Milk Matters: An Article Series by Angela E. Swieter
# 1: The Final Answers for the Reasons to Breastfeed
“Why breastfeed? Doesn’t it take more time? How can I ever go anywhere?
I will have to do it all and dad won’t be involved.” These are common “million dollar” questions and concerns for our new moms regarding the decision to breastfeed. Educating moms on the benefits of breastfeeding is crucial in order to allow them to make an informed decision. When mom asks you why she might consider breastfeeding you can give her the following evidenced based information. These are the FINAL ANSWERS………
Why is it best for baby?
Species specificity: Breastmilk is specific for the needs of the baby, just like other mammals’ milk is specific to their offspring. THE FINAL ANSWER IS: “Your breastmilk is made specifically for your baby."
Nutritional benefits: The unique composition of breastmilk provides ideal nutrients for growth, especially for brain growth in the first year. Digestion and absorption of this milk is highly efficient. Many more nutrients in breastmilk can be absorbed compared with the formula fed infant. Only a small amount of nutrients in formula can be absorbed. Two examples are taurine and epidermal growth factor which are not found in formula but are found in breastmilk and are essential elements for the infant. THE FINAL ANSWER IS: “Your breastmilk is easily used by your baby, giving him all the nutrients he needs for normal growth and for the best brain growth.”
Infection protection: Leukocytes, specific antibodies and other antimicrobial factors in breastmilk protect the baby against many common infections. This includes GI infections, upper and lower respiratory infections, and urinary infections. Lactoferrin in the breastmilk binds iron so that E. Coli, which depends on iron for growth, is unable to grow. THE FINAL ANSWER IS: “Your baby will have less infections/illnesses due to the protection your milk provides.”
Immunologic protection: Epidemiologic studies have shown a reduced incidence of childhood lymphoma, childhood-onset insulin dependent diabetes and Crohn’s disease in babies who have been exclusively breastfed for at least four months. THE FINAL ANSWER IS: “Your baby will have less chance of lymphoma, diabetes, and Crohn’s.”
Allergy prophylaxis: Breastfed infants who are at risk for eczema and asthma show a reduced incidence and severity of symptoms in their early lives. Some studies suggest the protective effect may continue through childhood. THE FINAL ANSWER IS: “Your breastmilk provides allergy protection.”
Psychological and cognitive benefits: Research shows that children who are breastfed or premature babies who receive pumped milk via tube feeding advance more developmentally. This suggests that breastmilk has a significant impact on the growth of the central nervous system. Other studies show that childhood cognitive and educational achievement is increased. At age 18 these babies score higher on IQ tests. They are observed as children who are more mature, secure, and assertive. THE FINAL ANSWER IS: “Breastfeeding your baby has proven to result in more secure children with higher IQs.”
Other findings now being studied: Studies are being done that show less childhood obesity, less orthodontic needs, and less colic. Breastmilk is produced by supply and demand so the baby controls the amount of milk mom makes. The supply will increase during times of growth spurts (due to more frequent nursing) and drops back off during normal growing times. Mom’s natural, soft nipple does not alter the shape of the oral cavity and thus does not contribute to the need for orthodontic assistance. Since breastmilk is easily digested and species specific it causes very little gastro upset and therefore less gas and colic. THE FINAL ANSWER IS: “There are other benefits of breastfeeding that include less chance of childhood obesity, decreasing the need for orthodontic work, and a calmer, less fussy baby.”
Why is it best for mom?
Postpartum recovery: Women who breastfeed will return to their prepregnancy state more quickly. They also have a lower incidence of obesity in later life. The uterus contacts/involutes when oxytocin is released with the nipple stimulation caused by the baby’s suckling. This will decrease the chance of heavy bleeding during the early postpartum period. The uterus returns to it’s prepregnant state more quickly. Five hundred extra calories are burned each day while breastfeeding. Breastfeeding moms find that they can eat generous amounts of food and still loose their pregnancy weight. THE FINAL ANSWER IS: “Your body (and uterus) will return to the prepregnant state much faster and you feel good about yourself.”
Empowerment: The relationship of a mom with her nursing baby is considered to be the strongest of human bonds. Providing her baby total nutrition and nurturing him/her creates a more profound and psychological experience than carrying the baby in utero. Studies show that women who breastfeed develop positive self esteem and assertiveness, become more outgoing, and interact more with their babies. THE FINAL ANSWER IS: “Breastfeeding empowers you to do something special for your baby.”
Decreased risk of osteoporosis: Serum calcium and phosphorus concentrations are greater in breastfeeding moms. Breastfeeding stimulates the greatest increase in fractional calcium absorption and serum calcitriol after weaning. These four components are responsible for strong healthy bones. THE FINAL ANSWER IS: “The risk of osteoporosis in later life is less likely for you if you breastfeed.”
Protection against breast and ovarian cancer: In countries where breastfeeding is common the incidence of breast cancer is uncommon. Breastfeeding normally suppresses ovulation for 4-6 months or longer. Studies show that decreasing the number of cycles decreases estrogen levels during that time. The more unopposed estrogen time a woman has the more protection she will have from breast and ovarian cancer. THE FINAL ANSWER IS: “Breastfeeding lowers your risk of breast and ovarian cancer.”
Intimacy: Breastfeeding provides mom and baby with body contact and is a source of comfort, security, and warmth. THE FINAL ANSWER IS: “Breastfeeding is a beautiful and intimate way for you to bond with your baby”.
Other FINAL ANSWERS: “It is economical-No cost; it’s free! It is also convenient- always warm and ready to go! No bottles and nipples, to wash, no formula to mix, and no mess.”
Breastfeeding can make your moms feel like a “millionaire!” These are the correct million dollar FINAL ANSWERS for you to give as you encourage your moms to breastfeed their babies.
#2: Engorgement, It Happens/Mastitis, A Pain
Engorgement, It Happens
It is normal for moms’ breasts to become heavier, larger, and tender when greater quantities of milk are being produced. This usually happens between the second to sixth days after birth. The cause is not only an increase in the volume of milk, but is also due to extra blood and lymph fluids which travel to the breasts to prepare them for producing milk. Some moms will develop painful engorgement and will require comfort measures to relieve their discomfort.
The symptoms of engorgement, which affects both breasts, are swelling, tenderness, warmth, redness, throbbing pain, low grade fever and flattening of the nipple. Moms may complain that their breasts feel “hard” or that the “skin feels stretched tight.” They may also complain that the areola is hard and the nipple doesn’t evert much. These symptoms generally happen as the milk is coming in, between day two to day six.
The number one treatment for engorgement is for the baby to breastfeed frequently (eight to twelve times a day). A mom whose baby nurses unrestrictedly and often will have much less chance of painful engorgement. However, even when babies do nurse long and often we still occasionally see moms who will encounter painful engorgement.
If the breasts are too full for the baby to latch, moms should pump or hand express some milk. Moms should be taught how to hand express their milk prior to discharge from the hospital. Hand expression is done by first massaging the breast to help release oxytocin and therefore stimulate the milk ejection reflex. Next the mom should cup her hand around the breast with the thumb on top of the breast just above the areola and her fingers on the underside. She then puts pressure back against her chest wall and rolls her fingers and thumb toward the nipple. This can be done until the nipple and areola soften some and therefore will allow for an easier, more comfortable latch.
Massaging the breasts before the feeding and during the feeding will assist with let down and therefore the removal of milk. If the breasts become too uncomfortable between feedings, moms can pump for comfort. This is best done either right after a feeding for comfort or right before the feeding if mom is too full and tight. Ice packs (frozen bags of peas or corn work great) applied to the breasts after feeding (or pumping) will help reduce swelling. Another plan would be to put ice on the breasts and pump every 2 hours until the milk flow starts and mom becomes more comfortable. Motrin 400 mg., an anti-inflammatory taken every 4-6 hours also helps with the discomfort.
The old home remedy of cabbage leaves applied to the breasts gives many moms relief. This should not be recommended to moms who are allergic to sulfa. (see side margin, this page)
What If Engorgement Goes Untreated?
Complications such as poor feeding, and slow weight gain may be the results of a poor latch due to engorgement. Mom can easily develop sore nipples when the baby is unable to latch due to an areola that is too firm with milk. If untreated, the risk of mastitis is greater because the milk is not allowed to flow out of the breast and therefore causes pressure and back flow. Damage can also be done to the milk-producing cells when the pressure of engorgement is not relieved. This can be severe enough to ultimately decrease the mom’s milk supply.
The Good News
When engorgement is treated properly breastfeeding success is very likely. Remind moms: it will last no more than 48 hours.
~Mastitis, A Real Pain
When moms complain of a sudden localized painful, red, hot, swollen breast accompanied often times with flu-like symptoms (aches, chills, and headache) and a temperature over 101 she is likely experiencing a breast infection called mastitis. This usually affects only one breast.
How Does It Happen?
Mastitis can be the result of an open area on the nipple or areola that has become infected or has allowed an entry for infection. By cleansing an open area with the Dreft soak and then applying antibiotic ointment (as described in a previous newsletter) the possibilities of mastitis can be reduced significantly.
Another cause can be that the breast is overfull and the milk flow is then restricted. This restriction causes the milk to leak into the surrounding tissue and can trigger inflammation. This can happen if the mom is limiting the time she allows her baby to breastfeed and the breast does not have time to empty. This can also occur when a baby is sleepy and not actively nursing long enough. When a baby begins to sleep through the night or is given supplemental bottles, breastfeeding is not as frequent, which can also attribute to an overfull breast leading to mastitis.
Mastitis is also more likely if a mom is under stress, is fatigued or if her immune system is weak. This usually occurs when the baby is about three weeks old, but can happen at anytime. We often see mastitis during the holidays or around special family events. This is most likely due to more stress, less sleep, and/or not breastfeeding as frequently as usual.
Frequent breastfeeding is the best thing mom can do. This helps to empty the breast and decreases the risk of an abscess developing. If mom is pumping it is important for her to continue pumping. Heat and massage while nursing helps with the let down of milk and feels good to the mom. I have suggested using a crock pot on low with water and several washcloths in it. Mom can wring washcloths out and apply them to the breast while massaging the breast before and during feeding if desired.
Moms need to rest if they suspect they may be developing mastitis. If diagnosed they need to continue to rest often during the day. Drinking plenty of fluids-at least eight glasses of water a day- is another way to encourage the healing process.
Over the counter medications such as Motrin help with the discomfort and swelling associated with mastitis. Motrin 400 mg is often taken every four to six hours the first couple days.
Mastitis quickly needs to be treated with antibiotics especially if the symptoms do not improve and/or the mom is acutely ill. Most antibiotics are safe to take while breastfeeding. Usually, moms find that after they have been taking the antibiotics for 24 hours they begin to feel much better. If, after 48 hours, the mom is not feeling better she needs to call her health care provider. It is possible that the organism causing her mastitis is resistant to the medication she is currently taking.
Moms who have had mastitis want to do everything they can to prevent it from reoccurring. This can be done by having the mom check her breasts daily for any firm areas. If the baby leaves milk in the breasts after feeding she may want to empty them by following one or two feedings each day with a pumping. Moms should also continue to assess their nipples daily and treat any breakdown. It is also important that she get plenty of rest, drink plenty of fluids, and decrease stress. Continuing to take prenatal vitamins and having a medical check-up to insure overall health is recommended. Some moms will also take extra vitamin C and E to combat infections.
More Good News
Babies can continue to nurse through mastitis treatment. Breastfeeding can continue for as long as the mom and baby desire.
#3: Keeping Babies From “Falling Through the Cracks”
The number of babies born between the 34th through 37th week of life has increased. Even though they are not normally considered premature, they are not fully mature either. These are the babies that might “fall through the cracks”. They are not pre-term enough to be admitted to the Neonatal Intensive Care Unit and they also are not of the usual gestational age (38-40 weeks) common to the normal nursery. The term for this specific group of newborns is: Near Term Infants. “Near-termers,” as we often will call them, are usually stable enough to remain in the regular nursery but are at risk for complications. They lack the storage of glucose and the extra brown fat that is normal for the full term baby and therefore may show evidence of low blood sugars. Low blood sugars can lead to a poor energy level, which is likely to result in poor feedings. This will possibly cause a poor weight gain and an increase in bilirubin/jaundice. Because of these multiple issues, it is imperative that a feeding protocol for these breastfeeding infants be followed. The overall goal is to reduce possible complications and to protect their breastfeeding experience.
Parents should be encouraged to keep their baby in the room with them and feed the baby every 2-3 hours. Supplementation should also be done according to the baby’s age and weight. Moms will need to pump their breasts after each feeding to ensure good stimulation and milk production along with providing the supplement for the baby. A breast pump for home will be necessary. A feeding and diaper log worksheet should be sent home with the parents for tracking intake and output. Follow-up care during the first few weeks is vital if the mom and baby are to have a positive breastfeeding experience.
Rooming In and Feeding Every 2-3 Hours
Parents need to be encouraged to keep their baby with them in the hospital room as much as possible. The noise and lights should be kept low so that the baby is not over-stimulated. It is advisable to put the baby skin to skin with either the mom or the dad. Keeping the baby close enables the parents to observe for feeding cues that will often go unnoticed by staff in the normal nursery. These feeding cues can be as little as the baby turning his/her head or smacking his/her lips. If the baby needs to be taken to the nursery for observation it is important that the baby be returned to the parents’ room as soon as possible. When the baby does show feeding cues he/she needs to be put to breast for breastfeeding. The baby should be fed at least every 2-3 hours.
Near term babies need to be supplemented to ensure a stable blood sugar and weight gain. Supplementation is best if done right at the breast using a SNS (Supplemental Nursing System). A SNS is a volu-feeder with a very small tube. The volu-feeder can be placed low on the mom’s shoulder with the tubing taped so that milk drips out near the end of the mom’s nipple. Supplementing in this manner means that all of the baby’s nutrition comes right at the breast. If this system seems too overwhelming or is unsuccessful then cup feeding or a bottle may be given after the baby has been to breast. The SNS however, should be tried first because near term babies tend to nurse shorter amounts of time and stay more actively feeding if they obtain the immediate reward of milk from their suckling.
The amount of supplement suggested is listed below. These are general guidelines. Supplements can be gradually decreased after the mother’s milk comes in and she begins to feel breast fullness which softens after nursing. These gradual decreases are done best if based on the baby’s weights before and after breastfeedings (done in grams). It is important to track the baby’s output while decreasing the supplementation. The baby must have a continued weight gain of 2/3 -1 ounce per day or 5-7 ounces per week.
Weight Age Amount
4 lbs. 4 oz.-4 lbs. 8 oz. 0-24 hours 5-10 mls. every 3 hours
4 lbs. 8 oz.- 5 lbs. 0-24 hours 5-10 mls. every 3 hours
5 lbs.-6 lbs. 0-24 hours 5-15 mls. every 3 hours
4 lbs. 4 oz..-4 lbs. 8 oz. 24-48 hours 15-20 mls.every 3 hours
4 lbs. 8 oz.- 5 lbs 24-48 hours 20-25 mls.every 3 hours
5 lbs.-6 lbs. 24-48 hours 25-40 mls.every 3 hours
4 lbs. 4 oz..-4 lbs.8 oz. 48 hours and older 20-45 mls. every 3 hours
4 lbs. 8 oz.- 5 lbs 48 hours and older 30-60 mls. every 3 hours
5 lbs.-6 lbs. 48 hours and older 45-60 mls. every 3 hours
6 lbs.-7 lbs. 48 hours and older 60-80 mls. every 3 hours
Pumping After Feedings
Moms are recommended to pump their breasts after each feeding for 15 minutes. The near term baby does not often stimulate the mother the full length of time nor does he/she suckle with as much vigor as a full term infant. Any milk that the mom obtains should be saved at the bedside to be used as part or all of the supplement for the next feeding. This pumped breast milk does not need to be refrigerated if used within 4 hours.
A Breastpump for Home
Currently the Medela pump (the Advanced or Original) is the pump recommended for home use with the near term infant. Most moms will be pumping and doing some supplementing for at least a week or more. Many will continue to use the pump when they return to work. Pumps can also be rented if the insurance will not cover the cost or if the parents do not want to purchase a pump.
Tracking Intake and Output
The parents should be given and feeding and diaper log worksheet so they can keep record of feedings, pumpings, and the baby’s stools and voids. This can be started during the hospital stay so they become familiar with how to use it. The goal at the end of each 24 hour period is to have 8 or more feedings and pumpings. The goal (general guidelines) for the baby’s output is listed below:
Day 1 1-2 wets 1-2 stools (dark)
Day 2 2-3 wets 2-3 stools (dark to greenish brown)
Day 3 3-4 wets 3-4 stools (greenish brown to yellowish)
Day 4 3-4 wets 3-4 stools (greenish brown to yellowish)
Day 5 5-6 wets 4 stools (greenish brown to yellowish)
Day 6 and thereafter 6-8 wets 4 or more stools (greenish brown to yellowish)
Generally, lactation consultants will send all near term babies home with a specific feeding plan based on how the baby has done during his hospital stay. They oten will call the parents the day after discharge to adjust the plan according to the log sheet or mom’s and baby’s needs. Further follow-up calls are uaully made on an as needed basis.
Some insurance companies will cover a home visit for a near term baby and this is strongly suggested. Physicians are normally following these babies in the office for weight check within 2-3 days after discharge and then again if needed before their 2 week routine visit. Moms should also be encouraged to attend a support group so pre-breastfeeding and post-breastfeeding weights can be done to assist in the revision of the feeding plan.
Using the above plan will reduce the number of near term infants that are readmitted for poor feedings, weight loss, hyperbilirubemia, and failure to thrive. The plan will also promote adequate nutritional intake for the baby while protecting the mother’s milk supply. Most importantly, by keeping these babies from “falling through the cracks” we will promote a positive and enjoyable breastfeeding experience for the breastfeeding family.
#4 Ouch!!! Sore Nipples!!! Now What????
It’s uncomfortable to have sore nipples! Some moms give up breastfeeding because they say, “It hurts too much!” It is our goal to keep babies on the “milk that matters.” We need to know how to prevent this and if moms do get sore nipples we need to know the treatment.
It is important to observe moms and nursing babies in the hospital to ensure the baby is latched on properly and is not tongue-tied. Next we need to assess for any treatment needed for the nipples. Correcting the latch even if the baby is tongue-tied may be all we need to do. But generally we use some type of treatment. The question is which option for treatment do we want to use? Do we want to use expressed breastmilk, PureLan, shells, comfortgels, a soak and antibiotic application, or pump and bottle feed until mom heals?
Check the Latch
This is a must for all nursing babies. Most sore nipples are a result of an improper latch. It is important to look at mom’s anatomy before latching to see that the nipple is everted before latch attempt. You can assist with this by having mom gently roll her nipple between her thumb and index finger. Make sure the baby’s mouth is wide open and the tongue down and out beyond the gum line before even trying the latch. A mouth that is not wide open will cause a pinching feeling for mom and will result in a sore nipple. We often see a positional stripe on the nipple when this type of sucking has occurred. The tongue that is not down and out will cause the lower gum to rub on the underside of mom’s nipple which will cause soreness. Once the baby is latched, look for flared “fishy lips.” If a lip is sucked in, gently pull it out while the baby is nursing. If you pull on the bottom lip you should be able to see the tongue on the top of the baby’s lower gums. If the latch looks good and mom is uncomfortable, wait about 30 seconds to see if the discomfort goes away-initial discomfort with latch-on is normal the first few days of breastfeeding. When the baby comes off the breast you should again assess the nipple. Look for a pinch line or blanching which would indicate an improper latch. With a good deep latch moms will feel a tug or pulling feeling. When the baby comes off the breast the nipple will look round or slightly oval shaped, which quickly returns to a round shape.
Check for Tongue-tie
A short frenulum, known as tongue-tie, may sometimes cause breastfeeding problems. When a baby is tongue tied the tongue is often unable to extend far enough to properly cup the breast. When the tongue can not extend over the lower gum the breast may be compressed between the gums during feedings which may cause nipple trauma. If you notice this potential problem with a baby, work on a deeper latch and have the baby’s doctor assess the situation. Approximately 25% of these babies may need a frenulum clipping to breastfeed well without causing undue maternal nipple trauma, poor milk transfer, and failure to gain.
Expressed Milk Application
Applying a small amount of breastmilk or colostrum on the nipple after breastfeeding helps with soreness. The mom’s milk has antibacterial properties and studies have shown that women who used this method had significantly shorter duration of cracked nipples. The best conditioner for nipples is mom’s own milk!
PureLan, which is provided for each mom, can be applied after mom has allowed her expressed breastmilk to dry on the nipple. This hypoallergenic, 100% lanolin cream is safe for baby and mom and helps maintain a moisture barrier. Current studies now show that moist wounds heal 50% faster then the old treatment of drying the nipple with a hair dryer to keep the nipples dry. PureLan should be used in small amounts to prevent the baby from sliding off the nipple and does not need to be washed off before feeding the baby.
Using breast shells to keep the nipple from being pressed by the bra can be helpful after expressed milk/PureLan has been applied. Make sure to use the large nipple opening and place in a bra cup that is large enough to accommodate the shells. Too small of a cup can be uncomfortable for mom and could cause undue pressure on mom’s breasts attributing to plugged ducts or a breast infection.
Comfortgels/soothies are another way to promote healing. Many moms seem to prefer them cooled in the refrigerator before application. These can be used after the breastmilk has dried on the breast but should not be used after PureLan has been applied. When taken off between feedings they should be kept in a Ziploc bag or the ComfortGel carrier sheet to retain moisture. They should be rinsed with water before each application. They generally will need to be replaced in 4-6 days.
Proper Daily Cleansing of Nipples
Moms need to avoid using a washcloth or soap directly on the breast nipple but should instead let her shampoo water flow over her breast. Rubbing the nipples can remove cells which are trying to heal. Soaps can remove the perfect lubrication and antibacterial properties provided by the Montgomery glands which surround the nipple on the areola.
Soak and Apply Antibiotic Ointment
Although soaps are not normally recommended, because they can dry out the nipples, soaking in a mild soap is recommended for broken nipple skin. This cleansing treatment is soothing and may help prevent an infection or mastitis. After the soak, a prescribed or an over-the-counter antibiotic can be applied. This should be done right after a baby’s feeding once to twice daily. Currently I am recommending a couple drops of Dreft soap (a mild baby laundry soap) in a bowl of warm water. The water will not be sudsy but just slippery when you rub your fingers together in the water. The mom would then lean over the bowl to soak the nipple for 5–10 minutes followed by a gentle rinse of warm water. After air drying, a topical antibiotic is applied.
Pump to heal
When the above treatments do not seem to be working the mom may want to pump her breasts on a medium to low suction, allowing her nipples time to heal without loosing her milk supply. Twenty-four to forty-eight hours of pumping, instead of nursing, may be needed for the nipples to heal.
Other comfort measures can be given to mom. Suggest that she avoid tight bras and bras that have a seam over the nipple area. It is also good to avoid bras and breast pads with plastic liners or synthetic fabrics. Remind mom to break the suction by inserting her finger into the baby’s mouth before taking the baby off the breast. If she is doing any pumping, make sure her flanges are the correct size.
The Reminder That Matters
Of utmost importance is that we assure our mothers that their nipples will heal and they can continue to enjoy the benefits of breastfeeding for months. Keeping our babies on “the milk that matters” is top priority!
#5 Employment and Breastfeeding: A Combination That Works
Moms can continue to breastfeed even if they are separated from their baby due to work, school, or any other outside commitment. It is important that we help them come up with a pumping/feeding plan while they are away. To maintain a good milk supply and avoid overfull breasts moms should plan to express their milk or breastfeed the baby every few hours. When setting up a plan for moms who desire to go back to work the following items are very important: establish a good breastfeeding relationship, introduce the bottle, start building a reserve supply, have a trial run at home, return to work in the middle of the first week back, breastfeed at daycare drop-off and pick-up, and revise the pumping plan as the needs change, or if mom is unable to pump at work.
Establish a Good Breastfeeding Relationship
Moms should solely nurse for the first 3-4 weeks to establish a good milk supply and a strong mother-baby relationship. The baby stimulates her supply and also learns the proper suckling at the breast. Everyone gets in step with the dance!
Introduce The Bottle
Babies need to be introduced to a bottle between 3-5 weeks of age. This usually needs to be done by someone other than the mom. Sometimes babies will even refuse if the mother is close by, desiring to have what he is used to and to be where he feels most secure. Once the bottle is introduced the baby should be offered a bottle 2-3 times a week until the mom starts back to work. This reassures the mother that the baby can take the bottle and keeps the baby accustomed to this type of feeding.
Start Building a Reserve Supply
About 2-4 weeks before the mom goes back to work she should be encouraged to start building a supply of her pumped breastmilk. Some moms like to pump in the morning when they feel their milk supply is greatest. The baby can nurse one side while the mom pumps the other. Another option is to pump after several feedings during the day and combine the small amounts of individually cooled milk at the end of the day.
Have a Trial Run at Home
Inviting a family member or friend into the home for a mock “mom has gone to work” day is often times very encouraging and comforting for the new mom. The family member/friend acts as the day care provider while the mom nurses “before work”, pumps “during work” (at the times she would be able to pump on the job), and then nurses “after work”. While she is doing this at home, her “day care provider” is feeding the baby bottles of pumped milk. This trial run is a way that mom can observe and experience the baby taking bottles throughout the day and mimic the actual pumping routine she plans to use for work.
Start Work in the Middle of the Week the First Week
Going back to work in the middle of the week allows mom to adjust to being away from her baby and begin her pumping and daycare routine. Two or three days the first week eases the mother into her new role as a working and breastfeeding mom. This is much easier than working a full week and gives the mom confidence for the following week when she will work five days.
Breastfeeding at Daycare
Breastfeeding the baby right before mom leaves the daycare will help satisfy the baby and limit the amount of milk mom needs to express at work. The daycare should be asked to not feed the baby 1-2 hours before her planned return so the baby is ready to eat when mom arrives.
Revise the Pumping Plan as the Needs Change
Ideally, moms who work an 8 hour day should pump 3 times a day. This amount of pumping is likely to be the same number of times the baby feeds at daycare. The demand for milk is made so the supply will continue to meet the baby’s feeding requirements.
If Unable to Pump at Work
Occasionally, moms are not able to pump three times a day. If this is the case, about 2 weeks before going back to work the mother should drop 1 feeding during the day. She will then need to introduce a substitute. She should allow 3-5 days before dropping another breastfeeding so that her milk supply has a chance to adjust. Dropping these feedings will help her supply adjust to only 1 pumping in 8 hours. Moms will be most comfortable if they can pump at least once while at work, in the middle of the day, if possible.
Babies can continue to breastfeed when the mom is with the baby and can take bottles of previously pumped milk or formula when at the daycare. Even though the baby may not be getting all breastmilk, we know that any breastmilk is always better than none. Baby will continue to receive the antibodies and immunities through the breastmilk and the mom and baby continue the bonding and intimate relationship of nursing.
We want to encourage mothers to pump breastmilk for their babies once they return to work. Remember, it is important for mom to establish a good milk supply for a few weeks and then introduce a bottle. She can begin building a supply of breastmik in her freezer a few weeks before going back to work. A trial run at home before mom starts back to work midweek will help her to gain confidence in her ability to continue breastfeeding while working outside the home. A day care who will allow mom to feed right before going to work and upon returning is encouraged. By talking through her work schedule a plan can be devised to meet both the mom and the baby’s needs.
#6 BREASTFEEDING CHECKPOINT: Check Your Breastfeeding Knowledge
What did you retain from the Milk Matters newsletters?
Fact or Myth (from “The Final Answers for the Reasons to Breastfeed”)
1. Breastfeeding excludes fathers.
2. Breastmilk provides immunity for the baby.
3. Babies can not do both breast and bottle.
4. Breastfeeding hurts.
5. Breastfeeding is an intimate and bonding experience for the mom and baby.
6. Spicy food should be eliminated while breastfeeding.
7. Breastfeeding will cause droopy breasts.
8. Breastfeeding reduces SIDS.
9. “I can not make enough milk.”
10. Breastfeeding reduces allergies, childhood obesity, dental needs, and infections.
11. Breastfeed babies have a higher IQ.
12. The American Academy of Pediatrics recommends breastmilk and/or formula for 12 months.
True or False (from “Ouch!!! Sore Nipples!!! Now What????”)
1. The easiest and first treatment for sore nipples is PureLan crème.
2. Comfortgels must be refrigerated.
3. The most likely reason for sore nipples is poor latch.
4. Moms can pump for a short time to heal and then put the baby back to breast.
5. Soaking cracked or bleeding nipples in very light Dreft warm water solution will clean and soften the nipple and promote healing.
Mastitis or Engorgement (from “Engorgement, It Happens/Mastitis, A Real Pain”)
1. Affects both breasts
2. Mom feels very sick
3. Requires antibiotics
4. Slight fever
5. Apply heat
6. Apply ice
7. Usually lasts 24-48 hours
Near Term fill in the blanks (from “Keeping Babies From ‘Falling Through the Cracks’ ”)
1. Near term babies are born between the______ and ______ gestational weeks.
2. Near term babies need to be fed every _____ to _______ hours.
3. It is important to keep the lights and noise ________.
4. It is recommended that the mom pump after feedings for ____ minutes.
5. Pumped milk should be _________________.
6. Pumped milk must be refrigerated after ______ hours if not used.
7. The best way to supplement a near term baby is by using a ___ ____ ______.
8. Each day the amount of supplement for the near term baby will __________.
9. All babies that are near term will be discharged with a _________ __________.
Fill in the correct numbers (from Employment and Breastfeeding: A Combination That Works
1. Mom should solely breastfeed ___ to ____ weeks to establish a good milk supply.
2. Introduce a bottle at ___ weeks of age.
3. Offer the bottle ___ to ____ times a week.
4. The mother should start building a supply of milk about ____to ____ weeks before returning to work.
5. Working _____ or ____ days the first week eases the mother into her new role as a working and breastfeeding mom.
6. Ideally a mom should pump ____ times during an 8 hours work day.
7. The daycare should be asked to not feed the baby ____ to ____ hours before mom’s planned return so the baby is ready to eat when she arrives.
8. Moms will be most comfortable if they can pump at least ____ time while at work, in the middle of the day, if possible.
Fact or Myth
True or False
Mastitis or Engorgement
Near Term Fill in the Blanks
1. 34 37
2. 2 3
5. saved and given to the baby
7. Supplemental Nursing System (SNS)
9. feeding plan
Fill in the Correct Number
1. three four
2. three five
3. two three
4. two four
5. two three
7. one two