By Kristen Gerencher


SAN FRANCISCOJennifer Mehaffey was lucky to have enjoyed a seven-month leave to be with and breastfeed her baby daughter before going back to work full-time.

Once she returned to her job, her goal was to supply breast milk for her daughter's first full year, said Mehaffey, 31, a marketing and public relations professional in Tuscaloosa, Ala. She pumped milk in her office at least three times a day, she said, until keeping up with it interfered with the many long meetings and client calls she had to juggle.

Then "the incident" happened. A male co-worker who was new to the job was looking for the break room. Her office door didn't have a lock and the sticky note she affixed to it asking for privacy had fallen off. To the chagrin of both, he walked in on her mid-pump, she said. All was forgiven, but around that time she decided two months of expressing milk at work would have to suffice.

"There was a little bit of a heartstring pull when it ended," said Mehaffey, whose daughter is now 3. "But for my health and my sanity I was fine with it. It was what needed to be done."

It's a common but discreet ritual for many new mothers who return to work after maternity leave: pumping and storing breast milk for their babies, a relatively inexpensive and healthful way to supply nourishment while separated.

Despite the advantages for both mother and infant's health and the potential for employers to reap fewer absences in the long run, expressing milk on the job remains a sensitive subject for many working women. Pumping can keep new mothers connected to their children and help them maintain their milk supply so they can continue to breastfeed when they're at home, but it often comes at a cost.

Touchy subject

In the best of circumstances, expressing milk at work can bring lactating women a new kind of camaraderie with their colleagues, not to mention management support as they carve out break times, find private accommodations and use sinks to clean equipment. But pumping also can be inconvenient, awkward and downright impossible at worst, depending on the job and the workplace, experts say.

Data on pumping at work is scant, but some women may be more likely to shy away from the time-consuming activity now for fear of appearing less productive and thus more expendable in a tough economy. Others may be more likely to pump to save money on formula.

"In this economic climate, I think people are going to be under a lot of pressure to look like a model employee," said Heather Boushey , senior economist at the Center for American Progress, a think tank in Washington. "You're seeing a lot more people who are going to be increasingly afraid of doing anything that's going to mark them as a less productive employee."

Mothers working low-wage jobs and jobs with high turnover are especially vulnerable to quitting breastfeeding early, experts agreed.

"Poorer women often have to come back to work much more quickly and are much less likely to have arrangements where they can hide out somewhere to express milk," said Ariane Hegewisch , study director for the Institute for Women's Policy Research in Washington.

Still, not everyone sees the economy as a driving factor.

"It has nothing to do with a recession. It's a personal health decision," said Loretta McCallister , public-relations representative for La Leche League International in Schaumburg, Ill.

"Some women feel their jobs are too stressful," McCallister said. "Sometimes stress will inhibit milk production so they will make the decision not to continue. Other women value the benefits and will find any possible way, whether working with the employer or changing jobs."

Addressing the mismatch

The American Academy of Pediatrics recommends exclusive breastfeeding during an infant's first six months of life, with some additional breastfeeding as solid food is introduced and continuing at least for the baby's first year.

But that can be a high bar. Among breastfeeding women in 2005, 12 percent were breastfeeding exclusively at six months compared with the government's public-health goal of 17 percent set for 2010. Still, many more mothers — 43 percent—were doing some breastfeeding when their babies were six months old versus the 50 percent goal set for next year. Just over one in five women were still nursing their babies at a year compared with the U.S. goal of 25 percent.

The benefits of breastfeeding are well established, and medical societies almost universally promote it over formula feeding in most cases. For babies, breastfeeding is associated with a lower risk of infectious and chronic diseases including ear and lower respiratory tract infections, diabetes, obesity, asthma and sudden infant death syndrome, according to a 2007 review of 400 breastfeeding studies from the Agency for Healthcare Research and Quality. Mothers with a history of nursing also appear to have a lower risk of type 2 diabetes, breast cancer and ovarian cancer.

Breastfeeding also is a strategy in fighting the spread of the H1N1 flu virus, according to the Centers for Disease Control and Prevention, which recently encouraged mothers to do it.

"Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness," the CDC says on its Web site. "Ideally, babies should receive most of their nutrition from breast milk. Eliminate unnecessary formula supplementation so the infant can receive as much maternal antibodies as possible."

Despite the entreaties to breastfeed, few employers go out of their way to help women continue to do so. One in four companies offered an on-site mother's room last year, and 6 percent had lactation support services, according to the Society for Human Resource Management. Fifteen percent had paid maternity leave beyond what short-term disability covers, and only 6 percent of companies had on-site child care.

Expressing milk on the job isn't covered under the federal Pregnancy Discrimination Act. But 23 states, the District of Columbia and Puerto Rico have laws with varying degrees of protection for breastfeeding mothers in the workplace, according to the National Conference of State Legislatures. Some require employers to make a reasonable effort to provide a private, sanitary place for expressing milk. Toilet stalls don't count.

Several bills are circulating in Washington that would make it easier for women to breastfeed. Rep. Carolyn Maloney , D-N.Y., has championed one called the Breastfeeding Promotion Act for the last few years.

"Working mothers should be able to express milk in the workplace without fear of being fired or discriminated against for choosing to do so," Maloney said in an email. "This protection is long overdue, and this bill would ensure it's in place."

The U.S. Department of Health and Human Services is seeking input from the public through May 31 on how to increase Americans' breastfeeding rate. See the site.—call—to—action—on—breastfeeding/

On the front lines

Aimee Giangrave , 36, a teacher in Wallingford, Conn., went back to work in January when her twins were 4 months old. She wasn't able to breastfeed because of pregnancy complications and the fact that her children were born seven weeks early, but she was determined to express breast milk for them for at least their first six months. At work, she pumped about every three hours for two months in a storage closet that had an electrical outlet.

"It was a job and a half," she said, noting that she lost sleep because she had to wake up at night to pump. "I would go in with all my equipment and come home with full bags and ice packs. It was not convenient."

"It was a trade-off: The money-saving factor vs. the convenience factor."

Giangrave also had an accidental walk-in when a custodian opened the door. Still, she had trouble giving herself permission to stop pumping when her kids reached six months.

"I made my goal, but I was unexpectedly sad and feeling extremely guilty over stopping," she said. Ultimately she came to terms with it. "My husband and I decided I had done it long enough, and six months of formula we could handle financially."

Among the things Giangrave said she misses about breastfeeding is a feeling of safety. "I miss knowing what I'm feeding my children is pure and natural and chemical-free and I know where it comes from."

Her son and daughter, who weighed four pounds, 11 ounces and five pounds, 11 ounces at birth more than seven months ago, now eat baby food and formula and tip the scales at around 20 pounds each, she said. "I think they're big, fat healthy babies because I gave them breast milk."

Mehaffey said she has no regrets either. "It was worth it. I felt no matter what I was going through it was for the health and betterment of my child."

Stephanie Reck of Greensboro, N.C., recalls pumping milk for her second son, now 6, when she worked at a regional magazine in Florida. Though she had an office, she chose an unused bathroom because it was more private and secure.

Reck, 43, said she enjoyed the good-natured teasing that resulted from her supportive work environment.

"The bathroom was renamed the dairy," she said. "It was all light-hearted."