Breast-Feeding Can Work for Working Mothers
"When people ask me why I went through the hassle of breast-feeding after I returned to work, I have to laugh," says Manhattan-based product designer Sally Kassidy, mother of one year old Daniel. "I never thought of it as a hassle. Nursing was just the best possible thing I could do for my baby. I felt a real sense of pride that I had given Daniel life and was now sustaining and nurturing him. It's a feeling of purpose and satisfaction that I've never experienced from anything else."
For a working mother who breast-feeds after returning to work, nursing sessions are that wonderful time of day when she can totally relax and connect with her baby. That's why Sally Kassidy is just one of thousands of moms who juggle schedules or tote breast pumps, mini coolers and even babies to the office in order to continue nursing when their maternity leaves are over. "It's a big commitment," says pediatrician Marianne Neifert, MD, medical director of the lactation program at AMI Luke's hospital in Denver, mother of five and author of the best-selling child care guide "Dr. Mom." "But there are ways to smooth the back-to-work transition without sacrificing the benefits of breastfeeding. The key is knowing what to expect and being prepared for tricky, but predictable periods of difficulty."
There are many ways to handle nursing once you return to work. You might choose to breast-feed exclusively and pump milk for those feedings that occur during your working hours. Or you may decide to use a combination of nursing and feeding your baby bottles of formula. The thing to remember is that your body will I adapt to however much or little you choose to breast-feed. And long-term benefits for your baby such as helping to prevent subsequent obesity and some allergies and building immunity to a variety of diseases can be established in as little as two months. Even two weeks of nursing is better than no breast milk at all," says Dr. Neifert. "The point is that women should feel good about whatever choices they make."
Making The Most of Your Maternity Leave
Maternity leave should be just that a chance to leave all thoughts of work so you can get to know your baby and adjust to the joys and demands of motherhood. It may take practice before nursing sessions go smoothly, but persevere now and you'll find breast-feeding easier for both of you once you're back at work.
-How long a leave can you take? In a study of 567 women to determine the effect of employment on breast-feeding, Kathleen G. Auerbach, PhD, medical sociologist at the University of Chicago, found the length of the maternity leave was critical. A shorter (two months or less) leave doesn't seem to give the mother a chance to develop maternal confidence or solve breast-feeding crises, such as breast infections, before it's time to go back to work.
Auerbach suggests taking at least a four-month leave if possible, and Sally Kassidy agrees, "When I first started nursing, I worried about everything, my breasts hurt and I was sure my son would starve because he wasn't getting enough milk. By the fourth month, though, I was much more relaxed." But what about the majority of working women who are unable to take extended maternity leaves?
Auerbach's study reveals that 40 percent of those women who returned to work before the baby's fourth month continued to nurse beyond the baby's first birthday. This indicates that many mothers have the motivation and tenacity it takes to keep on nursing once they're back on the job.
-Practice pumping. Since most moms have extra milk in the first few weeks after giving birth, your baby maybe satisfied before the breast is empty. This is a good time to practice pumping and, if possible, stockpile frozen milk to use when needed. The better you are at it, the quicker your pumping sessions will he once you're back at work; frequent pumping will also increase your output.
-Introduce a bottle. A few weeks before you go back, but before baby is three months old, familiarize her with the bottle by offering it about twice a week. The bottle can contain breast milk, formula or water. (Don't attempt this when your baby is overly hungry or frantic, or immediately after a feeding when she's completely full.)
-Be up-front. Smooth out the details of where and when you will pump in the office before you're back full time. Find an appropriate pumping location and, if necessary, get permission from a supervisor to take flexible breaks. If possible, arrange to use a company refrigerator to store your expressed milk.
-Work with your care giver. Be sure your care giver knows the feeding schedule she's expected to follow and how to handle your expressed milk.
Back-To-Work Strategies
While it may seem hard to believe, you can start to control the amount of milk your breasts produce (after your milk supply is well established) so that your nursing schedule accommodates your baby's and your own needs. Your milk supply will increase or diminish depending on how often you nurse your baby. If you choose to give your baby breast milk exclusively, you'll need to pump often to keep up your supply.
Judsen Cullireth, WORKING MOTHER editor-in-chief, pumped first thing each morning, then nursed her son before she left for the office. "While I was at work, Charlie had one bottle of expressed milk, then supplements of formula," she explains. "I nursed him a lot at night to maintain my milk supply."
There's no right or wrong here, what's best is to develop a routine that allows you to provide both love and nutrients to your baby without driving yourself crazy. If work gets hectic or you're sick and unable to nurse for a few days, don't panic, your milk will not dry up. Although it may be difficult to get your milk supply back up to where you were, just get back on schedule as soon as you can.
If you're having trouble achieving let-down (the reflex that allows milk to flow) at the office, try stimulating your nipples to simulate the baby's sucking". Another trick is to think about the way your baby smells or sounds. Carrying a picture of your baby or a piece of clothing can also help in putting you in the right frame of mind.
Some women can't achieve let-down at work. If this happens, don't give up. "Not every drop needs to he breast milk" says Dr. Neifert. If you need to give formula supplement, that's fine. Just enjoy the nursing sessions you do have."
Expect you first few weeks at work to be tough. You will feel disoriented as you try to shift gears, catch up on what's happening, and express milk if you're pumping - all this on too few hours of sleep. Handbag designer Stephanie Daniel, after five-month maternity leave, returned to a discouraging situation at her New York City office. "There was only one small, smelly bathroom, and while I would sit in one stall pumping, a succession of strangers would come to use the other," she says. "My pump made a loud humming sound, which I felt obliged to explain, and after a few days, I went from expressing five ounces of milk to eking out barely one." Fortunately, a colleague in the building offered Daniel the use of her private office to pump in and she was soon back expressing milk efficiently. Co-workers may also have difficulty adjusting to your new routine. Daniel encountered a young woman in the bathroom who took one look at the bottle of expressed milk and pronounced it gross." But Laura Benford-Sullivan, a production editor at TRAVEL & LEISURE magazine, reports that a flurry of whispering and giggling was soon replaced by warm support as colleagues got used to the fact that she would disappear for a half hour every afternoon to pump.
To maintain your milk supply, you'll probably need to express milk once or twice during the 9 or 10 hours you're away from your baby. Pumping usually takes about 20 to 30 minutes, including prep and cleanup; set aside enough time so you don't feel pressured, and make sure hands and equipment are thoroughly clean before you begin. Wear two-piece outfits and avoid garments that zip or button in back. If leakage is a problem, be sure to have a supply of nursing pads on hand and change them frequently.
Safe Storage
Proper cooling and storage of pumped breast milk is crucial. Store it in a refrigerator or cooler immediately and make certain it remains chilled all day even as you travel to the care giver's to drop it off. Fresh milk should be used within 48 hours of pumping. If you plan to add freshly pumped milk to a bottle of frozen milk, cool the fresh milk in the refrigerator first. Always mark the date on the frozen container so you can use the oldest milk first.
The colder your freezer, the longer your milk will last. In a small freezer compartment within your refrigerator, milk will last three weeks; in a separate, self-contained compartment, three months; in a deep freezer (below 0 degrees), six months to a year. Always thaw frozen milk in the refrigerator or under running tepid water-never on the kitchen counter and use within 24 hours. Warm frozen milk gently on the stove, and never refreeze previously frozen milk.
Note: Use extreme caution if heating milk or formula in a microwave oven. Uneven heating may cause "hot spots" that can burn baby's mouth. To thaw frozen milk in the microwave, use the Defrost or Low setting only. Overheating may destroy nutrients.
Coping With Problems
You may experience one these common nursing pitfalls, but you can get past them if you know what to expect and how to handle the situation.
-Breast engorgement is a feeling of extreme fullness and tightness in the breasts that occurs as the body produces milk in large quantities and then cuts back to meet the actual demand. When you first return to work, you might feel engorged, much as you did on the third day after birth when your milk came in. If you plan on feeding your baby breast milk exclusively, pump your engorged breasts until they are empty to maintain the milk supply. But if you plan on leaving formula supplements for baby while you're at work, just express a little milk to relieve the pressure when breasts become engorged. This way, your body will start making less milk to accommodate your diminished nursing needs.
-Breast infections and plugged ducts
are commonly caused by exhaustion, excessive pumping, insufficient emptying of milk and restrictive clothing. Symptoms of infection are flu like aches and fever and a sore, inflamed hard spot on your breast. If you develop an infection, you will need an antibiotic to clear up the infection and the pain. A small white tender spot on your nipple may be an indication of a plugged duct; apply a warm compress to the area or dip your nipple in a bowl of warm water to increase circulation. Nurse from the affected breast first. Prevention is important for both conditions. Take care of your body nap after work and don't exhaust yourself by dieting frantically. Pump breasts whenever they feel full; even if you don't have time for a complete emptying, at least express enough milk to prevent plugged ducts. Pay attention to the fit of your bra a little too big is better than too small.-Sore or cracked nipples
are a common ailment especially when you first start breast-feeding as soft nipples become conditioned to baby's sucking, tongue movement and saliva. Make sure your baby is positioned correctly with your nipple in the center of her mouth. Just before nursing, try to relax by taking a few deep breaths and massaging your nipples to stimulate letdown. After a nursing session, don't cover up immediately; let a little breast milk dry on your nipples. Avoid irritating soaps and change your bra or nursing pads whenever they are wet. Expose your nipples to the air as often as you can. If you are just too sore to nurse, skip a feeding from the affected breast; to keep up your milk supply, express milk hand.-A temporarily lowed milk supply
may occur upon your return to work. This happens because pumping is not as effective as baby's sucking, so your milk supply adjusts to a decrease in stimulation. If you're not too exhausted, breast-feed more frequently during the night and on weekends to stimulate production. In the office, follow your at-home feeding schedule as closely as possible. If you're pumping manually switch to a more effective electric pump. Pay attention to stress levels; learn how to delegate or say no at work and avoid taking on extra projects if possible. Curb housework and maintain a healthy diet that includes plenty of water.-A successful combination of breast-feeding and working
can mean nursing your baby for three months or two years. The point is to set your own goals and make your own choices. "I just do what works for me and my baby" says Sally Kassidy, who nurses her baby when at home and leaves formula for him while she is on the job. "When it comes down to it, nursing Daniel is more about the intimate relationship between us than it is about feeding him. I wouldn't miss this for anything in the world."FRED CREUTZMANN, M.D. – CARROLLTON – 972-394-7277 or www.DrCmd.com