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Changing institutional culture is a difficult task. In the U.S., with only 13.6 percent of infants exclusively receiving human milk for the first 6 months of life, breastfeeding is not the cultural norm.¹ Many women begin breastfeeding, but the drop-off rate is alarmingly high.

One reason women list for suspending breastfeeding is returning to work. 

Setting the Stage for Lactation Support

In 2000, I was hired to improve the breastfeeding practices of mothers of children in our care at the Children's Hospital of Philadelphia.

The institution was determined to instill a culture that values human milk and breastfeeding, yet there were no organization-wide policies, trained staff, sufficient equipment, or space to facilitate milk production for mothers with children at Children's.

Given the hospital employs approximately 3,000 nurses - many with little breastfeeding education - one of the first steps was to ensure a well educated and trained nursing staff.²

The Breastfeeding Resource Nurse (BRN) model was developed to ensure staff nurses could provide evidence-based lactation care and support.³

Toward that end, selected nurses take a 2-day, 16-hour course on the research and science of breastfeeding and human lactation and how to support families who are cared for in the hospital's network.

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While the BRNs were pleased with the progress the organization made in supporting families, they asked what could be done to support our own employees so they, too, could be successful in achieving their breastfeeding goals when returning to work from maternity leave.

The answer? The creation of a program specifically to support employee lactation.

A group of concerned employees from a variety of disciplines began to meet with a representative from human resources, a lactation consultant and me. We decided a portion of each meeting will be dedicated to employee issues surrounding return to work and continued breastfeeding.

Employee Lactation Program

The formalized program of employee lactation support developed over time, incorporating pump rooms, loaner pumps for offsite locations, an employee pump purchase option, expectant parent classes, a prenatal breastfeeding class, intranet resources and an employee lactation policy.

Here's a closer look at each component:

• Pump Rooms: In 2000, Children's Hospital had just four pump rooms and a handful of pumps that could be loaned to individual units. From 2002 to 2004, there was a hospital-wide assessment of pump room usage and parent satisfaction with pumping at Children's, resulting in data clearly demonstrating a lack of sufficient pumping facilities. A plan, created by myself and the chief nursing officer, included purchasing to hospital-grade pumps and putting a pump on each inpatient unit. In addition, as hospital renovations and expansions were planned, they would include the building of additional pump rooms. Since that time 10 additional pump rooms were built both on the main campus and off-site locations, bringing the system's total of pump rooms to 14.
  
• Loaner Pumps for Offsite Locations: Being a network with facilities throughout the region, it was important to establish a system to support Children's employees in outlying facilities. In 2009, through human resources and with the help of Andrea Howard-Supervisor of Wellness & Work-Life Balance programs, seven loaner pumps were purchased. Employees can fill out a request on the intranet for a free loaner pump. The request is then processed and the pump is delivered to the location and may be used by the employee for as long as she is pumping. Once she stops pumping she must return it.
  
• Pumps for Purchase: To give employees more options, an employee pump purchase program was initiated in 2009. Through this program, employees can purchase a personal-use pump at a discounted rate.Employees on the main campus simply go to the cashier window in the hospital, pay for the pump and pick it up from occupational health. Employees at off-site locations can mail a check to human resources and have the pump delivered to their home. Since the program started, 227 pumps have been purchased. The pump can be purchased for a spouse, daughter, sister or friend.