Getting It Together: Working and Breastfeeding

Are working and breastfeeding compatible? Yes! It boils down to commitment -- how serious you are about giving your baby the best nutritional start.

Basically, you have three challenges to consider: how to feed baby while mother is gone, how to keep up mother's milk supply when she's away from baby, and how to minimize the amount of time mother and baby spend away from each other. Many mothers choose to pump their breasts every two to four hours during the time that they are away from their babies. This helps to maintain their milk supply, and the expressed milk can be stored and later given to baby while mother is away at work. When mother and baby are together -- nights, weekends, holidays -- mother encourages baby to nurse often, so that they can continue to enjoy their breastfeeding relationship. As baby gets older and starts to eat a variety of foods, mother may mump less at work by continues to breastfeed her baby when they are together.
Benefits of Continuing To Breastfeed While Working
Once you realize the benefits of extended breastfeeding for baby, mother, and family, you will find a way to do it.

*Mothers miss fewer workdays. Because breastfed babies are healthier, mother (or father) will need to stay home less often with a sick baby.

*Breastfeeding saves money. Even considering the cost of a high-grade breast pump, breastfeeding is cheaper than buying formula. Also, because breastfed babies are healthier, you will need to spend less on medical care.

*Breastfeeding help you feel connected. Pumping and storing your milk helps you feel connected to your baby even while you are apart. This is a special relationship that no other caregiver will have with your baby.

*It's the modern this to do. Years ago breastfeeding while working was considered unusual. Now most mother do it, and workplaces are becoming more breastfeeding friendly.

We have seen mothers come up with the most creative plans for minimizing their time away from their babies while working. They find ways to enjoy longer maternity leaves, work from home, commute with their babies or even bring baby to work. Here are some possibilities to keep in mind as you plan your working and breastfeeding lifestyle.
Plan Ahead - But Not Too Much
It is best not to dwell on "the day I have to go back to work." Don't be concerned with all of the what-ifs: "What if he won't take a bottle?" "What if he won't settle for the babysitter?" "Should I get him used to the bottle and start leaving him right away so he won't get spoiled?" Being preoccupied with leaving baby and dilute your attachment to your newborn. This subconscious detachment does not seem right. Mothers should have the joy of being absorbed into mothering, at least for a few weeks! Focus on your baby for the first few weeks; it will do both of you good.

Work and Wear
Mothers the world over blend their mothering and working, and we are attempting to popularize this wonderful custom in the Western world. If you have the kind of job that allows you to take your baby with you, get a sling-type carrier and wear your baby to work. Many mothers do this.

Your Schedule, Baby's Schedule
Enjoy a happy departure and a happy reunion. Breastfeed your baby at the caregiver's before leaving for work and as soon as you return. Instruct your caregiver not to feed your baby within an hour before you leave work. An eager baby and a full mother make for a happy reunion. It depends on your work hours, but you can usually get in an early morning feeding at home, one at the caregiver's, a late-afternoon feeding after work, a couple of evening feedings, and a before-bed feeding. An alternative if you live close to your workplace is for your caregiver to bring baby to you for a feeding once or twice during the day or for you to return to the baby during your lunch break. With work-based day care, some mothers are able to totally breastfeed their baby during lunch and coffee breaks. Return to full-time breastfeeding on weekends, holidays, and days off, as periodic full breastfeeding days are necessary to keep up your milk production. Your breasts will be fuller than usual on Monday if you have been full-time breastfeeding over the weekend.

Expect baby to wake up and want to breastfeed more often at night after you return to work. Experienced mothers who have successfully managed breastfeeding while working accept this nighttime attachment as a natural part of working and mothering. They simply take their baby to bed and enjoy nighttime breastfeeding. Fairly quickly, mother and baby learn to sleep while breastfeeding. Nestling together and breastfeeding at night give baby and mother the touch time they both miss during the day and help compensate for the time apart. Many mothers who have achieved nighttime harmony with their baby report they sleep better, possibly due to the relaxing effects of breastfeeding helping mothers unwind from a busy day. As an added family benefit, this nighttime arrangement gives daytime working fathers extra touch time with baby, too.

Store Up a Milk Supply
Some babies either refuse to take formula or are allergic to all the commercial formulas and only thrive on your breast milk. To avoid being caught empty-handed, you will need to express and stockpile a supply of your mil before returning to work. See Expressing Milk below.

Introducing the Bottle
Present the bottle around two weeks before going back to work. After baby has had his first bottle, he doesn't need one every day. Two bottles a week should be enough practice to prevent a cold turkey experience for baby. Encourage dad or your substitute caregiver to offer your baby the bottle. Baby may be more willing to experiment if he is not desperately hungry -- try when he is happy and alert. It is usual for babies to be rather selective in their eating behavior and refuse to accept a bottle from mother. This is not in their nutritional mind-set.

Bottle-feeding the Breastfed Baby
When part-time breastfeeding is necessary or desired, expect the mostly breastfed baby to be less than enthusiastic about the new container and its contents. Try these suggestions on your little connoisseur.

* If baby is a confirmed breast feeder, enlist an experienced bottle feeder such as grandmother or another bottle-feeding mother. A breastfeeding mother normally feels a bit awkward in offering her baby a bottle, and the baby may smell his mother's milk and sense her ambivalence. After baby has learned to accept the bottle from an experienced feeder, father is next in line to bottle-feed his baby.
* Don't confuse your little gourmet. Some babies accept a bottle while being held in the breastfeeding position; others reject the bottle if given in the situation or position that reminds them of breastfeeding. If baby is baffled by the cradle hold, expecting the bosom to mean more than a cushion, try holding baby at a less suggestive angle, sitting in places different from the ones used during breastfeeding, or putting baby in a sling carrier and walking around while offering the bottle

* Use nipples that resemble the real thing. Choose a nipple that has a wide, areola like reservoir beyond the tip. Avoid nipples that offer only a nubbin to latch on to. The slow-flow nipple that baby really has to suck on is less likely to be rejected than the quick-gush type that overwhelms the eager feeder, causing choking.

* Encourage baby to latch on to the artificial nipple using the same techniques employed with his favorite nipples: mouth wide open, lips everted, and gum pressure at least an inch beyond the tip of the nipple. If baby learns lazy latch-on habits on the rubber sub, making daily transitions to your nipples may be a confusing and painful experience.

* To further entice the discerning feeder, warm the bottle nipple in warm water, making it more supple, like the breast. Try changing the temperature of the nipple for the changing needs of the baby. A chilled nipple may be more inviting to a baby who is teething.

* Instruct the caregiver to interact with your baby during bottle-feeding much the way you do when breastfeeding. Advise the caregiver to undress baby and wear a short-sleeved blouse to promote skin-to-skin contact. Maintaining eye contact during the feeding is important; feeding is not only giving milk but enjoying social interaction.

* Show your caregiver how to let baby suck on her finger between feedings. This helps satisfy baby's sucking needs and will warm baby up to a substitute caregiver.

* Avoid bottle propping. It is unsafe to leave baby unattended in a crib or infant seat to take his own bottle.

Expressing Milk
At some time in your breastfeeding career you will almost certainly encounter medical or life-style circumstances for which you need to express milk. Whether by hand, by pump, or a combination of both, the methods of expressing milk are a matter of personal choice. Experiment with the following techniques, modifying them in ways that work for you.

How to Hand Express Your Milk
The advantages of using a manual technique rather than a mechanical pump include the following.

* Some mothers find pumps uncomfortable or ineffective.

* Mothers often feel put off by the gadgetry and prefer the natural approach.

* Skin-to-skin stimulation can actually produce the milk-ejection reflex better.

* Your hands are "handy" - convenient, portable, always available, and free!

Choosing and Using a Breast Pump
Breast pumps are convenient and often necessary for expressing milk to relieve engorgement, to preserve a mother's milk supply when baby cannot nurse, and to collect milk when mother and baby are separated because of the mother's employment. Here are some general considerations for choosing the right breast pump for you, as well as some ideas for more efficient and comfortable pumping.

* Unless you must frequently pump n an area that does not have an electrical outlet, consider a high-quality electric pump. These are best at mimicking a baby's natural sucking pattern. You can pump both breasts at once, which saves time. Some electric pumps can also be used as manual pumps.

* If you are pumping to keep up your milk supply because your baby is premature or ill and is not nursing, use a hospital-grade electric pump. These are the most effective pumps and the most convenient to use, which really makes a difference if you are pumping six to ten times a day. Studies have shown that pumping both breasts at the same time with a hospital-grade electric pump produces higher prolactin levels than pumping with a manual or battery-operated pump. Maintaining your milk supply for the day when your baby can breastfeed is an important job. It takes good tools to do it well.

* Cost varies widely. Hand pumps are the least expensive, and hospital-grade electric pumps (usually rented) are the most expensive. Some insurance companies reimburse the cost of renting an electric pump, provided you submit a doctor's prescription (with baby's name on it, not yours).

* If your nipples become sore during pumping, massage an emollient, such as Lansinoh, on your nipples prior to pumping.

* Before pumping, look at a picture and think motherly thoughts of your baby. In some mothers, just anticipating breastfeeding or pumping may stimulate the milk-producing hormones to flow.

* There are many breast pumps for different occasions and life-styles. The list of breast pumps (shown in table below) is a useful guide, but because breast-pump technology is rapidly improving to meet the varying demands of today's mothers, we recommend contacting your lactation consultant for the most up-to-date information on selecting the right breast pump and accessories for you.

Practical Pointers for Pumping
* Buy or rent your pump from a lactation consultant who can instruct you in how to use it and can answer your questions about pumping. If you're not sure about how to assemble and use the pump, or if you are not able to pump much milk, talk to your lactation consultant. There may be a problem with the pump that is easily solved, or you may need to use a better pump.

* Don't select a pump based on cost alone. Good pumps are expensive, but if you are pumping several times a day at work or pumping at home to maintain a milk supply for a baby in a hospital, the ease and convenience of a better-quality pump are well worth the money. Renting a pump is cheaper than buying formula.

* Pump parts do wear out. If you are not able to pump as much milk as you once did, the problem may be the pump, not you. Talk to your lactation consultant or contact the pump manufacturer. Note that all but the hospital-grade pumps are made to be single-user products. A used pump may not work as well as a new one.

* Follow a set routine. As often as possible, pump in the same place, in the same chair, with the same "get ready, relax, and pump" routine. This conditions your milk-ejection reflex and you'll be able to pump more milk.
' * Use breast massage before and during pumping to help you relax and bring more milk down to the nipple. (See the "Assisting the Milk Ejection Relax section in the Marmet Technique chart.")

* Take some slow, deep breaths and let go of the day's worries. Visualize flowing water, fountains of milk -- whatever helps to get your milk moving down into the pump. Picture yourself nursing your baby in a quiet, comfortable place.

* Use a portable stereo with headphones to enjoy your favorite music or background sounds from nature.

* Pumping should not make your nipples sore. Be careful that the nipple doesn't rub against the side of the breast shield when the pump is operating. Adjust the suction level if your nipples are hurting.

* Pumping calls for clothing that makes it easy to get at your breasts. Dresses and blouses designed for discreet breastfeeding also make pumping more convenient. Some of the companies the make and marker nursing fashions specialize in sophisticated clothes for breastfeeding working moms.

* Network with other breastfeeding mothers at your workplace. Perhaps you can pump at the same time and enjoy each other's company. If you are the only breastfeeding mother at your workplace, you may have to educate co-workers about breastfeeding and why you are pumping. Be patient and tolerant of others' opinions, while remaining confident that you are doing what's best for your baby and yourself.

What It's Like When You Begin Collecting Milk at Work
When you begin pumping your milk, don't be discouraged if you initially obtain only a small amount. With practice most mothers are able to pump at least several ounces within ten to fifteen minutes. It is normal for you to experience high-production and low-production days. Don't expect your relationship with the mechanical pump to be love at first sight. It will take time to warm up to the metal and plastic when you'd rather be holding your soft baby. While pumping your milk, think baby and look at a picture of your baby. This stimulates your milk-producing hormones and activates your milk-ejection reflex, which gets your milk flowing. Pump as much milk as you can at least every three hours and store it in a refrigerator or use a portable cooler. If you are unable to take time off during your regular schedule to pump your milk, collect your milk during coffee breaks, lunch breaks, or more frequent bathroom breaks. Choosing an electric pump that uses a double (both breasts at once) pumping system should cut your pumping time in half.

At first your breasts my leak milk, perhaps when you think about your baby or during usual feeding times. To deal with this tug from your hormones, nonchalantly fold your arms across your chest, applying pressure directly to your nipples for a minute or two. Also during the first week after going from full-time to part-time breastfeeding, expect your breasts to fill up periodically at feeding times as a reminder to pump. After the first two weeks your body will naturally make biological adjustments to adapt to this change in routine.

Storing and Transporting This Liquid Gold
Stockpiling a supply of nature's most valuable nutrient is an investment in the future nutrition and health of your baby, especially as a reserve when you return to work, during a major illness, or in any other situation that may temporarily separate mother and baby. Here's how to take care of this valuable product.

Storing Expressed Milk
Reusable items involved in the collection and storage of breast milk need to be cleaned and sterilized. Rinse all milk containers, bottles, and accessories with cool water, then wash them well with soap and hot water. A dishwasher with a water temperature of at least 180 degrees F/82 degrees C adequately sterilize these items. (For an alternative approach, follow these Tips For Quick and Easy Sterilizing and Formula Preparation. 1. Use disposable pre-sterilized nurser bags to hold the formula in a plastic holder; this is convenient and minimizes air swallowing, as the bag collapses during the feeding. 2. Use a dishwasher to sterilize bottles and nipples, and use ready-to-feed liquid formula. No water to boil, no extra sterilizing or measuring needed.)

To safely store the milk, follow these suggestions:

* Wash your hands well before collecting your milk.
* Use hard plastic or glass containers.
* If you find disposable plastic storage bags the easiest to store and transport, be sure to double bag in case the outside bag tears.
* Use four- to six-ounce containers, a few of them filled with only two ounces (one ounce equals approximately thirty milliliters). This makes thawing easier and wastes less.
* Freezer bags sold through the La Leche League catalog are especially designed for freezing and storing breast milk (self-sealing and pre-sterilized).
* Leave space in the container at the top of the milk, allowing for expansion as it freezes.
* Date each serving, placing the oldest in front, and note anything that you've recently ingested that is not routine -- for example, any unusual food, medication, even aspirin.
* You can add to milk that is already frozen, but be sure to chill the new milk first in the refrigerator, as adding warm milk can defrost the top layer of the frozen milk.
* Breast milk may be safely kept unrefrigerated in a clean container or six to ten hours. However, we advise refrigerating milk as soon as possible after it is expressed.
* Breast milk may be stored in a refrigerator for up to eight days before use, after which it should be frozen. Fresh breast milk is better for baby than frozen, so if you know you will be using it within a few days, store it in the refrigerator.
* Milk can be stored in:
* the freezer section of a one-door refrigerator for two weeks.
* the freezer of a two-door refrigerator/freezer for three to four months.
* a deep freeze at constant 0 degree F (-18 degrees C) for six months or longer.

Using Stored Milk
Freshly expressed breast milk may be given to baby within several hours without any special storage. Milk that has been stored, however, requires special care.

* To defrost milk, place the container of frozen milk upright in a bowl of warm water.
* As you warm the milk, turn the container around and around to mix the separated cream and milk, and swirl the bottle of milk again before feeding. Don't heat beyond body temperature, as heat destroys enzymes and immune properties.
* If you do not use all of the milk in the container, you can refrigerate the remaining milk and use it again within the same day. Don't refreeze thawed milk.
* Do not:
*Thaw frozen milk on top of the stove; overheating may result.
* Heat breast milk or formula in a microwave oven. The uneven heat may cause hot spots and valuable nutrients may b destroyed; also, microwaving weakens the infection-fighting factors in breast milk.
* Refreeze thawed breast milk; this may allow bacterial growth.

Be proud of your milk bank. A dual-career mother and committed breast feeder, reserves a shelf in her freezer for at least a dozen neatly stacked and dated bottles of her expressed milk. She proudly refers to her collection as "the bank."

Transporting Expressed Milk
In making the milk run from work to home, take great care to protect your precious cargo. An insulated bag filled with ice packs is best for transporting milk. Special insulated milk-transport tote bags and containers are available from lactation consultants and La Leche League.

What's In It For You?
Is all this paraphernalia, pumping, leaking, storing, and making the milk run really worth it? A resounding yes! Mothers who are juggling breastfeeding and working have seen their investment pay off. There have even been several flight attendants who are away from their babies two or three days at a time, but have managed to continue part-time breastfeeding for two years. Their testimony: "We feel closer and more sensitive toward our babies." As an added benefit, working mothers notice the relaxing effects of breastfeeding. One mother, who has an executive sales job, reports, "I have a very stressful job and I'm very tense when I return home. I settle down and breastfeed my baby. She feels better and I feel better. What a happy reunion."

There will be more articles on breastfeeding, raising baby and other related topics so be sure to keep an eye out for my articles.