27 Sep Working mothers can also breastfeed
By Jane Pitt – nursing sister and midwife, breastfeeding advisor
Breast milk has antibodies that pass from mother to baby, protecting baby from infection and this could mean having fewer medical bills and less days off work caring for sick children. Babies in crèches can pick up more infections than babies at home. Even if you breastfeed or give baby expressed milk only once a day, your baby still benefits from these antibodies. Recent studies show that breast milk has multipotent stem cells. These living cells have immense differentiation potential, vital for neonatal development and a target for stem cell therapy and breast cancer research.
Many mothers are employed outside the home. While you are on maternity leave, enjoy these precious first few months breastfeeding your baby even if you have no intention of feeding longer.
When back at work, the first option is to take your baby with you. If this is not possible, ask if you can have a private place to express. This needs to be negotiated before you return to work as you will have more bargaining power than if you wait until you are back at work. Some mothers even arrange for crèches to be opened in the workplace and then they feed baby at lunchtime and tea breaks, a wonderful solution.
Expressing at the office
The Minister of Labour enacted “The Code of Good Practice on the Protection of Employees during Pregnancy and after the Birth of a Child”. This code specifically states that employers must grant a breastfeeding employee a 30 minute break twice a day for breastfeeding or expressing milk, and this must be done on each working day until the child reaches 6 months of age. There is a chance that Government will extend this time for mothers with babies up to one year of age and those with multiples will hopefully get more time.
If you have your own office, you can close the door or book the boardroom if there is no other private place to pump. Wherever you are make yourself as comfortable as possible. If you are lucky enough to have a baby room or specific area, you will use this space. If not, some mothers who work in an open plan office can pump discreetly in a corner, reps pump in their cars, others choose to go to the ladies room as their best option. Some look forward to a break at lunchtime, put their feet up, read a book, eat their lunch and pump, all at the same time. However, Government regulations also say that your employer should give you time off to pump that is not your lunch time.
Working mothers continue to breastfeed in the following ways
- Expressing breast milk for the feeds you miss is the key factor. This helps maintain breast milk supply;
- Expressing must be quick, hygienic, comfortable and cost effective;
- Some mothers breastfeed just before leaving their baby with a caregiver, before going to work. On returning home, they feed the baby first and pump afterwards, keeping the extra milk for the next day. These mothers, especially if they only work half day, do not pump at work at all.
- Not expressing when you miss a feed, especially in the beginning, could cause inflammation leading to mastitis and will reduce your milk supply. To reduce/prevent overfilling of your breasts, express at least to comfort level.
Choosing a breast pump
Some mothers manage very well with hand expressing. Learning to express or use any breast pump sometimes takes time and practice. Once you are back at work it could be easier, as your breasts will be full and you will be pumping an entire missed feed. Just keep practicing and talk to your lactation consultant.
Some manual pumps only require one hand to operate – best if the handle is able to rotate / swivel to any position for ergonomic pumping which is the most comfortable action on hands and wrist. These are very popular with some moms.
Other manual pumps are still the original piston type. It is best to choose one with vacuum regulation.
Many working moms prefer electric breast pumps, as they are easier, quicker and more effective, especially with 2-phase suction. 2-phase pumps are designed to mimic the way the baby sucks; the stimulation phase, which has a fast and light sucking action, is followed by the expression phase, which is a slower and stronger rhythmic suction, like baby drinking/suckling. Really good pumps are gentle and effective, easy and comfortable to use.
Multi-user electric pumps (example: Medela Symphony and Lactina) can be hired and it is suggested you investigate and experiment to determine what is best for your needs. For hygiene reasons every mother needs to have her own kit.
Before purchasing your own pump, you can test hospital grade pumps using a disposable sterile kit. This will allow you an opportunity to feel the difference between single phase and 2-phase technology and you will be able to choose which feels best for you. When costing for pumps, remember to calculate the saving on regular monthly formula bills (R600 to R900 per month).
Working mothers would be advised to use a double electric pump with good 2-phase action for fast efficient expressing. Mothers also get more let-downs and more milk with double, 2-phase pumps. In addition, when used with a bustier (pumping bra), mothers have both hands free and can do something else at the same time (all mothers do seem to multitask). This also helps with more spontaneous let down and more milk as they are not holding up bottles of milk whilst pumping. They are more relaxed and get a better let down.
There are also good 2-phase, single electric pumps but research shows mothers get more milk with 2-phase double pumping and in addition a higher fat-content in their milk..
The size and portability of the pump is also a factor. An electric pump with battery option is preferable. Depending on your situation these factors might influence your decision: some are handheld, others can clip onto your waistband, while still others are bigger and need to be used on a desk or table top. Another deciding factor could be the noise a motor makes. Although all electric pumps have a motor, some are quieter than others.
Whatever pump you choose, make sure all replacement parts are readily available locally.
Comfort & Breastshield Fitting
If the pump you are using is not comfortable, check you are not using a vacuum setting that is too high for your body. Also check the fit of the breastshield. A breastshield which fits correctly keeps milk ducts open and gives you maximum comfort when expressing and also optimal emptying of the breast– this will help maintain your milk supply. Some companies have various size personal fit breastshields ranging in sizes from 21mm to 36mm. Try different sizes when necessary.
Before you pump and to increase comfort, always wet the whole areola around the nipple and/or the breastshield with milk or clean water to facilitate a smoother movement of the nipple and areola inside the breastshield. It should not be tight. Ensure your nipple is pulling centrally to the vacuum action.
Times to Express?
Early, before or while you feed baby in the morning (you have extra then), once or twice when you are at work and perhaps again before you go to bed, especially if baby misses a feed at night. Some mothers need to express less often than other mothers, to maintain their milk supply.
Milk supply fluctuates – working mothers have most milk on Mondays – least on Fridays and it builds up again over the weekend, when she breastfeeds more often. Moms will often feel most full in the mornings. This milk is high volume but lower calorie-value whereas in the evenings you might find you have less volume but remember this milk is very high in calories.
On the whole, use the milk you express today to give the baby’s caregiver tomorrow.
To increase milk supply, pump after feeds until milk stops flowing. Then pump for an extra 3-5 minutes on each side, 3-5 times a day and in a few days’ time, your supply should increase. For best results, use a gentle effective 2-phase, double breastpump.
Eat well! A good, well-balanced diet with regular meals. Drink enough fluids, lots of water (2 – 3 litres a day), especially just before pumping or feeding. This is essential to maintain your supply. Make sure you drink before arriving home. Also drink with night-feeds.
It is essential, after use, to separate and rinse all parts that come into contact with the milk with cold water. Then wash all working parts of the pump with hot water and liquid soap and clean off fat gently with a bottlebrush. Rinse again with clear water. (Please also ensure that your hands are clean whenever handling your breast pump or breast milk – especially when at work). Re-sterilise before pumping. Re-usable steam sterilising bags used in a microwave are very useful for mothers who are not at home. Dry all parts with clean paper towel before assembling the pump again.
Managing your breast milk
Breast milk should preferably not be stored at room temperature in hot climates. Best kept in a cooler bag with a good size frozen cooler brick nearby to store and transport expressed milk while at the office or out and about, then refrigerate immediately when you return home. Expressed milk can be refrigerated for 3-5 days at approximately 4°C before being used. Breast milk can be frozen for up to 6 months at approximately -16 to -18°C. It is best to store breastmilk at the back of the fridge or freezer, where it is coldest. Date your milk, so that you can use the oldest first. There are disposable freezer bags and breast milk storage containers available especially for storing breast milk. Make sure they are all BPA free. Some freezer bags are double lined to prevent freezer burn and to maintain the optimum nutritive value of your breast milk. Only refreeze thawed milk if there is still some frozen milk present and try to use milk within 10 hours of thawing.
How much and how often?
Working mothers always ask how much milk they should leave for the baby for a feed when they are at work. You take the baby’s weight in kilograms and multiply by 120ml – 150ml breast milk and divide by the number of feeds baby has in 24 hours.
For example for a breastfed baby –
A 4kg baby x 120 = 480ml in 24 hours,
Feeding four hourly = 6 feeds in 24 hours
480ml divided by 6 = 80ml per feed
Recent studies show that from 3 to 5 months of age breastfed babies gradually require less breast milk per kg of body weight because their growth rate is slower. This is good news for the mum who is expressing. Offer a maximum of 90-120ml per feed. Also, of course, once solids are introduced at 6 months all babies require less milk. Experiment and see what your baby needs, but don’t let him drink too much while with the caregiver.
How long does it take to express?
This is the question on everyone’s lips. This varies from mother to mother and breast pump to breast pump. Some mothers can pump even faster than they can breastfeed; others pump twice to get enough milk for one feed. Some mothers express easily. Other mothers need the very best and most effective breast pumps available. These breast pumps comfortably mimic the sucking action of the baby. The really sad thing is that if a mother uses a breast pump and it doesn’t work for her or it is not comfortable, she sometimes does not try another pump, thinking that all pumps are the same. They are different. Try another type of pump.
Most breast pump surveys state that pumping with a good electric pump is quicker than a manual pump. Double pumping is definitely fastest, (this means both breasts at the same time). A recent study shows that double pumping also increases the fat content as well as the quantity of mother’s milk especially for mothers of premature babies.
Try these tips:
- If you are struggling, pump on one side while you feed on the other;
- massaging the breast for a minute or two before, during or after expressing can also help increase milk flow if you need this extra assistance;
- to assist with increasing milk supply and decreasing the time it takes you to get it try alternating between the stimulation and expression phases of 2-phase pumps; and/or
- Keep a picture of your baby nearby. Thinking about your baby while pumping can assist with your let down. (Some moms scroll through all the pictures on their mobile phone while pumping and others even record their baby crying).
- Pump at regular times, especially while you are at work. Set your alarm on your cell to remind you. Your body gets used to regular pumping.
Feeding expressed breast milk to your baby – what to look out for
Remember never to heat your breast milk in the microwave as this will destroy many of the nutrients and living organisms which make human milk so precious e.g. antibodies.
If you introduce any alternative feeding device while at work it is important to note how your baby’s suckling action on the breast is affected. The suckling action on the breast should not change and your milk supply should remain stable.
More useful tips for expressing
Nipple problems are best prevented by good management including frequent feeding using correct latching techniques and variable feeding positions.
Expressing a little prior to latching, if breasts are very full or hard, will improve latching and aid comfort. Some moms find their pump to be a useful tool right in the very beginning when both mom and baby are learning the art of breastfeeding, especially after the milk first comes in (when baby is around 3 – 5 days old).
Pumping after a hot shower or hand expressing in the shower is very helpful for engorgement.
Do remember these are only suggestions and mothers cope in so many different ways. It is amazing what solutions mothers will find if they really want to work and still enjoy the pleasure and benefits of breastfeeding their baby. Anytime that you find that your milk supply dips, pump or feed a little more often and drink well and usually your supply will increase in a few days.
Enjoy your breastfeeding and the special relationship with your baby. We would love to hear your stories and experiences. Please write to us so we can also share your good information with other new moms.
For more information phone Jane Pitt. See our contact details below.
Breast Pump Hire
Tel: (011) 788-9102 / 083 300 4302
Hospital grade breast pumps available for hire nationwide. Phone for your nearest agent or for expressing advice.