Breastfeeding by Working Mothers. How It Works? Written by : dr. Dyah Febriyanti, IBCLC Infant feeding practice recommended by UNICEF and WHO includes how to start breastfeeding the baby soon after birth, exclusive breastfeeding for 6 months, and continued breastfeeding until the baby is 2 years old and beyond accompanied with adequate and effective complementary feeding. The best way to feed the baby is breastfeeding it directly. Not all mothers are able to breastfeed the baby directly all the time, some of them have to work and leave the baby home with the caretaker. The mother usually has to go for work if her leave has already been used (usually 3 months after delivery). In order to be able to continue breastfeeding her baby, a working mother has to know how to express, how to store, and how to give the breastmilk to the baby. During working hours, while the baby is not with its mother, expressing breastmilk is the only way to replace breastfeeding session. Expressing breastmilk manually is the most common way in the world. This does not require a special device, electricity or money. It is the best for all mothers to learn how to express breastmilk by hand. Although the mother already feels more comfortable with breastpump or mechanic devices, in some unexpected condition she will need to express by hand (for example if there is no electricity and sanitation, or the part of the breastpump is broken or left at home). Besides, hand expression technique can be used independently or combined with breastpump. Before using breastpump, expressing breastmilk by hand can elicit MER (milk ejection reflex) and after using breastpump to optimize breast emptying. The following is hand expression technique: How To Express Breastmilk Wash hand before expressing the breast Place the thumb and index fingger 3-5cm from the base of the nipple at 6 and 12 o’clock direction Push back the fingers into the chest wall, not too hard Release and push back the finger again in rhytmical movement, repeat until breastmilk is not appear anymore Place the thumb and index finger at different direction, for example at 9 and 3 o’clock direction then another direction, until around the breast is reached. Repeat the same step as before Express one breast until finished and then switch to the other one Expressing by hand may take 20-30 minutes Avoid squeezing, rubbing, or pulling breast tissue The advantage of using breastpump are faster, more comfortable, and no user fatigue. Instead of it, there are many aspects to think about:BANNER 728 x 90 breastpump Breastpump must be hygienic, the rubber bulb or “bycicle horn” type manual pump should not be used because the potential for bacterial contamination of breast milk. Electric pump that maintain negative pressure can elicit nipple or breast trauma. Size or diameter of the flange must fit the nipple and breast Used pumps or borrowed pumps may not operate at its optimum because each pump has limited lifetime. Before start to work again, mother can start to express the breastmilk and build stockpile when their baby is 4 weeks old. Mother can express breastmilk after the baby has been breastfed well. Breastmilk is stored in freezer as a ‘BACK UP’ for the working days. During the working days, mother has to express the breastmilk at work every 3-4 hours until the breast felt empty. The purpose of expressing breastmilk at work is maintaining breast emptying and replacing each breastfeeding session. In other hand, pumping is not able to replace all the breastfeeding sessions, the mother has to breastfeed her baby on demand at night to maintain breastmilk production. Expressed breastmilk is stored at refrigerator (not the freezer) and given to the baby next day. If the milk is not enough, caregiver can thaw the frozen “BACK UP” milk from freezer. Ideal containers for breast milk storage are glass bottle and pilypropylene (5PP) plastic bottle with lid. Fill the container ¾ full or leave some space (about 2,5 cm from lid) for the milk to expand when it freeze. The container must be washed thoroughly. Do not mix the frozen milk with the fresh one in the a container. Do not store the milk at the door of the refrigerator or the door of the freezer. Breastmilk storage guideline according to HMBANA (Human Milk Banking Association of North America): Method Time Room temperature (250C) <6 hours Refrigerator (40C) (fresh expressed) <8 days Insulated cooler with frozen gel packs (150C) <24 hours Completely thawed and placed in refrigerator (40C) <24 hours Freezer compartment (1-door refrigerator) 2 weeks Freezer compartment (2-door refrigerator) (25 0C) *not in door <6 months Deep freezer <12 months Before giving the milk to baby, remember the following things: Check the date at the container. Use the newest milk It is not always a must to make milk warmed. Some babies take the milk without being warmed Thaw the frozen milk, move it from the freezer to the refrigerator then wait overnight. Do not boil breastmilk on the stove Do not put breastmilk in the microwave. It can damage milk components. It cooks unevenly and makes hot spot in the milk that harms the baby. To make the milk warm, put the container filled with cold milk into warm water in a larger container. Do not re-freeze warmed milk Do not store used milk for next use Do not shake milk. Just rotate the container horizontally until the milk mixed well. WHO recommend giving expressed breastmilk to baby using small cups. Giving artificial nipple to the breastfed baby interfere the baby’s skill to suckle at the breast or even elicit nipple confusion. Point no.9 at ten steps to successful breastfeeding from baby-friendly hostpital initiative says “Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.” In indonesia there is government regulations (Peraturan Pemerintah no.33/2012) that sign by president. It regulates everything that interfere breastfeeding, including artificial teats or pacifier. The reasons to feed with a cup include (WHO,2009): Cups are easier to clean, and can be cleaned with soap and water. Feeding from a cup does not interfere with the baby learning to suckle at the breast. A cup can not be left for the baby to feed him- or herself. Someone has to hold the baby and give him some of the contact that he needs. Cup feeding is generally easier and better than spoon feeding: spoon feeding takes longer and requires an extra hand. How to cup feed a baby (WHO, 2009) Cup Feeding Hold the baby sitting upright or semi-upright on your lap, wrap the baby with a cloth to provide some support and to stop his or her hands from knocking the cup. Hold the cup of milk resting on the lower lip so that the rim touches the baby’s upper lip. Tip the cup so that the milk just reaches the baby’s lips. A younger baby will start to take milk into his mouth with his tongue. A term or older baby will suck the milk, spilling some of it. DO NOT POUR the milk into the baby’s mouth. Just hold the cup to the baby’s lips and let him or her take it him- or herself. When he or she has had enough, the baby closes his or her mouth and will not take any more. Baby will not take the amount of the milk by cup as much as by bottle. The care giver should offer milk to the baby when the baby is not too hungry and not too satisfied, and on as much as the baby wants. The baby will only drink the milk not for satisfied him/her sucking needs. The baby will fulfill the needs and takes more milk once she/he breastfed directly when the mother has return home. Because of this reason, the baby will suckle more at night. It will elicit more milk to produce and maintain milk production at breast. Mother should breastfeed her baby in side lying position so that she can get enough rest and enjoy cuddling her baby. As long as the baby suckle the breast actively at night, pee 6 times a day or more, and gain weight well, we can tell that they get enough milk. Let’s support successful breastfeeding in working mom! If you need to back to work and have to make preparation for it, do not hesitate to contact us. Breastfeeding and work, lets make it works! REFERENCE Pictures by dr. Dyah Febriyanti, IBCLC International Lactation Consultant Association. 2013. Core Curriculum for Lactation Consultant 3rd Edition. Jones & Bartlett Learning. p621-642 Riordan & Wambach. 2016. Breastfeeding and Human Lactation, enhanced 5th edition. Jones & Bartlett Learning. p 419-468 World Health Organization. 2009. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Presiden Republik Indonesia. Peraturan Pemerintah Republik Indonesia Nomor 33 Tahun 2012 Tentang Pemberian Air Susu Ibu Eksklusif.