By Wendy Wright, MBA, IBCLC
In May 2012, I had the opportunity to contribute “Pumping Strategies for the Working Mother” to Lactation Matters. We have had tremendous interest and discussion on this topic, so let’s explore the topic a bit further.
Over the past several years, I have helped hundreds of breastfeeding women in the work force and have found three tools that provide the most help to working mothers:
- Creating a breastfeeding calendar
- Hands on pumping
- Childcare provider education around breastmilk feeding
Creating a Breastfeeding Calendar
Most mothers intending to breastfeed have their due date and back to work date firmly in place on their calendars, so, what about adding other dates that can assist in scheduling and milk supply forecasting? At each Back-To-Work Breastfeeding class I teach we have an exercise where we pull out our calendars, and actually import important dates into them for enhancing breastfeeding success. Here are the dates I help women to import:
- Due Date: We discuss the importance of being ready, finishing important work projects in plenty of time and handing off responsibilities so there are no last minute phone calls from the hospital.
- 11-day Growth Spurt: Many new mothers are not aware of this growth spurt and often interpret it as “my baby is not getting enough milk.” By marking it on their calendar, they are more likely to remember being warned about this 11 day push to increase volume and take in stride with greater confidence in their breastfeeding abilities.
- Three-week growth spurt: Initiating pumping after this growth spurt is a great way to minimize the breastfeeding burden on the mother during the first few weeks. I encourage mothers to allow their infants to “program” their milk supply for the first three weeks, until the growth spurt, and then take on pumping for storage and bottle introduction.
- Initiate pumping (3 – 4 weeks): A great time to learn about the pump, work pumping into daily routine and begin milk storage for return to work.
- Introducing a bottle (4 weeks): Breastfeeding should be well established by this point, and the return to work is on the horizon, bottles should be small and only once a day at most but again, once baby takes a bottle, mother’s confidence is enhanced as the return to work grows closer.
- Return to work date: Other dates, if appropriate or helpful, can be incorporated here as well, such as: secure childcare, test childcare, practice days for returning to work or part time return to work days to get caught up on items missed during leave.
- Three month growth spurt: Good to have this on the work calendar – mothers often become fearful about supply during this growth spurt, “How can I possibly pump that much?” Once they realize it is only temporary, breastfeeding confidence again return.
- Introduction of solids (around 6 months): This is a great relief for fully breastfeeding, working mothers. Just knowing that if a meeting runs late or traffic is terrible, the baby can enjoy avocado or banana until the mother returns home tends to lessen stress around milk supply. Milk is of course still the primary source of nutrition yet the stress about exclusivity is reduced as solids are introduced.
Teaching hand expression and hands on pumping to mothers returning to work can ensure milk supply when the mother and baby are separated. Jane Morton, MD provides a helpful video and has found that adding breast massage and hands on pumping increased mothers’ average daily volumes by 48%.2 This additional pumped milk may make the difference in breastmilk exclusivity for the first six months of life especially once the stress and fatigue of returning to work set in for the very busy working mothers.
Child Provider Education Around Breastmilk Feeding
In California, by three months of age, 41% of mothers are breastfeeding, this means 59% are not. Due to this statistic, many of the care providers in our state have limited experience handling breastmilk. Here are some questions I arm my clients with as they select the care providers for their breastfed infants:
- Are you familiar with the latest milk storage guidelines?
- Will you refrigerate and reuse any leftover breastmilk? Let her know the re-use parameters you’re comfortable with, if any (for example, two hours).
- Will you store a back up supply of my breastmilk in your freezer?
- Do you require all parents to clearly label milk containers to avoid mix-ups?
- Will you check with me before supplementing with formula?
I hope these three simple tools help the mothers you are working with ensure success as they return to work while breastfeeding. Anticipatory guidance with the calendar and careful childcare selection along with increasing parental confidence with enhanced breastmilk supply utilizing hands on pumping should help all mothers meet their breastfeeding goals.
La Leche League’s, “The Breastfeeding Answer Book” (1997) by Nancy Mohrbacher,
IBCLC and Julie Stock, BA, IBCLC
Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhone WD. Combining hand
techniques with electric pumping increases milk production in mothers of preterm
infants. J Perinatol. 2009, July 2.
Wendy Wright, MBA, IBCLC spent 15 years in the biotech industry in the Bay Area and worldwide prior to breaking out on her own and founding Lactation Navigation in 2007. Wendy has a B.S. in Health Services Administration from the University of Arizona and an MBA with a Marketing emphasis from the University of Cincinnati. Wendy’s daughter is 13 and her son is five; both, of course, were breastfed! Lactation Navigation allows Wendy to combine skills learned in the corporate setting over the past 15 years with her love of breastfeeding. It allows her to spend time with her children and also with new mothers. It also encourages health and happiness for other families, and brings bottom-line profits to progressive companies.
I really like the calendar idea — Thanks!
Childcare providers have excellent guidance for caring for the breastfed infant in “Caring for Our Children: National Health and Safety Standards, 3rd Edition.” You can find this entire text on line; chapter 4 (Nutrition) covers breastmilk storage,handling, and feeding. Some US States have more or less guidance in their formal regulations. Providers may also follow more detailed guidance/requirements if they are participating in the US Federal Child and Adult Care Food Program (CACFP), since that will give reimbursement to providers feeding meals containing breastmilk. Mothers can look up both of these documents to learn the standards the childcare provider should be following. It is also excellent guidance for a babysitter or smaller, unregulated childcare provider. FWIW, in neither of these documents does it address how long to keep ‘breastmilk leftovers.’ So, since there is no evidence giving a ‘safe’ window, mothers may want to consider providing smaller servings rather than having to judge whether leftover breastmilk is ‘safe’ to re-feed at a later feeding. Childcare providers may err on the side of caution and be unwilling to offer leftovers since they do not want to be liable if the infant develops food poisoning/GI issues.
Thanks for the information Doraine – I will check out “Caring for Our Children: National Health and Safety Standards, 3rd Edition.” I also like the idea behind a document like this to add consistency to the care of our breastfed babies in public settings.