Breastfeeding in the military: Part II. Resource and policy considerations

Military Medicine, Oct 2003 by Bell, Michael R, Ritchie, Elspeth Cameron

Breastfeeding is widely acknowledged as the ideal form of nutrition for infants. Because of this, increasing the incidence and duration of breastfeeding is a major goal in Healthy People 2010. Part I of this series illustrated that the Department of Defense and its health care system, TRICARE, may not be meeting that goal, particularly after active duty mothers return to work. This study outlines the resources that would be required to optimally support breastfeeding after active duty mothers return to work. Selected policy implications of supporting breastfeeding are discussed, and recommendations for policy on breastfeeding are presented.

Resources Required to Optimally Support Breastfeeding after Return to Work

The ability to successfully continue breastfeeding after returning to work involves four elements: space, time, support, and gatekeepers.1,2 The ideal situation is to have onsite daycare so that mothers can breastfeed their infants directly while they are at work. Since this is not possible in most cases, providing designated space in the workplace where mothers may express breast milk is critical because many active duty mothers who wish to continue breastfeeding after they return to work do not have private offices. The optimal space and equipment requirements are listed in Table I.

The Oregon health division estimated the one time cost to provide a furnished, private room with a lock and an electric outlet as $585. For a room with an employer-owned hospital grade electric breast pump and written resource materials, the price was estimated as $1660.3 Although this might seem expensive, it is important to consider that more than 20 women can use a nursing mothers' room during an 8-hour period.

If space is at such a premium that a designated room cannot be provided, allowing the use of empty conference rooms or offices may suffice. However, women should not be forced to pump or breastfeed in bathrooms or closets. Just as you would not expect an employee to prepare or eat a meal in the bathroom, you should not expect her to provide nourishment for her baby in that environment.

Breastfeeding or expressing breast milk takes time. A mother who exclusively breastfeeds her infant will probably need to take two to three 20-minute breaks to pump or breastfeed during an 8-hour workday.2 Less frequent pumping or breastfeeding can result in leakage and cause breast engorgement, which is uncomfortable and reduces the milk supply. The amount of lime required for expressing breast milk is influenced by several factors, including the length of the commute from the mother's work space to the nursing mothers' room, the efficiency of the breast pump, the number of pieces that must be cleaned after the pump is used, and the amount of stress that the mother is under.2 Typically, hospital grade pumps are much more efficient because they provide greater suction, can be used on both breasts simultaneously, and have fewer parts to clean.

While allowing a soldier an hour of break time per day may seem excessive, it should be remembered that this is supporting a behavior that should make both the mother and infant healthier and happier. This may pay dividends in terms of reduced health care costs and absenteeism. The opposite is true for cigarette breaks, which are currently accepted practice in many military workplaces. Additionally, research has shown that mothers whose breastfeeding-related needs are supported in the workplace are more likely to put in extra effort on the behalf of the company or co-workers when needed.4

Obviously, maintaining breastfeeding will pose additional challenges if the mother has to go to the field. If the exercise is relatively short, such as a week or less, the baby can be fed with breast milk that was expressed previously and frozen. Of course this implies that the mother had sufficient notice to accumulate a stockpile of breast milk. If she did not, her infant can be fed formula or a mixture of breast milk and formula while she is away. During the exercise, the soldier will need to continue to express breast milk every 3 to 6 hours to prevent engorgement and to maintain her milk supply. Breast milk can be expressed under field conditions by hand or with a hand-operated vacuum pump. This is often not as efficient as using an electric pump; therefore, it will be important for the soldier to plan ahead and practice before the exercise. The soldier will need to have access to soap and water for washing her hands and cleaning her equipment to reduce the risk of breast infection. She will also need access to a space where she can have a few minutes of privacy. Breast milk that is expressed in the field will most likely need to be discarded. This is because it will probably be too difficult logistically to store it at the appropriate temperature, and the mother may have exposures in the field that could contaminate the breast milk. Examples of these exposures will be discussed in detail later in this article.