An article on this topic is available in this issue of AFP.

Returning to Work While Breastfeeding

Breastfeeding is good for your baby--and for you. It provides the best nutrition for your baby and protects your baby against many illnesses. The American Academy of Family Physicians, along with other physician and public health groups, recommends that babies be breastfed or be given only breast milk for about the first 6 months of life, and that they continue to receive some breast milk until they are at least 1 year old.

Before you return to work, you may want to make a breastfeeding plan. This plan can help you with problems that could keep you from breastfeeding your baby.

Your Employer and CoWorkers

Before you go on maternity leave, or well before you return to work after your baby is born, talk to your employer and coworkers about your plan to breastfeed.

If possible, you will want to have your baby close enough that you can provide at least one feeding during your workday. On-site (work place) daycare might be available to you, or the baby's sitter (caregiver) might bring your baby to you for one or more feedings.

If having your baby nearby is not possible, you will want to make a breast pumping schedule. You will need answers to these questions:

• When can you pump your breasts?
• Where can you pump, and will this area have electricity and privacy?
• How often can you pump?
• What changes might have to be made in your work schedule to allow you to pump your breasts?

A "pumping room" can be created in any area that provides privacy. The area should contain a chair and working electric outlets. A sink is helpful for cleaning up after you pump your breasts. A refrigerator is helpful for storing your breast milk.

If you cannot pump at work, you can breastfeed whenever you are with your baby. Then your child can be fed formula by a caretaker when not enough of your breast milk is available.

If you don't pump, your breasts will adjust and stop making milk during your workday. For the first few days, your breasts may become overly full and leak. You can use breast shells in your bra to catch leaking milk. Crossing your arms over your breast with firm pressure can stop your breasts from leaking. If your breasts become very uncomfortable, you can go the bathroom and hand express or pump just enough milk to feel better.

Your Work Schedule

Going back to work can be stressful. Think about what you can do to make your work schedule less stressful. Here are a few ideas:

• Take the longest maternity leave that you can. This will allow your milk supply to become strong before you return to work.
• Work part time for the first week or two that you are back at your job.
• Return to work on a Wednesday or Thursday, so that your first week back at your job is short.

A checklist (see the box) can help you be sure that you have everything you need for breastfeeding when you go back to work.

Pumping Your Breasts

If you will be pumping your breasts, practice for one or two weeks before you return to work. You can try pumping just after your baby feeds. Or you can pump your breasts between your baby's feedings.

You may not get much milk when you first start pumping. After a few days of regular pumping, your breasts will begin to make more milk.

Practicing at home will help you learn how your pump works. During this time, you also can start to collect and store breast milk to feed your baby when you return to work.

With practice and a good pump, you can pump your breasts in as little as 10 to 15 minutes. While you are at work, try to pump as often as your child usually feeds. To keep up your milk supply, give your baby extra breastfeedings when you are together.

Return to Work Checklist Breast pump, plus adapter if needed. Extra batteries if you are using a battery-powered pump. A small cooler, plus ice for the cooler, if a refrigerator is not available for milk storage at work. If you forget the cooler, keep in mind that breast milk can be stored at room temperature for 4 to 8 hours. Enough milk storage containers for the number of pumping sessions you will need during your work day. An extra shirt or a sweater or vest to wear in case your breast milk leaks. It is a good idea to wear patterned clothing. Milk leakage is much harder to see on patterned material. "Easy access" clothing. Your clothing should open in the front. A shawl or small blanket for personal privacy if you need to pump in a common area. A water bottle and nutritious snacks. Calorie needs are greater in women who are breastfeeding. A pillow for supporting your arm while you pump your breasts. This may make pumping more comfortable. A "Do Not Disturb" sign to use if you are pumping in a shared space. Optional A portable radio or a tape or CD player (plus your favorite music), an entertaining book, or a magazine. If you are relaxed, your milk will release more easily (the "let-down reflex"), and you will be able to pump your breasts better. A picture of your baby or an item of your baby's clothing. Thinking about your baby can stimulate the let-down reflex. Other items:

Storing Your Breast Milk

You can store your breast milk in daily amounts. The breast milk can be stored in a plastic or glass bottle with a sealable top. Keep in mind that your baby will want more milk during growth spurts. The best way to increase your milk supply for a growth spurt is to breastfeed or pump more often.

Pumped breast milk should be cooled in a refrigerator or other cooler as soon as possible. The milk also can be frozen.

It is normal for frozen breast milk to separate (the fatty part of the milk goes to the top). Shake the bottle, and the fat will go back into the milk. Thaw frozen breast milk slowly by swirling the container of milk in warm water or by putting the container in the refrigerator the day before it is to be used. Do not thaw frozen breast milk in a microwave oven.

Here are some general guidelines for how long you can store your breast milk:

• At room temperature (less than 77°F) for 4 to 8 hours
• At the back of a refrigerator for 3 days
• At the back of a freezer for 3 months

Some studies suggest that these storage times can be even longer. For example, breast milk could be stored in a refrigerator for up to 8 days.

Introducing Your Baby to a Bottle

If you use a bottle too early, your baby may not breastfeed as well. This problem is called "nipple confusion." It is best to avoid bottles and pacifiers until your baby is 4 to 6 weeks old and has learned how to breastfeed well.

Being a Mother and Working Outside the Home

Before you return to work, talk to your family about the extra help you will need with household chores. You may have to let some housework go undone so that you can get the rest you need. As your baby gets older, you will be able to get more sleep, and your schedule will become more regular.