Nice job, mama! How a physician makes breastfeeding work.

At a family outing to the zoo a few weeks ago I sat on a bench to nurse my 6-month-old son while my husband took our older son on the carousel. I felt a tap on my shoulder. “Nice job, Mama!” I looked up and saw a woman smiling ear to ear as she was dragged by her own child towards the carousel. I got a little misty. Even as a neonatal intensive care doctor who is well-versed in the numerous, well-documented benefits of breastfeeding, acts of solidarity from total strangers sometimes do more to strengthen my resolve to keep doing this … this, not the nursing, a truly gratifying experience for which I am deeply grateful, but this, what it actually takes to be a working mother with an exclusively breastfed infant.

Over the past few years, I have welcomed the explosion of social media attention on nursing mothers. Viral videos and photography installations are helping to debunk old-fashioned ideas about breastfeeding, and bring much needed attention to the lack of safe, private, non-bathroom space for breastfeeding in public places. Most states now have laws on the books protecting public breastfeeding.

Federal law requires employers to provide break time and non-bathroom space for women to express breast milk.  In our newborn intensive care unit, as in many others, our breastfeeding rates are quite high — this is important as premature babies get extra benefits from breast milk, like protection from serious intestinal illness. But as the theme of 2015 World Breastfeeding Week — “Let’s Make it Work” — reminds us, we still have a long way to go to fully support mothers who breastfeed, particularly those who rejoin the workforce shortly after they deliver.  And working mothers aren’t the only women who need reasonable places to pump – there are many women who are able to produce plenty of milk but have infants who aren’t able to nurse at the breast.

I’m lucky. I work in a nice, modern children’s hospital with lactation rooms on almost every floor. My health insurance covers the cost of a high-quality electric pump. Most importantly, my colleagues all understand the benefits of breastfeeding, and uniformly respect my need to step away from my professional responsibilities so that I can do this. Every few hours. Every day. For a year.

If I really want to keep this up, to send my son to daycare with three six-ounce bottles of milk every day, I can’t ever take a day off from this routine. But I also can’t be in my office all the time, and the second I step outside of the boundaries of my exceptionally accommodating workplace, I’m reminded that however much things seem to be improving for nursing in public, we’re still really behind when it comes to truly supporting breastfeeding moms.

Don’t want to nurse in a bathroom? Try pumping. Where is the electrical outlet? Is there an even vaguely clean surface to put your stuff? A chair? Nice, relaxed mamas nursing cute babies at the zoo on a Sunday afternoon are appealing. Frazzled, vaguely disgusted women in business casual attire hooked up to loud machinery by long plastic tubes are not. People look away.  I recently attended a professional conference for pediatricians that couldn’t accommodate me. Try pumping in an empty conference room you found, desperately hoping that nobody comes in. Or in your car in a parking lot. Where will you wash your supplies? Hint, you’re usually back in the bathroom.

More than half of married-couple families have two working parents. That’s a lot of babies, and we should be committed to helping as many of those babies as possible reap the benefits of breast feeding, such as stronger immune system and  lower risk of sudden infant death syndrome (SIDS) and  chronic health conditions like asthma and diabetes. There are benefits for nursing mothers as well, like faster return to pre-pregnancy weight and lower risk of some cancers.  (Just to be clear, I’m not saying that only married women matter — that’s just a reminder that even in traditional nuclear families most women work.) Access to reasonable accommodations for working women to continue to supply breast milk to their babies shouldn’t just be for the lucky few.

So whether  I’m nursing my son at the park, or hooked up to my pump in the bathroom at the gas station, give me a “nice job, Mama,” and help me bring this out into the open so we can do better by all of our working moms and their growing babies.

Naomi Laventhal is a neonatologist.

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