Working Cow

[*I realized I started this post awhile ago, but never got around to posting it . . .]
Levi is almost 8 months old now, and I have been able to provide breast milk exclusively during this entire time. I hope you can allow me some self-indulgence here. Levi has never had any formula during this time. Not that there is anything wrong with formula, but no one can argue that breast milk is the best and most preferable source of nutrition for your baby. Plus, since I knew that Levi would need to learn to go between taking milk from a bottle and then nurse with me, I wanted to avoid another variable of formula that could possibly make continued breastfeeding difficult.

Here's thanks to my pump (pictured above). If I could have a moment to address my pump: "Thank you for making it possible for me to provide the best food possible for my little baby. I don't really enjoy our time together. No offense, please. We have spent quite some time together, haven't we? Sometimes 4 times a day! Thank you for cooperating on our morning car-rides together. That has been a real time saver. I won't miss you at all when I have to say goodbye. Don't be sad--I am sure we will reunite in the future. And although I don't like you, know that I love what you have been able to do for my baby. "

My hope is that people reading this post would feel encouraged and not discouraged if they chose or went a different path for their own personal reasons. I wanted to share some of my experiences and things I've come across along the way to help those who want to accomplish a similar goal currently, or in the future. I wonder if random people ever come across this blog from internet searches. If so, I hope they are helped too because I was helped by random people from the internet in constructing my "support system".
First off, I wanted to list some reasons why I chose to continue to breast feed while working full-time.

Reasons to Breastfeed:

1. The American Academy of Pediatrics recommends it as well as World Health Organization and UNICEF (recommended for the first year).
2. Breast milk provides perfect infant nutrition.
"Human milk is uniquely superior for infant feeding and is species-specific; all substitute feeding options differ markedly from it. The breastfed infant is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short and long-term benefits."
3. Breastfeeding promotes bonding between mother and baby.
4. Not breastfeeding increases mother's risk of breast cancer and ovarian cancer.
"If all women who do not breastfeed or who breastfeed for less than 3 months were to do so for 4 to 12 months, breast cancer among parous premenopausal women could be reduced by 11 percent, judging from current rates. If all women with children lactated for 24 months or longer, however, then the incidence might be reduced by nearly 25 percent. This reduction would be even greater among women who first lactate at an early age." -Newcomb PA, Storer BE, Longnecker MP, et al. Lactation and a reduced risk of premenopausal breast cancer. N Engl J Med. 1994;330:81-87
5. Breastfeeding increases baby’s IQ. The cut-off seems to beyond 8 months in the studies I saw.
6. Breast milk is always ready and comes in a nicer package than formula does. It’s always the right temperature! Well, it’s more convenient while at home, but, of course, more challenging while working.
7. Breast milk contains immunities to diseases and aids in the development of baby's immune system. There are live antibodies and cells that cannot be reproduced with formulas.
8. Breast milk is more digestible than formula. I know some babies have problems with formula, and it is then a stressful journey trying to find the best one to use.
9. Suckling helps shrink mother's uterus after childbirth.
"Nursing will help you to regain your figure more quickly, since the process of lactation causes the uterus (which has increased during pregnancy to about 20 times its normal size) to shrink more quickly to its prepregnancy size." -"The Complete Book Of Breastfeeding", M.S. Eiger. MD, S. Wendkos Olds
The uterus of the non-breastfeeding mother will never shrink back to its pre-pregnant size. It will always remain slightly enlarged. - Chua S, Arulkumaran S, Lim I et al. "Influence of breastfeeding and nipple stimulation on postpartum uterine activity." Br J Obstet Gynaecol 1994; 101:804-805
10. Nursing helps mom lose weight after baby is born.
**I needed all the help I could get here!!!**
“Breastfeeding requires an average of 500 extra calories per day.” -Dewey KG, Heinig MJ, Nommwen LA. Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr 1993;58:162-166
“Mothers who breastfed exclusively or partially had significantly larger reductions in hip circumference and were less above their prepregnancy weights at 1 month post partum than mothers who fed formula exclusively." -Kramer, F., "Breastfeeding reduces maternal lower body fat." J. Am Diet Assoc 1993; 93(4):429-33
Man, at the rate I’ve been losing weight, I’m afraid what would happen if I stopped breast feeding!!
11. Breastfeeding protects against Crohn's disease, ulcerative colitis, asthma, diarrheal infections, bacterial meningitis, respiratory infections, eczema, food allergies, Hodgkins disease.
12. Formula feeding increases baby's risk of otitis media (ear infections) up to 3-4 times.
13. Breastfeeding decreases the risk of sudden infant death syndrome (S.I.D.S.).
14. Formula-fed babies are more at risk for obesity in later life. Levi needs all the help he can get with our genes! ;-)
15. Breast milk is free, and formula is very expensive!!
16. Breastfed babies get sick less often.
17. It's what breasts were designed for! Sorry to break the news, guys.
18. Providing milk for Levi every day was one way I could stay connected with him while I was away at work.

I am quite proud of what I have been able to provide for Levi despite working up to 80 hours per week. According to the US Bureau of Labor Statistics, "over 50 percent of mothers with children under the age of three are working outside the home. Among mothers who work full-time, more than half begin breastfeeding in the hospital, yet only 12.5 percent are still nursing five to six months later, in contrast to nearly 23 percent of mothers nursing who are at home" (from Breastfeeding and the Working Mother. by, Diane Mason, Diane Ingersoll).

How Did I Do It?

1) First off, I had already decided ahead of time that I was going to *make* it work. Before Levi was born, if he was able to latch and breastfeed (which wasn't a breeze for us—a very challenging first month!), I had made up my stubborn mind that I was going to provide exclusively breast milk at least until he was 6 months old (as much as possible). It is recommended by the American Academy of Pediatrics to exclusively breast feed for the 1st year, so I was going to shoot for that goal, step-by-step, as much as possible—the first goal 6 months, then the next goal of 9 months.

As I usually do with challenges and questions I faced: I researched it and read as much as I could about it. What kind of bottle should I get? What kind of pump? How should I store the milk? On and on. I was obsessed. See below for what I found.

2) I pumped frequently, and early on, while at home on maternity leave in order to become an “over-producer”. I knew that your breast milk supply comes in based on demand, so I was going to trick my body into thinking I had 2 babies to feed. I didn’t go too over-board on this. Outside of the time during my 1st month when my supply went down and I pumped a lot more to build it back up (Levi was falling asleep during nursing sessions, not taking in enough, leading to a decrease in my supply. I would have him nurse, then pump immediately afterwards.), I pumped most of my 2nd month at home just twice a day. I would pump, religiously, immediately after the morning feeding when I would have the greatest supply. The second time I would pump was usually in the evening, after putting Levi down for “the night”. Towards the end of the 3rd month, I would just pump after the morning feedings. I actually continued pumping after the morning feedings for the next 2 ½ months back to work, even on my days off, to keep my supply up, keep up with Levi, and add any excess to the frozen storage. I knew once I hit November, back in the wards, I wouldn’t be able to nurse him in the mornings prior to work, and would rely a lot on the stored milk. [I want to thank my friend, Amanda, for letting me borrow her pump those first months at home. I wasn’t sure how breast feeding would go and apprehensive about buying an expensive pump ahead of time. I am indebted to her in allowing me to use her pump to build up a storage supply before going to work, before I bought my own pump.]

3) I accumulated a hefty supply of frozen breast milk before returning to work. I actually was able to store approximately 140 ounces of breast milk in our freezer before going back to work! I am quite proud of this storage, and it took away a lot of stress once I went back to work if I wasn’t able to pump enough milk a particular work-week.

4) Hands-free, double-pumping—A MUST. Very early on, I invested in the “Expression Bustier”, basically a bra with holes cut in the center for the pump shields to go through and hold the pumping apparatus in place, leaving your hands free. This was an absolute necessary for sustainable pumping, at least for me. I was able to multi-task. At work, I could return pages I got, type my clinic notes, look up info on my patients, and even put in orders in the computer.

5) I pumped on the way to work. This was probably the most comical (and scary?) of all my efforts, but so crucial for me. I would hook everything up, put the Hooter Hider cover over my neck, hook up the pump, and 15-20 minutes later when arriving to work, I would be done pumping, and could just take it all down. This was important the first couple months when I nursed Levi at home before work and was still pumping afterwards. There wouldn’t have been enough time to do both and get to work on time (without waking Levi up even earlier). Then, as I transitioned to working in the “wards” (aka, inpatient hospital care), I would have to be at the hospital so early—it was too hard for me to wake up even earlier (the month of November, I would have to be at work at 6am!). Plus, I was already hooked at that point (no pun intended . . .). That way, I would only have to pump once at work, and only a third time if I had a late day (every day in November was a late day), or if I was on call.

6) I nursed Levi whenever I was home with him. This was, of course, so much more enjoyable than the darn pump! It was a sweet reminder on why I was doing this.

7) I LOVED my small Medela Freestyle pump (pictured above). This pump fit can fit in just one hand! Some rotations I had to carry my bag with me everywhere as well as my pump supplies, “cooler”, lunch, and study material with me wherever I went. It was good to have everything in one big bag instead of a separate bag for my pump. Plus, it made it so very discrete. (ok, I know I’m starting to sound like an advertisement. I’m not getting paid . . . but maybe I should?). NOTE: I was able to find a deal on some obscure website online—thanks to google—and got it about $90 less than usual retail!!

8) I developed an efficient routine of storage and pumping. After much research before I had Levi, I decided to get the Playtex Nursing Drop-In system.
This is how it works:
The bottles are not actual “bottles” (they are “nursers”), in that there is no bottom to it. You pour milk into a disposable liner that is BPA-free which is placed into the nurser. The fact that it was BPA-free was important to me and a reason why I didn’t choose other bottle-systems. The crucial part of these bottles in sustaining the breast-feeding relationship are the nipples itself. They are wide-based, so baby has to get use to opening his mouth wide to feed—so important in breastfeeding! Levi was able to easily go between the bottle and me!

The efficient part of the system are the actual liners. I could pump directly into the liners with an adapter (good with Medela pumps), freeze the milk in the liners. When it’s feeding time, I just pop one of the liners in the bottlw, thaw out the milk in the liners, add the nipple on top, and feed Levi from the same liner without having to pour any milk! So easy! The lack of transferring is also important for several reasons: (1) Each time breast-milk is poured from one container to another, a film of nutrient-rich fat is left behind along the sides of the previous container. I wanted to minimize transfers to retain all the nutrition. (2) Didn’t have to clean pumping bottles. (3) Didn’t have to also buy milk-storage bags and deal with them. (4) It’s a lot quicker to heat up a bottle with warm water through a little liner vs. through the plastic of a bottle.

The milk I froze was milk I pumped directly into the 4 oz. liners. Playtex sells a freezer-storage-system, but it’s not good for high-volume storage (too many parts to buy; note: you’ll need at least 2 boxes of the storage-system if you double pump b/c only one pump adapter comes in each set). So, I used this storage-system from Playtex to freeze the milk, then once frozen, I would disconnect the attachments and store just the liner in a double-bagged, freezer-strong-Zip-lock bag. I would have the liner labeled with the date and amount of milk.

The down-side to this bottle system is that you have to keep buying liners. But, they are not that expensive, and the little expense is soo worth not having to clean bottles daily in addition to the pump supplies I have to wash every night. Plus, the liners are suppose to reduce colic in reducing the amount of gas baby drinks buy collapsing during the feeding.

To further increase efficiency, I also bought a couple extra pump adapters to use during my work day so that I wouldn't be slowed-down by having to wash the supplies in order to use it again later that day. It was hard enough to find time at work to pump, so all that I could do to make the time more efficient was better. When I had to wash a couple pieces quickly, I used these Quick-Clean wipes from Medela, which was great to have on hand.

9) I got comfortable breastfeeding in public. Of course, I would always be tastefully covered up with my Hooter Hider. It would have been impossible to get anything done on the little time I had off if I had to always nurse Levi at home, in “private.” Not to mention, it’s important for me to get out and enjoy non-working time out in the world. So, I got comfortable with nursing Levi in restaurants and malls, even when I got the occasional strange look. (I’m sure it must’ve looked funny to see Levi’s flailing arm come out from beneath the cover as he likes to do.) Honestly, most of the time, I don’t think people noticed what I was doing.

10) When giving a bottle, use only slow-flow nipples. Even though the nipples advertise that slow-flow is only for 3 months or less, it is actually recommended by www.kellymom.com, my favorite breastfeeding website, to keep using the slow-flow nipple so that the baby won't tend to prefer the bottle with quick, easier flow over breastfeeding. I can't emphasize how important this is!

Whew. Congratulations if you read this all! Hope this was helpful or encouraging to someone!


Yet you are He who took me from the womb;
you made me trust you at my mother’s breasts.
On You was I cast from my birth,
and from my mother’s womb you have been my God.
Psalm 22: 9-10