When Working Impacts Breastfeeding, Let’s Make Sure It’s Positive!

La Leche League Leader and resident Sensitive Midwifery breastfeeding contributor, Jane Maasdorp, advises midwives on how they can help mothers to understand that working and breastfeeding can be combined.

Background

It took a while for those in the meeting room of the Department of Health in Pretoria to realise that the soft swooshing noise was the breast pump of one of the provincial directors of nutrition; and the irony of this was not lost, as we were there to discuss the next steps in updating the Code of Ethics for the Marketing of Breastmilk Substitutes! One of the target markets for these non-human milks was working mothers, but this dietician had decided to express her breast milk to be fed to her baby when she was away.

Introduction

Many new moms contemplating their return to employment believe that their choices are either to stay at home and breastfeed, or to give an artificial milk to their babies if they need to go to work. Some may not even breastfeed their babies from birth for this reason. About 44% of the South African workforce is female; many of them will have babies and face what they see as this agonising dilemma.

Help Her Plan Ahead

Discuss the benefits of negotiating optimal maternity leave, and of minimising leave before the birth and maximising leave after the birth to allow more time to establish breastfeeding. Studies have shown that waiting until the baby is four months old before returning to full-time work is more likely to lead to a longer breastfeeding relationship, especially exclusive breastfeeding.

Explore the mother’s work situation with her: while her baby is still young, could she consider flexi-time, job-sharing, or part-time work? Could a group of colleagues motivate for a child-care facility at her place of work to enable breastfeeding at tea and lunch breaks? A growing number of companies worldwide have discovered the benefits of providing this for their employees.

Suggest that she might possibly ease her return to fulltime work, e.g. three days a week for a couple of weeks. Also, it may be less stressful to go back for a Thursday and Friday, and then have the weekend to reconnect with their babies, instead of the daunting prospect of that first long week of separation.

Encourage By Example

It’ll likely encourage South African mothers to believe in their ability to continue nursing their babies once they resume employment if you share some inspiring local examples of mothers who had positive experiences. Celebrities like Miss SA Jo-Ann Strauss, Freshlyground’s Zolani, and Yvonne Chaka Chaka have integrated breastfeeding into their demanding schedules, as has politician Geraldine Fraser-Moleketi, who nursed her son during negotiations for South Africa’s new constitution!

Mothers in more rigid work environments like the military, or whose jobs may often involve separation of several days – like being a flight attendant or foreign journalist – have made arrangements to leave enough breast milk, and cherished the connection this gave them with their babies, saying: ‘It is something we share, and reassures me that I am irreplaceable to him.’

Give Her Invaluable Emotional Support

It is helpful when health professionals and other support people acknowledge a mother’s intense feelings of anxiety and trepidation about leaving her baby. This is normal and shouldn’t be dismissed.

Support her when her motivation to keep expressing at work is low, especially when her baby is over six months and many factors may affect her will to continue, e.g. the disbelief or lack of support of colleagues and bosses; distractions and time-consuming networking; unpredictable meetings; general fatigue; and reduced feelings of connectedness with the baby.

Remind her that breast milk is the most important part of her baby’s diet for the first year (and that after six months the other, complementary foods are in addition to her breast milk not instead of it). Also, she is providing vital protection against the germs to which her baby is exposed in daycare, so she is actually taking care of him even though they are apart. Another powerful motivation is that breastfeeding keeps mothering hormones circulating in a mother’s system, enabling her to sustain that precious strong attachment to her baby.

Reassure her that she can increase a low supply again. Frequent expressing is the crucial element – a little bit more often is better than the pressure to get a large volume just once a day. Remind the mother to breastfeed whenever she is with her baby – nights, weekends, holidays, following the principle of ‘plenty of nursing instead of plenty of pumping’, the latter being a habit that working mothers may get into. She may also have slipped into a ‘meal-only’ attitude to nursing her baby to fit into a daycare pattern, so she could go back to breastfeeding for other reasons like comforting and calming Baby in-between feed times. As The Womanly Art of Breastfeeding reminds us, such feeds are ‘really about connection. All that connection adds up to a stronger milk supply.’

Listen to mothers when they express their feelings, when they are anxious, despondent, regretful, or guilty. Reassure them that their feelings and strength of attachment are normal. Praise them for their continued commitment to breastfeeding. The stories of working mothers who breastfeed show that they also feel proud, and empowered, and even that the anguish and heartbreak of being separated from their babies is to some extent healed by this special relationship.

Employment Intentions

Check that the mother is informed about what the Basic Conditions of Employment Act encourages in the ‘Code of good practice on the protection of employees during pregnancy and after the birth of a child’. While possibly not legally enforceable, in Paragraph 5.13 the Act states that in addition to lunch and tea times, ‘Arrangements should be made for employees who are breast-feeding to have breaks of 30 minutes twice per day for breast-feeding or expressing milk each working day for the first six months of the child’s life.’

Reluctant employers may need to be persuaded by the health benefits to both mother and baby, leading to lower absenteeism and lower medical aid claims. Most mothers are pleased to be reminded that they have colleagues who take time for smoke breaks so their request for nursing breaks should be granted!

The Art of Milk Expression

Practical tips to help mothers continue breastfeeding often revolve around expression of breast milk. These five tips will help her achieve a let-down and express successfully at work:

1. Placing a photograph of her baby, or a video clip on a cell phone, close by
2. Draping an item of clothing with her baby’s smell over her shoulder
3. Doing deep breathing exercises before expressing
4. Asking a colleague for a quick shoulder massage
5. Listening to music with earphones

If privacy is important to her, she could put a cute notice on the door, asking colleagues to respect that space, be it the stationery storeroom, kitchen or her own office. Some mothers express in their cars to avoid being disturbed. Just the thought of her baby being nourished by her breast milk the following day can be enough, as one mother explained: ‘When my son’s babysitter said that he drank all the milk I had expressed the day before, I would feel so proud and excited that I could be giving that to him and still be working.’

Mothers have many questions needing clear answers when feeding their babies expressed breast milk. You can be a huge help with this information about their two primary concerns:

How much milk should I leave for my baby?

There is no one correct answer, and mothers can select from differing guidelines like the three below, to suit their own babies’ needs. Their milk is best stored in small containers so that this ‘liquid gold’ is not wasted if defrosted but not finished at a feed.

Source 1: The average baby of XX months drinks 89–148ml per feed, 750–1035ml per day, leading to the following average amounts:

Source 3: Babies may take 60–120ml per feed, and feed 8–12 times in 24 hours. For an 8-hour separation, this would mean leaving amounts from as little as 160ml, to 240ml, 320ml or as much as 480ml.

How should my milk be given to my baby, and should I start practising with a bottle from birth?

Explain that it is best if the baby associates his mother completely with the breast, and other caregiver(s) with the other feeding method chosen. Reassure her that in the early weeks she should just enjoy the special closeness of breastfeeding, building her confidence and milk supply; and that only shortly before returning to work does another feeding method need to be introduced. Discuss the option of cup-feeding, which many mothers prefer, like this mom who said: ‘More than avoiding nipple confusion and hygiene reasons, I appreciate that Zaba was cup-fed when I was at work because that ensured that she was carried, looked at, given undivided attention by her carer at various intervals during the day, instead of being left with a propped bottle.’

Food For Thought

Encourage the mother who works outside the home to try to find a warm, caring, responsive, ‘mother-substitute’ to care for her baby, someone she can trust to give honest feedback about her baby’s behaviour, needs and milk consumption. She may need to teach the carer about exclusive breastfeeding and how important it is to her. Some mothers are lucky enough to find daycare very close to their workplaces, so can go to nurse their babies during breaks, or even have the babies brought to them.

Discuss normal infant behaviour, warning her that many babies whose mothers are away at work want to nurse more at night. Co-sleeping will make this easier, and give the baby much-needed reassurance, as well as ensure a good milk supply. One La Leche League guiding principle is that ‘In the early years the baby has an intense need to be with his mother which is as basic as his need for food.’ However, society tends to promote an unrealistic degree of independence from an early age (in terms of sleeping, feeding, accepting other carers) so many mothers find their babies’ strong feelings of attachment unexpected and unsettling. Reaffirm that her baby’s instincts to be close are healthy and normal. She may have been misled by people telling her that ‘Children are so adaptable’, but they are not really, so reassure her that breastfeeding is providing priceless continuity for her baby in the midst of challenges and change.

While some babies are eager to nurse as soon as they are reunited with their mothers, others may be rather wary and aloof. Explain that the mother can’t expect to breastfeed only on her terms; her baby is an equal participant and she may first need to spend some time regaining her baby’s trust, carrying him until he has relaxed and is willing to nurse again.

References

• Cozza, G, ‘Breastfeeding and working, yes we can!’ based on her book Allattare e lavorare si può!, LLLI Online Conference 2017 session, 2012
• Granju, KA, Attachment Parenting – instinctive care for your baby and young child, Simon and Schuster, 1999
• La Leche League International, The Womanly Art of Breastfeeding, 8th edition, Ballantine Books, 2010
  Pryor, G, Nursing Mother, Working Mother – the essential guide for breastfeeding and staying close to your baby after you return to work, Boston, Harvard Common Press, 1997
• Roche-Paull, R, Breastfeeding in Combat Boots – a survival guide to breastfeeding successfully while serving in the military, Hale Publishing, 2010