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A Working Mom's Guide to Breastfeeding

Reprinted via Permission of Marike For Rachel and Ben
With love from Marike and Gray
And with thanks to the dedicated working and pumping mommies at ParentsPlace.

Table of Contents
  1. The Pump 
    • When should I get a pump?
    • What kind of pump will I need?
    • Where can I find a pump?
    • Should I buy or rent?
    • Should I buy a used pump?
  2. Introducing the Bottle 
    • What type of bottles should I use?
    • When should I start to give my baby a bottle?
    • What do I do if my baby refuses the bottle?
  3. Getting Ready 
    • How can I prepare myself and my baby for my return to work?
    • What will I need to pump at work?
    • What is freezer stock and why do I need it?
    • How do I build up a supply while I'm nursing?
    • What should I wear to work?
  4. All About Milk (EBM) 
    • How much will my baby take at each feeding?
    • Fresh or frozen?
    • How do I thaw frozen milk?
    • How should I store my milk, and for how long?
    • My milk separated - do I have to throw it out?
    • How can I tell if my milk is bad?
  5. Supply & Demand 
    • I don't get let-down when I pump - what can I do?
    • How often will I need to pump?
    • My supply is dropping - what can I do?
    • What harm will a pacifier do?
    • Help! My baby's going through a growth spurt!
    • Will my baby always need this much milk?
  6. Problems
    • How do I heal a cracked nipple?
    • What can I do to prevent plugged ducts?
  7. How Am I Going to Make this Work? 
    • What does a typical pumping mom's schedule look like?
    • Do I have to lug this pump back and forth every day?
    • Do I really have to sterilize everything?
    • How will I ever wash all these bottles?
  8. Resources
  9. Testimonials
The Pump
When should I get a pump?
The answer to this varies from mother to mother. Some say it's best to be prepared early and to get a pump before your baby arrives - that way you will be prepared if your baby is born prematurely or is ill at birth and you need to pump to start your supply. You will also be able to pump to relieve engorgement when your milk comes in - a big plus!

However, if you want to wait, you can. You don't really need a high-quality pump until you start getting ready to go back to work - which will be when your baby is about 6 weeks old, regardless of the date you actually plan to return. If you do need a pump in the hospital, your hospital will either provide one or help you find one. It is nice to have a small manual pump around for engorgement (see "What kind of pump will I need?", but hand expression will serve just as well for that purpose.

If you are not 100 percent certain that you will be returning to work once your baby is born, it is a good idea to wait - pumps are considered personal hygiene products and are *not* returnable.

What kind of pump will I need?
There are many different pumps to choose from, and each one fills a different need. Here's a brief rundown of what's available and how they might help you. It is not a comprehensive list - it is more designed just to give you an idea of what sort of pump you will want for your own needs.

The Manual Pumps Avent Isis is one of the best in the manual class. A manual pump is good for one-time pumping, say for an evening out, or to relieve engorgement. Mini-Electrics Medela Little Hearts, Evenflo Mini-electrics as a class tend to be overpriced for their purpose. They are designed to be used not more than once a day. Generally they offer little cycle control, and the pumps can therefore be painful to use. Used more than once a day, they will burn out and lose suction. You are better off with a less expensive manual pump. Double Electrics Ameda Purely Yours, Medela Pump In Style (PIS); these pumps were designed for working moms. They are close to hospital grade and come with discreet carrying cases, cooler packs, storage bottles, etc. They offer variable controls and are comfortable and easy to use. Either would be perfect for a mom who works full time, or even an extended part-time schedule. Hospital Grade Ameda & Medela both make hospital grade pumps These pumps are offered as rentals and are often purchased by companies who support nursing mothers with a fully equipped lactation room. They are generally too expensive for a working mom to buy.

You will need to decide what pump to buy or rent based on your own schedule and your own likes. However, if you are returning to work full time or will be gone for more than one feeding a day, you must have a high-end double electric or hospital grade breast pump. The other pumps will not maintain your supply as effectively and are less efficient, which means you will spend more time pumping and less time working.

That said, it is also helpful to have a small pump at home - many women leave their electric pumps at the office during the week and keep a smaller pump at home for when they need to supplement or if they want a night out without baby.

Between the high end double electric pumps, either the Medela or the Ameda will serve you well. They are very similar pumps - the only real differences are that Ameda offers a more flexibility in cycling and suction, and the Ameda pump can be removed from its case. The Medela is a little more expensive, though, and since they will give you essentially the same quality of pump, you may want to consider the Ameda.

Where can I find a pump?
There are many places to find pumps. Hand pumps and mini-electrics are available at baby supply stores such as Babies R Us. For a double electric or hospital grade pump, you will need to dig a bit deeper.

The following companies sell both the Medela and the Ameda double electric pumps:

    Babylove Products: A Canadian company, so the exchange rate will likely result in a very reasonable price. They can be reached at http://www.babyloveproducts.com/
    Motherwear: This company sells a full line of nursing clothes as well as nursing accessories such as pumps, nursing pads, etc. They can be reached at http://www.motherwear.com/

You can also contact a Medela or Hollister (they distribute Ameda) representative. Local representatives will often both sell and rent pumps. Sometimes a rep who sells one type of pump will sell the other as well, so don't be afraid to ask!

Medela: Phone 1-800-435-8316, or visit www.medela.com/ to make use of an interactive rep finder - simply enter your zip code, and it will give you a list of local representatives.

Hollister: Call for an Ameda sales rep at 1-800-323-4060, or visit www.hollister.com.

To rent a pump, contact your hospital or your Medela or Hollister representative.

Should I buy or rent?
That depends on how long you plan to pump. Most rental contracts run for terms of three months and will cost about $150. If you plan to pump for no more than three months, it will likely be cheaper for you to rent - but only just.

If you decide to purchase a pump, you should plan to spend about $200. If you plan to pump for longer than three months, or for any future children, this is the route you should choose. By the way, compared to the cost of formula, even an expensive pump in this range will pay for itself in just 11 weeks!

Should I buy a used pump?
If you want to pump but don't have the money to buy a new pump, then by all means purchase a used one. Used pumps are often sold at auctions.

However, you should be aware that many communicative diseases - including AIDS - can be transmitted via breastmilk. So if you do purchase a used pump, contact the manufacturer to get a new pump kit and replace all the parts that come in contact with the milk, including the valves, the horns, and - on the Medela pumps - the tubing. These will not be that expensive to replace, and it is worth the investment to ensure your child's good health.

Introducing the Bottle


What type of bottles should I use?
Whatever type your baby prefers!

That said, you may want to start baby with a nipple that comes closest to yours in the way it is shaped. The two most frequent choices are the Avent bottle system, or any bottle that uses an "orthodontic" nipple. Most lactation consultants recommend that you steer clear of the Playtex nipples shaped like little cylinders - because of their shape, these nipples encourage babies to bite when they want to stop the flow of milk, and that's not a habit you want your child to get into.

Whichever bottle you choose, however, don't invest a lot of money in them up front. Be sure that your baby will nurse from that bottle - then go ahead any buy what you need.

When should I start to give my baby a bottle?
Timing is important in getting your baby to take a bottle. You want to start early enough that your baby will take it happily, but you also want to be certain that the baby doesn't learn to prefer the bottle to the breast. Remember, it is easier for a baby to get liquid from a bottle.

Most lactation consultants recommend giving your baby a bottle at about four to six weeks of age. Try the bottle once every couple of days, and keep that pattern until it is time for you to return to work. A week or two before you head back to the office, give the bottle once daily, then more frequently, so that the baby can get used to getting most of its meals that way.

What do I do if my baby refuses the bottle?
First off, don't panic! It is very common for babies to refuse to take the bottle. There are many things you can try - and if you don't find an idea here that works for you, take to the Web! The ParentsPlace Working & Pumping board has a lot of women who've been through this and can offer you ideas and support to get through it to.

Some things you can try:

  • Mom should not be giving the bottle - many babies will refuse a bottle if Mom is nearby because they know the breast is available. Make sure to hand the baby and the bottle to someone else, and to stay out of sight. It is hard, but it helps.
  • 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.
  • 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.
  • 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.
  • 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.
  • Rub some milk on the bottle's nipple to encourage baby to try it.
  • If you've tried several times with no success, try another nipple type, or even a sippy cup (Avent bottles have sippy cup attachments). Your baby may not like the nipple you've been using.
  • 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.
  • If all else fails, use a spoon! It's hard and it's messy, but it will work.

Getting Ready


How can I prepare my baby and myself for my return to work?
The best thing you can do is to practice.

When your milk comes in, you may need to pump a little to relieve engorgement. If you do, don't throw this milk away! Store it in the freezer - you'll need it later.

Start practice pumping your milk when your baby is between four and six weeks old. You should try to pump an hour after and at least an hour before a feeding. You don't need to pump much, but doing so will give you something to practice with and will help you start to build up a supply of frozen milk (also known as "freezer stock").

Start giving your baby a bottle when he is between four and six weeks old, and continue to give a bottle every couple of days.

A week or two before you head back to work, start giving the bottle more frequently - first, once a day, then more often. This will help you and baby feel comfortable, and will allow you to gauge how much milk your baby will need during the day. Then, do a couple of full practice days - leave your baby with his caregiver and take a day or two for yourself (taking time out to pump, of course).

It is a good idea also to check at your office before you return to be sure that they have the facilities you need to pump successfully. See the next question to determine what you will need.

Finally, plan to start back to work mid-week. Starting off slowly will be easier on both you and your child.

What will I need to pump at work?
First, you will need a place to pump. This place should be private enough that you are comfortable and will be able to relax, ideally with a door that locks and blinds for any windows. You will also need a comfortable place to sit, and an electrical outlet.

If you do not have an office of your own, some offices do provide lactation rooms that come equipped with at least the essentials mentioned above - some will also provide a small refrigerator for milk storage, a sink where you can wash the pump, and even a hospital grade pump. If your office does not have a lactation room, make certain to arrange for a private place to pump. Many women make do with utility rooms, supply closets, and restrooms, although of course these are far from ideal.

What is freezer stock and why do I need it?
Freezer stock is your back up - a supply of frozen milk that you have pumped and stored. You will want to keep a one to two day supply of fresh milk for your baby's needs. However, there will be times when that fresh supply will be insufficient - when your baby is going through a growth spurt, or when your supply drops briefly. For those times, your caregiver will want to have some extra milk handy - and frozen of course keeps much longer - to supplement with.

For this purpose, it is wise to store your freezer stock in small increments of one to three ounces. You can freeze it in ice cube trays (each cube is about an ounce) and then store the cubes in plastic freezer bags, or you can freeze it directly in the bags. Many women freeze it in the bags, flat like a shingle. These milk shingles thaw quickly and don't take much room in the freezer.

How do I build up a supply while I'm nursing?
There are two ways to do this.

  • If your baby nurses on one side at a time, you can pump on one side while baby nurses on the other. This encourages let-down and will enable you to pump more milk.
  • You can also pump between feedings. If you do so, try to make sure that you pump no sooner than an hour after the first feeding, and at least an hour before the next.
The best time to pump will be in the morning, when your supply is greatest.

What should I wear to work?
Remember to keep your wardrobe pump friendly! While it's tempting to wear that beautiful jumper you lived in pre-pregnancy, if it doesn't allow easy access to your breasts you'd better leave it at home. You don't want to get caught pumping naked at the office because you didn't have buttons on your dress. Two pieces are best, but any dress that buttons down the front will work as well. That goes for undergarments as well - a one-piece slip just won't work with a pump. While this may seem obvious, on those harried mornings where you're struggling to get the diaper bag packed, the pump gear stowed, and the baby to daycare, it's easy to forget.

You also want to think about leakage. It is possible that meetings or other commitments will keep you from pumping on time, and even the best of breast pads won't keep you from leaking. Always bring a jacket or sweater with you just in case. It is also a good idea to stick to patterned blouses of washable materials - leaks won't show as much with a pattern, and the milk will come right out in the wash.

All About Milk


How much will my baby take at each feeding?
This is going to depend on a lot of things, from the size of your baby to how often he eats to how he feels when you are gone. That is why it is a good idea to do a few practice runs before you start back officially. A baby who will drink a full five-ounce bottle every time from dad may take only two ounces from a caregiver. It will take a couple of weeks before your baby becomes predictable in how much he will take at daycare. That's another good reason to have a full freezer stock ready when you return.

Although once-warmed milk can be rewarmed and served again within 24 hours, a bottle that has been given to baby is good only for about an hour - even a baby's saliva contains bacteria that will contaminate the milk pretty quickly. So it is a good idea to give the milk in small portions - no more than 3 or 4 ounces at first - until your baby has established a regular pattern. You work hard to pump all that milk, and it would be a shame to see it go to waste because your baby only took two ounces from a seven-ounce bottle.

Fresh or frozen?
Any breastmilk, whether fresh or frozen, is great for your baby - it contains all the nutrients your baby needs, and is especially designed for your child's digestive system and development.

However, freezing does destroy certain properties of breastmilk, particularly the special immunities breastmilk contains. For that reason, it is best to keep at least a day's supply of fresh milk in the fridge for your baby to drink each day. Frozen milk should be kept in reserve for those days when the fresh milk just isn't enough for your hungry child.

How do I thaw frozen milk?
Fresh or frozen milk should be heated the same way - in warm, not hot, water. Do not heat breastmilk on the stove or in the microwave. High heat and microwaves will destroy certain essential qualities of the milk.

How should I store my milk, and for how long?
Milk can be stored at room temperature for up to 8 hours, and in a cooler with ice packs for up to 24 hours.

Fresh milk can be kept for up to eight days in the back of the refrigerator. Many women store either directly in bottles, or in plastic storage bags - Avent makes good, relatively inexpensive storage bags that come with clips and that fit right into their disposable bottle holders. If you use plastic bags, it is a good idea to place each bag into a plastic cup - the cup will hold the bag upright and prevent leaks and accidental spills.

Frozen milk can be stored in the separate freezer compartment of your refrigerator for 3-6 months, and even longer in a deep freezer. Is your ice cream soft or hard? That will give you a good idea of whether your milk will keep at the short or long end of the range.

Remember, if your milk was kept at room temperature or in a cooler first, it may not keep as long in the fridge or freezer.

My milk separated - do I have to throw it out?
No! Separated milk is not bad. We are used to seeing cow's milk, which has been homogenized. Your milk has not been homogenized, which means that the fat will separate and float to the top. Just give the bottle a gentle shake and it will look like normal again. And remember, that fat is good for your baby!

How can I tell if my milk is bad?
The smell of sour breastmilk is unmistakable. Believe me, you'll know.

Also, remember to date your milk whenever you store it. Keep a roll of masking tape and a Sharpie in your kitchen, and label each bottle, baggie, or ice cube tray before you put it away.

Always use the oldest milk first.

Supply and Demand


I don't get let-down when I pump - what can I do?
Let-down, the tingly sensation that indicates free flow of milk from your breasts, can mean the difference between a good pumping session and a bad one. Without let-down, it will be difficult for you to pump more than an ounce or two.

When you first return to work, it can be difficult to induce let-down. You may be uncomfortable pumping in this new environment. Some women must deal with the chance of being walked in on. And it can be hard to relax at the office.

When you go to pump, try to create a relaxing, secure environment for yourself. Lock your door, or, if you can't, put a sign on it so that no one will accidentally walk in on you. Use a picture of your baby to bring him to mind, or bring an article of his clothing with you - scent is a powerful motivator. Some women play soft music to help them relax and dream about their baby. Warm, moist compresses also help - if you have a problem with let-down, bring a few disposable diapers with you, wet them, and put them in the microwave for a few seconds. It makes a great warm compress.

Many women who pump view their pumping sessions as a special time they can spend with their baby, right in the middle of the work day. It is a chance for them to spend some valuable time thinking of the little one they are pumping for.

How often will I need to pump?
You should pump around every three hours when you are away from your baby.

My supply is dropping - what can I do?
The first thing you should do is relax. Ups and downs in supply are very common. It is particularly common to notice a marked dip in supply during your second week back to work. Your body is adjusting to this new means of "nursing" just as your baby is adjusting to getting milk from the bottle.

There are many things you can do to increase your supply. These will help you survive those low weeks and compensate for your baby's regular growth spurts.

  • Get plenty of water! While you shouldn't force feed yourself fluids - too much water can also decrease your supply - be aware of your water intake and try to make sure you get at least those eight glasses a day the doctors recommend. It takes liquid to make liquid.
  • Eat!! It is hard for a busy mom to remember to sit down to a good meal three times a day. But you need that food to make milk. So make sure you get it!
  • Add a daily pumping session. The number of times your breasts are stimulated plays a big role in how much milk you produce. The more often you empty your breasts each day, the more milk you will produce. However, you should not expect your supply to increase immediately when you do this - it will take a couple of days to take effect. Then, you should be able to go back to your usual number of sessions. You may not be able to do this at work - consider adding a session early in the morning, or after your baby has gone down for the night.
  • Oatmeal. This is an old wives tale that really seems to work. Most pumping moms start their day with a bowl of oatmeal and swear it help keeps their supply up (I'm one of them).
  • Fenugreek. This is an herb that will increase your supply. It does work, but you need to take quite a bit of it - three to four tablets, three times a day. You should start to smell like maple syrup - if you don't, you're not taking enough. Other herbal remedies - such as More Milk Tincture and Mother's Milk Tea, made with fenugreek, blessed thistle, and other herbs proven to increase milk supply - are available.
What harm will a pacifier do?
Babies need to suck. But while it may seem natural to reach for the pacifier to soothe your child, if you're a pumping mom, that's not such a good idea. When you are with your baby, he should be satisfying all his sucking needs with you. This will help stimulate your milk supply so that when you are not together, you can continue pumping for him successfully.

Studies have shown that nursing moms who regularly use pacifiers often have to wean earlier. So keep that in mind. (We use a pacifier to help Gray sleep once his is in the crib - but he always falls asleep first on the breast.) It is best to allow your baby almost unrestricted access to your breasts over the weekend. This will help balance your supply.

Help! My baby's going through a growth spurt!
During a growth spurt, you may be in a panic because you no longer seem to be producing enough milk for your baby. Try to add a pumping session if you can, and remember that this is what your freezer stock is for. Your baby will catch your body up on the weekend.

Will my baby always need this much milk?
No. Your baby's need for milk will increase regularly until you start feeding solids. As solids begin to make up a significant portion of your baby's diet, he will take less and less milk. Remember, however, that the American Academy of Pediatrics recommends that breastmilk be the baby's primary source of nutrition for at least the first year.

Problems


How do I heal a cracked nipple?
A cracked nipple is extremely uncomfortable, but it's fairly easy to resolve. A little purified lanolin rubbed on after nursing will help heal it up quickly. In the meantime, start each nursing session on the other breast - baby sucks hardest at the beginning of a nursing session - and switch to the sore breast later. It also helps to rub a little of your own milk into the nipple and let it air dry after a nursing or pumping session. The fat in the milk will also speed healing.

What can I do to prevent plugged ducts?
When you pump, try to empty your breasts. If you are very full, try to massage your breasts - this will stimulate the release of additional milk. Massage can also help with let-down.

How Am I Ever Going to Make This Work?


What does a typical pumping mom's schedule look like?

Every mom and baby need to find a schedule that works for them. But a typical pumping mom's schedule might look like this:
6:00 a.m. Wake, shower and have breakfast 7:00 a.m. Wake baby and breastfeed 8:00 a.m. Leave for office 10:00 a.m. Pump and have a snack and a glass of water 1:00 p.m. Pump and eat lunch 4:00 p.m. Pump and have a snack and a glass of water 5:00 p.m. Leave for home 6:00 p.m. Nurse baby 9:00 p.m. Breastfeed and put baby to bed for the night 11:00 p.m. Pump again, if needed.

Do I have to lug this pump back and forth every day?

Many moms leave their pumps at work during the week. If you have a small hand pump at home, you will be able to pump at home if you need to. With the Ameda pump bag, you can remove the pump from the bag, carry your milk in the cooler area, and store your lunch in the pump compartment.

Do I really have to sterilize everything?
No. Once your baby is older, they do not need to have everything sterilized. Many moms will simply rinse the pump parts in warm water between sessions at work and then wash the parts carefully in hot soapy water when they get home. (I run mine through the dishwasher every night). But once your baby is putting his hands in his mouth, sterilization isn't really an issue anymore.

How will I ever wash all these bottles?
When I first started pumping, I spent a half hour each night washing bottles and pump parts. I was washing all six collection bottles, Gray's three bottles, and then any sundry bottle equipment, plus the pump parts - all by hand. Save yourself some time and commit now to running the dishwasher every night, whether the dishwasher is full or not. Put in the bottles, nipples, pump parts - everything - turn the dishwasher on, and get a precious half hour of sleep.