This is a favorite subject of mine, and I'm pleased to see it's come up. 
I think that there are very different issues at play here that break women into 
two groups - in the US called "white collar" and "blue collar". For the white 
collar women - typcially women who work at a desk, are well-educated and in 
the middle or upper socioeconomic classes - the issue is lack of information. 
They may intend to continue providing breastmilk after returning to work, but 
as soon as a challenge presents, they're stuck. As many have written, the 
absense of a peer group is a real problem, because they don't have other 
moms to say "Oh, that happened to me, it's easy to fix". Addressing this lack 
of information was the motivation for all the work I've done the last few years. 
(Book published by Hale Press, Working without Weaning, and my website, 
www.workandpump.com - I have a financial interest in the success of the 
book, but the website is something I do for free). My materials are pretty 
much aimed at women who have enough power in their jobs that they can 
take their pumping breaks when they need to, and they can afford to 
purchase a pump. It's amazing how many women with these advantages are 
still failing because they just don't get the basic mechanics of milk production. 
The internet is a great boon for these women - the support groups are really 
amazing. I have a message board on my website, but the ones for working and 
breastfeeding moms at breastfeeding.com and kellymom.com are more well-
attended. 
The other issue, that's much harder to address, is women in blue collar 
positions - working on factory floors, food service, house cleaning, child care, 
bus drivers, I could go on and on. They do not have the same kind of control 
over their schedules, and the ability for them to express milk during the day 
really needs to come from the top. Middle class moms in rigorously scheduled 
jobs, like nursing and teaching, face the same challenges. They need 
protected time in their schedules, and this does require a cultural change - 
normalizing breastfeeding enough that of course the mom in her first year back 
would get these breaks, even shifting her job responsibilities so that she's 
more able to take breaks when she needs to. Is this happening? I don't think 
so. And how many of us are addressing these situations? Again, not many. It's 
large white collar firms that are hiring lactation services for their employers 
and are concerned with being "family friendly" for hiring and recruitment. I 
freely admit that I'm not doing much for our less advantaged sisters - other 
than hoping for a trickle-down effect, where normalizing breastfeeding in the 
workplace will make it more available to all moms who want it. Jodi Kantor in 
the NY Times wrote a good article about this a few months ago - worth 
looking up if you didn't catch it. 
In many states, the health departments are taking on Breastfeeding Friendly 
Employer awards. Washington, Texas and Oregon are leaders in this field, and 
we've just posted new information for the state of Vermont at 
<http://healthvermont.gov/family/breastfeed/employer_project.aspx>
We have separate sections of information for mothers, for employers and for 
child care providers - who play a vital role in making breastfeeding possible for 
new moms. The materials are all downloadable as pdf files for easy printing, 
and anyone can access them for patient handouts. (I wrote this material, but 
certainly have no financial interest in anyone viewing it). Going the public 
health route does have the potential to reach out to moms in the lower 
socioeconomic levels - but it's still challenging - and this is the group with the 
lowest breastfeeding rates anyway - and, in a lot of ways, with the most to 
gain from breastfeeding. 
I hope we can continue to work together to support working and 
breastfeeding moms. Many lactation professionals and LLL leaders don't have 
direct experience with working outside the home while breastfeeding, so I 
think it's important to recognize that need in our own training. 
It sounds like Esther's program at her hospital has been a great success - and 
this is just the kind of thing we need to raise awareness. 
I think the best we can do right now is let the women we work with that this 
is a normal thing to do, and that we do have informational resources to help 
them out! Sorry this is so long - I tend to get carried away!!

Kirsten Berggren, PhD, CLC
www.workandpump.com

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