What do newborn babies know about breastfeeding? More than we thought, apparently, according to some recent research into "self-attachment."

A team of Swedish researchers wanted to see if newborn babies left on their mothers' stomachs after birth could find the breast on their own. Videotape documentation showed the babies "crawling" up their mothers' bodies without assistance and finding the breast. The babies then moved toward the nipple and nuzzled or licked at it, eventually latching on and beginning to suck.

Subsequent studies suggest that this process of self-attachment should be encouraged. Babies who are left to self-attach have very few problems latching on and their mothers almost never experience sore nipples or related breastfeeding problems.

Dr. Pat Martens, a researcher and assistant professor in the Faculty of Medicine at the University of Manitoba, notes that self-attachment has become common practice in Norway and Sweden.

"Research from those countries has given us some new pieces of information," says Martens. On average, it takes 50 minutes for babies to find the breast on their own and begin suckling if they're placed on the mother's abdomen after birth. (Babies whose mothers received pain medication during labour had more difficulty finding the breast and latching on.) This suggests to Martens that trying to put babies to the breast too soon after birth - before they're really ready - may be causing breastfeeding problems.

Self-attachment is still unusual in Canada, says Martens, but nurses who have tried the technique are seeing very positive results. If you want to encourage self-attachment when your baby is born, discuss this with your caregiver before the birth. You will need to make sure there will be a good source of heat (such as a radiant heater over you and your baby) to keep the baby warm during this process.

If you didn't get the opportunity for this kind of first feeding, and find your baby is having latching problems, the self-attachment research may offer another solution. Martens notes that Australian researchers found that putting the mother and baby in a warm bath together - so that both were relaxed - and then allowing the baby to find the breast and self-attach seemed to improve many breastfeeding problems. "It was like giving them another chance at the process they'd missed at birth," Martens explains.

It adds up to more intriguing evidence of the inborn abilities of babies.

Why is breastfeeding STILL such a taboo?

By Miranda Levy
Last updated at 12:44 PM on 09th July 2009

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The letters arrived in their hundreds. 'I was breastfeeding my daughter on the bus - she was covered in a blanket,' wrote Hayley Johnson from Luton.

'The conductor got on and told me I'd either have to stop, get off the bus, or move to the back.'

Helen Orr, of Northern Ireland, told me: 'I've sat on toilet seats in cubicles and taken 20 items of clothing to "try on" into changing rooms, just so I can feed, because there's nowhere else.'

Natural bond: Two thirds of mothers maintain that feeding their baby in public had been a stressful experience

Then there was Elle Hanson, recalling the time she discreetly tried to feed her son in a 'family-friendly' pub until 'a woman told me I shouldn't do that in front of other people's husbands because it's obscene'.

Anyone who thought breastfeeding in public is no longer a contentious and provocative issue should think again.

Those are just some of the personal experiences that poured into me at Mother & Baby magazine when we lauched a nationwide breastfeeding survey.

We were seeking an answer to the question: Is Britain breastfeeding friendly? And the answer was a resounding, regretful 'no'.

Of the 1,200 women who took part in our online poll, 60 per cent felt that the UK frowned on breastfeeding mothers. Two thirds maintained that feeding their baby in public had been a stressful experience, and more than half of these had been asked to move out of a restaurant, cafe or coffee shop when they were feeding.

These figures might go a long way to explain the official statistics on how many women actually breastfeed in Britain.

According to the 2005 UK Infant Feeding Survey, just 78 per cent of new mothers ever attempt breastfeeding, compared with 99 per cent in Norway, 91 per cent in Italy and 84 per cent in Spain.

'A staggering 65per cent said they simply 'felt too self-conscious about people staring'

By six months, only 22 per cent of UK mothers are still doing it. Of course for some people, a woman with a newborn at her breast is seen as the quintessential image of new motherhood, the natural way to bond.

Moreover, thanks to high-profile government campaigns, we are more aware than ever of the health benefits for both baby and mother. These include protection against childhood infections, obesity and allergies, as well as lowering the risk of cancer and diabetes for the baby. And for the mother, there is protection against breast and ovarian cancers, osteoporosis, heart disease and stroke. And yet for many other people, it remains something that is unpleasant or even physically repugnant that should be hidden away.

The feeling from our survey is that most women actually want to breastfeed. Everyone we asked (whether breast or bottle feeding) said they understood the health benefits. But the saddest thing was the reason so many women said they didn't even intend to try. A staggering 65per cent said they simply 'felt too self-conscious about people staring'.

So why is Britain still stuck in the dark ages in our attitudes to this basic part of motherhood? Rosie Dodds, senior public policy officer of the National Childbirth Trust (NCT), who supported our research, says: 'The results of this survey are unsurprising. There are many reasons why we're lagging behind much of Europe.

'First, the Mediterranean countries and Scandinavia have much more of a family culture. Parents and children are seen out together far more at restaurants in the evening; in the UK, there's still a residual "children should be seen and not heard" approach.

'Then there's the prudish British attitude that breasts are for sex, not for babies, coupled with the fact that many women just aren't as confident in their bodies as women are in other areas of Europe.

'And finally, breastfeeding is a generational thing - if you've never seen your mum, parents or aunts breastfeed, it's hard to start doing so yourself. Many young women have never seen another woman breastfeed.'

Many women are still finding themselves on the wrong end of hostility if they breastfeed in public

A generational thing, perhaps, but it's also a class thing. According to a 2004 study by University College, London, women in routine jobs are four times less likely to breastfeed than universityeducated women - those with professional jobs and those aged over 30 when they gave birth.

This new survey also revealed a regional split. Breastfeeding mothers in London found themselves less likely to be challenged by other people in the same restaurant, for example, whereas the North-West (65 per cent) and West Midlands (63 per cent) were considered the most stressful areas to be a breastfeeding mother in terms of being abused or made to feel unwelcome.

Wherever they live, and whatever their chosen careers, many women are still finding themselves on the wrong end of hostility if they breastfeed in public.

Annabelle Turner, 31, is a sales manager for a national catering chain and mother to Jemima, who's ten months. 'It was always my intention to breastfeed,' she says.

'My mum breastfed me, and my NHS antenatal class convinced me of the overwhelming health benefits. Luckily, my daughter took to breastfeeding straight away.

'Until the British public decides to embrace breastfeeding, it's down to mothers to stand our ground'

'When she was a month old, my husband and I decided to take Jemima out for lunch for the first time, to a local pizza restaurant in South London.

'I started to feed her, very discreetly. Suddenly, I got the feeling everyone was staring at me, as if I were doing something inappropriate. One couple were even whispering behind their hands.

'I started to feel incredibly stressed, and Jemima could sense my tension and slowed down her feed. My husband encouraged me to continue, but I felt like bursting into tears.'

And in the end, Annabelle and her husband gobbled up what was left of their meal and went home.

'Since then, I've changed the way I organise my day,' she says. 'I avoid going out a feeding times, and only go to specific "baby friendly" cafes.

'The public's attitude has affected my friends, too - several of them now feed their baby with formula milk during the day, and only breastfeed at home at night, precisely because they hate that kind of reaction.' Many groups - including the NCT - are working hard to make public breastfeeding more acceptable.

'We know most mums start out breastfeeding their babies, but one of the reasons they stop is that they feel uncomfortable doing it when they are in public,' says Anne Fox, head of campaigns at the NCT.

'I agree that the biggest change in attitude has to come from the public. In our survey, two-thirds of our readers wanted 'more positive images of breastfeeding women'.

For this reason, for the August issue of Mother & Baby, we've taken the groundbreaking step of putting an image of a breastfeeding model and baby on the cover - the first time a UK magazine has used such an image.

Until the British public decides to embrace breastfeeding, it's down to mothers to stand our ground.

Mothers such as Tamsin Hazelwood, who contacted us this week to share her memories of breastfeeding her firstborn in a pub toilet cubicle.

'Outside, women were swearing and laughing, and there I was, baby in my arms, crying because I was alone and feeling stupid that I was in a loo trying to feed my child,' she wrote.

'My fiancé and I are planning for another baby in a few months and I've promised myself I will breastfeed wherever I want to. I'm just going to get on with it, and simply smile back at anyone who stares until they stop looking at me.'

Explore more:

Read more: http://www.dailymail.co.uk/femail/article-1198433/Why-breastfeeding-STILL-taboo.html#ixzz0SAFTtf8X

Breastfeeding activities cancelled in Quebec over H1N1 worries

Canwest News ServiceSeptember 24, 2009

The Breastfeeding Challenge is held each year in October in some 20 cities across Quebec with the goal of having the greatest number of babies breastfeed at the same time around the world. Provincial health authorities have cancelled the series fearing the H1N1 virus could pose too much of a health risk to mothers and babies.

Photograph by: Julie Oliver, Ottawa Citizen

Quebec Health authorities have cancelled a series of breastfeeding gatherings across the province fearing the H1N1 virus could pose too much of a health risk to mothers and babies.

The Breastfeeding Challenge is held each year in October in some 20 cities across the province with the goal of having the greatest number of babies breastfeed at the same time around the world.

The activity attracts some 2,500 women and their babies in Montreal and 500 in Quebec City.

Authorities said they don't know how the pandemic will evolve and would rather err on the side of caution.

"Statistics gathered during the first pandemic wave show pregnant women, women who just gave birth, newborns and young children are more vulnerable to the virus and risk developing major complications," the health agency said in a press release.

Moreover, the agency said babies and toddlers can't follow the basic hygiene guidelines such as washing hands regularly.

The Quebec government will announce Friday if it is cancelling or delaying the seasonal flu vaccination campaign in favour of a mass inoculation against the H1N1 strain.

© Copyright (c) Canwest News Service

Multinationals selling baby formula in Vietnam break milk law meant to promote breastfeeding

By: BEN STOCKING
Associated Press
09/19/09 11:35 AM PDT

HANOI, VIETNAM — Multinational companies in Vietnam sell baby formula so aggressively that they routinely stretch and sometimes break laws designed to promote breastfeeding, an AP investigation has found.

International guidelines and Vietnamese law recognize breast milk as superior to formula for an infant's health. Yet dozens of interviews with mothers, doctors, health officials and shopkeepers suggest that formula companies pay doctors to peddle their products, promote it for infants under age one and approach mothers and health care workers at health facilities — all of which are against the law.

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.

The companies say they follow the law and attribute increased sales to other factors, chiefly more working women with money to spend and less time to breast-feed. Health experts agree that these factors have played a role, but also point to relentless marketing by formula companies.

The aggressive marketing of formula is common across the region, from China to Indonesia to the Philippines, according to the International Code Documentation Center, a Malaysia-based nonprofit that seeks to eliminate the irresponsible marketing of baby foods. While companies often violate the voluntary international milk code, the center says, they are usually careful to follow the letter of individual country laws.

When the Philippine government tried to tighten its advertising laws for milk products two years ago, the companies took it to court.

"The health workers there were part of the marketing arm for those products," said Jean-Marc Olive, Vietnam representative for the World Health Organization, who used to work in the Philippines.

Vietnam's struggle shows how difficult it is for developing countries to take on international companies with hefty advertising budgets and aggressive sales and legal teams.

"The companies have millions of dollars and dozens of lawyers, but the Vietnamese government has a tiny budget and just two people promoting breast-feeding," said Annelies Allain of the International Code Documentation Center.

In early August, during World Breastfeeding Week, 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.

Workers at a women's health clinic in Dong Nai province had an exclusive deal with Dutch Lady, a brand of Friesland Foods, based in Meppel, the Netherlands, said Dr. Vo Thi Kim Loan, the clinic's former vice director.

"We got a small commission for each can," she said.

Jan Bles, the Vietnam director for Dutch Lady, denied the allegation.

"We do not compensate doctors, clinics, hospital or their staff for selling or promoting our products," he said, although he acknowledged providing furniture for the clinic, whose waiting room is adorned with a large Dutch Lady logo.

Tran Thi Hanh, the clinic director, said the clinic signed a contract to promote a Dutch Lady powdered milk product for pregnant and nursing mothers, but didn't sell products for babies or receive commissions by the can.

The clinic also printed a Dutch Lady logo on registration forms for women who came for ultrasounds or prenatal check-ups, she said. In return, Hanh said, Dutch Lady provided lunch for about 50 staffers from smaller clinics around the province who came to the bigger clinic for training every three months.

Several other big formula companies also tried to land a deal with the clinic, said Loan, the former vice director. Another clinic employee, who declined to give her name because she still works at the clinic, confirmed Loan's account.

The staff didn't promote formula for babies under six months, Loan said, but they frequently pushed it for babies between six and 12 months. 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.

Several Hanoi shopkeepers also said that formula companies pay doctors commissions for promoting sales.

It is illegal to sell infant formula inside Vietnamese hospitals, except in pharmacies, but the alley just outside Hanoi's main maternity hospital is lined with shops prominently displaying American and European brands.

"Most customers are sent by their doctors right after they give birth," said Ngo Thanh, 27, who has worked next to the main maternity hospital for five years. She and other shopkeepers said their customers bring labels or plastic caps from formula tins back to their doctors for documenting sales.

Vietnam's low-paid doctors are easy targets for formula companies, which offer them "formidable benefits," said Dr. To Minh Huong, deputy director of Hanoi's main maternity hospital. Last year, she said, company representatives came to the hospital and posed as academic researchers, looking for patient information.

"When we asked for their IDs, they fled," she said.

Formula companies denied paying commissions.

"Our employees are routinely trained and held to high standards of compliance," said Gail Wood, a spokeswoman for Mead Johnson Nutrition, an American firm based in Glenview, Ill.

Vietnamese law also prohibits formula salesmen from approaching health workers or mothers at health care facilities. Wood said staff abide by the law and the international code.

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.

Other new mothers were called by phone instead. A dozen told the AP they had been bombarded by calls from salesmen. Minh said she received calls from Abbott and Mead Johnson when her baby was 3 months old. Another mother, Nguyen Lan Huong, said she received four calls from Abbott.

"They must get mothers' names from the hospitals," she said. "They knew my name, my baby's name and his birthday."

Tracey Noe, a spokeswoman for Abbott of Abbott Park, Illinois, said the company only calls women who sign up for promotions, but the women interviewed by the AP said they had not requested information.

"We provide extensive training to our employees and conduct routine audits to ensure compliance," Noe said.

As Vietnam has embraced market reforms and opened up to outside investment, Western products, including baby formula, have gained cachet. More mothers can afford formula, said Bles of Dutch Lady, whose Vietnam profits surged by 30 percent last year.

Company spokesmen point to statistics showing that many Vietnamese women breast-feed at some point after giving birth. In some categories, Vietnam compares favorably with other developing Asian nations.

But health experts say the one number that truly matters is the percentage of women who exclusively breast-feed their children for the first six months. And in this category, Vietnam fares poorly.

"We are one of the worst in the region, and that has happened over the last eight years," said Marjatta Tovanen-Ojutkangas, head of UNICEF's health and nutrition section in Hanoi.

Breast milk significantly reduces infant mortality, according to international health experts, who recommend that mothers exclusively breast-feed for the first six months and continue breast-feeding, supplemented by solid foods, until their babies are two.

The International Code of Marketing of Breast-Milk Substitutes, sponsored by the World Health Organization and UNICEF, is not legally binding. It is up to individual countries to implement the code by enacting their own laws. Vietnam did so in 1994.

But loopholes in Vietnam's decree make it hard to hold formula companies accountable, said Yeong Joo Kean, an attorney with the International Code Documentation Center.

"Just when you think you might have a watertight case, you'll get shot down on a technicality," she said.

In recent years, formula companies have introduced an array of powdered-milk products for older children and mothers. These don't fall under the restrictions of the code or Vietnamese law, so companies can advertise them freely and market their brand.

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.

One television ad for Milex, a Scandinavian brand, shows a young boy dressed up in a NASA uniform, suggesting that powdered milk will make him smart enough to fly to the moon.

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.

___

Associated Press writer Vu Tien Hong contributed to this story.

Lactation and the Law

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By Jake Aryeh Marcus
Issue 143, July/August 2007

Most women who breastfeed their children will, at some time or other, find it necessary to nurse their children outside of their homes. For most women who nurse in public places, feeding their children will be no more stressful than nursing at home. Other people often do not notice when someone is breastfeeding near them, and those who do notice are generally indifferent or even supportive. All too often, however, we read stories of women who have been told to use a bathroom to nurse their children, asked to cover themselves and their child with a blanket, or told they must leave a place because they want or need to nurse.

"I have the right to breastfeed anywhere I have the right to be" has become the rallying cry of mothers who breastfeed outside their homes. But is this true? And if it is true, what can be done if someone interferes with that right while a woman is breastfeeding in a public space?

There are no laws in the US forbidding breastfeeding outside of the home, and only two states in which laws place any limitation on the way in which public breastfeeding may be done.¹ However, in the absence of a law establishing and protecting the right, a woman who breastfeeds in a public accommodation—a privately owned place open to the public, such as a restaurant or shopping mall—might lawfully be asked to leave, either by the owner or in accordance with the owner's instructions. If she refuses, she might be removed by the police or placed under arrest for trespass. Without a law to protect her, a woman breastfeeding in a public place such as a park, or state-owned properties (e.g., a courthouse), risks removal by the police and potentially (though this is rare) a charge of some form of indecent exposure. A basic maxim of American law is that a right without a remedy is no right at all.² In plain terms, this means that although you may have a "right" to do anything not otherwise forbidden by law, if you do not also have a legal protection against someone interfering with that right, your ability to exercise it may be limited.

What do state public breastfeeding laws say?

State laws that protect public breastfeeding fall into three categories. Currently, the strongest state laws are those that both protect a woman's right to breastfeed anywhere she or her child have a right to be, regardless of whether the breast is showing, and that also give the woman the power to bring a legal action against anyone who interferes with her breastfeeding.³ Other state laws establish a woman's right to breastfeed in public, but don't provide a way for her to enforce this right. The third category specifies that the act of breastfeeding is not indecent exposure (sometimes given other names, but always referring to the exposure of body parts), and prevent a woman from being charged with a sex crime for breastfeeding.

What does enforcement mean?

In Vermont, a woman whose right to breastfeed has been violated "may file a charge of discrimination with the human rights commission ... or may bring an action for injunctive relief and compensatory and punitive damages and any other appropriate relief in the superior court of the county in which the violation is alleged to have occurred."⁴ She may also seek an order for the offending party to pay her attorneys' fees.⁵

This statute enabled Emily Gillette to file a complaint against Freedom Airlines and Delta Air Lines before the Vermont Human Relations Commission in 2006. Gillette, a mother from New Mexico, was removed from a Freedom Airlines flight, while it was still on the ground in Vermont, for refusing a flight attendant's demand that she cover herself while breastfeeding her child. Without the law, she might have been left only with the statement of a Delta spokesperson (Delta had an agreement with Freedom to carry its passengers) that "Delta Air Lines fully supports a mother's right to breast-feed on board our aircraft, and we were very disappointed in the decision to move Ms. Gillette from the flight."⁶

Gillette and her family were not only humiliated by an airline employee, but had to wait until the next day for a new flight. Other than a few public words, the airlines have offered her nothing, and in the absence of a court or commission ruling, there are no guarantees that a Freedom or Delta employee will not behave the same way in the future.

In the other states that currently have enforcement mechanisms for their public breastfeeding laws, the possible awards include an injunction—a court order that the discriminatory behavior stop immediately—or, in a few states, a fine. New Jersey law, for example, imposes possible fines "not to exceed $25.00 for the first offense following initial notification, and not to exceed $100.00 for the second offense, and not to exceed $200.00 for each offense thereafter."⁷ Laws in some states also create a private right of action for someone who has suffered discrimination, which means that a woman may file a lawsuit to recover money damages.⁸ The stress, embarrassment, and humiliation that a woman may suffer when she is harassed is difficult to quantify in dollars, but the fact is that in many other contexts, our state and federal courts make these determinations every day. Often, the threat of having to defend against a lawsuit will motivate the offending party to settle the case. Most state laws enforcing protections for nursing in public also include the right to recover attorneys' fees and other costs incurred in bringing a complaint or lawsuit.

What if the public breastfeeding law has no enforcement provision?

Most state laws protecting the right to breastfeed outside the home do not have enforcement provisions. However, this does not mean that there is nothing a nursing mother or her supporters can do. In a heart-wrenching incident last April, Jessica Swimeley was told to stop nursing her 17-month-old son, Tobin, in a common area of the Ronald McDonald House of Houston, Texas.⁹ What made this story particularly compelling was that Tobin and his family were staying in the House because Tobin was recovering from surgery to remove a brain tumor. According to his family, he was in such great postsurgical pain that breastmilk was all that he could consume and nursing was his only comfort. Although the facility later denied it, Tobin's family insist that they were told by the Ronald McDonald House administration that they would be evicted from the facility if they refused to comply with what was called an "oral guideline" forbidding breastfeeding anywhere other than in the family's private room—in Tobin's case, a three-story ride on a slow elevator.

Texas state law provides that a "mother is entitled to breast-feed her baby in any location in which the mother is authorized to be."¹⁰ Unfortunately, however, the law does not contain a penalty for violating it, or provide for a department in the state government to enforce it. But this didn't stop Swimeley's sister, Melanie Mayo-Laakso, who had pulled the Texas law up on her laptop computer to show facility staff as soon as her sister was told to stop nursing. Mayo-Laakso took her sister's story to the Internet, where her request for help from breastfeeding supporters resulted in so many phone calls and e-mails that Ronald McDonald House of Houston reported that its server crashed and required repair. After a tense few days, facility administration called a meeting with the family, at which representatives from La Leche League International were present to support Tobin's mother and aunt.

The outcome of the meeting was highly controversial. It was agreed that Swimeley (who was also nursing Tobin's twin brother) and Mayo-Laakso (who was nursing her own three-year-old daughter) could remain in the facility and could breastfeed in common areas. However, both women would be required to announce to all present in the room that they were going to breastfeed, so that anyone who did not wish to be present could leave. The mothers were also told to breastfeed "discreetly." While the definition of "discreetly" was left up to the mothers, the administration reserved the power to stop the public nursing if it received complaints about a lack of discretion on the part of the mothers. Also of note is that the permission to breastfeed applied only to Tobin's family. The Ronald McDonald House administration would not commit to a written policy concerning breastfeeding, or describe the rules that would apply to nursing families in the future.

Would this family have been forced to rally public support on its own, had Texas law contained an enforcement provision? Clearly, the answer is "no." Would the facility have been allowed to place restrictions on the way these moms breastfed, had there been a way to enforce the law? Again, probably not.

What about indecent exposure?

No nursing mother or supporter of breastfeeding would consider the act of breastfeeding indecent exposure.However, in the process of latching a child on to the breast or while nursing a squirming child, it is certainly possible that some or all of the mother's breast could be revealed to an onlooker. While I could find no reported case of a mother being criminally charged with indecency for breastfeeding outside the home, the possibility exists.

In 2003, Jacqueline Mercado temporarily lost custody of her two young children after she was reported to Child Protective Services in Richardson, Texas, by an Eckerd drugstore clerk who had processed photographs taken of Mercado breastfeeding her son, then one year old. Mercado and the children's father, both natives of Peru, were arrested and charged with "sexual performance of a child," a felony for which they could have served 20 years in prison.¹¹ It took six months for the local district attorney to drop the charges and for the couple to regain custody of their children.

Unlike Alaska, in which a law explicitly states that breastfeeding is not "lewd conduct," "lewd touching," "immoral conduct," or "indecent conduct,"¹² most states do not protect nursing mothers from prosecution under indecency laws. Though the Mercado case was unusual, the absence of explicit legal protection made it possible.

What about federal law?

When Rhea Wolf was told that she needed to cover herself or go into the bathroom as she prepared to latch her daughter, Scarlett, on to her breast, she knew that her right to breastfeed was protected by Oregon law. What she didn't realize, as she refused the demand made by a receptionist in the otherwise empty waiting room of an Internal Revenue Service office in Portland, was that she was also protected by federal law, which states: "Notwithstanding any other provision of law, a woman may breastfeed her child at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location."¹³ Unfortunately, this federal law lacks an enforcement provision.

Even though Wolf continued to breastfeed her daughter under the hostile glare of the flustered receptionist, Wolf wrote a letter to the director of the Portland IRS office reporting the fact that, in violation of Oregon law (which also has no enforcement provision), she had been told to stop. She also asked that the office adopt a clear policy, and that employees be trained in the law regarding breastfeeding. She never received a response, and plans to continue writing to higher authorities within the IRS until someone replies.¹⁴

What to do in states with no enforcement provision or no breastfeeding law

Even without an enforcement mechanism, a law clarifying the right to breastfeed should always be cited in any complaint made about harassment. Though she may never need to use them, every nursing mother should know her state's laws regarding breastfeeding. Most discrimination can be resolved by reporting it to the person in the highest position of authority where the incident has taken place. A waiter or store clerk does not have the authority to ask a mother to stop breastfeeding, regardless of the breastfeeding law. A mother should always insist on speaking to the owner of a public accommodation. In some situations, that may mean going to a board of directors of an organization. A worker does not necessarily represent the views of the owner; the person with power may support breastfeeding or simply want no trouble.

In Pennsylvania, a state with no breastfeeding law, a mother was harassed by a teacher for breastfeeding her infant while her older child attended a class in a nonprofit community center. She first attempted to settle the matter by negotiating with the teacher and the director of the community center. When that failed, she wrote them letters documenting the exchange and requesting a change in policy. When that was unsuccessful, she went to an attorney, who wrote to the board of directors of the community center, threatening to file a lawsuit for infliction of emotional distress because the teacher had yelled at the mother, embarrassing her in a group of other parents. Not wanting the expense and negative publicity of a lawsuit, the center's board of directors—which, according to its lawyer, had no objection to breastfeeding at the center—quickly settled the matter by issuing a written apology to the mother and posting a breastfeeding policy at the center that specifically stated that breastfeeding was welcome.

Sometimes, harassment of a woman for breastfeeding violates other state laws, such as those relating to the infliction of emotional distress. Recently, a mother in Alabama reported that, while she was nursing in a restaurant, a waitress placed dirty dishtowels on her baby's head.¹⁵ Under some state laws, an unwanted touching, particularly with an object, might be considered battery or assault. In the absence of an enforcement provision for a clear state law protecting the right to breastfeed in public, a mother must decide how comfortable she is with the publicity that might follow drawing attention to discrimination. Leigh Bellini, whose harassment at a Pennsylvania shopping mall inspired a large, well-publicized nurse-in, says, "Every time someone looks my way, I think to myself ?here we go again,' especially if it is a security guard. I really hate leaving the house with the kids." But, Bellini says, she continues to speak publicly about the need for a breastfeeding law.¹⁶ Rhea Wolf says she will continue to fight because "I don't want women to be bullied." Wolf believes that harassment "leads to women deciding not to breastfeed."¹⁷

The power of power

When Emily Gillette was forced off that Freedom Airlines flight, she didn't know she could bring a legal action against the airline under Vermont law, an option she does not have in her home state of New Mexico. She called and wrote to Delta Air Line officials about her experience but received no satisfactory response. "I felt I had no power against this very big, very powerful organization," she says. When she hired a lawyer to help her proceed under Vermont's public breastfeeding law, her position changed. She says, "I don't think anything would have happened without this law," and describes it as "a godsend" and "the only way to hold an industry accountable."¹⁸

Delta and Freedom recently lost their attempt to have the Gillette complaint dismissed. Despite this preliminary defeat, the airlines involved have yet to approach Gillette or her lawyer with any offer to settle the matter. Gillette's lawyer, Elizabeth Boepple, has stated that it is "evident from the Airlines' utterly superficial responses and complete lack of attention to this case that they simply do not care about what happened to Emily and her family. This is an appalling example of two corporations' callous disregard for their actions and adds to the humiliation Emily and her family experienced when they were thrown off the plane."¹⁹ When asked what is her best hope for an outcome to the complaint, Boepple says, "First, to see these two airlines become the leaders in the industry as proponents for accommodating a woman's right to breastfeed when on their airplanes or in their airport terminal locales, through policy and training of their employees. Second, a public apology to not only Emily but all mothers who breastfeed their children. Third, a monetary settlement that makes Emily and her family whole. And finally, a punitive monetary penalty because the original act of kicking Emily and her family off the plane was so outrageous coupled with the callous disregard the airlines have shown since then."²⁰ Under Vermont's law, a change in policy and practice while the airlines' planes are in Vermont, and the monetary payments, are very real possibilities. The rest will depend on the laws in the other states in which the airlines land their planes.

For Gillette, the case is about more than what happened to her. She knows other women who have been discriminated against but did not take further action, and have been left with feelings of anger and guilt. "Not following through is an easy space to fall into," she says.

The future

When Emily Gillette was forced off the plane in Vermont, more than 800 breastfeeding supporters nationwide attended nurse-ins at Delta terminals. The harassment of Leigh Bellini brought over 150 people together just a week later, and the actions by Ronald McDonald House of Houston resulted in a server-crashing flood of e-mail within days. Several state legislatures, including those of Pennsylvania and Texas, are currently considering creating or strengthening their states' breastfeeding laws.

Whether breastfeeding advocates write letters, make phone calls, call legislators, seek help from other breastfeeding supporters, hire a lawyer, contact the press, or organize a nurse-in, there may be stress and hardship, but there are also community and power, and often, much-needed change.

See also: Breastfeeding in Public: Are You Protected - a map of state laws governing public breastfeeding.

NOTES
1. Under Illinois law, a mother's right to breastfeed in public is protected, but "a mother considering whether to breastfeed her baby in a place of worship shall comport her behavior with the norms appropriate in that place of worship." 740 Illinois Consolidated Statutes 137 (2004). Missouri law also protects the right to breastfeed in public, but requires that it be done "with as much discretion as possible." 191 Missouri Revised Statutes 191.918 (2006).
2. See Marbury v. Madison, 5 US 137, 163 (1803): "it is a general and indisputable rule, that where there is a legal right, there is also a legal remedy . . . whenever that right is invaded."
3. A child also has a right to breastfeed, but no law in the US is currently drafted to protect the right to breastfeed in public, from the child's perspective.
4. 9 Vermont Statutes Annotated 4506 (2002).
5. Ibid.
6. Cecilia Kang, "Mothers Rally to Back Breast-feeding Rights," The Washington Post (22 November 2006).
7. 26 New Jersey Statutes Annotated 4B-5 (2006).
8. See, e.g., Hawaii Revised Statutes 489-22. See www.lalecheleague.org/law/lawbills.html for a complete list of state breastfeeding statutes.
9. Statements from the Swimeley/Mayo-Laakso family can be found at www.birthwithoutboundaries.com.
10. Texas Health & Safety Code 165.002 (2001).
11. Thomas Korosec, "1-Hour Arrest: When Does a Snapshot of a Mother Breast-feeding Her Child Become Kiddie Porn? Ask the Richardson Police," Dallas Observer (17 April 2003).
12. Alaska Statutes 29.25.080 (1998).
13. Public Law 106-058, sec. 647 (1999).
14. Personal communication (24 April 2007).
15. Nancy Glasscock, "Protest Smaller than Planned," The Cullman [Alabama] Times (15 March 2007).
16. Personal communication (16 April 2007).
17. See Note 14.
18. Personal communication (26 April 2007).
19. Personal communication (27 April 2007).
20. Ibid.

Jake Aryeh Marcus is a lawyer, a freelance writer, and a member of the Legal Advisory Council of La Leche League International.

Working It Out:
Breastfeeding at Work

By Elizabeth N. Baldwin, Esq. and Kenneth A. Friedman, Esq.

ENCOURAGING NURSING IS GOOD BUSINESS. HERE'S HOW TO CONVINCE YOUR BOSS

Breastfeeding should be so easy and so widely supported. It is natural, inexpensive, requires no special equipment, and lulls even/the fussiest infants to sleep. For the practical minded, it is also staggeringly cost-effective. Individual households can save nearly $ 1,000 in healthcare costs during their baby's first year if the mother nurses. Nationwide, up to $ 4 billion a year could be saved in healthcare costs, and $ 93 million a month in lower food-package costs if all women nursed their babies.

The potential savings to businesses are almost as large. Women who continue to breastfeed after returning to work miss less time because of baby-related illnesses and have shorter absences when they do miss work, compared with women who do not breastfeed. Working mothers who continue nursing also have higher morale and, perhaps most interesting, tend to return to work earlier from maternity leave, presumably because they are less concerned about the effect of their return on the nursing relationship.

Why, then, is nursing so rarely encouraged or even allowed on the job? Only a tiny percentage of American companies provide new mothers with break time or with facilities for pumping, both of which are essential. A woman's milk supply is directly related to how much stimulation her breasts receive; in other words, the more a baby nurses, the greater her milk supply, and vice versa. If a mother is unable to breastfeed or pump sufficiently, she'll gradually lose her milk supply, which can result in her baby weaning prematurely. Also, if a mother is unable to express milk during the work-day, her breasts will become engorged. This can result in the development of plugged ducts, which can lead to mastitis, or a breast infection, requiring the use of antibiotics and bed rest. In other words, she won't be able to work.

THE BEST, LONG-TERM RESPONSE TO THE ISSUE OF BREASTFEEDING and working is legislation dealing with this issue. At present, only the state of Minnesota has passed a law requiring employers to reasonably accommodate breastfeeding mothers, providing them with break time and a room to express milk. California enacted a joint resolution of the legislature that calls on all employers to support and encourage working mothers who want to continue breastfeeding, recognizing that it benefits the employer as well as the mother and baby.

On the national front, Representative Carolyn Maloney last year submitted a federal bill (H.R. 3531) that would provide the most-extensive protection yet to working mothers, including one hour of unpaid leave time; a tax incentive to employers who provide a lactation-friendly environment; and an amendment to the Pregnancy Discrimination Act to clarify that it does apply to breastfeeding mothers. (For more information on breastfeeding legislation, see "Staying Abreast of the Law," Mothering, November-December 1998 and "Big Capital; Small Steps," Mothering, January-February, 1999.) While this bill hasn't yet become law, it does foreshadow the not-too-distant future. It heralds the inevitable arrival of a new, more progressive attitude on the part of businesses toward nursing.

For many of us, the very idea that a boss would forbid or discourage a woman from breastfeeding seems ridiculous. Don't most employers support breastfeeding mothers who return to work? Sadly, the answer is no. Breastfeeding has skipped several generations, and many people today view it as a "lifestyle" choice, not a health concern. As a result, employers don't see any need for mothers to continue breastfeeding when they return to work, viewing formula as much more convenient. Women bosses who did not breastfeed their own children may feel an implied criticism of their parenting choices when another working mother insists that she wants and needs to breastfeed. In this context, breastfeeding-support legislation is a very positive step, a recognition by our government that breastfeeding is a basic act of nurture. Legislation also helps to change the public perception that breastfeeding is not important. But legislation is not enough. For one thing, none may be passed for several years, especially at the national level. In the meantime, women who wish to both work and nurse must find some kind of private accommodation with their companies, their direct supervisors, and their coworkers. This will require compromise on all sides. Keep in mind that nursing must be perceived by everyone as good business. You are not asking for special treatment, just for the ability to give your baby, yourself, and your company all the benefits that prolonged nursing can provide.

HOW CAN YOU CONVINCE YOUR BOSS TO help you continue nursing? Begin by sharing information about the fiscal and physical importance of breastfeeding, and about efforts to support mothers when they return to work. Tell your employers that many prestigious medical and children's-advocacy groups, including the American Academy of Pediatrics and UNICEF, strongly entourage employers to facilitate the continuation of breastfeeding when women return to work. In 1993, the World Alliance for Breastfeeding Action (WABA) even prepared a booklet entitled Women, Work and Breastfeeding: Everyone Benefits! To receive a copy, contact your local La Leche League office. Get an extra copy for your boss.

Then sit down with him or her. If you are thinking of requesting an extended maternity leave to deepen your nursing relationship, keep in mind that there are two federal cases that denied such requests based on the current language of the Pregnancy Discrimination Act. Consult an attorney before seeing your employer.

Most of the other nursing and employment-related problems fall into one of the following categories:

• Being told that you cannot express milk on your regular breaks. This may constitute discrimination, especially if there are other employees who are treated differently. Can others smoke a cigarette or run an errand during breaks? You should be allowed to express milk during your scheduled breaks, even if the process makes some of your co-workers uncomfortable.
• Having no place to express milk. Try looking realistically at where you could express milk at your particular workplace. Is there a room that isn't being used? Don't expect your company to find you a place. Find one yourself. Then try to convince your employer to let you use it. Unless you happen to work in Minnesota, employers are not required to accommodate you. However, if you offer a reasonable solution, presented with a persuasive smile, you should be able to convince your bosses.
• Not having enough time to express breastmilk. If this seems to be the case for you, begin by looking at whether you could speed up the process of expressing milk. Some breast pumps are not intended for daily use by a working mother. Are you using a double kit to express milk from both breasts simultaneously? If you are having difficulty, seek help from your local La Leche League. If, after all this, you still feel your employer is not providing you with enough time, look at other options, with the aim of accommodating your work needs and your nursing needs. Could you perhaps shorten your lunch break to make time for other breaks when you could pump? Could you come in early or leave late to make up for the missed time? Ask your boss what combination of break times would be most acceptable, making it clear that you do not necessarily want extra time off, just a better combination of breaks.

IN ALL SITUATIONS, TAKE A FRIENDLY, helpful, cooperative attitude. This will work much better than threatening to sue. Provide accurate information about the current medical recommendations and about breastfeeding's economic benefits. Look to see if your local or state breastfeeding task force has information on educating employers. Feel free to share information about Congresswoman Maloney's pending federal bill.* Tell them also about California's 1999 Assembly Concurrent Resolution (look for the "legislation button") which contains information about why employers should encourage working mothers to breastfeed. You can search for ACR 155 and the name "Lempert."**

If all else fails, you can consider a discrimination suit. But do not forget that these are often expensive and time-consuming. Litigation and the judicial system are rarely going to provide as prompt a remedy as educating key people in a non-confrontational way.

Most important, consider these issues while you are still pregnant and before you take your maternity leave. Look at what is and isn't feasible. Decide whether it would be beneficial to discuss the various issues ahead of time with your employer. Many companies are eager to retain and accommodate their valuable employees. If you show your bosses how nursing is beneficial for them, they should be happy to help you make things work.

Elizabeth N. Baldwin was an attorney and family mediator in private practice with her husband, Kenneth A. Friedman, in Miami, Florida. She died in March 2003 after an extended illness. Her family law practice primarily focused on protecting young, securely attached and breastfed babies in divorce cases. Elizabeth was also a La Leche League Leader, and a member of LLLI's Professional Advisory Board, Legal Advisory Council. She published numerous articles on breastfeeding and the law, and often spoke at conferences. She assisted hundreds of parents involved in breastfeeding legal cases, and provided information and help to parents, attorneys and other professionals dealing with these issues.

This article originally appeared in Mothering Magazine in 1999. We thank them for allowing us to reprint it.

This article may be printed out for personal use but may not be reproduced in any other manner nor for any other purpose without permission.

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*The link to the Maloney bill has been updated since the article appeared and is current as of 2003

**The California Assembly Concurrent Resolution 155 referred to in the article's information has changed, which has been reflected in editing of this document.

THIS ARTICLE WAS WRITTEN IN 1999. FOR UP-TO-DATE INFORMATION ON LEGISLATION PERTAINING TO BREASTFEEDING, PLEASE SEE OUR ARTICLE "A CURRENT SUMMARY OF BREASTFEEDING LEGISLATION," WHICH IS FREQUENTLY UPDATED.

Is it safe for a smoker to breastfeed her baby? What about using the nicotine patch and other smoking cessation aids?

Today, most people are aware of the health risks associated with cigarette smoking, both for the smoker and those around them. Pregnancy is often a good incentive for a woman to cut down or quit entirely. If a mother smokes cigarettes, her baby can still enjoy the benefits of breastfeeding. But the more cigarettes a mother smokes, the greater the health risks for both her and her baby- whether he is breastfed or bottle-fed.

According to the LLLI publication THE BREASTFEEDING ANSWER BOOK, if the mother smokes fewer than twenty cigarettes a day, the risks to her baby from the nicotine in her milk are small. When a breastfeeding mother smokes more than twenty to thirty cigarettes a day, the risks increase. Heavy smoking can reduce a mother's milk supply and on rare occasions has caused symptoms in the breastfeeding baby such as nausea, vomiting, abdominal cramps, and diarrhea. (Vorherr 1974). By keeping smoking to a minimum, a mother can decrease the risk. When a mother smokes a cigarette, the nicotine levels in her blood and milk first increase and then decrease over time. The half-life of nicotine (the amount of time it takes for half the nicotine to be eliminated from the body) is ninety-five minutes. For this reason, a mother should avoid smoking just before and certainly during a feeding.

Maternal smoking has been linked to early weaning, lowered milk production, and inhibition of the milk ejection ("let-down") reflex. Smoking also lowers prolactin levels in the blood. One study (Hopkinson et al 1992) clearly suggests that cigarette smoking significantly reduces breast milk production at two weeks postpartum from 514 milliliters per day in non-smokers to 406 milliliters per day in smoking mothers. Mothers who smoke also have slightly higher metabolic rates and may be leaner than non-smoking mothers, therefore, caloric stores for lactation may be low and the mother may need to eat more.

Smoking has been linked to fussiness. In one study, 40% of babies breastfed by smokers were rated as colicky (two to three hours of "excessive" crying) as compared with 26% of babies breastfed by nonsmokers (Matheson and Rivrud 1989). It's important to note that this link between smoking and colic has also been found with artificially fed babies with one or more smokers in the home (Lawrence, p.519).

However the baby is fed, parents should avoid exposing him to second-hand smoke by smoking in another room or preferably outside the house. Breathing second-hand or "side-stream" smoke poses health risks. Researchers have documented the health hazards to children when one or both parents smoke. In one study (Colley and Corkhill 1974) researchers monitored the respiratory health of 2,205 babies and found a significant correlation between parents' smoking habits and the incidence of pneumonia, bronchitis, and SIDS during their babies' first year of life. These increased risks are present in both breastfed and bottle-fed infants.

Bottle-fed infants have a much higher incidence of respiratory illnesses than breastfed infants. A bottle-fed baby whose mother or other household members smoke would therefore be at even higher risk of these problems. Dr. Jack Newman states "The risks of not breastfeeding are greater to the baby than the risks of breastfeeding and smoking. The decision is up to the mother and I would encourage her to breastfeed."

Due to the highly addictive nature of cigarette smoking, mothers who would like to quit may wonder about the safety of smoking cessation aids which replace nicotine. When used as directed, these products pose no more problems for the breastfeeding infant than maternal smoking does.

According to the 1999 edition of "Medications And Mother's Milk" by Thomas W. Hale, R.Ph., Ph.D., the blood level of nicotine in most smokers (20 cigarettes per day) approaches 44 nanogram per milliliter (ng/mL) whereas levels in patch users average 17 ng/mL, depending on the dose in the patch.

Dr. Hale writes, "Therefore nicotine levels in milk can be expected to be less in patch users than those found in smokers, assuming the patch is used correctly and the mother abstains from smoking. Individuals who both smoke and use the patch would have extremely high blood nicotine levels and could endanger the nursing infant. Patches should be removed at bedtime to reduce exposure of the infant and reduce side effects such as nightmares."

"With nicotine gum, maternal serum nicotine levels average 30-60% of those found in cigarette smokers. While patches (transdermal systems) produce a sustained and lower nicotine plasma level, nicotine gum may produce large variations in blood plasma levels when the gum is chewed rapidly, fluctuations similar to smoking itself. Mothers who choose to use nicotine gum and breastfeed should be counseled to refrain from breastfeeding for 2-3 hours after using the gum product."

Recommended Reading:

"Smoking and Breastfeeding" -- This informational sheet, available from the LLLI Store or from your local LLL Leader, explains how to minimize the effects of smoking on a breastfeeding baby. Includes information on nicotine gum and the nicotine patch.

Page last edited Wed Nov 12 17:15:40 UTC 2008.