Fetal Loss & Bereavement in the Military: Department of Veterans Affairs Family Servicemember’s Group Life Insurance

By Amanda Rebhi

WARNING: This article contains information and pictures about fetal loss.

“I’m sorry but your baby does not qualify as a child per the definition of the VA.” The words echoed around the pastel pink room and replayed over and over in my head. Only hours prior I had held my daughter, kissed her tiny hands, and looked at her face for the last time before laying her down gently in the hospital bassinet and allowed her to be taken down to the morgue.

I had suffered a placental abruption and my daughter was born still after 17 long hours of labor. But Liliana’s death fell just 3 days shy of 20 weeks gestation – at least as calculated by my Last Menstrual Period, a date I had made “easy” by saying 1 June. Had I recorded the more accurate 29 May, my daughter would have reached that arbitrary 20-week benchmark. I wouldn’t have heard that somber social worker say those cutting words. My daughter would have “qualified” for the VA to recognize her death. We wouldn’t have had to pay thousands of dollars out of pocket for her funeral expenses in the midst of the worst day of our life.

Despite having seen and felt her kicks and head-bumps, despite birthing her, despite cutting her cord and holding her perfect little body, despite her hands and feet (and eyes and nose and lips) formed as identical replicas of her daddy and her chin and face taking after me, despite her receiving a fetal death certificate, despite needing to make disposition decisions and calling funeral homes from my hospital bed…the VA had the gall to tell me that my baby isn’t considered a child. That Family Servicemember’s Group Life Insurance only covers qualified children of service members, starting at 20 weeks gestation. That those 3 extra days would have somehow changed the validity of her life to be worthy of a funeral.

The VA leaves parents with the choice between thousands of dollars of debt or the having hospital discard their baby along with medical waste.”

What happens when a young Airman loses their baby and doesn’t have a Captain and Engineer’s salary and savings to bootstrap the funeral expense? The expense of flying in their mom to help take care of them? The expense of ordering takeout every night because they have no will or physical strength to cook? The expense of childcare for their other children while the mother physically recovers or they attend grief counseling? The expense of memorial keepsakes? The VA leaves parents with the choice between thousands of dollars of debt or having the hospital discard their baby along with medical waste. As though their child were a bloody rag from surgery or a tumor cut from someone’s body.

While it does not relieve the pain of losing a child, Family Servicemembers Group Life Insurance through the VA helps remove one burden from the backs of bereaved parents – affording the funeral. Unfortunately, funeral expenses for a fetus or baby are just as expensive as for a toddler or teenager. From the cost of the funeral home services, to the casket or cremation and urn, to the burial plot, to transportation of remains, to taxes and fees…anyone who has buried a loved one knows costs easily skyrocket into the thousands. This is why service members receive the FSGLI “benefit” of a $10,000 child life insurance policy – it meets the national average expense to cover a funeral.

“Laying your child to rest is a basic human right.”

But burying your baby or fetus is not a benefit. Laying your child to rest is a basic human right. Not a parent on the planet views their child’s life insurance with glee or a greed to collect a payout. Every grieving parent should be able to have their loss recognized and have the peace of mind in at least the singular fact that they are financially able to afford burying their baby. Excluding parents of an unborn child due to an arbitrary cut-off calculated based on the often inaccurate recollection of the Last Menstrual Period is cruel. It also ignores medical realities and legal rights of parents.

Yes, the miscarriage rate in the United States can be as high as 25% of clinically recognized pregnancies. But, statistically, losing one’s baby after a heartbeat is detected at 8 weeks is only a 2-4% risk,. The risk of loss after 12 weeks is less than 1%. So once the second trimester is reached, it is all but expected that there will be a living baby. Those of us unfortunate few in that 1% prior to 20 weeks gestation often have full labors and deliveries of our babies who we get to see and hold as our hopes, dreams, and lives are shattered. For us, the VA provides no assistance to give our child a proper and dignified funeral.

The risk of loss after 12 weeks is less than 1%. So once the second trimester is reached, it is all but expected that there will be a living baby.”

The VA can say they “serve and honor” America’s veterans, they can say “I CARE”. But where was their service in honoring the life of my baby? Where was their commitment and advocacy for the rights of my daughter? What respect did they show my Lily? Where was the care in telling a bereaved mother that her baby doesn’t qualify as her child? We can be thanked for our years of selfless service to our country, but we cannot receive the mere decency of being able to provide our children with a dignified funeral. At least, not if they don’t “qualify” as a child. Not if they don’t make it to 20 weeks of gestation.

I believe that just as FSGLI helps alleviate the financial burden for bereaved parents of fetal children meeting the current arbitrary 20-week snap-line, the VA should provide such support to all grieving parents who have dedicated their lives to serving our country. Given the medical literature and risk factors, fetal eligibility for full FSGLI benefit should start in week 12, when the risk of loss hits 1%…when parents fully expect to welcome a living baby. This would better serve bereaved families and alleviate a large burden from the backs of grieving parents, a burden which they should never had to face.

Further, while first-trimester loss is sadly prevalent, providing funerary cost-reimbursement for the few, if any, parents who choose to take care of the disposition of their fetus’ remains following first-trimester losses would truly support all bereaved parents. While exceedingly rare in practice, many states do grant parents the legal right to give a dignified funeral to their miscarried child. There are even states trying to mandate fetal burial. For parents forced by law, or willfully exercising their right, or the religiously inclined, provisions or waivers should be made available to submit for funerary cost-reimbursement. 

If the VA truly strives for the highest quality and continuous improvement, they will look at their policies and make the legal changes that are needed. Choose the harder right instead of the easier wrong, so parents can bury their children. Submit to change Public Law 110-389, Title IV, Section 402 to include miscarried children. Amend § 9.1 under authority 38 USC 502, 1965-1980A, to revise paragraph (k)(1) for a member’s miscarried or stillborn child. Change eligibility to the 12th week of gestation. Add a waiver process for earlier losses to receive funerary cost-reimbursement. Remove the minimum fetal weight entirely. Do this so the VA will be able to say “I CARE” knowing they are fully committed to taking care of service member families. Do this so no other mother and father will have to hear the echo of the words “your baby does not qualify as a child.”

***

Amanda Rebhi is a Captain in the Department of the Air Force currently serving in the National Capital Region.

DISCLAIMER: The views expressed are those of the author and do not necessarily reflect the official policy or position of the Department of the Air Force, the Department of Defense, or the U.S. government.

NOTES:

1- National Library of Medicine

2 – Medical News Today

3 – National Library of Medicine

How the military is losing its top talent because of pregnancy discrimination and what we can do about

45 years after women were discharged from military service for pregnancy, pregnancy discrimination polices still do not apply to its military members 

By Jessica Ruttenber

March 2020, I provided personal remarks before DACOWITS, the Defense Advisory Committee on Women in the Services. They represent one of the oldest Department of Defense (DoD) federal advisory agencies. DACOWITS is composed of civilian leaders appointed by the Secretary of Defense to provide advice and recommendations relating to the recruitment, retention, employment, integration, well-being, and treatment of servicewomen in the Armed Forces. Since 1951, the committee has submitted over 1,000 recommendations to the Secretary of Defense for consideration. As of 2019, approximately 98% have been fully or partially adopted by the DoD.1

I approached the committee in part because I had researched the topic of pregnancy being a long-standing and significant barrier to the career advancement of women in the Armed Forces for many years and recommended multiple policy changes to the Department of the Air Force’s Barrier Analysis Working Group (DAFBAWG) Women’s Initiatives Team (WIT). Truthfully, I came forward out of pure frustration for myself and for the countless Airmen I had helped navigate the Inspector General, Equal Opportunity and Patient Advocacy process over my career. What I have found was many women often do not file complaints due to fear of reprisal, especially after learning that there are no clearly defined protections for their situation. I wanted to give women warriors a voice. I was deeply concerned that in 2020, service members’ careers are still unnecessarily impacted when they become pregnant. Current policies seem to imply that those members become a burden and have less value to the force. This attitude is not lost on pregnant service members, members considering potential future service combined with motherhood, and even their colleagues who are taking their cues from the institution and its leadership on how much women’s service and contributions are valued.

For context, the Pregnancy Discrimination Act of 1978 makes pregnancy discrimination a form of illegal sex discrimination. This law does not always apply uniformly to the military. Department of Defense Directive (DoDD) 1020.02E, Diversity Management and Equal Opportunity in the DoD, prohibits unlawful employment discrimination based on sex (to include pregnancy), but only for civilian employees. Although DoD nondiscrimination protections mirror other categories under the Civil Rights Act (i.e., race, color, religion, sex, and national origin), pregnancy among military members is a glaring omission. 

Until 1975, military women were involuntarily discharged when they became pregnant. Married servicewomen did not receive the same benefits as men, (e.g., military housing for families) and their spouses were not always entitled to routine family medical care.2 Forty-five years later, pregnancy remains a barrier to the careers of female warriors. While women are no longer affirmatively forced out, they still risk harm to their careers when having a child. Additionally, a strong argument can be made that current policies encourage servicewomen to hide their pregnancies because of real and perceived impacts to their careers that begin the moment they disclose they are pregnant. As a result, some servicewomen do not obtain prenatal health care during the early stages of their pregnancies.

This is due in part to outdated policies as well as outright discrimination. DoD policies need to be modernized at the service-level. But an important step, both symbolic and practical, is to bar pregnancy discrimination altogether when the member can competently perform the mission. Destigmatizing pregnancy is essential to servicewomen’s sense of inclusion in the military. By taking this important first step, the military will be in a better position to compete for diverse talent, enhance operational readiness, and retain qualified personnel–all while preserving mission accomplishment.

Restrictive policies and blanket occupational health profiles intended to protect servicewomen during pregnancy can negatively impact unit readiness, individual career progression, and the retention of female Service members. As a result, servicewomen miss training opportunities, leading to less experience than their male counterparts. In some cases, they are unnecessarily losing qualifications in critical career fields. These highly trained professionals should be provided the opportunity to perform their duties and/or attend training while pregnant, as long as it does not impact the mission. Policies need to be written to give servicewomen the ability to make informed decisions with their obstetricians’ approval vice automatically removing them from their careers with no consideration given to medical recommendations or the member’s desires. 

In addition to DoD changes, congress should amend Title VII, EQUAL EMPLOYMENT OPPORTUNITIES – 42 U.S.C. § 2000e-16a (2012), to apply to the military, thereby requiring the military to articulate a sound justification for any differential treatment of women based on pregnancy discrimination. This much needed amendment could conceivably be phrased as follows: “Military departments, as provided in Sec. 2000e-16(a), shall include uniformed personnel. This shall not preclude pregnancy as a bona fide occupation qualification, as define in Sec. 2000e-16(a), for education, training and employment.”

In the past month, the DoD has begun a policy review for the career enhancement of pregnant U.S. Service members. I applaud them for recognizing this issue and being willing to take action. Change in any large institution is difficult because of the vastness of the bureaucratic layers that exist. Astutely stated by Victor Hugo, “there is nothing more powerful than an idea whose time has come.” I believe for the armed services our time has come. The armed services are ready for the much-needed change that will transform our culture to one of inclusion, fostering an environment of even greater competence and lethality. After all, the same era that discharged women when they became pregnant was also a service that had ashtrays installed in-between flight controls so their pilots could smoke while flying. Look how far we have come and imagine how much further we will go. 

This is not a phenomenon unique to military culture and policies; the private industry faces equally significant issues. In 2008, a study by the National Partnership for Women & Families found that pregnancy discrimination complaints have risen at disproportionate rate compared tothe steady influx of women into the workplace.3 Research reveals that pregnant workers continue to face inequality in the workplace.4 The study found that much of the increase in these complaints has been fueled by an increase in charges filed by women of color. Pregnancy discrimination claims filed by women of color increased by 76% from FY 1996 to FY 2005, while pregnancy discrimination claims overall increased 25% during the same period.5

Why should we care? By addressing these barriers and coming up with solutions, we will increase retention rates necessary to maintain our lethal edge and sustain the warfighter imperative. Highly trained women choose to leave the military at a disproportionate rate compared to their male peers. It costs more than $1 million dollars to train one Air Force pilot.6 When it comes to retention, 63% of rated male Air Force officers continue to serve beyond their initial service commitment. In comparison, only 39% of rated female officers elect to continue service beyond the end of their commitment.7 Exit surveys directly contribute family considerations and culture as reasons that Airmen choose to leave service. These reasons that women chose to leave are ones that can be fixed through policy and culture change. Why wouldn’t we want to protect this investment?

Women are a significant component of our recruiting pool, and by not fostering a sense of inclusion, we lose our ability to compete for that talent. We risk filling our service branches with less qualified individuals simply because we do not consider the needs of one gender. It is a warfighter imperative that we focus our efforts on future talent to ensure that we inspire, recruit, develop, and retain highly skilled service members capable of meeting current and future mission requirements. “The United States faces challenges recruiting and retaining men and women in the military, as approximately 71% of young adults do not qualify to enlist in the military, mostly because they are physically unfit, do not meet educational requirements, or their criminal or drug use history is disqualifying. Women qualify for military commissions at higher rates than men but continue to be recruited and retained at lower rates than servicemen.”8

The 2018 RAND study, “Addressing Barriers to Female Officer Retention in the Air Force” identified that pregnancy issues influenced 85% of the focus groups on female officers’ retention. A common pregnancy-related concern raised focused on the difficulty of timing pregnancies to fit within rigid career timelines. Female officers relayed that they have felt the need to “program” pregnancy at precise times in their careers to minimize adverse career effects. Despite attempts to “schedule” pregnancies, service women still encountered negative career impacts such as the inability to attend in-residence Professional Military Education (PME), or, career field-specific problems such as loss of flight time for pilots.

Representation in role models and the lifestyles they lived was another staggering finding. Focus groups found that 83% of participants identified the importance of having female role models in senior leadership positions. Participants emphasized that they rarely see female leaders who are married with children. The resulting perception among younger female officers is that it is not possible for women to both have a family and become a senior leader in the Air Force.9

Pregnancy discrimination does not always derive from a practical concern for mission accomplishment, but rather a robust implicit bias present in every individual. Implicit bias is the “unconscious attribution of particular qualities to a member of a certain group. These stereotypes are shaped by experience and based on learned associations between particular qualities and social categories, including race and/or gender”.10 Here is an example of two Airmen, call signs Taboo and Radar.  Both are the same year group and have almost indistinguishable careers, yet the Air Force and society see them very differently. They graduated from the same college and commissioning source and both were identical in rank as F-16 wingmen. When Taboo was in her first interview with her squadron commander, she was asked what her plans were to start a family. In the same circumstances, Radar was asked if he wanted to go to Weapon School. It doesn’t take a misogynistic supervisor or commander to make these distinctions, but they happen every day. Recognizing and accepting that we all have implicit bias is the first step. We also need to accept that in most cases, we don’t even realize it is happening. You can learn more about how to avoid these hidden biases derived from a lifetime of exposure to cultural attitudes in the book Blind Spot written by psychologists Mahzarin R. Banaji and Anthony G. Greenwald. 

Maternal bias is another concern that we, as leaders need to consider. This is a stereotype and discrimination encountered by working mothers and mothers seeking employment. Motherhood often triggers false assumptions that women are less competent and less committed to their careers.11 As a result, service members who are pregnant or have young children are statistically less likely to be selected for a competitive position or promotion by their leadership. Although pregnancy discrimination has many varying degrees, this one is one of the most prevalent that I have witnessed during my time in service. Commanders may become overly concerned about the time a member may be not accomplishing the mission without seeing the full picture. They may also make assumptions about the members’ career ambitions on their behalf without taking into account the member’s desires.

The truth is having a child will take Airmen out of the fight for a small period of time. The convalescent period after an uncomplicated delivery is six weeks. In most cases, the service member will opt for primary caregiver leave (42 days) or secondary caregiver leave (21 days). For every pregnancy, it is expected that the member will be out of the office for a period of 57 to 78 days.12 Men may be designated as the primary caregiver but are often discouraged. Exit studies are increasingly revealing that males are departing the force due to family incompatibility as well. And while we are calling out the elephant in the room, we also have to factor in current postpartum deployment deferments. This may seem like a significant period when looking at a career under a microscope. But when you retract the lens to look at more than a 20 year career, prioritizing that time and allowing members to support their families will pay dividends andretaining crucial talent in the long run. This is not just a female problem. Families should become a leader’s problem. By allowing all Airmen to take the intended leave to start and nourish their families, creates a needed high-trust environment. Leaders who show their Airmen that they care about them as individuals and value all aspects of their service, to include how they are as parents, will only make our force stronger and retain talent longer.

Another aspect to leading Airmen who are starting families is to not make decisions on their behalf. While I believe leaders are not intentionally disadvantaging careers due to pregnancy, even the greatest of uninformed intentions can cause rippling negative career implications. Leaders may think they are helping a new mother by not putting her in for a competitive position or pulling her from training or upgrade to give her more time to recover or be with her child. When this is done without consulting the female results in missed opportunities that will impact progression for the rest of their careers. As leaders, I would encourage you to speak with your pregnant subordinates to clearly understand their goals and priorities. You may be surprised by what a new mom is capable of doing and which opportunities they desire. As part of your feedback with them before the birth, have that conversation of their expectations and ask how you can assist her in achieving them. Through being intentional, proactive and having a plan, leaders can have a significant impact on that Airmen’s ability to continue serving to their maximum potential.  

We need to ensure a servicewoman’s career is not negatively affected as a result of pregnancy. I am encouraged that OSD’s recognizes this barrier and is considering potential policy changes that would improve women’s sense of inclusion.  Unfortunately this by itself will not be enough.  How we implement policy changes individually at a unit level is just as crucial; otherwise, it’s just words on a paper. We need to take our diversity and inclusion training and education more seriously.  If we put real resources toward social changes, we can achieve true equality and enhance our military’s foundational readiness. Our military is the most capable and lethal team the world has ever seen. To retain this world-class advantage in the future and meet the needs of our National Defense Strategy, we must deliberately ensure that all Americans have an equal opportunity to serve.

***

Edited by Megan Biles

Featured Photo by Jeff Wojtaszek: Air Force Commander of the 305th Operations Support Squadron at McGuire Air Force Base, Lt. Col. Jannell MacAulay handed the baton to Lt. Col. Michele Lobianco (2017)

Photo 2: Air Force KC-135 pilot, Lt Col Jessica Ruttenber with her 4 year old son Daniel at Altus Air Force Base (2018)

Photo 3: Air Force F-16 pilots, Lt Col Kathryn Gaetke (Taboo) and Lt Col Matthew Gaetke (Radar) at Misawa Air Force Base (2012)

***

NOTES:

1. Defense Advisory Committee on Women in the Services (DACOWITS). Accessed June 13, 2020. https://dacowits.defense.gov/.

2. “1970s: Family Policy.” Detail. Women’s Memorial Foundation. Accessed June 13, 2020. https://www.womensmemorial.org/history/detail/?s=1970s-family-policy.

3. Nat’l Partnership for Women & Families, The Pregnancy Discrimination Act: Where We Stand 30 Years Later (2008), available at http://qualitycarenow.nationalpartnership.org/site/DocServer/ Pregnancy_Discrimination_Act_-_Where_We_Stand_30_Years_L.pdf?docID=4281 (last visited May 5, 2014)

4. While there is no definitive explanation for the increase in complaints, and there may be several contributing factors, the National Partnership study indicates that women today are more likely than their predecessors to remain in the workplace during pregnancy and that some managers continue to hold negative views of pregnant workers. Id. at 11

5. U.S. Equal Employment Opportunity Commission., and U.S. Equal Employment Opportunity Commission. “Enforcement Guidance on Pregnancy Discrimination and Related Issues.” Enforcement Guidance on Pregnancy Discrimination and Related Issues | U.S. Equal Employment Opportunity Commission. Accessed June 13, 2020. https://www.eeoc.gov/laws/guidance/enforcement-guidance-pregnancy-discrimination-and-related-issues.

6. Mattock, Michael G., Beth J. Asch, James Hosek, and Michael Boito, The Relative Cost-Effectiveness of Retaining Versus Accessing Air Force Pilots. Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR2415.html.

 7. Keller, K. M., Hall, K. C., Matthews, M., Payne, L. A., Saum-Manning, L., Yeung, Douglas Lim, N. (2018), Addressing Barriers to Female Officer Retention in the Air Force, RAND Corp.

8. Erika L. King, Diana M. DiNitto, David Snowden & Christopher P. Salas-Wright (2020): New Evidence on Retaining Air Force Members with Young Children: Exploring Work and Personal Factors by Gender, Military Behavioral Health

9. Keller, K. M., Hall, K. C., Matthews, M., Payne, L. A., Saum-Manning, L., Yeung, Douglas Lim, N. (2018), Addressing Barriers to Female Officer Retention in the Air Force, RAND Corp.

10. “Understanding Implicit Bias.” Kirwan Institute for the Study of Race and Ethnicity. The Ohio State University. Accessed June 13, 2020. http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/.

11. “We Tend to Believe Mothers Are Less Committed to Their Careers (VIDEO).” LeanIn.Org. Accessed June 13, 2020. https://leanin.org/education/what-is-maternal-bias.

12. DoDI 1327.06 June 16, 2009 Incorporating Change 3, Effective May 19, 2016, Leave and Liberty Policy and Procedures

Pregnant Pilots

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.

Major Melissa Hammond taking care of her physiological needs in the KC-135

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.