Responsive Feeding

Our monthly words of lactation wisdom from Donna Walls

New information from UNICEF has been released supporting responsive feeding strategies for breastfeeding and for formula feeding, including breastfeeding mothers who bottle feed expressed milk exclusively or for return to work or school.

UNICEF defines responsive breastfeeding as “ a mother responding to her baby’s cues, as well as her own desire to feed her baby. Crucially, feeding responsively recognises that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and mother.”

They also stress that responsive feeding makes breastfeeding and early parenting easier, less stressful and that breastfeeding will not spoil a baby nor can you overfeed a breastfed infant.

Responsive breastfeeding is generally regarded as instinctive for mothers but societal views and cultural attitudes can often hamper a mother’s natural instincts such as fear of breastfeeding in public.  Misinformation persists regarding scheduling of feeds and the need to train newborns to sleep longer are persistent and can have a negative effect breastfeeding and milk supply.

Responsive bottle feeding is defined as “encouraging mothers to tune in to feeding cues and to hold their babies close during feeds. Offering the bottle in response to feeding cues, gently inviting the baby to take the teat, pacing the feeds and avoiding forcing the baby to finish the feed can all help to make the experience as acceptable and stress-free for the baby as possible, as well as reducing the risk of overfeeding.”

Other tips for responsive bottle feeding include keeping the bottle horizontal during the feeding to minimize gulping and overfeeding and allowing for frequent pauses that occur naturally during breastfeeding. Responsive feeding allows the baby to be “in control” of the feeding and is related to better self-regulation of food impacting the later possibility  of obesity.

Beginning with smaller amounts of formula and gradually increasing the amounts slowly over the first weeks is also a more physiologic way of mimicking the normal pattern of feeding and may help to avoid stomach upsets, fussiness and unnecessary formula switching.

Encouraging cuddling time before, during and after feedings creates an opportunity for supporting the parent/child relationship and consider feeding while skin to skin to comfort and soothe infants during feedings,

For more information on responsive feeding go to:

Responsive-feeding-infosheet-UNICEF-UK-Baby Friendly Initiative.pdf

Helping Clients Build Personal Advocacy Skills: Step Four

The Power of the Birth Community

By Michal Klau-Stevens

There is a saying, “It’s not what you know, it’s who you know.” Community is a powerful mechanism for learning, accessing resources, and getting physical and emotional support. It also can either serve to make us feel alienated from others, or can reinforce or enhance our beliefs about our choices and our actions. In this post, which is part of a series on personal healthcare advocacy skills, we’ll explore the value of helping our clients connect with their birth community.

What is a “birth community?” It is the group of people who are active in working with expectant families, and it can be local, national, or online. Members of the birth community may include doctors, midwives, nurses, doulas, childbirth educators, lactation experts, chiropractors, activists, advocates, parents, and others with an interest in maternity care. The birth community may be well organized, such as a birth network with a diverse membership, or may be a loosely connected group of people with a willingness to share knowledge with people who seek information. Although many of the members of the birth community may be paid professionals in the healthcare field, healthcare practices with a business stake in caring for pregnant patients do not constitute the whole community, which includes those who are outside the medical establishment as well. The birth community is the group of people with expertise and passion about birth, and they are an excellent resource for clients who seek to advocate for themselves throughout their maternity care experience.

Meeting the birth community puts our clients on a fast track to information and empowerment. Imagine trying to learn something new all on your own. It’s a process of trial and error which can be time-consuming and frustrating. Maybe you’ll be successful with it, but maybe you won’t. Maybe it will feel too hard and you’ll give up. Now imagine that you have a supportive community to help you learn. Not only do you learn more, faster, you have experienced people who point out the pitfalls and the shortcuts, and you are not alone on your journey. When we help our clients connect with the birth community, we make it easier for them to get access to the resources they require to advocate for themselves to get their needs met.

Like any community, there are some people who have similar beliefs to us, and others who hold different beliefs from us. Who we choose to spend time with can shape the actions we take and how we think and feel about ourselves. Diversity in a community is a positive thing, since different people have different needs, and one size rarely fits all. Having a variety of resources and approaches allows more people to get what they need from participating in the community. Sometimes our clients need our help to identify who in the community will create a positive effect for them. For example, I had a client, a medical doctor, who followed attachment parenting practices. With her medical peers she felt uncomfortable talking about her parenting, and she often felt judged for the choices she made. With the other parents from her child’s preschool, who mostly followed attachment parenting practices too, she felt more comfortable and accepted. The suggestion that she develop her relationships with the parents from her child’s preschool, because that’s where she found more connections to solve the challenges she faced, provided a surprisingly simple solution for her. Similarly, helping our clients connect with resources in the birth community that align with their needs and their care philosophy lays the groundwork for them to find the solutions that work for them.

You can be the gatekeeper who introduces your clients to the larger birth community:

• Offer to attend meetings of the local birth network, birth circle, or breastfeeding support group with your clients. Having a “wingman” makes checking out a new group less intimidating, and it’s a great way for you to network and learn more about the resources in your community too.

• Maintain a list of local resources to share with your clients.

• Stay connected online with national and international experts through online forums.

• Make introductions between like-minded people who can be helpful to each other.

• Be open to answering the particular needs of seekers, even if they don’t become your clients. They might need or want something different than what you are offering as a service provider, but your reputation for helping them get the care that works best for them will be spotless.

We, as care providers, comprise the birth community. It’s important that we nurture our connections to each other and that we provide the knowledge, resources, and support that newcomers to our community need. We shouldn’t underestimate the power of offering a name or a piece of information to someone who is seeking help. That outstreched hand and welcoming embrace into the birth community can set people onto the path for an empowered birth, and we know what a difference that can make.

If you missed last month’s advocacy step, you can catch up here:

Helping Clients Build Personal Advocacy Skills: Step 3 

Maximizing Research for Healthcare Advocacy by Michal Klau-Stevens

There is so much information available on the internet about pregnancy, birth, and breastfeeding, but there’s one important type of information that will help your clients with their efforts to advocate for themselves with their care providers: peer-reviewed research. In this post, which is part of a series on healthcare advocacy skills, we take a look at the different types of information available to our clients, which types are most effective in helping them communicate with their doctors, midwives, and other care providers, and how we can help our clients make use of scientific research to make evidence-based healthcare decisions.

Scroll through any social media site and you’re likely to find posts about the latest discovery in healthcare. New sites report on studies that have been released, celebrities and advocates write blog posts, magazine reporters write articles, and people post about their personal experiences with one remedy or another. Maternity care advice, in particular, is everywhere. To many people, the information from a well-known news site, a magazine, and a blog post may all carry the same weight, but nothing could be further from the truth. Each step away from the original source of the data increases the addition of bias, conjecture, misunderstanding, and embellishment. And what is the original source of the data? Scientific research, and the gold standard for scientific research is the peer-reviewed study.

Peer-reviewed research has been critiqued by other professionals in the field, and been deemed worthy to publish in journals or other professional publications. It represents the highest standards of scientific inquiry. True, it has shortcomings, especially relating to maternity because of the ethics of doing research on pregnant women, but peer-reviewed research is some of the most useful information that our clients can use while advocating for themselves with medical professionals. It is the source of the evidence that creates the foundation for evidence-based practice, and is therefore hard for medical professionals to deny.

Unfortunately, peer-reviewed research rarely goes directly to the average maternity care consumer. It gets filtered through other sources before it gets to them, and those sources can be framed in a hierarchy of most reliable to least.

At the top of the hierarchy are government websites and publications, which are directed either at professionals or at consumers and detail the most up-to-date research from government agencies.

Next are sources such as brochures, websites, or pamphlets from medical, midwifery, nursing, and childbirth education professional organizations, such as the American Congress of Obstetricians and Gynecologists, The American College of Nurse Midwives, and the Association of Women’s Health, Obstetric, and Neonatal Nurses, and ICEA. This information tends to closely adhere to the findings in the research, but it still may be presented through the lens of the mission of the organization.

Below that are advocacy organizations that focus on particular causes, such as The March of Dimes and Childbirth Connection. Advocacy organizations may raise money for research, educate and raise awareness about a topic, and/or lobby for policy changes. These two organizations have excellent reputations for adhering to the evidence, but other organizations may not be as exacting and should be vetted for accuracy.

Below that are experts, who either work in the field or synthesize the research to make it understandable for others. They may work for a company or organization with a particular agenda, or work independently, with little oversight or accountability and only their reputation and income at stake. The quality of their work can range from very accurate to wildly inaccurate. Experts might author books, appear on television shows, offer educational programs, or promote their material in other ways, and the quality of the information they teach is dependent upon their adherence, or lack of it, to the research.

Further down the list are news sites, pregnancy sites, magazines, and television shows. Reporters, who may or may not be experts in the field on which they are reporting, gather the content on these sites. They rely on experts and others who have various kinds of experiences relating to the topic being covered. With each person the information passes through, the chance for bias to enter increases. Also, these are collaborative fields, in which editors filter and refine the information, but may do so in ways that further alter what gets through to the public. More importantly, these sources are usually commercial endeavors that focus on promoting information that will be of interest to their specific audiences and will sell advertising for revenue.

At the bottom of the list are personal blogs. These are like the wild west of the internet, where anything can be stated as fact or truth, but with almost no accountability or fact-checking.

With each step down in the hierarchy, more vigilance is required from the consumer to ensure the accuracy and lack of bias in the information. Healthcare professionals are unlikely to practice “internet medicine.” They need to work from reliable sources of information that align with standard of practice. Those sources are most likely to be at the top of the hierarchy of information. Information on the higher levels is most likely to be useful in advocating with medical professionals because it comes from the most accurate and most respected sources in their field. Using scientific data also puts the patient on a more even playing field with their caregiver, making the relationship less authoritarian and more of a partnership.

How can we help our clients use scientific research to their advantage? There are a few steps we can take:

• Help them access the peer-reviewed research through sites like PUBMED, Cochrane, university library databases, and through colleagues who have access to those sources.

• Help them read through the studies, which can be daunting for someone without experience in reading scientific research.

• Find the sources at the top levels that are in a format they can understand and are most likely to be acceptable to their caregivers.

• Find the reliable sources at the mid-levels of the hierarchy by doing the research about the organizations and the experts and vetting them yourself.

• Teach them how to be more discriminating about the information they are taking in, through discussions about media literacy.

As birth workers, we have a much better understanding of the range of information that is available to our clients, have experience reading research from reliable sources, have opportunities to teach our clients how to make sense of the data they encounter, and can be a resource for them for accessing high-quality information. We can be instrumental in helping our clients maximize scientific research to advocate for their healthcare needs.

Stay tuned for Step 4 next month!







The New AAP Guidelines on SIDS and Safe Sleep Recommendations

On October 24th, 2016 the American Academy of Pediatrics released their Policy Statement entitled “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment”.

So what does this mean for childbirth educators, doulas and lactation care providers?

Here are the basic recommendations from the AAP:

  1. Breastfeeding is recommended to reduce the risk of SIDS and to enhance the health and well-being of the infant and the mother. The AAP recommends exclusive breastfeeding for 6 months (no formula,  nutritional liquids or solid foods). Newer research demonstrates that exclusive breastfeeding can reduce the risk of SIDS by as much as 70%.
  2. Skin to skin care is recommended for all mothers and newborns, regardless of feeding or delivery method…for at least an hour after birth.
  3. Room-sharing with the infant on a separate sleep surface is recommended. Keep infants in close proximity to parents.
  4. The AAP recognizes that parents may fall asleep in bed after or during feeding their infant, so remove pillows, loose blankets, loose sheets and move the bed away from walls to prevent entrapment, and follow remainder of safe sleep recommendations.
  5. Avoid nighttime feeding on couches and arm chairs which are not considered safe sleep surfaces at any time for infants.
  6. It is important that anyone who cares for the infant puts the baby to sleep on their e back. Prone sleeping (sleeping on the stomach) increases the risk of re-breathing the same air that is under the baby’s face which can increase the levels of carbon dioxide in their blood, not enough oxygen in their blood which can be potentially fatal.
  7. Creating a safe sleep surface. Recommendations from the National Action Partnership to Promote Safe Sleep (in partnership with the AAP) recommends:

“Use a firm sleep surface, such as a mattress in a safety-approved crib covered by a fitted sheet, to reduce the risk of SIDS and other sleep-related causes of infant death. Firm sleep surfaces with no other bedding or soft objects. Nothing soft such as pillows etc. should be placed under the baby. Appropriate surfaces can include safety approved cribs, bassinets, and portable play areas. Safety approved cribs are those that have been manufactured and sold since the requirements went into effect on June 28, 2011. They have been designed to have the spaces between the bars too small for a baby’s head to get through and get stuck. Standards for other safety approved spaces such as bassinets, portable play areas and side cars (attachment to an adult bed that provides a separate, but close safe space) have also been developed by the U.S. Consumer Product Safety Commission, the agency that tracks accidents and deaths with products and helps keep babies safe from products that can be harmful or cause accidents. For information on safety standards for sleep products, contact the Consumer Product Safety Commission at 1-800-638-2772 or

Other considerations for safe sleep surfaces:

  1. Do not use bumper pads in a crib.
  2. Never place baby to sleep on soft surfaces, such as on a couch or sofa, pillows, quilts, sheepskins, or blankets.
  3. When using a sling to carry a baby, make sure the baby’s face is facing up and is above the fabric completely uncovered and open to the air.
  4. Do not use a car seat, carrier, swing, or similar product as baby’s everyday sleep area.
  5. Infants should not be placed to sleep on adult beds. Portable bed railings intended to keep a child from falling off a bed should not be used for infants.
  6. Avoid smoking, alcohol, and drugs during pregnancy and after birth.
  7. Avoid devices marketed to reduce risk of SIDS such as monitors, wedges, devices or specific mattresses.
  8. Swaddling does not reduce the risk of SIDS and in some cases may increase the risk for overheating and SIDS.
  9. Consider offering a pacifier at nap or bed time, after breastfeeding is firmly established (no specified time frame). If not breastfed can introduce as soon as family desires.
  10. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.

Teaching points for expectant or new parents includes the importance of open discussion on infant sleeping concerns and questions. Emphasize information on the benefits of exclusive breastfeeding as a strategy for SIDS risk reduction and how to create a safe sleep surface for infants in the first months of life. Encourage parents to have a frank, open conversation with the infant’s health care provider (Pediatrician or Family Physician) and any other infant care providers including family members, daycare providers or babysitters.

  • Written by Donna Walls, RN, BSN, IBCLC, ICCE, ANLC

References and Resources

Moon RY; Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5). Available at:

National Institute of Child Health and Human Development/National Institutes of Health. Safe to Sleep campaign. Available at: Accessed September 21, 2016

National Infant Sleep Position Study Web site. Available at: Accessed January 10, 2016

Highet AR, Berry AM, Bettelheim KA, Goldwater PN.. Gut microbiome in sudden infant death syndrome (SIDS) differs from that in healthy comparison babies and offers an explanation for the risk factor of prone position. Int J Med Microbiol. 2014;304(5–6):735–741pmid:24951305

McKenna J. Sleeping With Your Baby: A Parent’s Guide to Cosleeping. Washington, DC: Platypus Media, LLC; 2007

Kendall-Tackett K, Cong Z, Hale TW.  Mother-infant sleep locations and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clin Lactation. 2010;1(1):27–31


2016 ICEA Conference Recap

The 2016 ICEA Conference “Reaching the Highest Peaks in Evidence-based Practice” exploded in Denver October 13-15! Our conference app, Guidebook, made its debut and enabled conference attendees to have immediate access to speakers, sessions, exhibitors, advertisers and notifications of any changes right on their smart phone or device!

Located at the Renaissance Denver Stapleton Hotel, the conference opened with Jennie Joseph LM setting the stage for change in maternity care – helping us in identifying and plotting a course to incrementally eliminate inequities in care. Thursday was packed with concurrent session speakers, the annual awards presentation at the ICEA Membership Meeting plus the ICEA Members Reception hosted by the President. At the Annual Membership Meeting, participants were introduced to several special attendees including Past ICEA President Nancy Lantz, the members of the Front Range Council of Childbirth Educators of Denver, and all international registrants. The Board of Directors presented attendees with a synopsis of all of the accomplishments of ICEA this year as well as the winners of the 2016 ICEA Awards! This year’s award winners were: Connie Bach (2016 Doris Haire Lifetime Achievement Award), Kelli Barr-Lyles (Outstanding IAT), Deb Codde (President’s Award), and Dolly Wagner, Bonita Katz and Candy Mueller (2016 Meritorious Service Awards). World-renown expert Barbara Harper ended Thursday with a research-based session, “Entering the Sanctuary: The Long Term Effects of Skin to Skin”.

Providing additional education were the many exhibitors in attendance. From the innovative and new SleepBelt ( to CryoCell (, APPPAH (, Postpartum Support International (  to Injoy Videos (, the exhibitors added much to the educational environment. Other exhibitors included Dunamas Center, Family Paws Parent Education, Family Way Publications, Health Children Project Inc., IBCLE, LactaMed, Mandala Journey Birth Art, Mothers Milk Bank, Perinatal Education Associates, Plumtree Baby and ThermoFisher Scientific.

Friday continued with an amazing general session by Rep. Kelly Townsend, “Maternal Health and the Transmission of Trauma” that took a look at transgenerational genome imprinting. It has opened the doorway for understanding and research! Just before the lunch hour, ICEA had a Committee Call-Out, where Directors/Committee Chairs answered questions of attendees and were able to get many ICEA members to join the growing Committee community within ICEA! Later in the day, ICEA debuted the Learning Lab for Skills sessions – two, one hour sessions where attendees learned four hands-on skills each hour! The day ended with Barbara Harper sharing “The Science and Safety of Waterbirth Around  The World”. Later that evening, many attendees were invited to share their thoughts and ideas in an Injoy Productions think tank setting.

The final day of the 2016 Conference included such ground breaking sessions as “Growing Green Families,” “What is Mindfulness? How Can it Enhance Childbirth Education,” and an “Update on Cannabis in Pregnancy and Breastfeeding.” Then, all attendees were invited to attend a free certification program: the Maternal Child Health Specialist Certification offered by Jennie Joseph, LM. This program demonstrated the very core of Jennie’s efforts in reducing racial disparities in her own community of Orlando Florida, as well as the steps that anyone can take to make this work in their own community. Identification of Materno-Toxic  Area, how to become a Perinatal Safe Spot, and information about the National Perinatal Task Force was shared. What a fantastic ending to an amazing conference!

I must admit, although I am biased as President and member of the conference committee, that this was perhaps the best conference I’ve ever attended. From the customer-service oriented staff of the hotel, to the amazing food (and we all know that a great conference has great food!), to the quality and quantity of the sessions speakers, this conference had it all.

I would like to thank all of the members of the 2016 Conference Committee: Director of Conferences Kathy Bradley, Colleen Weeks, Jana McCarthy, Lisa Wilson, Jackie Thingvold, Director of Membership/Marketing Jennifer Shryock, and President-Elect Debra Tolson plus ICEA staffers Sarah Carlton, Jessica Lytle, and marketing consultant Heather Livingston for their countless hours of work this past year. This was a mighty team that produced great results!

Would you like to be involved with ICEA for any of our standing committees? Please contact our main office at for more information on how you can make a difference!

This conference recap brought to you by

ICEA President Connie Livingston, RN, BS, FACCE, LCCE, ICCE

Helping Clients Build Personal Advocacy Skills: Step Two

You Need to Know What You Want in Order to Get It

If you don’t know what it is you need, you won’t be able to ask for it. When a person has clarity on their values, needs, and wants, they are much better able to advocate for themselves. They can express themselves clearly to the people who are in position to meets their needs. One way we can help our clients get their needs met is by leading them through an assessment of their values, needs, and desires, so they can gain the inner knowledge they’ll need to communicate effectively with their caregivers.

In my previous post in this series focusing on teaching personal healthcare advocacy skills to clients, we discussed the importance of acquiring a foundation of knowledge about the maternity care system in order to be able to make informed healthcare decisions. The second step in teaching personal healthcare advocacy skills involves teaching your clients how to take a personal inventory of their values, needs, and desires. Individuals are experts on themselves. When your clients tune in to these aspects of themselves and gain clarity on how to verbalize them, they are able to bring important information to the table as they work with their healthcare providers. In our roles as childbirth educators, doulas, and birth workers, we can offer our clients tools to do this type of personal inventory.

The personal inventory begins with exploring core values. Core values are closely held beliefs about what is right and what is wrong. They dictate actions, behaviors, and expectations for oneself and for relationships. When clients explore their beliefs about health, illness or impairment, vulnerability, personal agency, and the caregiver/patient relationship, they uncover the drivers of both their own behaviors and their working philosophy towards pregnancy, birth, and parenting. Clients who identify their core values and use them as a guide for finding caregivers with similar values and beliefs will be more likely to experience care that is in alignment with their personal philosophy, and that is more likely to be satisfying.

The next part of the inventory involves exploring the client’s needs. A thorough inventory will include a review of all physical, emotional, spiritual, and practical needs. It should address medical needs, physical supports, psychological concerns (especially if there is a previous history of abuse or trauma), religious practices including special dietary needs or rituals around the time of birth, practical concerns relating to care and healing once home, care of other children or pets, work concerns, financial needs, insurance coverage, and other family concerns. The more comprehensive this part of the inventory, the better prepared your clients will be in arranging for these needs to be met.

The last part of the inventory addresses your client’s desires. What does their ideal birth look like? What does it mean to them to be fully supported, physically and emotionally throughout pregnancy, birth, and beyond? Often our clients can more easily identify what they don’t want, but there is great power in visualizing clearly what it is they do want.  Sometimes desires are so strong they cross over to become needs. This is fine. It’s these personal touches that give our clients the opportunity to make their vision of birth and parenting more closely match their reality, create life-long memories, and give them feelings of confidence and competence that are vital to a positive experience. For example, I client of mine wanted candlelight and drumming at her hospital birth. We used battery-powered tea lights, and her husband brought his 3-foot djembe drum along. He tapped out a beat that helped her quickly get into the rhythm of her labor after the rush of getting to the hospital. The dancing and drumming was a highlight of their birth experience.

This inventory should be comprehensive and cover the time span of pregnancy, birth, breastfeeding, and the first few months of parenting. Couples should work on this inventory together, with husbands or partners contributing about their values, needs, and desires too. Rather than seeing this as a one-shot deal, the inventory should be a working document that changes as your clients grow and learn. It should inspire expectant parents to have open conversations with their loved ones, and to develop plans to ensure the care they are signed up for with their obstetrician or midwife and place of birth is in alignment with their expectations.

This type of inventory can easily be incorporated into your childbirth education classes or prenatal appointments. Your clients might need to guidance or coaching to complete their self-assessment, or they may be fine filling it out on their own. The purpose though, is to get them to think about what is important to them, and what they anticipate they will need as they face the physical and mental challenges of childbirth, and they make this life transition into parenting. By incorporating this assessment into your repertoire you will be giving your clients a powerful tool to help them advocate for individualized care.

What other values, needs, and desires will you add to the self-assessment you create for your clients?




By Michal Klau-Stevens, LCCE


Breastfeeding and the Working Mother

Congratulations on choosing to breastfeed your baby! Now, if you are returning to work or school after your baby is born you may wonder how you can combine breastfeeding and working. With a desire to breastfeed, and some careful planning, you can do it.

As a working mother there are some special advantages to continuing breastfeeding after return to work or school. While there may be many caregivers for your infant, breastfeeding is something only you can do for your baby and working mothers enjoy the special time with their baby that nursing provides.

How can I return to work and continue to breastfeed my baby?

Many new mothers successfully combine working and breastfeeding.

Exclusively breastfeeding in the first weeks and months is the best way to optimize your milk supply- avoid supplementing with formula unless medically necessary. Once you return to work you will develop a breastfeeding pattern that works for you, your baby, and your time away.

Breastmilk production is a “supply and demand” process— the more the baby nurses, or you stimulate your breasts with hand expression or pumping, the more milk you produce. Each woman’s working schedule and situation will be different, including time availability and accommodations for pumping and storage of milk. Federal laws are in place to assure that most women are legally protected to express the milk they need for their baby for the first year of life.

Often new mothers feel like they need to have a large reserve of milk by the first day they return to work, but, in reality, all they need is milk for day one and maybe a few bottles for “emergency”. No need to pump madly for a huge stockpile.

How will my baby be fed while I’m at work?

Your baby’s feeding patterns change frequently during the first year of life. A six-week-old infant will breastfeed more frequently than a four-month-old. Generally, there are three ways your baby can be fed while you are working:

  • breastfed by you if you work at home or have access to your baby at work
  • fed by bottles of expressed breastmilk
  • fed by supplemental bottles of formula

A general guideline is that you will need to express you milk the same number of times you would be feeding if you were at home. Another option is to use “reverse cycle” nursing which is moving to a pattern of more frequent feedings while at home and less frequent feedings or milk expression while you are away at work or school.

How do I store breastmilk?

You can begin storing breastmilk 1-2 weeks before your return to work or school. Glass bottles are recommended over plastic bottles or storage bags because of the exposure to harmful plasticizing chemicals.

The Academy of Breastfeeding suggest the above storage guidelines.

It is easiest to remember 7s – 7hours at room temperature, 7 days in the refrigerator, 7mo in the freezer. When in doubt, smell or taste it!

To warm milk place bottle in a glass of hot water or run hot water over the bottle until the milk is no longer chilled, although some babies might prefer cool milk. DO NOT warm milk in the microwave. If the milk is frozen store overnight in the refrigerator for use the next day or warm in a glass of hot water.

What do I need to express breastmilk?

You first need to educate yourself on the options available to express your breastmilk. There are a number breast pumps currently available, including manual or electric with a wide range of styles and prices; your childbirth educator, doctor, midwife or lactation care provider can answer questions about their favorite models.  Another way is by hand-expression. Women report varying degrees of success with both these methods, although after some practice and experience they become comfortable with one or a combination of both. It is helpful to become comfortable with expressing milk, trying both methods before returning to work.

You will need a clean container and a place to store your expressed breastmilk. If a refrigerator is not available a small cooler chest works well.  Finally, find a comfortable place to express your milk, preferably somewhere private and quiet. Some women find that bringing reminders of their baby helps, too. Try looking at a picture of your baby, smelling an article of your baby’s clothing, or listening to a tape of your baby’s sounds. The amount of milk you can expect to express varies from woman to woman and also depends on the age of your baby but most infants between 1 and 6 months will need about 2-4 ounces at each feeding.

What can I do to maintain my milk supply?

There are a few things you can do to make sure you establish and maintain your milk supply. These include:

  • Nurse or express milk often, at least 8-10 times each 24 hours, especially if your baby is less than three months old, the breast stimulation provided by frequent nursing or expression is important for mothers to build and maintain a milk supply.
  • Spending time skin to skin with your infant also helps maintain a good supply.
  • If you are noticing a decrease in your supply, “power pumping” is an effective technique to increase your milk production. Simply spend a block of time, several times a day, and pump frequently between feedings. An easy way to work power pumping into your schedule is to pump during every commercial while watching a TV program.

Will my baby begin to prefer the bottle?

This is difficult to know in advance since each baby is unique. Try having someone else give any bottles, so that your baby associates breastfeeding only with you. If you find that your baby seems to prefer the bottle, try the following:

  • At each feeding nurse your baby first
  • Offer the breast while the baby is still sleepy
  • Spend time cuddling skin to skin
  • Stimulate your breasts so that the milk is available at the beginning of the feeding
  • If your baby does not nurse well (or at all) pump or express to maintain milk production.

What about weekends and holidays?

There is no need to express milk and bottle-feed your baby when you are at home. Breastfeed full-time during weekends and days when you do not work.

What about child care?

Choose a child care provider who is supportive of breastfeeding. Talk with your care providers about milk storage, paced bottle feedings and your baby’s individual feeding cues and needs. It is very helpful to have a child care provider who is willing to support you, your baby, and your schedules.

Continuing to breastfeed after return to work or school Is certainly possible. Prepare yourself by talking with other mothers who have successfully combined working and nursing as well as co-workers and your boss. Plan ahead for childcare options as well as places to pump and store your milk. Separation from your baby can be stressful but with good planning and support It can make the transition as easy as possible.

Written by Donna Walls, RN, ICCE, IBCLC, ANLC