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Breastfeeding and returning to work or school

Once you successfully make it through the early weeks of breastfeeding, and manage to overcome any problems you may have had in the beginning, such as soreness, engorgement or hormonal rushes, you usually experience a “honeymoon period.” Just at the point when you are beginning to get the hang of this whole mothering thing and are settling into a routine, it is time to go back to work or school. Here are some tips to help you adjust.

Continuing to nurse
Although many working mothers used to nurse for a few weeks and then wean before they returned to work, more and more moms are choosing to continue to nurse after they return to work. As the many advantages of breastfeeding become more obvious, mothers don’t want their babies to miss out on the benefits of nursing just because they have to return to work or school.

There are several important elements to consider to successfully continue nursing your baby when you return to work or school: first, you need to select an appropriate pump which will empty your breasts quickly and efficiently. Second, you need to select a care provider who supports your commitment to breastfeeding. Third, you need to arrange breaks at regular intervals (ideally, about every three hours) during your day to have time to pump. Fourth, you need to find a private place to pump, preferably with access to an electric outlet. Fifth, and very important, you need to establish a good milk supply after your baby is born and before you return to work or school. This will make maintaining your supply when you are separated much easier.

You will want to purchase or rent your pump no later than three weeks before returning to work. Even if you are at home with your baby for the first several weeks or months, it is helpful to have the pump to store up some milk to have on hand when you start working, to introduce baby to bottles so you can be sure he will take them when you leave him with a care provider and to give you time to familiarize yourself with the operation and cleaning of your pump, as well as get an idea of how long each pumping session is likely to take.

How much to pump ahead of time
You will feel better if you have some extra milk stockpiled in the freezer. You don’t need to have gallons on hand, just enough for a few feedings. Pump after feedings for five minutes, or on the other side when your baby takes one breast at a feeding (your supply will be more plentiful in the mornings) and store the milk in two-ounce portions. Try to have at least 12 ounces on hand. If you have strong feelings about not wanting your baby to have any formula at all, or if he is allergic to formula, you may want to have a little more stored up.

Selecting a care provider is seldom easy. Leaving your baby will be much less stressful if you feel really comfortable with your childcare situation. Putting a baby (especially a tiny infant) into a day care center with multiple infants is probably the least optimal situation. Look for a center with the highest possible ratio of adults to infants. Drop in unexpectedly and see how things operate when they aren’t expecting a visit. Be sure to let the care providers know that you are nursing. If they aren’t familiar with handling human milk or nurturing nursing babies, look elsewhere or share the information in “Caregiver’s Guide to the Breastfed Baby” with them. Take comfort in the fact that breastfeeding protects your baby from many of the nasty germs that seem to get passed around day care centers. Try to do a “trial run” the week before you return to work/school. Leave the baby with his caregiver and go to wherever you will be pumping. This will give you a chance to scope out the situation — Do you have an electric outlet? Do you need an extension cord? Do you need to find out which office space will be available, and when? Do you have access to hot water to clean your pump parts? Is there is refrigerator, and if so, can you store your milk in it if needed? You should also let the caregiver feed the baby while you’re gone, so you can see how he will take the bottle, and get an idea of how much he will take at a feeding. Leaving him for the first time is stressful enough, but will be easier if he is left in a familiar environment. How often you pump when separated from your baby depends on several factors. One is whether your goal is to pump enough during the day for the baby to have exclusive breastmilk feedings the next day, or whether you plan to combine formula and breastfeeding. If your goal is for your baby to have only breastmilk, then ideally you will empty your breasts about as often as he nurses when you are together. For example, if you return to work when your baby is six weeks old and still nursing every two to three hours, then you should try to pump every two to three hours when you are separated.

An optimal schedule
This is an optimal schedule for the mother of a young baby who wants to provide only breastmilk for her baby:

  • Set your alarm 20 minutes early (OUCH!) Nurse your baby, even if he is half asleep.
  • Get both of you dressed and ready to go. Pack up everything you can the night before — diaper bag, bottles in cooler, lay out clothes, etc.
  • Eat a good breakfast. Don’t skimp on this, even if it is something you can eat quickly like a carton of yogurt or bagel with cream cheese. Be sure to include a nutritious drink, such as juice or milk.
  • Nurse again for a few minutes before you leave if possible. Some babies get so much milk at the first feeding that you can’t get them to eat again, but try anyway.
  • Pump mid-morning. Allow at least 20 to 30 minutes for each pumping session (10 minutes for pumping with a good double pump, and 10 minutes for assembly and clean-up). Have a drink and a nutritious snack while you pump.
  • Pump again at lunchtime. If possible, leave work and go to your day-care site to nurse. More and more companies are providing on-site day care, or you may live close enough to travel home and back if Dad is with the baby or your caregiver lives nearby. It may even be possible for your caregiver to bring your baby to you at lunchtime. Once again, eat a nutritious meal with something to drink.
  • Pump again mid-afternoon. Have a drink and a snack.
  • Nurse as soon as possible after you pick your baby up from day-care or return home.
  • Eat a nutritious dinner.

Nurse your baby frequently during the night. Tucking him in bed with you is a good way to make up for the closeness and skin-to-skin contact that you miss out on during the day. Some babies start to nurse more frequently during the night when they are separated from their mothers during the day. This is called reverse cycle feeding and works well for many mothers, especially if they find it hard to pump during the day. If baby is in bed with you, you will get the rest you need while he gets the milk he needs.

Don’t get the idea that if you can’t pump three times during the day, you shouldn’t even try to continue nursing. Many mothers have work schedules that are very inflexible, and they don’t have either the time or the place to pump more than once a day, or even not at all. If this is the case, you can still breastfeed. Pumping even once a day will give you some stimulation, help maintain your supply, and help keep you from becoming engorged. If you are only able to pump once each day, you will probably have to supplement with formula, but at least your baby will have one feeding of breastmilk, and you can continue nursing while you are together.

While some employers provide a special place set aside for mothers to pump, as well as frequent breaks during the day, this is the exception rather than the rule, especially in the United States. I expect that this will change as more and more employers realize that encouraging their employees to breastfeed is cost effective for them, due to breastfed babies being healthier (fewer trips to the doctor, resulting in fewer health care claims and less time missed from work to care for a sick baby). Studies have also shown that when employers promote and encourage breastfeeding, it creates a better work environment and a more loyal, satisfied employee.

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