Before you go back to work, you can calm a lot of your anxiety and get ahead of the game. This is a nuts-and-bolts section to get you up to speed with the mechanics of pumping, give you shopping lists of the gear and clothes you'll need, help you build a milk stash at home, and equip you with the basics about your legal rights. If you can, read this section while you're pregnant or on maternity leave so you have a good head start. Get these basics down, and in sections 2 through 4, we'll move on to the practicalities of working and breastfeeding, where you'll hear from the working moms whose wisdom is the backbone of this book.
CHAPTER 1
The Basics of Making Milk
Supply and Demand
In a nutshell: Producing milk is all about supply and demand. You have to demand milk from your body every day for it to keep on making milk. And give or take a bit, you have to demand the amount of milk your baby needs every day in order for your body to keep producing the volume of milk that baby needs.
Rely on at least one of the standard breastfeeding books and any number of breastfeeding websites (see chapter 18 for a list of resources) as a necessary part of your arsenal. These resources can teach you about latching, positioning, clogged ducts, mastitis, and more. This is important stuff. I will not attempt to do the job of those resources, but as we learn about the dance of working and breastfeeding, I do think it's useful to provide a little bit of the basics on milk-making.
Your baby demands milk from your body by sucking and compressing your breasts, and your body (for most women) responds by producing milk. Not only that, but as your baby begins to demand more milk-by nursing harder, longer, and/or more frequently, sometimes to the point at which you think you just don't have any more to give the little sucker-your body reads those messages, too, and produces more milk over time.
This increased-supply-and-demand thing doesn't happen instantaneously; it's a gradual process. Sometimes you'll notice that your baby is doing it-like during a two-day growth-spurt where you feel like all you are doing is nursing a vampire-and sometimes you won't, but it's still happening behind the scenes. Before you go back to work, if you aren't pumping much, you might not even know it's happened at all because you can't see how much your baby is eating at any given feeding.
Just like increased demand can lead to increased supply, a drop in demand can, over time, reduce your supply of milk. Sometimes the baby does this himself-he goes on a nursing strike, he gets sick, or he is simply taking fewer ounces of milk for each feeding as he begins to eat solid food. In these cases, as he gets interested in eating again, or recovers from his illness, he will start to demand more milk from your body, and your supply is likely to go up again. (Other factors can reduce supply, too, like being stressed, taking certain medications like decongestants or hormonal birth control, or getting sick yourself.)
For the working mother, the other culprit that can harm supply is working itself. There are many ways that work can reduce supply over time. For example, some women's bodies do not respond as well to pumping as they do to nursing a baby, so you might produce less milk during the workday than your baby is eating at home. Over time, that might lessen your overall supply.
Some women do find success with exclusive pumping (EP), which means providing breastmilk only by pumping, and not by nursing the baby. Some women EP because of persistent latch, tongue-tie, or cleft palate problems, or because they like it better, or because the discipline of pumping actually helps them set goals and maintain supply.
Even if pumping does produce a good amount of milk for you in a given session, the demands of work can affect supply. If you consistently can't get in as many pumping sessions per workday as your child is having feeding sessions with his caregiver, you might see a gradual decrease in supply.
Making Sense of Supply
All of this sounds like a total nightmare to a new mother planning a return to work. It's a lot to take in and a lot to try to accomplish on top of keeping a new baby alive, worrying about your nanny or day care or mother-in-law keeping your baby alive, being presentable for work every morning, doing your job extra well to prove to your boss that you haven't lost it as a result of having a baby, and balancing a new budget that includes hefty kid-related line items. It's stressful to feel like you have to stay on top of your milk supply, that precious resource you are trying so hard to keep flowing for your baby.
The first thing I want to say about supply stress is that I'm sorry. I have been there, as have millions of other working mothers. And we agree that, like your trusty breast pump, supply stress, well, sucks.
The second thing I will say is that establishing breastfeeding early is the best thing you can do to set yourself up for success. If breastfeeding is important to you, put in the time early on to see dividends later.
Ann, a consultant, noted, "I was successful at breastfeeding and working-nineteen months with the first child and I'm still breastfeeding a seven-month-old-because I was able to strongly establish nursing patterns before going back to work."
Finally, I want to note that this supply-and-demand thing is pretty resilient. With my first baby, I seemed to think that all that milk that was spraying across the room whenever I took off my bra would just dry up in an instant if I didn't keep a constant vigil over it. If you are able to establish a decent supply of milk during the first couple of months of the baby's life, your supply will hang in there with you through some ups and downs.
If you have a couple of days at work that are so back-to-back that you can't pump more than once, you can bounce back from it. If you go on a business trip and find yourself producing less milk even when you are fitting lots of pumping sessions in, you can bounce back from it. Just like supply gets built up over time, it is lost over time-not overnight.
At some point, you are going to find yourself sitting in a lactation room or a supply closet or your car or an airport bathroom, staring at your two pump bottles with half an ounce of milk in them, when you're used to producing two, or even five (some overproducers go even higher) ounces per session.
You are going to look at those stupid not-full-enough bottles and think, "This is it. I've ruined my supply and I'm not going to be able to do this and I'm a horrible mother…" and on and on. Believe me: One bad pumping session, one bad day, one bad business trip, will not ruin your milk supply.
CHAPTER 2
Meet Your Pump
Your Pump: Freedom and Burden
Working motherhood has long involved a trade-off that is painful for many: Breastfeed or go back to work. Today, many working mothers have a third choice: Go back to work and bring your breast pump along with you.
This technology is liberating. We can work (most of us have to for financial reasons; some of us also want to because we love it) and continue to provide breastmilk for our babies.
We also can feel trapped; because the technology exists, many of us feel we have no choice but to use it, no matter how difficult, stressful, and awkward the process might be, and no matter how much profanity we direct at our pumps.
Often both dynamics-liberation and burden-are at work at the same time.
For example, when my son was five months old, I had to go to Nepal on a business trip. Even planning for the minimum possible time on the ground (less than four days), with travel that had me literally circumnavigating the globe, I was going to be gone for a whole seven days.
Getting on a pumping schedule early on by pumping immediately after the morning feeding while I was still on leave meant that by the time this trip came around I had almost 300 ounces (or almost 9 L) of breastmilk in my freezer. (I recognize that this is a lot of milk, and I really stressed myself out stockpiling it. I realize in hindsight that a little formula while I was gone wouldn't have killed the kid.) In a world without breast pumps, I would have had two choices:
1. Skip the trip.
2. Go on the trip and stop breastfeeding.
But because this device exists, I had only one choice, in my guilty-working-mother mind: Store up 300 ounces of milk in five months. Go on the trip, bring a pump and lots of batteries, and pump and dump six times a day for a week. Do this on airplanes, in the backs of moving Land Rovers, in the crowded domestic terminal of the Kathmandu airport while wrapped in a shawl (please do not attempt this), in bathrooms of all levels of hygienic upkeep, in a parked car in a field while two boys on bicycles watched me through the window, and in the presence of my company's CEO. Then come home and keep breastfeeding. This duality of freedom and burden was never more obvious to me than during that wild week.
Whether you see your breast pump as your best friend or your worst enemy, if you're going to pump at work, you need to get to know this machine. Just beware: You may become so close that you start to hear actual words in place of the pump's sounds. My friend Emily absolutely swears that her pump says "red-hot panini" over and over.
Now, it's time to choose your frenemy.
What Is a Breast Pump?
Remember: When a baby nurses, she uses both compression (squeezing) and suction to get the milk out. Hand-expressing uses compression. A breast pump uses suction, but you can simulate a little bit of compression by squeezing and massaging your boobs while you are pumping.
A lot of the breastfeeding books that were written years ago and are in their zillionth edition of print will be confusing to a new mother getting ready to go back to work. First of all, most of them speak in a voice that is decidedly directed at stay-at-home moms. Plus, when it comes to expressing milk, they have things like diagrams showing a woman hand-expressing milk into a little cup, which is not really practical at work. When they talk about pumps, they talk about single, manual pumps vs. double, electric pumps, as if these are all equally usable choices for a working mother. Please let me clear all of this up: If you are going back to work, you need a double electric pump.
By all means, get yourself a single hand pump to keep next to your bed for the early weeks when your baby starts to sleep longer at night and you wake up with porn-star boobs, or to bring out on date night to take the pressure off. Keep this single pump in the car or at your desk once you're back at work in case you forget your pump or an essential part of it one day (this will happen).
Learn to hand-express as well, but do not confuse either tool with the milking machine you will need at work. For the average woman, trying to hand-express milk every day at work would be impractical, although I do know of a few women whose bodies don't respond to the pump and who, amazingly, successfully use hand-expressing while at work. Some women use a hand pump at work, but it does take at least twice as long (because, two boobs, ladies) and it might eventually give you Incredible Hulk muscles in your hands. This isn't a hard-and-fast rule, but most of us go double electric and never look back. Some women even splurge on two pumps-one for home and one for the office-to minimize the schlepping and the inevitability of forgetting the pump and/or some of its parts at home or at work.
Choosing Your Pump
I am pretty conservative when it comes to breast pump choice. I figure bestselling must mean something, so I used the Medela Pump In Style twice. (They're not paying me to say this.)
There are other reputable brands out there-Lansinoh, Ameda, Avent, and Hygeia, for example-and I think the choice really comes down to asking your friends and your lactation professional and, since the Affordable Care Act requires nearly all health insurance plans to cover breast pumps, seeing what your insurance company provides (more on this health insurance thing in just a bit).
As you are shopping around, pay attention to:
· Cycling rates: A cycling rate between 40 and 60 times a minute is best, as this mimics a baby's sucking. Anything under 30 is probably too slow. This information can be hard to find on some pump brands. Most of the major brands will fall within this range, but if you're curious or concerned, give their customer service line a call.
· Suction (vacuum) strength: La Leche League suggests vacuum pressure of 220 to 230 mmHg. Anything above 250 mmHg could hurt. Not every pump advertises this information on the box, so you might need to investigate.
· Open vs. closed system: A "closed system" pump has mechanisms in place to prevent moisture from getting into the tubing and machinery of the pump. An "open system" pump does not, meaning that there is a small chance that milk could get into the motor, creating a contamination risk. Open-system pumps are not considered safe to share or resell. Most Medela pumps are "open," and while some see this as a drawback, Medela is still a popular brand. Multi-user pumps (more on this in the next bullet point) are required to be closed-system. Ameda, Lansinoh, and Hygeia offer closed-system pumps; Lansinoh, for one, has voluntarily made even its single-user pumps "closed."
· Multi-user vs. single-user: Multi-user pumps are required by the Food and Drug Administration (FDA) to be closed-system. The "multi" part means that multiple women can use them as long as each person uses her own collection kit (flanges, connectors, bottles, and tubes). These pumps are often more powerful and can therefore help you produce more milk, but they're expensive. Insurance companies might cover the rental or purchase cost, especially if there is a medical reason, such as having a premature baby. Do note that as you look for a pump, you will see and hear about "hospital-grade" pumps. The FDA doesn't actually regulate the use of the term "hospital-grade" for pumps, so there's no standard definition. Most companies mean "multi-user, closed-system" when they say "hospital-grade," but you should do your research on any pumps that use that term.
· Warranty: Make sure your pump offers a warranty of a year or more. This can be a good indicator of durability. Many pumps are at their best for about a year, and motors may decrease in strength after that. If you're curious about your motor strength, have it checked out by a lactation professional or at a maternity store that sells pumps.
· Updates and new models: There are innovations happening all the time in breast pumps, to the point where I'm sure my daughter will see a photo of my pump someday and marvel at the medieval nature of the thing. Check out what the major pump manufacturers are up to.
Back to the health insurance question. As of 2010, the Affordable Care Act ("Obamacare") requires most health insurance plans to cover the costs of a breast pump and lactation support (and they're not allowed to charge you a co-pay or deductible). This benefit exists because breastfeeding is considered "preventative health." Healthcare.gov says that this rule applies to most health insurance plans, including any health insurance you buy on the marketplace. There are a few "grandfathered" plans that are exempt, so check with your employer and/or your insurance provider to make sure your plan is not one of those exceptions. If you have Medicaid, your coverage varies by state and you need to check with your provider.
Getting a pump that is covered by your health insurance is not as straightforward as picking out your favorite pump and swiping your health insurance card at checkout, because why would anything ever be simple and straightforward? According to the US Department of Health and Human Services, some insurance plans make you get a prescription or preauthorization from your doctor, so you need to ask your insurance company what's required before you do anything. And different plans cover different types of pumps; that means that your plan might only cover a manual pump (ridiculous, yes, but it's true), or that you might not get your top choice of make or model. It could also mean that your plan only covers pump rental rather than purchase.
Long story short, you just have to suck it up and call the number on the back of your insurance ID card and slog through the phone system until you reach a real person you can pepper with questions (I just shout "OPERATOR!" over and over until the system gives up and gives me a human). If you have a great HR department at work, they might be willing to do some of the legwork for you.
Once you get your insurance company on the line, ask them the following questions:
1. Does my plan cover lactation support and breast pumps, or is it a grandfathered plan under the Affordable Care Act?
2. What kinds of breast pumps are covered by my plan? Does my plan cover manual or electric? Rental or purchase?
3. Do I have to get my pump through a specific company or ordering system?
4. Do I have a choice of make and model of breast pump, or is there a list I have to choose from?
5. If I have to pay up front, when and how will I be reimbursed? And is there a dollar limit to what I can spend?
6. Do I have to wait until after my child is born to get my pump?
7. Do I need a prescription or referral from my doctor? If so, what does it need to say, and what kind of doctor needs to write it?
8. If my doctor says I need a hospital-grade pump but my plan doesn't cover those, what are my options?
9. Are accessories like tubing, flanges, membranes, battery packs, and car adaptors covered?
10. Does my plan cover any breastfeeding support like prenatal breastfeeding classes or access to a postnatal lactation consultant? How do I find out which providers are covered and how many visits my plan covers? Do I need a prescription or referral for these?
If you can't get your pump covered by your insurance provider, they might still be able to give you access to discounts through approved vendors, so if the person on the phone tells you you're out of luck, keep them on the line and ask about discounts. You can also check out WIC, the FDA's Special Supplemental Nutrition Program for Women, Infants, and Children. Chapter 18 has more information on finding your state's WIC breastfeeding coordinator.
Understanding the Pump Parts
The parts of your pump vary based on the make and model, but they boil down to a few things:
· The pump machine. This is usually housed inside a bag, with a power cord, an on/off switch, and usually one or two dials to control the suction and speed of the pump.
· The horns that go on your boobs. These are called "flanges" or "shields," and they will spend more time touching your boobs than your high school boyfriend.
· The plastic things that attach to the flanges. I actually had to look up what these are called as I was writing this book. Apparently they are the "connectors."
· For many pump models, the little white membranes that attach to the connectors. These are far more important than they look, and they have a knack for disappearing.
· Tubing. Tubes plug into the connectors on one end and into the pump on the other. They are not where the milk flows through. The pump forces air through these tubes to create suction.
· The power cord. Some pumps also offer a battery pack.
Improving on Your Pump's Basic Parts
You might be thinking, "That's all I need, right?" No, unless you plan to never leave the house. Aside from what Samantha, a news producer I interviewed, says is the essential item for pumping at work-"a really thick skin"-there is additional gear that will make your life easier.
New flanges
Standard pump flanges stick straight out from your body, so to avoid spills, you have to sit ramrod straight while pumping, then hunch forward while gingerly pulling the flanges off. It's stupid, and I don't understand why the pump companies haven't fixed this simple problem, since there is obviously a fix: Pumpin' Pal. I swear that I am not on the payroll of this company, but you can solve this problem by going online to www.pumpinpal.com to buy a set of angled flanges. The set comes with various sizes (more on that in just a sec) so you can find the right fit for you. And let me tell you, that angle makes all the difference in the world.
Another consideration with flanges is size. Women have different breast, areola, and nipple sizes, so testing sizes can help with both production and comfort. When pumping, your nipple will be drawn into the tube of the flange, and with a proper fit, your nipple should not be rubbing against the sides of that tube.
Battery pack and car adapter
If your pump offers a battery pack and car adapter, keep them and backup batteries with your pump at all times. If you know you'll be in the car or other weird locations to pump, and your chosen pump brand does not offer these options, you might want to reconsider your choice. A friend gave me a plug-in battery charger and rechargeable batteries, which was a nice money-saving addition.
ALSO OF NOTE: It took me until I was in another country to realize that my battery pack had two sides, each holding four AA batteries. I had been replacing only the batteries on one side and wondering why the pump was so slow.
Bag
Nobody is fooled by the "briefcase" that your pump comes in. OK, maybe men are fooled by it because they don't notice anything, but women are not. If you care, you can buy a specialty bag designed with style and functionality in mind. Nurse Purse is a good place to start because their bags are spill-proof, nice-looking, and made to hold breast pumps, laptops, and more.
Cooler bag for trucking milk back and forth
Get an opaque cooler bag and ice packs, or freezable lunch bags that can remove the stress of remembering ice packs. A lunch bag size works for a workday or a business trip of one or two days. You'll need something that would hold a six-pack of beer (and hopefully will, in the future) for a longer time away.
Your Packing List
Start by packing your bag with everything you might need and pare down over time as you learn what works for you.
Routine and preparation are your friends. One option: Every night, pack the pump bag so you can grab and go in the morning. One woman I talked to had her husband do this, which took some stress off of her. He even preassembled all the pump parts for her. If it were me? Leaving this to my husband would have made me paranoid that he'd forget something (which, I love him, but he would).
First-day-at-work pump-bag packing list
· 1 reusable lunch bag or small cooler bag
· At least 4 milk bottles with lids
· 2 connectors with membranes intact
· 1 package of extra membranes
· 2 flanges/horns
· 2 sets of tubing
· 1 battery pack with batteries
· 1 Medela microwave sterilization bag
· 1 pack of Medela sanitizing wipes
· 1 bottle of hand sanitizer
· 4 extra breast pads
· 1 small pack of wet wipes (for spills)
· 10 breastmilk storage bags and a Sharpie to label them
· 5 gallon-size (about 3.7 L) Ziploc bags with the slider to zip shut
· 1 hand pump
CHAPTER 3
Pumping School
Welcome to School
Now you own a ton of weird stuff you never knew you'd want or need. So let's learn how to use the &%@# pump.
Pumping makes many women feel like farm animals. For me, it is everything actual nursing is not: sanitized, cold (sometimes literally, if you've just washed the parts or tend to keep them in the fridge at work in between sessions), stressful, and industrial. It was also totally and completely foreign to me, up until the first time I tried doing it, which is where Pumping School comes in.
Unless they make you pump in the hospital (which happens for some women), you might find yourself at home, with a baby and a very porn-star-esque pair of boobs, wondering who the hell is going to show you how to use this thing.
I am a visual and tactile learner, and I needed someone who could see me with my shirt off to show me how to do it. So my best friend Karen took me to Pumping School. Her older sister had done Pumping School with her, and I have since taught Pumping School sessions with my own sister as well as several other friends. I imagine us like a bunch of cave people passing down life lessons from woman to woman-except with a weird machine on our boobs.
How to Get Taught
Between weeks three and six of your baby's life, you should invite to your home a mother with recent experience with pumping breastmilk (you don't want your pumping professor's last pumping experience to have been with a 1970s "bicycle horn" manual machine). This should be a woman you are comfortable having see both of your newly gigantic boobs.
Tell her that she is coming over to teach you how to use a breast pump. You will not beat around the bush on this. You will have waiting at your house your pump and its basic parts, breastmilk storage bags, and a Sharpie or other permanent marker. And maybe some coffee for her. And maybe just a little for you.
Time this little date so your friend comes by just before the first morning feeding (or during, if she has a key or you have someone else to open the front door for her while you have a baby attached to you). If she has a toddler, find a way to suggest that she leave this lovely small person at home.
This friend will come over and, if necessary, unpack your pump from its box for the first time and clean the parts. (Perhaps you have left it in the box in a closet, unsure what the hell you'd do with it, when, and how. Believe me when I say that you are not alone. I had to unseal the tape from the box of my sister's breast pump when I arrived at her house when her son was about four weeks old.) Your friend will then be patient while your baby totally screws up the feeding schedule.
You're going to feed your baby as normal, then pump immediately after the feeding. I recognize how silly and arbitrary a term like "first morning feeding" is, given that for many of us this could be 12:17 A.M., 2:52 A.M., 5:03 A.M., or 7:30 A.M. What the books mean (and what I mean) when they say "first morning feeding" is the first one that occurs at a time that seems remotely reasonable and sustainable for a happy life, marriage, and parenting experience. Just pretend that any feeding at or after 6:00 A.M. is the first one of the day, even if it isn't and it makes you want to throw this book against the wall.
The reason you'd shoot for the first morning feeding for pumping is that your body is making more milk at this time of day. Also, if you pump immediately after a morning feeding, it can help trick your body into making a bit more milk throughout the day. However, if for some reason you just can't do this time of day, it is not the end of the world. Any time of day will work.
Once you've actually been able to nurse, your friend will set you up with the pump-placing the parts onto your boobs if need be-and have you pump for the first time. She will show you how most modern pumps have an initial "letdown" setting, which pumps quickly and with less suction, to simulate the way your baby sucks when she is first on your breast. Your friend will show you how this letdown setting then switches over to the general setting, resulting in slower and deeper suction cycles, again to simulate what your baby does once the milk starts flowing. And she'll show you the little dial that you can use to control how strongly this machine suctions your boobs.
NOTE: You can work your way up to the highest setting on this little dial, and you should pay attention to what setting works best for you-it isn't always the highest one. If this is your first time pumping, I wouldn't recommend trying that highest setting. You can eventually get there, but it would not be comfortable to start off there.
Break for Questions
Here's what you might worry about during this process:
1. If I pump after I feed the baby, will I have enough milk for the next feeding? Yes, you'll be fine. Your breasts are always making milk and you don't need to "fill up." In fact, you will probably produce more milk that day because of the increased demand.
2. Will there be any milk to pump since my baby just finished eating? Maybe. Maybe not. This first time around is just for practice, so don't sweat it if all you see is a few drops.
3. Am I really going to do this several times a day when I go back to work? Um, yes. That's why you bought this book, honey. If you want to breastfeed after you're back at work, you are probably going to pump a lot at work. It's not fun, but it is doable.
4. Who is going to hold the baby while I do Pumping School? Options: your Pumping School teacher, your spouse, a baby swing or chair, or the floor.
Back to School
During the first fifteen minutes or so (which aren't going to feel awesome), you might produce just a couple of drops. Or you might produce 4 ounces (120 ml) and feel awesome and/or like a cow. There is no definition of success, other than learning how to pump and experiencing it so it stops seeming so foreign and weird. (NOTE: It will never completely stop seeming foreign and weird.)
You are going to see, for example, that your nipples are stretching to a greater length than you thought possible (a friend described seeing his wife pumping for the first time as "two thumbs in a garden hose"). You are going to realize with horror that this is what is happening to your nipples every time you nurse your baby.
You are going to wonder what will happen to your sex life if/when (it's a "when," trust me) your partner sees this process. It may be awkward, but you'll both survive it.
Your first time, you might be surprised to see what your breastmilk looks like. It can be thin and watery or thick and creamy. It can be white, yellowish, bluish, or greenish. In fact, it will be all of the above (which is normal) at different times of the day and over time.
Congratulations. You've just joined the most exhausted, most multitasking, most ass-kicking club of women in the world.
CHAPTER 4
Bottles and Freezer Stash
To Schedule or to Demand-Feed
I'm almost afraid to write anything about scheduled-feeding vs. demand-feeding, because good Lord do people have strong opinions about these things. The schedulers think the demanders are crazy helicopter parents who have signed away their whole lives and freedoms to their babies, and who are ruining their babies, catering to every whimper by whipping a boob out. (SIDE NOTE: Can we all sign a petition to ban anyone but nursing mothers from using the phrase "whipping a boob out"? It makes my skin crawl when I see some guy tweeting about a lady who just "whipped her boob out" on a city bus.) Meanwhile, the demanders think the schedulers are narcissists who don't realize that having a baby changes your life, and who starve their babies just to get more sleep at night.
News flash: They're all wrong about one another, and they're all right about their own choices. Some babies do much better on something resembling a schedule, and some do better when demand-fed. Some parents do better on a schedule, and some do better when demand-feeding. As a new parent, I thrived on getting my babies, gently and safely, onto a schedule. It helped a lot with my new-mom anxiety, and I figured it would make the most sense to get on a schedule before I went back to work. And my kids did great with it, too, although my daughter was a little more demand-y and a little less schedule-y sometimes. I just paid attention to their needs and everybody was happy. Which is the point: As long as everybody is keeping the baby loved and hydrated and fed, and keeping the parents relatively sane, then this comes down to a parenting choice that nobody needs to fight about.
The reason demand-feeding vs. scheduling matters when thinking about returning to work is that how you feed your kid will play into your thought process when starting to get yourself into a pumping routine that ensures you're maintaining a good milk supply.
So, if you are feeding your baby on demand (because you're definitely a horrible monster), you'll have two choices when it's time to go back to work: Find a caregiver who will continue to feed your baby on demand, or start moving your baby to a more scheduled-feeding routine. You will still want to get yourself on a pumping schedule at work, since pumping with the same frequency as a demand-fed baby is not usually compatible with putting in a productive workday.
If you're the scheduling type for your baby (again: horrible monster), you will probably have an easier time making sense of how often you need to pump and how much milk you need. There are many resources available for moving your baby, gently and safely, to a feeding schedule. They range from the attachment parenting school to the parent-led school. As long as your baby is nourished and hydrated, do what works for you and your family.
Introducing the Bottle
If you're going to go back to work, you're going to have to teach this baby how to use a bottle. And even while still at home with the baby, the combination of milk stash and bottle readiness can be a great physical and mental relief. After having my first baby, I found myself pretty quickly needing to feel that I could leave the house for more than ten minutes without imagining my baby howling with hunger back at home (this does not make for a very relaxing yoga class or trip to the store). Plus, it's a lovely bonding opportunity for your spouse or a grandparent to get to give the baby a bottle now and then.
Bottle introduction freaks a lot of new mothers out because of the risk of "nipple confusion" (also a good name for a punk band), meaning that the baby might start to prefer bottle to breast. Working mothers also have to deal with the fear that the baby won't take a bottle at all when it's time to go back to work.
Stressful bottle situations can happen in both directions: The baby refuses the bottle, or the baby loves the bottle and starts to refuse the breast. It's best to seek out a lactation professional if things are not working well. But with patience and good planning, most people can help their babies learn bottle skills without too much drama.
I went straight to the experts on this one, consulting lactation professionals and a friend who is both an intrepid at-work pumper and a pediatrician herself. According to them, the basics of bottle introduction are as follows:
· Start three to six weeks in. After six to eight weeks, babies lose their suck reflex and could get choosy.
· Use a small amount of milk: 1 to 3 ounces (30 to 90 ml).
· Have someone other than you give the first few bottles. Some babies will never happily take a bottle from mom, and a few stubborn little guys flat-out refuse to let mom give them a bottle. But with patience, almost all babies will take a bottle from others. You might even want to leave the room (or the house!) for the first few tries.
· Give the first bottle about halfway between normal feedings-about an hour after the previous feeding. This is to make sure the baby is not super hungry, so he doesn't really need the milk and get frustrated that it's not coming from a boob. This first bottle is practice, not a full meal.
· Make sure you have the slowest-flow nipple on the bottle (called "Level NB" or "Level 1" in most major brands). You don't want him getting used to fast flow, then getting mad at your boobs for being too slow.
· Don't expect the baby to get it on the first try. Many babies require a few tries over the course of a few days or a week. Don't push it, and don't panic. When my son first rejected a bottle, I went immediately to a dark place of "I'm never going to be able to go back to work; I'm going to be tied to this baby until college; how will I afford college if I can't go back to work?" I was wrong.
· Keep the bottle in the mix, even if it's way before you go back to work, in order to keep your baby's bottle skills up. Offer a bottle at least once or twice a week. Give pumped breastmilk or formula for a bottle feeding and pump while the baby is eating. If you don't have any breastmilk and don't want to use formula, you can pump fifteen minutes before the feeding and use that milk for the baby's bottle. This will give you more practice with pumping, and give other caregivers extra bonding time.
· If you've tried and it's not working, experiment with different bottles and nipples (borrow from friends if you don't want to buy a bunch of new stuff), and consult your pediatrician and/or lactation professional.
Burning Questions
With bottle readiness under way, it's time to start working on that breastmilk stash. Once you start thinking about your first day back at work-whether it's while you're still in the hospital or the week before your leave is over-you're likely to have some questions about how to make and handle the milk you hope to leave with your baby's caregiver:
1. How do I start saving up breastmilk before I go back to work?
2. How much breastmilk do I need in the fridge/freezer before my first day back at work?
3. How do I store breastmilk?
4. How do I know breastmilk is safe to use?
5. How do I train caregivers on giving breastmilk?
6. What happens if my milk stash runs out?
1. How Do I Start Saving Up Milk?
Once you've learned how to pump, your next step is getting on a regular schedule of pumping and saving breastmilk.
You know about supply and demand-that supposedly perfect cycle of your body making as much milk as your baby needs. This might make you wonder how you will ever get any milk to save for when you go back to work. I don't think it's coincidence that Internet search terms like "milk stash back to work" are one of the most common ways that people find my blog.
Building up a decent milk stash is entirely possible, assuming you have a pretty normal milk supply. If you have a low supply and/or are already supplementing with formula, you will have to work harder to store up milk, and you might be looking at some supplementing during the day. And you are still an awesome mom.
There are two pretty good times of day to get that extra milk:
1. Pumping immediately after the morning (6 or 7 A.M.) feeding.
2. Once your baby is sleeping longer hours at night, pumping while she is asleep.
Let's focus on #1, since #2 is much less predictable, and also you might want to actually be asleep at night. Most women's milk is more abundant in the morning, so pumping at this time is ideal. It also offers the benefit of setting you up for a more milk-productive day, by kicking the day off with some additional demand. Feed and burp your baby, set her up somewhere comfortable, and sit down to pump.
In the first few days or weeks, you might get very little milk, but you will see the volume go up over time, and if your baby stretches out for longer and longer nighttime sleeps, you will wake up fuller in the morning and have more milk to spare. The milk you pump can go straight into a freezer bag or in a storage bottle in the fridge until you have enough to fill a freezer bag. Within a few weeks, you will have a nice little supply.
PLEASE, PLEASE TAKE NOTE: You do not have to do this additional pumping every single day. Some days you will be tired. Some days your baby will need you, or you'll just plain not feel like it. Give yourself a break. It's gonna be OK.
2. How Much Milk Do I Need?
The obvious answer to this question is that you need enough milk to get your baby through a single workday of feedings. This is based on the premise that you will pump enough on your first day back at work to replenish your at-home supply. But taking into consideration the stress and emotion of the first day back, plus navigating your way to find the time and space to pump, it's best to have a bigger stash at home while you get your routine worked out. Let's call that three workdays as a goal.
If you are breastfeeding most of your baby's feedings (rather than bottle-feeding formula or expressed milk), you might have no idea how many ounces of milk your baby eats during a typical day. You might think you can figure it out by doing a whole day of bottle-feeding your expressed milk while you pump during or just before feedings, but this actually isn't a great idea. Because babies can sometimes overfeed from a bottle, and because some women's bodies don't respond as well to the pump as to the baby, you could end up confusing yourself further.
I'd suggest going with experts' estimate of what an infant eats in those early months: on average, 26 ounces (770 ml) per day. Keep in mind that every baby is different, and this is an average, so your baby could be eating more or less than that by a few ounces-and of course, babies don't eat the same amount at every feeding. But that's OK; we're just trying to get a reasonable number to shoot for as you head back to work for the first time.
Divide that 26-ounce (770-ml) figure by the number of feedings your baby is on per day (this varies, but is probably between six and twelve feedings for a two-to four-month-old baby), and figure out how many feedings you will miss while at work. There's your magic number for a single workday.
For example, let's assume the following:
· My baby needs 26 ounces (770 ml) of breastmilk per day.
· She is doing six feedings in a twenty-four-hour period when I go back to work.
· 26 ounces (770 ml) divided by six feedings = a little more than 4 ounces (about 130 ml) per feeding
· In a nine-to-five workday I will miss three of her feedings (10 A.M., 1 P.M., and 4 P.M.).
· Three feedings times a little more than 4 ounces (130 ml) = I need to leave her caregiver with between 12 and 14 ounces (355 and 415 ml) of breastmilk for a single day.
Another way to look at it: A baby needs 1 to 1? ounces (30 to 45 ml) of milk for every hour he is away from you, his source of milk. So for my nine-to-five workday, which is eight hours, he would need between 8 and 12 ounces (235 and 355 ml).
You can see that depending on how you calculate what your baby needs, you will end up with different numbers. Don't stress about this. Remember, we are just trying to get to a decent target.
I am a worrier and an overplanner, and I would stress about things like growth spurts and spilled milk, so I would probably shoot for 15 ounces (445 ml) for a workday. For a three-day stash, then, I would need 45 ounces (1.3 L) of milk.
I know this figure looks daunting on paper, and you might be wondering where and when, exactly, you will get 45 ounces (1.3 L) of milk. It is doable if you start early. Even if I were to "bank" only 2 ounces (60 ml) a day, within three weeks I'd hit my goal, and many women will get much more than a couple of ounces out of that morning pumping session as time goes on.
If you have a short maternity leave or no leave at all, don't panic. A single day's worth of breastmilk is great. And supplementing with formula is not the end of the world. Honest.
If you think or know you will have business travel in your near future, you have some additional decision-making to do. Being away from your baby for one or more overnights is not only heart-wrenching, it requires quite a lot of milk in the freezer if you want your baby to get only breastmilk while you're away. Go back to that 26-ounce (770-ml) amount-that is the average for a twenty-four-hour period. So a three-day business trip would use up something in the neighborhood of 78 ounces (2.3 L) of milk. Of course, you will be pumping on the road and can try to bring that milk back with you, which will be covered in chapter 12.
3. How Do I Store Milk?
Whatever you produce, you have to figure out how to store expressed breastmilk since you'll be doing this multiple times a day at work. Some people get crafty with ice cube trays and about a million other ideas you can find on Pinterest, but most working women seem to use bottles (either the kind you pump milk into or the bottles your baby will drink from) to store milk in the fridge, and BPA-free plastic milk storage bags to store milk in the freezer.
I have found that Lansinoh milk storage bags leak less than Medela brand, and I have heard good things about the Target brand bags, but I would still recommend always transporting bagged milk (liquid or frozen) inside another Ziploc bag and thawing frozen milk inside a bag or other clean, closable container (like a Tupperware) to catch any leaks.
As for pouring milk from the pump bottles into the freezer bag: I got all the way through breastfeeding my first baby, and nine months into breastfeeding my second baby, before I stumbled upon a great trick in an online comment to a blog post I wrote about pumping. Use the breast flange as a funnel to pour milk from bottles into bags. Genius!
There are a few ways to ensure you have milk for your baby while you're at work, and they are not mutually exclusive. You will probably end up using most of these tactics at some point.
Option 1: Day-by-day pumping
With this option, everything you pump today goes into bottles for tomorrow. The downside is that if you spill milk or have a low-production day, or your baby has a growth spurt, you might not have enough milk for the next day. This is where a freezer stash is helpful for top-ups.
Option 2: Freezer stash
Using the tactics described above, you can build up a freezer stash ranging from dozens to hundreds of ounces of milk.
There are three basic schools of thought on how much milk to freeze in bags. Some women prefer to do 3 ounces (90 ml) at a time, making little pouches of milk that give them a more nuanced ability to decide how much milk to thaw.
On the other end of the spectrum are women who fill the milk storage bag almost to the top, to maximize what it can hold. I found that my comfort level on "full" worked out to about 8 ounces (235 ml). I have a friend who swears she could fit 11 ounces (325 ml) into those suckers.
Somewhere in the middle is the 5-ounce (150-ml) approach since it's close to the maximum stomach size of an older infant. Over time, you can play around with what makes you comfortable, including storing a mix of sizes so you have some larger bags and some mini-bags to thaw quickly when just a bit more is needed.
Whatever volume you choose, squeeze the air out of the bag and write the date on it with a Sharpie. Get into the practice of adding your initials if you think you'll share a fridge or freezer at work. Some women also list number of ounces. If you do this, read the ounces while the milk is still in the pump bottles; once the milk is in the bag it's hard to accurately read the volume. I gave this practice up long ago, because I just don't have the energy for it, so I have learned how to eyeball a freezer bag.
If you like detail, you also can write the time of day on the bag. Milk changes somewhat throughout the day, and some people like to give their babies milk that was pumped at a similar time of day as the feeding. But really, put this on the list of things that are nice but not necessary. I haven't seen any real evidence that doing this makes a measurable difference in babies. Expressed breastmilk is great for babies, and this time-of-day thing feels like yet another thing to stress about. But listen: If you want to do it, more power to you.
Once the milk is bagged, it goes into the freezer. I learned to lay the bags flat on their sides, which allows them to freeze into stackable bricks. An additional trick I have seen is to freeze them flat and then store these bricks, standing upright, in a shoebox in the freezer with the oldest in front. You can pull individual bricks from the front when you need them, and add new bricks to the back once they're frozen.
To thaw, move your oldest frozen bags into the fridge and give them a full day. If you're in a rush, put the bags in a bowl of warm or hot water (never boil or microwave breastmilk, in any container). Either way, when thawing milk, remember to seal the milk bags in Ziploc bags or clean containers first to catch any milk that might leak.
Note that freezing reduces some of the beneficial properties of breastmilk, but certainly not all of them. Please don't start to worry that giving your baby frozen, thawed milk is bad for him. You are doing a great job.
Option 3: Formula
With my first child, I was obsessive about exclusively breastfeeding. People would ask me, "Are you breastfeeding?" expecting a yes/no answer, and I would reply, "YES! Not one drop of formula has crossed his lips in seven months, three weeks, and four days!" (I cringe when I remember this version of myself.)
When my second child was six weeks old, my husband gave her 2 ounces (60 ml) of formula, just to test it out. It reduced my pretty significant anxiety just to know that there was a backup option if someone spilled the breastmilk or if I had a low-production day.
You might know within a couple of hours whether your baby will tolerate regular formula (some babies have issues with the cow's milk it is derived from): She might get fussy or gassy, develop a rash or hives, start vomiting, or have weird poop. More commonly, intolerance to the milk proteins in formula can take days or weeks to develop; you might see blood in your baby's poop if this happens. In all cases, talk to your pediatrician. You can test out different formulas and find one that works for your baby.
I should note that there are some breastfeeding advocates who say that introducing formula in the first few months of a baby's life can impact the good bacteria (or "flora") in the baby's gastrointestinal tract. I'm not telling you this to put any pressure on you; I'm just trying to represent the whole spectrum of feeding choices so you can make your own informed decisions.
Option 4: Donor milk
If giving your baby only breastmilk is a big priority for you, and you aren't making enough of it yourself, you could consider donor milk. Note that it can be expensive to purchase, as from a milk bank (these organizations do amazing, lifesaving work, and that costs money!).
4. How Do I Know Breastmilk Is Safe to Use?
The Internet is your friend and foe on a lot of things related to parenting, and use of breastmilk is no different. Guidelines for how long you can store and use breastmilk range, a lot:
· At room temperature: 4 to 8 hours
· In the fridge: 72 hours to a full week
· In the freezer: 3 to 6 months, or a year with a deep freezer
· Frozen, then thawed: good in the fridge for 1 to 3 days
All of this depends on whom you ask-and also on what number kid you're on (what seemed risky for a first baby will sometimes end up feeling fine for a second or third). You will have to find your own comfort level. I really believe in the stability of breastmilk, so I lean toward the longer recommendations.
On the topic of usage: If you're going to be dealing with breastmilk that's been stored in the fridge and freezer, bite the bullet and taste your milk. Take a tiny taste of newly expressed, refrigerated, and frozen, then thawed milk (more on what to do if your thawed milk smells or tastes "off" in chapter 16) so you know what good milk is supposed to taste like. If you can, get your spouse to do the same (not something I ever accomplished at my house). Knowing what "normal" tastes like can help you make decisions. I rely on my nose and, if absolutely necessary, my taste buds, along with the usage guidelines, when making keep-or-toss decisions.
Along with storage time in the fridge or freezer, most women have questions about whether they can combine milk from different pumping sessions or reuse breastmilk from a bottle that the baby didn't finish the first time around. Combining batches is fine as long as you follow a few rules:
· Milk should be the same temperature before it's combined, so chill fresh milk before adding it to fridge milk.
· If you combine old milk and new milk, treat the whole batch like it was pumped on the date of the older milk.
· You can even add liquid milk to frozen milk, as long as the liquid milk is cold, so it doesn't thaw the frozen milk.
If you're wondering if you can give your baby breastmilk left in the bottle from a previous feeding, you will find a range of answers. Some experts say that you have to discard whatever is left in the bottle after a feeding. La Leche League, however, says you can reuse milk once, and I like that option because I hate throwing away breastmilk.
5. How Do I Train Caregivers on Giving Breastmilk?
Leaving your breastmilk with a caregiver-be it your spouse, a nanny, a day care, or a relative-can be stressful. You might worry that no one will treat your precious milk with as much care as you do. You might have concerns about the caregiver handling the milk safely, and you will probably stress about how much breastmilk the caregiver gives to your baby, especially in comparison to how much you are pumping at work.
Training your family and caregivers on those usage guidelines mentioned in step 4 above (consider printing them and displaying them on your fridge and at your day care) and on how to thaw frozen milk is an essential part of protecting your baby and your stash.
Here's what can happen when you don't train those who will be handling your milk:
Melissa had a three-day business trip. She pumped and brought back a cooler full of milk, relieved at being able to replenish her freezer stash. The next day she went to work, and her husband thawed out a frozen bag to give to the baby. The bag leaked and most of that milk was lost. So he took all fifteen bags out of the freezer (why? whyyyyy????) and thawed them in a bowl of water. Another one of those bags had a leak, which was evident from the water in the bowl becoming cloudy, so he (again: why?) threw every last bag away.
Walk family and caregivers through the storage and thawing points above. Ask them to call you before throwing any milk away. Remind them never to shake milk-this is tempting because the creamy part can separate and tends to cling to the bottle or bag. While the evidence is slim, some experts say that shaking breastmilk can damage some of its components (but it's still safe to drink, so if someone does shake your milk, don't toss it). Instead, teach them to swirl the milk, tornado-style, until the creamy fat rejoins the rest of the milk.
It's not just safe milk-handling that you have to consider: I have lost count of how many working mothers have told me that caregiver-overfeeding is at the top of the list of their breastfeeding worries. Make sure to set up an ongoing dialogue with caregivers about how much milk your baby should be getting per feeding.
The risk of overfeeding is greater with a bottle than with the breast. While the milk flow will slow down over the course of a feeding from the breast, requiring the baby to work harder for it, a bottle will continue to deliver milk at the same rate. Wiggling the nipple of a bottle in a baby's mouth can also stimulate his sucking reflex, causing him to keep sucking when he's not all that hungry anymore. And there is also that very human tendency to want to see a baby finish the bottle.
Understanding how much a baby tends to need in a single feeding, on average, is important, and helpful in figuring out whether you have an overfeeding problem. Every baby is different, so don't be rigid about these numbers-instead, use the numbers, plus your mother's instinct, advice from your pediatrician and lactation professional, and your baby's hunger cues:
· Birth to a month: up to 2 ounces (60 ml) per feeding
· 1 month to 4 months: 2? to 5 ounces (75 to 150 ml) per feeding
· 4 months to 9 months: 3 to 7 ounces (90 to 205 ml) per feeding (the higher end is more likely if your baby starts sleeping through the night, which means he will take larger volumes of breastmilk per feeding during the day to compensate)
· 9 months and up: decreases over time as table food ramps up
Yes, these are pretty wide ranges. Nothing to be done about that; every baby is different. If your baby is significantly blowing past these per-feeding volumes and/or past the amount you can pump while you're at work, do some investigating to figure out whether any overfeeding is at play. Work with your caregiver to see if you can slightly reduce bottle size while keeping your baby happy, fed, and hydrated. That is nonnegotiable: happy, fed, and hydrated.
Some tips to help keep overfeeding to a minimum:
· Try dropping ? to 1 ounce (15 to 30 ml) per bottle and see if your baby seems happy with the feeding.
· Use slow-flow nipples (start with "Level NB" or "Level 1" size).
· Try a pacifier after a feeding, to see if simply sucking on something will comfort the baby.
· Google and learn about "paced bottle-feeding," a technique that many lactation professionals recommend.
· Talk with your caregiver to make sure he or she understands that feeding is not a solution to every cry or sign of fussiness. If you feel that your caregiver just doesn't get (or agree with) this, start looking for a new caregiver.
· Make sure your caregiver feels empowered to make the call and feed the baby if the baby truly is hungry. You don't want to scare anyone into not feeding your baby when he needs it.
If you work on all of the above with your caregiver, and your baby is still consistently outconsuming what you produce during the day, you might have not have an overfeeding problem. You'll find more on assessing and addressing milk supply issues in chapter 14.
NOTE: It might be helpful to let new caregivers know that, in terms of temperature, they can pop the bottle in a cup or bowl full of warm water (not boiling!) to make the milk a little warmer. Or you can do as I did, and teach your kids the beauty of drinking the milk cold and right from the fridge.
6. What If My Milk Stash Runs Out?
Whether it's a single workday or a weeklong trip away from your baby, there is always the chance that your stash of milk at home will be depleted. Spills happen (try not to murder the person who does this). Power outages happen, and they can spoil milk stashes. Babies go through growth spurts.
You need a backup plan, because you don't want to be on the phone with your frantic caregiver while your hungry baby is screaming her face off. One option, as noted earlier, is to test out a couple of ounces of formula on your baby while you are still on maternity leave. Let your spouse give a bottle of formula while you pump (and that's a whole feeding's worth of milk that you can bank). If you have your baby sorted on formula, you have it as a backup just in case of total disaster. Some women prefer not to give any formula to their babies, so whether you take this step or not is entirely up to you.
If you begin to see your freezer stash as a way to supplement because you are not pumping enough, you will be telling your body that its current supply is fine and that it doesn't need to make any additional milk. This will get you stuck in a supply plateau if you supplement consistently-and it will slowly but surely deplete your freezer stash. This is fine if this is what you want to do, but you just need to be aware of the ramifications as they relate to whatever your breastfeeding goals happen to be. Otherwise you'll wake up one day and your stash will be gone and you will need to start supplementing with formula-and you will blame me for not warning you about it.
The Most Important Part
What you are about to do is hard. Having and raising a baby is hard, and adding work and pumping takes it to a new level. Be kind to yourself-as kind as you'd be to your best friend in the same situation. If you're not making enough milk to get your baby through the day, you're not a failure. Seek help, yes, but don't see formula supplementation as an enemy or a sign of defeat.
If your job is so hectic that you can't get in the pumping that you need, know that by working, you are providing for your family in an important way. If you love your job, you are also doing something that fulfills you. I believe you are allowed to still value yourself and your happiness after having children. If you throw in the towel on breastfeeding at some point, for your own reasons that are not anybody else's business, please, please remember this: Your worth as a mother is not measured in ounces.
CHAPTER 5
Pumping Couture
Your Fashion Battle Is Not Over
Good news! You no longer have to shop for maternity clothes! Thank God, because it was so difficult to find cute things.
Bad news, on a couple of fronts. First, don't put those maternity clothes away yet. You're going to need them for a few months. You're definitely walking (OK, hobbling) out of that hospital looking at least six months pregnant. And if you've had a C-section, anything with a waistband is just a bad idea for a couple of weeks.
Second, now you have to get clothes for nursing and pumping. Where maternity clothes just had to accommodate your growing body, nursing clothes have to accommodate your amazingly/terrifyingly large boobs (if not on day one, then within a week or so), a (maybe) shrinking tummy, spills of milk and many other substances, and the need for your baby (and, at work, your pump) to get access to your boobs.
This results in a shockingly limited set of designs that you are supposed to make do with for the duration of breastfeeding.
Finally, here's the really bad news. You thought maternity clothes were bad? Most nursing clothes are just terrible. Except for the very expensive variety, most do not seem to be made with looking professional and halfway decent at work in mind.
The Good News
You can make normal clothes work for both nursing and pumping. Remember this: If you can nurse a baby in it, you can pump in it.
If you have a private office with a locking door, you can wear whatever you want, as long as you're comfortable sitting in your locked office with your dress pulled up to your neck or down around your waist. But I promise you that even with a lock, you'll feel exposed, and your butt cheeks will be on your office chair, which is just weird.
Your first shopping decision point is bras. You might choose to get a pumping bra: a medieval-looking device that is basically a tube bra with two nipple holes in it. Lansinoh's Simple Wishes is a pretty good version. Wait until your milk has come in to buy this thing, or you'll end up with something too small. A pumping bra provides a solid hands-free pumping experience, but it can be time-consuming to put on and take off for each session. Pumpin' Pal sells a simple hands-free "necklace" that can be put on and taken off pretty quickly. If you want to go low-budget, cut your own holes into a cloth or sports bra.
Some women just stick their pump flanges into their regular bra cups. Others hold the flanges to themselves while they pump, but this seems incredibly inconvenient for working (a.k.a. checking Facebook). You should experiment with this bra thing during your dress rehearsal day (see chapter 7).
Once you are bra'd up, there are two staple "nursing clothing" designs that you need to know about and largely avoid:
· The shelf top: No idea who invented this. This is a shirt with pornographic holes or slits over the nipples, and then an extra layer of fabric just across the boob area. You're meant to lift this layer up to get your girls out when it's time to pump or nurse. This thing is fooling absolutely no one in terms of looking like a normal top.
· The fake two-layer top: This looks like a V-neck with a camisole underneath. But when you pull the V to the side, you will see a gigantic slit or a hole over your boob. Nobody believes that this is actually two tops.
There are some nursing brands that the women I talked with do like. These include Glamourmom, Peek-a-boo (peekaboo.co), and Japanese Weekend, to name a few.
What to Shop For
There are plenty of styles that are not breastfeeding clothes per se, but that you can rig up to work for you, and probably look a hell of a lot better than most of the specialty stuff.
The trick is to look for dresses and tops that will allow you to get access to your boobs without taking the garment off or pulling it up around your neck. Some ideas to get you started:
· The crossover/overlapping V-neck: Go ahead and get used to almost every shirt you own being cut like this. Wrap dresses are a good option, too, except they make a postbaby tummy even more noticeable, so whether to do this (and whether to employ some Spanx) is your call.
· Button-downs: Any top with buttons is good so that you can just unbutton and go. Don't forget the Henley shirt-not a true button-down, but it has a few buttons at the top that can provide boob access.
· The camisole with something else on top: You can pull the top layer up and pull the camisole down to pump. (NOTE: We like to tell ourselves that those nursing camisoles just look like a tank top, but they don't. There are gigantic plastic snaps just above each boob to allow you to open up one side and nurse. Everyone sees these snaps, and no one thinks this is a normal tank top.)
· Cowl-necks: Enough said.
Try to avoid scoop and V-necks. They have to be pretty deep or you'll end up stretching the hell out of them, and once they're that deep, your new-and-improved boobs will be really visible in them. So unless you work at Hooters, avoid. If you do work at Hooters, it's a win-win.
While we're on the clothes topic, we need to talk about leaking. You're going to leak at work, especially in the early months. You'll get busy, and something will make your milk let down, and then you will be part of the sisterhood of women whose coworkers have seen their breastmilk on their clothes.
Those little breast pads are important. There are washable kinds and disposable kinds; I personally go disposable, because I've heard enough negative reviews of the actual leak-proofing of the washable kind. Whatever your choice, change them regularly to avoid moisture and the dreaded thrush.
On top of actual leak guards, give some thought, especially early on when you are more likely to leak, to color, fabric, and pattern. Heather gray is not your friend: It will show leaks more than any other color. Dark colors, patterns, and textured fabrics can help mask leaks. And always, always have a backup shirt option and a cardigan stashed in your car or at your desk.
CHAPTER 6
Breastfeeding Rights at Work
Before you walk through the door of your workplace on your first day back, you ought to know your legal rights-if you have any-for pumping at work. This chapter will walk you through the legal protections for working, breastfeeding women in the United States. Because I am not a legal expert, note that any analysis or suggestions, in this chapter and in this book, are not legal advice. Consulting an attorney is your best bet for fully understanding and acting to protect your rights. There, I've said it.
The US System
This is not a simple topic to tackle; only a good employment lawyer can provide full analysis and advice. But I have talked with lawyers, sifted through lots of legalese, and read opinions and court cases in an effort to present at least the basic facts about what your rights are-and are not-when you want to pump breastmilk at work.
I'd advise that you keep this legal information in your back pocket to use if you need it, instead of leading with it when approaching your employer to discuss pumping at work. If at all possible, you want this conversation to be friendly, and walking in armed with legalese does not set that tone.
Here's what's important to understand in the United States: We operate on a federal system, where federal law (passed by Congress) can set a baseline for all citizens. Individual states have to follow federal law, and can (but don't have to) implement additional laws and policies that are more generous than the federal laws. In plain English, this means that there is a federal law on the books-courtesy of the Affordable Care Act (a.k.a. Obamacare)-that provides some rights and protections for some working and breastfeeding mothers.
Many women are not protected by this law, so some individual states (definitely not all of them) have additional laws that extend workplace lactation rights to more women. Some states also have language that allows employers to be breastfeeding friendly, but doesn't require them to do anything. We will get into all of this in this chapter.
Yes, this is confusing and, frankly, stupid, and we are going to have to raise our voices if we want to see longer maternity leaves and universal protections that we can count on for all breastfeeding, working mothers. Supporting nursing mothers in the workplace is good for business, it's good for babies, and it's good for society. Also, it makes us like our employers a hell of a lot more.
Federal Law
At the time of this edition of this book, the important federal stuff happens in Section 4207 of the Affordable Care Act, which provides an amendment to Section 7 of the Fair Labor Standards Act (FLSA).
It requires some employers to give "reasonable break time for an employee to express breastmilk for one year after the child's birth each time such employee has need to express the milk" and to provide "a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breastmilk."
Some notes on this language:
· "Reasonable break time" is not currently defined; it's hoped that this guidance will be forthcoming.
· Non-bathroom space doesn't have to be permanent; it can be temporary or made available when needed.
· Employers do not have to pay for break times used to pump. However, if the employee is not "completely relieved from duty" while pumping, the time must be compensated as work time.
· If an employer does provide paid break time, employees can use that time to pump, and must be compensated as they would for any compensated break time.
This sounds great, but it comes with a huge catch, sometimes called the "white collar" exemption: This law only applies to employees covered under the FLSA-known as "nonexempt" employees in FLSA lingo. In practice, this means the law applies only to federal employees (all of them) and employees in the private sector who are paid an hourly wage. In other words, if you are paid a salary and don't work for the US government, this law and its protections most likely do not apply to you.
There is also a potential exemption from the law for employers who have fewer than fifty employees, even if their employees are covered under FLSA, but these employers would have to prove significant hardship in having to comply with the law, and this is not an easy task for an employer.
Long story short: If this law does apply to you, your employer must provide you with reasonable break times and a private, non-bathroom place to pump. If your employer provides paid break time, you are allowed to use your paid breaks to pump.
State Laws
Where does this leave all of the "exempt" employees-essentially most women who earn a salary rather than an hourly wage?
Unfortunately, at this time, you're left at the mercy of the laws of the state you live in.
Almost all states have some laws to protect the rights of women to breastfeed a baby in public. Fewer states (twenty-four at the time of this writing) have laws that relate in some way to lactating women in the workplace.
These range from amazing (Vermont employers must provide reasonable time and a non-bathroom, private space to express breastmilk for three years after the birth of a child) to totally toothless (Texas allows businesses to call themselves "mother-friendly" if they have supportive policies in place-but it doesn't require anything of employers).
Because these laws can and will change over time (hopefully for the better), you should always look online for the most up-to-date information to understand your rights. Here are the most straightforward and up-to-date resources I have found (see chapter 18 for web addresses):
· United States Breastfeeding Committee is an organization committed to protecting and promoting breastfeeding in the United States. The site's Employment section has plain-language explanations of the federal and state laws affecting breastfeeding and work. They also regularly advocate for better legislation and ask followers to get involved by contacting their members of Congress.
· National Conference of State Legislatures maintains an online list of state laws related to breastfeeding in public and lactation in the workplace.
Individual Employer Policies
On top of this mishmash of laws (and lack thereof), individual employers sometimes write their own policies for breastfeeding mothers. When they do, the internal policy is often more generous than the federal or state laws in place.
Check your employee handbook (if you have one) and speak to other new mothers to find out the real scoop. You also can talk to HR (more on this in chapter 8). If your company has a policy, lucky you! You have a clear foundation on which to build your plan for pumping at work.
It's still a good idea to familiarize yourself with the federal and state laws, though, just to be sure that your employer's policy doesn't run afoul of any existing laws.
Discrimination
Discrimination at work exists, on the basis of race, religion, age, gender identity, childbearing, disability, sexual orientation, and lactation-you name it.
There is no guarantee that a company bound by federal or state laws will actually comply with those laws. Some women I interviewed for this book reported being treated in ways that were questionable at best and illegal at worst.
For example, a manager might take advantage of the fact that the federal law does not specify what a "reasonable" length of time is and give a woman ten minutes total to get to the lactation room, pump, and get back to her workspace. If you are protected by federal law, a manager might play dumb-or truly be ignorant of how this works-and say that since there is no state law, the business doesn't owe you anything.
The bad news is that women tend to feel isolated because we fight these battles one at a time, when we are already in a vulnerable state. Many women who are discriminated against or denied the ability to pump at work don't pursue legal recourse, because they need the job and are scared to lose it, can't afford the legal fees, or simply don't have the energy. So they just suffer discrimination at work, move on and find a new job, or stop breastfeeding to make the problem go away.
If you feel your legal right to pump at work is being violated, or you are being discriminated against because you are pumping, try printing out the relevant legal language and approaching someone in a position of power within your company. Don't do this antagonistically-take the tone of hoping to educate and get help. If this doesn't work, find an employment lawyer. You can also file a complaint with the US Department of Labor's Wage and Hour Division.
Do what feels right for your life right now, and know that if you have to choose staying at your job over breastfeeding, you are not alone, and the choice does not change the fact that you are a great mom.
