Breastfeeding at 40,000 feet; 8 things I learned along the way.
By Jessica Ruttenber
Only 5% of Air Force pilots are female. In 2018, 9.5% of female pilots (117 of 1237) were pregnant. Total women in the commercial industry mirrors these ratios ranging between 5-7%. Given the thousands of aircraft in the Air Force inventory and the low numbers of females, the likelihood of seeing a pregnant pilot in the cockpit is a rare event. Statistically speaking it falls somewhere between seeing a unicorn and winning the lottery.
Not every Air Force pilot can or opts to fly during pregnancy. Aviators are encouraged to work with their obstetrician and flight surgeon to pick a path tailored to accommodate their needs and preferences. For uncomplicated pregnancies, most heavy aircraft pilots may elect to continue to fly in their second trimester. Currently, the service is reviewing occupational hazards in aviation to see if more opportunities can be expanded for pregnant airmen on all platforms. In fact, the Federal Aviation Administration (FAA) does not consider “pregnancy under normal circumstances” as a disqualifying condition. Most major airlines have pregnant pilots electing to fly into their third trimester.
In 2011, I was expecting my first child. Although I was not the first pilot to have a baby, I had never seen a pregnant aviator fly or one that continued to breastfeed while returning to work. This was before the creation of Facebook social media sites like Pilots Moms and Female Aviators Stick Together (FAST). I found myself making up the rules as I went on this incredible journey. Over three pregnancies, I flew the KC-135 Stratotanker and the C-21 Learjet while stationed at Birmingham, Alabama; Ramstein, Germany; and Altus Oklahoma. Fortunately, I experienced healthy pregnancies, did not encounter complications, and was able to fly training and operational missions while maintaining my qualifications.
After pregnancy, choosing whether to breastfeed or to use formula is a personal choice. I chose to breastfeed because of the health benefits for both mom and the baby. The Air Force lactation policy mandates time and a private, secure and sanitary location for the purpose of breastfeeding. So how does that work when your office is a flight deck?
The FAA and most airlines lack clear guidance on breastfeeding policies for their pilots. Commercial pilots are exempted from the provision of the Affordable Care Act that requires employers to provide a reasonable amount of break time and a space to express milk as frequently as needed for up to one year following the birth. Delta Airlines Flight Ops Manual (FOM) does not explicitly address breastfeeding during flight but does state that pilots may leave their duty stations for physiological reasons. Delta also guarantees one year of unpaid leave of absence after delivery for the purpose of bonding and breastfeeding. Most pilots do not use the one year option due to the loss of income in conjunction with their healthcare premiums quadrupling due to the extended absence.
Along the way I learned a few things, some more comical than others. I’d like to share with you what worked for this flying mama. So let’s start this awkward conversation.
1. There will be a wide range of people that will be supportive, curious, and uncomfortable with you flying pregnant and pumping postpartum.
In the minds of most there is a narrative implanted by social conditioning that describes what a pilot “should” look like. Spoiler alert, this pilot is never pregnant. The best tool to de-stigmatize pregnant aviators is education. Most unease comes out of well meaning concern for safety and not from fact based evidence. The absence of knowledge leaves room for fear of the unknown. Lead these conversations and talk about the worrisome risks. My fondest postpartum question was from a commander that came to me before flying a nine hour oceanic crossing to ask “I don’t need to know how the thing works (the pump). I only need to know if it has a quick disconnect in case we have an aircraft emergency.”
2. Pumping MUST be included in your mission planning
A key to a successful mission starts with the preparation put into the sortie during mission planning. Mission timing is planned out by the minute from when the crew shows at the beginning of the day until engine shutdown and the crew debriefs. Not setting up time in your planned profile to pump will set you up for failure. For me, I ended our pre-flight briefing 20 minutes prior to walking out to the jet to pump. Enroute cruise flight time to and from air refueling operations made an ideal time for pumping. Expect that flight operations will have changes and you may need to adapt to the new plan. The world won’t end if you need to remain in an airborne holding pattern an extra five minutes. If you are not the aircraft commander make sure you explain your physiological needs to them in advance.
3. If you have a difficult time breastfeeding in public on the ground it’s not going to get any easier in the air.
At this point you need to decide if you will pump in the pilot seat on the flight deck or check off and find an alternate location on the aircraft such as the cargo compartment. Communication is everything. Be open with your crew about when and how you plan to pump. For example, if a pilot leaves the seat above 35,000 feet the remaining pilot flying the plane may be required to wear an oxygen mask. These conversation may feel awkward at first but they are important.
The advantage of a two piloted aircraft is that you don’t have to be in the seat in most aircraft to take care of physiological needs. For me I started by checking off to the back as I fumbled with this new process. By the time I was on my third child I would turn on the autopilot while I pumped in the seat with a modest cover that was a neutral green to blend in with my flight suit. There may be reasons you will need to stay in the seat such as an unqualified student, time constraints or the aircraft is logistically too small. In the C-21 I was less than 12 inches from the other pilot so things got personal real quick. Your confidence will increase over time and you need to prepare yourself for the high likelihood that at some point your crew may get an unintended “sneak peek.” For your first couple flights after you return to fly, I would recommend selecting another pilot to fly with that you are comfortable with as you figure out how the logistics will work for you. Often men that have had spouses that breastfeed are already familiar and comfortable with the process.
4. Buy the expensive hands free pump.
Do NOT buy a pump that needs to be plugged in while in use even if it is the only one your insurance covers. Even if you have to pay out of pocket the logistics while flying is next to impossible and the stress isn’t worth it. The best option for me at the time was the Medela Freestyle Breast Pump for about $400. However, the latest wearable breast pump by Willow has been a game changer. There are no external tubes or wires and it slides into your bra. In my later years I flew with a pilot wearing one and I didn’t even realize she was pumping until she popped it out to put in the cooler. It’s expensive but so is formula and an investment in a quality pump can be used for more than one pregnancy.
5. ALWAYS, have spare parts and a backup manual pump with you on EVERY mission.
Your pump will break or malfunction and it will be at the worst time. Perhaps, it looks like an unexpected weather divert and you didn’t make it back to your home base. Alternatively, maybe you will be on a trip that landed late because you stepped to a spare jet and now nothing is open to get replacement parts. Spend the $30 dollars on a manual pump with some storage bags and throw it next to your divert kit. You know the one with your spare tooth brush and old makeup. You cannot simply decide to stop physically pumping past your normal interval for a long period of time and tough it out. You are setting yourself up for a medical condition called Mastitis that is a painful inflammation of the breast which symptoms include pain and a fever. Within 24-48 hours you will go DNIF (Duties Not Including Flying) and if you are on a multi-day trip you can see how problematic this can be.
6. Have a plan to bring back breast milk on long trips and learn to be okay with it not making it back.
For short trips make sure you have a refrigerator in your hotel room and have access to ice to replenish your cooler. If you are at a civilian airport TSA will allow you to take it through security (on occasion they might ask to test it). For longer trips you may need to access dry ice because once milk is frozen it must stay frozen or be used within days. This goes back to mission planning and knowing in advance where you can find this resource. I once flew with a new mom who saved her supply from a 30 day deployment we were on. We planned it perfectly and got dry ice on every stop on our three day trip home until the last leg. We had a maintenance delay and landed in Hawaii in the middle of the night. The only place with dry ice had closed and my friend was on the brink of losing a month’s worth of breastmilk. We saved her milk by the grace of a night gas station manager that allowed us to put the cooler in the back storage freezer until the morning.
7. Your child will still get into college if you supplement with formula.
You may feel guilty if you set unrealistic goals for yourself. I wanted to breastfeed for a year and made it to six months with all three of my children. Give yourself permission to say that you did your best and take it from there.
8. Flying will dehydrate you and your supply will drop.
The air pulled from high altitudes is dryer than the air below and you will need to drink more water to prevent dehydration even when you are not breastfeeding. So stop decreasing your water intake (which some call tactically dehydrating yourself) and drink more water–when you think you have had enough, drink some more water. Dehydration will significantly lower your milk supply and frustrate you.
Balancing the demands of your career and the needs of your child is tough on every working parent. Being a successful pilot and a mother is achievable with proper planning and expectation management. The origins of aircraft designs and policies did not have women in mind and create varying degrees of difficulty. That is why it is important that we continue to have these awkward conversations.