Breastfeeding the Older Baby: 12-18 Months

Written by Anna Choi, BS, IBCLC

Thank you for joining us for our third and final article in our blog series, Breastfeeding the Older Baby – What to Expect and How to Adjust. I’ve enjoyed writing these articles, as we have explored the evolving breastfeeding relationship between mama and baby, and I hope to have provided some insight for you about what this evolution might look like for you and your little one. In this final article, we will look at months 12 through 18 of your toddler’s life.

PHOTO CREDIT CHRIS WOJDAK

How often do toddlers breastfeed?

This answer varies greatly from one toddler to the next. Some mothers and nurslings have slowly decreased the number of breastfeeding sessions they have each day and may find that at this age, their toddler is breastfeeding as little as once or twice a day. Others may have a toddler who nurses like a newborn and goes to breast frequently throughout the day, nursing as many as 10 or more times in 24 hours. What’s important to remember is that there is no one “right” way to nurse a toddler and no magic number for how many times each day your toddler should or shouldn’t nurse. As long as mama and baby are happy with their nursing relationship and have found a rhythm and balance that works for them, then breastfeeding is going well.

Now that my little one has celebrated his/her first birthday, do I need to introduce cow’s milk or another milk alternative?

Such a great question – and one that we find ourselves answering frequently! In order to provide you with the most educated answer to this question, I enlisted the help of one of San Diego Breastfeeding Center’s favorite Registered Dieticians, Rachel Rothman. Here is what Rachel had to say:

Cow's milk is a good source of fat, protein, calcium and vitamin D, though it is not the only potential source of such nutrition. As infants become toddlers, many pediatricians make the recommendation to start baby on cow’s milk in order to meet baby’s specific nutrient needs.   If your baby is consuming a sufficient amount of these nutrients (in other forms), there is no reason he/she needs cow's milk or an alternate milk source.   One note I always give to my patients is that for children up to at least 2 years of age it’s advisable to give them full-fat / whole milk dairy products (cheese, yogurt, or milk) to ensure they receive enough fat to satisfy their needs. Keep in mind -  breast milk is an excellent source of fat and other nutrients.

- Rachel Rothman, MS. RD

If you find yourself having further questions about your little one’s diet, I encourage you to reach out to Rachel, as she possesses a wonderful wealth of information on nutrition {http://rachelrothman.com}.

I’ve reached my goal of breastfeeding for one year and I am ready to wean, what is the best method?

Congratulations on reaching your goal! If you are ready to wean from breastfeeding, there are several methods to choose from. Weaning gradually often makes for the smoothest transition for you and your little one {and your breasts!}. To start the weaning process, choose one breastfeeding session and replace it with something else {such as previously pumped breastmilk, water, solid food, etc}. After a few days, you’ll choose another breastfeeding session to replace with something else, and so on. Usually the nursing sessions before naps and bedtime are the hardest to wean from, and therefore the last to go. Your little one will appreciate extra snuggles as they adjust to this big change in their life. Depending on the temperament of your child, and how often they are currently nursing, the weaning process may take a few weeks or a few months. If you’d like more information on weaning, check out this link to a previous blog series all aboutweaning an older child

Can I stop pumping at work and continue to breastfeed when I’m with my toddler?

Absolutely! As a working mom myself, I was eager to put away the pump after my little one turned one year old. I knew I’d miss that lovely womp womp womp sound and getting undressed and redressed in the middle of my workday, but figured I’d somehow survive. How soon you can stop pumping at work will depend on your work schedule, baby’s solid food intake, and what you have decided baby will consume in place of the pumped breastmilk you’ve been supplying. If you stop pumping at work and continue to breastfeed your toddler when you are with them, your supply should adjust to meet the needs of this new routine. Some moms find that their supply decreases as a result, but this usually isn’t a huge concern since your toddler should be eating plenty of table foods at this point. If you decide to stop pumping at work, remember to drop pumping sessions and reduce the amount of time spent pumping gradually, to reduce your risk of engorgement and plugged ducts.

 

How do I handle unsolicited advice about my toddler being “too old to breastfeed?”

The short answer is, don’t feel the need to defend yourself. When someone makes a comment about your toddler breastfeeding, simply say, “We are doing what’s best for our family. Thank you.” And then, walk away.

If you’d like to get a little more detailed with your response, or perhaps provide some breastfeeding education to the person, you can reference the American Academy of Pediatrics and the World Health Organization’s recommendations, which advocate continued breastfeeding past twelve months of age. You can also let them know that nursing toddlers are generally sick less often and have fewer allergies than non-breastfeeding toddlers.

What did breastfeeding look like for YOU during months 12-18?

Breastfeeding Memoirs: Working as a Resident

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

Today’s story was written by Amelia Sorenson.

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When I found out I was pregnant as I was about to start a surgical fellow, which can mean a seven day, sixty (sometimes eighty) hour work week with erratic long nights of call, I thought a lot about what it would be like to do the work while pregnant and how to manage maternity leave (six weeks, worked the day I delivered). What I didn't think about was how I would establish a breastfeeding relationship during those first few short weeks and how I would manage to keep breastfeeding when I went back.  

PHOTO BY ERIN AT THE THEO LOVES

Once my son was born I realized I should have been preparing for breastfeeding. I went to a breastfeeding support group three times in the first week and am so grateful to the mothers I met and the support from the lactation consultants.  (First piece of advice - figure out support groups BEFORE baby arrives and utilize them early. Every time baby latches he is learning what to do, so the quicker you can get him doing it right, the better).

The night before I started back at work my brand-new electric pump made one long whirrrr and wouldn't turn on again….necessitating a frantic trip to buy a hand pump (Second - buy a hand pump just in case). I was more than anxious that first day back with my little cooler and hand pump.  Fortunately, I work in a “baby-friendly” hospital and a NICU nurse gave me a kit to the hospital grade pump and a few days later I found the most beautiful lactation room with a view of the ocean (Third - Figure out where you will be pumping before you leave for maternity leave).   

I’ve never been able to make a schedule since surgical case length and clinic patients are too different, so I decided that food for my baby had to be on the list of priorities and that some pumping is better than no pumping and tried to pump every three to four hours. (Fourth – Feeding your baby is something important; so let yourself treat it like it is a priority).

Orthopedics is 90% men and I am the first woman in a long time to have a baby, so I’ve been straightforward about what I am doing, hoping that it will make it easier for the next resident. (Fifth – Tell people what you are doing.  You have to do it a lot and really aren’t taking a break.)     

Now that we have made it to 6 months and have enough supply to have donated milk I want to say that you can do it too! Don’t give up early or think that because you are working long hours you can’t do it.  Most of all enjoy the time with your baby before your go back to work. 

PHOTO BY ERIN AT THE THEO LOVES

Breastfeeding Memoirs: Returning to Work in the Navy

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

Today’s story was written by Cinda Brown.

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I’m an active duty Navy officer and mother of two girls. My journey to becoming a working, breastfeeding mother started almost 4 years ago with the birth of my first daughter. Breastfeeding was challenging in more ways than I could have imagined. I thought that it would just be easy and natural, not knowing that those two little words can mean so many different things.

My baby had a high palate combined with tongue and lip tie. I had no idea what this was. All I knew is that my nipple was damaged and cut from her very first latch and that it hurt each time there after. Soon I was scabbed and crying each time she latched. So much pain. I didn’t know where to get help and the nurses at the hospital told me it would get better with time. When my daughter was about 5 weeks old I finally met a nurse who promptly referred me to a pediatrician who was also an IBCLC. Her issues were diagnosed and we were then set up for a revision. I learned so much from this IBCLC. He taught my husband what to look for and we both were sent home with more knowledge that helped us on our road to success. My husband knew what looked wrong and was there to help me reposition. He supported me through all of the pain and sleepless nights. He did diaper changes and baths and allowed me to keep working on breastfeeding, instead of asking to bottle feed so he could bond. He found other ways to really bond with our baby girl while ensuring that our breastfeeding relationship would be preserved. Partners play such an important role and I can’t say this enough!

Once my daughter and I finally started to get the hang of breastfeeding, it was time for me to go back to work. I struggled with a very intense oversupply and was worried about how I was going to manage it when I was back at work. It had been difficult enough to manage it when I just had to take care of my baby at home, but now I was looking at adding in daycare, going back to work full time, and still trying to keep up with everything else that needed to be done at home. While many people I’ve encountered have told me how lucky I am to have oversupply, I also know that it’s very difficult to manage. It takes an extraordinary amount of time to pump, collect, freeze, and store the milk not to mention the washing of all of the pump parts. Adding this extra needed time into an already compressed day was overwhelming to think of, much less try to put into action.

We were very lucky to find a daycare teacher who was experienced with bottle-feeding breastfed babies. That was hurdle #1. She was an amazing communicator, which helped the process so much more. The day came to go back to work and I still remember it like it was yesterday because the experience is forever imprinted in my memory. Leaving my baby girl with someone new for the first time to go back to work was just devastating to me. And her. For me I felt like it absolutely went against my innate knowing to separate us. But yet I had no choice and my leave was over so it was time to go back. In that moment I would have given anything to stay home with her. Having a caring provider and making the most of the time that I did have with my baby while at home helped to ease the separation but it definitely took time before that ache started to subside. I really had no idea about the obstacles I was about to encounter and had no one to guide me along the way.

Day one back at work, I found myself in a land of cubicles, with no place to pump breastmilk. Over the next several months I improvised wherever I could to find a place to  pump when I needed to. I pumped in bathrooms, in my car in the parking lot, in my car on the way to and from meetings, basically anywhere I could find that would provide some sense of privacy and still allow me to complete work requirements. It was far from ideal and was super stressful, and mastitis and clogged ducts became more usual than unusual. I had to wake up super early before work so that I could pump since I would be so engorged. Wash parts. Try not to forget parts, bottles, or storage bags. Or the plug for the pump! So many things to remember!

My job had been so busy and intense before I had my baby and I knew that it was going to be no different when I returned. The biggest challenge was trying to coordinate pumping between meetings that for the most part I didn’t have a lot of control over scheduling. Many times meetings would come up at the last minute, or would be rescheduled right in the middle of when I’d need to pump. I had to figure out a way to talk to my supervisors about my need to pump, the importance of keeping a regular schedule, and at the same time keep my head held high.

In the military culture, it can be intimidating to ask your supervisor for permission to do things outside of the norm or what’s expected. I wanted to be able to show that I was able to handle it all: be a successful officer and a successful mother. But the reality is that each demands 100% or more of a person, and there’s only so much effort and time that can be allotted to each. Some compromises had to be made, and it was up to me to advocate for myself and my baby. I’m not going to say that the conversations were the most comfortable that I’ve ever had or the most easy, or that they were well received. They certainly were not. But I thought of all of the other more junior women going through the same journey and realized that if I couldn’t advocate and speak up for myself, then there’s no way that my example would set other women up for success.

I asked for what I needed and over time it became more normal for everyone I worked with. I did find out something very interesting in that most of the people I worked with were male, and that their wives/partners were full time stay at home parents. None of them were mothers who had breastfed and many of their wives had not breastfed. Education and communication with my male leadership helped them to realize the importance of breastfeeding and how it could in fact make the workplace better for everyone since breastfed babies tend to get sick less often. Mothers are able to get back into fitness standards more quickly since breastfeeding can help mothers lose weight. These are only a couple of examples amongst many. I know that the Navy is keenly interested in retaining females in order to have females rise in the ranks of leadership. Advocating for breastfeeding is one step in the right direction to retain mothers in the military. Mothers who are shamed or made to feel that they can’t fit in are not likely to want to stay as a part of an organization that can’t accept them for doing something that’s good for both their baby and themselves.

After several months of making do, a fellow military breastfeeding mother and I set out on a journey to have our commands come into compliance with current Navy breastfeeding instructions and guidance. This meant that our command was required to provide a room that wasn’t a bathroom space, with privacy, a locking door, a refrigerator/freezer, outlets, and furniture. It also allowed for time to pump milk that would accommodate what the mother would need to maintain her supply. It was a long process, but with diligence and help from many people, by the time I left my command there were 5 mother’s rooms set up for breastfeeding mothers to pump milk and an instruction that provided guidance so that mothers were protected in their ability to pump breastmilk.  Each room had a multi-user pump and pump kits donated by the San Diego County Breastfeeding Coalition. The command won the SDCBC Breastfeeding Friendly Workplace Award in 2014, which was such an amazing accomplishment given where it had started from. A monthly breastfeeding support group led by Sarah Lin, IBCLC, started in 2013 and continues to this day. She selflessly stepped up to donate her time to help countless mothers who have so benefitted from her expertise when there was a definite need.

I’m now a mother of two and I honestly thought that going back to work for the 2nd time with an infant would be easier since I had done it before, but it’s been just as challenging. I’m at a new command, so I have new people to interact with. Dynamics are different and the juggling act of timing pumping around work requirements is still as alive today, if not more than it was when I went back to work with my first daughter. Mastitis and clogged ducts continue to make their presence known, which was disappointing since I thought that I had them figured out. Goes to show that just because it worked last time doesn’t mean that it will work this time. Each baby is so very different, as is each pregnancy and postpartum period. I’ve been known to excuse myself from meetings with very senior personnel so I can go pump, which hasn’t been easy. I know that I need to take care of myself so that I’ll be at work tomorrow. Sacrificing today isn’t worth getting sick tomorrow and I keep telling myself that. Because there’s a part of me that still struggles to have a voice and speak up for what I need.

I pumped for 2 years for my first daughter. She will be 4 this fall and breastfeeds right along with my infant. I’m pumping for my infant at work and will continue to do so until it’s the right time to stop. I never thought that I’d make it this far in our breastfeeding journey, but now I can’t imagine it being any other way. There have been so many that I can attribute our success to in our San Diego community. The amazing support of IBCLCs and mothers has carried me when I needed to be lifted up too many times to count. I hope that through my efforts I can help other military mothers achieve the success that they envision for breastfeeding their children, whether it be for days or years.

Breastfeeding Memoirs: Trusting my Body when Returning to Work

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

Today’s story was written by Georgina.

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When I had to go back to work I knew I wanted to keep providing my son with the very best I could offer and one of them was his dear breastmilk.  I was very confused with the whole pumping at work idea. I had done some research at work before delivering as to where the lactation room was and what the process was to reserve the room.  I work at a hospital and I thought that just by going to the L&D department everyone would know where our lactation room was and it was going to be very easy to find.  Well to my surprise, no one knew exactly what I was referring to, all the nurses looked at me with puzzled faces and confused as to why an 8 month pregnant employee was asking about this room and they didn't even know where it was!  When I finally found it, it was a rather disappointing, sad room that looked like a utility closet, but at least it was clean and it had the necessities: a chair, a desk and a fridge.  

I took the longest maternity time off I could take with and without pay and in the meantime I read and read and read everything I could about breastfeeding and pumping at work.  Breastfeeding had its challenges, but we quickly adapted to one another and it started to feel like a breeze.  It was near the end of my baby bonding time that I started to become stressed about the whole logistics about pumping at work. The  more I researched, the more confused I got. How many hours can breastmilk be in the fridge? What if he didn't finish the whole bottle?  Was it safe to use it again? How many ounces to feed? How often? What if I don't make enough milk? Ugh! Sooo frustrating! So many doubts! So many mixed emotions!!  I joined several breastfeeding support groups and would often go to baby weight-ins just to make sure baby was eating enough only through my breast.  But, how would I know if we were overfeeding him when using the bottle while I was at work? What about underfeeding him,? Would he prefer the bottle over me?   I decided to attend aBreastfeeding for the Working Mom class through the SD Breastfeeding Center by Robin Kaplan.  Even though I had already read what she said, it was extremely reassuring to hear it by a someone who had gone through it before. Robin was very patient.  She sat with me and we made a "pumping at work plan."  How many times and the estimated hours that I would be pumping.  I still remember my pumping schedule as if it was yesterday. Nurse at 5am,  pump at 8:30am,  pump at 11:45am and nurse at 3pm.  Slightly adjust schedule as breasts were engorged when I would feed the baby earlier than 5am. It worked like a charm!

It was definitely a learning curve for the nanny and our family members who were taking care of our little guy while we were at work.  We had to teach everyone not to shake breast milk - only swirl.  Fat particles in breastmilk are normal.  It’s normal to have different colors.  And never ever dump any breast milk that smelled fine... we could always make breastmilk soap, lotion and even use it for rashes and cuts.  Everyone, myself included, has been amazed about the little we knew about the amazing properties of breastmilk and how powerful it is.  We learned about paced feeding and growth spurts the hard way and we succeeded.

I pumped until little dude was about 11-13 months.  That was last year when our summer in San Diego was just extreme.  During the day while I was at work he was asking for more water than breast milk and shortly after he refused to drink breastmilk from his sippy cup only from the tap :)   He is past 2 years old now and we are still nursing strong.  It has been a marvelous, unexpected experience for both of us.  

Every once in a while I still pump to make our little dude some breast milk soap and I was very happy to find a beautiful bright freshly remodeled lactation room at the hospital where I still work.

If I could go back in time I would tell myself to trust my body to do its magic.  Eat oatmeal, drink lots of water, watch pictures/videos of baby while you are pumping, relax and watch your baby being nourished by your wonderful body.  Take advice with a grain of salt.  Everyone is different, trust the relationship you have with that amazing human creature your same body nourished for 9 months in your belly.  You can do this! You are meant to do this and you can!

Breastfeeding Memoirs: My Three Bs

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

Today’s story was written by Louanne Ferro.

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Prior to May 27th, 2014, the word baby meant something very different to me: my baby was my business. At the young age of 17, I entered the world of cosmetology. Knowing I wanted to strive and create greatness in my industry, I focused on building. In 13 year's time, I had nurtured my baby and created a small empire. One of the leading educators for the world's largest professional beauty company, I frequently traveled to teach my craft.  In the heart of North Park, I opened my very own salon. My baby was thriving and I was the proud mother, spending further countless hours tending to make it what it is today.  Then, May 27th, 2014 happened, changing everything I knew about babies.

The test was positive. To my shock, my work "baby" was going to be replaced with a real-life, micro-human! My pregnancy was something my husband and I had been hoping for and we were thrilled!

As the days went by and I soaked in the reality of this new chapter in our lives, I quickly realized that the acronym B.B. meant far more than a makeup product; my new "B.B." was Business and Baby! I started to prepare myself with all things human baby-related. In addition to the copious things on lists and registries, preparing for the physical exit of my child by way of my body required some serious consideration. My birth plan was short and extreme: 1. Do whatever you need to do to deliver a healthy baby, and 2. If baby and mom get separated, dad goes with baby. My preparations seemed both rational and thoughtful.

As the months crawled forward, I was asked, "Do you plan to breastfeed?" "Sure," I would state casually. I mean, doesn't everybody do it? The portrayal of happy mothers stroking their babies' heads seems the most natural and obvious choice. The commitment to breastfeeding tacked a third B on my list. Self-assured, I reiterated to myself, "Three Bs and three-step birth plan." Simple right?

As the ideas gestated, so did my little human. On February 1st, 2015 when most people seemed to be watching the Patriots win the Super Bowl after the controversial "Deflategate," I was in labor. I had no delusions of grandeur, and felt that the experience progressed well, or at least as well as it could. Literally dancing myself into labor, and thus, the hospital, I was celebrating my salon partner's thirtieth birthday only the night before.

In a lighthearted moment of somewhat inappropriate comedic relief, as I was pushing my sweet boy into the world, my husband, nurse staff, and I were laughing while Maureen, the midwife, styled my son's full head of hair mid-birth canal into a Mohawk for his grand exit. Ezra entered the world healthy and strong, with all the right parts and two healthy lungs. Things were great, that is, until they weren't.  Laying him on my naked breast, as I looked into his eyes for the first time, all I could say was, "I'm going to be sick." Those weren't the words I was expecting to first say to my baby.

Before I knew it, Ezra was being transferred to my husband chest and my birth plan, the one that everyone says won't be needed, became needed. Ripping itself from my uterus, the placenta dislodged, and I, unknowingly, quickly began to bleed out. Because the hospital staff was great, the bleeding quickly stopped and I was generally unaware of the severity my body endured. Before I fully understood what had happened, I was on the mend. So I thought...

Latching my son in the hospital, he seemed to latch well. We left the hospital feeling very supported and excited to start our new lives as parents, and I was eager to be a mother who could sustain life solely from my own body. This, too, proved that things could go well until again, they don't. Shortly after arriving to our home as a family of three, I noticed my son no longer wanted to latch. Unable to wake him for feeds, we were heading down a slippery slope at excruciatingly high speeds. With no formula in the house because it wasn't part of the "plan" and no idea what was wrong, helplessness took hold of me and rattled this new parent's head and heart. Breast feeding should be easy, right? Everyone does it! It's natural.

I held my baby through the night, the first night home, praying we'd make it until morning when I would seek professional support. There was no marveling over the beauty of childbirth or reveling in the moment that our chests rose and fell together. This was the worst night imaginable.  In the mean time, it was after midnight and my husband scoured for 24-hour stores, and finding none, finally sought out a NICU nurse at the hospital to get the formula an after-hours advice nurse suggested.  

As the sun rose, I ran into the Kaiser breastfeeding support group, crying my eyes out as I told the head lactation counselor that I was starving my baby and I didn't know why. I was failing, and failing was something I was never good at doing. Rose, this angel, this pinnacle of breastfeeding knowledge, sat with me most of the support group and promptly made me a one-on-one appointment following the support group that day. Ezra had lost over 20 percent of his birth weight and was comparable to a premature baby. She asked me to share my story leading up to that point, and as soon as I mentioned the hemorrhage, she exclaimed, "There's your road block. You're not broken, you're healing." Not fully understanding, I listened, captivated by what the angel was telling me. She explained to me that our bodies can almost always produce milk for our babies, but major blood loss was one hindrance that halts milk production in its track. My body was healing me so it then could support my baby.

A woman - a new mom, rather - on a mission, I spent 24/7 learning how to help kickstart my supply, all the while supplementing at the breast, and educating myself on how to properly feed my baby. This harrowing and hormonal journey took a couple weeks, but my milk eventually came in and I had a new routine. I referred to myself as "The Dairy Queen," and I was always open for sweet treats!

Realizing quickly, in order to be successful with breastfeeding, I also needed to be knowledgable. This, after all, was one of the most important jobs I'd ever had. My short eight-week maternity leave was filled with work, just not the type of work I was accustomed to. My 13-year-old older child, my business, was doing well, but still needed my care. Much like a regular teen, it seemed as though it could self-manage, but a true mother, I realized it needed me to continue to grow. A new balancing act had begun. My new baby and breastfeeding also needed my constant care, and as the weeks passed, I slowly figured out how to balance my three Bs.

The key to success in working and breastfeeding, I have found, is to set boundaries with myself, my clients, and colleagues. Making food for my baby was just as important as my business. My work schedule has a pump break every three hours and for no circumstance should that pump break be booked - after all, it is my most important appointment of the day. When traveling for my company, it's made known that pump breaks must be allotted in order for me to take the job. Compromising my need to feed is not an option. My hands-free pump bra and car adapter for my breast pump have become my best friends. They really do support me. The ladies at the drive through coffee shop now know me as the pumping, purple haired mom as I pull through for my iced coffee while pumping on my way to work. My friends on speaker often ask, "Is that noise I hear your pump?" I say, "Sure is" with a smile, knowing that I am finding balance.

My flanges might not be a Marc Jacobs accessory, and my black pump bag may not be Prada, but I wear them with the same sense of excitement because I'm doing something I thought I couldn't achieve. They are also symbolic reminders of a label I do wear: mother, maker of milk and master of the Three-B balance, business, baby, and breastfeeding. My journey has not been lengthy, but on August 1, the first day of World Breastfeeding Week, I will celebrate my six-month "nurse-iversary." I've always argued that you can't hold a driven woman back, and now I know another word synonymous with driven woman is "mom!"

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!

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

So, You're Going Back To Work?

A few months ago, this spunky, firecracker mama started attending our weekly breastfeeding support group and I knew from the start that she was amazing!  Over these past months, Jessica has warmed the hearts of all of the moms in the group, as well as lifted their spirits with her quick wit and sass.  Well, Miss Jessica landed this fabulous new job a few weeks ago and ended her maternity leave a little sooner than she had planned for.  I have missed her parenting insight, so I thought I would interview her about her return to work, as a breastfeeding and pumping mama.  Well, as you can see, her insight prevails!

Thanks, Jessica for your candor and advice for those breastfeeding mamas returning to work!

First day back at work

What did you do to prepare for going back to work?

Finding a good childcare provider was a huge part of overcoming my fear of returning. I don't have family here and my partner works full-time as well. I probably went to a dozen home daycares and a handful of corporate ones. You have to find someone who has a philosophy similar to your own and you feel comfortable with. As I went to providers, I discovered there were alarm bells for me: if the television was on the entire time I was there, if the provider interacted with a child in a way that I didn't like, if the terms of the contract were suspicious. I went with my gut. In the end, I found a nanny I could trust.

Breastfeeding was the surprise stressor. I was depressed I wouldn't get to breastfeed Ellie during the day and I was worried about pumping. To get used to pumping, I started pumping at home. It helped me stockpile a supply. Since I was starting a brand-new job, I made sure to thoroughly read their policies on pumping. Read the laws and understand your rights. You don't have to go in waving a boob flag or anything but you can gently inform and educate employers. Be ready to offer options like suggestions for places to pump. My employer did not know I was pumping when I was made the offer and I didn't ask any questions until I had accepted. After that, when I ran into a snag, I made sure to ask the HR rep.

What worked? Would you do anything differently?

Ask about your work schedule! The biggest surprise to me was that my employer let me have a flexible schedule. I found that getting to work by 6:30am worked very well for my family. My daughter wakes at 5AM, I nurse her and put her back down to sleep. Then I get ready and leave. My partner then takes over the morning routine until the nanny get there. My daughter doesn't have an emotional separation from me in the morning and neither do I! Then, I come home early so we can hang out most of the afternoon.

I also can't say enough about BabyConnect. It's an app on my smart phone. It tracks feeding, sleeping, diapers, medication, etc. I used it religiously before I went back to work and my nanny has the app on his smartphone as well. There is something very comforting about glancing at my phone and seeing that she went down for her nap. It tracks how much breast milk she's taking by bottle so I know if what I am pumping at work is on par with what she's eating.

What advice can you offer to a breastfeeding mom going back to work?

For breastfeeding moms, whether they plan to go back to work or not, I recommend finding a way to have a relationship with your pump. In the same vein, let your child take a bottle once in a while. You may want to leave the house one day. You might not think so in the beginning, but eventually, you will. And the more practice you and your baby have, the less stressed both of you will be.

I had a very negative relationship with the pump because of some difficulties when I first started breastfeeding but I had to get over it. I started by letting myself eat chocolate while pumping, then moved to trashy magazines. At work, I run through my to-do list for the week or look at pictures of my daughter. My point is the pump is a tool to help you continue breastfeeding.

Jessica Hilt is fiction writer that works in the technology field. In the BC era (Before Child), I hosted elaborate dinner parties, drank heavily, and stayed up late. Now I love my slow cooker, drink more water than a fish, and think 9PM is late. But it's all worth it when my seven-month-old Ellie gives me that big, gummy smile.

Also, check out Jessica's video about why she loves going to a breastfeeding support group!