Interview with Nancy Holtzman from Isis Parenting {Part 2}

twitter_profileimgLast week I introduced you to Nancy Holtzman, co-founder of Isis Parenting. Hopefully you have had some time to check her out by now. I know she has been busy on Twitter helping me with the stomach bug!

In my initial interview with her, I had planned to get some more information around pumping in the workplace. So in part 2, I have compiled  tips, advice and some fun Nancy anecdotes! Take it away NANCY!

I know a major road block some of us face is communicating our desire as breastfeeding moms to daycare staff. We don’t want to be all preachy to the people who take care of our kids all day but we also don’t want to waste precious liquid gold. Do you have any advice or resources to help communicate that relationship to them?

Yes. I work with a great many breastfeeding and pumping moms around the transition back to work and so have developed a number of webinars to address these topics, including “Childcare, Caregivers and Breastmilk”. “Traveling, Working & Pumping for the Breastfeeding Mom” is another good one on the topic.

There can be a strain between the childcare provider (who is accustomed to seeing 7-8 ounce bottles of formula) and the breastfeeding, pumping mom who provides very carefully measured out bottles of precisely 4.25 ounces. There is often pressure to the pumping mom to leave more milk for her baby.

From the care-provider’s perspective, it’s not surprising. No caregiver want to worry she’ll be left with a hungry, fussing baby and no additional milk to offer. On the other hand, there is a tendency to interpret that all fussing or sleep concerns are related to hunger, and a lack of understanding that a breastmilk-fed baby may need slightly less milk than a formula-fed baby, yet continue to grow, gain and thrive. Breastmilk fed babies really don’t need 7-8 oz bottles of expressed milk! Most will “max out” around 5-6 ounces by 6 months, and remain at that volume between 6-12 months with additional solid foods gradually added. (see Introducing and Advancing Solids Foods from 6 – 12 months)

From the parents’ perspective, realize that licensed childcares must follow state regulations about warming, feeding and discarding milk within specific guidelines. They may not be able to honor your request to feed a baby the milk left in a bottle for the next feeding. Some childcare facilities have breastmilk waivers parents may sign, allowing the caregiver to save the leftover breastmilk to send home with you, so that’s one thing to investigate with the childcare director.

In general, make the bottles the size that the baby typically finishes, but without much left over. Just because a baby routinely finishes the bottle doesn’t mean they should have more milk. I usually finish my lunch, but it doesn’t mean I should have a bigger lunch! Another important tip is to stick with the slowest flow bottle nipple the baby and the caregiver will tolerate. It really should take about 15-30 minutes for a baby to take a bottle feeding. The same four ounces of milk, enjoyed over 20 minutes of rocking and sucking, will be much more satisfying than the same volume guzzled down over 7 minutes with a faster-flow nipple. That baby will seem restless, unsettled and the caregiver will naturally assume the baby is still hungry. Even if your baby is 5 months old, it’s fine to stay with the 0-3 month or “stage 1” nipple if that is keeping the bottle feedings in the 20 minute zone.

Kind of in line with that, I know I suffer from a low supply. Is there any supplement you highly recommend for trying to stimulate more in a pump supply?

It seems like this should be a quick answer: “Sure, I’ve seen great results from <insert some herbal remedy, prescription medication or oatmeal/brewers yeast recipe here>. But it’s actually a much longer answer. (As you can see, most of my answers are!)

Firstly: Stimulating a full milk supply during the earliest days of breastfeeding is important. Even if a baby was born early or there were latching or other problems early on, the most critical factor to future breastfeeding success is to initiate, then maintain, milk production – this means moving milk early and often. It can be hard to recover a full milk supply when there were issues early on and mom was not set up to express milk regularly if baby wasn’t nursing well. (See webinar, “Slower Starts to Breastfeeding” )

The second issue is the pump itself. Not all breastpumps are created equal! If mom has been using a single-user standard pump (like the Purely Yours or Pump in Style), upgrading to a hospital-grade rental pump like the Medela Symphony may make a big difference.

Third issue: pumping technique. There is a distinct advantage to what I call “hands-free, hands-on, double pumping”. A high-quality double electric pump is more than twice as good as a single electric. Yet, I find many women with double automatic pumps still just pump one breast at a time. Expressing from both breasts at the same time is more than a time-saver, the double stimulation actually helps to yield additional milk by producing stronger hormonal responses – even if you’ve just fed from one side and want to express the other, consider double pumping. A hands-free pumping bra (the Simple Wishes is my favorite by far) is more than just a bizarre but nice-to-have gadget: in my opinion, it is an essential part of the working mom’s pumping gear to allow her to express both breasts at the same time, use massage and compression, reposition the flanges for better yield, and also have hands free to tend to her baby, type or eat a snack – all while pumping. We’re moms. Multi-tasking is essential and so is hands-free double pumping. Hands-free, means Hands-On: your breasts, your baby, your keyboard or your lunch. (See “5 Tricks for better Pumping” for more info)

Fourth issue: Flange Size. We don’t all wear size 6 shoes, and we don’t all use the same size “cone” while pumping. For many women having difficulty expressing milk, moving to a larger flange will make pumping more comfortable and more effective. If the flange isn’t the right size, the pump may stimulate milk let down, but won’t do a good job removing the milk, resulting in poor output, soreness or frequent blocked ducts.

Fifth issue: Frequency of milk removal. The more milk you remove, the more milk your body is stimulated to make. To make more milk, the first step is to “increase the ask”. You won’t see results immediately, but will over time (usually within 5-7 days). This means, making sure to pump 3 times during the workday, not twice. Maybe pump after breastfeeding, to signal to your body that more milk is being requested. Pump just before you go to bed, especially if this reduces a much longer period of time between nursing sessions. This may sound like a lot of pumping (and it is) but usually after a period of a week, you’ll begin to see an increase in yield which you can then maintain by your usual breastfeeding or pumping.

Sixth issue: Miscellaneous yet Significant Reasons  – Retained placenta? Mini-Pill or other hormonal medications? Thyroid issues? Surprise pregnancy? Lack of milk-making tissue in breasts? These are all reasons why milk production may be less than expected. About to get your period? Fighting a cold or recovering from mastitis? There’s often a temporary dip in production.

So you see, it would be easy to say “Oh, try ___ , and drink more water” but milk supply questions – like baby sleep questions – are usually so nuanced. There is rarely a “quick fix” magic pill to cure concerns over supply. Would be nice though.

Thanks to the affordable care act, most moms are now required to have a pumping break and location. But even with that, some jobs are harder to work with than others(teaching, retail, etc.). What do you recommend for a pumping schedule that is outside of your control to come extent?

I always encourage moms to look for their “Pumportunities” during the day: opportunities to pump. Can you fit in a short pumping session just before heading into a long meeting? Can you pump at your desk, while on a conference call? (“What sound? I don’t hear a sound… must be on your end…”) Brandy’s note: I actually keep my pump in a drawer so I can temporary close it while pumping and the phone rings.

Working moms may need to think outside the box when it comes to finding a location for pumping. If there’s no great place to pump at work, can she express in her car in the parking lot, perhaps using a nursing cover-up? If lunchtime is the only break available for expressing, can she pump first thing on arrival and last thing before leaving for the day as well, even if it’s “off the clock”? Learning how to streamline the pumping process at work, so it can be more efficient, resulting in more milk in less time, is essential. In our Pump Talk classes, we talk about shortcuts like keeping expressed milk and pump parts in a cooler bag during the day, then washing everything well once at home. The less disruptive we can make pumping to the work-day, the more likely it is that pumping will happen rather than being pushed off longer. 

What is the one piece of advice you could give new working moms about pumping/breastfeeding?

Start preparing early. During the first few weeks, just focus on getting breastfeeding established and getting to know your baby. Then around week 3 or 4, start expressing once or twice each day right after breastfeeding, and introduce the bottle around then – by 4-5 weeks. Continue to offer one bottle every other day to keep it familiar and avoid a bottle feeding vacation. Meanwhile, continue expressing once or twice a day after breastfeeding, and alternate storage between “feeding the fridge, and feeding the freezer”. Milk in the fridge is for the bottle feeding, and milk in the freezer becomes your longer-term storage. When started around week 4, this will slowly but surely build up and become a nice stash of frozen milk by the time you return to work. Though your baby will mostly be drinking freshly expressed milk when you are back at work, having plenty of milk in the freezer makes most moms feel confident and secure.

Since you field tons of calls and questions about sleeping, what advice would you give new working moms in the sleep department?

First, have realistic expectations of life with a newborn. Weeks 3-8 may be the hardest weeks for you as a new mom. Don’t expect to be able to put your baby down and get much done during those weeks. It’s ok to hold and nurse your newborn to sleep. Don’t worry that you are creating bad sleep habits when your baby is only 4 or 8 weeks old! Focus on what works for you and your baby, though always with an eye toward safety. Work on establishing fairly consistent “bookends to the day” – a bedtime and morning wake up time – by 8-12 weeks. Don’t worry that your ten week old doesn’t have a real feeding or sleeping “schedule” before beginning childcare. It will gradually evolve with consistency and maturity. Oh, and watch our Sleep Webinars for support and suggestions on newborn sleep and establishing nurturing routines.

I’ll also add: don’t feel you need to be a martyr to infant sleep, suffering with sleep deprivation until it works itself out. If your 6 month old is waking up even more at night now than he used to, and you’re starting to feel like you can barely function at work, there are many gentle but effective approaches to help that don’t need to include “crying it out”. Fragmented sleep isn’t healthy for you, your family, or your growing baby. We see so many families who wait until 8-10 months before calling for a Sleep Consult, hoping things would naturally resolve as their baby grew older, or thinking that since they always nursed to sleep or bed-shared, they were now “stuck” in a particular situation. Not so at all! In the reviews on our Sleep Consults page, you’ll see many say “I never thought this would work for my baby” or “I wish we’d called sooner!”.

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