Many women have to return to work while still breastfeeding. This does not mean that you now need to transition to formula. With the right preparation and schedule, a smooth, easy transition for you and baby is possible. Remember, the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months of life and then continuing breastfeeding until at least one year of age with the introduction of solid foods and ideally beyond (2+ years).
1. GETTING A SUPPLY FOR STORAGE: About one month before you need to return to work, introduce one pumping session / day to start building up a nice supply of milk. This will help to keep your mind at ease while you are work, knowing your baby has more than she needs and will eliminate the need to have formula on hand. I find either the morning (about 60 minutes after the first feed) or evening (before you go to bed) the best time to add in this pumping session. Begin with manual stimulation of the breast (massage the breast and stretch the nipples slightly for about 1 minute) then pump on both breasts at the same time for approximately 20-30 minutes (once you’ve had a let down and the milk considerably slows, you can stop—times will vary). You will most likely only get 1-2 ounces the first few times you pump. This will increase as your body adjusts to the pump and the demand for more milk. Be sure to store this milk in sterile freezer bags, write the date on the bag, and keep in the freezer (in the back) for up to 3 months. Always use the oldest milk first. I find it’s best to store in 3-4 ounces, as once you thaw the milk, you cannot reuse it. You will always want to use thawed milk within 24 hours.
2. INTRODUCE THE BOTTLE TO BABY: You’ll want to be sure baby takes milk from a bottle without trouble about one month before you need to return to work. Some babies are pickier than others, so you may need to try a variety of nipples and scenarios. Most babies do best taking a bottle from someone other than mom (they smell you and know they can simply breastfeed!). I advise mom to at the least leave the room while dad or another support person is trying the bottle… ideally, mom should leave the house for an hour or so. Try both when baby is hungry and when she is not, several times a day until she gets the hang of it. Make sure the milk is at body temperature from the bottle, try different holding positions, and be patient with baby. Use a small amount of milk at a time so you don’t waste your precious pumped milk. If she refuses, don’t force it. Try again a few hours later with a renewed sense of calm and patience. She’ll get there! Once she gets the hang of it, continue offering her expressed milk at least once a day so she keeps up the habit and practice.
3. RETURNING TO WORK–SUPPLIES: You’ll obviously need your breast pump and storage materials. Be sure to wear clothes that are conducive to pumping without having to get naked! Also be sure to have extra nursing pads on hand, as you may find yourself having unexpected let downs (and that can be quite embarrassing). A change of clothes, especially the top, is always a good idea.
4. RETURNING TO WORK—PUMPING: A basic rule of thumb is to pump whenever baby would nurse. So, if you’re returning to work at 3 months and baby typically nurses every 3 hours, you will need to pump every 3 hours while you are away. If baby is a bit older, you will be able to pump every 4 hours or so. This is all about keeping up your supply. Remember, breast milk production is a system of supply and demand. If you neglect to pump frequently enough while at work, you will see an overall decline in your milk supply. Fortunately, your body will adjust to the pump quite quickly and you should quickly be able to pump a complete session within 10-15 minutes. Please also remember that pumping while at work is your LEGAL RIGHT. If your employer gives you any trouble about frequent breaks to pump, they are in violation of this right and you should immediately speak to your human resource department or equivalent.
5. RETURNING TO WORK—FEEDING BABY: The best way to feed baby is directly from the breast, so always strive to maximize on this. Many women prefer to breastfeed baby first thing in the morning, right before they have to depart for work, and then immediately upon returning from work. Baby should then get a bottle based on her general schedule (likely every 3-4 hours, but this is entirely dependent upon age). Freshly refrigerated milk will maintain more of its live cells than frozen milk (fresh milk can be kept in the fridge for 72 hours), so always use fresh milk for baby before using the frozen milk. When reheating, never use the microwave or stove (as excessive heat can destroy many beneficial properties), thaw in the refrigerator, then warm via warm tap or bowl of warm water and gently swirl the milk to mix all of the layers together. Breast milk should be no warmer than body temperature. If there is milk left in the bottle after a feeding, you may keep that milk until the next feeding (but discard after that).
Ellie Lindenmayer is a birth doula, HypnoBirthing Practitioner, and Lactation Counselor, serving the greater Boston area, its North Shore, and seacoast New Hampshire.