Breastfeeding Strategies for Returning to Work

I haven’t been very active the past few months, but life got very busy! I may have a few more updates soon, but I make no promises! I did a write up for a friend on what was successful for me to breastfeed/pump after I returned to work, and have subsequently shared it with several work colleagues, who then shared it with their friends and so on and so forth. Anyhow, I thought it might be useful to stick it on the internet for anyone with a search engine to have a chance at finding! Returning to work was one of the most stressful things about my breastfeeding goals, because I didn’t have a clue how it would go – but Kerrigan is now 14 months and still nursing every night!

Supply Strategies

 Feeding – Nursing and Bottle

Here are the things that I have done to ensure that my supply remains strong even while working and pumping:

  • I nurse Kerrigan four times a day – I imagine this will drop to three at some point, but we aren’t there yet.
    • She nurses right before I leave for work. I leave at 6:15 am, so I get up at 5:00 and shower and then feed her about 5:30.
      • I really stressed about this right when I went back to work, but have learned to relax some. If she gets up at 4:45, I feed her and don’t stress over the fact it’s not the “last thing I do before leaving”.
    • She nurses as soon as I get home at 5:00. To accommodate this, we request that she is not fed after 3:00 in the afternoon so that she is hungry when I get home. If she is SUPER fussy, and nothing else will soothe her, she is allowed to have one ounce of milk to tide her over until I can nurse.
    • She nurses again before bedtime, after her bath at about 7:30-8:00.
    • We give her a “dream feed” at 10:30.
      • This will be the first feed that we drop, but since she occasionally will wake herself up hungry at 10:30, we continue to offer it to her every night.
    • Early on, I’d offer her both breasts each feeding. Now she generally gets what she wants from one – but I will still offer both if she seems hungry.
      • Once she went down to just nursing from one side most feedings, I figured out what worked best based on the way my breasts produce (i.e. my right is my big producer, so I made sure it’s the one she gets at the dream feed so I don’t wake up super engorged).
    • Kerrigan gets three bottles a day on weekdays – 8:30, 11:30 and 2:30
      • The times are somewhat flexible, but she generally sticks to that schedule for her bottles.
      • She will get a 1 oz snack after her 2:30 bottle if she seems fussy and hungry after 3:00.
    • We keep pretty closely to this schedule on the weekends, which sucks a little bit because it means I am up at 5:00 on the weekends, but it’s been successful so I stick with it. Sometimes if I’m extra tired I go back to bed after her 5:00 nursing and Robert will get up if she doesn’t go back to sleep, but nine times out of ten she will go back to sleep for us.
    • Once I went back to work, if I am home (i.e. weekends, holidays, vacation, etc.) Kerrigan only gets the breast and never gets a bottle to help keep my supply up. If I choose to go out I will time it so that I only miss one feeding and I’ll pump while I’m out (or in the car on the way home, etc.).

Pumping – Work and “Insurance Pumps” at home

  • I pump three times at work: 7:30, 11:00 and 2:30. The times don’t have to be exact and can be flexible, but I usually try to keep them within 30 minutes of my intended time.
    • Pumping is the first thing I do when I get to the office (I imagine you could probably get to work early if needed or pump on the way in the car for your first pump). This first pump is always my biggest pump by far – partly because she hasn’t nursed on it since 10:30. Sometimes if I am REALLY full when I wake up, I will hand express a little in the shower and wear my theragels on the way to work.
    • I pump for 15-20 minutes each session, until my breasts feel empty. Sometimes my morning pump will take a little longer if I am really full.
      • I will hand massage when I start each pump to help with letdown, and if I am REALLY full, I will massage the entire pump to make sure I get completely empty. (I use a hands free pump bra – I linked it below!).
      • If you notice your flow is slowing down, you can hit the letdown button on your pump again and let that run for a minute or so to try and stimulate another let down. You can also add more massaging while you pump to help stimulate production.
        • Apparently there are studies done that show actual physical contact with your breasts help make pumping more successful – it’s like the manipulation your baby offers when you nurse.
      • Sometimes looking at pictures of Kerrigan or listening to a recording of her crying can help stimulate letdown. I have both available to me while I am pumping.
      • I know it’s easier said than done, but relaxing really helps! I will browse facebook/Instagram, write blog posts/emails or chat with friends via text so I don’t focus on pumping.
        • If you find you are really stressing over how much you are pumping, a suggestion I was given was to put a sock over the bottles while you pump so that you can’t see how much is being pumped.
        • Now that pumping at the office is second hand, and I have the luxury of my own office, I just work through my pumping session. But if I’m having a particularly bad day, I still use the above to help relax while I’m pumping.
      • You do not have to wash/sanitize your parts after every pump. You can just toss them in a ziplock bag and keep them in the fridge/cooler bag (with ice block). I do this at home now too, and it save a lot of time! I just wash and sanitize at night when I am done with them for the day.
      • As an aside, one of the mom’s in my group is a teacher and has been foiled by fire drills in the middle of her pump time. She has since requested to be given advanced notice of the drills so she can plan her pumps around them.
      • Be liberal with the lanolin! I find that pumping is rough on the nipples, so I use lanolin after every session.
    • The standard flanges that come with the medela pump don’t fit most women. I asked my lactation consultant to size me, and I actually needed a different size for each breast! So don’t hesitate to ask to be sized or to experiment with a size that works well for you – the medela flanges aren’t very expensive and places like Amazon, Target, Babies R Us and Buy Buy Baby carry them.
    • When I am at home (weekends/holidays/vacations) I will pump for 15 minutes after my first two nursing sessions – my 5:00 am and my 8:00 am, unless I’m just flat exhausted and then I go back to bed and pump at 8:00 and 11:00.  You really do get better production if you can do it after your first two, because your prolactin is higher (it peaks at like 3 or 4 in the morning). These pumps do a few things:
      • It helps keep your supply up without having to add extra pumps on the weekdays.
      • It helps to build your freezer stash.
      • It gives you fresh milk for Monday morning, if you’d like to offer fresh instead of frozen milk.
      • I know it’s tedious, and kind of sucks, but it is really worth the time and effort!
        • I would add that I also did this on maternity leave and returned to work with something like 600 ounces of milk in the freezer (I had 3 months of leave, and did it from the start, so don’t stress if you don’t have as much!).

Nursing and Pumping Bras for Work

  • If you haven’t yet, I’d recommend investing in one or two hands free pumping bras. I really like the simple wishes one and it’s the one most of the ladies in my moms’ group use. The only thing of note is that you shouldn’t wear it for anything other than pumping, it should be snug fitting and extended wear will cause your supply to drop.
  • If you want to buy underwire nursing bras for going back to work make sure to go get fitted for them so that they are a proper fit (i.e. not too tight), so they don’t cause your supply to drop. I have a couple of the Anita underwire bras and was fitted at the mom and baby center at my hospital by someone that is certified to fit nursing moms. Make sure to get fitted right before you need to nurse so that you are full, and can get an accurate fit. http://www.anita.com/en_us/products/maternity-and-nursing/nursing-bras-and-lingerie.html
    • If I have a very casual day, I will just wear my regular bravado nursing bras. Unfortunately, they just simply don’t offer me enough definition for my business attire. Your mileage may vary!
    • Nursing bras are expensive, but I really have found that it’s one of the best things to splurge on – I purchased two of the underwire ones, a nude and a black. Good quality bras are really comfortable and I find make a huge difference.

Misc. Tips

  • Take extra snacks to work! I find I am STARVING all of the time. I keep string cheese and little individual Colby jack pieces handy. I also have Cliff/Luna bars handy because they are high in protein. Peanuts and Almonds are also good! I also keep things like pretzels, wheat thins, fruit (clementines, apples, etc) and graham crackers in my desk.
    • Don’t let your calories drop when you go back to work! How much you eat will affect your supply! I am constantly snacking.
  • Don’t skip breakfast! I usually have a bowl of oatmeal or peanut butter toast, along with some fruit to start my work day.
  • Stay hydrated. Drink more than you think you should! I keep a large Nalgene bottle at my desk at work to track my water intake, and fill it up regularly.
    • I do notice that it’s easy to forget to hydrate when you get busy, so I try to make it a point to think “empty bottle by lunch, refill and empty by the end of the day”.
    • I also find drinking a Gatorade or Vitamin Water helps keep my supply up and I drink one a day. I think the electrolytes really help with keeping my hydrated.
  • I eat lactation cookies every day (recipe below). They are yummy and freeze REALLY well and I still eat them every day at work.
    • If you have supply issues, your LC can help you with supplements to help. I have an oversupply, so I didn’t use any, but did a lot of research because given my age and some health factors I was at high risk for supply problems.
  • Your supply will probably drop when you start your period, and subsequently each month during your cycle. Mine bounces back afterwards, but it is a little panic inducing each time it happens!
    • I find my supply takes the hardest hit in the week leading up to my period, and then comes back up once my period starts. Other ladies I know see their supply dip during their period and it comes back for them once it’s over.
    • Some of the ladies I know will take supplements (like fenugreek) in the week leading up to their period to help offset the drop. I haven’t needed to do this, but it might be an option you could explore.
  • Hand express a little each day – there have been studies that show your supply will be better if you hand express. I usually do a little bit in the shower each morning and after each pumping session.
  • If you end up with a cold do not use Benadryl or Sudafed! Both are not good for your milk supply. Taking a Sudafed is basically flattens your prolactin for 24 hours, or something akin to that.
    • My LC recommended using: Cough Drops (I like the burt’s bees ones), plain Claritin (not Claritin D), Plain Robitussin (it should NOT have a decongestant), Flonase.
      • If you use cough drops, be careful not to chow them. Peppermint and menthol can diminish supply!


Bottle Feeding Strategies

I wanted to add this here, because I think bottles and how you bottle feed are important to continued success nursing. I followed my LC’s advice and Kerrigan still prefers nursing to taking a bottle. Some of the ladies in my mom’s group just picked whatever bottle – and several have now weaned because their babies started to prefer the bottle over nursing because it was easier to get milk from the bottle. Here are some of the things we found really helpful/valuable.

  • We didn’t introduce a bottle until Kerrigan was 4 weeks old and only Robert gave the bottle. I still have not fed Kerrigan a bottle (and probably won’t!).
    • While I was on leave, Robert gave a bottle once a day and I pumped while he gave the bottle (in addition to my two insurance pumps).
      • Your baby can smell you from 20 feet away. If he’s being fussy about taking a bottle, try leaving the house while he eats!
    • Now Kerrigan only gets a bottle during the week and she nurses any time that I am home.
  • We followed the instructions for bottle feeding a breastfed baby here: http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/
  • We used the Dr. Brown’s Natural Flow Bottles that our LC recommended. They have a lot of parts, and are a bit of a pain to clean, but they really do have the best venting and help a lot with air intake and gas. If you’ve not invested in a lot of bottles yet, I’d really recommend these.
  • This next part is the most important – use a preemie nipple. Even if you use a different bottle, find a preemie nipple for the bottle. It makes the baby really work to get milk from the bottle, you want them to always get milk from the breast faster than they do the bottle. This is a VERY slow flowing nipple!
  • I make smaller bottles and leave a little extra milk to be added if Kerrigan is still hungry. She still prefers to nurse, and so usually doesn’t eat more than 4-6 ounces from the bottle. I leave three 4 oz bottles, one 2 oz bottle and then 4 ounces of “extra” milk in case she needs a little more. This helps us to prevent waste. If there is any milk left over (and it’s fresh), we use it as the first bottle the next day. She usually only eats 12-14 of the 18 ounces we leave.
    • Because I have high lipase, I only use fresh milk, since scalding milk removes lots of the immunities from the milk.
    • If you have a good freezer stash, you can use your oldest milk first, and freeze your freshest milk to keep your stash current. My LC recommended doing 2 bottles frozen 1 bottle fresh milk, for example.
      • We number our bottles to make sure that the oldest milk is being offered first. This is more important if you are using frozen milk since it’s only good for 24 hours after its thawed.
    • If anyone is sick (you, spouse, sister, etc.) use all fresh milk so that your immunities are passing to the baby!

Freezing Milk

  • I just wanted to add a quick note here that if you are freezing milk, make sure to pull a bag out at 2 weeks to thaw it and test it. You may want to do it another test at one month. Sometimes milk does not freeze well due to either High Lipase or Oxidation. It can gain a soapy taste or strong metallic taste/smell when frozen. The milk is fine, but your baby may not like drinking it.
    • We found out I had high lipase after returning to work and starting to use my freezer stash. I have replaced about 800 ounces of frozen milk as a result.
    • I included information on how I scald my milk before freezing it now below.
  • I really like the lansinoh storage bags, just because of how flat they freeze!
    • As a note, I’ve heard the Target brank Up and Up bags are very similar to the lansinoh ones and I have a lot of friends who swear by them.
  • I found cutting the top half off of a 12 pack soda box is a really easy way to store milk in the freezer. One box holds about 30 of the lansinoh bags. You can probably also google it and images will come up if this doesn’t make sense!

Scalding Milk

In the event you need this information, and I hope you don’t because it is a bit of a chore every night, I thought I would include it. We haven’t had to use any of our freezer stash since we started scalding, but we still do it each night just in case.

  • I put all of my milk in a heavy bottomed stainless steel pan. The heavy bottom part isn’t necessary, but does help even out the heat and keep it from burning. I heat it on medium high heat (8 on my stove knob) until it starts to bubble around the edges. Sometimes it might start bubbling a little in the middle and I’ll pull it off at that point also. I use a stainless steel spoon to stir it while it’s heating.
  • Once it’s heated, I pour it into a stainless steel bowl (the ones I use are from Williams Sonoma, but I’ve seen lots at other stores). I put that bowl immediately in an ice bath to cool. Usually I have the bowl already sitting in the ice bath and just pour from the pan into the bowl in the ice bath.
  • Once the milk is cool, I pour it into a liquid measuring cup and use a bottle to measure out amounts to put into the storage bags. Then move the bags to the freezer.
  • I wash everything nightly.
  • You will lose about an ounce of milk in all the transferring between devices. I haven’t found any way not to have this happen.
  • I would definitely still do a few small test bags to make sure scalding fixes the issue. We opened one at one week, two weeks and one month to be certain. We also froze additional unscalded test bags in a different brand bag to be certain it was the milk and not the storage bags we were using.

Lactation Cookies

Here is the recipe for lactation cookies that I mentioned earlier.  I actually know Noel (the creator of the recipe) personally and she’s a very earth mama type of woman and phenomenal baker. Anyhow, I’ve made these regularly and they are very tasty.

A few notes on the recipe:

  • Brewer’s Yeast – I found mine at whole foods in the supplement section. I’d think any supplement store such as GNC might carry it as well. I think Mom might have found some at Hy-Vee but I don’t remember for sure. I use the Twin Labs brand, which is also available on Amazon. It is about $15-$20 a jar, but the jar is big and will make tons of cookies. I’m still using my original jar.
    • I use four heaping tablespoons in mine, since this is one of the ingredients to help lactation.
  • Ground Flax Seed Meal – I find this at the grocery store. We have a huge bob’s red mill display and I find it there. I’ve also seen it at target in either the baking section or the breakfast section.
  • Chips – I actually double the chips in mine. I do a bag of chocolate chips and a bag of butterscotch chips. Not the healthiest, but really tasty! You can use any ingredient you want here, it doesn’t have to be chips. It’s just for flavor. A friend of mine does walnuts and cranberries. Another uses raisins.
  • Freezing – these freeze REALLY well. I make a half batch every other week and freeze half of them for the following week. If make a full batch if I had enough room in my freezer. I usually eat four a day.

 

The Momentous Task of Finding Childcare

Childcare. The bane of the working mother. I wish I didn’t have to be a working mother, I miss my girl so much when I’m at work. But it’s simply not an option to stay at home – and if I’m being 100% honest, I like and need the adult interaction and stimulation that work provides. I like my job and I love my kiddo. It’s a hard balance and I’m not entirely sure that I’ve gotten it right.

However, because I have chosen to go back to work, I also had to chose who would take care of Kerrigan while I’m there. And it was a really hard choice. Ultimately we decided that three months was too young to put her into daycare, so my in-laws are helping us out until the end of the year so she can stay at home until she’s a little older. But that didn’t mean we didn’t have to start thinking about it. Because the reality is that there are wait lists. Wait lists that people get on as soon as they find out they are pregnant, before they’ve even announced it to their families. It’s pretty insane!

Since we knew that we had a little extra time, we didn’t make a selection until late November 2014 – and even at that time, the wait lists were full through August 2015! It was not an easy decision and we had to weigh out a lot of factors, including: cost, location, pick up and drop off, center or at home care.

If we start with the first factor, cost, we had a few big decisions to make. There was recently this article about the high cost of childcare in the US, and Washington is one of the most expensive states. The article is really interesting and talks about how that cost is forcing a lot of women out of the work force, and I’d like to explore that more, but not today.

When it came to cost, we were fairly liberal in what our ceiling was for the expense. But we also had to be realistic. For us, we wanted a quality program but also didn’t want to feel so stretched financially that we were miserable and having to pinch every penny to squeeze by. That ruled out a few of the highest end infant rooms. And that was okay. We knew we were going to use somewhere we didn’t trust just because it was less expensive. We just also weren’t going to pay the highest price under the assumption that it was the best. Our goal was to find a program we were comfortable with at a cost that we were also comfortable with. It was a long search, but we did succeed.

Next we really had to decide if we wanted to utilize a day care or a nanny. This wasn’t a very long discussion for us, partly because we had some friends who had a really bad experience with a nanny which resulted in an injured baby. But mostly because with the high liklihood that Kerrigan would be an only child, we felt that socialization was important for her and she wasn’t going to get that with a nanny. As such, very early on in our discussions we’d decided that we wanted to send her to day care/pre-school.

Once that decision was made, we had to choose if we want to use a center or in home daycare. I wasn’t opposed to in home daycare IF we would find the right person. And that’s hard without any references. And as new parents without a lot of baby friends, we didn’t have references. There was one that I was seriously considering that I found online, but ultimately we opted to go with a center. We liked the accountability of having multiple people responsible for the well being of our child.

Being in a large metropolitan area we had a lot to choose from, in varying locations. And we had to select what we thought would work best for us. Part of this discussion included deciding who would handle drop off and pick up. We looked at centers that were close to where Robert works, meaning he would handle both. Centers close to where I work, where I would handle both. And centers that were somewhere in between us so we could split drop off and pick up.

Ultimately we decided to go with the later option. Simply because it would shorten the amount of time Kerrigan would be in daycare. Robert can drop her off later and I can pick her up earlier. We picked a smaller center that is slightly out of the way for both of us, but not so much so that it will be cumbersome. We also liked that it was not in the city and out by the mountains, where her outdoor play would not be in a concrete jungle, but in a play yard with grass and trees and nature. We are undecided if we will opt to move her to a more comprehensive preschool program when she’s a little older – but this school also offers a very good program.

So how did we find the daycare we chose? Through lots of research, reading lots of reviews and taking tours of all of the facilities that we were considering. Ultimately what sold me on the center we chose is that there were reviews from parents who attended the school themselves as children who loved it there and sent their kids. The other huge factor for me was the tenure of the staff. While there were a few newer staff members, the majority of the staff had been teaching there over 7 years. With some having been there for 16 and 20 years. That’s a long time. It also speaks to how they treat their employees, and in my opinion a happy employee is much more likely to be better for my kid than one who is disgruntled. I also think that level of consistency is important as well.

As such, after our tours and interviews we went ahead and paid our (hefty) deposit to hold our spot and got Kerrigan registered to start in January. I feel fortunate that we are financially able to send her to a good facility, but bittersweet about what I’ll miss while I’m at work. I know that this is the best decision for us as a family, as well as me as an individual, but it’s still difficult. I can only hope that we made the best decision for Kerrigan’s care and that she will thrive as a result of our efforts.