Chronicles of Breastfeeding as a Working Mom
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Any woman who has gone through pregnancy and birth has a good chance of getting constantly reminded of how wonderfully beneficial it is to breastfeed or nurse her baby. No woman needs extra reminding, but for the uninformed, benefits include lower risks of postpartum hemorrhage, SIDS, depression, and certain types of cancers; greater immune protection for the baby, and being an always-on source of nutritious, tailored-to-baby sustenance. Nursing specifically confers more benefits than simply being a fresh, on-demand food source for baby; nursing is also a source of at-the-ready comfort - a convenient way to soothe a baby and provide a bonding moment. Then, there are the practical benefits - the convenience of popping out a boob anytime baby was hungry and not having to deal with mixing formula and washing bottles (that is, if you nurse and don’t pump). It sounded like a heck of a good deal so going in, I was hell bent on making it work.
At the same time, there was no shortage of horror stories everywhere about the strife, especially the mental tax - that not every mom can breastfeed despite trying every tactic out there, that it was going to be really, really difficult, and that the logistics of it all spent many women spiraling into postpartum depression or anxiety and switching to formula, because for goodness’ sakes, an unhappy and overwhelmed mom will have a harder time tending to her baby. And of course, layer on the usual shame that mothers get for the decisions they make for their baby and you get a perfect set-up for a mental breakdown. There is absolutely no shame in formula-feeding. Has any adult ever been questioned about how they were fed as a baby?
Sadly, so many women are unsupported in their motherhood journey, especially with maternal care deserts and the OB-GYN shortage plaguing the United States today. With public health becoming further defunded and muddled with misinformation, the future of women’s health in the United States is bleak. So many mothers are unable to get support from IBCLC’s (lactation consultants) and many of them are disappointed even when they do. Living in one of the only countries in the world without mandated paid parental leave despite extraordinarily high cost of living, mothers who work are forced to be apart from their baby much sooner than the recommended “exclusive breastfeeding” duration of 6 months to 1 year or longer. Apart from overhauling maternal support in this country, we can only adapt while continuing to push for systemic change.
So, why am I writing this post? I am not a medical professional so am not qualified to give medical advice. I do, however, feel compelled to share my story as a way to get one person’s experience out there and explain what at least worked for me, and what a breastfeeding journey could look like. It was hard for me and even still, may not work for everyone, but can hopefully plant a little seed of hope and perhaps some help to someone who wants it.
Weeks 1-3: How to Survive & Establish Supply
I was most afraid of nipple pain, but that turned out to be the least of my worries. And these were the hardest weeks, so the first thing I did was to keep reminding myself that this period was not forever.
I was fortunate enough to have a relatively uneventful birth and privileged enough to experience golden hour with my newborn. Within the first hour of birth, my nurse helped me get my baby in position for breastfeeding which was of course an awkward exercise as it was my first time, but she latched right away - hurdle number one cleared. Despite experiencing quite a lot of nipple pain during pregnancy, my baby’s suckle was not painful. However, some attempts at latching did end up with fairly sharp pain. The hospital had lanolin I could use (safe for baby), but be aware that it will stain clothing. Later on, I purchased a different brand of nipple cream that was not lanolin-based.
I was surprised that I was already producing colostrum at that point. I did not harvest colostrum in the days leading up to birth, as some women did, and honestly I’m not sure if it would’ve helped me since my baby was full term. Newborn stomachs are the size of a grape so she did not need much to feel satisfied. However, my 5 pound peanut had trouble drawing enough milk and would cry to nurse frequently - what felt like every hour. “Second Night Syndrome” was a rude awakening.
Several things I learned from the first two weeks of breastfeeding that I did not learn from any of the numerous YouTube videos and preparation articles:
Breastfeeding frequency & duration: What I was told was that newborns would feed every 1-3 hours, give or take. Cool, I thought, that meant I would have plenty of time to relax in between. In reality, I was bringing baby to breast about 14-16 times a day and she would nurse anywhere between 25 to 45 minutes per session. I was shocked at how much of my day I was spending couch-bound. And when we say 1-3 hours, we say 1-3 hours from the start of the previous feed. That means if she feeds at 7:00 for 30 minutes, then her next feed could be anywhere between 8:00 and 10:00. For my baby, she would feed every 90 minutes to 2 hours on average. In other words, there is a very short break in between feeds in which you can maybe hand baby to your partner and take a short nap or a shower. For the first few weeks, this was around-the-clock feeding.
Hand expression, not using a breast pump, saved my milk supply: Hand expression was the easiest way for me to boost supply in the early days, but it is a skill that takes some practice. However, once I mastered it, I got a huge confidence boost. I found this video helpful. My early attempts at pumping felt dismal. I was so ready to bust out the fancy Spectra Synergy Gold SG that I had gotten through insurance, and didn’t realize that I would be yielding 1 oz at best per pump session. Rather than deal with washing all the parts, I hand expressed after every feed to boost my supply. In those early weeks it was important to signal to my body that my baby needed a steady supply of milk. I used hand expression not just to signal to my body that there was a tiny baby who needed milk, but also to start building a stash. More on this below.
Middle of the night feeds: Night shifts were unsurprisingly really, really hard. But not necessarily in the way I thought. My initial expectation was that I would just be awoken by the baby crying. Instead, I had to wake up my baby to feed! She was a sleepy, small peanut and I would set alarms every 2.5-3 hours to get her up and bring her to breast. If baby is gaining weight well, this may not be necessary, but because my baby was so tiny, we were monitoring her growth very closely. Sometimes she would fall asleep without eating enough which meant I needed to find a way to annoy her to keep her awake (cold towels were more effective than tickling her feet). Since this meant we were going to be super sleep deprived, we were afraid that one of us would be holding her and fall asleep by accident. One strategy my husband and I used was taking shifts in separate rooms. We were lucky enough to have a bassinet that attached to our stroller so we simply wheeled her into the other bedroom when we switched. This was our strategy:
All day: Hand express after every feed and collect milk in bottles. Consolidate at the end of the day and freeze in 4 oz portions to build stash.
Around 9:00 PM: Nurse baby, then express milk into a bottle right before going to sleep in our bedroom.
Around 12:00 PM or whenever baby started to fuss for food: Hubby would feed her a bottle of expressed milk (she was tiny and only took 1-2 oz) around midnight, put her to sleep if she wasn’t already and go to sleep.
Between 2:00 and 3:00 AM: She woke up somewhere in this time window; he would bring the baby to me to nurse and he would go back to the other room to sleep.
3:00 AM - 6:00 AM: I would take her subsequent feeds through the rest of the night by using my phone alarms.
We used this method for about the first 2-3 months and most of the time, both of us got at least 4 hours of continuous sleep. This, of course, assumes that baby will fall asleep between feeds without too much trouble, which did not always happen, but with survival mode, we just had to try our best. During the day, we would make sure to nap when we could. As we approached 2 months, baby was gaining weight well and we didn’t need to set nightly alarms - we simply let her wake us when she was hungry.
Nursing mother’s neck: The soreness in my neck and shoulders from all the looking down at my baby and making sure she was latched properly was painful. Even after 7 months I still got awful tightness at times. I tried my best to stretch my shoulders and back for a few minutes every day. The “cobra” yoga pose is wonderful.
Breastfeeding pillow: Every mom has their preference on breastfeeding positions and while I could have used a regular pillow, I really loved my “My Brest Friend” pillow. I loved it so much I also bought the inflatable version for travel. This pillow has a buckle that you clip around your waist/hips and provides lumbar support. With this pillow, I did not need to hold the weight of the baby. It also made for a decent “seat” for just holding her in my lap.
Bottles and cleaning: I knew I would need a lot of supplies as soon as I got my first breast pump. One of my generous coworkers got us the Dr. Brown sanitizer which we still use today. I’m also a huge fan of Mila’s Keeper bottles (affiliate link) - they are pretty and the silicone ones are great for pumping, plus they are plastic free. For feeding we use the Nanobebe silicone bottles - she took the bottle and nipple right away so we never needed any other ones. I have heard however that not all parents are so lucky and have to find a particular one that baby will tolerate. Nipples also have different levels of flow. Either way, essentials include a bottle brush (we like Oxo), a bottle drying rack, (this Munchkin bottle rack was our favorite; I love the all-silicone design), and a sanitizer to avoid boiling bottles all the time.
Nipple pain: I mentioned this briefly above, but I was pleasantly surprised at how my body adapted. I had some pretty painful moments with cracking/bleeding, but steeled myself through. I used Silverettes and nipple balm for the first couple months. These days though, I have no need for them.
Nursing bras: This is a very personal choice. I found these to be very affordable and surprisingly comfortable. I machine washed them in wash bags and air dried.
Nutrition and hydration: While there are so many specialty products claiming to boost milk supply based on some rather paltry evidence, I always needed a big water bottle with me and I needed to eat ample calories to support milk production. I needed to drink a lot more fluids than I was used to and was really watching my diet to make sure I was maximizing nutritional value. I also continued to take my prenatal vitamins to replenish lost nutrients.
4 Weeks - 4 Months: Supply Management, Mastitis/Clogged Ducts, Stash Building
With perseverance, I was able to breastfeed my baby exclusively to this point - the hardest part was over! Yay! By this point, my nipple tenderness had all but disappeared. I had very minor leakage for a few weeks initially as my supply was getting established. I never leaked so badly that I needed breast pads, but I did encounter mastitis when I accidentally over-increased my supply or when my baby slept longer than usual. Between 3 and 4 weeks, I noticed that my expressed milk was starting to transition from deep yellow to the typical white color that you think of when you think of milk. Mature breastmilk also is greater in volume, so I noticed it was getting easier and easier to get more than an ounce when hand expressing.
Mastitis & supply regulation: Establishing supply was a balancing act. Too little milk and my baby wouldn’t be gaining weight properly. Too much milk and she might have trouble latching or I would experience mastitis/clogged ducts which was preceded by feeling somewhat ill (like I was coming down with a cold) and my breasts would get extremely tender and painful to the touch. Previously, guidance for mastitis was to work the clog out by aggressively massaging the breast. That guidance has changed in 2022- the recommendation is to continue to breastfeed but avoid overfeeding on the inflamed side, apply cold packs, apply gentle massage, and rest.
Building a freezer stash: I continued to express milk diligently at least every morning and evening to give myself a slight oversupply - enough to continue to freeze milk in 4 oz portions, then 6 oz portions as time went on. This was in an attempt to prepare for the transition to pumping. Many moms experience supply drop upon returning to work and I wanted the backup just in case. The freezer stash was super useful when I needed to be out of the house for more than an hour or two and my husband could warm up a bag and feed her with a bottle. I’ve used Lasinoh, Motif, and Medela breastmilk storage bags. Medela ended up being my preferred bag, with Lasinoh my second choice.
4 Months+: Pumping at Work
After 16 weeks I needed to go back to work and baby started daycare 2 weeks after that. This meant that I needed to bust out my pump and start to substitute some of our nursing sessions with a pumping session.
Choosing the right pump: Not all pumps are created equal. Hospital-grade pumps are best as they are a “closed-system” pump (milk can’t get into unit) and have stronger suction strength than standard pumps. When I was initially picking out a pump, I was intent on getting a more compact unit I could travel and commute with without having to bring a big bag. Unfortunately, this turned out to be a mistake. I had purchased a fancy “Mini Spectra Synergy Gold SG” using my insurance, but it lacked the vibrating suction that the standard Spectra S1 (cordless option) or Spectra S2 (cheaper, but needs wall outlet) had which made the difference between getting a let down (the casual term for the milk ejection reflex which releases the milk toward the nipple). The Spectra S1 and Spectra S2 are tried and true models. I’ve never needed a hand pump since I’ve been pretty successful with hand expression.
Flange sizing: The Spectra models come with two flange sizes - both of which were too big for me. If you can get sized by an IBCLC, that’d be easiest. Otherwise, you can use a nipple ruler and try to size yourself.
Practice pumping: About 2 weeks before I needed to return to work, I started to substitute pumping once a day to get used to the pumping workflow. I wasn’t having any luck with pumping when was nursing initially, instead using hand expression, but as it turned out, the pump I was using simply wasn’t effective and my flange size was wrong.
“Refrigerator trick”: Not so much a “trick” so much as
Replacing pump parts:
Baby drinks the same volume:
