Breastfeeding in the Work Place

Last night on CNN Campbell Brown addressed the case of LaNisa Allen, the mother of a 4 month old who was fired by Totes/Isotoner because she was taking pumping breaks to provide breastmilk for her baby. While other employees could take smoke breaks or bathroom breaks, LaNisa lost her job for taking the same length break.

In her introduction, Brown talked about how lucky she is to have an employer who allows her to pump milk regularly for her baby. Not all women have that opportunity, however. Rep. Carolyn Maloney (D-N.Y.)also appears on the segment talking about a bill she has sponsored, The Breastfeeding Promotion Act. Maloney's bill would provide protection for breastfeeding in the workplace under civil rights law. No woman could lose her job or be discriminated against in any other way for pumping during a break. Employers would have to provide break time to pump. They would also be required to try to find a private, secure place for nursing moms to express their milk. It would provide a tax credit for up to fifty percent of any expenses an employer incurs as a result.

We have a lot of working moms come into A Nurturing Moment. Many of them are professional women who have lactation rooms at their companies or who have private offices. Nevertheless, we still see many mothers like LaNisa who have to pump in a restroom, arguably the most germ-filled place in the whole company. No mother should have to pump in a bathroom! So we tell moms that we will work with their human resource director to help make pumping work for them.

Pumping Benefits Everybody
The U.S. Department of Health and Human Services has put together a comprehensive guide for employers called The Business Case of Breastfeeding. This material is available free of charge to companies. It details the many benefits to the company itself when it creates a lactation support program.
- Greater employee satisfaction
- Higher retention rates
- Reduced employee absenteeism
- Lower health-care costs for babies receiving breastmilk

We will help companies evaluate their situation to find the optimal lactation program that will work for them. We will even contract with them to provide on-site breastfeeding support and education for their employees and for spouses of employees.

LaNisa's little boy is now four. She took her case against Totes/Isotoner all the way to the Ohio Supreme Court where she lost. They said the case was about her taking unauthorized breaks. I wonder what the company would have done if she was smoking instead of pumping? My bet? She'd still have her job!

Human Milk in the NICU

In February of 2009 the National Association of Neonatal Nurses Board of Directors published a position statement entitled "The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit."
Based on a body of research which clearly demonstrates the superiority of human milk for premature infants, this position statement clearly enunciates optimal guidelines which should all NICU nurses should follow.


Responsibility toward the Mother
It is critically important, according to this position statement, that mothers be provided a hospital-grade double breastpump and pump kit. They should be encouraged to pump every 3 hours for optimal milk production. Keeping a pumping log will help both mother and healthcare provider to make assessments and adjustments. Receiving the mother's colostrum helps prepare the immature intestine by coating it with Immunoglobulin A. Fat content is an important factor when looking at the milk a mother pumps for her preterm baby. The paper recommends the use of a crematocrit to determine the fat content in order to determine how much human milk fortifier might be necessary to provide the caloric value necessary for optimal growth and development.

Responsibility toward the Infant
Obviously the neonate is the nurse's primary patient. Studies show that even a preterm baby as young as 28-30 weeks can demonstrate rooting and areolar grasp and latching behavior. Skin to skin exposure has been shown to have a myriad of benefits. After pumping a mother can allow her baby to nuzzle and lick her empty breast. The authors of the position paper recommend the use of a nipple shield to help the premature infant suckle more effectively and obtain more milk in early feeds.

The publication of this position paper is an important step in validating what many NICU nurses already knew. As research-based evidence continues to mount about the amazing benefits of breastmilk for at-risk infants, hopefully we will see more and more breastfeeding support in NICU's everywhere!

Breastfeeding Claims Under Attack...Again

In an article published on abc.com on April 27, Lauren Cox asserts that claims about the benefits of breastfeeding are overblown. This comes about a month after that Atlantic article in which Hannah Rosen disputed the medical benefits of breastfeeding. I actually responded to the Atlantic article in a previous post.

This interesting timing of these 2 articles undermining the benefits of breastfeeding in such a short period of time makes me wonder what's up. I've thought of several possible reasons
1. Some mothers may feel pressured by the growing pro-lactation movement and are reacting to that perceived pressure in writing.
2. Maybe the artificial human milk industry has done a pretty decent job of convincing the general public that breastmilk and infant formula are about equal.
3. Or perhaps, as I wrote in my previous post, the studies that do indeed show conclusive benefits are titled and the abstracts are written in such a way that artificial milk isn't depicted as a causative factor in multiple negative infant outcomes.

Whatever the reason, it is more important than ever that breastfeeding advocates rely on solid scientific evidence for every claim we make. The American Academy of Pediatrics Policy Statement, Breastfeeding and the Use of Human Milk, contains 216 references to studies, scholarly articles, and public policy documentation dealing with the superiority of breastmilk over artificial milk for infants. While it may not be feasible to read every study in detail, a cursory review of this literature demonstrates overwhelming, objective evidence gathered in reproducible study conditions that repeatedly prove the inferiority of milk substitutes.

It is true that some mothers are unable to breastfeed for one reason or another. And some mothers do struggle with supply issues. A lact-aid with supplement can help. Nevertheless, there is an International Code of Marketing of Breastmilk Substitutes which strictly prohibits many of the kinds of marketing which the large infant formula companies do in this country. Until the United States government decides to enforce this code, we will continue to see the systematic undermining of breastfeeding in this country. No doubt about it, our work is cut out for us! But we have science and nature on our side, and that's a winning combination!

DHA in Infant Formula

A report released last year by the Cornucopia Institute, a Wisconsin based group devoted to fighting for the family-based farm, raises some very serious questions about the safety of the DHA and ARA that are added to many infant formulas. Much of the concern comes from the way in which these additives are produced in the laboratory setting.

What Is DHA and Why Is it Important?

DHA stands for docosahexaenoic acid. It is a long chain Omega 3 fatty acid which occurs naturally in breastmilk, in many cold water fish, in eggs, and in some algae and fungi. It can be synthesized in the liver, from another Omega 3 fatty acid that is found in foods like walnuts and canola oil. It is also found in the grey matter of the brain. Many researchers believe that the presence of DHA in the infant diet optimizes brain development.

What is ARA and Why Is it Important?

ARA stands for arachidonic acid. It is a long chain Omega 6 fatty acid which also occurs naturally in breastmilk as well as in some meats and in eggs. Like DHA, it is also found in the brain, and is considered to be a key component for optimal brain development. If DHA is added to infant formula without ARA, the aomount of ARA inthe infant's tissues actually decreases. For that reason, these two fatty acids are always added together.

How Are These Acids Created in the Lab?

Martek Biosciences Corporation has patented a process to create both DHA and ARA in the laboratory setting. The problem is that the laboratory products are not the same as the naturally occurring products in human milk. In fact, the DHA that is added to formula is actually DHASCO (docosahexaenoic acid single cell oil), and the ARA is actually ARASCO (arachidonic acid single cell oil). They are strudctually different from the DHA and ARA that a breastfeeding infant receives.

DHASCO is created from algae grown in tightly controlled fermentation conditions in a solution of glucose and yeast. Then the oil is extracted using hexame, a toxic petroleum by-product that has been associated with disorders of the central nervous system. The hexane is then removed. What remains is only about 40-50% DHA in a dilution of sunflower oil.

ARASCO is extracted from soil fungus using a similar process. According the Martek documents hexane is used in the processing of ARASCO as well.

Do These Additives Improve Formula?

The makers of infant formulas like Lipil and Good Start are quick to say they do. In fact, they claim that formula is now more like breastmilk than ever before. Nevertheless, ongoing research fails to show a significant beneficial effect. In early documents marketing their DHASCO and ARASCO to the formula companies, they claimed that even if these additives didn't make a difference, they could be "widely incorporated into infant formulas, as a marketing tool...." (Quoted in International Baby Food Action Network (2004) Breaking the rules, stretching the rules 2004: evidence of violations of the international code of marketing of breastmilk substitutes and subsequent resolutions.” , edited by Yeong Joo Kean and Annelies Allain. Available online at http://www.ibfan.org/english/pdfs/btr04.pdf. Last accessed on July 17, 2007. Source of the quote: Martek Biosciences Corporation, Investment Thesis 1996.)

Do They Cause Any Harm?

According the the Cornucopia report, the FDA has received 98 reports of adverse effects in infants that have been attributed to the use of DHASCO and ARASCO fortified formulas. One of the most common complaints is intestinal problems characterized by diarrhea. Some babies have even suffered dehydration and been admitted to Neonatal Intensive Care Units as a result of their inability to tolerate this formula.

What Should the Consumer Do?

Ideally, every mother would breastfeed her baby. However, some mothers face real struggles with nursing or find themselves in a situation where they must use formula. It is wonderful to live in a country where safe infant formula is readliy available. Nevertheless, mothers must recognize that no formula will ever replicate all the qualities of breastmilk. A mother should talk with her pediatrician about any concerns she has. If she is using a DHASCO/ARASCO enhanced formula and notices any gastro-intestinal symptoms, she should immediately contact her doctor and change to a formula without these addititives.

Mothers must always remember that they are the first and most important advocate their children will ever have. When it comes to feeding time, a mother must be sure she is truly giving her baby the best possible nutrition. Perhaps the Cornucopia report will help mothers do just that!