Tuesday 3 January 2012

Tips for Going Back to Work & Breastfeeding

As baby gets older, you have to start thinking about going back to work.  It is a tough decision for any mother to have to make and you have to take many factors into consideration before making that final decision.  Nursery care is a huge decision for any parent because you will be relying on a stranger in most cases to care for your baby after being the sole carer for such a long time.  It can be hard to find a good nursery (especially in Sevenoaks), so you may decide to start looking before you have your baby.

Here are some tips for you to consider when you are looking for a nursery –
      Would it be easier for you to have the nursery close to your work or home?  When I went back to work full time after my first baby was born I decided to find a nursery close to my work.  It meant that I could nurse when I dropped off in the morning, visit at lunchtime to nurse and then nurse immediately on pick-up.  This meant that I did not need to pump as often, and I was hardly ever delayed getting to work and it was easy for me to pick up in an emergency (snow, illness etc).  This may not work if you commute on a train for a long distance or if someone else will be dropping off or picking up.
          Has the nursery handled breastmilk before?  Breastmilk does not need to be handled in any weird or unusual way, but the carer will need to understand that the milk will separate and need to be shaken before giving it to baby.  I have heard of carers throwing away good milk because it looks separated and must be “off”.  They may also need to know that breast milk comes in different colours (blues, greens, oranges are all common colours).  The best way to warm breastmilk is under a warm running tap, a microwave can create hot spots that will burn your baby’s mouth and excessive heating can damage all the good antibodies in your milk.  Breastmilk that is not eaten at one sitting can generally be saved until the next feeding depending on your comfort level.
          You nursery should allow you to visit at any time, and you then have the legal right to nurse your baby anywhere in the building.  The nursery may provide you with a special place and chair if you ask, but I do recommend nursing in the room that your baby is cared for.  I spent a lot of time with my first baby at nursery and I found it very enlightening.  I got to know all the carers, who were the best, and general knowledge about what was going on during the day there.  The things I heard about might make your toes curl, but at least I knew about them and could make decisions based on what I learned (whose baby went home with the wrong dummy in and which carer was liked by the other carers etc).
          The carers may need to understand that breastfed babies feed more often than formula fed babies and that they will need to feed on demand.  This should not be a problem because there is usually not a whole lot of structure in the infant room, but I was confronted by a carer (one that I and no one else respected) and told that my baby should be getting larger feeds just like the formula fed babies.  When William started nursery he was 3 months old and he needed a lot of stimulation.  My favourite carer (Linda) understood this completely and whenever he got fussy she would give him a new toy, move him to a new position, or knew that he needed to sleep.  Many carers assumed hunger when a baby cried, and they really didn’t last long in the infant room.  I would always call ahead when I was going to visit for a lunch feed so that they could hold off on the bottle until I got there so that William was hungry.

Things that you may need to consider when returning to work.
          You will need to start expressing your milk at least a week before you return to work.  You will need to be able to leave enough milk for the first day at least.  Pumping one additional time each day will tell your body to start making a little more milk and your body will get used to responding to hand expression or your breast pump.  You may not get very much to begin with because your body is not used to the pump and because at the start you will be pumping leftovers.  Once your body learns that you need an additional feed each day it will begin to make more milk.  Once you are pumping missed feeds when you return to work you will pump full feeds worth of milk.
          When you pump your milk you will need to store it until it is needed.  There are many guidelines out there for breastmilk storage, some more conservative than others ranging from 48 hours in the fridge to 10 days in the fridge, then freezing up to and over a year in a deep freezer.  I am not conservative at all in milk storage, but I will tell you that you will know if your milk has turned because it will smell bad.  If you decide to freeze your milk then remember that it must be used within 24 hours of being thawed in the fridge.
      Store your breastmilk in small quantities so that you can be as flexible as possible.  You can use storage bags or bottles to freeze breastmilk, ice cube trays can even be used to freeze ~1oz portions.  Remove them from the tray and put in a dated plastic freezer bag.  Always use the oldest milk first so that the milk is less likely to go bad.  I never put more than 3-4oz in a bottle for William at nursery.  He was a big 9lb baby and grew on the 97% line of the growth chart.  During a growth spurt he would be a little bit more fussy and feed more during the night, and I took small 1oz portions to nursery for emergencies but they were never used.  So, I would agree that 2-4oz is a normal feed for an infant (after 30 days).  A baby that feeds more often will take less per feed, and a baby that feeds less frequently will take more per feed on average.
           Practise bottle feeding before your baby start nursery.  I should have taken my own advice on this one for my new baby as she will not take a bottle.  You may have heard rumours about babies refusing bottles during the day and nursing all night to make up for it.  This can be true, breastfeeding is so much more than just food for your baby and they can refuse bottles because they really want to breastfeed.  If you are concerned about this you will want to get your baby used to a bottle before you go back to work if you know you will be.  Introducing a bottle should be done after your milk supply has been established but before you go back to work.  It probably isn’t the case in the UK, but it can be very common in the US for new mothers to return to work before their baby is 6 weeks old.  Your milk supply should be established by 4-6 weeks.  A bottle is usually best introduced by someone other than Mummy, and in a way that is more like breastfeeding than you usually see babies being bottle fed in public.  Kellymom describes it here.
          The nursery may ask you to provide feeds made up and ready for feeding.  I provided breastmilk already in the bottles numbered in order of date pumped.  Each part of the bottle was labelled with our name and a number from 1-4.  I carried the milk to nursery in a small cooler with a large ice pack.  I then used the same cooler and ice pack to store any milk I pumped that day and any bottles that weren’t used at nursery on the way home.  I did not use the fridge at work to store milk so I chose a cooler and ice pack that would keep everything cold for the entire day. 
           If you are unable to be with your baby for each feed of the day then you will need to express your milk.  The best times to express your milk are at the same times that the baby receives a bottle, but if you don’t have this information just express as often as you would feed at home.  If you find you are not expressing enough milk you may want to express an additional time during the day to make up for it.  The most important thing to remember is that you need to stimulate your breasts and remove milk the same number of times as you would if you were home with the baby.  If you miss a feed because of a meeting, you need to make it up later with either pumping or feeding the baby (pumping if you need enough milk for tomorrow).  It’s easy to forget to pump or find an excuse not to pump (it’s not the most exciting task).  If you find that you are always needing to dip into your freezer stash to have enough milk for the next day then you need to be proactive about it.  Pump an additional time each day, and if that doesn’t work think about taking herbals to increase your supply (Fenugreek is a common one).  An evening power hour is a good way to get your supply back on track.  Once the baby has gone to bed choose a television show that will last an hour and is not on the BBC.  Pump during each commercial break for the entire hour using the same equipment.  Do this once a day for a week and your supply should improve.
           I haven’t mentioned pumps yet.  You will need to decide how you are going to express your milk.  Hand Express - If you will be doing it for the odd date night you can easily hand express into a clean bowl/jug/bottle depending on your aim.  You should be taught how to hand express before you leave the hospital, but don’t be afraid to ask your midwife or local breastfeeding counsellor.  It can be quite painful if performed by someone else, it’s kind of like ripping off a plaster, only you know your pain threshold and what is comfortable for you.  You will be able to do it without causing any pain.  I have known women that could hand express better than they could pump so don’t dismiss it just because there is no gadget involved.  Manual Pump – If you are going back to work very occasionally or you would like to go out for the occasional evening and you don’t want to hand express, a manual pump may be all you need.  You can buy one to do single pumping (one breast at a time) or buy two and pump both breasts at the same time.  It is more labour intensive than an electric pump, but very effective.  Single Electric Pump – These are great for those that are going back to work part time.  They can be faster and less labour intensive than manual pumping, but you still have to do one breast at a time (you could buy two and use both at the same time but you might as well buy a double electric pump).  Double Electric Pump – This pump is the most suitable pump if you are planning to go back to work full time (or school).  Double pumping usually yields the largest volumes of milk in the least amount of time.  Hospital Grade Double Electric Pump – If your baby is unable to establish your milk supply due to being sick or unable to latch or a medication you may be taking you really should think about hiring a hospital grade pump.  It is the best chance you will have of establishing your full milk supply until your baby is able to take over.  You can rent a pump from many different places as mentioned here.  You may also want to hire a hospital grade pump if your supply dips when you return to work or if you need to re-lactate/lactate for an adopted baby (produce milk without giving birth).
          When looking for a pump you may want to consider that the best pump manufacturers put a lot of effort, research and expertise into their design.  Companies that sell bottles are often more interested in you bottle feeding than continuing to breastfeed and don’t put a whole lot of effort into their pumps.  The three main companies that I have had the best experience with are Hygeia (not in UK yet), Medela and Ameda.  Each company puts the majority of their efforts into manufacturing a great pump.  I will talk more about this at a later date

      10.   When talking to your human resources contact before you return to work you may want to talk to them about finding the most appropriate place for you to pump and store your milk.  As I mentioned before you may not need a place to store your milk if you are able to find a cold pack that keeps the milk cold all day.  A conference room or office with a door could be a good place to pump.  A dedicated lactation room is the perfect scenario, but may not be possible.  Try to have ideas when discussing this with your employer so that they know you are flexible and committed to pumping.  A part time colleague may leave an office empty on certain days of the week, or your boss might have a regular meeting leaving their office available.  If you work in a retail setting you could consider using a changing room in which to pump, or a breastfeeding room in the mall.  You can pump almost anywhere if you use a nursing cover.  I have pumped in the car as well as in meetings and during lectures.  I’m sure that with just a little imagination you can come up with a solution that meets your needs and your employer’s needs.  Remember, breastfeeding benefits your employer too.  They will have more loyal employees who take less time off work due to childhood illness.

I hope that this information is useful to you and I understand that going back to work is a rollercoaster of emotions for both you and your baby.  Take it one day at a time, and take plenty of tissues with you on your first day back.

If you need new nursing bras for going back to work don’t forget to check out my website for Hotmilk, Emma-Jane and Carriwell nursing bras

No comments:

Post a Comment