How to Establish
a Workplace Lactation Program

Workplace lactation programs are an inexpensive way to reduce employee absenteeism, lower health insurance costs, and improve employee retention.  

by Kathryn Tyler

In the last four years, breastfeeding legislation has been enacted in over one-third of the states in the U.S.  Most laws deal with the right to breastfeed in public, but in 1998, Minnesota enacted legislation that addresses breastfeeding in the workplace. That law requires that Minnesota employers make reasonable efforts to provide unpaid break time and a room, other than a restroom stall, where nursing employees can express their milk in privacy.

Employers in other states may soon need to consider how to accommodate breastfeeding employees. This year, Congresswoman Carolyn Maloney will reintroduce several bills in the House of Representatives which would promote breastfeeding. One bill clarifies the Pregnancy Discrimination Act so that it protects a woman’s right to breastfeed or express milk during the work day. Another provides a tax credit for 50 percent of employer expenses for providing an appropriate environment on business premises for employed mothers to breastfeed or express milk.

Breastfeeding and workplace lactation programs have gained more public attention recently because the American Academy of Pediatrics (AAP) has amended its breastfeeding recommendation. Originally the organization recommended that infants were breastfed for six months. Now the AAP recommends that infants are breastfed for at least one year.  In addition, at least 50 percent of women who are employed when they become pregnant return to work by the time their children are three months old. Thus, women who want to follow the AAP’s recommendation need to find a way to pump and store their milk for at least nine months after returning to work. Moreover, women with infants and toddlers is the fastest growing segment of today’s labor force.

The Benefits
Workplace lactation programs reduce health care costs and employee absenteeism, as a result of infant illness, because breastfed infants are healthier. According to the AAP, breastfed babies have fewer allergies, respiratory infections, ear infections, and serious diseases, such as diabetes. Breastfeeding also keeps mothers healthier, including a reduced risk of ovarian and breast cancers.

A study between breastfeeding and formula-feeding employed mothers by Rona Cohen, RN, MN, and an international board certified lactation consultant (IBCLC), published in the American Journal of Pediatric Health found that one-day absences from work occurred more than twice as often among formula-feeding mothers as they did among breastfeeding mothers. The workplace lactation program at the Los Angeles Department of Water and Power (LADWP) “reduced absenteeism by 27 percent and healthcare claims by 35 percent. For every dollar we invested, we saw at least a $2.50 return,” says Cohen, a consultant to LADWP and owner of Maternal Child Health Services, a company that provides corporate lactation programs in Beverly Hills, California. Karen Mainelli, program coordinator at Aetna, a health insurance company in Kensington, Conn. has seen similar results: “We have had a 2.7-to-1 return on our investment.”

In addition, lactation programs can improve employee retention. “If a mother knows she can pump or breastfeed at the job site, those are big reasons” to stay. “It costs money to recruit and train new employees,” says Karen Cavaliero, public relations director at La Leche League International, a non-profit organization that promotes breastfeeding.  “With my first two pregnancies, we didn’t have a program. I had to find a pump, nursing bag, and literature about how to store milk,” says Eva Long, a breastfeeding employee at Aetna. “This time was so easy because the lactation consultant was there.” One reason Aetna decided to institute a lactation program is because its workforce is 76 percent female. “We look at it as a big return-to-work initiative,” says Mainelli. Diane Cushman, manager of workforce parenting for St. Paul Companies, a property-casualty insurance company in St. Paul, Minn., says their lactation program also has created a support system that eases mothers’ transition back to work: “It puts them in touch with other new moms.”

Lactation programs not only help retain current employees, they can also attract new ones. “Providing lactation rooms is a good recruitment tool for women of childbearing age,” says Cindy Leep, work/life coordinator at Amway Corporation, a multi-level marketing company in Ada, Michigan.

Finally, the morale boost is not limited to breastfeeding employees.  “The thing that surprised me was the support of all the women in the workforce, older women, women who hadn’t nursed or had nursed and quit when they returned to work,” says Leep. “I got a lot of email and phone calls, even from men saying that their wives had nursed and this program was great.” Cushman has seen similar responses: “It’s a great morale builder, even for people who aren’t using it. It’s a low-cost, high-impact program. And it’s not difficult to implement.”

The Logistics
Several large companies have workplace lactation programs, but small- and medium-sized companies can also reap huge benefits for relatively little money. How much does it cost and what is required? It depends on the level of benefits you want to provide. “It could be as little or as large as you want it to be,” says Cavaliero.

“The minimum criteria for a space is: privacy, an electrical outlet, a table, and a chair,” says Cushman. Employees bring their own breast pumps, bottles, and coolers. “It doesn’t have to cost you a penny,” says Elizabeth Baldwin, a lawyer specializing in breastfeeding and the law from North Miami Beach, Florida.

Chuck Patrick, managing director at Bluestone Consulting, a high-technology consulting firm in Slickerville, New Jersey, agrees.  His small company originally created a lactation station to accommodate one employee.  “I found an executive office that wasn’t being used,” says Patrick. Baldwin recommends HR professionals brainstorm with employees to find a space that can work. The door to the room must lock to ensure privacy.  At Amway, “the mothers have their own access code into the room,” says Leep.

Once you have a room, you must make three major decisions. The first is “whether to lease breast pumps, buy pumps, have employees provide their own, or share the cost,” says Cushman. The lactation station at Amway’s headquarters has breast pumps and sinks for employees to rinse their apparatus. (Electric, multi-user breast pumps require mothers to attach their own flanges, tubing, and bottles so there isn’t any cross-contamination of milk.) They cost about $800. 

Providing electric breast pumps is a good idea because it helps mothers pump faster, which means they return to work sooner. Long says she used to have a hand-held pump, but that the ones the company provides are dramatically different. My old one “was OK, but it took a long time to get the milk out. With these pumps it takes ten to fifteen minutes.”

The second factor in selecting or designing a lactation room is a sink. A sink is crucial because mothers need to wash their pumping apparatus when they are finished. If you don’t have a sink in the room, the room must be near a bathroom. 

Thirdly, you must decide whether to provide refrigeration. “You don’t need refrigeration. You can put the milk in a cooler with blue ice packs and it will keep fine,” says Marsha Walker, RN, IBCLC, president of the International Lactation Consultant Association. Amway decided against refrigeration for two reasons: they feared problems with milk mix-ups and they didn’t want mothers to forget their milk. St. Paul Companies does not provide refrigeration, either. “We were afraid people might use it to store other things. Then we would be dealing with issues like, ‘Whose moldy cheese sandwich is this?’ Somebody has to take the responsibility to clean it out,” says Cushman. 

In addition, you may want to provide: parenting magazines, lockers, paper towels, antiseptic spray, mirrors, and a clock. “One mom suggested we include a coat hook for hanging up their clothing,” adds Leep. Some of the lactation stations at St. Paul Companies have privacy curtains that pull around each pump. Cushman also recommends posting “a bulletin board so moms can stick up pictures of their babies,” which builds camaraderie. Long suggests stocking emergency bottles and collection kits. “The first day I forgot a big piece of my pump.  Fortunately, there was a piece in the supply cabinet.”

Some of the lactation rooms at Texas Instruments in Dallas have telephones and computers so employees can conduct business while pumping. However, this can be problematic. St. Paul Companies, for instance, removed the telephone from the lactation room because “people who weren’t nursing moms were going in to use it,” says Cushman.  Moreover, some women may prefer to use the time to relax, which can be difficult if others are working.

Finally, if you have a lot of women using the pumps, you may need to create a schedule. Betty Purkey, manager of work/life programs at Texas Instruments, says, “Our online sign-up system was really helpful.”

Additional Support
Workplace lactation program services are not limited to breastfeeding rooms. Aetna offers breastfeeding assistance during pregnancy and maternity leave, as well as when employees return to work. “We encourage moms to participate by their 36th week of pregnancy. We begin the process early so we’re not just catching them when they return to work,” says Mainelli. The program provides breastfeeding education classes; unlimited telephone access to a breastfeeding consultant, 24 hours a day, 7 days a week; on-site breastfeeding consultations; and free use of an electric breast pump so mothers can become comfortable with it.

LADWP also provides prenatal breastfeeding education classes and lactation consultations to all employees and extended family. “We have a male employee whose sixteen-year-old daughter is having a baby and we provide the service to her as well,” says Cohen. Eighty percent of the employees at LADWP are male, but Cohen estimates that at least fifty percent of employees or their extended families take advantage of the program. Upon returning to work, both Aetna and LADWP provide employees with free breastfeeding accessory kits which include the tubing required to use the breast pumps, collection bottles, ice packs, and a portable cooler.

The Potential Obstacles
One potential obstacle is finding space for a lactation room. When an office is crowded or an employee’s job doesn’t provide access to a lactation center, it requires some “creativity on management’s part,” says  Baldwin. For example, at LADWP, some of the breastfeeding employees climb utility poles. Says Cohen, “We’ve had to make some accommodations, such as giving employees company cars so they can go to” the nearest company-owned building.

Other potential obstacles center around misinformation about breastfeeding. “The biggest obstacle is society’s attitude about breastfeeding,” says Baldwin. “You should do is some cursory education of employees. Otherwise, you” may have problems with co-workers.  Managers, especially, need to be educated about the importance of the program so they are willing to give breastfeeding employees the time they need to express milk. “You can have a pretty room sit there unused unless you have a policy that employees can have an hour break a day—two thirty-minute breaks or three twenty-minute breaks—to pump or breastfeed,” says Walker. “Train supervisors to encourage employees to use it. You don’t want to have an atmosphere where employees can’t take advantage of the service because the work environment won’t permit it.”  At Amway, “all supervisors got letters telling them the service was available,” says Leep.  “Supervisors’ main fear was: ‘How long is this going to take? An hour three times a day?’” Skeptical supervisors were surprised to realize that employees would return to work within half an hour. Kathleen Glucksman, RN, IBCLC, a lactation consultant at Aetna, says she had the same experience with a supervisor who questioned the amount of time an employee spent pumping: “I was able to provide the actual sign-in sheets for a month which indicated that the employee never spent more than an hour total per day in the pump room.” Adds Leep, “Sometimes employees can pump within ten to fifteen minutes. The fear that this is going to take too much time is not well founded.”  However, managers and co-workers need to offer breastfeeding employees some flexibility. For instance, Julie Treimer, senior systems analyst at St. Paul Companies, says, “Sometimes I had to work around meetings.  The people I worked with were understanding.”  

A Health Choice
“There is no financial excuse for not doing this, even for a small company,” asserts Patrick. Without spending any money “we improved employee morale. It’s a low-cost way to get a high reward. There are no down sides, except giving up some space in your building.” And Cushman says that space should be planned for during construction. “You need to plan for a lactation room, just like a restroom.” Concludes Baldwin, “Breastfeeding is a health choice, not a lifestyle choice.”