I'm Told that my Breastfed Baby Needs to be Supplemented.... What Should I Do?

Being told that your breastfed baby needs to be supplemented can feel extremely overwhelming and can often feel like quite a blow to the self-esteem.  You might be concerned about your milk supply and if your baby will prefer the bottle to your breast. You may feel confused as to why your baby isn’t gaining the appropriate amount of weight while breastfeeding.  

So, let’s talk about the reasons why a baby might need to be supplemented and how to do this without sabotaging your milk supply and your breastfeeding relationship.

What is a supplement?

A supplement is anything in addition to what your baby receives from your breast while breastfeeding.  Babies can be supplemented with: 

Mom’s own pumped milk (if baby is not removing her milk well enough)

Donor milk (from a milk bank or from another breastfeeding/pumping parent)

Formula

How do I know if my baby truly needs supplemental feedings?

Babies are expected to gain a certain amount of weight based on their age.  So, if a baby is NOT gaining that expected amount, additional supplementation is often recommended.  Here are the weight gain expectations for the first year of baby’s life:

Initial weight loss in the first few days of life - no more than 10% of baby’s birth weight

2 weeks - baby should be back to birth weight (or very close, if he/she lost more than 10% in the first 2 weeks

2 weeks - 4 months - baby should gain about 7 ounces per week

4 months - 6 months - baby should gain about 4-5 ounces per week

6 months - 1 year - baby should gain about 2-4 ounces per week

Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  

Some common medical issues that can arise shortly after birth that may lead to supplements are prematurity, low birth weight, poor feeding, low blood sugar levels (hypoglycemia), elevated bilirubin levels (jaundice), dehydration, excessive weight loss or poor weight gain.  After those first few weeks, some common reasons for supplementation are baby not removing milk well while breastfeeding (due to tongue tie, reflux, very long feeding sessions) and a low milk supply. In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  Next we want to assess mom’s milk supply to make sure that she is producing enough milk for her baby. Sometimes all it takes are a few modifications to the baby’s feeding routine to help baby start to gain weight. Other times it requires a lactation consultation (done by an IBCLC) to assess baby’s feeding and mom’s milk supply for the cause for baby’s low weight gain.

What if I can't express enough milk for my baby?

First you’ll want to make sure that you have everything you need to express your milk.  If using an electric pump, make sure the pump flanges fit correctly and that you are pumping for about 15 minutes after breastfeeding.  Some moms let down for the pump easily. Others find that they prefer a hand pump or hand expression. You will want to find what works best for you.

In those first few days after birth (when milk production has not quite yet surged), it can be a bit challenging to express a measurable amount of milk.  In this case, sometimes baby might need to be supplemented by donor milk or formula.

Once your mature milk is in (after those first few days), you might want to meet with an IBCLC to put together a breastfeeding/pumping plan to see if you are able to express enough milk for your baby, as well as increase your milk supply, if necessary.  If you are not yet able to express enough milk for your baby’s supplemental feedings, donor milk or formula would be recommended.  

Do I have to use a bottle when giving my baby supplemental feedings?

Not at all!  There are several ways to supplement a baby.  Each way has its pros/cons and will be determined by what works best for you and your baby.

Cup feeding is great for older babies, as well as some younger babies who will not take a bottle

Finger feeding is great for the first few weeks of life, as the flow is slow and your finger can help organize your baby’s sucking rhythm.

Supplemental nursing systems (SNS) allow your baby to be supplemented at the breast so that he/she still thinks everything is coming from you!  The SNS has a tube that slips into your baby’s mouth, at the breast, to provide the supplement at the same time baby is breastfeeding. This works best when baby is latching/breastfeeding well and mom is trying to increase her milk supply.

Bottles are definitely an option, as well.  You will want to offer a bottle in a baby-led (paced) manner so that your baby doesn’t begin to prefer the ease and flow of the bottle, compared to your breast.

Will my baby ever be able to fully breastfeed after supplements?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term problems that are resolved relatively quickly with good treatment.  Premature babies grow and get stronger, and typically get better at breastfeeding around their due dates or shortly after.  A baby who is having difficulty with breastfeeding immediately after birth will often be ready for breastfeeding within a few days after birth.  If breastfeeding challenges linger for more than a few days, an IBCLC can help identify the reasons and set you on a path for reducing and hopefully eliminating supplementation as soon as possible. In the meantime, expressing your milk in addition to breastfeeding will help maintain and build your milk supply as challenges resolve.  

When can I stop supplementing?

Part 2 will discuss how you’ll know it's time to wean from supplements and helpful tips for doing so. 

For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby

When Breastfeeding Doesn’t Go As Planned 

Low Milk Supply: Donor Milk, Milk Banks, and Formula

Partial Breastfeeding: When Supplements are Needed

Why Has My Pumping Output Decreased?

I love when we receive emails with questions that our blog readers could benefit from!  Here is a question from one of our mamas who is wondering why her pumping output has decreased.  

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Hi Robin!

I met with you awhile back when I first went back to work to set up a good pumping schedule.  It has worked like a charm these last 6 months.  Thank you for that!

My little guy is about to turn one and I’ve noticed a big reduction in my pumped breast milk the last few weeks. I’ve gone from pumping around 25 ounces of milk/work shift to around 15 oz.  It feels like it happened overnight. I’m just wondering if you have any suggestions on things I can do to get milk back or if this is just a normal progression.  I’m not ready to give up breastfeeding yet, but want to make sure he is getting enough milk.  He has been eating ALOT of solid food for about 5 months, so I’m sure this has had an impact on my supply :-(

Thanks for your time!

N

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Hi N,

I am thrilled to hear that our plan worked so well for you!  That is awesome!  

So, pumping output can dip for many reasons, regardless of baby’s age.....

1. Baby is sleeping through the night.  When babies start to go longer stretches in the middle of the night without eating, it can cause a mom’s milk supply to dip overall.  If your kiddo is going to sleep a few hours before you are, you can consider adding in a dream feed or pumping before you go to bed so that your breasts don’t go for such a long period of time without removing milk.  Also, if your kiddo wakes up in the middle of the night, you could consider breastfeeding at that time, rather than soothing back to sleep right away, if you are worried that your supply is dipping too low.
2. Pump suction is losing its stamina (which is HUGE and definitely common!)  I would recommend getting your pump suction checked immediately.  Many lactation consultants have pump suction gauges to check the pressure created when running.  A less-than-stellar functioning pump can definitely decrease pumping output, even when supply is right where it needs to be.  Renting a hospital-grade pump will also help you determine if your own pump is not working as well as it should.
3. Pumping frequency has gone down while at work.  As moms get closer to that year mark, many prefer to cut down on the pumping frequency at work.  Sometimes they are able to keep up their supply when this is done.  Others find that their milk supply is more sensitive, so it requires that extra pumping session.
4. Baby is eating solids before breastfeeding (when mom is with baby), so he isn't as hungry when breastfeeding. Up until about a year, solids should be offered after breastfeeding so that babies are getting the bulk of their nutrition from breast milk and getting solids after their bellies are more full.  
5. You got your period and are experiencing a temporary dip. When mom’s hormones are shifting due to her cycle, this can temporarily dip her supply.  
6.  Something else has changed in mom’s routine…. More working out on a regular basis, not eating enough calories per day, recovering from stomach flu or a cold, etc.  Again, all temporary.  But, make sure that you are eating at least 2000 calories a day to keep up your supply, as well as even extra, if you are working out.  If you are recovering from an illness, this will take a few days to rebound once you are feeling better.

That being said, 15oz of pumped milk at 1 year is pretty awesome!  At this point, your little guy doesn't need much more than that to complement all of the whole foods he is eating.  Plus, that doesn’t even take into account how much breastmilk he is getting from you while breastfeeding.  As long as he isn't getting frustrated at the breast, then just keep on plugging along, knowing that a breastfeeding baby should always be able to take out more than the pump.

Hope that helps!  Definitely get your pump suction checked, asap, and let me know if you have any other questions.

Warmly,

Robin

Check Out These Lactation Rooms at the San Diego Airport!

Traveling just got easier for breastfeeding and pumping moms traveling through the San Diego International Airport!  Just in time for the holidays, right?

Last month, the San Diego Nursing in Public Task Force was contacted by a local breastfeeding mom, Emily Mest, who frequently travels through the San Diego International Airport for work.  Here is Emily’s story, which set the wheels in motion to make breastfeeding and pumping easier for all moms traveling through the San Diego airport.

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Over the last year breastfeeding twins as a fulltime working mom, I’ve had a lot of  “air travel adventures”. There was the first time I pumped in my seat on a packed plane, and the glorious time an American Airlines stewardess curtained off her jumpseat area to give me a clean, private space. I’ll never forget bringing 25lbs of frozen milk back for the twins after a week in Costa Rica, and the kind United agent who waived the overweight bag fee since all the extra weight was breastmilk. I’ll  also never forget pumping tucked into a dirty corner of the Houston airport, just to have a tiny bit of privacy without pumping in an even dirtier bathroom.

Through it all, I couldn’t stop thinking how uncomfortable and emotionally draining this all was. From being away from my small babies, the normal stresses of air travel, and dealing with pumping, to clogged ducts, maintaining supply, and the ever-looming threat of mastitis.  If I hadn’t fought with everything I had to breastfeed my 35-weeker twins, I’d likely have thrown in the towel. If I hadn’t found a savvy working moms breastfeeding support group on Facebook, I doubt I would have had the confidence for those moments when I chose to throw on a cover and pump in front of hundreds of people in a crowded airport (choosing that over pumping in a foul-smelling bathroom). I found myself sad for other mamas who would have to endure this. I was disheartened thinking that if they didn’t have strong support or entrenched stubbornness, maybe they would stop breastfeeding because pumping during air travel can push you to your limits.

I had seen other mamas posting pictures of beautiful lactation rooms or lactation pods in other airports, so I started to investigate a bit. I emailed some of the pod companies to ask about how they go about getting their pods installed in airports. I Facebook messaged Jenna Ikuta, the manager of the San Diego Nursing in Public Task Force, responding to a post of hers about breastfeeding advocacy, and asked if she knew anything about Terminal 1 in the San Diego International Airport, where pumping is particularly hard. From Jenna, I found out that as of January 2016 a new law in California would require a place for moms to pump that is not a bathroom in all airport terminals that had over 1 million flights per year, except terminal 1 in San Diego.  

I became a mom on a mission: even if it happened after I was done breastfeeding, something had to be done about Terminal 1 in San Diego. As it turns out, my “mission” had really already been completed – the lactation room in Terminal 1 opened earlier this fall.  The San Diego Breastfeeding Coalition sent me an email to this regard, and I was shocked and excited. The following week I had a business trip and low and behold, after asking 5 employees someone finally knew what I was talking about and pointed me to the lactation room. It was beautiful.

There’s still a bit of work to be done: educating employees about the lactation room, putting up a well-placed sign or two, and spreading the word among nursing mamas. I posted in a few of the local breastfeeding groups, and added the location to the great app “Moms Pump Here” that helps moms find pumping locations around the country. I’m ironically writing this on my first business trip in over a year without a pump – I’m just gone for the day and the twins are only nursing morning and night now.  I hope that the next time you’re at the San Diego International Airport for a Southwest flight you enjoy the new facilities: just past security to your left, tucked under the escalators.

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After submitting Emily’s letter to the San Diego International Airport’s Customer Relations Coordinator (with the help of the UCSD’s Lactation Supportive Environments Department), we were thrilled to report back to Emily that there were, in fact, THREE Lactation Rooms at the San Diego airport.  It appeared that the security and airport staff just had no idea that all three existed.  Since this misinformation was brought to the airport’s attention, they have gone above and beyond to make these Lactation Rooms available and accessible to breastfeeding and pumping moms.  First, they have placed the breastfeeding symbol on their interactive map, showing where all of the lactation rooms are located. Secondly, they have sent out a press release so that all of their staff members will know about the Lactation Rooms and where they are located.  

Hopefully the last step will be to take Emily’s advice and affix well-placed signs throughout the airport so that moms can easily find these rooms when they need them.  

We would like to commend the San Diego International Airport for making breastfeeding and pumping moms a priority in their renovation plans and for creating a wonderful space where moms may have some well-deserved privacy.

Thank you, Emily, for bringing this to our attention so that all breastfeeding and pumping moms traveling through our airport can benefit from these rooms!  And, for moms who would like to breastfeed their children throughout the terminal, remember that California law protects your right to breastfeed in public!  

Safe travels during the busy holiday season, and beyond!

Have you seen a Lactation Room or a Mamava Lactation Suite at one of the airports you have traveled through?  Snap a photo and place it in the comments so that we can share this information with other traveling moms!

Work. Pump. Repeat. with Jessica Shortall

In honor of World Breastfeeding Week 2015, we are sharing inspirational stories from breastfeeding/working moms.  Today’s story is a special interview with author, Jessica Shortall.  Jessica is an entrepreneurial mother of two, with a career dedicated to the intersection of business and doing good. She's been a Peace Corps Volunteer, a non-profit co-founder, the first Director of Giving for TOMS Shoes, and an LGBT advocate. She's the author of Work. Pump. Repeat: The New Mom's Survival Guide to Breastfeeding and Going Back to Work.

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Jessica, what inspired you to write this book?

When I had my first baby, I was the first woman at the start-up where I worked to have a baby on the job. And my first business trip was a week in rural Nepal when my son was 5 months old. I was totally panicked about how to manage pumping and working, especially with such extreme travel, but I assumed that, as with everything on parenting, there was a book that would tell me exactly how to do it. I couldn't find what I needed: an intensely practical, non-judgmental, and approachable resource. I realized that if I wanted that to exist, I'd have to write it myself. So I set myself on what would become a five-year journey (my baby just turned five!!) of interviewing hundreds of working, breastfeeding moms and sharing their stories, their hacks, their triumphs, and their struggles.

 

What was your pumping situation like at work?  You traveled for your job, as well, right?

I worked from home (at the time, in Austin TX), which made things really easy on a daily basis - I did a lot of pretending I couldn't hear "that weird noise" everyone else seemed to hear on conference calls. But I traveled a LOT - often twice a month - both to my company HQ in Los Angeles, and extended trips all over the world. So I had a bit of everything - at home and not worried about privacy; in the HQ office and commandeering a storage closet, since the company was too small and too young to even know what a lactation room is; and literally on planes, trains, and automobiles, often in rural locations.

What are your Top Tips for becoming friends with your pump?

First off, rip off the Band-Aid and learn how to pump early in your maternity leave. Invite an experienced friend over to take you to "pumping school" - as long as you're comfortable with her seeing your boobs, she can show you the ropes and get you set up on a daily routine of pumping after the morning feeding session to start to build a freezer stash for when you're back at work.

Second - and I am in no way paid to say this - buy Pumpin Pal flanges. They are compatible with most pumps, they are WAY less messy than the flanges that come with your pump, they are designed to be more comfortable, and they can even help some women get more milk per pumping session.

Third - know how to maintain your pump. Check regularly for the state of those flimsy white membranes that come on Medela and other pumps. They are essential to the thing actually working. If your output drops, take the pump in to a maternity store and ask them to test it. Try snipping an inch off the ends of the tubes to see if you can get a snugger fit.

Finally - don't expect to love the thing. I'd say "frenemy" is more accurate than "friend." It's going to help you feed your baby, but it's going to literally suck, too. Many women I interviewed for this book reported imagining their pump saying a specific phrase over and over: "red hot panini" was my favorite. Many women fantasize about going Office Space on their pumps when they're done breastfeeding. It's ok to have a love/hate relationship with the thing.

What strategies can you recommend for moms who feel like they don't have enough time to pump at work?

My top strategy is to be kind to yourself. Mixing work and breastfeeding is really, really difficult, and it's not always possible to pump as frequently or for as long as you'd want or need. That's just a reality of being a working mom. It doesn't make you a bad mom in any way. If work pressures build up and you find you just can't keep up, remember that breastfeeding does not have to be all or nothing - you can nurse when you're with your baby, pump when you can, and supplement the rest, and we fellow working moms will still be amazed by what you're able to accomplish.

It's also a good idea to buy a single, manual pump. Sometimes all you can sneak in is a few minutes in a bathroom stall. This at least relieves engorgement, provides some "demand" for your milk, and gets some supply out.

Some women with a commute also discover the beauty of Pumping While Driving (PWD). You have to do this very, very safely, which means setting up before you get moving, and pulling over to disassemble everything if you're still driving when you're done pumping. But with a good nursing cover and some careful setup, car time feels like bonus time and can help you fit in the pumping sessions you need.

What is the best clothing to wear for pumping at work?

Anything that is good for nursing is good for pumping, too, but obviously you need it to be work-appropriate. There is a lot of "normal" clothing that can work for pumping. Button-down shirts and dresses are great, as are crossover/wrap tops and dresses, cowl-necks, and camisole/shirt combos. Don't wear a dress that you'd have to pull up around your neck or down around your waist - even if you have a private space to pump, you're going to feel really exposed.

What are your Top Tips for keeping up milk supply when back at work?

Stay hydrated and try to protect your pumping time as best you can. Block it off in your calendar if you're in an office environment. Even if you're not confident about protecting that time, like with a simple "I have to duck out for a few minutes - I'll be back" - fake that you are until you believe it yourself.

What are your Top Tips for maintaining sanity as a working/pumping mom?

As I've said above, being kind to yourself is #1. You are trying to do THREE jobs: new mom, worker, and milk-maker, all at once, while you're at a very physically vulnerable time. And you're probably trying to do those jobs in an environment that is SO not set up to make it easy.

My sanity-saving mantra is "your worth as a mother is not measured in ounces." It is 100% true. Yes, breastmilk is great. Yes, women who can pull it off should be proud. But breastmilk, or lack thereof, does not define your worth as a mother. You are not a failure if it doesn't work, or if you have ups and downs. To the contrary, you're a working mother, which is amazing in and of itself.

Check out Jessica’s amazing new book, Work. Pump. Repeat: The New Mom's Survival Guide to Breastfeeding and Going Back to Work., set to be released on Amazon on September 8, 2015!

Breastfeeding Memoirs: Third Time's a Charm

In honor of World Breastfeeding Week 2015, we are sharing inspirational stories from breastfeeding/working moms.  

Today’s story was written by Lilly Penhall.

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Being a freelance contractor has its benefits to a work-at-home mom, that’s for sure. Flexible schedule, control over your workflow, and a certain sense of freedom comes with working for your own business instead of someone else’s. However, when it comes to maternity leave, freelancers don’t have the advantage of six weeks of paid leave that some employers offer. I returned to work two weeks after the birth of my daughter, who is now 18 months old, and started working only ten days after my son was born in June. To complicate matters, I was determined to breastfeed my babies.

My first child, born over 10 years ago, was given formula in the hospital nursery (at the time I lived in a small Texas town where that was standard procedure) and only breastfed for about 6 days until we had such trouble latching that I, being young and uneducated about nutrition, decided to just continue to give her formula.

Many years and a cross-country move later, I started freelancing when I was six months pregnant with my second child, after having lost my sales job for lack of productivity. Sales wasn’t my field, but I was doing it because I needed to support myself; however, at that point my boyfriend and I were combining our finances and I was able to take some time to figure out what to do next. I had been volunteering my graphic design skills for years, but had not really tried to pursue it as a career, thinking my skills were not enough to make a living. Thankfully, having years of experience designing books for self-publication for family and friends, I started advertising myself as a book designer to fulfill that niche market. My business took off right away and I was able to start building a loyal clientele who loved my work and sent more clients my way.

After a full working day in labor at 41 weeks, we had a nearly tragic delivery and my daughter spent six hours in the NICU before I was able to see her, hold her and feed her. When I finally had her in my arms, she had the same troubles latching that her sister did—specifically, on my right breast. She was given a pacifier in the NICU, but whether that contributed to her breastfeeding issues is really hard to determine. I called the nurses at almost every feeding to help me latch her, but it was a frustrating routine that I continued at home, replete with many tears especially during the night when I was tired and couldn’t get her to latch.

I started pumping right away on the right side so that I could at least feed her breastmilk in the bottle. After two weeks, the (relatively) cheap single pump burned out and I was again struggling to get her to latch, which was more difficult now that she was used to the bottle. On top of that, a very demanding client who I had been put on hold when I went into labor, started calling daily and asking when I was going to finish her project. As much as I wasn’t ready to start working, I was guilt-tripped into it and started spending four or more hours a day on my client’s project which limited my ability to breastfeed even further.

At my child’s one month WIC appointment, I expressed my concern to my caseworker and was met with a blank stare and the reply, “You don’t think breastfeeding is easy? I think it’s easier than making a bottle.” She did not offer lactation consultant services or any help at all. My frustration turned inward into anger and depression because I felt incapable of providing nourishment to my baby that was supposedly so easy. I blamed my sagging breasts with nipples that pointed at my toes. I blamed my baby’s severe reflux that caused her to spit up half of what I fed her, leaving her still hungry and crying when I didn’t have any milk left.

I blamed the pediatrician we saw at her two week appointment because he misdiagnosed her thrush as “just dried milk” and it got so severe in her that her entire mouth was white and her skin broke out in rashes, while I had a full-blown candida overgrowth throughout my whole body that left me drained and deeply depressed, as well as an intense burning pain when my milk let down. I blamed my demanding client for taking up all my time, and further blamed myself for taking on the job when I should have been dedicated to my baby. I blamed myself for drinking too much on my birthday when she was one month old—a night when I really needed a break—and bought a can of formula to feed her, thinking my breastmilk was toxic.

Finally, I made an appointment with the lactation consultants at WIC and went in for some help, but by then it was almost too late. I was only producing a small amount of milk and my baby was constantly hungry. Still determined to breastfeed, I had clients write letters to WIC saying that I was working full-time so that they could supply me with a Medela double pump at no cost. When I finally got the pump at six weeks postpartum, even pumping every hour for days didn’t produce more than 2-3 oz of milk over the entire day, plus dry pumping was very painful. As hard as I tried, with all the tears I cried and all my efforts, I couldn’t continue breastfeeding my baby any longer. I remember when I put her to by breast for the last time, at six weeks old, and feeling the strangeness of her trying to drink from me when I was completely dried up. I felt useless and rejected by my own child, but I had to surrender to reality. If I couldn’t breastfeed, at least I would get her the best organic baby formula on the market.

Even with all the trouble I had with my girls, I knew I would try again with my next baby, and this time I would have more tools, more knowledge and more patience. I got pregnant again when my daughter was 7 months old, and we decided to be surprised as to the gender of our new arrival. I continued working from home and taking care of my baby at the same time until she was one year old, when I was offered a really well paying work-from-home job that would require more of my time. We put our toddler in daycare so that I could work full-time for my new employer, a university that needed web design work on a contractual basis.

I was working 40+ hours per week until I went into labor, at first from home, then I spent two months working at the university before I went back to working from home as my due date got closer. This time my baby decided to show up unexpectedly 2 weeks early and I was right in the middle of a project. I emailed my bosses from the hospital and told them I was having my baby and I would be back to work in a few weeks. This time, the delivery went more smoothly and my son was placed on my chest directly after birth, as nature intended. He latched right away on both sides and I can’t even express my relief and satisfaction at how easy it has been for him to breastfeed.  It’s the experience I always wanted, but never had. Even the clogged duct I got the first week when I was severely engorged didn’t stop us from breastfeeding; in fact, the colostrum-rich milk I pumped during that time was fed to my older child who had a cold when her brother was born (and it was the last time she got sick—coincidence? Perhaps…)

Although I had intended to wait at least three weeks before returning to work, we had gotten behind on our bills during my transition from contractor to employee back to contractor, so after just one week I requested another project and returned to work part-time at 10 days postpartum. This time, however, I have been able to successfully breastfeed my baby while working because of some things I did differently.

We established a good breastfeeding routine before I returned to work, and we didn’t introduce a pacifier or bottle until he was over one month old. I have been able to pump easily with the Medela and my nifty homemade pumping bra (an old bra with holes cut in the nipples to stick the pump shields through—works like a charm!). I have spent entire days not working when the baby has been more demanding, instead of sacrificing my time with my baby for a demanding client. My son is so easy to feed that sometimes I can hold him and feed him with one hand while working with the other, and when he’s milk drunk I put him in a wrap or carrier and wear him while I work.

I also put a lot less pressure on myself this time—pressure to work AND pressure to breastfeed. I have a more “que sera sera” attitude about it now, and instead of stressing over working while breastfeeding, I relax in knowing that any amount of time I am able to breastfeed my son is awesome and feel blessed that I am able to support my family on a part-time income for now. My boyfriend wants to put him in daycare already so I can work more hours, but he’s only six weeks old and I want to spend as much time with him as I can. I’m increasing my working hours this week, and some time in the next few months I might return to full-time work on-site, but I’m in no hurry.

Breastfeeding while working has not been an easy journey, but I realize that I have many advantages that others don’t. I feel for moms who have to return to work outside the home after maternity leave and all the struggles that brings: pumping in smelly bathrooms or uncomfortable closets for the sake of “decency,” eight hours of engorgement followed by two hours of traffic, bosses and/or coworkers who don’t understand why you get to take so many breaks as if it’s some sort of mommy privilege instead of your other full-time job, etc. I am so grateful for finally having the positive breastfeeding experience I dreamed of, while still able to work and support my family. My goal is six months of breastfeeding, which is much longer than I have been able to do in the past, and I really hope to make it over one year for my baby’s sake. And if I am blessed with one more child, I will breastfeed again for as long as I can, because I know it’s what’s best for all of us.

Top 6 Tips for Protecting Your Milk Supply While Traveling for Work

We had this terrific question posted on our Facebook page:

“Dear Robin,

I leave tomorrow for a four day work trip and I can't take my baby with me. She has 6 feedings a day (one of those at night) so I'll be doing a good amount of pumping while I'm gone. Do you have any tips, specifically for pumping at airports and/or on planes? I'll be on a red eye there and a direct flight on the way back.”

Absolutely!  Just because you have to travel for work doesn’t mean that you can’t protect your milk supply while you are gone.  

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Here are my top 6 tips for protecting your milk supply while traveling for work

Freemie Collection Cups

1. Pick up a few insulated cooler bags with a zipper, like this one from Trader Joe's, with several blue ice packs, from Rubbermaid, to bring with you in your check-on luggage.  When traveling for more than a day or so, you may have a lot of pumped milk to bring home with you.  Using insulated cooler bags with ice packs will allow you to bring all of that liquid gold home with you, without having to lug it through security.
2. Call your hotel before you leave home to ask if there is a fridge in your room.  If not, you can request one and that is where you will place all of your pumped milk while on the trip.  Store your milk in breast milk storage bags so that you can fit a lot of them in the insulated cooler bags on the way home.  Also bring a small cooler with ice packs to store pumped milk when you are away from your hotel room.
3. Depending on the length of your flight, you could either skip the pumping session and just make sure to pump extra long when you arrive in at your destination.  Or, you could bring a nursing cover, your pump pieces, and a battery pack and pump while on the flight.  On the red eye, this should be easy, since it will be dark.  On the daytime flight you might ask the flight attendants if you could sit in the back in one of their seats so that you have a bit more privacy.  If you are going to pump on the flight, bring a small cooler with you with blue ice so you can save your pumped milk.  You could also just pump right before you get on the plane and then completely forget about pumping while on the flight.
4.  Invest in some Freemie collection cups.  These cups are amazing!  You can pump with your shirt on and no one will know what you are doing!  They are incredibly discreet and hold up to 8oz per cup.  These are great for on the plane, in the cab, and in between meetings.  
5. Try to pump every few hours, and once at night if your baby is still breastfeeding in the middle of the night, to keep up your milk supply for when you get home.  If your meetings are in a conference center or hotel, ask the concierge if there is an open room that you can use (NOT A BATHROOM) to have some privacy while pumping.  Aim for pumping for about 15 minutes, which is about as long as it will take your co-workers to enjoy a coffee break.
6. Do some research ahead of time to see if the airport you are spending time in has a Mother’s Room, Nursing Room, or Pumping Room.  Download the Mamava app to find publicly placed Mamava Lactation Suite in United States airports.  

Mamava Lactation Suite

American Airlines: Please change your policy about checked pumped breastmilk!

A few weeks ago, the San Diego Nursing in Public Task Force was contacted by Theresa Morawski Pulickal about an incident she needed help resolving with America Airlines.  Theresa has already done an amazing job advocating for herself and almost completely resolved the situation she had with the airlines, but she needs your help to change American Airline's policy regarding transporting breast milk.  She doesn’t want another mother to have to deal with the challenges she dealt with a few weeks ago. 

Here is her story.  

_____

I am trying to change an American Airlines policy after an experience I had traveling from Puerto Vallarta to Phoenix to San Diego a few weeks ago. While in Puerto Vallarta, I pumped breast milk for my child home in San Diego. He was not traveling with me. At the Puerto Vallarta airport I was told by the TSA agents that I could not carry my breast milk on the plane. I tried to tell them that the rules in the US state that it's okay to carry pumped milk onboard the plane and it could be tested, but they gave me a firm ‘NO’. I took my breast milk coolers to America Airlines (AA). I told them I was told to check my breast milk by the TSA agents. The American Airlines ticket agent generated a check bag tag and said it would cost $499MXN pesos. I asked if the could be waived, as it is breast milk. I told them I was not expecting a fee. They said, no, because the baby was not with me and that it was company policy to charge a fee and that he (the AA Agent) didn't agree with it either, but had to charge me.  I paid the fee, as it was very important to me to bring home my milk. I checked the bag to Phoenix. In Phoenix, I spoke to the AA customer service representative. The agent told me that they should not have charged me for the bag in Puerto Vallarta, but he was unable to reimburse at his location. He told me there is no one to call and I would have to make a claim online through the comment/compliant website. I picked up my bag and went through TSA in Phoenix to San Diego with no problem. They looked at my milk and tested the cooler bag. I was allowed to carry on. 

When I got home, I submitted a complaint on the AA website and I posted my experience on Facebook, Twitter, and Yelp. 

The next day I received a call from Jana at AA’s customer relations explaining she was contacting me due to my social media posts.  She reiterated that AA’s policy is that you only get a free bag only if the child is along with you for travel and that milk is not considered a medical necessity so it does not qualify to be free. I asked how I could get the policy changed and she said I had already voiced my concern and it was now being handling internally.  I was offered a $50 voucher (that I did not want) and instead asked her to follow up with the policy change. 

I posted my updated status on Facebook.  Later I received a message through Facebook saying that AA will reimburse me for the bag in 7-10 days.   I wrote back thanking them for the reimbursement, but asked if this could lead to a policy change. I received a generic message saying they appreciated my feedback. 

Last week, I received a formal letter from American Airlines’s customer relations stating that they had done a thorough investigation of my incident.  The letter included this paragraph: “We apologize for the inconvenience caused when you were unable to carry-on your breast milk with you from Puerto Vallarta to Phoenix. Our customer service personnel are expected to be knowledgeable of our baggage policies including information about exempted articles such as medication and other assistive devices. Please accept our sincere apology for our service failure as well as any resulting anxiety or inconvenience this may have caused you.”  I was then offered a full refund for my checked breast milk bag. 

After I received this formal email, I called back to clarify American Airline’s policy and was told by the agent that a fee would still be charged if breast milk is checked because it was not considered a medical necessity.

While I am very appreciative that American Airlines worked so quickly to resolve my incident, I would like to take this opportunity to ask American Airlines to change their baggage policy with regards to checking pumped breast milk.  I am reaching out to other mothers and advocates of breast feeding/pumping/nursing to get this policy changed. I feel that even though my child wasn't with me and TSA wouldn't allow my breast milk to be carried on that American Airlines shouldn't be charging a fee to check pumped breast milk.  I think it should be free, just like a cane, a diabetic’s insulin, or an oxygen tank. To some babies, pumped breast milk is a medical necessity and a mom shouldn’t have to pay to bring it home to her baby. That is what I want to see changed.

Call to action: How you can help!

Let’s see if we can get American Airlines to change their policy on checked breast milk!  Here are some easy ways to have your voice heard:

Post the following message on American Airlines’ Facebook page:

Thank you for refunding a mom’s baggage fee when she had to check her pumped breastmilk due to a TSA mistake.  How about instating a policy update where all moms are exempt from paying a baggage fee if TSA requires them to check their pumped milk with your airlines?  What a great way to support your passengers and their families!

Copy this email and send it to American Airlines’ Customer Relations Department

(Make sure to use these parameters: Topic (Customer Relations), Subject (Complaint), Reason (Other), and when it asks 'Is your comment or concern related to your flight', choose 'No')

Dear American Airlines,

As a breastfeeding advocate, I am asking that you consider updating your policy so that breastfeeding/pumping moms may check their pumped milk on your flights, at no charge.  Whether a mom is traveling with or without her child, she depends on bringing home her pumped breastmilk safely so that she can provide nourishment to her child at the end of her travels.  The benefits of breastmilk are vast and beyond any other substitute, which is why a mom works so diligently to pump and bring home her milk to her child.  While TSA is supposed to allow a mother to carry her pumped milk on board, sometimes TSA agents make a mistake, which require a mother to check her pumped milk.  I am asking you to consider adding pumped breastmilk to your list of items that are exempt from baggage charges, such as a cane, booster seat, or stroller.  Breastmilk is DEFINITELY a medical necessity! This would help your airlines stand out among the others as being supportive of all families and their needs.

Thank you for your time and consideration.

How Can I Pump Enough for my Baby When I’m at Work?

 Going back to work can be a very stressful time for many new moms.  It’s difficult to leave your baby for the first time.  You may feel nervous about returning to a job you’ve been away from for months.  Your schedule/routine may have changed due to child-care arrangements.  Plus, if you’re anything like me, none of your work pre-pregnancy work clothes fit yet!  A concern that often adds to this stress is the fear that you may not be able to pump enough for your baby’s bottles while you’re at work. Some moms find that they are constantly playing a game of catch-up, trying to keep up with their baby’s intake while with the caregiver.  Below are some things you can do to improve your ability to keep up with your baby’s needs.

Do some research before returning to work.

Most importantly, know your rights!  There is a federal law that protects your right to express milk for your baby while at work, in a private location, that is not a bathroom.  Speak to your Human Resources Department or direct supervisor (before you return to work) to find out where you will be able to pump.  Take note of where it is, how far it is from your work-space, and what equipment you’ll need to bring with you. Check to see if there are other breastfeeding moms using the space to express milk… that way you’ll know if you need to reserve the room or if you are free to use it as you please.  Take a look at your general work hours and responsibilities and create a plan for when you will be able to pump.  

Be sure your caregiver isn’t over-feeding baby!

Often, the issue isn’t the amount that mom is pumping (or not pumping), but the amount that baby is taking while in the care of someone else.  Many caregivers unintentionally offer too much breastmilk to babies, therefore “sabotaging” mom’s supply.  There are a number of reasons this may happen - your caregiver may allow the baby to finish the bottle too quickly and babies will take in more than they need when they eat too fast.  It’s similar for us when we sit down to a big meal.  If we eat very quickly, we often end up eating past capacity as our brain doesn’t have the chance to catch up with our stomach and tell us to stop eating.  A baby may finish a bottle and still show hunger signs, and the caregiver, wanting to soothe baby, will offer more milk when if given just a bit of time, the baby would have calmed on his/her own.  

Sometimes a caregiver may not understand the proper handling and storage of breastmilk and will treat it like formula, throwing any left in the bottle, when the milk could be placed back into the refrigerator for the next feeding.  Be sure to talk to your caregiver before returning to work to help them understand how to best bottle feed your breastfed baby.  Nancy Mohrbacher, IBCLC, wrote a wonderful article addressed to the caregivers of breast-fed babies that you can forward to your nanny/sitter/daycare worker to help them.  

Lastly, make sure your caregiver knows what time you will pick your child up and ask him/her to not feed the baby for the hour or so prior, so that baby will want to breastfeed when you are reunited.

Create a calm and relaxing space/routine for yourself while you express milk at work.

Trying to pump in a stressful environment can negatively impact the amount that you are able to express.  Take a good look at where you pump milk for your baby - is it a convenient, quiet, private space?  Are you able to lock the door so that you’re not worried about a co-worker unintentionally walking in on you?  

Here are some of our top tips for expressing milk at work: 

• Bring articles of clothing that your baby has worn, or a blanket he/she has used.

• Have a picture nearby of your baby, or even better, a video of him/her - perhaps of your baby showing hunger cues. These items can help to get your hormones moving which will help your milk to let down and flow more quickly and fully.

• Use a hands-free pumping bra so that you can do other things while you express - check your email, eat a snack, play scrabble on your smartphone!

• Bring a blanket or towel and cover the flanges while you pump, so that you can’t see the amount that is coming out. Hyper-focusing on how much milk you’re expressing can inhibit your body’s response to the pump.

• Listen to calming music, or a podcast you enjoy.

• Watch funny videos on YouTube - we have a few that are oxytocin inducing on our San Diego Breastfeeding Center YouTube Channel.

• Bring water and snacks to stay hydrated and satiated. Moms often see a dip in their milk supply when they are dehydrated or are not eating enough calories. (Breastfeeding women need about 2000 calories a day to sustain a robust milk supply.)

Engaging in activities that bring you joy or peace can help you relax and may increase the amount that you are able to pump.  You may find that you start to look forward to your pumping sessions!

Techniques that can help increase your output

There are a number of tips/tricks that can help you maximize your output when pumping.  

• Be sure that all of your pump parts are in working order - that there are no damaged pieces.

• Hands-on-pumping has been shown to help increase the amount of milk a woman expresses.

• Learn a combination of breast massage, hand expression, and electric pumping and practice it whenever possible.

• Apply a bit of organic olive oil to the inside of your flanges to help reduce any friction or discomfort.

• Play around with the amount of time that you pump, but remember that stronger and longer doesn’t always mean more milk!

• If you find that you are absolutely not able to express the amount of milk that your baby needs in a day, you can add an extra pumping session in at night before going to bed and on your days off.

Here are a few more tips from our Facebook friends: Help a Mama Out: Getting the Most Milk Out while Pumping

And MOST IMPORTANTLY, feel proud of the hard work you’re doing to provide your baby breastmilk while you’re at work!  Remember that breastfeeding is never an all or nothing endeavor.  Some women are not able to pump enough, some because of work situation or how they respond to the pump, but are still able to provide their baby as much breastmilk as possible, as well as breastfeed their baby while home with them.  Know that every drop of your breastmilk that your baby gets, whether it’s 1% or 100% of their total needs, is an amazing gift that only you can provide!

What are your favorite tips for pumping enough milk while at work? 

Help a Mama Out: Tips for Talking with your Boss about Pumping

'Help a Mama Out' Topic of the Week:

Tips for Talking with Your Boss about Pumping

What's your best tip for discussing your pumping rights/schedule with your boss? 

Shelly Hovies Rogers: Be assertive with your rights, but be flexible and willing to work with your boss and coworkers.  I found my workplace to be quite accommodating to me when I nicely, but matter of fact, told them what I needed.  Also, although I didn’t have to quote the state law, I familiarized myself with it, just in case I needed to use it. 

Kelly Reyes: Before I left for maternity leave, I discussed my need to pump with my boss and then HR, just to make sure we were all on the same page.  When I had issues with the way the ‘wellness room’ schedule was being managed, my boss went to bat for me and fixed the problem that day! 

Marie Bishop: My best advice is to know the law and stand up for yourself and your baby.  In states, such as California, it is required by law that your employer provides a non-restroom space that is private for you to pump.

Meggin Dueckman: We just talked about it!  We’re all pretty close at work, so it was no problem.  I was the first of our staff to want/need to pump at work.  Mind you, here in Canada we get a year of maternity leave, so it’s not as common for people to want to pump as frequently when they return to work.  I only pumped 1 times a day at work, more for my own comfort!

Jamie Howell Swope: As a teacher at a school, it wasn’t an easy process, but I went in knowing the law and advised my principal ahead of time why I wanted to meet with her.  That way she had time to think about how to make it work, too.

Kat Picson Berling: I was really lucky in that 2 of my coworkers were pumping moms, so they had paved the way.  I told my boss that I was going to take 2 pumping breaks at x and y time and I will be in this office and it will take 15 minutes.  He was fine with it.  I’m not going to lie…. Because I had a cubicle at work, it was sometimes difficult to find a place to pump.  Even our HR coordinator wasn’t sympathetic for me.  Just make sure to know the law. 

Chantel McComber: My advice would be to put your fears aside.  Sometimes it’s hard as a working mom to ask for things because not everyone has them.  Remember that you are doing this for your health and your baby’s health and those are two things that should always come first.

Jennifer Haak: When I discussed my date of return, I told my boss that I needed a lock installed on my office door and I explained why.

Andrea Blanco: First, know your right.  Be sure that your company falls under those rights.  Then file that information away and try *not* to use it as it can be perceived as a threat (and no one likes to be threatened.)  Second, have a plan in place.  I find that if you’re willing to have the conversation in advance, go into it as sweet as possible, and have it all planned out as to how it will work for you (with consideration given to work environment/demands/pumping law.)  Then, it is much harder for your employer to say no. 

For the United States Lactation Accommodation laws, check out Break Time for Nursing Mothers

Help a Mama Out: Getting the Most Milk Out While Pumping

Alison: Massaging the breasts!  That’s the biggest helper for me.  Also, leaning over a bit, as gravity can sometimes help.

Nova: Crank it up if you can tolerate it.  If your pump has those little white membranes, change them once a month or so.

Sondra: Relax!

Melissa: Whenever I pump at work, I put a little coconut oil on the inside of the pump flanges.  This way the inside is lubricated and my areola doesn’t chafe alongside of the plastic flanges.

Laura: If I need to increase volume, I get into a pumping boot camp and spend an hour pumping with 10 minute intervals and 10 minute breaks.  Whenever I have a supply dip, this would bring it back within a day or so.  Also, I’ve had great output when I watch a comedy where I am laughing out loud.  And it never hurts to have my hubby give me a back massage just before pumping or during a break.  Also, my supply is related to my water intake, so I make sure to drink a minimum of 100oz per day.

Jen: Pump the full 20 minutes.  I always get a late let down of another ounce or so if I wait it out.  Also, a hands-free bra is a lifesaver!

Jennifer: A picture of my baby always helped when I was away from him.  Focus on him and how much you love him.

Ann: Relax for sure!  Lots of deep breathing and looking at photos of my sweet girl’s chubby cheeks.

Sarah: Staying hydrated (lots of water and coconut water) and pumping at the same times each day.

Stacy: Hands-on pumping (massage and compression), staying hydrated, and changing the cycle speed and angle of the flanges.

Veronica: Watching videos of my little one always made a big impact.

Lydia: Warm compresses, relaxed and comfortable, use the correct flange size and check the suction.

Pumpin' PalsAngelica: Pumpin Pals!  Made pumping so much more comfortable!

Ria: Massaging my breasts while pumping almost doubled the amount I could get!

Carmen: Hands on pumping!  See the Stanford pumping video about maximizing pumping.

Don't miss our Boob Group podcast episode about Maximizing Your Pumping Sessions!