Breastfeeding in the News: September 16th – Sept. 24th, 2009

Hello All,
For those of you who are unhappy with the way infant formula companies conduct their business in your neighborhood wait till you hear what they are doing in Vietnam. Even though it’s against the law to advertise formula in Vietnam the big formula companies spend $10 million dollars a year doing just that (making them the 5th largest advertising market in the country.) Doctors are paid a commission on each can of formula they sell, mothers are invited to ‘nutritional seminars’ at five start hotels to watch a video of a girl who could talk at 6 months, and formula companies claim outrageous benefits for their products (“make your baby taller!”). Exclusive breastfeeding rates at six months have dropped to 17%, half of what they were a decade ago, while in 2008 alone formula sales rose 39%.

Here at home formula companies are pushing additives like DHA. (DHA derived from fish oil by the way, contains EPA which can be absorbed by adults but not by infants. In breast milk “the amount of DHA is four times higher than the amount of EPA – Mother Nature knows best!”) But one blogger asks an interesting question, shouldn’t we be in favor of these companies making their products healthier and safer? He uses the analogy of motorcycles which we know to be riskier than cars, don’t we pass helmet laws to try and make them safer to use? My answer to that is yes, improving formula is a wonderful thing, but marketing it as good as or better than breast milk is false advertising. And not informing people of the known risks is unconscionable. Wouldn’t it be great if every magazine ad for formula had to list all the possible risks just like all the pharmaceuticals do?

In China breastfeeding rates have fallen from 76% to 64% in 2002. But after last year’s formula scare more mothers want to breastfeed but like working mother’s every where they face obstacles when they get back to work. Even though a national law exist giving two 30 minute feeding breaks a day, hardly anyone seems to know about it. But here’s an interesting twist, in Shanghai there is a delivery service that will pick up and drop off a mother’s freshly pumped milk. Imagine that, a milk man who delivers human milk!

Here in America if Starbucks is any example, the biggest factor in reaching the 6 month exclusive breastfeeding goal seems to be whether or not you work behind the counter or in the corporate office. While Starbucks headquarters may boast of a lactation room, their chain store employees are still pumping in the bathroom. The CDC says that while 53% of college grads are still breastfeeding at 6 months (I’m assuming this is not exclusive breastfeeding – can anyone tell me for sure?) only 29% of mothers with just a high school education make it that far. Like me I’m sure this isn’t news to most of you. I still remember the mother I once met who worked as a paralegal in a lawyer’s office. While the female lawyer’s received 6 months maternity leave, paralegals were only given 6 weeks. This is crazy! It’s like saying an executive recovering from a heart attack automatically deserves 6 months to recover, while a janitor with the same health condition only needs 6 weeks.

In TV this week the HBO series “Mad Men” featured a birth typical of the 1960’s complete with twilight sleep and hallucinations. True to form when the mother was asked if she wants to breastfeed the answer was a defiant “no”, only people who can’t afford formula do that! Meanwhile in England the Royal College of Midwives complained when a soap opera star quickly turned to formula. For those of you who think letter writing is a waste of time take heart, as a result of their complaint the producers are considering making breastfeeding “the nub of a story on some future occasion.”

Meanwhile in Jamaica breastfeeding activists hosted a game show challenging health workers from different regions on their knowledge of breastfeeding. Reading the scores it sounds like people really got into it! If you want to host your own breastfeeding quiz show you might consider using the questions in the AAP’s new “Breastfeeding Residency Curriculum.” Better yet take their quiz yourself and tell me what you think. Would you teach it any differently?
In odds and ends a new use has been found for Fenugreek, seems adults can use it for weight management! (Like formula it slows the rate of gastric emptying.) Here’s an interesting statistic – apparently the air in a typical American home contains 135 more toxins than those found in breast milk. And just a reminder – the H1N1 vaccine can’t be given to infants less than 6 months old, which is just one more reason to breastfeed exclusively for the first 6 months.

Meanwhile Ghana is proud to have one of the best rates for exclusive breastfeeding at 6 months in Africa, but apparently after that mothers are feeding their babies substandard food so childhood malnutrition is still a problem. What’s interesting is that the problem is not linked to poverty – it seems that children in rural poverty stricken areas are doing better than others, mainly because of their access to traditional local foods.

Come January 1st, 2011, New York residents can expect to chose a hospital based on a new “Maternity Information Leaflet (MIL) that hospitals will provide to all new mothers. New required information includes the percent of infants breastfed at the hospital, the percent of infants exclusively breastfed, and the number of instances in which breast milk is supplemented with formula.” This is a direct result of new changes in the CDC’s mPINC survey. (I’m honestly not sure if every hospital in the US will have to distribute a similar leaflet – does anyone know for sure?)

Last week there was an interesting split on the question of whether or not we should stop talking about the benefits of breast milk and talk more about bonding instead. 32% said we still have to convince the medical community while another 32% said we should cautiously start talking more about bonding. (See for the results.) While you’re there answer this week’s question “Should corporations like Starbucks be required by the law to offer the same lactation benefits to all their employees?” The crux of this question is whether or not law makers should take a stand on the issue. Personally, after my experience testifying at the State House I get nervous when lawyers get involved, but I would like to hear what you think.

As always I look forward to hearing from you!
Kathy Abbott, IBCLC
On Facebook: “Breastfeeding in the News”
My Blog:

Using Organic Breast Milk
What are the pros and cons of feeding babies formula versus breast milk? And if I purchase formula, should I spend the extra money on the organic variety?
One concern with breast feeding is that toxins present in mom’s bloodstream can make their way into baby. But a 2007 study by Ohio State and Johns Hopkins University researchers found that levels of chemicals in breast milk were far below U.S. Environmental Protection Agency maximum acceptable levels for even drinking water, and that indoor air in typical American homes contains as much as 135 times as many contaminants as mother’s milk. The U.S. Centers for Disease Control maintains that the benefits of breastfeeding far outweigh any chemical exposure risks. “To date, effects on the nursing infant have been seen only where the mother herself was clinically ill from a toxic exposure,” reports the agency.

Health authorities’ quiz highlights Breastfeeding Week (Jamacia)
IN TRUE Schools’ Challenge Quiz style, health workers faced each other in the National Breastfeeding Competition, which marked the peak of National Breastfeeding Week activities.
The competition this year featured health workers from across the island, who answered questions concerning breastfeeding. In one semi-final match, the Southern Regional Health Authority (SRHA) squared off against the Western Regional Health Authority in a tightly contested competition. SRHA ended close 36-35 victors. In the other semi-final, the North East Regional Health Authority lost 32-34 to the South East Regional Health Authority (SERHA).
Ding-dong battle
In a dazzling final match, which showcased the speed and awareness of the participants about the various health issues surrounding breastfeeding, a fierce battle took place between the SERHA and the SRHA . The final was played at the Ministry of Health. The first segment of the competition, ended 10-10. However, the SERHA squeezed by its opponents, earning a two-point lead by the end of the second segment. In the third and final segment, the SRHA extended its lead, ending 34-28 winners. Though the competition proved exciting, it was about much more than scoring points, as the Ministry of Health has plans to take the message of ‘breast is best’ throughout the island.
Welcome to the Breastfeeding Residency Curriculum
The American Academy of Pediatrics developed this Breastfeeding Residency Curriculum to help residents develop confidence and skills in breastfeeding care.
Time to Complete the Curriculum
The curriculum is flexible. It can be implemented over 1 rotation, 1 year, or during the entire length of residency. Go to the Implementation Strategies page for examples of how some residency programs have implemented the curriculum.
Activities and Evaluation
The curriculum allows you to make choices. Whether you implement 1 activity or 20, you are helping residents to develop confidence and skills to help breastfeeding infants and mothers. The Essential Activities are the activities that you should strive to complete with every resident. The Additional Activities are provided to give more options if time allows. It is strongly urged that you evaluate residents on these activities. Evaluation will help the residents know how they are doing and will help you keep track of their progress. The evaluation tools are effective in evaluating the residents as well as the breastfeeding residency curriculum as a whole. Here are some examples of the tools included.

Corrie’s Maria sparks breastfeeding row
Coronation Street producers have been criticised by the Royal College of Midwives over scenes involving the soap’s new mum Maria Connor.
Macdonald also slammed the ITV1 drama’s portrayal of breastfeeding. Earlier this year, viewers saw Audrey Roberts (Sue Nicholls) advising Maria to start using bottles after she experienced problems with feeding her child naturally
The RCM manager commented: “The representation of bottle-feeding as the way to feed an infant in a family programme such as Coronation Street contributes to normalising bottle-feeding in our society.”
A producer for the programme responded to the concerns by claiming that Coronation Street cannot always match the requirements of “accuracy and interested bodies”.
The representative added: “We do not want Coronation Street, which is a character-led drama serial, falling into the genre of drama-documentary. Notwithstanding, we have of course taken your comments on board over the issue of breastfeeding and it may well become the nub of a story on some future occasion.”

Labor and Delivery, Starring Betty Draper
The Emmy-winning AMC hit “Mad Men” (featured today on “Oprah”) is well regarded for its story lines that remain loyal and true to the clothing, trends, current events, and social attitudes of the early 1960s. It’s the scenes displaying primordial parenting skills that cause many viewers to wince: Kids without seatbelts climbing in the front seat, playing with dry cleaner bags, little Sally sneaking sips of Daddy’s martini, and all that second-hand smoke.
A recent episode centered around the birth of Betty and Don Draper’s third child, which was a painful reminder of the birthing process (and lack of comfort) during that time. When Betty was wheeled into the labor room, a burly nurse abruptly stops Daddy Don and sternly tells him “Your job is done” (as if it ended at conception) and banished him to the “father’s lounge,” where he meets another dad-to-be with whom he shares a bottle of scotch whiskey. The first-time dad is kept in the dark about his wife’s progress until a graduate from the Ratchet School of Nursing nonchalantly informs him that he has a son, he was breech, and his wife, who had a transfusion, “is recovering, as she lost a lot of blood.”
In the next scene, Betty is informed that her regular doctor is unavailable, and to deal with her delivery. When asked if she’ll be “giving the baby the breast,” she quickly snaps “NO!” as if it was beneath her. Mind you, at this time in our past, many believed that breastfeeding was for the lower-income families that couldn’t afford formula.
Betty is eventually knocked out in a Demerol-induced “twilight sleep,” hallucinates, and wakes up with a baby in her arms.
Do you think husbands should return to the waiting room? Do they have a place in the labor room? Have we lost intimacy by revealing, uh, a little too much?

Read more:

Being a Breastfeeding Dad
Author’s note: This piece of humorous truth was written in response to a disturbing statistic: The number-one factor in a woman’s decision to nurse her child is her partner’s attitude.
Now, we all understand the primary job of your babaloos, I mean, that is, your wife’s babaloos. Yes, God put those fabulous twins on earth entirely for your pleasure. Period. But God also gave them a stint of hard labor as punishment for all the naughtiness they have performed. It’s called breastfeeding. And during this time of hard labor, you will be the holder of the keys — the jail guard, if you will. You are about to oversee the work camp of a breastfeeding mother. And, lemme tell ya guys, this gig is not for the faint of heart.
Have you ever sat in a pediatrician’s office, dude? I mean really sat in that petri dish of a waiting room, where snot reigns supreme and the Muzak is obliterated by the screams of infected infants? Eye infections. Allergies. Green vomit. It’s all there, man. Well, you won’t be there much. Your kid will have the immune-boosting benefit of white blood cells that get manufactured on demand, on site, at the first sign of your baby’s sniffle. The technology is right there in your girl’s cantaloupes. For real. Who knew?
Breastfeeding boot camp often — though not always — lowers estrogen levels enough to impact a woman’s sex drive. Oh, and there’s one other problem. That dudette is so damn drained that when you get home from work, she’ll most likely want to hand you a stinky bundle and take a long nap. It’s all part of the game. You’re on the team and she’s just handed you the ball. Run with it. And pray she stocked the freezer with plenty of pumped supplies. How long will she behave like a sexual anorexic? Well, as long as it takes. And if the going gets really rough, buy her a steak, some new shoes, and remind her about the corkscrew motion.
Remind her politely. Because breastfeeding mamas may have the cha-chas of La Madonna, but they also have the heart of a mother bear. Tread carefully, brother. This is a woman wired to protect her little miracle above all. This is not the time to argue over the bills, the laundry, or the room service. She’s focused on winning the game. She needs a trainer, a coach, a team physical therapist, and a paycheck.
Breast-feeding a burden for Shanghai working moms

Qian, 31, is one of a growing number of mothers in China who have thrown out their supermarket baby formula, and rely on breast milk to keep their baby healthy.
The number of women who do this has grown especially after last year’s tainted milk scandal that sickened 300,000 infants
Despite the positive benefits of breast-feeding, the number of mothers who breast-feed in China fell from 76 percent in 1998 to 64 percent in 2002, according the United Nations Children’s Fund
Some mothers in Hangzhou, Zhengjiang Province, are using a delivery service that promises to collect and drop off milk within two hours, according to a report by China News Service.
While it is common for Chinese people to stress the family bond, the public shows little sympathy for breast-feeding mothers.
Only a few companies reportedly provide mothers a room they can use discreetly to pump milk ,so many end up doing the task in public
According to Regulations Concerning the Labor Protection of Female Staff and Workers issued by the State Council, working mothers with babies under 1 year, are entitled to two feeding breaks daily, each one lasting 30 minutes.
But most mothers are unaware of this policy. However, those who know their rights are reluctant to demand time off to pump milk.
Ge Yingmin, director of women’s rights department of Women’s Association of Shanghai, told the Shanghai Morning Post that if a mother has difficulties arranging nursing she could apply for feeding holiday.
“But if the mother and baby are both healthy, it’s OK for the company to turn down the application,”she said.

Multinationals break Vietnam law in formula sales
The number of Vietnamese mothers who exclusively breast-feed in the first six months — the most crucial period — stands at just 17 percent, less than half what it was a decade ago, according to UNICEF. Meanwhile, formula sales in Vietnam jumped 39 percent in 2008, according to a study by Nielsen, a market research firm. Another survey found that the industry spent more than $10 million on advertising last year, placing it among Vietnam’s top five advertisers.
Multinational companies in Vietnam sell baby formula so aggressively that they routinely stretch and sometimes break laws designed to promote breastfeeding
the Vietnamese government adopted an ambitious target: a 50 percent exclusive breast-feeding rate by 2015. Health Ministry officials also announced they had uncovered dozens of violations of formula labeling rules.
But only one fine was levied — for less than $200.
Among the most serious violations that sources described separately to the AP were commissions paid to doctors to sell formula.
“We got a small commission for each can,” she said
Vietnam’s law prohibits advertising formula products for children under age one — a weakened version of an earlier law that set the age limit at 2.
But Nguyen Thi Minh, 29, a Hanoi paralegal, said she was approached by a Mead Johnson salesman at a Hanoi maternity clinic shortly before giving birth.
“I chose Mead Johnson’s EnfaGrow because the advertisements said it boosts your child’s IQ and makes them taller,” Minh said.
Nursery schools across Hanoi and Ho Chi Minh City are adorned with the logos of Mead Johnson and U.S.-based Abbott, which have provided benches, playground equipment and other gifts. Companies routinely suggest that children will be smarter and stronger if they drink formula, claims widely rejected by independent health professionals.
Salesmen also often invite women to “child nutrition seminars” at 5-star hotels. About 600 mothers packed a recent Abbott seminar co-sponsored by the Vietnam Nutrition Association, which receives heavy funding from formula companies. They listened to a talk called “Awakening Your Child’s Intelligence Potential” and watched a video of a girl learning to talk at 6 months and read at 14 months.
Doctors often appear at these seminars. The ties between the companies and the medical community are very close, said Olive, the WHO representative. Shortly after he arrived in Vietnam, Olive was invited to speak at a pediatrics association meeting and found a formula logo hanging behind the podium.
“I turned it around before speaking,” he said

Nothing fishy about this
Developing infants cannot efficiently produce their own DHA and must obtain this vital nutrient through the placenta during pregnancy and from breast milk after birth.
Breast milk DHA versus fish oil DHA
Fish oil is derived from the tissues of oily fish and it contains both DHA and EPA (eicosapentaenoic acid). However, ordinary fish oil supplements contain fairly large amounts of EPA and moderate amounts of DHA. In adults, both are digested and absorbed. However, in infants and foetuses, EPA might compete with DHA for a place in the nerve cell membranes and this may be detrimental to the developing brain, eye, and nervous system. In human breast milk, the amount of DHA is four times higher than the amount of EPA – Mother Nature knows best!

Ghana makes giant strides in promoting exclusive breastfeeding
Ghana is rated among the best breastfeeding countries in sub-Saharan Africa but expressed worry that the feat was being marred by high rates of malnutrition among children under five years due to improper feeding
Mrs Agyapong noted that after six months of exclusively breastfeeding some mothers failed to give nutritional foods to their children and stressed that the local dishes had all the rich sources of nutrients that would facilitate the healthy growth of children.
She said the problem of malnutrition could not be attributed to poverty because some mothers from very poor communities had well nourished children and they revealed that they gave them local foods such as nuts, green leaves, fruits and fish during their weaning from exclusive breastfeeding.

Fenugreek extract may boost satiety, aid weight management
“animal studies have suggested a slowing in the rate of gastric emptying, meaning the stomach stays fuller for longer.”

Is formula with DHA and ARA better than breastmilk?
A new study this week concluded that formula fortified with fatty acids DHA and ARA (also known as Omega 3s and 6s) is better for babies’ brain development than unfortified formula.
The study looked at how 202 nine-month-olds dealt with a cognitive test involving a rattle and found that babies that had been given formula fortified with DHA and ARA did better on the tests than those given regular formula. According to this LA Times blog post on the subject:
Among babies who drank formula from Day One, the proportion that successfully completed all three tests was 51% in the DHA/ARA group and 29% in the control group. Among babies who were weaned at six weeks, the results were 46% for the DHA/ARA group and 13% for controls.
The study did not compare breastmilk to to the fortified formula. And most experts I’ve seen quoted still agree that breastmilk is still the healthiest option for babies overall. But that hasn’t stopped some breastfeeding advocates from complaining that this latest study is just another marketing ploy by formula makers to get mothers to give up breastfeeding…
But as long as some women feed their babies formula — whether by choice or because they can’t breastfeed — shouldn’t we applaud any effort that makes formula safer and healthier (ie. more like breastmilk)?
Surely we shouldn’t prevent advances in formula simply to encourage breastfeeding. After all, if our main goal is encouraging breastfeeding at any cost, maybe we should go beyond banning supplements and instead force formula makers to put added toxins and carcinogens in their product to make it even less appealing.
Think about it: In what other context would we be against making an inferior product more healthy and more safe? Take motorcycles, for example. It’s well-documented that motorcycles are far more dangerous to drive than cars (28 times more deadly to be precise). But we still try to design safer helmets and pass helmet laws to make the practice as safe as we can.
No doubt there is a line somewhere — something that is so clearly harmful that we, as a society, would decide reducing its harms would just encourage too many people to do it.
But I’d argue that line is way, way, way past mothers giving their baby infant formula. Heck, here in Vancouver we’ve even been experimenting with giving people free heroin.
Indeed, I think the most shocking story to come out this week about DHA and infant formula is not this latest study, but a story by Canwest’s excellent consumer reporter Sarah Schmidt that Health Canada allows formula makers to make claims about the benefits of DHA on their label even if they have only trace amounts of it in their product.
According to Schmidt’s story, even though most studies have found you need to have at least 0.3% DHA in your product to make a difference, some formula makers make claims about being “DHA fortified” with less than 0.1% DHA content!

Maternity Leaflet Must Include Additional Reporting Next Year
The Department of Health (DOH), beginning in 2010, will require maternity hospitals to include new information in the Maternity Information Leaflet (MIL) that hospitals provide to all new mothers. New required information includes the percent of infants breastfed at the hospital, the percent of infants exclusively breastfed, and the number of instances in which breast milk is supplemented with formula. The new reporting measures are part of a broader initiative launched recently by DOH to promote and to highlight the importance of breastfeeding among new and expectant mothers.
Hospital administrators received a letter in late August indicating that DOH would begin sharing with each hospital its most recent available data on hospital-specific breastfeeding practices. The data are collected in the DOH birth certificate supplement and the New York City birth certificate medical report. Hospitals will have an opportunity to review and evaluate the data before they are added to the MIL.
Information on infants cared for in a neonatal intensive care unit will not be included in the data.
Hospitals outside of New York City will be required to include their performance on these measures in the MIL beginning May 1, 2010; New York City hospitals will be expected to begin reporting on their performance on January 1, 2011.
DOH will also review maternity hospital policies and practices related to promoting and supporting breastfeeding. DOH plans to use that information to develop training and technical assistance for providers to further encourage and support breastfeeding-friendly policies.
Commissioner of Health Richard

Q Doc, my wife has just given birth and we have a fine son. A female relative has told her we need not use any birth control for the next year because she is breastfeeding, which gives her special protection against pregnancy.
I am not so sure. Is this safe?
A This way of preventing unwanted pregnancy is called ‘the lactational method’, or the ‘lactational amenorrhoea method’. The word ‘amenorrhoea’ means ‘absence of menses’.
The method is based on a discovery in Africa years ago, when it was found that women who breastfed intensively were unlikely to conceive.
Does it work? Well, earlier this month a very good research paper on contraception was published. It originated from the University of the West Indies’ St Augustine campus in Trinidad and from a university in Belgium.
The conclusion of the authors was that the lactational method generally works, because suckling (feeding) a baby suppresses egg release and also prevents the periods from returning for a while. However, the researchers say that for the method to work three conditions must be fulfilled:
The baby must be nearly exclusively breastfed (i.e., no bottles) on demand, day and night.
The mother must have had no periods since the delivery.
The method must not be used for longer than six months.
If your wife thinks she really can breastfeed as intensely as that, the method will probably work.
Please bear in mind there are alternatives. For instance, your wife could simply go on the mini-Pill (progestogen-only Pill) while she is breastfeeding.

Surviving H1N1 — with baby in belly
Is it safe to get vaccinated while breastfeeding? Should my newborn also be vaccinated?
According to the Advisory Committee for Immunization Practices, the H1N1 vaccine will be recommended for children ages six months and older. Newborns and infants younger than 6 months cannot receive the vaccine.
Health officials say breastfeeding is one way a mother might be able to help protect her baby. “The vaccine is safe if she breastfeeds, and she may even pass along some immunity to her infant,” says Tepper of the CDC. “It will also reduce the chance that [the mom] will get the flu and pass it to her infant.”

Low breast feeding numbers “pathetic,” say doctors
In a meeting last month at the Centers for Disease Control
, officials said they plan to issue a “Call to Action” to address the surprisingly low numbers of women who breast feed, calling it “an urgent public health priority.”

According to CDC statistics, almost 74 percent of women in 2005 breast-fed in the days right after birth. But just 12.3 percent of those women exclusively breast fed for the first six months of life.

“We have come a long way in helping moms start, but those are still pathetic numbers,” said Dr. Sheela Geraghty, of the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital

On the Job, Nursing Mothers Find a 2-Class System
When a new mother returns to Starbucks’ corporate headquarters in Seattle after maternity leave, she learns what is behind the doors mysteriously marked “Lactation Room.”
Whenever she likes, she can slip away from her desk and behind those doors, sit in a plush recliner and behind curtains, and leaf through InStyle magazine as she holds a company-supplied pump to her chest, depositing her breast milk in bottles to be toted home later.
But if the mothers who staff the chain’s counters want to do the same, they must barricade themselves in small restrooms intended for customers, counting the minutes left in their breaks.
But as pressure to breast-feed increases, a two-class system is emerging for working mothers. For those with autonomy in their jobs — generally, well-paid professionals — breast-feeding, and the pumping it requires, is a matter of choice. It is usually an inconvenience, and it may be an embarrassing comedy of manners, involving leaky bottles tucked into briefcases and brown paper bags in the office refrigerator. But for lower-income mothers — including many who work in restaurants, factories, call centers and the military — pumping at work is close to impossible, causing many women to decline to breast-feed at all, and others to quit after a short time.
Twelve states have passed laws protecting pumping mothers — Oklahoma’s law, the newest, will take effect in November. But like Oklahoma’s, which merely states that an employer “may provide reasonable break time” and “may make a reasonable effort” to provide privacy, most are merely symbolic.
According to the nonprofit Families and Work Institute, a third of large corporations have lactation rooms.
Even without these perks, professional women can usually afford a few months of maternity leave during which to breast-feed. When they return, they can generally find an office for the two or three 20-minute sessions per workday typically necessary. Even bathrooms — the pumping spots of last resort — are more inviting at an accounting firm than in a fast-food restaurant.
Because of this and similar efforts, 73 percent of mothers now breast-feed their newborns, according to the Centers for Disease Control and Prevention. But after six months, the number falls to 53 percent of college graduates, and 29 percent of mothers whose formal education ended with high school. In a study of Oklahoma mothers who declined to breast-feed, nearly a third named work as the primary reason. Others, like Ms. Moore of Starbucks, find the early days of breast-feeding frustrating, and their impending return to work means they have little incentive to continue.
“Sometimes my co-workers will sneak in two or three smoking breaks” before she can steal away to pump, said Laura Kruger Rowe, who works at a Starbucks in Rochester.
As at Starbucks, the gap between working mothers can play out within a single organization. At many law firms, lawyers can pump in their offices, while secretaries use bathroom stalls; in the Army, which also has no policy on the matter, officers are less likely to encounter problems than enlisted soldiers, who have less autonomy and a more complex chain of command.
Shortly after Marlene Warfield, a dental hygienist in Tacoma, Wash., began pumping on the job, she said her boss wore a Halloween costume consisting of a large silver box — his interpretation of a pump, perhaps — with a cutout labeled “insert breast here.” When he instructed Ms. Warfield to leave her pump at home, she said, she quit her job— and consulted the local human rights commission, which found nothing illegal about the dentist’s actions.
Dr. Philipp recalled a small furor about whether Jane Swift, the former governor of Massachusetts who gave birth to twins, would breast-feed after returning to work.
“That’s a great thing to do, but she had her own office and could set her own schedule,” Dr. Philipp said. “The one I want to know about is the lady cleaning her office.”

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