Breastfeeding: Returning to work and weaning

For most babies, the American Academy of Pediatrics recommends breast milk as the primary source of nutrition for the first year of life. This recommendation is based on research that has shown breast milk to be the best source of nutrition for babies, with the added advantage of offering protection from certain diseases.

If you're a working mother, you can continue to provide these benefits to your baby when you return to work.


Possible solutions
Returning to work doesn't necessarily mean you need to stop breastfeeding. Some mothers continue to breastfeed their babies exclusively, and others combine nursing with bottle feedings of expressed breast milk or formula.
Here are a few possibilities:

If you're able to work from home, you may be able to continue nursing as always.

Some mothers work part time, nursing before and after work.

If child care is available at your work site or nearby, you may be able to nurse your baby during the work day.

You may want to express milk during the work day for bottle feedings from the caregiver. This works best in a breastfeeding-friendly work environment, with time allotted to pump milk and a designated pumping room.

You may choose to breastfeed when you're at home and provide formula for work days.
To determine the best solution for your situation, you may want to consider your options with a breastfeeding specialist. Ask a nurse in the postpartum unit at your hospital, your doctor or your baby's doctor for a referral -- many hospitals have breastfeeding specialists on staff.

As another option, the nonprofit organization La Leche League provides education, information, support and encouragement for breastfeeding mothers through support groups with specially trained leaders. To learn more about La Leche League, call (800) 525-3243.


Before returning to work
If you plan to have a caregiver bottle feed your baby expressed milk or formula, introduce the bottle before you return to work. Because different sucking techniques are used for the bottle and the breast, wait until breastfeeding is well established -- probably not until age 3 to 4 weeks. When you introduce the bottle, your baby may accept it more readily from someone other than you.
If you're planning to express milk for your baby during the work day, begin at least two weeks before you return to work. You may be able to express enough milk by hand to meet your baby's needs. (Even if you're planning to provide formula for your baby while you're at work, some degree of manual expression may make you more comfortable while you're away from your baby, as well as prevent a clogged milk duct.)

If you'd prefer to use a breast pump, consider your options. A portable electric pump that can express milk from both breasts at the same time may be a good choice if your free time at work is limited. (You'll probably need to express milk every three to four hours while at work.) On the days you don't work, you may be able to breastfeed your baby exclusively. Or you may choose to breastfeed in the early morning and at night. The amount of milk you produce will adjust to the demand.


Storage
When you express breast milk and store it for future use, careful handling and storage is important to keep it fresh and free from harmful bacteria. Here are some general guidelines:
Wash your hands thoroughly before expressing milk or handling it. If you're using a breast pump, wash all parts of the pump carefully after each use.

After expressing, breast milk can be left at room temperatures of 66° F to 72° F for up to 10 hours or at a room temperature up to 79° F for four to six hours.

Label the container with the date. Refrigerate any breast milk you plan to use in sterile glass or plastic containers. If a refrigerator isn't available, store the milk in a cooler with ice packs. The milk can stay fresh for up to 24 hours in a cooler. Discard any breast milk that's been in the refrigerator more than eight days.

Breast milk can be safely frozen for two weeks in a freezer compartment located inside a refrigerator; three or four months in the self-contained freezer unit of a refrigerator; or six months or longer in a separate deep freeze. It's helpful to freeze milk in the amount you think your baby will take at a feeding -- 2 to 4 ounces is often a good starting point.

Thaw frozen breast milk gradually in the refrigerator or quickly under running warm (not hot) water. To avoid uneven heating, don't use a microwave. Frozen milk that's been thawed shouldn't be refrozen. It can be stored in the refrigerator for up to 24 hours.

Fresh milk can be added to frozen milk after the fresh milk has cooled for about 30 minutes. The amount of fresh milk should be less than the amount of frozen milk.

Discard any extra expressed breast milk at the end of each feeding. Don't freeze or refrigerate it again.

Breast milk can separate into milk and cream. Gently shake the milk to mix it before a feeding. Also, keep in mind that the milk may look bluish, yellowish or brownish in color. This doesn't mean the milk is bad.

Weaning
Weaning is making the transition from breastfeeding to another form of nutrition. Weaning may be initiated by the mother, baby or mutual agreement between the two. There's no set time considered best for weaning -- it's a personal decision for you and your baby. It may occur when your child is a few weeks or a few years old.
To help make the decision, consider the following suggestions from the American Academy of Pediatrics:

Exclusive breastfeeding is best through age 6 months for most babies.

Gradually introduce iron-enriched foods after age 6 months.

Continue breastfeeding for 12 months or longer if you feel it's the right choice for you and your baby. If you wean your baby before age 12 months, choose an iron-fortified formula. Ask the baby's doctor for a recommendation.
If you have questions about the best time to wean your baby, consult your baby's doctor or a breastfeeding specialist.

Benefits of gradual weaning
Whenever possible, wean over the course of several weeks. This will give you and the baby time to adapt to your new relationship, as well as let your breasts gradually decrease milk production. Gradual weaning will also help you avoid painful engorgement (when the breasts become excessively full of milk) and a possible breast infection.

It may be best to replace one feeding every two to three days with formula or, depending on your child's age, cow's milk in a bottle or cup, or solid foods.

Remember to give your child plenty of extra attention -- this may make it easier for your child to accept substitute behaviors for the comfort he or she once found through nursing.

While you're weaning, your milk ducts will become smaller. During the next six months, your breasts will gradually return to their previous size.

When fast weaning is necessary
If you must wean your baby quickly, you may experience breast fullness or tightness. Wear a supportive bra during this time. It may also help to express just enough milk to soften your breasts, but not as much as your baby would normally take during a feeding. Expressing a small amount of milk will also ease the fluid accumulation that can lead to a painful breast infection.

To allow milk production to decrease gradually, express the excess milk less and less often over about two weeks.

If you're having difficulty with abrupt weaning, your breasts are painful or you feel ill, consult your doctor.

Be aware that abrupt weaning may be difficult for your baby, who will suddenly lose the regular closeness and comfort once provided by breastfeeding. Again, it's important to give your child plenty of extra attention during this time.