Jay asked about other peoples' recommendations about pumping for mothers who will be working away from home. I usually start by praising the mother for wanting her baby to continue to get the best possible nutrition while they are separated and to encourage her to express her feelings about going back to work. After I  get a clear picture of the baby's present nursing patterns (how often? solids?) we then go on to the changes that will take place. How long will the mother be separated from her baby, including travel time? Will she have a regular schedule? What kind of work will she be doing? Will she have access to a private space in which she can pump? How many coffee breaks/meal breaks will she have and how long will they last? Who will be taking care of the baby? Would it be possible for the mother to visit and nurse the baby during her lunch break or for the care-giver to bring the baby to her work place?
        Every situation is different and changes as the baby's needs change. With a fully breastfed baby, I suggest that the mother would ideally pump during her morning break, her lunch break (if she were not able to nurse then) and during her afternoon break. If she does not normally get morning and afternoon breaks, we discuss the possibility of asking her supervisor about working an extra half an hour to make up the time. In fact, I let the mother know the importance of getting her boss on her side by telling him/her about the benefits of breastfeeding to the company. If the mother will only have the opportunity to pump during her lunch break, we talk about pumping before the baby awakens in the morning and before the mother goes to sleep at night. I emphasize the importance of exclusive nursing (no bottles) whenever the mother is available, since it is so easy to fall into the habit of letting somebody else feed the baby while the mother makes dinner/runs to the store/goes to !
 an exercise class etc. We also tal

k about making sure the care-giver knows how to handle human milk, the importance of holding the baby during all feedings and trying to give the least amount possible if the mother is expected back shortly. If she shows interest, I teach the mother how to cup-feed so that she can teach the care-giver. This is especially important to those mothers who are concerned about nipple confusion or who simply dislike the idea of bottles. I suggest the possibility of continuing to pump (as well as nurse) on weekends so as to build up her supply.
        Over the years I have seen mothers continue to nurse and pump in many situations, ranging from students who pump in the nurse's office to airline attendants who send their milk home by special carriers. Flexibility is definately the key to success. One of the oddest situations involved a NICU nurse who was pumping for her handicapped toddler. She was getting a lot of flak from some colleagues who resented the time she took to pump and could not understand why she was *still* nursing him . We solved this problem when I discovered that her critics smoked - she told them that while they were ruining their health on smoke breaks, she was building up her son's immunities by pumping! Mothers who continue to provide their babies with their own milk despite being separated ned all the help we can give them.

Norma Ritter, IBCLC, LLLL                       "If not now, when? If not us, who?"