Breastfeeding and Working

Plan Ahead Before Returning to Work

During pregnancy you might want to gather information about your work setting. Have other women been able to schedule their days to allow time and privacy for expression of milk? Is there a refrigerator? How supportive will your co-workers and superiors be?

If you eventually want your baby to drink from a bottle for some feedings, begin offering the bottle at least three times a week when your baby is about three to four weeks old and your milk supply is established. You can give the baby water, breastmilk, or formula. Your baby may be more likely to accept a bottle from someone other than you. Make sure that your baby is not hungry when offered a bottle for the first time. This is important because the baby may reject the different feel and flow-rate of the bottle’s nipple. Most babies are very willing to take a bottle at three weeks but they get much more particular as they get older. It’s easier on you, your baby and your future child care provider if you begin as early as possible to get the baby used to taking a bottle. Experts recommend introducing the bottle as soon as possible after the baby is three weeks old.

Start to look for a child care provider well before you need to return to work. Choose a provider who will support your plans for breastfeeding and providing breastmilk. When you look for child care, consider your commute time and distance from work or home. Ask your caregiver if she has experience with caring for breastfed babies. You’ll need her support and cooperation. You may need to provide instructions on how to store and heat your milk. Although planning ahead is helpful you can still succeed without extensive advance planning. Just be prepared to give your system, whatever it is, a try!

How it all Works: Supply and Demand

Your body will produce as much milk as your baby requires. As you begin to express milk regularly, you will discover that you can produce varying amounts of milk as needed. This means that it is possible to develop a routine which includes using different weekday and weekend nursing schedules and expressing milk at work.

In the first month it can be difficult to establish a routine. Your baby is growing rapidly and nursing frequently. This is how your milk supply is established. During this time, it may be hard to express milk in addition to meeting the baby’s heavy demand. Although some women have an abundant supply of milk from the first week, most find that in the beginning their supply stays just about even with the baby’s needs. Don’t worry – your milk production will increase as the baby gets older, probably within four to six weeks.

It’s important to learn how to express, or pump, your milk. While it may come naturally to some, others may find it more difficult to master. After your baby’s first month, try expressing milk once a day when your milk supply is greatest. Most often this occurs in the morning. It is usually easier to pump one breast while the baby is nursing on the other breast, as the let-down reflex will be stimulated. When you first begin, you may have to pump or massage your breast for a little while before the let-down reflex occurs. Many women will express only half an ounce from each breast in the beginning. The amount will increase as your skills improve and your overall production is “boosted.” After you are comfortable expressing once a day, you may want to express again at a time when your baby will be getting a bottle – the mid-afternoon is a good time.

Stimulation every three to four hours for 10 to 15 minutes on each breast is necessary to maintain a good milk supply once you are back at work full-time. Keep in mind that the amount of milk you collect by expressing is not a gauge of what your baby will be able to get, because your baby is the best pump of all.

About two weeks before returning to work, start to pump at the same time of day you will be pumping when at work. The baby should be training to receive a bottle at the same time. This is a good time to do a trial run with the caregiver.

The Daily Schedule

Both your baby’s need for breastfeeding and your schedule will change over time. In the first two months, the baby may nurse eight times a day. By three months, six times a day may be satisfactory, although the baby will still probably have brief “growth spurts” and nurse frequently for two to three days at a time. Your baby will continue to nurse in this manner until you start solid foods. If you’re lucky, the baby will sleep six to eight hours at night. It will take your body from five to seven days to adjust to any skipped feedings, such as when your baby regularly sleeps through a middleof- the-night feeding.

A common pattern for working mothers is to bring the baby to bed in the early morning for a long feeding. You may be able to sleep while the baby nurses. After this initial morning nursing, if possible, try to nurse one more time before leaving for work. When you pick up your baby after work, nurse immediately. In the middle of the evening or at bedtime, nurse again. If the baby wakes during the night, nurse then too, if it seems appropriate. You will find that you can nurse your baby at least four times a day using this approach. This schedule is often enough to keep up your milk supply until you choose to wean. After six months, if the baby is taking solids or formula, some mothers choose to breastfeed only in the morning and at bedtime. Many mothers find that this pattern can continue indefinitely.

How to Express Milk

It can take a while to learn to express milk efficiently. Remember, half an ounce your first time is great. Wash your hands well. The following may sound a little corny, but you really need to set the stage for expressing milk. Relax in a comfortable chair. Have a towel and your pumping equipment near you. Think about your baby. You can listen to a tape of soothing music. Using the tape at work and a photo of your baby will help you get in the mood to express. Massage your breasts gently, using a circular motion. All of these actions will help stimulate your let-down reflex.

Hand Expressing

This costs nothing and can be fast and easy (but not for everyone!). Start by washing your hands and massaging your breasts. Cup one hand around the areola, thumb on top and fingers opposite (where the baby’s gums are during feeds). First press in towards the chest wall with thumb and fingers and then move forward toward the nipple, rhythmically rotating all around the breast. Uneven drainage can lead to plugged milk ducts. Use a clean funnel or a widemouth cup to collect the milk and transfer to a container (bottle or “baggies”) for storage. Expressed milk may appear thin and bluish, somewhat like nonfat milk. That is normal. You can completely express by hand or you can use a pump once your milk is flowing.

Pumping Milk

If possible, borrow different types of breast pumps from friends before deciding which one to buy. You’ll benefit from their advice and experience before you make a purchase. You will need to supply your own breast shields, tubing and containers, since these components are not made to share. Below is a list of different types of pumps, in order of lowest cost to highest.

Manual Breast Pumps

These are the least expensive pumps. These pumps can be very effective if used properly. The principle of short, stimulating bursts – mimicking baby’s initial suck until letdown – then proceeding with gliding pressure (being aware of how the milk flows), will allow for milk collection. The mistake often made in using hand pumps is creating too much pressure too fast, hence constricting the flow of milk. Manual breast pumps are recommended for occasional use.

Battery-Operated Pumps

These fully automatic pumps cycle at about 30 to 38 times a minute and can be operated by AA batteries, or by plugging in. They are recommended for women who need to pump only three to four times per day. They are available in single or double kits.

Automatic Pumps

If you will be collecting a large quantity of milk regularly, an electric pump is very convenient. The cycling rate most closely corresponds to the sucking action of the baby so these pumps withdraw milk very effectively. Some also offer the option of double-pumping which allows for better stimulation and more milk production. Check with your health plan or your hospital’s prenatal department to see if they offer these breast pumps for rent or sale (sometimes at a discount). Many baby clothing and equipment stores offer these pumps for rent or sale as well. You can ask other mothers and check the Internet or flea market papers for used pumps. Remember to always clean and sterilize breast pumps according to the manufacturer’s instructions.

Storage of Breastmilk

Breastmilk must be stored carefully to avoid bacterial contamination. Keep it COLD until ready to use. Don’t save leftover milk for another feeding. Bacteria multiply rapidly in the few minutes milk is at room temperature.

Refrigeration

Breastmilk should be refrigerated soon after expression. At 32° Fahrenheit, you can store it for eight days. If there is no refrigerator where you work, put the bottle into an insulated container surrounded with “blue ice” to keep it cold. Don’t use a thermos since that storage method will keep the milk at your body temperature, unless you can cool the milk first. Use this milk within 24 hours or freeze it.

Freezing

Date milk before storing. A stand-alone freezer at 0° Fahrenheit will keep breastmilk from spoiling for six months. Use a thermometer to determine the temperature of your freezer. If your freezer is attached to the refrigerator and not a constant 0°, it will keep breastmilk fresh for three to four months. Don’t store breastmilk in the door of the freezer – it won’t stay cold enough. Breastmilk that has been thawed should be used or refrigerated within 24 hours, then discarded. Never refreeze milk that has been thawed.

Storage Methods

The following methods of storage are the most popular. The first is the “ice cube” method. Wash and scald a plastic ice cube tray. Cool expressed milk, then fill each opening. Cover with plastic wrap. Freeze. Repeat process later with more expressed milk. When tray is full, empty frozen cubes into durable plastic containers or freezer bags. To use, put cubes in the bottle and defrost under hot running water. This method makes it easy to defrost milk quickly. It also allows you to add a small amount of breastmilk to a feeding if baby still seems hungry.

The second method is to store breastmilk in plastic bottles or bottle liners (store in 2-oz., 4-oz. and 8-oz. batches). Remember to cool milk in the refrigerator before freezing and “double-bag” milk in a zip-lock freezer bag. Don’t fill the bags to the top, to allow for expansion as the milk freezes. If you are adding fresh milk to already frozen milk, cooling the fresh milk is especially important because it keeps the frozen milk from thawing and refreezing.

Defrosting Methods

Breastmilk can be defrosted in the refrigerator (shake if it separates), in a store-bought bottle warmer, or by holding the bottle under hot tap water. Do not boil – high heat destroys its immune properties. Never defrost or warm milk in the microwave since this destroys some nutrients and can create “hot spots” that can burn baby’s sensitive mouth.

Storage Guidelines

Freshly Expressed Milk

• Room temperature: 4 - 6 hours
• Refrigerator: 8 days
• Freezer: 3 - 6 months

Thawed Breast Milk

• Refrigerator: 24 hours (do not refreeze)

Combining Breast and Bottle

Unless you will be returning to your baby during the day to nurse, you’ll be leaving the caregiver with bottles of expressed milk or formula.

If you choose to use expressed milk, start to save and freeze milk before you return to work. This will give you an extra supply. Babies usually drink more from a bottle than a breast because the milk flows faster with less sucking effort. Also, pumping at work will probably not yield as much milk as the baby’s own efficient sucking. After you return to work, you can try to express enough milk each day to give to the baby the following day. Your frozen supply can be your backup. You should also freeze some new milk and gradually use the older milk to “rotate your stock.”

If you decide to use formula, begin a few weeks before you return to work by substituting one formula feeding at a time every three or four days. Gradually add more formula feedings until you reach a balance between breast and formula feedings which you think will work, once you are back on the job. After you begin working, you can choose to keep up the breastfeeding/formula combination on your days off and let your milk supply adjust to the new pattern. Or you can choose to try to breastfeed exclusively on the days when you’re home from work. If you decide on this approach, you will still need to express some milk at work, even if you don’t save it, in order to maintain your milk supply. Your schedule will depend on how many days and hours you work and how much milk you are able to express while working. Your baby will want to nurse fairly often on your days at home. If the baby seems hungry after every feeding, you can try offering some formula at the times the baby would be getting it if you were working.

When you adjust to your pumping routines at work and home you will help maintain the bond between you and your baby by continuing to provide the best nutrition – breastmilk.

Patience

It will take some time for you to blend your home and work life together. Pumping your breastmilk will provide a little rest time so you can focus on your baby while at work. However, being separated from your baby can, at first, cause anxiety and feelings of sadness and loss. Be patient with learning a new routine that includes pumping. Remember how much patience it took to learn to breastfeed when the baby was first born.

Helpful Hints

• Organize your lunch, clothes and diaper bag the night before.
• Wear two-piece outfits or button-down clothes to make pumping easier at work. Keep a sweater or jacket at work in case you leak. Take extra nursing pads.
• Take a cooler for transporting breastmilk to the caregiver and home from work.
• Have a picture of your baby at work to look at while you pump to help with the let-down reflex.
• Take a thermos of something soothing like “Mother’s Milk Tea” (hot or cold) to drink. You can find it at most health food stores.
• Read a book or do a Sudoku or crossword puzzle while you pump – anything that will relax you and take your mind off of work.

Taking Care of Yourself

A woman who is breastfeeding needs to take especially good care of her own health. The extra demands of working increase this need while diminishing your time to care for yourself.

• Eat balanced, nutritious meals. Try not to use sugary foods to boost your energy – the lift won’t last.
• Drink lots of fluids, especially water.
• Avoid caffeine and soda.
• Continue taking prenatal vitamins.
• Rest and sleep as much as you can. Enlist your partner or another adult to help with the baby and the house.
• Plan your day around the needs of you and your baby.
• If you find that you are too tired to enjoy your baby, reevaluate your expectations of yourself. Most of us aren’t supermoms!

Recommended Reading

Since every woman’s situation is different, the information in this handout may or may not work for you. You may wish to turn to one of the many books on breastfeeding and working. These books provide sensible advice for working mothers who nurse: Kathleen Huggins’ The Nursing Mother’s Companion (Harvard Common Press, 2005); Working without Weaning: A Working Mother’s Guide to Breastfeeding, by Kirsten Berggren (Hale Publishing, 2006); Nursing Mother, Working Mother, by Gale Pryor (Harvard Common Press, 1997); and The Everything Breastfeeding Book: Basic Techniques and Reassuring Advice Every New Mother Needs to Know, by Suzanne and Ray Fredregill (Adams Media Corporation, 2002).

Many thanks to Bonnie Bruce, R.N., IBCLC, and Meg Zweiback, R.N., M.P.H. for contributing to this handout.

BANANAS Child Care Information & Referral • 5232 Claremont Avenue, Oakland, CA 94618 • 658-7353 • www.bananasinc.org

©1986, 1999, BANANAS, Inc., Oakland, CA Revised 2007.