Abstract
Librarians at Rowland Medical Library collaborated with individuals from across the campus of the University of Mississippi Medical Center (UMMC) to transform an unused library office to a nursing mothers room. This project resulted in a functional and attractive room for breastfeeding students and employees to pump breast milk.
Keywords: library space, nursing mothers, breastfeeding, health promotion, outreach
Background
Rowland Medical Library’s charge is to provide access to biomedical and health sciences resources for students, faculty, and researchers at the University of Mississippi Medical Center (UMMC) --- Mississippi’s only academic health science center. Additionally, Rowland Medical Library provides expertise and knowledge-based point-of-care resources for the clinical enterprise, including all hospitals, clinic sites, and healthcare professionals.
Rowland Medical Library (RML) is located on the second and third floors of the Verner Smith Holmes Learning Resources Center, built in 1981. It is in the center of campus with enclosed walkways connecting to the hospital and main part of campus. The main parking garage is located at the end of the main walkway, so the library entrance sees much foot traffic. The configuration of the 55,000 square foot library stayed essentially the same from 1982 until 2011 when approximately 11,000 square feet of the library was repurposed for university administration. The library currently occupies 44,000 square feet and provides seating for 477 patrons with tables and chairs, student carrels, individual study carrels, and group study areas. RML also has a 9,000 square foot dedicated storage area where pre-1990 print books and journals are housed. Though moving older material was disrupting at the time, it had the added benefit of repurposing space for our patrons, particularly students.
In 2013, a seldom used area of the library was remodeled to provide for a collaborative study area and the library was able to retain possession of a small unused office at the back of the area. Also in 2013, the university began an annual space audit and thus arose the need to repurpose the 135 square foot unused office space to benefit the UMMC community. When the possibility of a nursing mothers room arose, the answer for the library was not Why in the library? Rather, the answer was Why not in the library?
Expanding librarians’ roles
The library enjoys a close relationship with Medical Center leadership and the academic community in particular. The Vice Chancellor for Academic Affairs is continually challenging the library director to think outside the box and expand the role of the library on campus. To that end, library faculty are called on to take on new roles including: documenting the art collection on campus, coordinating retention of regulatory documents, and serving on a statewide project documenting land use and burials on the current property where the state asylum was previously located. Additionally, one librarian with a medical background assists and teaches students in the gross anatomy lab. Librarians stay busy with traditional roles, but the new roles are expanding exposure on campus.
Federal regulations
Federal regulations concerning break time and space for nursing mothers became law on March 23, 2010 with the passage of Patient Protection and Affordable Care Act (PPACA). Employers with 50 or more employees are required to provide break time and space for employees to express breast milk. Although the law does not require a dedicated space for pumping, it is important to note that:
a bathroom, even if private, is not a permissible location under that Act (1).
Employers must provide:
a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk (2).
Benefits of breastfeeding
The benefits of breastfeeding for both mother and child are published extensively in the biomedical literature and by professional health care organizations. The World Health Organization (WHO) recommends that infants should be breastfed exclusively for the first six months of life (3). The American Academy of Pediatrics also recommends breastfeeding exclusively for six months and continued breastfeeding with complementary food for one year or longer (4). The former U.S. Surgeon General outlined the many benefits for mother and child in the publication, The Surgeon General’s Call to Action to Support Breastfeeding (5).
Barriers to breastfeeding
Although the benefits of breastfeeding are well known, there are barriers that may prevent new mothers from continuing to breastfeed after returning to work or school. In fact, the CDC reports that 60% of mothers stop breastfeeding sooner than they had planned (6). Some mothers may be concerned with how separation from their baby could affect their milk supply when they return to work or school. Breastfeeding mothers who are away from their infants for an extended amount of time must express breast milk to maintain the supply. A lactating woman usually needs to pump or breastfeed every 3–4 hours to avoid discomfort and maintain milk supply (7, 8). Each pumping session may take 15–30 minutes. In addition to the time concerns, breastfeeding women may be unaware of the best place to pump in their workplace or school.
The Centers for Disease Control Healthy People 2020 set a breastfeeding target for 60.6% of infants to be breastfeeding at six months of age (9). The state of Mississippi has the lowest breastfeeding rates at the ages of six months and one year. According to the Centers for Disease Control’s 2018 Breastfeeding Report Card statistics, the national average of infants breastfeeding at six months was 57.6%. Mississippi ranked last with only 35.4% of infants being breastfed at six months of age (9).
RML librarians recognized the nursing mothers room addition as an opportunity to support breastfeeding mothers and the mission of A Healthier Mississippi, an institution-wide initiative to improve the overall health of Mississippians. This motto encourages all UMMC employees to work towards making Mississippi a healthier state and improving health outcomes for its residents.
Project gains momentum
Numerous factors came together in early spring 2017 that propelled the library’s nursing mothers room project. First, the Associate Vice Chancellor for Academic Affairs expressed interest in providing a more convenient space for breastfeeding students to pump on the academic side of the campus. Second, the women’s hospital at UMMC, Wiser Hospital for Women and Infants, was in the process of pursuing Baby Friendly Hospital designation. Finally, the federal regulations passed in 2010 requiring employers to provide a private space for breastfeeding mothers to pump strengthened the need for more nursing mothers rooms on campus.
Student involvement
Rowland Medical Library collaborated with the Office of Academic Affairs to coordinate a nursing mothers room student task force. The mission of this task force was to determine student needs and preferences for the space. A librarian coordinated the student task force that included student representatives from six of the seven schools (School of Medicine, School of Dentistry, School of Nursing, School of Graduate Studies, School of Pharmacy and School of Health Related Professions). A lactation educator from UMMC’s Wiser Hospital for Women and Infants also served on the taskforce.
The nursing mothers room task force met twice. In the first meeting, the group discussed the importance of having a space convenient for students, as well as furniture requirements and suggestions for room décor. At the second meeting, the group toured the two established nursing mothers rooms, both on hospital floors of UMMC. Touring the already existing nursing mothers rooms gave the group the opportunity to establish likes and dislikes of room design.
Baby Friendly Hospital Designation
In the spring of 2018, the UMMC was in the final steps of applying for Baby Friendly Hospital designation. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) began the Baby Friendly Hospital Initiative as a program to recognize health care facilities that have met rigorous requirements in promoting breastfeeding to new mothers. UMMC was designated as a Baby Friendly facility – one of only 551 health care facilities in the U.S. with this distinction (10) – by the end of 2018.
Planning the space
The basic design plan for the room was to create a comfortable space that would accommodate up to two women, with a privacy partition separating the two stations. A wish list for room requirements was created from visiting the two other nursing mothers rooms on campus, consultations with the lactation nurse, and reviewing published recommendations (7, 11, 12).
A commitment to equip the room with a sink with hot and cold water was made in the early stages of the project, since the lactation nurse recommended a sink with sufficient depth to wash plastic pumping parts. In addition, the U.S. Office of Personnel Management’s recommendations on nursing mothers room includes the presence of a sink as one of its best practices (11). At UMMC, the institution’s Office of Planning, Design, and Construction supervises all construction projects: from drawing plans, to selecting floors and finishes, to choosing decorative items. The Office of Planning, Design, and Construction’s project manager gave recommendations on the best room layout design based on running new plumbing for the sink. Figure 1 shows the unused office before construction began, and Figure 2 documents the construction process.
Figure 1:
The vacant office was ideal for a nursing mothers room because of its location, privacy, and lack of windows. The space is in the back corner of the Collaborative Learning Center within Rowland Medical Library.
Figure 2:
A privacy wall was constructed to ensure privacy for mothers while pumping.
Room features (Figure 3 & Figure 4 show the current space):
Sink – The stainless steel sink is deep enough to wash plastic pumping parts with enough counter space for drying. It was decided that a motion-sensing faucet and spray nozzle were unnecessary.
Refrigerator – A small under-the-counter refrigerator was installed; however, room policy states that no items should be left in the room.
Privacy wall – A floor-to-ceiling wall was constructed at the room’s entrance to ensure privacy when opening the door to room.
Counter with privacy partition – A standard height (30 inches) counter, 24 inches deep and 60 inches wide. The size of the counter provides plenty of space for a computer, keyboard, mouse, and breast pump, as well as instructions on searching LactMed. A partition was installed at shoulder height to provide some degree of privacy between the two stations.
Counter height electrical outlets – Placing the outlets above the counter adds convenience when plugging in the breast pump, eliminating awkwardly bending under the counter to access electrical outlets.
Wiring and internet connection under the counter – Additional outlets for cable, phone, and electricity were placed under the counter.
Comfortable chairs – Two chairs with casters, adjustable arms, and adjustable seat position with vinyl fabric for ease of cleaning.
Flooring and Paint – Flooring and paint selections were made from institutional standards in coordination with UMMC’s Office of Planning, Design, and Construction. Vinyl tile in a neutral color was chosen for flooring. The walls were painted off-white with one muted blue accent wall.
Computers – Two computers were purchased with a technology grant from the National Network of Libraries of Medicine to access the National Library of Medicine’s LactMed database. The computers were configured to allow access to LactMed only.
Breastfeeding information – Printed consumer health information on breastfeeding and the use of LactMed is provided.
Cleaning items – The room contains soap, disinfecting wipes, paper towels, and a trash can.
Lighting – Removing half of the florescent lightbulbs served as a simple solution to give the room a more pleasant and calming ambiance.
Bench – A bench was placed adjacent to the counter to hold purses or other items. The upholstered bench also softened the room by adding some texture.
Mirror – A full-length mirror was a nice addition to the room, but caution was exercised in mirror placement to ensure privacy.
Art – Custom art that captured a feminine, nurturing quality completed the room.
Figure 3:
The room features two stations so that two mothers can pump with some degree of privacy. Computers with LactMed access are also available.
Figure 4:
The sink was a “must have” for the function of the room.
Furnishing the room with hospital-grade breast pumps was seriously considered, since hospital-grade breast pumps are more efficient and the pumping process takes less time. However, the responsibility of maintaining breast pumps was out of library staff’s comfort zone and skill set. Ultimately, the decision was made not to supply the room with hospital grade pumps. Women using the room bring their own individual pumps, taking all pumps and other supplies with them after each room use.
Since some women prefer to elevate their feet while pumping, the librarians contemplated adding footstools or ottomans. Concerns about the additional cost and keeping the footstools clean outweighed benefits. The decision was made not to purchase footstools; however, a protective plastic wall covering was added to the lower portion of the wall to protect the paint.
Marketing
Surprisingly, the first mother arrived to utilize the new room on January 24, 2018 before the room’s official opening. Since the space required only a handful of details to finalize with art, furniture, and housekeeping, she was still able to use the room. Information regarding the nursing mothers room had been delivered to students via an email ahead of the official opening. After art installation, the room was completed in April 2018.
A writer from UMMC’s Department of Public Affairs came to view the space and consulted with the librarians who worked on this project. The writer also interviewed the staff member who had been the first to use the space. The article was distributed on March 2, 2018 to all faculty, staff, and students in the eCV, which is the University of Mississippi Medical Center’s semi-weekly e-mail publication.
The nursing mothers room is promoted during library tours, through digital signage (Figure 5) in the library, and through a subject guide on the library’s website. Information on the space is also shared during select campus events. Most recently, a flyer was designed and distributed at an informational session on breastfeeding held at UMMC’s Wiser Hospital for Women and Infants. Library faculty are also scheduled to promote the room to students at an upcoming Wellness Fair in spring 2019. Despite the many methods of marketing the space, word of mouth appears to be one of the most successful tools. As mothers utilize the space, they share information with other breastfeeding mothers that may benefit from the centrally located room.
Figure 5:
Digital signage advertises the library’s nursing mothers room.
Surveying the nursing mothers
A survey is regularly sent to each new user of the nursing mothers room (Appendix A). Since the survey was implemented in January 2018, nineteen individual nursing mothers have taken the survey. Survey responses and comments have been overwhelmingly positive. Ninety-five percent of respondents said the location of the room was convenient and said they planned to use the room again in the future. Out of the nineteen respondents, only one said the temperature in the room was uncomfortable, and another answered that the chair was uncomfortable. Mothers reported that they were:
Very thankful for this space, So grateful for this room, and
… super excited that this room is open.
Others appreciated the computers, mirror, and convenience of the location. In addition to providing feedback on user satisfaction, the survey has been one way for Rowland Medical Library to keep track of any requests or complaints.
The library has become a convenient location for nursing mothers to one stop shop; this room allows users to drink coffee, study, work, and pump all at the same time in a private location. One mother describes the convenient location as a significant factor in her decision to come back to work after maternity leave. The nursing mothers room has given many employees and students a safe and private location for pumping. In the first year alone (January 24, 2018- January 24, 2019), the room has been used 446 times. Popularity of the room reached those in hospital administration, and the possibility of adding another nursing mothers room to the hospital is being discussed.
Lessons learned
The remodel involved many departments and was a lengthy process; it took thirteen months from the initial planning meeting to completion of the project. The librarians involved in this project first met with UMMC’s Office of Planning, Design, and Construction in May 2017, and construction did not begin until November 2017. One challenge that delayed the start of construction and added to the expense of the room was the plumbing installation for the sink. Another challenge was the complexity of working in a large academic health science center; over twenty institutional departments were involved with this project.
The following are practical steps for librarians taking on a similar project:
Communication. Clearly communicate to institutional leaders why a nursing mothers room is important.
Find a champion. Initiating a new library project can require the support of a champion at the institutional level. Support from the Office of Academic Affairs was instrumental in this project’s success.
Tour existing rooms. Visit other nursing mother rooms: colleges, universities, hospitals, larger employers, shopping centers, or airports.
Set budget and secure funding. As this was an institutional priority, the library was able to use a portion of funds held outside the library’s budget.
Timeline. Set a timeline for construction, but realize that flexibility is necessary.
Room policies. Develop and publicize room policies (Appendix B) both in the room and on the library’s website.
Marketing. Supporting breastfeeding mothers is positive exposure for the library, so finding multiple avenues for publicity is necessary to the project’s success.
Housekeeping. Communicate the cleaning requirements to housekeeping staff and supervisors.
Review room policies and make changes as necessary.
Conclusion
The decision to breastfeed after returning to work or school takes a considerable amount of commitment from the nursing mother. Employers supporting this decision by providing a clean, convenient, and tranquil space to pump breast milk can play an important role in that decision. Spearheading the construction of nursing mothers room is unique way for librarians to promote wellness, support breastfeeding mothers, meet federal labor requirements, and provide positive exposure for the library.
Acknowledgement
Developed resources reported in this publication are supported by the National Library of Medicine (NLM), National Institutes of Health (NIH) under cooperative agreement number UG4LM012340 with the University of Maryland, Health Sciences and Human Services Library, under Subaward No. 1600679, with the University of Mississippi Medical Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Appendix A: Rowland Medical Library Nursing Mothers Room Survey
Thank you for using the new Nursing Mothers Room in Rowland Medical Library. We would like to ask a few questions regarding your experience. Your answers will be de-identified and will help us continue to improve this space. If you have any questions or concerns about this survey, please contact Elizabeth Hinton at ehinton@umc.edu.
Was the temperature of the room comfortable? Y/N
Will you use the room again? Y/N
Is the location of the room convenient? Y/N
Did you find the chair comfortable? Y/N
What did you most enjoy about the room?
What else does the room need?
Additional comments?
Appendix B: Nursing Mothers Room Policies
The Nursing Mothers Room is located in the Learning Resource Center on the first floor of Rowland Medical Library, Room U115–2. The room is available to UMMC students and employees who are seeking a private and comfortable place to pump breast milk. Please be aware that breast pumps are not provided.
The room is available during all hours that the library is open. Keys should be returned to the circulation desk at least 15 minutes prior to closing.
The room is equipped with:
Comfortable chairs
Electrical outlets for plugging in a breast pump
Counter for breast pump and supplies
Sink with soap and paper towels
Computer with internet access
The Nursing Mothers Room is located in the Rowland Medical Library and is in close proximity to heavily used study and meeting spaces. Considerations have been made regarding noise. Therefore, the space is designated for pumping only.
Key checkout is available at the circulation desk. A current UMMC ID badge is required. Keys should not leave the library at any time.
The room is available on a first-come, first-serve basis during library’s operating hours. No reservations are accepted.
Room use is limited to 60 minutes. Patrons are asked to return the key as soon as finished pumping.
Patrons are expected to leave the room clean and to take all possessions with them when exiting the room.
Rowland Medical Library is not responsible for any items left in room (including breast milk).
The room has a maximum capacity of two. However, privacy may be requested at checkout.
Please refer to the library website for holiday and interim hours.
Contributor Information
Sarah Adcock, Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS.
Elizabeth Hinton, Rowland Medical Library and Scientist-Educator, School of Nursing, University of Mississippi Medical Center, Jackson, MS.
Susan Clark, Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS.
Chameka Robinson, Access Services, Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS.
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