Breastfeeding and going back to work

How do you combine going back to work with breastfeeding? How do you keep up your milk supply and meet your baby's needs, even when he is at daycare? Here are some guideposts for getting there.

A quick physiological reminder

Milk production depends on stimulation of the mammary glands: the greater the demand, the more milk they produce, when all is going well for the mother.

A mother who has been breastfeeding for 8 months, and whose milk is enough for her baby, can set herself the goal of maintaining that supply by stimulating her breasts in another way, even if her baby no longer nurses at every feed. That does, however, take preparation and concrete steps.

At this age, if your baby is suddenly given bottles very frequently, he may no longer want to make the effort to nurse, and may even refuse the breast completely. To avoid that situation, you can give breast milk in a cup when the mother is away, for example at mealtimes and naps at daycare. It is then possible to keep the breastfeeds in the late afternoon (if it is not too close to supper), in the evening at bedtime and in the morning on waking.

Your baby, who is the best stimulator of production, then gives a clear signal that he still wants to feed at the breast, which helps maintain the mother's supply. If she wants to offer her milk exclusively, she will have to stimulate production another way for the rest of the day, for example with a double electric breast pump. Pumping both breasts at once clearly improves stimulation of the mammary gland and helps increase production faster; it also means half as much time spent expressing milk.

How do you wean your baby from the breast while keeping up your milk supply?

If the mother still has a few weeks before going back to work, she can start right away expressing her milk regularly, 3 times a day, between two feeds, with a double electric breast pump.

Do not be discouraged if very little milk flows in the first days, even after 10 to 15 minutes of pumping: with time, production will increase.

With the return to work in mind, you also have to start weaning your baby from the breast gradually, for the mother as much as for the baby. At first, she can offer a cup of her milk at meals and snacks, in the morning and in the afternoon, to get her baby used to receiving breast milk another way, while keeping the breastfeed at sleep times. For her part, the mother keeps expressing her milk 3 times a day and will probably see the amount she collects increase.

About supply

After a good week of expressing, it becomes possible to see the amounts collected, and perhaps even to freeze some to build up a reserve. That helps you anticipate your baby's needs and plan the amounts to prepare for the start of daycare.

If regular pumping is not enough to keep up the supply as breastfeeds decrease, you can move on to a plan B.

Plan B: other measures to support supply

• Good nutrition and enough hydration every day for the mother.
• Rest, to have the energy needed for production.
• Certain natural products, which can sometimes help milk production, including fenugreek and blessed thistle. These products tend to be more effective in the immediate postnatal period, and less so after several months of breastfeeding; it is still suggested that you try them to see how the mother's body responds.
• Domperidone, by medical prescription (for a woman with no underlying heart problems), which often makes production easier and helps continue breastfeeding longer.
• Metformin, which can also be prescribed depending on the mother's health condition.

Starting daycare

When your baby starts daycare, the mother can supply her fresh milk first, then, in a second stage, the milk she has frozen. The educator will be able to offer it in a cup at any time. Since your baby eats everything, has other dairy products and keeps breastfeeding at home, there is no reason to worry about his intake or his growth: he will have everything he needs over his whole 24-hour day.

On days off work, the mother can breastfeed directly at sleep times rather than expressing her milk, in order to keep up the rhythm of stimulation. She can thus continue combination feeding for as long as she wishes.

When she wants to stop, she will only have to stop expressing milk during the day and let her baby nurse in the evening and in the morning, for as long as he is willing. That is probably the best weaning there is, since it is your baby who chooses to stop, when the milk no longer comes fast enough or in large enough amounts. The transition then happens quietly and more easily, without imposing anything on him.