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LACTATION E-490 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: INMATE LACTATION PROGRAM NO: E-490 FILE: LACTATION EFFECTIVE DATE: 12-16-19 REVISED: AUTHORITY: Sheriff M. Mims APPROVED BY: Assistant Sheriff T. Gattie REFERENCE: California Code of Regulations, Title 15, Section 1058.5; and Penal Code Sections 3407 and 4002.5. PURPOSE: The purpose of this policy is provide lactation accommodations for inmates who want to provide breast milk for their babies. POLICY: It is the policy of the Fresno County Sheriffs Office Jail Division to allow lactating inmates access to a breast pump for the expression of milk to relieve discomfort, to maintain milk supply, and/or to prevent infection. PROCEDURES: I. BREASTFEEDING EDUCATION AND NOTIFICATION A. Upon confirmation of an inmate's pregnancy, the inmate must be advised orally or in writing of the standards and policies governing pregnant inmates. The required information and supporting laws are contained in the Pregnancy Services pamphlet. [Refer to Addendum A.] The pamphlets are issued by Medical staff, but are also available on the female housing floors. B. Pregnant inmates will be informed of the benefits of breastfeeding by Medical staff. In addition to the benefits, inmates will be educated about breastfeeding with active tuberculosis; Hepatitis B, Hepatitis C, HIV, syphilis, and other infections which can transmit from mother to child; illicit drug use; alcohol, tobacco and marijuana use; and while on certain prescribed medications. C. A copy of this policy shall be posted in all locations in the Jail where medical care is provided. Page 1 of 5 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: INMATE LACTATION PROGRAM NO: E-490 FILE: LACTATION II. BREAST PUMP A. After giving birth, inmates will be issued a manual breast pump by the hospital. Manual breast pumps are considered single-user and inmates are not expected to share. B. New arrestees who are currently breastfeeding a child will be encouraged and permitted to continue to pump. Medical staff will either procure a breast pump for the inmate, or consult with correctional staff to determine if a breast pump can be brought from home (meeting necessary security requirements). For a lactating inmate who is detained for less than 24- hours, Medical staff will offer instruction on hand expression to relieve symptoms of engorgement. C. Because consistent pumping is the key to keeping the milk supply steady, inmates will be permitted to retain possession of the breast pump for the duration of need. "Need" considerations include maintaining the milk supply, relieving discomfort, and preventing infection. NOTE: The frequency of pumping is dependent on the age of the infant (and/or feeding patterns at the time of mother's incarceration). Lactation for a young infant will require pumping every 2-3 hours, including during the night. Pumping normally takes approximately 10-20 minutes. D. Medical staff will be responsible to modify the inmate's "Pregnant" ALERT, noting the issuance of the breast pump in the Remark section. Upon cessation of lactation, the breast pump is to be retrieved and the ALERT is to be inactivated. E. Inmates who misuse the device (or storage bags), or otherwise abuse the privilege will not be permitted to retain the pump and will be required to pump in a medical holding cell. III. PRIVACY Due to security considerations, safety concerns, and structural limitations of the Jail, there is no certainty of privacy for an inmate who wishes to express breast milk. Housing officers and Medical staff should assist the inmate in determining the best solution based on the inmate's classification and housing location. If necessary, an extra sheet may be issued to use as a temporary privacy screen when pumping. Page 2 of 5 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: INMATE LACTATION PROGRAM NO: E-490 FILE: LACTATION IV. SANITATION A. Before pumping, the inmate's hands should be thoroughly washed with soap and water. If soap and water are not available, an alcohol-based hand sanitizer that has at least 60% alcohol can be used. Breasts and nipples do not need to be washed before pumping. B. The inmate is responsible to clean and maintain the breast pump according to instructions. 1. A small supply of dish soap and paper towels will be provided to the inmate. The pump should be allowed to drip dry on a paper towel, then stored in a clean container (e.g., the packaging box, or issued bag). 2. Breast milk is not a biohazard and it is improbable that washing pump parts in a shared sink will pose a health risk (sanitary or safety issue) to others. V. STORAGE A. The breast milk will be stored in disposable plastic bags that have been pre-labeled with the inmate's name and JID number. The inmate is responsible to indicate the date and time that the milk was pumped on the label. Although the milk can remain at room temperature for several hours, the expressed milk should be placed in a refrigerator as soon as possible. 1. The inmate should notify correctional staff, who will be responsible to transfer the milk to the inmate refrigerator and/or notify available Medical staff. (Breast milk is food, and is completely safe to store alongside other foods in any refrigerator that is appropriate for food storage.) 2. Medical staff will be responsible to retrieve the breast milk at least once each day and store the milk in the Main Jail infirmary freezer. B. Arrangement for the pickup of stored breast milk is the responsibility of the inmate. C. Breast milk that is not picked up within seven (7) days of pumping will be discarded. Page 3 of 5 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: INMATE LACTATION PROGRAM NO: E-490 FILE: LACTATION D. The inmate will be responsible to dispose of milk not collected for purpose of breast feeding (i.e., "pump and dump"). The milk may be flushed or poured down any drain. VI. TRANSFER OF BREAST MILK A. To expedite the transfer process, the inmate may predesignate up to three (3) individuals who are authorized to retrieve the breast milk. The designation shall be listed on the Inmate Lactation Program — Pumping Instructions and Designation of Recipient form (Addendum B). 1. The name(s) of the designated individuals will be noted as a "Breast Milk Designee" (under ALERTS in Offendertrak). The document shall be scanned into the inmate's records in Laserfiche (under Pregnant/Lactation). 2. If an individual not previously designated attempts to retrieve the milk, the regular property release process will need to be employed (i.e., a Property Release Authority (J-27) form needs to be initiated, and the release approved by the inmate). [Refer to policy C-450/Inmate Property Release (FILE: PROPERTY-RELEASE)] B. The individual will be required to report to the Main Jail Lobby with valid photo identification. It is recommended that the individual bring a clean ice chest or insulated cooler bag containing frozen gel packs (to ensure the milk remains frozen during transport). C. When the designated person arrives at the facility, Lobby staff shall confirm the person's identity and contact Medical staff to have the milk brought to the lobby. D. Medical staff will complete the Acknowledgment of Receipt of Breast Milk and Handling Instructions form (Addendum C). The identified person picking up the milk must sign the form and will be provided with a copy of the instructions. The original form shall be scanned into the inmate's records as a property release, and a copy retained as part of the inmate's medical record. VI I. EXCLUSION FROM PARTICIPATION A. Inmates may be excluded from participating in the lactation program if: 1. The inmate is currently housed in a safety cell. Page 4 of 5 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: INMATE LACTATION PROGRAM NO: E-490 FILE: LACTATION 2. A medical diagnosis has confirmed that providing breast milk would pose a risk to the intended child based on the parent's medical condition or recent use of illicit or certain prescription drugs. B. Inmates who are excluded from providing breast milk to their child due to a medical diagnosis will be notified of their status by Medical staff. C. Inmates who are excluded from providing milk may still be provided access to a breast pump for the purpose of preventing discomfort and/or to prevent infection. Vill. WEANING OR CESSATION OF LACTATION Inmates will be provided medically appropriate support and care related to the cessation of lactation or weaning. Page 5 of 5