Originally published in The Ottawa Citizen September 14, 2004

What are some of the problems breastfeeding mothers face when they return to work or school? What are the solutions available to help them continue to breastfeed or provide breast milk to their infants?

In Canada, maternity leave can be 12 months for those who are not self-employed. Those who have the option may split this time between spouses.

Self-employed women may have to return to work weeks to months after birth. The recommendations to breastfeed for the first six months may be a difficult proposition for some based on their work situation and life circumstances.

Studies indicate that breastfeeding continuance rates decline precipitously when mothers return to work. In addition to maternity leave benefits in Canada, other factors may influence a working mother’s ability to continue to breastfeed: the office environment, number of breaks, travel, work hours, shift work, availability of local or office childcare programs, milk storage, use of breast pumps, and spousal and family support, among others.

Preparing a breastfeeding plan and sharing it with the employer and co-workers prior to returning to work can help everyone understand the situation.

Depending upon the circumstance, it would be ideal to have the infant brought to his or her mom at least once during her work day for a feeding. Sometimes a caregiver may be able to bring the infant in to the workplace for a feeding.

Should the logistics of the workplace environment or work day prevent on-site infant breastfeeding, then the priority should be production and storage of breast milk for later use.

This means having the opportunity to use a private room to use a breast pump. Different breast pump systems exist to accommodate the mother. The room should have a sink, refrigerator, chair and electrical outlets.

If the mother is unable to express milk during her work day, breast milk production will eventually decrease. The pumping schedule should follow the mother and infant’s usual feeding routine.

The stress during the initial days at work can contribute to reduced milk production. If possible, a graduated-hours work schedule for the first week or two will allow the mother to integrate a new routine that does not disrupt her ability to continue breastfeeding. Returning to work on a Thursday or Friday will help work out any bugs in the breastfeeding plan, minimizing disruption of the full work week.

Using a breast pump effectively requires practice. Incorporating its use two weeks before the end of maternity leave will increase proficiency. Pumping between feedings offers the best results. Although initial attempts may not produce much milk, with patient persistence the breast will respond by increasing production after a few days of regular pumping.

Breast milk can be stored at room temperature (less than 26 degreesC) for up to eight hours, remain in the back of the refrigerator for up to eight days and frozen in the back of the freezer for a maximum of three months.

The milk containers (glass or plastic bottle with a tight sealable top) should have a tag or space to write the milk production date. Playtex makes a system that attaches to a breast pump and collects the milk into a ready-to-use bottle that doubles as a storage container.

The milk fat in frozen breast milk will normally rise to the top of the container. The milk can be thawed either by gently swirling the container in warm water or placing it in the refrigerator a day before use. Thawing using a microwave oven is not recommended. Shaking the bottle will reconstitute the fat into the thawed milk.

A workplace breast pump kit should be prepared ahead of time and include:

* Breast pump;

* A small cooler if a refrigerator is unavailable;

* Milk storage containers;

* Extra clothes in case of breast milk leaks;

* A shawl or blanket for privacy;

* Water, juice and snacks to provide extra calories for milk production;

* A pillow for arm support while using the breast pump;

* A CD/tape player, favourite music, books or magazines to provide a relaxing environment. This will help with the milk let-down process;

* A picture of your baby.

Breast milk production is usually well underway by the time an infant is four weeks old. A motivated mother with good support can succeed with many types of breast pumps. A lactation consultant can help with the breastfeeding plan and any problems that may arise.

One other aspect is the division of household chores and cleaning. Family support is imperative so the mother can get some rest.

There are solutions to help mothers continue to breastfeed should they wish to do so. Support of this effort should be encouraged by all.

© Dr. Barry Dworkin 2004