There are three critical components necessary for successfully maintaining milk supply when re-entering the workforce or returning to school:
• a high quality breastpump that removes milk quickly and effectively
• a place to use a breastpump at work/school that is clean, private, and with access to electricity, if needed
• time to use a breastpump at work/school at least every 3 hours
Selecting a Breast Pump
When assessing the performance criteria of a breastpump, the breastfeeding baby should set the standard. When a baby nurses he creates approximately 200-250 millimeters Hg negative pressure and sucks approximately once every second (45-55 times/minute).
Breastpump suction pressures range from 20-650 mm Hg negative pressure. Pressures above the high 200s often cause pain. Pressures below 150 are reported to be ineffective at extracting milk. A breastpump that is similar to a nursing baby creates 200-230 mm Hg negative pressure and cycles about once every second. Two Medela pumps meet both criteria for suction pressure and cycles (sucks) per minute: the Lactina and the Pump In Style. Both of these pumps are also designed for frequent, long term use and their simultaneous double pumping action may help maintain milk supply more effectively.
If only working or taking classes part-time - less than 4 hours a day or 2 eight-hour work/school days - the Medela Mini Electric or Avent Isis are other options. Although these pumps do not meet both criteria for perfomance, they are still acceptable when used in this limited and short-term fashion.
When choosing a breastpump, you should consider where at work/school you will be using it. Will you have access to an electrical outlet? If not, does the pump convert to battery operation or can it be used in your car? Both the Lactina and the Pump In Style are electrically operable and can also be powered by a vehicle lighter adaptor or battery pack. The Mini Electric can be powered with an AC adaptor, 2 AA batteries, or manually. The Avent Isis pump can be operated manually without the need for additional power sources or worry about wear and tear on motor parts.
Breastpumping in the Weeks Prior to Your Return to Work/School
During the time after your baby is born and before you return to the workplace or classroom, your primary goal will be to establish your supply. This is best done through frequent day and night feedings and the avoidance or limitation of supplemental bottles. (See "Breast, Babies and Schedules" for more on this).
Also during this time you will want to select or purchase your breastpump. This will allow you time to become familiar with the operation and cleaning of your pump, enabling you to determine if you need extra parts, etc. and to remedy any pumping problems.
This is also a good time to begin stockpiling your milk reserve and introducing your baby to an alternative feeding method, usually a bottle. Be advised that you will want to avoid bottles unless medically indicated for at least 4 weeks if possible in order to lessen the risk of nipple confusion Plan to pump milk to stockpile whenever the opportunity arises:
• In the early days when the milk supply may be more than the baby needs, often referred to as the engorgement period.
• On the other breast when the baby only takes one side.
• A few minutes (5-10) after feedings.
• In the morning hours when milk supply is most plentiful.
When pumping during these days, expect to only be able to pump small amounts as your body adjusts to a different type of stimulation and while your baby is nursing frequently throughout the day and night. You may have to pump several times in order to acquire the amount needed for one bottle. Once you return to work or school, however, and begin missing feedings regularly, you will be able to pump greater amounts.
To determine how much milk to leave for your baby, take your baby's weight in pounds and multiply that number by 2.5-3. Now divide the new number by 8. The answer is the approximate amount of milk in ounces, per every 3 hour feeding, that your baby will need while you are at work or school. (See more on storage and handling of breastmilk here.)
Managing Breastpumping in the Work or School Setting
• Frequency of pumping: Ideally you should plan to pump at least 3 times during an 8 hour work/school day, 2 times during a 6 hour day, and at least once during a 4 hour day. If pumping opportunities are extremely limited, brief pumping sessions of 5 minutes are better than no pumping. If there is no pumping for prolonged periods; ie. 8-9 hours or more, expect milk supply to drop. Supply can be increased through frequent nighttime and weekend (days off) nursing sessions. See "How Can I Increase My Supply?" for more tips.
Some mothers resort to reverse cycle feeding if pumping is not an option at work. This is simply feeding your baby at least as frequently during the night hours as he would normally feed during the day. It is made easier by bringing the baby to bed with you so that you can obtain the rest that you need.
• Possible locations for pumping: a women's restroom, lounge, locker room, or break room, an unused conference room or office, an employee health office, your vehicle, or a designated employee breastpumping room. Wherever you decide to pump, make sure that you have access to electricity (if needed for pump operation), the location is private and comfortable (not too hot or too cold; comfortable place to sit), and there is sufficient cleanliness for collecting milk. If using a public restroom wash area to wash pump parts after collecting milk, consider bringing your own wash basin from home in order to maximize hygiene.
Consider doing a "practice run" the week before you return to work/school. Leave the baby with the caregiver and go to your workplace or school a couple of times during the day to pump when you normally will be pumping. This will give you the opportunity to identify any problems; ie. with the pump, location of pumping, whether or not your collection/cleaning/storage options are adequate, and the estimated time required for pumping.
Strategies for Maintaining Milk Supply
The number of breast emptyings (nursing or pumping) per every 24 hours is critical:
• 8 times is optimal
• 7 times is minimal
• 6 times - expect milk supply to decrease
More frequent feedings can be encouraged by increasing skin-to-skin contact and co-sleeping.
Avoid bottles and pacifiers whenever you and baby are together. This will ensure that all the baby's sucking needs are met at the breast and that you receive vital stimulation to maintain your supply.
Minimize any stress in your life and delegate responsibitlies when you can.
Optimize your physical status by going to bed earlier, increasing rest times on off days, getting moderate exercise (increases Prolactin levels which in turn increase milk supply), and consume adequate fluids (many busy moms do not take the time to drink enough, so make it a point to have something nearby that you can sip throughout your work/school day). For more tips on increasing supply, go here.
A Typical Work/School Day for the Breastfeeding Mother
• Set your alarm clock 20-30 minutes early. Nurse your baby during this time even if you have to awaken him.
• Dress yourself and the baby.
• Eat a well-balanced breakfast including something to drink.
• Nurse again before leaving.
• Plan to pump around mid-morning. Have something to drink and a snack.
• Plan to pump again - or nurse if possible - at mid-day/lunchtime. Eat a well-balanced meal with something to drink.
• Plan to pump around mid-afternoon. Have a snack with something to drink.
• Pick up baby after work/school and nurse as soon as you arrive home.
• Eat a well-balanced dinner with adequate fluid.
• Nurse on demand throughout the evening. This is beneficial to increasing your supply and it helps your baby reconnect with you.
• Work in some moderate exercise as this increases the hormone that is responsible for milk production.
• Have a bedtime snack with something to drink.
• Nurse on demand throughout the night. Bring baby to bed with you to allow for adequate rest.
Is it worth all this effort?
Using a breastpump at work/school takes a real commitment. Some mothers make this effort so that they are clearly distinguishable from their baby's caregiver. Only a mother can breastfeed. Others decide to pump at work or school simply because they enjoy breastfeeding and want to continue it for as long as possible. Pumping while at work/school makes this more possible.
There is no doubt about the continued health benefits of breastfeeding to you and your baby even after you return to work or school (see "Advantages of Breastfeeding"). Even with the cost of a breastpump and related supplies and the added burden that pumping brings, the cost of NOT continuing to provide your baby with breastmilk after your return to work/school is HIGH! The cost of formula ranges from $48 - $190 per month and specialized formulas required by some babies cost even more. Additionally, formula-feeding is associated with more frequent doctor's office visits and hospitalization, prescriptions, and parental absenteeism from work/school in order to take care of an ill baby. Breastmilk cannot be purchased. Only YOU can provide it!