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Ask Dr. Sears: Breastfeeding Questions

Q. I have to stop breastfeeding full-time because I'm going back to work in a couple of weeks. After I start giving my baby formula, is it still possible to breastfeed at least twice a day?

A.
Not only is it possible to continue breastfeeding, it's advantageous -- to you, your baby, and your employer -- to do so. Each day millions of women tote their breast pumps to work and pump milk for their baby, a modern style of breast- and bottle-feeding called "combo-feeding" that can make the switch to formula unnecessary. Here's how to make it work for you.

Pump yourself up. Realize that there are many social, intellectual, and economic benefits of combo-feeding. New research has shown that the more often babies are breastfed, the smarter and healthier they tend to be. Because your baby is likely to get fewer colds and intestinal infections, you are likely to miss fewer workdays to stay home with her. Studies show that breastfeeding mothers miss three to six times less work compared to those who formula-feed. Also, with a healthier baby you are likely to save money on doctor visits. Finally, part-time breastfeeding helps you feel connected to your baby in a way that no one else can.

Pick the right breast pump and create a milk bank. Consult with a lactation specialist to explore your options for pumps. The best time to build up a milk bank is when you have extra milk.

Select a breastfeeding-friendly substitute caregiver. Tell your caregiver how important it is for you to continue breastfeeding and that you appreciate her cooperation. Show her how to thaw and warm your milk; how to give a bottle; and how you want your baby held during feeding. Be sure she doesn't 'bottle prop' by laying Baby down in a crib along with her bottle.

Choose a bottle nipple friendly to combo-feeding. Babies need to learn to properly suck from your nipple in order to get enough milk and to keep your nipples from getting sore, yet they suck on a bottle nipple very differently. Babies tend to suck on the tip of a bottle nipple and don't need to open their mouths as widely as they do during breastfeeding. Choose a nipple with a wide base and instruct your caregiver how to open baby's mouth widely to suck from the base of the nipple and not just the tip. Teach your baby to latch-on to the bottle nipple the same way he is used to latching onto your breast.

Time your combo-feeding appropriately. There's a time for breast and a time for bottle. Try to get in at least one nursing in the morning before you leave for work. Let your caregiver know exactly what time you are to be expected home from work and instruct her not to give Baby a bottle within one hour before your anticipated return, so that Baby is hungry enough to feed from you. If you are going to be late, call ahead and let your caregiver know. Many working mothers find that they are able to time their breastfeeding so that their babies only get two bottles from the caregiver during the workday.

As soon as you get home, enjoy a happy reunion with your baby. Take the phone off the hook, kick off your shoes, turn the music on, nestle in your favorite chair, and nurse your baby. Not only will Baby be happy to see you, you will be happy to nurse. During breastfeeding you will feel relaxing hormones that will help you unwind after a busy day's work. Working and breastfeeding mothers in our practice describe this hormonal perk as "better than an evening cocktail."

On weekends and holidays, resume full-time breastfeeding to build your milk supply back up. Expect your supply to dwindle a bit by the end of the week and build up again after full-time breastfeeding during the weekend. As a general guide, if you breastfeed your baby at least as often as you bottle-feed, preferably more, your milk supply is likely to stay adequate.

Enjoy night nursing. Be prepared: Smart combo-feeding babies may try to make up for the missed feedings during the day by waking up to breastfeed more often at night. To help meet your baby's needs for nursing and your needs for sleep, develop a sleeping arrangement that works best for both of you. You may find it most comfortable to nestle next to your baby in your bed. That way you can simply roll over and nurse without either member of the nursing pair fully awakening. Night nursing and co-sleeping allow you to reconnect with your baby and make up for touch time missed during the day.

My wife, Martha, has successfully juggled working and breastfeeding, as have hundreds of mothers in our pediatric practice. It is well worth the extra effort, and I would encourage you to give it a shot.

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