Pumping and going back to work

Going back to work while still pumping is one of the hardest decisions you will have to make as a mother.

There is no right or wrong. If you must do it, then you will find that balance. If you have the luxury of postponing getting back to work to stay longer with your baby, then why not. The decision is HARD and personal.

 

To make it harder, going back to work for many mothers means trying to maintain their milk supply if they wish to continue breastfeeding. Human milk of course at any age continues to be an amazing source of nutrition for your baby. It continues to support his/her immunity, IQ, and an amazing bond between the two of you.

 

What are some things you should keep in mind?

The basic concept you should know is, any milk sessions your baby will be taking while you are at work, should be pumped for him/her ahead of time.

 

Let's imagine an ideal scenario.

The ideal scenario is you go to work from 9 AM-4 PM. Let's assume the following schedule:

6 AM Breastfeeding

8:30 AM Breastfeeding

11:00 AM Pumped milk

2:00 PM Pumped milk

5:00 PM Breastfeeding

8:00 PM Breastfeeding 

and then continued breastfeeding at night IF your baby breastfeeds at night.

 

Ideally, the 11:00 AM feed and 2:00 PM feed should be pumped at work the day before, saved in the proper temperature, brought home, and given to the baby the next day. (More on that below)

***If you are wondering if I have a recommendation for a cooler bag, check this cooler bag.  However, there are bags that fit the pump as well such as the one below. Please check with product details to make sure the bag fits your pump, the cooler bag, and even your laptop, phone and more details if you would like a very convenient option.

 

You would need to pump twice at work for 20 minutes each if you have a double electric pump which I highly recommend if you plan on going back to work.

A double electric pump saves you time (Half the time, instead of going from one breast to the other) and is also more efficient at extracting milk.

**Recommendation: The Medela Instyle is one of the most trusted models and comes with a bag that fits the pump, the pumped bottles, and more. I have also heard great things about the Spectra and it has won many awards and is said to be superior. I personally used a Medela and enjoyed it but I am happy to hear other moms' feedback.

You can of course pump into bottles (you would need 2 additional bottles for pumping) or into pumping bags. Always label them with the day.

 

Doing breast compressions and massages while pumping will also save you a ton of time.

 Wet wipes (disinfectant), earphones for entertainment, and a pumping bra would all make the process much easier for you.

How do I start transitioning to going back to work?

Remember our scenario above? You would start this scenario 2 weeks ahead of time. While at home, you would one day at 11:00 AM pump  and give it to your baby and then again at 2:00 PM so your baby gets used to it.

Ideally, another caregiver would give the pumped milk because many babies will refuse pumped milk from their mom.

Read about paced bottle feeding.

Also starting 2 weeks ahead of time allows you to experiment with the right bottle nipple that your baby is used to.

Now, if you have previously frozen pumped milk, this milk would be the milk you would give your baby when you go back to work the first day you go back. You would then begin the cycle of pumping at work, bringing it home, your baby has it 24 hours later.

IF you do not have previously frozen milk, then starting 4 weeks before going back to work, you can start one additional pumping session at night after your baby sleeps or in the morning (in times your baby doesn't usually breastfeed for 4-5 Horus ideally). This pumping session has the role of increasing your milk supply and also making extra milk for your baby to freeze for emergencies and also for going back to work.

In the first week, only a few drops of milk will be made, however, after doing the extra session for around 10 days, you will see your body will make an additional bottle of milk.

 

More questions on pumped milk

Storage and handling of breast milk.

4 points to address:

  • Storage containers
  • Storage temperatures
  • Defrosting and handling human milk
  • FAQ

 

First, what should you store the milk in and does it really matter?

You may be wondering why breast milk should be stored in special containers, why can’t the typical Tupperware do?

  • First, because beneficial ingredients of breast milk can stick to the sides of containers and be lost. So, special containers are needed
  • Second, because you don’t want the container to break or be contaminated from nearby sources, so you want it to be hard-surfaced and closed air-tight.
  • Third, you want it to be BPA free. A chemical that has negative health effects on children. Always look for BPA free sign on the bottle. Make sure there is no #7 sign under the bottle. Mayoclinic.health.bpa and Ewg.org

 

No matter what your choice of container is it should be cleaned appropriately before use with warm soapy water or sterilized using boiling water or sanitizer.

So, what can you use?

Breast milk should be stored in glass or hard food grade plastic containers that have an air tight seal. This is preferred over plastic bags which can be easily contaminated with nearby objects. Important nutrients may also stick to the sides of plastic bags and be lost.

Plastic bags that are made specifically for breast milk can be used for up to 72 hours ONLY. This does not mean you can use regular plastic bags or ziplock bags.

 

How to best store the pumped milk?

How to store the pumped milk depends on what you need it for. The table below is for healthy full term infants, info by ABM protocol number 8

What do you want to do with the breast milk?

What to do to achieve the purpose.

Temperature

Give it to my baby within a few hours(up to 8 hours)

 

Keep it covered and at room temperature

Up to 77°F or 25°C

 

Give it to my baby within 5 days

Refrigerate it in back compartment

39°F or 4°C

Give it to my baby within a few weeks or months

Freeze it for up to 6 months in the back of the freezer.

You can keep it for up to 1 year if it is a deep freezer −4°F or −20°C

0°F or −18°C

Give it to my baby within 24 hours

Keep it covered with ice packs and give it to your baby within 24 hours

Ice cube and insulator

 

When you are at work, a cooler bag with icepacks can safely store your breastmilk. It comes with some pumps or you can buy a lunch box which is insulated and any ice packs.

Mirna Sabbagh: Adult and Child Nutiritionist

 

How do you give your baby refrigerated or frozen milk?

  1. You can let it run under hot water
  2. You can put it in a hot bowl.

Don’t let the water from the bowl touch the top of the container/bottle.

  1. Do not use a microwave or oven top to heat milk as this would destroy the antibodies which are of high benefit for your baby.

An additional method for frozen milk:

  1. You can put it in the fridge for 24 hours so it can go back to liquid form, then you can warm as you would the refrigerated milk
  2. Once the milk has been de-frosted, you should give it to your baby within 2 hours. If not, you will have to throw it out as you should not refreeze defrosted milk.

Note: In regards to refrigerated milk you can give it to your baby chilled, room temperature, or warm.

 

 

Important FAQ

If you have one frozen bottle, one refrigerated bottle and one fresh milk bottle which one should you give?

You always give the fresh bottle first, followed by the refrigerated, followed by the frozen. This way you ensure that your baby gets the most beneficial ingredients out of the breast milk.

I just pumped new milk, can I put it on top of pumped milk already in the fridge or do I have to use a separate container?

You can chill the newly pumped milk in the fridge for 1 hour then add it to the old container. This comes in handy when you’re pumping a few times a day in order to make a big feeding for your baby.

Note: ABM (Academy of Breastfeeding Medicine) states that you can add milk if pumped within the same day. Pumps from other days should be in different containers

Can I add newly pumped milk to frozen milk?

Only in small amounts, and not if it is warm.

My baby left some milk in the bottle, can I put it in the fridge and use it again?

No, you should not. You can use it for alternative breast milk uses if you would like such as wound healing. However, you cannot give it to your baby.

If this is happening often with your baby. Start storing your breast milk in smaller quantities (30-60 ml in comparison to 120 for example).

My milk has separated into 2 layers can I use it?

Yes. This is normal. The fattier layer floated to the top. Gently swirl your container before giving it to your baby.

My milk has changed colors can I still use it?

“The color of milk may vary from day to day, depending on maternal diet. It may look bluish, yellowish, or brownish. Frozen breast milk may also smell different than fresh breastmilk. There is no reason not to use the milk if the baby accepts it” ABM: protocol number 8

That being said, in my opinion if you’re not comfortable with it definitely don’t give it.

Do I have to store my milk in a separate fridge at work or at daycare?

Expressed breastmilk can be kept in a common refrigerator at the workplace or in a daycare

Center. The US Centers for Disease Control (CDC) and the US Occupational Safety and

Health Administration (OSHA) agree that human milk does not require storage in a separate refrigerator.

 

I feel my milk supply decrease after going back to work?

The stress of going back to work may cause a dip in your milk supply for a few days OR you may psychologically believe your milk supply went down. Also, pumps are not as efficient as babies in extracting milk, so your milk supply may decrease a little bit.

 

Either way, the best way to increase your milk supply is to do one of the following or a combination:

1. Add 5-6 minutes to your pumping session

2. Do breast massages very often while pumping and do hand expression of milk after finishing each pumping or feeding session.

3. Breastfeed your baby often when you are home and on weekends

4. Add a pumping session a day

5. Relax and admire the power of your body, it might be just in your head. Remember, bringing back your milk supply is ALWAYS an option. There is nothing called milk going away forever.

 

Of course always make sure when milk is given to your baby it's done gently in a paced bottle feeding method and if your baby refuses to latch I will make a blog post about it but in the mean time, a GREAT resource is KellyMom on what to do in this case 

 

 

I talk about breastfeeding, pumping and more in my free breastfeeding course. 

 

 

 

 

 

References:

Medela, Inc, La Leche League International,; U.S. Department of Health and Human

Services Office of Women's Health (2010), Academy of Breastfeeding Medicine (2010),

American Dietetic Association (ADA) Infant Feedings: Guidelines for Preparation of Formula

 

- ABM protocol: number 8

http://www.bfmed.org/Media/Files/Protocols/Protocol%208%20-%20English%20revised%202010.pdf

- United Kingdom Association for Milk Banking.

Guidelines for the Establishment and Operation of

Human Banks in the UK, 3rd ed. London: Royal

College of Paediatrics and Child Health and United Kingdom Association for Milk Banking,2004.

-Human Milk Banking Association of North America. Guidelines for Establishment and Operationof a Donor Human Milk Bank. Raleigh, NC:Human Milk Banking Association of NorthAmerica Inc; 2003.

 

- WHO and UNICEF. Breastfeeding counselling:A training course. Geneva, World HealthOrganization, 1992 (WHO/CDR/93.5/UNICEF/NUT/93.5).

- Bahl, R. (2006). WHO: Optimal feeding of low-birth-weight infants.http://whqlibdoc.who.int/publications/2006/9789241595094_eng.pdf?ua=1 REVIW