The document provides information and advice for mothers who need to pump breast milk at work, including: - Recommendations for choosing an appropriate breast pump based on pumping needs and goals for continued breastfeeding. Higher grade pumps are recommended for regular or full-time pumping. - Guidelines for proper milk storage including room temperature, refrigeration, and freezing times and temperatures. Thawed milk should be used within 24 hours. - Tips for establishing and maintaining a pumping schedule at work such as pumping within an hour of working, during lunch, and after returning home from work. - Additional suggestions to increase milk supply such as nursing frequently when not at work and using breastfeeding-friendly supplements. Proper

1. Working it Out: Using a breast pump at work. Janet Peirce-Hollett Certified Lactation Counselor

2. Pumping your milk is an important part of breastfeeding for some mothers. Whether you need to return to work, increase your milk supply, or your baby is having trouble breastfeeding, your pumped milk can be a crucial part of your baby's health and your peace of mind. Ameda.com

3. Hospital Grade Double Electric (Rental) Daily use Double Electric Single Electric/Occasional Use Hand Held Manual You can purchase the most expensive pump but if you don’t use it diligently and correctly you will end up with a very expensive doorstop! Ask your Lactation Consultant for direction.

4. What are your pumping needs? Baby doesn’t breastfeed ~ Hospital Grade Rental Pump Full-Time Work or School ~ Double Electric Purchase Pump Part-Time work or School ~ Daily Use single pump (Medela Swing) Occasional use ~ Single Electric OR Manual Pump A higher grade pump can always be used instead of lower grade pumps. Consider cost, the length of time you expect to breastfeed or express milk, and how much time you will have to pump.

5. benefits: pump both breasts at once portable easy to use quiet These types of pumps can completely replace baby at the breast. These pumps can be purchased but can be over $1,000.00. The best pumps to use if your baby doesn’t nurse well, if you will be pump-ing regularly before baby is 6 weeks old, or if you will be breastfeeding less than 50% of feedings. Another thing to consider is how long you are planning to breastfeed or express breastmilk. If your goal is 6 months or less renting is the way to go.

6. Quiet Super portable Can run on batteries or vehicle adapters Pumps, stores, and transports all in one Lots of room in bag Automatic cycling Preferred Brands Pump in Style Advanced Freestyle (Hands-Free) Purely Yours Ultra Other brands: Playtex Embrace Avent Isis Duo The First Years This is the right kind of pump to use if you will be feeding at breast 50% of the time!

7. Medela pumps are found in Target and Babies R Us. Save some money and check out New Beginnings Boutique @ Banner Del E. Webb. Ameda owned by Evenflo can be harder to find. Try Burlington Coat Factory, Wal-Mart (Lansinoh label) – or New Beginnings Boutique. Ameda Elite Ameda Purely Yours Ultra Medela Symphony Plus Medela Pump in Style Advanced Medela Freestyle The bottom line is that these pumps work! And, you get a one year warranty to protect your purchase.

8. Start pumping at about 2 weeks postpartum. Pump 2-4 ounces a day above what the baby will eat, usually moms find first thing in the morning is a good time to pump. You can pump while you feed baby or pump after baby’s morning feed. Practice double pumping so you will be a pro when you go back to work. Use different settings on your pump to find what works best for you. Many better brands offer custom breast- shields for a comfortable and efficient fit.

9. Single Deluxe by Medela This pump is single sided, it pumps one breast at a time. The pump runs off of batteries or AC. Great for road trips taken with baby. Harmony by Medela A one handed manual pump. It has as two expression phases due to swivel handle. Comes with soft flange. Double Select by Medela This pump is a double pump but it pumps each side alternately. It only has a 90 day warranty. ISIS by Avent A one handed manual that has a special cushion insert to stimulate let-down. Works with Avent bottles.

10. Milk storage guidelines R oom temperature (up to 77°F or 25°C) for 6 to 8 hours . Temperatures greater than 77°F (25°C) may not be safe for room temperature storage. R efrigerated (39°F or 4°C) for up to 5 days . Store milk in the back of the main body of the refrigerator, where the temperature is the coolest. F reezer with separate door from refrigerator (0°F or −18°C): 3 to 6 months C hest or upright manual defrost deep freezer that is opened infrequently and maintains (−4°F or −20°C): 6 to 12 months Source: Academy of Breastfeeding Medicine Protocol #8

11. Thaw milk overnight in the refrigerator, or hold the bottle under warm running water to quickly thaw. You can also place the sealed container in a bowl of warm water for 20 minutes to bring it to body temperature. Thawed milk is safe in the refrigerator for 24 hours. Do not refreeze. Frozen milk that tastes or smells bad may be high in the enzyme Lipase. You can scald milk before freezing if needed. Completely handle a test batch before you start filling up the freezer. CAUTION: Don’t use microwave to heat or scald breastmilk - it could cause hot spots and destroy anti-bodies

12. It is normal for pumped milk to vary in color, consistency and scent depending on your diet. Stored milk separates into layers. The cream will rise to the top. Gently swirl the warmed bottle to mix the milk layers. You can continue to add small amounts of cooled breastmilk to the same refrigerated container throughout the day. Do not add warm milk to already cooled milk. Freeze milk in 2 to 5 oz portions. Small amounts will thaw more quickly. You will waste less milk this way and will avoid over-feeding. Liquids expand when frozen. Be sure to leave some extra room at the top of the container so the bottle or bag won’t burst. If you do not plan to use the milk within a few days, freeze it right away in the coldest section of your freezer. Do not place the bottle or bag up against the wall of the freezer.

13. Store your milk in containers made of glass or BPA free plastic, or in milk storage bags made specially for breast milk. Always label the container with the date. Use milk on a first in first out basis.

14. Before you go on leave meet with your supervisor and outline your needs when you return to work. A private place to pump, with a lock, sink, and electric outlet. Let your supervisor know that you will arrange pumping around your work obligations. Educate her about why your baby needs your milk and how pumping will benefit your employer. Breastfeeding = Healthier baby Healthier Baby = Less time off work Healthier Baby = Lower health care costs Less time off = Greater productivity

15. Try to go back to work in the middle of the work week. This will give you chance to experience the new routine – without actually being responsible for a full work week. Working a partial week will ease the emotional transition for you and baby. Indulge when you are with baby to make breastfeeding a priority. Relax, bathe, and keep your sleeping baby close at hand for lots of catch-up nursing. Call your lactation consultant right away if you are having trouble draining your breasts or using your pump. Keep a picture of baby handy to look at while pumping.

16. Pump first thing in the morning before baby wakes up - then get ready for work, feed baby and off you go. Pump as soon after work as you can especially if you didn’t get to pump after lunch. Baby will be happy with the leftovers from the tap! Plan your day to allow for one pumping before lunch. One at lunch, and if possible one after lunch. Feed baby for the rest of evening and at least once at night. Now you have fed or pumped at least 8 times in 24 hrs

17. Bring baby into bed for some dosing and nursing before you get up in morning. Get ready for work. Feed one more time as you drop off baby at caregiver. Pump at lunch drain well at least 15 mins. Pump when you get home drain well. OK to feed baby after. Feed baby rest of evening including at least one night feeding. If baby sleeps through night, pump right before you go to bed.

18. Be consistent with pumping schedule Pump frequently for less time Make up for skipped pumpings by clustering them for rest of day Have baby brought to you for feeding Look into onsite daycare options Delay your return to work Have an established milk supply

19. Use wide base silicone nipples on bottles. Vented bottles help milk flow to baby without fighting bottle vacuum. Use smaller bottles 5 ounces or so to prevent waste. Pump into feeding bottle to save time and money. Many moms can pump 2-5 ounces per session, a combined amount from both breasts. Baby may take 10 to 17 ounces while mom is at work. Use the slowest flow bottle nipple that baby will tolerate to prolong feeding, prevent overfeeding, and give greater sucking satisfaction

20. Redouble your pumping effort Add extra pumping time even if you don’t get more milk at first May take 3 days or so to see benefits Herbal supplements Fenugreek alone More Milk Plus herb blend Lactaflow herbal blend Lactogenic foods Whole grains: oats, barley Homemade Chicken Soup – bone in Lactation teas Empty the breasts effectively –try larger flanges sizes FIL – Feedback Inhibitor of Lactation – shuts down production during fullness. Storage capacity of breast varies some may need to pump more frequently. Stimulation keeps hormone levels high Hands free devices make pumping more convenient Massage breasts before pumping Lean forward, let gravity help

21. Sometimes pumping creates condensation in the breastpump tubing Run your pump with tubing attached and tubing will dry out Tubing rarely needs to be cleaned but do inspect weekly - don’t store in plastic bag. Valves and membranes are the parts that create suction Clean them carefully to ensure maximum suction Refrigerate pump parts during work day to save clean up time.

22. Microwave steam bags allow you to sterilize collection parts. Chemical wipes allow you to clean parts after use when water is not available. Air dry before next use.

23. Keep one pump at work, one at home. Keep an extra collection set at work. Use rechargeable batteries whenever possible. Regular batteries can fade in performance before they die. Keep an extra set handy if you rely on batteries to pump. Don’t wrap cord around transformer plug. Thin wires can break when pulled tightly. Always have a backup plan: alternate pumping place, manual pump attachment, vehicle adapter.

24. Practical advice and encouragement Inspiration for your journey Nursing Mother, Working Mother (rev. 2007-Pryor) The Breastfeeding Mother's Guide to Making More Milk (West) New Beginnings Magazine (LLLI ) free with one year membership Hirkani's Daughters (Hicks) The Milk Memos (Colburn-Smith) Working Without Weaning (Berggren)

25. http://www.breastfeeding.com/directory/states/arizona.html http://www.ilca.org/i4a/pages/index.cfm?pageid=3337 ADHS Pregnancy and Breastfeeding Hotline: 1-800-833-4642 LLL of AZ: 602-234-1956 WIC (peer support, breastpumps, and extra nutrition for nursing moms): 1-800-252-5942 Find an Internationally Board Certified Lactation Consultant at ILCA.ORG