Breastfeeding: Y ou Can Do It! Breastfeeding is achievable. Professional & community support is available. Breastfeeding is a significant health and medical choice for both mother & baby. You & your baby go, so does your milk. No running to the store for formula, mixing or heating at 2 a.m. If you want to go out for an evening, without your baby, go back to work or go to school, pump breast milk while at work. Breastfeeding makes you & your baby portable. Pump & store your breast milk to allow work & breastfeeding. You can adjust breastfeeding time around your schedule.
While you are pregnant, talk to family or friends you know who have breastfed. Ask about their experience. Find other pregnant moms who plan to breastfeed. Form an informal support network. Ask your obstetrician for the name of the hospital’s lactation consultant. Call this person BEFORE you deliver to introduce yourself and get comfortable with asking questions about breastfeeding.
There are so many ways your partner and other family members can bond with your new baby that don't involve feeding. Newborns benefit from lots of touching, holding and skin-to-skin contact. Your partner and other family members can give you much-needed relief by changing the baby, burping her after a feeding, giving her a bath, changing diapers, or just playing with her. Dads often enjoy putting on the sling/baby carrier and taking the baby out for an evening walk (maybe as you rest or prepare dinner).
You can breastfeed discreetly if you wear the right kind of clothing. Generally two-piece outfits with lightweight tops that are pulled up from the bottom to breastfeed are best. If you combine that with a jacket, over-blouse, or cardigan that covers your side and can be used as a &quot;screen&quot; to hide the baby. Also, there are special lines of clothing for breastfeeding moms that include pleats and slits over the breasts for easy and discrete access. There are also special &quot;capes&quot; are which are especially designed for discrete breastfeeding. Nursing your baby in a sling can also help facilitate discrete nursing. Slings are baby carriers made of cloth that are worn like a sash over mom's shoulder to carry the baby. They have lots of extra cloth to provide cover.
One option for working mothers is to continue to feed the infant by going to the infant or having the infant brought to the worksite for each feeding. However, this is typically not a feasible approach. The option used by most working mothers is to express milk with a pump during the work day which will be fed to the infant by bottle during the next work day. Ask at your workplace to see if a lactation room is available for pumping and storage. A third option is to have the care provider feed the infant formula during the day while you continue to breastfeed at night. This will, however, decrease your supply of milk. You should e xpress your milk for each feeding missed to keep the supply adequate.
Baby provides optimal stimulation for maintenance of your milk supply. In reverse-cycle nursing, a baby often begins to feed less while being cared for in your absence and increases the frequency of nursing when you are together. This is very effective in helping to keep your milk supply abundant. However, it also requires that you and the baby are up more frequently during the night. To increase the number of times your baby nurses is to bring your baby to bed for the last feed of the day, rather than feeding expressed milk. Lie down with your baby, nurse( take a short nap) when you get home from work Allow your baby access to your breasts throughout the evening and at night. The baby will nurse at least once or twice during the night. A young baby needs to be breastfed (or fed your expressed milk in your absence) at least 10 to 12 times a day. Your breasts also need frequent and regular stimulation to maintain a good milk supply. Your baby is much better than any breast pump at getting milk from your breasts. Dr. Bell’s comment: “I’ve seen some sources that say this is dangerous because of the risk that the baby might suffocate or be hurt when an adult inadvertently rolls over. This applies mostly to infants.”
At least one week before returning to work: Use the pump and practice expressing milk. Get your baby used to taking the expressed milk from a bottle. Talk to your supervisor about the fact that you will need time and privacy to express milk. ***Remember to include time for getting to and from the location where you pump, for cleaning the pump, and storing the breast milk*** Talk to Occupational Health about materials in your workplace that may transfer into breast milk. Make a recommendation to consult Occupational Health if there are concerns about potential exposures in the workplace. A few days before return to work: Simulate your work schedule, pumping during “break times” and giving baby a bottle for feedings during the day. Pump often to build up your supply. Try to return to work later in the week so you can trouble shoot problems and have the weekend to nurse the baby and build up your supply.
In order to maintain an adequate supply of milk, a working mother must express milk when separated from her baby. Continuous production of milk depends on repeated stimulation of the nipple & areola to produce prolactin & oxytocin. The more you express, the more milk your breast will produce. This milk can be refrigerated, then transported to the day care provider to be fed to the baby. Milk should be expressed for each feeding for which the does not nurse. Continuously engorged breasts can lead to plugged ducts and mastitis.
Sterilization is not routinely required.
Manual expression is cheaper and requires less set-up than using a pump. Adapt your technique to your comfort. Frequent practice will improve your milk supply. Use all sensory means to foster relaxation and effective let-down. A picture of your baby or a blanket with her smell is often helpful. Gentle breast massage should facilitate milk flow 1. Place thumb & forefinger on areola 2. Push back towards chest wall 3. While pushing back, press thumb and forefinger gently together 4. Repeat gentle compression of thumb & forefinger 5. When no more drops of milk are expressed, move hand position and repeat 6. When the milk flow decreases to an occasional droplet, express from the other breast
Types of pumps: Hand pumps (manual) Battery-operated pumps Electric pumps (must be plugged in) All pumps are not created equal. Consult your lactation consultant for advice on a pump for your particular situation. Rubber bulb breast pumps are not recommended in any situation. Hand pumps, battery pumps & small electric pumps are intended for occasional use. They do not provide adequate stimulation for maintaining the milk supply in a situation of mother/baby separation. Before using a pump, read and follow the manufacturer’s instructions. Don’t share pumps and collecting kits. Each mom should have her own pump and collecting kit.
Hospital grade pumps are recommended to establish and maintain the milk supply. These pumps are much more efficient, especially if milk is expressed from both breasts at once. They are the best choice for a mom who needs to express milk quickly. The main limitations are cost, weight, and requirement for an electric power supply. These pumps can also be used for sick infants.
If a baby is not breastfed at all during 24 hours, plan on 8 pumping sessions per day for 15-20 minutes per session using double collecting kits.
Do not store breast milk in the freezer or refrigerator door.
Healthy Term Infant: La Leche League states that milk can be stored up to 10 hours at room temperature. American College of Obstetrics and Gynecology (ACOG) says human milk can be stored up to 8 hours at room temperature.
For storage, plastic bags are not the best choice. If you have to use them, store them inside a freezer zip- lock bag.
Microwaving breast milk destroys nutrients. Microwave and excessive heat from hot water heats milk unevenly and increases risk of burning baby.
Breastfeeding mom on the move
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Support <ul><li>Family and Friends </li></ul><ul><li>Lactation consultants in: </li></ul><ul><ul><ul><li>Community Health Nursing </li></ul></ul></ul><ul><ul><ul><li>Women Infants Children (WIC) </li></ul></ul></ul><ul><ul><ul><li>State and Local Health Department </li></ul></ul></ul><ul><ul><ul><li>Medical Treatment Facility </li></ul></ul></ul><ul><li>La Leche League </li></ul>
Your Partner and Family Members: Other Ways to Bond <ul><li>Cuddling </li></ul><ul><li>Bath time </li></ul><ul><li>Walks </li></ul><ul><li>Diaper changes </li></ul>
Mom on the Move Breastfeeding Discreetly <ul><li>It is possible to breastfeed discreetly in public </li></ul><ul><ul><li>Wear clothing for easy access </li></ul></ul><ul><ul><li>Use a blanket or diaper to cover breast and baby </li></ul></ul><ul><ul><li>“Sling” baby carriers are useful </li></ul></ul>
Feeding Options for Working Mothers <ul><li>Direct breastfeeding </li></ul><ul><li>Expressing milk </li></ul><ul><li>Supplementing with formula </li></ul>
Another Option: Reverse Cycle Feeding <ul><li>Baby feeds less often during the workday </li></ul><ul><li>Baby feeds more often when you are together </li></ul>
Before Returning to Work <ul><li>Practice with the pump </li></ul><ul><li>Get baby used to the bottle </li></ul><ul><li>Talk to your supervisor </li></ul><ul><li>Consult Occupational Health about hazards </li></ul><ul><li>Simulate work schedule </li></ul><ul><li>Breastfeed exclusively on weekends to keep supply up </li></ul>
Reasons for Working Mothers to Express Milk <ul><li>Maintain an adequate supply </li></ul><ul><li>Engorged breasts are painful and decrease your milk supply </li></ul><ul><li>Express milk manually or by pump </li></ul>
Milk Expression Basics <ul><li>Wash hands thoroughly </li></ul><ul><li>Breast cleansing is not routinely necessary </li></ul><ul><li>Wash pump and collecting kits in hot soapy water after each use </li></ul>
Manual Expression <ul><li>Use all senses to foster effective let-down </li></ul><ul><ul><li>Baby’s picture </li></ul></ul><ul><ul><li>Blanket with her smell </li></ul></ul><ul><li>Use gentle breast massage </li></ul><ul><li>Adapt manual technique for your comfort </li></ul>Illustration by Joyce Kopatch, USACHPPM
Breast Pumps <ul><li>Types </li></ul><ul><ul><li>Manual </li></ul></ul><ul><ul><li>Battery </li></ul></ul><ul><ul><li>Electric </li></ul></ul><ul><li>Performance varies greatly </li></ul><ul><li>Hand pumps, battery pumps, & small electric pumps are intended for occasional use </li></ul><ul><li>Price Ranges </li></ul><ul><ul><li>$20.00-$250.00 </li></ul></ul>
Breast Pumps “Hospital Grade” <ul><li>Best choice to establish and maintain milk supply </li></ul><ul><li>Dual pumps/collecting kits are helpful for women employed full-time outside the home </li></ul>
Recommended Pumping Protocol <ul><li>During a normal workshift, a mom should plan on 2-3 pumping breaks </li></ul><ul><li>Dual pumping results greater total milk volume </li></ul><ul><li>If a single collecting kit is used, each breast should be pumped for 15 minutes per session </li></ul>Illustration by Joyce Kopatch, USACHPPM
Extra Tips <ul><li>It is better to express for 15 minutes 3 times a day rather than 45 minutes straight </li></ul><ul><li>You will yield more milk and keep your supply up </li></ul><ul><li>Hand massage helps to drain the breast faster </li></ul>
Storage of Human Milk <ul><li>Store in the coldest part of the refrigerator or freezer </li></ul><ul><li>Antibacterial properties of human milk help to prevent bacterial growth </li></ul><ul><li>Store milk in feeding-size portions to minimize waste </li></ul><ul><li>Milk that has been partially used should not be reused (1 hour window) </li></ul>
Storage Containers <ul><li>Hard-sided, self supporting containers with air-tight caps are the best </li></ul><ul><li>Label containers with infant’s name, date of expression, and number of ounces </li></ul><ul><li>Use oldest milk first </li></ul>
Thawing Frozen Milk <ul><li>Never microwave human milk!! </li></ul><ul><li>Run lukewarm (not hot!) water over container </li></ul><ul><li>Set container in pan of warm water </li></ul><ul><li>Leave in refrigerator overnight </li></ul><ul><li>Avoid excessive heat </li></ul>
Warming Human Milk <ul><li>Use warm water </li></ul><ul><li>Shake warmed milk to resuspend fat globules </li></ul><ul><li>Too much warming may initiate bacterial growth </li></ul>
Acknowledgements <ul><li>Ms. BethAnn Cameron </li></ul><ul><li>Health Educator </li></ul><ul><li>Directorate of Health Promotion and Wellness </li></ul><ul><li>US Army Center for Health Promotion & Preventive Medicine </li></ul><ul><li>Ms. Cindy Plank </li></ul><ul><li>Health Educator </li></ul><ul><li>General Leonard Wood Army Community Hospital </li></ul><ul><li>Fort Leonard Wood, Missouri </li></ul><ul><li>Wellness Center </li></ul><ul><li>Martin Army Community Hospital </li></ul><ul><li>Fort Benning, Georgia </li></ul>