Returning to Work

by LiseAnne Dietz McGalliard

You know you will be returning to work after your baby is born. You want to continue breastfeeding, but you know that you will not be able or don’t want to pump at work. Can you still breastfeed? YES!! Mothers who have made this arrangement work suggest the following tips:

> Delay your return to work as long as possible. A long period of exclusive breastfeeding before returning to work ensures that your milk supply is well established and will be more tolerant of the varying demands placed on it. If possible, it works best if you can wait until your baby is at least three months old.

> Bring a manual pump, or a small battery-powered or electric pump with you when you first return to work. Pump only as much and as often as needed to remain comfortable (not too full). It will take a week or two for your body to adjust to not making as much milk during the workweek and picking up production again on the weekends or days off. After a week or two, you will not need to pump at all.

> Keep your work schedule consistent by working close to the same hours each day. This consistency helps maintain a good milk supply for nursing when you are not at work.

> Don’t be afraid to nurse even more frequently on weekends or days off. Your body will adjust.

> Nurse your baby right before you leave for work and first thing upon returning home. Some moms even use a reverse feeding schedule, waking their babies to nurse every two hours at night so that they eat less during the work day and need less formula supplementation.

Click here for more information.

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Pumping and Storing

Keep in mind that no method of expression will remove the milk from a mother’s breasts as effectively as a baby who is nursing  well. However, there are a variety of circumstances that require a mom to  express her milk.

Hand expression is always an option for any mom. It  works best for the mom who only has to express milk very infrequently. The biggest advantage is that there is no expense and nothing to clean up.

Hand operated pumps are inexpensive and will work  well for the mom who only pumps occasionally.

Automatic electric pumps are the best option for a mom who has to pump on a regular basis. They can be purchased or rented at a  daily rate.

NOTE: Some hand and electric pumps work better than  others. Please check with a counselor or lactation consultant before making a  major purchase to make sure the pump suits your needs.

Visit the Medela website for specific information about pumping and storing breastmilk.

Daily Log

This log is meant to help you keep track of how often the baby is nursing and how many wet and soiled diapers there are each day.   This is a good way for you to know that he is getting enough breastmilk, because what goes in…comes out.

DIRECTIONS:

Circle the hour when your baby nurses (Goal: 8-12 times in a 24 hour period)
Circle the W when your baby has a wet diaper
Circle the S when your baby has a soiled diaper
During the first week, you will use more diapers each day.
DAY ONE
Time:      Mid 1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                  W
Black tarry soiled diaper   S

DAY TWO
Time:      Mid  1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W
Brown tarry soiled diaper    S     S

DAY THREE
Time:      Mid 1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W
Green soiled diaper          S     S

DAY FOUR
Time:      Mid  1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W
Yellow soiled diaper         S     S    S

DAY FIVE
Time:      Mid 1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W    W
Yellow soiled diaper         S     S    S

DAY SIX
Time:      Mid  1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W    W     W
Yellow soiled diaper         S     S    S    S

DAY SEVEN
Time:      Mid   1  2  3  4  5  6  7  8  9   10  11  Noon  1  2  3  4  5  6  7   8  9  10  11
Wet Diaper                   W     W    W    W    W     W
Yellow soiled diaper         S     S    S    S

It is okay for your baby to have more wet diapers or more soiled diapers.  Call your breastfeeding counselor if your baby has less than the number on the log.

Positioning

Not sure if baby is latching on correctly? Click here for step-by-step instructions with helpful PICTURES. http://www.breastfeeding.com/helpme/helpme_images_latchon.html

POSITIONING THE BABY CORRECTLY FOR NURSING
Breastfeeding is meant to be a pleasant, comfortable experience.  You can avoid the problem of sore nipples most of the time.  Many new mothers find their nipples are tender for the first few days when the baby starts nursing.  This usually disappears by 1-2 weeks.  To prevent nipple tenderness, correct positioning and latch on are important.  There are several different positions you can try.

CRADLE POSITION
Place a pillow or two in your lap to support the baby
Place your baby’s head on the crook of your arm
Support the baby’s back with your forearm
Your hand should cup the baby’s buttocks or thigh
Make sure your baby is turned towards you (chest to chest)
The baby’s ear, shoulder and hip should be in a straight line
The baby’s bottom arm can be either under your breast or around your waist

FOOTBALL OR CLUTCH HOLD
(The football hold is a good choice for the mother who has had a cesarean section because it allows her to breastfeed without putting pressure on the incision)
Place a pillow or two at your side to help support your arm and your baby
Your baby should be facing you while his body is tucked under your arm along your side
The baby’s bottom should rest on the pillow near your elbow with his hips against the back of the chair
The baby’s upper back rests along your forearm while you support his neck with your hand

SIDE-LYING
Lie on your side
You can put pillows under your head, behind your back and under the knee of your upper leg
Your body should be at an angle to the bed as you lean slightly backward into the pillow behind your back
The baby should be on his side facing you
The baby’s back should rest against your forearm
To keep the baby on his side, a folded towel or small pillow may need to be propped behind his back
You can offer both breasts while lying on one side or roll over for the baby to nurse on the other side

SLIDE-OVER
(The slide-over position can be helpful in persuading a baby who is refusing one breast to nurse on the less preferred breast)
The baby will start in the cradle position (see above) and nurse from one breast
When it is time for the baby to take the second breast, slide him over without changing his body position

CROSS-CRADLE
(Also known as the modified clutch or transitional hold.  This is an effective position for babies who are having difficulty latching on.)
Support the baby in your lap on a pillow in a horizontal or semi-upright position
Hold the baby using the arm opposite the breast at which he will feed
Your hand supports the baby’s neck and head, his body extends the length of your forearm
Use your same side hand to support the breast
Position the baby’s mouth at the level of your nipple with the baby on his side facing you

Getting Started

Getting Started    
During the first few days after birth, many babies want to breastfeed often and long, until the mother’s milk supply becomes more plentiful.

Frequent and unrestricted breastfeeding in the early days offers health benefits for both mother and baby.

-Provides the baby with the colostrum he needs
-Prevents painful engorgement in the mother
-Stimulates uterine contractions in the mother and lessens the chances of hemorrhage
-Prevents newborn jaundice
-Stimulates the mother’s milk to increase more quickly

Babies should nurse 8-12 times in a 24 hour period.  Watch for your baby’s cues that he is hungry and don’t worry about the length of time since the last feeding.   Most babies will fall into their own pattern of nursing.  Some will space them evenly and some will nurse more often at certain times of the day and less at others.   It is the overall amount in a 24 hour period that is important.

One or two wet diapers a day are normal for the exclusively breastfed baby during the first two days after birth.  By day five, there should be 5-6 wet diapers per day.

The baby’s first bowel movement, meconium, is dark and tarry.  After the first few days, bowel movements should be a “golden mustard” color with “seeds” in it.  Their is usually no odor associated with the bowel movements of an exclusively breastfed baby.

When breastfeeding is going well, water or formula  supplements are not needed.  There are several reasons that supplements should be avoided.

-Supplements fill up the baby, making him less interested in breastfeeding
-Artificial nipples can weaken a baby’s suck or cause the baby to refuse the breast
-Supplements decrease the time at the breast which can lead to engorgement
-Supplements interfere with the establishment of the milk supply
Allow the baby to finish the first breast before offering the second.

Introducing Solids

by Holly Lucard, IBCLC

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life. The AAP also suggests a gradual introduction of solids in the second half of the first year, which should complement the breastmilk diet.

Human Milk Is Baby’s Primary Nutrition
In my nineteen years of counseling breastfeeding mothers, I have received numerous calls from women who fear their babies are losing interest in breastfeeding and that they are losing their milk. The culprit in almost all of these cases? Solids! It is important to remember that human milk is the primary source of nutrition for your baby for the first year of his life. Breastmilk provides 100% of a baby’s nutritional needs for the first six months of life, and 75% for the second six months.
Important Guidelines
To ensure that your baby won’t wean before both you and she are ready, there are two important things to do when adding solid food to her diet.

1. For the first year, nurse immediately before giving solids. Don’t offer meals between or before
breastfeeding. Giving solids between feedings will stretch out the time between nursings,
causing a decrease in your milk supply.  Remember, the more you nurse, the more milk
you make. If you feed solids before nursing, your baby will likely become too full and won’t be
interested in breastfeeding.

2. Don’t rush into giving three meals a day. Start slowly with one meal a day, adding a second meal
in a few months, and the third a few months after that. Your baby may not be on three meals a day
until she is a year old. Gradually during your baby’s second year, the amount of solids your
baby eats will increase to become a major part of her diet. Keep in mind that your
baby will have a lifetime for eating solid food, but breastmilk is only available in the early years.

Breastfeed a Toddler? Why on Earth?

By Jack Newman, MD, FRCPC
www.bflrc.com

 Because more and more women are now breastfeeding their babies, more and more are also finding that they enjoy breastfeeding enough to want to continue longer than the usual few months they initially thought they would do it.  UNICEF has long encouraged breastfeeding for two years and longer, and the American Academy of Pediatrics is now on record as encouraging mothers to nurse at least one year and as long after as both mother and baby desire.  Breastfeeding to 3 and 4 years of age has been common in much of the world until recently, and breastfeeding toddlers is still common in many societies.

Why should breastfeeding continue past six months?  Because mothers and babies often enjoy breastfeeding a lot.  Why stop an enjoyable relationship?

But it is said that breastmilk has no value after six months.
Perhaps this is said, but it is wrong.  That anyone can say such a thing only shows how ignorant so many people in our society are about breastfeeding.  Breastmilk is, after all, milk.  Even after six months, it still contains protein, fat, and other nutritionally important and appropriate elements which babies and children need. Breastmilk still contains immunological factors which help protect the baby.  In fact, some immune factors in breastmilk which protect the baby against infection are present in greater amounts in the second year of life than in the first.  This is, of course as it should be, since children older than a year are generally exposed to more infection.  Breastmilk still contains factors which help the immune system to mature, and which help the brain, gut, and other organs to develop and mature.

It has been well shown that children in daycare who are still breastfeeding have far fewer and less severe infections than the children who are not breastfeeding.  The mother thus loses less work time if she continues nursing her baby once she is back at her paid work.

It is interesting that formula company marketing pushes the use of formula (a rather imperfect copy of the real thing) for a year, yet implies that breastmilk (from which the imperfect copy is copied) is only worthwhile for 6 months.  Too many health professionals have taken up the refrain.

I have heard that the immunological factors prevent the baby from developing his own immunity if I breastfeed past six months.  This is untrue; in fact, this is absurd.  It is unbelievable how so many people in our society twist around the advantages of breastfeeding and turn them into disadvantages.  We give babies immunizations so that they are able to defend themselves against the real infection.  Breastmilk also allows the baby to be able to fight off infections. When the baby fights off these infections, he becomes immune.  Naturally.

But I want my baby to become independent. And breastfeeding makes the toddler dependent?  Don’t believe it.  The child who breastfeeds until he weans himself (usually from 2 to 4 years), is generally more independent, and, perhaps more importantly, more secure in his independence.  He has received comfort and security from the breast, until he is ready to make the step himself to stop.  And when he makes that step himself, he knows he has achieved something, he knows he has moved ahead. It is a milestone in his life.

Often we push children to become “independent” too quickly.  To sleep alone too soon, to wean from the breast too soon, to do without their parents too soon, to do everything too soon.  Don’t push and the child will become independent soon enough.  What’s the rush?  Soon they will be leaving home.  You want them to leave home at 14?

Of course, breastfeeding can, in some situations, be used to foster an over-dependent relationship.  But so can food and toilet training.  The problem is not the breastfeeding.  This is another issue.

What else?  Possibly the most important aspect of nursing a toddler is not the nutritional or immunological benefits, important as they are.  I believe the most important aspect of nursing a toddler is the special relationship between child and mother.  Breastfeeding is a life-affirming act of love.  This continues when the baby becomes a toddler.  Anyone without prejudices, who has ever observed an older baby or toddler nursing can testify that there is something almost magical, something special, something far beyond food going on.  A nursing toddler will
sometimes spontaneously break into laughter for no obvious reason.  His delight in the breast goes far beyond a source of food.  And if the mother allows herself, breastfeeding becomes a source of delight for her as well, far beyond the pleasure of providing food.  Of course, it’s not always great, but what is?  But when it is, it makes it all so worthwhile.

And if the child does become ill or does get hurt (and they do as they meet other children and become more daring), what easier way to comfort the child than breastfeeding?  I remember nights in the emergency department when mothers would walk their ill, non-nursing babies or toddlers up and down the halls trying, often unsuccessfully, to console them, while the nursing mothers were sitting quietly with their comforted, if not necessarily happy, babies at the breast.  The mother comforts the sick child with breastfeeding, and the child comforts the mother by breastfeeding.