Roxy Todd Published

Working Moms Feel Pressure to Breastfeed, But Struggle Getting the Time and Support to Make it Work


Only 17 percent of Americans have paid family leave from their jobs, according to the Bureau of Labor Statistics. In the early 1990s, the Family Leave Act was passed. It requires most employers to offer workers 3 months off after the birth of a baby — both men and women. But here’s the catch, employers don’t have to pay them for the time off.

Also, businesses with less than 50 employees are exempt from the Family Leave Act, so it’s legal for small businesses to fire workers if they take time off after a birth.

What all this means, is many parents — mothers in particular — who can’t afford to take unpaid time off, return to work soon after having a baby.

We don’t know when, on average, women in Appalachia return to work. There isn’t any research on that. But some breastfeeding advocates say they believe a need to return to work quickly may be one of the reasons women in Appalachia are less likely to breastfeed than women in the nation as a whole.

Nearly 900 women answered a West Virginia Public Broadcasting survey about being a working mom in Appalachia. From this, we were able to glean some insight into what working women in our region face, especially when it comes to the challenges of breastfeeding.

  • More than half of the women said they breastfed their babies.
  • More than half also said they received no paid time off work.

Returning to work after giving birth can be hard, regardless of how parents choose to feed their babies.

Kat Biller’s Story

On a Saturday morning in downtown Charleston, West Virginia, people are queuing up at the coffee shop inside a local bookstore.

Kat Biller has worked here for four years.  

Like most hourly workers, Biller didn’t get any paid time off after giving birth to her daughter, Jackie. She said she would have loved more time off, but she couldn’t afford to miss another paycheck.


Credit courtesy Kat Biller
Kat Biller with her daughter, Jackie

But she said there are benefits to working for a locally-owned business. Her bosses encouraged her to bring her infant to work. They provided space for her to feed the baby, change her diaper, and they made sure she didn’t work on her own, so that she could step away if she needed to. So four weeks after giving birth, Biller was back behind the register, with her baby sleeping in a sling across her chest.

After a month of working with her daughter at the bookstore, Biller asked if she could work evenings and weekends instead of during the day. Her employers agreed. So, while she was at work, her husband watched their daughter. He fed her the breast milk Biller pumped at work.

Biller said she knows family-friendly work environments like hers are rare. “Were the system as a whole to open up and allow for women everywhere to have even as much opportunity as I had, I think that would be much better,” she said.

Biller said she’s grateful for the flexibility that her job offers. Still, she said she wishes she would have had a few months paid time off to spend with Jackie.

No Paid Leave

Like Biller, many working mothers return just a few weeks after giving birth.

“I’ve had patients that they had the baby on a Friday night, and they had to go back to work on Monday morning,” said Stephanie Carroll, a lactation consultant in southeastern Ohio. Carroll is also the founder of the nonprofit Appalachian Breastfeeding Network, which seeks to increase breastfeeding in Appalachia. She said there’s a lot of pressure on women in our region — both cultural and economic — to go back to work early.

Why Some Women Dread Breast Pumps


Credit Adobe Stock
breast pump


Pumping breastmilk  which can be stored and fed to babies through a bottle — is an option that a lot of the moms we interviewed said they tried. Some had mixed success and all had conflicting emotions about pumping.

Breast pumps in the United States cost about $200 dollars. The Affordable Care Act of 2010 requires that most health insurance plans cover at least some of the cost. But while pumping enables working moms to feed their babies breast milk, there are drawbacks.

“It’s very mechanical,” said state employee Caitlin Ashley-Lizarraga. Lizarraga pumped at work until her son Cillian was 10 months old. “You start to feel like you’re a drone in a sci-fi movie or, you know, a post-apocalyptic world.”

Lizarraga just gave birth to her second baby in June. Before her baby was born, we met at a coffee shop one evening after work, and she told me she dreads pumping, even though she loves breastfeeding.

“For me at least, it was a connection to my mother, my grandmother, all the way back. But pumping strips it all away. And you literally feel like you’re just a dairy cow,” Lizarraga said.

She said she and some coworkers hang a sign of a cow over their cubicles when they pump breast milk at work. Often they pump right at their cubicle, so they can keep working, even though there is a designated pumping space at the office. Designated pumping spaces are another part of the Affordable Care Act, the Break Time for Nursing Mothers, that requires employers with 50 or more workers to offer a room and time for mothers to pump breast milk. And it can’t be a bathroom.

Milisha’s Story

But employers don’t have to pay women for the time they spend pumping, so working moms can lose money, or have to stay late to make up the work. That’s what happened to Milisha.

“I don’t think it’s right. I think we should get paid for it.” We agreed not to use Milisha’s last name because she’s worried her employer might fire her for talking to a reporter. She said she had to clock out whenever she took a break to pump.

“Financially I made probably $150 less on each paycheck, because I was pumping. And a lot of people can’t do it financially.”

Milisha works at a call center, And sometimes calls went on so long that she went without pumping. “So sometimes you’d just sit there and you’d be miserable. And that was terrible.”

Not only is waiting to pump  uncomfortable, it can cause an inflammation of the breast, called mastitis.

Inconsistent Pumping Breaks Leads to Lower Milk Supply

Milk works on a supply and demand system, so if women skip a feeding or a pump break, they can lose or weaken their supply of milk, especially in the first few weeks after giving birth.

“Stress itself doesn’t decrease your milk supply, but what it does is it might make you forget or neglect to pump or skip a feed. That’s what causes you to lose your milk supply,” said Dr. Kailey Littleton, a pediatrician and a lactation consultant.

Littleton said the best way to maintain a supply of milk after returning to work, is  to pump regularly, every few hours.

“Which, it’s easy for me to say cause I was in a job where it was respected and honored,” said Littleton. But for women who work in restaurants or gas stations or other jobs with hourly pay, it’s not as easy to take a break every few hours, she said. “They probably would just fire you.”

Littleton said she hears this all the time. “People say, ‘I don’t think my job will let me do it.’ I write letters for moms all the time saying that they are legally required to allow this. I don’t know how effective all of that is, but sometimes it works.”

Even salaried employees struggle to juggle regular pumping schedules, and still, nine years after the Break Time for Nursing Mothers became federal law, not all employers offer women a place to pump milk.


Credit Eric Douglas/ WVPB
Reporter Roxy Todd with her 6-month-old daughter

Angela Burkhart’s Story

Former kindergarten teacher Angela Burkhart said during a work training, she couldn’t find anywhere to pump.

“So I had to leave during the morning to go pump, I would pump on my way there, at lunch I would pump, and then I would pump on my way back. And every time I pumped basically in those three days was in my car,” said Burkhart.

These trainings were held at the local high school. She said she felt reluctant to ask for a special room to pump, especially for a training that only lasted a few days. And she said her boss was usually accommodating, and she felt lucky. At school she was given both time and a room to pump. Although, the janitor has walked in on her.

“Like at least a dozen times he walked in, absentmindedly.”

Still, Burkhart said she considers her situation better than what a lot of women face at work. Although she now works a different job, part time for the school system, she said she knows there are other teachers who still struggle to maintain pumping while they work.

Legal Consequences

There have been some lawsuits across the country for breastfeeding discrimination.

In February, a woman in Delaware won a $1.5 million lawsuit against Kentucky Fried Chicken for not being given an adequate place to pump breast milk.  

Of the women who answered our survey, nearly 4 out of 10 said they didn’t feel like they had the flexibility to pump milk after they returned to work. Others feel more fortunate.

“In terms of having paid maternity leave and having a very flexible job, and having an office with a door that closes, and a refrigerator in my office. I’m able to pump at work,” said Molly Clever,  an assistant professor of Sociology at West Virginia Wesleyan college. “And I’m able to have that support in my in my work environment. And I still struggle to do it. So how do women who don’t have that kind of job flexibility, and don’t have that kind of paid maternity leave, how do they do it?”

This lack of support in the workplace may be one reason why so many women stop breastfeeding earlier than they intended. The Centers for Disease Control released a report last year that said “most mothers in the United States want to breastfeed and start out doing so,” but after 3 months, those numbers begin to decline, and only a third continue to breastfeed for a year, which is what the American Association of Pediatricians recommends for all infants.

“How do we reconcile what we tell women is the recommendations of what you’re supposed to do to keep your child healthy, without providing them with any of the support that they need to actually accomplish that?” Clever said.

This story is part of an Inside Appalachia Episode about breastfeeding and motherhood.