Breastfeeding and Work

No that is not me in the picture- I borrowed a random person's picture online.  This post is from a request and I still do not feel like I am quite the expert at this, but I will do my best to give my tips.

So breastfeeding was most challenging during my first two weeks. The first five days were colostrum and my daughter was loosing weight.  Colostrum has high calorie and fat and though very thick and so you may not be able to pump, your child will be ok.  But this was hard for me because I had everyone around me giving me look and asking are you sure you don't want to supplement.

I was so determined to nurse her that I refused to go out and buy formula.  It was very difficult but I knew if she got it elsewhere (i.e. formula) she would not need to work hard to get her food from the breast.  I was so desperate that I set alarms every 2-3 hours to get up and pump first for 10 minutes (at the beginning I got nothing) before trying to nurse her and then eventually my milk supply came plenty. This back fired since my brain felt that I had twins and I ended up with an overproduction. It is however better to have this problem than the opposite, especially with my type of job.

My mom was the generation that formula was starting to be promoted more than breastfeeding both her and my grandma had their opinions, to my surprise they did not support me completely, whenever the baby cried they would tell me it is because I am not providing her with enough nutrition.  It was hard for me and I almost gave up at that 2 weeks mark when everything else also seemed to be failing but started going to the breastfeeding clinic once a week and sometimes twice a week and the wonderful lactation nurses encouraged me and I was able to tell how much she was getting with each feeding.  Usually she will be weighed pre and post nursing and we will subtract the weights to get the amount in ounces.  Her weight gradually increased and I became quite the defensive one whenever anyone questioned she was not getting plenty.  I brag about how much she weighs and even add in, that she is all breast fed.  She is 13+ pounds (5.91 kg) at 11 weeks (all breast milk lol).

I had mastitis and a painful nipple bleb and so on; i had everything that could discourage one from nursing.  Men! I remember when I would cry when the baby would first latch and my husband had to help me with her- you can't imagine how far I have come.

Some tips
1) it is going to be challenging but you will survive
2) decide if you want to do it and stick with it;
3) don't compare yourself or your milk supply to anyone else.
4) Take all the positive support you can get- i was fortunate to have free breastclinic and the wonderful lactation nurses to go to.
5) remember your supply is dependent on how often your baby is on the breast, so if she is not on the breast at least every 2-3 hours for that first few weeks, your supply will be less.
6) At night may be tiring so pump during the day (best time is early in the morning) and save so that your partner or help can do one or two feedings to let you sleep.
7) It is very common for new mom's to have mastitis, if you can latch her and yes it is safe- it is the only way your breast will heal, if you can't stand her latching then take a nursing holiday and pump for 24 hours- you will feel better.  I didn't need antibiotics in less than 48 hours chills, fever, and pain were gone.
8) Your nipple will hurt at the beginning that is because, your baby is learning how to latch and you are learning how to nurse, change positions until you are comfortable, use a nipple shield as well as lanolin to keep breast from cracking, avoid soap around your nipple when you reach the third trimester and throughout nursing.
9) If you don't have breastfeeding clinic in your area, then carry your baby and weigh yourself with her in a clean, dry diaper, then nurse her and re-weigh immediately without changing her diaper.  Subtract and that should tell you how much she got from each breast.  She should get roughly add 1-2 to how many months old she is every 2-4 hours.  So if she is 0 months 2 oz every 3 hours is ok, remember their belly is very small. I have enough milk to feel her up with one breast but sometimes she finishes off with another breast especially now that she's bigger.
10) do what you can but if you are not enjoying it after 2-3 weeks, don't torture yourself
11) and take vitamin D or give it to the baby if you are solely nursing.
12) catch them when they are rooting, smacking or showing other signs of hunger rather than when they are hysterical and screaming.
13) again for the first few days latching will hurt, make sure her mouth is wide enough, and she is not getting just the nipple but the whole areola is in her mouth- your baby has to learn this- she gets more out this way and she causes mom less pain.
14) No pacifier for the first 1-2 months. Or until she learns to suck from the breast.
15) If you feel that your breast is not empty, pump, this will help keep your supply.  Pumping eventually gets old but you cannot get lazy in the beginning stages.


Why in the heck did I do it?  It seems like hard work but I felt useful, everyone fights to hold your baby, but they will give her back for you to nurse and there's no formula to make and feed. My reasons are:

For baby:

1) Because I wanted my baby to have the best and I feel that breast milk is genius! and God given and is better than man-made milk/formula.
2) I wanted all the bonding with my daughter because I know how demanding my job can be, my daughter knew me by 3 weeks old and gave me all the right cues to show that she recognizes me.  I can literally walk in on my daughter having a screaming tantrum and she hears my voice turns towards me, stop and smile.  Sometimes my grandma is surprised that she isn't even hungry, she just wants her mama's affectionate touch.  Nursing is one of your baby's soothing mechanism, and soon she begins to recognize your smell, touch, and your voice and even your face. It is heart warming when she stops and looks at me, learning my face.  As she gets older she will recognize you as well.
3) I saved money! I literally bought a ~$400 pump the advanced free style medela pump and if I were buying formula all these while I would have spent ~$470 by now purchasing formula. Now this has changed for low income earners because of WIC, especially if for some reason you are unable to meet the demands of your growing child.  WIC is a government sponsored program that provides formulas and milk for families who meet their criteria.
4) My baby has a stronger immune system- this is because your antibodies gets passed on and hence less sick days off work because my baby will not get sick as often.
5) I would like to think it will make her smarter but I am unsure how this works- I believe genetics, reading and interacting with your child may have more to do with this.  But hey anything from God is genius! and possible.
6) she will have a lower risk of leukemia, heart disease and MS; I told you in a previous post that as doctors, we see the worst hence, we tend to err on the side of caution.  I can also remind her of how mummy protected her from these things, so she better listen to me more than her dad. j/k
7) she will have fewer ear infections- this is likely from your antibodies and if she is solely breastfed she is less likely to accept a bottle in bed (very bad!!!!!).
8) she will be leaner for life- this is partly from expert opinion and in my experience, breast fed baby have to work to get their food, and hence they learn to stop when they are full.  It makes sense right? who continues to labor or farm when there is already abundance.  They tend to carry this on as they grow.  You cannot force them to finish the breast milk :) that being said if you have to bottle feed when your baby is full, remove the bottle from their mouth and try not to encourage them to finish it, I know it is expensive but it is bad for them and don't give em a bottle every time they cry- they are not always hungry.
9) it is easier on their gastrointestinal tract compared to formula

Benefits For mom:
1) I get to form the strongest bond with my daughter and the satisfaction that she will not confuse me for anyone else who cares for her.
2) The satisfaction that I am providing her with my best natural food that I can provide
3) I don't have to get up to warm milk or make formula; I just half asleep stick out my breast facing her and then after she falls asleep lay her on her bed.  I don't have to carry a bottle with me when we go out- just my nursing cover and my breasts are all I need.
4) I lower my risk of breast and ovarian cancer- while nursing you decrease your body's exposure to estrogen, which is associated to the risk of developing these types of cancer.
5) I help loose weight and hence obesity related illness such as heart disease, diabetes and so on- I had a c-section so I could not do anything for 6 weeks, but at my 6 weeks check up I had lost 40 pounds (18 kg) and with work (still no exercise routing) I am now fitting in most of my clothes.  My belly is yet to be back in shape but maybe I will write a post in the future about it.
6) Studies have shown that nursing protects against osteoporosis later in life- I cannot explain this because it makes sense to me that it causes osteoporosis but pregnancy itself helps with bone density.  That being said I love evidence based medicine and studies have show this.
7) again- save money!!! diapers and everything else are too expensive.

When you go back to work be sure to buy the hands free pumping bras- they are awesome! just go to a private corner and wear them over your nursing bra and pump both breasts at the same time. Remove them, then fold and store. Pump as often as she eats so that your supply does not decrease too much (typically every 3 hours).  Be sure that two weeks prior to going back to work, you pump in the early morning (your highest supply- oxytocin is high between the hours of 4 and 7) and store in freezer.  No bottles or pacifiers during the first month, or until she learns to latch/nurse and then you can do as you please.  Start introducing bottle the 2 weeks before you go back to work so that she can get used to the bottle.  My daughter hates pacifier's and rather use her hand or my nipples to soothe herself.  I don't discourage it- at this stage they need to soothe themselves and if she doesn't like the pacifier then o well.  My job is extremely busy and I had to make time as a resident doctor by planning each day ahead of time, i was able to pump and keep up with the others. I had a good pump so that i could pump effectively.  I got so good that I can do my paper work for admissions while in my private pumping corner.  Every 3-4 hours was my goal and maybe one or two times I got close to 5 hours but you don't want to make a habit of this.  I came home with bottles, poured them out in a bag and froze them, I had almost a month supply in the freezer prior to starting work because I had an over supply but it is ok because she is growing and will one day use them.  With my type of job, an oversupply is not a bad problem to have.

I hope these helps some of you, who plan to nurse. I realize that this may not be difficult to those who do not have a durable electric power supply (i.e. NEPA) or this may not just work for some people. What works for me may not work for you. What did you guys do?

http://www.usatoday.com/news/health/2010-04-05-study-breast-feeding_N.htm