A question that regularly pops up in my inbox comes from breastfeeding mothers who must return to work and feel that they have no option (or do not wish) to pause their career and stay home with their baby. These mothers are dedicated to giving their infants the liquid gold that babies were intended to receive for those first few years of life, but working away from our little ones places a huge strain on the breastfeeding relationship.
I am going to be real with you (something I don't think we do enough of these days in the world of lactation): It is much more difficult to exclusively breastfeed your baby when you are not with your baby for much of the day, during most of your days. Carry mammals (the type of mammal that we are as humans) were designed in such a fashion that mothers and their infants are meant to be in close proximity with each other pretty much 24-7 for the first few years of life in order for everything to function properly. This is how the intricate web of our hormones operate. Babies need to be next to mom in order to relay their needs to her (both via nonverbal cues and unseen pheromones). When mothers and babies are separated, the whole system tends to break down.
So, it is always best if mom can keep her baby next to her throughout the day and night. If I could call your boss and help her set up a mother/baby-friendly work zone, I'd do so in a heart beat. Because really, this is what we need most.
Mothers and babies would live more optimally in the U.S. if we had a mother/baby-friendly postpartum support system in place that provided a postpartum doula to every mother and at least 1 year free from outside work responsibilities so that mothers could care for their babies. This is a useful system with rewards for not only mom and baby, but society as a whole, as human infants grow to be healthy, intelligent, securely bonded individuals when they are fed human milk and kept securely close-to-mom as babies. It is a system we do find in many other developed nations but one that is still severely lacking here in the States.
I know the difficulties of this situation first hand. I was successful in a full time career that I absolutely loved - which, coincidentally, revolved around the health and development of babies and their mothers. I took additional assignments at the University I was with, joined a book editing team, carved out a lecture tour, and did all I could to save my pennies so that I could stay home with my baby for at least the first year of his life. My plan was still to return to my career - one which cost 8 years of graduate schools and more tuition money than the federal government has dished over to most people.
But then my son was born.
And soon after I realized I was going to have to find a way to make ends meet, and still achieve some professional goals, while mothering him all day, all night, every day, every night. There was simply no way I was going to hand him over to someone else to raise while I worked - even if that meant we would be selling the extra car, moving, and canceling cable (which we did do).
So I do understand the place you are in - how hard it is. The choices we are forced to make in a society that likes to think of itself as having emancipated women...yet, really, tying mothers hands behind their backs at the same time. And honestly, I cannot imagine the struggle that must come when you leave your baby to head out to work that first day. I cannot fathom the pains of separation on either of your parts -- for you, mom, or your newborn. And so I hope that through the experience I have had with breastfeeding, working, mothers over the years I am able to empower at least someone out there. Because with a few proactive problem-solving strategies in place, mothers who must return to work can also continue to give human milk to their human babies.
The action plan:
1) Stay home with your baby for as long as possible post-birth. Even if you must save up $$ ahead of time and take weeks without pay - nothing can replace those first months of your newborn's life. His natural habitat is on your chest and anywhere but close to you is not 'home' to him. The breastfeeding relationship and your milk supply is set in the first 4 weeks post-partum. This means that those first 30 days are absolutely essential for laying a good foundation for the rest of life (literally). Your body is busy balancing milk supply and getting the amount perfected during this first month. Everything is fairly 'set' after this time - babies tend to consume more milk at each feeding, but generally do not eat more overall throughout the day after their first 30 days earthside. This means that it is much more difficult to increase milk supply after the first 4 weeks. Therefore, plan ahead and start pumping/freezing (additional tips on this below) as soon as possible after birth (or even before birth if you so desire).
2) When you do plan to go back to work, reduce your hours/days as much as it is doable for you - for at least the first year (and preferably 3 years) of your child's life. A good deal of what we have discovered through the science of attachment suggests a baby/toddler needs his/her mother for those first 36 months of life for optimal growth and development. When you are in the baby planning stages, make attempts to arrange your life around this new human being as much as possible. Nothing matters more than mothering at this early stage.
3) Read a few good books ahead of time that will help you to proactively ward off problems and navigate through issues as they may arise. Life is more challenging for a breastfeeding mother who must return to work, but being apart during the day only compounds the value that mother's milk provides for baby. See this list of excellent choices of books for breastfeeding moms. One book that I give to everyone I know is Breastfeeding Made Simple. If you read no other book but this one, get it in your hands and the knowledge within into you head. My other top pick for breastfeeding mothers is The Baby Bond. This book will empower you with research info needed to encourage you to keep at it along the way.
4) Before the birth of your baby (or right now if you already have your bundle in your arms) find an experienced, professional lactation consultant in your area. She can help to ensure that your breastfeeding relationship gets off to a good start, help to calm fears that may surface, and problem-solve along the way. Many lactation consultants also offer hospital grade breast pump rentals and other mother/baby-friendly breastfeeding items.
In addition, you may find support and encouragement from other moms in similar situations by joining your local La Leche League, a Mom's Milk Cafe (sometimes found on Meet-Up.com), or another attachment parenting group.
5) Rent a hospital grade breastpump, such as the Ameda Elite. Hospital grade pumps are specifically designed to increase milk supply and keep it high during times when baby is not regularly nursing. This is essential for mothers who are returning to work. I cannot emphasis this enough. Far too often I've seen mothers with the best of intentions who are lugging around their latest Target purchase and the non-hospital grade pumps that you buy at Target, WalMart, Babies R Us, etc., are simply NOT designed for the breastfeeding mother who is returning to work and needs to pump daily. Yes, they will market them to you. Your cash is good for them too. But don't be fooled - those are the pumps that are meant for occasional use (for the weekly baby sitter bottle, for example). They are not meant for daily use by working mothers who must be apart from their baby. So, right now - go find your nearest options to rent a hospital grade pump. The Ameda Elite just happens to be my favorite, but others are also available such as the Hygeia EnDeare and the Medela Symphony and Medela Lactina.
Hospital grade breastpumps are usually $25-$40/month depending on where you live. Often lactation consultants will give you a discount when you rent for several months at a time (10% off or a flat $30/month instead of $33 for example). Again, you can call around to various locations near you and price compare to find what is best. The pump tubing stays with you and can be used for a future baby. If you'd like to purchase, rather than rent, a hospital grade pump to use over the years with all your babies, they have a high re-sale value, and will likely cost between $700-$1200 depending on the brand you select and whether you are purchasing one brand new or lightly used.
Begin pumping (and freezing) extra milk as soon as you are able to. You can pump after you nurse your baby (to fully empty the breasts). If your baby only nurses on one side at a time, you can pump the other breast while s/he is nursing. You can also pump your breasts empty immediately after a nursing session, or 30 minutes after you are done nursing, or 1 hour prior to your baby needing to eat again. The key is to nurse/pump as often as your baby desires to eat and always empty your breasts completely (this causes them to fill up faster and fuller adding to your milk supply for the time when you return to work).
I've occasionally heard from women who pumped to empty and then (surprise!) baby is up and hungry right now! Don't fret - just offer your breast anyway - babies are more skilled at getting the rich hind milk out than a pump is. If baby does not seem to be getting anything from your breast, simply use the fresh pumped milk to feed her from a bottle, and re-pump or breastfeed an hour later to restock your supply.
Your first 40 days will be filled with a lot of nursing and pumping... but it does get easier! The rewards far outweigh any initial difficulty. After those first several months, breastfeeding is the easiest thing in the world...and other aspects of life are made more enjoyable as well because you do not have as much infant illness and doctors visits that you are having to miss work for. Plus, as one recent neuroscientist put it, "Isn't your baby's brain worth it?!" Not to mention your baby's immunity...health...development...lifelong well-being...
6) Babywear! When you are able to be with your baby (as much as possible) sling him. Experiment, ask around, and find your favorite slings and wraps and carriers so that you can be skin-to-skin with baby and he can be close by you for as much of the day as he is able to be. This serves several important functions for infant development (motor, mental, hormonal, cardio, respiratory) and also decreases SIDS risk in the first year of life. But just as important, babywearing has an impact on YOUR hormones and thereby your milk supply. Being close to baby - actually holding and touching and carrying him with you wherever you go causes the two of you to be in close harmony with each other hormonally. Baby is able to regulate your milk supply through this perfect dance of pheromones. In addition, baby will be happier, more content, more at ease, relaxed, and sleep better, the longer and more often you babywear. Again, babies natural habitat is on your chest. Whether it be the wildly popular Moby Wrap, or the Ergo, or an Over the Shoulder Baby Holder, or even your own homemade wrap - look into all the wonderful babywearing options parents have today and choose a couple that meet your needs.
Check out these articles and examples of babywearing
and learn how it will benefit you and your baby.
and learn how it will benefit you and your baby.
7) Share Sleep! This is another monumentally important factor in hormone regulation that impacts milk production and baby's roll in the breastfeeding relationship. Night time is the time when hormones naturally kick into high gear and milk production is at its peak (often women will find they pump the most upon waking in the early morning hours). In addition, night time can be a special quiet bonding time between you and baby - even while asleep. Babies are acutely aware of mom being close to them and sharing sleep serves many important regulatory and health functions during the first year of life (in addition, like babywearing, sleep sharing reduces the risk of SIDS).
To share sleep you do not need to bedshare (although this is certainly a possibility and tends to be the sleep sharing style most commonly used). But by simply moving baby's sleeping arrangement close to your bed, you both benefit from sleeping within an arm's reach of each other. She can nurse easily and freely during the night time hours, and you never have to get up out of bed!
Sleep sharing is certainly a 'lazy mom's dream' ...but it is also the natural, normal way that all mammals sleep by their young (including humans for most of history and throughout most of the world today). There are many reasons for this - one of which is milk production regulation, and another is for baby's access to mother's milk during night time hours is when his brain is growing most rapidly. Brain research tells us that the same hormones that impact growth spurts and neuro activity during sleep are those that encourage an infant to nurse and intake all the good stuff needed to support this night time development. Night nursing (or just sleeping near baby) shifts your hormones into high milk-production gear and keeps them going during the days and weeks when you are not near your little one during day time hours.
One of the most beneficial things you can do, if you haven't already, is to practice and perfect your side-laying nursing position. By doing so, you can lie down with your baby anytime, anywhere, and nurse while napping or sleeping. This is relaxing for you (encouraging milk production through natural hormone regulation) and it is extremely enjoyable and relaxing for your baby. Try tucking one arm up under a pillow while keeping baby on his/her side next to your breast. You can use the opposite arm/hand to cup your breast and help baby latch if s/he is still too young to latch on her own (typically by about 5 months of age babies are able to latch and nurse completely on their own during night time and nap times - no effort on your part!). Push a pillow up against the curve of your back to help support you comfortably on your side.
Many sleep sharing moms also report that this special time of quiet night nursing has allowed them to develop secure attachment bonds with their babies despite having to be gone all day, every day. It provides babies with an opportunity to be close to mom - as nature intended them to be.
There are many options for sleep sharing arrangements. You can share a flat, firm bed surface if you have mattresses on the floor and arrange them near a wall where they cannot shift or move. Do not cover baby with a blanket or have her head too close to your pillow - leave her some space of her own, but feel free to nestle in next to her when she nurses. You can also place a separate co-sleeper bed next to your bed. Or you can arrange a separate baby mattress next to your bed mattress (again, on the floor so they do not shift around). Parents who already have a crib can move this next to their bed (between the wall and bed for security) and drop one side to use as a co-sleeper.
For additional reading on how perfectly sleep sharing and breastfeeding go together (as well as tips on safe bedsharing), check out some of the excellent articles here:
8) Nurse your baby as much as you can when the two of you are together. Babies nurse for 3 reasons -- hunger, thirst, and comfort. Suckling differs between these three needs and infants are skilled at nursing in just the right way to meet their particular moment's need. You may have noticed the deep, hard sucking that occurs when baby is very hungry. Or the shallow, light sucking when baby just needs a drink. Especially if you are not using an artificial nipple substitute for comfort (plastic pacifier) at home, you have likely watched in wonder at the light, butterfly flicker of your baby's tongue, or the gentle fishy-lips as baby nurses gently for comfort and security. The breast is nature's original perfect 'pacifier'. Each style of nursing serves an important purpose for your baby and none should be denied to her.
During the day while you are at work, baby is getting your milk for nourishment, but she still needs this special time to nurse for comfort whenever she can. Expect that her need for comfort nursing will increase while you are home with her after being away all day.
Babies have a need to suck - and some babies have higher sucking needs than others. While I am not a fan of artificial nipple pacifiers (because they inhibit successful breastfeeding and they lead to infant attachment to an artificial object rather than to mom/dad), I believe that babies who are separated from their mothers for a good portion of the day may need this substitute for comfort sucking while she is not there. Listen to your own individual baby and provide her with the comfort she requires - both at home and while you are away.
There is yet another reason to breastfeed (even when solely for your baby's comfort) as often as possible. Ground breaking lactation research demonstrates that there is an intricate method of communication in the saliva of a baby that triggers mother's milk production via receptors on the areola. This communication signals all of baby's needs to mother by way of hormones and enzymes (and likely things we have not even begun to understand). How much milk your baby needs, the fat/calorie composition he requires today, what specific antibodies he needs a boost of, the immunological properties he requires most right now -- it is all transferred to you and your body's amazing milk making wisdom via your baby's suckling at your breast.
Your baby's nutrition, brain, and immune system needs change on a day by day, hour by hour basis. Therefore, it is always best to breastfeed anytime, any day, anywhere that baby expresses the desire. Nurse on demand. This is baby's only way to regulate her needs -- and she can do so quite perfectly if simply given the opportunity.
9) Milk Bags and Frozen Milk Supplies. When you reach for frozen milk to use during the day in a bottle when you are at work, simply send along the oldest frozen milk first and use in order. The person caring for your baby during the day should keep the milk frozen until it is time to use, and simply place the bag (if you are using pumped milk bags) in a cup of luke warm water to thaw. Or, s/he can place the frozen bag into the fridge and allow it to thaw more slowly until needed. The bag (or other container) should be swirled (to mix fully the fatty parts with the liquid parts) and then put into a bottle. If milk is fresh, it should not be shaken because this contributes to the rupture of the white blood cells in the milk. Some lactation experts will also advice to only gently 'swirl' thawed frozen milk as well, and others say that the composition of the white blood cells has already changed via freezing and the mixing does not matter as much. I'd caution on the safe side and swirl mine. ;)
Try to nurse your baby immediately before leaving him for the day. If you also pumped recently (within the last couple hours) you can give this fresh milk to your baby's care provider and simply have them leave it out and feed to baby or place in the fridge within 6 hours.
Fresh milk is especially beneficial to provide for your baby if s/he gets sick. Again -- the immunological needs are expressed to you from baby via nursing. Your milk immediately changes its antibodies/antiviral/antibacterial composition to meet baby's needs. Therefore, when you or your baby is sick, it is even more important than ever to nurse often and provide fresh milk whenever possible. Healing will be faster and health will be exponentially better.
Although it is probably best to freeze in glass rather than plastic, I realize it would be difficult for most mothers to freeze enough pumped milk to return to work and cart this around in glass containers. So, some of the best plastic bag options are those you can purchase at any store or online. One item that is especially useful for the pumping mom is a breastmilk storage container for the freezer that can be used with any breastmilk freezer bags. The First Years makes a breastmilk storage container that is PERFECT for working mothers because it systematically will compress your milk bag flat (so it freezes into an easy-to-transport solid pack) and also holds milk bags with the oldest ones at the front (for easy access by date). I'd suggest buying 2 of these containers as they hold about ten 5-6 ounce frozen bags each, or use one for freezing the newest bags, and organize the rest of your stash by date in another freezer location.
Many back-to-work moms find it especially beneficial to have a small chest freezer for their milk supplies (and other items). You can pick up a small 5-cubic foot chest freezer that will meet all your needs for frozen milk storage for about $150-200 and it is small enough to fit into even a tiny apartment. We happen to have one here at our home that is currently filled with milk for donation and it is tucked inside our walk-in closet. Yes, small chest freezers can be very useful anywhere you feel like fitting them. An added benefit to using a chest freezer for your frozen milk is that it will stay 'good' longer - up to 1 year in a deep freeze as compared to 6 months in a standard freezer.
10) Bottles. The three 'best' bottles we have found that most closely imitate nursing at mother's breast are:
Adiri Natural Nurser Ultimate Bottles (Available at many Babies R Us, Target, Whole Foods, Day One, BuyBuyBaby, most lactation consultants and online. However, after winning multiple awards for this bottle, Adiri sadly went out of business due to financial stresses in Oct 2009. If you are going to try this bottle, you best pick them up quickly before they are gone.)
This bottle most closely mimics mother's breast and is a new favorite among many nursing babies who must be apart from their mother during the day. Many lactation consultants still have this item in their stores and it is quite popular in hospital L&D gift shops. The Nurser Ultimate is 100% BPA and polycarbonate free. It has an easy to use 'fill, twist, and feed' system.
Breastflow Bottles (available at many retail stores and online)
This bottle is also designed to closely replicate the sucking design of mother's breast. Your baby may prefer this style instead (each baby is different).
Born Free Bottles (available at Babies R Us, Toys R Us, and online)
Born Free is the company that makes not only BPA-free plastic bottles, but also excellent, durable, glass bottles with a venting system (that can double as sippy cups as your baby grows older). At our house we tend to not use plastic when we can make do without it (for toxicity reasons), so the glass bottles (now sippy cups) have come in very useful. Not only is Born Free's venting system excellent at preventing air bubbles from getting into your bottle-feeding baby, but they are strong and easy to use and clean. The glass does not harbor smells like many plastics do, and they can easily be washed in the dishwasher at hot temps. Born Free glass bottles do not break easily - despite numerous drops on hard floors, we've only had one break and that was because a babysitter put a very cold bottle from the fridge directly into very hot water on the stove. The 5-ounce glass bottles have a plastic sleeve that can be slipped over them to protect them and our son has used them as sippy cups since he was 10 months old (when he first started non-breastmilk items) without a problem. Both glass and plastic Born Free bottles are available in stores and online, but if you order online make sure you are selecting the type you desire. If they do not say "Glass" then you are getting the plastic style. Both are great choices from Born Free.
11) EAT! It takes 60% more calories than your pre-pregnancy baseline caloric need to produce the milk needed to exclusively breastfeed your baby. A major problem we find among mothers who return to work is that they start skipping breakfast (the most important meal of the day) and start slacking on their food consumption. The pressure might be on for you to fit into your pre-pregnancy work attire, but trust me, it is not worth the expense of a declining milk supply to achieve this goal in the immediate future. Right now you have to focus on fueling your body so that you can feed another rapidly growing human being. And this requires a good amount of nutritious food. So eat! And while you are at it, don't forget the water!!
12) Fenugreek. Fenugreek is an herbal supplement that has long time been used to increase milk supply among nursing mothers. It has been given the rating of GRAS by the FDA (generally recognized as safe). A few mothers may experience light headedness if they take fenugreek on an empty stomach as it is also used to calm stomach troubles and seems to interact with blood sugar levels in some people. If you are diabetic, you would want to talk to an expert first. For most mothers, however, taking fenugreek during or after a meal will have no impact on you other than helping to boost milk production.
Take 3 capsules of 500mg each 3 times a day (1500mg each meal) when you are trying to increase milk production. This is more than the amount recommended on the Fenugreek bottle because it is marketed as a stomach aid - not as a milk production booster. If you solely wish to supplement your current milk supply, or you feel like 1500mg/3 times a day is too much for you, it doesn't hurt to take less and see what works for you. I've worked with many women who experience dips in milk production during their periods (this is normal as milk production is hormone-related). During their menstrual cycles, these women added Fenugreek to their daily regimen, but typically in smaller quantities (1000mg/3 times a day for example).
You can buy fenugreek at most health food stores, from your local lactation consultant, or online.
If milk production really becomes an issue (which it typically will not if implementing all of the above mentioned tips to regulate breastfeeding hormones) there are two prescription drugs that are sometimes used to boost milk supply. They are more commonly prescribed for stomach related problems, and do carry potential side-effects for a small percentage of women. However, metoclopramide (Reglan) or domperidone (Motilium) have been used by women in a last ditch effort to breastfeed their baby when milk production hormones down shift as a result of being apart from baby all day long. Domperidone was unapproved for sale in the United States by the FDA in 2004. It is available in most other countries and can be purchased online from Canada, but is difficult to find at U.S. pharmacies because the FDA still maintains the right to seize domperidone entering the States.
Because prescription drugs always carry side-effects in one form or another, I (personally) would try every other means necessary for breastfeeding my baby before resorting to prescription drugs. However, I would take them if it were the choice between breastmilk with drugs vs. artificial feeding. If a point comes in your baby's life where you need donor milk, please do not hesitate to reach out and ask for help. There are mothers in every section of the country (and world!) ready, willing, and able to give their milk to babies and mothers in need. For more on donating and receiving milk, see this page and ask your local lactation consultants, midwives, doulas, and La Leche League leaders.
No other mammal on the face of this earth gives birth to live young and is then not able to successfully feed these young from her own milk. It breaks my heart that we are experiencing this culture-induced problem among the human mammal when mothers are set up in such a way that their natural, normal, primal mothering potential to feed their babies is jeopardized from the outside in.
If you are going to be separated from your baby due to work, and still wish to breastfeed, you are (unfortunately) going to have to navigate the sometimes rocky waters of our modern day North American society and take steps that will lead to breastfeeding success. In the end, all your efforts will be worth it and your little one will thrive because you fed her what was perfectly designed just for her. Look at your baby and realize that every cute little inch of her perfect body was nourished and grown on YOUR milk! Now that's impressive.
Nursing Mother, Working Mother [book]
Lactation Cookies: Increasing Milk Supply [resources linked to help you boost milk supply]
Milk Donation [if you find you need supplementation for any reason, find your local Human Milk 4 Human Babies group here or other milk share options here.]
Breastfeeding Resources (books, articles, websites) located here