Breastfeeding and Pumping Q&A with Work. Pump. Repeat's Jessica Shortall

July 20, 2016

 

Before my son JB was born a few months ago, breastfeeding was something I knew I wanted to do -- I had read about the pretty stellar benefits, and, hey, free food for the baby. It wasn’t until I left the hospital exhausted and with nipples so shredded I can’t believe they didn’t fall off that I began to realize how intense nursing is. Each week brought new breastfeeding challenges -- just when I thought I had finally mastered it, a new roadblock would pop up and throw me completely off course. And then, after almost four months of maternity leave and breastfeeding exclusively, I went back to work, plagued with guilt over taking my boobs away from JB and anxiety about keeping up my supply.

 

Now, during the weekdays, my double electric pump is my new best friend. We have breakfast, lunch, and an afternoon snack together every single day. And while I’m really lucky to work at an awesome baby tech company with supportive colleagues who aren’t weirded out by my milk chilling in bottles next to their lunches in our company refrigerator, pumping at work is not always breeze.

 

I met Jessica Shortall, author of Work. Pump. Repeat., a TED Talk speaker, and breastfeeding and pumping activist and mama extraordinaire at a baby conference back in October. While I devoured Jessica’s book during 3am nursing sessions, I wish I had read it way earlier -- I would have been much better prepared and less anxious about returning to work while continuing to breastfeed. I can’t recommend her book enough for all breastfeeding and working moms -- everything you need to know is in this book, in an easy to digest and really fun, totally judgment-free way.

 

If you haven't already, head on over to www.workpumprepeat.com for all the details, and then head over to Amazon to buy the book. Your life will be forever changed.

Luckily for me, Jessica had been kind enough to give me her cell phone number in case I had any breastfeeding or pumping at work freakouts while I was in the thick of it all. It was like having a breastfeeding fairy godmother on speed dial, and we thought it would be helpful (and fun) to share some of the most anxious, what-the-f-is-happening-right-now questions I had on my journey, and Jessica’s expert advice. So here we

 

Sonya Bonczek (Mimo): It’s only day three of breastfeeding -- and my nipples are SO messed up, like, they look scary -- but should I start pumping already? My supply seems to be OK, so is there any need?

Jessica Shortall: A lot of this depends on a combination of how long your maternity leave is, how committed you want to be to exclusively giving breastmilk, and how good your mental health and family’s overall well-being is. In a world without anxiety and sleep deprivation, starting to pump on Day Three is a great idea for upping your milk supply and starting to build a freezer stash for when you’re back at work. But in the real world, I’d say don’t start yet, if you can help it. (Unless there is a medically necessary reason to do so, in which case, work with your medical folks on that - but remember that your mental health is part of the medical picture!) Give yourself some time - for your milk to come in, for your body to start to heal, for you to bond and sleep and get used to the freight train that just came into your life. I’d give it a few weeks, if you can, and even then, just pump once in the morning, right after you feed the baby. Over time, you’ll start to get some good milk from that one session, and can build up a little freezer stash. You have GOT to give yourself a break on this - you just GOT A BABY OUT OF YOUR BODY. Your hormones are a disaster. You’re exhausted. Step away from the pump for a little while.

 

SB: JB is barely 3 weeks old and my MIL has offered to babysit so my husband and I can go out to dinner. Really nice offer, but we haven’t introduced a bottle yet. Is it too soon? If we wait too long, will he refuse the bottle?

JS: I’d take that offer! You’ll be stressed and worried, but that will happen on your first night out, whether he’s 3 weeks or 3 years. It’s just something you have to learn to live with, so I figure you might as well get started. Bottle introduction freaks a lot of people out, because of nipple confusion (which I think is a good name for a garage band) - meaning the baby might prefer bottle to breast. So make sure you are using a very slow flow nipple - NB size in most brands. The pediatrician who consulted on my book tolds me that 3-6 weeks is the optimal age for bottle introduction. Any later and the baby could lose its suck reflex and reject the bottle - and if you’re going back to work, that is a stressor you don’t need. So I say, give it a try. Pump an ounce of milk and hand the bottle to your partner, and leave the room (or maybe the house). Some babies are picky about mom’s smell. Have him/her give the bottle in between feedings, when the baby isn’t so hungry...that first time is just for practice. Do this a few times before date night - you do NOT want that to be the first time, in case all hell breaks loose at home.

 

SB: Are my nipples supposed to look like that after I pump? Insert horror face emoji here.

JS: A male friend of mine described seeing his wife pump for the first time as “two thumbs in a garden hose.” It’s just awful. There are some flanges that make pumping less uncomfortable and I think they mess with your nipples less - Pumpin Pal flanges saved my life. When I was done with breastfeeding I bequeathed mine to a friend in a solemn ceremony.

 

SB: How much milk do you recommend having in the freezer before going back to work if you’re planning on providing your baby exclusively with breastmilk? I’m heading back to work in just a few weeks and I’m starting to worry I don’t have enough milk stored up.

JS: Straight from my book: The obvious answer 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 (780 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 (780-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 (780 ml) of breastmilk per day.

  • She is doing six feedings in a twenty-four-hour period when I go back to work.

  • 26 ounces (780 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 (360 and 420 ml) of breastmilk for a single day.

Another way to look at it: A baby needs 1 to 1½ 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 (240 and 360 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. And as we already talked about, you can build up that little stash of 36-42 ounces of milk over a few weeks of pumping once or twice per day, after feedings.

 

SB:I finally thawed out some frozen milk from February, and JB wouldn’t take it! I’m kind of freaking out now, since I go back to work in just a week. What do I do now?

JS: Google “lipase” and read all about it. I won’t get into it here, but some women produce more of an enzyme called lipase and that enzyme breaks down the fats in breastmilk over time. In those cases, milk that has been refrigerated or frozen can have a soapy or metallic smell and taste. DON’T THROW IT AWAY! You can learn to scald your milk (again, just Google it) or try mixing part fresh, part frozen, to see if lipase is the culprit.

 

SB: I’m so anxious about taking my boobs away from JB during the day. It feels so unnatural. Any words of wisdom?

JS: My mantra: Your worth as a mother is not measured in ounces. I mean, you’re right, it is supremely weird to leave a very small baby in the care of someone else and go back to work - especially with his food source attached to your body. Even weirder to bring a robot baby to work with you every day to squeeze that milk out. I’m not judging when I say weird - it’s not “wrong,” it just feels weird to a lot of people. Please just be kind to yourself. You are no more or less a good mother based on how well pumping at work turns out for you. I promise, and the older your kid gets, the more you’ll know this. Much more important? How you react the first time your kid swears (probably learned it from you) or how you handle the dramas of bullying and friends and emotions and feelings. Also a good measuring stick: how well you can teach your kid to work the remote and turn on an appropriate show on Netflix by himself. I know there’s no way of knowing this now, when your baby is tiny, but parenting is long, and this is a blip on the radar. If you do great at it, that’s awesome. If you don’t, you’re still a freaking Viking and I love you.

 

SB: I made it through my first week at work AND I pumped more than the baby needed the next day (yay!)! But, this week, my supply has been halved. Is it normal for supply to fluctuate or should I be concerned? Is it because I didn’t pump all weekend?

JS: It’s normal. I would say DON’T pump all weekend - relax, and bond, and let your baby do the work. Work can be stressful, and we don’t eat and drink enough, and many women just don’t respond to the pump in the same way as they do to a baby. Google “hands on pumping” - basically going to second base with yourself while you pump - that might help increase supply. And also: lactation cookies can be super yummy, but please don’t spend all of your time and money on a zillion lactation aids. You’ll drive yourself crazy in the process.

 

SB: I’m pumping three times a day right now and my baby is four months old. When will I be able to drop a pumping session? And do I just stop cold turkey?

JS: If you want to exclusively provide breastmilk, you kind of just work with your caregiver and follow along as your baby spaces out his feedings as he introduces solids and gets older. If your baby was taking a bottle at 10, 1, and 4, and you were pumping at those times at work, he might eventually move to 11 and 2:30, so you can, too. If you want to drop a pumping session and your baby’s not there yet, that’s cool too - this is YOUR decision and no one else’s. You’d just move to that 11 and 2 pumping schedule (or something like it) and bring that milk home every day. Any shortages in milk would be made up with formula, donor milk, or your freezer stash (the latter will dwindle quickly if you do this - just FYI). You can still nurse your baby when you’re with him. When you do drop a pumping session, just keep an eye on your breasts for lumps, clogged ducts, etc. And if you want or need to wean altogether, try to do it over a couple of weeks rather than all at once - it’ll be much easier on your body. Drop one feeding or pumping session and give it a couple of days, then drop the next one, until you’re done. You do NOT want to invite mastitis into your life, if you can help it.

 

SB: Any tips on how to be as productive as possible during pumping? The actual pumping itself takes roughly 10 minutes, but the setting up and cleaning up makes each pumping session last 20, sometimes 30 minutes. Can I cut any corners to reduce the amount spent before and after pumping?

JS: 10 minutes! That’s impressive. Most people I know need at least 20 on the pump - but everyone’s different! My favorite trick (lactation consultant-approved!) is to not wash your pump parts during the work day. Just throw them in a Ziploc or wet bag and into the fridge between sessions. They’ll be, um, refreshingly cold when you put them on your boobs, but it will save you SO much time.

 

SB: Taking my shirt off three times a day and cramming my boobs into a hands-free pumping bra is a drag. Any advice on making this less annoying?

JS: I found I was able to just slide the flanges into my regular nursing bra cups. If that doesn’t work for you, try a hands-free pumping bra that you can wear all day. Simple Wishes makes a Supermom bra that I think does that.. Also - shirt type matters. Button downs and cowl necks can save you a lot of time and hassle.

 

SB: I have a meeting I can’t miss scheduled during my first pumping session of the day -- to maximize milk output, is it better to pump earlier than usual, before the meeting and before my breasts feel full, or wait it out and pump after the meeting?

JS: If it’s just one day, honestly, it doesn’t matter all that much. I’d try to do it before, to avoid the stress and discomfort of getting engorged during that meeting, though.

 

SB: AHH -- I’m about to pump and realize I’ve somehow lost one of the little white membranes on the valve! Can I pump without it??

JS: Sort of. Those damned membranes are super important. You can pump one breast at a time (make sure to cover or plug the little hole on the pump for the tube you’re not using. Or you can make a membrane - or at least so I’ve heard - using scotch tape folded onto itself to make a little flap over the opening where the membrane ought to go. This, though, is why you should always keep an extra pack of those suckers in your pump bag - and a single, manual pump in your car or desk, just in case.

 

SB: I’m nursing in the mornings, pumping at work, nursing when I get home, nursing to sleep, and nursing a few times in the middle of the night. I’m so tired. Any tips for staying sane? I’ve started having dreams about formula…

JS: Don’t discount your mental health. Working, parenting, and breastfeeding is a hard triple threat to pull off - and you shouldn’t be expected to be perfect at all three. If your family’s well being and your mental health or job performance needs something to give, figure out what can give. If that “give” means formula, well, you know your life better than any judgy person ever will. You decide. Some of the nighttime stuff is also up to your parenting style. My daughter was waking to nurse fully into nine months of age, and I was a zombie. My pediatrician held up her super chubby little body and said “this isn’t about nutrition.” What she meant was that it was more about comfort for my daughter. Comfort matters, too, but it helped me to know that she wasn’t starving, and we eventually gently moved her toward sleeping all night. And - here’s another trick: I used to nurse at, say, 7 pm, then pump at 8:30 or 9, hand the milk to my husband, and go the eff to sleep. He would stay up (or fall asleep on the couch), leaving that milk at room temperature, and give the next bottle. It bought me some real sleep, and it was great bonding for him and the baby.

 

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