Returning to Work: The Breastfeeding Mother’s Guide

Returning to work after giving birth can be stressful for many mothers and their families. It is often hard to adjust to being both a mother and an employee, and you may have mixed feelings about leaving your baby. Mothers often report that they are sad to leave their children, and it is normal to feel hesitant or reluctant to part with the small person who holds a lion’s share of your heart. Both new and veteran parents worry about childcare for their new infants. You may be wondering how your baby should be fed when you are away and how milk you should leave at daycare. This article will address some common questions breastfeeding mothers have about continuing to breastfeed and providing breastmilk for their babies after returning to work or school.

How much milk will my baby need while I’m away?

Breastfed babies need, on average, 24 to 32 ounces of milk per day (Kent et al., 2006). If you spread that amount over a full day it equals 1-1.25 ounces per hour. With that information in mind, plan on leaving about 1-1.25 ounces of milk for each hour of separation. Most breastfed babies need no more than 2-4 ounces at each feeding (Kent et al., 2006). Breastfed babies need less milk than formula-fed babies do, and unlike with formula, the amount of breastmilk your baby needs does not increase as he grows bigger. When you return to work, your baby will need only a portion of this daily amount of milk from the care provider, because he will still be getting much of it by breastfeeding during the hours of the day and night when you are together.

Offering smaller bottles, of no more than 2-4 ounces, means there is a smaller chance that your baby will not finish his bottle and leave milk that must be thrown away by licensed daycares.

How many times do I need to express milk at work?

How many times you pump at work will depend on a few factors: how long you are away from baby, how well you respond to milk-expression, and your work situation. Many working moms plan to pump milk at least as often as every 3 hours. If you are becoming engorged between pumping times, you may need to remove milk more frequently. Every mother has her own “magic number” and will differ in how frequently she needs to express her milk to both maintain milk production and provide enough expressed milk for her baby. Try to remove milk as often as it takes to collect enough for your next work day.

What if I can’t stop to pump as frequently as I would like?

When it is challenging to find enough time to pump your milk, here are some time-saving options:

• Breastmilk can be kept at room temperature for 6-8 hours (ABM, 2004). With this guideline in mind, you do not need to take time to wash out your pump parts after every use. Keep your pump parts and bottles of milk in a cool place, and cover them with a cool towel; a small cooler or insulated lunch pack is another option.
• Some mothers place all of their pump parts in the refrigerator along with their bottles of expressed milk each time they pump. At the end of the day, they take all of the parts home to wash.
• Consider arranging your schedule so that you can arrive at work 15 minutes before you need to “clock in” and pump before you start work. 
• If you don’t have enough time to completely drain your breasts, it is still valuable to stop and express some milk, even if it you only have 5 minutes.
• If expressing in your car could help you save some time, consider purchasing a car adapter for your pump and a hands-free pumping bra (or you can make your own) so that you can pump with your hands free. For your safety, we recommend that you do not express milk while driving.
• If you are mobile during your work hours, a cooler for your milk will help preserve your milk at a lower temperature, and you can save time by expressing milk whenever you have an opportunity.

How should I store the milk I pump at work? Do I put it all in the freezer?

In order for your baby to get the most anti-infective properties from your milk, it is best to offer it fresh whenever possible. Freezing has been found to denature some of the antibodies and kill some of the living cells in milk (Orlando, 2006; Buckley & Charles, 2006). Whether fresh or frozen, your milk provides all the nutrition your baby needs, and you can count on your milk to support your baby in all areas of growth and development.

Here is a schedule many working mothers recommend for using frozen milk. With this system, your baby gets more fresh milk and therefore the best possible nutrition and immune factors to protect him from illness:

• Pump on Monday; give this milk to your babysitter to use on Tuesday.
• Pump on Tuesday; use this milk on Wednesday and so on until Friday.
• Pump on Friday, label with the date, and freeze this milk; put it in the back of the freezer.
• Use the oldest milk in the freezer for Monday.
• Use your freezer stash only when you have an unusual need for extra milk, for example, when your baby is going through a growth spurt or you accidentally spill all of your freshly-pumped milk.

This system prevents the frozen milk from getting too old and needing to be thrown out. Another option would be to refrigerate Friday’s milk over the weekend and let your babysitter use it on Monday. This practice would preserve more of the antibodies in Friday’s milk but would not use up your frozen milk before it goes out of date.


What if my baby’s caregiver says my baby needs more milk?

With bottle-feeding, there can be a tendency for the person feeding to encourage the baby to finish the bottle. Milk flows easily from a bottle nipple, even when the baby is not actively sucking, and the faster flow can cause a baby to continue feeding after he is full. Caregivers may believe that a baby needs more milk than he actually does, and many childcare workers are accustomed to the larger amounts of formula they feed many babies. Make sure that your caregiver has the correct information about how much breastmilk a baby needs and understands the difference between bottle-feeding breastmilk and formula.

You can offer some tips to your baby’s caregiver on how to bottle feed in a way that supports breastfeeding:

• Use a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind).
• Start by resting the tip of the nipple on the baby's upper lip and allow him to take it into his mouth himself, as if he were nursing.
• Keep the bottle only slightly tilted, with the baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel overwhelmed by the flow (Kassing, 2002).

What if my baby is refusing bottles?

If your baby is refusing bottles, or you prefer not to use one, there are other options available:

• You can try cup or spoon feeding. If you use either a cup or spoon, make sure your baby is fed while sitting in an upright position and that the feeding is “paced” (slow).
• If your baby continues to avoid any type of feeding while you are away, despite offering your milk from a spoon or cup, you may want to investigate slow-flow sippy cups (avoid ones that encourage babies to bite the tip to get milk).
• Some mothers have said that offering frozen milk in a mesh feeder worked for them; babies may respond favorably to the new texture and temperature of the milk.
• Investigate whether you can have your baby brought to you by your care-provider during a break so that you can nurse.
• Another option, when your baby is refusing expressed milk, is offering to make up missed feedings when you are together. This is often called reverse cycling.
• If your baby is over 6 months, and ready for solids, you can send foods for him that have a higher content of water such as melon. Your baby will ideally be able to get an amount of your milk in some way, but there are other ways to cope with hydration issues if your baby is unwilling to take your milk in a liquid form.

What if I’m not expressing enough milk?

Here are some tips to increase the amount of milk you are expressing:

• Go back to the basics of learning how to express your milk.
• Relax. Take a few deep breaths and get comfortable before you begin expressing your milk.
• Avoid watching the bottles to see how much milk is coming out. Instead, focus on your baby, listen to music, or try some relaxation methods. Many mothers find that watching how much milk is coming out reduces the amount they are able to express. Try covering the bottles with a cloth or towel, so they are not visible. There is evidence that music can be soothing to mothers while they are pumping and improve milk-removal. Music-based practices have been shown to encourage better milk production in mothers who have babies in the nicu (Keith, D.R. et al., 2012).
• Add another breastfeeding session, especially if your baby is sleeping 5 or more hours in a row at night. 
• If you are unable to express more frequently at work, another option is to express milk at home first thing in the morning.
• Try more frequent, shorter sessions of expressing milk. Many mothers have said that several 20-minute sessions will yield more total milk than a couple of 30 minute sessions.
• Send what you are able to express. Nurse at drop-off and pick-up to decrease the total amount of milk needed while you are separated. Remember that your baby has 24 hours in the day to get all of the milk he needs. If he does not get enough in the time you are apart, he can nurse more when you are together in order to get the total amount he needs.
• If you are using a pump, check its condition. Some pumps need parts replaced frequently to maintain full suction.
• Rule out any health-related complications to milk production with your health-care team; there are many reasons that mothers experience a dip in supply.
• Try “hands on pumping” when you are expressing milk to empty the breast.
• Use some gentle massage before you express: starting in the armpit and work toward the nipple in gentle, circular motions. 
• Update the pictures of your baby that you are using when you are expressing. Bring some worn baby pajamas and try smelling them to help you mentally bring your baby into the room with you. Some mothers have said that recordings of their babies are also helpful. One mother reports that creating a sound file of her baby’s sounds and favorite lullabies together was most effective for her.

If you need more information about returning to work or expressing your milk, a Breastfeeding Counselor , La Leche League Leader, or International Board Certified Lactation Consultant may be able to help. Accessing a community support system can help you reach your breastfeeding goals.



You may also be interested in these articles:

Preparing for Your Return to Work: The Breastfeeding Mother’s Guide
Baby-Led Bottle Feeding
Breast versus Bottle: How Much Should Baby Take?
Facts Every Employed Breastfeeding Mother Needs to Know



References

Academy of Breastfeeding Medicine. (2004). Clinical Protocol Number #8: Human Milk Storage Information for Home Use for Healthy Full Term Infants [PDF-125k]. Princeton Junction, New Jersey: Academy of Breastfeeding Medicine.

Buckley, K. Charles, G. (2006). Benefits and challenges of transitioning preterm infants to at-breast feedings. International Breastfeeding Journal, 1,13

Callahan, A. (2012). Pump Up the Music: Improving Breast Milk Production in the NICU. Website: http://scienceofmom.com/2012/04/12/pump-up-the-music-improving-breast-milk-production-in-the-nicu/

Kassing, D. (2002). Bottle-feeding as a tool to reinforce breastfeeding. Journal of Human Lactation, 18(1),56-60

Keith, D.R., Weaver, B. & Vogel, R. (2012). The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Advances in Neonatal Care, 12(2):112-9.

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

Mellentine, K. (2003). Converting a Regular Bra into a Pumping Bra. Jan Andrea, at home on the web. Website: http://www.sleepingbaby.net/jan/Baby/pumping_braconvert.html

Orlando, S. (2006). The immunologic significance of breast milk. J Obstet Gynecol Neonatal Nurs, 24(7), 678-83

Stuebe, A. (2011). Podcasts for Breastfeeding. itunes. Apple, Inc. Website:
http://itunes.apple.com/us/podcast/podcasts-for-breastfeeding/id432087823#



© 2012 Serena Meyer, IBCLC and Teglene Ryan, IBCLC