Mothers On the Go: Breastfeeding and Pumping in Airports Across America

Join Marie for “Born to be Breastfed” on Monday, July 28 and discussion of this important topic.

Every podcast episode makes me think. Preparing beforehand, reflecting afterwards, or both—every topic, every guest, every show is on my mind for some time. But this show, “Mothers On the Go: Breastfeeding and Pumping in Airports Across America,” is on my mind even now, hours after taping. I am still reeling from talking with Jeremy Blackman and his wife Nina about how airports lack a reasonable accommodation for a woman who needs to pump milk for her baby. I’m impressed by the vision of Gene Richardson, Director of Avitation at the Burlington International Airport, and Sascha Mayer, owner of the Mamava, who spearheaded efforts to build a modular Lactation Station within that facility. Several times during the show, Mr. Richardson said the decision to create such a room was a “no-brainer.” I think he probably underestimates his insightfulness, but there is a no-brainer in this story—airport personnel thinking that the “restroom” or “bathroom” is an appropriate place for a mother to express her milk.

The Purpose of the Place

Let’s think about it. It may sound innocuous and maybe even helpful for the airport staffer to direct a woman who needs to pump her milk to go to the “restroom.” But a restroom is actually not a place for rest.  The restrooms in airports, hotels, and other public places are anything but restful. They would be better termed “hurry-up rooms,” as one generally does what one must do before quickly dashing to catch a flight.

The words “bathroom” and “lavatory” may be used and are similarly unhelpful to the breastfeeding mother. Even in one’s home, where a “bath” may be present, the bathroom is more likely to be used for urination or defecation than for bathing. While the word “lavatory” is drawn from the Latin “to lavare” and means “to wash,” although one does wash one’s hands there, the main purpose is to leave and flush excrement.

Maybe airport personnel would understand the problem if we referred to these rooms for what they are: the” toilet room,” the “pee room,” the “poop room,” the “excrement room.” Grossed out? Disgusted? Does it seem repulsive to use such terms—slang for what really goes on there—for those places?

Such terms are evocative. Powerful, even. I bet you could practically see the room, maybe even smell it, when you read those terms.  Good, I’m glad. Thinking that way is a strong reminder that the room where adults excrete waste from food should not be a room where a woman secretes her baby’s food! That is the true no-brainer here.

A Place for the Purpose

Some people seem to think that just because the “women’s rest room” is the place for women in the airport (the place that men are not allowed to be) that it is the place that they should feel comfortable feeding their baby or expressing the milk from their breasts.

I’m trying to imagine how comfortable I would feel as a pumping mother: finding an outlet … standing at the counter … leaning over my breast pump … bare-chested … trying not to spill any of the precious milk my baby needs … hoping  the milk and my pump aren’t contaminated by splashing water,  soapy hands, or germs I’d rather not consider … trying to ignore the ‘wheeee-wheooo’ noise of the pump and focus on a good let-down of milk … praying for the bottles to fill quickly … balancing the flanges … trying not to spill milk on myself while another woman is rushing by—in a hurry, with luggage, holding a child’s hand, whatever …

Or how about as a breastfeeding mother: perching on a toilet … holding baby in my arms and trying not to let her come in contact with the surrounding walls or seat … constrained by the dimensions of the bathroom stall and the diaper bag hanging on the hook of the stall door … trying not to think about the germs that we are unable to avoid … wondering how others would feel if their lunch were prepared in the restroom (toilet room) …

It’s a no-brainer that’s not a place for the purpose of pumping. But it’s the reality of many women traveling through U.S. airports every day.

A Place With a Purpose

It seems to me that we make all sorts of accommodations for people who have needs—and rightly so. Our public buildings are ADA-compliant. Businesses set aside parking spots for the comfort of their pregnant patrons. We have express checkout lanes in the grocery store to accommodate those who are buying just a few things, and there are escorts available for children who are flying without a parent or guardian along. Airports have chapels to meet the needs of flyers who worship, free Wi-fi for those who want to access the Internet, and any number of other accommodations to meet the creature comforts of travelers.

It’s time for all airports to follow the lead of Gene Richardson and Sascha Mayer and offer lactation stations or mother’s rooms for those who need them.

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A Word from Your 4-Month-Old — as Translated by a Passing Nurse

Hot and sweaty, I began the trudge from the cardio machines to the women’s locker room at the YMCA. I passed two young mothers who were sitting together in lounge chairs. One had a baby with her whom I took to be about 4 months old. She was trying to feed him something; I couldn’t tell what. Each time she brought it to his mouth, he batted it away. Offer and bat, offer and bat, offer and bat. I wanted to blurt out, “Lady, he doesn’t want it!” But, I needed a shower, and honestly, I always have trouble figuring out where my nurse-advice should begin or end when I encounter strangers. I headed for the shower, and didn’t give the incident a second thought. Until, walking from the shower area to the locker area, I passed by the women conversing on a bench.

“Well, what did your pediatrician say?” asked the one woman. The other replied, “He said to start solids at 4 months.” There was a pause. “Oh. Well, yeah, mine said that too. Maybe you can try a different food with her.” Okay, that did it! I felt compelled to go into nurse mode.

Clad in a towel and flip-flops with hair sopping wet, I decided to deliver my abbreviated rant to these two mothers. “Every pediatrician I’ve ever met belongs to the American Academy of Pediatrics, the AAP. But the AAP, the Academy of Breastfeeding Medicine, the United States Breastfeeding Committee, the World Health Organization, the American Academy of Family Physicians, the American College of Nurse Midwives, the American Dietetics Association, the Centers for Disease Control and Prevention, and every other major organization that I know of says that soft, solid or semi-solid foods should not be started until the baby is 6 months old.” The women looked at me, with eyes as big as saucers. I quickly added. “You can verify what I said by checking on the web-and you should check, don’t take my word or anyone’s word for it-but I’m very confident that what I’ve just said is accurate.”

Did I poke my nose in where it doesn’t belong? Maybe. But I’ve about had it here. The baby had clearly spoken. But the mother didn’t hear the baby’s message. She heard only the pediatrician’s message. Unfortunately, this scenario is not uncommon. I hear this over and over from mothers. I hear this from nurses, lactation consultants, childbirth educators and others in cities where I teach. It’s not a local thing. All across the country, wherever I go, this is what I hear. What do mothers hear?

Mothers hear the message from the doctor. But they aren’t hearing the message from their babies. This mother’s baby spoke loud and clear. She did not hear her baby’s message. I just tried to amplify that message in a way that she might hear it.

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Relieve Yourself of Worry about Research!

I wish I had a nickel for every IBLCE exam candidate who has said to me: “The research questions scare me. What should I do?”

I wish I had a nickel for everyone who has hated my answer!

It’s simple: Know your stuff. I can give you all of the test-taking tips in the world, but they won’t do you bit of good if you don’t actually know your stuff. And, after preparing literally thousands of people for the IBLCE exam, I can tell you, with certainty, most IBLCE candidates don’t know their stuff where it comes to research. I distinctly remember an interaction from my Lactation Exam Review course in Denver. A woman sitting on my left about half-way from the front said, “Marie, this research stuff all looks like Greek to me! And so I can’t understand it because I don’t speak Greek! I don’t read Greek!” Oh, I felt like this conversation had been scripted! She had given me the cue, and I was ready to deliver my next line!

I said to her, “If you were going to Greece and wanted to speak the language of the locals, what would you do? You would learn the vocabulary. True, you might have great difficulty actually putting a sentence together, but you wouldn’t stand a chance of doing so unless you knew your vocabulary! You must know simple words or phrases. Bathroom?  Along with a shrug and raised eyebrows, would be a one-word but much-needed question if you need to relieve yourself! But if you didn’t know the Greek word for bathroom, you’d continue to find yourself mighty uncomfortable.  Knowing the vocabulary is the first step in speaking Greek, or in learning the research.”

Feel free to go back to college or buy a big heavy textbook if you wish. But instead, please consider our flashcards. I doubt that $12 for the pack will send you to the poorhouse–but knowing the vocabulary for just one question might make the difference between your passing or failing the IBLCE exam. Shuffle them, re-use them, wear them out. Just learn the vocabulary, have the conversation and relieve yourself of this worry!

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IBLCE Exam Success Depends On … You!

Note: Registration now open for Marie’s FREE Five Keys to IBLCE Exam Success webinar, on July 10 (two times available — 9 am ET or 3 pm ET — space is limited).

As you prepare for the IBLCE exam by reading through practice questions and mock exams, do you find yourself thinking “It depends on if …” as you try to figure out your answer? (I hear this a lot from participants of my Lactation Exam Review course I admit that I sometimes fall into the habit myself.)

Well, that’s not a good thing. Read on for an explanation of why you (like most people) might initially do this — and why it isn’t a good idea.

Usually, “depends-on-if” thinking is a symptom of greater lactation or postpartum care experience. I know; in nearly 30 years of providing clinical care, I’ve seen a wide variety of circumstances, challenges, and outcomes.  In those situations, I’ve done what any good clinical expert would do: I’ve looked at the whole clinical picture. I bet you’ve done the same! But while the “depends-on-if” approach is good in the clinical area, it is not good for answering exam questions.

Here’s why: If the answer to the question hinged on the “depends-on” info you’re wondering about, that info would have been in the stem of the question. For test-taking purposes, you need to pay attention to what the exam item says–and ignore the possibility of anything it doesn’t.

Certainly, I’m not going to sit here and tell you that every single question on the IBLCE exam is air-tight. But apparently the answer doesn’t depend on the “depends-on-if” factor that leapt to your mind — or else that would have been specified. Although we train ourselves to think through each situation with our clients, we need to be careful that we don’t overthink the question when our “client” is the IBLCE exam!

So, you ask: What about when they give you a ton of information? How should you deal with that? Well, it depends on if …

Just teasing. But come on back to the blog for another post on that topic later.

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Looks Like … Sounds Like … IBLCE Exam Success!

Another question from the (FREE!) Five Keys to Lactation Exam Success webinar:

What kind of question can get me in trouble when I actually do more or less know the answer?

In truth, there are several kinds of questions that might be troublesome. (Deep breath, folks! We’ll get through it.) I think, that the biggest one is what I call the look-alike, or the sound-alike, questions. Here’s an example from my Test-Taking Strategies module:

Which of the following would be prescribed for a mother who was diagnosed with postpartum depression?
a. Celebrex
b. Cerebyx
c. Celexa

Ok, take note: You’re not going to see brand names on the real IBLCE exam. You’ll see only generic names. But this example clearly hints at the look-alike/sound-alike nature of some  text questions. (Register for an upcoming Five Keys to Exam Success for other examples.)

Having generated thousands of test items over the years, I’ve noticed that the look-alike or sound-alike questions separate the “almost-know” test-takers from the test-takers who are dead-sure of their answer. So don’t get caught in one of these. Know your stuff.

We talk about these and other test-taking issues during the Five Keys webinar, offered frequently. It’s a live discussion of hot topics in lactation exam-taking, delivered via the Internet. In addition to the folks here in the U.S., we’ve had attendees from Brazil, Australia, Ireland, and elsewhere, so come on in! You’ll have an opportunity–I’d even say an invitation–to ask questions on the spot.

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Think It Through on the IBLCE Exam

Have you heard this story? A kid comes out of a room after having taken an exam. His friend asks, “Did you have trouble with those exam questions?” The kid’s response: “No, not really. The questions didn’t bother me. It was the answers I had trouble with!”

It reminds me of the IBLCE exam.

Let’s face it. There will be questions on the IBLCE exam that you’ll have trouble with. There will be questions on content that you never studied, or to which you’ve had no exposure. There will be questions for which neither you nor I know the answer. It happens. Don’t panic!

Sometimes, we know more than we think we know. I’ll show you how this works. I’m going to give you a question for which I’m sure you don’t know the answer! Then, you’re going to figure out the correct answer–or at least make an educated guess. Here’s the question:

Marie’s sister began working in Rochester NY in 1962. She is now happily retired, but volunteers at a local charity 3 days a week. Which of the following was Marie’s sister’s occupation during her years of paid employment?
a. Chemical engineer
b. Professional firefighter
c. School teacher
d. Scuba diving instructor

Now, let’s reflect for a moment before we go on. You know right away that “firefighter” isn’t a likely answer. How did you know that? Because you know that Marie’s sister is, well, a woman! You instinctively know, without ever having learned it, that the vast majority of emergency-services jobs are held by men. See how you knocked off that option? Good. Let’s look at the other options.

You’re thinking it’s unlikely that the scuba diving instructor is the answer. You realize that you just eliminated the “firefighter” option by reasoning that women don’t usually have that occupation. But you’re eyeing this carefully. You’re wondering: Maybe there is something very unusual about this woman! Maybe that’s why this showed up on a question! Ok, fair enough. But where does the sister live? In Rochester NY! Aha! You suddenly remember that TV commercial from Subaru several years ago showing the man all bundled up in a blizzard with his dog sled and his vehicle. The commercial ended by saying that Rochester NY is the most snowed-upon city in the United States. Hmmmmmmm. Not likely that this woman spent her career doing something that could be done only a few months of the year.

OK, you’ve eliminated two options. Your gut is telling you “school teacher.” But you’re afraid to go with your gut. You wonder if you’re overlooking something here. You’re really, really wondering because, of course, you really don’t know the answer! You know you don’t know the answer! You know you’re taking a WAG (wild-ass guess). So you’re pondering the possibility of the chemical engineer. Rochester was a big Kodak city in its heyday. They surely employed chemical engineers, right? Ok, so you’re thinking that’s possible. But then you realize: If she started working in 1962, she probably went to college in the late 1950s. What were the three top occupations of women in those days? Secretary (not an option here) … nurse (also not an option) … teacher.

And sure enough, there you have it. Marie’s sister went to college to become a teacher, and she taught Special Education in the Rochester City School District for about 45 years. Marie’s other sister went to college to become a secretary. And Marie went to college to be, umm, yes, that’s right: a nurse!

See? There is no way you could have known this information by studying. But by thinking about the information in the stem of the question, you can improve your chances for picking the correct option for your answer. Think. Call up some information from your subconscious (like the Subaru commercial.) Use some logic. Think about likelihoods. You can almost always narrow your choices down to the two best options and improve your odds of success.

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What Comes First … the Photo or the Text?

Question from Five Keys participant: “Should I look at the photo first, or look at the question first?”

I could make an argument for either approach. I’ve spent much of my career with one foot in the clinical camp while the other foot is in the academic camp.  How I approach a test item depends, to a degree, on what kind of camp I need to be in to answer the question.

If I was in front of a patient who had a question about her sore nipples, I would listen to her question and then look at her nipples. Generally, in the real-life clinical setting, I first hear the question posed and then I get to see the situation–whatever it is–myself. I do not see the patient and say to myself “I wonder what this problem is?” I don’t see the nipples or the incision or the lochia or the jaundice first and then say, “Gee, I wonder what she wants to ask me about this?” So, in general, I suspect I’m better at looking at photos after I’ve taken in the question. That gives me a sense of context.

But as an educator, I do sometimes find compelling photos and think “Oh, this is an interesting photo. I bet I could cook up a good question on this.” I bet the same thing happens to IBLCE exam writers!

When I’m taking the IBLCE exam, I sometimes do try to examine the photo first, so that I read the question in the context of the photo.  If I can do that successfully, I’m usually much quicker at answering the question. The only downside: This approach can backfire on me if I focus on the baby’s nose, and discover that the question is about what’s on his forehead!

Ultimately, reading the question first feels more clinically comfortable for me, and it may improve the accuracy of my initial thinking. However, if I focus on the right thing and recognize what’s going on in the photo, seeing it first can improve the speed of my answer.

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Is a Picture Worth 1,000 Words on IBLCE Exam?

“Should I tackle the text-only questions first, or do the photo questions first?” is a question I received during a recent (FREE!) Five Keys to Passing the Exam webinar.

I’d love to give an evidence-based answer, but honestly, it’s really a matter of personal preference. On the IBLCE exam, the questions are arranged with the 75 text-only questions first, followed by the 100 photo-based questions. If you want to do them in the order in which they are presented, then you have your answer.

Personally, I have always tackled the photo-based questions first. I really believe that old saying “If you must eat a frog, eat the biggest frog first!” I have taken the exam 3 times, and in my opinion, the “biggest frog” is the photo-based portion of the exam. Interpretation of photos seems to take more expertise and energy than the text-only exam items. I would rather use my energy to knock out the toughest questions when I’m fresh and more able to focus. After a few hours, I am more tired and less focused. (If you think that teaching lactation courses makes this exam somehow “easier” for me, I assure you, that’s not the case! Like everyone else, I have test anxiety.)

Of course, the photos-first strategy isn’t for you if you choke while eating the biggest frog. Back in the Fred Flintstone days–when tests were written on paper and nurses used pens–I sat for the NCLEX exam. To this day, I can recall that the first question I faced was about eye surgery. I gulped. I didn’t know anything about eye surgery then; I still don’t! That question was a real downer for me. It caused me to feel fearful that the whole exam would be questions for which I wasn’t prepared. The third or fourth question was about gastroschisis. I was freaking out. If this kind of frog-eating destroys your self-confidence, you may want to eat the smaller frogs first and build confidence. And for the record, I had a “Yabba dabba doo!” day when I found that I passed the NCLEX on the first try!

About twenty years later, I had my first experience on the panel of experts who prepare the NCLEX exam! That’s proof positive: There is life after exams–even if you don’t know the answer to the first question!  Use the approach that feels best to you.

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The “Best” Answer for IBLCE Exam Takers

Five Keys to Passing the IBLCE Exam is my online, live one-hour seminar. Recently, while I demonstrated some IBLCE-type exam questions during the seminar, an attendee commented on my emphasis on the noting the superlative qualifier “most” or “best” in the stem of the question.

“So do you think we’ll get a lot of those questions?” she asked.

Of course, I don’t have any crystal ball for knowing the answer. But honestly, based on both my extensive training in exam item-writing and my personal experience writing literally thousands of questions for university-based nursing students or IBLCE exam candidates, I think the answer is, probably, yes. Do expect those “best” questions. Why so?

The exam writer has only one option in mind as the right answer, but she realizes that others might be possible. Therefore, she uses the  “best” qualifier in the question’s stem. This format is difficult, because technically any of the options may be correct. However, one of them is better than all of the others. Variations of this format include such constructions as “the first action,” “the most important,” “the primary reason,” and “the least likely.” Here’s an example of the “best answer” format:

Which of the following is the best utensil for eating yogurt?
a. knife
b. spoon
c. fork

Heaven knows, if you’re clever and patient, you could probably load your yogurt onto a knife and eat it that way. I cheerfully admit that I’ve eaten yogurt with a fork when I’ve been on the road and that was the only utensil I had with me. But we can all agree that the best utensil for handling goopy, drippy yogurt is the spoon.

The trick about “best” questions is to think about why the other options aren’t the best. In this example, the knife is slender; you won’t be able to load much yogurt onto it. The fork has slots, so the yogurt is going to slip through. The best answer, therefore, is the spoon.

Of course, even without my crystal ball, I think it’s safe for me to say that you’re not going to get a question about yogurt–at least, not about how to eat it!

This example from my 40-Question Public Health Drill illustrates this “best” question approach. This is one of the easier questions in that set; using the “why not” approach, try answering it:

Your lactating client needs to have an x-ray and asks you to accompany her. You agree. Which of the following would be the BEST precaution to take?
a. Ask for a lead apron to protect yourself.
b. Get a badge that measures the amount of radiation to which you are exposed.
c. Step out of the room while the x-ray is taken.
d. Suggest that she get an MRI instead.

If you’re a person who has spent time working in a hospital, you probably know this answer immediately. If you’re not, you may be puzzled. You’ve been draped with a lead apron when you’re at the dentist’s office getting an x-ray of your teeth. You’ve seen movies where people have those little badge things to measure radiation. Stepping out of the room seems like you’re abandoning the woman who asked you to go with her. You might be wondering if an x-ray is safe for the breastfeeding mother, and so you’re inching your way towards picking the option for the MRI.

Think carefully. Getting a lead apron may give you some protection, but it won’t be as effective as leaving the room. Getting a badge to measure the amount of radiation to which you are exposed only gives a measurement; it doesn’t really do anything to protect you in this instance. If the mother gets an MRI, neither she nor you are exposed to the radiation. But you have to ask yourself, “Whose safety is this about?” and “Would that be within my scope of practice?” Therefore, the best answer is, leave the room. If you’ve actually seen this procedure, you know that you’re not abandoning the client; you’ll be out of the room for only a few seconds.

Makes sense, right? This was a fairly simple example, but I hope it helps you think through other “best” questions.

Was this helpful? Drop me a note if you’d like to see more about how to deal with exam questions.

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Free CD Giveaway!

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I loved having the Laurie Berkner Band on tonight’s show! If you weren’t able to listen on VoiceAmerica at 6 PM ET, be sure to look for this episode on iTunes or Stitcher–it’s a keeper!

In the meantime, I’m excited to announce that we’re holding a contest to give away a FREE copy of the Laurie Berkner Band’s fantastic new lullabies CD. Pop on over to the Born to be Breastfed Facebook page for contest details. It’s simple and easy to enter!

Contest ends Monday, June 30, 2014. Good luck!

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