I saw a documentary many years ago, the most salient part (for me) was that the women in prison maintained their milk supply by hand expression ALONE for weeks or months in order to be able to once again rejoin and become part of their breastfeeding dyads upon release. Keep in mind that the situation in prison is very particular--there are long stretches of time without other gainful occupation, so an extremely motivated woman could do this, although it would take an almost Gandhi-like ability to stay focused on the goal, day in and day out.

Nevertheless, I have worked to get electric hospital grade pumps into our local jail. Unlike prison, where one becomes prepared through the slow workings of the judicial system to face a long sentence with a set end date, jail presents a mother with a shockingly sudden separation from her nursing baby in the immediate present for an unknown period of time.

Everyone of us needs to make sure their local jails are fully prepared to deal with the physical needs of lactating women. How? Go and ask to talk to the jail nurse, or head nurse, or nurses, and then talk with the administration there. If you are told there is a pump, ask to SEE it, and judge for yourself if that model is safe, effective, and clean--a hospital grade in good condition. If there is no pump there because ook around at the set-up and see what could creatively work there. Ask about rules and routines. Again, be creative. Don't take "no" for an answer. 

I had been asking and taking "no" for an answer for too long at my local jail, when I had a certain client that needed me. She had just given birth and was still in the engorgement risk period, a high producer who had up until then had very easy let down, but who was now engorged and unable to let down. I saw it as an opportunity to help her and make policy at the same time. I asked the county nurse, a remarkable, soft-spoken woman who had worked in South Africa during many turbulent years, to accompany me.

I was told I couldn't supply electric pumps because there were no outlets, and prisoners couldn't operate electric appliances. Yet, as soon as I entered the common room, I saw that the room was replete with outlets, and many outlets had a microwave oven plugged into one of the two spaces. Apparently prisoners could operate electric appliances, no problem.

"Fine," I said, "there are the outlets. The moms will pump there. They can turn their backs to the other prisoners and face the wall."

Then I asked to see a particular prisoner for whom I had brought a pump. The nurse, the administrator, the prisoner, the county nurse, and I stood in the exam room, and it was fine, because once I get started, no one exists for me but the mom, not even myself. So there were several witnesses to see an IBCLC talk a mom's milk into coming down, and how respect and caring and reminding her of the good memories she has of her baby, while showing her how to use her hands and pump most effectively, all combined to solve this painful condition and keep the jail from being responsible for causing mastitis through improper care.

She had previously been wonderfully successful at breastfeeding her new baby, but in the days since she had been taken from her baby she had had increasing difficulty in using manual expression. The rules strictly forbad letting her breastfeed, although we had her baby outside the jail's walls, being held by her boyfriend. (I should say at this point that the crime she was charged with, and would later go to court and be found guilty of, was one involving opportunistic theft of a small amount of money, but neither violence nor drugs entered into the picture at all.)

In the end was decided she and any other lactating prisoner could use continue to use this exam room that opened onto the common room, because while they'd still be in view of the guard, they'd have a modicum of privacy. I left the electric pump and a box of pump kits and some printed instructions and my phone number, but it'll take some follow-up inservices before it becomes policy, I'm sure.

Arly Helm, MS, IBCLC

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