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Introduce the bottle Before returning to work or school make sure that baby is used to taking milk from a bottle. "Both my children took breast milk from the bottle without complaint, but many babies resist vigorously. A general rule is to introduce breast milk in a bottle at 3 weeks of age. Too soon may cause "nipple confusion", too late and nothing but mommy's breast will do," says Kate Newkumet, M.D. It often helps to have daddy or another caregiver give the first bottle while Mommy is out of the room. While at home it is also useful to build up a good milk supply in your home freezer, that way if you miss pumping sessions there will be spare to compensate. Pump, pump, pump! Once back at work, in short, successful breastfeeding primarily means lots of pumping. "I returned to full time pediatrics practice when each of my 2 babies was 11 weeks old, but was able to continue breastfeeding until 10 months of age. I know a few physicians who have continued longer. I started with pumping 3 times per 10 hour day, but was down to once a day by 6 months, combined with 3 breastfeeds while at home. Some people suggest waking the baby up at night to do extra breastfeeding will help you to nurse longer, but I don't think they worked the hours of a typical physician! " says Kate. Physician AE says, "I was fortunate enough to have a clinic position when nursing. I Pumped 3 times a day, EVERY work-day for 8 months with success. I had plenty of milk for the baby". However, maintaining this schedule can be hard. "I went away for a week, and was only able to pump every 8 hours for 6 days, my milk fell off by about 75%. I think 48 hours of only pumping can work if it is done at least every 4 hours, but that can be difficult if one is admitting patients, or caring for newborns on call. If the baby could be brought to the hospital for at least one nursing per day, that should help keep the breasts stimulated", continues AE. SC shares her story, "I have breastfed 2 children while in private practice... Pumping exclusively did not keep my supply high enough for total breast feeding. The baby just has a better suck. I blocked off time in my office schedule to pump. When on call I took my pump with me and pumped when I could". SC also has some useful tips:
Finding a time and a place
Finding time to pump can be difficult, but it can help to tell a few chosen people what you are doing.
Kate Newkumet says, " Slipping away to pump can be difficult, but not impossible. I don't think I ever pumped without at least one call on my pager. Pumping on the run is not a relaxing experience, but I haven't met anyone who felt it affected their milk supply... Expect women in the workplace to be supportive and willing to cover for you for the few minutes you might be delayed - they appreciate your dedication and commitment to your children. Without meaning to sound derogatory, expect some men to be clueless. Although I was very open about what I was doing, one of my partners thought I was taking a catnap when he saw my office door close every day. I think they just did not realize how many working woman actually pump and how important it is to us, or why someone so busy would go to so much trouble. For medical students and residents, I would suggest confiding your plans to a female senior resident or attending (especially if she's a Mom) who will likely vigorously support your short pump breaks."
Finding a place to pump is also key. If you have your own office, you can set up your own 'pump station', bring a picture of baby, a snack, a drink and your breast pump. If you work in a hospital, pediatric resident Rivka Stein advises us "that most hospitals with a maternity unit or NICU will have a breastfeeding room with hospital grade machines and a freezer to store breast milk". They often will provide sterile "specimen cups" to store the milk in as well. I spent many hours reading in a comfortable rocking chair during my PICU rotation. It was a great break from the stresses of the unit, and no one minded my disappearing for 20 minutes every couple of hours (especially since the fellow was joining me as well!) Breastfeeding while working as a resident is hard, but tremendously rewarding".
A powerful pump helps make pumping quicker and easier. "A 'double-barreled' electric pump with hands-free attachments (Medela is good) is essential- you can complete the process in 10-15 minutes and do chartwork at the same time. You will look absolutely ridiculous, but you will be used to it from your experiences during the infant's birth", says Kate. Another useful tip "is to have a handpump, so that one breast could be pumped any private place without need of an outlet" suggests AE.
Remember how ever long you manage to nurse your child, one week, one month or one year it is a gift that will last a lifetime. Good luck, it can be done!
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