Breastfeeding And The Working Mom

GENERAL INFORMATION:

Why is breastfeeding important?

• Breastfeeding offers many good effects for both your baby and you. Your breast milk is available at no cost, requires no preparation, and is always clean, fresh, and at the right temperature. Human breast milk has the best combination of nutrients for your baby. Nutrients include all the protein, fat, sugar, vitamins, and minerals your baby needs for his body and brain to grow. Breastfeeding helps protect your baby from infections. It may also decrease your baby's risk of getting allergies and certain diseases. These diseases include sudden infant death syndrome (SIDS), asthma, diabetes (high blood sugar), lymphoma (lymph node cancer), and leukemia (blood cancer). Your baby gets the most good effects if he is fed only breast milk for the first six months of his life.
  
  
• Breastfeeding helps stop bleeding from your uterus (womb) right after giving birth. It also helps you lose the extra weight and fat you put on during pregnancy. Breastfeeding without giving any formula to your baby can delay the return of your menstrual cycles. It can help control or decrease the amount of sugar in your blood. Breastfeeding can help make your bones stronger and decreases your risk of getting osteoporosis. It also helps protect you against breast, ovarian, and uterine cancer. Breastfeeding also strengthens the bond between you and your baby. You may need to learn and practice breastfeeding methods so your baby gets all the milk that he needs.

How do breasts make milk?

• Your breasts change during pregnancy to prepare for making milk. Your breasts contain milk glands and milk ducts that increase in number, causing your breasts to get larger. Milk is made in small sacs called milk glands or mammary glands. The milk glands are arranged side by side in small grape-like clusters. The milk glands connect to milk ducts, which are pathways for milk to travel through before reaching your nipples. These small ducts join other ducts and form bigger ducts as they get closer to the nipple. Breast milk flows from the ducts into the sinus (collection area) behind the nipple. It then comes out through 15 to 20 small openings on your nipples.
  
  
• During the later part of your pregnancy, your breasts start to make and store colostrum. Colostrum (KO-lah-strum) is a substance made by the breasts before they start making milk. It contains protein, vitamins and minerals, and sugar. Your baby will receive colostrum during breastfeeding before your breasts start making milk. This yellow, creamy substance may be in your milk for up to two weeks after your baby is born. Your breasts start making milk 2 to 4 days after your baby's birth. The milk glands will make milk continuously while you are breastfeeding. The amount of milk made depends on how much milk is removed from the breast, such as during feeding or pumping.

Can I still breastfeed my baby when I return to work?

• You can still breastfeed your baby even if you return to work. The amount of breastfeeding support in the workplace varies by factors such as the state you live in and the size of your employer. The amount of maternity leave you can take can affect you being able to continue to breastfeed. You should try to take at least 12 weeks of maternity leave if possible. Another factor is whether flexible or part time work schedules are available to you. In some workplaces, breastfeeding is encouraged and can be done during working hours if onsite or close-by child care is available. Some workplaces provide a lactation (nursing) room where you can express or pump out your milk. This should be a private room with access to a sink and a refrigerator.
  
  
• Your baby can continue to be fed with breast milk, even when you are away from him. Your breast milk can be expressed, collected, and stored. Expression of breast milk is getting milk from your breast without your baby suckling on it. Your breast milk can be expressed using your hands, which is called "hand expression" or "manual expression." You can also use a breast pump device to express milk from your breasts. Expressed milk that has been stored properly can be used even for months later. Expressing your milk will make sure that your breasts continue to make enough milk for your baby. Ask your caregiver for more information about the expression, collection, and storage of breast milk.

How should I prepare to breastfeed my baby when I return to work? Having a plan in place for when you go back to work will help you be able to continue to breastfeed your baby. The following should be included in your plan:

• Set up a good milk supply. You need to start with having a good supply of milk when you are breastfeeding your baby. This will depend on how often and how well your baby is feeding. It also depends on how much milk you are able to make. Early breastfeeding right after giving birth may help. Breastfeeding often will also make sure of a good milk supply. Ask your caregiver for more information about breastfeeding and increasing your milk supply.
  
  
• Start expressing and storing your breast milk. You can start expressing your breast milk at any time. When you are planning to return to work, you should start doing this at least two weeks before you go back to work. Before you start doing expression, your breasts will only be making as much milk as your baby suckles during a day. When you start expressing, you will be increasing the amount of milk your breasts make. This will happen over several days to weeks, so you need enough time to build up your supply. When you are away from your baby, you will probably need to empty your breasts of milk every 3 to 4 hours. Ask your caregiver for more information about the expression, collection, and storage of breast milk.
  
  
• Start your baby on bottle or cup feedings. You can start bottle feedings when your baby is at least four weeks old. Doing it earlier may cause "nipple confusion" and lead your baby to refuse to breastfeed. Suckling is more work and a more complicated way to feed for your baby than bottle feeding. Your baby will become skilled at suckling with 4 to 6 weeks of only breastfeeding after he is born. This reduces the risk of him then refusing to breastfeed after he is feed with a bottle and artificial nipple. If you prefer not to bottlefeed your baby, you can try feeding him from a cup.
  
  
• Decide how you want your baby fed while you are away from him. You can choose to express milk and have your childcare worker feed this to your baby when you are at work. You can choose to breastfeed only at home or only at night. Then your baby would be bottlefed with your stored breast milk at his other feedings. Building up a supply of stored breast milk will help make sure that there is always enough available for your baby. Doing this may allow you to be able to breastfeed your baby until he is one year old and beyond.
  
  
• Talk to your employer before you return to work. You should discuss with your employer what support is available to you as a breastfeeding employee. Ask about any breastfeeding programs available for working mothers. Ask your employer if there are any "work from home" arrangements possible. Ask if your baby can be brought to your workplace for feedings. Ask if there is a lactation room available, and where and how often breastfeeding or breast milk pumping can be done at work. You may need to ask about your break schedule and your working hours.
  
  
• Choose your work schedule. Returning to work can make you feel tired and stressed, which can decrease your breast milk supply. If possible, you should try to work part-time while you are breastfeeding. Your baby gets the most good effects if you are able to continue to breastfeed him without formula for the first six months of his life. Mothers who work less than 20 hours per week are usually able to breastfeed longer. You can ask to work part-time for a few days or weeks before returning to a full-time schedule. Starting back to work in the middle of the week, such as on a Wednesday or Thursday, may also help you adjust. Consider choosing a workplace that has onsite or nearby childcare where you can go and breastfeed your baby.

What is milk let-down, and what can I do to make my milk let-down?

• Your breast milk stays in the milk glands until it is released into the milk ducts. The process of this release is called let-down. The "let-down reflex" at first is triggered when the nerves in your nipple and areola (dark circular area) feel your baby suckling. This reflex is also known as the "milk-ejection reflex." When your baby suckles milk from your breast, hormones (special substances) in your body are released. You may have a warm, tingling feeling in your breasts when this happens. When you get ready to feed your baby, milk may drip or spray from your nipples when your let-down happens. You may feel breast fullness 30 to 60 seconds after your baby is correctly attached to the breast. Multiple let-downs happen during every feeding.
  
  
• Your body responds with let-down more easily to your baby than when you use a pump or do manual (hand) expression. When pumping or expressing milk, you will need to trigger your milk let-down without your baby's sucking. Being relaxed, free from distractions, and in a place where you feel comfortable can help your milk let-down. Seeing pictures of your baby, or smelling and feeling his clothing may also help. You can also record and listen to his voice. Placing warm cloths on your breasts may also help. Ask your caregiver for more information about pumping and manual expression.

How do I express milk while at work?

• Some companies have a lactation (nursing) room, which is a private room where you can breastfeed or express your milk. This room should have a comfortable chair, and a table for your breast pump and breast milk containers. It should also have in it or nearby a sink with running water to wash your hands and pumping equipment. You should also have access to a refrigerator to store your breast milk.
  
  
• Breastfeeding mothers can express milk while at work during work or nursing breaks. Hand expression of breast milk may take up to 30 minutes to empty both breasts. Using an electric double pump to express milk from both breasts at the same time may only take 10 minutes. Ask your caregiver for information about expressing milk by hand or by using a breast pump.

What can decrease my breast milk supply?

• Drinking too much alcohol or caffeine. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, and other adult drinks. Tea, coffee, or sodas have caffeine in them.
  
  
• Getting pregnant soon after having a baby. Breastfeeding is not completely effective as a means of preventing pregnancy. You will need to use other methods of birth control, such as condoms. Ask your caregiver for more information on ways to avoid becoming pregnant again just after having a baby.
  
  
• Pressure on your breasts. Sleeping in a face down position may squeeze your breasts and block milk ducts. Wearing bra that is too tight or a sling that press on your breasts can decrease milk supply.
  
  
• Smoking. Cigarette smoking can decrease the hormones that help your breasts make milk. It can also decrease or slow down milk flow from your breasts.
  
  
• Stress. This includes physical, mental, and emotional stress. Stress can decrease your milk let-down and the amount of milk you make. Decreased milk let-down for a long period can stop your breasts from making milk.
  
  
• Taking certain medicines. These include oral contraceptive pills that contain estrogen and over-the-counter (OTC) medicines, such as antihistamines. Antihistamines are medicines used for allergies. Ask your caregiver for information on other medicines which can decrease your milk supply.

What can I do to increase my breast milk?

• Decrease the amount of alcohol you drink. Do not drink more than one glass of wine, or 2 bottles or cans of beer in a day. Do not drink alcohol at least two hours before you breastfeed. Drinking alcohol close to a feeding can change the taste of milk and be passed on to your baby. Ask your caregiver for more information about alcohol use while you are breastfeeding.
  
  
• Decrease the amount of caffeine you drink.
  
  
• Drink enough liquids. Drink 1.8 Liters of liquid each day (close to 8 eight-ounce cups). Good liquids to drink are milk, water, and juices.
  
  
• Eat a variety of healthy foods from all the food groups every day. Choose foods that will give your body the extra nutrition it needs as you breastfeed. Dairy products, such as milk, yogurt, and cheese, and brown and white bread provide calcium. Red meat and fortified breakfast cereals provide iron. Eat a variety of fruits and vegetables, including dark green and orange vegetables, and legumes (dry beans). Eat the right amount of calories as advised by your caregiver. Ask your caregiver for information about breastfeeding and your diet.
  
  
• Feed your baby more at night and space out feedings during the day. This pattern of feedings may help your body make more breast milk. Ask your caregiver for more information on ways to increase your milk supply.

What other things should I know?

• Expressed breast milk can last for several days to weeks when properly collected and stored. When collected breast milk cannot be stored, you should still continue to express the milk and throw it away. This will help maintain the amount of milk your breasts make.
  
  
• Give babies older than 6 months old some solid food, or juice or water during the day. This may decrease the amount of breast milk needed while you are at work. Ask your baby's caregiver for more information about introducing solid food into his diet.
  
  
• Tell your baby's childcare worker to avoid feeding your baby in the two hours before you see your baby. This will increase your baby's interest in breastfeeding when you arrive.
  
  
• Use a cooler bag with ice packs to store the milk when no refrigerator is available at work. This will provide a steady, cool temperature for the breast milk and prevent it from spoiling early.
  
  
• Your breasts may leak when they are full of milk and not emptied regularly. You may notice milk coming from the small openings in your nipples. This is normal. It may be prevented by crossing your arms carefully over your chest and pressing your arms against your breasts. This mild pressure applied over your nipples works to stop the milk let-down. Wear nursing pads inside your bra to soak up the milk. Wear several layers of clothing, and avoid wearing solid colored shirts. Doing these things may make the leaking milk harder to see on your clothes.

When should I call my caregiver? Call your caregiver if:

• You feel you are not making enough breast milk for your baby.
  
  
• You feel a lump or a hard area in your breast.
  
  
• Your breasts become hard, painful, or swollen, or you cannot get your milk to flow.
  
  
• Your breasts do not feel full before feedings and softer after breastfeeding.

Where can I go for support and more information? Ask for information about breastfeeding and make sure caregivers know that breastfeeding is important to you. Ask your caregiver for the name of a Lactation Consultant. This person is specially trained to help women breastfeed their babies. Ask caregivers to help you find a breastfeeding class before your baby is born. Take a breastfeeding class, or join a group with other breastfeeding mothers. Contact the following:

• La Leche League International
  1400 N. Meacham Rd
  Schaumburg, IL 60173-4808
  Phone: 1-847-519-7730
  Web Address: http://www.lalecheleague.org
  

• The National Women's Health Information Center
  Phone: 1-800-994-9662
  Web Address: http://www.4woman.gov
  

• Centers for Disease Control and Prevention, Breastfeeding
  1600 Clifton Rd
  Atlanta, GA 30333
  Phone: 1-800-232-4636
  Web Address: http://www.cdc.gov/breastfeeding/recommendations/index.htm
  

CARE AGREEMENT:

You have the right to plan how you are going to feed your baby. To help with this plan, you must learn as much as you can about breastfeeding. Ask your caregiver questions about breastfeeding. You can talk with your caregiver about the best way for you to feed your baby.

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