Combining Nursing and Employment

More women than ever are returning to work after their babies are born. Some choose to nurse only in the early weeks after birth. Increasingly though, many are unwilling to discontinue nursing after they return to work. The reasons mothers give for wanting to continue breastfeeding are as varied as the mothers themselves.

• The mother isn't ready to give up something she and her baby enjoy.
• The mother wants to continue providing her child the best possible start in life through breastfeeding.                            
• She may feel nursing helps promote a special bond between her and the baby, even though they must be separated.
• She may feel she is providing her infant something that only she can give.
• The infant may be unable to tolerate formula.

Many women believe their only choice, once their maternity leave is over, is to wean. You may think nursing is an all-or-nothing undertaking. It needn't be. Nursing while you are employed outside the home is definitely possible. With a little advance planning, both you and your baby will be able to make the transition with ease.                                                                                                      

How Do Mothers Do It?                                                                                                                                                

Each woman's home and work circumstances are individual, so the strategies you choose will depend on what you are able and willing to do. Work closely with your Nursing Mothers counselor to devise a plan that will work well for you. Although each woman will make unique choices, your situation will very likely have something in common with one of the scenarios below.

• Bring baby with you. Sharon works in a family-centered dentist's office as a telephone receptionist. Her employer doesn't want Sharon to quit the office, but Sharon doesn't want to leave her baby. For the first six months of her baby's life,Sharon is able to bring the infant to work with her and continue nursing on demand. As her infant grows and the nursing frequency decreases, Sharon is able to leave her baby with a care provider for longer periods each day.
• Nursing with on-site day care. Maureen works for a company that provides on-site day care for their employees. After Maureen's six-week maternity leave, she returned to work and enrolled her son in the day care. With the cooperation of her supervisor, Maureen is able to visit her son during her breaks and over the lunch hour. She uses this time to breastfeed. The day care staff helps Maureen by not feeding her son too close to the time she is due to arrive. Maureen provides bottles filled with breastmilk she has pumped at home for any substitute feedings that are necessary.
• Nurse at home and bottle-feed during the day. Lynn is unable to have her child in day care close to her place of employment. Instead, she uses her work breaks and lunch hour to pump milk. She brings a portable pump with her and a small cooler to store her expressed milk. Lynn arranged with a co-worker to use a private office for the pumping sessions. The milk she pumps on Monday will accompany her daughter to day care the next day.
• Sarah breastfed exclusively during her maternity leave and pumped at each feeding to set aside a large supply of breastmilk for her daughter. Her manager, however, was not agreeable to arranging the time and space Sarah needed to continue pumping at work. In the weeks before Sarah returned to work, she started to wean her daughter from the work-time feedings, giving the infant her expressed breastmilk in a bottle. By the time Sarah returned to work, the day care provider could give the baby bottles filled with the breastmilk Sarah brought from her supply. Through the morning and evening, Sarah continued to nurse her daughter at home.
• Karen's situation was similar to Sarah's, except Karen had no desire to pump and store her breastmilk. She decided she would rather supply formula to the day care provider. She breastfed exclusively for the majority of her maternity leave, weaned her son from the work-time feedings and sent bottles of formula with him to day care. Karen nursed her son each morning before work and through the evening.

To make the transition from in the home to out-of-the-home easier, it helps to do some planning in advance of your return date. Consider both the baby's needs and your needs, and the special circumstances of your workplace.                        

Choosing the Caregiver                                                                                                                                                                         

Some families have an idea who will provide day care for their children even before the babies are born. If you have not yet located a day care, you may find some of the following suggestions helpful.

• Talk to friends, relatives, neighbors and other working families for recommendations. The state agency that regulates day care facilities will also be able to make suggestions. In New Castle County, Child Care Connection provides counseling and a computerized system to match parents with day care facilities. The Child Care Solution also lists care providers.
• Try to find someone who has either nursed her own children or is supportive of your decision to nurse. This caregiver will understand the dynamics of breastfeeding (types of stools, frequency of feeding, etc). She may be better able to tolerate a more flexible schedule, and may be willing to provide a place where you are welcome to breastfeed.
• Look for a place that meets and promotes the needs of your particular family: similar parenting styles and values, a comfortable relationship with you and your child, and affordable prices.
• The location of the caregiver may be an important consideration if you choose to return through the day to nurse.

Feeling comfortable with the person who will care for your child and the environment in which the child will spend her day is very important. You will communicate your sense of comfort to your child. If you are dissatisfied with the arrangements or the staff, that message will come across to your child, and she may become dissatisfied and fussy. Consider the choice carefully if the caregiver seems unsupportive or outright intolerant of your decision to breastfeed. 

Feeding the Baby                                                                                                                                                                                  

You have three basic options for feeding your baby when you return to your workplace.

You can provide breastmilk, either at the breast or in bottles. If you plan to give breast milk to the caregiver, you will need to pump with breastpump or manually express milk in sufficient quantity. Alternatively, you may choose to supply formula. Or you can provide both breast milk and formula, pumping what you can and making up the difference with formula

• If you plan to supply breastmilk, it is a good idea to start collecting your milk as soon as possible. Let your baby nurse as long as he wants on the first side. This will ensure he gets not only the carbohydrate-rich foremilk, but also the fat-rich hindmilk. When he falls asleep or releases the breast, burp him, diaper him if necessary, and offer the second side. The baby who has "finished the first breast first" will very likely take little from the second side. You can pump or manually express this side following the feeding, then offer it first at the next feeding. Feeding and expressing in this manner means you don't have to find spaces in your baby's feeding schedule to collect milk.
• If you choose to supplement during the workday with formula, consult your pediatrician for formula recommendations. It is a good idea to introduce the baby to the formula before returning to work. Some infants have adverse reactions to one formula preparation, but not another.
• If your baby will bottle-feed at day care, introduce the bottle before you return to work, sometime between the third and sixth week postpartum. To help minimize any confusion your child may experience in the transition and to help maintain your nursing relationship, you may want someone else to be the dedicated bottle-giver. Your baby knows you as the source of breast milk; she doesn't expect a rubber nipple from you. If your baby seems disinterested in taking a bottle from you, try feeding him in an infant seat, car seat, or baby swing. This can help reinforce the connection between nursing and being held closely in your arms.
• Consider how you will store your breastmilk. You can store your milk in various ounce-quantities to meet the changing needs of your baby. Two-ounce and four-ounce quantities are most useful for newborns and young infants, while older babies may take six- or eight-ounces in a feeding. Breast milk is "liquid gold;" storing in smaller batches will help avoid unnecessary waste.
• Provide the caregiver with an idea of how often and how long your baby usually nurses throughout the day. In the week before you return to work, keep a chart of your baby's schedule. This will also help you decide how much breast milk to bring to day care each day. The following chart should also help you estimate how much milk your baby will consume.

(Source: Breast Milk Collection and Storage, Guidelines for Normal Newborns: Medela, Inc, 11/94.)

If you are unable to pump or nurse your baby at work, you will need to wean her from the work-time feedings. Several weeks before you plan to return, start gradually replacing these workday feedings, working toward the feeding schedule you will adopt. Drop a feeding every three or four days (one a week is even better if you have the time). Start with the feeding your baby seems least interested in. Offer a substitute feeding if your baby is hungry at that time.

Gradual weaning will help minimize any fullness you may feet through the process. If you experience discomfort, express only enough milk to relieve the fullness. Remember the goal is to get your body to stop producing milk at these times. We encourage you not to drop all of your workday feedings at once. Abrupt weaning can lead to plugged ducts or even mastitis. It may also be emotionally difficult for your baby.

Milk Collection                                                                                                                                                                                                  

It is helpful to try several methods of expressing breastmilk before you decide which you will use. Many women find they produce the most milk using manual expression techniques. Others prefer to use hand, electric, or battery-operated pumps that can be purchased from most drug stores. Some women choose to rent a commercial pump that allows them to "double-pump" (pump both breasts at once). Your Nursing Mothers counselor can supply the names of commercial sources.

If you plan to continue expressing your milk at your workplace, you may need to make special arrangements. You may be fortunate enough to have a private office, lounge, or dedicated pumping station at work. If these are not available, you will have to be more creative. Try to find a place that is clean, private and comfortable. Discuss the situation with your supervisor or co-workers. An unoccupied room with a lock on the door, behind a portable screen in the school nurse's area, a car parked in a private spot -- all are possibilities.

You should decide how to store your milk while you are at work and on the trip home. A refrigerator at work is an ideal place to store milk. Alternatives include a portable ice chest, a large Thermos filled with ice, or an insulated carrier with ice packs.

Taking Care of Yourself                                                                                                                                                                                 

All mothers lead hectic lives. Each time we add another layer of complexity to our lives, we should not forget the need to take care of ourselves- While it is all too easy to deny our own needs, the time we are breastfeeding is a critical period. To care for our nursing infant, we must care for ourselves. Returning to your place of employment and separating from your child for a portion of the day are yet other demands made upon your time and peace of mind. You may find some of these suggestions helpful.

• Check with your doctor about continuing your prenatal vitamins. This supplement to your diet can make a big difference in how well you function and feel.
• Eating well and maintaining your intake of fluids is very important. No one can overemphasize the importance of good nutrition for the mother who works outside the home. Meals do not have to be fancy, just nutritious. It doesn't take long to prepare a delicious salad, a fruit plate, boil some pasta, or open a container of yogurt. Keep a glass of juice, milk, or water near you at the office (monitor your caffeine intake if it seems to affect your baby).
• Make realistic goals, compromise, and set priorities for what needs to be done during the day or week. No mother can do everything and still have enough time and energy to care for herself and her baby!
• Rest as much as possible. You needn't nap, but try to find small chunks of time through the day when you can close your eyes and relax. Try nursing your baby lying down when you are at home. Set up a few minutes of quiet time for you and the baby at the end of each day.
• The transition to day care often interrupts a baby's feeding and sleeping patterns. A baby may increase the frequency of nursing in the evening or during the night, as if wanting to make up for lost time with his parents. You may welcome these late-night periods of contact. Then again, you may find them exhausting. If he was previously sleeping throughout the night, you may agree to one or two awakenings at night and help him work through the other wakeful times. You may choose to have your baby sleep in the same bedroom or bed with you, so you can nurse more easily. Some mothers set up a mattress in the baby's bedroom for these night feedings. Or you may decide to have someone else take charge of any night awakenings (especially if the baby does not seem hungry).

Many families have been able to devise strategies that allow them to continue providing the nutritional, emotional, and health benefits of breastfeeding and breast milk, even when the mother works outside the home. Employment and nursing can coexist, with a little planning and flexibility on your part. It can also help to put this brief time in your child's life into perspective. Babies grow so fast, and their needs and habits change so quickly that the problems posed in the early months will pass. Soon the mechanics of coordinating breastfeeding, employment and childcare will develop into an orderly pattern. Your Nursing Mothers counselor is there to help you make the transition.