So, you are getting ready to go back to work. Where did the time go? All those sleepless nights really go by in a flash. But I digress…
Many women ask me about how to prepare for the transition back to work almost as soon as they deliver their baby. There is a lot of anxiety tied up around milk supply and having a end of day’s sized milk stash. Here’s the thing… the best thing you can do for you and your baby to prepare for pumping at work is this… breastfeed.
During the early day’s postpartum, the frequency and the amount of breastmilk removed from the breasts are laying the groundwork for your supply for the REST of your lactation cycle. The more thoroughly your breast is being emptied, the more milk your body will make. It is literally all about supply and demand.Most people understand milk supply is influenced by supply and demand. Yet knowing and understanding are two different things. Understanding how your milk supply is established will later help you maintain or boost your supply while working. Real quick, here is a down and dirty version of of lactation physiology.
FIL stands for Feedback Inhibitor of Lactation. Phew, that’s a mouthful. We can just settle with calling this little whey protein FIL. FIL is manufactured along with breastmilk by the the milk producing cells in your breast call lactocytes. In between feeds, FIL and milk accumulates. FIL’s job is to inhibit (or prevent) the production of milk. The more FIL accumulated, the less milk your body will make. This is how your body knows that your breast are getting full and it is time to stop making milk so you don’t pop. When baby comes to the breast to eat, they empty all the milk and FIL out of the breast. Because there is very little FIL left, your body gets the message to MAKE MORE MILK.
PROLACTIN HAS A JOB TOO
After the placenta is delivered, Prolactin levels increase. Prolactin is the hormone responsible for milk production. Prolactin is released in response to breastfeeding. Each time your baby feeds, you are putting in a milk order for the NEXT feed. The lactocytes are responsible for making milk. These cells have receptor sites for Prolactin to attach.
More Prolactin in Receptor Sites = More MILK
When your breast become full, the milk producing cells become distended making it impossible for Prolactin to attach to the receptor sites. This impedes milk supply. As milk is again removed, the sites return to their normal shape and prolactin can again attach to the receptor sites and order up the next milk serving.
Here is where things get interesting… Milk removal in the early stages of lactation (the first 1-2 weeks) actually determines the number of receptor sites your body will make. The more frequently your baby feeds at the breast, the more receptor sites your body makes to accommodate. The amount and frequency you allow baby to nurse early on actually influences your overall supply capacity for the rest of your lactation cycle!
More receptor sites = the ability to order MORE milk.
The moral of the story, let your baby feed on demand (especially during the first 1-2 weeks) to help ensure a healthy milk supply long term.WHEN DO I START PUMPING?
This is a bit of a loaded question as each mother and baby dyad are different and their needs are specific to their family dynamic. Ideally, mom and baby will exclusively breastfeed for AT LEAST the first 2 weeks. If you have a shortened maternity leave (6 weeks or less), I would start pumping at around the 2 week mark. Before then, get use to your baby and let your baby get proficient at breastfeeding. If you have no medical reason to start pumping, don’t rush it.
Why would you not start pumping immediately and start massing a frozen breastmilk stockpile? Well, there are couple of reasons.
OVERSUPPLY IS A BIG PROBLEM
Remember Prolactin? Remember how I said the more you feed in the first 1-2 weeks, the more receptor sites your body makes? Well, that includes the effects of pumping. If you are breastfeeding your baby on demand and pumping like a maniac, you are placing surplus orders for milk. The idea of breastfeeding on demand the first few weeks to determine your supply is to allow baby to tell your body how much milk he needs. It is specific to you and your baby.
But isn’t more milk always better? No. Too much milk is a huge problem. Oversupply can lead to engorgement, clogged ducts, mastitis, thrush, and ultimately early weaning because it makes breastfeeding an absolutely miserable experience.
It can also effect baby. When there is too much milk, letdown can be fast and overwhelm young babies. They literally are getting waterboarded by your breastmilk. Infants come off gagging, sputtering, and sometimes will refuse the breast. Many swallow excess air while they attempt to keep up with the deluge and end up being very gassy colicky babies. Many babies will adopt a shallow painful latch for a quick escape.
As an oversupply survivor, let me tell you too much milk is not a good thing. If you think you have oversupply, check out THIS LINK where I dig in deeper to signs, symptoms, and SOLUTIONS.
HOW DO I START PUMPING?
The best way to introduce pumping while exclusively breastfeeding is to start slow. Pick one feed time that you will consistently pump after breastfeeding the baby. Morning tends to be a good time to do this as Prolactin levels are elevated at night and most women find their supply to be greatest first thing in the morning. Feed baby as normal and then after the feed you will pump for 15 minutes. At first, you will not be getting much milk because your body has equilibrated to make just enough to feed your baby. By pumping, you are putting in an order for more milk in the future. If you are consistent, your body will eventually reward you with more milk.
DON’T FORGET YOUR BAG
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WHAT IS NORMAL OUTPUT?
Initially, it is not abnormal to get 1/2 an ounce or less from both breast combined in an after feed pump session. In fact, on average most women with established milk supplies can only expect to pump 1/2-2 ounces in a pump session. Pumping output is frequently misinterpreted as an indicator of LOW SUPPLY. You can click THIS LINK for more information on potential causes of Low Supply.
The breast pump is not nearly as effeciant at extracting milk from the breast as your baby is. It is normal to not get enough milk from a single pump session to constitute a “feed.” When you first start pumping, it is expected to get small amounts. Women often feel compelled to put away a large stash of frozen breastmilk before returning to work. While it is important to have a few days worth of milk put away, you by no means need a freezer overflowing with breastmilk.
When you return to work, you will be pumping at intervals that match baby’s feed schedule. In other words, whenever baby should be eating, you should be pumping. The reason you need a stash is to have a back up store incase life gets in the way. Perhaps you have a crazy day at work and you are not able to pump as frequently as you would have liked. Or maybe you drop a whole bottle of pumped milk on the floor (been there 😭)!
Then there is my personal favorite, your babysitter decides to feed your baby and OBSCENE amount of milk one day and leaves you without any backup. Not to throw my dear husband completely under the bus, but one night he fed our 3 month old son 7 OUNCES of milk IN ONE FEED! I about flipped my lid when I found out. My friends, these things happen and that is why we all need a bit of a backstop.
HOW MUCH DO I NEED IN MY FREEZER?
What you don’t need is extra milk in the freezer to be supplementing your baby with everyday. If you have a normal healthy supply, what you pump at work, should be divided up and be your baby’s feed the next day… EVEN if it is less than you would normally feed the baby. Why?
Lets say you are gone from 9-5 every day and baby eats before you leave at 8, then at 10, 1, and 4. This baby normal gets 3 ounces a feed so would need 9 ounces a day but you only pump 7. Many women believe they need to to be thawing 2 ounces from their stash everyday to make up the difference. The problem with this plan is that your baby is getting use to a larger volume of milk but your breasts are not getting an order to an equivallent amount of milk. You are creating a supply and demand issue and using up your stockpile at the same time. This is why many women find themselves falling behind with breastfeeding once they return to work.
Instead, mom should take her 7 ounces and divide it up for the day. Does baby just go hungry? No, you make up for it in different ways that will help boost your supply. You can fit in a 4th pump session for a week and see if your pumping output catches up with baby’s demand. Some babies will simply cluster feed when mom comes home to play catchup. This is a double win because baby rapidly catches up on any missed intake and he boosts mom’s supply while he is at it. Some women will feed the baby and then do a quick pump session before going to work. This again gives a little extra milk for baby during the day and it puts in another order for mom’s body to make MORE MILK.
The point is, you do not need to have a months supply of frozen breastmilk in your freezer. You need to have enough to cover you if you have a bad week. Life happens, especially when kids are in the mix. Give yourself some wiggle room but do not drive yourself insane trying to stockpile a freezer full of breastmilk.WHEN AND HOW DO I START?
Introducing the bottle is much like introducing the pumping. It can wait. The best case scenario is if baby exclusively breastfeeds for at least the first 2 weeks of life. This is the best scenario for establishing a good milk supply and it is best to help baby establish solid breastfeeding skills before introducing the bottle. With that said, don’t wait until the day before you go to work to introduce a bottle. Babies have strong preference about the way they eat and it is not just preferring a bottle. Some babies will very adamantly prefer feeding at the breast. That is why it is important to let a baby and mother have time to establishing a breastfeeding relationship in the beginning but it is equally important to allow enough time before returning to work to introduce a bottle into baby’s routine.
There are about a MILLION different bottle brands out there to choose from. I could really write a whole post about bottles (and I might!). The most important factor when choosing a bottle… pick one your baby likes! Babies have preferences so don’t be afraid to try a variety of styles if your baby is not taking to bottling right away.
Establish a routine that includes bottling. Start by picking one feed a day that Dad (or someone other than mom) feeds the baby. This gets baby use to someone other than mom providing food in a ritual that becomes familiar. When mom goes to back to work, it is a big shift for baby. Rituals and routine are soothing for babies and having an element of familiarity can be helpful.
When you pick a time of day that baby is going to routinely take a bottle, mom should be pumping during that feed time. It is important that mom be on the same schedule as baby so that supply keeps up with demand. Whatever is pumped, can be put in the fridge for the next bottle feed.
HOW MUCH MILK SHOULD I GIVE IN A BOTTLE
Research tells us, on average breastfed babies consume approximately 25 ounces a day from age 1-6 months. Babies are all different. Some will consume a bit more… some a bit less. Some will feed less frequently and take larger volumes, others will take in less but feed more frequently. We start with the assumption that baby will eat around 25 ounces and divide it by the number of times baby eats in a day. If baby eats 8 times in a day, your bottle size would be around 3 ounces.
Another method for figuring baby’s intake is using this rule of thumb:
2.5 X (infant weight)/ # of feeds per day
Baby is 7lbs
7 X 2.5= 17.5 ounces
There are 30ml in an ounce so that is 517 mls
Baby Breastfeeds between 7 times in a day
17.5 ounces/ 7 = 2.5 ounces
WHY DOES BABY NOT EAT MORE AS HE GETS OLDER
Many people assume as baby gets older, they need to be eating more. But if you look above, I said the average intake of a baby 1-6 MONTHS is 25 ounces a day. So it doesn’t change much in the first for five months. How is this so?
There are a couple of reasons. Babies grow rapidly in the first month and their intake amounts change rapidly to reflect that. From month 1-6, growth rate slows. As baby grows, the composition of your milk (how much fat is in it) will change to meet the needs of your growing baby. So instead of your baby eating more, your milk will actually get richer to meet your baby’s needs. Cool eh?
What about after 6 months? Well, things change after baby starts taking solids. How much baby is eating affects milk intake. Some babies cop onto table food right away whiles others are 9-10 months before they eat an appreciable amount. How much milk baby eats will actually decrease as baby takes more table food. I usually continue with the average 3 ounce feeds but space them out further and ultimately end up with less feeding sessions.
WHY IS MY FRIEND’S BOTTLE FED BABY EATING SO MUCH MORE
Research shows on average bottle fed babies eat more than breastfed babies (as much as 2x). This happens because of the composition of formula versus breastmilk and the nature of bottle feeding versus breastfeeding.
Formula is harder to digest than breastmilk. A baby needs to consume more formula to extract the same nutritional benefit in a feed that he would from breastmilk. This can lead to baby eating more in a feed. There are also hormones in breastmilk that influence baby’s satiety cues (signals that tell baby he is full). Formula does not have these hormones which is believed to also contribute to overeating.
Eating from a bottle is also a more passive experience. Flow from a bottle is quicker and more consistent making it easier to overeat. Young babies are eating by reflex and often will finish a bottle before satiety cues have caught up. We also tend to ignore babies cues and encourage baby to “finish the bottle.” Studies show that more milk in a bottle directly correlates with more milk fed to baby.
Generally, when making a bottle, I round up slightly from these numbers and then I see what baby eats. If baby is eating 2 ounces, then we know freezing 2.5 ounce bags is plenty. If baby eats a bit more than 2.5, then we freeze 3 ounce bags. Do not feed a lot more than these recommendations. Keep in mind our propensity to overfeed babies when bottling, your babies eating style (small frequent feeds/large spaced out feeds), and average recommendations when determining bottle size.
WHAT CAN I DO TO PREVENT OVEREATING?
Breastfed babies that are bottle fed should be using a slow flow nipple. This will make baby work harder to get the milk and extend the feed time. While it is tempting to opt for the quick efficient method, the idea is baby will eat less as satiety cues catch up. Using paced feeds is another method for helping prevent baby from overeating.
Paced bottle feeding is a technique used to prevent babies form chugging a bottle mirroring gentler rhythm of breastfeeding. Using paced feeds helps baby not overeat and for the breastfed baby it helps prevent nipple confusion or bottling preference. Baby is held upright for the feed with the bottle held horizontally. This ensures gravity is not doing the lion’s share of work. Baby must actively suck to take in milk. Baby is allowed to drink for 20-30 seconds and then the bottle is tipped down while still allowing the nipple to stay in the baby’s mouth. This will stop the flow of milk and “pace” the feed. This mirrors the experience of breastfeeding as baby naturally takes small breaks between sucking bursts. When baby starts actively sucking again, the bottle is brought back to horizontal and the flow of milk is restored.
The biggest take home message is to respect your baby’s feeding cues and satiety cues. It is tempting to encourage baby to finish that last bit of hard earned liquid gold at the bottom of the bottle. If baby is not actively sucking or is giving other cues of being full (dropping/pushing out the nipple or falling asleep) the feed is done and bay is full.
Watch this video for a quick demo!
Some babies benefit from using a pacifier to help satisfy their oral need to suck. Non nutritive sucking is very soothing for babies and some babes have a really strong compulsion to soothe this way.
Enjoy your maternity leave with your baby. This is a time for getting to know each other, beginning to create a meaningful routine, and to establish a healthy breastfeeding relationship and supply. Do not stress out about storing breastmilk. The prep you need to be doing to prepare for returning to work should be minimal. Start slowly by introducing a pump session to make a freeze supply that can buffer life’s little tragedies and begin introducing your baby to a bottle. Ideally, none of this should be happening before 2 weeks of age (that is a minimum, it is okay to wait longer if you do not have a pending deadline). The best way to prepare for work is breastfeed on demand and build a healthy supply. Remember, a healthy supply is the biggest factor influencing your longterm breastfeeding success.
Check out the other installments of my pumping series Pumping Mamas. I dive into techniques to help you Pump More Milk. Next I dive into Pumping Basics covering types of breast pumps, their assembly and care, needed accessories, storage guidelines for pumped milk and how to make the most of your pump session!