WBW 2016: 5 tips for a strong nursing relationship while working away from home

wbw2016-logo-textEditor’s note: Among the 17 Sustainable Development Goals central to World Breastfeeding Week this year is a call for better workplace support of breastfeeding women. Certainly employers have a large part to play in meeting this goal, but women also need step up to advocate for themselves, their babies, and their right to express breastmilk while at work:

It’s that day…the dreaded day that no new mother wants to face — the last day of maternity leave.

For a mother able to take 12 weeks of unpaid leave afforded by the Family & Medical Leave Act, the last 3 months in baby bliss may instead feel like 3 short weeks, but regardless of the maternity leave length, the end of that special period arouses many emotions, especially for a nursing mother.

Naturally, a nursing mother’s mind becomes occupied with fears and questions:

  • How will I be able to provide enough milk while I am away?
  • What if my baby refuses a bottle?
  • Where will I find enough time to pump while I’m trying to work?
  • How will my boss and coworkers feel when I need time to pump?
  • What will happen to our nursing relationship?

This uncertainty creates even more stress and anxiety for the breastfeeding and working-away-from-home mother for she knows the important role breastfeeding plays in a secure attachment in addition to the numerous health benefits.

Mommy Kissing Baby LContinued nursing after the maternity leave period helps maintain a strong attachment between mother and baby. In his book, The Attachment Parenting Book, Dr. William Sears includes a chapter entitled “Working and Staying Attached,” in which he points out that giving your baby your milk is a very important way of staying attached to your baby after returning to work. Expressing milk for baby to drink during the day allows mother to, in a sense, be with baby while she is away at work. When mother and baby are reunited, their attachment through breastfeeding can resume as if she never left.

Nursing beyond maternity leave not only helps strengthen attachment but also provides numerous health benefits for the nursing mother and her nursling.  In 2012, The American Academy of Pediatrics (AAP) published their policy statement, “Breastfeeding and the Use of Human Milk,” in Pediatrics. In this document, the AAP notes the numerous benefits of nursing, including those of nursing beyond 3-4 months. Some of these benefits for baby include a lower risk for developing serious colds, asthma, and other allergies; Sudden Infant Death Syndrome; and childhood and adult obesity. For the nursing mother, benefits include a lower risk of diabetes for mothers not diagnosed with gestational diabetes, a lower chance of arthritis, and breast and ovarian cancers. Essentially, the longer a mother can provide her baby with mother’s milk, the more health benefits received by both mother and baby.

In order to continue a secure attachment and experience the health benefits of breastfeeding, nursing mothers can maintain a strong nursing relationship while working away from home by following a few simple tips:

  1. Know your breastfeeding rights — Under the Patient Protection and Affordable Care Act, many U.S. employers must provide a nursing mother with break time and a place to pump for up to 1 year after the birth of her baby. It is to be noted that companies with less than 50 employees are exempt from this law and instead offer pumping breaks at the discretion of the employer. Information, along with instructions for filing a complaint, can be found through the United States Department of Labor. Many other countries have generous allowances for nursing mothers at work, so be sure to check with your nation’s laws.
  2. Plan a pumping schedule — This schedule will differ from mother to mother. Planning to nurse right before being separated from baby and as soon as mother and baby are reunited can help reduce the amount of pumping sessions needed at work. While at work, a mother should try to pump about every 3-4 hours. For a mom working an 8-hour shift, she might pump once in the morning, once during her lunch, and once in the afternoon. The idea is that for each time baby receives expressed milk from his or her care provider, mother is pumping. In doing this, mother should be able to pump the amount of milk that baby will consume the following day. Talk with a local breastfeeding specialist for a pumping schedule tailored to your work environment and other needs.
  3. Discuss needed accommodations with employer — When a mother meets with her employer, she should be prepared by knowing her legal rights. A working-away-from- home mother should inform her employer of the needed accommodations before returning to work. The employer may need some time to make changes in order to accommodate the nursing mother. When the mother meets with her employer, she should provide her employer with a copy of her nursing schedule. This may also include pumping space accommodations. For example, the room where milk will be expressed needs to have an easy-to-access electrical outlet and should be heated and cooled.
  4. Nurse on demand — Although a working mother must have a pumping schedule while at work, at home, she can nurse her baby on demand. Nursing on demand means that a nursing mother nurses when cued by the baby. This might be every 30 minutes or every 2 hours. Since how much milk produced is based on demand, a nursling can help increase a mother’s supply by nursing frequently. Nursing on demand also allows baby to re-establish the nursing bond that was missed during the day. Nursing on demand can continue during the night. Frequent night nursing may lead to reverse cycling, meaning the baby will nurse more frequently during the night than he or she does during the day. Some mothers who encourage reverse-cycling find that they don’t need to pump as much while at work during the day. For example, a baby may only drink 4-5 ounces of milk while his or her mother is at work, but the remaining amount of milk needed will be attained during the evening and all through the night. Essentially, in 24 hours, the baby will have consumed his or her total amount of milk needed.
  5. Get support — Most nursing mothers need support throughout the breastfeeding journey, and nursing mothers that work away from home are no exception. La Leche League International and other nonprofit organizations provide local and online opportunities for mothers to connect and support each other.

While the end of maternity leave marks a transitional period for mother and baby, a strong nursing relationship can be maintained by carefully preparing for this changed and remaining dedicated to the desire to nourish baby with mother’s milk.

Breastfed Babies and The Growth Chart

I am not a large person. At 5 foot 8, I’m taller than average, but I’ve always been a healthy size and my weight gain during both my pregnancies was well within the range recommended by my doctor. My husband isn’t a big guy either.

So it was no surprise to me that both kids seemed to follow those same growth trends. Both were the same size at birth, just over seven pounds. My daughter was an ounce heavier and an inch shorter. Both were healthy. I was happy. So why were so many others concerned with their size, or lack of it?

Among the many comments I heard from mostly strangers were:

“Is your pediatrician okay with you breastfeeding?” (Of course she was.)

“When are you going to stop breastfeeding?” (None of your business.)

“Wow, my baby is the same age and he’s much bigger-was he premature?” (No, actually he was born on his due date. And hey, guess what, it’s not a contest.)

“If you give her some formula, she’ll grow more.” (Actually, she’s growing just fine, thanks.)

I got to be pretty good at brushing off the comments and ignoring the unwanted advice, but the more I looked into it, the more stories I heard about parents of breastfed babies being hassled by family members, strangers or even their own doctors about the lack of “adequate” weight gain, regardless of the size of the parents or the health of the child. Why, in the face of a childhood obesity epidemic, does bigger continue to equate with better? Why are growth charts considered to be the number one indication of a child’s health, rather than just one tool of many to assess wellness?

Consider the following:

**Ounce for ounce, breast milk contains far more naturally occurring ingredients than cow’s milk-based formula does. According to Dr. Sears, when vitamins and minerals are added to formula to compensate, it makes it harder to digest. Breastfed babies generally need to eat more often because of the easier digestibility of breast milk.
**A 1992 study at UC Davis showed that breastfed babies tend to be leaner than formula fed babies. Specifically, while weight gain for each group was similar, the breastfed babies had a lower weight for length ratio.
**Many doctors in the USA are still using the charts from 1977, which are based on decades of measurements of actual children, most of whom were formula fed. The CDC updated the US growth charts in 2000, and these charts can be used to track the growth of exclusively breastfed infants, but don’t take into account how breastfed babies tend to grow. In 2006, the WHO published growth charts that represent healthy breastfed babies, but many doctors don’t use them.

While both my kids are at the bottom of the US growth charts, they score significantly higher on the WHO charts. In addition, while small, both mostly stayed on the same growth trajectory as they got older. While my son did have a milk protein allergy, removing any traces of milk from his diet fixed his symptoms. And two years later when my daughter was born and she grew in almost the exact same way her brother did, without a milk protein allergy to complicate or slow things down, I didn’t worry. She was healthy, and was just growing the way her genes had programmed her to do.

Still, I wondered. Are breastfed babies doomed to be the shorter members of their classes, simply because of how their mother’s choose to feed them? Out of curiosity, I posted a poll on my personal blog, titled “How Large or Small Were Your Children On The Growth Chart?” 30 people voted and the results looked like this.

I breastfed and my babies were smaller than average. (5/30-16%)
I breastfed and my babies were larger than average. (11/30-36%)
I breastfed and my babies were average size. (8/30-26%)
I formula fed and my babies were smaller than average. (1/30-3%)
I formula fed and my babies were larger than average. (4/30-13%)
I formula fed and my babies were average size. (3/30-10%)

I didn’t know what to expect from the poll, but the results show one thing candidly–babies come in all shapes, sizes and weights, regardless of how they are fed. Yes, both my children were little, but it wasn’t because they were breastfed or because there was anything wrong with my breast milk.

Both kids are older now, and they remain small. My almost three year old is a twenty-five pound bundle of energy that eats anything that doesn’t eat her first. At my son’s recent five-year well child visit, his BMI categorized him as underweight, but his pediatrician isn’t concerned. He did gain both weight and height over the past year, is rarely sick, is meeting or exceeding his milestones. He’s just on the skinny side–just like his dad, his grandfather and other assorted male family members.

How about you? How were your breastfed babies sized, and did anyone hassle you about it?