Katie Burnham Wilkins was in labor with her daughter the day the World Health Organization declared the coronavirus outbreak a global pandemic. 

It was March 2020. Shortly after her daughter was born, Burnham Wilkins and her husband were given tips and tricks for breastfeeding, then quickly ushered back to their home in Columbia to navigate new parenthood amid a global lockdown.

The next few weeks were a blur of anxiety for Burnham Wilkins, magnified by her daughter’s struggle to breastfeed. In-person clinic appointments had been swapped for virtual check-ups for both herself and her newborn, adding to the uncertainty she felt.

Burnham Wilkins’s twin, who’d recently had her own baby, knew it was time to call in reinforcements. 

Soon, Burnham Wilkins had a rotating guest list of experts at her door. 

A retired midwife — the mother of a childhood friend — noticed the baby was losing weight. A friend pumped extra breast milk and dropped it off to supplement Burnham Wilkins’ own supply. A doctor from a small medical practice diagnosed her daughter with a tongue tie, then performed a simple surgical procedure to fix it at Burnham Wilkins’ kitchen island. A local lactation consultant met the new mother and baby on Burnham Wilkins’s back deck to help with her ability to latch to the nipple after surgery. 

“Yes, it’s natural and it has all these beautiful benefits to mom and baby, but it’s not easy,” Burnham Wilkins, 42, said of nursing. “You need a support squad.” 

Burnham Wilkins’ conclusion mirrors many of the findings of a new study out of Saint Louis University looking at the effects of the pandemic on breastfeeding and the future of maternal work policies and health equity. 

María José Romo-Palafox, the senior author on the study and an assistant professor of nutrition and dietetics at SLU, asked women to write down their experiences nursing during COVID. She heard back from about 500 mothers across the country. 

The study found that many women lacked what Burnham Wilkins remains incredibly grateful she found: support. 

“Whenever we talk about breastfeeding as something that is free, that is assuming that women’s time is free, or that women’s time is not worth money,” Romo-Palafox said.

One woman wrote that she was forced to switch to formula feeding because of the lack of support.

“I had breastfeeding issues, and I feel confident I would have been able to work to overcome them if I had been able to meet with a lactation consultant regularly,” that woman wrote. “But this was not an option due to the coronavirus pandemic.”

In 2022, a reporter with the Washington Post tracked the cost of her own breastfeeding journey through the first six months of her child’s life. It totaled nearly 500 hours nursing and pumping, and she spent more than $1,000 on supplies. 

That same year, the American Academy of Pediatrics increased their breastfeeding recommendations from at least one year to at least two years. But the policy update also noted that social and systematic changes would also need to take place to allow for this.

While the adage “fed is best,” remains, breastfeeding is increasingly encouraged because of the health benefits both the child and mother can reap if in a position to nurse rather than formula-feed. But often that’s easier said than done.

The Independent spoke with several lactation consultants and breastfeeding peer counselors around Missouri who shared some of their clients’ experiences and challenges breastfeeding. 

They said an array of fixable hurdles remain: 

• Mothers who collect breast milk by pumping need better workplace accommodations. 
• The state’s ongoing child care crisis continues making it difficult for working parents to find and afford daycare.
• A dearth of International Board Certified Lactation Consultants, especially consultants of color to assist new mothers. 
• The hyper-sexualization of breasts and the resulting stigma around nursing. 

“Out of everything that makes raising a child and breastfeeding in the first year difficult,” Romo-Palafox said, “the resources and access to breastfeeding shouldn’t be one of them.”

Barriers to breastfeeding at work

One of the most notable anecdotes from Romo-Palafox’s study was how much longer women who didn’t have difficulties breastfeeding were able to do so while working from home during the pandemic. That can change when they return to an office setting.

Those working to ease the burden of breastfeeding around the state said workplace conditions are often the reason why their clients stop nursing.

The stories they told include an Amazon worker in the Kansas City area who stopped breastfeeding after she found it too difficult to leave her station to pump; an employee at a Family Dollar who couldn’t leave her spot behind the cash register for several hours because of a lack of staff; and a hair stylist who stopped pumping because her schedule was too unpredictable to book enough clients to make an income while also providing a short window between appointments.

Federal law requires workplaces to give “reasonable break time” for mothers to feed or pump in a private area other than a bathroom. But “reasonable” time remains undefined.

The amount of time it takes to pump varies from person to person, and workplaces don’t always include the time it takes to clean the pump. 

Going several hours without expressing milk can lead to diminished supply, and to health issues like clogged ducts or mastitis, an infection that can leave women hospitalized. 

Courtney Pauley, a registered nurse and lactation consultant with Uzazi Village, a Black-led doula organization in Kansas City, understands the workplace dilemma many women face. 

Pauley was a labor and delivery nurse when she gave birth to her second child during the pandemic. While the hospital she worked at had reasonable accommodations for nursing mothers, she frequently found herself going several hours without pumping because of the demands of births and emergencies, like post-birth hemorrhages. 

She left the job when her daughter was about a month old, fearing her supply would diminish too much to continue breastfeeding. Pauley knows it’s an option not every mom has. 

“We need more societal support,” Pauley said. “There’s a lot of lip-service given to breastfeeding and how important it is. But there’s not a lot of real support … We’ve got moms who are afraid to nurse in public because it’s still taboo to whip a breast out to feed your child.”

She champions universal paid parental leave, pointing to studies that show such policy increases the likelihood that mothers return to work after their leave and doesn’t negatively impact workplace productivity.

Alyssa Rodgers, a breastfeeding peer counselor coordinator and lactation consultant with the Columbia-Boone County WIC program serving, said that paid parental leave should be the No. 1 priority.

“The first eight to twelve weeks is so vital to establishing that breastfeeding relationship,” said Rodgers, who is also president of the Central Missouri Breastfeeding Coalition. “Work can make or break a breastfeeding relationship.”

In recent years Rodgers has seen a lot of parents go back to work sooner, including one mom who returned to her three part-time jobs two weeks after undergoing a C-section delivery. She couldn’t afford not to. 

Sarah Hartenberger, owner of Nurture Lactation LLC, a private practice staffed with board-certified consultants in the Kansas City area, said as more families return to work, they’re also returning to a lot more complications, including in child care. 

Missourians continue to face a limited supply of child care. An investigation of child care spending by The Independent and MuckRock last year found that almost half of Missouri’s children under age five, or about 202,000 children, live in child care deserts, with one or fewer child care openings for every three children. 

If parents do find an opening, it’s expensive. The average cost of full-time center-based care for an infant in Missouri was $11,059 as of 2022, according to Child Care Aware. On the other side of the equation, staff at child care facilities often make just over minimum wage, which can make hiring and retention difficult. 

“Childcare is way more expensive. There’s a lot more turnover in childcare,” Hartenberger said. “So we’re seeing a lot of moms now capitalize on the flexibility that a lot of companies gave for them to work from home or do a remote situation.” 

But that only applies to those who can work from home.

Compounding this ongoing child care crisis in Missouri is a months-long backlog of child care subsidies. 

“We can’t ignore the fact that a lot of people who were main caregivers lost their jobs,” Romo-Palafox said. “The pandemic also brought to our attention that our society is currently not in a place that it can properly run the way we are running it without child care.” 

Breastfeeding in communities of color 

Okunsola Amadou, the founder and CEO of Jamaa Birth Village based in Ferguson, was 14 when she gave birth to her first child. 

At the hospital, she was put under for a C-section delivery. When she woke up, hospital staff had already given her baby a bottle. It was assumed she’d formula feed, in part because of her age, and in part because of her race. When her second child was born, she said the hospital staff again failed to introduce her to the idea of breastfeeding. 

But by the birth of her third child in 2012, after learning about doulas and midwifery, Amadou gave birth to her child at home, then breastfed him for two years and two months. 

“While the rate of Black women breastfeeding is slowly increasing, there still isn’t enough normalization of Black women or minority women breastfeeding,” she said. 

Studies over the past decade have shown that Black infants are significantly less-likely to be breastfed than white infants, in part because Black mothers were less likely to be introduced to breastfeeding in a health care setting prior to and after birth than white mothers.

In 2018, Amadou launched a program at Jamaa Birth Village called First Foods, which walks expectant and new parents through the logistics of breastfeeding, including how a history of trauma, including sexual or generational trauma, can impact families. From there, they make a plan on how to move forward. Jamaa Birth Village also runs the state’s first Black-led milk bank depot and dispensary. 

Post-pandemic, most of the barriers to access she hears from women are social. Some tell stories about sagging breasts and bleeding nipples. Others are pressured by partners to stop breastfeeding. Some were raised in families who came from a time when breastfeeding was seen as a sign of poverty.

Others are discouraged by community elders who grew up during segregation, or who were impacted by the generational trauma of Black women going back to slavery who were forced to be wet nurses for white families. 

All of it centers around a lack of updated information. 

“This conversation of breastfeeding needs to be integrated into the culture from school to church,” Amadou said. “To all those different spaces where we’re talking about parenthood.”

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