HEALTH
01/31/2018 04:14 pm ET Updated Feb 01, 2018

For Breastfeeding Moms, A Difficult Choice: Work Or Pump?

Insufficient legal protections and indifferent workplaces have caused many women to fall short of pediatric guidelines.
Ji Sub Jeong/HuffPost Photos: Getty

Before she left for eight weeks of unpaid maternity with her second baby, Jen   — a dental hygienist from Indiana — made sure to tell her practice’s office manager she planned to keep breastfeeding when she returned, which would require pumping throughout the day.

The office manager spoke to the dentists in charge. They informed Jen, who is an hourly employee, that she’d need to clock out every time she pumped, meaning she’d be docked the time.

Eight years ago, the Affordable Care Act mandated that employers provide women with reasonable break time in which to pump and a space to do it, though businesses with fewer than 50 employees can apply for an exemption if they can prove the policy burdens them.

Jen, who asked to not to use her real name out of fear of employer retribution, wasn’t sure if her practice had officially received an exemption, or whether she was covered by the policy as a contract employee. But she didn’t want to push it. She was worried about losing her job. And with two children to support, it was a risk she felt she could not take. 

So for three months, the 31-year-old tried her best to swing it. She got to work by 7:45 a.m. every day, flying through her first appointment so she could clock out, run to her car, pump, wipe down her pump parts, throw her milk into the refrigerator, and be ready for another patient — all in about 20 minutes. At lunch, Jen repeated the routine, eating and pumping in the dental practice’s bustling parking lot, trying to avoid eye contact with the patients whose mouths she knew she’d soon be staring into. 

One day, she decided enough was enough. She was losing two hours of work a week ― or about $60. Her milk supply was shot. A co-worker had complained it was gross to see Jen’s breast milk in the communal fridge. She considered asking her bosses for more time or some help with the arrangements, but she didn’t want to get fired. Five months after giving birth, Jen stopped breastfeeding altogether. 

“I was disappointed that I didn’t make it as long as I wanted to,” she told HuffPost. “But honestly, it was also a relief to not have to fumble with it all and to try and make it work.”

While some medical professionals, writers and mothers have in recent years pushed back against the one-time dogma of pushing breastfeeding, the research is nonetheless clear that there are health benefits to moms and babies, particularly in the infant stage. Babies who are breastfed have decreased risk for diarrheal diseases, infection and even sudden infant death syndrome, and nursing a baby can help postpartum mothers heal. 

The public health goals pediatricians have laid out for breastfeeding mothers are clear: six months of exclusive breastfeeding, followed by breast milk and complementary foods through at least the first year. But as has been well documented, the number of mothers who actually hit those goals is relatively small — and experts point to the lack of support and public health infrastructure once women leave the hospital as reasons why many fall short.

In the United States, 80 percent of moms start out breastfeeding, a rate that has greatly improved as hospitals have adopted policies to support nursing moms and education has spread. But by six months, only 50 percent of moms are still going, and at one year, it’s down to 27 percent

There is a tendency to lay the blame at the feet of women, who are told in direct and oblique ways that breastfeeding is their responsibility. But the reasons why women abandon their goals are complex and often systemic. Pumping at work is at best drudgery, if not downright impossible, and many new moms often find their only “choice” is to quit pumping or quit their jobs, despite public policies that are supposed to protect them. 

Ji Sub Jeong/HuffPost

Barriers To Meeting Guidelines

Even with some protections in place for nursing mothers at the office, there are other fundamental impediments for women meeting breastfeeding guidelines. One of the biggest factors is the lack of parental leave policies in the U.S., which lags behind other developing nations on the issue, and is one of the only countries in the world that doesn’t mandate paid leave. 

A quarter of American women return to work less than two weeks after giving birth — often when they’re still bleeding and just days after their milk comes in. And about 40 percent of workers are not eligible for the Family and Medical Leave Act, meaning they have zero guarantee that their job will be waiting for them if they choose to take any kind of leave.

But the research is clear that longer leaves and higher breastfeeding rates go hand-in-hand. In a 2011 study in the journal Pediatrics, moms who went back to work after 13 weeks were almost twice as likely to still be giving their babies predominantly breast milk at that point than those who returned sooner. A 2011 study in the American Journal of Public Health found that a woman who returns to work after having a baby has more than double the odds of quitting breastfeeding in her first month back than a woman who stays home. 

There is a physiological basis to these differences. Babies are uniquely adept at getting milk from their mothers’ breasts, which signals to the body that it is time to produce more milk. Breastfeeding is fundamentally a supply-and-demand process, and babies are just better at it than breast pumps.

“Pumps rely on sucking, but infants don’t just suck at the breast. They compress it with the tongue, so in effect you’re doing two very different actions,” explained Julie Matheney, a Los Angeles-based lactation consultant.

Better pumps will go a long way toward making breastfeeding at work more manageable, she added, and they are on the horizon. But there are other factors at play. Women experience a love-related hormone rush when they nurse their babies at the breast that triggers the letdown reflex and helps milk flow. That can be challenging to replicate with a bottle, some plastic tubing, and a wheezing machine. Matheney says the work she does with mothers often involves teaching them how to try and “woo” their pump. 

Plenty of women are able to maintain sufficient breast milk supply and breastfeed for as long as they want after returning to work, but much like Jen, they encounter workplaces that are not supportive of breastfeeding in meaningful ways.

Workplace Guidelines Fall Short

The provisions put in place when the Affordable Care Act amended the existing Fair Labor Standards Act (FSLA) were meant to make it easier for many women. Employers across the country must provide employees with a “reasonable break time” to pump for one year after giving birth, every time they need to do so. And workplaces are required give women a private space — not a bathroom, but not necessarily a permanent, dedicated lactation room — in which to pump. 

“We think this was a great first step. It was huge. It allowed many women to be able to pump,” Tina Sherman, campaign director for breastfeeding and paid leave with the advocacy group MomsRising, told HuffPost. She added that many states have their own additional protective policies.

“But unfortunately it still leaves out millions of workers,” she added. 

Businesses with fewer than 50 employees are exempt from the ACA provision, provided they can show the policy places an “undue burden” on them. The provision also applies only to employees who are considered “nonexempt” under the FLSA — basically, those whose employers are required to pay them overtime beyond 40 hours a week.

“As of right now, 60 percent of working moms don’t actually have an adequate place to pump,” Sherman said. “They don’t have adequate break time, or a private space to pump in the workplace.”

A 2015 study in the journal Pediatric Clinics of North America found that the number of employers providing on-site lactation rooms had actually decreased in recent years.

Even many women whose employers are legally obligated to adhere to baseline pumping policies say they are on their own, and that is true across industries. 

HuffPost ran a Facebook callout looking to hear from women with workplace pumping problems, and stories poured in from women who work as nurses, teachers, consultants, administrative employees, sales representatives, restaurant workers, and more. One woman described having to pump in her office’s only single-stall bathroom as colleagues banged on the door. An attorney said she has walked into court covered in breast milk on multiple occasions after pumping in the parking lot while colleagues walked by.

A health care employee, who also asked not to use her name, said she received as many breaks as she needed, but that she had to use her supervisors’ offices, which meant asking them to clear out every time she needed to pump. 

“I had one supervisor who always had comments like, ’How long are you going to breastfeed, until he’s 10?” she recalled. Her baby was 3 months old at the time. 

Elizabeth, a 35-year-old public school teacher from Massachusetts who asked that only her first name be used, tried to pump when she returned to work after delivering her second baby in 2015, and she managed it for two months. But she had to run from class to what she described as a “very dirty bathroom” on the opposite side of the school near the recess yard, and fit in setup, pumping and break-down in 15 minutes or less.

“There was one time I had put milk down, and a ball hit a window,” she said. “I watched this, like, inch ball of dust float down and there was nothing I could do before it settled in my 4 ounces of milk.”

“In this industry that feels so female heavy, I was so shocked that was the kind of space and accommodations we were given,” she added. “I know that we are tight on space, I get that. But it just feels, like ... teaching is a lot of young women at childbearing age. It just felt really surprising that it was so challenging.”

Faced with an environment that makes pumping difficult for women, some are increasingly looking to the courts for a legal recourse. 

The ACLU has filed discrimination complaints on behalf of a handful of female flight attendants and pilots with Frontier Airlines, all of whom say the company failed to accommodate pregnant and breastfeeding employees. The flight attendants described having to work 10-hour shifts with no breaks for them to pump. A class action lawsuit is currently before the Equal Employment Opportunity Commission and will soon be filed in federal court, ACLU staff attorney Galen Sherwin told HuffPost, although she was unable to provide further details on a likely timeline. 

“I think people are looking at it closely,” Sherwin said of the case. “Certainly, I think it would be the largest case that has been filed related to accommodations for women who are breastfeeding on the job. All of the other lawsuits have been individual cases.”

Frontier did not immediately respond to HuffPost’s requests for comment, but has previously told news outlets the company complies with state and federal law. 

For now, so much of the onus falls on women to understand to what degree they are covered by state and federal requirements concerning pumping, Sherwin said. 

Elizabeth, the teacher, is expecting her third baby in a few months, and while her plan is to continue breastfeeding after she returns to work, her past experiences have made her skeptical that she will be able to succeed. She certainly does not expect any additional support from her workplace this time around.

“I feel really overwhelmed by the lack of time I have now and cannot fathom adding another piece to any moment of my day,” Elizabeth said. “I feel defeated before I’ve even had this baby.”

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