For better or worse, motherhood isn’t what it used to be.
Statistics from the U.S. Department of Labor show more of today’s first-time moms are working during pregnancy (and pretty much right up until the baby arrives) when compared to first-time moms in the early 1960s. They’re also returning to work a lot faster, with more than 44 percent back on the job within three months.
And while 46 percent of moms in two-parent households stayed home with the kids in 1970, the same percentage of families now feature two full-time working parents.
So what’s a modern mom who wants to breastfeed to do? The answers will be as varied as the moms you ask, but it’s part of Sandy Porco’s job as the manager of maternal child services for Allegheny Health Network to lend a hand and a little advice along the way.
Amanda Changuris (AC): Sandy, I understand you added a new class this year that’s specifically geared toward new moms returning to work. What can you tell me about that course?
Sandy Porco, RN, BSN, LCCE, IBCLC (SP): The goal of our “Working and Breastfeeding” class is to try and provide moms with more in-depth information about some of the challenges and management strategies for returning to work. It’s more than pumping to maintain their milk supply.
We try to educate moms about the laws that protect breastfeeding in the workplace and the importance of having a discussion with their employer during pregnancy about their plans to breastfeed, their needs and what accommodations can be reasonably made. There are many online resources to assist new moms with this, including the Business Case for Breastfeeding, which includes many helpful tools.
Some moms experience a decreased milk supply when they go back to work. We teach them strategies to help minimize it. We also review the various pumps that are out there and which are suitable for which circumstances.
AC: With 44 percent of moms going back to work within three months of giving birth, do you also talk about the psychological aspects of that transition?
SP: Returning to work can be a very emotional time. It speaks to our humanity and biology that moms and babies should be together. Unfortunately, the U.S. lags behind many other countries, including Canada, that provide for extended maternity leaves up to a year or longer for new moms (and even dads).
The more we can get partners and family members involved and make them aware of what a new mom needs and how important that support is going to be, the more we can help aid their success. Moms today want to work, and yet even when things get off to a good start, sometimes they fall apart when she goes back to the workplace if she doesn’t have the support at work or some anticipation of what some of those challenges are going to be.
AC: What about when the time to go to work actually arrives? Do you offer support at that point?
SP: We’ve set up one evening meeting each month so that the moms have a touch point to come back to when these changes and challenges become a reality.
We talk about their emotions. We talk about the importance of regular pumping and ways to maximize the milk production. Sometimes if they don’t take some preemptive steps, their breast-milk supply starts dropping off just from the stress of being away from the baby. We also talk a lot about the importance of skin-to-skin contact with their baby, not only from an emotional standpoint but also from a milk production standpoint.
AC: Why is it so important to work through all of this and breastfeed your baby?
SP: The science is clear. Human milk is best for human babies. It is nutritionally perfect and contains live cells that protect babies from many harmful diseases. Human milk is also acidic; very different from formula. It also changes over time to meet the needs of growing babies, whether they be one week old or one year old. It’s quite amazing what a mother’s body knows how to do!
From an infection standpoint, I think everybody is aware of the acute infections that breastfeeding reduces, but it is dose dependent, so the more breast milk, the more disease protection. It’s beyond the common diseases. Now we know that breast milk is very protective against many, many chronic diseases including diabetes, Crohn’s disease, childhood obesity, many lymphomas and leukemias … so the protection lasts well beyond that newborn period.
Early milk, known as colostrum or “liquid gold,” is critical during the vulnerable newborn period. I explain it this way: The newborn’s gut is like a brick wall without the mortar. Colostrum acts like “mortar” that seals that cracks. It prevents pathogens and foreign proteins from entering the baby’s gut, protecting him from diseases and allergies.
AC: I’m sure a lot of mothers-to-be have similar questions. What’s one you find yourself answering on a regular basis?
SP: Probably the most universal one is moms wondering if babies are getting enough breast milk. That’s always on the top 10 list, at number 1 or 2. For so long, we’ve been a bottle-feeding society more than a breastfeeding society, so we get into this measurement mode, and if moms can’t see the milk sometimes they don’t believe their babies are getting it.
So we encourage moms to look for signs beyond ounces in a bottle that their babies are getting enough milk, from the pees and the poos to the softening of the breast to the baby’s weight gain.
Another concern is why babies need to eat so often. Because of the small size of a newborn’s tummy (about the size of a shooter marble) and easy digestibility of human milk, babies needs to eat 8 – 12 times each day. If the moms grew up around bottle-fed babies, this can be very confusing. Often, too, the new mom can be vulnerable to “off the cuff” remarks like “He’s still hungry!” or “Are you sure the baby’s getting enough to eat?” In addition, babies often “cluster feed” for the first few months, eating multiple times in a row for several hours each day. If moms don’t understand why this is happening and that it is normal, they can start to doubt themselves, which is unfortunate.
Often babies can’t go [without breast milk] for longer than four hours. Our milk is species specific; it’s easy-in, easy-out milk. So one to three hours between feedings is very typical.
AC: Do moms often ask you about using a breast pump?
SP: With the Affordable Care Act, a lot of moms are getting their pumps early (see sidebar). So they’ll ask, “When can I pump?” If breastfeeding is going well, new moms should not need to use the pump during those early weeks. Things are busy enough without pulling out the pump. Time is better spent resting so she can get through the nighttime feedings.
Sometimes I think because we’re so techno-oriented in this culture, that parents believe the pump is really as good [for the baby], and they’re really anxious to open up that box and use it. But if things are going well, one of our constant messages is, the best thing to do is let the baby set the pace of the milk production. Work on the latch; work on getting the baby to the breast. There’s plenty of time to pull out the pump.
But I know it gets very complicated because babies are eating 8, 10, 12 times a day. When do you fit in the pump and try to sleep sometimes? And plus, in those early days, when moms are most likely to be concerned, there’s not a lot of milk there. So if they start pumping and don’t see anything, they start doubting that they have anything. We’re putting a big emphasis now on teaching moms, just like we did 30 years ago, to do manual expression.
With the early milk, because it’s more like honey than like the milk people think of coming out the carton, it’s much easier to be hand expressed. That’s something we are building into our repertoire of skills again for our nursing staff.
AC: Are there any breastfeeding myths you’d like to bust?
SP: Even in 2016, there are many breastfeeding myths! For years, women were told, “You need to toughen up your nipples because breastfeeding hurts.” We know now that this is a myth and breastfeeding should not hurt. Pain with breastfeeding typically means a bad latch. If mom feels pain, she needs to seek help from a skilled board certified lactation consultant.
Also, moms used to be given strict rules about what to eat while breastfeeding, but we know that most babies tolerate a wide variety of foods in mom’s diet and we don’t need to make those food restrictions.
Breastfeeding can be one of life’s most memorable and rewarding experiences, but moms should also know that — like any new skill — it takes work and support to succeed. Fortunately, today, moms have access to many more resources and support groups than in years past; including the lactation services right here at West Penn Hospital.
If you’re expecting and interested in signing up for one of Sandy’s classes, visit ahn.org/events to find the current schedule.
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