Working and Breastfeeding
October 13, 2018
I never met Kerry in person. We had one of those La Leche League Leader/Mom phone relationships. She initially called me with a few basic questions about breastfeeding her newborn. She then reached out to me as she was going to be working full time. She was having trouble pumping enough milk for her baby while she is away. I asked if it was possible to visit her baby during the day. We live in New York City and Kerry’s office was two subway stops away from her office – about a mile away.
Every Monday through Friday Kerry hopped on the train during her lunch break.
She had communicated with her nanny that she was on the way and that she would be nursing her baby.
This worked for Kerry and her baby as she had planned this in advance. Kerry communicated with her employer that she would take her lunch break out of the office. She communicated with her caregiver not to feed the baby a bottle at lunch.
Kerry was able to make up the difference with pumping while at work and at home in between nursing.
Employment outside the home is one of the biggest barriers to breastfeeding in the United States.
Does that mean it is impossible? No.
There are strategies and lifestyle decisions to consider.
What are the obstacles employed moms face?
- Maternity leave duration
- Time to pump
- Quality pumps
- Support from family and caregivers
- Support from employer
- Inconsistent information
- Balancing home and work life
Tina, an attorney, negotiated her maternity leave as well as her pumping schedule while she was pregnant and still working. She noticed that many of her colleagues returned to the grueling hours and were not breastfeeding when they returned to work. Tina laid out a plan for her firm and told them what she needed. This communication helped both her and her employer. They had never had a mom who was breastfeeding once she returned towork. Tina changed the culture of her firm. Some of those moms saw her as a champion and when they had a second baby they too had more success in breastfeeding.
Women are often told they need to sleep train their babies. That she needs to have her baby sleep in a separate room. If a baby sleeps for twelve hours and the mom is gone for nine hours that leaves three hours a day for them to be together. What is a mom to do?
Stacy, a physician, nursed her baby through her residency by keeping her baby in bed with her, despite criticism from her community. She was gone for twelve hours at a time. “How else would I get to know my baby?” she stated in delight.
Unfortunately, in the US standard maternity leave is twelve weeks. Sometimes moms will negotiate for more. Others will spread it out. For example, Lisa, a bookkeeper, returned to work at nine weeks for two days a week. It was early but it gave her an easier transition. She felt this allowed for her to slowly build up to five days a week instead of being home full time and then suddenly being gone all week.
Similarly, some moms who do need to return full time will have their first day back to work on a Thursday (if she works Monday through Friday) making this first “week” away a short one.
I am frequently contacted by moms of older babies of about three or four months of age. Breastfeeding was going well until two or three weeks back to work. Her milk supply is faltering and she cannot keep up.
She is pumping but the baby is flying through her stash.
Sometimes moms nurse and pump while on maternity leave and put themselves into an oversupply. They stockpile great volumes of milk and then when they head back to the office they rely on that stash. Even if they are pumping at work they may not be pumping as much as the baby is consuming. Then suddenly there is no more stash and the mom now has a low milk supply.
Some moms are truly not able to pump at work for various reasons so pumping during maternity leave is essential. For these moms it is important to nurse as much as possible when she and her baby are together. And she can add some pumping sessions in at home between nursing.
Many moms who are able to pump at work can enjoy the maternity leave without having to focus so much on pumping milk. As they transition back to work they can nurse the baby as much as possible when they are together.
To keep up and to reduce the need for more bottles and more pumping a mom can nurse her baby as the last thing she does before they part ways – either at the day care center or with the caregiver. She can then pump first thing when she gets to work to have one pumping session done. Then pump one or two more times during her workday. Then as she reunites with her baby the first thing she does is sit and nurse. This gives her and her baby the opportunity to reconnect and it also gives the opportunity for the mom and the caregiver to communicate. On days off the mom can focus on nursing her baby as much as possible.
Another challenge is the marketing of the faster bottles for older babies. This can undermine breastfeeding as the baby consumes more than he may need because the flow is faster. Once the baby has a bottle that works there is not need to move to a faster flow. Also, the caregiver can use paced bottle feeding to avoid overfeeding and flying through the milk.
Here are some strategies to keep nursing while working:
- Establish a good supply from the beginning
- Communicate with your employer
- Communicate with your caregiver
- Pump when you are away from baby
- Use a slow flow bottle
- Nurse your baby when you are with your baby
- Nurse all weekend (or on your days off)
- Pump as soon as you get to work (this gives you a jump start)
- If it is possible: visit your baby during the day so you can nurse
- Have your baby sleep with or near you
It is important to remember that breastfeeding is not just a way to get a baby fed. Breastfeeding is a complex relationship. By nursing a mother and her baby’s bodies are communicating. Bacteria are passed back and forth to build baby’s immune system. Hormones are passed back and forth to tell a mom’s body to make milk, to give her baby melatonin. There is feedback we do not entirely understand. And breastfeeding does not have to be all or nothing. If a person needs to supplement they can keep nursing for however much works for her and the baby. Working does not have to mean weaning.
Lactation Education Nirvana
June 9, 2017
This week I was in lactation nirvana.
On Tuesday I attended an all day conference on TOTs – this is Tethered Oral Tissues – this includes tongue tie, lip tie and buccal tie. The conference was put together by Dr. Scott Siegel, a physician and dentist who is uses laser to release these ties. The event was multidisciplinary with sessions given by and attended by IBCLCs (International Board certified Lactation Consultants), SLPs (Speech Language Pathologist) CNMs,(Certified Nurse Midwife) OTs (Occupational Therapist) Orofacial Myologists, doulas, and more.
I have been in Private Practice as an IBCLC for 15 years. I have worked with hundreds of tongue-tied babies and even nursed two tongue-tied babies. I learned so much and more importantly had explanation for the things I knew instinctively and saw in my practice but could not quite explain. I have a better understanding of the impact of TOTs on people of all ages.
Wednesday night I attended a reading of the book, The Big Letdown by Kimberly Seals Allers. The subtitle is How Medicine, Big Business and Feminism Undermine Breastfeeding. I live this book everyday. The obstacles against breastfeeding are immense. They keep coming. As we solve one issue another pops up.
I was asked by a journalist yesterday to answer a few breastfeeding questions. One was “Does my ethnicity affect my ability to breastfeed?” My gut response was, “heck, no! Mammals are mammals.” But the reality is that breastfeeding is a learned and cultural experience.
What needs to happen is that families need to be supported on many levels. Education is imperative. There are so many obstacles. (More on these later.)
Sometimes I get weary of the repetition of some of the problems that could be resolved with education and normalizing breastfeeding. I never get weary of empowering and educating families. And I NEVER get weary of holding babies.
I will continue to help families, educate myself and keep sharing my knowledge – even when met with resistance.
Babies & Holidays
November 22, 2016
The holidays are upon us and for new parents it can be fraught with anxiety. Whose family do we spend the holidays with? Do we travel? If so, how: car, bus, train, airplane?
Should we just stay home and have family visit us? But how will we be able to host people? I can’t even feed myself half the time let alone a dozen guests? And my baby just got into a somewhat predictable routine! Help!
Many families are eager to show off their new baby and want to have holidays with family and friends. It is not impossible to enjoy the the festivities with some planning and a change of expectations.
First, expect that your baby who is used to somewhat of a routine may want to be in the arms of her parents more. She may also nurse more than usual – nursing is calming for a baby, she feels safe in your arms, safe at the breast.
Depending on where and how your baby sleeps, her sleep may be different when traveling or when you have company. This is not uncommon and know that you can get back into a routine once you get back home or the guests leave.
Sometimes it works to invite people over to your place so that your baby’s routine is fairly regular. Make it a potluck to take the pressure off. Make definite times for your event:
People want to help but often need direction.
Assign jobs: setting the table, washing dishes, vacuuming, etc.
Some new families like to keep it simple and stay home and create their own traditions.
One family has a tree trimming party in early December. They make it an open house with set hours where people do not have to stay the whole time. Their friends bring ornaments and food. This is a great way to see friends and family in a festive way without the overwhelming scene of everyone all at once.
Another family started a tradition of staying home, eating their favorite junk food and watching silly movies. They wear matching pajamas. No friends or extended family – just their little family.
This may be the first time many of your loved ones are meeting your new baby. They all want to hold her. That does not mean she wants to be held by all of them.
I recall my sister’s wedding was the the first time many of my family were meeting my oldest for the first time. She was nine months old. She was comfortable in the arms of my husband, my mom, my sister and me. But everyone wanted to hold her. I have lots of photos of her with tears or a red face. It was overwhelming for her. After a while I told everyone they could take a picture with me holding her. Those photos show a smiling baby with her cousins and aunts and uncles – and me!
Some people may be critical that your baby is “clingy.” Your baby is in survival mode. You may be met with criticism of how often your baby nurses.
Speaking of nursing your baby may nurse more than usual or she may even get distracted and nurse less. If she nurses less your body will let you know! Just take her back and nurse her if your breasts are getting full. If she is distracted go to a private room – take a nap together! This can be your escape excuse!
Some have never nursed in front of family. Practice in front of a mirror or with a group of other nursing moms and you will see that very little skin shows. If you are one who feels like you need to partially undress to nurse, a pretty scarf can help offer some privacy.
Before these gatherings discuss your plans. If Aunt Martha is always critical of your parenting and you have to see her, plan on a few replies to her comments.
“My that baby isn’t dressed warm enough! I would never have let my babies dress like that.”
“Aunt Martha, thank you for your suggestions, we will consider them, for now things are working for us.”
“My, that baby sure nurses a lot, you may want to give her some cereal in her bottle!”
“Aunt Martha, our pediatrician says we do not need to give her cereal, my milk is all she needs.”
Many couples have an escape plan. They have a code for when the time is up.
It could be a wink or a phrase. “Honey, I left the oven on.” “Sweetheart, I have on two different color socks!”
Make sure you take lots of photos. These memories should be preserved.
Happy Holidays!
Tandem Nursing
August 10, 2016
Tandem Nursing means nursing two babies at once. This can be twins or it can be siblings born at different times i.e. an toddler and an newborn.
Many people believe that you cannot get pregnant while nursing or that if you are nursing when you are pregnant you need to wean.
You can get pregnant while nursing.
Breastfeeding can be birth control under specific conditions. There is the Lactational Amenorrhea Method (LAM).
LAM works like this:
- No return of menses since birth
- breastfeeding on demand, night, and day
- baby does not take any food or other liquids regularly
- baby’s sucking needs met primarily at the breast (no pacifier or bottles) baby is less than 6 months old.
- baby does not go longer than four hours during the day and longer than six hours during the night between nursing
With LAM there is about a 1-2% chance of getting pregnant – similar to taking birth control pills.
Many people get pregnant while nursing. Often moms are advised to wean their older baby if they become pregnant. There is no need to wean unless you are at risk for premature labor and you are advised by your health care provider to refrain from intercourse.
What can you expect while nursing while pregnant?
About halfway through pregnancy your milk changes from mature milk to colostrum. Colostrum is thicker and does not flow as easily as mature milk. Some toddlers get frustrated and wean. Others hold on for dear life!
One telltale sign of pregnancy can be sore nipples. Some moms find nursing painful or they become averse to nursing and they choose to wean their older baby.
Others will put limitations on nursing – one mom used counting as her strategy – “you can nurse for ten seconds – 10, 9, 8 . . .“ Another mom had a nursing chair where they could only nurse sitting in the chair in a quiet room.
Some advantages of tandem nursing can be:
- nursing toddler can help relieve engorgement
- older baby not feeling left out
- mom doesn’t feel she is abandoning the older child
- she still has her magic toddler wand
- sibling bonding
- stronger immune system of the toddler
Disadvantages:
- mom may feel touched out
- judgement from family, friends and health care team
When nursing twins it can be a good idea to alternate breasts for the twins. This can be every feeding or everyday – Twin A gets the left breast while Twin B gets the right breast for one feeding and then alternate the next feeding or on Monday Twin A gets left breast and Twin B gets right breast and on Tuesday Twin A gets right breast and Twin B gets left breast and so on. Many moms of twins will choose to nurse one at a time once they get older to have one on one time. In the early days it can be a time saver to nurse both at once.
How does one manage tandem nursing babies of different ages?
The Last First Day
September 9, 2015
This morning as I dropped off my youngest child at school I was weepy. Was this Kindergarten or PreK? No, this was fifth grade. Finn is over five feet tall. He has been going to the same school since her was four years old. Why was I weepy? This marks the end of an era for me – as a mom, as a community member, as someone who is seeing time go by in my middle years.
This is my last First Day of School at the Earth School.
My first First day of Earth School was in September of 2000. For the last fifteen years I have been trekking up and down Avenue B in the East Village of New York City
Just north of 14th Street is Stuyvesant Town where we live. I have walked in snow, sleet, rain and in the blazing sun to get to our beloved elementary school. I have walked with babies in my belly, babies in slings and babies in strollers. I have seen teachers come and go and some come back! I have been through three principles. I have fund raised and recruited other families. I have escorted countless field trips often with a toddler in tow!
At Earth I have found community. I have met some of my closest friends. My family has forged relationships with other families with whom we share holidays and birthdays.
I remember the first annual Earth School Auction.
I have enjoyed the art on the walls and read some inspiring poetry and memoirs by the wonderful children who populate the halls and hearts of our community.
I remember when the roof garden was an idea and then it became real.
I have seen families grow and I have seen families leave. I have seen tragedy and great joy and simply ordinary days at Earth. I was at Earth that terrifying morning on September 11, 2001.
I have watched children perform on the stage.
I have nursed babies in the halls and in the lobby. I have sold popcorn and cookies in the lobby. I have done on-the-spot lactation consulting in the lobby.
I have grown as a human at Earth. I have watched my children grow and thrive. I have seen them learn to tie their shoes and learn conflict resolution and learn to construct a sentence and to defend an original idea.
I have learned about community building and about celebrating the seasons by marching in Tompkins Square Park to celebrate solstices and equinoxes.
I learned about what education is. I have learned so much more. I have learned to let go and watch my babies grow into smart, confident people.
In nine months my youngest child will graduate from the Earth School. But today is the first day of fifth grade for Finn. I will embrace this day and open my heart to the Earth community.
The Lactivist
February 4, 2015
Lactivist
The word was accusatory. I felt her anger over the internet.
What had I done to her? I did not say anything about formula feeding. I did make the case against the unethical marketing of formula. That is distinctly different from condemning moms who formula feed.
There is a formula campaign going around social media under the guise of making the “Mommy Wars” go away. In actuality most of the conflict of motherhood, parenthood really, is sparked by media and advertising.
The line between marketing and entertainment is becoming more and more murky. I have learned for the most part to discern what is being sold to me as opposed to what is there to entertain me.
This is the comment I made:
This is not about breastfeeding vs formula feeding, it is about the nefarious marketing of the pharmaceutical industry that undermines all families. Formula has its place. This is about using guilt to promote their product and to make us divisive – are we really? At the heart of it on the playground I can say that most moms get along. The images in the media create fear and defensiveness. I work professionally to support all mothers, I know when formula is needed and wanted. People are not always given the opportunity to make an informed choice.
Why was she angry with me? Why did she think I was attacking her?
I started thinking about it. She was directing her anger at me because I am safe. She does not know me – I am just that breastfeeding advocate. What had happened to her? Was she really experiencing grief and anger over her baby feeding experience?
I have many friends who did not breastfeed and they are not angry at me. They made informed decisions or at least dealt with what they were handed and they have made peace with it.
I thought about the times I get angry at people. I moved to New York for many reasons but one of the big ones was for an acting career. I am not a Broadway or TV or movie star. I could list all of the obstacles that prevented me from becoming famous but it doesn’t matter. I still get jealous and angry sometimes when I see actors my age who have made it. I also wrote and performed stand-up comedy. I loved watching the Golden Globes but I felt little jolts of envy watching Tina and Amy up there.
These feelings are far overshadowed by my happy life. I have a loving husband whom I love hanging out with – he really is my best friend and I am looking forward to growing old with him. We have three awesome children who are smart, healthy and beautiful.
I have moved on. (Casting directors – I can still provide a resume!)
I am also a bit envious of the moms who have had babies at home. Complications prevented that from happening with my babies and me. Still, I ache a bit about some of the birth experiences my babies and I went through. In the end they are all healthy and we made it through.
I have worked out the things in my life that got in the way of some of my goals. I have accomplished many of my goals and I am a happy woman.
So, going back to the name caller, I think she is angry and sad that she is not breastfeeding. I do not know if her birth interfered with her plans. I do not know if her family gave her a hard time about breastfeeding. I do not know if she is taking a medication that is incompatible with breastfeeding. I do not know if her body never made milk. I do not know what experiences she may have had in her past that makes it uncomfortable for her to have anyone touch her breasts.
I sure as hell bet she loves her baby immensely. I hope she can find some peace. I will be the brunt of many a new mom’s anger and frustration.
That is a role I can play.