Working and breastfeeding

With the onset of Fall and back-to-school, it seems like this is a good time to talk about going back to work as a breastfeeding mom. It can seem a daunting proposition, and believe me, it’s no small feat to work and be a mom. Add pumping and maintaining a breastfeeding relationship with your baby to the mix, and it’s nothing short of heroic. Yet, most of the moms I talk to make it harder than it needs to be, feverishly trying to stock a freezer with their milk and trying to make concrete “plans” of how it will all work. So what do you need to know to be a working/breastfeeding mom?

First of all, make sure your baby is familiar with and comfortable with a bottle. It’s so stressful to have to leave a baby for 8-10 hours who refuses a bottle. It’s difficult for mom, the caregiver, and the baby. While we don’t recommend introducing a bottle before 4 weeks of age due to bottle preference (we all prefer easy and instant gratification if given the choice- babies are no different), but if you wait too long, your baby may balk at a bottle. I find that 6 weeks seems to be the age when a lot of babies start to become opinionated. After 2 months, many kids will flatly refuse. So somewhere around the one month mark, you want to start to familiarize your baby with a bottle. It doesn’t have to be every day- a couple times a week is enough, and it doesn’t have to be a full feeding: just an ounce or two to keep them comfortable with it. You can nurse after to give them their “mommy fix”. Moms are often told that they should never be the one to give the bottle since the baby knows you’re the one with the magic boob, but I have seen some kids that take it better from mama. Whoever is going to give the baby their bottle needs to know how to pace- bottlefeed (you can watch it on YouTube) so that the baby doesn’t drink too much too fast. You want it to hit their brain that their tummies are full. Probably the most common issue I encounter with working moms is the constant pressure from daycare that they need more and more milk. Breastfeeding is a leisurely dining experience and often even after drinking more than a feeding’s worth of milk from a bottle, a breastfed baby will look like they’re wanting more. Really, what they want is that warm, cuddly experience that they get at the breast. If your baby doesn’t immediately fall into a milk-drunk stupor after their bottle, the daycare may think they need more. A breastfed baby should never need more than 4oz in a bottle if they are still nursing at home and during the night.

Another common question is what kind of bottle/nipple is best for a breastfed baby? I always answer that by saying, “ask your baby!”. For every nipple out there, there’s a baby that loves it and a baby that hates it. Wide base nipples are marketed to breastfed babies because it more closely resembles a breast, but your baby knows it’s not the breast and may prefer a longer, more narrow nipple. The one thing you want to do is ALWAYS stick to the slowest flow. The nipple manufacturers want you to move up in “size” (categorized differently depending on the brand) so that you need to keep replacing and buying nipples, but sticking to the slowest flow is important for a breastfed baby so that they don’t drink too much too fast. Buy just one nipple of a couple of differing sizes/shapes and see which one your baby prefers. If you buy a 16 bottle starter kit of one particular kind, that’s a guarantee that your baby will hate it!

Then we have the question of when to start pumping. Other than to help your baby latch when you’re engorged postpartum, or if your baby isn’t nursing effectively at first to protect and preserve your milk production, you don’t need to be doing a lot of pumping in the first weeks of breastfeeding. Tiny newborns feed very frequently, which can feel overwhelming, and adding the pressure of pumping to start storing milk can be too much. Plus we know that the first few weeks lay the foundation for milk production and establishing your supply, and if you’re pumping like crazy, you essentially tell your body you have two babies. You might think the more breastmilk, the better, but more is not always better! More is often too much. Moms who overproduce are more prone to plugged ducts and have babies who are gassy and fussy from too much watery, sugary foremilk. Plus, who wants to walk around overfull and leaky all the time? It’s a wonderful thing when your body is in sync with your baby and your breasts are only full when it’s time for a feeding. So the best time to start pumping is when you’re ready to start introducing the bottle. Many moms find it works well to pump first thing in the morning at the same time the baby is nursing. Just keep your pump set up on your bedside table, and then plunk the baby on one breast and the pump on the other. Your breasts work as a team, so you’ll get a good letdown that way, and most moms find that early in the morning their breasts are quite full. If you make that your morning routine every day, you’ll end up with a nice little stash, as well as some milk to begin familiarizing your baby with the bottle. You don’t need a freezer full of breast milk to go back to work. Fresh milk is always better. So each day, you’re pumping at work for the next day’s feedings. You only need enough stored for the first day and some to spare in case you get stuck in traffic on the way home, or god forbid, somebody drops a bottle and spills your milk! I could tell you numerous stories of moms who had freezers full of breastmilk, only to have it all go bad during a power outage, a freezer malfunction, or somebody not closing the freezer all the way.

It is important to have the right size flange for optimal milk removal and comfort. Consult a lactation consultant for help with this. Most breast pumps come with flanges that are too large for the average woman. Choosing a good pump is important too. If your insurance doesn’t cover the better quality pumps, it is worth it to invest the extra money to upgrade. (or put it on your baby registry!) Many moms are attracted to the wearable pumps, which are trendy and expensive. My experience with them is that most moms find they don’t work as well, and the convenience is not worth the deficit in milk output.

When it’s time to leave your baby (sniff…) make sure you always have what I call the “bookend” feedings- meaning you nurse last thing before you go out the door (or at daycare, if it’s a drive from your house) and then first thing when you get back at the end of the day. You don’t want to drop off a baby that needs to eat 15 minutes after you leave and you certainly don’t want to arrive at the end of the day with full breasts, and daycare just fed them a full bottle! If you give them these “bookends”, it will cut down on the amount of milk you have to leave and thus make pumping less of a pressure. What works well for many moms is to have a very early morning feeding before you get up where you can nurse and snuggle and have a nice leisurely feeding. Then you can get up and take your shower, get dressed, eat, etc. and then feed your baby once more right before leaving. Figuring out how many feedings you’ll miss and how much milk you need to leave is trial and error. If you’re a planner, this can be a tough one. Many moms I talk to want to know exactly how much milk and how many bottles they need to leave. There are “formulas” for figuring this out mathematically, and I’ve never been one to quantify like that. Some babies just take the bare minimum, some babies drink more (especially if they’re not being appropriately fed), and there is not really a way to figure this out ahead of time. Start with smaller amounts in the bottle (especially if your baby doesn’t seem thrilled with them), so that you’re not wasting your precious milk. The caregiver can always add more, but if the baby doesn’t finish it, you have to toss it unless they finish it within an hour or so of first offering it. I am not going to go into milk storage guidelines here, as they are readily available from many sources. You will find that there are differing recommendations when it comes to breastmilk storage, which is confusing and frustrating, but that’s because some sources list the most conservative or “ideal” guidelines, while some list “acceptable” recommendations.

Remember that your employer must provide you a private place to pump that is not a bathroom and they are also required to allow you to pump when you need to. You can refer to your state statutes for guidelines on the current laws for pumping while working. It is helpful to work out these details before returning to work. Contact your employer and tell them you will need to pump and ask them where your designated pumping space will be. Fortunately, most workplaces have already had their share of pumping moms, so lucky for you, other moms have paved the way for you! If you run into a conflict about this, contact your human resources person to address the issue.

A hands-free bra is a must so that you can do compressions while pumping, which increases pumping efficacy and output. It also enables you to eat or complete paperwork while pumping! Watching a video of your baby, complete with all their adorable little sounds can help you relax and get more milk. Some moms find that bringing an article of their baby’s clothing to smell before pumping also helps increase milk yield. Breastfeeding is a hugely hormonal experience and thinking of your baby and getting those pheromones going can really help. If you’re panicking about how much milk you’re getting, some moms put little socks over the bottles so they’re not constantly watching (and obsessing over) how much milk they’re pumping. Make sure you continue to eat enough and drink enough water- busy working moms often neglect this. You need fuel to produce milk for your baby! Flooding yourself with water doesn’t make you make more milk, but if you’re not drinking enough and get dehydrated, that can make you produce less. If you have concerns about your milk supply or pumping output, as always, contact your lactation consultant.

While working and pumping and continuing to breastfeed may seem impossible at first, most moms find that given proper management, it is certainly doable. It becomes easier once your baby gets to 6 months and can start a little food, and your routine is established. At one year, you can kick that breast pump to the curb and continue nursing your baby while home with them, but no longer needing to leave bottles all day. It is truly a gift to be able to continue to give your baby all your wonderful antibodies (daycares are germy places!) and it is so satisfying to come home at the end of the day and reconnect with your baby by sitting down and nursing. It’s still the thing that only you can do for your baby, which is very satisfying for moms when they have to share the care of their baby with their nanny or daycare provider

Most of all, don’t think about working and pumping and leaving your baby in the first weeks of your baby’s life. I would often have moms asking me about this in the hospital with their hours-old baby in their arms. I always have said, don’t think about leaving your baby until the time comes. The only thing you have to do is make sure your baby is familiar and comfortable with the bottle. Otherwise, relax and enjoy your baby. Even if you’re fortunate enough to have a longer maternity leave, it will go by in a blink.