Balancing Breastfeeding: When Moms Must Work

By Danelle Frisbie © 2010



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...

Moby Wrap

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.





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.


The First Years Freezer Storage Container

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.

5-cubic foot chest freezer filled with pumped milk


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.

Born Free 5oz glass bottle
turned into sippy cup with spout, handles and silicone sleeve



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.



Related reading:

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

45 comments:

  1. From another working "Dr Mama", thank you for such a comprehensive article. I am EBFing my 3 month old first child and working 25 hrs/week and it's going beautifully. Bedsharing and babywearing really help.

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  2. Thank you for this extremely helpful post. Thankfully I don't have to work but will pass it along to moms who do!

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  3. This is perhaps the best compilation I have seen on these issues. What an excellent resource!

    Just to note: some Targets have started to carry the Adiri bottles! I found a set on super clearance and nabbed it for a friend who is going back to work.

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  4. DrMomma - I am loving your blog!

    This post is excellent. I am the "breadwinner" in my family, so I had no choice but to go back to work after a four month maternity leave and leave my baby at home with my husband (who is a SAHP) - however, I am still successfully breastfeeding my eight month old. I wholeheartedly agree with almost all of your points here.

    My only concern is that pregnant, soon to be working moms will be convinced by your very thorough post that breastfeeding while working is more onerous and difficult than it is! I am blessed with a high supply and flexible work hours, but I have not found it to be particularly difficult.

    I suffered from engorgement and high supply in my early months (I think I easily made enough milk for twins!), so I did not have do any additional pumping to build up a freezer supply, and I would caution mothers with high supply to schedule one or two extra pumpings a day (at the same time each day) in the early days, rather than pump all day, or you will soon become chained to the pump!

    For mothers with normal to low supply, pump away!

    But once you are back at work, try not to rely on that freezer stash! On a day-to-day basis, try to ensure that you are pumping enough each day to feed baby tomorrow - otherwise, your supply will start to creep down. It took me a month or so to realize that my freezer stash was for emergencies, not day-to-day use. Of course, you will have some good pumping days and some bad - that's normal.

    There are lots of great pumping tips (to help you pump more, faster) on various websites, including Kellymom. These days, I only pump twice a day at work, and provide enough milk for my baby, who also eats some solid food now.

    So, yes, I was lucky to have a great supply to begin with, but I believe I have maintained it as well as I have by cosleeping and breastfeeding at night. This seems to be one difference between me and some of my coworkers who struggled to maintain their supply once they started working. "Sleep training" and babies who "sleep through the night" are very bad for working, breastfeeding mothers! This is counterintuitive, because working moms need their sleep, but not breastfeeding your baby at night, and trying to pump the majority of the baby's milk during the day at work is a recipe for early weaning. I've sucked up (ha, bad pun there) some sleep-deprivation in the interests of continued breastfeeding. Cosleeping encourages both sleep and lots of nursing. My baby "reverse cycles" now, allowing me to pump much less than I would if he ate more during the day.

    Thank you so much for your great posts!

    Are there any hospital-grade pumps that are small enough to be transported to work? If so, I want one!

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  5. Sorry to go on and on, one more thought - I highly recommend the book Nursing Mother, Working Mother, by Gale Pryor, as a resource for mothers who need to return to work but want to continue breastfeeding for as long as possible. This is a great, attachment-parenting friendly guide for working moms. It is not a basic nursing how-to, but focuses on the issues faced by nursing/working mothers.

    I would love to stay home longer with my baby, or take him to work with me, but in this economy, this is simply not an option for many women. Most of us do the best we can in difficult circumstances. Rather than guilt-tripping mothers about this, we should give them the tools to maximize their attachment with their babies. Still, when I talk to pregnant working women, I always say "Take as much time off as you can possibly afford, and a little more!"

    Again, great post!

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  6. This is excellent information. I went back to work after 12 weeks when I had my son. I was determined not to stop breastfeeding. I stood in a 4th floor non-airconditioned bathroom, balancing my pump and bottles on the sink, pumping my milk for my son. Soon, he reverse cycled and we nursed and co-slept at night. When he was 4 months old, I was given the greatest gift and was laid off. I was the breadwinner in my family, but after being at home with my son, I'm more than ready to give that up!

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  7. Wow - what a great, informative post! I had a bit of a shock like you did after your little one came home. I thought I'd be going back to work after a few months but there was NO WAY I could do it. (Prior to her birth we had downsized to a smaller home, paid bills etc.) She's 16 months now and I'm still home. I SO admire women who do the hard work of pumping so they can give their babies the perfect food.

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  8. This is a magnum opus post on the topic! Sharing far and wide.

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  9. I love this article. I went back to work when my son was 6 months old and am still pumping twice a day, one year later! I pump in my car, and actually look forward to taking a break, turning on NPR and relaxing to the **whish whish** of my Pump-in-Style (Medela) which wasn't mentioned, but has been a great pump.
    It's not as hard as some may think and actually makes me slow down and take those much needed breaks that I often skipped before I had to pump.

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  10. This is a wonderful list of resources! I appreciate the time it took to put this together. I wholeheartedly agree with most of the advice - especially co-sleeping - for working moms. My son is now 10 months and we are still going strong breastfeeding, despite my returning to work at 3 months.

    The only quibble I have is your advice about pumping. As long as moms have the opportunity to establish their milk supply before returning to work, I would counsel against pumping frequently at first. I had to do that due to some major latch issues in the beginning, and ended up causing a massive oversupply. Not a terrible thing since that extra milk is donated, but not exactly a great thing either!

    The milk you pump one day can be fed to your baby the next day, so all you really need a freezer stash for is emergencies and your first day back.

    In the end though, it is so worth it! Coming home to a smiling baby ready to nurse is the best part of my day.

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  11. Lisa, this was my not-so-well-articulated point as well.

    I suffered from oversupply as well. The excess milk made for a great freezer stash (and I donated some as well), but it also contributed to chronic clogged ducts, one one case of mastitis - in short, NOT FUN.

    In retrospect, I believe that starting pumping too early (in the first couple of weeks, when my body was still trying to work out supply/demand) probably contributed to these problems. Now, if I had suffered from lack of supply, that same amount of pumping would have been a good thing, but I think as long as you have a couple of months maternity leave and an adequate supply, you shouldn't worry about pumping until three to four weeks before you're scheduled to return to work.

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  12. Lisa/Inder-ific:

    Thank you for your personal experience and insight into how different women are going to be different in hormones and milk supply. I'm sorry that you had to deal with the difficulties that you did. It must have made *life* a little less enjoyable during those trials.

    Most women, however, hit the 4-week-mark with the perfect amount of milk to feed baby exclusively IF they stayed home and stayed with their baby 24-7. Because they have not built up a slightly larger supply, when they do return to work (often at the exact same time that baby hits a 6 week growth spurt!) they are away from their baby all day, every day, baby cannot signal to their body/breasts that they need MORE milk at this time... And supply dwindles or is not adequate during growth spurts while away from mom all week.

    Unfortunately, many babies are also not sleeping next to their mothers or offered her breast at night. This complicates the matter further. Again - there are no opportunities for baby to signal to mother that they need MORE, they need RICHER composition, etc.

    As sad as it is, the majority of mothers in the United States today (the vast majority actually) face one or two (or three) of several things at birth:
    1) induction
    2) pitocin
    3) c-section
    All of these can lead to latch issues, milk supply issues, and breastfeeding complications. Many mothers are supplementing right off the bat with artificial means of baby feeding, when no one has ever told them this will be detrimental to milk supply down the road.

    Rather than supplement with formula in the early weeks, it would be MUCH better to pump, build up an extra supply. Feed it all to your baby if you like.

    Pumping can always be slowed gradually (a few less minutes each time) to slowly decrease milk supply.

    That being said, pumping/nursing is not the cause of clogged ducts/mastitis. Although it may be blamed (because the breasts should be emptied). Bigger culprits are (1) not nursing enough
    (2) wearing restrictive clothing - even a bra - during most of the day or while nursing which puts pressure on milk ducts and lymph nodes and leads to their engorgement and irritation
    (3) yeast - one of the most common causes for mastitis

    I caution us to not jump to conclusions and blame particular aspects of our experiences without diving into other variables that are frequently those that lead to complications.

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  13. Dr.Momma,

    I agree, and I think there were many causes for my clogged ducts and certainly, for the mastitis. My chronic oversupply (exacerbated by using pumping to relieve engorgement instead of other methods) was at most just a contributing factor (I could whine about the other contributing factors, but I'll spare you!).

    I was blessed to have abundant supply to begin with, and a much longer maternity leave, so that my supply was well established when I went back to work.

    Thus, in my case, occasional, scheduled pumping (rather than pumping multiple times per day) would have done the trick for me. But, if I had gone back to work at (horrors!!) four weeks, or had lower supply due to birth complications, things might have gone very differently! My comment was meant more as a footnote to your suggestions for women "blessed" as I was! In the circumstances you describe, your advice is spot on.

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  14. Great information. I feel so blessed be able to stay home with my little ones! Another book that many of my friends have suggested to me - http://www.momfaves.com/faves/1054. Have you read into babies that have an intolerance to certain foods? With my first I had no clue of what to do about his fussiness and gas, with my second I eliminated dairy and soy and he was a totally different and happy baby. I had to do this until he was about 8 months. With my third I am eliminating quite a bit more, and haven't figured it out yet.... she is now 3 months.

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  15. Absolutely, Rebecca. Eliminating cow's milk and nuts/soy is so impacting for a new, undeveloped (open) baby gut. It has a dramatic effect - on some more than others. But no baby is born ready to comfortably digest cow's milk proteins or nuts/soy (in his mother's milk or in artificial baby feeding means). One of our top recommended books - "The Baby Bond" - discusses this extensively.

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  16. Great post! In Canada we are so lucky to have a year of maternity leave. Most Moms tend to wean their babies at this time, thinking they need to. But nursing as soon as you are reunited is such a great way to reconnect at the end of the day.

    I suffered from low milk supply from the very beginning - in addition to fenugreek, it was recommended I take Blessed Thistle. The combination of the both is important. I believe Jack Newman's website has some information on this.

    Again, thanks for putting such great information out there!

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  17. My goodness thank you Peaceful Parenting! This is the most wonderful post ever about working and breastfeeding. You touched every topic and didn't sugarcoat which I appreciate.

    Going back to work while continuing breastfeeding can be hard work but if thought out really isn't that bad. With my first I went back to work at 6 weeks. I had a manual pump and pumped in the cedar lined cigarette storage room at the grocery store I worked at. This was back in 1993. Daughter weaned herself at 13 months. There were good days and bad days but every second was SO worth it.

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  18. where do I get the got breastmilk shirt!!!????
    Laura
    http://blissedoutbaby.blogspot.com/

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  19. There are several versions of the shirt (baby, toddler, onesies, long sleeve, tshirts) here: http://madebymomma.spreadshirt.com/ [Also a link over on the left side of the Peaceful Parenting blog page <---]
    Spreadshirt does a great job with these items and we've always been pleased with our purchases. :)

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  20. I think this is a great article, but I also am concerned that it makes breastfeeding and working sound impossible. I would be home with my daughter in a heartbeat if that were an option, but I had to return to full-time work once my 12 weeks of leave were up. It is heartbreaking at times, but we make the best of it. She's 11 months old now and has had no formula at all. I'm still pumping at work for her. Sure, it's a pain, but it can be done and done successfully. I just want to make sure other women in the same position as me are encouraged that if they can't make the choice to be home, they can definitely still keep up with breastfeeding, babywearing, etc. that will keep the bond with their babies. I also love my Medela Pump in Style Advance! I can't recommend it enough.

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  21. I love this article, and have printed it out to give to people, as well as included it on my website.
    I was wondering, where did the fabulous quote (below) come from? I use it all the time, but I would love to know the exact study/research/article that it came from. Thanks.

    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.

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  22. Melissa - The quote you pasted is by Danelle Frisbie. It is a compilation of many, many lactation studies over the past decade. I will attempt to get several references (for the studies) gathered in case you'd like to investigate it further.

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  23. It can be done! I am the sole financial support of my family so I had no choice but to go back to work. I am lucky though that Dad is able to nurture our baby whioe I work. I was committed to breastfeeding my child. I went back to work after 2 weeks so that I could work part time to help establish a good nursing relationship. My little one had a hard time latching but I knew we would get there. I had to pump while he learned how to breastfeed. It just didn't come naturally for him. I knew I could pump for an extended period. One of my 7 kids was born 3 months early spent over 2 months in the hospital and I nursed her for over a year. My baby is held and loved by Dad during the day. He sleeps with me and nurses all night. I pump once a day and most days little one gets one or two bottles from Dad. He did not start that routine till he was 3 months old. Co-sleeping is the key for us.

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  24. I agree, it can be done. I had a wonderful homebirth and started nursing my now 7 month old daughter right away. We've co-slept since she was a few hours old and are at it still. I went back to work after 8 weeks and had started pumping at 6 weeks. Luckily, I was close to home in that first month and would come home at lunch to feed her. I was also lucky in that my parents live close enough and demanded that they watch her since she was still so small. I take Fenugreek to help with my production, and we have some weeks where I'm able to bank a bit more, and some where we have to dip a bit in to my supply. But, so far it is working out. It has to. I went back to work full time at 8 weeks at 40 hours and given my job, have had some weeks where I've had to work 60 hours. There was never an alternative for me. So, the sleepless nights where my little girl needs me because she didn't get her fill during the day, are ok. For good or bad, she won't need me like this forever, and I imagine, that one day I'll miss these times. When I go to work, I refuse to pump in a bathroom or my car, and request that my clients provide me a private place to go. I'm just not willing to take "no" for an answer.

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  25. I had an elective c-section (which I discovered I didn't actually need, but that is a totally different story), and made sure to do my research in order to establish a successful breastfeeding relationship. I'm pretty sure I am one of the first in NZ to do delayed cord clamping for a c-section, and no Vit K. The obs and paeds were pretty peeved off about it, as they had to wait 14 minutes for the cord to stop pulstating. I made sure that I had skin to skin contact after that and my son was breastfeeding half an hour after he was born.

    I was also fortunate to have 14 weeks paid parental leave (which mothers are entitled to in NZ if they meet eligibility criteria), so was able to establish a good milk supply. I had to return to full-time study at university at 9 weeks PP, and was able to take my baby into lectures so he was demand fed. I then returned to work on a part-time basis at 16 weeks PP (as I also used 2 weeks of my annual leave), and was still able to demand feed him due to legislation in NZ, but also due to the baby friendly nature of my then-employer.

    I managed to exclusively breastfeed my son for 7 months, and breast milk still made up 90% of his nutrition when he was 12 months (I also did baby-led weaning when introducing solids). I am still breastfeeding him (he is 17 months old), and breast milk still constitutes 75% of his nutritional needs. He is a daycare during the day while I study to become a midwife, and he now reverse cycles, as only likes breast milk straight from the tap! I know he will still be breastfeeding him in 17 months time.

    I know my situation isn't going to work for everyone, but I managed to do whilst studying full-time and working 20 hours a week. Even now, with clinical placements for my midwifery study, I still manage to breastfeed him when he wants it.

    I always tell pregnant woman to do their research about breastfeeding in order to have a successful breastfeeding relationship. I am also working towards my certification to be a lactation consultant, so I am so happy when I can help a woman who needs help with breastfeeding, and the joy I see in their faces when they get pass hurdles.

    Btw, I love this blog and the inspirational posts :-)

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  26. Thanks for this article. I am EBFing my 3 month old as well, and I work part time - 3 days a week usually for only about 6-7 hours a day. I have to admit I was a bit put off at first but kept reading and found your information very good and valuable. I am very lucky to be self employed, I could take as long off as I needed/could afford to, but at the same time, I had to go back to work. We're already at bare bones and at this point, we couldn't pay our mortgage without my income. That said, we cosleep, baby wear, EBF and I knew from my first that when I come home, basically it's Em and me. And I'm fine with that. I missed her almost as much or more than she missed me. I passed your information on to a girlfriend of mine. So again, thanks.

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  27. The first photo in this post is breathtakingly beautiful!

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  28. I couldn't agree more in all the things you say!
    Here in Norway we are very lucky, we get a year off work to stay home with the baby, and 10 weeks is to the father. It's great, and I know it's not like that over in the U.S.

    Love from Stine

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  29. The two most important tips, from my experience are:

    1: stay home AS LONG AS HUMANLY possible. We went without insurance for several months with my first so I could stay home for 6. With my second I was able to maintain it and still stay home just as long.

    2: CO-SLEEP CO-SLEEP CO-SLEEP. I'll say it again for good measure, CO-SLEEP.

    Some details. My first baby was in the NICU for 4 days and thus was exposed to a bottle right off the bat (I cried and cried). It took me 2 months of exclusive pumping and bottle feeding before he would latch and bottles no more - until I had to return to work (the worst day of my life).

    With my second there were no such issues and he latched on shortly after birth and hasn't let go since.

    With each when I returned to work I began pumping twice a day and using that for the next day. I don't have a supply, and though this would be nice I expect, when I'm at home, I want to devote my time to my boys, not to the pump. I will speak the evil, on the rare occasion when he needs more he gets formula. Though this is sub-optimal it is VERY rare.

    Co-sleeping is the MOST important thing. My son nurses all night some nights plus I get to cuddle with him to my hearts content. My older sleeps with us a lot too. I wake many if not most mornings with all my men snuggled next to me and I LOVE it.

    Breastfeeding and work is without question possible, and frankly not difficult. It's instinctual to want what's best for our children so we do what we have to do to make it work.

    Breastfeeding is best, or as I prefer to say, breastfeeding is the least we can do for our littlest ones. We are designed to do it and it'll work if we give it even the slightest bit an effort and perseverance.

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  30. Kudos to you! You put some amazing effort into this post and I love it! I hope so much that this helps someone.

    I would love to see our country become more mother baby friendly. I am bothered deeply in a personal way that it is not. I was one of those moms who thought she was going back to work post-baby but couldn't once she was here with me. We scrape by literally but it is so worth it. I attempted to get my work to allow me to bring my baby in with me. I worked in an ideal setting for that (a community room that was empty most of the time) but I was told it was too much a "liability" even though I agreed to sign liability release paperwork. Hmph.

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  31. This article is wonderful, yes makes me so sad.

    My son's birth was a planned home birth ending in a transfer to a hospital (his head turned transverse), which ended in a c section. Immediately following the c section it was discovered that I had an infection in my bag of waters and the infection spread throughout my body, caused me to go into septic shock. I was in the ICU for several days, away from my baby who was formula fed for the first 7 days of his life. We got very little help from the hospital LC, and as a first time mom who was in lots of pain from my c section and still recovering from a near-death experience, I nearly gave up.

    8 months later, my son recieves 90% breastmilk, 10% formula. Unfortunately I was not able to ever recover my supply from the first few weeks and he does take two bottles a day (always in the evening).

    After everything that I went through physically and emotionally, I feel lucky that I am still breastfeeding at all. I now know that with my next child I will be fully prepared for the worst circumstances, yes will always hope for the best.

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  32. thank you so much for sharing this- I went back to work between 2 and 3 months with my kids and continued to nurse. Working is not an excuse - plus for kids in daycare it's almost more important to nurse them! Talk about liquid gold!
    My daughter is 19 mo now and is still a fantastic little nurseling ;)
    baby blessings,
    Jill

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  33. Love the first photo! Beautiful.

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  34. Thank you for this excellent article! It is the most complete one I've ever read online and I appreciate having a go-to place to send clients who need a bit more info before their baby arrives. I also regularly lend the book you mentioned, "Nursing Mother, Working Mother," but not all moms are ready and willing and able to read a book (especially if they already have multiple kids to start with). This piece gives a well rounded, well researched, accurate, but brief enough look at some of the important things to take into consideration if mothers wish to nurse their babies exclusively and work. Again, THANK YOU! It was greatly needed.

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  35. Great article! I had to go back to work and school when my baby was four weeks old (left the house at 6:30am, didn't get back until 10:30ish pm every day) and was able to EBF him for 18 months using the Ameda Elite pump. I had to pump in my car though since the only other place avaible was the bathroom and the car adapter was a life saver.

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  36. I think something important was forgotten here! Moms that have to return to work can struggle with supply. I was surprised to see milksharing as a minor blip at the bottom of the article! So many women with oversupply are there to donate their milk so your kiddo can have the best when things just aren't working. I hope we can highlight this option more for working mommies so they too can benefit!

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  37. @Moozikteacher ~ Milksharing is a *wonderful* thing indeed!! But this entire article is about milk supply for mothers who must return to work. The whole premise underlying all the suggestions above is to keep milk supply high - everything from babywearing to sleep sharing to having a hospital grade pump and staying home with baby as much/as long as you can - these are all things that directly impact supply (as a result of impacting hormones). Milk supply certainly wasn't "forgotten" in the article - it was what the entire thing was all about. Mothers who are apart from their baby struggle more with supply issues, and the author presented many ways to prevent this from becoming an issue in the first place.

    I found it very helpful, and have already implemented several of these things and read through the book that she suggested - "Nursing Mother, Working Mother" - it is good too!

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  38. Beautiful, Accurate, and well written. Once again you hit the nail on the head perfectly. I am a single mommy and went back to work when my son was 6 weeks old. Only 4 weeks after he got to come home from the hospital because I absolutely had to. No one else was going to be bringing any money home to take care of us! Luckily I get to take my sweet boy with me to work. I am still nursing and he is almost 13 months old now. Some days it's really hard to have him at work. He is in to EVERYTHING and my boss is less than thrilled about it. But, so far we've been able to continue. I love your blog and find myself wishing every mommy in the whole world could read them and understand them. The world would be a better place. Keep up the wonderful work you do!!

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  39. Great post. I'm a SMC to a still nursing two year old and planning for number two. Was lucky to get four months leave with my first but unlikely to get that with my second. Already stressing a bit about how to deal with nursing as my supply was always a bit low. Wonderfully helpful and I'm sure to be referencing in the future.

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  40. I wish I'd read this post 10 months ago when my daughter was born. I'm pumping, and she is back to EBF after a week with formula supplementation, thanks to a generous milk donation. Milk sharing is such a blessing.

    I am wondering, does my Medela Pump-In-Style count as hospital grade? I'm on a ton of supplements to try to up my supply, but maybe I just need to try a better pump?

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    1. Rachel - I agree on renting a hospital grade pump. It makes a huge difference for a lot of moms. I rented the Ameda Elite and loved it. They are made to get your milk supply up and keep it up for working moms, and any that are purchased in the store are not made for this purpose. If you can Google for a lactation group or consultant in your area, or even check at your local hospital, they should be able to give you options of where you can rent one for. Check around too, because here there are 4 places that rent them and they all charge a different price. We got a deal by renting for 3 months at a time...

      If you haven't tried the lactation cookies yet, you may like those too. Not sure they will have a big impact on milk supply at 10 months, but they do for some. http://www.drmomma.org/2010/08/lactation-cookies-recipe-increasing.html

      Yeah for Milk Sharing too!! :)

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    2. I do love those lactation cookies.

      Thanks for the advice; I will look into a hospital grade pump this week. My daughter just hit one year this weekend, but she is nowhere near weaning.

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  41. Rachel, your Medela PIS is NOT hospital grade (the Medela Symphony is), and you might find a hospital grade helps you with your supply issues. I would try renting one ASAP and see if it helps you. If you're supplementing, even with donor breastmilk, you'll want to pump a lot to try to increase your supply.

    Do you know about the La Leche League online forums? http://forums.llli.org/index.php There is a great section there for moms who are struggling with pumping at work, supply, and other issues, and you read other women's stories and post your questions there and get a lot of responses. Good luck!

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    1. Thanks, I'll definitely check it out - both the pump, and the forums!

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  42. Loved this! Thank you. I just wanted to say that when I returned to work (something I did not really wish to do, but gave into after pressure from my spouse...) my daughter did shift her own eating to nurse almost exclusively during the hours she and I were together. We coslept so she could nurse before/during/after sleep, and I made sure to nurse her as soon as we met up at the end of my shift, and it was the last thing I did for the 1/2 hour before I left for work each day (planned all my other getting ready activities to be done earlier so I could devote that last 30-60 minutes exclusively to her). Just wanted to lend an example of someone who didn't do much pumping (although I did pump 1-2 times at work to keep my milk supply up) but most of my feeding was during the hours I was home, and then she ate a little from the bottle (pumped) while I was away. We went on to nurse for almost 4 years (before and after bed were the last times to go). :)

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