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W&P FAQ
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In this section you'll find answers to the most common questions we see on the Working and Pumping Board. Don't worry if you don't see your question/answer here. Just pop over to the board to ask!

Welcome to our FAQ!

Getting Started:

1. I'm going back to work soon and plan to continue breastfeeding. How do I do this?
Congratulations for choosing to continue your nursing relationship with your baby! With some good pre-planning, you can make working and pumping a success for you. Check out our Pumping Guide for more tips: (Getting Ready)

2. What kind of breast pump do I need?
Most women who need a pump for regular use (2-3 times per day; 5 days per week) need a good double electric pump.
 Here are some links comparing pumps:

3. When should I start pumping?
You can start any time after your milk comes in (usually the first few days after your baby's birth). Most women start when the baby is about 3-4 weeks and breastfeeding has been well-established. You should start at least two weeks before you start back to work (and earlier than that, if possible). Whatever EBM you get from these practice sessions will be the basis for your freezer stash--this will be your cache of extra milk that will get you through the rough times when you return to work! (How do I build a supply when I'm nursing.)

4. What kind of bottles/nipples should I use and how should I introduce the bottle?
This will depend on each individual baby, though many BF moms have had success using the Avent system. http://www.kellymom.com/bf/pumping/bottle-feeding.html

5. How can I tell how much expressed breast milk (EBM or EMM) to leave for my baby?  Try this handy milk calculator -  http://www.kellymom.com/bf/pumping/milkcalc.html

6. How often should I pump when I am away from my baby?
Ideally, you should be pumping for every missed feeding--usually every 2-3 hours. Of course, this schedule may change once your baby gets older. ("How often will I need to pump?")

7. What's the best time of day to pump?
Prolactin, the hormone responsible for lactation, is at it's highest concentration in the body in the morning. So, if you're trying to build up a freezer stash, it's best to try and pump right after the first feeding of the day. One method is to feed the baby first thing, take a shower, and then pump. The idea is that the shower relaxes you. You also might try pumping one side while the baby nurses on the other (or let the baby nurse on one side and then pump the other side afterwards).

8. What are some techniques to help me letdown for the pump?  http://www.kellymom.com/bf/supply/letdown.html

9. Should I pump while still on maternity leave? If so, how do I do this?
(See "Getting Ready--how do I build up a supply while I'm nursing?")

10. How do I know that my baby is getting enough?
You will know by the count of wet/dirty diapers your baby produces each day--6-8 per day is average for most babies from newborn to about 6 mos. Also, you should know that weight/height measurements are not always the best indicator of growth--BF babies typically grow more in the first 6 mos., and then slow down in the second 6 mos. of life. The head circumference measurement is much more important since it measures brain development. Also, the standard weight/height charts that most doctors use are based on formula-fed babies and are sadly out-of-date. For more information on BF babies weight/height charts and growth patterns see the following links:

11. Where will I pump at work? How can I approach my boss about this issue?
It is important to discuss this issue with your boss. Many states have laws that encourage businesses to provide a place for working women to pump. Check your state's laws here:

We suggest that you be professional yet firm when discussing the issue of BF/pumping with your boss or human resource department. Explain the benefits of BF (less time off work due to sick child, etc.) and that you need a room with a door that locks, a chair, and electric plug. You might be surprised at how well you might be accomodated if you state your needs clearly. If you can't get the above accomodations, see if you can at least get a room with a door (perhaps an unused conference room or office) or even a closet. Anywhere is preferable to a bathroom where, unfortunately, many women who pump are relegated to.

More links about working, BF, and the law:


Storage/Freezing Issues:

1. How do I store my EBM/EMM?
(See "How should I store my milk, and for how long?")

2. How much EBM do I need to have frozen for back up?
It really depends on your situation. If you are a person who has a high pumping output that is consistent, maybe you don't need a large freezer stash. If you have a job which requires travel, it's best to have a large freezer stash so you have enough for your baby while away. If you have an irregular pumping schedule, you might want to have a good freezer stash to make up for any missed sessions. One thing I would say is that I rarely have heard anyone regret having a large freezer stash but have heard plenty of people wish theirs had been bigger. Some people use exclusively frozen at DC. They take in all the milk for a week on Monday frozen. This saves carting time and is one less thing to remember every day. Technically, fresh is better than frozen, but frozen is better than formula. Freeze in small - 2 to 4 oz portions until you figure out how much your baby takes normally. (See "What is a freezer stock and why do I need it?")

3. Freezer bags? What's the scoop? Do I need the expensive ones?
People use a variety of containers: Medela CFS bags are probably the best, but they don't fit in to nurser type bottles and are expensive. Some use bottle liners double bagged with success. You will have to either use a twist tie or an Avent clip to close them. They have to be propped upright until frozen solid, they can be placed in a bin or large ziplock bag. Some people like the Mothers Milk Mate. Some use Rubbermaid or Tupperware containers.

4. What's the proper way to thaw frozen milk to feed the baby?
(See "How do I thaw frozen milk?")

5. How do I build a freezer stash?
Pump on the weekends in the mornings. Feed baby, shower, then pump. Or you can pump in the middle of the night if baby is not waking to eat. If baby is a one side at a feeding eater, you can pump the other side after a feeding. (See "What is a freezer stock and why do I need it?" and "How do I build up a supply while I'm nursing?")


Troubleshooting

Feeding issues:

1. Help, my baby refuses the bottle!
First off, don't panic! It is very common for babies to refuse to take the bottle. It is also common for babies who have previously happily taken the occasional bottle when younger to start refusing once you go back to work. It can be very stressful and worrying, but a lot of babies have been through it and none of them refused forever. The key is to remain calm and persevere with different tactics until you find one that works. Some things you can try--

  1. You should not be giving the bottle - many babies will refuse a bottle if mother is nearby because they know the breast is available. Sometimes they will even stop in the middle of a bottle if they hear you anywhere nearby. Make sure to hand the baby and the bottle to someone else, and to stay out of sight. Go out (go shopping, go for a walk) if need be when you know baby is hungry. It is hard, but it helps.
  2. Create a calm environment - put on a lullaby CD and get comfy. The baby needs to be calm in order to eat. This goes for the person feeding the baby as well - the baby will pick up any tension from the caregiver, and that will make feeding difficult. When baby starts to get frustrated, take a break - play a game, sing a song - and when everyone is relaxed, give the bottle another go. Don't let it turn into a battle or everyone will end up in tears.
  3. Remember, it's important that your baby eat. Don't refuse to give the breast at all in order to force the baby to the bottle. Baby needs time to get used to another source of milk, and it may take a few tries. It can take up to a week or more, but baby will eventually get the hang of it.
  4. Don't wait to try the bottle when your baby is starving - when baby is screaming for food is not the best time to start something new. Try the bottle at the very first signs of hunger, or even earlier - think of feeding the baby as a game, and he will too. Try slipping a bottle in just as baby is waking up, or during a 'fun' time like bathtime.
  5. Make sure the milk is at room temperature, as most babies prefer slightly warm milk - after all, they are used to milk stored at body temperature. Try it even warmer than this as well (but be careful not to scald baby!) as a lot of breastfed babies seem to prefer their milk at least at blood heat. On the other hand, although rare, some babies seem to prefer it cold so experiment. It is best to stick to expressed breastmilk though - this is not the time to introduce new tastes like juice or formula.
  6. Rub some milk on the bottle's nipple to encourage baby to try it.
  7. Try different positions. Some babies like to be held as if they are nursing, others prefer to face outwards, or prefer not to be held at all but to sit in a rocker or car seat facing you. You could also try offering the bottle in the middle of a nursing session when baby is relaxed but not yet full. (We know, this contradicts the 'mother shouldn't be offering a bottle' advice but it worked for one mother!)
  8. If you've tried several times with no success, try another teat type, or even a sippy cup (Avent bottles have sippy cup attachments - this can work very well on older babies [4m upwards] and you won't have to wean to a cup later). Your baby may not like the nipple you've been using. Some breastfed babies seem to prefer strange shaped teats like the Playtex, others prefer silicone or rubber. Some seem to prefer the collapsible disposable systems (Avent, Playtex and other make these) to bottles.
  9. You can also try giving the baby a bottle in his sleep. Most babies suck in their sleep and will at the least get some milk that way.
  10. If all else fails, use a spoon, or an eyedropper! It's hard and it's messy, but it will work. You could try using a syringe first to take the edge off baby's hunger, then introducing the bottle.
  11. Remember, in all the years that mothers have been working and pumping, no baby refused a bottle forever. Something will eventually click and your baby will take a bottle. Then, of course, you might want to check out the nursing strike section when they start preferring the bottle to breastfeed, but that's anoter story--
Some links that may help:

http://boards.parentsplace.com/messages/get/ppworkingandpumping110/13.html
Also check out the W&P Guide

2. My supply seems to be dropping! Why is this happening and how do I increase it?
There are a few times during the first year when it seems most moms experience a drop in supply--those are: the second week after returning to work, sometime around the baby's 6 mos. birthday, and then again around the baby's 9-10 mos birthday. BF is all about supply and demand, so there will inevitably be some peaks and valleys. Here are some links to help you out during these times:

3. My baby refuses to nurse!
Here is some help with nursing strikes, getting newborns to get the hang of nursing, and dealing with babies over 12 mos. refusing to nurse:

4. My baby doesn't eat much during the day at daycare, but wants to nurse all night--why is this happening?
This is called reverse-cycling, and is your baby's way of telling you that s/he really prefers you over bottles! As long as your baby is producing enough wet/dirty diapers (6-8 per day), everything is fine. You may find that co-sleeping or "doing the family bed" will help you get much-needed rest during this time (especially if your baby wants to eat several times during the night). And you can build up your freezer stash with all the extra EBM you'll be getting!

There is another phenomenon called "cluster-feeding" where the baby wants to eat constantly in the evenings after you get home. Again, this is the baby's way of getting enough nursing in.

5. My baby has hit a growth spurt--how do I keep up with his intake of EBM?
(See "Help! My baby's going through a growth spurt!")

6. Are there any herbs or foods that I can eat to increase my supply?
Check out this link for information on herbs/foods that increase supply--


Also, see the other questions on increasing supply.

7. My freezer stash has dwindled and I'm having trouble keeping up, how can I build my stash back up?
The best advice is to pump, pump, pump! Also, make sure you are drinking plenty of water and getting enough rest. Sometimes just taking a weekend to pump intensively (in the AM, after each feeding, at night, etc.) will get you enough extra to start building that important freezer stock back up. Also see the questions relating to building a freezer stash and increasing supply.

8. When is the best time to start solids and what should I start with?
Opinions vary on when to start solids--but most experts say that you should wait until the baby shows interest. That may not be until the baby is 8 months old or more. One thing you should NEVER do is to put cereal in a baby's bottle--it is actually a choking hazard for the baby. The Academy of American Pediatrics says that breastmilk should be the primary source of a baby's nutrition for the first 12 mos., so think of solids as just practice until then. Here are some links that might help:

9a. What should the smell and taste be like with Frozen Milk (EBM)?
Information from Parentsplace's Lacatation Consultant

9b. I'm too embarrassed to breastfeed in public--how do I feed my baby when we're outside the home?
Breastfeeding in public is a learned art--you will get better at it with practice. Try practicing in front of a mirror--you will probably find that you show less than you thought. Wear separates--tops that pull up easy from the bottom--this will help you to get the maximum coverage while BFIP. You can also use a babysling or blanket to cover you and baby. One of our members talks about BFIP:

10.  I am having trouble with let down, what can I do?

11. Help, my baby will not take frozen breastmilk, what can I do?


Breast/Nipple concerns:

10. My nipples are sore, cracked and/or bleeding!
(See "How do I heal a cracked nipple?")

11. Help, there's a hard, red lump/spot on my breast and I feel like I'm coming down with the flu!
Sounds like mastitis. You should call your health care professional as soon as possible. Mastitis, if not treated promptly, can turn into a breast abscess--a very nasty infection, indeed. Don't let anyone tell you that you need to wean because of mastitis--the very best thing you can do is get your baby to nurse on the infected side as often as possible. Use hot compresses to relieve the pain. You can also try herbal remedies if you are unable (or unwilling) to take antibiotics--echinacea, oregon grape root, and garlic are all good infection-fighters.

12. My nipples are itchy/sore and my baby has white patches in her mouth--what is this?
Probably thrush--both baby and mom should be treated for this. Here are some links that should help:

13. Is it normal for one breast to produce more than the other? Yes it is. Most women tend to be lopsided when it comes to production. If you can express more milk from one breast than the other, don't worry. This is normal.


Work issues:

14. I've just returned to work and I'm an emotional wreck. I keep crying. How do I get through this?
The first week is the hardest, emotionally. It will get better! A good support group helps--if you don't have one near you, you can access our Working and Pumping board. There are lots of women there who have done this before you, and they can offer support and encouragement. And keep in mind that you're doing this to provide your baby with the best nutrition possible! Make sure to take pictures of the baby with you to work, and enjoy that re-connecting time with your baby at the end of the day.

15. I forgot my pump at home! Now what do I do?
If you can't use your electric pump, try hand-expression (sometimes called the Marmet Technique). Here's link with detailed information on how to do it:

Believe it or not, some women are so good at this that they don't need or use electric pumps (kudos to them!). If you are worried you might forget pump parts, get some extras to keep at your desk so that you'll be okay if you forget parts at home.

16. The place set aside for me to pump at work has been taken away. Now what do I do?
The first thing to do is to alert your supervisor and/or Human Resources department about this problem. Usually it can be taken care of at this level. If the problem persists, you may need to find out about the laws in your area (see "BF & the law" links in question 12 under the first section). Above all else, don't give up!

17. I don't have much time to express milk. Are there any strategies I can use to make pumping faster or to work while I pump? Any standard tricks for making this easier? (ie. rubber bands, leave tubing attached, get two sets of horns, spare bottles or parts in desk etc).
Some moms get more than one set of horns, etc. so that they don't have to wash the parts each time--just put the used parts in a baggie and wash them all in the dishwasher at home. Also, you can leave the tubing in place on your pump until the end of the day. And it's always a good idea to have extra pump parts at work in case of an emergency!

Here is the famous "hands-free" rubberband trick:
Get two rubber bands and attach them to your nursing bra. (One for each side) With one of my nursing bra the "hook" of the hook and eye closures is at the top, so I can just hook the rubber bands on. With the other bras, they "eye" part is at the top, so I stick the rubber band through and loop it through itself to anchor it. Then stick the horns of your pump through the other ends of the rubber band. I have the Pump-in-style and usually start out on low suction in the beginning and have to hold the horns on, but after about a minute when I get let down and switch to medium suction--the suction is greater and the rubber bands give support so they stay on by themselves. Also I lubricate the horns with a little water and this helps the suction.

Another tip-- if your bra has more than one "eye" part to hook into to allow for various stages of fullness, you can thread the rubberbands through the second eye and just leave them there. Then use the first or third to hook the bra into when you're done pumping. It makes it nice, you only have to the setup once. (You can even wash the bra with the rubberbands in place.)

18. When do I get to eat if I'm spending my breaks pumping? Isn't it important to eat properly when you are BF?
Yes, it is important to eat properly while BF. Most women find that they can do at least one other thing while BF (see "hands free trick" in question 16)--make phone calls, read magazines, type on the computer, and even eat and drink! Bring snacks to work that are not too messy and eat them while you're pumping. Some suggestions are: trail mix (the peanuts are especially good for keeping up milk supply), cut-up veggies, rice cakes, anything with oatmeal in it (like cookies, etc.). And always keep a cup/mug of water by your side--pumping makes you thirsty! Try to drink to thirst throughout the day.

19. What do I do about keeping everything sterile?
(See "Do I really have to sterilize everything?" and "how will I ever wash all these bottles?")



Travel issues:

21. I have to go on an overnight business trip away from my baby. How do I do this and continue to nurse/pump?
You will have to start planning for this several weeks ahead of time if you don't have a good freezer stock already. Call the hotel ahead of time and arrange for a fridge to be in your room. Don't be surprised if you have to remind the staff at check in. While the fridge is cooling, you can put any EBM on ice in an ice bucket. If you have a Purely Yours pump, I suggest you buy extra ice packs and use the second storage compartment for carrying milk as well. This will allow you to transport 12 4 oz bottles. If you don't have this pump, you will need to bring an extra insulated bag for transporting your milk back home. Bring a tiny container of dish soap to wash your horns. If your pump runs on batteries, don't forget spare batteries because they are used quickly. Try to pump every 3 to 4 hours( I even pump in the night since my baby eats at night) Don't be surprised if you come home slightly more engorged then you normally would be - even if you are used to pumping. Babies are much more efficient than pumps. Sometimes the little fridges aren't cold enough o freeze your packs solid. Ask room service to take your freezer packs to the kitchen freezer at night. It might be helpful to have a ziplock bag with your name on it for this purpose.

22. I am travelling for a whole day with colleagues and will have no privacy all day. What do I do?
If your pump runs on AA batteries, you can use the restroom stall. I might suggest you buy a Avent ISIS, for use on these occasions, since it doesn't require an outlet. The Purely Yours pump is another option since it runs on AA batteries. Another Idea is to bring an extension cord and run it to the bathroom stall. On one occasion I made arrangements to borrow a hotel room for 15 minutes at the hotel I was attending a conference at. This worked well.

23. I have a job that involves a lot of time on the road. Any ideas on how to combine regular travel with pumping?
You can refrigerate milk for several days, so if it is less than a week, I'd just carry it back on freezer packs. If you must be away longer than a week, I recommend you either dump the oldest milk or have your hotel freeze it. Take along a picture of your baby and maybe a blankie with baby's smell on it. After a couple of days letdowns are harder and you'll want every trick you can think of.

Links to old boards discussing Pumping & traveling tips:
http://boards.parentsplace.com/messages/get/ppworkingandpumping111/25/1.html


Other issues:

24. My baby just got teeth and has started to bite me while nursing--how do I stop this?
The best way to stop biting is to pull the baby close to the breast as soon as s/he bites. This forces the baby to open her/his mouth in order to breathe and stops the biting. I know how hard it is to do that, though, when your instinct is to get the baby off your breast as soon as the biting starts! If a baby is nursing properly, the tongue inhibits biting, so it usually occurs after a feed when the baby is still latched on. You can watch for the real ending of a feeding, and take the baby off when it's over. For older babies, some moms have had success with simply taking the baby off the breast when the biting happens, and saying, "No biting" in a fairly stern tone (not too loud or it will scare the baby!). The baby will usually get the message that biting equals no nursing! More info on biting:

25a. I haven't had a period in a while--when can I expect it to return?
Ahh& the return of AF (Aunt Flo)! Theoretically, the hormones that help you to breastfeed inhibit the return of your period until you stop breastfeeding. But, many women can tell you that AF returned as soon as a month after birth even though they were exclusively nursing. Some women have gone as long as a year without a period while nursing. It depends on the individual and their situation. If you want to suppress ovulation and AF's return, you should try to continue to nurse exclusively for as long as you can. But beware that this is not a reliable form of contraception!

25b. Tips on sterilizing pump parts in the microwave
Tip from Kristy


Weaning:

26. Now I'm ready to stop pumping (because I've met my goal!)--how do I "wean" myself off of the pump? What do I give my baby in place of EBM? Can I continue to nurse?

Congratulations on making it to this far! When you are ready to stop pumping, the first thing you must decide is what you will substitute for your milk. You should discuss this with your pediatrician. If your child is less than 12 months old, you will need to give him an infant formula. You may need to introduce formula gradually so that your child gets used to the taste. You can begin by mixing formula with EBM and gradually increasing the ratio of formula to EBM. If your child is over 12 months old, you can begin giving cow's milk (with your pediatrician's approval). Other options are soy milk or rice milk.

You will want to begin by eliminating one pumping session at a time. There is no set way to go about this, but here are some suggestions.

  • When eliminating a pumping session, try to move it later over a few days until you no longer need that session.
  • As you are eliminating sessions, you may feel engorged. If this occurs, you may want to pump just enough to relive discomfort. Your body will need time to adjust to a new schedule.
Will you still be able to nurse while you are with your baby?
For many women, the answer is yes! Your body will adjust so that you produce milk as needed, for instance in the morning and evening. You can try nursing during the day on your days off, however, you may feel fuller when you are back at work. Some women may not continue to produce enough milk to continue nursing. In this case you may need to wean entirely. Whatever your situation may be, you have done an outstanding job of giving your child a wonderful start in life!

27. Help, my baby seems to be weaning herself and she's under a year old--what do I do?
According to most experts, babies under the age of one usually don't wean themselves. It may be a nursing strike that you're dealing with (See question on nursing strikes). Here is some more info about self-weaning under age one:


Related Links:

1. Places to buy pumps, nursing bras, etc. on the web:

2. Organizations that support breastfeeding

3. Personal home pages that are just great!
These are the 2 pages we got the majority of our info for this FAQ from:

4. Special breastfeeding situations:

5. Benefits of breastfeeding

6. Extended breastfeeding

Nursing Toddlers

8. The American Academy of Pediatrics official policy on BF:

9. Children's books that include BF:

10. Some interesting sites on bacteria growth in breast milk: