by Anne Smith, IBCLC
Once you successfully make it through the early weeks of breastfeeding, and manage to overcome any problems you may have had in the beginning (soreness, engorgement, hormonal rushes, etc.) you usually experience a "honeymoon period". This tiny helpless infant you have nurtured for so many weeks or months has become an individual with his own unique personality, and is now starting to grin at you constantly. Just at the point when you are beginning to get the hang of this whole mothering thing and are settling into a routine, it is time to go back to work or school. This is the unfortunate reality for many nursing mothers these days. I say "unfortunate" because I can think of very few nursing mothers I have worked with over the years who really look forward to going back to work and leaving their babies. While I do believe that the optimal situation is for a baby to remain at home with his mother for the first several years of life, I know that this is just simply not an option for the majority of women today. It's hard enough to survive on two incomes without the added burden of supporting a new member of the family -- and babies are expensive. Most mothers return to work or school simply because they feel they have to. Although many working mothers used to nurse for a few weeks and then wean before they returned to work, more and more moms are choosing to continue to nurse after they return to work. As the many advantages of breastfeeding become more obvious, mothers don't want their babies to miss out on the benefits of nursing just because they have to return to work or school.
It is hard to be separated from your baby, but being able to nurse when you are together benefits both of you physically and emotionally. The look on your baby's face when you walk in the door after a long separation as he eagerly anticipates "reconnecting" at the breast makes the effort of maintaining the nursing relationship well worth it.
There are several articles which may be helpful in helping you continue to breastfeed after returning to work or school: Collecting and Storing Breastmilk will give you detailed information about different types of pumps, how to maintain your milk supply, how much milk to leave for your baby, and how to store and handle expressed breastmilk. Introducing a Bottle to the Breastfed Baby can help you get your baby used to bottles before you return to work. Caregiver's Guide to the Breastfed Baby will provide you with useful information for the person who will be caring for your baby while you are separated (explaining in detail the difference's between formula-fed and breast-fed infants feeding, sleeping, and stooling patterns, as well as how to handle human milk as opposed to formula).
There are several important elements to consider in order to successfully continue nursing your baby when you return to work or school: first, you need to select an appropriate pump which will empty your breasts quickly and efficiently. Second, you need to select a care provider who supports your commitment to breastfeeding. Third, you need to arrange breaks at regular intervals (ideally, about every three hours) during your day in order to have time to pump. Fourth, you need to find a private place to pump, preferably with access to an electric outlet. Fifth, and very important, you need to establish a good milk supply after your baby is born and before you return to work or school. This will make maintaining your supply when you are separated much easier.
For information on selecting the appropriate pump, see Collecting and Storing Breastmilk. You will want to purchase or rent your pump no later than three weeks before returning to work. Even if you are at home with your baby for the first several weeks or months, it is helpful to have the pump to store up some milk to have on hand when you start working, to introduce baby to bottles so you can be sure he will take them when you leave him with a care provider, and to give you time to familiarize yourself with the operation and cleaning of your pump, as well as get an idea of how long each pumping session is likely to take. Storing up some milk beforehand in the freezer is a good idea, because even with a good pump, the stimulation you get while separated from your baby will be less than you are getting while you are together. Also, there is no pump on the market that is as efficient as the baby at removing milk and stimulating your supply. When you add in the fact that leaving your baby often creates stress, it isn't surprising that many mother's milk supply will drop off somewhat when they return to work/school. You may have days that are more hectic than usual, or you just may not feel good physically some days. Your baby may go through a growth spurt, and demand may temporarily exceed supply. In the beginning, you won't be sure exactly how much to leave for a feeding, although you will quickly find out how much he takes each day.
For all these reasons, you will feel better if you have some extra milk stockpiled in the freezer. You don't need to have gallons on hand, just enough for a few feedings. Pump after feedings for five minutes, or on the other side when your baby takes one breast at a feedings (your supply will be more plentiful in the mornings) and store the milk in 2-ounce portions. Try to have at least 12 ounces on hand. If you have strong feelings about not wanting your baby to have any formula at all, or if he is allergic to formula, you may want to have a little more stored up.
Selecting a care provider is seldom easy. Leaving your baby will be much less stressful if you feel really comfortable with your child-care situation. Probably the ideal provider is a family member, like dad or grand-mom. If this isn't an option, you may want to look for a mother who provides child-care in her home for one or two children, or a nanny who can come into your home. Putting a baby (especially a tiny infant) into a day care center with multiple infants is probably the least optimal situation, but if that is your only choice, talk to other parents whose children are enrolled. Look for a center with the highest possible ratio of adults to infants. Drop in unexpectedly and see how things operate when they aren't expecting a visit. Be sure to let the care providers know that you are nursing. If they aren't familiar with handling human milk or nurturing nursing babies, look elsewhere or share the information in Caregiver's Guide to the Breastfed Baby with them. Take comfort in the fact that breastfeeding protects your baby from many of the nasty germs that seem to get passed around day care centers.
Try to do a "trial run" the week before you return to work/school. Leave the baby with his caregiver and go to wherever you will be pumping. This will give you a chance to scope out the situation:
• Do you have an electric outlet?
• Do you need an extension cord?
• Do you need to find out which office space will be available, and when?
• Do you have access to hot water to clean your pump parts?
• Is there is refrigerator, and if so, can you store your milk in it if needed? etc, etc.
You should also let the caregiver feed the baby while you're gone, so you can see how he will take the bottle, and get an idea of how much he will take at a feeding. Leaving him for the first time is stressful enough, but will be easier if he is left in a familiar environment.
How often you pump when separated from your baby depends on several factors. One is whether your goal is to pump enough during the day for the baby to have exclusive breastmilk feedings the next day, or whether you plan to combine formula and breastfeeding. You may decide to combine breast and formula feedings if your baby tolerates formula well and is used to it, or if your schedule at work doesn't allow time for frequent emptying of your breasts. If your goal is for your baby to have only breastmilk, then ideally you will empty your breasts about as often as he nurses when you are together. For example, if you return to work when your baby is six weeks old and still nursing every 2-3 hours, then you should try to pump every 2-3 hours when you are separated. If you return to work when your baby is six months old, eating solid foods, and going 3-4 hours between feedings, you may only need to pump every four hours.
This is an optimal schedule for the mother of a young baby who wants to provide only breastmilk for her baby:
• Set your alarm 20 minutes early (OUCH!) Nurse your baby, even if he is half asleep.
• Get both of you dressed and ready to go. Pack up everything you can the night before -- diaper bag, bottles in cooler, lay out clothes, etc.
• Eat a good breakfast. Don't skimp on this, even if it is something you can eat quickly like a carton of yogurt or bagel with cream cheese. Be sure to include a nutritious drink, such as juice or milk.
• Nurse again for a few minutes before you leave if possible. Some babies get so much milk at the first feeding that you can't get them to eat again, but try anyway.
• Pump mid-morning. Allow at least 20-30 minutes for each pumping session (ten minutes for pumping with a good double pump, and ten minutes for assembly and clean-up). Have a drink and a nutritious snack while you pump.
• Pump again at lunchtime. If possible, leave work and go to your day-care site to nurse. More and more companies are providing on-site day care, or you may live close enough to travel home and back if dad is watching the baby or your caregiver lives nearby. It may even be possible for your caregiver to bring your baby to you at lunchtime. Once again, eat a nutritious meal with something to drink.
• Pump again mid-afternoon. Have a drink and a snack.
• Nurse as soon as possible after you pick your baby up from day-care or return home.
• Eat a nutritious dinner.
• Nurse your baby frequently during the night. Tucking him in bed with you is a good way to make up for the closeness and skin-to-skin contact that you miss out on during the day. Some babies start to nurse more frequently during the night when they are separated from their mothers during the day. This is called "reverse cycle feeding" and works well for many mothers, especially if they find it hard to pump during the day. If baby is in bed with you, you will get the rest you need while he gets the milk he needs.
Having given you the hypothetical "optimal" schedule for a working mom, let me hasten to say that this is an ideal which many mothers find impossible to implement. Don't get the idea that if you can't pump three times during the day, you shouldn't even try to continue nursing. Many mothers have work schedules that are very inflexible, and they don't have either the time or the place to pump more than once a day, or even not at all. If this is the case, you can still breastfeed. If at all possible, try to pump at least once during the day (usually you can find time at lunch, even if you don't have any other breaks). Pumping even once a day will give you some stimulation, help maintain your supply, and help keep you from becoming engorged. If you are only able to pump once each day, you will probably have to supplement with formula, but at least your baby will have one feeding of breastmilk, and you can continue nursing while you are together.
I often have mothers ask me what will happen if they don't pump at all during the day, but want to nurse in the mornings, evenings, and weekends when they are with their baby. The answer depends on the baby's individual temperament, as well as his age. A young baby whose diet consists solely of milk is likely to lose interest in nursing when your supply drops drastically, as it is certain to do if you go an eight or nine hour stretch without emptying your breasts. This is not true for all babies, however, so it is worth trying if you absolutely can't pump at work. The worse thing that will happen is that your supply will drop and your baby will wean himself. Some babies seem to enjoy nursing for the sake of nursing as much as for the milk, and will continue nursing no matter how low your supply gets. This is more likely to be the case with older babies who are nursing less frequently and eating solid foods. If you can't pump at work, expect a period of engorgement, leaking, and discomfort while your body adjusts.
Mothers often get extremely creative when finding locations and opportunities to pump at work/school. Ideally, you should try to pump at least three times during an eight- hour work -day, twice during a six- hour day, and once during a four- hour day. Short pumping sessions of five minutes or so are better than not pumping at all, and with a good double electric pump, you'd be surprised at how much milk you can get out in five minutes.
While some employers provide a special place set aside for mothers to pump, as well as frequent breaks during the day, this is the exception rather than the rule, especially in the United States. I expect that this will change as more and more employers realize that encouraging their employees to breastfeed is cost effective for them, due to breastfed babies being healthier (fewer trips to the doctor, resulting in fewer health care claims and less time missed from work to care for a sick baby). Studies have also shown that when employers promote and encourage breastfeeding, it creates a better work environment and a more loyal, satisfied employee.
Given the fact that, in many cases, we are light years away from a uniform breastfeeding friendly work environment in the U.S., here are some suggestions on places to pump: lounge, locker room, unused conference room or office, your car (yes, that's one reason that Medela makes vehicle lighter adapters), or a women's restroom. As yucky as it sounds, for many mothers pumping in the restroom is the only option they have. Make sure you have hot water available for cleaning pump parts, and bring your own soap. You may even want to bring your own basin from home if you don't feel comfortable with the cleanliness of the sinks.
Try to find a comfortable space with an electric outlet. If you absolutely don't have a place to plug in your pump, you can use a small battery pump (which is less effective than the Pump In Style or the Lactina) or you can rent or buy a PowerPack. Medela offers this option that allows you run either the Pump In Style or the Lactina on battery power, and it also contains a vehicle lighter adapter for pumping in the car.
I know of one mother who pumped in a locked storage room right inside the employee break room. Since no one knew she was in there, she got to hear all the juicy office gossip before anyone else.
Before returning to work, you may want to discuss your options with your employer. If at all possible, try to return on a part-time basis, even if only for a week or so. You may also try to return to work on a Friday rather than a Monday so that you'll have the weekend to recover from your first day back.
Another reason to have a discussion with your boss is to make him or her aware of any changes you may need to make in your work schedule. For example, you may need to take two 30-minute breaks instead of one 60-minute one.
While all employers should be supportive of your efforts to continue nursing, you may occasionally encounter a boss or supervisor who not only is not supportive, but may actually be hostile when you try to pump at work. In situations like this, sending a copy of the following letter may be helpful:
To whom it may concern:
Jane Doe, the mother of a six-week old breastfed infant, will be returning to work on a full time basis on March 11, 2000.
While nursing an infant this age, it is important for the mother to empty her breasts at regular intervals (ideally every two to three hours) in order to maintain her milk supply and prevent medical complications such as plugged ducts and mastitis (breast infection).
My recommendation is that Jane be allowed several fifteen minute breaks each day, in addition to her regular lunch break, in order to express her milk with an electric breast pump.
I hope that you will be willing to work with her regarding this matter, since regular milk expression during prolonged periods of mother-baby separation is in the best interest of both mother and child.
Please feel free to contact me with any questions that you might have.
Anne Smith, IBCLC (International Board Certified Lactation Consultant)
I know of several situations where employers didn't want mothers to store their expressed milk in the refrigerator at work because they were concerned about "contamination", since they argued that human milk is a body fluid and should be covered by the same precautions used with blood and saliva. Be assured that the policy of OSHA, the CDC, and the American Public Health Association is that human milk is not considered in the same category with other bodily fluids, and no special precautions are necessary, other than the standard hand washing and refrigeration protocols. If your employer or care giver has concerns about this topic, you can request a publication called "Caring for Our Children", which supports the feeding of human milk to infants in out-of-home child care settings. It is published jointly by the AAP (American Academy of Pediatrics) and the American Public Health Association. Call 1-800-433-9016 to request a copy.
Leaking at work is much more of a concern than leaking at home. Some mothers experience minimal leaking, while others wake up with the sheets soaked every morning. While leaking does tend to lessen after the early weeks of nursing, many mothers still experience a significant amount of leakage when they are ready to return to work. Soaking through your shirt may be inconvenient while you are at the grocery store or visiting a friend, but when you are making an important presentation in front of your boss and a roomful of clients, it can be disastrous. That’s why I offer the BLIS (Breastmilk Leakage Inhibitor System) This product can be a life -saver for moms who leak a lot and have to be separated from their baby for extended periods of time. It really works. See product information for more details.
Here are some other tips for dealing with leaking:
• If you feel your milk letting down, cross your arms across your chest and apply pressure for about ten seconds or so. No one but another nursing mother will know what you are really doing.
• Choose bright or dark colored prints. Avoid white and pastel colors. They show leaks more. Cotton and synthetic fabrics show leaks less than silks, linens, and clingy fabric
• Wear a loose jacket or blazer to throw over your blouse.
• Keep the clothes loose and comfortable. You may find that your pre-pregnant clothes don't fit well anymore, so invest in a few multi-purpose outfits that fit loosely. Choose outfits that button in the front or two- piece outfits that you can pull up easily.
• Keep a spare blouse at work (one in a neutral color that can be worn with most outfits).
• This may seem obvious, but choose clothes that are washable and don't require ironing. Your life is complicated enough right now without adding ironing to your list of things to do.
Continuing to breastfeed after returning to work is a real labor of love, but it is well worth the effort. No, it isn't easy, and requires a great deal of commitment and work on your part. Only you can provide the best possible nourishment for your baby, and there is no doubt about the physiological benefits (immunities, fewer illnesses, less time missed from work/school), the financial benefits (cost savings associated with fewer doctor visits and not buying formula, which can cost anywhere between $100 - $200 per month, depending on the type), and the psychological benefits (the closeness, bonding, and skin-to-skin nurturing) that only you can provide.
Anne Smith, IBCLC has breastfed a total of six children (three boys, three girls). She feels that her first hand experience plus her more than twenty years experience of counseling nursing mothers are among her most important credentials. Anne has been a La Leche Leader since 1978 and IBCLC since 1990. As a nursing mother, LLL Leader, and IBCLC, Anne has worked in many areas over the years. She has led support group meetings, taught breastfeeding classes, trained breastfeeding peer counselors to work with low income mothers, worked one-on-one with mothers to solve breastfeeding problems, helped thousands of mothers with breastfeeding questions over the phone, held workshops for health professionals on various breastfeeding topics, taught OB, Pediatric, and Family Practice Residents breastfeeding at Bowman Gray School of Medicine, and run a breast pump rental station with over 100 pumps, scales, and nursing bras for the past eleven years. We invite you to visit Anne's website.
Copyright © Anne Smith. Permission to publish granted to Pregnancy.org, LLC.