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Breastfeeding When You Go Back to Work

5 easy tips for the transition

January 28, 2014 by Ayelet Kaznelson, CLC, IBCLC

This article first appeared on the Seleni institute Website http://seleni.org. The Seleni Institute is a nonprofit organization that provides the care, information, and research support central to women’s reproductive and maternal mental health and well-being.

Some moms look forward to the day they will return to work and re-enter a familiar environment from their “old life.” Others dread it after having concentrated time with their baby at home. However you feel, my advice is to not think about it at all until your baby is at least 1 month old (unless, of course, you have to return to work right away). Once breastfeeding is established and going well, it’s a good time to start thinking about a plan to continue breastfeeding when you go back to work.

Start small by collecting a little milk in the days leading up to your first day back. You want to have at least enough milk for the first full day you’ll be away. Most women find that they have the highest surplus of milk in their breasts after morning feedings.

Be careful not to pump too much. You want to get a little extra, but you don’t want to cause overproduction, which can bring its own problems (such as plugged ducts and mastitis).

If you want to build up a reserve in the freezer, do so in small increments. Assuming your milk production is adequate, an ounce here and there is the way to go.

To estimate how much you need for a day, know that by the time most babies reach nine pounds (or by about one month of age), most will take an average of 25 ounces daily, divided by the number of feedings. So a baby who eats 7 or 8 times each day will need 3 to 4 ounces of milk per feeding.

Return to work midweek if possible. That way, you can ease in slowly and have a weekend right away to regroup and prepare for a full week back. If you have any flexibility in your work schedule, consider working from home one day a week or more.

You may still need someone to come and care for your baby while you work from home, but it will help keep up your production if your caregiver can bring the baby to you for a feeding or two.

Get a good pump. The Affordable Care Act mandates coverage of breast pumps, so check with your health insurance to see which brands are covered and how much they will pay. Also make sure the models they cover will suit your needs.

Most women find that a buying a double electric pump or renting a hospital-grade pump is most effective. Start using it a few weeks before you return to make sure it works well and you’re comfortable with it.

You can also ask your HR department whether your employer provides pumps or pumping rooms.

Pump every three hours at work or as close to your baby’s usual feeding times as possible. If you live near your workplace, ask your caregiver to bring the baby to you on your lunch break for a feeding. Many women find that looking at a photo of your baby or smelling a blanket or onesie helps get the milk flowing. Some moms say that listening to a recording of their baby cooing and babbling helps as well.

Make it work for you. If you can’t (or don’t want to) pump at work, you can still continue breastfeeding before and after work and on the weekends. If you are able to pump at home, you can use some of that milk for feedings during the week.

However, you may find that your production declines, so talk with a lactation consultant about the best way for you to maintain an adequate level of milk production.

The most important thing to remember is that going back to work doesn’t have to mean the end of breastfeeding. There are many ways to combine work and breastfeeding. Contact a lactation consultant or go to a breastfeeding support group if you need help preparing for the transition or troubleshooting issues that come up. But the bottom line is, you can do it.

5 Signs You Need Breastfeeding Help

Common problems that a lactation consultant can help you overcome

June 27, 2013 by Ayelet Kaznelson, CLC, IBCLC

This article first appeared on the Seleni Institute website http://seleni.org. The Seleni Institute is a nonprofit organization that provides the care, information, and research support central to women’s reproductive and maternal mental health and well-being. 

Some women find breastfeeding easy and enjoyable right from the start, but others hit a few bumps along the way. If you are struggling with any of the issues listed below, know that there is almost always a way to overcome them with the right support.

Nipple pain. Although nipple pain is common, it is not normal and is usually a sign that something is not going well. The most common reason for nipple pain is an improper latch. Nipple pain is one of the main reasons women stop breastfeeding sooner than planned.

If you find yourself dreading feedings, tense up during them because of pain, or have a nipple injury, it’s definitely time to see a lactation consultant. Getting help in the early stages will help you recover faster and prevent more problems from developing. A lactation consultant can get you back on track to a pain-free and enjoyable breastfeeding experience.

Latch difficulties. A lactation consultant can also help if your baby cannot attach to your breast at all or is unable to stay on long enough to complete a feeding. Sometimes simply adjusting your feeding position or latch will help her stay on successfully. Other times anatomical issues related to your baby’s mouth, tongue, or palate can cause problems. In that case, a lactation consultant can refer you to a health care provider to help with your particular issue.

Breast surgery. Surgeries, especially breast reductions, can sometimes lead to decreased milk production and make breastfeeding more difficult. If you have had breast surgery, it’s a good idea to contact a lactation consultant before you give birth to learn what may help you breastfeed successfully. After delivery, it’s important to have your milk production assessed by an experienced lactation consultant to make sure your baby is getting enough milk – and to come up with a plan if she is not.

In general, breast augmentation surgeries don’t usually impact milk production or breastfeeding much, but it’s still best to talk to a lactation consultant for advice specific to your situation.

Breastfeeding After Breast and Nipple Surgeries is a great online resource with more information.

Issues with baby’s weight gain. If your baby is gaining weight too slowly, not gaining at all, or is losing weight, it’s very important to have an international board certified lactation consultant assess a feeding. Whether or not your baby’s pediatrician suggests that you supplement feedings with breast milk or formula, a lactation consultant can be instrumental in making sure your baby is getting enough milk – and coming up with a plan if she is not.

Complicated delivery. Not every complicated labor and delivery causes breastfeeding difficulties, but some complications, such as an unplanned c-section or excessive blood loss, can present problems. If you feel the circumstances of your delivery are making it challenging for you to breastfeed successfully, a lactation consultant can make things easier or reassure you that things are actually going well.

Get help with whatever breastfeeding issues you encounter. Research shows that a lack of support is one of the reasons women stop breastfeeding. If it’s not possible for you to have an in-home visit from a lactation consultant, many hospitals and other organizations offer support groups and outpatient clinics. And sometimes even just a brief call or email can provide the support you need to achieve your breastfeeding goals.

 

Ten Myths About Breastfeeding

What’s normal, what’s not, and when to get help

May 6, 2013 by Ayelet Kaznelson, CLC, IBCLC

This article first appeared on the Seleni Institute website http://seleni.org. The Seleni Institute is a nonprofit organization that provides the care, information, and research support central to women’s reproductive and maternal mental health and well-being. 

1. Breastfeeding should come naturally.

Though biologically natural, breastfeeding is actually a learned behavior. Like any other new skill, it may take time, practice, patience, and persistence to master. It can be quite frustrating at times. And during the already emotionally fragile period after having a baby, it’s even more difficult to cope with frustration and difficulties. But breastfeeding will become easier with time and professional help, if necessary.

2. Nipple shape matters.

For most women, nipple size or shape has no impact on breastfeeding. If you have flat or inverted nipples, they may self-correct by the time the baby arrives or shortly thereafter. Even if the shape doesn’t change, it may not impact breastfeeding much. Babies breastfeed, not nipple feed. However, in some cases nipple shape can make breastfeeding a little more challenging. If that happens, a knowledgeable lactation consultant can offer some strategies, such as wearing breast shells or nipple shields, pumping, and using manual manipulation, to help overcome those challenges.

3. Small breasts won’t make enough milk.

The capacity for a woman’s breasts to make milk is determined by the breast tissue (milk-producing cells), not by the size of her breasts. Breast size is determined by fat, which has no bearing on milk production.

4. If breastfeeding starts out difficult, it will just get worse.

Most breastfeeding issues are manageable and can be overcome in a relatively short amount of time. Some challenges, such as nipple pain, are fairly simple and can be taken care of rather easily by adjusting the latch, for instance. Other problems, such as low milk production or a baby who is unable to latch, can be more complex. But with the right support – such as the help of an internationally board certified lactation consultant – you can overcome almost any breastfeeding problem.

5. Nipple pain is normal.

Nipple pain is common but not “normal.” Nature designed breastfeeding to feel good. When breastfeeding works, it floods our system with hormones that contribute to relaxation and mother-infant bonding. Pain does the opposite; it fills our bodies with stress hormones. Tugging and pulling is normal and painless. Sometimes a woman may experience slight discomfort for the first few days. If you find yourself dreading feeding, curling your toes to get through the pain, or tensing up as your child begins to nurse, something is not working. A board certified lactation consultant can help you improve your position and help you work on a painless latch.

6. Babies should only nurse from one breast at each feeding.

Most babies need to feed from both breasts. Some take the same amount of milk from each, and some take most of the milk from one and “dessert” from the other. A few don’t need the second breast at all. In the beginning, try to feed your baby from both breasts at each feeding. If you notice at any point that your baby is not interested in feeding from both breasts, seems satisfied after feeding from just one breast, and is gaining the appropriate amount of weight, that arrangement may be just fine. You may need to pump a little milk from the second breast to avoid getting overly full (engorged) as your body adjusts.

7. Newborns need schedules.

The American Academy of Pediatrics recommends that babies be fed every 2 to 3 hours (or about 8 to 12 times in a 24-hour period) during the first couple weeks of life. But once your baby is back to birth weight (by two weeks at the latest), you can start following her cues. Feed her when she shows signs of hunger, such as restlessness, smacking and licking lips, sucking on hands, or opening and closing her mouth. Most babies start to have a more predictable eating pattern within a few weeks.

8. Skipping feedings won’t affect my production.

If you give your baby a bottle of pumped milk or formula, you need to help prevent your breasts from becoming engorged and your milk production from diminishing. When a hungry baby is breastfed, the breast and brain get the message to produce milk. If your child is fed from a bottle instead of directly from your breasts, extra milk could build up in your breasts. This can lead to painful overfullness, or engorgement. That, in turn, tells the brain to slow down milk production. To avoid both of these problems, the best solution is to pump whenever your baby is fed with a bottle.

9. You will probably need to wean when you go back to work.

Going back to work doesn’t have to mean the end of breastfeeding. If you can pump once every three hours when you are away from your baby, you should be able to maintain adequate milk production.

If it’s not possible to pump that much during work (or you don’t want to), you can pump at other times and breastfeed when you are home with your baby. Some women decide to pump immediately after breastfeeding at home, especially on weekends, to keep milk production up and to get more milk stored up for the workweek.

Many moms find they’re able to breastfeed in the morning before leaving for work, in the evening after they get home, and on weekends and holidays. You can supplement the rest of the feedings with pumped breast milk or infant milk substitutes (formula).

If you wean from pumping at work, your milk production may decrease just a little or it may decrease significantly. Your baby might be okay with continuing this pattern for a while, or she may wean shortly after you stop pumping at work. You won’t know until you try, but the bottom line is that going back to work doesn’t have to mean weaning.  You may need to be creative, but it is possible to work and continue to breastfeed.

10. You can’t take medications when you’re breastfeeding.

Many medications are compatible with breastfeeding. If you’re taking one that isn’t, you may be able to find a safer substitute. Ask your doctor or lactation consultant to look up the most recent data on any medications you need. If you have to take medication that is not safe for breastfeeding, pump and discard your milk while taking the medicine and then resume breastfeeding after it’s no longer in your system.

 

Going Back to Work and Breastfeeding – Ayelet Kaznelson, CLC, IBCLC, October 17, 2012

This article was first posted on Milk Diary. http://www.milkdiary.com/blogs/news/6742316-going-back-to-work-and-breastfeeding-ayelet-kaznelson-clc-ibclc

You’ve had your baby. You have gone through the most vulnerable part of the post partum period. “The First Three Months”. You may have had to deal with breastfeeding challenges, or you may have had a relatively easy time with it. But regardless of how it all started for you, it is now time to go back to work. By the way, I realize that some of you may have to return to work earlier than 3 months. The same rules apply.

“Work”. That time you have been thinking about from the beginning, right after your baby was born. Those middle of the night anxiety-provoking thoughts, possibly dread, or maybe anticipation and excitement. We each have our own unique response toreturning to work. But regardless of how you feel about going back there are a few things you can do to prepare.

First, about three weeks before your first day back at work, you may want to start building a small reserve in the freezer. But hear me, ladies, when I say SMALL!  I know you moms. I say “build a reserve”, and before you know it, you have 1,000 ounces of extra milk stashed away in four freezers: yours, your mother in-law’s, your best friend’s and neighbor’s. I really mean only having 2-3 days extra stored in case the first few days of pumping at work are not going as smoothly as you’d like.

If you have nothing stored yet, you want to start pumping occasionally after the morning feeds. An ounce here, an ounce there. Be mindful not to pump too much as to not to create an overproduction. It may sound appealing at first, but too much milk has its own set of problems.

Start freezing the milk in different increments: 1, 2, 3, and 4 ounces.  Place them in milk storage bags. Make sure to place the bags flat, so when the milk freezes, it is very thin, thus taking less time to defrost and also takes less room in the freezer.

In terms of which pump to use at work; you can use an electric pump, or you can buy a hand pump. Some really like to have the most efficient pump on the market, the hospital grade pump. However, keep in mind that this is a very heavy pump and not so easy to carry around, especially if you are using public transportation. You may need to leave it at work, and if you need to pump at home as well, you will need to get another pump for your home.

You want to pump once for every three hours you are away from your baby, if at all possible. Most mothers need to pump both breasts at the same time for about 15 minutes to get about the same amount as the baby is taking from the bottle. But if you don’t need that much time to get that amount, pump for less.

Another thing to think about is where will you be pumping. What room? Do you need to contact anyone at work in advance to set up a room for you? Do you have your own office? Does it have clear large windows that may need to be covered or can you lower the blinds and have privacy?  Do you have a hands-free pumping bra? Many women find hands-free to be very helpful.

In terms of when you are starting your first day, some women report having a better, smoother, and easier transition when their first day back at work is a Wednesday or a Thursday. This way, the first week back at work is short and allows you to have the weekendto figure out any issues that might come up during the first 2-3 days and relax with your baby.

You have rights. Pumping in the work place needs to be something you should be able to, if this is your wish. Here is a link for you to read regarding laws protecting your rights to pump and getting pumping breaks at work:

http://www.ncsl.org/issues-research/health/breastfeeding-state-laws.aspx

If pumping at work is not something you want, can, or are allowed to do, yet you still want to partially breastfeed, know that many moms find they are able to breastfeed in the morning before they leave for work, in the evening after they return from work and on weekends and holidays. For the rest of the feedings their babies are being supplemented with either frozen milk they have left over from earlier times or infant milk substitutes (formula).  Some women decide to pump extra after their feedings at home especially on weekends to keep milk production up and to get more milk stored up for the workweek.

If you wean from pumping at work, your milk production may decrease somewhat, or the decrease may be significant. Your baby might be okay with continuing this pattern for a while, or they may wean shortly after you stop pumping at work. But you won’t know until you try.

The bottom line is that going back to work doesn’t have to mean weaning.  You may need to think outside the box and be creative, but it is possible to work and continue to breastfeed.

For great information about milk storage guidelines and everything breastfeeding, you can go to kellymom.com.

 

The 411 on Pumping

This article first appeared on the blog weeSpring, September, 2013

What are the different kinds of pumps?

1. Hospital-grade electric pumps

A hospital-grade pump is the most efficient pump on the market. It’s a multi-user pump, which means it’s safe for many people to share it, as long as you have your own attachments that connect from your breast to the pump. It is usually quite expensive, so most women choose to rent. It is the optimal pump to initiate milk production, if you have milk production problems at first.

Reasons to consider renting a hospital-grade pump:

  • Have had breast surgery, especially breast reduction
  • Having multiples
  • Having a premature baby
  • Your baby has been hospitalized after delivery
  • Low milk production
  • Postpartum medical complications

2. Large portable double electric personal use pumps

A large, store-bought double electric pump is a great option for women who are going back to work or need to pump regularly. Most double electric personal use breast pumps can be used with store-bought, snug fitting hands-free bustiers or ones that you create out of an old sports bra. We advise caution with one particular pump model that advertises a “hands-free method” since its smaller size and rechargeable battery seems to be considerably weaker at maintaining an adequate milk supply.

3. Small electric double pumps

A small double electric pump generally has a motor, which is too small to be effective, and is usually not efficient enough for women who need to pump regularly.

4. Single electric pumps

A single electric pump allows you to pump only one breast at a time and is generally not very efficient.

5. Battery operated pumps

A battery operated single pump is also not reliable and will usually not work well for someone who needs to use it regularly.

6. Manual pumps

A hand pump can be quite effective for those who do not plan to go back to work, don’t want to give many bottles, and only need to pump occasionally.

7. Your hands

Although it may take some practice at first, some women learn how to use their own hands to extract milk and find it easy, pleasant, and efficient. Here is a link to watch how it is being done.

What does my insurance cover?

Many insurance companies now offer free pumps. Check with your plan to see what they offer participants. However, please keep in mind that many of these pumps are not considered particularly efficient or effective, and that some of the more reputable companies provide a “watered down” version of their top pumps to be used in this context. While these pumps may work well enough for you, you might find that you need to purchase or rent a more efficient pump.

If you live in the NYC area, there is a fantastic service at the Upper Breast Side, a breastfeeding resource center on the Upper West Side of Manhattan. They offer “The Milk Bar”, where you can get a thorough consultation. To find a lactation consultant wherever you live, click here.

When should I pump?

The general guideline is to pump whenever your baby is being given a bottle. How soon to start pumping after you give birth depends on how quickly you need/want to give your baby a bottle. If you need to supplement your baby with your own pumped breastmilk or formula, you will want to pump to avoid having your milk production decrease. Contact a lactation consultant to find out what the best pumping plan is for your particular situation. Most women need to pump for around 15 minutes to replace a feeding.

If you are pumping a little extra, along with breastfeeding, you want to pump after you have fed your baby so that you don’t compromise their milk intake from your breast. Most women find that they have the most surplus after morning feedings. Adding pumping sessions on top of breastfeeding can increase your production unnecessarily. Overproduction, tempting as it might sound, can have a negative impact on breastfeeding and should be avoided if possible.

How do I store my milk?

For milk storage guidelines visit Kelly Mom. This is the ultimate website for all evidence-based breastfeeding information.

How should I clean my pump?

If you have a healthy full term baby, and you have access to clean, non- contaminated water, many recommend just washing the pump pieces with hot soapy water after each use. Sterilize before first use. If you feel there is a reason to sterilize frequently, you can do so by either placing the pump pieces in a pot of boiling water, or by using a sterilizing kit in the microwave.