The AFA Blog

Food Packaging Significant Source of BPA Exposure, New Study Finds

The American Fertility Association congratulates allied non profit organization, The Breast Cancer Fund and the Silent Spring Institute on their groundbreaking new study on BPA exposure and women's health.  The AFA has been sounding the alarm on BPA and other toxins that affect reproductive health for many years; our most recent press release quoted Executive Director Ken Mosesian as stating, "The AFA is proud to be a thought leader in this arena, and looks forward to definitive answers being realized.  We recognize that more research is urgently needed."

  A peer-reviewed study published today in Environmental Health Perspectives suggests that food packaging is a substantial source of exposure to the endocrine-disrupting chemical bisphenol A (BPA), which laboratory studies have linked to breast cancer, infertility, early puberty, and other serious health problems. In this unprecedented human study, scientists at the Breast Cancer Fund and Silent Spring Institute discovered an average drop of 60 percent in BPA levels when study participants ate a diet that avoided contact with BPA-containing food packaging, such as canned food and polycarbonate plastic.

“This study suggests that removing BPA from food packaging will remove the number one source of BPA exposure,” said Janet Gray, Ph.D., Science Advisor to the Breast Cancer Fund and professor at Vassar College. “The study should serve as a call to action for industry and government to get BPA out of food packaging and to fix the broken chemical management system that allows it to be there in the first place.”

The study, “Food Packaging and Bisphenol A and Bis(2-Ethyhexyl) Phthalate Exposure: Findings from a Dietary Intervention,” tested the levels of BPA in the urine of five San Francisco Bay Area families who had a high likelihood of regular exposure to food packaging containing BPA (they consumed canned foods and beverages, ate meals outside of the home, used polycarbonate water bottles, and/or microwaved in plastic). The families were provided with three days’ worth of freshly prepared organic meals with no canned food, and using only glass storage containers. The families’ urine was evaluated while they ate their typical diets, again during the period when they were provided with freshly-prepared meals, and then again after returning to their normal eating habits. While the families were eating the fresh-food diet, their BPA levels dropped on average by 60 percent. Reductions were even more pronounced—75 percent—for those with the highest exposures. When families returned to their regular diets, their BPA levels increased back to pre-intervention levels.

In addition to BPA, participants were tested for phthalates, plastic-softening chemicals that can interfere with reproductive development. Levels of DEHP (a phthalate used in food packaging) dropped by an average of 50 percent during the intervention; and the highest exposures dropped by over 90 percent.

"Our study provides clear and compelling evidence that food packaging is the major source of exposure to BPA and DEHP,” said Ruthann Rudel, lead author of the study and Director of Research at Silent Spring Institute. “The study shows that a fresh-food diet reduces levels of these chemicals in children and adults by half, after just three days."

BPA and the phthalate DEHP are both used widely in food packaging. BPA is used to make polycarbonate plastics and is used in the lining of food cans, and DEHP is an additive used in some food containers and plastic wraps to increase flexibility. BPA and phthalates are both known as endocrine-disrupting chemicals because of their effects on hormone systems. BPA has been shown to mimic the hormone estrogen, and exposure has been associated with effects on the developing brain, reproductive system, and mammary and prostate glands in laboratory studies. Phthalates have been demonstrated to interfere with androgen signaling and male reproductive development in laboratory and human studies.

“The findings of this food packaging study suggest that if the food and food-storage industries reformulated packaging to remove BPA and phthalates, or if there were a federal ban of these chemicals in food packaging, a large portion of the population would experience a rapid reduction in the levels of these chemicals in their bodies,” said Dr. Gray. “Industry and government need to ensure the safety of any substitute chemicals before they are put into use.”

Suggestions from the Breast Cancer Fund and Silent Spring Institute for reducing exposure to BPA and DEHP include cooking at home with fresh foods and making some changes in the kitchen, such as avoiding canned foods, choosing glass and stainless steel food and beverage containers, and not microwaving in plastic. After aggregating the results of tests of 300 canned food products, the Breast Cancer Fund found that BPA especially leaches into canned foods that are acidic, salty or fatty, such as coconut milk, soup, meals (e.g., ravioli in sauce) and vegetables. For additional tips or to download a shopper’s guide, visit www.breastcancerfund.org.

  

Twins are everywhere!

by Jamie Schenk DeWitt

Next time you are walking down the street or jogging in the park, notice how many double or even triple strollers there are.  I was at the park yesterday with my 21-month-old twin daughters and saw three pairs of twin strollers and one set of triplets!  

Based on figures from the American Society for Reproductive Medicine, approximately 30% of couples that undergo ART (Assisted Reproductive Therapy) will give birth to twins versus 1-2 % of spontaneous pregnancies.  

Below are two of the reasons why:

1.  Fertility drugs that are prescribed to patients encourage the ovaries to release more than one egg during ovulation.  

 2. During the embryo transfer of an IVF (In vitro fertilization) cycle, doctors often implant more than one embryo in the womb.  (Ever since the infamous Octomom debacle fertility doctors have been under fire for implanting more than one embryo, but -- needless to say -- depending on the woman’s age,  infertility diagnosis and doctor’s medical evaluation, sometimes it may make sense to implant more than one embryo).  

The first consultation that my husband and I had with our fertility doctor he asked us,   “How do you feel about having twins?”  Spontaneously I responded, “Great!  I would love it.” Our physician went on to inform us that there was a greater chance of having multiples when using assisted reproductive methods.  Because I was so distraught over not being able to get pregnant naturally it seemed like a blessing to get pregnant with one baby, let alone twins.

8 months after our initial visit with our fertility doctor, I was pregnant with twins.  It was one of the most joyous days in my life.  After all of the failed treatments, it felt like a miracle that I was pregnant.  And since being pregnant with twins put me in the high-risk pregnancy category, I was consumed with staying healthy, and the reality of what it meant both physically and financially to take care of twins after they were born did not faze me right away.  Yes, we bought two cribs, two car seats and a double Snap-n-Go stroller (an essential item) in preparation for their arrival.   Yet, the notion that we would have to do two of everything at the same time, -- two diapers, two feedings, and two baths – did not hit me until the morning they were born. Literally, my life changed in an instant. 

The challenges of their first three months, from trying to figure out how to simultaneously breastfeed two babies, to consoling two hysterically crying infants, to learning how to synchronize their schedules, so I could get some sleep at night were tremendous.  I can still remember the first night that I was alone with both of them.  The baby nurse and my mom had left to go back to their respective cities and my husband was working late.  I had successfully positioned both girls on each breast in the football position for their evening feeding.  However, when it came time to give them each a bottle (I had to supplement with formula since I didn’t produce enough milk for two babies) all hell broke out.  They were both crying.   I couldn’t figure out how to hold both of their heads up at the same time to give them their bottles. It was a disaster.  By the time my husband came home, I was bawling.  

Needless to say, I ended up figuring out how to manage that situation, but in the process I felt awful.  It would take several months of trial and error for me to feel like a “mother of twins.” Taking care of my daughters was the most difficult job that I had ever encountered, but with each new challenge that I conquered, I found my voice as a mother.  I learned how to trust myself, rely on the advice of other parents of twins, and use parenting experts in my community.  I also drew incredible strength from observing my spectacular girls grow and develop.  I was proud of who we were becoming as a family and with this newfound confidence, I never shied away from taking them to the park, classes, play dates or the grocery store by myself, which believe me, felt like quite an accomplishment at the time. 

Over the course of the first year I can still clearly remember the comments and looks that I got from other parents or strangers when they would see me out with my twin daughters.  

 “Wow twins!  You’ve got your hands full.”

“Are they twins?  So adorable!”

“Twins!  Two for the price of one.” (If they only knew how much IVF cost)

“A boy and a girl?”

“Are they identical?  Wow, they sure look identical don’t they?”

“You sure have a lot of energy for having two babies.” 

“They must keep you on your toes.”

“Agh twins.” (Insert look of desire) “I wanted twins, but I didn’t get so lucky.  I only have one baby.”

“Agh twins. How’s that going for you?” (Insert look of terror)

“Two babies.  Bet you’re busy.”

“I can’t believe you have twins!”

 Dead silence.  (Insert look at the babies, then look at me. Enough said.)

“Are you enjoying both of them?”

“So precious!”

“Do you have help?”

“Oh my God – Twins!  I could never imagine.”

“She looks so much like you.” (Pointing to the daughter who looks exactly like her father)

“They are so adorable.  You must get sick of hearing that?  They sure must keep you busy?  Okay I’ll leave you alone.”

“A boy and girl?  No.  Two boys.” (One is dressed in purple and the other in hot pink.)

 “You are so lucky and blessed.”

“That’s a lot of work.”

“Do twins run in your family?”

So whether you are taking care of one baby, two or three babies, motherhood is a journey and not a destination. Enjoy the ride because it all goes by so fast!   And just realize that if you need fertility treatments, know if you are willing to have a multiple birth, and know all the facts, both medical, emotional, and practically speaking. 

 Even though we did not plan on having twins when we began our fertility treatments I have learned from my own experience, as well as that of other mother’s of twins that the question of whether or not it is safe to have multiples is one to be taken very seriously. There are tremendous risks to both mother and babies when someone attempts to have a multiple pregnancy and you should make sure that you discuss this in depth with your doctor prior to conception being attempted.. 

 According to the Society for Assisted Reproductive Technology (SART).  the objective of infertility treatment should be the birth of a single, healthy child.  Multiple gestations, meaning twins or greater, can pose significant health concerns.  These include but are not limited to:

• Increased Rates of Miscarriage
• Increased Rates of Fetal Death, Even After Birth
• Cerebral Palsy:
• Increased Levels of Nausea, Heartburn and Vomiting during Pregnancy
• Pre-eclampsia (High Blood Pressure)
• Gestational Diabetes:
• Placenta Previa
• Heart Problems, Including Heart Attack for the Expectant Mother:
• Increased Need for Partial or Complete Bedrest, and Limited Physical Activity:
• Emotional Issues, including the possible need for Mutifetal Reduction
• Increased Rates of Caesarian Section Delivery
• Complications after Birth such as Development Delays or Autism

A sobering, and partial list.  It is important to note that not all twin pregnancies are problematic, many like mine, only posed temporary challenges that we as a family were able to overcome.  The American Fertility Association will be publishing several significant commentaries on this issue during 2011, as well as a fact sheet and video on elective Single Embryo Transfer, later on this month.  In depth information on all aspects of mutliple birth will be covered.

Breast feeding - a state by state guide

 

The U.S. Department of Health and Human Services has just issued an updated state by state guide on breastfeeding laws (below).  My own personal opinion is that women should be free to safely nurse their baby(s) anywhere they need to at any time, and that this should not be an issue that needs to be regulated by law; thankfully, the laws in most states are however significantly favorable for nursing moms and babies, this is very good news. I have personally seen women nurse comfortably on New York City subways and in parks, but I have also seen unsuspecting moms harshly removed from tables where meat could not be mixed with milk, or asked to leave restaurants.  I have witnessed people attempt to shame mothers for breastfeeding their babies.  Having nursed my own twins for almost a year, I am a strong advocate that breast is best.  And as a woman who herself conceived through In Vitro Fertilization, I felt that the information given here was important to pass along to the current population of women who are striving to become mommies themselves - Corey Whelan

Breastfeeding Laws

Updated March 2010

Resources

Health professionals and public health officials promote breastfeeding to improve infant health. Both mothers and children benefit from breast milk.  Breast milk contains antibodies that protect infants from bacteria and viruses.  Breastfed children have fewer ear infections, respiratory infections, urinary tract infections and have diarrhea less often.  Infants who are exclusively breastfed tend to need fewer health care visits, prescriptions and hospitalizations resulting in a lower total medical care cost compared to never-breastfed infants.  Breastfeeding also provides long-term preventative effects for the mother, including an earlier return to pre-pregnancy weight and a reduced risk of pre-menopausal breast cancer and osteoporosis. According to the Centers for Disease Control and Prevention, approximately 70 percent of mothers start breastfeeding immediately after birth, but less than 20 percent of those moms are breastfeeding exclusively six months later. It is a national goal to increase the proportion of mothers who breastfeed their babies in the early postpartum period to 75 percent by the year 2010.  

Federal Health Reform and Nursing Mothers

President Obama signed the Patient Protection and Affordable Care Act, H.R. 3590, on March 23rd and the Reconciliation Act of 2010, H.R. 4872, on March 30, 2010. (See the combined full text of Public Laws 111-148 and 111-152 here.)  Among many provisions, Section 4207 of the law amends the Fair Labor Standards Act of 1938 (29 U.S.Code 207) to require an employer to provide reasonable break time for an employee to express breast milk for her nursing child for one year after the child's birth each time such employee has need to express milk.  The employer is not required to compensate an employee receiving reasonable break time for any work time spent for such purpose.  The employer must also provide a place, other than a bathroom, for the employee to express breast milk.  If these requirements impose undue hardship, an employer that employs less than 50 employees is not subject to these requirements.  Furthermore, these requirements shall not preempt a state law that provides greater protections to employees.

State Breastfeeding Laws

• Forty-four states, the District of Columbia and the Virgin Islands have laws with language specifically allowing women to breastfeed in any public or private location (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin and Wyoming).

• Twenty-eight states, the District of Columbia and the Virgin Islands exempt breastfeeding from public indecency laws (Alaska, Arizona, Arkansas, Florida, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nevada, New Hampshire, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Virginia, Washington, Wisconsin and Wyoming).

• Twenty-four states, the District of Columbia and Puerto Rico have laws related to breastfeeding in the workplace (Arkansas, California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine, Minnesota, Mississippi, Montana, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming).

• Twelve states and Puerto Rico exempt breastfeeding mothers from jury duty (California, Idaho, Illinois, Iowa, Kansas, Kentucky, Mississippi, Montana, Nebraska, Oklahoma, Oregon and Virginia).

• Five states and Puerto Rico have implemented or encouraged the development of a breastfeeding awareness education campaign (California, Illinois, Minnesota, Missouri and Vermont).

Several states have unique laws related to breastfeeding. For instance,

• The state of Virginia allows women to breastfeed on any land or property owned by the state.  Puerto Rico requires shopping malls, airports, public service government centers and other select locations to have accessible areas designed for breastfeeding and diaper changing that are not bathrooms.

• At least two states have laws related to child care facilities and breastfeeding.  Louisiana prohibits any child care facility from discriminating against breastfed babies. Mississippi requires licensed child care facilities to provide breastfeeding mothers with a sanitary place that is not a toilet stall to breastfeed their children or express milk, to provide a refrigerator to store expressed milk, to train staff in the safe and proper storage and handling of human milk, and to display breastfeeding promotion information to the clients of the facility.

• California requires the Department of Public Health to develop a training course of hospital policies and recommendations that promote exclusive breastfeeding and specify staff for whom this model training is appropriate.  The recommendation is targeted at hospitals with patients who ranked in the lowest twenty-five percent of the state for exclusive breastfeeding rates.

• Maryland exempts the sale of tangible personal property that is manufactured for the purpose of initiating, supporting or sustaining breastfeeding from the sales and use tax.

• California, New York and Texas have laws related to the procurement, processing, distribution or use of human milk.

• New York created a Breastfeeding Mothers Bill of Rights, which is required to be posted in maternal health care facilities.

First Letter of State A C D F G H I K L M N O P R T U V W 

States	Summary of Statutes
Alabama	Ala. Code § 21-1-13 (2006) allows a mother to breastfeed her child in any public or private location.
American Samoa
Alaska	Alaska Stat. § 29.25.080 and § 01.10.060 (1998) prohibit a municipality from enacting an ordinance that prohibits or restricts a woman breastfeeding a child in a public or private location where the woman and child are otherwise authorized to be. The law clarifies that lewd conduct, lewd touching, immoral conduct, indecent conduct, and similar terms do not include the act of a woman breastfeeding a child in a public or private location where the woman and child are otherwise authorized to be. (SB 297)
Arizona	Ariz. Rev. Stat. Ann § 41-1443 (2006) provides that indecent exposure does not include an act of breastfeeding by a mother and entitles a mother to breastfeed in any public place where the mother is otherwise lawfully present.
Arkansas	Ark. Stat. Ann. § 5-14-112 and § 20-27-2001 (2007) allow a woman to breastfeed in any public or private location where other individuals are present. The law also exempts breastfeeding women from indecent exposure laws.   Ark. Stat. Ann. § 11-5-116 (2009) requires an employer to provide reasonable unpaid break time each day to an employee who needs to express breast milk for her child and requires an employer to make a reasonable effort to provide a private, secure and sanitary room or other location other than a toilet stall where an employee can express her breast milk. (2009 Ark. Acts, Act 621, HB 1552)
California	Cal. Civil Code § 43.3 (1997) allows a mother to breastfeed her child in any location, public or private, except the private home or residence of another, where the mother and the child are otherwise authorized to be present. (AB 157) Cal. Civil Code § 210.5 (2000) allows the mother of a breastfed child to postpone jury duty for one year and specifically eliminates the need for the mother to appear in court to request the postponement. The law also provides that the one-year period may be extended upon written request of the mother. (Chap. 266; AB 1814) Cal. Health and Safety Code § 1647 (1999) declares that the procurement, processing, distribution or use of human milk for the purpose of human consumption is considered to be a rendition of service rather than a sale of human milk. (Chap. 87; AB 532) Cal. Health and Safety Code § 123360 and § 1257.9 require that the Department of Public Health include in its public service campaign the promotion of mothers breastfeeding their infants. The department shall also develop a training course of hospital policies and recommendations that promote exclusive breastfeeding and specify staff for whom this model training is appropriate.  The recommendation is targeted at hospitals with exclusive patient breastfeeding rates ranked in the lowest twenty-five percent of the state. (2007 Chapter 460, SB 22) Cal. Labor Code § 1030 et seq. (2001) provides that employers need to allow a break and provide a room for a mother who desires to express milk in private. Cal. Assembly Concurrent Resolution 155 (1998) encourages the state and employers to support and encourage the practice of breastfeeding by striving to accommodate the needs of employees, and by ensuring that employees are provided with adequate facilities for breastfeeding and expressing milk for their children. The resolution memorializes the governor to declare by executive order that all state employees be provided with adequate facilities for breast feeding and expressing milk.
Colorado	Colo. Rev. Stat. § 25-6-301 and § 25-6-302 (2004) recognize the benefits of breastfeeding and encourage mothers to breastfeed.  The law also allows a mother to breastfeed in any place she has a right to be.  (SB 88) Colo. Rev. Stat. § 8-13.5-101 et seq. (2008) require an employer to provide reasonable break time for an employee to express breast milk for her nursing child for up to two years after the child's birth.  The employer shall make reasonable efforts to provide a place, other than a toilet stall, for the employee to express breast milk in privacy.  The law also requires the Department of Labor and Employment to provide, on its website, information and links to other websites where employers can access information regarding methods to accommodate nursing mothers in the workplace. (2008 Colo., Sess. Laws, Chap. 106, HB 1276)
Connecticut	Conn. Gen. Stat. § 31-40w (2001) requires employers to provide a reasonable amount of time each day to an employee who needs to express breast milk for her infant child and to provide accommodations where an employee can express her milk in private. (HF 5656) Conn. Gen. Stat. § 46a-64 (1997) prohibits places of public accommodation, resort or amusement from restricting or limiting the right of a mother to breastfeed her child. (1997 Conn. Acts, P.A. 210) Conn. Gen. Stat. Ann. § 53-34b provides that no person may restrict or limit the right of a mother to breastfeed her child.
Delaware	Del. Code Ann. tit. 31 § 310 (1997) entitles a mother to breastfeed her child in any location of a place of public accommodation wherein the mother is otherwise permitted. (Vol. 71 Del. Laws, Chap. 10)
District of Columbia	D.C. Code Ann. § 2-1402.81 et seq. amend the Human Rights Act of 1977 to include breastfeeding as part of the definition of discrimination on the basis of sex, to ensure a woman's right to breastfeed her child in any location, public or private, where she has the right to be with her child.  The law provides that breastfeeding is not a violation of indecent exposure laws.  The law also specifies that an employer shall provide reasonable daily unpaid break periods, as required by the employee, so that the employee may express breast milk for her child.  These break periods shall run concurrently with any break periods that may already be provided to the employee.  Requires that an employer make reasonable efforts to provide a sanitary room or other location, other than a bathroom or toilet stall, where an employee can express her breast milk in privacy and security.  The location may include a childcare facility in close proximity to the employee's work location.  (2007 D.C. Stat., Chap. 17-58; B 133)
Florida	Fla. Stat. § 383.015 (1993) allows a mother to breastfeed in any public or private location. (HB 231) Fla. Stat. § 383.016 (1994) authorizes a facility lawfully providing maternity services or newborn infant care to use the designation "baby-friendly" on its promotional materials. The facility must be in compliance with at least eighty percent of the requirements developed by the Department of Health in accordance with UNICEF and World Health Organization baby-friendly hospital initiatives. (SB 1668) Fla. Stat. § 800.02 et seq. and § 827.071 exclude breastfeeding from various sexual offenses, such as lewdness, indecent exposure and sexual conduct.   Fla. Stat. § 847.0135 (5) (d) (2008)  excludes a mother breastfeeding her baby from the offense of lewd or lascivious exhibition using a computer. (2008 Fla. Laws, Chap. 172, SB 1442)
Georgia	Ga. Code § 31-1-9 (1999) states that the breastfeeding of a baby is an important and basic act of nurture which should be encouraged in the interests of maternal and child health and allows a mother to breastfeed her baby in any location where the mother and baby are otherwise authorized to be. (1999 SB 29, Act 304; 2002 SB 221)  Ga. Code § 34-1-6 (1999) allows employers to provide daily unpaid break time for a mother to express breast milk for her infant child. Employers are also required to make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the workplace for this activity. The employer is not required to provide break time if to do so would unduly disrupt the workplace operations.
Guam
Hawaii	Hawaii Rev. Stat. § 367-3 (1999) requires the Hawaii Civil Rights Commission to collect, assemble and publish data concerning instances of discrimination involving breastfeeding or expressing breast milk in the workplace. The law prohibits employers to forbid an employee from expressing breast milk during any meal period or other break period. (HB 266) Hawaii Rev. Stat. § 378-2 (1999) provides that it is unlawful discriminatory practice for any employer or labor organization to refuse to hire or employ, to bar or discharge from employment, or withhold pay, demote or penalize a lactating employee because an employee breastfeeds or expresses milk at the workplace. (HB 2774) Hawaii Rev. Stat. § 489.21 and § 489-22 provide that it is a discriminatory practice to deny, or attempt to deny, the full and equal enjoyment of the goods, services, facilities, privileges, advantages, and accommodation of a place of public accommodations to a woman because she is breastfeeding a child.
Idaho	Idaho Code § 2-212 (2002) provides that a person who is not disqualified for jury service under § 2-209 may have jury service postponed by the court or the jury commissioner only upon a showing of undue hardship, extreme inconvenience, or public necessity, or upon a showing that the juror is a mother breastfeeding her child. (2002 HB 497)
Illinois	Ill. Rev. Stat. ch. 20 § 2310/55.84 (1997) allows the Department of Public Health to conduct an information campaign for the general public to promote breastfeeding of infants by their mothers. The law allows the department to include the information in a brochure for free distribution to the general public. (Ill. Laws, P.A. 90-244) Ill. Rev. Stat. ch. 705 § 305/10.3 (2005) amends the Jury Act.  Provides that any mother nursing her child shall, upon her request, be excused from jury duty. (Ill. Laws, P.A. 094-0391, SB 517) Ill. Rev. Stat. ch. 720 § 5/11-9 (1995) clarifies that breastfeeding of infants is not an act of public indecency. (SB 190) Ill. Rev. Stat. ch. 740 § 137 (2004) creates the Right to Breastfeed Act.  The law provides that a mother may breastfeed her baby in any location, public or private, where the mother is otherwise authorized to be; a mother who breastfeeds in a place of worship shall follow the appropriate norms within that place of worship. (SB 3211) Ill. Rev. Stat. ch. 820 § 260 (2001) creates the Nursing Mothers in the Workplace Act.  Requires that employers provide reasonable unpaid break time each day to employees who need to express breast milk. The law also requires employers to make reasonable efforts to provide a room or other location, other than a toilet stall, where an employee can express her milk in privacy. (SB 542)
Indiana	Ind. Code § 16-35-6 allows a woman to breastfeed her child anywhere the law allows her to be. (HB 1510) Ind. Code § 5-10-6-2 and § 22-2-14-2 (2008) provide that state and political subdivisions shall provide for reasonable paid breaks for an employee to express breast milk for her infant, make reasonable efforts to provide a room or other location, other than a toilet stall, where the employee can express breast milk in private and make reasonable efforts to provide for a refrigerator to keep breast milk that has been expressed.  The law also provides that employers with more than 25 employees must provide a private location, other than a toilet stall, where an employee can express the employee's breast milk in private and if possible to provide a refrigerator for storing breast milk that has been expressed. (2008 Ind. Acts, P.L. 13, SB 219)
Iowa	Iowa Code § 135.30A (2002) a woman may breastfeed the woman's own child in any public place where the woman's presence is otherwise authorized. Iowa Code § 607A.5 (1994) allows a woman to be excused from jury service if she submits written documentation verifying, to the court's satisfaction, that she is the mother of a breastfed child and is responsible for the daily care of the child.
Kansas	Kan. Stat. Ann. § 43-158 and § 65-1,248 provide that it is the public policy of Kansas that a mother's choice to breastfeed should be supported and encouraged to the greatest extent possible and that a mother may breastfeed in any place she has a right to be.  The law was amended in 2006 to excuse nursing mothers from jury duty (2006 HB 2284).
Kentucky	Ky. Rev. Stat. § 29A.100 (2007) directs judges at all levels of the court to excuse women who are breastfeeding or expressing breast milk from jury service until the child is no longer nursing. (SB 111) Ky. Rev. Stat. § 211-755 (2006) permits a mother to breastfeed her baby or express breast milk in any public or private location. Requires that breastfeeding may not be considered an act of public indecency, indecent exposure, sexual conduct, lewd touching or obscenity. Prohibits a municipality from enacting an ordinance that prohibits or restricts breastfeeding in a public or private place. (SB 106)
Louisiana	La. Rev. Stat. Ann. § 46. 1409 B 5 prohibits any child care facility from discriminating against breastfed babies. (HB 233) La. Rev. Stat. Ann. § 51. 2247.1 (2001) states that a mother may breastfeed her baby in any place of public accommodation, resort, or amusement, and clarifies that breastfeeding is not a violation of law, including obscenity laws. (2001 HB 377) La. House Concurrent Resolution 35 (2002) establishes a joint study of requiring insurance coverage for outpatient lactation support for new mothers. 2008 La. Senate Resolution 110 requests the Department of Health & Hospitals to study and/or consider a provision of providing non-emergency transportation for new mothers to allow them to visit the hospital and bring their breast milk for their babies.
Maine	Me. Rev. Stat. Ann. tit. 5, § 4634 (2001) amends the Maine Human Rights Act to declare that a mother has the right to breastfeed her baby in any location, whether public or private, as long as she is otherwise authorized to be in that location. (Me. Laws, Chap. 206; LD 1396) Me. Rev. Stat. Ann. tit. 26, § 604 (2009) requires an employer to provide adequate unpaid or paid break time to express breast milk for up to 3 years following childbirth. The employer must make reasonable efforts to provide a clean place, other than a bathroom, where an employee may express breast milk in privacy. The employer may not discriminate against an employee who chooses to express breast milk in the workplace. (2009 Me. Laws, Chap. 84, HB 280)
Maryland	Md. Health-General Code Ann. § 20-801 (2003) permits a woman to breastfeed her infant in any public or private place and prohibits anyone from restricting or limiting this right. (SB 223) Md. Tax-General Code Ann. § 11-211 exempts the sale of tangible personal property that is manufactured for the purpose of initiating, supporting or sustaining breastfeeding from the sales and use tax.
Massachusetts	Mass. Gen. Laws Ann. ch. 111 § 221 (2008) allows a mother to breastfeed her child in any public place or establishment or place which is open to and accepts or solicits the patronage of the general public and where the mother and her child may otherwise lawfully be present.  The law also specifies that the act of a mother breastfeeding her child shall not be considered lewd, indecent, immoral or unlawful conduct and provides for a civil action by a mother subjected to a violation of this law. (2008 Mass. Acts, Chap. 466, SB 2438)
Michigan	Mich. Comp. Laws § 41.181, § 67.1aa and § 117.4i et seq. (1994) state that public nudity laws do not apply to a woman breastfeeding a child.
Minnesota	Minn. Stat. Ann. § 145.894 directs the state commissioner of health to develop and implement a public education program promoting the provisions of the Maternal and Child Nutrition Act.  The education programs must include a campaign to promote breastfeeding. Minn. Stat. § 145.905 provides that a mother may breastfeed in any location, public or private, where the mother and child are authorized to be, irrespective of whether the nipple of the mother's breast is uncovered during or incidental to the breastfeeding. Minn. Stat. § 181.939 (1998) requires employers to provide daily unpaid break time for a mother to express breast milk for her infant child. Employers are also required to make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the workplace for this activity. (SB 2751)  Minn. Stat. Ann. § 617.23 specifies that breastfeeding does not constitute indecent exposure.
Mississippi	Miss. Code Ann. § 13-5-23 (2006) provides that breastfeeding mothers may be excused from serving as jurors. (SB 2419) Miss. Code Ann. § 17-25-7/9 (2006) prohibits any ordinance restricting a woman's right to breastfeed and provides that a mother may breastfeed her child in any location she is otherwise authorized to be. (SB 2419) Miss. Code Ann. § 43-20-31 (2006) requires licensed child care facilities to provide breastfeeding mothers with a sanitary place that is not a toilet stall to breastfeed their children or express milk, to provide a refrigerator to store expressed milk, to train staff in the safe and proper storage and handling of human milk, and to display breastfeeding promotion information to the clients of the facility. Miss. Code Ann. Ch. 1 § 71-1-55 (2006) prohibits against discrimination towards breastfeeding mothers who use lawful break time to express milk. Miss. Code Ann. § 97-29-31 and § 97-35-7et seq. (2006) specifies that a woman breastfeeding may not be considered an act of indecent exposure, disorderly conduct, or disturbance of the public space.
Missouri	Mo. Rev. Stat. § 191.915 (1999) requires hospitals and ambulatory surgical centers to provide new mothers with a breastfeeding consultation or information on breastfeeding, the benefits to the child and information on local breastfeeding support groups. The law requires physicians who provide obstetrical or gynecological consultation to inform patients about the postnatal benefits of breastfeeding. The law requires the Department of Health to provide and distribute written information on breastfeeding and the health benefits to the child. (SB 8) Mo. Rev. Stat. § 191.918 (1999) allows a mother, with as much discretion as possible, to breastfeed her child in any public or private location.
Montana	Mont. Code Ann. § 39-2-215 et seq. specifies that employers must not discriminate against breastfeeding mothers and must encourage and accommodate breastfeeding.  Requires employers to provide daily unpaid break time for a mother to express breast milk for her infant child. Employers are also required to make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the work place for this activity. Mont. Code Ann. § 50-19-501 (1999) states that the breastfeeding of a child in any location, public or private, where the mother otherwise has a right to be is legal and cannot be considered a nuisance, indecent exposure, sexual conduct, or obscenity. (SB 398) Mont. Code Ann. § 3-15-313 (2009) specifies that the court may excuse a person from jury service upon finding that it would entail undue hardship for the person; an excuse may be granted if the prospective juror is a breastfeeding mother. (2009 Mont. Laws, Chap. 167, HB 372)
Nebraska	Neb. Rev. Stat. §25-1601-4 (2003) states that a nursing mother is excused from jury duty until she is no longer breastfeeding and that the nursing mother must file a qualification form supported by a certificate from her physician requesting exemption. (LB 19)
Nevada	Nev. Rev. Stat. § 201.232, § 201.210, and § 201.220 (1995) state that the breastfeeding of a child in any location, public or private, is not considered a violation of indecent exposure laws. (SB 317)
New Hampshire	N.H. Rev. Stat. Ann. § 132:10-d (1999) state that breastfeeding does not constitute indecent exposure and that limiting or restricting a mother's right to breastfeed is discriminatory. (HB 441)
New Jersey	N.J. Rev. Stat. § 26:4B-4/5 (1997) entitles a mother to breastfeed her baby in any location of a place of public accommodation, resort or amusement wherein the mother is otherwise permitted. Failure to comply with the law may result in a fine.
New Mexico	N.M. Stat. Ann. § 28-20-1 (1999) permits a mother to breastfeed her child in any public or private location where she is otherwise authorized to be. (SB 545) N.M. Stat. Ann. § 28-20-2 (2007) requires employers to provide a clean, private place, not a bathroom, for employees who are breastfeeding to pump.  Also requires that the employee be given breaks to express milk, but does not require that she be paid for this time. 2009 N.M. House Memorial 58 requests the governor's women's health advisory council to convene a task force to study the needs of breastfeeding student-mothers and make recommendations for breastfeeding accommodations in school environments.
New York	N.Y. Civil Rights Law § 79-e (1994) permits a mother to breastfeed her child in any public or private location. (SB 3999) N.Y. Labor Law § 206-c (2007) states that employers must allow breastfeeding mothers reasonable, unpaid break times to express milk and make a reasonable attempt to provide a private location for her to do so.  Prohibits discrimination against breastfeeding mothers. N.Y. Penal Law § 245.01 et seq. excludes breastfeeding of infants from exposure offenses. N.Y. Public Health Law § 2505 provides that the Maternal and Child Health commissioner has the power to adopt regulations and guidelines including, but not limited to donor standards, methods of collection, and standards for storage and distribution of human breast milk. N.Y. Public Health Law § 2505-a creates the Breastfeeding Mothers Bill of Rights and requires it to be posted in a public place in each maternal health care facility. The commissioner must also make the Breastfeeding Mothers Bill of Rights available on the health department's website so that health care facilities and providers may include such rights in a maternity information leaflet. (2009 N.Y. Laws, Chap. 292; AB 789)
North Carolina	N.C. Gen. Stat. § 14-190.9 (1993) states that a woman is allowed to breastfeed in any public or private location, and that she is not in violation of indecent exposure laws. (HB 1143)
North Dakota	N.D. Cent. Code § 12.1-20-12.1 was amended in 2009 by Senate Bill 2344 to exempt the act of a woman discreetly breastfeeding her child from indecent exposure laws. N.D. Cent. Code § 23-12-16 allows a woman to breastfeed her child in any location, public or private, where the woman and child are otherwise authorized to be. (2009 SB 2344) N.D. Cent. Code § 23-12-17 provides that an employer may use the designation “infant friendly” on its promotional materials if the employer adopts specified workplace breastfeeding policies, including scheduling breaks and permitting work patterns that provide time for expression of breast milk; providing a convenient, sanity, safe and private location other than a restroom for expressing breast milk; and a refrigerator in the workplace for the temporary storage of breast milk. The law also directs to the state department of heatlh to establish guidelines for employers concerning workplace breastfeeding and infant friendly designations. (2009 SB 2344)
Ohio	Ohio Rev. Code Ann. § 3781.55 (2005) provides that a mother is entitled to breastfeed her baby in any location of a place of public accommodation wherein the mother is otherwise permitted. (SB 41)
Oklahoma	Okla. Stat. tit. 38, § 28 (2004) exempts mothers who are breastfeeding a baby from jury duty, upon their request. (2004 HB 2102) Okla. Stat. tit. 40, § 435 (2006) requires that an employer provide reasonable unpaid break time each day to an employee who needs to breastfeed or express breast milk for her child.  The law requires the Department of Health to issue periodic reports on breastfeeding rates, complaints received and benefits reported by both working breastfeeding mothers and employers. (HB 2358) Okla. Stat. tit. 63, § 1-234 (2004) allow a mother to breastfeed her child in any location that she is authorized to be and exempts her from the crimes and punishments listed in the penal code of the state of Oklahoma. (HB 2102)
Oregon	Or. Rev. Stat. § 109.001 (1999) allows a woman to breastfeed in a public place. (SB 744) Or. Rev. Stat. § 10.050 (1999) excuses a woman from acting as a juror if the woman is breastfeeding a child. A request from the woman must be made in writing. (SB 1304) Or. Rev. Stat. § 653.075, § 653.077 and § 653.256 (2007) allow women to have unpaid 30-minute breaks during each four-hour shift to breastfeed or pump. Allows certain exemptions for employers. (HB 2372)
Pennsylvania	Pa. Cons. Stat. tit. 35 § 636.1 et seq. (2007) allows mothers to breastfeed in public without penalty. Breastfeeding may not be considered a nuisance, obscenity or indecent exposure under this law. (SB 34)
Puerto Rico	1 L.P.R.A. § 5165 declares August as "Breastfeeding Awareness Month" and the first week of August as "World Breastfeeding Week" in Puerto Rico. 3 L.P.R.A. § 1466 and 29 L.P.R.A. § 478a et seq. provide that breastfeeding mothers have the opportunity to breastfeed their babies for half an hour within the full-time working day for a maximum duration of 12 months. 23 L.P.R.A. § 43-1 directs the Regulations and Permits Administration to adopt regulations, which shall provide that in shopping malls, airports, ports and public service government centers there shall be accessible areas designed for breastfeeding and diaper changing that are not bathrooms. 34 L.P.R.A. § 1735h states that any woman breastfeeding her child under 24 months old and who presents a medical attestation to such fact is exempt from serving as a juror. (2003 SB 397)
Rhode Island	R.I. Gen. Laws § 11-45-2 (1998) specifies that indecent exposure-disorderly conduct laws do not apply to breastfeeding in public. (1998 HB 8103, SB 2319; 2008 R.I. Pub Laws, Chap. 183, SB 2616) R.I. Gen. Laws § 23-13.2-1 (2003) specifies that an employer may provide reasonable unpaid break time each day to an employee who needs to breastfeed or express breast milk for her infant child.  The law requires the department of health to issue periodic reports on breastfeeding rates, complaints received and benefits reported by both working breastfeeding mothers and employers, and provides definitions.  (2003 HB 5507, SB 151; 2008 R.I. Pub. Laws, Chap. 475, HB 7906) R.I. Gen. Laws § 23-13.5-1 and § 23-13.5-2 (2008)   allow a woman to feed her child by bottle or breast in any place open to the public and would allow her a private cause of action for denial of this right. (2008 R.I. Pub. Laws, Chap. 223 and Chap. 308, HB 7467 and SB 2283)
South Carolina	S.C. Code Ann. § 63-5-40 (2005) provides that a woman may breastfeed her child in any location where the mother is authorized to be and that the act of breastfeeding is not considered indecent exposure. (2008 HB 4747)
South Dakota	S.D. Codified Laws Ann. § 22-22-24.1 and § 22-24A-2 (2002) exempt mothers who are breastfeeding from indecency laws.
Tennessee	Tenn. Code Ann. § 68-58-101 et seq. (2006) permits a mother to breastfeed an infant 12 months or younger in any location, public or private, that the mother is authorized to be, and prohibits local governments from criminalizing or restricting breastfeeding.  Specifies that the act of breastfeeding shall not be considered public indecency as defined by § 39-13-511; or nudity, obscene, or sexual conduct as defined in § 39-17-901. (HB 3582) Tenn. Code Ann. § 50-1-305 (1999) requires employers to provide daily unpaid break time for a mother to express breast milk for her infant child. Employers are also required to make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the workplace for this activity. (SB 1856)
Texas	Tex. Health Code Ann. § 161.071 (2001) requires the Department of Health to establish minimum guidelines for the procurement, processing, distribution, or use of human milk by donor milk banks. (HB 391) Tex. Health Code Ann. § 165.112 (1995) authorizes a woman to breastfeed her child in any location. Tex. Health Code Ann. § 165.003 et seq. provides for the use of a "mother-friendly" designation for businesses who have policies supporting worksite breastfeeding. (HB 340)  The law provides for a worksite breastfeeding demonstration project and requires the Department of Health to develop recommendations supporting worksite breastfeeding. (HB 359)
U.S. Virgin Islands	14 V.I.C. § 1022 specifies that a woman breastfeeding a child in any public or private location where the woman's presence is otherwise authorized does not under any circumstance constitute obscene or indecent conduct.
Utah	Utah Code Ann. § 17-15-25 (1995) states that city and county governing bodies may not inhibit a woman's right to breastfeed in public. Utah Code Ann. § 76-10-1229.5 (1995) states that a breastfeeding woman is not in violation of any obscene or indecent exposure laws. (HB 262)
Vermont	Vt. Stat. Ann. tit. 9, § 4502 (j) (2002) and 2002 Vt. Acts, Act 117 state that breastfeeding should be encouraged in the interest of enhancing maternal, child and family health. The law provides that a mother may breastfeed her child in any place of public accommodation in which the mother and child would otherwise have a legal right to be. The law directs the human rights commission to develop and distribute materials that provide information regarding a woman's legal right to breastfeed her child in a place of public accommodation. (SB 156) Vt. Stat. Ann. tit. 21, § 305 (2008) requires employers to provide reasonable time throughout the day for nursing mothers to express breast milk for three years after the birth of a child.  Also requires employers to make a reasonable accommodation to provide appropriate private space that is not a bathroom stall, and prohibits discrimination against an employee who exercises rights provided under this act. (2008 Vt. Acts, Act 144, HB 641) 2008 Vt. Acts, Act 203 directs the commissioner of health to convene a healthy worksites work group to identify priorities and develop recommendations to enhance collaborative learning and interactive sharing of best practices in worksite wellness and employee health management.  The work group shall examine best practices in Vermont and other states, including strategies to spread the adoption of workplace policies and practices that support breastfeeding for mothers. The commissioner is required to make recommendations in a report on healthy living initiatives to the legislature by January 15, 2009. (HB 887)
Virginia	Va. Code § 2.2-1147.1 (2002) guarantees a woman the right to breastfeed her child on any property owned, leased or controlled by the state. The bill also stipulates that childbirth and related medical conditions specified in the Virginia Human Rights Act include activities of lactation, including breastfeeding and expression of milk by a mother for her child. (HB 1264) Va. Code Ann. § 8.01-341.1 (2005) provides that a mother who is breastfeeding a child may be exempted from jury duty upon her request. The mother need not be "necessarily and personally responsible for a child or children 16 years of age or younger requiring continuous care during normal court hours." (2005 Chap. 195, HB 2708) Va. Code Ann. § 18.2-387 (1994) exempts mothers engaged in breastfeeding from indecent exposure laws. Va. House Joint Resolution 145 (2002) encourages employers to recognize the benefits of breastfeeding and to provide unpaid break time and appropriate space for employees to breastfeed or express milk.
Washington	Wash. Rev. Code § 9A.88.010 (2001) states that the act of breastfeeding or expressing breast milk is not indecent exposure. (HB 1590) Wash. Rev. Code § 43.70.640 (2001) allows any employer, governmental and private, to use the designation of "infant-friendly" on its promotional materials if the employer follows certain requirements. (2001 Wash. Laws, Chap. 88) Wash. Rev. Code § 49.60.30(g) (2009) provides that it is the right of a mother to breastfeed her child in any place of public resort, accommodations, assemblage or amusement. (2009 Wash. Laws, Chap. 164, HB 1596) Wash. Rev. Code § 49.60.215 the law states that it is an unfair practice for any person to discriminate against a mother breastfeeding her child in any place of public resort, accommodations, assemblage or amusement.
West Virginia
Wisconsin	Wis. Stat. § 944.17(3), § 944.20(2) and § 948.10(2) (1995) provide that breastfeeding mothers are not in violation of criminal statutes of indecent or obscene exposure. (AB 154) 2009 Wis. Laws, Act 148 provides that a mother may breastfeed her child in any public or private location where the mother and child are otherwise authorized to be. The law specifies that in such a location, no person may prohibit a mother from breastfeeding her child, direct a mother to move to a different location to breastfeed her child, direct a mother to cover her child or breast while breastfeeding, or otherwise restrict a mother from breastfeeding her child. (2009 AB 57)
Wyoming	Wyo. House Joint Resolution 5 (2003) encourages breastfeeding and recognizes the importance of breastfeeding to maternal and child health. The resolution also commends employers, both in the public and private sectors, who provide accommodations for breastfeeding mothers. Wyo. Stat. § 6-4-201 (2007) exempts breastfeeding mothers from public indecency laws and gives breastfeeding women the right to nurse anyplace that they otherwise have a right to be. (HB 105)

Sources: National Conference of State Legislatures and StateNet
Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.

Resources

The Economic Benefits of Breastfeeding
NCSL LegisBrief, January 2010

The Benefits of Breastfeeding
This article appeared in the April 2005 edition of NCSL's magazine, State Legislatures.

American Academy of Pediatrics (AAP) : Breastfeeding

                  AAP: New Mother's Guide to Breastfeeding

American Academy of Family Physicians: Promoting and Supporting Breastfeeding

Center for Disease Control and Prevention: Breastfeeding Topics

Breastfeeding Report Card, 2009

Online Data from the Infant Feeding Practices Study II

Guide to Breastfeeding Interventions, 2005

Food and Nutrition Information Center: Breastfeeding

Le Leche League International

March of Dimes: Breastfeeding

Investing in Workplace Breastfeeding Programs and Policies: An Employer's Toolkit
National Business Group on Health, June 2009. 

Office on Women's Health, U.S. Department of Health and Human Services: Breastfeeding

HHS Blueprint for Action on Breastfeeding

Women, Infants, and Children (WIC): Breastfeeding

Photo: PhotoXpress

 

 

 

World Breastfeeding Week

by Corey Whelan

The World Breastfeeding Week (WBW) is the greatest outreach vehicle for the breastfeeding movement, being celebrated in over 120 countries. Officially it is celebrated from 1-7 August.  It seems like a good time to share this blog post, originally published in April of this year, on breastfeeding after infertility. 

Women who undergo infertility treatment often report that their self confidence continues to be shaken, even if pregnancy results.  An inability to conceive naturally may leave women feeling betrayed by their own bodies, and it can take years of proactive work as well as outside support to combat those feelings. 

A large Australian study of mothering after assisted conception found that  women who conceive through assisted reproductive technology often have less confidence in their own ability to care for their newborns and experience higher levels of anxiety than women who conceive naturally.  This lack of self confidence can extend to breastfeeding as well; and women who have undergone infertility treatment  are less likely to either try, or continue, to breastfeed their babies. According to lead researcher Dr. Karin Hammarberg, "Women who take longer to conceive, go through more treatment cycles and have miscarriages, have lower levels of confidence when they go home with their new babies". 

This is very unfortunate.  The benefits of breastfeeding are widely acknowledged; according to the U.S. Dept. of Health and Human Services, breast milk has disease-fighting cells (antibodies) that help protect infants from germs, illness, and even Sudden Infant Death Syndrome (SIDS). 

In addition, the experience of breastfeeding can serve to empower the new mom, and supply a sense of control over her own body that will help her to regain a sense of self as well as confidence in her ability to parent her baby successfully. 

While not for everyone, if you do decide that you want to breastfeed your baby, establish a support system early on in  your pregnancy and educate yourself prior to delivery.

Most women who have undergone infertility treatment are physically capable of breastfeeding, but that doesn't mean that the process  will automatically be easy.  Find out if your hospital has a lactation support person on staff who can meet with you right after delivery, and look for a local chapter of the La Leche League near your home.    

It is common, when undergoing infertility treatment, to conceive and deliver multiples.  Many women breastfeed their twins simultaneously, utilizing a football hold on both babies.  Others choose to nurse  each baby individually.  Some women will benefit from the use of a nipple shield at first, while the baby is learning how to latch on.  This is often the case with premature babies.  Again, support from experts as well as the people in your life can be key if you are finding this to be challenging. 

One celebrity mom who breastfed her multiples is Marcia Cross, of the cast of Desperate Housewives. Said Cross, "'I'll tell you my routine - it's really exciting!  I feed, I burp, I change diapers, I pump.  I can then breastfeed both babies at the same time, which for me is a huge accomplishment!"

You are your baby's only mother.  There is no one more uniquely qualified to care for your baby, or babies, than you are.  If you have always dreamed of breastfeeding your baby you will most likely be able to do so.  If you find that you are unable to breastfeed, like some women, it may feel as if your body is giving up on you once again.  It is very important for you to remember that you have not failed, and that this is not your fault.  Find and maintain a support system that can get you through the experience and hold onto the knowledge that, just like you did when you worked so hard to conceive, you are doing everything you possibly can to ensure that your baby's life, and future, are happy ones. 

For a list of La Leche chapters nationwide as well as mom to mom message boards, please click here .

Reprinted with permission from www.examiner.com

Photo:  Getty Images

IVF and Stimulation Questions

by Fred Licciardi, M.D.

Should you avoid pregnancy if you are starting an IVF cycle with day 21 Lupron or Synarel or Buserelin? The stock answer is yes. However there are many women who have become pregnant while on those meds. If you do become pregnant, make sure you get luteal support with progesterone and maybe estrogen. Ask your doctor.

Does it help to take estrogen for luteal support in an IVF cycle? Probably not. There have been studies showing no improvement. There is even scientific evidence that estrogen may be unnecessary in the luteal phase. Some clinics routinely prescribe the estrogen; I tried it for a while in select cases with no improvement. I have had a little success using estrogen in women who have luteal bleeding despite progesterone. It’s used in medicated frozen cycles and DE cycles because the ovaries in those cases make no hormones (no estrogen or progesterone) so we add both hormones during their cycles.

Should you try IVF again if you are 29, have an FSH of 12 and make 8 eggs with 2 fertilized? Yes. I have been getting many comments from young women, some with high FSH levels, who are failing first cycles. Get to the best clinic possible and have your doctors come up with possible improvements for your cycle. Age is key. A high FSH in a 27 year old woman, or even a 36 year old, is not as telling as it may be with a woman in her 40’s.

What can I suggest to up your odds for the FET? Most FETs are pretty routine. Sometimes we suggest thawing more than you need and picking the best for transfer. Not everyone wants to do this. Some would rather thaw few so they can get more cycles out of what they have frozen. Either way is ok; see what your doctor says.

Hopeless after failed iuis, 2 fresh IVFs and one FET cycle? You do have to take into consideration age and FSH levels and embryo quality. It’s rarely hopeless. Maybe less hope, but not none. Know your stats, get another opinion and take it from there.

Can a para-ovarian cyst interfere with IVF or implantation? Probably not.

What if you are an established young poor responder who has had multiple failed IVFs. In addition there is a question about your uterus, meaning the was a scar but hysteroscopies and hsgs are now normal? This depends somewhat on the thickness of your lining on ultrasound. I have said before, and still believe, the lining thickness may be less important than we once thought, but of course everyone’s story and uterus are a little different. If you want to carry and our uterus is “acceptable” then donor egg without carrier is what most women would do, and probably with a very acceptable pregnancy rate. If you feel strongly that carrying is not important, just getting that baby asap, consider a carrier. However, donor egg, carrier is not guaranteed either.

I am hearing from women who have premature surges during antagonist cycles. I have not had this so I don’t know why people are having this problem. Antagonist should start at a follicle size of 13 mm (some clinics use 12 mm). Sometimes the estrogen levels do fall a little when the antagonist is started, but this fall does not mean there has been premature ovulation. So if the estrogen falls (but not by too much), but the follicles still grow, and the estrogen level goes up the next day, that’s all ok. There has not been a surge.

How long after the last depot lupron shot do you need to wait for IVF? The depot shot is supposed to stay in your body 4 weeks, but may be in a little more. Ask your doctor about this one but probably if you start 4 weeks after your last shot, but the time you are retrieved it will be 6 weeks after the shot.

What’s the doctor doing at my transfer, and why is there a delay? You can’t see what’s going on at the transfer, but any of your questions at the time should be answered. Doctors have certain catheters they like to start with. If they have trouble getting the catheter through the cervix, they may ask for another type. They should keep you informed.

Breastfeeding during IVF. FSH levels in breast milk will be higher than during a natural cycle. I really can’t comment more than that. There are some women who do IVF while breastfeeding.

Can a varicocele repair correct azospermia? I am not a urologist, but I have not had an azospermic patient develop sperm in is ejaculate after a varicocele. I’m not saying it can’t happen. It is also possible that the counts could go up without surgery.

What about a period that lasts for months with a completely negative workup? Make sure you do not have a bleeding disorder. Some women have vascular abnormalities if the uterus that cause constant bleeding. Maybe an MRI will help.