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Creating a Local Task Force to Address Nursing in Public

By Robin Kaplan, M.Ed., IBCLC

Screenshot 2015-01-05 10.33.05

Editors Note: Robin Kaplan, M.Ed., IBCLC, is an IBCLC in private practice in California, USA. She has developed a program for supporting families who breastfeed in public. Robin shares the impetus for her work, some how-to tips for creating programs in your own community, and an opportunity to learn more in this week’s Lactation Matters:

I’ve never considered myself an activist. Sure, there are many things that I am passionate about, but usually I am the person offering quiet support to a cause, not standing with the megaphone. That all changed when I was contacted on my Facebook page by a mother who had been harassed in a local courthouse because she had been breastfeeding her baby. What transpired was something I never expected. It has turned into a community venture to stop nursing in public (NIP) harassment in San Diego, California, USA.

The mother who contacted me recounted the incident where a bailiff had thrown her out of a courtroom full of people simply because she had been breastfeeding. I was outraged! How could someone, especially a government employee, feel like it was okay to publicly humiliate this woman for breastfeeding her baby in a public place? I felt compelled to assist this mother in changing this situation and help her to regain some of the self-esteem that had been squashed in such a insulting manner. I consulted with Best for Babes, Breastfeed LA, and several other IBCLCs to formulate a plan on how to remedy this wrongdoing. Based on everyone’s experiences, we concluded that the most progress could be made by corresponding in a professional, non-threatening manner with the person who could actually implement positive changes. After countless emails, hours on the phone, and finally a meeting with the Commander of the Court Services Bureau, we arrived at an acceptable solution to the situation. The mother was written a letter of formal apology from the San Diego Police Department, the bailiff was under investigation and the entire staff of the San Diego Police Department was given an informal training on the rights of breastfeeding mothers and how to protect these rights at all times. We were pleased with the outcome of our efforts.

Next thing I knew, I was being contacted by other local families who had experienced harassment for nursing in public. It was like the flood gates had been opened! I thought San Diego was a fairly progressive and tolerant city, but apparently this wasn’t always the case. It was time to take my newfound advocacy to the next level.

NIPlogo_color BIG-2In April 2013, in collaboration with several local mothers, the San Diego Nursing in Public (SDNIP) Task Force was created. The goals of the SDNIP Task Force were:

  • To educate our local community about the California laws that protect a mother’s right to breastfeed in public.
  • To provide support and guidance to mothers who have faced harassment or discrimination for breastfeeding in public.
  • To provide resources that empower mothers, by educating them on their civil right to breastfeed in public and how to handle an NIP harassment incident.
  • To empower business owners, by providing resources that they can integrate into their employee handbooks and training materials so that they and their staff are compliant with the CA law.
At the Poway Nurse-In

At the Poway Nurse-In

Currently, our SDNIP Task Force webpage hosts a collection of resources to support the above goals. Since April 2013, the SDNIP Task Force has helped to resolve seven local nursing in public harassment incidents. Some were very public, such as the incidents at a local LA Fitness and with the Poway School District. Others were resolved quietly, at the request of the family involved.

Recently, it became apparent that by providing more online resources and guidance, the task of resolving these types of situations could become a more collaborative process between the SDNIP Task Force and the aggrieved families. In my experience, those who experience NIP harassment have difficulty figuring out where to begin or whom to contact to remedy their situations. By providing the most effective language to use in the most effective formats, any NIP Task Force can guide a family in the right direction. That way, they can take the power of resolving the situation into their own hands, while still having the confidence that the full force of the NIP Task Force would be behind them if any further action was needed.

We thought that the best way to accomplish these new goals and disseminate this updated information would be to host something like a town-hall meeting. So, on January 15, 2015, from 4-4:30pm PST, we will host our first SDNIP Task Force Town Hall Meeting on Google+ Hangout On Air. If you are unable to watch the Town Hall Meeting live, we will also place its recording on our website and YouTube channel the following day. During our Town Hall meeting we plan to explain the steps in which a mother can resolve a NIP harassment incident, enlist a group of core volunteers to assist with expanding the SDNIP Task Force resources, as well as provide information for others who wish to start a Nursing in Public Task Force in their own community. We hope you will join us. Hopefully joining our town hall meeting will inspire the nursing in public advocate deep inside of you!

How are you working to support breastfeeding families in your community?

RobinRobin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home and in-office breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding co-editor of the International Lactation Consultant Association’s (ILCA) blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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Current Global Recommendations Regarding Breastfeeding with Ebola Virus for Mothers and Infants

By Kathleen Marinelli, MD, IBCLC, FABM
ILCA Board of Directors Director of Professional Development

Screenshot 2014-11-07 20.10.02As the global community comes to grips with the Ebola epidemic, most of the press and information available pertains to surveillance, recommendations for quarantine, containing the geographic spread, determining risk of exposure, protection of health care workers, and support and treatment of those diagnosed with the deadly virus. Of particular concern to those in the maternal-child health, nutrition, and lactation fields is the effect of potential exposure and proven infection with the Ebola virus on pregnant and lactating women and their infants.

Compounding the difficulty with finding this information is the simple fact that we don’t really know the answers at the level of evidence-based medicine. This is our first experience with an Ebola epidemic of this proportion. Decisions are being made to direct clinical practice by authorities like the Centers for Disease Control and Prevention (CDC) and UNICEF and the World Health Organization (WHO) based on our knowledge of how other viruses act, anecdotal stories from the field, and an occasional clinical report. While we all want the answers yesterday, authorities are doing their best to guide practice to save lives, while not panicking health authorities into making decisions that will cause more harm than good.

The CDC has recently issued guidelines for field and partner organizations regarding how to advise breastfeeding women with likely or confirmed Ebola infection (1), as has the Emergency Nutrition Network (ENN) in collaboration with UNICEF/WHO/CDC/ENN, which has significantly more detail. (2)

Important points are:

  1. Pregnant women have a much higher mortality rate with Ebola than non-pregnant women. At this time, there have not been any reported cases of a pregnant woman infected with Ebola virus surviving.
  2. Data from the field are spotty. WHO, CDC, ENN and other agencies are trying to aid in improving data capture so that we can better understand the history of Ebola in different types of patients and thus make informed determinations such as related to breastfeeding.
  3. Ebola virus has been found in human milk (1 sample). (3) In earlier outbreaks, no infants born to infected women and/or who were breastfed have survived. Presence does not equal infectivity, but at this point we do not know in the case of Ebola.
  4. Virus remains in some bodily fluids, like semen and human milk, after the blood has cleared. For lactating mothers who recover from Ebola, and are able to maintain or resume lactation (another issue to be considered and dealt with due to the illness severity), it is not known when it is safe to resume breastfeeding. Recommendations are to have the milk tested every 2-3 days in a laboratory that tests blood. For many women this is not feasible related to where they live. The recommendation then being made is to refrain from breastfeeding for 8 weeks, although not based on any evidence.
  5. For detailed instructions on feeding, please refer to reference 2. Essentially, when safe alternatives to breastfeeding and infant care exist, mothers with probable or confirmed Ebola virus disease should not have close contact with their infant, which includes breastfeeding.
  6. If mother must stop breastfeeding, the mother must be helped to express her breastmilk to alleviate pain and prevent inflammation. The expressed milk must be treated as an infected bodily fluid and discarded as such. There are some suggestions to heat treat (pasteurize) the expressed milk for the baby, but equipment and thermometers to make sure the milk is heated to the proper temperature for the correct amount of time to destroy virus and preserve nutrients and immune factors are not readily available. Most mothers become rapidly so sick that expressing milk becomes very difficult.
  7. In resource-limited settings, non-breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease when deciding to breastfed or feed a substitute.(2)
  8. Wet nursing is very common in West Africa. However do not allow wet-nursing to avoid any possibility of infection of the infant by the wet nurse, or of the wet nurse by the infant.
  9. If both mom and child have confirmed Ebola, if mom is able, breastfeeding should continue. If mom becomes too ill, a safe alternative should be used.
  10. Orphans should be fed with a safe alternative.

ILCA recommends following the guidance for feeding of infants and young children given in these documents and continuing checking for updates to the CDC (1) and the ENN (2) papers as more information becomes available.

References

  1. http://www.cdc.gov/vhf/ebola/hcp/recommendations-breastfeeding-infant-feeding-ebola.html (accessed 11/5/2014)
  2. http://www.ennonline.net/infantfeedinginthecontextofebola2014 (accessed 11/5/2014)
  3. http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full.pdf (accessed 11/5/2014)

Kathleen Marinelli has been a neonatologist for over 25 years, an IBCLC since 2000 and is a Fellow of the Academy of Breastfeeding Medicine (FABM). Although unable to practice clinical neonatology for over a decade due to a significant water-skiing accident, she has continued her life-long commitment to improving breastfeeding, the use of human milk, and the use of donor milk, everywhere but especially in the NICU through all of her volunteer roles, research, teaching both here in the US and abroad, and publishing papers, monographs and chapters.

She is an Associate Professor of Pediatrics at the University of CT Medical School, and a member of the Human Milk Research Center at CT Children’s Medical Center, in Hartford, CT. She graduated from Cornell University & Cornell University School of Medicine; and was a pediatric intern, resident, nephrology and neonatology fellow at Children’s National Medical Center, George Washington University, Washington DC.  Additionally, she is founding Medical Director of the New England Mother’s Milk Bank and is currently co-Medical Director of the Mothers’ Milk Bank of the Western Great Lakes.  She is a founding and current member of the Connecticut Breastfeeding Coalition, has been on the Board of the Academy of Breastfeeding Medicine for many years, and chairs its Protocol Committee.  She has served as Chair of the United States Breastfeeding Committee, and was chosen to Chair the new US Baby-Friendly Hospital NICU Initiative. 

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Nursing in Public: When Did It Become So Controversial?

Written by Robin Kaplan, M.Ed., IBCLC

When I look back at 2012 and recall the variety of breastfeeding stories that were covered by American media, I can’t help, but grimace and wonder,

“When did breastfeeding become so controversial?”

News story after news story depicts a breastfeeding mother being harassed for breastfeeding in public:

Charlotte Dirkes was asked to stop, cover up, or go somewhere else when she breastfed her 10-month old at a water park in Englewood, Colorado.

Tiffany Morgan was asked to stop breastfeeding her 6-month old, cover up, or leave Denny’s in Sedalia, Missouri.

Dawn Holland was asked to finish breastfeeding her 20-month old son in the bathroom of Applebee’s in Georgia.

Photo via Nurse-In @ Hollister Facebook Page

Photo via Nurse-In @ Hollister Facebook Page

Most recently, Brittany Warfield was screamed at and forced to leave a Hollister store in the Galleria Mall in Houston, Texas, when she breastfed her 7-month old, sparking a nurse-in across the United States and Canada of over 1,000 breastfeeding mothers, children, and friends on Jan 5th, 2013.

What ensued during this most recent nurse-in was truly shocking.

Three women participating in the Hollister nurse-in at Wilmington, Delaware’s Concord Mall were asked to remove their signs (written about normalizing nursing in public) and move to another part of the mall.  After taking down their signs, they continued to nurse in front of the Hollister store.  The mall’s security guards called the local police, who ended up not taking any action with the mothers once they showed them a copy of Delaware’s law that protects a woman breastfeeding in public.  The security officers took it upon themselves to continue to harass the mothers by threatening them with removal from the mall and then followed the mothers throughout the mall.

Photo via Nurse-In @ Hollister Facebook Page

Photo via Nurse-In @ Hollister Facebook Page

When other mothers heard about what happened at the mall, they posted on the Concord Mall’s Facebook page that they should be ashamed for calling the police when mothers were just feeding their babies.  In response, the Concord Mall responded that the breastfeeding was an ‘eyesore’ and that they ‘hope you guys don’t mind if I suck on my wife’s breasts in public.’

Since this Facebook exchange, The Concord Mall has disabled their Facebook Page (and denies that it ever had a Facebook page).  They also have apologized to the three mothers, yet the apology never admitted wrongdoing or that the women were treated improperly.

By the way, all of these harassment stories took place in states where breastfeeding women are protected by law to breastfeed in a public space.

While this type of harassment ruffles my IBCLC-feathers, it truly upsets me as an avid advocate for a breastfeeding mother’s right to meet her personal breastfeeding goals.  How can we expect mothers to breastfeed for any decent amount of time if they are relegated to their homes, cars, and public restrooms whenever their babies are hungry, just to avoid degradation and humiliation?

How can we, as mothers and IBCLCs, create the necessary change in our society where women will be able to feed their babies as nature intended?

I asked these questions to a group of mothers at my breastfeeding support group today, as well as of the followers on my business Facebook page, and their answers were honest and insightful.  Here’s what they had to say:

  • More women need to breastfeed in public so that people become desensitized to it, just like ‘we’ (Americans, in general) are desensitized to the sexualization of the breast and to violence on TV.
  • More breastfeeding on television shows and in movies, rather than always bottle feeding.
  • Public service announcements about how breastfeeding protects the health of the baby and of mom.
  • Have easier access to the laws that protect breastfeeding mothers, to use as a defense when asked to stop breastfeeding in public, cover up, or leave a public place.
  • In addition to the laws that protect a woman’s right to breastfeed in public, there is a need for laws that involve recourse for those who harass a woman for breastfeeding in public.

Fortunately, breastfeeding advocates are already thinking these same ideas!

Thanks to the Breastfeeding Law website, breastfeeding mothers can find all of the laws in the United States that protect their rights to breastfeed in public.

In California, on September 28, 2012, Governor Jerry Brown signed into law AB2386, which states that it is unlawful to engage in specified discriminatory practices in employment or housing accommodations on the basis of breastfeeding or medical conditions related to breastfeeding.  What this means for breastfeeding moms… they are now considered a ‘protected class’ of citizens and will receive a full spectrum of workplace discrimination protection.

In October, 2012, Best for Babes announced the launch of their Nursing in Public Harassment Hotline.  Now, breastfeeding mothers can report incidents of nursing in public harassment, document them, and receive guidance on how to deal with the situation and approach the offending institution.  The goal… to have enough documentation to influence policy makers to create laws that require enforcement of existing breastfeeding in public laws, the creation of laws that cover harassment and discrimination against breastfeeding in public, and educational and sensitivity trainings for employees.

Even MTV is changing their stance on breastfeeding.  While season 2 of Teen Mom removed scenes showing Kailyn Lowry breastfeeding, season 3 star, Katie Yeager, stated on Facebook and twitter that the show “will show me breastfeeding for a year.  I’m breaking the stigma and normalizing it again.”  That’s quite a commitment for a 16 year old!

For me, I plan to hand out a business card-sized copy of the California state laws that protect breastfeeding in public and prohibit discrimination in the workplace and housing to every breastfeeding mother I work with.  Hopefully having it in her wallet will provide some comfort that the law is on her side.  I also plan to submit an editorial to my local newspaper every time I hear a story about a mother being harassed for nursing in public.  I figure, it’s my job to educate my community about a mother’s right to feed her baby in public, without fear of persecution.  Lastly, I plan to promote Best for Babes Nursing in Public Harassment Hotline.  The more documentation they can collect, the better chance we have of creating a REAL change in our communities to help mothers meet their personal breastfeeding goals!

What plans do YOU have to create change in your communities for protecting a mother’s right to breastfeed in public?

RobinRobin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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