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?

Understanding Infant Sleep - The First 6 Weeks

“I slept like a baby”  

When I hear this saying, I immediately envision sleeping deeply, soundly, and for 10 hours straight.  Whoever came up with that saying clearly didn’t have children!  All of the babies I know definitely do not sleep soundly for an extended period of time until at least toddlerhood… and even then sleep can be disrupted by teething, colds, and just regular night waking. With current infant sleep recommendations stating that babies should learn to sleep on their own, all night, by 6 months, I have to wonder how much of this information is hearsay and old-wives’ tales and how much is evidence-based (using good research models). 

So, let’s break this down using the most current research.  

SOURCE: UNITED STATES BREASTFEEDING COMMITTEE

What does research tell us about infant sleep patterns?

Today I am going to discuss sleep patterns and behaviors for infants during the first 6 weeks.  I will continue to share information about sleep patterns for older babies throughout the next few weeks.

How much does a 0-6 week old newborn typically sleep in a 24 hour period?

• Newborns sleep in short spurts, both day and night.

• Most babies this age sleep between 9-19 hours over a 24 hour period (that’s a huge variation!)

• Newborns have extremely small stomachs, which means they need to eat small, frequent meals, at least 8-12 times per day (as a minimum).  These feeding sessions can take anywhere from 15 minutes to over an hour, on average.  

• Newborns eat about ⅓ of their food during the night.

• Some babies may take one longer stretch of sleep at the beginning of the night (maybe 4 hours), but then may spend more time eating throughout the rest of the night and day to make up for the food intake they missed while sleeping longer. 

Take home message: It is biologically and developmentally normal for your baby to sleep in only 1-3 hour increments during the first 6 weeks because they are unable to eat enough at a feeding session to go for longer.  

Why do newborns wake often?

• Besides having a small stomach capacity, newborns are hard-wired to wake frequently during the day and night.  This is one of the ways their bodies are protected from SIDS.

• Newborns’ sleep cycles are different than adults: when they fall asleep, they spend more time in active (REM) sleep rather than quiet sleep (which means they wake more easily), their temperature doesn’t drop in the middle of the night (which means that they cannot distinguish daytime from nighttime), and they have no circadian rhythm.

• Newborns are often unable to join multiple sleep cycles together.  This takes a few months for their bodies to figure out.  A newborn sleep cycle is 45 minutes long.  You might get two sleep cycles strung together for 90 minutes of uninterrupted sleep, but then they are right back up again.

Take home message: Babies are programmed to wake frequently and sleep lightly.  This is developmentally normal infant behavior.

What are realistic sleep expectations for your 0-6 week old newborn?

• Your baby’s sleep patterns are going to be all over the place.  Unpredictable. Some short spurts (20 minutes).  Some long spurts (3 hours).  This is normal and will become more predictable over time. 

• Your baby is going to wake frequently during the day and night until he/she develops a circadian rhythm around 3 months.  At 3 months, your baby may still wake frequently during the night, but will at least be able to fall back asleep fairly easily and quickly.

• Your baby is also going to eat all of the time.  This is what builds and maintains your milk supply.  This is also what helps your baby gain weight and grow.

• Sleep patterns will be disrupted during growth spurts.  Growth spurts happen around 2 weeks, 4 weeks, and 6 weeks.  What this means is that your baby will sleep less for a few days and want to eat more.  Once these growth spurts pass, your milk supply should be even more robust than before and your baby will slow back down to eating slightly less frequently.

What are some tips for parents feeling really overwhelmed and sleep deprived with baby’s frequent waking?

• Sometimes just knowing that these sleep patterns are normal and temporary makes the situation seem more manageable.  Remember, your baby will eventually start sleeping for longer chunks of time (which we will discuss in the next few articles)

• Have your baby sleep on someone’s chest while you take a nap.  Babies LOVE to sleep on an adult’s chest and usually sleep a bit more soundly and longer.  This is not spoiling your baby or creating a bad habit.  This is meeting your baby’s developmental need to be near others.

• Look into safe co-sleeping guidelines, as research has shown that families who safely co-sleep or bedshare get more sleep than those whose babies sleep in a different room. 

• Try what the authors of Sweet Sleep call ‘Front Loading:’ do more work early in the day and start to unwind earlier in the evening.  If you can unwind earlier, that means you can fall asleep earlier and easier, as well.  Check out this Huffington Post article about 15 Science-Backed Ways to Falls Asleep Faster

• Start filtering out the misinformation you receive from others about what they think your baby should be doing regarding sleeping and eating.  This will only create a situation where you think there is a sleeping problem, when in actuality your situation is most likely perfectly normal.

In our next article about infant sleep, we will discuss normal sleep patterns for babies 6 weeks to 4 months.

Resources for evidence-based info about normal infant sleep:

http://www.secretsofbabybehavior.com/2010/03/science-of-infant-sleep-part-i-first-6.html

http://www.amazon.com/Sweet-Sleep-Nighttime-Strategies-Breastfeeding/dp/0345518470

https://www.isisonline.org.uk/hcp/how_babies_sleep/

https://www.psychologytoday.com/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development

Breastfeeding Memoirs: Best 'Bring Your Baby to Work' Situation EVER!

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

Today’s story was written by Margo Byrd.

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As a new mother, the fear of going back to work haunted me as my maternity leave days grew smaller and smaller.  Although I am one of the most fortunate mothers in the world who got to bring their child to work, I still feared that somehow it would not work out.   I worried that my company would decide my bundle of joy was not so joyous, or I would completely collapse under the pressure of feeding a 3 month old in my office. I personally struggled with postpartum.  I had irrational fears about what it would be like at work, felt completely helpless on multiple occasions, and had a very hard time letting my son out of my sight even to run to the bathroom (when my husband was home).  As those small fears subsided, coincidentally my bigger fear of breastfeeding in my new work environment grew. For the summer, my office would be shared with my boss as I am her assistant and during the school year I would have my own office (which happens to be all glass).  I work for the Boys and Girls Clubs of San Dieguito and while “Bring your child to work,” has always been a motto for our club, the fear of breastfeeding with 70-150 kids on the other side of my door was very apparent.  I envisioned curling up on a toilet wiping everything down with cleaners or hiding in dark closets on the floor while I lulled my 3 month old to sleep while comfort nursing. While I was promised a, “Safe,” environment to nurse I had no idea what to expect. The struggle of postpartum and the struggle of a new environment breastfeeding made me so nervous. I had never nursed in public, let alone nursed in front of my co-workers and peers.  Personally I was too scared and too naive to understand the support I would have at my job.

I had made up my mind when attending my first meeting with my supervisors to quit. With my hormonal self and hormonal worries I just felt that it was going to be a disaster.  Yet, as my son, Charlie, and I were greeted by each of my co-workers and supervisors, I started to see the support for my son’s health and well being would not only be my priority, but my entire leadership team’s priority.  I was greeted with warm smiles and happy faces.  To my surprise one of the first questions everyone asked was, “Are you still going to breastfeed?”  I sheepishly answered, “I am going to try,” and each person in my leadership team smiled and said, “Go girl!” The more people I talked with, the more I realized that our company fully supported my commitment to breastfeed him each and every day.  

One of the first things my company did was set up my office.  Not only did they put in a curtain to cover the glass in my office, my supervisor told me that whenever I needed to feed my son, I would have a quiet and safe place to do so.  They fashioned my office to make it more suitable for a changing table, pack and play, and a swing, as well as make sure my son had what he needed to be happy and healthy.  They removed large filing cabinets and replaced them with smaller ones so I could maneuver them so I could fit everything comfortably.  Over the summer, when I began to share an office with my boss, her commitment to making me feel comfortable was overwhelming.  My boss brought in extra items in case my son needed them, she did not put me on the schedule (so I could arrive within reasonable hours to take care of my son), and suggested making a sign for my door that said, “Feeding Charlie, Please Knock before Entering.”  I was completely overwhelmed with the support to breastfeed from the beginning.  And the most beautiful part of all of this was, even staff members who saw my sign on the door would knock and enter without hesitation.  Males, females, co-worker’s children and volunteers all felt comfortable and normal walking in.  I even held staff meetings with multiple staff at a time while feeding my son and the wonderful response to my question, “Would you mind if I fed my son,” was welcomed with an overwhelming, “Absolutely!”  

While I know I am blessed and incredibly lucky, I can only speak from my experience.  Each and every day is still challenging with our regular breastfeeding issues, but having the support of my co-workers and leadership team has been incredible.   I can contribute to my family, provide the best nutrients for my son through breastfeeding, and I can continue to watch my son grow within the walls of the Boys and Girls Clubs of San Dieguito.   

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!"

Breastfeeding Memoirs: Persevering 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 Maggie.

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I had a long, stressful delivery that resulted in an emergency c-section, a tongue tie revision on day 2, followed by 48 hours in NICU. I was given a nipple shield, instructed to supplement with formula through an SNS and sent on my way. Breastfeeding was painful and difficult even with the shield, I went to many support group meetings and did weighed feeds and was able to stop supplementing. We were also dealing with a "colicky" baby until about week 8 . Then at week 10, I was able to get off the nipple shield with the help of an LC at Mary Birch. I was supposed to go back to work after 12 weeks but I was so exhausted and we were finally starting to turn a corner where we could actually enjoy our time with baby, I thankfully was able to extend my maternity leave to 16 weeks.

This prelude is to say that with all the struggles we went through in the beginning, I was very anxious about going back to work, whether I would make enough milk, whether he would get nipple confusion or a bottle preference. I worked so hard and suffered through so much literal blood, sweat, and tears to make breastfeeding work I started to really resent the fact that I had to go to work and interrupt our breastfeeding relationship.

Thankfully through my breastfeeding support group journeys I came to the San Diego Breastfeeding Center. She told me about the upcoming "going back to work" class. I was so excited! I had so many questions. I had scoured the internet, and learned a lot through websites, but still needed much more guidance and support. The information from that class helped me plan and feel prepared to go back to work.

Before I went on maternity leave, I worked out with my HR department where my lactation accommodation would be, but I didn't fully understand my needs until I returned. It was obvious that what we had planned was not going to be feasible long-term, so the first two weeks back were a challenge until they were able to give me my own office and make it private so that I could pump there. My pre-baby brain was trying to cause as little disturbance as possible to the rest of the office when planning my accommodations, but once I was back from maternity leave my only concern was making enough precious milk for my little guy! I'm grateful to have a supportive team at work that have had no issues whatsoever about giving me what I needed.

The first day back I barely pumped 9 oz. I was aiming for 12-15oz. I tried to keep calm and take it one day at a time. I still try to keep this mindset and not worry if I pump a little less some days. Gradually overtime I started consistently pumping 12 oz every day, and for a while was getting 16oz and was able to build a decent freezer stash. One of the LCs I met along my journeys suggested 5 minutes of hand expression after every pumping session, and that has worked wonders for me. It's amazing how much the pump leaves behind. The facebook group, "working moms who make breastfeeding work" has been also been an amazing resource.

We're now almost 4 months back at work and things are going smoothly. Bedsharing has been a saving grace...it helps my supply to let him nurse all night long, I don't worry about whether he is getting enough to eat or not, and I'm well rested for work each morning despite waking up every 2-3 hours all night. Plus its awesome snuggly bonding time that I miss out on while I'm working.

While I plan to breastfeed as long as baby wants to, I can't wait to break up with my pump in 4.5 months once he turns one!

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