Wednesday, August 14, 2013

Strategies for Pumping When Going Back to Work



I 100% believe in breastfeeding and knew I would pump when I returned to work. But while the internet is filled with help on breastfeeding, I found very little useful information about back-to-work pumping. There's tons of information about breastfeeding (thank goodness) and some bit on exclusive pumping (and WOW, do I have a LOT respect for that commitment!), but I wish more working moms would share their strategies of jugging both. 


So I decided to put together this post. It's the big and little of my back-to-work pumping success. Maybe it will help someone else --- or it will just remind me what to do when we're on Baby #2...
 
 
PREPARING TO GO BACK TO WORK:
 
 
Being the sole income (while Adam is in law school) and because my company only pays the short-term disability portion (8 weeks) of FMLA (12 weeks), I went back to work at 8 weeks. Fortunately - and this is a HUGE relief - my mom and mother-in-law come in two days each to care for him, and I work from home on Fridays. (I know there are moms who have no choice but to put their babies in daycare, but I can't even imagine how difficult that is. I consider myself very blessed.)

I started pumping weeks in advance. Experts recommend pumping immediately after feeding, but I found that cumbersome and irritating since I had to entertain Aaron and I still wouldn't get much milk (and yes yes, I know it's supposed to increase your supply, but I didn't have the patience). I either pumped a few hours after Aaron went to bed or first thing in the morning when I was overflowing from the night; both of which yielded the most volume in the fastest time.
 
 
I also had a unique situation whereby I was hosting my sister's out-of-town bachelorette party overnight just a MONTH after Aaron was born, so I needed to have an overnight supply sooner than my back-to-work date.
 
 
As recommended by the doctor, we started introducing the bottle to Aaron around 3 weeks. I would never give the bottle; I wanted Aaron to associate bottles with other people, not with me. Adam gave him the bottle and oh boy did Aaron FIGHT it, but after a few days he got the hang of it. Doctors' say you should give a bottle once every 1-3 days so the baby doesn't "forget" how to take it. Well, after we got through my sister's bachelorette party, we slacked on the bottle for a few weeks... yikes. When we started up again for my return to work, Aaron HATED the bottle again.  Ugh.
 
 
BACK TO WORK
By my 8-week back-to-work date, I had 40 ounces in the fridge. This was backup for work as well as my sister's wedding the following weekend (talk about a crazy week!). After the wedding, we had about 20 ounces in the fridge as backup. My motto was to out-pump Aaron every day to continually build up that supply (for growth spurts, emergencies, etc).
 
 
SCHEDULE AT WORK


I work 8am-5pm, and pumped 4 times a day for 15 minutes each time.
I created 20-minute meeting blocks on my calendar at 9:30am, 11:30am, 1:30pm, and 3:30pm. Although I'm fortunate I could pump in my office with the door closed, if I ever have to go to a designated pumping room (which any employer with over 50 employees must provide), those meeting blocks would remind me to pack up and leave my desk.

Process:
  1. Make sure I have PLENTY of water at arms' reach.
  2. Shut and LOCK office door.
  3. Pull up shirt/bra and strap on hands-free pumping bra.
  4. "Lube up" (haha) the breast shields with lanolin
  5. Attach storage bottle to one side and bag to another*
  6. Start pump, set timer, and go back to work for 12-15 minutes (or, read blogs, pinterest, facebook, etc)
  7. Once time is up, disconnect everything, pour storage bottle into bag*, and SEAL UP MILK. (Never EVER clean yourself or parts before that milk is securely sealed. Trust me, a spill of freshly pumped milk will ruin your WEEK. I would rather the male president of our company walk in on me half-dressed than to spill a bottle of milk... which I did once and sobbed)
  8. Wipe down all parts with Medela Quick Clean wipes (unless it was the last pumping session of the day, then I would just put them in a bag to wash at home)
  9. Milk bag goes into cooler in fridge in kitchenette and I go back to work.

Time: 20 minutes.
 
 
 
*I use storage bags for one pumping session, and feeding bottles for two sessions.  The bags go in the freezer for storage and the bottles are for the next day's feeding. Note that the one pumped bottle may not net enough for one feeding, in which case, at night, I'd cut open a bag and distribute amongst the bottles to top them off for the next day.
Every night, I tossed my pump parts in the dishwasher in a Munchkin basket or put in a Medela Microsteam bag.
 
 
QUANTITY
Every baby's consumption is different. I read a good article by KellyMom about how to estimate your baby's breastmilk consumption and I ask the pediatrician every visit. Regardless, it took me TWO MONTHS to figure out the right amount (and even now I still question it). Aaron has always been a BIG baby and LOVVVEESSSSS his food. He would suck down a bottle in a matter of seconds and then cry when it was done, regardless of how many ounces were in the bottle. So, my best guess was to feed him how I pumped, assuming that my supply on Monday constituted his need from Sunday (right? maybe? this is still a work-in-progress to this day...).
Back-to-work 8 weeks: ~12 ounces
4 months old: ~13 ounces
My supply always decreased by 0.25-0.50 ounces every consecutive day at work. So if Monday I started at 14 oz, I'd be around 12.5 ounces by Thursday. I tried to nurse Aaron as much as possible in the morning and evenings to keep up the supply, but I guess my body just doesn't take to the pump as well.

If anyone else has tips on how to calculate their baby's consumption needs, I'd LOVE to hear it!
 
 
INCREASING SUPPLY FOR GROWTH SPURTS
My friend Erin gave me several pumping pointers, and I also read up on some advice on KellyMom's article here. My strategies:
  • Adding in a 5th pumping session at work (least successful)
  • Pump at night
  • Cluster feed Aaron as much as possible when home
As I said before, my milk supply was always the strongest on Monday mornings, after a weekend of nursing. If Aaron ever out-consumed my daily supply, I automatically pumped that night to make up for it. I also asked my mom and mother-in-law to keep me abreast of his bottle habits during the day via text so I could know how I was doing. Sometimes this was a relief; sometimes it was stressful (like the days he decided to be a little piggy!).
 
I read a lot about lactation-rich foods.  To this date, I have not noticed any significant increases based on oatmeals, whole grains, etc. diet changes.  Websites recommend herbs and teas, but in my opinion, as long as I can out-pump Aaron every day, I don't feel the need to dive into herbal rememdies (which also have very mixed reviews).

{Side note: I do, however, eat a lot; I never let myself be hungry.  After losing 30 lbs of my 40 lbs baby (yes, I was a big preggo mama), I stalled on the last 10 lbs.  I know several people who said their last 10 lbs stayed on until they were done nursing, and any attempt to remove the 10 lbs caused a dip in their supply.  At first, I was highly annoyed by this (uhm, isn't nursing supposed to make you thinner FASTER than formula moms?!?!), but then I realized that I'm giving my baby the MAXIMUM nutrition and health benefits.  I thought of it this way: because I'm giving Aaron an immunity boost against allergies, ability to fight cancer, and a higher IQ... it's worth holding onto the extra 10 lbs for a year.}
 
MILK STORAGE
 
#1 Rule: LABEL LABEL LABEL.  For bags, you can write the date and quantity right on the bag in sharpie.  For bottles, I used post-it flags that I already had at my desk. You can also buy Medela labeling lids, which work if you just need to note your day of the week (aka: not going in the freezer). 
 
For the most detailed storage requirements, I'll point you to this KellyMom article here.  However, my quick-and-dirty is this:
  • Fridge (fresh milk): a week
  • Fridge (thawed): 24 hours
  • Freezer: 6 months
The freezer supply will become your best friend as a nursing mom.  It will be your safety net of "what if..."  In my 4th month, I started to actively build my freezer supply to supplement Aaron on my first business trip at 7 months.  My goal: 100 ounces.

When a bad storm blew through one night, I thought: "omg, what if the electricity goes out?"  Because we live in the highly-populated area of King of Prussia, this is unlikely, but I found a fabulous KellyMom article on what to do when your power goes out just in case!
 
ROTATING FREEZER SUPPLY
Milk can change based on mother's diet and baby's needs.

Therefore, although milk can freeze up to 6 months, I never wanted my supply to get too old. Every day, I tried to do 50/50 of frozen milk and fresh milk. Sometimes it was 25/75. And sometimes I forgot to take milk out of the freezer entirely and just went with yesterday's pump supply. I always wanted Aaron to have some fresh milk so if there's anything he needs (i.e.: antibodies for a cold, etc) he can get a freshly boosted supply in the recent milk. Usually I was no more than a month or two old in my freezer supply.


PUMPING PAIN

Pumping pain can be caused by...
  • Pumping too long - never an issue for me
  • Suction too strong - never an issue for me
  • Poor breast shield fit - OUCH OUCH OUCH
Poor Fit: I was absolutely positive that the normal size breast shields (24 mm) fit my boobs just fine.  I do not know if I was delusional or if my nipples shrank, but around 4 months, I started to get a LOT of pain where I couldn't pump more than 11-12 minutes.  I bought the Small 21 mm and AHHHH...  So much better.

Dry Boobs: My current issue is dry boobs.  I couldn't tell you if this is caused by pumping or by breastfeeding or by the summer heat or hormones or WHAT.  It's NOT dry or cracked nipples; my nips are fine.  It's ITCHY ITCHY ITCHY boobs.  And contrary to the somewhat-socially-acceptable phenomenon where men can itch their balls (although I completely disagree with this), it seems that itchy your boobs is a bit frowned upon. 

The tough thing is finding a cream that works for dry boobs AND is safe for baby.  Lanolin is just far too viscous to spread on boobs (I tried!).  In her article about Breastfeeding Products, blogger Elena mentioned Extreme Cream by Zoe Organics.  Zero toxins and safe for baby (i.e.: I don't have to wipe it off if Aaron suddenly wants to eat shortly after applying).  I think it's helping, but I don't think it's solving the problem.  I would be extremely curious to hear of anyone else's solution or recommendations for this.

MY PERSONAL RULES OF PUMPING
These are, by no means, universal rules of pumping. They are the little things that helped me stay sane.
  1. Commit to out-pump Aaron's feeding every dayI also worked to pump an additional 7-8 oz every week for the purpose of storing up enough milk for my 3-day business trip when Aaron is 7 months old. I found this most success by pumping 2 hours after Aaron went to bed when I would get 2-3 oz.
  2. Never drink alcohol* or caffeine during the work week. Both alcohol and caffeine can slightly diminish milk supply, and EVERY LITTLE BIT counts when pumping. Those nighttime beers and morning chai lattes were put on hold for weekends!
  3. Prioritize pumping over work. As I said, I put 20-min "pumping meetings" on my outlook calendar and stuck to them, declining other meetings if they conflicted with my pump time. Of course, I can't even imagine how hard it is to manage this as a nurse, teacher, factory worker, etc. I have GREAT respect for those professions with crazy workdays!
*I have read that the hops in beer can boost supply.  I would imagine this applies to very dark beers and not the Bud Light Limes of the world.  I have not confirmed this at all, but would be interested in hearing feedback of anyone who had success with this.
PUMPING GEAR
I really enjoy breastfeeding but not so much pumping. It's inconvenient and it's boring. This is a collection of gear I assembled to make it more bearable. You could skip a ton of this but I love gear that makes my life easier!
Pumping Process Gear:
  • Medela Pump-in-style Pump* I considered the Medela Freestyle, but after reading a few reviews about the poor bra-connectors, I went with the all-around-favorite pump-in-style.
  • Hands-free pump bra : this was CLUTCH. I could pass the time working on my computer or playing on my iPhone instead of just holding the pump to my breasts for 15 minutes - snooozzzeee.
  • Lanolin - Lube up those flanges!
  • Medela wipes** : So I didn't have to wash the pump parts in the kitchen with my male coworkers hanging around... AWKWARD.
  • Medela pump-and-save bags : Convenient for measuring, despite the fact that it's difficult to fully expand the bag to get the correct measurement reading. As depressing as it is, I often rounded down to be conservative since the bag regularly showed more than there was when poured into the baby bottle.
  • Storage Bottles and Feeding Bottles - Some people pump enough for a bag on either side; I pumped about 1.5-2 oz per side, so I'd use a storage bottle to collect from one side and pour into the bag so I didn't have a million 1.5 oz bags in the freezer.  I also would pump some direct into his feeding bottles for the following day.
*My insurance reimbursed 70% of the cost of the pump!  We have a very progressive insurance anyway, but I heard this is becoming a requirement of the Affordable Care Act, so CALL YOUR INSURANCE and find out!  If you still don't know because insurance companies are annoyingly vague (as in my case), submit the claim anyway and see what they do.  Worst is they reject you.  Best is you get a check for $100+ back!
 
**As an alternative to cleaning your pump supplies, you can refridgerate them between pumping sessions.  I did not do this for two reasons: 1) I didn't like the extra trip to the fridge to fetch my pump parts before I started a pump session (LAZY) and 2) I didn't like the cold flanges on my tatas and 3) It just felt DIRTY to me to have unwashed pump parts.  This is just me being picky, but it felt... gross.
 
Milk Transportation:
  • Cooler and freezer pack: At work, I leave the cooler in the fridge and the freezer pack in the freezer. When I leave work to drive home, I stick the freezer pack in the cooler so that if I don't take out the milk immediately when I get home (which happens a LOT) or if I run errands, the milk is still good. Medela Pump-in-style has a cooler that comes with the pump; it's not tall enough for the bags to stand upright, but you can fold over the top (which also further prevents spills). We also received a free Enfamil cooler from the hospital which is a great backup (formula companies just LOVE to push their products!).
Pump Cleaning Parts:
  • Dishwasher Basket - Also useful for bottles parts, I used mine nightly for a thorough pump santizing. Those Medela wipes are great throughout the day, but they don't get everything.  I have the two-pack Munchkin ones.
  • Medela Microsteam Bags - You get one bag for free with a 40-pack of wipes. One bag gets 20 uses. So if the dishwasher didn't need to be run, I would just pop this baby in the microwave. 
  • Spinning Bottle Rack - Primarily for your bottles, but I also used this to dry out my pump parts because I didn't want my flanges sitting next to the pots and pans in the dish strainer.
Other Helpful Items:
  • Baby Connect app: In order to constantly measure my pumping versus Aaron's bottle consumption, I used this app religiously. It also allows an auto-timer while pumping so that I could concentrate on my laptop and my phone would alert me when I could unhook. Very handy! There's nothing that makes the time go by slower than watching the clock... tick tock tick tock.
  • Spare pump parts*: It is SO IRRITATING to get to work, open your pump bag, only to realize your clean pump parts are still sitting on the drying rack at home. ARRRRGGGHHH. After doing this twice, I had the bright idea to use the spare parts I was given in the hospital when I rented a pump. They were designed for the hospital-grade Medela pump, but guess what? Medela parts fit ALL Medela pumps! Now I never take out the days' parts unless I am putting the new ones back in. 
*Side note: Spare pump parts are kind of expensive, and originally I don't think I would have bought a second set if I hadn't gotten the "free" ones in the hospital ("free" because they were probably billed through our insurance like everything else).  But after switching to smaller flanges due to pumping pain, I did buy a second pair because it was just TOO convenient!
 
 In conclusion, I dream of the day that I can stay at home (or work from home permanently) and rarely have to pump. But in the meantime, gotta work with what you have!

2 comments:

  1. Oh my stars! Best post ever!

    Question: when using the medela wipes, how did you get in all the hard places in your valves?

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    Replies
    1. To be honest, I've never solved that. I just shake out the valves as much as possible before wiping down, then throw in the dishwasher at night to make sure that spot gets cleaned. Over 7 months of pumping, I've noticed the valves have accumulated some residue, but even after taking a nipple brush to it, I can't get rid of it. So I tell myself as long as its sanitized residue (ha), I'm ok with it. Let me know if you find anything that works better!

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