BREASTFEEDING MEDICINE Volume 9, Number 10, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2014.0058
Outcomes of a Hospital-Based Employee Lactation Program Diane L. Spatz,1,2 Gabriella S. Kim,2 and Elizabeth B. Froh1
Abstract
Background: Little has been published about employee lactation support in hospitals and other healthcare facilities. The Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA, has a comprehensive employee lactation program. The objective of this study was to describe the breastfeeding practices of our employees and compare these results with national Centers for Disease Control and Prevention (CDC) data. Materials and Methods: The human resources department generated a list of all employees who filed for maternity leave between 2007 and 2011. These employees were contacted confidentially via e-mail to complete an electronicbased (SurveyMonkey.com) questionnaire. An initial message and three reminder messages were sent over a 3month period during the last quarter of 2012, with 545 women completing the survey (response rate, 40%). Results: Women who responded to the survey had significantly higher breastfeeding initiation rates compared with national CDC data (94.5% vs. 76.9%; p < 0.0001). At 6 months, significantly more CHOP employees were breastfeeding (78.6% vs. 47.2%; p < 0.0001). At 12 months 32.4% of CHOP employees were still breastfeeding compared with CDC data of 25.5% ( p = 0.0003). Additionally, over 20% of CHOP employees breastfed their infants for over 12 months (no national data for comparison). Conclusions: Within CHOP’s comprehensive employee lactation program, women achieved breastfeeding milestones that well exceeded national data and the Healthy People 2020 targets for breastfeeding initiation and duration. CHOP’s employee lactation program can serve as a model for other institutions.
Introduction
T
he American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, with continued breastfeeding for a year or more.1 The Surgeon General of the United States has identified returning to work as a barrier to successfully achieving the American Academy of Pediatrics’ recommendations.2 In 2010, women accounted for 47% of the U.S. workforce.3 A U.S. Census Bureau report found some notable trends over time among women who worked during their pregnancy; 64% of women are working within a year of giving birth (2005–2007) compared with 39% in 1976–1980 and 17% in 1961–1965.4 The American Affordable Care Act, Section 4207, modified the Fair Labor Standards Act of 1938 to require employers to provide ‘‘reasonable’’ time throughout the day to express milk at work in a private space other than a bathroom.5 A review of published literature conducted by the authors found only one study specifically on hospitals, which was about hospital practices, not actual employees, and it was conducted in Hong Kong.6 1 2
The employee lactation program of the Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA, includes pumps rooms throughout the campus, a personal-use breast pump purchase program at cost for employees, free prenatal breastfeeding classes, a Breastfeeding Resource Nurse (16hour) course, and a hospital-grade loaner pump program for off-site locations. Additionally, in March 2008, CHOP instituted an ‘‘Employee Lactation Policy.’’ This policy predates the Affordable Care Act, and the policy is stronger than the Affordable Care Act in that it provides guidance for specific break times for pumping mothers. Materials and Methods
Following the development of the survey tool, approval for the study was obtained from CHOP’s Institutional Review Board. Human Resources reviewed records of all women who filed for maternity leave between the years 2007 and 2011. This review initially yielded a sample of 1,816 women. Human Resources then used the hospital directory to obtain CHOP e-mail addresses for that sample. This effort resulted
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. The University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
510
HOSPITAL-BASED EMPLOYEE LACTATION PROGRAM
in 1,362 viable e-mail addresses (75% of women who had filed for maternity leave between 2007 and 2011). The remaining portion of unavailable e-mail addresses was attributed to employees who left their position at CHOP or elected not to return to work following their maternity leave. Therefore, inclusion criteria for participation in the study were as follows: all employees who filed for maternity leave between 2007 and 2011 and were current hospital employees (as verified by Human Resources). A Web-based survey (SurveyMonkey.com) was developed by the authors modeling after the statistics reported annually in the Centers for Disease Control and Prevention (CDC) Breastfeeding Report Card.7 The survey included 30 questions including demographic information (i.e., ethnicity, age at time of delivery, type of delivery, full-time/part-time employment, and position). Participants were queried on their overall awareness of the workplace lactation program and their usage of specific components of the employee lactation program. Participants self-reported their breastfeeding initiation, exclusivity, and duration for their most recent child. (A copy of the survey tool is available from the authors by request.) Human Resources e-mailed the survey to all women with viable CHOP e-mail addresses (n = 1,362 women). Following the initial e-mail, three reminder e-mails were sent over a 2month period. Human Resources sent all e-mails to protect the women’s privacy. To provide incentive, the participant could select to submit her name to win one of 10 $50 gift cards. Participants were not required to do so to maintain confidentiality. In total, 545 of the 1,362 women responded, giving a 40% response rate. Results Demographics
The majority of participants were white (75.8%), and almost half (47.9%) were between 30 and 34 years old. Nurses are the largest portion of the CHOP workforce, so it is not surprising that 42.2% of the participants were nurses. The survey asked about the birth of the most recent child, and 66.8% of participants reported on births that occurred in 2010 and 2011. The majority of women (63.1%) had vaginal births. Over 55% of women returned to work full-time within the first year (Table 1). Usage and awareness of components of the employee lactation program
Forty-two percent of respondents reported participation in either the prenatal breastfeeding class or the Breastfeeding Resource Nurse class. The majority of respondents (92.5%) purchased a personal-use pump; however, only 39.4% purchased their personal-use breast pump from CHOP (taking advantage of the Personal Use Breast Pump Purchase Program benefit). A small portion of women rented a hospitalgrade pump (13.2%) or obtained a loaner pump for their off-site location (3.7%) through CHOP-sponsored programs (Hospital Grade Pump Loaner Program). A majority of women (61.6%) used the available private pump rooms throughout the CHOP enterprise (Table 2). The majority of women (51.2%) reported being aware of the ‘‘Employee Lactation Policy,’’ as well as the Personal
511
Table 1. Demographics Characteristic Respondents (n) Ethnicity White/Caucasian Black/African American Asian/Pacific Islander Hispanic American American Indian/Alaskan Native Position Nurse Other Research Advanced practice nurse Attending physician Clerks/administrative assistant Information technology support Psychology Nutrition Respiratory therapist Pharmacy Technician Fellow physician Business services Physical therapist Human resources Physician assistant Child life specialist Resident physician Environmental services Year of delivery 2007 2008 2009 2010 2011 Age (years) at delivery < 20 20–24 25–29 30–34 35 + Type of delivery Vaginal delivery Cesarean section Return to work Full-time Part-time
% (n) 545 75.8% 13.0% 7.9% 2.9% 0.4%
(413) (71) (43) (16) (2)
42.2% 15.6% 7.7% 6.6% 5.0% 4.0% 2.9% 2.6% 2.0% 1.8% 1.8% 1.5% 1.3% 1.3% 1.1% 1.1% 0.7% 0.4% 0.2% 0.2%
(230) (85) (42) (36) (27) (22) (16) (14) (11) (10) (10) (8) (7) (7) (6) (6) (4) (2) (1) (1)
5.5% 10.1% 17.6% 22.4% 44.4%
(30) (55) (96) (122) (242)
0.2% 1.8% 24.0% 47.9% 26.1%
(1) (10) (131) (261) (142)
63.1% (344) 36.9% (201) 55.4% (302) 44.6% (243)
Use Breast Pump Purchase Program benefit (73.6%). Almost one-third of the employees (27.9%) were not aware of the Hospital Grade Pump Loaner Program for off-site locations (Table 2). Breastfeeding outcomes
An overwhelming majority (94.5%) of the respondents initiated breastfeeding, with 69.7% infants being exclusively breastfed during the first month of life, 62.9% being exclusively breastfed through the third month of life, and 35% during the sixth month of life (Table 3).
512
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Table 2. Awareness and Usage of Workplace Lactation Support % (n) Awareness of workplace lactation support Aware of ‘‘Employee Lactation Policy’’ Yes No Delivered before program was effective Aware of personal pump purchase program from Employee Health Yes No Delivered before program was effective Aware of Symphony pump loaner program from off-campus locations Yes No Usage of workplace lactation program Classes Yes, I took CHOP’s Prenatal Breastfeeding class Yes, I took Breastfeeding Resource Nurse class No, never took either class Purchased personal-use pump from CHOP Yes No Delivered before program was effective Purchased own personal pump Yes No Rented hospital-grade pump Yes No Used pump rooms at CHOP Yes No Received loaner pump from Human Resources Yes No
51.2% (279) 44.0% (240) 4.8% (26) 73.6% (401) 18.0% (98) 8.4% (46) 27.9% (152) 72.1% (393) 21.3% (116) 20.7% (113) 60.9% (330) 39.4% (215) 50.3% (274) 10.3% (56) 53.0% (289) 47% (256) 13.2% (72) 86.2% (473) 61.6% (333) 38.9% (212) 3.7% (20) 96.3% (525)
CHOP, Children’s Hospital of Philadelphia.
At 6 months, significantly more participants were breastfeeding (78.6% of our sample versus 47.2% in the national CDC data; p < 0.0001).7 At 12 months 32.4% of employees were still breastfeeding compared with CDC data of 25.5% ( p = 0.0003).7 Additionally, over 20% of CHOP employees
Table 3. Breastfeeding Initiation and Exclusivity Breastfeeding initiation and exclusivity Initiation Yes No Exclusivitya 1 month 2 months 3 months 4 months 5 months 6 months
breastfed their infants for a duration of over 12 months (Table 3). Currently, the CDC does not collect data related to breastfeeding duration beyond 1 year of age.7 Figure 1 displays the breastfeeding initiation rates, the 3month exclusive breastfeeding rates, and the 6-month exclusive breastfeeding rates for CHOP employees in Philadelphia, for the Commonwealth of Pennsylvania, and for the nation, as well as the breastfeeding target goals for Healthy People 2020.
% (n) Discussion
94.5% (515) 5.5% (30) 69.7% 67.9% 62.9% 50.8% 40.6% 35.0%
(380) (370) (343) (277) (221) (191)
a Exclusive breastfeeding per the definition of breastfeeding (no supplementary formula, water, vitamins, or juice) of Labbok and Krasovec.8
To the authors’ knowledge, this the largest survey of U.S. women working at an employer with a comprehensive employee lactation program. Additionally, it is the only study published about breastfeeding initiation and duration of hospital employees (Table 4 gives a summary of the published studies on female employees with country of origin and sample size). The women in this study achieved significantly higher rates of breastfeeding on all outcome measures. An argument could focus on the fact that the participants work at a hospital, and therefore one should have expect better breastfeeding outcomes than the national data. However, the lead author serves on the United States Breastfeeding Committee and is
HOSPITAL-BASED EMPLOYEE LACTATION PROGRAM 94.5
100 90
81.9
76.9
80 Percentage
70
513
68.1
62.9
60 46.2
50
37.2
40
36
35 25.2
30
14.1
20
16.3
10 0 Initiation
Exclusivity at 3 Months
Exclusivity at 6 Months
Breastfeeding Initiation and Duration Healthy People 2020 Goals
Children's Hospital of Philadelphia
Pennsylvania
United States
FIG. 1. Children’s Hospital of Philadelphia’s employee breastfeeding outcomes. National and Pennsylvania data are from the Centers for Disease Control and Prevention.7 aware that there is a lack of supportive hospital practices nationwide. Additionally, a taskforce has been established through the United States Breastfeeding Committee with efforts to address this issue. An additional limitation of the study could be response bias. Women who had positive breastfeeding experiences
may have been more likely to respond to the survey. However, they survey included qualitative questions. Through analysis of this portion of the survey, the participants revealed they faced challenges in regard to breastfeeding. A second limitation of the study is recall bias. The majority of women in the sample gave birth within the past 2 years. This
Table 4. Summary of Published Studies on Female Employees Reference
Sample size
Chen et al.9
Country
n = 998 female employees n = 187 female employees n = 104, pregnant women n = 46 women
Taiwan
Ortiz et al.13
n = 462 female full-time employees
United States
Payne and Nicholls14 Rishel and Sweeney15
n = 20 females
New Zealand
n = 261 females
United States
Skafida16
n = 6,150 females
Scotland
Slusser et al.17
n = 343 female employees n = 496 female employees n = 121 female employees
United States
Cohen and Mrtek Greene et al.
10
11
Kosmala-Anderson and Wallace12
Weber et al.18 Whaley et al.19
United States United States United Kingdom
Australia United States
Type of facility Female employees at semiconductor manufacturing company Female employees at Los Angeles Department of Water and Power and Space Corporation Pregnant women responding to survey from Michigan companies Women recruited from four large public sector organizations in United Kingdom who were planning to go on maternity leave or returning from maternity leave Female full-time employees employed by five corporations in the United States; review of lactation consultants’ charts of women enrolled in the lactation program Women recruited at eight New Zealand Equal Employment Opportunities Sample of records of mothers in three military facilities 6 months after birth. Two sites had a lactation consultant; one did not. Sample taken from the Early Childhood Longitudinal Study-Birth cohort in Scotland; examined biological mothers who were in 9-month interview and had worked 12 months before delivery Female employees from a large corporation (CIGNA) in Los Angeles, CA Female employees in Sydney South West Area Health Service Employees at six of seven local agencies in WIC employees in Los Angeles County
WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.
514
time frame is similar to other national reporting mechanisms/ surveys regarding breastfeeding.7 Finally, a small portion of respondents were still breastfeeding at the time of the survey, thus truncating their actual breastfeeding duration. Conclusions
The results of this study suggest that comprehensive hospital-based employee lactation support programs may increase breastfeeding initiation, exclusivity, and duration for their employees. All hospitals should consider increasing their support for employed breastfeeding mothers. The Business Case for Breastfeeding offers guidance for development of such programs.5 Acknowledgments
We would like to acknowledge the CHOP Human Resources Department for their assistance, CHOP’s employees who took the time to participate in the study, our lactation consultant staff, and CHOP’s Breastfeeding Resource Nurses. Their support was paramount to the success of this study. The survey used in the study was supported by a Helen Fuld grant at the University of Pennsylvania School of Nursing. Disclosure Statement
No competing financial interests exist. D.L.S. conceptualized and designed the study, assisted with data management and analysis and writing of the manuscript, and approved the final manuscript as submitted. G.S.K. assisted with study development as well as all data collection tools, developed the initial draft of the manuscript, and approved the final manuscript as submitted. E.B.F. assisted with writing the manuscript and making final revisions to the manuscript and approved the final manuscript as submitted. References
1. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827–e841. 2. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: Office of the Surgeon General, 2011. 3. Women’s Bureau, U.S. Department of Labor. Women’s Bureau (WB)—Quick Facts on Women in the Labor Force 2010. Washington, DC: U.S. Department of Labor, 2010. 4. Laughlin L. Maternity Leave and Employment Patterns of First Time Mothers: 1961–2008. Washington, DC: U.S. Census Bureau, 2011. 5. Maternal and Child Health Bureau, U.S. Department of Health and Human Services. The Business Case for Breastfeeding Steps for Creating a Breastfeeding Friendly Worksite: Easy Steps to Supporting Breastfeeding Employees. Washington, DC: Office of Women’s Health, Health Resources and Services Administration, 2008. 6. Dodgson JE, Chee YO, Yap TS. Workplace breastfeeding support for hospital employees. J Adv Nurs 2004;47:91–100.
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7. Centers for Disease Control and Prevention. Breastfeeding Report Card 2013. Atlanta: Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, 2013. 8. Labbok M, Krasovec K. Toward consistency in breastfeeding durations. Stud Fam Plan 1990;21:226–230. 9. Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: A cross-sectional survey. BMC Public Health 2006;6:160. 10. Cohen R, Mrtek MB. The impact of two corporate lactation programs on the incidence and duration of breastfeeding by employed mothers. Am J Health Promot 1994; 8:436–441. 11. Greene SW, Wolfe EW, Olson BH. Assessing the validity of measures of an instrument designed to measure employees’ perceptions of workplace breastfeeding support. Breastfeed Med 2008;3:159–163. 12. Kosmala-Anderson J, Wallace LM. Breastfeeding works: The role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006;28:183–191. 13. Ortiz J, McGilligan K, Kelly P. Duration of breast milk expression among working mothers enrolled in an employersponsored lactation program. Pediatr Nurs 2004;30:111–119. 14. Payne D, Nicholls DA. Managing breastfeeding and work: A Foucauldian secondary analysis. J Adv Nurs 2010;66: 1810–1818. 15. Rishel PE, Sweeney P. Comparison of breastfeeding rates among women delivering infants in military treatment facilities with and without lactation consultants. Mil Med 2005;170:435–438. 16. Skafida V. Juggling work and motherhood: The impact of employment and maternity leave on breastfeeding duration: A survival analysis on Growing Up in Scotland data. Matern Child Health J 2012;16:519–527. 17. Slusser WM, Lange L, Dickson V, et al. Breast milk expression in the workplace: A look at frequency and time. J Hum Lact 2004;20:164–169. 18. Weber D, Janson A, Nolan M, et al. Female employees’ perceptions of organisational support for breastfeeding at work: Findings from an Australian health service workplace. Int Breastfeed J 2011;6:19. 19. Whaley SE, Meehan K, Lange L, et al. Predictors of breastfeeding duration for employees of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). J Am Diet Assoc 2002;102:1290–1293.
Address correspondence to: Diane L. Spatz, PhD The University of Pennsylvania School of Nursing 418 Curie Boulevard, Office 413 Philadelphia, PA 19104-4217 E-mail: [email protected]
Outcomes of a Hospital-Based Employee Lactation Program Diane L. Spatz,1,2 Gabriella S. Kim,2 and Elizabeth B. Froh1
Abstract
Background: Little has been published about employee lactation support in hospitals and other healthcare facilities. The Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA, has a comprehensive employee lactation program. The objective of this study was to describe the breastfeeding practices of our employees and compare these results with national Centers for Disease Control and Prevention (CDC) data. Materials and Methods: The human resources department generated a list of all employees who filed for maternity leave between 2007 and 2011. These employees were contacted confidentially via e-mail to complete an electronicbased (SurveyMonkey.com) questionnaire. An initial message and three reminder messages were sent over a 3month period during the last quarter of 2012, with 545 women completing the survey (response rate, 40%). Results: Women who responded to the survey had significantly higher breastfeeding initiation rates compared with national CDC data (94.5% vs. 76.9%; p < 0.0001). At 6 months, significantly more CHOP employees were breastfeeding (78.6% vs. 47.2%; p < 0.0001). At 12 months 32.4% of CHOP employees were still breastfeeding compared with CDC data of 25.5% ( p = 0.0003). Additionally, over 20% of CHOP employees breastfed their infants for over 12 months (no national data for comparison). Conclusions: Within CHOP’s comprehensive employee lactation program, women achieved breastfeeding milestones that well exceeded national data and the Healthy People 2020 targets for breastfeeding initiation and duration. CHOP’s employee lactation program can serve as a model for other institutions.
Introduction
T
he American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, with continued breastfeeding for a year or more.1 The Surgeon General of the United States has identified returning to work as a barrier to successfully achieving the American Academy of Pediatrics’ recommendations.2 In 2010, women accounted for 47% of the U.S. workforce.3 A U.S. Census Bureau report found some notable trends over time among women who worked during their pregnancy; 64% of women are working within a year of giving birth (2005–2007) compared with 39% in 1976–1980 and 17% in 1961–1965.4 The American Affordable Care Act, Section 4207, modified the Fair Labor Standards Act of 1938 to require employers to provide ‘‘reasonable’’ time throughout the day to express milk at work in a private space other than a bathroom.5 A review of published literature conducted by the authors found only one study specifically on hospitals, which was about hospital practices, not actual employees, and it was conducted in Hong Kong.6 1 2
The employee lactation program of the Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA, includes pumps rooms throughout the campus, a personal-use breast pump purchase program at cost for employees, free prenatal breastfeeding classes, a Breastfeeding Resource Nurse (16hour) course, and a hospital-grade loaner pump program for off-site locations. Additionally, in March 2008, CHOP instituted an ‘‘Employee Lactation Policy.’’ This policy predates the Affordable Care Act, and the policy is stronger than the Affordable Care Act in that it provides guidance for specific break times for pumping mothers. Materials and Methods
Following the development of the survey tool, approval for the study was obtained from CHOP’s Institutional Review Board. Human Resources reviewed records of all women who filed for maternity leave between the years 2007 and 2011. This review initially yielded a sample of 1,816 women. Human Resources then used the hospital directory to obtain CHOP e-mail addresses for that sample. This effort resulted
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. The University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
510
HOSPITAL-BASED EMPLOYEE LACTATION PROGRAM
in 1,362 viable e-mail addresses (75% of women who had filed for maternity leave between 2007 and 2011). The remaining portion of unavailable e-mail addresses was attributed to employees who left their position at CHOP or elected not to return to work following their maternity leave. Therefore, inclusion criteria for participation in the study were as follows: all employees who filed for maternity leave between 2007 and 2011 and were current hospital employees (as verified by Human Resources). A Web-based survey (SurveyMonkey.com) was developed by the authors modeling after the statistics reported annually in the Centers for Disease Control and Prevention (CDC) Breastfeeding Report Card.7 The survey included 30 questions including demographic information (i.e., ethnicity, age at time of delivery, type of delivery, full-time/part-time employment, and position). Participants were queried on their overall awareness of the workplace lactation program and their usage of specific components of the employee lactation program. Participants self-reported their breastfeeding initiation, exclusivity, and duration for their most recent child. (A copy of the survey tool is available from the authors by request.) Human Resources e-mailed the survey to all women with viable CHOP e-mail addresses (n = 1,362 women). Following the initial e-mail, three reminder e-mails were sent over a 2month period. Human Resources sent all e-mails to protect the women’s privacy. To provide incentive, the participant could select to submit her name to win one of 10 $50 gift cards. Participants were not required to do so to maintain confidentiality. In total, 545 of the 1,362 women responded, giving a 40% response rate. Results Demographics
The majority of participants were white (75.8%), and almost half (47.9%) were between 30 and 34 years old. Nurses are the largest portion of the CHOP workforce, so it is not surprising that 42.2% of the participants were nurses. The survey asked about the birth of the most recent child, and 66.8% of participants reported on births that occurred in 2010 and 2011. The majority of women (63.1%) had vaginal births. Over 55% of women returned to work full-time within the first year (Table 1). Usage and awareness of components of the employee lactation program
Forty-two percent of respondents reported participation in either the prenatal breastfeeding class or the Breastfeeding Resource Nurse class. The majority of respondents (92.5%) purchased a personal-use pump; however, only 39.4% purchased their personal-use breast pump from CHOP (taking advantage of the Personal Use Breast Pump Purchase Program benefit). A small portion of women rented a hospitalgrade pump (13.2%) or obtained a loaner pump for their off-site location (3.7%) through CHOP-sponsored programs (Hospital Grade Pump Loaner Program). A majority of women (61.6%) used the available private pump rooms throughout the CHOP enterprise (Table 2). The majority of women (51.2%) reported being aware of the ‘‘Employee Lactation Policy,’’ as well as the Personal
511
Table 1. Demographics Characteristic Respondents (n) Ethnicity White/Caucasian Black/African American Asian/Pacific Islander Hispanic American American Indian/Alaskan Native Position Nurse Other Research Advanced practice nurse Attending physician Clerks/administrative assistant Information technology support Psychology Nutrition Respiratory therapist Pharmacy Technician Fellow physician Business services Physical therapist Human resources Physician assistant Child life specialist Resident physician Environmental services Year of delivery 2007 2008 2009 2010 2011 Age (years) at delivery < 20 20–24 25–29 30–34 35 + Type of delivery Vaginal delivery Cesarean section Return to work Full-time Part-time
% (n) 545 75.8% 13.0% 7.9% 2.9% 0.4%
(413) (71) (43) (16) (2)
42.2% 15.6% 7.7% 6.6% 5.0% 4.0% 2.9% 2.6% 2.0% 1.8% 1.8% 1.5% 1.3% 1.3% 1.1% 1.1% 0.7% 0.4% 0.2% 0.2%
(230) (85) (42) (36) (27) (22) (16) (14) (11) (10) (10) (8) (7) (7) (6) (6) (4) (2) (1) (1)
5.5% 10.1% 17.6% 22.4% 44.4%
(30) (55) (96) (122) (242)
0.2% 1.8% 24.0% 47.9% 26.1%
(1) (10) (131) (261) (142)
63.1% (344) 36.9% (201) 55.4% (302) 44.6% (243)
Use Breast Pump Purchase Program benefit (73.6%). Almost one-third of the employees (27.9%) were not aware of the Hospital Grade Pump Loaner Program for off-site locations (Table 2). Breastfeeding outcomes
An overwhelming majority (94.5%) of the respondents initiated breastfeeding, with 69.7% infants being exclusively breastfed during the first month of life, 62.9% being exclusively breastfed through the third month of life, and 35% during the sixth month of life (Table 3).
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Table 2. Awareness and Usage of Workplace Lactation Support % (n) Awareness of workplace lactation support Aware of ‘‘Employee Lactation Policy’’ Yes No Delivered before program was effective Aware of personal pump purchase program from Employee Health Yes No Delivered before program was effective Aware of Symphony pump loaner program from off-campus locations Yes No Usage of workplace lactation program Classes Yes, I took CHOP’s Prenatal Breastfeeding class Yes, I took Breastfeeding Resource Nurse class No, never took either class Purchased personal-use pump from CHOP Yes No Delivered before program was effective Purchased own personal pump Yes No Rented hospital-grade pump Yes No Used pump rooms at CHOP Yes No Received loaner pump from Human Resources Yes No
51.2% (279) 44.0% (240) 4.8% (26) 73.6% (401) 18.0% (98) 8.4% (46) 27.9% (152) 72.1% (393) 21.3% (116) 20.7% (113) 60.9% (330) 39.4% (215) 50.3% (274) 10.3% (56) 53.0% (289) 47% (256) 13.2% (72) 86.2% (473) 61.6% (333) 38.9% (212) 3.7% (20) 96.3% (525)
CHOP, Children’s Hospital of Philadelphia.
At 6 months, significantly more participants were breastfeeding (78.6% of our sample versus 47.2% in the national CDC data; p < 0.0001).7 At 12 months 32.4% of employees were still breastfeeding compared with CDC data of 25.5% ( p = 0.0003).7 Additionally, over 20% of CHOP employees
Table 3. Breastfeeding Initiation and Exclusivity Breastfeeding initiation and exclusivity Initiation Yes No Exclusivitya 1 month 2 months 3 months 4 months 5 months 6 months
breastfed their infants for a duration of over 12 months (Table 3). Currently, the CDC does not collect data related to breastfeeding duration beyond 1 year of age.7 Figure 1 displays the breastfeeding initiation rates, the 3month exclusive breastfeeding rates, and the 6-month exclusive breastfeeding rates for CHOP employees in Philadelphia, for the Commonwealth of Pennsylvania, and for the nation, as well as the breastfeeding target goals for Healthy People 2020.
% (n) Discussion
94.5% (515) 5.5% (30) 69.7% 67.9% 62.9% 50.8% 40.6% 35.0%
(380) (370) (343) (277) (221) (191)
a Exclusive breastfeeding per the definition of breastfeeding (no supplementary formula, water, vitamins, or juice) of Labbok and Krasovec.8
To the authors’ knowledge, this the largest survey of U.S. women working at an employer with a comprehensive employee lactation program. Additionally, it is the only study published about breastfeeding initiation and duration of hospital employees (Table 4 gives a summary of the published studies on female employees with country of origin and sample size). The women in this study achieved significantly higher rates of breastfeeding on all outcome measures. An argument could focus on the fact that the participants work at a hospital, and therefore one should have expect better breastfeeding outcomes than the national data. However, the lead author serves on the United States Breastfeeding Committee and is
HOSPITAL-BASED EMPLOYEE LACTATION PROGRAM 94.5
100 90
81.9
76.9
80 Percentage
70
513
68.1
62.9
60 46.2
50
37.2
40
36
35 25.2
30
14.1
20
16.3
10 0 Initiation
Exclusivity at 3 Months
Exclusivity at 6 Months
Breastfeeding Initiation and Duration Healthy People 2020 Goals
Children's Hospital of Philadelphia
Pennsylvania
United States
FIG. 1. Children’s Hospital of Philadelphia’s employee breastfeeding outcomes. National and Pennsylvania data are from the Centers for Disease Control and Prevention.7 aware that there is a lack of supportive hospital practices nationwide. Additionally, a taskforce has been established through the United States Breastfeeding Committee with efforts to address this issue. An additional limitation of the study could be response bias. Women who had positive breastfeeding experiences
may have been more likely to respond to the survey. However, they survey included qualitative questions. Through analysis of this portion of the survey, the participants revealed they faced challenges in regard to breastfeeding. A second limitation of the study is recall bias. The majority of women in the sample gave birth within the past 2 years. This
Table 4. Summary of Published Studies on Female Employees Reference
Sample size
Chen et al.9
Country
n = 998 female employees n = 187 female employees n = 104, pregnant women n = 46 women
Taiwan
Ortiz et al.13
n = 462 female full-time employees
United States
Payne and Nicholls14 Rishel and Sweeney15
n = 20 females
New Zealand
n = 261 females
United States
Skafida16
n = 6,150 females
Scotland
Slusser et al.17
n = 343 female employees n = 496 female employees n = 121 female employees
United States
Cohen and Mrtek Greene et al.
10
11
Kosmala-Anderson and Wallace12
Weber et al.18 Whaley et al.19
United States United States United Kingdom
Australia United States
Type of facility Female employees at semiconductor manufacturing company Female employees at Los Angeles Department of Water and Power and Space Corporation Pregnant women responding to survey from Michigan companies Women recruited from four large public sector organizations in United Kingdom who were planning to go on maternity leave or returning from maternity leave Female full-time employees employed by five corporations in the United States; review of lactation consultants’ charts of women enrolled in the lactation program Women recruited at eight New Zealand Equal Employment Opportunities Sample of records of mothers in three military facilities 6 months after birth. Two sites had a lactation consultant; one did not. Sample taken from the Early Childhood Longitudinal Study-Birth cohort in Scotland; examined biological mothers who were in 9-month interview and had worked 12 months before delivery Female employees from a large corporation (CIGNA) in Los Angeles, CA Female employees in Sydney South West Area Health Service Employees at six of seven local agencies in WIC employees in Los Angeles County
WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.
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time frame is similar to other national reporting mechanisms/ surveys regarding breastfeeding.7 Finally, a small portion of respondents were still breastfeeding at the time of the survey, thus truncating their actual breastfeeding duration. Conclusions
The results of this study suggest that comprehensive hospital-based employee lactation support programs may increase breastfeeding initiation, exclusivity, and duration for their employees. All hospitals should consider increasing their support for employed breastfeeding mothers. The Business Case for Breastfeeding offers guidance for development of such programs.5 Acknowledgments
We would like to acknowledge the CHOP Human Resources Department for their assistance, CHOP’s employees who took the time to participate in the study, our lactation consultant staff, and CHOP’s Breastfeeding Resource Nurses. Their support was paramount to the success of this study. The survey used in the study was supported by a Helen Fuld grant at the University of Pennsylvania School of Nursing. Disclosure Statement
No competing financial interests exist. D.L.S. conceptualized and designed the study, assisted with data management and analysis and writing of the manuscript, and approved the final manuscript as submitted. G.S.K. assisted with study development as well as all data collection tools, developed the initial draft of the manuscript, and approved the final manuscript as submitted. E.B.F. assisted with writing the manuscript and making final revisions to the manuscript and approved the final manuscript as submitted. References
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Address correspondence to: Diane L. Spatz, PhD The University of Pennsylvania School of Nursing 418 Curie Boulevard, Office 413 Philadelphia, PA 19104-4217 E-mail: [email protected]
