Returning to work with the breast pump

Not too long ago, it was almost unheard of for a mom to breastfeed and work full time. Formula feeding was the standard for working moms but now many moms are breastfeeding and working full time. Choosing to breastfeed no longer means sacrificing your career. Breast pumps are more affordable and easier to purchase. You can purchase a breast pump for as little as $40 that is suitable for using at work. With more and more women choosing to breastfeed and work, the tide is turning in the workplace. More companies are accommodating moms and even providing nursing stations for their employees to pump while at work (1a).

To figure out how much breast milk your baby needs multiply your baby’s weight times 3 oz. This will tell you approximately how much breast milk your baby needs over a 24-hour period. You can start pumping as soon as your milk comes in. You probably want to wait for a week or so until you are no longer producing colostrums. Don’t be surprised if the first time you pump you produce nothing or very little. Milk production works by supply and demand. It takes several days before your body will get the signal to make more milk for your pumping session. The best advice would be to pump around the same time each day, preferably in the morning when your body’s milk production is the best. Once you have been pumping consistently you should start to produce milk for your freezer stash (1b).

Before you return to work you should talk to your employer and tour your workplace. You will want to have a place where you can pump that is clean and private. Talk to your employer about possibly places that you can pump. Be confident and don’t worry about what your boss will think. Most of the time this is no big deal. You may spend time unnecessarily worrying about this and your boss may not think anything about it. Usually this goes over better than expected. Sometimes moms settle for pumping in the bathroom without even having a conversation with their employer. Pumping in the bathroom is not a good solution. Once you have found a few options for places to pump talk it over with your employer and see how it goes. If for some reason your direct supervisor is not cooperative, check with your company’s human resource manager or state labor department for options. Most employers are cooperative with breastfeeding moms (1c).



Weaning Night Feeds

We often heard that having a baby comes sleep deprivation. Your infant waking up in the middle of the night, crying till your ears bleed, needing your attention to survive. It’s a labor of love, but in an adult human’s daily life, sleep is something that is cherished. Though there are ways to wean your baby off of night feeding.

First, you need to make sure your baby is developmentally ready to start sleeping for longer stretches without the extra nourishment. Most babies between 4 and 6 months of age get enough nutrition during the day that they don’t need to feed at night (1a).

Once your baby is ready, you can try a number of different strategies to help your baby sleep for longer stretches through the night.  You could give them a lot of loving attention. Babies need lots of this, and a full night is a long time for them to go without it, especially if they’re not getting enough during the day.

Make sure that they get full feedings during the day and right before bedtime.  If your baby is breastfed, you can try cluster feeding right before bed, which is multiple feedings spaced closely together.  By spacing the feedings close together, your baby will be able to go for longer stretches without needing to nurse (1b).

Make sure that the room is dark and warm and quiet. Use black-out shades on the windows and a white noise machine if necessary. Also make sure that the baby is not waking up because of a wet diaper and/or pajamas. If he needs a change, do it as quickly and quietly as possible.

You may think that having the baby sleep with you will lessen the chance of it waking up, but actually your smell and sounds will give it more reason to wake at night, than if it were by itself (1c).

If you are bottle-feeding, gradually water down the formula until the baby is getting mostly water. Many babies decide at this point that the water isn’t worth waking up for.

This will take some time for your baby to get used to. You can expect two steps forward, one step back kind of progress. Just be patient if you help your baby establish good sleep habits early, he or she will be more likely to return to a good sleeping pattern once the latest distraction has passed. Before you know it you, your baby, and the rest of your household will be sleeping peacefully through the night.


Breastfeeding Position Overview

Learning how to hold and support your baby in a comfortable position for you calls for coordination and patience. Yet finding a nursing hold that works for you and your infant is well worth the effort. After all, the two of you will spend hours breastfeeding every day.

This classic breastfeeding position requires you to cradle your baby’s head with the crook of your arm. Sit in a chair that has supportive armrests or on a bed with lots of pillows. Rest your feet on a stool, coffee table, or other raised surface to avoid leaning down toward your baby. Hold her in your lap so that she’s lying on her side with her face, stomach, and knees directly facing you. Tuck her lower arm under your own. If she’s nursing on the right breast, rest her head in the crook of your right arm. Extend your forearm and hand down her back to support her neck, spine, and bottom. Secure her knees against your body, across or just below your left breast. She should lie horizontally, or at a slight angle. d a cesarean section may find it puts too much pressure on their abdomen (1a).

Another position is the cross-cradle hold. This position differs from the cradle hold in that you don’t support your baby’s head with the crook of your arm. Instead, your arms switch roles. If you’re nursing from your right breast, use your left hand and arm to hold your baby. Rotate her body so her chest and tummy are directly facing you. With your thumb and fingers behind her head and below her ears, guide her mouth to your breast (1b).

Next is the clutch or football hold. As the name suggests, in this position you tuck your baby under your arm, on the same side that you’re nursing from like a football or handbag. First, position your baby at your side, under your arm. She should be facing you with her nose level with your nipple and her feet pointing toward your back. Rest your arm on a pillow in your lap or right beside you, and support your baby’s shoulders, neck, and head with your hand.  Guide her to your nipple, chin first (1c).

Finally is the lying position. Ask your partner or helper to place several pillows behind your back for support. You can put a pillow under your head and shoulders, and one between your bent knees, too. The goal is to keep your back and hips in a straight line. With your baby facing you, draw her close and cradle her head with the hand of your bottom arm. Or, cradle her head with your top arm, tucking your bottom arm under your head, out of the way (1d).


Breastfeeding Diaper Rash

Diaper can be somewhat of a misnomer. It may sound like it directly caused by the diaper. But actually, a mother’s diet may have an impact on the development of diaper rash, especially if she consumes a lot of dairy products. Because sensitivity can change over time, diaper rash caused by an allergy to something in the mom’s diet is likely a temporary condition. (1a)

Diaper rash can stem from a variety of different causes. Most of the time, the reason for diaper rash is simply irritation from the urine and stool that contacts the infant’s bottom. In some cases, a yeast or bacterial infection brings on red patches in the diaper area. If the diaper rash resembles a red ring around the anus, this could indicate something in the baby’s diet. For breastfed babies, allergy-caused diaper rash could result from proteins from the mother’s diet that make their way into the breast milk (1b).

In cases of a food sensitivity that causes diaper rash, the culprit in mom’s diet is frequently dairy products. Unlike a lactose intolerance, an inability to digest sugars in milk that is rare in babies. Dairy allergies result from an allergic reaction to the proteins in milk. Dairy allergies in the breastfed baby usually have more symptoms than simply a diaper rash. Signs can include colic, eczema, vomiting, diarrhea or hives (2a).

To determine whether the symptoms your baby is experiencing are the result of a reaction to dairy in your diet, you’ll need to go on an elimination diet for a few weeks. Completely avoid all dairy products, including milk, cheese, yogurt, butter and ice cream, for two to three weeks.  It may take up to three weeks for all of the milk proteins to leave your system and symptoms to subside in the baby. Once the infant is symptom-free, you can reintroduce dairy into your diet in small amounts and watch for any reactions in your baby. If the baby’s symptoms return, you’ll need to avoid dairy products until the baby is a little older (2b).

Because a sensitivity to dairy proteins is not the same as lactose intolerance, switching to a lactose-free milk will not affect the breastfed baby. Many babies with a sensitivity to milk protein outgrow their allergy. You can try reintroducing dairy to your diet when your baby is between six and 18 months to see if the diaper rash and other symptoms return (2c).




What Is Meconium?

During pregnancy, an unborn baby ingests amniotic fluid and excretes it daily, which passes through the mother’s kidneys and urination. This built-up of material is called meconium and is the first stool a baby passes (1a).

Sometimes babies will pass their first stool, meconium, while they are still in utero. Depending on how soon it is before the mother gives birth, it could be potentially dangerous. A baby who becomes stressed for some reason during pregnancy may pass the meconium which then becomes mixed with amniotic fluid and something the baby can get into the lungs if not handled properly (1b).

There is no way to know if meconium has passed until the birth of the baby. When the amniotic sac, or water, breaks, the color of it tells the story. A normal color would be a clear one and one with meconium could be either green or yellow. A yellow color indicates the meconium is very old and has been inside the uterus for an unknown amount of time. A green color means it is more recent and if it has particles to it, poses more of a health risk to the baby (1c).

When meconium is noticed during labor and delivery is imminent, the practitioner will be ready with what is called a DeLee suction which is used before the baby takes the first breath after birth. Any meconium that might be present in the baby’s airway needs to be suctioned out before the lungs expand or the meconium will be aspirated into the respiratory system (1d).

The baby may gasp, from distress, in utero and cause meconium to go further into the airway since babies do not fully expand their lungs until after birth and doing so prior is dangerous.Once meconium has been aspirated into the lungs, it can cause a chemical pneumonia. These babies are at high risk of becoming very sick rather quickly. Babies with meconium aspiration will need antibiotics to treat infection and oxygen to help them breathe until they can do so unassisted (1e).

There is no way to prevent meconium from being passed before birth so new mothers should spend no time worrying about it. If it does happen, having a competent practitioner who can handle the situation is the best prevention of further difficulties.



All About Lactation Consultants

A lactation consultant is a health care professional who is knowledgeable, skilled, and experienced in lactation, or breastfeeding. The lactation consultant’s primary focus is to provide education, assistance and support to breastfeeding women (1a).

Lactation consultants work in a variety of settings, including hospitals, clinics, physicians’ offices, and private practices. Many consultants are Board Certified, using the initials IBCLC (International Board of Certified Lactation Consultants) after their name. This designation is a valuable credential for identifying a member of the health care team who has demonstrated advanced knowledge and experience and who can provide breastfeeding assistance and skilled technical management of breastfeeding problems (1b).

Your first encounter with a lactation consultant may be during a prenatal breastfeeding class, where you will learn benefits of breastfeeding, basic anatomy, proper positioning and latch-on, prevention and management of potential problems, and more (2a).

A class is a great way to begin your breastfeeding experience. Ask the instructor if there is a lactation consultant on staff at the hospital or birthing center where you will deliver. Find out how to contact the lactation consultant. At some hospitals, lactation consultants see every breastfeeding mother before discharge. At others, mothers may make an appointment, or can be referred by their physician. Phone and/or personal consultations are generally available. Many hospitals offer these services to their patients free-of-charge, while others charge a fee. Still other hospitals do not have a consultant on staff, but will refer to a lactation consultant in private practice (2b).

During a consultation, the lactation consultant will gather information, which may include a medical history of the mother and baby, a breastfeeding history, and an observation of a nursing. This information will be used to formulate a plan of action. Depending on the situation, the consultant may also communicate with the primary health care provider or make referrals to other health professionals, community services, and support groups. With certain breastfeeding situations, a hospital-grade breast pump may be recommended as part of the mother’s plan of care (2c).





What is the Clutch Hold?

While breastfeeding your baby there are many ways to hold your baby. Each position has it’s own nuances that may be better suited for your needs.

In the clutch hold, baby is positioned to the side of mother during breastfeeding, tucked under her arm. It is especially helpful for babies who have difficulty latching on; babies who arch their back and squirm at the breast; babies who come off the nipple frequently during breastfeeding; and babies who are small or premature (1a).

In this position you get a good view of baby latching onto the breast, while your hand at the nape of his neck gives you control of his head. Baby is bent at the waist, which helps tense babies relax better. If his body is relaxed, he’ll latch on better.

To achieve best results, sit up in bed or in a comfortable armchair with your back and shoulders well supported. Position one or more pillows at your side to bring baby up to breast level. If you’re sitting in a chair, wedge the pillows between you and the arm of the chair.Place baby on the pillow, tucked under your arm, with your hand on that side supporting his neck and shoulders. Bend him in the middle, so that his legs are pointed upward and his bottom rests against the pillow supporting your back, or against the back of the chair. Be sure that baby does not push his feet against the back of the chair, causing him to arch his back (1b).

Cup the nape of his neck in your hand. Avoid holding the back of baby’s head, as this stimulates some babies to arch away from the breast. If baby finds your touch too stimulating, put a cloth diaper or a receiving blanket between your hand and his skin.Pull baby in close to you. Once baby is sucking well, wedge a pillow under the hand and wrist that are supporting baby at the breast to help hold him close. Lean back into the pillows behind your shoulders, rather than hunching forward over your baby. Remember, bring the baby to the breast, not the breast to the baby (1c).




What are the Disadvantages of Breastfeeding?

Breastfeeding can be a very powerful bonding experience for mothers with their babies. However, it’s a discipline that a mother must respect. It comes with its share of hardships.

You may have trouble with sore or cracked nipples, engorged and painful breasts and mastitis. All of these are uncomfortable for the mother and mastitis will require treatment, but it’s quite common and can be treated effectively.

As you are continuing as your baby’s source of nutrition you have to be careful about your own nutrition and continue to avoid certain food and limit your intake of others, eg. alcohol and caffeine.

Breastfeeding releases hormones that make you feel good, but the continuing fluctuation in hormones after pregnancy can also play havoc with your emotions (1a).

While in some ways breastfeeding is incredibly convenient in that you can in large part dispense with hauling around bottles and sterilizing equipment everywhere you go, it’s less convenient when you’re not at home and trying to find a suitable quiet place to feed. Breastfeeding may also make you feel a little trapped as your breasts are in frequent demand.

Breastfeeding is obviously something that dad can’t take part in and he may feel left out (though probably not at 3.30 in the morning when baby’s demanding a feed), to compensate for this you can express milk with a breast pump so dad can bottle feed your baby while you get chance to be somewhere else for a change

Some mothers find that they have lower libido when breastfeeding and it may interfere with your sex life in other ways, for instance by changing the way you view your breasts.

To balance this you really should have listed under cons of formula feeding which are increased risk or eczema, asthma, obesity, cot death, diabetes and lower IQ. Breastfed babies are far healthier than formula fed babies and this should be highlighted (1b).




Overcoming Breastfeeding Difficulties

Learning to breastfeed may be easy for some women, while more difficult for others.

Most mothers worry at some point that they do not have enough milk. A delay in the time when milk “comes in” sometimes occurs in mothers dealing with certain health conditions.Infrequent or insufficient breastfeeding (milk removal) is the most common reason for a delay in the time when the milk “comes in,” for insufficient milk production, or for any drop in production (1a).

Some of the conditions, or treatments, that experts think may contribute to a delay include the following: (1b).

  • severe stress
  • cesarean (surgical) delivery
  • postpartum hemorrhage
  • maternal obesity
  • infection or illness with fever
  • diabetes – juvenile, adult-onset and gestational
  • thyroid conditions
  • strict or prolonged bed rest during pregnancy

Mothers with previous breast surgery that cut some of the nerves, milk-making tissue, or milk ducts, may have difficulty producing enough milk to fully feed a baby.

Other factors can also lead to insufficient milk production. Maternal smoking has been shown to result in less milk. Some medications and herbal preparations have a negative effect on the amount of milk produced. Hormonal forms of birth control, especially any containing estrogen, have been found to have a big impact on milk production. However, some mothers report a drop in milk production after receiving/taking a progestin-only contraceptive during the first four to eight weeks after delivery (postpartum). Milk production may also decrease if you become pregnant again (1c).

A plugged duct feels like a tender lump in the breast. Some mothers seem to be more prone to developing them, but usually they occur when a mother goes too long without emptying her breasts, or if insufficient milk is removed during feedings. Review your baby’s feeding routine and see if the time between one or more feedings has recently changed for any reason (2a).

If you develop a plugged duct, be sure to breastfeed/remove milk often and alternate different feeding positions. It often helps to apply warm compresses to the area or soak the breast in warm water. Massage above and then over the affected area when breastfeeding and after application of warm compresses (2b).

Sore nipples are probably the most common difficulty mothers have when breastfeeding. Sore nipples may be caused by different factors. Breastfeeding should not hurt, and the skin on your nipple should not break down any more than the skin anywhere on your body should break down. However, mild tenderness, similar to the kind of tenderness some women experience with their menstrual cycles, is fairly common for the first week or two of breastfeeding. Then it should go away (2c).

When nipples become red and burn, or feel extremely sore after weeks or months of pain-free breastfeeding, it may be due to a yeast infection such as thrush. Yeast may appear as white patches in the baby’s mouth or it may show up as a bright red diaper rash. Specific medications are needed to treat yeast infections. Contact your baby’s physician for more information and treatment (2d).




Life After Breastfeeding

After nursing ends, mothers and their children experience a mix of reactions, both physical and emotional. These reactions vary greatly in kind and intensity, depending on the age and temperament of the child, how fast weaning has occurred, and how the mother has felt about breastfeeding (1a).

Unless your milk production has stopped before weaning is complete, you will probably experience some decrease in appetite when you stop breastfeeding. Some women report losing weight and feeling restless for a week or so after weaning. Others, perhaps because they eat according to habit rather than appetite, gain weight after weaning (1b).

After any post-weaning engorgement and breast lumps dissipate, you will probably find that your breasts are smaller even than they were before pregnancy. The areola may look shriveled, from being stretched in the baby’s mouth, particularly after several years of nursing. After six months or so, new fat stores may make your breasts fill out a little (1c).

Your breasts will probably continue to produce some fluid, if you try to express it, for months after complete weaning. Some women notice continued milk production for as long as two years after nursing ends. And, for months after the last nursing, some mothers occasionally notice the tingling sensation of milk letting down. One mother, whose breasts had never leaked while she was nursing, said milk dripped from them one night when she was very worried about her child’s cough, three months after she had stopped nursing (2a).

If your periods didn’t resume before the last nursing, they probably will within a few weeks — and so, probably, will your fertility. If you began menstruating before weaning was complete, expect that your next period may be early and heavy. Heavy periods may continue for several months as your body adjusts to the hormonal changes of weaning (2c).

With the resumption of menstruation may come an increase in sex drive and vaginal lubrication. If your periods started while you were still nursing, your sex drive may still increase at weaning, though this may be partly due to the decrease in tactile stimulation from your child. Some mothers find, however, that their breasts are less sensitive to erotic stimulation after weaning than before (2d).

In a few women who have personal or familial histories of depression, rapid weaning in the first year may precipitate severe depression or even psychotic behavior. This may result from the hormonal changes at weaning, perhaps in combination with feelings of loss of the symbiotic mother-baby bond. Extreme anxiety, fears, frequent tearfulness, insomnia, and loss of appetite are signs that medical help is needed (2e).