Throughout time, mothers have worked continued their education, and pursued volunteer activities while successfully breastfeeding their children. Women today not only have the benefit of their wisdom, but they also have new resources and technology to increase their success. Whether you are starting out with milk production that is already low or have low milk production challenges as a result of returning to work or school, this chapter will help you find strategies to make the most milk possible for your baby. To simplify, we’ll call all mothers separated regularly from their babies “working mothers,” but we understand that your work” is not always in a traditional job.

  • Maximizing Your Milk Production

Your best chance for continuing to breastfeed successfully is to invest the time to establish maximum milk production before you go back. The higher you can calibrate your initial milk production, the more resilient it will be if you have difficulties later on. It may help to pump several times a day in addition to breastfeeding for at least the first two to three weeks to deliberately overstimulate your production and create a cushion for the inevitable bumps down the road. For a maternity leave of six weeks or less, continue to pump as many times a day as you can For a leave of two months or longer, hold off pumping until a week or so before you return, or you can pump once a day whenever milk production is at its highest point. Any milk pumped now can be stockpiled in your freezer as insurance for later.

          You may not get a lot in the beginning. Don’t think that means you’ll have problems making enough milk when returning to work. Your baby has simply taken all the available milk, and there’s not much left to pump. The point of using the pump is to tell your breasts to make more than they’re currently making. When you’re pumping in lieu of breastfeeding, there will be plenty of milk.  

           As you work to maximize your milk production, keep your time with baby in the forefront, because those first few weeks fly by quickly. Yes, you need to plan for the day you have to go back to work or school, but don’t spend so much time preparing and stressing about it that you miss out on this precious chance to bond with your baby. You’ll produce more milk and make the transition back to work more easily if you put baby first and fit preparations in as you go.

  • Make Your Plan

Before you return, you’ll need a plan for how to manage breastfeeding while you are away from your baby. Keep it flexible so you can adapt to the unexpected. There is no single right approach because situations and childcare options vary. The main factors that affect your plan are how long you’ll be away from baby, how close your caregiver is, and what your baby will be fed during the workday.

        Some moms choose not to pump at all while they are away from baby, breastfeeding only at night and on weekends and having the sitter give formula instead. This creates a challenge for keeping milk production up, especially if the time away is long, but a number of mothers have done it successfully. The key is making sure to breastfeed as much as possible when you and baby are together. If you want your baby to have only your milk, or at least as much of it as possible, you’ll need to express milk for when you aren’t together. Just like the first few weeks after baby was born, returning to work or school may be a little bit awkward as you find your way and settle into a routine. The following recommendations will help minimize the impact on your milk production.

  • Get a Good Pump

 While some mothers are very skilled at hand expressing, most find it more efficient and time-effective to use a high-quality pump with a dual kit when away from baby. If you start with a good supply, a high end consumer pump is usually sufficient; but if you struggle with milk production, a hospital- grade pump is a wiser choice. Shop until you find one that you really like; it’s worth the investment. For helpful information on choosing. Check the Part-II increasing milk supply (spectra)

  • Plan Your Schedule

To know how many times you’ll need to pump each day, pay attention to how many times baby normally feeds during the time period you’ll be away from him. Aim for fitting in that many pumping sessions, adding extra opportunities for feeding and pumping into your schedule to help keep your supply up. Here’s an example for an eight-hour day: Before it’s time to get up, wake baby for a leisurely feeding in bed while you rest for a few more minutes. With his tummy full baby should be content while you get ready for the day. Give him a “top off” feeding right before you leave home or at the sitter’s. If you have time, pump as soon as you get to work or school even though you may have nursed just a short while before. Then pump during your morning, lunch, and afternoon breaks. Ask your caregiver not to feed baby close to the time you’re due to arrive so that he’ll be ready to eat when you pick him up or right when you get home. Should you be late, baby can be given just an ounce or so to keep him happy so he’s still hungry when you get there. Nurse baby once or twice in the evening, right before he goes to sleep, and at least once during the night.

          By now you’ve fit more than eight sessions of pumping or nursing into your day! Even though you’ve been away from baby for eight to ten hours, you’re still nursing or pumping as many times as mothers who are with their babies full-time. That’s going to go a long way toward keeping your high. Of course, there will be days when fitting in all those nursing and pumping sessions just can’t happen. Doing your best to breastfeed and pump as often as you can will keep your milk production as high as possible.

           When you’re with baby, make breastfeeding a high priority. Many mothers set a rule that baby gets bottles only when they are at work, and all the rest of the time they commit to breastfeeding. Resist the temptation to let someone else feed a bottle of pumped milk just because it’s already prepared and handy and you have something else you need to do. Giving a bottle of milk instead of nursing decreases your supply by that amount, so bottles should be given only when you aren’t with him. Plus, too many bottles can lead to breast refusal if baby spends more time with the bottle than the breast. On evenings and weekends, keep baby with you wherever you go so you can nurse when he wants to, even at the movies or out to dinner.

  • Creative schedules

Don’t overlook creative scheduling possibilities. Can you minimize the time you and baby are separated? How about working or going to school part-time at first? Or taking online classes or working from home? Can baby come with you for some or all of the time, at least in the early weeks or months? Can baby be brought to you, or can you go to baby, for at least one nursing each day? Could you take part or all of Wednesday off so that you have to rely on pumping to maintain your milk supply for only two days at a time? Would fewer longer days or shorter days’ work better in your situation? Think creatively and don’t hesitate to express your needs to those who can help, especially your employer or professors.

  • How Milk Production Can Decrease

 It’s so common to hear about working mothers having problems with their milk supplies that it seems inevitable. Milk production may start off very well at the beginning of the week but lag by the end. A pumping routine that works well on Monday may not produce the same amount of milk on Thursday or Friday. Other times, mothers find that milk production seems to decrease around two to three months. These experiences aren’t inevitable, but there are many reasons they can happen.

  • Pumping Frequency

The most likely suspect when a working mother’s milk supply drops is a decrease in pumping. If your job or class schedule keeps you running most of the day, it can be difficult to fit in enough pumping sessions. You may start of expressing three or four times each day but eventually find that you’re pumping only a couple of times at most on busy days, and there seem to be more busy days than not. One solution may be to use a hands-free kit so you can multitask while pumping. Another idea is to schedule pumping time on your day planner, PDA, or shared calendar. If you don’t have enough time for a full pumping session it’s better to pump for even a few minutes than not at all. Anything is better than nothing.

           What if your pumping schedule hasn’t changed but baby starts sleeping longer at night so he’s nursing less when you’re with him? It might seem great at first because you’re getting more rest. But baby has to make up those feedings in some way, and it’s probably going to be during the day at the sitter’s. To keep up with his need for more milk then, you’ll need to either add in another one or two pumping sessions, wake baby for an additional feed right before you go to bed, or reconsider the value of uninterrupted sleep. If baby can be encouraged to nurse at least once during the night, you can minimize the effort of night feeding by having him sleep with you or near you for the next few months.

       One last possibility when frequency is an issue is how you determine when it’s time to pump. Do you wait until your breasts feel full? That can lead to longer and longer pumping intervals because milk is made most slowly when the breast is full.

  • Travel

Everything can be going along wonderfully until you’re called away on a trip out of town, wreaking havoc with your pumping schedule, let alone finding ways to store the milk you pump while you’re away. You may need to think creatively to work around any travel-related obstacles. Diana Cassar-Uhl, an instrumentalist in the U.S. Military Academy Band at West Point, La Leche League Leader, and mother of three exclusively breastfed children, has dealt with her extensive travel schedule by having an au pair accompany her and the baby on trips. Of course this can be expensive and isn’t always possible, but its one option to consider. A family member such as a grandma can also be a boon in such situations.

       If you are worried about hauling around your electric pump or power sources for it, bring a manual pump; they can be used almost anywhere. Some mothers find a way to store the milk and bring it home. On long trips, determined mothers have even shipped milk home. But another option is to “pump and dump”. It seems a shame to waste it, but it keeps your supply up. Whichever you choose, just keep the milk flowing.

  • Caregiver Feeding Methods

You may think there’s a problem with your milk supply because your caregiver is telling you that your baby needs more milk during the day than you’re sending in. But if the amount you’re making hasn’t changed, the problem is more likely to do with how your sitter is feeding your baby.

        Is she offering a bottle as a first resort when baby fusses? Most babies will take a bottle even when the problem isn’t hunger. What they’re ally need is the cuddling that comes with the feeding, Encourage your sitter to try other ways to soothe baby than just reaching for a bottle. Is baby taking more and more milk? Babies will usually take more if it’s offered even if they don’t really need more. Your sitter may not know that breastfed babies don’t need ever-increasing amounts of milk like formula-fed babies do because their metabolic needs are different Have you upgraded to a nipple size larger than “newborn” or “slow flow”? Has the sitter cut the opening to make it flow faster? Breastfed babies should stay at the slowest flow nipple so the flow is similar to the breast, to avoid flow preference. How is baby gaining? If he’s gaining more weight than normal, it is a clear sign he’s being given too much to eat.

         Is the feeding being ended when baby seems satisfied, or is he being encouraged to finish the bottle so none is wasted? Find out if any milk is being thrown away at the end (and if so, how much), and let her know that unlike formula, your milk lasts longer and may be usable for a couple of hours. It also may help to send the milk in smaller increments so that it is used only as needed.

         Is baby being fed in a mostly upright position? If not, the milk can flow so quickly that baby may still root for more, not realizing he’s already full. Demonstrate how to pace the feeding by periodically leaning baby forward for a break, this will help both your caregiver and baby learn to regulate the feeding naturally .Reassure her that it won’t prolong the feeding, and it may reduce the need for burping.

  • Growth Spurts

 Even when the sitter feeds baby in all the right ways, there will be days when baby goes through all the milk you pumped the day before by noon and nurses nonstop when you get home. He’s probably going through a growth spurt and will want more milk than usual until it passes. During this time, you may need to add an extra pumping or two to keep up. If that isn’t possible, it’s a good time to dip into your frozen stockpile if you have one. Fortunately, it should last for only two to three days, and then he’ll be back to the normal amount.

  • It Isn’t Always about Work

What if you’re pumping often enough with a great pump and your caregiver isn’t overfeeding but there’s still not enough milk? First, rule out any other management-related, baby-sided or structural problems. Is it possible that you’re pregnant? Have you taken any decongestants or new medications or eaten a lot of mint candy, tabbouleh or sage? Have you started taking hormonal birth control? Has baby started sleeping through the night? If nothing fits, the problem may be hormonal. Were you able to maximize your milk production capability by removing as much milk as possible in the first few weeks? If not, you may not have enough receptors, which may be affecting your milk production now. Look into the previous eBook, and if necessary, make an appointment with your doctor to discuss your concerns.

  • Pump Effectiveness

 The second most likely suspect when a working mother’s milk production decreases is her pump. How good is the one you’re using? Most working mothers need a high-end pump to remove their milk effectively. Make sure your flanges fit well and all the connections are correct. Try adjusting the cycling speed either up or down to better match the way your baby nurses. If you’re using a consumer-grade pump, how old is it? AS explained in Chapter 11, they’re not designed to work at top efficiency for much longer than a year and can deteriorate so slowly that you may not notice. If you used it with your last baby or you borrowed it from someone else, try renting a pump for a week to see if you get more milk. If so, maybe you need to invest in a new pump. It may also help to read back through eBook-part-I-II-III for tips to increase your pumping output.

  • Increasing Your Supply While Working

The faster you take action to correct a decrease in milk production, the easier it will be to bring it back up. Don’t hesitate, hoping that it will get better on its own. Addressing the cause now will help things get back to normal sooner. If the problem is due to a faulty pump or scheduling problems, the following ideas may help. Increase Frequency One of the most effective ways to compensate for a decrease in pumping output is to spend your weekend “power nursing” your baby, Encourage him to nurse often to rebuild your supply for the new week. If baby doesn’t want to nurse more often or other things interfere, “power pumping” as described in previous eBook can accomplish the same result.

  • Breast Compressions

Try using breast compressions to increase the amount of milk that you can remove while pumping. Breast compressions are a way to add pressure inside the breast so the milk flows more forcibly through the ducts, almost like creating another milk ejection.

  • Reverse Cycling

 Seeking to avoid the pressure of pumping enough milk for daytime feedings while working the demanding schedule of a resident, Dr. Marilyn Grams developed a unique strategy that she calls “reverse cycling”: deliberately feed more at night than during the day. She discovered that when she encouraged lots of nighttime nursings, her baby needed less pumped milk during the day. She also found that she was able to maintain a strong supply under challenging work circumstances. The quality of her rest didn’t suffer because she learned to nurse comfortably while lying down and to sleep through the feedings.

       It’s a counter intuitive strategy that has worked well for many working mothers and is worth trying. Babies have also been known to initiate this themselves, taking little at the sitter’s and waiting until mom returns, after which they start feeding in earnest. If you’re worried about sleep, go to bed an hour or two earlier than usual (after feeding) and let your partner care for baby so you can sleep alone for a while. On weekend mornings, have your partner get up with baby (after feeding) so you can go back to sleep. Nap with baby whenever possible.

  • Milk Ejection Remedies

After several weeks or months nursing your baby before you returned to work, your milk ejection was conditioned to happen when he breastfed. It can take some adjustment to make it happen when you turn the pump on.

         Since the sense of smell has an amazing power to trigger a physical reaction, try holding our baby’s unwashed blanket or clothing next to your face as you pump. An iPod recording of his gurgling, coos, or gentle cries, or even a picture of him may elicit the same response. If you have a special song that you sing to your baby, try humming it to yourself as you pump. On the other hand, some mothers find that reminders of their baby actually keep the milk ejection from happening because they miss him so much.

         Samantha Leeson, a doula in Ontario, had never felt milk ejection with her first son, Fergus, or her new baby, Quinn, so when she returned to work, she found it difficult to know what to do to let down to the pump. One night, she tried nursing Quinn on one side and pumping on the other at the same time. This gave her a guide for timing and helped her transition from Quinn to the pump. After doing this several times, she was able to have a milk ejection while pumping without needing Quinn to help.

       If privacy is the issue, see if you can find either a more secluded place to pump (not the bathroom!) or a way to make your pumping place more private. Can you put up a sign to discourage visitors? Can you install a lock on the door? Can you hang curtains? Can you go to your car? There are also many other ideas for enhancing milk ejection.

  • Consider Galactagogues

 If you’ve done your best to maximize milk removal but are still falling short, galactogogues may help fill the gap. For a modest boost, one great idea is to brew and ice a pitcher of a nursing mother’s tea in the morning and sip on it throughout the day.

  • Solids Take the Pressure Off

 Once baby begins taking solids, they can be used as part of baby’s supplement at the sitter’s. This will begin to take the pressure off how much milk you need to provide each day. Of course, solids should be offered only in small amounts at first, so this transition will be very gradual. When given at home, be sure to breastfeed first so he fills up on your milk. However, when your sitter gives baby solids, they should be given before the bottle to reduce his need for milk while you’re away.

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