Hi Jessica,

This is a tough situation and there’s not a simple algorithm.  You’re getting to know your baby and yourself.  You’re discovering your parenting style and what it means to combine You-The-Woman with You-The-Mother.  And now you’re adding in You-The-Employee. 

You want to make a life that works; you want your baby to get what she needs; you don’t always know what to do next.  It’s an incredible, individual journey of discovery, and you need supportive, generous people who help you care for yourself and for Tilda.  It’s complicated enough without worrying about milk! 

It’s important to avoid a quest to provide an arbitrary number of ounces, which forgets the mother attached to the breasts, the baby drinking the milk, and the life they share.  And yet it’s easy to get distracted counting ounces.  It can be hard, as a new mom, to imagine the carer could be wrong, if she has more experience with babies generally.  It can be hard, as a caregiver, to engage in thoughtful conversations about each family’s individual situation.

But nuanced, individualized care is what a mother requires. So, as you investigate these issues, frame your questions around what helps you feel supported. 

Your priority is to continue breastfeeding exclusively and there is every reason to think this is doable. I would not prolong a pumping session beyond 10 minutes if you’re not getting milk after 5.  Pumping more frequently than 2-hourly will likely drain your sanity and ability to work – not the best first course of action here. I would absolutely not supplement with formula in this situation unless it becomes obvious after some scrutiny that there really isn’t enough breast-milk, and there isn’t another option. 

So what’s left?  The first possibility is that what you pump is already enough.  The second possibility is that Tilda needs more.  More specifically:

1.    Daycare

·      Are the carers familiar with breastfed babies’ intake? Although it varies, average intake for exclusively breastfed babies this age is about 26 ounces a day.   

·      Do her carers know how to feed a breastfed baby?  It’s a common misconception that if a baby finishes a bottle, she was hungry for all of it.  Most babies, though, will drink a bottle to empty, even if they would have taken less at the breast.  It’s not so much that it’s harmful to overfeed a baby this way – many moms who let down easily for the pump leave many more ounces of expressed breast-milk than their babies would take self-regulating at the breast. The problem is, for moms who don’t, over-feeding the baby with freezer stash and imagining she was hungry for all that milk can undermine the mom’s confidence and lead to an obsessive pumping regime, and panic about a supply problem that doesn’t exist.

·      Do her carers know how to comfort a baby without feeding?  Some breastfed babies seem unsatisfied after a bottle because it wasn’t soft and warm and Mom-smelling.  It helps to make bottle-feeding like nursing – holding and cuddling the baby, slowing her down, etc.  Breastfed babies are used to a lot of physical contact.  Are the carers holding her and carrying her around enough?

·      Is she being fed frequently enough?  If Tilda nurses every two hours at home, waiting 2.5-3 hours at daycare might leave her worked up, ravenous and difficult to settle.

·      Do her carers understand that pumping is work?  If breast-milk grew on trees, it might be harmless if they overused it a little.  But you’re working hard to make and pump that milk, in addition everything else you’re doing. Ask them to call you at work before defrosting more.  They may pause long enough to see that she can be comforted some other way.  If she’s really hungry, delay of a few minutes is not abuse. 

Daycare should support moms who need to be apart from their babies.  Support means personalized, sensitive care for the mother and her baby.  Is this daycare supporting you and Tilda or expecting you to conform? 

2.    It is possible that Tilda does want more milk than you’re pumping.  These things might increase her intake, and also your confidence:

·      Do not withhold the breast when you are together.  Aim to have more than half her feedings at the breast.  This may mean adding more nursing at home.  Babies often get more milk at the breast than mom lets down for the pump.

·      Massage the breasts and/or apply a warm compress before you begin pumping.

·      Drink a glass of water and do breath-exercises before or while pumping.

·      Some moms find it helpful to look at a picture of their baby while pumping.  Others don’t.  Follow your heart.

·      I assume you’re using a high quality double electric pump.  If you’re not, do. Make sure the parts are securely in place so you’re getting enough suction.

·      Conversely, believe it or not, many women get more milk when they hand express.  It’s worth a try.

·      If it’s feasible, go to daycare to nurse her once during the day.

·      Attend a breastfeeding clinic; being around other nursing moms and hearing their stories is extremely helpful.   Ayelet Kaznelson, Susan Burger and Heather Kelly run good clinics.

Whatever else, look at your whole life, not just the ounces in a bottle.  If Tilda has plenty of wet and soiled diapers, if she is meeting milestones and seems happy and well-fed, and if she continues to gain weight, it’s working.  If it would help, you could try starting with a weight check and following up on weight a week later.

One more thing.  I had to look through literally thousands of stock photos to find one that shows a nursing, working mother – as though they are exotic and rare. 

(When I finally found the one above and clicked “more like this” I got a series of sexy photos of a pregnant woman in just a black lace bra.  ??wtf??)

As a culture, we talk a lot about “work-life balance,” but it is rarely nuanced, sensitive talk about the journey into motherhood identity.  Again, it’s easier to talk about ounces.  This limited public discourse – which often gets strident and divisive – is a shame, and it leads to a really dumb idea of motherhood as generic.  This is your life!  It’s not generic. 

We discuss these issues in the Working Moms’ Workshop; register!  It helps.

Good luck!