While we have not met our Healthy People 2020 goals, the breastfeeding rates in the United States have improved over the years.  One of the reasons that women have found it difficult to choose breastfeeding or to maintain breastfeeding, is the fact that they must return to work very soon after having their babies. 

There is an ever-increasing number of women entering the workforce with a child less than one year of age.  Some studies have suggested that employment has a negative impact on a woman’s decision to breastfeed, especially if she must return before or at twelve weeks postpartum.  For many women within the workforce, it is seen as incompatible with long term breastfeeding. 

Type of occupation also influences a women’s decision and longevity of breastfeeding.  Those within professional, administrative, or managerial positions tend to have longer duration of breastfeeding than women in lower-skilled occupations. 

Barriers to successful breastfeeding and employment:

• Insufficient milk supply
• Lack of knowledge in how to manage breastfeeding at work
• Lack of time
• Workplaces that are not conducive to breastfeeding/pumping

Facilitators to successful breastfeeding and employment:

• On-site childcare
• Longer maternity leave
• Flexible work schedule
• Availability of a lactation room
• Types of breast pumps
• Supportive work environment

Steps to help prepare to return to work:

• Learn as much as you can BEFORE baby arrives
• Plan, plan, plan- talk with your employer BEFORE you go on maternity leave
  • Establish or find out a place where you can breastfeed or pump at work when you come back
  • Establish or find out where you can safely store your milk in the facility or if you will need to bring your own cooler bag
• Talk with other women who have returned to work and successfully breastfed
• Seek a lactation counselor about six weeks before you return to work to develop a plan
• If possible, start back by working from home for a few weeks and then transition back to full-time, on-site employment

Benefits for employers:

• Increased productivity
• Reduced absenteeism
• Lower healthcare costs

Returning to work after having your baby is a very hard decision to make.  The times are hard, but the moments are fleeting.  Many women struggle with this decision.  Ultimately, if being able to stay home from work is an option, financially, a family may decide to do that to increase breastfeeding duration and time spent with baby.  If this is not an option, going back to work and breastfeeding duration is closely correlated with preparation and knowledge.  The more confident you feel going back to work and the more supportive the environment, the better the outcome. 

​You got this mama!
 
Source: Wambach, K. and Riordan, J. (2016). Breastfeeding and human lactation.  Burlington, MA: Jones & Bartlett Learning.

I know some other lactation consultants will shudder at the thought of recommending a nipple shield, but I really believe in them. My personal belief is that if we can get a mom to continue to breastfeed for a few days, weeks, months, or years than she would have without the shield, then give that lady a nipple shield! Personally, I used a nipple shield for the DURATION of breastfeeding both of my children, 15 months and 24 months.

What is a nipple shield?
A nipple shield is an artificial nipple that is placed over the mom’s actual nipple and the baby latches to it. Older nipple shields were made from glass, plastic, rubber, or latex. Newer shields are made using a very thin silicone. They allow for more direct contact with the breast, with cutouts by the baby’s nose and chin. The silicone shields also do not appear to interfere with milk production or appropriate infant weight gain (although there is a “mixed bag” of research out there).

First and foremost, a nipple shield is NOT for everyone and should NOT be used as a pain management technique. The use of a nipple shield should only be implemented under the care of a lactation consultant and after all other techniques to aid in breastfeeding have failed. Common reasons that a nipple shield is used:

• Preterm babies
• Babies with a short tongue, tight frenulum, or high palate
• Moms who have flat or inverted nipples that do not respond to techniques to evert
• Transitioning a baby who has been solely bottle fed to breastfeeding
• Moms who are having difficulty with the breastfeeding process and want to wean early (nipple shield may help them get through the difficult time and preserve breast milk supply)

A nipple shield is, at appearance, a simple looking device to use, but it’s application is important for correct usage.

1. Moisten the edges (breastmilk)
2. Partially inverting the nipple portion
3. Place over the center of the nipples
4. Push back the outer edges of the shield and smooth over the breast

Weaning from the shield may not happen quickly, especially if a baby has been using it for a long period of time. The mother should watch for signals that the baby may nurse without the shield. She can then try and go cold turkey, and if that works, ‘hats off to ‘ya!’ or she can start feeds with the nipple shield in place and then remove it and allow the baby to nurse once they have already gotten a little full. Skin to skin is very important for this process, so please keep that in mind. Also, never trim down a nipple shield to try and wean the baby from the breast, it’s not safe.

At the end of the day, remember what the goal is: healthy baby and happy mom. Do not let one person’s opinion influence your success at breastfeeding. Do what feels right for you and your baby, and if that means using a nipple shield temporarily or forever, so be it. Just arm yourself with knowledge and support, always.

You got this mama!

Recently, I was asked on my social media platform about weaning and whether I offered a course (shout out to Melanie!).  Well simply, I do not, but maybe in the future! With that being said, I decided a blog post related to weaning was needed!
The preferable method for weaning is what we call “baby led weaning.” What the what? As the name states, it is essentially when your baby decides, on their own terms, that they are done with breastfeeding.  If you can continue to breastfeed and are comfortable with extended breastfeeding, baby led is the way to go.

First and foremost, I want you to ask yourself “why am I weaning?”  Are you weaning because you just want to stop, are you wanting another child, are you overwhelmed, are you returning to work? All of these are valid reasons, but when armed with a bit more information, you might change your mind.

Let’s first start with facts: globally, the normal range for weaning is anywhere between 2.5 - 7 years (when first molars erupt). Before you run away screaming from this post, let me say that I know that sounds like an obscene amount of time since I am from a Western culture, where the most common ages for weaning are between 12 months and 3 years, and in the United States, between 3 and 6 months (that’s obscener to me than the first set of numbers!).  Remember that statistic is based on EVERY country worldwide.  They may not have clean water, easy access to food, etc.  Therefore, they breastfeed their children for so long for pure survival and necessity.  My point is: if your baby is nursing at 2 years old and you’re panicking because your husband, sister, or mother in law keeps saying “is that baby still on the boob??” Calm down, you’re not an oddball, you’re not a freak, your baby will one day stop nursing, he or she will not go to college still requesting a nighttime feeding, I promise (but if they do, technically they are the freak and you’re in the clear…just kidding). 

Baby led weaning is the natural and biological way of a child determining when they are ready to move on to the next best thing! So how do you know when this is happening?

• Mom does not deny or initiate breastfeeding, but baby begins skipping sessions
• Baby is more self-assured and can go for long periods without nursing
• Baby may accept a snack or drink in place of a normal nursing session
• Baby may spend less time at the breast or become easily distracted
• Baby may refuse the breast and show more interest in solids
• Baby may prefer rocking, cuddling, reading or quiet activity to calm themselves down

What if you don’t have the time or patience to wait for this to occur?  Then we call that “mother led weaning.” What the what? Again, exactly as the name states, its when mom decides breastfeeding is done without the baby initiating these steps.  Again, I want you to ask yourself why are you weaning? Make sure it feels right to YOU and keep in mind your baby’s needs and understand that they might have some difficulty during this time.

If you want to initiate weaning, start gradually, do not go cold turkey.  You will suffer, and your baby will be super confused. 

• Eliminate the least favorite feeding first and do this for 2 days before making any other changes
• Substitute a drink or snack for this feeding
• After 2 days, eliminate another feeding and so on and so on until there are no feedings left
• This may take weeks to a few months to complete

Be wary of weaning too quickly:

• Baby may rebel and become even more needy and want to nurse more frequently
• Baby may become constipated
• Mom’s breasts may become full and uncomfortable
  • Watch for plugged ducts, engorgement, and mastitis
• Mom can express milk, but just to relief, not to completely empty (you’d only compound the problem)

Another option is to practice what is called “minimal breastfeeding,” which is a nice compromise between the two.  You work your way down to 1-3 feedings per day and maintain that level until the baby is ready to completely wean on their own terms.  This is an option when mom and baby need to be separated for periods of time during the day but still want to maintain the connection and benefits of breastfeeding to some extent.  If you wanted to do this, you would use the mother-led weaning until you reached 1-3 of your favorite feedings, when you know you’ll always be with your baby.  Then offer baby other snacks, drinks, and activities while you’re apart or not having nursing sessions, and only breastfeed those 1-3 times per day until your baby decides they want to decrease it further.

Remember to watch your baby’s cues very carefully before, during, and after weaning.  Some reasons your might mistake that your baby is ready to wean:

• You have been told “you should”
• Your baby is crying a lot- so naturally you’re questioning everything
• Your baby is biting
• Your baby is teething
• Your baby is sick, and you’re told he/she needs more calories
• Your baby is feeding frequently at night
• Your baby is stressed by family circumstances and exhibits different behaviors
• You experience a nursing strike

At the end of the day, it’s your baby, it’s your body, and it’s your choice.  How you wean should be left up to you.  My final piece of advice is to make the decision that best meets the needs of your baby and yourself.  Next time someone says, “is that baby still on the boob??” Smile, nod and reply “are we still obsessed with my boobs??”
 
You got this mama.

According to the 2016 Breastfeeding Report Card, four out of five infants born started to breastfeed and “high breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so. However, low breastfeeding rates among infants six to twelve months of age indicate that many mothers do not continue breastfeeding as recommended. These rates suggest that mothers, in part, may not be getting the support they need, such as from healthcare providers, family members, and employers.”