Preparing for Your Return to Work: The Breastfeeding Mother’s Guide

Preparing for Your Return to Work: The Breastfeeding Mother’s Guide

When a family is expecting a baby, it’s a time full of wonder and happy expectation. For months, a mother feels fluttering and quickening, the soft movements of her baby. For many families, it is also a time for making plans to welcome a new family member. Parents may also use the time of pregnancy or the waiting period for adoption to investigate how to support the breastfeeding relationship in the workplace or in school. This article addresses some common questions breastfeeding mothers have about preparing for a return to work and includes the concerns that mothers who do not have a pro-breastfeeding workplace or school may face.

Talk to your employer

This article, Pumping 9 to 5, provides some information on how to talk to your employer about breastfeeding and how to make a plan for expressing your milk at work. Being ready for this conversation, with an idea of what you will need in terms of space and time, will help make your points clear and concise. Take the time you need to make a plan before you speak with anyone at your school or job. Other workplaces, tribes, and many places of higher education have set up lactation rooms; think about bringing them up in your conversation to support your requests. It may also be important to mention the ways your workplace or school will benefit from setting up a lactation room for other families. This booklet explains some of the possible concerns that a business or institution may have about setting up a lactation program for individuals that either work in or attend the facility.

Know your rights

There are State and Federal Laws in place to support breastfeeding mothers. For example California Labor Code 1030-1033  stipulates:

Every employer, including the state and any political subdivision, shall provide a reasonable amount of break time to accommodate an employee desiring to express breast milk for the employee's infant child. The break time shall, if possible, run concurrently with any break time already provided to the employee.

Additionally, the IHS and many Government agencies provide pumping breaks for their employees, and many institutions already have supportive programs in place for breastfeeding mothers. The Affordable Care Act of 2010, states that:

Effective March 23, 2010, the Patient Protection and Affordable Care Act amended the FLSA to require employers to provide a nursing mother reasonable break time to express breast milk after the birth of her child. The amendment also requires that employers provide a place for an employee to express breast milk.


Consider all of your options

Are you able to change your work schedule or delay returning to work or school? Some mothers have worked out job shares or found other ways to minimize separation from their babies. Talk to your employer about what might work for you.

• Some companies offer on-site day-care or allow a mother to bring her baby to work with her so that she may continue to breastfeed. This arrangement eliminates the need to express milk because the mother can breastfeed her baby throughout the work day. Plan ahead: many on-site day-care facilities have long waiting lists.
• Working from home part or full time is an option in some situations.
• If you are not able to bring your baby with you or visit him during the day, consider a day-care situation that would allow a care-provider to bring him to you.
• Split the work week with a co-worker who is looking for extra hours or a partial shift.

When should I start expressing milk?

Babies grow so fast! They are newborns for only a few weeks, and before you know it, they are smiling, cooing, and reaching for your face while you are nursing. In the first several weeks after birth, take all the time you can to relax, get to know your baby, and just enjoy being his mom. Unless you have to return to work right away, it is recommended that mothers wait until breastfeeding is well-established before they begin expressing milk for returning to work: for most mothers, somewhere between 3-4 weeks. If you have to return to work earlier than 4-6 weeks, you might wish to begin pumping milk two weeks before you plan to return to work.

Learn how to express your milk

Preparing for your return to work or school can begin with learning to express your milk.

• You can express milk by hand, with a breast pump, or by using a combination of the two.
• Learning how to remove milk without your baby requires both developing your own expression technique and conditioning your milk ejection reflex (MER) or “let down” to respond to it.
• Most mothers experience MER in response to the sensation of their babies suckling as well as other stimuli like the sound of a baby crying. If you are having trouble eliciting MER during expression, try visualizing your baby at the breast or listening to a recording of your baby's cry. Looking at pictures of your baby or smelling your baby's clothes or a blanket may also be helpful. If you have a video feature on your phone, try recording your baby breastfeeding so you can play it back while expressing. One study indicated that mothers who replicated their babies’ sucking patterns by adjusting the cycle settings on their pumps expressed more milk (Meier, et al, 2012).  
• Warming the breast before expressing and gentle breast massage (working from the armpit towards the nipple with a soft kneading touch or in a circular motion with flat fingers) has been effective at increasing the amounts of milk removed during expression (Jones, Dimmock & Spencer, 2001).
• Combining hand expression and massage with a pumping routine has been shown to assist with increasing milk production and output (Morton, Hall & Wong, 2009).

How do I hand express?

Hand expression requires no special equipment and can be an effective way for you to remove milk when separated from your baby. Some mothers find that hand expression is more effective for them than pumping because it is more comfortable, and they can feel for areas of fullness and apply pressure with their fingers exactly where it is needed. Once you have success with a method of hand expression, you may feel that you are able to meet your baby’s needs without a pump.

What type of pump should I use?

A high-quality, full-size, double-electric pump is recommended for a mom who plans to pump milk every day. A pump that is made by a manufacturer specializing in breastfeeding equipment will be of higher quality than cheaper pumps made by a company whose primary products are bottle-feeding equipment or baby food. A breast pump is an item for which the old adage, “You get what you pay for,” often rings true. Another option for many mothers is renting a multiple-user pump from a trusted source such as a Hospital, Tribal Health Clinic, or local IBCLC. Most WIC offices provide pumps to moms who are returning to work or school; contact your local WIC office to see if you qualify. Many families have health insurance that is willing to cover the cost of renting a hospital-grade pump. If you are able, call your insurance provider for the details of your own coverage when you are pregnant. Recent 2011 news from the IRS states that electric pumps are now tax deductible, so keep your receipts for your tax records.

In our opinion, the top three single user pumps on the market today are:

Pump Brand/Model
Cost range
Warranty
Mechanics
WHO-CODE

Spectra S1 or S2
$115-250
2 year
Closed system
Compliant

Hygeia Enjoye*
$180-300
3 year
Closed system
Compliant

Ameda Purely Yours
$150-180
1 year
Closed system
Compliant

Medela Pump in Style
$250-350
1 year
Open system
Non-compliant
*Sold in the category commonly referred to as single-user pumps; Hygeia is the only pump company that has sought and received FDA approval for their pump to be used by more than one person.

What is the difference between an open and closed system pump?

• With an open system, if milk or condensation makes its way into the tubing, it is possible for mold to begin to grow in the motor. There is no way to clean the pump motor, and any mold spores present could come through the tubing and possibly into contact with the expressed milk. Furthermore, if the pump is second-hand or was used by another mother, germs from one mother or her milk could contaminate the milk in the same way. An open system is built to be a single-user system only.

• Closed system pumps are just what they seem: there is no way for the milk to come into contact with the motor. Theoretically, any closed system pump could be safely used by more than one person (each with her own tubing and other external pump parts).

What is the WHO CODE, and why is it important to consider when buying a breast pump?

The “WHO CODE” is short for the World Health Organization’s International Code of the Marketing of Breastmilk Substitutes. Part of the purpose of the WHO CODE is to protect breastfeeding by preventing aggressive marketing of breastmilk substitutes and artificial nipples. Many people prefer to purchase a breast pump from a company that is supportive of and compliant with the WHO CODE.

More information on both the breast pumps, the WHO CODE, and open and closed systems can be found at: The Problems with Medela

How often should I express milk?

Once a day is usually plenty at the beginning. Most moms find that they are able to express the most milk in the morning hours. You can nurse your baby on one side while expressing milk on the other side. Or you could pump both sides about one hour after your baby’s first morning feeding. Don’t worry if you don’t get very much milk at first. It takes practice, and your body needs to “learn” to make milk for that extra “feeding.”  When milk is removed, your body responds by making more milk at a faster rate.  It can take a few days for your body to increase production (Daly, Kent, Owens et al.,1996). Any milk collected during these practice sessions can be stored in the freezer.

How much milk should I have stored in my freezer?

Many mothers find that they feel less stress if they to know that they don't need to create a large freezer stash of milk before they return to work. Instead, they can use their maternity leave to focus on being with their babies and getting breastfeeding well-established. If you have enough milk to send with your baby on your first day, then you have enough in the freezer.

It is important to express as much milk while you are at work as your baby needs during that time. If your baby needs 10 ounces while you are away at work, then you need to pump at least 10 ounces each day.
For example:
If you were to only pump 8 ounces and send 2 ounces from the freezer each day, you would not be expressing the amount of milk your baby requires. Your body will “think” that your baby needs 2 fewer ounces each day than he really does, and your production will not match his demand. If you start to run out of milk in your freezer, you may face the difficult decision of how to meet your baby’s needs. Many mothers learn too late that increasing their milk supply to meet their baby’s demands is more complex than it seems. Meeting your child’s daily needs for expressed milk during separation is the best way to avoid difficulties later.

Using the simple system described, you pump each day what your baby would need the next day. This way you only use the small freezer stash for emergencies, such as dropping and spilling a day’s worth of milk, or other milk-related calamities.

If you need information about returning to work or expressing your milk, a Breastfeeding Counselor , La Leche League Leader, Nursing Mother’s Counsel or International Board Certified Lactation Consultant  may be able to help. Accessing a community support system can help you reach your breastfeeding goals.

You may also be interested in these articles:
Returning to Work: The Breastfeeding Mother’s Guide
Are There Differences Between Breastfeeding Directly and Bottle-Feeding Expressed Milk?
Breast versus Bottle: How Much Should Baby Take?
Facts Every Employed Breastfeeding Mother Needs to Know
I’m Worried My Milk supply is Drying Up, What Can I Do?

References

Black Bear, J. (2011). Breastmilk Storage and Handling Guidelines. http://nativemothering.com/2011/04/breastmilk-storage-guidelines/

Daly, S., Kent, J., Owens, R. & Hartmann, P. (1996). Frequency and degree of milk removal and the short-term control of human milk synthesis. Exp Physiol, 81(5), 861-75.

Easy Steps to Supporting Breastfeeding Employees. (2008). U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau. Produced in contract with Every Mother, Inc. and Rich Winter Design and Multimedia. http://mchb.hrsa.gov/pregnancyandbeyond/breastfeeding/easysteps.pdf

Forbes, B. (2011). What is the WHO-CODE? Website: http://www.bestforbabes.org/what-is-the-who-code

Internal Revenue Bulletin. Lactation Expenses as Medical Expenses. (2011). Website: http://www.irs.gov/irb/2011-09_IRB/ar11.html

Jones E., Dimmock, P. W. & Spencer, S. A. ( 2001). A Randomised Controlled Trial to Compare Methods of Milk Expression After Preterm Delivery. Arch Dis Child Fetal Neonatal Ed, 85, F91–F95

Meier, P. Engstrom, J. Janes, J. Jegier, B. & Loera, F. (2012). Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. Journal of Perinatology, 32, 103-110

Morton J., Hall, J., Wong, R., Thairu, L., Benitz, W. & Rhine, W. (2009) Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology, advance online publication,29, 757-764

Shebala, M. (2012, January 26). Benefits of breastfeeding in workplaces touted. Navajo Times, http://www.navajotimes.com/opinions/2012/0112/012612notebook.php

Silver, B. (2010). College and University Lactation Programs, some Additional Considerations. The Elsevier Foundation, University of Rhode Island Schmidt Labor Research Center.http://www.uri.edu/worklife/family/family%20pics-docs/LactationPrograms%20FINAL.pdf

Simmance, A. (2011). Why You Shouldn't Buy, Sell, or Borrow a Second Hand Medela Swing Pump. Website: http://mythnomore.blogspot.com/2011/08/why-you-shouldnt-buy-sell-or-borrow.html

State of California, California Labor Code § 1030.
2002: Chapter 3.8, Section 1030, Part 3 of Division 2 of the Labor Code http://www.google.com/url?q=http%3A%2F%2Fwww.cdph.ca.gov%2FHealthInfo%2Fhealthyliving%2Fchildfamily%2FPages%2FCaliforniaLawsRelatedtoBreastfeeding.aspx%23workingandbreastfeeding&sa=D&sntz=1&usg=AFQjCNHUWIwkLISI2im9IiolxL9ZB-IVhA
West, A. (2011). The Problems with Medela. Website: http://www.justwestofcrunchy.com/2011/01/19/the-problems-with-medela/

© 2012 Serena Meyer, IBCLC and Teglene Ryan, IBCLC