BREASTFEEDING IN THE EARLY WEEKS
Breastfeeding in the early weeks is a natural system of supply and demand. The more you breastfeed the more milk you'll have. Feeding soon after birth, and feeding often, will help to get breastfeeding off to a good start.
It is important to make sure that you are comfortable and that your baby is well positioned at the breast. Your baby's body should be on his side completely facing you. Baby's head should be in the crook of your arm with your nipple directly in front of his mouth, so that he does not have to move his head to nurse. If you tickle his bottom lip with your nipple he will open his mouth very wide. Bring the baby to the breast rather than the breast to the baby. Make sure that some of the darker area (areola) around the nipple is in his mouth, not just the nipple itself.
Your husband or partner may be ideal for this, someone who already knows and cares for your baby. At home your baby is in a familiar environment, and all your baby's belongings are already there. Some mothers find this arrangement reduces stress, especially in the morning. It may be possible for fathers to make some adjustments to their working hours. Other family members, maybe your own mother, may be a good choice of help, although there can be problems if you don't agree on how to care for baby.
If you haven't got a family member who could care for your baby, a childminder can provide a secure and homely environment. Your public health nurse may be able to make suggestions about a kind and reliable baby minder in your area. Start to look early-good child minders are kept pretty busy and it may take time to find someone with whom you are happy to leave your baby. Talk to other working mothers bout what worked for them-a La Leche League meeting may be ideal for this.
A creche is another possibility. Do look around in advance and check how many babies are being cared for, what is the staffing ratio like, and how responsive the staff are to babies' needs.
If you are pregnant for the first time, it is actually difficult to imagine how you will actually feel about going back to work and leaving your baby with someone else. If it is at all possible try to keep your options open about when, or if, you return to work. Perhaps job-sharing or flexi-time could be worth investigating. The longer you stay at home with your baby, the more time you will have to develop a relationship with your baby and the easier it will be to manage breastfeeding and working.
Most mothers find it takes at least six to eight weeks before their milk supply is really established. During this time both mother and baby are still learning about breastfeeding. After several weeks your baby will become more settled and predictable and you will grow in confidence as a mother. The longer you can stay at home, perhaps until your baby begins to eat solid foods, the easier you are likely to find continuing to breastfeed. Most babies show readiness for solids about the middle of their first year of life.
Some employers will hold your job open for six months or a year, so it's worth asking even if you're not sure what the position is. Another way of delaying your return is to take holiday entitlement at the end of your maternity leave. However, even if you do have to return soon after the birth, you will still be able to breastfeed.
Many working mothers find it much easier to manage a shorter working week Could you job-share, perhaps with another working mother? for some women a shorter working day works best. A full day, plus travelling time, can mean a very long time away from your baby.
If you do have to work a full day, or if you have to travel a long distance to get to work, it is worth considering looking for a babyminder near to your place of work. For example if you find a sympathetic babyminder, you may be able to arrive early so that you can feed your baby just before you go into work, and again straight after work. Some mothers have been able to feed their babies at lunchtimes and during other breaks throughout the day, which cuts down on the need for bottlefeeds. In Norway, working mothers who are breastfeeding are entitled to a two hour nursing break daily. It is of interest to note that Norway has the highest breastfeeding rate in Europe.
Make the return to work easier by returning to work on a Thursday or Friday as the first day back. You will then have the coming weekend to recover strength a plan a strategy for the following week.
Working mothers who have young babies will probably need to express their milk to help them obtain a continuing supply. The milk you collect while you are separated from your baby can be given to him the next day. Expressing your milk will help to stimulate the supply and avoid over-full breasts.
Hand expression for many mothers feels natural and comfortable, and the direct skin contact helps boost the milk supply. Hand expression is the most sterile method of breast milk collection and is likely to keep the milk flowing well over a long period of time.
- Make sure your hands and fingernails are clean and that the container you are using is sterile.
- Position your thumb and first two fingers about one to one-and-a-half inches behind the nipple.
- Place the thumb pad above the nipple and the finger pads below to form a "C".
- Push straight into the chest wall, avoid spreading the fingers apart. Roll thumb and fingers forward as if making thumb and fingerprints at the same time. Repeat rhythmically; position, push, roll.
- Rotate the thumb and finger position, changing hands as necessary, to milk all the ducts.
If nothing comes at first, vary the pressure and position of your fingers until you get the knack. Don't worry if quantities are small at first. It may take a few days for you to learn to express your milk.
A pump can be used at work during breaks and lunch hours, and can also be used at home in the weeks prior to returning to work. Your choice of pump may depend on the length and frequency of separation from your baby. Always remember to follow the manufacturer's instructions for use and sterilisation. Care must always be taken when expressing milk as pumping too vigorously may damage the breast.
La Leche League does not endorse any particular type of pump but cautions against the bulb-type "bicycle-horn" hand pump. This pump is neither comfortable nor effective in use and cannot be sterilised adequately. The range of pumps currently available for purchase or rental includes hand-operated, battery powered and electric pumps.
If your baby is six months or older there is no need to make elaborate plans about breastmilk. Solid foods and a drink can replace your milk while you are at work, although you may need to express to avoid getting blocked ducts until your milk supply adjusts. (Click here to see La Leche League leaflet Sore Breasts).
This information is based on current research and applies to mothers who have healthy, full-term babies; are storing their milk for home as opposed to hospital use; wash their hands before expressing; and use containers that have been washed in hot, soapy water and rinsed. All milk should be dated before storing.
Fresh breastmilk is a live substance which actually contains cells which kill germs, so a mother's milk stays fresh longer than other sorts of milk. There are certain precautions which you must take however; to keep breastmilk safe for your baby.
First, your hands need to be clean if you are pumping or expressing milk, although it is not necessary to wash your breasts first - your usual daily shower or wash is enough. All pumps and other equipment need to be sterilised following the maker's instructions.
Milk that is going to be used within five days can be kept in the fridge until it is time to feed the baby. If you express milk several times a day, use separate containers each time and allow to cool in the fridge. These cooled batches can be combined later for feeding or for freezing. Milk which you plan to freeze should be frozen as soon as possible after it has been expressed and cooled.
When freezing breastmilk you may use sterilised heavy plastic or glass containers, or freezer milk bags which are designed for storing human milk. Disposable bottle liners are not recommended.
When filling containers, allow room for expansion, and do not tighten lids until the milk is completely frozen. You can add refrigerated milk to milk that is already frozen provided the amount you are adding is less than the amount already frozen, so that it does not thaw the frozen milk. Freezing in small quantities will help to avoid waste, as the appetite of a breastfed baby can vary from one fed to another. Always remember to date the container.
Frozen milk will keep for two weeks in the freezer compartment of a refrigerator, for three months in a separate door fridge/freezer and for six months or longer in a separate deep-freeze at 0 degrees Fahrenheit. (Do check this with a freezer thermometer.)
Some mothers express and store their milk for several weeks before they return to work so they can have a reserve supply. Others pump when they are away at work, and have enough milk for baby's feed for the following day.
It is often easy to express an ounce or two after the baby has finished feeding because the milk has 'let down'. Don't be tempted to pump just before a feed - you want to provide your baby with a pleasurable and satisfying experience at the breast.
Finding a suitable location for pumping of expressing milk at work will depend on each individual situation. You may be able to use a private office or a specially designated room. A photograph of your baby will help your milk 'let down'. all you need is somewhere you can relax and have some privacy. remember that wearing separates makes the task easier.
You may have access to a fridge at work for breast milk storage. If there isn't one available a cool bag can then be used, and these are also useful for transporting milk home or on to your childminder. Ideally it makes most sense to store the milk in the childminders fridge the same day you pump it, so that it can be used fresh the next day. If you are having a day or two off work, the milk can be frozen at the minder's house. Again remember to date the container.
About a fortnight before you go back to work try letting your baby have some freshly expressed breast milk in a bottle. If your baby is reluctant to take the bottle from you, ask someone else to offer it to him. Different teats suit different babies and you may have to try a few. Warming the teat with previously boiled warm water may help him accept the unfamiliar feel. It may take a while before your baby accepts the bottle so try to be patient. Babies over four months often cope remarkably well with a cup or trainer-cup. Babies who don't like bottles can be given expressed milk from a cup. If you have a baby like this, it is possible to give several ounces of milk for each feed by cup. Your baby can then make up the day's requirements when you return from work, provided you let him nurse freely during your time together.
In this situation (as with all babies) you can be reassured that your baby is getting enough milk if he has at least 6 really wet nappies per day (5 disposable nappies) and gains an average of 1-2 pounds per month (about 4-7 ounces per week). Older babies who are eating solid foods can be given water or well-diluted fruit juice from a cup or trainer-cup with their meals. The baby may want to nurse more during the evening, night and early morning.
Some mothers opt to have some formula given during the day and continue to breastfeed at home, but you need to be aware that in these circumstances your supply will be reduced.
If you are returning to work before baby is taking a variety of solids you may still prefer to keep your baby fully breastfed, especially if there is a history of allergies in the family, as these can be triggered off by introducing solids too early. Good simple first foods are mashed banana, potato, carrot etc. If you find it difficult to keep up supplies of expressed milk, you can increase your milk supply by feeding more frequently when you are at home and expressing more frequently when you are at work. (Click here to see If you need to increase your milk in La Leche League's Early Days leaflet ).
GUIDELINES FOR YOUR BABY MINDER
Explain to your babyminder that your baby may need some persuasion in learning to accept a bottle. You may need to stress that your baby should be held while being fed, and that you don't want him left to cry.
Point out that refrigerated breast milk separates into layers - just shake it gently to mix. Fresh breastmilk can be warmed by holding the bottle under warm running water for a few minutes or by standing it in a pot of hot water , but do be careful not to overheat it as this will destroy the valuable live cells.
Frozen milk needs to be thawed by holding the container under warm running water. Once thawed, the bottle can be warmed in a jug of hot water. Frozen milk should not be heated directly in a pot on the cooker as it will curdle, nor should it be left to thaw at room temperature or be refrozen. Breastmilk should not be heated in a microwave oven. Valuable components of the milk will be destroyed and 'hot spots' may burn your baby.
Remind your babyminder that while a bottle fed baby is usually accustomed to receiving a standard number of ounces at each feeding, a breastfed baby's appetite can vary. When you freeze milk in small quantities (2 - 4 oz per container) your babyminder can thaw as much as she thinks your baby will need.
The biggest problem faced by employed nursing mothers is fatigue. Try to get as much rest as possible, learn to nurse lying down and look after yourself by eating a nutritious diet.
Most mothers who work outside the home like to be full-time breastfeeders at weekends. This can help you feel close to your baby and ensures a good milk supply. It will not upset your baby's weekday routine, because he will associate breastfeeding with you and bottle feeding with his minder. He will need lots of your attention in the early weeks after your return to work, so don't be surprised if he is extra clingy at first. Your baby will miss your presence as much as your milk, so be prepared to give lots of extra cuddles and breastfeeds when you are at home.
Although housework chores are important, try to restrict housework to the essential minimum, as your baby will be little for only a very short time. Look for practical help and support from your partner and other family members.
A mother who combines breastfeeding and working outside the home will find La Leche League meetings invaluable. Breastfeeding mothers who are regularly separated from their babies need the support that comes from being with other nursing mothers. Babies are always welcome at La Leche League meetings.
While you are breastfeeding you are giving your baby the very best food that you can provide. You are protecting him from potentially serious illnesses like gastro-enteritis and respiratory infections. You are giving him the close loving relationship which will lay the foundation for all his relationships in the future.
Although babies come in both genders, in this leaflet we have referred to baby as "he", for clarity's sake, since mother is unquestionably "she".
You can get a copy of this and other La Leche League of Ireland leaflets from a La Leche League Leader or at any of our meetings. Click here to find your nearest Group.
Do get in touch, we look forward to meeting you!
ŠText and Illustration La Leche League of Ireland
