Breastfeeding Policy Created By Fort Bliss NCO Serves as Model for Other Installations
By Meghan Portillo - NCO Journal
February 25, 2016
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A recently revised Army directive spells out the basics of breastfeeding and lactation support, but gives commanders and supervisors leeway to balance mission requirements with the unique needs of Soldiers at their installations.
As individual commands begin to create their own policies in line with the directive, they are looking to one installation’s policy as a model.
Even before there was an Army directive, the breastfeeding policy at Fort Bliss, Texas, was created by Staff Sgt. Amanda Marion, then the 1st Armored Division Medical NCO and the Pregnancy and Postpartum Physical Training (P3T) Program NCOIC.
“It’s like any other regulation, field manual or directive. You can never take away from the regulation, but you can always add to it. Even though our policy came out before the directive, it is still in line with it and adds to what it already states,” Marion said. “I think that if others were able to sit down and take the time to establish an installation policy and look over all the federal and state laws that apply, it would benefit their Soldiers and the entire force as well.”
A model for the rest of the Army
With Army maternity leave now extended to 12 weeks, more Soldiers will be able to breastfeed successfully, said Robyn Roche-Paull, a registered nurse, internationally board-certified lactation consultant, author, Navy veteran and founder of the organization Breastfeeding in Combat Boots.
“I am a lactation consultant at a military hospital, so I see what it’s like for these moms to come back at six weeks,” Roche-Paull said. “At six weeks, you’ve barely got it together, and now you have to throw in pumping and work and all the rest of that, too? Your body is not ready. So 12 weeks is fantastic. Moms who can get to that point breastfeeding tend to have a better chance at breastfeeding successfully and for a longer duration.”
With more Soldiers breastfeeding, Roche-Paull hopes more installations will follow Fort Bliss’ lead in setting up the framework to support them when they return. Fort Huachuca, Arizona; Fort Drum, New York; and Fort Bragg, North Carolina, have all contacted Roche-Paull for help as they write their policies, she said, and she hopes others will do the same.
Breastfeeding in Combat Boots, a nonprofit organization committed to advocating, informing and supporting all active-duty, Guard and Reserve personnel who are breastfeeding while serving in the military, praises the Fort Bliss policy on its website for being comprehensive and clearly outlining the responsibilities of everyone from the garrison commander to the breastfeeding Soldier.
“The Fort Bliss policy outlines commander and supervisor responsibilities, and that in and of itself is very important, because each level of leadership has a different piece to play,” Roche-Paull said. “What the commander can do to support these Soldiers is different than what an NCO can do and what the mom can do for herself – each plays a part in making this successful. So outlining what is expected at every level of leadership and why – that is fantastic.”
Roche-Paull also praises the Fort Bliss policy for bringing everything together. Information on deferment from deployment, breastfeeding in uniform and lactation support can be found in one place. The 22-page policy even includes sample pumping schedules for both eight- and 12-hour workdays.
“I love Fort Bliss’ pumping schedules,” Roche-Paull said. “Showing where those breaks should be and how it would fit into a workday, it takes the guesswork out of it for everybody. These are the reasons this policy is so, so wonderful. It’s all here. Everything you could possibly need is right here in one document.”
Responding to Soldiers’ needs
Marion created the policy in response to problems Soldiers in the P3T program were facing. Some were being shamed by other Soldiers for breastfeeding in public, and many were having difficulties securing a place and time to pump, she said.
“To help out the Soldiers, veterans and civilians of our community, something needed to be put in writing,” Marion said. “I wrote the original installation breastfeeding policy and then shared it with a nurse practitioner and a labor and delivery officer, both international board certified lactation consultants at William Beaumont Army Medical Center, as well as the hospital’s chief of midwifery services. They were starting to write a policy for the hospital, so we created this breastfeeding task force on the installation. We would email, and every couple of months we would sit down together to go over things. Then we finally finalized the policy, brought it upstairs and got it signed.”
Before the policy was in place, Soldiers were simply told to figure it out on their own, Marion said, and were not given the tools they needed. But now, almost every brigade within the 1st Armored Division at Fort Bliss has a lactation room or is in the process of setting one up.
“Within four months, we were getting calls from units all over the installation saying, ‘Hey, I am setting up this room, can you come take a look at the area and let me know if it’s suitable?’” Marion said.
Building a lactation room
The Army directive requires a private space – other than a bathroom – for Soldiers needing to breastfeed or express milk. The space must have locking capabilities and be within a reasonable distance of a safe water source. It needs to have a place to sit, an electrical outlet and a flat surface other than the floor on which to place the pump and other needed supplies. But that is the bare minimum, Marion said.
Many NCOs and officers are inquiring about other ways to make sure their breastfeeding Soldiers feet comfortable, Marion said. And because the room she created at the 1st Armored Division Headquarters building serves as an example, she went above and beyond to make sure every detail of the room would serve that purpose.
There is a refrigerator for Soldiers to store their breastmilk and a microwave with a sterilizer for bottles and pump parts. Extra outlets line the walls in case the Soldier wants to play music or plug in a laptop. Cushy seats, pillows, blankets and a footstool help her get comfortable. The lights can be dimmed, and portraits of Soldiers breastfeeding in uniform hang on the walls, which are painted a calming neutral color. The door is clearly labeled when in use so she doesn’t worry about being disturbed. There are hooks to hang up her ACU top and a mirror so she can make sure her uniform is squared away when she is done.
It might sound silly, Marion said, but anything that has a calming effect and reminds the mother of her baby will facilitate a faster let-down, meaning it will help her milk start flowing and result in a shorter pumping session.
“We want to try to take away that temporary stress that they may feel – the ‘I need to hurry up and get this done’ and other stresses they may have,” Marion said.
There are bottles of water to help keep the Soldier hydrated and granola bars and other snacks to provide those extra 500 calories she needs each day to keep up her milk supply. The room is also stocked with disposable nursing pads, lanolin nipple cream, reading material and disinfectant wipes.
“I tried to make it very welcoming for the Soldiers and as comfortable as possible,” Marion said. “All that stuff doesn’t need to be in there, but a lot of the individuals creating rooms here on the installation are taking that extra step.”
Affording Soldiers time
The Fort Bliss policy is very flexible when it comes to the time allowed a Soldier to pump, because it depends on so many factors, Marion said. It depends on the age of the child, the quality of the pump being used and how the Soldier responds to it, as well as the distance of the lactation room from her workspace. She may even need to “power-pump,” which means to pump more frequently within a certain time period to boost her supply – a technique that may be especially useful as she prepares to leave her baby and go into the field.
“She will need to work with her supervisors and keep them informed,” Marion said. “She may need to sit down with her NCO and let them know, ‘Hey, my supply is starting to diminish, and I need to do this thing called power-pumping.’ NCOs – especially young male NCOs – may feel embarrassed, but they need to create an environment where the Soldier feels comfortable talking about it, because it may be a difficult subject for her as well.”
Roche-Paull also emphasized the importance of NCOs’ support. They need to educate themselves and be there for these Soldiers, she said, because their actions could make or break a mother’s ability to breastfeed.
“I hope NCOs realize how important their support is for these Soldiers,” Roche-Paull said. “It is something so simple that they can do – just making time. It’s no more than the time someone would take to go smoke, honestly, if you add it up. And it goes such a long way toward mom and baby’s health and the morale and the readiness of the unit.”
If a Soldier is not afforded enough time to pump, her milk supply will diminish, and she may face some serious medical issues, Roche-Paull explained. If she does not express milk often enough, she may develop painful lumps in her breasts called clogged ducts, or even mastitis, an infection that requires emergency medical care. She would then have to be taken out of the fight for days, Roche-Paull said, and it could all have been avoided if only she had been given the time she needed.
“I think the big thing here is that NCOs, they are the ones Soldiers are going to go to first,” Roche-Paull said. “Though having support from the top down is obviously great and makes the overall climate more conducive to breastfeeding, really the ones in the trenches who are going to run interference for you are your NCOs. So if they are supportive, if they are going to make sure Soldiers are given the time to pump and not given a hard time about it, that sets these Soldiers up for success.”
In the field
Lactation support in the field is another area in which the Fort Bliss policy shines. The Army directive requires Soldiers be given the same amount of time to pump in the field in order to maintain the physiological capability for lactation, but commands are not required to provide a means to store the milk.
The Fort Bliss policy, on the other hand, encourages Soldiers to make arrangements with their command to store the breastmilk in the unit refrigerator – if there is one – or bring a refrigerator themselves, if possible. They may even put the milk in a cooler and send it back to garrison with the food transportation crew. The child’s caretaker can then pick up the milk at the dining facility on post or at another predetermined location.
“We don’t tell the Soldier she has to ‘pump and dump’ because, for one, it is wasteful. It is heartbreaking, especially if she has a hard time pumping anyway and gets just enough for her baby to eat the following day,” Marion said. “But we do mention in the policy that the Soldiers should think about that and try to establish a stash in their freezer and a good supply before they go to the field – just in case no accommodations can be made and they have to pump and dump.”
‘We have come so far’
Though field exercises and deployments still present challenges, breastfeeding Soldiers have much more support than they did a few years ago, Marion said.
In 2010 when Marion had her daughter, she was working in a clinic that provided medical care to trainees at Fort Leonard Wood, Missouri. Though she had support from her supervisor and the civilian nurses she worked with, she struggled to find a place and time to pump.
“There was no Army policy, no installation policy, no clinic policy. So any time I needed to pump, I just went in to one of the exam rooms and closed the door,” Marion said. “I would put a sign on the door, but the door didn’t lock. There were plenty of times someone would come in saying they needed the room for a trainee, and I would only be 5 minutes into my pump session. I would just have to stop and pack everything up. Then there were some days the optempo was so high that I would go the whole day without pumping. Sometimes I would leak in my uniform right through the breast pads I was wearing because I was so engorged. I would come home, desperate to pump on one side while my daughter fed on the other at the same time just to get relief.”
Luckily, Marion never came down with mastitis, but her supply diminished quickly and she was unable to continue breastfeeding after six months. Looking back at the struggles she faced makes her grateful for the support available to breastfeeding Soldiers today, Marion said, and she is proud to have been a part of the change.
“Being able to do this for Soldiers here at Fort Bliss has been very fulfilling,” she said. “For me to see where I was with my daughter and then see how much I have been able to provide the Soldiers here now – so much has changed in five years. And just think, five years from now, maybe every installation will have a lactation room. Maybe the fight will be even more forceful because Soldiers are better able to fulfill both their duty to their country and their duty to their family. Maybe we will even find ways to ship breastmilk home for free for Soldiers who are deployed. Who knows?”