Lactation Narration

The latest nursing-in-public scandal involves a mother who was nursing in her gym (Pure Fitness). The gym did not want her to nurse in the child care area because they were concerned about children being exposed to breastfeeding without their parents’ specific consent. (It is interesting to note that no actual parent complaints were noted) The quote from the gym included:

We feel that children should not be exposed to these events without every parent being ok with their child being exposed to the action.

This incident reminded me of my own nursing-at-child care experience.  Munchkin never took a bottle, even when I went back to work full-time. One of the ways that I dealt with that was by nursing her at daycare on my lunch break each day. When Munchkin was 15 months old, she was scheduled to move from the infant room to the toddler room, and I was informed that I would not be able to nurse her in the toddler room at daycare. I was told that if I would like to nurse her, I could bring her into the infant room and nurse there, or into the staff lounge, but they felt that it was inappropriate to expose the toddlers to breastfeeding because some of their parents might object (though there had been no parental complaints at that time). I objected to this decision, and wrote a letter to the director of the center detailing my reasons:

1) Breastfeeding is not just for infants

By requiring a mother to nurse her toddler in the infant room, you are implicitly saying that nursing is an activity that is appropriate only for infants, which is incorrect.

The American Academy of Pediatrics (AAP) currently recommends breastfeeding for at least one year because of the associated health benefits to the infant. The US Department of Health and Human Services’ Healthy People 2010 objective is 75% of US mothers initiating breastfeeding and 25% still breastfeeding their children at 12 months of age by the year 2010. According to the CDC, in North Carolina currently only 61% of babies are breastfed initially and 17.6% are still breastfed at one year, which is below the national average, and falls far short of the recommendations. The statistics for working mothers are far worse. According to one study of employed US mothers who started out breastfeeding, only 58% continued after returning to work from maternity leave, and only 5% were still nursing at 12 months.

Breastfeeding continues to benefit toddlers nutritionally and psychologically. The American Academy of Pediatrics (AAP) states that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child… Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.” (AAP 2005) The World Health Organization (WHO) exceeds the AAP recommendations and advises breastfeeding for at least two years. This goal is difficult enough to meet for working mothers who are separated from their babies for a significant part of the day, without the negative social pressure that you are currently a part of.

2) Breastfeeding is not indecent, and does not need to be hidden from other children or parents

When you ask me to hide my breastfeeding, it makes me feel that you think breastfeeding is dirty, indecent, or shameful (or otherwise why should it be hidden?). It makes me feel that you think my breastfeeding is something to be ashamed of instead of something to be proud of.  Breastfeeding is not obscene, indecent, or impolite. It is a normal, natural, everyday parenting activity and is a way for me to feed, comfort, and bond with my baby.

No parents have come forward to express discomfort with my breastfeeding at daycare as of this time, so removing me and my child from the room is a response to a potential future complaint. Even if others are uncomfortable, you are then putting the prejudicial social mores of those others above the real needs and feelings of myself and my child.

3) My right to breastfeed is protected by the law

North Carolina law gives me the right to breastfeed anywhere I am authorized to be, whether that location is public or private. If you wish to not allow me to breastfeed in the toddler room, then you would have to revoke my authorization to be in that room. This would go against your already existing open-door policy, as stated in the parent manual: “We do have an Open Door Policy for all enrolled families. Once enrolled, parents are allowed, and even encouraged, to participate in their child’s classroom and in Center events.”

North Carolina law states:
N.C. Gen. Stat. sec. 14-190.9
(B) Notwithstanding any other provision of law, a woman may breast feed in any public or private location where she is otherwise authorized to be, irrespective of whether the nipple of the mother’s breast is uncovered during or incidental to the breast feeding.

4) I enjoy being in my daughter’s classroom

Munchkin (18 months) in the toddler room at daycare

One of the things I like about visiting my daughter at lunchtime is that it gives me a chance to talk to her teachers about how her day is going and what activities they are planning. I also have the opportunity to see how the teachers interact with the other children, and this gives me confidence to leave my daughter in their care while I am at work. Breastfeeding her in the infant room instead of in her own classroom would not allow me to have this interaction with her teachers.

5) I want my daughter to feel “at home” at daycare

I want daycare to be a place where my daughter can feel free to be herself as she does at home. This means that I don’t want her to feel excluded or ashamed because she is breastfeeding. I fear that making her move to another room to breastfeed will make her feel that way, especially if she gets the message that breastfeeding is for “babies,” not for “big girls,” and that it is something that she can’t do openly at school.  I believe that you share these ideals, based on your educational philosophy which states: “We believe that young children need to feel safe, be loved and receive positive feedback and attention. We believe that all children need to be encouraged to develop their unique personalities and explore their interests. All children and their families are respected and valued for their differences.”

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I am happy to report that after reading my letter, the daycare director immediately withdrew her previous decision and told me that I was welcome to nurse my daughter in her classroom any time I’d like. I continued to nurse her on my lunch break until she was 21 months old, and the decision to stop at that time was completely mine.

My first daughter, Munchkin, did not take a bottle. Even at daycare, even when I was back to work full-time. It was stressful at first, but it all worked out for us in the end. She reverse cycled and I nursed her on my lunch break. Her daycare teachers offered her bottles daily, though she never did take one.

A friend of mine had the opposite problem – her baby would only take a bottle and wouldn’t latch to the breast. She ended up exclusively pumping, but hated it and wished that her baby could nurse.

My pediatrician told me that “nipple confusion is a myth” but my experience is to the contrary. Obviously, many babies can and do switch between bottle and breast with no problem, but some have a strong preference. And you can’t know if your baby is one who will have a preference until it is too late!

When Sweets was born, I knew that I would be going back to work when she was 4 months old, and I hoped that she would take a bottle while I worked.  Here is what I did do to introduce a bottle until I went back to work, with the intention of avoiding preference for the bottle:

1. I waited until breastfeeding was well-established, about 4-6 weeks, to introduce the bottle for the first time. The breast and the bottle require a different type of mouth/tongue position, and I didn’t want her to develop a poor latch due to confusion with the bottle nipple. Some people suggested that I should start giving her a bottle from day 1 just to be sure she would take it, but I was afraid of nipple confusion/preference, and chose to wait.  I felt that if my baby was going to have a preference, I would rather she take only the breast than only the bottle.
2. I always used a slow-flow bottle nipple. My breasts didn’t come with fast/slow options. I didn’t want my baby to become accustomed to a fast flow bottle and then be frustrated at the slower flow of my breasts.
3. I used a small amount of milk in the bottle, 1-2 oz at home. My goal was not for her to have a full feeding from the bottle at that time – she just needed enough to become accustomed to the bottle. I know that it is easier for a baby to take a larger feeding from a bottle, and I didn’t want to stretch her stomach so that she needed that larger feeding to feel full. Then she might feel unsatisfied from a feeding at the breast. I continued to keep her portions small in daycare too, and never sent bottles with more than 3 oz.
4. I always had someone else, usually my husband, feed her the bottle. I stayed out of the room and used that opportunity to spend some one-on-one time with Munchkin. I never fed her the bottle myself – I wanted her to know that the only option from Mama is nursing.
5. We did not use a bottle every day, but aimed for 2-3 times per week so that she didn’t forget. I think that was the main mistake we made with Munchkin – she took a bottle a few times early on and we thought everything was fine. We went 2 weeks without giving her a bottle, and then she never took one again.We wanted to give Sweets a bottle often enough that she didn’t forget, but not so often that she expected it while at home.

I didn’t enjoy pumping at home, and my husband didn’t enjoy having to feed bottles either. We both found the bottle routine to be very cumbersome, and if I wasn’t going to be going back to work we would not have bothered with the bottle at all. As soon as I went back to work, the one upside was that we never had to give bottles at home anymore!

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I’m celebrating World Breastfeeding Week with Natural Parents Network!

You can, too — link up your breastfeeding posts from August 1-7 in the linky below, and enjoy reading, commenting on, and sharing the posts collected here and on Natural Parents Network.

(Visit NPN for the code to place on your blog.)

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

This post was written for inclusion in the Carnival of Breastfeeding: Your Family History.
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My mom doesn’t know if she was breastfed as a baby.  My grandmother died several years ago, and by the time I was breastfeeding my children, and my mom thought to ask about it, it was too late.  My mom was the youngest, so she didn’t see how her mother fed any of her siblings.  And my mom’s sisters are several years older and don’t remember anything about how their mom fed her babies.  If they were breastfed, it wasn’t something that was talked about.

My sisters were both adopted, and were formula-fed, so I never saw my mom breastfeed.  But I always knew that I was breastfed as a baby.  I remember my mother’s stories about how she went back to school with an hour train commute each way, and by the time she was on the train coming home her breasts were rock hard and hurting.  As soon as she walked in the door, she would say “Give me the baby!” and my dad would happily hand over the screaming baby.  I asked my mom, why didn’t she just pump while she was at school?  Even if just to relieve her engorgement?  She said she tried, but that it just didn’t work.  The pump she had was the kind where you squeeze a bulb.  She said nothing came out.  Eventually, the pain of engorgement got to be too much for her, and she decided to wean me when I was 7 months old and the new semester started.

My mom weaned me cold-turkey.  She says I was stubborn and wouldn’t take a bottle – I would just wait until she got home.  She said the only way to get me to take a bottle was to just refuse me the breast altogether, so that’s what she did.  I think it took over 24 hours before I would take the bottle!

My mom breastfed me in the ‘70s, when as she puts it, “only the hippies were breastfeeding.”  And 7 months was a really long time, even for the hippies.  My mom didn’t know a lot of people who had breastfed.  Breastfeeding rates were at an all-time low in the early ‘70s – only 24% of mothers in the United States initiated breastfeeding in 1971, and only 5% breastfed for at least 6 months.  By 1978, when I was born, my mother was part of 46% of mothers who initiated breastfeeding, and 19% who breastfed for at least 6 months.  So, while she felt alone in breastfeeding, she was actually a part of a growing trend.

I knew that I would breastfeed my babies, but I didn’t know for how long.  I had the idea, likely reinforced by knowing my mother’s story, that it was nearly impossible to go back to work and continue breastfeeding.

Primarily because I wanted to be able to breastfeed, I originally tried to get a year off of work for maternity leave.  My boss begged me not to leave for a whole year, and promised to do whatever he needed to do to support my breastfeeding.  I took 3 months off completely, and then another 3 months at half-time before I went back full-time.  I was really worried that I wouldn’t be able to nurse once I went back full-time, so I made sure to wait until after 6 months.  I guess I thought that 6 months is about how long most people breastfeed anyway, so if I had to quit then, it would be okay.  It would be just what my mom had done with me.

But by the time Munchkin was 6 months old, I had a new goal, and I was determined to breastfeed for the first year and beyond!  I had a quality double electric breast pump and my boss was very supportive in finding me a place to pump even though there was no lactation room available.  Like I had as a baby, Munchkin also refused the bottle while I was at work, but I didn’t wean her – I pumped at work for my comfort and supply, and I let her reverse cycle at night to get enough milk.  Thanks to advice from a supportive community, both in person at La Leche League and on the internet, I was able to combine working and breastfeeding.

My mother and I faced many similar challenges with combining work/school with breastfeeding, but I had several resources that she lacked.  With a supportive boss, a supportive community, and a good breast pump, I was able to successfully combine working and breastfeeding with both of my children.

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Be sure to stop by the other Carnival of Breastfeeding posts:

Christine @ Christine’s Contemplations: Carnival of Breastfeeding- My Family History of Nursing
Judy @ Mommy News Blog: My Family History of Breastfeeding
Jona @ Breastfeeding Twins: Beer & Bottles (and other motherly advice)
Jake Aryeh Marcus: Breastfeeding? Not in My Family
Elita @ Blacktating: Three Generations of Breastfeeding
Mama Mo @ Attached at the Nip: How Women in My Family Feed Babies
Alicia @ Lactation Narration: Only the Hippies Were Breastfeeding
Dr. Sarah: Breastfeeding, Circa 1950s
Motherwear Breastfeeding Blog: An Unbroken Chain

Munchkin was born in May 2006.  I took “maternity leave” (aka 12 weeks of unpaid FMLA leave), and when I came back to work, I went to HR to ask where I should go to pump.  I work in a hospital.  You would think they would have a lactation room, wouldn’t you? They said there were no facilities, and that I should ask my supervisor to find me a space.  Lucky for me, I have a good relationship with my supervisor and he was completely supportive of my doing whatever I needed to do.  Also lucky for me, my supervisor has worked here for 30+ years, knows everybody, has tons of connections and a good bit of power, and everyone likes him and is willing to help him out.  So, he was able to find me an unused office to pump in.  And when that office became occupied, he found me a second office, and then a third, and then a fourth as time went on.  Eventually, he got permission for me to use the “OD rooms” – the rooms where the on-call doctors can sleep – and that was a great set-up that I was able to use for the remainder of my pumping time with Munchkin.

Though I had a boss who was willing and able to help me out, I know that not everyone is so fortunate.  Another co-worker on my hallway had a less than amicable relationship with her boss and didn’t feel comfortable asking him to find her a space to pump.  Not knowing what else to do, she decided to pump in the bathroom. The bathroom doesn’t have an outlet though, so she could only use a hand pump.  After a few weeks her milk supply was greatly decreased and she decided to switch to formula.  Another co-worker told me that her supervisor let her pump in a supply room where the door didn’t fully close and people were constantly in-and-out of it.  She also only lasted a few weeks. Some supervisors want to help, but don’t know how to find a suitable space.  I decided that our hospital ought to have a lactation room, so that anyone who wants to pump will have a place to do so regardless of the approachability or level of power of her supervisor.

I wrote up a proposal for our hospital to create a designated space for a lactation room.  I also offered that we could just designate an existing space, such as the OD rooms, that could serve a dual purpose, and just give pumping moms authorization to use that space, but for some reason that wasn’t agreeable to the administration.  I submitted my original proposal on October 17, 2006. I was told that I should hear a response of some kind within 2 weeks.  Two weeks went by and I heard nothing, then 4 weeks, then 12 weeks.  Finally, on Feb 22, 2007 (18 weeks, if you’re keeping track), I got this response:

“Your suggestion was given full and careful consideration.  However, due to the lack of space within the hospital, your suggestion has been placed on the project planning list.  Projects on this list will be re-addressed once off-site leases are acquired and additional space is identified within the hospital.”

In March of 2007, I contacted my congressman’s office about the issue, and they were very supportive.  They said they would contact the hospital and encourage them to find the space for a lactation room.  I highly recommend contacting your member of congress – I think that’s what really got the ball rolling.  Within a few days, I heard a new response:

“We have thoroughly searched throughout our building to see if there is a room we could currently re-designate as a lactation room.  Unfortunately, our current space shortage is significant enough that doing so would require evicting someone from an office at a time when we have no offices in which to place newly hired employees and not enough exam rooms to ensure efficient clinic operations.  We do definitely plan to create a dedicated lactation room once we have moved staff and programs to our new off-site lease and have added two modular buildings.  This additional space will be activated in the fall of 2007.  Until that time, our current practice of using locker rooms and private offices will continue.  It has been our experience that our supervisors have been supportive of the needs of nursing mothers and have worked with the staff to identify private areas for their use on an as-needed basis.  While this is not ideal, we believe it should be tolerable for the next several months until we have additional space available.  Thank you for your interest.”

By fall of 2007 I was no longer pumping for Munchkin, but I continued to followup on the lactation room proposal on principal.  Here is part of the response I got on September 13, 2007:

“I expect it to be at least another 6-7 months before we can move functions to the off-site lease…   We definitely still have the lactation room on our list of space needs and will create one as soon as things start to clear out.  I am sorry it has taken so long.”

A year later, I found out that I was expecting Sweets.  I followed up again, saying that I would be in need of a lactation room again in another year’s time, and would it be ready for me by then.  Here is the response on August 8, 2008:

“We expect to award the off-site lease this week and move to the new space in January.  We have this need on the list of priorities for vacated space, and are thinking through the best central location for use by staff.”

January came and went.  In March, I was thinking ahead to my approaching due date and asked again for a progress report.  March 6, 2009:

“The lactation room location has been identified on 5B…  …Probably in May.”

In April, Sweets was born and I went out on “maternity leave” again with no idea if the lactation room would be ready when I came back to work.  I continued to follow-up from home.  May 7, 2009:

“Probably mid to late June when Ward moves.”

In August, I was preparing to come back to work.  I asked again whether the room would be ready by the time I came back.  August 19, 2009:

“The room will not be ready Monday but should be ready after next week. I am still working on receiving and having carpet installed. It will not be installed until sometime next week. There is a chair and small table on order for the room. They should be here in 4 to 6 weeks.  I do have some furniture that can be placed in the room on a temporary basis.”

I came back to work in August and used the OD rooms to pump, as I had 3 years earlier, but I had hope that a real lactation room would be ready soon.  September 1, 2009:

“Hello – the room appears to be done – it just needs to be cleaned, and to have a small table placed and a chair.  If [XXX has] temporary furniture, please go ahead and put into the room.  [XXX] will have the paper towel and soap dispensers hung.  I’ll ask [XXX] to do the final cleaning and hang a sign.”

On September 3, 2009 I took it upon myself to go check out the new room and see what still needed to be done.  There was a temporary bench chair and table, a sink, outlets, and a locking door, so that was good enough for me!  They had basically converted an old supply closet by adding carpet and a sink.  I used the room to pump that day for the first time!  It took three years from the time I first proposed the lactation room until it became a reality! And while it was far too late for me to use the room to pump for Munchkin, it was just in time for me to use it for Sweets!  See the top picture to see what the room looked like that day.

I found a bookshelf that the Volunteer Service let me use, and I bought some used books to stock it with.  I also started bringing in magazines, including New Beginnings and Mothering, and others took the initiative to bring in their own magazines too – Parents, Parenting, Baby Talk, and occasionally others.  I brought LLL series sheets too.  I brought a clipboard and a notepad so that users could write notes to each other.  I brought in a bulletin board which I originally used to post notices and series sheets, but we decided later to use it to post pictures of our kids.  Here is what the lactation looks like now, a year later.

After a year, the lactation room is getting a lot of use.  At first, we would all lock the door while pumping and wait our turn outside.  But now we leave the door unlocked and you can often find us pumping two at a time, or sometimes even three together!  We now have a folding chair and a small table to accommodate two users at a time.

I’ve had an MD mom tell me that she was asked to come back early from her maternity leave to round and that the only reason she agreed to do so was because they told her that we now have a lactation room.  We have two moms in the room who use it to pump, but also use it to nurse their babies once a day when their nanny brings the babies during their break time (they share the nanny).  We have one mom in the room who uses a wheelchair and finds the room to be a very tight fit due to the smaller than standard door, but she is able to manage as long as we keep the floor clear for her, so we have rearranged some of the furniture.  All in all, we are finding the room to be small and crowded sometimes, but we are very thankful that it is there for us.

In the year that we’ve been pumping in this room (yes, I’m still pumping for Sweets), healthcare reform has created a new mandate that would require the hospital to provide us a lactation room by law anyway.  Hopefully that will make the process easier for other moms who want a lactation room in their workplace, and it won’t take three years for them to get it done!

Sweets is 16 months old, and I’m still pumping at work.

Munchkin never took a bottle, but I still pumped with her for my comfort and supply anyway. And I nursed her on my lunch break. I did need some milk to send to daycare – just in case she would take it, and because they legally had to at least offer her something – but I only sent 4 oz per day (2 bottles or cups with 2 oz each) after I went back to work full-time. Four oz was easy enough to get though, and I didn’t have a lot of pressure on my pumping output because I knew she wasn’t drinking it anyway – I was pumping for me, not for her. I dropped my afternoon pumping at around 9-10 months, and then I dropped my morning pumping right at 12 months. I was glad to be done with pumping as soon as possible!

But I kept nursing Munchkin at lunch until she was 21 months. I timed my arrival at daycare for right after lunch, but before nap time, so I could nurse her to sleep and then sneak out while she was napping. This worked out well for everyone because then there wasn’t a sad goodbye when I had to leave again. And the teachers liked it because it was one less kid they had to put down for nap. Munchkin would wait for me on her nap cot until I got there to nurse her, and around 20 months I noticed that sometimes she would already be asleep by the time I got there. By 21 months she was usually asleep when I got there, so I just stopped going. It seemed like a very natural way to wean the lunch feeding, and by then I found that it wasn’t a problem to go all day without nursing or pumping, and that I could still nurse at home on evenings and weekends without any issues.

With Sweets, it has been a different situation, because she had no problem taking the bottle. So I experienced pumping at work as most moms do who pump at work – I had to pump enough milk to have enough for daycare! Fortunately, my daycare provider feeds on-demand and I didn’t have a daycare overfeeding issue like so many other working moms I talk to. I started off at 4 months sending two 2 oz bottles for half-days. At 6 months I went back full-time, and I sent four 2.5 oz bottles, plus I nursed on my lunch break. Most days, Sweets would only drink 3 of these bottles, so the 4th was just a buffer bottle, just in case. That meant that I really had to pump at least 7.5 oz per day, and anything extra went towards making the buffer bottle. At maybe 7 months, I was sending 3 bottles of 3 oz plus a buffer bottle. So in general, I needed about 9-10 oz per day on average. I found that some days I pumped more and other days less, but over the course of the week, it always worked out to be enough. I pumped on Monday what I would send to daycare on Tuesday, and on through the week. At the end of the week, I kept Friday’s milk for Monday, and froze whatever was left over in ice-cube trays.

When Sweets was 12 months, I considered that I could cut down on pumping now and she could start drinking cow’s milk at daycare. But she hadn’t taken well to yogurt yet, so I decided to hold off on cow’s milk for a while more. I was also still nursing her at lunch, but this was getting more difficult. Unlike Munchkin, Sweets would often still be awake after nursing, and then would cry when I left. Also, Munchkin and Sweets were together in the same home daycare, and Munchkin would keep herself awake so that she could see me too when I came in. The lunchtime visits were proving to be a disruption to their day, so at 13 months I decided to stop nursing at lunch. I was still pumping twice per day, but Sweets was only drinking two 3 oz bottles by this time with her table food, so I only needed 6 oz per day. At 15 months, I decided to cut down to pumping only once per day. I sent whatever milk I got (anywhere from 3-6 oz) to daycare and her teacher supplemented her with cow’s milk for the rest, which she could tolerate by then. And that’s where I am now – back to pumping for my comfort and supply more than for the milk. I figure that with Munchkin, I did continue to empty my breast once per workday until 21 months, and I guess it is the same with pumping for Sweets.

I do often wonder whether I could stop pumping at work at this point though and still keep my supply for nights and weekends, or if it is really necessary to keep pumping. I guess I’m taking a “better safe than sorry” approach because I don’t want to risk it. Munchkin was always very attached to nursing, but Sweets is a different kid and is less interested. I worry that if the milk wasn’t readily available when she wanted it, that she might wean before I am ready. It is my high priority for her to nurse for a minimum of 2 years, and I don’t want to do anything that might jeopardize that if I can help it.

I remember that with Munchkin, I thought that 12 months would be the maximum that anyone would pump. I knew plenty of people who practiced “extended breastfeeding”, and plenty of people who worked while breastfeeding, but I didn’t know anyone who pumped longer than 12 months. Most of the advice that I’ve gotten on this topic has come from people who haven’t nursed until at least 2 years, which is a high priority for me. I wonder if their advice to quit pumping at 12 months would impact my milk supply so that I would have trouble nursing at home until at least 2 years. I would welcome any advice on how long you continued pumping, from moms who have nursed for at least 2 years and have been separated from their baby for work or school.

For daycare bottles I almost always send fresh milk to daycare and can only think of one time I actually used frozen for a bottle. I just pump today what I will send to daycare tomorrow. At the end of the week I freeze any surplus that’s left.

I freeze in ice cube trays for convenient 1 oz aliquots. I just pour the milk in the tray, put saran wrap over it, and put it in the freezer. The next day, I pop the cubes out and put them in a ziplock bag. I write the date on the ziplock with a sharpie. Then I place that small ziplock into a larger ziplock freezer bag with the others for storage.

This could be useful if mom isn’t home and baby finished her bottle but wants a little more, but you don’t want to use another whole bottle (trust me – the milk is precious – you don’t want to use a 4 oz bottle if baby is only going to drink 1 oz!). If I needed to use the cubes for a whole bottle, I just pushed the frozen cubes into the bottle and then put the bottle in the fridge to thaw. It would be ready to use by the time daycare needed it.

I have mostly used my cubes for thinning baby food. I take out a food cube and a milk cube (or 2 food cubes and a milk cube depending on baby’s age), and put them in a small tupperware container in the morning. We use the little take-and-toss kind because they are a good size for it. I put the container in the fridge to thaw, or I can heat it up in a container of warm water with the lid closed. Honestly, I didn’t really need to worry about it at home much because they mostly went to daycare and would be thawed by the time she needed them.

Another use is to put the milk cube in one of the mesh feeders in the summer for a “momsickle”.

I thought this would be a good topic to start with because it’s one that I see a lot online, and one that I was very concerned about when I went back to work when Munchkin was 3 months old. You see, we had tried giving her a bottle a few times before, starting when she was 6 weeks old, and she seemed to be okay with it. After missing a few weeks, when we tried to give her a bottle again, she wouldn’t take it – and she never did again! Sometimes she would just wail and sometimes she would kinda chew on it or push it around with her tongue, but she wouldn’t suck on it. I had taken off 12 weeks of FMLA leave, and it was time for me to go back to work, but how could I leave her at daycare if she wouldn’t take a bottle?!

What we tried:
My husband feeding her, me feeding her, grandma feeding her
Me in the room, me in the other room, me upstairs for 30 mins
When she’s hungry, when she’s not that hungry, after she just ate
When she’s awake, sleepy, asleep, just waking up
In the morning, in the afternoon, in the evening
In a cradle position, in a sitting position facing out, in a sitting position against your legs facing you, standing up and walking around
Using frozen milk or freshly pumped milk
Using room temp milk, body temp milk, warmer milk
Using many brands of bottles with various types of nipples, using various brands of sippy-cups – both with and without valves
I also tried nursing her until she was sleepy, then switching in the bottle without her realizing it

These are all different things you can try if you are having this problem, and one of these suggestions might help you. I’m sure that most babies will eventually take the bottle. Many people told me things like “Babies are smart enough to eat when they are hungry. If you let her get hungry enough, she will eventually take the bottle.” I left her up to 5 or sometimes 5.5 hours at daycare, and she never did.

What happend:
I nursed at the daycare at drop-off and pick-up. I also went there and nursed during my lunch hour. I pumped twice at work for my comfort and supply, and provided 2 bottles (or cups) to daycare each day which they would attempt to give her. Munchkin had been sleeping 10 hours through the night, but she started waking to nurse throughout the night (reverse cycling). Once she started solid foods, she ate all solids at daycare and nursed while at home. Daycare would mix some milk with her solid food to get a little more into her.

You can also use other methods of getting milk into your baby at daycare that may be less convenient – spoon feeding, dropper/syringe feeding, open cups, or straw cups. Don’t feel limited to just bottles.

Conclusion
It was stressful in the beginning to have a baby in daycare who wouldn’t take a bottle, but it was all okay in the end. While I am glad that Sweets takes a bottle at daycare just fine, I wouldn’t actually be that upset if she was like Munchkin and refused it, because now I know I could deal with that. And in the end, if my baby is going to have a preference and only take one, I would absolutely prefer if she didn’t take the bottle vs. didn’t take the breast.

Chances are good that your baby will eventually accept the bottle if you go back to work. But if she doesn’t, also know that you can get through that too.