Making it Work Supporting the Breastfeeding Employee A training for managers and supervisors 2016

Introduction Balancing work and family is an important priority for all employees. When an employee returns to work after welcoming a new baby, time and space to express milk during the work day help that individual to continue to give the best to both work and baby. These family-friendly benefits also bring a return on investment through lower health care costs, lower employee absenteeism rates, lower turnover rates, and higher employee productivity and loyalty.

Key topics Benefits of breastfeeding The business case for breastfeeding Affordable Care Act, Oregon and Washington Requirements FOR YOU TO EDIT: Your organization’s policies Employee example Creating a culture of support Summary and closing Additional tools and resources

Training objectives Upon completion of this training, supervisors will be able to: List three organizational requirements for supporting breastfeeding employees Describe the location of lactation spaces within their department State two ways they can support breastfeeding employees Develop talking points for a meeting with an employee who is expecting a child or breastfeeding

Benefits of breastfeeding Understanding the value of breastmilk helps to frame the discussion of why it is important to support breastfeeding employees. The World Health Organization (2016) recommends exclusive breastfeeding for six months. Thereafter, infants should received complementary foods with continued breastfeeding up to two years of age or older.

Benefits of breastfeeding Benefits of human milk include: Lower risk of infections and illness for babies. Faster recovery from birth and lower risk of certain cancers for the breastfeeding employee.

Business case for breastfeeding More than 90% of mothers in our region begin breastfeeding after birth (CDC, 2014). When they return to work, a supportive environment will encourage productivity and higher job satisfaction. Workplace support for employees who want to breastfeed or express milk results in a 3:1 return on investment (HRSA, 2008)

Business case for breastfeeding Workplace support for breastfeeding results in: Lower health care costs Lower turnover rates Lower absenteeism rates (Babies fed human milk are healthier, and their parents are less likely to miss work. One-day absences occur half as often among parents whose infants are fed human milk.) Increased productivity and company loyalty Improved ability of employer to recruit and retain talent

ACA requirements In 2010, The Patient Protection and Affordable Care Act (ACA) amended section 7 of the Fair Labor Standards Act (FLSA) to require employers to provide nursing employees with: Reasonable break time to express milk A place, other than a bathroom, that may be used to express milk Ensure provisions 1 and 2 for up to one year after the child’s birth

Washington State In addition to enforcing ACA requirements, Washington State also allows any employer to use the designation of “infant-friendly” if the employer has met certain guidelines*. Washington State also prohibits discrimination and/or retaliation against breastfeeding parents. *An employer may use the designation of “infant-friendly” on promotional materials if they have an approved workplace breastfeeding policy and meet at least the provisions outlined in the code requirements 2001 c 88 § 3.

Oregon Requires Provisions 1 and 2 of the ACA for up to 18 months At least 30 minutes per four hours of work for the expression of milk A private place and unpaid employee rest periods for the expression of milk (Oregon Wage and Hour Law) Temporary changes of regular job duties if necessary Lactation area in close proximity to employee’s work area $1,000 fine per incident for non-compliance (Oregon Bureau of Labor and Industries)

FOR YOU TO EDIT: Introduction slide for information on your organization’s policies Organization Name has worked to develop supportive policies and practices that enable employees to successfully return to work while breastfeeding. These practices send a message to all employees that breastfeeding is valued. We ask that supervisors make reasonable accommodations to help employees reach their goals for milk collection and breastfeeding. These practices encourage other employees to exhibit a positive and accepting attitude.

Your organization’s policies Discuss your organization’s policies and practices for supporting employees. Include information on locations of available lactation spaces. Include pictures or maps if available.

What employees need to know Location of lactation spaces If policies permit baby to breastfeed on site How to reserve and access lactation spaces. A shared calendar works well* How to accommodate milk expression when in the field Time to discuss lactation accommodations with manager/supervisor -- ideally, before parental leave is taken That management and leadership support breastfeeding and milk expression at work *Remember HIPAA, privacy, and security issues when planning access to shared lactation spaces. Are there locks on the entry doors?

What employees should expect from a lactation space A clean, private space free from intrusions Lockable door or “In Use” signage Comfortable chair that can be cleaned easily An Electrical outlet A desk or table Cleaning supplies (wipes, paper towels) Running water (or access to running water) Small refrigerator or access to one, if available. A shared lunchroom fridge is okay for milk storage

Examples of lactation spaces

Christina at Work Meet Christina! An employee and a new mom. Christina works in the front office of a health clinic. When not answering phones, Christina is at the front desk admitting clients, processing paperwork, and maintaining the clinic’s flow. Christina’s job is demanding, and her contribution is critical to the efficient operation of the clinic.

When Christina returns to work, she plans to use the designated lactation room. She and her manager discuss staff coverage to maintain good customer service.

Christina and her manager plan staff coverage and flexible break times to meet her milk expression needs and good customer service. In Christina’s case, she will take a shorter lunch and extend two other break periods each day.

Milk production is a constant, ongoing process Milk production is a constant, ongoing process. When Christina removes milk by breastfeeding or pumping, her body automatically makes more milk to replace it. The more frequently milk is removed, the greater the quantity of milk produced. If milk is not removed regularly, Christina will experience pain and discomfort. She also risks infection and a drop in milk supply.

When Christina was at home with her baby, she breastfed approximately 10 times in a 24-hour time period. This schedule maintained her milk supply at about 30 ounces per day.

7:00 am 8:00 am 9:00 am 10:00 am 11:00 am 12:00 pm 1:00 pm 2:00 pm 3:00 pm 4:00 pm 5:00 pm 6:00 pm 7:00 pm 8:00 pm 9:00 pm 10:00 pm 11:00 pm 12:00 am 1:00 am 2:00 am 3:00 am 4:00 am 5:00 am 6:00 am When she returns to work, Christina’s schedule will need to shift, as she is unable to express milk as frequently during the workday. Table: Simplified example of Christina’s Breastfeeding routine prior to returning to work.

7:00 am 8:00 am 9:00 am 10:00 am 11:00 am 12:00 pm 1:00 pm 2:00 pm 3:00 pm 4:00 pm 5:00 pm 6:00 pm 7:00 pm 8:00 pm 9:00 pm 10:00 pm 11:00 pm 12:00 am 1:00 am 2:00 am 3:00 am 4:00 am 5:00 am 6:00 am Because Christina will express milk less frequently during the day, she will now breastfeed more frequently in the evening and nighttime hours in order to maintain production. Occasionally, Christina will also need to express milk more often during the work day. Table: Example of Christina’s breastfeeding routine after returning to work.

It’s break time! When Christina’s break starts, she grabs her bag and walks to a nearby lactation room, approximately two minutes away.

When Christina arrives in the lactation room, she washes her hands, unpacks her equipment, and settles into a comfortable chair to express milk for about 10 minutes.

Christina labels her collected milk and seals the lid.

8 hours 24 hours 5 days Human milk is safe at room temperature for up to eight hours. It will be safe for 24 hours in a cooler on ice. If refrigerated, it will be safe for 5 days.

Time to pack up!

Christina returns to her workstation, feeling relieved and happy to feel supported at work. It took Christina about 10 minutes to complete a pumping session. It also took time to get there, get ready, and pack up. Three 30-minute breaks work well for her and her workplace.

Christina has been maintaining this routine for six months Christina has been maintaining this routine for six months. She and her baby are thriving!

Christina’s schedule may not work for every employee in every department, but her team was able to provide the coverage needed to meet business needs while she was away from the workstation. Some situations call for creative solutions. Is it possible for an employee in your department to arrive early, leave late, work part-time, or modify duties temporarily?

Create a culture of support DO: Know your organization’s policies Know where lactation spaces are located Know who to ask for supervisor support (EDIT: include your organization-specific information) Recognize that employees experience stress when returning to work after welcoming a new child. Work with employees to balance work duties and personal needs. Be flexible with breaks and schedules. Provide employees with supportive resources: a simple handout or web link with community breastfeeding support information, FAQ’s etc. Set aside a time to meet with your employee to discuss plans and demonstrate your support.

Create a culture of support DO: Ensure your department knows how to support clients, customers, vendors, patients, and visitors who need privacy to breastfeed or express milk. Inform your work team about parents’ rights to breastfeed wherever they are. If a parent requests privacy, direct the individual to an available lactation room or private space in your work area.

Create a culture of support DO NOT: Ask an employee when they will be done Treat an employee’s needs like an inconvenience Consider a restroom a suitable place to express milk Insist pumping should be done only at certain times, or for a certain amount of time. Every individual varies. Ask personal questions such as, “How many ounces do you collect?” or “What do you do in there?” Treat a breastfeeding employee as if they are ill Tolerate disrespect toward the breastfeeding employee from other team members

Summary Support for breastfeeding employees brings many benefits: Healthier babies, happier employees, cost-savings to organizations, and compliance with state and federal requirements. It is important for supervisors to be familiar with organizational policies that support breastfeeding employees. (EDIT: include how to access your organization’s information) Creating a culture of support includes respecting individual needs, offering flexibility and collaborating toward practical solutions.

References Exclusive Breast Feeding. (2016). Retrieved from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en United States Breastfeeding Committee (USBC). (2016). Federal Workplace Law. Retrieved from http://www.usbreastfeeding.org/p/cm/ld/fid=234 CDC National Center for Chronic Disease Prevention and Health Promotion. Division of Nutrition, Physical Activity and Obesity. (2014). Breastfeeding Report Card. Retrieved from http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau. (2008). The Business Case for Breastfeeding. Retrieved from http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-breastfeeding/business-case-for-breastfeeding-for-business-managers.pdf U.S. Department of Labor, Wage and Hour Division. (n.d.). Retrieved from http://www.dol.gov/whd/nursingmothers/sec7rflsa_btnm.htm WithinReach. (2013). Know Your Rights: Breastfeeding Laws. Retrieved from http://www.withinreachwa.org/what-we-do/healthy-communities/breastfeeding/about-breastfeeding/breastfeeding-laws/ Oregon Health Authority. (n.d.). Breastfeeding Laws. Retrieved from https://public.health.oregon.gov/HealthyPeopleFamilies/Babies/Breastfeeding/Pages/Laws.aspx

Additional resources The following slides provide supplemental materials to support this training: Lactation space “in-use” signage Supervisor checklist Suggested websites to share with employees Suggested apps to share with employees who spend time in the field (nursing room locators) Sample map

This room will be available at: ________________________ Breastfeeding Parent Please do not disturb This room will be available at: ________________________

Supervisor Checklist Identify lactation spaces. Discuss the organization’s lactation policy for supporting breastfeeding employees prior to the employee’s leave if possible, so you can make needed arrangements beforehand. Praise! Express support for your employee’s decision to breastfeed. Assure the employee that direct supervisors and other relevant managers are aware of needs. Review the employee’s typical work/break schedule to arrange for milk expression breaks. Arrange for coverage while the employee is away from the work station. Seek feedback from the employee.

Paste a map of lactation spaces in your organization here EXAMPLE

Websites to share with employees Womenshealth.gov http://womenshealth.gov/breastfeeding/breastfeeding-resources.html Oregon Health Authority https://public.health.oregon.gov/HealthyPeopleFamilies/Babies/Breastfeeding/Pages/workplace.aspx Washington Work and Breastfeeding http://www.withinreachwa.org/what-we-do/healthy-communities/breastfeeding/about-breastfeeding/breastfeeding-laws/ Breastmilkcounts.com http://www.breastmilkcounts.com/

Lactation room locator apps For Android and Apple phones MomsPumpHere Nursing Room SG Mamava Lactation Suite Locator Feed Finder latchME* Mamamap* Breastfeed Proudly Android phones only Baby Room Finder Feeding Friend Apple phones only Breastfeeding Team App iBreastfeed2 *Highest number of users (10,000-50,000).

Making it Work Supporting the Breastfeeding Employee A training for managers and supervisors The Healthy Columbia Willamette Collaborative (HCWC) believes a healthier next generation starts with us. As leaders in healthcare, we play an important role in supporting families as they return to work while continuing to provide human milk as their babies’ first food. Through our practices, policies, buildings, and personnel, we are working to ensure all of our employees are supported in providing the best, most nutritious start to their babies’ lives. Our organizations are committed to addressing and improving our organizational policies and practices in lactation support in order to support a healthy workforce, reduce health inequities, and increase rates of breastfeeding in our region. 2016