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Juggling Babies and Work

"If breast is best, why are women bottling their milk?"

That's the question posed by Jill Lepore in The New Yorker this week. Lepore runs through the long history of breastfeeding before getting to the crux of her question. As we continue to put our emphasis on providing better, faster, smaller breast pumps and posher, fully stocked lactation rooms at workplaces, are we missing the point?

Is it the mother, or her milk, that matters more to the baby? Gadgets are one of the few ways to 'promote breast-feeding' while avoiding harder—and divisive and more stubborn—social and economic issues.

Two recent studies released in Pediatrics, the journal of the American Academy of Pediatrics, look at the work/breastfeeding landscape. And what these studies find is that the more maternity leave a mom gets and the easier it is to keep mom and baby physically together, the more likely she is to breastfeed her child for a longer period of time. Parental leave is one of those policies that the U.S. continues to lag on worldwide.

"Feeding the infant from the breast during the work day is the most effective strategy for combining breastfeeding and work," wrote Dr. Sara B. Fein and others in Success of Strategies for Combining Employment and Breastfeeding in October. "Ways to enable direct feeding include on-site child care, telecommuting, keeping the infant at work, allowing the mother to leave work to go to the infant, and having the infant brought to the work site. Establishing ways for mothers to feed from the breast after return to work is important to meet U.S. breastfeeding goals.

And a study released this month shows that moms in managerial or autonomous positions as well as moms with flexible work schedules are more likely to breastfeed their children for longer.

Maybe it's just me, but all this seems like common sense. If you're a barista at Starbucks who can take only a short maternity leave and you have to pump in the bathroom -- if you're allowed to take a pumping break at all -- you're more likely to turn to formula than if you're a mom who is able to telecommute from home or put your child in a day care conveniently placed at your office.

While I don't agree with Lepore fully, she has a point. If we look at breastfeeding as something purely to be accomplished by gadgets, we are missing the point. But the real question I see is this: What do we, as a country, do about promoting the needs of parents so that we can be both good parents and good employees?

What policies should parents unify around and push to become standard? Better leave? Subsidized child care? Telecommuting? All the above and more?

By Stacey Garfinkle |  January 16, 2009; 7:30 AM ET  | Category:  Babies
Previous: Do Dads Whine Less Than Moms? | Next: Teaching The Why of the Dream


How about even a generalized recognition that family is important, both for men and for women?

I can speak only to my family's experience, but it seems like the pressure on working parents (particularly dads) to act as if work is the #1 priority has been racheting up in this past year. I'm talking work hours expanding from 8 am to 6:30 pm, meetings and conference calls scheduled on weekends and evenings, and forget about such niceties as paternity leave. It's as if employers know they have their workers over a barrel in this economy and are doing all they can to wring workers dry because there simply aren't many other jobs out there.

Posted by: newsahm | January 16, 2009 8:03 AM | Report abuse

Ditto (what newsahm said). It's very scary and tough on "quality family life".

Posted by: ishgebibble | January 16, 2009 8:50 AM | Report abuse

newsahm- I don't disagree with your point about pressures on the family, but I think the pressures on businesses in this economy are more to blame than employers' desire to "wring the workers dry". The economy stinks. We all are having to work harder. I look forward to the day when I am more worried about breastfeeding than I am about keeping my job.

Posted by: jjtwo | January 16, 2009 9:04 AM | Report abuse

On-site daycare would be my biggest wish. I'd love to nurse at least at lunchtime. I'm one of the unlucky ones who couldn't produce for a pump, so the great pumping environment I had was useless to me. I lasted 6 months before I was dry. I'm apparently also one of those women who doesn't keep up milk production even with 3 nursing sessions a day.

However, the likelihood of on-site daycare is slim to none, since my gov't agency is cutting work/life programs. This despite the fact that there are 2-year wait lists for the few agency-sponsored daycares we have. Those daycares are no good to me anyway since they don't have part-time slots, and my husband works part-time.

As far as telecommuting, we can do it, but you also sign a waver saying you will have childcare during that time, which makes sense. How much work can you get done while caring for an infant? Ditto for keeping an infant at work.

I don't have time enough to drive to see my kids, so that's out, unless I want to work longer days. No thanks.

As far as bringing the infant to me, I hope my husband will do that a couple times a week. It worked well for one of my coworkers. But unless your spouse is at home, how would that be possible? I guess a nanny could do it.

Posted by: atb2 | January 16, 2009 9:07 AM | Report abuse

Geez- I feel guilty enough as it is leaving my 7-month-old in daycare, but now pumping isn't good enough? Well that's fine because it sucks (no pun intended) anyway. I have on-site daycare, but I still don't have time to go feed my daughter four times in an eight hour day (which is her current feeding schedule). I guess extended paid maternity leave would be the best solution for me, but I won't hold my breath.

Posted by: snuggie | January 16, 2009 9:28 AM | Report abuse

I'd like to see some acknowledgment that parents and children contribute essential human capital to our society. But that's a long-term benefit in a quarterly report society. Making it easier for parents to raise their kids using "best practices" is a social benefit that accrues to all of us. We need to be careful about being so short-sighted economically.

Posted by: annenh | January 16, 2009 9:31 AM | Report abuse

When I returned from my 12-week maternity leave, I pumped twice a day, and nursed my child during my lunch break. I did this schedule for 6 months!! Yes, it was difficult to drive to his daycare to nurse (15 min one way), but I had to do it in order to keep up my supply. When he reached 9 months, I pumped 3 times a day and supplemented with formula to keep up with his needs. Finally, at 12 months, he transitioned to whole milk.

I was only able to keep up with the pumping due to my extrmmely supportive co-workers and boss. Yes, I ate lunch at my desk, and even pumped during conference calls (thank goodness for a mute button and my own offcie). But the effort, to me and my son, was worth it!

It is unfortunate that other work environments are not as supportive. BTW, I work for the federal government.

Posted by: LikeaPanda | January 16, 2009 9:46 AM | Report abuse

I think it would be good if job descriptions weren't written as if they were only for single people without children or other responsibilities. That'd be a good start. I'm saying this as a Blackberry carrying, 24/7 kind of worker who loves working for a living, loves the satisfaction it brings me, loves the paycheck. But it is not the be all end all of my life. My family is my number one priority. I have had the good fortune and skill to work my way into positions that had a lot of flexibility, but I think consideration needs to be given primarily to those who don't have it -- mainly, non-exempt workers. My $.02.

Posted by: WorkingMomX | January 16, 2009 9:48 AM | Report abuse

It's irritating to me that now it's not good enough to provide your child breastmilk but you absolutely must breastfeed. I'm expecting twins in the spring and intend to as much as I can to supply breastmilk to my children but I'm not going to kill myself to only breastfeed them because now the AAP has found another way to tell women that whatever they recommended before isn't good enough.

So incredibly irritating.

Posted by: danielle514 | January 16, 2009 10:04 AM | Report abuse

Danielle - so because everyone can't do everything should we just stop making recommendations for how best to keep kids healthy? Better to keep people in the dark than to have any hurt feelings.

Posted by: moxiemom1 | January 16, 2009 10:58 AM | Report abuse

I'm expecting in May and the breastfeeding issue is a difficult one for me. I'm lucky enough that I'm a high school teacher and so having "summer vacation" will afford me some time to be with the baby before I'm back to teaching in August. Although, teaching provides some flexibility, I need my job for the health insurance and the income. Needless to say, I can't exactly interrupt my class to breastfeed and I really wouldn't feel right bringing the baby to school anyway.... So what it comes down to is that not every woman is in an ideal situation and you have to do what is best for you and your baby at the time and place you have.

Posted by: annwhite1 | January 16, 2009 11:15 AM | Report abuse

"It's irritating to me that now it's not good enough to provide your child breastmilk but you absolutely must breastfeed."

Do you think, though, that any rational person really thinks this way? Most of the people I know are too busy dealing with their own families and their own worries to notice how another woman is feeding her kids.

I know that the media loves to hype this kind of "whatever you're doing, you're doing it wrong" story, but have many of us actually encountered that in real life?

Posted by: newsahm | January 16, 2009 11:57 AM | Report abuse

newsahm- I think the problem is the internet. Most of us will maybe run into a crazy person or 2 in real life (sometimes friends/family, sometimes a stranger) who tries to make a big stink about how we feed our kids. (It would most likely be someone who is appalled that you're breastfeeding in public.) Online, though, all bets are off. Rationality is dead. People will flay you for every decision you make. (In this case, it tends to be the bottle/formula feeders who are flayed.) Either way, they can stick where the sun don't shine. A healthy debate is one thing. A judgment-laced tirade/comment/sneer deserves nothing but laughter or an eye roll.

Posted by: atb2 | January 16, 2009 12:10 PM | Report abuse

The problem I have is with this statement:

"Feeding the infant from the breast during the work day is the most effective strategy for combining breastfeeding and work,"

In what rational world is that the most effective strategy? How many people can actually do that? Even people in 'autonomous management positions' -- are they really going to focus all of their attention on the baby while feeding or will they have the computer in front of them?

I think a recommendation should be mindful of what reality is because if it's not then what purpose does it serve? In the case of this recommendation -- why is feeding directly from the breast better than bottlefeeding breastmilk? Is there some sort of extra health benefit? Is it a bonding issue? Why doesn't the AAP spend more time advocating for ways to promote and make breastfeeding easier for everyone instead of coming up with recommendations that only apply to a small subset of the population? Or make recommendations that apply to a largest population possible where it can have the most benefit? So, yes moxiemom, I do think the AAP should consider it's audience before making recommendations.

Part of my elevated frustration level comes from expecting twins - a lot this couldn't apply to me if I tried. And that I'm pregnant with twins... my patience and occasionally my rationality is more likely to fly out the window these days. :)

Posted by: danielle514 | January 16, 2009 12:39 PM | Report abuse

Danielle, I don't blame you for being annoyed. I agree that it's so easy to feel judged for whatever choice you make as a parent. I have a friend who breastfed her twins and she said it was the hardest thing she's ever done and it was possible ONLY because her mother moved in with her for three months, and all she did was basically lay in bed and have the babies brought to her. That kind of scenario is something very, very few of us can manage. Make your choices and don't look back, and for God's sake (well, your own, actually), don't listen to the naysayers. :)

Posted by: WorkingMomX | January 16, 2009 12:53 PM | Report abuse


Ditto what workingmomx said. DO what you need to do, and don't let anyone make you feel bad for it. Also, congrats on your twins. When are you due?

Posted by: newsahm | January 16, 2009 1:00 PM | Report abuse

Goodness, who knew the recommendations of experts would be taken so personally. I know my kids will ideally get 5 servings of fruits and vegetables every day and not have exposure to phtalates and myriad other things, but just because I don't, can't or won't do everything perfectly doesn't mean I don't appreciate the information. Life's and knowledge are a buffet, take what you need/want and leave the rest, but remember, just because you don't want the roast beef, doesn't mean someone else doesn't.

Do what you best and own whatever you do.

Posted by: moxiemom1 | January 16, 2009 1:05 PM | Report abuse

"Danielle - so because everyone can't do everything should we just stop making recommendations for how best to keep kids healthy? Better to keep people in the dark than to have any hurt feelings.

Posted by: moxiemom1 | January 16, 2009 10:58 AM"

Gotta disagree, Moxie. To my mind, before you start making recommendations for how "best" to keep kids healthy, you better have some science to support that claim. I'm going to take as given that there is good scientific support for breastmilk over formula (don't want to re-open that debate!). But I don't know of any data that says the delivery device is the important thing instead of what is being delivered.

And, yeah, there is a real negative to overreaching recommendations: unachievable expectations spur people to not even try. Think about it: with retirement savings, how many times do you hear "I'm never going to make that million dollars they say I need, so why bother?"

Same thing here. Example: my sister's lactation consultant told her all breast, all the time -- no bottles at all. 4 weeks later (2 w/baby in hospital, which didn't help), she cracked -- sobbing that she was going to have to give up breastfeeding entirely, because she just couldn't do it. I talked her off the ledge, convinced her that the only thing that mattered was what worked for her, not what someone else's (completely unreasonable) expectations were, and that the occasional bottle was a really, really good thing if it let her get some sleep, run an errand, go out with her husband, and generally maintain her sanity. 9 mos. later, she's still breastfeeding (far more successfully than I ever managed). Some more realistic expectations going in would have saved her a lot of pain and grief.

Which brings me back to the original point: yes, the pain and grief is worth it if the issue is important and scientifically supported. But until there's some evidence that says that it is, I think people need to back off on the pressure and guilt.

Posted by: laura33 | January 16, 2009 1:12 PM | Report abuse

I typed too quikckly - Do your best and own whatever you do. YIKES - good thing I'm not a secretary anymore.

Posted by: moxiemom1 | January 16, 2009 1:13 PM | Report abuse

Not sure how significant this is, and it's been about nine years since I was breastfeeding a baby.

Anyway, one of the huge differences for me between putting baby to breast, and pumping at work, was the amount of time I had to spend setting up the pump and tubes and all that junk. And then cleaning it all up and putting it away until next time. I could put the baby at one breast for ten minutes, then another ten on the other side, then done! But the pumping (same 15-20 minutes of actually getting milk, because even the best pump wasn't as efficient but it was getting both at the same time) took an hour with all the prep and clean-up.

Also, with pumping and storing milk, there's some (small) risk of contamination or spoiling, and the possibility that the little one might get sick from it. When the baby is at mom's breast, there's practically no risk of that.

Posted by: SueMc | January 16, 2009 1:47 PM | Report abuse

Laura, I think the pressure and the guilt are all internal and say more about the people hearing the message than the people making the recommendation. Other people don't make you feel guilty, you do. Breastfeeding can be difficult and if there were not incentive then people probably wouldn't stick with it. If you didn't think breast milk was important, why would you have a machine suck milk out of your breasts. There are two sides to every coin and the people who obsess about breastfeeding are the same people who obsess about hand sanitizer and meningitis when the kids get older. As for the people who say "I'll never make 1 mill, so why try?" they are the same folks who can't lose 50 pounds so why lose any. Its not the message, its how you interpret it.

Posted by: moxiemom1 | January 16, 2009 1:51 PM | Report abuse

I think what we're missing is that the target audience of AAP and its journal is physicians. These broad guidelines aren't meant as mass communicaiton to parents, but a best-practicies guideline to pediatricians. A good ped will then help guide parents with kind of kind, sensitive, and non-judgemental counseling. In an ideal world, that is. This was a peer reviewed article we're discussing, not a brouchre for lactating women.

There was no on-site day care for my nursing son, and no stay-at-home dad to bring him to my office. I pumped till I couldn't pump no more, then kiddo weaned when my supply fell below what he felt was acceptable. Both kid and I are both happy and healthy two years later.

Posted by: mamabean | January 16, 2009 1:53 PM | Report abuse

I think the pressure and the guilt are all internal and say more about the people hearing the message than the people making the recommendation. Other people don't make you feel guilty, you do.

Well, congrats Moxie. You're a stronger person. Many women and men are so overwhelmed at being new parents or parents again and are trying to struggle with their hectic schedules that often the guilt is -maybe- irrational. I know perfectly sane, independent, competent, etc. women who positively crumbled after having a baby. The guilt over breastfeeding, daycare, sleep issues, bpa, organic foods, etc. You name the issue. It is very, very hard -impossible in many instances- for people to achieve the perfect scenario the AAP and other groups set forth. The fact that YOU don't feel the guilt doesn't mean othere -a great many others - do. And, I'm just not sure that this "announcement" was helpful at all since it is not acheivable for many, many people.

Posted by: liledjen4901 | January 16, 2009 3:36 PM | Report abuse

Well, congrats Moxie.
Thanks. Don't blame the messenger just becuase you don't like the message.

Posted by: moxiemom1 | January 16, 2009 4:33 PM | Report abuse

Aaah, the great debate . . . healthier for the infant to have breastmilk, healthier for the infant to be breastfed . . . I don't take issue with that. But also . . . healthier for the infant to be raised in a family that is economically stable, healthier for the infant to be given good working role models, healthier for the infant to be in a family where the parents are themselves fulfilled . . . whatever that might mean. The answer is, we all have to find a balance. None of us gets to have it all . . . we just have to find the point of optimization for us and our families, which may be different than the point of optimization for the next family.

Posted by: ElaineatLipstickdaily | January 17, 2009 11:20 AM | Report abuse

In case you are still wondering, days later, the reason breastfeeding is preferable to bottle-feeding breastmilk (from a medical perspective, not including bonding/convenience issues), is because babies jaws develop better when being breastfed. The mouth is in a different position when breastfeeding, one that is evolutionarily designed to coincide with proper jaw alignment.

AAP is all about promoting ideals. But that doesn't mean that your child is doomed if he gets a bottle during the day, or, you are forced to resort to formula to supplement. Ideally all babies would be breastfed exclusively for 6 months, and at least part-time until age 2 (WHO recommendation is a year longer than AAP). We don't all live in an ideal situation, but that's not a reason to get angry or give up entirely, though I know (from experience) how great the guilt can be when you can't do everything perfectly when it comes to breastfeeding. Just know that it's more imporant to your babies that their mom isn't a complete emotional wreck! Do what you can, and stop worrying about the stuff you can't help.

Posted by: foreoki12 | January 20, 2009 11:19 AM | Report abuse

I've been pumping exclusively since returning to work (part-time) when the baby was 3 months old. I pump about every 4-5 hours round-the-clock, including twice at work -- nobody has a problem with it. The little one is now 7 months old and still getting the full benefit of my breast milk. It's a win-win for both of us.

Posted by: layla2 | January 20, 2009 2:30 PM | Report abuse

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