Alicia writes: 

I hear about mothers trying to figure out when to fit a pumping session in
between feeding the baby. Often, when trying to fit a pumping session in she
only gets a very scant amount (enough cover the bottom of the bottle) - at
that point a get a call from a freaked out mother worrying about whether she
has enough milk to feed her baby and what is she going to do when she has to
go back to work/school (Go Gators ;->).  At this point I have an exhausted,
stressed, and resentful  mother who feel as if she is either hooked up to
the baby or hooked up to the pump 24/7.

Alicia, I hear these concerns all the time.  However, it is quite common for
mothers of exclusively breastfeeding babies to not be able to pump very
much.  This means mom's milk supply is in sync with her baby.  Hopefully, if
you tell her this, she will relax about not being able to make enough milk
for her baby.  (Of course if you have concerns about baby's weight gain or
behavior, that is another story.)

But that still leaves the issue of preparing for the return to work.  It is
so unfortunate that new moms in the US have so very little time to enjoy
their babies before the stress of returning to work looms on the horizon.
Even though my first child is now 21 years old, I can still vividly remember
when I was 3-4 weeks postpartum, and I was crying hysterically at the
thought of going back to work and leaving my baby with a stranger within the
next month. Between hormonal changes (possibly a bit of postpartum
depression), the exhaustion of being a new mom, fear of leaving my child
with someone I didn't know, and trying to figure out the logistics of making
sure that my daughter would have plenty of breastmilk, I was an emotional
wreck.  Fortunately, I ended up working part-time from home as a Lamaze
instructor and didn't go back to full-time work.

To deal more specifically with the stockpiling issue, the first thing I tell
moms is that they do not need to have a freezer full of milk on the day that
they return to work.  Assuming that she has figured out a realistic pumping
schedule for work that will help to maintain her milk supply, she will
probably be pumping on Monday and using that milk on Tuesday, pumping on
Tuesday and using that milk on Wednesday, etc.  I tell her that she needs to
have at least enough milk for 2-3 days of work (just to be safe).  And if,
by the end of the week, her milk supply has fallen off just a little, she
should exclusively breastfeed on demand around the clock over the weekend
and it will come right back. 

If she is exclusively BF, I don't usually recommend that she begin pumping
as early as 2 weeks as you have described, except under the following
conditions: 
1) She is going back to work when her baby is 4 weeks old (obviously she is
under more time pressure)  OR
2) She feels that her breasts are still full after feeding the baby .(this
is often the case after the first morning feeding) and I can tell that, like
the women we described above, she is anxious to begin to store milk.

Otherwise, I encourage moms to start stockpiling approximately 2-3 weeks
before returning to work.	  As far as a pumping routine, I recommend
stockpiling by pumping after feeding the baby.  If mom does this, it will
less likely affect the volume of milk that will be available for the baby at
the next feeding.  If she is disturbed about the small quantity she pumps,
help her figure out at what point of the day she usually feels more breast
fullness (usually in the morning), and have her pump after those feedings.
Reassure her that it is likely that as the days go by, she will be able to
pump more and more as her hormones are stimulated.

As for the plan of BF on one side and pumping on the other, this can result
in the baby not being able to eat enough and can actually create a decrease
in the milk supply.  

============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
Tarzana, CA




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