As many of you know, I work as a corporate LC and speak w/employed 
breastfeeding moms every day, all day. I don't think that there is general 
rule that we should follow when counseling employed breastfeeding women. 
It has been my experience that we need to treat each dyad as an entity. 
All babies need to be treated with respect when a bottle is introduced to 
them.  Nipples should never be forced into a baby's mouth.

Some babies have no difficulty going back and forth from bottle to breast, 
whether they were started at 2 weeks or 2 months. Others need to be 
coerced into taking a bottle. Sometimes they need to be wrapped in mom's 
shirt, faced away from bottle giver or fed head on while sitting in a car 
seat. Sometimes, a caregiver can mimic sucking on the bottle and baby will 
ape her. Allowing the baby to play with the nipple/bottle can also be 
helpful.I find that some babies do well with 'paced bottle feeding' with 
slo-flo nipples, but not all. Babies whose moms have OMER or an over 
abundant supply are simply 'let down junkies' and become irate when paced 
feeds are tried. These babies need to have their milk flow quickly, so 
bring on those big nipple openings! Some babies do well with sippee cups, 
hard or soft, when artificial nipples and bottles are rejected and some do 
not. Some will sip from a spoon, some will not. And then there are those 
sweet, frustrating babies who refuse to take very little nourishment while 
in daycare and cluster feed from the time mom walks in the door until she 
leaves in the morning.

When counseling moms about milk supply issues it is important to realize 
that there really is no quick fix. When did our society become so 
dependant on the quick fix? Don't they realize that anything worth working 
for is a true accomplishment?

We can educate them about fenugreek, blessed thistle, domperidone, 
reglan...but, if they are not eating well, hydrating themselves well, and 
giving their breasts consistent stimulation, then all the drugs/herbs in 
the world will not increase the milk supply. One's body needs to be 
nourished to function well. High protein snacks and fluids are important 
for the metabolism of a busy mom, whether they are employed outside the 
home or not. I, at times, even suggest electrolyte drinks for good 
hydration. There is NO silver bullet. Consistent breast stimulation and 
fueling the body are equally important. 

Let us not forget that the best regulator of mom's milk supply is the 
baby. I always counsel moms to sit down and spend the first 30-45 minutes 
with the baby when they get in from work. Prolactin does wonders for 
harried women. I counsel them to exclusively breastfeed in the evening and 
throughout their days off to maintain a good milk supply. Most moms find 
that they pump more milk on Monday than they do on Friday. 

I usually suggest that they pump for at least 20 minutes, w/double pumping 
system, three times during the day, mid-morning, lunch, mid-afternoon. 
This is ideal, however, not all moms are able to do so in the course of 
their day. Some women pump sporadically and are able to produce what their 
baby consumes at daycare. Some moms pump in parking lots and store 
everything (including their snacks and water) in a large cooler. Some moms 
do no pumping during work hours and their bodies adjust to just having 
milk when they are at home.  Strange but true. Some moms have huge 
supplies stored in the freezer and some have just enough for a few days.

Their work situation, as well as their home environment, directly 
influences their breastfeeding/pumping practices. Some women have 
wonderfully supportive environments, others do not. Some male bosses are 
terrific and some female bosses are horrid. These moms need to feel 
supported in their decisions. They need a sounding board, someone to talk 
to about all these factors. A good LC hears all of the frustrations, 
disappoints and fears and responds accordingly.   

All breastfeeding moms who return to work need to be counseled to pack an 
emergency kit. It should include an extra bra, pads, shirt and/or sweater. 
It is embarrassing to stand in a meeting, or ring out a customer, with two 
wet spots on the front of your shirt (and it has happened.) Remember, the 
first two weeks are truly a transition period for both mom and baby. It 
usually is a good idea to have some practice runs, take baby to daycare 
for the afternoon so he/she and mom can slowly become accustom to the 
separation. ALL moms deal with guilt, either because they are returning to 
work and miss the baby OR they couldn't wait to drop the baby off (yes!) 
so they could get back to their worklife. 

We also deal with a large population of women (mostly, interestingly 
enough, Asian), who have made the choice to pump exclusively from day one. 
Supplies can be maintained for a long time as long as the mother is 
consistent about pumping time. I counseled a woman several years back who 
decided to do this when she found out that she was having twins. It was 
harder for her to try to latch on two screaming babies than pump and have 
help with the feedings. She recently called to find out how to wean 
herself from pumping, the girls were exclusively fed human milk for over 8 
months and are now almost two. And yes, she did work a 40 hour week 
returning at 2 months postpartum. I let her know that I was very proud of 
her, she did a terrific job! It was important for her to know that I 
acknowledged her hard work! We must not judge moms for the choices that 
they make, but instead offer them information and support, so they are 
able to reach their personal goals.

Not every woman falls in love with breastfeeding. Sad, but so very true. 
They make choices that are right for them and their families. And I am 
here to support them. 

Ellen Penchuk, IBCLC, RLC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html