UCLA

Background: More than half of women return to the workforce within one year following the birth of their child. To continue offering breast milk to their infants and follow AAP and WHO recommendations for breastfeeding, these women often need to express breast milk in the workplace. Registered Nurses who work in bedside roles do not traditionally have access to private office spaces or personal control over their work schedule, making them uniquely susceptible to workplace barriers for expression of breast milk. Currently, the CDC recommends cleaning a breast pump with soap and water and leaving it to air dry after each use. It is unknown what the current knowledge and adherence levels to these recommendations are within a working population or how knowledge and adherence may affect breastfeeding practice outcomes.Objectives: The study was conducted: 1) To determine relationships between employee perceptions of workplace support for expression of breast milk in the workplace (EBMW) and duration of breastfeeding, duration of EBMW, and other infant feeding practices, 2) To describe knowledge of CDC recommendations for cleaning of a breast pump across Registered Nurse (RN), Nurse Manager (NM), and Hospital Representative (HR) groups, 3) To determine if RN knowledge was associated with RN adherence to CDC recommendations for cleaning of a breast pump, 4) To describe relationships between RN breastfeeding practices and: RN knowledge and adherence, NM knowledge, and HR Knowledge, and 5) To learn about the experiences of working RNs who have expressed breast milk in the workplace and provide recommendations to employers for improving employee lactation experiences. Methods: This was a cross sectional research study. Registered Nurse participants who had given birth within the past three years (n=199), Nurse Managers (n = 36), and Hospital Representatives (n = 6) were recruited from 10 hospitals within the county of Los Angeles. Registered Nurses completed four questionnaires online: The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q); the Duration of Breastfeeding, Duration of EBMW, and Infant Feeding Practices Questionnaire (BEIF-Q); the Knowledge of CDC Recommendations for Use and Cleaning of a Breast Pump Questionnaire (KBP-Q); and the Adherence for Use and Cleaning of a Breast Pump according to CDC Recommendations Questionnaire (ABP-Q). Nurse Managers completed two online questionnaires: The Managers' Attitude Toward Breastfeeding Support Questionnaire (MATBS-Q) and the Knowledge of CDC Recommendations for Use and Cleaning of a Breast Pump Questionnaire (KBP-Q). Hospital Representatives completed two online questionnaires: Company Support for Breastfeeding Questionnaire (CBS-Q) and Knowledge of CDC Recommendations for Use and Cleaning of a Breast Pump Questionnaire (KBP-Q). Demographic information was collected from all participants via an online questionnaire. Pearson’s correlation coefficient was used to determine significant associations. Linear regression models were used to determine the relationships between workplace breastfeeding support constructs and breastfeeding and infant practice outcomes; and to explain relationships between knowledge of and adherence to CDC guidelines and breastfeeding and infant feeding practices. Qualitative responses from the open-ended question of the EPBS-Q were analyzed for categories using Strauss and Corbin’s Grounded Theory approach. Open coding, axial coding, and selective coding was used to develop the underlying codes and a conceptual description. Workplace recommendations were then created based upon the analysis. Results: Using the EPBS-Q, increased perceived time and frequency of lactation breaks was associated with an increased duration of feeding solids and breastmilk to the infant, and a decreased duration of solids and formula. Increased communication among coworkers was associated with a decrease in the duration of feeding solids, breastmilk, and formula combined. Among RNs knowledge scores of CDC recommendations for cleaning a breast pump were high, but adherence scores to those recommendations was not as high. There was an association between increased RN adherence to CDC recommendations for cleaning a pump and an increase in the duration of feeding solids and formula to an infant. At the manager level among the hospitals, there was an increase in duration of solids and formula with increased manager knowledge of CDC recommendations for cleaning a pump. Qualitative responses to the open-ended question of the EPBS-Q showed that experiences demonstrating a lack of support for EBMW continue to exist among RNs who expressed breast milk upon return to work.