Back to Work: Is My Baby Getting Enough Breast Milk?

When a breastfeeding mother returns to work, she often has questions about how much breast milk her baby needs while she is away. How can you best calculate how much your baby will eat and what are the varying factors? How much breast milk should you keep in each bottle? And how can you ensure that your caregiver isn’t overfeeding your baby?

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The Boob Group
Back to Work: Is My Baby Getting Enough Milk?

Robin Kaplan: When a breastfeeding mother returns to work, she often has questions about how much breast milk her baby needs when she is away. To make sure that her caregivers are not over feeding her baby and what she can do to avoid formula supplementation when she returns to work.

Today, I'm thrilled to welcome back to the show Wendy Wright a Private Practice International Board Certified Lactation Consultant and founder of Lactation Navigation, a business based in the Bay Area in California that helps support breastfeeding moms and the businesses they work for. Today we’re discussing how to make sure baby is getting enough while mom is back at work. This is The Boob Group, episode 61.

[Theme Music/Intro]

Robin Kaplan: Welcome to The Boob Group, Broadcasting from the Birth Education Centre of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I am your host Robin Kaplan. I am also an International Board Certified Lactation Consultant and owner of the San Diego Breastfeeding Centre.
Thanks to all of our loyal listeners who have joined The Boob Group Club, our members get all of our archived episodes, bonus content after each new show plus special giveaways and discounts. Subscribe to our monthly newsletter for a chance to win a membership to our club each month. Another way for you to stay connected is by downloading our free App available at iTunes and in the Android marketplace. Today we are joined by three lovely panelists in the studio. Ladies, will you please introduce yourselves?

Christine McCarthy: My name is Christine McCarthy, I am 23. I am in the military and I have one 14 months old daughter named Zoe.

Robin Kaplan: Would you like to go next?

Kelly: My name is Kelly, I am 26 and I am a clinical supervisor for children with autism and I have two boys, one is almost three and one almost nine months.

Robin Kaplan: Wonderful, and Theresa?

Theresa Sample: My name is Theresa Sample I'm a Postdoctoral Research Associate at The Scripps Research Institute. I have one daughter who is twelve and a half months old, her name is Nicole.

Robin Kaplan: Well, ladies welcome to the show!

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Robin Kaplan: So today we’re with Jon Gillan, he is the co-founder and product designer of one of my favorite products, the company’s called Pumpin’ Pal and so John is one of our sponsors of our episode today, so welcome to the show John.

Jon Gillan: Thanks Robin, it’s great being here. Really appreciate you inviting me.

Robin Kaplan: Sure. So we want to know a little bit about your company. What sparked the idea to start the company Pumpin’ Pal?

Jon Gillan: Well, I think it started – I grew up working in a family hardware store where everything was about having the right tool and when my wife and I had our daughter, she started to use a breast pump and kind of struggled with it and as the more I watched her the more I thought, she doesn’t have the right tool that she needs to get that to operate as well as it could. So, that’s kind of what started it, I designed a few things for her, just simply for her to use and to get through it and then I introduced those products to some co-workers and they really liked them and so it kind of spun it off from there. And here we are 13 years later and we’re making products that are sent around the world.

Robin Kaplan: That’s so terrific. Can you tell us a little bit about the products that Pumpin’ Pal offers?

Jon Gillan: Sure. These are accessories for moms who try to get the most out of their pumps. And one of the first products that we did which is just a very simple Hands-Free Strap, in today’s busy world instead of being handcuffed to some bottles, often moms prefer to be able to utilize their hands in typing or writing letters or doing other things and so we have a Hands-Free Strap that’s under $15. So that’s kind of our first product. Then we have a little mesh bag that is a purse bag that allows all those freshly washed pump parts to dry naturally and it allows air movement through the bags. So moms keep all of her parts in one bag.

And then our flagship product really has been that we called them Super Shields but they’re angled breast pumping flanges that either insert directly into the standard shield and flange them that came with a pump that a mom has or if a mom has a pump that has a replaceable flanges then they use ours as a replacement to those.
Robin Kaplan: Absolutely, I mean those are the one that I definitely recommend all of the time. My moms absolutely love them and so for our listeners who have never seen these before can you describe, how is the shape of the Super Shield different than regular pumping flanges and what makes them so comfortable?

Jon Gillan: A regular pump flange is basically if you can picture this in your mind, it looks just like and oil funnel. It’s just a symmetrical funnel that starts widest at the top and then narrows down until it converges on a tube that then hooks up to the bottle. The first thing that I notice is that that wasn’t the shape of my wife. By manipulating and changing the shape of that bell it created a much better latch, a better inner space between the pump and the breast and so that was the first thing is that it’s not symmetrical, it’s an oval shape and it allows moms to rotate it a little bit here or there to more fit what their shape is.

The other thing is that if you think about that funnel and how it tapers down at the very bottom of the funnel there is a – on a standard shield, it’s a hard ring. The diameter of that ring is kind of the most important part of a standard shield that’s fitting it to a mom. At the same time that ring could be where some trauma happens to tissue because it’s completely unforgiving if it’s not the perfect size or mom changes – swells while she is pumping if anything changes, it can create tears, blistering things like that, we eliminated that right altogether. That was definitely a move in the right direction for us and our customers.

Robin Kaplan: Absolutely and the things that I recommend, the Super Shields for my moms like you mentioned, the ones who are having nipple trauma from the pump, there’s nothing worse than breastfeeding and getting nipple trauma than having a nipple trauma from a pump that isn’t even cute and squishy like a baby and so I call it ‘ring around the nipple’ and it’s like when they have those little cuts around the side and they’ve found a lot of relief using this Super Shield as well as for the moms who are larger breasted and find that they have to lean over the whole time while they’re pumping or else the milk slides out the back of the flange and drips down and they’ve been working so hard to get all this milk out and it’s dripping out the side of their flanges and this Super Shield really, really takes care of that as well.

So, again I'm super excited that you’re on our show today because I just love plugging your products. So Jon, how can our listeners purchase Pumpin’ Pal products and the set of Super Shields?

Jon Gillan: Well the best thing to do and the easiest way is to either go to pumpinpal.com that’s W-W-W.P-U-M-P-I-N-P-A-L.COM. So listeners go to check out if they click on where there is a promo code spot they can put in The Boob Group 15 and receive a 15% discount off of anything that they buy online. A lot of listeners, I'm sure shop at Amazon, we are on Amazon, well those were the two best and fastest ways to get the product.

Robin Kaplan: Perfect. All right, well thanks so much Jon. We really appreciate it and thanks for making products that are making a difference with mom.

Jon Gillan: Well, thank you for letting me do too. Information really helps these moms out. Everything that you show them is a real fantastic benefit to them.

[Theme Music]

Robin Kaplan: So, today in The Boob Group we’re discussing how to make sure baby is getting enough when mom returns to work. Our expert Wendy Wright is an International Board Certified Lactation Consultant and founder of Lactation Navigation in the Bay Area in California which focuses on supporting and advising working breastfeeding moms as well as setting up corporate lactation programs.

She is also the creator of the work and pump iPhone App and the 16 Minute Club, a home delivery lactation support program focused on helping nursing mothers meet their breastfeeding goals. Thank so much for joining us Wendy and welcome back to the show!

Wendy Wright: Hey Robin thanks, great to be here.

Robin Kaplan: So Wendy how can a breast feeding mom determine how much her baby needs per bottle when she is at work? Is it based on the baby’s age, weight or both?
Wendy Wright: You know that it’s so interesting about breast milk is that from the age of about six weeks until six months that quantity of milk that the baby consumes doesn’t really change over time. So it’s about 25 ounces per day. So mom, something you need to decide how frequently her baby likes to feed or nurse and then how many hours she’s going to be gone. So for example, if I'm working an eight hour shift, and I've an hour commute on each end, I’ll be gone for 10 hours a day. I would generally then leave between 10 and 12 ounces. Always a little bit extra just because you never know when there is going to be a growth spurt or, we think we know but sometimes we can't predict them. And also just in case there was a car accident or something held you up on the freeway on the way home you wouldn’t want to run low and then you need to resort to formula supplementation. So it’s nice to leave a little bit extra. So again, about an ounce an hour while you’re gone is a super guideline.

Robin Kaplan: So I know I recommend a lot to moms to use something called the milk calculator online and so it actually sounds like there’s not that much calculating that needs to be done. It really is about an ounce per hour.

Wendy Wright: It really is about an ounce per hour but it doesn’t hurt to double check it on the milk calculator because some babies, for example, babies in a daycare setting where many babies are put on to similar schedules for the ease of the staffs, those babies, for example, may feed at 9:00 a.m., noon, 3:00 p.m. and then maybe a little bit before mom picks up or something like that. Those babies actually may consume more during the day because they are on a schedule not necessarily by cue and so then you would like to use a calculator in a sense because then you might feed actually less at night if you would opt for bottle.

Generally, you would just go off with the breast until the baby will take what they need. But it doesn’t hurt to double check and get a range because again some babies, just like some adults, eat more than others and some have different metabolisms so it’s one of those things you need to constantly track.

Robin Kaplan: Okay, and does this change a lot over time, you had mentioned that up to about six months baby kind of plateau it about 25 ounces. Do you find that they go up a little bit more after six months?

Wendy Wright: I actually do find that because we are very, very hesitant and slow in our introduction of solids. You know how we are recommending start one solid and use that solid for about five to seven days before we initiate another one. So it takes a long time for babies to actually have a full repertoire of solids that they’re eating sometimes up to about nine months or even longer. Just because moms are busy or babies may just love bananas and so we just stick with that out of comfort, all those different things.

Yeah, we do see a slight increase in the breast milk, as they began to start those solids and we can't really count on the solids to form in calories. But if mom just really watches her baby and honors those growth spurts and allows that baby when that growth spurt hits to breastfeed as much as possible, the components of that milk will change to reflect the baby’s needs. So it’s fantastic protein levels go up, fat goes up so the baby can survive on the breast milk as they get more and more interested in solid food.

Robin Kaplan: Okay fantastic, so I’d love to open this sub to our panelists now. Ladies, how did you determine how much breast milk to leave your child when you were working? Did this change over time from the early days to when your child got older? Christine, you want to start?

Christine McCarthy: Sure, I don't really remember how I figured out how much milk to leave with her at first because I went back to work when my daughter was six weeks old. And I think that I just – because I started pumping when she was four weeks because she started sleeping through the night at four weeks, oh my gosh. So I would pump at 1:30 in the morning every night and I just took pretty much everything I had to my daycare provider because I have an in-home provider. And I pretty much took everything over there and said, ‘okay let me know how much she is eating’ is really where we started because she was super breastfeeding friendly although she had never breastfed herself so she was pretty familiar with what to do and we kind of settled it, I would leave 20 ounces over there and she would just keep one bag like one 5 ounce bag in her freezer at all times just like you did, just in case like a last resort back up and she would usually have about 15 ounces while I was at work like three 5 ounce bottles.

Robin Kaplan: Okay, Kelly how about you?

Kelly: Well, both of my boys have always been home with my husband when I work so I didn’t have to transport milk anywhere so that made that easy. But kind of the same thing I left like a good amount in the fridge, we always had the freezer back up. And we started with 2 ounce bottles and slowly increase them as we got an idea of more of a consistent routine for when they would be eating but both of my boys took about three weeks of me being back at work to get into a routine of eating on a more consistent basis because they would hold out for a while hoping I was coming home and so it eventually worked up to about 3.5 ounces every two and a half hours.

Robin Kaplan: Okay how about you, Theresa?

Theresa Sample: So for my daughter, she likes to eat every hour and a half to two hours when I was home with her and I was concerned with going back to work with that frequency. We ended up sending five of 3 ounce bottles to the daycare provider at first with the instructions to feed her every two hours and more if needed. And that worked really well with her eating three to four of those bottles and the last one was back up. That worked for about three weeks, I went back when she was 12 weeks old and around four months old my daughter woke up and decided she was more interested in the world and she fussed from boredom and our care provider interpreted as hunger and she started feeding her bottles back to back so my daughter was getting six ounces at a time. And this was more than she needed and there would a day when she’d have 17 ounces before 5:00 o’clock at night.

We ended up having a discussion with her and we actually ended up switching providers for other reasons but the same baby, a week later was perfectly happy with 12 ounces of milk while I was gone, 4 ounces every three hours. A month later she went up to 5 ounce bottles but she was steady at 15 ounces a day until about 11 months she dropped that bottle on her own so we gave her solids.

Robin Kaplan: Okay, and I'm really glad that you brought up well a couple of different factors, definitely we’ll be talking in the second half of this interview about how to make sure the daycare providers are reading cues just like you were describing with Nicole. But also lots of babies are snackers when they’re breastfeeders because it’s there when they need it and so they don't have to necessarily eat on these more restricted schedules that sometimes they are put on when they’re at large daycares and things like that. So Wendy, if a baby is snacking at the breast every two hours, should a mom leave a bottle for every two hours while she is at work or does it depend on the care provider, what have you found works best?

Wendy Wright: Yeah, I really believe it does depend on the care provider and I'm a big proponent of empowering the care provider, I mean I really want to trust them, they’re the ones there with the baby, right? So if they say the baby’s hungry, assuming they are reading cues appropriately and we can have a dialogue and a discussion about that with them because, of course, as the mother, you’re going to know those cues the best. So they, just like you trust them, should trust you but yeah leaving a little extra enabling them to snack but also saying this is a snack and needing that it is a snack so it certainly shouldn’t be 3 ounces.

A snack might be 1 ounce but really a pacifier or a game or looking at the sunshine or a sparkly toy probably will do the same. A snack is just like as an adult, it’s a habit we get in to and you’re right the breastfed baby comes to the breast every hour, hour and a half if they are around mom, keeps crying down, it keeps them totally satisfied and it keeps that milk really flowing so we like that but in a workforce it’s a whole different story and scheduling probably is the easiest thing over time with your caregiver. Those of you who went back to work super early, six week to a week those babies – it’s a little bit easier to give them a little snacks just a little bit, but older babies four months, five months they are much more easy to get into routine if that helps the whole daycare situation.

Robin Kaplan: Sure, so baby might actually snack while they are at home with mom but they might be on more of a defined schedule when they are at day care or with a day care provider.

Wendy Wright: Yes, although the one thing I do notice of the moms who have the babies on a more rigid schedule Monday to Friday, it’s sometimes helpful to just stick with that through the weekend because the baby sometimes don't cue quite as well because they are used to just ‘oh I know I'm going to get fed in 30 minutes’ so it’s good for mom to really be aware of that schedule just in case the baby does prefer that on the weekends as well.

Robin Kaplan: Theresa did you find that – did Nicole go back and forth between what her feeding schedules were like?

Theresa Sample: She did, actually for a couple of months she was eating every three hours at day care and on the weekends she would still nurse every one and half to two hours. And then around six or seven months she started spacing out her feeding on the weekends on her own.

Robin Kaplan: Yeah, as well. Okay. Fantastic, well when we come back we will discuss with Wendy tips to make sure the baby’s caregiver is not over feeding the baby while mom is back at work. So we’ll be right back.

[Theme Music]

Robin Kaplan: All right, so welcome back we’re here with Wendy Wright discussing how to know your baby is getting enough when you are back at work. So Wendy what tips can a mom give her baby’s caregiver so that her breastfed baby isn’t being over fed while she is at work. Kind of like what Theresa was mentioning in the first half of the scenario?
Wendy Wright: Right and good for you Theresa because that is such a difficult thing to not be there and yet to realize what’s happening, so excellent, excellent job in reading that situation. So there’s a few things and it’s still fascinating in the state of California which is primarily where I practice, we have so few moms actually continuing to breastfeed while they return to work. The numbers range between from about 17% to 25% of moms so just given those numbers you can see then that 75% of day care providers are dealing with formula babies.

So it’s not as though these day care providers are intentionally doing anything wrong, it’s just that you and I, 75% of the time, we take one route to work and the other time we take a different route, it’s just going to be a little bit more unfamiliar. And we might tend to treat everything like the one we’re more familiar with so that’s simply what’s going on.

So we talked a bit earlier about cue, these are all engagement and disengagement cues and those engagement cues just being that intense they are at the phase, that desire to interact and then of course the feeding cues so the hands come to the mouth, the head roots and the body kind of crawls offs and they even start doing a little fussing or crying. If the baby has been exhibiting some cues for a while and has not been acknowledged or fed, so those are very, very important to review. But I like to review those not in terms of feeding, I like to review those just in terms of how to get along with my infants, here’s what she does and she wants to work with me, play with me, interact with me and that also includes feeding. Here’s what she does when she needs her off space and time, when she’s over stimulated or when she’s fatigue.

So that’s one discussion but then also with the caregivers I think it’s really important that we also review with them the latest milk storage guidelines. Because again if they are normally feeding 75%, 85% of the time feeding formula, they’re going to treat breast milk very, very differently than we may treat it ourselves because it’s durability and its ability to be in the freezer and sitting on the counter and those sort of things, so we need to talk about that with day care provider.

Also discussions over reusing or refrigerating any leftover breast milk, so it’s important -- the formula bottles, of course, once it touches the baby’s mouth we do discard that bottle. Breast milk can be different, in the state of California it is a requirement that you discard that milk in a large day care centre once it has touched the lips. In your own home or a private day care provider, a nanny, you can then establish your household rules around that and you may want to chat with your lactation consultant, make sure everything is working out not too long out of the refrigerator, of course, but I would definitely re-introduce a bottle especially there wasn’t that much in it.

So it all comes down to packing, of course, because if we’re not going to re-introduce the bottle once the baby has started it then packaging in one or two ounce bottles, and may be the caregiver warming up two 1 ounce bottle at a time is a much better option so we don't waste milk in those day care setting where it must be discarded. And then also we definitely just want to make sure, and one of the panelists mentioned this, having an extra 5 ounces in the freezer, very, very important that the caregivers would do that because you just never know when you’re going to need it because caregiver could even spill the milk, I mean it doesn’t have to be that you’re late or anything, you just don't know, so important to have some extra. And then I just like to also just double check that every parent that’s a part of my day care is clearly labeling and then that’s a requirement for everyone so there is no mix up of bottles and formula and the last thing I’ll have to check with my caregiver is call me or check with me before supplementing this formula. And again, it’s never really intentionally done in a bad just sort of 75% of babies in the room are drinking that stuff right, what’s wrong with it? And there’s nothing wrong with it of course, but if our intention is to 100% exclusively breastfeed. I want to be the one to decide when my baby gets supplementation not someone else and so just to have a clear dialogue about that is important especially in areas where breastfeeding is not the norm.

Robin Kaplan: Those are great, great tips, thank you. And what if the care giver says that the baby was really hungry and mom didn’t leave enough milk, does your advice differ for baby under six months and one over six months for example, one that’s getting breast milk and solids, what’s the best to negotiate this?

Wendy Wright: I think it does differ a little bit. Of course, try to read the baby but the baby that’s over six months and let’s say it introduced to avocado or banana or something like this and that baby is showing some hunger cues after a bottle, I would then go ahead and go with the solid especially if it’s in the afternoon, mom’s on her way within an hour. Just that distraction of course, there could always be an ounce or two in the freezer if necessary, but really just to learn that it’s not necessarily the milk, but it can be a solid that can add and then if we see that that solid is not sufficing then it’s really a suck need and probably not a hunger need and that’s a whole different situation where we could do some skin to skin or just some cuddle time or probably just needs to be with mom. So, it’s important that day care providers or caregivers can read those cues.

Robin Kaplan: Okay ladies, I would love to know what has your experience been with your baby’s caregiver. I know Theresa had already kind of alluded to what was going on with her first one. Did your caregiver have an issue with the amount of breast milk that you left for your baby? Was there ever a problem and – Theresa actually after that first thing with your first day care provider how has it been with your second one?

Theresa Sample: With the second provider it’s been very consistent, they wanted 12 ounces total and that was good and then they let me know when she started needing more and we did have a freezer bag of back up that I think she used that first week when we first realized she needed a little bit more in her bottles and we went up to 4.5 ounces and then 5 ounces and after she was content so – and I trusted that provider to know that she really was still hungry.

Robin Kaplan: Yeah, how about you Kelly? It’s your husband.

Kelly: It’s my husband yeah so, communications really easy, we talk throughout the day even just bottle to bottle. Sometimes, he’ll say, ‘he naps longer than usual, is it okay if I give him a little bit extra, can I give a little bit less’ that kind of thing and that’s been really helpful and he does really well – I mean, this is the second time around so now he is a pro with it and doesn’t really even ask me anymore he just makes the call and he’s right. But the first time around he definitely deferred to me and wanted to make sure that he was increasing, decreasing appropriately but in the end it usually, for a lot of babies ends up being the same amount of ounces sometimes just in different amounts throughout the day but we haven’t had any problems with over feeding or if anything maybe underfeeding sometimes just because then he’s starving at the end of the day.

Robin Kaplan: That’s his choice.

Kelly: Yeah.

Robin Kaplan: Well how about you, Christine?

Christine McCarthy: Well my child care provider never had any issues of how much milk I was bringing but I had issues because especially around five months I had a huge dip in my supply. I was pumping like a half ounce per boob per session while I was at work, like I was in tears to my IBCLC- see look I'm losing my milk, I don't know what I'm doing. And so I had to get a lot of supplements and stuff to get it back up but in the meantime I was like, listen if I'm not making this much I can't bring this much to work. I can't keep taking stuffs out of my freezer to bring to you every single day or my freezer’s going to be bone dry in the next couple of days so how about I just bring you what I can and we’ll work with it for now. And that’s what we did and she is 14 months and has never had a drop of formula but one thing that I did was I printed out an article from KellyMom that was how to bottle feed the breastfed baby and that really helped my care provider because she was super on board with breastfeeding but had never breastfed herself. So she didn’t know really that there was a difference in bottle feeding, like a formula fed child and a breastfed child so that really helped and yeah, we had a talk about cues so that really helped and – yeah, just like Wendy was mentioning like I had the conversation with her from the very, very beginning, ‘do not give her formula without my consent, that’s not okay and that’s not ever going to be okay and if a problem were to ever come up and we’re to look for any reason that she would need to have formula let’s have some fore thought and some planning and give her half breast milk and half formula bottle, just split up that last bag of milk in two so it’s not just giving her 100% formula in that bottle.’ And so it was a really good thing that we established that from the very beginning and I don't remember that being an issue so.

Robin Kaplan: Yeah and you had mentioned bottle feeding the breastfed baby Wendy, do you want to talk a little bit about that?

Wendy Wright: Yeah, I'm so glad you brought that up because really if we’re not experiencing or teaching our care providers the difference we just expect them to know that’s kind of silly. So thank you, thank you great thing to bring up and it’s really called pace bottled feeding. Just a whole idea being that we never really want that bottle to be turned parallel or perpendicular to the baby’s face, we don't want the baby gurgling, gurgling, gurgling in that milk end because as a breast fed baby that’s certainly not what they do, they actually have to suckle to remove that milk and compress to remove that milk from the breast.

So that is a great article that you’re mentioning I know the one from KellyMom. It’s just really keeping that bottle parallel and then also tipping the baby up and you haven’t actually letting her have two or three sucks, five sucks out of a bottle without getting anything out and then tipping that bottle back. So the feeding of a 2.5 ounce bottle, for example, is going to last until 20 minutes which is going to sound like a really long time to the day care provider right, ‘I don't know I don't have that much time, can I do this?’ then you just really have to work with them.

I actually had said to several day care providers when I give some talk at different centers that, I know I just empathized with them every time they say, ‘but that takes so long’ and I just say, ‘I know it drives us crazy too!’ but then I'm thinking a lot of doctors because of other reflexes happening, really insisting on it and you just blame it on someone else. So that seems to go okay because it does take a lot long to feed a breastfed baby and it should than a formula baby so it’s a very, very interesting situation you brought up.
Robin Kaplan: Perfect! Wendy, Whitney had posted on our Facebook page a question for you and it was, ‘if a mom’s output is decreasing while at work’ kind of like Christine just mentioned ‘do you have tips to increase the amount of milk she gets through pumping?’

Wendy Wright: Yeah, it does seem to happen especially when you go back to work a little bit early and now you’re going to be pumping at work for the next nine, 10 months. At some point something can happen and that supply can go down a little bit. So basically, the things that I recommend is just increase pump frequency and or time. So she could get back another pumping session or pump in the morning before work, maybe while breastfeeding on one breast, that’s a great way to go or if you only have three breaks during the day even if you added five minutes, just add a little bit more stimulation three times a day that’s an additional 15 minutes of stimulation could make a difference over time.

Also a lot of moms, when they first use their pumps, they find a suction that is appropriate for them in month one and month two and then some moms never even touch that suction dial. And now they’ve been pumping milk for four and five months well like you and I, I mean the breast could feel a little bit more hardy, right? A little bit easier to use a little bit higher suction, so we could definitely play with that. It’s definitely a tool we have in our arsenal we should play with the suction, see if there is a day or two when we could amp that up a bit and sometimes that produces a little bit more at each pumping session.

Definitely breastfeeding more at home, we also find that the mom that’s been back to work has starting now to maybe take a night off and let her husband give her bottle or going out with the girlfriends or doing something, there’s little bit less breastfeeding going on if we’re honest with it so again just paying really, really good attention that ‘am I truly breastfeeding all weekend or did I have a baby sitter for the last three Saturdays?’ And that makes a difference, right. So we definitely just want to look at ourselves and our own patterns to make sure we’re not really trying to get something out when we can't. Then of course, breastfeeding exclusively on our days off is just a great way to go. And then at home even if – and this is so difficult with our time schedules but even adding in a few pumping sessions right after breastfeeding just to make sure those breast are absolutely drained, really, really signaling to your pituitary that I've got to turn this milk supply on because this baby’s draining me, right. That’s what we want the breast to think.

So the emptier we get that breast everyday and I could be pumping in and breastfeeding together right it makes it so much, much emptier. Another piece of advice I often give to mom is if they are using a personally used pump and travelling to and from more work with it they might consider renting a hospital grade pump just for the short time that they could have at home or at work. Again, just a stronger motor, a little bit more effective and efficient to really empty that breast that can often sort of jump start especially if you’ve had a travel situation away from baby or something going on like that, maybe a brief illness, that hospital grade pump can really put you back up into the production levels that you’re used to.

And then of course, as one of the panelist mentioned there’s lot of foods, teas, tinctures, capsules and even medications that can increase supply and those are things that can definitely be tried but definitely want to have a plan with those. It’s not something we want to just start taking and think that we have to take for the rest of our breastfeeding experience. It’s often just a little rough patch that we have to get through and then baby either changes their patterns or better they start solid something like that and it all works out. So those are basically the suggestions that I gave for freezer supply issue.

Robin Kaplan: Sure, sure ladies how about you? Christine, I’d love to start with you since you had mentioned it first. So what tips did you have for kind of eking out every bit of breast milk possible when you were pumping?

Christine McCarthy: Pumping, I went through the ringer with this one. I've done everything under the sun, I'm pretty sure. So I was on supplements for a long time and then I realized my body was adapting, the best supplements aren’t doing anything for me anymore, like I was on More Milk Plus, Fenugreek, lactation cookies and my diet was super altered and I just stopped all of it and gave it a couple of months and then when I needed to again I started it and it worked again because then your body adjusts to the supplements that you are taking and for the longest time I was pumping on one side at a time and just switching to the other side and just doing one side at a time instead of simultaneous. So I switched to doing simultaneous and that helped a lot.

And I found out the correct way to do breast massage as you’re pumping so you can stimulate and after a while I found that my body worked best with my pump if I constantly had it on that first stimulation mode instead of the let down mode so as soon as my pump would switch over after the two minutes or however long it is from the stimulation mode to the let down mode, I would just turn it right back on the stimulation mode and that helped a lot.

And yeah, I think besides that I watched the videos of my daughter a lot, not necessarily the, ‘oh we record the baby crying’ stop because that just stress me out, and then stopped but I just watch videos of her and my husband take bath or just hanging out, just the fun things and that helped a lot. Just leaving my pump my on for a like – I made sure that no matter how much milk I made if I was done producing after five minutes I left that thing on for 20 minutes no matter what I told everyone, leave me alone for 20 minutes I'm not coming out of this bathroom for probably 30 just so you guys know, so that helped a lot.

Robin Kaplan: Cool, so lots of extra stimulation?

Christine McCarthy: Yes, yes, yes, yes.

Robin Kaplan: All right, I appreciate that you brought up the difference between the single side pumping compared to the double too because I remember listening to – I can't remember – there was a lactation consultant speaking at one of our conference is saying that, ‘the difference in pump output compared to single and then single with massage and then double, double with massage was so drastically different’.

Christine McCarthy: Yes.

Robin Kaplan: How much more you could get out using the double pump at the same time I should say with massage, so.

Christine McCarthy: I never knew what a second let down was until I started doing the simultaneous double pumping.

Robin Kaplan: Okay, fantastic.

Christine McCarthy: Yeah.

Robin Kaplan: How about you Theresa, how are you eking out your breast milk with the pump?

Theresa Sample: Well, one thing that I realized is that I was reminded of with the changing the pump settings over time was actually the size of pump flanges that I needed changed around four and a half or five months and I ended up getting a lot more milk out and my supply went back up when I just switched down to a smaller size of flange. I guess it was after the initial engorgement period when the larger ones fit. So that’s something to think about.

Robin Kaplan: Absolutely.

Theresa Sample: That might not occur to someone. But also for me, I noticed whenever I had a supply drop I always pumped one side while baby nursed first thing in the morning and I did that even on the weekends to get a little back up and that really helped, that was always my biggest pump of the day. And then I would also add a pump session in the evenings when I needed to, when I wasn’t keeping up with my baby, so that helps.

Robin Kaplan: Those are great tips.

Theresa Sample: Now I still have a freezer stashed for her, stopped pumping two weeks ago.

Robin Kaplan: Nice! That’s awesome, very cool. How about you, Kelly?

Kelly: I always pumped on the way to and from work. I work out in the field so I'm going to cleanse houses throughout the day so 95% of my pumping is in my car anyway either driving or not driving and so pumping on the way to and from work was an easy way to add extra sessions. And also I found that I pumped most when I was driving because I absolutely could not pay attention to pumping.

Robin Kaplan: Yeah.

Kelly: I was completely focused on something else. And even now after years of pumping, I will get more in my car than from – like if I'm in my office or at home I don't get as much and if I just go to my car I get more, so my body is definitely used to pumping in the car. And then also changing the membranes on the pump, I didn’t know about that at all with my first son and I didn’t have any issues with it but I've seen the difference changing it since with my second.

Robin Kaplan: Oh and I think an important thing to mention with that as well is that if you start noticing that the supply is going down with your pump, getting your pump checked for the suction because you just never know when that motor’s going to kind of kick out and then it actually has nothing to do with your supply it’s just that the motor’s not strong enough to get the milk out anymore.

Kelly: And one thing I cannot stress this enough, if you’re having issues pumping at work and you really, really want to maintain your goal of breastfeeding, however long that is and you’re having issues please see your lactation consultant and take your pump to them and be like, ‘hey I have such a situation, is something wrong, am I doing something wrong’ because your nipples are inserted in it incorrectly, maybe your membranes need to be changed, maybe your flanges are not the correct size, maybe your tubing there’s something wrong with that, maybe they can hear something funky in your motor they’re used to hearing that stuff, see a lactation consultant.

Robin Kaplan: Yeah, and the sponsor of our show, actually I shouldn’t mention this Pumpin’ Pal and their products have been so helpful for many of my moms when they go back to work because their back hurts from having to sit up lean over, sit up lean over, all that kind of stuff in the way that their pump flanges are angled actually makes it so that it drips in there more comfortably. So I don't know if you’ve worked with those Wendy at all but I find my moms when they go back to work they find that pretty helpful as well.
Wendy Wright: They’re really helpful yeah, and it’s one of those things where I hate to be a person that’s always telling people, ‘go buy more stuff, go buy more stuff’.
Robin Kaplan: Sure me too!

Wendy Wright: But that’s a truly a wise investment for the pumping at work mom.

Robin Kaplan: Wonderful. Well, thank you so much Wendy for your insight into knowing if a baby’s getting enough when a mom returns to work and for our Boob Group Club our conversation will continue after the end of this show, as Wendy will discuss how the amount a baby takes in a bottle correlates to what he or she can take from the breast during a breastfeeding session. For more information about our Boob Group Club please visit our website at theboobgroup.com.

[Theme Music]

Robin Kaplan: So today we’re looking at the Eat Sleep App that we downloaded on our iPhones and so the main thing with this app is that it tracks eating, sleeping, diaper change and that it has a really nice place for notes as well. And so ladies what did you think of this app?

Christine McCarthy: Well, I like that you can track everything eat, sleep and diaper changes what more do you need? I think that’s awesome. It was free which is amazing, who can beat a free app! I think that anatomically there are some things that could be improved, just personal preference like – this isn’t going to record well because I'm like showing but the cancel button and the next button, I feel like those could be switched and it would make more sense like the next button to be on the right side instead of the cancel button because I just want to click cancel and I don't actually want to cancel.

Robin Kaplan: And that’s the part where you’re actually adding the times.

Christine McCarthy: Right.

Robin Kaplan: For example, when your baby ate or ---

Christine McCarthy: Right, but one thing that I really appreciate is for the feedings it has left side, right side, formula and pumped because a lot of apps don't have pumped and the duration of time that you’re pumping. And how much you pumped so that’s great and besides that I really like the app, I think that for diaper changes, for dirty diapers it would be awesome if you could describe the consistency, maybe the color of the diapers because that can kind of help you talk with your pediatrician if maybe they’re sick and help you kind of figure out patterns for that especially when they are so young and you’re kind of figuring out like if they’re breastfed, if they’re 100% breastfed and they have not started solids yet and when they start solids, like is this okay for their poop to be this color and stuff. Those questions that you feel silly asking but you need to ask.

Robin Kaplan: Yeah, and there is that note section which –

Christine McCarthy: Right.

Robin Kaplan: Which you could put it in there as well.

Christine McCarthy: Exactly, exactly which I think that it’s also brilliant that they have a note section because I can't tell you – I would have wanted to find a pediatrician app because I have so many questions to ask my pediatrician that I will absolutely forget by the time I go back to him so that note section is great to be able to write in things like that to remember to ask.

Robin Kaplan: Yeah, Theresa did you have a chance to look at it at all?

Theresa Sample: Yeah, just a little bit and I agree that the next button and the cancel button need to be switched. The cancel button shows up in blues making it very easy to accidently delete your entry that you’re trying to create but otherwise it looks like a pretty good app for keeping track of things if you’re the kind of mom that has that level attention to detail. I’ve had trouble with it even in early days.

Robin Kaplan: Yeah, and I liked that it was pretty, pretty basic I mean there weren’t a lot of bells and whistles which is fine because from a lactation consultant perspective I don't want you spending too much time on your phone tracking everything, I want you to look at your baby’s cues and everything so just very basic tracking can be very helpful, for example, when you do go to the pediatrician and they ask you how many times has your baby fed in the past 24 hours and in your sleep deprived mind you’re like I have no idea! Well, let me pull up my phone so I do like that there wasn’t too much stuff because I felt like it didn’t take away from the time you’re spending with your baby, it was just like bam, bam, bam I'm done, fantastic, and then that note section was really nice.

Christine McCarthy: And aesthetically, it’s really cute so I mean --

Robin Kaplan: Yeah.

Christine McCarthy: You can’t turn that down.

Robin Kaplan: Exactly, although I'm still waiting to see the app that has a boob for the feeding rather than the bottle.

Theresa Sample: Yes.

Christine McCarthy: But I don't know if we’ll ever see that.

Robin Kaplan: Or maybe just a baby.

Theresa Sample: Yeah, totally let’s keep it simple.

Robin Kaplan: Exactly, but again yeah I thought the app was good. So would you thumbs up or thumbs down? For you, Christine?

Christine McCarthy: Thumbs up.

Robin Kaplan: Okay, how about you, Theresa?

Theresa Sample: Thumbs up.

Robin Kaplan: Yeah, I thought it was pretty decent too so I would give it a thumbs up as well.

[Theme Music]

Robin Kaplan: That wraps up our show for today. We appreciate you listening to The Boob Group. Don’t forget to check out our sister shows, Preggie Pals’ for Expecting Parents and our show Parent Savers for Moms and Dads with Newborns, Infants and Toddlers.

Thanks for listening to The Boob Group; Your Judgment Free Breastfeeding Resource.

[Disclaimer]
The views and experiences shared by Christine in this episode are her own personal opinions and not that of the United State Arm Forces.

This has been a New Mommy Media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in these areas are believed to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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