Lots of moms wish to continue their breastfeeding relationship once they return to work, and with some diligence, it is quite possible for most moms with the excellent pumps available today. However, it does take some planning ahead. For more information on pumping and working, visit the Breastfeeding and Working section of this site. Here for can find information on your legal rights, choosing a pump, and when to pump throughout your work day.
Note: some experts will recommend that you try to use an alternate feeding method for breastfed babies, especially if they must be left at a very young age or if they have trouble taking a bottle. Because most care providers are more comfortable with bottles, I will discuss only bottle feeding during mom/baby separation here, but if your caregiver is willing to cup or syringe feed and it becomes necessary, contact your breastfeeding counselor or lactation consultant for more information.
There are two crucial things that need to happen on your maternity leave if you want to pump milk for your care provider to bottle feed your baby while you are are away from him at work or school.
1. Master the Deep Latch. Make sure you have a great latch for a while before you start giving your baby a bottle. If you start with bottles too soon, you run the risk of your baby rejecting breastfeeding because getting milk out of a bottle is much easier for the baby than getting milk from the breast.
2. Make sure you introduce your baby to the bottle in advance. Most breastfeeding books and experts will recommend waiting at least a month before introducing a bottle. While you want to avoid nipple confusion and make sure you are getting a good latch, some babies have quite a bit of trouble if you wait this long. Check out the information here about getting your baby to take a bottle if you run into trouble. One tip for introducing bottles – it would make sense that freshly pumped milk would be the perfect temperature, but anecdotal evidence suggests that heating it just slightly makes the baby more likely not to reject it. It’s worth a try – just be sure not to overheat!
Beyond that, a lot of women simply just don’t know where to start with pumping. When to start pumping for your “stash” will depend on how long your maternity leave is, but you will want to pump at least occasionally early on to introduce the bottle. I honestly believe that 3 weeks is more reasonable than a month, and if your baby is nursing well, even two weeks can be a great time to get started with bottles. You don’t want to introduce too many bottles at this point, but if you give one bottle a day, or even one every other day, beginning at two or three weeks, you will give your baby time to accept the idea. If you are lucky, your baby will take to the bottle immediately and with no problem. If she doesn’t, then just calmly keep trying. If she resists the bottle, once a day is a good plan in the early weeks.
In general, you will want to have at least two full days of milk “stashed” for your return to work. If you can have a week’s worth, even better. To get started on pumping, the best thing to do is when your baby is a couple of weeks old, add a pumping session to your daily routine. A great time to do this is during your baby’s morning nap. Because breast milk is generally highest volume in the morning, you are most likely to be successful at this time of day. If your baby nurses just before his nap, try pumping about a half hour after he has finished nursing.
Don’t be discouraged if you don’t get much (or anything) when you first get started. Your baby has given your body cues on how much to make and when throughout the early days of her life if you have been nursing on demand, and some women at this point are producing precisely as much as their baby requires. Don’t be concerned if you get a lot, either. Some women find that they are producing even more than expected. The amount that you pump at each session will vary dramatically from one mom to the next, so don’t be concerned if the amount you are able to pump is much lower or higher than other women you know. It is perfectly normal to pump anywhere from .5 to 5 ounces per breast. In general, pump output will increase over time, so don’t be discouraged if you find that what you are pumping early on is not what you had hoped you would be able to express. If you find over time that you just aren’t getting enough, take a look at the topic on this site on increasing supply for more help.
Ideally, you will have 12 weeks or so of maternity leave – realistically, you might only have 6 or 8. Start building up your stash at least a couple of weeks ahead of time if you have a shorter leave; if you have a longer leave, go ahead and start working on the stash a month out.
Building the Stash
One of the most important things to know when you are beginning to store breast milk is how to correctly store it. You can store it in BPA-free plastic or glass bottles, but the problem with that is that you then don’t have the use of that bottle if it is in the freezer, and it takes up quite a bit of space. A more practical (although less green) option is to buy disposable bags specially designed for breast milk storage, which can be found at most baby supply stores, superstores, and often even in the baby aisle at the grocery store. If you are freezing the milk, you will want to make sure you leave enough room for the milk to expand when it freezes. You also want to make sure you remove as much air as possible from the bag by pinching it at the top of the milk line and flattening the top of the bag before sealing (I did this by holding the bag at the milk line at the edge of the counter and flattening the top of the bag on the counter). Make sure to label the number of ounces, the date, and your baby’s name. I found it helpful to lay the bags flat to freeze so that when the milk is frozen, you can line them up. One thing that helped me keep track of what I had was when I had about 20 bags, I would put them all in a gallon freezer bag and mark the earliest and latest dates of the milk inside, as well as the total number of ounces of all the smaller bags in the freezer bag. This way, if I wanted to inventory how much I had, I only had to look at the outsides of the larger bags.
You will find varying information on milk storage, but within a small margin of variation. Here are some links to information on how long milk can be stored in various settings:
What time of day to pump while you are on maternity leave and trying to build a stash will vary from mom to mom. As much as you want to sleep every possible minute, you may find it helpful to wake up before your baby in the last weeks before you return to work to pump when your supply is at its peak. One thing that some women find helpful is to wake before baby does and pump only one breast so that when baby is ready to nurse, one breast will be full to feed him. Because supply is at its highest at this time, this often yields more than pumping both breasts after a feeding or later in the day. To help keep your supply as even as you can, it’s a good idea to alternate daily which breast you pump first thing in the morning.
To increase supply and continue building your stash, there are two basic methods women tend to use for collecting extra milk. One is to pump after each feeding. The other is to pump about midway between feedings.
Pumping after each feeding (or after selected feedings). This sends the signal to your body that the milk your baby just drank was not enough, and to make more. Some women will not be able to express much milk at this time, particularly at first, but others will be able to collect a reasonable amount. One downfall of this method would come if you have a tendency toward oversupply. If you already have an oversupply and signal your body to make more milk, you run the risk of engorgement if you miss or delay a feeding, which can lead to plugged ducts or even mastitis. In addition, in cases of great oversupply, your baby may end up getting more foremilk than necessary at a given feeding, which can sometimes cause gassiness, gastric upset, or colicky behaviors. This is not a particularly common concern, but is a concern nonetheless. However, if you tend toward a lower supply, this method may be helpful both for keeping your milk production up long-term and building your stash. A lot of women choose to pump this way to allow their breasts more time to produce milk for the next feeding (although this may not really be necessary – see the next section).
Pumping between feedings. Some women choose to pump between feedings rather than immediately after a feeding. This is probably most helpful in the morning hours to midday, or in the middle of the night (although waking up in the middle of the night to pump extra milk doesn’t sound like a lot of fun to me, and frankly, I don’t think I’d do it). This similarly signals the body to create more milk and can also be tricky if you tend toward oversupply. Some women steer clear of this method with the idea that it will mean that their breasts won’t “refill” in enough time for the next feeding. However, the lactating breast is never entirely empty, and will in fact continue to produce milk even while your baby is feeding. One thing that may be helpful for some women when using this method is to pump only one side, and begin the next feeding with the breast you did not pump.
How much to stash.
You will want to make sure that you have enough stashed for at least a couple of days. The amount that a baby needs per day is going to vary for every mom and baby. A very general rule of thumb is about 1.25 ounces per hour of separation, although this will vary. So, for a 9 hour separation, you would want to leave approximately 11.25 ounces. In the early days, until your baby develops a feeding pattern while she is away from you, it is best to send multiple bottles (or bags) of milk in small quantities of about 2 ounces or so so that your care provider can start with a small amount and prepare more if needed. So, for a 9 hour separation, 6 portions of 2 ounces each would be a good place to start. Most breastfed babies will take bottles of about 3-5 ounces throughout their first year of life. Your milk will change to meet your baby’s changing needs; the quantity does not need to increase in the same way a formula-fed baby’s will. For the first day, a few extra ounces to have on hand is a good idea, and a few emergency bags to keep in the care provider’s freezer for use when your daily milk isn’t enough is a good idea as well. Having enough for the first day delivered to go in that day’s bottles, and another day’s worth or more for freezer backup should be sufficient. Be sure to make sure they let you know if the freezer milk is used so you can replace it when possible.
Day-to-day milk delivery.
Most moms will pump each day what their baby will drink the following day. Any extra milk you collect each day can be frozen. There are bags that you can attach to your pump and pump directly into, however it is difficult to measure the amount in the bags and they can be difficult to manage without spilling. An easier method is to pump into a bottle, and pour the milk into bags so you can accurately measure how much milk is in each serving. This also allows you to combine milk from multiple pumping sessions if need be to portion out in the desired amount per bag. Refrigerated milk has a higher health benefit than frozen, so delivering recently expressed milk is more desirable than frozen when possible. If you work Monday through Friday, you can deliver the milk from each work day on the next, using Friday’s milk for Monday. Within a week or two, most babies will start to develop a pattern to let you know how much milk should be included in each bottle or bag. This may never change until they no longer drink from bottles.
Talking to your child care provider.
Some caregivers have had few, if any, breastfed babies in their facility, so it is important than they understand that breastfed babies eat differently than formula fed babies. It is important that they don’t encourage babies to finish bottles when the baby indicates he is finished, as you don’t want to get the baby accustomed to an amount of milk you can’t provide. Babies have a per day need for milk intake – it’s important to make sure that they will want to nurse when you are together as well. In addition, it may be helpful to request that the care provider not give any bottles after a certain point in the day so that you are able to nurse as soon as possible when you come to pick your baby up after work. Even if it feels like an uncomfortable conversation, it’s important to make sure you are on the same page.
Maximizing your stash.
If oversupply is not a concern and you want to work to increase your supply/pump output, there are a few things that can help. First, don’t stop the pump when the milk stops. Letting it run a few minutes after the milk stops signals the body to make more. Second, pump more often. If you are pumping 3 times a day and want to get more, try to pump a fourth time. If you can’t manage to fit in another session at work, pump after your baby goes to bed or before he gets up in the morning. Last, using breast massage and compression, as well as combining hand expression with pumping, can help increase pump output. Here is a great article about hands-on pumping.
Questions? Contact Megan!