Going Back to Work? Here is What You Need to Know.

Suzanna was nearing the end of her pregnancy.

“I wish I could stay home with my baby longer,” she said, “but my job is the one which carries the health insurance we need. I am going to start off breastfeeding and would like to continue nursing when I return to work. How can I make this work if my baby will be in daycare?”

There are so many things to take into consideration when going back to work. Being prepared enables you to nurse longer, so take the time to get the information you need. Talking to others who are nursing and working can also be helpful, something you may be able to do at a local Breastfeeding USA meeting.

This article covers several areas: establishing breastfeeding, choosing a caregiver, learning what your caregiver needs to know about breastfed babies, preparing your baby and yourself for separation, and understanding your rights under the law.

Establishing breastfeeding
Being able to get breastfeeding off to a good start is especially important for mothers who will be separated from their babies. It is in those first few weeks that babies learn how to nurse, and mothers can build their milk production. Breasts only make more milk when milk is removed: the more frequently mothers nurse (and/or pump,) the more milk they make. Nursing is usually more efficient than pumping, so nurse whenever your baby gets fussy, as well as when he signals hunger. This will help to boost your milk production as well as satisfy his sucking needs. Comfort nursing is the key to making lots of milk.1 If you have any concerns about making enough milk or your baby is having trouble nursing, your local Breastfeeding USA Counselor or an IBCLC can help.

With this in mind, it makes sense to stay home as long as possible before returning to work, so the first thing to look at is negotiating maternity leave. Find out how much time your company usually allows for maternity leave and start from there. If you have accrued vacation time consider taking it immediately after your maternity leave ends.

Some companies are now allowing babies to be brought to work. This is something you might want to look into! Even if this is not currently part of your job’s culture, it is something to consider talking about with your supervisor. The Parenting in the Workplace Institute (PIWI) provides free resources and advice for the implementation of formal programs in which parents can bring their children to work and care for them while doing their jobs.

If this is not possible, then here are some other options to consider:

Can you work at least part time from home? Many jobs now only require computer access, and conference calls are taking the place of some in-person meetings.

Can you arrange to work only part time at first? This will ease the transition for both you and your baby. Half days will mean less time away from your baby, less pumping, and more nursing. Even one day off a week can make a difference. For example, work Mondays and Tuesdays, take Wednesdays off, and go back Thursdays and Fridays.

Would it be possible to job share? Maybe there is another staff member who would also appreciate such an arrangement, at least for a while.

Who will care for your baby while you are away?
Let's look at some of the possibilities:

     Your partner (stay home full time or work alternate shifts)
     Your parents, other relatives, or friends
     Another stay-at-home parent
     A nanny in your own home
     A nanny shared with one or two other families
     Family daycare
     A daycare center (some big companies have their own!)

Whichever option you choose, you will want to be comfortable with your caregivers’ parenting methods. This is your child, and you are the one who determines how he is raised. These are the people who will not only be changing your baby's diapers and giving him bottles, but will also be toilet training him and feeding him other foods. Equally important, they will be the ones who are comforting him and keeping him safe.

Before interviewing prospective caregivers, make a list of all the things that are important to you. For example, do you have a preferred method of putting your baby to sleep? Do you expect your caregiver to take your baby for walks or in their car while they run errands? Do you want your baby to spend much of his time being carried in a sling? This can be tricky when it is a relative or close friend who has offered to take care of your baby, especially if they will be doing so for free. If your parenting philosophies are not in sync and you cannot work out an amicable agreement, it may be better to choose another caregiver.

Here are some other factors to take into consideration:

  • Is it going to be more convenient for your baby to be cared for in or near your home, or closer to your work?
  • Will he be close enough for you to be able to go to nurse him during your lunch break?
  • If you and your partner work different hours, can you minimize the time your baby is away from home by having one of you drop him off and the other one pick him up?
  • If you are looking at a nanny or family-type daycare, does your caregiver have a backup if she or her children are sick?
  • What is the plan if your own child is sick?
  • Does the daycare have rules and routines which are set in stone, or are they flexible?
  • In daycare settings, illnesses can spread from one child to the next with amazing speed. What routines are in place to minimize chances of infection?
  • What is the turnover rate of caregivers in the business?

Every situation is different – and may change with time. Only you know what will work best for you.

What does your caregiver know about breastfeeding babies?
Of course, you will have a multitude of questions to ask prospective caregivers. After all, these are the people who will be with your child for most of his waking hours. You will want to be sure that you share a similar approach to parenting, especially with regard to breastfeeding.

How will your caregivers support breastfeeding? Here, for example, are the state of Missouri's Requirements for a Breastfeeding Friendly Child Care Facility:

  1. Has a written policy that reflects their support of breastfeeding
  2. Provides a welcoming environment for breastfeeding families
  3. Offers breastfeeding resources to parents
  4. Feeds infants on demand and communicates with moms about feeding preferences
  5. Trains staff to support breastfeeding parents

Not all caregivers are familiar with breastfed babies. They may not know how to handle your milk safely, or understand the differences between breastfed and artificially-fed babies. These are some of the topics you may want to cover:

How much milk your breastfed baby needs
The amount of milk your baby will need at daycare will depend, of course, on how long you will be separated. Don't forget to include your travel time from his caregiver to your work. Most babies need about 1 to 1 ½ ounces of milk for each hour they will be away from you.

If your caregiver is used to giving babies six or even eight-ounce bottles of formula, then she may be surprised about your leaving much smaller amounts.2 She may even question whether or not you are making enough milk, and this can be upsetting. You can reassure her that your baby is gaining well and is healthy and that your doctor is happy with his progress. Unlike artificially-fed babies, your baby's need for human milk will not increase as he gets bigger. Your milk is constantly changing to meet the needs of your baby. If you really do need to increase the amount of milk you leave each day, there are some great tips here: I’m not pumping enough milk. What can I do?

Milk production takes about four to six weeks to become established.3 After that, the amount of milk he takes each day will not significantly increase. Of course, there will be days when he needs to eat more frequently due to growth spurts, but these will be the exception rather than the rule. You can leave an extra bottle of milk for those times. If he has taken his usual amount and is still hungry, then your caregiver can pour more milk into his bottle from the extra one you left, about an ounce at a time.

How frequently your baby needs to eat
Your baby's tummy is only about the size of his fist, so he can only eat a little at time. When you are nursing, of course, you have no idea how much he is eating, You only know that he stops eating when he is full. Bottle-feeding uses a different set of muscles, and it is very easy to overfeed a bottle-fed baby, no matter what is in the bottle. It helps to make bottle-feeding as much like breastfeeding as possible, using Bottle-Feeding as a Tool to Reinforce Breastfeeding.

Why your baby may be fussy after eating
Breastfed babies may be used to being held and cuddled a lot at home, which is wonderful. A caregiver who is looking after two, three, or more children may wonder how to meet your particular child's needs for close body contact when she has so many other things to do as well.

ALERT!
When caregivers look after several babies at the same time, they may be propping bottles instead of holding babies while they eat. This is dangerous and can result in choking and ear infections. Besides, eating should be an enjoyable experience for your baby, a source of one-to-one interaction. Making unannounced visits to the center is a good way to check on the care your baby is receiving.

Consider leaving a soft baby carrier at the center so that the caregivers can hold your baby whilst tending to other chores. If you already use a carrier at home, then your baby will appreciate a similar one there.


Getting yourself and your baby ready for daycare

When to start pumping
The recommendations for when to start pumping seem to change all the time, so you will hear anything from two weeks onwards. However, it is important to first establish stable and adequate milk production, and that is best done by spending as much time as you can just nursing. Generally speaking, you do not need to start pumping until two weeks before going back to work.

Storing your milk
Store your milk in 2-3 oz portions to minimize waste. Remember that your baby's tummy is about the same size as his fist. Be sure that your caregiver understands how to handle human milk. It can be kept at room temperature (68-72F) for 6-10 hours and in a warmer room (73-77°F) for up to 4 hours. There may be state regulations which regulate how long ANY milk may be kept out, yet another reason to store it in small quantities.

This is important information for those who need to supplement with powdered formula:4
Guidelines for the safe preparation, storage and handling of powdered infant formula

Building a stash

You will be pumping every day for the next day’s feeds, and your milk changes as your baby grows, so it makes sense to give him the milk matching his needs. While you will want to have SOME milk for emergencies, you probably will not need a freezer full of it! Enough milk for one or two days is usually enough, maybe for a week. If you are concerned about being able to pump enough milk talk it over with your local Breastfeeding USA Counselor, or IBCLC, who will be able to help you find ways to maximize your milk production.

When to introduce a bottle
If you are going back to work at 6 weeks, you could start introducing your baby to a bottle about two weeks beforehand. Starting earlier is sometimes suggested to prevent bottle refusal. However, there is no way of telling ahead of time whether your baby will go happily from breast to bottle and back again. Some babies who take a bottle early will come to prefer it to the breast, and some will refuse the bottle later. Whenever possible, have somebody else offer your baby the bottle, because you want him to associate you only with breastfeeding.

Here are some guidelines for Paced Bottle Feeding - As Much Like Breastfeeding as Possible

If you do not need to return to work until your baby is 3 months old or later, you could start introducing bottles at about 4 to 6 weeks, but you only need to give them occasionally to keep up that skill.

Some babies refuse to accept a bottle: if that happens to yours, there are alternative feeding methods. You could also try using a different brand or type of bottle, as some babies do seem to have strong preferences.

Introducing your baby to daycare
The separation involved when going back to work is hard on everyone.Your baby will miss you as much as you will miss him, so you will want to allow enough time for both you and your baby to become familiar with his caregivers, the facility, and their routines. This will also enable the caregivers to get to know your baby. Ask his caregivers how things went after each visit and if they have any concerns or questions. You can also ask your caregiver to keep a log detailing your baby's day, including when and how much he ate, number of wet and poopy diapers, naps, and so on.

Introducing your baby to daycare is best done gently and gradually. You can start by taking him to visit the center, walking around, and nursing him. The next stage is nursing him there and then going off yourself for a couple of hours, followed by leaving him there long enough to be fed once by a caregiver, and so on. When you feel comfortable leaving him there for half a day, move on to a whole day. This way your caregivers will get to know your baby before he comes to them full time, and you will feel more confident that he is being taken care of to your own standards.

Whenever possible, allow at least two weeks for this transition. Follow your baby's lead, repeating one or more steps until baby is comfortable with it, backtracking as needed. Feeding your baby at the facility enables you to pick up their unique combination of germs and viruses so that you can make and feed back their antibodies in your milk.

If your caregiver will be coming to your own home, start by having her come just to visit and play with your baby a couple of times. Then you can follow a similar sequence to the one above, nursing your baby before you leave for increasing amounts of time.

Here is a sample schedule for when you go back to work. Of course you can modify this for your own circumstances.

    At home, early AM: Nurse and pump
    At caregiver's: Nurse
    At work: Mid morning: Pump
          Lunchtime: Pump (nurse, if possible!)
          Mid afternoon: Pump
    At caregiver's: Nurse
    At home: Nurse on cue
          Before you go to bed: Pump for work
          At night: Nurse on cue

Nursing at the daycare, where illnesses tend to spread quickly, will give you more opportunities to pick up the germs and viruses there, so that you can make the antibodies your baby needs.
At work, you will be able to store your milk in your lunchbox in the staff fridge or in your own cooler.
On weekends, nurse frequently to build up your supply, AND pump at least once or twice to rebuild your “stash.” Most people find that they are able to pump more at the beginning of a workweek than towards the end of it. It is also normal to get more milk at the beginning of the day than in the evening.

NOTE: Some babies prefer to wait until they are able to nurse and will only take small quantities of milk from a bottle during the day. This is fine, as long as they are nursing frequently while you are home and are producing lots of wet and poopy diapers. For many families, this is the new normal.

All this means talking to your employer about your changing needs.
Have you heard about the government program called The Business Case for Breastfeeding?5 This contains a wealth of information for both employers and employees - why breastfeeding is so important, how employees who are not nursing are more likely to need more time off because their babies get sick more frequently, how breastfeeding can help the company's bottom line, and even information about federal and state laws protecting your right to breastfeed and pump.

Let's look at the section for employees, The Employee's Guide to Breastfeeding and Working:6 Right there, on page 6, is a sample letter for you send to your employer. You can adapt it to your own circumstances, explaining your need for regular pumping breaks in a private area – NOT the bathroom!

All employers covered by the Fair Labor Standards Act (FLSA) must comply with the FLSA break time requirement provision for nursing mothers. As explained in “Does the nursing mother’s break time provision apply to small businesses?” all such employers are subject to the FLSA break time requirement7 unless they have fewer than 50 employees and can demonstrate that compliance with the provision would impose an undue hardship.

More information, including how to file a complaint, can be found here:

Here is one mother's experience with returning to work:

We had a rocky start since my caregivers didn’t know anything about paced bottle-feeding. So I printed out some information for them, How much expressed milk will my baby need? and How to bottle-feed the breastfed baby, and highlighted areas of importance, including the calculator that showed how much was recommended to put in each bottle. I also shared a video of paced bottle feeding. It took them a few weeks to get paced bottle-feeding down. They kept saying that he was still hungry after each bottle, and I kept having to remind them that milk comes out more quickly from a bottle compared to the breast, and he just doesn’t realize that he is full. I also explained that this is one of the reasons paced bottle-feeding is important, and how mommy’s milk is most comforting to him while I am away.

I asked them to soothe him and distract him with a toy until he realized that he was full and stopped crying and all was fine. If they truly felt he was still hungry, then I told them it was okay to give another ounce of milk, but not another whole bottle. This rarely happened once they got paced bottle-feeding established. It took a while for them to get to know him and his cues. I asked them to offer bottles on demand instead of a schedule. Over time, he eventually got himself on his own schedule. At first, I was unsure about what to put in each bottle. I started sending 2-2.5 oz at 12 weeks and then eventually moved up to 3 oz just before 4 months. By around 4 months, he was taking 3 oz about every 3 hours.

I asked them to not give a bottle after 4 pm so he would be ready for me when I got off work at 5 pm. If he had a long nap and woke up at 4 pm or later, they would text to ask me what to do. I would tell them to offer a little bit to hold him over - I was almost finished at work, and I would be right over - and to keep him comforted until I got there. The most important thing was to keep the communication lines open. They would always text me if they have any questions or doubts, and I appreciated that. I felt like it was breastfeeding friendly of them.

They didn’t understand why I was sending such small amounts of milk for my son. They would ask, “Why is Raylan only getting 3 oz when the other baby his age is getting 6 oz?” They didn’t understand that human milk changes to meet baby’s needs, and the volume doesn’t need to be increased like formula. I would get asked this often, and I had to keep reminding them.

I asked his caregivers to not toss his unfinished bottles. One daycare that we had would offer it at the next feeding, but the other daycare wouldn’t. Instead of them tossing it, I had them put it back in my milk cooler so it wasn’t wasted.

The main concerns were paced bottle-feeding and them not knowing that breast milk changes to meet baby's needs so volume doesn't increase. I kept getting asked why other babies got more (whether it was breast milk or formula). Moms around here don't seem to know about this and we are hoping to fill this gap.

A lot of moms here are quitting after a month or two back at work because they can't keep up. We are working on a daycare project to educate caregivers and to have support for working moms to hopefully fill this gap.

Stormy Miller

Some of Stormy’s experiences are unique to her and her baby. Every mother will need to experiment a little to figure out approximately how much milk her baby needs for each feeding and what schedule is best. As with feeds at the breast, some babies like more frequent, small feeds while others like their feeds larger and spaced farther apart. Regardless of that, the issues of learning how to work with caregivers in the best interest of her baby and gently educating them about breastfeeding are not unique to Stormy. Forging a good relationship with employers and caregivers is an ongoing, but ultimately rewarding, endeavor that will benefit everyone - most especially, your precious baby.

References

  1. Mohrbacher, Nancy IBCLC, FILCA, The “Magic Number” and Long-Term Milk Production
  2. Mohrbacher, Nancy IBCLC, FILCA, Breast Versus Bottle: How Much Milk Should Baby Take?
  3. Mohrbacher, Nancy. 2010 Breastfeeding Answers Made Simple, Hale Publishing L.P. Amarillo TX, P.74
  4. World Health Organization Guidelines for the safe preparation, storage and handling of powdered infant formula
  5. Office on Women's Health, US Department of Labor Guidelines for the safe preparation, storage and handling of powdered infant formula Womenshealth.gov
  6. Office on Women's Health, US Department of Labor, The Employee's Guide to Breastfeeding and Working Womenshealth.gov
  7. United States Department of Labor Break time for nursing mothers

Further Reading:

Norma Ritter is the mother of three grown children and the grandmother of seven grandchildren, all of whom breastfed.