Nursing Mothers Counsel

The Working Nursing Mother

Day Care
Introduction to the Cup or the Bottle
Mother's Milk Supply
Feeding Approaches
General Considerations for Working and Nursing Mothers

It is possible to work or go to school and maintain a successful nursing relationship with your baby. Women who choose to do this find that the warmth and physical closeness of breastfeeding helps to ease the anxiety some have of returning to work. Most find that breastfeeding is a quiet relief from the tensions of the day You need encouragement and support from the people around you, husbands/partners, caregivers, and counselors. It is best to postpone the return to work or school for as long as possible after the birth. In the first six weeks of breastfeeding, you are establishing your milk supply and recovering from the pregnancy and birth. You are also adjusting to your new baby's demands. Most new babies do not sleep through the night until several months of age.

Day Care
Proper planning of day care arrangements is necessary. This should be arranged as early as possible to allow yourself time to concentrate on preparing for the feeding routine you prefer. You will want to interview and/or visit many caregivers. The caregiver should understand and support your decision to breastfeed. For instance, she must agree not to feed your baby right before you are due to return. If at all feasible, chose a day care near your work to allow the option of going there at lunchtime to breastfeed your baby.

Introduction to the Cup or the Bottle
Your baby should be given a chance to practice once or twice a week on a cup or bottle for at least two weeks before the mother returns to work. If you offer a cup or bottle at least weekly since about three to four weeks of age, your baby will make an easier transition. Starting before three weeks may cause nipple confusion and compromise your milk supply. Artificial nipples should never be coated with corn syrup or honey (because of possible bacterial contamination or botulism.) If necessary, a reluctant feeder may be enticed with breast milk on the nipple. Also, someone else, other than you, the mother, may be more successful in encouraging your baby to accept a bottle. The bottle or cup may be introduced one half to one hour earlier than an anticipated feeding so your baby is not fussy from extreme hunger.

Mother's Milk Supply
Besides introducing the cup or bottle to the baby, you should store your milk to be used by the caregiver while you are away. Good quality electric breast pumps are now available for rent or purchase, that make expressing and storing milk much easier. This milk can be frozen and used in the cup or bottle your baby practices with.

Feeding Approaches
Experienced working nursing mothers have suggested the following two feeding approaches as the most manageable:
The first feeding approach is to encourage the breasts to continue producing milk on a 24-hour daily basis.

Preparation One:

Find the most efficient method of milk expression for you (hand or pump), and begin practicing the technique daily. Some mothers who will have short breaks at work may want to choose a system that allows pumping both breasts at the same time (called double pumping).
Milk expression requires patience. If your breasts are stimulated on a consistent daily schedule, they will gradually release more milk. A calm, relaxed, positive environment will be beneficial. Looking at your baby's picture can assist the milk ejection reflex. It is normal for morning pumping to yield more milk than afternoon pumping.
Pumped breast milk may be frozen for later use. See the Storage of Expressed Breast Milk pamphlet.
If 3 to 4 ounces of milk are expressed daily, a woman has actually increased her
milk supply by about 10%. This is a psychological boost for mothers who fear their supply may drop after returning to work.

Procedure One:

The baby will be breastfed before and after work as often as necessary or desired and be bottle or cup fed during your working hours.
The baby should be breastfed normally on the mother's days off.
You should plan on expressing your breast milk 2 to 3 times during the 8 to 9 hour workday. Some mothers wait until they get home to express, either just before or just after breastfeeding. This works best for mothers who are gone fewer than 4 to 5 hours. This is similar to the adjustment your breasts make when your baby sleeps through the night. But remember, that your baby may still need to be fed during this absence, so you will need to express milk at others times to provide breast milk while you are away.
Properly expressed breast milk can be saved for your baby's next day feedings. You should arrange for storage space at work. This can be in a refrigerator or portable cooler case with "blue ice." Although studies are showing the breast milk is safe being stored for 8 days in the refrigerator, it is recommended that if the breast milk will not be used within 72 hours, then it should be frozen as soon as you return home. Breast milk should be transported in a cooler case or insulated bag with a refreezable ice pack. Milk being transported may not be always at 40 degrees F. or below.
You may find that your breasts are overfull at the beginning of the workweek and gradually decrease in fullness near the week's end. This is normal. Breastfeeding only, with no bottles used on days off, helps stimulate the milk production. You should be sure you are eating and drinking fluids adequately while you are at work and at home to insure a good milk supply.

The second approach is to "train" the breasts not to fill during the hours you will be away from your baby. This is similar to the adjustment made when a baby sleeps through the night. This "partial weaning" process usually leaves you physically comfortable during your working day without the need for removal of milk by hand or pump expression.

Preparation Two:

You should evaluate the hours you will be separated from your baby and begin adjusting your milk supply accordingly. This partial weaning should begin at least 10 days before returning to work. (It is probably better to allow two weeks.)
On day one of the preparation week, chose a breastfeeding time that will coincide with your work schedule and replace it with a bottle or cup. From then on, this daily feeding will continue to be given by bottle or cup.
After 3 days your milk supply will have adjusted because of the lessened stimulation, and a second breastfeeding time may be dropped and replaced with a bottle or cup. For example, you breastfeed your baby a 6 am, offer a bottle or cup at 9am, then breastfeed at noon, and give a bottle or cup at 3pm. You would then continue to breastfeed in the evening and during the night.
If your breasts feel uncomfortably full when a breastfeeding has been eliminated, you may manually express just enough milk to relieve the pressure without stimulating a further supply.
On the 7th day, you now give a bottle or cup for 3 feedings a day. This will continue to be the daily feeding pattern when you return to work.

Procedure Two:

Your baby will be breastfed before and after work as often as necessary or desired. This means the baby is being breastfed during the time you will be home and given artificial baby milk during the feedings when you are at work.
This breast/bottle/cup schedule should continue on days off as well. Any extra breast stimulation during "weaned" hours may create a return of the milk supply at the undesired time.
In this feeding approach, mothers usually rely on artificial baby milk for the bottle or cup feedings. Juice should not be offered from the bottle. Solid foods should not be introduced until the baby nears or passes six months of age.

General Considerations for Working and Nursing Mothers

Some mothers find that breastfeeding a baby and the demands of a job leave them physically tired. Proper diet and prenatal/lactating vitamins are recommended (check with your physician). Housework and outside activities should definitely be given a low priority. Adequate night rest is essential, especially if your baby is still nursing at night. If you are breastfeeding at night, retiring early may help you get more sleep. Co-sleeping with your baby for all of the night or part of the night might be helpful. Fatigue can reduce milk supply.

Most mothers find it appropriate to breastfeed their babies just before leaving for work. Arranging with your caregiver not to feed your baby just before you return allows you to breastfeed your baby immediately upon your return. You should allow enough time before work to complete a relaxed breastfeeding, either at home or at your caregiver's. One of the most common advantages of a working nursing relationship is the welcome "time out" after work to relax and enjoy breastfeeding your baby.

Working and nursing is a compatible, manageable, and enjoyable combination. If possible, contact another working and nursing mother and/or breastfeeding support group for support and reference. These suggestions are offered to assist you with organization and preparation. In actuality, no two mothers handle their working nursing situation the same. Experimentation within these guidelines is suggested so that you and your baby find a happy, workable relationship.