Loving my babies from afar {Breastfeeding Blog Hop}

I have previously mentioned that I have been blessed to stay home with Baby, but with the other three kiddos I returned to work way before we finished breastfeeding.  Each one has a slightly different story.  I must admit that I was very blessed to be able to pump enough milk to leave for 8-12 hours with little difficulty.  However, I do think that my babies have taken less milk from a bottle while I was gone and then made up for it when I returned home.  For me one of the hardest parts was getting enough milk for that first day at work.

Miss Froggie:
     I returned to work when Miss Froggie was 6 weeks old.  There is a really long story behind why I returned to work so soon or at all, but the short version is that hubby and I believe it was God's will for me.  When I returned to work I worked 12 hour day shifts three days a week on a hospital pediatric floor.  I had a friend who watched her when hubby was at work.  There was a private room and a refrigerator that I was able to use in order to pump.  I had a manual Avent Isis pump.  I generally pumped when I was computer charting.  I would lock myself in the room with my pump in one hand and chart with the other hand.  Officially we were given a 30 minute lunch break and another 15 minute break at some point in the 12 hour shift.  Initially I tried to pump when Miss Froggie would have eaten.  But I found she really wasn't eating that much or as frequently as I nursed.
    And once she was four months old she quit taking the bottle all together.  Now, I did not do the right thing to get her to take the bottle.  I know that now.  I didn't know it at the time.  I would rush home from work and nurse her.  If I wanted her to take a bottle I should have made her take the bottle before I nursed her.  But, honestly, at that time I would be bursting with milk.  The idea of pumping again and making her take a bottle before I nursed her seemed horrible.  But she was sleeping 12 hours at night, so...I went to work on the night shift.  This worked really well, for everything but my sleep.  I'd nurse her, put her to bed, and go to work.  Hubby and Miss Froggie slept all night and then they would have to wait about 45 minutes for me to get home from work.  But I was one tired momma during the day after working all night.  I had a babysitter who watched her for about 4 hours during the day until she was 14 months old when I put her in drop in daycare.  I nursed her until she was 20 months old.

Dear Daughter 10 years old (DD10yo)
   When I had my second daughter I moved from working in the hospital to working at a pediatrician's office three days a week.  This time I didn't go back to work until DD10yo was 4 months old.  I again had a (different) friend watch the girls when DD10yo was tiny.  This friend was really great about experimenting with different things to get DD10yo to take her breastmilk.  Different bottles, different nipples, etc.  My friend discovered that DD10yo would only take the bottle if the milk was HOT.  I have a feeling that my milk comes out at about 99-100 degrees.  And that was the ONLY way DD10yo would take it. 
   I had upgraded to a Medela Pump-in-Style by this time.  I worked Monday, Wednesday, Friday for 8-10 hour shifts and pumped at lunch.  Again I had access to a room and a fridge.  It was fascinating to me.  On Monday at lunch I would pump 16oz in about 15 minutes.  On Friday I usually got 10-12oz.  If I didn't have enough milk for the next day I would take Mother's Milk Tea and pump an extra time before I went back to work. But, DD10yo ate every three hours.  3a-6a-9a-12p-3p-6p-9p-12a.   Until she was 9 months old and started eating meat.  I pumped milk for her until she was 12 months old and then she got cow's milk while I was at work and breastmilk from me when I was home until she was 18 months old

Jujube:

Jujube on field trip for DD10yo

I went back to work when Jujube was 12 weeks old.  This time I worked full time and when he was tiny he came to work with me on my administrative day.  I hired a nanny.  Compared to the girls Jujube was really laid back.  I pumped at lunch.  He took his bottles no problem.  He didn't sleep 12 hours a night at 4 months old like Miss Froggie, but he slept through the night before he was 9 months old.  I pumped for him until he was 12 months old like DD10yo and nursed him until he was 19 months old.

Baby:
Baby has taken maybe 4 bottles in his life :)  He eats almost everything and does not complain when you give him a bottle even though he rarely gets one.  He is nine months old and still nurses at midnight, 3am, and 6am.  But we miss quite a few feedings during the day with our crazy four kid household.

TIPS:

1.  All babies are different.  You may or may not know the personality of your baby when deciding to go back to work and how to feed.

2.  Your body will adjust to what you do.  You can nurse when your home and give bottles when you are gone.  And those bottles can be pumped breastmilk or formula.  But, your milk supply might be different with each kid and each schedule.

3.  If you want to be SURE your baby will take a bottle start at 4-6 weeks and make them take one every day.  Don't breastfeed until after baby takes the bottle.  If this is difficult discuss the situation with your healthcare provider.

4.  Baby may attempt to nurse more at night if you are gone to work during the day.  This isn't necessarily a bad thing.

5.Use galactogogues if you need to.

Thanks for sticking with me through this long post.

Letter to myself (BFBloghop)

Today is the breastfeeding blog hop over at Sisters in Cloth and we are writing letters to ourselves as first time moms.

Dear a younger Nataline at the birth of Miss Froggie,

    Congratulations!  Miss Froggie has been born and will bring such joy and change to your life at home.   I have written and rewritten this letter, trying to get it just right.  You are now a mother and your number one job is to get to know your baby, to be an expert on her.  Trust yourself, trust your gut.  All the clichés about them growing up to fast, they are true.  Even the one about cooking and cleaning can wait until later... I wish I had learned live in the moment when she was born instead of when she was a middle-schooler.   And made the time to journal and keep a very good baby book for each baby.

     Take as long as you can for maternity leave.  Because once you go back it is harder to quit.  Having a car and stuff, it really is not as important as you think.  You can live with less.  You think that you will have more time and more money later… You will always want 10% more time and money than you have.  Figure out how to make time for what is important and how to spend less than you make now.

    That pacifier that you think is evil?  It is not.  Let her have it early or she won’t take it later.  You can wait until your milk comes in, but if she stays at the breast 24/7 you will have WAY too much milk.  And you will need a pump.  Because when your milk does come in, Miss Froggie won’t be able to latch on a bowling ball.  And while you are at it, get a good EXPENSIVE one.  But keep it forever!  (Even if you think you are done having kids.)

     If you want her to take a bottle, start her on it before 6 weeks.  And then make sure the milk is hot (100 degrees) because your breast milk is hot.  And at four months, when she starts to refuse the bottle you have a decision.  If you nurse her before she takes that bottle, she will quit taking a bottle all together.  It is ok if she won’t take a bottle, so if she is more stubborn than you fine.  But know that is the choice you are making. 

     And finally, you will love your babies so fiercely that you will be tempted to get your priorities out of whack.  Keep God first and husband second.  And make sure your husband knows he is more important than your babies by your actions not just your words. 

                                                                                                                Signed,

 An older Nataline

Can I breastfeed and have a glass of wine?

So, the holidays are fast approaching and with them many situations where breastfeeding moms will have to decide whether to have an alcoholic beverage or not.  The last thing any of us want to do is hurt our babies.  But does not mean you have to wean just because you want to have a few drinks this holiday season?   I am not suggesting that you SHOULD drink.  But if you want to here are some guidelines and my disclaimer.

The standard guideline is 1-2 servings of wine or beer a day with no more than 4 servings a week. A serving is12 oz of 5% beer, or 5 oz of 11% wine, or 1.5 oz of 40% liquor (80 proof).  And then you have to wait a while.  I can get all medial and technical on you, but basically after drinking you should wait until you do not feel any effects of the alcohol before breastfeeding.   Which means that some mom’s will be able to return to nursing sooner than others.  Pumping and dumping does not remove the milk with alcohol.  Only your body and time can remove the alcohol from the milk.  But the great news is that you don’t have to dump milk just because you over drank.  Now, if you get too uncomfortable, you may have to pump and dump.  But otherwise, just wait until the alcohol’s effects wear off before returning to nursing.

The younger baby is the more careful you have to be.  Less than 16% of what you drink will be preset in your milk even at peak levels, but before three months old, baby’s liver may not be mature enough to process even that small amount of alcohol. The other reason is that younger babies nurse more frequently, giving your body less time to eliminate the alcohol before the next feeding.

If you know you are going to have an holiday party and you are leaving baby with the babysitter then pump before you leave so that 1) baby has milk an 2) so you are comfortable during the party. After the party you don’t have to pump when you get home to get rid of the alcohol milk.  You only have to wait until your body has processed the alcohol to resume nursing.    Here is a calculator so you can see how low it will take you to have zero alcohol in your milk.

For more usual situations, you can have a glass of wine or a beer with dinner if it will be a couple hours before baby nurses again.  Four glasses a week is probably still a good guideline (some experts say two) because we don’t have studies to show exactly how much is safe.  There have been a few studies that show chronic or excessive drinking can cause complications like poor weight gain and developmental delay.

So, here are some more resources for you to look at

http://www.infantrisk.com/content/alcohol-and-breastfeeding
http://pediatrics.aappublications.org/content/129/3/e827.full
http://www.breastfeedingbasics.org/cgi-bin/deliver.cgi/content/Drugs/alcohol.html
http://www.lalecheleague.org/faq/alcohol.html

What is more valuable than gold?

Today is the breastfeeding bloghop over at Sisters ‘n Cloth and we are talking about pumping and storing milk.  This is something that I have done a lot of over the years.  Breastfeeding is a sweet bonding experience between mom and baby.  Pumping is providing the very best for your baby while you are away.  In my experience, moms get tired of pumping way before they get tired of breastfeeding.  It is sometimes such work to obtain and so valuable for baby that expressed breastmilk is often called liquid gold.  There are breastmilk banks for donations and people will often pay quite a bit of money for extra breast milk.  So what do you need to know about pumping?

One reason to pump milk is if you have a baby in the NICU who is not able to go to the breast yet.  In this situation I would recommend using a hospital grade electric pump while in the hospital.  Then consider renting one for home.  After baby is two to three weeks old and milk supply is well established you could reassess how pumping is going and decide whether to stay with the rented pump or purchase one.

The unusable milk defrosting by Rachel Coleman Finch on Flickr

Another reason to pump is if your breast has become so full of milk that baby cannot latch.  This is the reason I bought my first pump.  I found that my baby was unable to latch on a bowling ball.  I had to get in the shower with warm water to soften things up and then pump just enough to let my newborn latch.

For normal situations, the general recommendation is to avoid pumping until after milk supply is established.  In the first two to three weeks mom’s body is deciding how many babies she now has to feed.  Depending on the frequency of nipple stimulation from baby or pump and how much milk is left in the breast after a feeding, mom’s body may decide she has 0, 1, 2 or even 3 babies.  And in most circumstances this supply lasts for the duration of breastfeeding for this pregnancy.  While not having as much milk as you need for your baby is extremely frustrating, having too much milk for a year or more of breastfeeding is annoying.  It is best to avoid both extremes.  You will not want to be away from your baby at work or somewhere when let down occurs and overflow your breast pads and bra and end up with lovely milk stains on your shirt. 

 I know this from experience.  With my first, I was working twelve hour night shifts at the hospital and my routine was to pump around midnight.  Then by 5am my body was ready to nurse or pump again.  But my work schedule was very busy at 5am.  Among other things I had to draw blood from babies at about 5am.  This never failed to make me let down.  And frequently left me embarrassed.

So, if you will be working many hours away from your baby starting at 6  weeks after birth, then you might want to pump one 2-4oz bottle a day starting at 1-2 weeks old.  Otherwise wait until after 2 weeks.  The best time to pump is immediately after a feeding.  This way you take what baby has left, instead of what baby needs for the next feeding.  The first few times you pump, expect to only get drops.  Over time you will be able to get more milk at a pumping to make your supply for the freezer.  It is very hard to know how much milk your baby will take while you are gone.  It is my experience that the baby will try to wait for mom and feed less frequently from a bottle than nursing.   If you are not pumping as much milk as baby is taking while you are away look at my galactagogue post.

Medela 搾乳機セット - $200 by planet_oleary on Flickr

Ideally when you are away from baby, you will pump when baby would have eaten.  This is ideal.  I don’t think I have ever been able to do this.  But your body adapts to whatever routine you find.  I have used two different pumps with success.  For working moms who will be pumping frequently, I like the Medela Pump In Style the best.  But I also used the Avent Isis manual breast pump with good success.   Be aware that there are different sizes.  So, if pumping is painful either the size is wrong or the suction is turned up too high.

You can store milk in BPA free bottles or in plastic storage bags made for the pump you are using.  There are many systems you can try.  I personally think that you should use whatever the person giving milk to your baby likes to use.  My husband preferred the bottles to plastic bags, so that is what I did.  You have to invest more in bottles but it doesn’t spill as easy.

Avent Pump by Alberth2 on Flickr

Now that you have pumped all this milk, how long can you keep it?  The quickest easiest thing to remember is the rule of twos.  Two hours at room temperature, two days in the refrigerator, and two months in the freezer.  This is actually quite conservative.   I have seen four to eight days in the fridge.  A deep freeze can keep breastmilk for 6-12 months.  You can look at the AAP’s and LaLeche’s recommendations.  Ideally, you will have a frozen back up supply and then use fresh milk that is heated only as hot as baby wants it.  Because some parts of the breastmilk will die when frozen or heated too hot.  But it will not kill yeast.  So if you or baby have a yeast infection, do not use milk pumped during that time after the infection has resolved...or baby will get it back.

You will want to freeze your milk in 1 or 2oz amounts at first.  You won't want to waste any, you don't know how much baby will take and you can always defrost more.  This is also true for the bottles you warm up and give to baby.  Once you have warmed up the milk and tried to give it to baby, you should throw away whatever is left after two hours. 

Breastmilk in the fridge will separate.  You will see the cream rise to the top and the skim milk on the bottom.  My skim milk generally looks almost blue.  When you are ready to use the milk you can defrost it in the fridge or in warm/hot water.  Do not use the microwave to defrost or warm up breast milk. You can microwave water or heat water on the stove and place the milk into the heated water. 

Did I miss anything?  Do you have any questions about pumping and storing milk?