal and “natural,” and as much a part of human existence as breathing and digestion. “Medicalizing” breastfeeding makes it more complicated and appears to make the natural abilities and instincts of mother and baby secondary to the advice of the health care professional.

As noted in an Academy of Breastfeeding Medicine blog by breastfeeding researcher Alison Stuebe, MD, MSc, if breast pumps are added to the FSA-eligible list, then are we opening the doors for heavy marketing campaigns by the breast pump companies to sell every woman a breast pump—whether she needs it or not? Dr. Stuebe also points out that the Times article fails to mention that the services of lactation consultants “who play a critical role in helping mothers overcome early breastfeeding difficulties” and donor milk are also not listed as eligible or ineligible in the IRS guidelines. That means that individual insurance companies make decisions as to what is reimbursable and what is not. Some will pay lactation services, some only pay if a mother is unable to breastfeed, and some won’t pay at all.

Breast pumps as preventative care
A recent USLCA publication, Containing Health Care Costs Help in Plain Sight—International Board Certified Lactation Consultants: Allied Health Care Providers Contribute to the Solution asks on the cover, “Reimbursement of the IBCLC yields a significant return on investment. Why pay more for disease when prevention costs less?” Certainly there are times when specific breastfeeding problems require medical intervention, be it for treatment or medication. But the benefits of using a breast pump go beyond medical. From the USLCA letter:

“Under current specifications, the cost of purchasing or renting a pump cannot be reimbursed under FSAs unless the mother or child suffers from a specific medical condition that prevents nursing. This policy leaves millions of mothers with breastfeeding problems, but not diagnosed with a medical condition, and working mothers, without the financial assistance to obtain a breast pump. Without the availability of a quality pump, these mothers may be forced to wean prematurely.”

Mothers eligible for WIC services (typically low-income families at risk for nutritional deficiencies) are likely eligible for the loan of a hospital-grade breast pump through the WIC program. Says USLCA President Laurie Beck, RN, MSN, IBCLC, “Not every mother qualifies for WIC and most young childbearing families do not have the money necessary to rent hospital-grade double electric breast pumps. They try to go cheap and buy pumps that either cause maternal damage to the breasts or don’t establish a milk supply. Mothers wind up just switching to formula because their milk supply was mismanaged.”

Breast pumps, while certainly not a requirement for successful breastfeeding, are ubiquitous, and with good reason. They can make the difference for a mother who works outside of the home and who wants to continue providing breast milk to her baby, and they can be a lifeline for mothers whose infants are unable to nurse for whatever reason—prematurity, illness, latching difficulties. Just as with most any mechanical device, there are good quality pumps, and there are cheap pumps. The good ones, especially the hospital-grade pumps, work nearly as well as a baby at the breast when considering comfort and milk yield. A year’s worth of pump rental could run between $500 and $1,000.

Not only do these breast pumps often make the logistics of providing milk for babies unable to nurse at the breast workable, but the potential in health care cost savings would more than offset the loss of tax revenue. A recent study by the Harvard Medical School estimated that the U.S. could save $13 billion a year in health care costs if 90 percent of mothers followed advice from the AAP (and others) to exclusively breastfeed their infants for six months. Imagine what $13 billion could do for the U.S. economy if it were spent on something other than medical bills.

On a cautious note, we should be careful that this public outcry for reimbursement for breast pumps doesn’t feed into the “every mother needs a pump” mentality. Likewise, we should guard against these efforts becoming focused less on exclusive breastfeeding and more on exclusive breast milk feeding—or breastfeeding advocates will find themselves as uncompensated salesmen for the breast pump companies.

The Times article has become a rallying cry for breastfeeding supporters. Let’s hope the IRS pays attention—but that we don’t turn the breast pump into the new symbol for breastfeeding mothers.

Editor’s Note—February 10, 2011
In response to requests from U.S. Senators Jeff Merkley (D-OR), Tom Harkin (D-IA), and nine other Senators, and Representatives Sander Levin (D-MI), Carolyn B. Maloney (D-NY), and 32 other House members, the IRS reversed its previous ruling. Breastfeeding equipment, including pumps, will now be an allowable medical tax deduction, reimbursable via flexible spending accounts. According to the February 10, 2011 press release letters were sent in November 2010, in response to the previous ruling.

The Senators and Representatives highlighted the obvious—the preventive health benefits to mother and baby, the high cost of purchase or rental of good breastfeeding pumps, and that reversing this ruling would make breastfeeding more affordable for those mothers who must pump breast milk due to medical reasons or a return to work. This reversal dovetails nicely with the Break Time for Nursing Mothers’ Law recently passed as part of the Patient Protection and Affordable Care Act.

In response to today’s decision, Senators Merkley and Harkin and Reps. Levin and Maloney released the following statement:

“Today’s decision is a huge victory for nursing mothers everywhere. Modern medicine has documented numerous health benefits linked to breastfeeding, including a reduced risk of illness in infants and a reduced risk of cancer in mothers. And because breastfeeding is so effective in preventing disease, it also happens to save billions in health care costs. We thank the IRS for their careful consideration and quick response.”

Breastfeeding… For My Baby. For Me was launched on September 9 and features TV spots, online ads, and ads on buses and bus shelters statewide. The $1.6 million campaign is being funded with money awarded by the United States Department of Agriculture (USDA) in recognition of New York’s Women, Infants, and Children (WIC) program—one of 10 programs nationwide with the highest breastfeeding rates.

In an official press release, USDA Food and Nutrition Service Northeast Regional Administrator James C. Arena-DeRosa praised New York’s DOH-administered WIC program for using the award to further promote and support breastfeeding across the State, saying, “It’s admirable that New York State WIC took this opportunity to continue to build upon its successes in promoting breastfeeding and that it continues to provide the information and support WIC mothers and their families need to successfully breastfeed.”

The campaign—which coincides with the release of the 2010 Breastfeeding Report Card from the Centers for Disease Control and Prevention (CDC) in which New York boasts an 81.4 percent breastfeeding initiation rate (compared to 75 percent nationwide)—addresses the basic elements that are essential to breastfeeding success: family support, work place support, health care provider support, and community support.

The campaign also touts the many health benefits of breastfeeding for mothers and babies. One particular benefit—helping mothers more easily lose the baby weight gained during pregnancy—is being praised by some and panned by others (you can see the commercial here). But it’s only a small part of the comprehensive campaign that also highlights breastfed babies’ reduced risk for asthma, obesity, diabetes, and other chronic illnesses.

This isn’t the first time a breastfeeding campaign message sparked discussion, which could distract from its overall mission. You might recall the National Breastfeeding Awareness Campaign in 2005 and more recently Breast Milk Satisfies, a campaign sponsored by the Ohio Department of Health.

But surely there’s one thing that we can all agree on: Breastfeeding… it’s good for baby and good for mothers. It’s a message New York wants its moms to hear.