Friday, March 28, 2014

What you need to know about the “Break Time for Nursing Mothers” law

Last week, ACLU Nationwide sent a letter to a Colorado employer, documenting multiple violations of the federal “Break Time for Nursing Mothers” law and the state’s “Workplace Accommodations for Nursing Mother’s Act.”

In the letter of complaint, ACLU said that DISH Network failed to accommodate nursing mothers at the company’s corporate headquarters in Englewood, where employees are forced to pump breast milk in front of their co-workers and supervisors, without privacy screens or curtains, and at a DISH Network call center in Littleton, where the lactation room is located inside a bathroom in direct violation of federal and state law.

According to the ACLU’s complaint, the lactation room in one of the buildings at the DISH Network headquarters was so small and crowded that women were forced to pump while sitting on the floor.

While calling on DISH Network to provide adequate space and privacy in all of its lactation rooms so that multiple nursing employees can pump privately at the same time, ACLU sent a clear message to all the employers in the country: it is the employer’s sole responsibility to accommodations the law requires and honor the rights of nursing mothers.

The Workplace Accommodations for Nursing Mother’s Act, passed by the Colorado legislature in 2008, as well as the federal Fair Labor Standards Act as amended by the Affordable Care Act in 2010, require employers to provide sufficient private spaces other than a bathroom, for nursing employees to express breast milk, shielded from the view of all other co-workers and the public.

Many states have the similar law to protect nursing mothers. Here in California, Labor Code requires the employer to make reasonable efforts to provide the nursing employee with the use of a room or other location, other than a toilet stall, in close proximity to the employee’s work area, for the employee to express milk in private.

Federal Law also support nursing mothers at work place. Effective March 23, 2010, federal “Break Time for Nursing Mothers” law requires employers to provide break time and a place for hourly paid workers to express breast milk at work. The law states that employers must provide a “reasonable” amount of time and that they must provide a private space other than a bathroom. They are required to provide this until the employee’s baby turns one year old.

This law is part of Section 4207 of the Patient Protection and Affordable Care Act under the Fair Labor Standards Act (FLSA) of 2011.

If you are a nursing mother or a employer with nursing employees, there are several things about the law that you might want to know.

Who is covered by the law?
The law applies to nonexempt employees covered by the Fair Labor Standards Act (FLSA). Only employees who are not exempt from section 7, which includes the FLSA’s overtime pay requirements, are entitled to breaks to express milk. While employers are not required under the FLSA to provide breaks to nursing mothers who are exempt from the requirements of Section 7, they may be obligated to provide such breaks under state laws.

Are the breaks paid?
The law does not require pumping breaks to be paid. However, if your employer already offers paid breaks and you use those breaks to pump your milk, your time should be paid.

What if the state already has a law?
When both the federal and state governments address the same situation, the stronger law applies.

Who is in charge of enforcing the law?
The Department of Labor Wage and Hour Division (WHD) is in charge of enforcing the law.

What are the benefits to employers?
Many employers do not realize that breastfeeding can save money. Employer benefits for supporting breastfeeding employees include:

  • Breastfeeding employees miss work less often because breastfed infants are healthier.
  • Breastfeeding lower health care costs. 
  • Breastfeeding support helps employers keep their best employees so that less money is spent hiring and training new employees. 
  • Breastfeeding employees who are supported in the workplace report higher productivity and loyalty. 
  • Supporting breastfeeding employees creates a positive public image.

What does the undue hardship exemption mean for employees?
To apply for a undue hardship exemption the employer must prove that providing thee accommodations would cause “significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer’s business.” Even if you work for a small business, you have the right to break time and a private space to express milk for your baby while you are at work. Even if your employer has few than 50 employees, they must comply unless the federal government has issued them an exemption.

What are the space requirements?
The law requires employers to provide a place that completely private so that no one can see inside the space. A bathroom is not a permissible location under the act.

How much time is “reasonable?”
Employers are required to provide “reasonable break time for an employee to express breast milk for her nursing child.” The law recognizes that the amount of time it takes to express breast milk is different for every mother. According to the Business Case for Breastfeeding, it usually takes around 15 minutes to pump breast milk.

How often can you pump during the workday?
The law requires employers to provide time and space “each time such employee has need to express the milk.” The law recognizes that the frequency of breaks needed to express milk of each mother will like vary.

How long do you have the right to pump at work?
Employers are required to provide these break "one year after the child’s birth." Some states, like Colorado, guarantee break time for longer.

What are some creative solutions for space?
You may consider:

  • Unused areas like a storage closet, empty office, or meeting room. 
  • Manager’s office. Area that can be partitioned or blocked by a curtain. 
  • Company vehicle with window coverings. 
  • Pop-up tents or temporary walls in the office. 
  • Work from home, if possible.

What if your employer refuses to comply?
If your employer refuses to comply with the law, you can file a complaint by calling the toll-free WHD number 1-800-487-9243. For more information on filling a complaint against your employer, visit the website.

Wednesday, March 19, 2014

The role of Vitamin D in pregnancy, infancy, and lactation

I've been following my pediatrician's instruction and giving vitamin D supplements to my little one since he was two weeks old. Never have I known there was actually a lot of debates revolving this topic out there. Recently San Diego County Breastfeeding Coalition, where I serve as a volunteer, discussed this hot topic at its general meeting. There are some good information and I wrote the post for the coalition's blog:

Well, vitamin D. To supplement, or not to supplement: that’s the question. Why, or why not? How much is enough? How much is too much?

At the most recent San Diego County Breastfeeding Coalition general meeting, the coalition’s vice president, Dr. James G. Murphy(MD, FAAP, FABM, IBCLC), answered it all.

So the short answer is: yes. Vitamin D (really a hormone) helps us to develop strong healthy bones and immune systems, and it does the same for our developing babies. Babies who don't get enough vitamin D are more likely to develop rickets. Vitamin D also helps prevent major diseases including Parkinson’s disease and some cancers. However, “the average good American diet is very low in Vitamin D and no one can eat their way to Vitamin D sufficiency,” said Dr. Murphy, “We need supplement or sunshine!”

Exposing skin to the sun is a great way to get vitamin D. There was a time people enjoy sunbathing and kids love playing under the sunshine. But time has changed. Now everyone puts on sunscreen before getting dressed and any sunscreen with SPF 8 or higher would completely prevent the body from making vitamin D. Today’s kids enjoy staying indoors and playing video games more than going outside in the sun.

Thus supplementation with vitamin D is advisable for everybody, especially for pregnant women and exclusively breastfed babies.

Supplementation with Vitamin D is recommended for pregnant women because “the fetus takes what it needs from the mother if she has enough,” said Dr. Murphy, “Clinical manifestations of vitamin D deficiency are rare at birth but develop over the first month of life if mom is severely deficient.” Dr. Murphy also pointed out that insufficient vitamin D level is associated with a significant increase in the C-section rate.

Babies need vitamin D, too. In 2008, American Academy of Pediatrics (AAP) recommended increasing the vitamin D daily dose to 400 IU from the previously recommend 200 IU, and to begin the supplementation in the first few days of life instead of at two month of age.

Vitamin D supplementation is especially recommended for exclusively breastfed babies because formula is Vitamin D fortified.

Depending on the formula milk, there are between 40 and 100 IU of Vitamin D per 100 calories in baby formula. Breast milk is, well, not artificially vitamin D fortified. Some formula companies use it to advertise that breast milk is flawed and formula is better. “Not true!” Dr. Murphy said it clear, “we wouldn’t need the supplement if we would get out in the sun. The problem is that we no longer get out in the sun, not that breast milk is not fortified. ”

Dr. Murphy also reminded breastfeeding mothers to get vitamin D supplementation.

Not all organizations recommend the same amount of supplement each day. Vitamin D Council recommends 4,000 IU/day for pregnant women and 1,000 IU/day for babies. Food and Nutrition Board recommends 600 IU/day for pregnant women and 400 IU/day for the babies.

Why is the confusion? “Food and Nutrition Board’s current ‘normal’ levels for vitamin D are based on studies done over 40 years ago on persons selected from the general population who appeared to have no apparent vitamin D related disorder,” explained Dr. Murphy. “Hence the lower value of the normal range of 10-15 ng/ml and the sufficient level of 30 ng/ml.”

Dr. Murphy recommends daily intake of 400 IU for the babies and 4,000 IU for the mothers.

Still, it is possible that we take or give the babies too much vitamin D. “Research found that high concentrations of vitamin D are toxic to rats,” said Dr. Murphy, “we want to give babies something good for them but we don’t want to give them too much.” So far no adverse side effects have been reported with doses less than 10,000 IU per day and blood levels less than 100 ng/mL.

Monday, March 10, 2014

Mommy war: Breastfeeding benefits overstated?

By To-wen Tseng.  Original posted on San Diego County Breastfeeding Coalition Blog.
Or bottle?
A media-fueled mommy war over a new breastfeeding study was exploded across Twitter and Facebook. Last week, a colleague and friend of mine emailed me the new study with a note, “See, I told you. It’s not worth it.”

The study she sent me was, of course, the widely reported sibling study by Colen and Ramey that concluded breastfeeding has no effect on long-term child well-being. As for “it’s not worth it,” she was referred to my decision on quitting my journalism job. I left my position as a staff writer when my son was six months old just to say no to a working environment that’s very unfriendly to nursing mothers.

Now I had to look into the study. After all, it’s the first time that some researchers studied the long-term impacts of breastfeeding vs. formula-feeding on American children by comparing siblings, a distinction meant to distinguish the effects of breastfeeding from other effects such as family income, education levels, and social dynamics. Supposedly the study is interesting and worth reading. But does it deliver the best breast milk science?

Outlets like Slate quick to trumpet the study as a confirmation that the benefits of breastfeeding are overstated. “Hopefully this study will give women who don’t want to breastfeed for whatever reason more ammunition to tell the breast-is-best purists to piss off,” wrote Slate contributor Jessica Grose.

And then UC Santa Barbara anthropologist Melanie Martin wrote a rebuttal to that piece. Martin challenged the study’s method with an analogy, “I find 1000 people who, for at least 2 weeks in 2010, drank organic fresh fruit superfood smoothies everyday for breakfast. Then I find 1000 people who did not. I weigh them today, in 2014, and I find that the two groups differed in obesity rates, but between siblings that did and did not drink smoothies, there was no difference in obesity rates. If I concluded from this result that eating healthy isn't protective against obesity, would I sound like an ass? Yes I would.”

Thus, “Colen and Ramey effectively showed that the totality of one’s childhood experiences-and not simply whether one was breastfed or not-is what really explains variation in multifactorial health and behavioral outcomes. Good for them. Also, duh.”

Melissa Bartick, an assistant professor at Harvard Medical School, also criticized the research: “Strong evidence exists for a relationship between breastfeeding and SIDS, necrotizing enterocolitis, hospitalization for lower respiratory tract infections, ear infections, diarrhea, Crohn’s disease, ulcerative colitis, and acute leukemia...But this study looked at only two physical diseases, asthma and obesity. Thus, for the authors to conclude that breastfeeding has ‘no effect on child well-being’ is a gross overstatement and is overtly false.”

Apparently there are two very different perspectives on the new breastfeeding study. The debate may go on, but the takeaway here should not be “don’t bother breastfeeding” as Grose implied, but rather we mothers don’t need to stress out about whether we have to supplement with formula or how long we are going to breastfed. Still, the benefits of breastfeeding cannot be replaced, and for the society it’s worth supporting breastfeeding mothers.

The bottom line is, breastfeeding or formula-feeding is a personal choice but also a health decision. We as adults should make an informed choice. Is the study really the best breast milk science? It seems not to me. Breastfeeding is also a human right. Women who choose to practice the right should be protected. Now, if you ask me, I would still choose not to stay with an employer that’s not friendly to nursing mothers.

Wednesday, March 5, 2014

What I love about breastfeeding

By To-wen Tseng. Original posted on San Diego County Breastfeeding Coalition Blog.

Ah, breastfeeding! There’s nothing like that. Forget about the scientifically proved health benefits. Think it as pure joy for both mom and baby.

My first birth experience (and so far the only experience) was not very pleasant. 
I was in labor for more than 20 hours and ended up with an emergency C-section. I seriously (and sillily) thought I was going to die. When all was over and the nurse handed me the crying newborn, I barely had the strength to take him. And when I finally held him in my arms, I felt nothing, not the “love at first sight” that everybody has been talking about, but exhausting.

Then everything amazingly changed in two hours, when the baby first cried for food. A nurse showed me how to latch the baby. Soon as I brought him onto my breast, he widely opened his mouth and latched on. It was just great. Now I truly felt like I belong to my baby and he belongs to me.

That was the moment I became a mother.

I did not have a breastfeeding plan when I was pregnant. During a prenatal interview with my future pediatrician, I said, “I’ll try to breastfeed if I actually have milk.”

He told me, “Virtually every mother has milk. You’ll get plenty of breastfeeding support at the hospital.”

“Whatever,” I thought to myself.

But breastfeeding is truly a learning behavior. I learned to breastfeed and learned to love breastfeeding. Now, for me, breastfeeding is one of the best ways to enjoy being a mother.

I love breastfeeding sessions. They are the quality time I share with my baby. I have told him many stories I casually came up with while nursing. They can also be “my time.” I have watched an entire series of Case Closed, my favorite Japanese Animation as a teenager, on my iPad through several breastfeeding sessions.

I love the cabbage leaves that relieve breast engorgement. My husband said my cabbage leaf bikini top is cute.

I love pumping my breast milk and watch how I can get nine oz of milk out of a 10-minute pumping session. I love to fill my freezer with frozen milk. It makes me feel productive.

I love discovering how much I can do with only one hand. I surprisingly learned that, while holding my baby to my breast, I can also feed my cat, type on computer, or do my makeup...all with one hand.

I love applying my own breast milk on my face. It works even better than the most expensive facial mask.

Although I do not enjoy pumping in a bathroom stall, sometimes I just have no choice. I love reading funny bathroom literature. I would never read those if I did not spend those pumping sessions in different bathrooms.

I love the understanding I built with my baby through breastfeeding. I have mastered his hunger cues and am proud that I can offer what he needs, knowing that I am his world.

I love how the baby eagerly draws my nipple into his mouth and gently suckles until my letdown; I love how his little hands softly rest on my breast while nursing; I love how his eyes close when he gets “milk drunk...”

The list can go on and on. Even those breastfeeding problems are somewhat lovely--

Latching on can hurt like a hundred little knives twisting off my nipple, but thanks to that, I learned that Lansinoh that treats sore nipples also makes the best lip balm!

So, what’s NOT to love about breastfeeding?