August includes World Breastfeeding Week, a perfect opportunity for us to look at how close we are getting to the American Academy of Pediatrics' recommendation that all babies be given nothing else to eat but breast milk for their first six months of life. Remember that breast milk has all the nutrition (calories, protein, fat, carbohydrates, vitamins and minerals) that a baby needs during those first six months.
This recommendation is based on all sorts of studies that show breastfeeding helps protect babies from infections (for example, ear infections, lung infections, and vomiting and diarrhea), food allergies and sudden infant death syndrome (SIDS), as well as chronic problems such as diabetes, asthma and obesity.
Of course, it's good for moms, too: Breastfeeding can lower a woman's risk of several medical problems, including breast cancer, ovarian cancer and osteoporosis.
Starting Well, but Dropping Out
So how are we doing? When it comes to starting breastfeeding, the data look encouraging. Nearly three-quarters of mothers are at least giving it a try. But the numbers for continuing to breastfeed exclusively at age 6 months are much lower, far from the U.S. government goal of at least half.
One reason so many mothers may start but not continue is that being able to breastfeed exclusively while working outside the home is not so easy. Although many would love to do so, very few American mothers can take a six-month leave from work to be home full-time with their babies. A recent study underlined the difficulty. Working mothers whose maternity leaves were less than three months long, who were in nonmanagement positions, and who had inflexible work hours had particular difficulty continuing to breastfeed.
But that doesn't mean that working moms can't breastfeed. The first thing you need to do is get a breast pump.
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Picking a Pump
If you work part-time and are away for only three or four hours at a time, or work close enough to home or day care to nurse your baby midday (or even more frequently), a good hand-operated pump may be all you need. In addition, pumps that run with a battery and ones that work with a foot pedal (like an old-fashioned sewing machine) are worth a look. Get advice from family and friends whenever you can, as some models/brands definitely work better than others.
If you'll be gone most of the day, especially two or more days each week, an electric pump may be better for you — both to supply enough milk to leave at home for your baby and to provide enough stimulation to keep up your milk supply. Your body needs hormone messages sent when your baby — or the pump — sucks on the breast to let it know how much milk it needs to make. Look for double-pumping action, as this type of pump works more easily and is particularly good for helping to keep up your milk supply.
Breastfeeding mothers can buy or rent an electric pump. If you think you might use it for the full six months (or longer), or if you might have another baby and need to use it again, buying one probably makes the most sense, if you can afford it. Be sure to check with your health insurance company, though, as some will cover all or part of a pump rental.
It's also a good idea to try the pump before you go back to work — both to get used to pumping (which can take a little time and practice) and to have some extra breast milk saved up.
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Breast milk can be stored in plastic or glass bottles with tight-fitting tops, or in plastic freezer bags specially made for storing breast milk.
The La Leche League offers these guidelines for breast milk storage:
- At room temperature: 10 hours
- In a refrigerator: up to eight days
- In a freezer compartment inside a refrigerator: two weeks
- In a freezer with a separate door: three months
- In a separate deep freeze: six months
If you think the milk is likely to be used within one week, it's better to leave it in the refrigerator than to freeze it, because once you take milk out of the freezer to defrost, it's good for only 24 hours. Never microwave breast milk. The microwave doesn't warm the milk evenly and can change it in ways that make it less healthy. Instead, use warm (not hot) water for warming the bottle.
To have enough milk for baby when you're away from home, you may need to pump on days you are home. If so, your best bet is to pump in the morning when your breasts are most full. Feed your baby first, then pump.
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Pumping and Privacy at Work
More and more workplaces are becoming "breastfeeding-friendly" and offering rooms where mothers can pump. Some even have breast pumps available, so employees just need to bring in their own tubing and other attachments.
If your employer does not have a special room, all you really need is a place at work that is kind of private (for example, an office, a storeroom or even a bathroom). The room also should have somewhere for you to sit comfortably and an outlet if you're using an electric pump. Talk with your employer. Be sure to mention the American Academy of Pediatrics recommendation!
In general, it is said that you should be pumping as often as your baby would eat, but that's not always possible. At least try to do it every three to four hours. Pumping before you leave home (again, after you nurse) or at work right before you start (get there a few minutes early), can help you feel less uncomfortable from breasts overfilled with milk. Call your baby's caregiver before you get on the road home — holding off on a feed so you can nurse the moment you get home helps too!
Doing all of this takes work, time and patience, but once you get into a routine, it's not so bad — and by exclusively breastfeeding you are giving a true gift of health to your baby (and yourself!).
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You Can Do it — Really
A note from Dr. McCarthy: I have struggled with this issue myself. It wasn't until my fourth and fifth children that I was able to breastfeed exclusively while working as a pediatrician. Elsa and Natasha never had any formula and I nursed them until they were 2 and 3 years old. It took some work and organization (for example, learning to eat lunch with one hand while holding a double pump apparatus with the other was a big help!). In the end, it was really manageable — and totally worth it.
Even if you can't exclusively breastfeed while you work, nurse as much as you can. Every drop counts toward your baby's health. A great resource is www.lalache.org The website of this international breastfeeding organization offers lots of information, practical tips and links to local breastfeeding support groups and vendors that sell pumps and other useful items.
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Claire McCarthy, M.D., is a senior medical editor for Harvard Health Publications. She is an assistance professor in pediatrics at Harvard Medical School, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is also a contributing editor for Parenting Magazine.