Archive | Pumping

Working and Breastfeeding: An Interview With Nancy Mohrbacher

Copy of Journal of Human Lactation (2)

International Lactation Consultant Association® (ILCA®)  Medialert Team member Leigh Anne O’Connor recently interviewed Nancy Mohrbacher. Learn more about Nancy’s approach to supporting breastfeeding working families in Leigh Anne’s interview:

I first met Nancy Mohrbacher on a hot August day into 2001. We were both guests on the Montel Williams show. Nancy was the expert guest and I was the “real person” nursing mom guest. I was quite nervous. Nancy, though she said she was nervous, possessed a calm and confident air about her, not at all cocky.  She just knew her stuff.  

Over the years meeting her at various conferences I always learned something new. What has impressed me and what makes her different is that her information is consistently accessible while remaining up-to-date and relevant. Nancy never stops learning and she shares her wealth of knowledge for not only professionals but for breastfeeding families.

The information Nancy has made available about breastfeeding and working in her recent book, Working and Breastfeeding Made Simple, is critical to working families, as employment outside of the home can be a significant barrier to continued breastfeeding.

In her upcoming webinar for ILCA, Nancy will share practical strategies for the International Board Certified Lactation Consultant® (IBCLC®) and other breastfeeding supporters to help working mothers reach their breastfeeding goals. I had the great pleasure to interview Nancy Mohrbacher and here’s what she had to say:

What inspired you to write a book for working parents?

For two years I worked for a national corporate lactation program, where I spoke daily to mothers going back to work. During that time, I realized then that in the years since the last really good book on working and breastfeeding was published we have learned a lot. Even so, recent research found that two-thirds of U.S. mothers who intend to exclusively breastfeed for three months do not meet this goal. The time seemed right for an up-to-date resource that thoroughly addresses employed mothers’ questions and concerns.

What are the unique benefits of breastfeeding for working families?

Many employed mothers have told me what is most precious to them about breastfeeding is that it strengthens their emotional connection to their baby. We’ve also learned more in recent years about breastfeeding as a key women’s health issue. Breastfeeding helps to “reset” a mother’s metabolism after birth. Even decades later a lack of breastfeeding or early weaning increases mothers’ risk of many health problems, including Type-2 diabetes, breast and ovarian cancers, metabolic syndrome, and heart disease, the number one killer of women. Most people know that breastfeeding is important to baby’s health, but now more women are motivated by the importance of breastfeeding to their own health.

What is the biggest challenge for working mothers who are breastfeeding?

Life is complicated, and I think the biggest challenge for working mothers is to distinguish between what is important to achieving their breastfeeding targets and what can be ignored. During my years with the corporate lactation program, I discovered that many new mothers are over focused on the wrong things. Most mothers think, for example, that their milk supply hinges on how much fluid they drink and are drinking massive amounts of water. Research tells us that despite popular opinion this actually doesn’t have a significant effect on milk production. Mothers need to be clear on what does affect their supply so they can take control of their own experience. My goal for Working and Breastfeeding Made Simple is to simplify life for working mothers by clarifying what needs their attention and why. Hopefully, with this information, they can stop wasting their time on the unimportant and focus on those things that truly make a difference.

What is the most unusual strategy that a mother has used to balance breastfeeding and employment?

Breast storage capacity has a major effect on the number of milk removals needed per day to maintain long-term milk production. I’ve been amazed that some full-time working women with very large storage capacities can maintain their milk production without any milk expression during their workday. I’ve learned to never say never!

If you could only give one piece of advice to a working mother, what would it be?

My advice would be to take some time—ideally during pregnancy—to find her tribe. Having a good support network is priceless. During pregnancy, mothers can create this network themselves by talking to family and friends to find those who have had a positive breastfeeding experience. Then they can ask those women to mentor them as they get started. The idea of a career mentor is common. We need to encourage mothers to find breastfeeding mentors, too.

Another way, of course, is to take advantage of online and in-person mother-to-mother support from organizations like La Leche League International, which is almost everywhere, and national organizations like the Australian Breastfeeding Association, Breastfeeding USA, the National Childbirth Trust, etc. It is well worth it to take the time to find other women they can rely on for solid information and emotional support.

What’s the most important thing to know for IBCLCs who support working mothers?

When troubleshooting with an employed mother, my suggestion is to first focus on her number of milk removals (breastfeeds plus pumps) during her entire 24-hour day. Many IBCLCs ask only about a mother’s pumping patterns at work. What’s most important to long-term milk production, however, is the number of milk removals per day and how that compares to a woman’s Magic Number.

When I helped mothers through the corporate lactation program I had the luxury of time to talk as long as necessary to find out exactly what their issue was. I began to realize that due to common misconceptions many women were pumping often enough at work but were dropping feedings at home. I found that was the main source of many women’s milk-production challenges.

 

NancyMohrbacher-190x238Nancy began helping breastfeeding families in the Chicago area as a volunteer in 1982 and became board-certified as a lactation consultant in 1991. She founded and ran a large private lactation practice for 10 years. She also worked for a major breast-pump company and a national corporate lactation program. Nancy is author of Breastfeeding Answers Made Simple and co-authored with Kathleen Kendall-Tackett, the book for parents Breastfeeding Made Simple. Her 2013 tiny troubleshooting guide for mothers, Breastfeeding Solutions, is now available as the ground-breaking Breastfeeding Solutions app for Android and iPhones. Her new book, Working and Breastfeeding Made Simple, debuted in 2014. Nancy speaks at events around the world.

LAO headshot summer 2014Leigh Anne O’Connor is a IBCLC with a busy Private Practice in New York City. She is also a La Leche League Leader. She lives in Manhattan with her husband Rob and their three children. Leigh Anne blogs at www.mamamilkandme.com

 

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Freya’s Gold: Milk Donation After Loss

#ds37 - Mom and BabyIn today’s Lactation Matters, we’ll hear from Monique, who opted to donate milk after the loss of her daughter, Freya. Monique shared her story in honor of both daughters (Aviana and Freya) who passed away. For her, it is comforting to have their names out there and for their lives to be recognized in some way.

Clinical Lactation, the journal of the United States Lactation Consultant Association, has published an article entitled Lactation After Loss that you may find useful as you support bereaved families.

You may also find previous articles on how to become a milk donor and debunking common milk banking myths helpful as you educate others about milk donation options.

Monique’s story:

When I found out that I was pregnant in 2011, my husband, Justin, and I were both excited and scared because we had already been through a first trimester miscarriage and a loss at 23 weeks gestation when my cervix dilated and I went into early labor (Aviana only lived an hour and a half). Due to previous complications during pregnancy, we decided to work with a high-risk specialist to prevent preterm contractions and cervical dilation. During my pregnancy, I was on bed rest for over three months and was monitored very closely. In preparing for the possibility of preterm labor, I was working with a lactation specialist to learn how to pump milk for a preterm baby. At 33 weeks gestation, there was a cord accident and our second daughter Freya died in-utero. I never had the opportunity to breastfeed or pump milk for Freya.

Even though I had no baby to feed, I produced milk and decided that I wanted to pump. The lactation specialist that I worked with during my pregnancy was bewildered that I wanted to keep pumping my milk after Freya died. She seemed confused as to why a bereaved mother would want to keep pumping her milk . . .

My main support to keep pumping came from my husband and a dear friend, who is a naturopath and a midwife. Both of them encouraged me to pump my milk as long as I wanted to.

The pain of losing a baby is indescribable and for me, pumping milk helped create a structure for the days after my loss that were filled with grief. I pumped my milk multiple times a day for six weeks. I stored every drop of milk that I pumped in a freezer. I couldn’t imagine throwing away “Freya’s Gold” because there was so much love in that milk.

In my experience, there is a general discomfort with grief and loss in our culture. There is pressure to close the loop on suffering which is not realistic for bereaved mothers. Pumping milk is one way that bereaved mothers can manage the intense and ongoing grief of losing a baby.

I have always felt very lucky in love (I love you Justin), and even in the darkest days of my grief, I could feel this light and this love from Freya. I knew I wanted to do something meaningful in memory of our daughter. So I called the Mothers’ Milk Bank about donating my milk. For me, donating milk was a way to help other babies benefit from our daughter’s milk and it was a way to honor my body and my experience.

When I lost Aviana at 23 weeks, I suppressed lactation and never pumped my milk. When Freya died, I chose to continue expressing my milk and then donated it to the milk bank. I made these decisions based on what was best for me at the time. I feel strongly that it is important for lactation consultants to address lactation with bereaved mothers and give them the option to pump their milk so they can make an informed decision.

Special thanks to the Mother’s Milk Bank (a San Jose, California based non-profit milk bank serving 13 states in the U.S.) for working with Monique and sharing her story with Lactation Matters. To stay in touch with the Mother’s Milk Bank, please click here.

Photo credit: Indiana Mothers’ Milk Bank

What strategies and tools have you used when talking with bereaved mothers?

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From JHL: How US Mothers Store and Handle Their Expressed Breast Milk

Written by Robin Kaplan, M.Ed., IBCLC

Image via Mistel de Varona

Breast milk storage guidelines can be incredibly complicated for mothers to decipher. With each pump company and breastfeeding website having its own storage and handling recommendations, how’s a mother to know which one to follow? Plus, throw in whether the baby is full-term, pre-term, healthy, or in the NICU, and we have quite a confusing situation.

In the most recent online publication in the Journal of Human Lactation, How US Mothers Store and Handle Their Expressed Breast Milk, Judith Labiner-Wolfe and Sara B. Fein analyze the data they collected from over 2,000 pumping mothers in the United States. Their findings will probably not shock any lactation consultants, yet the authors bring up very valid conclusions for how we can educate the breastfeeding and pumping mothers that many of us work with.

Here are some of the significant results of the study:

  • 95% of mothers either never stored their milk at room temperature or did so for less than 4hrs. Recommendations range from 1-10 hours.
  • Roughly 50% of mothers never refrigerated their milk for less than 1 day and no more than 4% left it in the fridge for more than 5 days. Recommendations range from 1-8 days.
  • 10% of mothers heated their breast milk in a microwave, a practice that can cause uneven heating, as well as destroy some of the nutrient and anti-infective factors in breast milk. The professional consensus is to never microwave breast milk.
  • 17% of mothers with babies under 6.5 months old reported that they occasionally only used water to rinse the bottle nipples, which the authors stated could cause the baby to ingest harmful bacteria. Recommendations range from rinsing in warm, soapy to sterilizing daily.

What are our professional guidelines?

There are also some discrepancies as to how long pumped milk stays fresh and viable, even in our own professional guidelines. While these recommendations are similar to one another, there is still enough variability to cause confusion for even the most educated lactation consultant. Here are the recommendations, for a healthy infant, according to the newest edition of the Core Curriculum for Lactation Consultant Practice (2012):

Room Temperature 77 º: < 6 hrs.
Refrigerator: < 8 days
Insulated cooler with ice pack: < 24 hrs.
Completely thawed in the refrigerator: < 24 hrs.
Freezer compartment in 1-door refrigerator: 2 weeks
Freezer door in 2-door refrigerator: < 6 months
Deep freezer: < 12 months

The Academy of Breastfeeding Medicine Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants states:

Room temperature 16-29ºC (60-85ºF): 3-4 hrs. optimal; 6-8 hrs. acceptable under very clean conditions
Refrigerator ≤4ºC (39ºF): 72 hrs. optimal; 5-8 days under very clean conditions
Freezer < -17ºC (0ºF): 6 months optimal, 12 months acceptable
Reusing stored human milk – There is little information regarding the issue of refreezing thawed human milk or the duration of time that human milk can be used once a baby has begun drinking from the bottle or cup.

Both resources recommend washing human milk storage containers in hot soapy water and
rinsing or washing in the dish washer. Sterilization is not necessary.

How do these findings impact our practices when we work with breastfeeding and pumping mothers?

When we are discussing safe storage guidelines for breast milk, it is important to review our professional recommendations, as well as include warming, safe handling, and pump/bottle cleaning recommendations to protect the integrity of the breast milk, as well as the health of the child.

Recommendations should be accompanied by rationale, so that the mother understands WHY her breast milk is less compromised following these standards.

Where do we go from here?

This study’s findings highlight the need for a more systematic, researched-based recommendation for the viability of breast milk and what constitutes safe handling and storage. With so many variables (temperature of the storage space, type of storage equipment, handling, feeding, and cleaning procedures, etc.) there are just too many options, which I, myself, find incredibly confusing. While there are many factors that go into keeping breast milk viable for consumption, there has to be some way that we can create guidelines that are easier for new parents, and lactation consultants alike, to navigate and follow.

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor toILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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