You are breastfeeding your baby and all is going well.  You have made the decision to return to work outside of the home. It’s time to start thinking about how you are going to make this transition easiest for yourself and your baby.

Plan to introduce a bottle several weeks before returning to work to allow for enough transition time for you and your baby. Many experts recommend that you wait until your milk supply is well established before offering a bottle. This usually occurs at about one month of age. Introducing a bottle one to two times a week from someone other than mom, often yields the most success.

If going to work means that you will be missing one or more feedings while you are away, you need to choose a method of expressing your breast milk, especially if your goal is to feed your baby only breast milk.  If you need to leave your baby for longer than four to five hours a day and choose not to express milk, you may find that your milk supply may decrease and may not meet the baby’s needs.

Choosing the Method of Expression

When considering a method of expression, you have some choices. No matter which method you choose, remember to always wash your hands before you begin expression. Some women choose to manually express their milk. Manual expression can be mastered with some practice.  It does not require anything more than the use of your thumb and forefinger, along with a clean container to collect the expressed milk.  This method can be performed very successfully, but it can take as long as 20-30 minutes.  This may not be your method of choice if time is of the essence. If manual expression is not for you, don’t worry, there are many breast pumps on the market that can help you get the job done.

Basically, there are three types of breast pumps available: hand-operated [or manually operated], battery-operated, and plug-in/electric.  You will need to find the type that best fits your needs and personal style.  Hand operated pumps are affordable, easy to use and easy to transport.  The biggest asset is that they do not require any batteries or electricity.  Battery-operated pumps are a little more expensive and may need frequent battery replacement.  Some come with a convenient optional AC adaptor. An advantage of the battery operated pumps is that you need to use only one hand with them, leaving your other hand free to replenish your own body fluids with juice or water. Plug in pumps or electric pumps require an electric outlet to use.  These may be your expression method of choice if you are working full time or are having difficulty maintaining a good milk supply. These pumps are the most efficient way to express; if you are dual pumping, {pumping both breasts at the same time} you can be done in 15 minutes.  On the down side, electric pumps can be expensive to purchase or rent.  Many women find the investment well worth it.

How to Store & Transport Your Breast Milk

Once the breast milk is expressed it needs to be refrigerated and kept cool.  If no refrigerator is available, you can use a small cooler with ice or re-freezeable ice packs inside. You will need the latter, in any case, for transporting the milk from work to home.  Always date and time your expressed milk.  Keep in mind that fresh refrigerated milk has the most antibodies for the baby.  It should be used within 48 hours of expression or it should be frozen.

Tips to help maintain your milk supply once you return to work

• Nurse at least once, better yet twice, before going off to work. 

• Try to express 2 or 3 times in an eight hour shift.

• When at home, nurse as much as you can. Nursing as usual on your days off will help to keep up your milk supply.

• Adding one pumping per day to your schedule and freezing it is the easiest way to begin. What is most important is that the pattern of doing one pumping session per day be continued on a regular basis to ensure that your body increases and then maintains this higher milk supply. First thing in the morning is the time when the most milk is available.

• While using the pump, use the setting or pressure that is comfortable. Pumping should not hurt. If there is any pain or discomfort, it is a sign that something is wrong: most likely it is that the pressure setting is too high or the hand motion being used is too fast or too slow.

• If letdown is a problem, try gentle massaging of the breasts, deep breathing and visualizing your baby.

• Ask your employer to help you find appropriate times and a space at work to accomplish your goal.

• Be persistent.

Information about breastfeeding: www.lalecheleague.org

Information about working and breastfeeding: www.lalecheleague.org/bfwork.html

Current breastfeeding legislation, including employment and breastfeeding: www.lalecheleague.org/LawBills.html

Medela Pump in Style information: www.medela.com/products/pnsproducts.html

Avent pump information: www.aventamerica.com/products/breastpump.htm

Directions for manual expression of breastmilk using the Marmet technique: www.lactationinstitute.org/MANUALEX.html

The Nursing Mother’s Companion by Kathleen Huggins R.N., M.S., Revised Edition (The Harvard Common Press, 1990).

Bibliography

The Womanly Art of Breastfeeding, by La Leche League International, 6th Revised Edition (Schaumberg, Illinois: La Leche League International, 1997).

Breastfeeding by Ruth A. Lawrence, Third Edition (The C. V. Mosby Company, 1989).

Adapted by Christine Bartley, RN, Nurse Lactation Consultant. Ms. Bartley, the mother of four breast fed sons, worked for 17 years in Newborn Special Care at Yale New Haven Hospital and is currently a school nurse in West Haven.