Lactation in Court: Your Rights at Risk (and One Case to Watch)

Last week, I was directed to a headline that read, "Supreme Court lets stand ruling that firing woman for breastfeeding not sexist because men can lactate." I immediately thought "that doesn't sound right," and set off to investigate. The heavy partisan bias of the site and the lack of sources induced further skepticism, but I felt that such a claim must have originated somewhere, so I followed my diligently-Googling fingers to an ACLU blog post that had been heavily quoted in the first article. The headline was likewise sensational: "Firing a mom because she's breastfeeding is sex discrimination." Again, the ACLU post referenced the court's supposed claim that lactation is not unique to women (more on that in a minute), but again, no sources for this opinion were provided. What's more, the original headline of the first article has since been changed, possibly in response to a Snopes article that points out the misleading language.

What WAS certain was that a breastfeeding woman had lost her job, the circumstances pointed to possible discrimination, and a petition appealing the case had been submitted to and denied by the Supreme Court. Given the massive consequences this could have for breastfeeding mothers, really ALL mothers, I jumped down the rabbit hole to find the truth.

Don't start raging yet. Soon, I promise, I will give you a reason. Probably not the reason you think, though.

The Case: Ames v. Nationwide

First, a quick overview of the case, Ames v. Nationwide (yes, that Nationwide):

Angela Ames was a Nationwide Insurance employee who gave birth to her first child after seven months at her job, and discovered her second pregnancy five months after that. At this point, she claims she became the target of mocking and derogatory comments from her direct supervisor, Brian Brinks, and the head of her department, Karla Neel, regarding the intended length of her maternity leave, her weight and appearance, and her medical need to go on bed rest as a result of a difficult pregnancy.

Ames's second child was born prematurely, and during her maternity leave, Neel called to inform her that the length of her leave had been miscalculated, and she would need to return to work sooner than originally planned. Though further unpaid leave was available to Ames, Neel suggested this would send up "red flags," and offered a compromise of an extra week beyond paid leave. Ames, who was breastfeeding, called a disability case manager to ask about available pumping facilities, and was told that lactation rooms were available.

Upon her return to work, Ames needed to pump, and sought out the lactation room. After receiving an indifferent response from Neel, she was directed to the company nurse, who informed her that she needed to fill out paperwork that would take three days to process before she could be permitted access to the lactation rooms. Since Ames had not pumped in hours and was in considerable pain, the nurse offered an alternative room, but it was not immediately available and did not comply with federal guidelines for a suitable pumping space.

While waiting for an available room, Ames met with Brinks, and claims he told her that none of her work had been completed while she was on leave and that she was responsible for completing all of it within two weeks, even if that required overtime and at the risk of official discipline if not finished. Now fearing for her job and in even more pain because she still had not pumped, a visibly distraught Ames again sought out Neel for help. Neel then handed her a pen and paper, saying, "You know, I think it's best that you go home to be with your babies," and dictated a resignation letter to Ames, instructing her to sign it.

As a result, Ames brought suit charging sex and pregnancy discrimination, and later a claim of constructive discharge, on which much of her case depended. Constructive discharge means a forced resignation, usually because working conditions are made deliberately intolerable with the intent of causing an employee to quit rather than be terminated.

How is the Supreme Court involved?

Second, a grossly-oversimplified layperson's explanation of the case's route to the Supreme Court:

The case was initially tried in District Court in Iowa, where the events occurred. This trial court ruled against Ames, with two primary arguments: one, that she was unable to prove that she was treated at all uniquely for being a woman (particularly a mother and lactating woman), and two, that she did not adequately seek available redress prior to her resignation, as a "reasonable person" would. It was in the footnotes of this court opinion that the odd reference to lactating men was included, to support the assertion that lactation is not a sex-based condition and therefore could not prompt sex discrimination.

Next, Ames appealed the decision, taking it to the Eighth Circuit court. This appellate court affirmed the decision of the district court, but did NOT reference any of the more outrageous claims found in the original opinion, including the men-can-lactate-too argument. However, the decision of this court carries considerable weight, as its ruling is now binding for the entire Eighth Circuit, and may be referenced as precedent in cases before other circuit courts.

Now gaining the support of the ACLU (in an excellent little brief, I might add: well-worth the read), Ames petitioned the Supreme Court for a review of the case. Her attorneys sought this both for an appeal of the ruling and because several of the Eighth Circuit's opinions regarding constructive discharge conflict directly with readings by the other circuit courts, meaning only the Supreme Court can settle the dispute. The Court denied the petition, which means they will not hear arguments at all and there are no further avenues for appeal available to Ames. However, this does NOT mean that the Supreme Court has affirmed the circuit court's ruling as the Eighth Circuit did, and its denial should not be taken as approval of or agreement with any arguments made by Nationwide.

"Reasonable persons" and lactation as a choice

Is this fair? Are these bad rulings? Were Ames's rights infringed?

It's hard to say, because lawyers are good at what they do and, with scruples or without them, they can make a case. Even as a legal-illiterate, I can follow the logic that led to this outcome. But I can also see an equally logical path to the opposite conclusion. Some context that I think was overlooked:

The courts made much of Ames's failure to report her harassment and ill treatment to HR as a "reasonable person" would, citing that as their primary reason to reject her claim of constructive discharge:

"The Court is not insensitive to the burdens and stresses associated with parenthood, particularly those experienced by new mothers. Being under stress, however, does not excuse Ames from doing what any reasonable person in her position would have done. Therefore, the Court concludes that no reasonable fact-finder would determine that the unavailability of a lactation room on July 19, 2010 would lead a reasonable employee in Ames’s position to believe that her only option was to resign."

This ignores several important points:

One, that Ames had been a victim of a sustained campaign of harassment and intimidation throughout her pregnancy, both from her direct supervisor and from the department head. As it was a physically challenging pregnancy, Ames would have been suffering from physical discomfort, fear for her unborn child, the need for constant medical care that would interfere with her work, the mockery of colleagues and superiors, and of course fear for her job. Also, she already had a baby at home, and though other stressors are not cited in the court documents, it is also possible that her health insurance and her family's financial stability depended at least in part on her job with Nationwide. Any of these factors, combined with pregnancy and postpartum hormones, could easily and understandably make Ames less reasonable than she might be otherwise.

Second, Neel demonstrated a clear pattern of manipulation in her behavior toward Ames: First came her comments that were evidently intended to make Ames feel guilty for her need to go on bed rest during her pregnancy. Then, when she called to let Ames know that her maternity leave had been miscalculated and she would need to return to work earlier than originally planned, she made threats to Ames' job should she choose to take a longer unpaid leave. After thus putting her on the defensive, she then magnanimously offered an extra week of leave to Ames, assuring that Ames would return to work both fearful for her position and indebted to Neel for her apparent graciousness. Finally, it was Neel who suggested Ames resign and who offered her the pen and paper and dictated her resignation letter to her.

Third, though there are several references to Ames's "considerable pain" or discomfort of engorgement from going so long without pumping, it is very clear that no one who ruled on this case has any idea what that feels like. While of course judges are called upon to be as objective as possible in their rulings, the physical sensations Ames was experiencing, coupled with her extreme fear for her job that had been systematically instilled by her superiors, would have seriously affected her ability to make considered decisions. Engorgement can be agonizing, tortuous even. If you were in terrible pain, and someone offered you a pen and paper that would bring you relief within the hour, would you choose that, or wait hours longer to attempt to resolve the problem "reasonably," even knowing you might be unsuccessful? Of course not: you would take whatever option would allow you to end your pain sooner, and to expect otherwise is ludicrous.

Furthermore, the courts seem unable to understand why Ames could not simply wait the three days required for her paperwork to use the lactation room. As mentioned above, it would be extremely painful and very distracting to her, making it difficult to do her job. Remember, she had just been informed that she needed to complete eight weeks worth of work in only two, after months of harassment and direct threats to her job from Neel. She knew she couldn't afford to be distracted. Moreover, having to go three days without pumping would likely lead to early breastfeeding cessation for Ames, since lactation is a supply-and-demand system. The courts surely don't care since, in the judges' minds, there's always formula, but this shows a clear bias against breastfeeding women. They expected Ames, as a "reasonable person," to simply stop breastfeeding if that was what was necessary to keep her job, even though federal pumping laws were written to prevent exactly that.

Indeed, the rulings define lactation as a "choice," and not as a medical condition associated with pregnancy. Despite the fact that lactation is a natural biological feature of pregnancy and birth, even for unfortunate women whose babies do not survive, the fact that its continuation requires effort apparently disqualifies breastfeeding as a medical condition. No protections for it are therefore recognized. In fact, the court documents even mention that because federal pumping laws include no provision for enforcement, the law is essentially invalid.

What does it mean for me?

So, that's where we've landed with this case: regardless of whether these particular rulings were correct, there is now a strong precedent in favor of employers who do not support breastfeeding mothers. Employers like Nationwide can exploit the physical and psychological condition of mothers like Ames, set unreasonable expectations for their use of lactation resources, and if they happen to overstep federal pumping laws, it's no big deal because those laws have no teeth anyway. While the headlines concerning this case are grossly misleading, it's absolutely true that the outcome of this case could have tangible negative effects on breastfeeding moms.

One last thing: there is a related case that ALL MOMS should follow for the effect that it might have on us. In Young v. United Parcel Service, a woman is suing because her doctor ordered a weight-lifting restriction during her pregnancy, but UPS did not honor it and demanded that she continue with the same duties as before. She refused, so she spent much of her pregnancy out of work, and ended up losing her insurance coverage. The Supreme Court DID take this case, and is currently deciding whether pregnancy and related conditions can be classified as temporary disabilities and accommodated accordingly, or whether mothers being treated as equals means they must perform the same work they would do if they were not pregnant. Since the status of lactation as a pregnancy-related condition is still in question, it could potentially fall under whatever ruling the Supreme Court makes. The outcome of this case will have significant consequences for working mothers, so keep an eye on it!

As always, we welcome your comments! Do you think the ruling in favor of Nationwide was fair?

Breastfeeding and Jury Duty

 

a few months old

Literally the day I came home from the hospital with my daughter I had a summons in the mail for jury duty.  Insert freak out.  I immediately called and got it delayed as long as I could because I knew I wasn't ready to leave my days old baby.

Fast forward a year and it was my time to serve.  I was pretty nervous about being able to pump- would they tell me tough luck, would they make me pump in the bathroom, would I be allowed breaks at all?

a year later

Some states will allow you to get out of jury duty if you are a breastfeeding mother (check out if your state is one of them here).  New York is not one of those states, so I showed up at the courthouse with my pump in hand, ready to serve my civic duty.

After waiting in line, going through a metal detector and watching a video my name was called to be a potential juror.  I was escorted to the building next door where a judge informed us that we were being interviewed for a 3 month long trial.  THREE MONTHS??  My heart started pounding.  Technically there was nothing preventing me from serving, and I raised my right hand and promised I would be honest during the selection process.

I was brought back into the judge's chambers where about ten different lawyers surrounded me.  The judge said he'd heard every excuse in the book at this point (he'd already met with over 200 jurors) and wanted to know what mine was.  I told him I had none and I was fit to serve.  I just asked that I could have two breaks a day to pump.

He told me that wouldn't be an issue at all, by law I was allowed to pump.  And get this- he even told me by law I was allowed to bring my daughter and breastfeed her in the court room.  How cool is that??

It turns out I wasn't chosen for that case for other reasons, and was sent back across the street to sit in the jury waiting room again.  By this point it was time for my first pump of the day, so I went to the front of the room and asked where I could pump.  I was taken into an office where they let me pump, no issues at all.

Lunch time came, I went outside and got some food and fresh air and resumed my waiting in the juror's area.  I pumped again in the afternoon with no issues.

Honestly, the only bad part was I had forgotten an ice pack and didn't want to dump that precious milk.  So I got creative and bought sodas throughout the day from the vending machine and stuck it in the cooler bag with my milk.  Did an impressive job of keeping my milk chilled!

back home after jury duty with a milk drunk baby

Overall it was easy peasy, and I had worked myself up to think I'd have all kinds of issues.  I actually quite enjoyed my time sitting in the juror's waiting lounge.  I had no one at work expecting me to get back to their emails and I didn't have a little one pulling at my computer plug or trying to snatch my phone.  I feel good that I performed my civic duty even though I wasn't chosen for a case.

See ya next time, jury duty!

Milestones and The Top Five

A few weeks ago, we hit the goal we had been working toward for the last year. That's right, we made it! One year. Slow weight gain. Working twelve hour shifts. We made it. No formula, just mama's lovely, albeit skim, milk. I posted previously about my son starting to wean and that has progressed a bit but there are still days that he wants to nurse all day long and I'm totally fine with that. I told my husband today that I thought he would nurse til he turns two, to which he replied, "Are you surprised?". This leads me to my favorite top-five ever. The answers to the question I have been getting since we reached that year mark:

How did you do it?

5. Find a breast-friendly pediatrician

     While this is not number one on my list, I cannot stress how important this is. I've probably mentioned
     a handful of times now how big of a role our pediatrician played in our breastfeeding success. Find a
     pediatrician that you trust. Find a pediatrician who has positive feedback from breastfeeding mothers
     in your area. There are pediatricians in my are who are wonderful and sweet, maybe have shorter wait
     times in the office, but who would have encouraged supplementing in a heartbeat with my son. We
     went for my son's one year check up last week and the pediatrician laughed at the growth chart. Literally
     LOL'd. Maybe it's because it resembles a stock graph or something totally unrelated to infant growth or
     maybe because he was right. Remember I mentioned that our pediatrician, while my son was hovering in
    the second percentile for months, told me not to sweat it and around 6 months he would shoot up? He
    did. He jumped from the 2nd to the 23rd then at a year, he jumped to the 64th percentile for weight. We
    never supplemented with formula and we started solids slowly at 6 months, per the recommendation of the
    AAP. I trusted him and he trusted my body and my choice to EBF. He was a great fit for our family. At
    the end of our appointment, he asked if C was still a breast guy and I said yes. He said that was great and
    that we were in no hurry to wean. Swoon.

4. Don't be afraid to ask questions.

     No one expects you to know all of the answers. I tell first time moms in the hospital all the time: You
     have never done this before and neither has your baby. It is a learning process for both of you and every
     time you sit down to feed, you will both learn something about feeding and each other.

     There is no shame in asking questions. Reach out. Reach out to moms who have done this before you.
     Reach out to moms who will keep it real with you. Positive feedback is great, but if you are doing
     something that will be detrimental to your nursing relationship, it helps to have someone you can count
     on to help bring you back to center. One day, it will be your favor to return and you'll be grateful that
     you asked questions so that you can pass on the wealth of knowledge you have acquired.

     Asking your gal pals is a great idea but these gems will become your best friends:

Kelly Mom - the web's breastfeeding Bible

LactMed Drugs and Lactation Database

     Kelly Mom also has a Facebook page and there are many other social media pages that serve as great

     and informal resources on lactation. Please remember that advice given by friends, bloggers, etc. is 

     wonderful and generally accurate, but it does not replace that of an IBCLC, MD or other professionals

     trained in lactation. 

3. Stand your ground

     You know your baby and your body best. If you aren't comfortable giving your baby a pacifier, don't
     If you aren't comfortable leaving your baby with grandma to take a bottle so you can get some sleep,
     don't. Are you keeping track of wets, dirties and temperament and know that your baby is getting
     enough despite what feels like the rest of the world telling you otherwise? Tell them to shut it! Are
     there times you are going to want more sleep and that bottle will sound tempting? Absolutely. Just
     remember that you made this choice and you are the only one who can decide to go the other route.
     

2. Trust your body.

     Yes, there are women who, for various physiologic reasons, are unable to produce breast milk. The
     odds that you are one of them? Slim. Women tend to start doubting themselves when babies don't
     latch right away, aren't sleeping through the night when other babies of the same age are or may not
     have regular dirty diapers....or a plethora of other reasons. Remember: You were made for this! 
     Women are designed to lactate for our young. Am I saying there won't be stumbling blocks or that
     this beautiful and natural thing will come as easy as your natural labor - oh, wait...just keeping you on
     your toes! There will be times you will doubt your ability to produce wonder food for your baby and
     you will question the strength of your body and mind - nurse on. You've got this!        

1. Surround yourself with people who are supportive of your choice to exclusively breast feed.

    I tell moms in the hospital all the time: You will get a ton of feedback and advice about breastfeeding -           mostly from women who have never breastfed. There are so many support resources available:

    Adventures in Breastfeeding (ofcourse!)

Local Le Leche Groups

...as well as local hospital and community

based support groups.

     Becoming socially accountable for reaching breastfeeding goals goes far. I refer to it as positive peer

     pressure. Of course, there is nothing wrong with giving medically indicated formula, but there is something

     about knowing how your friends will react if you were to bring a bottle of ready-to-feed to a play date

     that keeps a breastfeeding mom motivated to trudge forward, even in the hardest growth spurts or

     sleepless nights.

I am so thankful to have come this far in our nursing journey and cherish each session now. The hardest thing is knowing that any day now I could nurse my sweet boy for the last time but the best thing is knowing how far we have come. When you doubt yourself, remember that you can do this. 

Til next time, mamas...

Keep calm and nurse on.

Breastfeeding is Easy! (For Stay-at-Home Moms)

Last Monday, I woke up some time before 6am, grateful that my 10-month-old had only woken once the previous night. We're down from 5-6 wakings (and feedings) per night to just 1-2, and it could not have come at a better time. You see, I was laid off from my full-time position when K was only 3 months old, and I've recently picked up some contract work that requires me to commute to an office a few times per week. Awesome, right? Well, mostly....

I dragged myself out of bed and immediately nursed the squirt awake, then popped him into his playpen so that I could begin the long process of preparing his food and my pumping gear for the day. I poured breastmilk that had been thawed the night before into bottles that had also been washed that night and would need to be washed again the next evening, packed them into a cooler bag with some cold packs and purees, then turned to my pump: I gingerly inspected the just-washed flanges, membranes, and diaphragms to determine if I needed to change any of them out, then packed them with six pump bottles, my pumping bra, and the pump itself into two more cooler bags, then stuffed those into another bag that also held some snacks, Mother's Milk Tea, and Fenugreek. I have a daily checklist on my phone for all of this. It has 22 items on it.

In spite of my attempt to prepare in advance the night before, we still got out of the house late that morning. My husband drove the 25min route to K's daycare while I pumped in the passenger seat. I was disappointed by the output: only 2oz when I can usually get at least 4oz at that time of day. After dropping off the baby, we switched and I drove the remaining 25min to work.

Upon arrival, I looked at my work for the day and realized that it was going to take a lot longer than I expected. This work has hard deadlines at certain hours of the day, and though I worked feverishly all morning, I was still not finished by the time my pump break rolled around. Then, I missed lunch. I was starting to panic because I might pump two hours late AND miss a meal altogether, and I knew my supply could not handle that. I was so stressed that I was shaking, and I could feel my heart racing.

Thankfully, my boss (whom, it should be noted, is a dude) was kind enough to push back our meeting, and I was able to pump and eat.... not very healthy, but it was better than nothing.  The second half of the day passed quickly, and then I was on the road again, pumping as I drove the 30+min (rush hour is nasty going the other way) back to daycare. My output wasn't as terrible as in the morning, but I knew I was still behind what my son needs in a day.

At home, I moved quickly to get all the pumped milk into the fridge and clean all the pump parts and bottles for the next day. I took care of a few other chores, nursed the baby briefly, then fed him dinner and put him to bed. Afterward, hubby and I had dinner, I pumped for the fourth time, and then transferred all the milk from my day into ice cube trays for freezing, careful to swirl the fat into the mix before pouring. I pounded a couple of Mother's Milk Teas and went to bed early, knowing K would be up in a few hours to nurse.


Tuesday, I was home for the day, so I just nursed my baby whenever he was hungry.


Is being a Stay-At-Home Mom easy? I think I speak for all women who have ever tried it when I say OH, HELL NO. But when it comes to breastfeeding, it's an absolutely massive advantage. Part of me wonders if I would still be breastfeeding if I had not lost my job. Would my supply have kept up? Would the stress of pumping four times a day and spending hours washing everything have finally burned me out? Would I have resented the fact that I spent more time with my pump than with my baby? Would middle-of-the-night feedings have worn me down until I had to just hand a bottle to my husband so I could take a break? I'd like to think that I'd be as hardcore as my fellow working mamas on this blog, but it's impossible to know.

There is some terrific information available on this blog to help working mamas maintain a thriving nursing relationship: tips like how much milk to send to daycare to avoid a bottle preference, how to use cute videos of your baby to encourage letdown, supply-boosters, and an extremely helpful overview of pumping rights. I could get into the piss-poor maternity leave policies in the US that contribute to the difficulty that working moms have with breastfeeding, but that's a topic for another post. Right now, I just want to say this:

Breastfeeding is hard. But if you're working away from your baby at all, it sometimes seems almost impossible. (In a nutshell: pumping sucks. Thank you, Captain Obvious....) So, if you're committed to breastfeeding and have the option to stay home, you should seriously consider it. If being a SAHM is not your thing or not a financial option, get your support system in place, because you will definitely need it! Offer support to your fellow mommies who are also trying to maintain a breastfeeding relationship while working, and go easy on those who struggle with that balance. And finally, (here comes the plug) keep coming back to Adventures in Breastfeeding for more tips on how to make it work!

Pumping Counts Too: A Working Mom's Story

We're so excited to have our very first guest poster on Adventures in Breastfeeding! Please give her a warm welcome as she shares her breastfeeding journey. 

Before Ellie was born, I knew I wanted to breastfeed. I’d read gobs of books (just doing what any good librarian would do) that taught me how to correctly position my new bundle of joy and felt as prepared as I could be to make it work. This was despite the fact that no one I was close to knew anything about breastfeeding - my mother and mother-in-law included.

Disclaimer #1: For something that is as natural as natural can be, breastfeeding sure the heck was hard in the beginning.

What the books didn’t do a good job preparing me for were tips on working with flat nipples (thank the Lord for nipple shields which got us through the first 4 months!) and how in the world to go about preparing to go back to work.

Disclaimer #2: This is my story. My story below is what has worked for Ellie and I. Use your mommy instinct to determine what will work best for you.

I went back to work at 6 weeks. While I’m thankful for those precious 6 weeks that I had, it was certainly early to have to introduce a bottle when breastfeeding still felt very awkward for us. But, you do what you have to do! 3 weeks prior to going back to work I started “building my freezer supply.” I had talked extensively with my sister-in-law (a working mom herself and one who had mastered the art of pumping at work long-term) who recommended pumping about an hour after the morning feeding and an hour after the night feeding. I had a slight oversupply, so I was able to put away quite a bit in that first week.

Disclaimer #3: I really didn’t know what the freezer stash was for, but it seemed everyone did it so I figured I would too. In hindsight I haven’t needed the freezer stash except for the very first day back to work. It sure helped knowing I had “backup” available, but I didn’t really need it to the extent that I initially thought.

2 weeks prior to returning to work, I introduced the bottle to Ellie. I pumped her afternoon bottle before she ate it and fed that freshly pumped miracle milk to her. In order to figure out just how much milk needed to be placed in the bottle, Kellymom’s very handy expressed milk calculator was extremely helpful. You punch in how often your baby is eating and you get back an average number of ounces. Pretty cool! I did the once-a-day bottle for the entire 2 weeks prior to starting back to work and also kept up with pumping 1 hour after the morning and evening feedings.

Disclaimer #4: All the literature says to let someone else feed the bottles to avoid issues with confusion, but I didn’t have that luxury since I was home alone with Ellie. Thankfully all went well and by the time I went back to work she was fully on board with taking a bottle.

Once I returned to work, I needed to establish a good routine for pumping. At the time, Ellie was eating 3 times during the hours that I would be away. That first day back, I thawed enough from my freezer for 4 bottles (just in case an extra would be needed). At work, I made sure to pump 3 different times (mid-morning, lunch, and afternoon for 15-20 minutes each). What I pumped that day I gave in bottles the next day and any extra were frozen with the rest of my bulk.

As time went on, Ellie began to expand the amount of time in between her feedings. On weekends I solely nursed and stopped pumping those extra sessions. During the week though, I continued pumping 3 separate times even though she was technically only eating twice while I was away. A good 2 weeks of this and my body was out of whack trying to figure out the foremilk/hindmilk balance. Because I was doing something different on the weekend than during the week, that was apparently enough to confuse my body (live and learn right?). I promptly stopped the extra pump at work, and within a few weeks, the green poops were gone and my supply was regulating.

I can now happily say that at 9 months, Ellie is still exclusively fed with breastmilk and I’m down to pumping once a day on my lunch break (and have been able to keep my supply up just fine).

Disclaimer #5: Literature is right and will tell you that demand (whether nursing or pumping) will signal more milk to be made. For some, dropping pumps may not be the right thing to do. For us, my mantra became pump when baby eats which has continued to work to regulate my oversupply. I also have a baby who makes it known when she’s hungry, who will. not. eat. when she’s not hungry, and who has put herself naturally on her current schedule of eating 4 times a day with one of those 4 times being a 6.25 ounce bottle while I’m away at work. Many will disagree with how I’ve done things, but at the end of the day you do what works and seems most appropriate for the situation.

Pumping totally counts! It’s hard work, certainly isn’t as fun or rewarding as straight out nursing, but the benefits are worth it. Keep calm and pump on!

What has your experience with pumping been like?

Rebecca is Wife to Adam, Mom to Ellie, and an Academic Librarian living in small-town Indiana. Her love of reading, writing, and crafting has sparked several blog attempts - most recently Humbled Ramblings of a Working Mom. You can find her here: http://humbledramblings.wordpress.com

If you want to submit a guest post to Adventures in Breastfeeding please fill out this form. We would love to hear your story and share it with our readers! Don't forget if you have any breastfeeding questions, comments or fun pictures to share feel free to post on our Facebook wall or message us on Facebook! 

Working Mamas Must Have Pumping Supplies

When I returned to work I had a few ounces of milk in the freezer and a whole lot of determination to continue feeding my daughter breastmilk.  My first day back to work I sat in my office's lactation room, hooked up to the pump, and cried.  It was so easy for me to just put my baby to the breast.  She preferred the breast!  She hated bottles!  So I cried.

I've been back at work a few months and so much has changed since that first day.  I actually look forward to my pumping sessions.  They're a few minutes for me to escape my busy day and watch videos of my babe, or catch up on social media, and sometimes even do some online shopping!  I've compiled my must have lists for what to have within arms reach while you're pumping, as well as useful things to keep at your desk to make life a little easier.

 

1. Kindle or iPad/tablet- I keep my iPad Mini within reach at all pumping sessions.  Whether to catch up on Facebook or to watch a video on Netflix.  I powered through the first two seasons of Scandal in a few days thanks to my iPad and pumping sessions.  I would find myself thinking, "I can't wait to pump again so I can watch Scandal!"

2. Phone- Again, something to keep you entertained while hooked up to the machine.  Send some texts, look at photos and videos of the baby, check out Instagram. 

3. Water bottle (with straw!)- While I'm pumping I find that I am so thirsty, so I always make sure my tumbler with ice cold water is within arm's reach.  It's so important for a breastfeeding mama to keep hydrated, so a cup close by is a must have.

4. Hands free pumping bra- I love this Simple Wishes nursing bra, but I know people who cut holes into a sports bra and that works just as well. 

5. Photo and videos of baby- Milk letdowns are based on hormones, so if you're stressed you won't produce as much milk as if you're relaxed.  An easy and awesome way to pump up those milk producing hormones while pumping is to look at photos and videos of your little one.  I love watching videos of my daughter on repeat while I pump!

1. Medela Quick Clean Sanitizing Bags- Before I had these quick clean bags, I would bring home my pump parts each night and boil them.  Now when I finish my last pump of the day I just throw them in the bag with some water and microwave.  I even keep a mini bottle rack in one of my cabinets at my desk to dry my parts!  I've heard great things about these Medela Sanitizing Wipes as well.
2. Lansinoh Breastmilk Storage Bags- These are personal preference, but I've been really happy with them.  I lay them down when I freeze them and they freeze flat.  I keep a permanent marker at my desk that I label them with the date.
3. Cooler bag and ice packs- You could really use a lunch box or anything you have on hand, but I love this insulated bottle bag.  I keep my pump parts and milk in it, in the fridge, and then sanitize the pump once at the end of the day.  It would be a major time suck to sanitize the pump parts after each session, so just keep them refrigerated and sanitize once at the end of the day.  If you have a shared fridge at work no one will know what's really in it!  I throw the insulated bag into my work bag at the end of the day with my milk and an ice pack.
4. Replacement Membranes- It's important to replace your pump membranes every few weeks.  If you aren't getting great suction out of your pump, try changing the membranes.  I've noticed significantly better output with fresh membranes!

What are your must have pumping items?  I'd love to know!

When Maternity Leave Ends...How To Have Continued Success with Breastfeeding

Since this isn’t Europe, with extended maternity leave times of up to 12 months, most mamas return to work at least part-time between six and twelve weeks after the birth of their babies.  For those who are breastfeeding, this can be a daunting experience, but with proper preparation, it is absolutely manageable.  You can have continued success with breastfeeding and pumping, allowing your baby to continue to have breast milk for as long as the two of you both want it to happen.  That’s not to say that there still will not be tears; when returning to work myself, I definitely cried.  As time passes, though, it becomes easier, I promise.

Above all else, I recommend getting a good breastfeeding relationship started prior to attempting to use the pump, unless there is a medical necessity for pumping sooner.  To illustrate this, my first child was born early at 37w5d.  She was jaundiced, and a sleepy nurser.  She would latch, nurse for thirty seconds or so, and fall asleep.  The key to removing her jaundice, though, was to nurse.  So, to help her with getting milk, I started pumping for her at 5 days old, and gave her 1 ounce of pumped breast milk at the end of every nursing session.  Pumping that early on, though, eventually lead into an oversupply situation for me, which will be discussed in a future article.

Let’s start with the most basic of questions, one I hear frequently, that being some variation of how much milk needs to be frozen ahead of the “the big day.”  A lactation consultant that I worked with after the birth of my second child gave me this wise piece of advice, “Not much.”  Ideally, the milk that you are making is exactly what your baby needs at the specific age and stage of development.  That’s not to say that milk pumped when he was 3 months old won’t be useful to him at 6 months, but it is definitely different in nutritional value and fat content. 

When pumping, ideally, you’d like to just keep up with your baby.  For that first week back, you’ll need a “starter stash,” but again, it may only need to be a day or two of frozen breast milk.  Presuming that you return to work on a Monday, you could use frozen milk on Monday to provide for your baby, but on Tuesday, you could use a combination of milk that was freshly pumped on Monday, and through the week, use less and less frozen milk.  Sometimes, by the end of the week, you will have excess milk, and that would restock your freezer supply.  In other words, there is no reason to stress out if you have a small freezer stash prior to your anticipated return to work date. 

Now with that established, let’s rewind a bit to discuss pumping, and what you’ll need to be as efficient and comfortable as possible.   When you decide you are ready to try pumping (ideally plan to do this about 4-6 weeks before you return to work), get out your pump and its instruction manual.  Read through the instruction manual, and set things up to make sure you are comfortable with the parts and the function of the pump.  If you were not sized at the hospital with a lactation consultant, definitely check out this link (http://www.medela.com/IW/en/breastfeeding/good-to-know/right-size-of-breastshield.html) first from Medela to figure out which size breast shield fits you best.  Not all women will be comfortable using the included (with Medela pumps) 24mm breast shield.  Having the wrong size breast shield can sabotage your success at pumping before you ever get a chance to get started!

While you certainly can simply hold the breast shields against your breasts during the pumping process, many mamas find that it is more comfortable to invest in some type of hands-free device.  While not all women can multi-task during pumping, for those that can, taking time from the workday to pump does not decrease productivity.  I have used two different options for hands-free pumping.  The first is a bra that goes over your nursing bra (with the clips undone), and has an opening in the fabric to slip the breast shield into that holds it in place.  One such brand name of this type of product is Simple Wishes (http://www.simplewishes.com).  The bra is highly adjustable with both Velcro sizing and a front zipper, allowing for a customizable fit. 

A second option is a device that goes fully within your nursing bra, and collects breast milk in a slightly different manner.  In some ways, it almost looks like the funnel part of the breast shield was turned “inside out,” and set inside a cup.  As there is not a traditional breast shield, there is also not a traditional collection pouch or bag!  With the Freemie (http://www.freemie.com), the milk collects inside the cup, inside your bra, and the only exposed portion of the device are the two thin hoses that come out from underneath your shirt to attach to the pump tubing.  When finished pumping, you simply remove the collection cups from your bra, and pour the milk from the collection cup into a pouch or bag for storage.   

When you begin pumping, prior to returning to work, I personally recommend pumping once daily, or even every other day, depending on the length of your maternity leave.  Typically, you will feel the fullest, and have the most milk, after the first morning nursing session.  This can vary if your baby wakes several times during the night, of course.  Waiting 30 minutes to one hour after that first nursing session (long enough to change a diaper, cuddle a bit, and set up the pump) will also increase the amount that you may be able to pump.  It’s important not to focus necessarily on the ounces that you pump initially.  That can be a significant hang-up to pumping mamas, and a stressor that may ultimately negatively affect milk production.  Pumping should last usually about two minutes after you stop seeing milk flowing freely into the breast shields (after the end of the let-down), but some women will have a second let-down in any given pumping session.  These pumping sessions may not initially result in an entire extra feeding of expressed milk, but will be the beginnings of what you use for your “starter stash” described above. 

Returning to work can be a daunting process for a new mother; there is so much emotion involved in the actual separation from your baby in addition to the desire to continue to provide breast milk.  However, with the right pump, properly fitting breast shields or other collection device, and some way to pump hands-free, pumping at work is entirely doable and can be done without much interruption to your regular workday.  In the next part of this series on returning to work, more information will be given on collection, storage, and usage of expressed breast milk.