By: Alexiyah Coughlin, IBCLC
Returning to work while breastfeeding may be one of the hardest experiences as a new mom. It’s easy to feel unprepared, both emotionally and physically. And when you’re a working breastfeeding mom, there is an additional weight on your shoulders to make sure that you’re prepared to feed your baby while you’re away. While I likely can’t resolve the emotional stress, I can help by sharing some useful advice on how to prepare for pumping and going back to work.
Freezer stash
The biggest question we get is when to start pumping and how much milk to store. The answer to this is not one-size-fits-all. If you ask other working breastfeeding moms, you’re likely to find different opinions about how much of a freezer stash is needed. As a lactation consultant, I have heard colleagues give out various information. Some recommend a specific number, like 70-100 oz of saved milk before you head back to the office. I tend to recommend enough milk to make it through 1-2 days for those who have a good milk supply. The reason for this is that you really won’t need more than what your baby will take in one day, because you really should be pumping to replace what your baby has taken that day. Over-pumping to prepare for back to work can drive a normal supply into oversupply, which can lead to a variety of issues.
The next question is, when do I recommend starting to pump and how often to pump? Again, this is not a universal answer. It really depends on each individual dyad. For working breastfeeding moms who have ample supply, I will often recommend adding 1 pumping session every other day, usually after the first morning feed. That is, feed your baby first thing in the morning and then pump to add to your freezer. I will often have moms start this 2-3 weeks before they head back to work. As an exception, those who don’t produce as much may want to increase their sessions to once every day or twice per day, depending on how much they’re getting on a less-frequent basis.
Bottle introduction
The next big concern is introducing a bottle to a breastfeeding baby. If you’ve made it through most of your maternity leave only nursing your baby at breast, kudos! As you plan to return to work, you’ll want to start familiarizing your baby with a bottle. Some professionals will recommend avoiding a bottle until the baby is at least 6 weeks old, if possible. For some, this may not be practical, leading very little time to work through bottle refusal issues if you’re heading back to work at 8 weeks. The recommendation to hold off on bottle intro is for a few reasons. First, it’s often a concern that baby would develop a preference for the bottle over the breast. Second, in the early weeks, milk supply is still being established, so the more direct stimulation from baby, the better a supply will match the baby’s needs. However, it’s still reasonable to be practical. For most babies who are vigorous at breast, introducing them to a bottle once you’re well into a healthy breastfeeding journey is totally acceptable. I don’t see many babies reject the breast after taking a bottle when they’re doing well at breast in the first place.
Now, there are a few things you can do to lessen the risk of issues surrounding bottle introduction. It’s always recommended to used a paced bottle feeding technique. That is, holding the baby in a side-lying position, as if they were in position to breastfeed, and feeding them small amounts at a time by shifting the angle of the bottle: https://www.youtube.com/watch?v=NqaenbzNqSU. When starting a feeding, try to allow baby to gape and latch appropriately, as they would at the breast. Then, allow them to suck on the nipple for ~30-60 seconds before allowing any milk to enter the nipple, which simulates the amount of time they have to wait for a letdown at breast. Additionally, bottles are not created equally. Choose a nipple that is sloped, which will encourage a wide, correct latch.
Practice runs & bottle refusal
Now that you know how and when to start introducing the bottle, it’s a good idea to have a few practice runs before the big day. I often tell families to use this as an opportunity to get out of the house and practice some self-care. As a trusted caregiver to watch your baby for a few hours, leaving them with milk and instructions on how to do a paced bottle feeding. This comes with a couple of big benefits. You will be reassured that your baby does well without you home, and you can use this time to have some alone time by yourself or with your partner.
If your baby refuses the bottle, don’t panic! Hopefully you’re reading this before you’re already back to work. Either way, there are ways to overcome this problem. In general, it’s a good idea to schedule a visit with a lactation consultant who has had specific training in dealing with bottle refusal. They will be able to help you work through the issue. You can try a few different bottle/nipple styles and see if one works better than others for your baby. Also try to adjust the temperature of the milk, as some babies will have a preference for warm vs. cool milk. Another thing you could try is adjusting who is attempting to feed the baby. Some babies certainly struggle more to take a bottle from their mom, so it’s often recommended to have someone else feed without mom in the room. Others might not understand why someone who doesn’t look, smell, or sound like mom is providing the milk. It might be a smoother transition for mom to do the first feedings, and then work to transition. If your baby is still refusing the bottle, a lactation consultant may give you some exercises to work on with your baby, but in the meantime, you can always cup feed with a small cup or shot glass. The following link is a video on how to cup feed: https://www.google.com/search?q=iable+cup+feeding&oq=iable+cup+feeding&gs_lcrp=EgZjaHJvbWUqBwgAEAAYgAQyBwgAEAAYgAQyDQgBEAAYhgMYgAQYigUyDQgCEAAYhgMYgAQYigUyDQgDEAAYhgMYgAQYigXSAQgyMDc0ajBqN6gCALACAA&sourceid=chrome&ie=UTF-8#kpvalbx=_7DQUZqKVN5bEp84P-8yakAc_29.
Stocking a work bag
Make sure you’re well-prepared to pump at work by stocking a work bag full of supplies to pump and store your breastmilk. I often have moms keep some back-up supplies at work in case they forget their parts at home. It’s a good idea to have an extra collection set and storage bags at your place of work, if allowed. In your pump bag, you should pack your breast pump, charger, multiple collection sets, storage bags, and cleaning supplies. If your employer does not provide a fridge or freezer to store your milk, you will need to bring a cooler bag with ice packs or utilize an alternative storage container that has built in cooling capabilities. It might be especially helpful to wear a pumping bra or pack one along so that you can pump hands’ free at work.
Achieving a letdown while away from your baby
It might be more difficult for some to let down milk when they’re away from their babies. If this sounds like you, you’re not alone! It just means that your body is really smart. When we ask your body to let down milk for a breast pump, we are basically trying to trick your body into thinking your baby is at breast. For some, release of oxytocin is harder when you’re not with your little one. This is because the body relies on all 5 senses to recognize a need for the release of milk. If you struggle with letdown while pumping, you can try a few things to help. Bring along an item of baby’s clothing and smell the article while pumping. You can also watch a video of your baby feeding or listen to them crying. Sometimes, hand expression (massaging your breast) while pumping can be helpful. Anything to remind your body of your baby.
For others, a little distraction may be more helpful. Take some time to tune out. Watch a favorite show, listen to music, or do whatever it is that takes your mind off of the pumping session.
Milk storage
Once you’ve pumped your milk, its important to know safe milk storage guidelines to ensure that you’re keeping the milk appropriately so that it’s safe for baby to consume. Milk storage guidelines are slightly different depending on the resource you refer to, but the most commonly followed information comes from the CDC, as follows:
At room temperature: up to 4 hours
In the refridgerator: up to 4 days
In the freezer: 6-12 months
Thawed from the freezer: 1-2 hours on the countertop, 2 hours in the refrigerator
Leftover from a feeding: 2 hours after baby is done eating
Some say that up to 6 hours at room temperature is appropriate, and many are saying that milk is likely good in the freezer for longer than 12 months, within reason. However, the risk lies more within depletion of key nutrients in the milk. The longer milk is stored, the less nutritious it is. If you’re using this milk for a subsequent baby, it’s better to not feed a newborn (especially a compromised newborn or a premature baby) exclusively frozen milk that has been stored for extended periods of time. Even for your current baby, always feed fresh milk first, rather than rotating your freezer stash! Your fresh milk has antibodies for your child’s current immune system needs, and it is the most nutritious without the depletion of nutrients that comes from storage.
A quick note about pump parts between pumping sessions: there is a new theory that pump parts can simply be stored in the refrigerator between pumping sessions. The CDC recommends against this, as bacteria growth can still occur in the refrigerator. It is most safe to pack multiple collection sets or to wash the parts between sessions. However, if this is not practical, it’s a reasonable second-best option to rinse your parts and put them in the refrigerator, washing them at the end of the day when you get home.
Know your rights – Talk with your employer
Did you know that you are protected under federal law as a breastfeeding parent? Your employer is required to provide you with time and a comfortable environment to express milk for your baby. For more information, check into my previous blog about the PUMP Act, which protects working moms.
If you need extra help
There are a lot of moving pieces when you’re preparing to head back to your 2nd full-time-job. This leaves room for a lot of complications to pop up! If you’re struggling, reach out to a local IBCLC or, if you’re a Rumble Tuff user, schedule an appointment with one of our IBCLCs who specialize in pumping by following this link: https://rumbletuff.com/pumping-appointments/. You’ve got this, and we’ve got you.
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