I’d like to preface this post with how thankful I am for the amazing community of mamas that I have met during pregnancy, and also after having Theo. It’s amazing learning from so many women who have had different experiences than me when it comes to raising our children, breastfeeding, and just life in general. Alison is here today to give you a different perspective on exclusively breastfeeding for one year, as a full time working mom, for both of her children.
Long before I was even pregnant with my first child, I knew that breastfeeding was going to be a very high priority for me. I can remember as a medical student on my OB/GYN rotation, seeing posters and data about percentage rates of various metrics, like cesarean sections and breastfeeding. My mom had four totally unmedicated births and breastfed us all at least for a while, so I thought things were looking great for the super calm, natural birth and easy breastfeeding experience I envisioned.
I’ll spare the details, but the punch line is I delivered via C-section and then had a really hard time getting my son to latch in the hospital. My postpartum nurses were angels and every one of them worked with us to help latch, even in the middle of the night. It’s all kind of a blur now, but at some point my husband put his hand on the back of Daniel’s head and smushed it onto my boob and he latched. For a few weeks we used a silicone nipple shield intermittently, especially at night when he was drowsy and would be a pokey little puppy about latching on.
The only real advice I remember getting was from my OB at my 6 week postpartum visit, which was about 3 days before I went back to work as a senior ophthalmology resident. She advised me to empty my breasts about seven times per day and told me to take the extra 15 minutes and pump before leaving work, rather than try to make it until I got home. Armed with those little scraps of knowledge, I went back to work at six weeks postpartum, still emotionally traumatized by my birth experience and having no idea what I was doing. Oh, and I was living and working about 1.5 hours away from my husband and our permanent residence, so we were apart M-F. Thank God for the grandmas who provided our childcare those few months until I finished residency!
Anyway, my first day back to work I forgot the flanges for my pump. Fortunately, my program coordinator had some spares and let me borrow them. I then went home at the end of the day and forgot the milk I had pumped. It was a rough start. With tons of family and workplace support, I managed to exclusively breastfeed until he was 11 months old. By that point I was so sick of my standard issue pump and what a nuisance it was to take breaks in the day to strip half naked and set up shop, and I was ready to stop. We pretty easily transitioned him to formula during the day, and I continued to nurse him at night until a few days before his first birthday.
The day after his birthday, I found out I was expecting baby #2! Much to my surprise. This pregnancy was much less stressful; I lived with my husband the whole time and scheduled a c-section at 39+1 weeks. Louisa came into the world like she had been waiting all nine months for her chance on the boob, and honest to god she latched on while the gurney was still in motion out of the OR into the recovery room. She was so robust with nursing that my milk came in quickly and we hit the ground running.
My second maternity leave was a world of difference, in some good ways but there are still things I wish I had done differently. This time I had a full 12 weeks of leave, and our nanny coming part time to help out. I became extremely interested in learning about breastfeeding, and spent hours reading on my phone while nursing around the clock in the newborn days. I was able to save quite a bit of extra milk in the freezer, which I knew would provide me some stress relief once I went back to work. I developed mastitis once when she was about 3 weeks old, which was a new and terrible experience. I rationalized purchasing a wearable pump (I’ll get to that later) because I realized the return on investment as a physician (not having to block appointments every day to carve out pumping time) would quickly pay for what felt like a very extravagant purchase.
Now that I’ve laid out my background breastfeeding journey, here are the keys that helped me make it a full year as a full time working surgeon mom.
- Education. Think of these as the ground rules for you and whoever will be taking care of your baby. Daycares are great about schedules and quantities; in my experience it is a lot more challenging with family or in-home caregivers. Set clear boundaries.
- This is the MOST important fact to know for your mental health: a breastfed baby requires 1.0-1.25oz of milk per hour, or 24-30oz per day. This is an enormously powerful piece of knowledge, and I want as many women to know it as possible. Secondary information in this equation is: baby should nurse or get a bottle about every 3 hours. This breaks down to somewhere between 3-4oz in each bottle to be given every 3 hours while you’re at work. Drill this into your brain, as well as into everyone’s brain who is responsible for the baby while you’re gone.
- Paced feedings. This is more about educating other caregivers than yourself. Drinking from a bottle takes less work for the baby than directly nursing. Your caregivers need to feed the baby in such a way that drinking from the bottle is similarly (or more) challenging as feeding from the breast. Paced feeding videos are a great way to demonstrate this technique, and make sure that each bottle is being consumed over about 15-20 minutes. This helps to avoid bottle preference, which can be extremely difficult to overcome. Also, use newborn/slow flow nipples, no matter baby’s age.
- Just like grown ups, sometimes babies will eat for comfort. Every time they cry, it doesn’t mean they need more milk. Sure, another bottle might get them to stop crying, but caregivers need to have more tools for comforting the baby than blowing through 10oz of milk in 4 hours. See: your own mental health above.
- Pumping logistics
- Decide on a pump and make sure you have it while you’re on maternity leave. Leave it alone for a while. Hopefully you have something longer than a 4 week leave – I think during the first few weeks it is best to focus on a strong direct breastfeeding relationship and not think about pumping. If you feel very engorged, you could pump once in the morning after baby has nursed. This is a good way to get a few extra ounces in the freezer in case of emergencies.
- I have had good luck with introducing a bottle at about 4 weeks of age, and still only here and there. Have someone other than you do the bottle feeding so baby gets used to it, and you should pump while they are feeding. It can take several trials to find a bottle your baby likes – for what it’s worth, both of mine took Dr. Brown’s bottles right away without issue, so that’s what I would recommend to start with. Yes, they have a lot of parts but it is what it is.
- Practice pumping in the morning after nursing the baby. Most women are more engorged in the morning, so think of this as some “bonus milk”. I would not recommend pumping after every single feed, because that can lead to a major oversupply and put you at higher risk for mastitis.
- If you can afford a wearable pump, DO IT. Consider that you can use your HSA or FSA funds to purchase, and if you are in a commission or productivity-based career, it will save you tons of money to not stop working for 30 minutes multiple times per day. I bought an elvie and was extremely happy with it. You can slip it on as quickly as a restroom break, and it’s quiet enough that most people won’t think twice about why you suddenly look like Dolly Parton.
- Pump on as close as possible to the same schedule as the bottles are given. Set an alarm on your phone so you’re not tempted to push “just another 10 minutes”. This is a hard line you have to keep yourself honest about. If you get a lunch break, pump then too. If you have a wearable pump, pump while you’re driving home.
- Make sure you can stay warm while pumping – bring an extra fleece or scarf. Being cold can really decrease your pumping volume.
- Instead of scrolling social media while you start to pump, look at pictures or even better – at videos of your baby. That really helps my letdown. I loved taking pics and videos every evening to have some new material to look at the next day.
- Put the baby to the boob as soon as you get home, even if it’s not “time” yet. No matter what pump you have, it’s not as good at stimulating your nipples as baby is. Breastfeeding is all about supply and demand, so the more time baby spends on the boob the better.
- Other things you should know.
- Cluster feeding is normal. It sucks and is stressful, and you feel really alone but it is normal. Just go with it. Your boobs feel totally empty and the baby still wants to suck on them. Think of it as baby “placing their order” for future milk. Get some airpods and some good podcasts and just plan on spending a lot of time nursing in the evenings when the baby is ~1 month old. Both of mine peaked with cluster feeding right around 4 weeks old. The first time I thought I was a terrible mom and was failing my child. The second time I pretty much felt the exact same way but knew that it would eventually end.
- You are in charge. Not your partner or your nanny or mother-in-law. You dole out the bottles and specify when they are due to be given. I like to use a vis-à-vis marker to write the time on the bottle so nobody can play dumb. If someone wants to offer you advice, they can advise on how to wash and store the bottles but they listen to you on how and when to give the bottles. Period. Nobody gives extra milk without discussing with you first. AGAIN – this is for YOUR mental health (and obviously the baby’s health). The amount of excess stress and anxiety it will cause if someone is blowing through mass quantities of milk is insane.
- Get a good pump bag and have two sets of pump parts. I like a backpack for all my pump stuff because my regular work bag is a shoulder bag. I always pack 1-2 dish towels in case of any spillage or to lay down if you need a clean surface. This is the backpack I have used with both breastfeeding journeys. It’s cute, modern, super functional, and super affordable.
- Be bold and clear about your needs in the workplace. There are legal protections in place for most workers regarding milk storage and protected pumping time. Do what you need to do and don’t apologize for it, but also don’t milk it (heh, heh) and take obviously longer than you need.
- Wean gradually. With both of my kids, my supply naturally decreased as they started consuming more solid foods. About a month before weaning completely, I stopped pumping at work. During that time, Daniel got formula and Louisa got breastmilk from the freezer. Once I was down to nursing only morning and night, weaning the rest of the way was smooth and I didn’t have any engorgement issues either time. I decided when to stop with Daniel, but on the morning of Louisa’s birthday she nursed one last time and then refused to latch on again after that. It was like she had a stopwatch set for exactly 365 days and that was it.
Being a working mom is insanely challenging at times but also incredibly rewarding. I highly value my career and profession, but there is truly nothing more important to me than caring for my children. I am so grateful that I was able to have a successful breastfeeding journey with my children and I think that for us, it was really instrumental to our bonding and closeness. Please feel free to reach out to me with any questions, or just to say hi at @dr.alisonearly on Instagram!
Disclaimer: This blog post contains the authors researched opinions as well as actual experiences, and not one of a medical professional (although the author of this post is a physician, this article does not constitute official medical advice). Please consult your medical professional for their official opinion on items referenced here, and defer to them in case of any conflict. This post contains affiliate links and I will be compensated if you make a purchase after clicking on my links.