The needs of breastfeeding mothers in public spaces gained state-wide attention on Sept. 22 after the lactation room in the Nebraska State Capitol was converted into an office, sparking conversation on the legislative floor about the resources available to mothers in the building. However, these recent events only provide a glimpse of the status of breastfeeding in Nebraska.
A 2019 CDC study reported that at 3 months old, only 53.9% of infants born in 2017 were exclusively breastfeeding in Nebraska. At 6 months, 32.6% of infants were exclusively breastfed.
Obstacles such as social stigma and the availability of resources have led to low retention rates across the state.
“Breastfeeding in public was tough as a new mom,” said Catie Van Gestel of Omaha, whose daughter was born in January 2020. “I was always worried that someone would come up to me and say something.”
Even though she was aware of the laws that protected her, Van Gestel was still nervous. This same stigma and difficulties, she feared of breastfeeding in public, can be present in the workplace too, when it’s time for moms to pump.
“A lot of moms will say it was going great until they had to go back to work,” said Christine Tracy, a registered nurse and lactation consultant at Methodist Women’s Hospital in Omaha. As a lactation consultant, Tracy assists mothers with breastfeeding, such as checking the baby’s latch and assisting with breast pumps.
Despite the Pregnancy Discrimination Act of the Civil Rights Act requiring workplaces to allow time and a private place for mothers to pump breastmilk, moms still face challenges in the workplace. According to Tracy, the space moms are given may be a closet and don’t always have a place for moms to store their pumped breastmilk or wash parts of the pump. Additionally, this law only applies to companies with 15 or more employees.
The rates of continued breastfeeding differ even more when race and ethnicity are considered. One study, the Pregnancy Risk Assessment Monitoring System (PRAMS), shows the disparity in Nebraska.
According to the 2018-2019 Nebraska PRAMS, only 55.1% of American Indian women were breastfeeding their babies at 8 weeks old. This is compared to only 62.4% of African American women, 66.7% of Hispanic women, and 74.9% of White women. Asian/Pacific Islander women were the most likely to still be breastfeeding at eight weeks, with 77.3% reporting having done so.
“A mom with a blue-collar job, working two to three jobs may have trouble finding time for a consultation,” Tiffany Keller said, a lactation counselor and RN at CHI Health Creighton University Medical Center – Bergan Mercy.
Speaking different languages and having access to travel to lactation consultations are also barriers to breastfeeding retention. According to Keller, hardly any breastfeeding support services are located in northeast Omaha, and in rural settings, there is a disparity of resources.
“Working with someone who speaks your own language and has the same skin tone can help moms be more receptive,” Keller said.
As a majority of lactation consultants in Nebraska are white, Keller said organizations such as the Nebraska Breastfeeding Coalition are working to create a more diverse population of lactation consultants in Nebraska.
Actions to increase retention are also being held at the hospital level.
In the most recent CDC survey on Maternity Practices in Infant Nutrition and Care (mPINC), which measures the practices and policies that impact newborn feeding and education, Nebraska’s total score of 71 was lower than the national score of 79. Nebraska also scored lower than the national score in all six subcategories except for one: immediate postpartum care.
At her own hospital, Keller said they do well at initiating skin-to-skin contact and feeding the baby breastmilk immediately. However, she says the improvements needing to be made, such as continuing education for hospital staff, are reliant on hospital resources like the hospital budget.
In addition to working for a more diverse workforce, Keller says the state of Nebraska’s strong WIC program and legal actions, such as proposed legislative bill LB429 to aid teen mothers in school, have been positive attributes to improve breastfeeding rates in the state.
For mothers like Van Gestel, with time and support, she has felt confidence in feeding her daughter in public.
“As time has gone on, I really don’t give a crap,” Van Gestel said. “I think it’s really important for moms to feel empowered to feed their babies in public.”