Employer-Based Programs to Support Breastfeeding: Lactation Rooms and Pumps

Popular knowledge is that the United States has a major problem in supporting mothers who wish to continue with exclusive breastfeeding at least for 3 months, let alone for the recommended 6 months. The absence of paid maternity leave, except for rare state programs (such as in New York, California, New Jersey, and Rhode Island, which have enacted programs to provide partial pay to workers taking time off to bond with a new child), is most likely “a” if not “the” major variable that results in the disappointing statistics. As such, for want of a better solution, the emphasis has been on the development of employer-based programs that provide proper designated clean facilities and adequate release time during the work hours to allow for pumping and storing mother's own milk. Such programs, in turn, result in the availability of adequate volumes of mother's milk and thus facilitate an infant being at least nourished exclusively by human milk while not exclusively breastfeeding.

In this issue, a major review of such programs is presented by Dinour and Szaro. Among their conclusions is that such programs need not be just the responsibility of large corporations or offices but that such breastfeeding support can be provided at minimal cost even in small businesses with small workforces. What I find striking is that this is not just a problem of the United States (with its 2014 exclusive breastfeeding rate of 44% at 3 months and <23% at 6 months ¹ ) but also a problem of the country with the largest workforce, that is, China. The Chinese economy is highly dependent on full participation of women in the workforce. China does not have paid maternity leave benefits. This results in a decreasing exclusive breastfeeding rate at 6 months of less than 28 percent. ² Not surprisingly, China also does not have a countrywide culture of workplace support of breastfeeding. Hopefully this review article will serve as an incentive for the Chinese public health authorities who are concerned about the poor breastfeeding rates and provide a guide for their health planning for the development of workplace programs. This is of particular importance, if not urgency, as they are undergoing a baby boom secondary to the recent abolishment of the one-child rule.

To facilitate both employer-based programs and as an end unto itself, the breast pump has become an increasingly “standard” item for infant care, especially in middle-class college graduate women. Baby showers typically now include presenting the new mother with the latest electric milk pump along with the standard presents of baby clothes, toys, picturesque mobiles, infant carriers, and the like. The increasing use (and potential value) of such pumps for an inner city low-income population is discussed in this issue by Bream and colleagues. Somewhat to their surprise, they found that although breast pumps were free, breast pump use among predominantly African American Women, Infants, and Children (WIC)-eligible mothers was not associated with increased rates of exclusive breastfeeding at 1.5 months postpartum.

Thus, it is clear that pumps are neither a panacea to compensate for the lack of paid maternity leave nor can their use be promoted without fully understanding the specific cultural context of mothering in general and breastfeeding procedures in particular. Furthermore, beyond semantics, one has to be careful and not equate the feeding of human breast milk with breastfeeding. Similarly, one has to be cautious about equating the quality of suckled milk with that obtained through the pump. The majority of the differences relate to the handling, storage, freezing, and thawing processes that pumped milk undergoes. However, there is need to study whether there are any inherent differences in the milk obtained directly by the baby and that obtained from the pump, be it in the microbiome or the live cellular elements of fresh human milk.

Although issues of exclusivity of breastfeeding are the main interest of the already cited articles, the flip side of the consequences of inadequate amounts of breast milk is the focus of the article by Boskabadi and colleagues who reported on long-term neurodevelopmental outcomes of infants who were hospitalized with hypernatremic dehydration. Their disturbing report should alert us to the greater challenge of avoiding primary breastfeeding failure and the consequences in high-risk infants, such as the late preterm, who all too often are those who fall between the proverbial cracks of a healthcare system that does not provide proper monitoring of the infant in the immediate postdischarge period.

A final note is I would like to take the opportunity to publically thank Dr. Wendy Brodribb for superb chairing of the Academy of Breastfeeding Medicine (ABM) Protocol Committee. Under her leadership and guidance, Breastfeeding Medicine has been able to publish on a regular schedule, of every other issue, a new or updated protocol. As a result, ABM has been able to maintain its deserved international reputation as the primary source for breastfeeding management protocols. The next protocol will be published in the May issue; the topic will be Supplementary Feedings in the Healthy Term Breastfed Infant, so stay tuned!