For most breastfeeding mothers who need (or choose) to go back to work (or school), the end of maternity leave is a stressful time. You may be wondering if your baby will take a bottle or not, or whether she will come to prefer the bottle over you. You may be wondering how you will be able to pump as much milk as you will need to provide for you baby while you are away, or how much milk you are going to need. These are common and reasonable concerns. Here are 15 Tips for the nursing mother going back to work.
First off, there is such a thing as nipple confusion/nipple preference. Though many, maybe even most, babies can go back and forth from breast to bottle just fine, there are also plenty who can’t. My good friend had a baby who once she got used to a bottle wouldn’t latch at the breast anymore, and my friend ended up having to exclusively pump, which she hated. My older daughter, Munchkin, wouldn’t take a bottle even though I was back at work. She just wouldn’t. So yah, some babies just have a strong preference for one over the other and refuse to take both. Chances are good that you won’t have that problem though, plenty of babies do both. My younger daughter, Sweets, did both with no problem.
Some babies come to prefer the faster flow of the bottle over the breast, so one way to combat that is to always use the slowest flow nipple that you can find and just never switch it up to a faster flow nipple (Tip #1). I also kept a strict rule that baby only got a bottle if mommy wasn’t around (Tip #2). She knew that mommy meant nursing, and never expected to get a bottle if I was there. Another tip is to provide more bottles with smaller amounts in them (Tip #3), which is more typical of how breastfed babies eat. I started with 2 oz bottles and eventually worked up to 3 oz bottles, but never went higher than that. (More on this later)
I also encouraged mine to comfort suck at the breast (Tip #4) and to nurse at night when we were together (Tip #5 – which is much easier if you co-sleep). Comfort sucking allows baby (and you) to view nursing as more than just about nutrition, but also about contact, so baby will want to nurse to re-connect with you even if they aren’t necessarily that hungry. This helps nursing time to be about more than just nutrition, but to be about attachment as well. I tried to encourage my daycare provider not to give Sweets a bottle soon before pick-up, but sometimes I would arrive shortly after she’d had a bottle anyway, and she would still want to nurse when I picked her up just to re-connect. Keeping close at night also helps foster attachment that you may be missing while you are at work. And letting baby night-nurse means you will need to provide less milk for while you are away, which means less pressure on the pumping and bottles (more on this later too).
One thing to consider if you are having trouble pumping enough milk for daycare, is that many daycare providers try to feed breastfed babies just like formula-fed babies, which is to say bigger bottles less frequently, increasing in amount as baby gets older. That’s just not necessary for breastfed babies. When Munchkin was an infant, she was in a daycare room of 8 babies, of whom 4 were fed breastmilk and 4 were fed formula. I remember noticing that all of the formula-fed babies, regardless of age, had bottles with 4 or more ounces in them, while all of the breastfed babies, regardless of age, had bottles with 4 or fewer ounces! When I hear a mom upset because her daycare provider wants her to bring 6 or even 8 oz bottles of breastmilk and she just can’t keep up, I think that the provider is probably trying to feed this baby like a formula-fed baby. Sometimes we need to educate our daycare providers about the differences between breastfed and formula-fed babies (Tip #6).
3 oz was the most I ever sent per bottle
Breastmilk changes over time with your child’s age, so you do not need to keep increasing the amount over time like you do with formula. Once your baby is about 4-6 weeks old, you shouldn’t really have to change the total amount until 6 months or so, at which time if you start adding solids you may even start decreasing how much milk you send. You can change how you distribute it (five 2 oz bottles or four 2.5 oz bottles or three 3 oz bottles, etc) but you don’t have to keep increasing the total amount that you pump (Tip #7). If your daycare provider says that your baby is still hungry after the bottle, you may consider changing the distribution of ounces in the bottles in this way, or you could suggest a pacifier after the bottle (Tip #8). When a baby is nursing, she can comfort suck after feeding, but with a bottle she may appear to still be hungry when she just wants to suck. The slow flow nipple helps with this too because it gives more sucking opportunity and more time for the brain to realize when it is full.
Another problem with providers trying to feed your baby larger bottles, is that this stretches baby’s stomach. I have always heard that if you start a pattern of over-eating that it is difficult to stop because you have stretched your stomach, which means that you have to fill it more in order to “feel” full again. This can happen with babies as well, and is said to be more common in bottle-fed vs breastfed babies (regardless of what’s in the bottle) because of a few reasons. First, caregivers try to add more to the bottles in an effort to “space” the feedings further apart. Second, the mechanism of a bottle makes it harder for a baby to stop eating in the middle because once the milk is in her mouth, she is forced to either swallow it or choke on it, and once the milk is swallowed, the suction of swallowing pulls more milk into the mouth, continuing the cycle (Fix: Smaller bottles). Third, milk empties from a bottle faster than it does from the breast, so by the time the brain to receives the signal that the stomach is full, it is over-full (Fix: Slow-flow nipples, using a pacifier after a bottle). Fourth, many parents and caregivers really try to push baby to “finish” the whole bottle because they don’t want to waste the contents (Fix: Smaller bottles, saving the leftovers for another feeding – Tip #9). This then causes problems for mom both with being able to pump enough for daycare, and with baby being unsatisfied with the breast when at home. It often leads to supplementing. The (unstretched) stomach is only about the size of her fist, which is not very big.
While it is a challenge for many moms to pump enough, you may actually need less milk than you think. If you co-sleep and night-nurse, baby can tank up at night and won’t need as much during the day. Munchkin never took a bottle, and we let her ‘reverse cycle’ like this so that she got a lot of milk at night instead of during the day. Imagine that baby X sleeps through the night for 8 hours w/o eating. That’s no different than baby Y who doesn’t take a bottle at daycare but eats at night instead. That’s all there is to reverse cycling. Sweets did take a bottle just fine, but I still encouraged her to night nurse because it’s easier for me to do that than to stress about pumping enough during the day.
An average baby takes in 24-30 oz per day. Baby X sleeps 8 hours at night, so that leaves 16 hours for eating, which is 1.5-1.9 oz per hour. At daycare for 8 hours, you need to provide 12-15 oz. Now, baby Z night nurses and also takes a bottle, so you have 24 hours for eating, which is 1-1.25 oz per hour. At daycare for 8 hours, you only need to provide 8-10 oz. And when you are pumping at work, the difference between needing 10 oz and needing 15 oz is enormous!
My co-worker’s baby slept all night in her crib, and my co-worker struggled to send 15 oz to daycare each day and had to supplement with formula because she couldn’t pump that much. She was always stressed about pumping. She read all kinds of books, took herbs and supplements, was part of a supportive LLL community, and pumped as much as possible, but she just couldn’t get as much as she needed for daycare. In contrast, my baby co-sleeps and I only sent 9 oz to daycare each day, and didn’t have a problem pumping enough. I also wasn’t stressed about it because I knew that if I didn’t have quite enough one day, that Sweets would make up for it at night, so I never felt any pressure to supplement with formula. If it can work for your family, co-sleeping and night-nursing can really decrease the stress of pumping at work.
But another thing to take from that story, is that even if you can’t pump enough and have to supplement with formula at daycare, it’s not the end of the world. It doesn’t mean you have to stop breastfeeding when you are together, or pumping when you are at work for that matter. Nursing does not have to be all or nothing. My co-worker nursed at home and pumped as much as she could at work for a long time. She worked really hard to not supplement before 6 months, and then felt more okay about it after she introduced solids. She thought of the formula supplement like another food that her baby ate along with solids. But, as often happens in situations like these, one bottle of formula a day at daycare became two bottles of formula a day at daycare, and then another at home, and by 10 months she was exclusively formula-feeding even though she had fully intended to breastfeed for at least a year. So, while mixed feeding can work for some, it is something that you have to be careful with because it can easily become a slippery slope away from your goals and intentions (Tip #10).
If you are still worried about pumping enough milk, it helps to have a good pump (Tip #11). I had a not so good pump when I started. I didn’t know it was not so good – I mean, it worked, I got some milk out. But when I upgraded to a better pump, I could tell the difference in how much milk I got right away. I just didn’t know what I was missing before. The pump I switched to is the Ameda Purely Yours, which gets the same ratings as the more popular Medela Pump-In-Style, but is significantly less expensive. Also, the Ameda is a closed system pump, so safer to get second hand if you can’t afford a new one. (Still recommended as only a single user pump though)
I had to train my body to the pump (Tip #12). Your brain and hormones know how to let down milk for a baby, but not necessarily for a pump. Some moms can’t pump hardly at all because of this, but they have plenty of milk when they nurse. To train my body to the pump, I would nurse on one side and pump on the other side simultaneously. When baby wanted to switch, I swapped them both. It is a little tough logistically and you’ll think you need 3 hands, but I do think it helped me to train my body this way. I did this only for the first feeding of the day starting at about 4-6 weeks. Then, when you are pumping without your baby, it also helps to have cues to remind yourself of baby: a photo, a video on your phone, the pajamas that she slept in last night that you can smell, whatever works for you (Tip #13). I also find that I pump much better in specific surroundings and at the same times of the day (Tip #14). Funnily enough, I pump much better at work than at home now – I think my body is used to that environment for pumping. I get a lot less milk if I pump at home. There is a lot of brain involvement, it’s not just your breasts. Another tip for pumping is to use “hands on pumping” (Tip #15). I have a friend who went back to school while nursing twins and used this pumping technique and swears by it.
Put all together, here are all 15 Tips:
1- Use only slow-flow bottle nipples
2- Mom doesn’t give bottles
3- Use smaller bottles
4- Encourage comfort sucking at the breast
5- Nurse at night
6- Educate your daycare provider about breastfed babies
7- Redistribute, rather than increase, milk with age
8- Offer a pacifier for comfort sucking after bottle feedings
9- Save the extra milk in the bottle
10- Beware the slippery slope of supplementation
11- Get the best pump you can
12- Train your body to the pump
13- Use cues while pumping to remind you of your baby
14- Pump with routine times and surroundings
15- Try hands-on pumping
