8.05.2013

Breast is best: breastfeeding and residency



I am an advocate for breast feeding. Sometimes to the point that I am crazy about it. I am a working mom and have the guilty feeling of leaving my kids when I go to work and take care of other kids. I made it a commitment to breastfeed for at least a year and also to pump while I'm at work. I feel that though I'm away from my infant, I'm still actively providing for him/her.

***For my first three babies, I used the medela freestyle. It's loud but so light. Then it petered out when SJ was ~8 months old. I called my insurance and they provided me with the medela pump in style.


Part I: starting it right
As part of my birth plan, {yes I had one but not something i laminated and gave to the doctors} I want to make sure I have skin-to-skin contact after delivery. As soon as my newborn was delivered, my new baby was placed on my chest right away. After drying and quick assessment, he/she was back on my chest for skin to skin time and first nursing. I remember needing help when Daniel was born. I read a lot of breastfeeding info before his delivery but I was a new mom and still didn't have a clue.

I'm also that mom that wanted to keep the baby near me. I only let the nurses take Daniel and Isabel for their daily weights and bilirubin checks and vital checks. Then they are back in my room. We were tired but I just want to start it right with feeding.

I also asked not to give them pacifiers at the hospital. I have nothing against pacis. I just want to start my milk training and so when my newborn is rooting, looking for his/her fingers, I know to offer the breast instead of the paci.

We offered pacis once breastfeeding is established. Especially for Isabel, she wanted tons of nonnutritive sucking. But both of my children didn't like them and I just got more frustrated offering it so we didn't push it after a few tries.


Part II: pumping as a resident
I was very fortunate not to come back to work at 6 weeks postpartum. I didn't break out my breast pump until 4 weeks postpartum, when breastfeeding and supply are established.
This timeline also means not offering a bottle until about 3-4 weeks of life. There are good and bad things about that. Good: breastfeeding supply is more established. There's less stress the first few weeks as a new mom. Learning how to breastfeed is already a steep learning curve, connecting with your breast pump is another feat.
The bad: maybe it's late to train the babies to like the bottle at that age. Both my kids were not crazy about their bottles. We changed different brands of nipples and bottles until we found one that Daniel or Isabel would drink an oz or two.

my husband offered the bottle every other day to everyday while I pumped. I also pumped after the morning feed about 20-30 mins later to build my milk bank. Some say: women make more milk in the morning so I did it then. Sometimes I did my extra pumping session at night. while pumping, I placed Daniel or Isabel on the bouncy chair and they kept me company. It started with a few drops of pumped milk then to an oz until I basically trained myself to make more after that first feeding.

My general rule is: when I'm away, baby gets bottle. When I'm with baby, baby only gets breast.
It's the only way I was able to keep my milk supply. That rule and of course pumping.


My pumping Sched at work:
--Nurse baby before leaving home
--Once in the am: before clinic or between pre-rounding and morning rounds when in the hospital wards
--Lunchtime
--Once in the pm: in between seeing patients or afternoon rounds or right after clinic while I'm dictating my notes.
--Nurse as soon as baby and I reunite at home or at daycare
I pretty much kept an every 3-4 hour emptying of the breasts schedule.

When I was on call and slept at the hospital, I pumped 7-8 times {!!!} in a 24-28 hour work period. Aaaahhhh! I was lucky that I had one session there of nursing because my hubs brought my babies so they could nurse while I eat the dinner he brought me.


Other tips:
--Hands free Breast pumping bra is a must have! It frees your hands to type, check patient notes, answer your beeper, eat lunch, dictate notes, etc.
--I pumped in call rooms with phones and computers so I can multi-task.
--I've also used lactation rooms and hospital grade pumps besides my own personal pump. Hospital grade pumps have a closed circuit connector so there's no transfer of milk. They're also much quieter than my pump, so talking on the phone is less awkward.
--I've used vacant clinic rooms to pump as well. I always put a sign that says in use/pumping to stop people from barging in. Still people will barge in even with my pre-made sign of stop: breast pumping in progress with a mom/baby nursing symbol. Since we can't lock clinic doors, I usually place the trash can at the door so when somebody opens it, there's some resistance.
--when letting down and connecting with the pump is hard, I look at my baby's pictures. I also take that time to call daycare and check up on my newborn.
--Do a trial run or test day... Drop off baby, be away from him/her for half a day or so and scout for places to pump at the hospital or clinic.
--Don't be too serious or get offended with jokes. Yes, I tell people we have a milk bank at home, I'm a lactating machine, I'm like a cow, etc etc.
-- don't drive and pump! I've pumped as a passenger...but never as a driver. Please be careful.
--don't be bullied. Don't pump in the restroom. If there's an adjacent powder room, I'm ok with that. I'll just use my nursing cover. I haven't been asked to pump in the restroom {thank goodness!} cause I won't do it. I don't prepare my lunch in the toilet. Why would I prepare my baby's lunch in the toilet!
-- Ignore stares, retorts, remarks etc from other residents, students etc. As long as I did my work efficiently and correctly, I didn't feel bad leaving every 3-4 hours to pump. Plus, I also end up working anyway while pumping....
--hydrate, hydrate, hydrate.
--I used my phone alarm to remind me it's pumping time. There's also apps for milk bank storage and timer for feeding and/or pumping.
--those medela wipes are helpful when I'm in a rush to clean my pump parts.
-- I also have more than one pair of connectors. So if one is dirty or still drying, I have another set to use right away. We don't have much time to pump as residents so efficiency is key.
--it's better to pump for only 5 minutes or so and have to stop for an emergency, etc rather than skip a pumping session. Remember, supply and demand. The more the breasts are emptied, the more they will produce milk.


Books that help me
--Nursing Mother, Working Mother: The Essential Guide to Breastfeeding Your Baby Before and After You Return to Work. I read this cover to cover when I had my firstborn.
-- Womanly art of breastfeeding: borrowed this from the library and read parts of it.



Helpful sites
Kellymom
Workandpump.com


Other resources:
Other residents! I've emailed other Peds residents before I went back to work and asked them suggestions and tips for success.
Lactation consultants: they are angels! I've called numerous times before going back to work and after! I had issues with plugged ducts with Isabel more than Daniel. The LCs were so helpful.


For those contemplating having babies during residency and breastfeeding: IT CAN BE DONE! It's not a stroll in the park but it's worth it.


Linking up with medical Mondays
And babies and beyond.

9 comments:

  1. This is great info. My daughter is pregnant and she is also a nurse practitioner who will need to go back to work. I will give her a link to your post.

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  2. Thanks for linking up with Medical Mondays. I loved your post on breastfeeding and applaud you for being able to breastfeed and pump while working. That's is amazing. Great tips.

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  3. I'm impressed! It takes a lot of love and determination to fight through with such a demanding schedule. I'm sure a lot of working moms will be encouraged. If you can do this while working long shifts on your feet all day, then any one can do this! Thanks for linking up to Babies and Beyond.

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  4. Thanks for sharing this! I found your blog through Medical Mondays and as another resident, I was thrilled to see that you have breastfed through residency (as is my future plan).

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  5. I do think you must be Wonder Woman!! I am so impressed with everything you're doing.

    Thank you for linking up with us for MM and being part of our community!

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  6. This is so great! i'm getting ready to start my first job as a nurse-midwife and we're starting to think about having a baby in the next few years. I council patients about going back to work while breastfeeding all the time but i think jobs with demanding schedules/call time create unique challenges. Thanks for sharing what has worked for you!

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  7. Thanks for posting this! It was highly encouraging - you are clearly incredibly committed. :)

    What kind of pump do you use? I have been leaning toward Medela, but I have heard good things about Ameda, too.

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  8. Gosh! I never knew anything about Hands Free Breast Pumping Bra! You know, not every mom has the same privilege to breastfeed their child just as you do. Although in your case, it's difficult with your hectic schedule, still you manage to give a breastfeed. And me, unable to give my child a breastfeed for some reason. How frustrating, isn't it? So you have to be grateful. :) That's why I'm only relying to maternal milk like Anmum Materna.

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  9. The Littmann Master Classic II-Is best suited for; CNA's, EMT/EMS, Licensed Vocational Nurses, Medical Assistants, Nursing Students, Teacher/Professor, Veterinarians. best stethoscope for nurse practitioner

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