(WOMENSENEWS)--Carmen Letscher's maternity leave ends this week and she's anxious about going back to work.

Though she was able to breastfeed her daughter Lucy for three months, she's not confident that she will hit her goal of six months. The public relations company she works for has 500 employees, over three-quarters of whom are women, yet Letscher has never known anyone to breastfeed there. Her human resources department has found a spare office she can use as a makeshift lactation room. It's all hers; until they hire someone who needs the space.

"If I'm leaving my daughter in day care, I want to give her the best of everything, given the situation," Letscher said. "My goal is to breastfeed for another three months, but I'm apprehensive about my work schedule, finding a good place to pump and trying to pump discreetly. I can't feel bad if I don't make it to six months. If I have to supplement with formula, I'll have to be OK with it."

Letscher has reason to be apprehensive. Despite the well-known benefits of breastfeeding and a controversial breastfeeding campaign by the U.S. Department of Health and Human Services, breastfeeding time can be cut short by the challenges women face when they return to full-time work. The number of mothers who feel this push-pull continues to grow as the proportion of mothers in the work force increases.

"Breastfeeding initiation is going up, but the duration is still not good," said Katy Lebbing, a leader with La Leche League International, based in Schaumburg, Ill., which helps mothers breastfeed, and manger of the group's Center for Breastfeeding Information. "Most American women choose to breastfeed; they just need a little help when they go to work."

Nursing Rates Quickly Drop

In 2003, 66 percent of new mothers breastfed following childbirth, but this dropped to 33 percent after six months and fewer than 20 percent were still breastfeeding after one year, according to the Ross Mothers Survey by Ross Products, a formula maker and division of Abbott Laboratories based in Columbus, Ohio.

The American Academy of Pediatrics in Elk Grove Village, Ill., recommends that infants be exclusively breastfed for the first six months because it may lead to lower rates of gastrointestinal and respiratory infections, asthma, obesity, diabetes and diarrhea, among other benefits. Benefits to nursing mothers' include a reduced risk of breast and ovarian cancers and cessation of menstruation while breastfeeding.

As a result, one goal of a government initiative called Healthy People 2010 is to persuade 50 percent of mothers to breastfeed their babies for at least six months by 2010. However, the federal Family and Medical Leave Act only allows women to take up to 12 weeks of unpaid maternity leave and that only in companies with more than 50 people.

Returning to full-time work increases the likelihood that mothers will stop breastfeeding, though. In 2003 only 26 percent of women working full time were still breastfeeding after six months and 14 percent after a year, according to the Ross Mothers Survey.

New mothers often face obstacles at work that make it harder to continue breastfeeding, said Dr. Frances Biagioli, an associate professor of family medicine at Oregon Health and Science University in Portland, Ore. They must negotiate the emotional distress of leaving a baby behind, social aspects such as a fear of leaking, lack of an appropriate space to pump (other than a bathroom stall), finding time for breaks and fatigue.

"It's a myth that all women know about breastfeeding," added Lebbing. "A breastfeeding woman's biggest problems when she returns to work are not having the right pump, not knowing how frequently to pump, low milk supply and management techniques."

Supportive Workplaces

Supporting a woman's choice to breastfeed can make all the difference. When Letisha Marrero returned to work in October last year, leaving her 7-month-old daughter Lola in day care, her company had no lactation room. Within nine months she went from pumping in random offices, where she taped a "do not enter" sign to the door, to having a nursing room. In March Marrero stopped pumping; she'd reached her goal of breastfeeding Lola for one year.

"If you succeed at breastfeeding people want to give you a gold star. But my situation shouldn't be the exception, it should be the norm," said Marrero. "I feel very fortunate because my work environment allowed me to be as successful as I was. I know other women don't have those options."

A supportive work environment benefits the employer too, said Dr. Tonse Raju, a medical officer and program scientist at the National Institute of Child Health and Human Development in Bethesda, Md. It can reduce the number of days a mother takes off work, improves worker retention and may attract other employees.

To increase awareness of these various benefits and encourage first-time mothers to breastfeed exclusively for six months, the Department of Health and Human Services and the New York-based Ad Council launched a two-year campaign that ended this spring. One television ad showed a pregnant woman being thrown off a mechanical bull and compared the recklessness to failing to breastfeed.

Campaign Focused on Risks

Dr. Wanda Jones, director of the department's Office on Women's Health, said the campaign focused on the risks of not breastfeeding because there are already many messages out there about the benefits. Women in focus groups they spoke to before the campaign didn't feel motivated to breastfeed after hearing about these benefits again, but the risks got their attention. Some critics say that the campaign took the wrong approach, though, and could make mothers who can't or choose not to breastfeed feel guilty.

"For women who choose to or have to go back to work it's not fair to say you could put your child in danger by not breastfeeding when it's so difficult to breastfeed at work," said Letscher. "Why not campaign with companies to create lactation rooms instead, or give us a more flexible schedule and provide that right through the Family and Medical Leave Act?"

Legislation can be a great motivator, said Biagioli. "Grassroots efforts are likely more effective, but legislation can help if you have stubborn corporations. Before the Family and Medical Leave Act a woman could have taken maternity leave, but now she knows she can take it. It makes it so employees know they have that right."

Roughly 40 states have enacted some type of law to support breastfeeding, according to La Leche League International. A few states, including Connecticut, Hawaii, Illinois, Minnesota and California, have legislation to protect mothers returning to work. Hawaii, for instance, prohibits employment discrimination against breastfeeding women; Connecticut requires that employers provide a place for women to use a pump or breastfeed during break periods.

"We need a multi-level approach to encourage breastfeeding, including family support, colleague support, the employer saying it's fine and legislation," said Raju. "Just like that saying, 'thank you for not smoking', we need to say, 'thank you for breastfeeding'."

Juhie Bhatia is a writer based in New York City.