2. Compiled by: Sarah DeCato, BSN, RN, CLC MSN Graduate Student, New Mexico State University 4/10/20121

3. Collaborators: Maine Roads to Quality & The State of Maine Breastfeeding Stakeholder’s Committee 4/10/20122

4. Why is it necessary to support breastfeeding in the childcare setting? 4/10/20123

5. Caring for Our Children (CFOC), 3 rd ed. 4/10/20124

6. Women in the Workforce The “good worker” versus the “good mother” 4/10/20125

7. Benefits for Child Decreased risk of obesity Decreased risk of asthma Decreased incidence of insulin and non-insulin dependent diabetes mellitus Decreased infant mortality rates by 21% Decreased incidence of infectious disease Decreased risk of Sudden Infant Death Syndrome (SIDS) Source: AAP. Breastfeeding and the use of Human Milk, 2005 Policy Statement. 4/10/20126

8. Benefits for Mom Costs less than non-natural feeding options Decreased postpartum bleeding Early return to pre-pregnancy weight Decreased risk of breast cancer Decreased risk of ovarian cancer Possible decrease risk of osteoporosis in postmenopausal period Source: AAP. Breastfeeding and the use of Human Milk, 2005 Policy Statement. 4/10/20127

9. Employers benefits Average annual savings equal $400 per breastfed baby (lower medical costs with fewer health insurance claims) Decreased turnover Lower absenteeism Productivity improvement Increased morale and loyalty to employer It's the Law Source: http://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf- workplace.shtmlhttp://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf- workplace.shtml 4/10/20128

10. Breastfeeding friendly workplaces Supports a mother in decision to breastfeed upon return to work Provides accessible location for pumping Provides flexible work schedule Source: adapted from Texas Department of State Health Services http://www.dshs.state.tx.us/default.shtm http://www.dshs.state.tx.us/default.shtm 4/10/20129

11. Maine Labor Law For an employee who is a nursing mother, the employer shall for three years after the birth of a child: provide adequate unpaid break time, or permit an employee to use paid break time or meal time each day to express breast milk for her nursing child. make reasonable efforts to provide a clean room or other location, other than a bathroom, where an employee may express breast milk in privacy. An employer may be exempted from this section if providing time or an appropriate private space for expressing breast milk would substantially disrupt the employer's operations. An employer shall not retaliate or discriminate against an employee who exercises the right provided under this section. Source: http://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtmlhttp://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtml 4/10/201210

12. Additional breastfeeding protection in Maine: The Nursing in Public Law Maine law (5MRSA §4634) provides protection for women who nurse in public. A mother may breastfeed her baby in any location, public or private, where the mother is otherwise authorized to be. Source: http://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtmlhttp://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtml 4/10/201211

13. Benefits to Society Decreased annual health care costs Decreased tax dollars spent on health care programs Decreased parental employee absenteeism and associated loss of family income Increased attention to family as a whole due to decreased infant illness Source: AAP. Breastfeeding and the use of Human Milk, 2005 Policy Statement. 4/10/201212

14. Childcare settings Develop workplace policy Identify a clean, private place with access to electric outlets and a chair. Orient employees and parents to the policy Offer flexible breaks to nursing staff Source: http://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtmlhttp://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtml 4/10/201213

15. Breastfeeding Culture 4/10/201214

16. Breastfeeding Culture 4/10/201215

17. Breastfeeding Culture 4/10/201216

18. Sample Childcare Center Breastfeeding Policy 1. Breastfeeding mothers shall be provided a place to breastfeed or express their milk. This area provides an electrical outlet, comfortable chair, and nearby access to running water. Source: Adapted from the Mississippi breastfeeding Coalition’s Building Breastfeeding Friendly Communities project by the Wisconsin Department of health and Family Services in collaboration with the Wisconsin Breastfeeding Coalition Division of Public Health – Nutrition Section; www.dhfs.state.wi.us/WICwww.dhfs.state.wi.us/WIC 4/10/201217

19. Breastfeeding Policy cont. 2. A refrigerator will be made available for storage of expressed breast milk. Breastfeeding mothers and employees may store their expressed milk in the center refrigerator. Mothers should provide their own containers, clearly labeled with the name and date. The center will follow guidelines from the American Academy of Pediatrics and Centers for Disease Control in ensuring that breast milk is properly treated to avoid waste. Universal precautions are not required in handling human milk. Source: Adapted from the Mississippi breastfeeding Coalition’s Building Breastfeeding Friendly Communities project by the Wisconsin Department of health and Family Services in collaboration with the Wisconsin Breastfeeding Coalition Division of Public Health – Nutrition Section; www.dhfs.state.wi.us/WICwww.dhfs.state.wi.us/WIC 4/10/201218

20. Breastfeeding Policy cont. 3. Sensitivity will be shown to breastfeeding mothers and their babies. The childcare center is committed to providing ongoing support to breastfeeding mothers, including providing an opportunity to breastfeed their baby in the morning and evening, and holding off giving a bottle, if possible, when mom is due to arrive. Artificial baby milks (formula) and solid foods will not be provided unless the mother has requested. Babies will be held closely when feeding and bottles will never be propped. Source: Adapted from the Mississippi breastfeeding Coalition’s Building Breastfeeding Friendly Communities project by the Wisconsin Department of health and Family Services in collaboration with the Wisconsin Breastfeeding Coalition Division of Public Health – Nutrition Section; www.dhfs.state.wi.us/WICwww.dhfs.state.wi.us/WIC 4/10/201219

21. Breastfeeding Policy cont. 4. Staff shall be trained in handling human milk. 5. Breastfeeding employees shall be provided flexible breaks to accommodate breastfeeding or milk expression. 6. Breastfeeding promotion information will be displayed. 7. Handbook includes Baby Friendly Facility (BF). Source: Adapted from the Mississippi breastfeeding Coalition’s Building Breastfeeding Friendly Communities project by the Wisconsin Department of health and Family Services in collaboration with the Wisconsin Breastfeeding Coalition Division of Public Health – Nutrition Section; www.dhfs.state.wi.us/WICwww.dhfs.state.wi.us/WIC 4/10/201220

22. Breastfeeding Friendly Facility Source: Wisconsin Nutrition, Physical Activity and Obesity Program http://dhs.wisconsin.gov/health/physicalactivity http://dhs.wisconsin.gov/health/physicalactivity 4/10/201221

23. Signage Source: The International Breastfeeding Symbol 4/10/201222

24. Additional Resources in Maine Child Care Health Consultant (CCHC) Network Allyson Dean, Maine Roads to Quality 207-780-5833, adean@usm.maine.eduadean@usm.maine.edu State of Maine Public Health Nursing 1-877-763-0438 Maine State Breastfeeding Coalition http://mainestatebreastfeedingcoalition.org/ WIC offices http://www.maine.gov/dhhs/mecdc/local-public-health/wic/ La Leche League http://www.llli.org/ Local Hospitals Maternity Units Lactation Consultants (IBCLCs) 4/10/201223

25. 4/10/201224

26. Getting started  Breastfeeding education  Breastfeeding environment  Breastfeeding policy 4/10/201225

27. Why is it necessary to support breastfeeding in the childcare setting? 4/10/201226

28. References American Academy of Pediatrics, American Public Health Association, & National Resource Center for Health and Safety in Child Care (2011). Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, 3 nd Ed. Chicago, IL: American Academy of Pediatrics; American Public Health Association. American Academy of Pediatrics (2005). Breastfeeding and the use of human milk; Policy statement. Pediatrics, 115(2), pp 496-506. http://www.aap.org http://www.aap.org Carothers, K. (2010). Best Milk. Katalac Books LLC. Retrieved from http://www.bestmilkbook.com/http://www.bestmilkbook.com/ The International Breastfeeding Symbol. Retrieved from http://www.breastfeedingsymbol.org/download/http://www.breastfeedingsymbol.org/download/ Maine Centers for Disease Control and Prevention; Division of Local Public Health. Maine workplaces support nursing moms. Retrieved from http://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtmlhttp://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtml Martin, C. (1995) We like to nurse. Hohm Press: Arizona. Mississippi breastfeeding Coalition’s Building Breastfeeding Friendly Communities project by the Wisconsin Department of health and Family Services in collaboration with the Wisconsin Breastfeeding Coalition Division of Public Health – Nutrition Section. Retrieved from www.dhfs.state.wi.us/WICwww.dhfs.state.wi.us/WIC 4/10/201227

29. References cont. Nemours. Let’s Move! Childcare. Retrieved from http://healthykidshealthyfuture.org/welcome.htmlhttp://healthykidshealthyfuture.org/welcome.html Payne, D. & Nicholls, D. (2009). Managing breastfeeding and work: a Foucauldian secondary analysis. Journal of Advanced Nursing, 66(8), 1810–1818.doi: 10.1111/j.1365-2648.2009.05156.x Texas Department of State Health Services. Retrieved from http://www.dshs.state.tx.us/wichd/bf/childcare.shtmhttp://www.dshs.state.tx.us/wichd/bf/childcare.shtm Warren, D. (2007). Best fast food; Mother’s milk. Oasis Publications: Sarasota, FL. Wisconsin Nutrition, Physical Activity, and Obesity Program. Ten steps to breastfeeding friendly childcare centers; A resource kit. Retrieved from http://www.dhs.wisconsin.gov/health/physicalactivity/pdf_files/BreastfeedingFriendlyChildCareCenters.pdfhttp://www.dhs.wisconsin.gov/health/physicalactivity/pdf_files/BreastfeedingFriendlyChildCareCenters.pdf Young, M. (2009). We like to nurse too. Hohm Press: Arizona. 4/10/201228