In November 2010 I found out I was pregnant with my first child. After reading up on all of the things that could possibly go wrong with my pregnancy, the foods I should avoid unless I wanted a baby with three eyes and all of the ways I can scar my child emotionally for life, I found information on a decision I could make which would reduce the chances that my child would have asthma, respiratory infections, eczema, diabetes or be obese, and would be more socially well adjusted and confident. What was this miraculous decision? Breastfeeding my baby.
The Benefits of Breastfeeding
What may seem like a private decision made by new moms can actually impact EMS workplaces in a positive manner. According to the American Academy of Pediatrics (AAP), babies who are breastfed have fewer illnesses, including ear infections, respiratory infections and bouts of diarrhea, than their formula fed counterparts.1 What this means for employers is fewer sick calls from the medic-mom due to an ill baby. Additionally, breastfeeding has been shown to help with post-partum weight loss, it reduces breast and uterine cancer risks and the risk of mom developing diabetes, and, thanks to the breastfeeding hormones, helps mom get back into her “skinny jeans” and uniform pants sooner. The psychological benefits of breastfeeding for mom and baby can’t be ignored either—the close bond and eye contact shared between mom and baby helps baby develop socially, and helps mom feel comforted that her baby is safe, secure and well nourished.
And with the current state of the economy, nobody can argue with the price of breast milk: aside from the increased nutritional needs of mom to produce the milk, it’s absolutely free.
The AAP and the World Health Organization (WHO) recommend breastfeeding exclusively for six months, although longer is “mutually desirable.”1 Unfortunately, working mothers in the U.S. are generally required to return to work within 12 weeks of the baby’s birth, rendering regular direct nursing at the breast impossible for most new moms.
This is especially true for medic-moms who return to work on an ambulance—babies aren’t allowed to “tag along” for EMS runs. The good news is that it’s possible to continue to provide breast milk, even when the mom isn’t able to directly nurse the baby directly, through expression, or pumping, of the milk.
Newborns tend to eat eight to 12 times per day, or every two to three hours. In order for a breastfeeding mom to maintain her milk supply, she should pump approximately every two to three hours for about 15 minutes, though some variations are OK and expected. Failure to regularly express milk can lead to a host of problems, from decreased milk supply to clogged milk ducts, which can result in mastitis, or an infection of the breast. EMS providers are at a greater risk for these conditions due to working long hours and the frequent inability to get adequate sleep, as well as the general stress of the job. The inability to pump at regular intervals only increases the likelihood of these conditions.
A new medic-mom will have to experiment to find what works best when it comes to how long and how often she needs to pump. She should also take the time to investigate what resources are available to her through her employer. Many employers are required by federal law to provide certain resources to nursing moms, including breaks and pumping locations. Employers need to be familiar with this law to ensure compliance and avoid lawsuits.
In March 2010, the Fair Labor Standards Act (FLSA) was amended as part of President Obama’s healthcare plan to include provisions for nursing moms at work. Section 7(r) of FLSA law states that an employer shall provide:
Reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk; and a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.
Note that these breaks do not have to be paid breaks under some circumstances. The letter of the law is not specific about how these objectives should be accomplished, and, as one EMS administrator said, “They clearly weren’t thinking about ambulance work when they wrote this law.”
However, the purpose of the law is simple. A nursing mom should be provided with the time to pump milk for her child(ren), and a clean place to do it.
A Time and Place
There are several ways EMS providers can absolutely comply with the law. The first is to put ambulances out of service to allow for pumping, and allow them to return to a designated location for pumping. The second is to provide field personnel with an opportunity to work off the ambulance in an office-type job that is not subject to irregular demands for service, and with a location that meets the requirements for pumping. A third may be to place a provider on a non-emergent “transfer” type truck that would be able to delay a transport for 15-20 minutes to allow for pumping.
Unfortunately, many ambulance providers will have a difficult time either providing a desk job or placing units out of service. While one option for absolute compliance with the law must be offered to nursing medic-moms, both employees and employers may find that an appropriate solution lies somewhere in the middle. Given the irregular nature of ambulance work no breaks can be guaranteed, but some natural breaks may occur throughout the day which would allow medic-moms to pump. For example, if time is generally granted after a patient interaction to finish reports, ready the ambulance, etc., a nursing mom can pump while working on a patient care report. If your service posts regularly or spends a significant amount of time driving, the medic-mom can be in the back of the unit (with a fastened seatbelt, of course) pumping while her partner is driving. To avoid any confusion, employers may find it useful to establish a policy of what is allowed and expected as far as where employees should be seated while driving non-emergently or while responding emergently to calls.
Places to pump are not difficult to find either. Designated pumping locations may be established; bedrooms at crew quarters are one good option. Another location which may be an option is the pumping rooms at hospitals. Hospitals are required to comply with the same FLSA laws and many of them have designated pumping rooms for use by hospital employees. Coordination with the hospitals may yield a perfect pumping location that is free of charge for ambulance employees. The last option for a pumping location is the back of the ambulance. While this may seem like a less “clean” option, think about which area gets cleaned and decontaminated more regularly—the station bedroom or the back of the ambulance? The challenge, though, is making it secure from entry and shielded from view. An inexpensive piece of muslin fabric with two-sided sticky Velcro makes a quick window covering, and utilization of the locks on the trucks will help secure it. Alternatively, a nursing cover over the mom will help maintain privacy, though the area would not strictly meet the requirements of the law. Nonetheless, pumping in the back of the ambulance is effective and efficient, and has personally served me well in my time as a pumping medic-mom.
Working with Supervisors and Peers
Upon discussion with some tried-and-true pumping medic-moms, one of the problems they encountered most frequently while pumping as a field medic was a lack of familiarity with the needs of pumping moms, both from peers and supervisors. One supervisor, when confronted with a pumping medic-mom, remarked, “If you need to do that, shouldn’t you still be out on maternity leave?” Of course not! Pumping medic-moms are still quite capable of working. Pumping is a regular need, just like eating, sleeping and going to the bathroom.
Because of the lack of information in the EMS field about breastfeeding and pumping, it’s incumbent upon the nursing medic-mom to communicate specifically and with confidence her needs regarding pumping with both her partner and supervisor. The La Leche League International (LLLI) website, www.llli.org, has good information on talking with supervisors.2 Another good resource for medic-moms in EMS and fire service is a book titled, Breastfeeding in Combat Boots: A Survival Guide to Successful Breastfeeding While Serving in the Military by Robyn Roche-Paull.3 Though the book targets military-related issues, military-moms face many of the same challenges as medic-moms, such as irregular duty hours, long shifts and a “uniform” environment.
Both the LLLI website and Roche-Paull’s book provide excellent details on how to approach a supervisor or peer regarding the need to pump.
Support for Nursing Medic-Moms
Perhaps the most important thing an employer or peer employee can do for a new nursing mom is to provide an environment of support. Fifteen minutes every three hours adds up to a significant amount of time over the course of a shift and it takes huge dedication on the part of the mom to make it work. In the course of a 24 hour shift a pumping medic-mom will have to wake up out of her sleep to pump—sleep which may have otherwise been preciously uninterrupted by cries of her newborn. And perhaps the hardest thing a new medic-mom will have to cope with is leaving her little one. In my own experience I was a complete wreck for an entire week after I returned to work. Not only did I have to leave my precious baby girl with someone else while I went back to work on an ambulance, I had a reminder every three hours as I pumped her milk that she wasn’t with me. In place of my warm, sweet daughter gently suckling was a cold, noisy machine. Without the support of my partner (who is an avid breastfeeding advocate), I never would have made it through that week.
I’m proud to be a nursing medic-mom, and I’m proud to be part of an EMS organization that is supportive of breastfeeding. Breastfeeding may not be the right decision for all medic-moms, but being a medic-mom shouldn’t preclude women from breastfeeding. A supportive work environment and FLSA law enables medic-moms to continue providing their babies with the benefits of breast milk, even after returning to work.
Items Pumping Medic-Moms Should Keep Handy:
- Double electric breast pump
- Car adapter, if needed
- Backup battery
- Manual pump, in case your electric pump fails
- Extra set of clean pump parts
- Enough milk storage containers for each time you pump, plus two extra bags/bottles
- Quick clean wipes
- Hands-free pumping bustier
- Mesh bag to hang-dry pump parts
- Cooler with ice packs for milk
- Steam-sterilizing bags for the microwave
- Water to stay hydrated
- Snacks (If you thought you were hungry while pregnant, wait until you’re nursing!)
- Towel (to cover your lap/uniform when you pump)
- Nursing cover-up or shawl, if privacy is a concern
1. The American Academy of Pediatrics. AAP Children’s Health Topics: Breastfeeding.
2. La Leche League International. Pumping and Breastfeeding at Work.
3. Roche-Paull R. Breastfeeding in Combat Boots: A Survival Guide to Successful Breastfeeding While Serving in the Military. Amarillo, TX: Hale Publishing, 2010.
Erin W. Lincoln, BA, NREMT-P, is a mom, graduate student and paramedic in Austin, TX Contact her at firstname.lastname@example.org.