Congratulations on making it through the first month with your new baby! As you move into months 1 - 3 of your breastfeeding journey, you may find renewed concerns or questions about milk supply, feeding with a bottle, or returning to work or school.

This post is the second in our breastfeeding series and in it, we address common questions the consultants at Breastfeeding Hawaii are asked about what to expect during months 1 - 3.

For some moms, breastfeeding becomes well established by one month of age, with mom and baby nursing well, perhaps sometimes pumping and giving a bottle of breast milk. Some moms may be working with breastfeeding support persons to get baby latched well, back to the breast and/or to establish or regulate their milk supply. Some moms may be exclusively pumping, while some moms may be supplementing breastfeeding with formula. Some moms may be headed back to work and/or school soon and wondering how to build up a milk stash.

Whatever stage you're in, we got you covered below!

How much milk is “enough” milk?

On average babies eat between 2.5-3 times their birth weight in breast milk, every day, through 6 months of life. That means an 8 pound baby eats on average 20-24 total ounces of breast milk a day, or between 2-3 oz per meal depending on how often they feed. Babies eating formula eat on average 50% more formula than breast milk.

When is the best time to introduce a bottle?

Introduce a bottle when your baby is 4-6 weeks old if you plan on needing to use it at a time when you will be away from the baby. It is best to have another person e.g., your partner, give the bottle.

When do you recommend introducing a pacifier? What kind should I buy?

It is best to wait until the baby is easily breastfeeding, gaining weight and about 3-6 weeks old before introducing a pacifier. Pacifier use prior breastfeeding being well established can affect latch, as well as reduce milk supply if the infant is being given a pacifier in place of a feeding. Pacifier use may increase risk of yeast infection for mom and baby, and may affect palate development in infants. There is some evidence to suggest that pacifier use between one and six months can help reduce the risk of SIDS when offered at naps and bedtime. For further information, check out “What should I know about giving my breastfed baby a pacifier?" By Kelly Bonyata, BS, IBCLC.

I’m headed back to work/school. How much milk do I need stored up before I go back?

We recommend having at least one to two days worth of breast milk stored up in the refrigerator/freezer prior to going back to work or school. You can achieve this by pumping once a day from both breasts for 15 minutes for about 2 weeks before going back to work/ school. You can freeze this milk. If you will return to work/school within a few days, you can put your milk in the refrigerator as it is safe to store for 4-5 days in the fridge. Whomever is caring for your infant while you are gone can feed your baby your breast milk. When you are at work/school, you can pump for every missed feed in order to maintain an adequate milk supply and provide breast milk for your baby to eat each day you’re at work/ school.

Most mothers who return to work/school choose to breastfeed before they are separated (either leaving the house or leaving day care) and again when they are reunited (return home or pick up at day care). Ask your child’s day care if they have an area for you to nurse your baby before and after work/school, or during work/school if your day care is on site. Ask whomever is watching your baby not to feed your baby right before you return at the end of your day; this way your baby will be ready to nurse. It can be helpful to keep some 1-2oz bags of milk on hand in case baby needs a little milk until you return. Whomever is watching your baby while you are separated can call or text you when your baby is hungry so that you are pumping for every missed feed as it aligns with your baby’s feeding pattern. Ideally they can bring your baby to your work/school for you to nurse your baby. Nursing and/or pumping breast milk is protected by Hawaii Revised Statutes.

Some great online resources for heading back to work/school are http://www.workandpump.com/ and https://kellymom.com/category/bf/pumpingmoms/

What are my rights for pumping or nursing while at work?

Employees in Hawaii are covered by both Federal and State laws.

Hawaii state law requires all employers to provide mothers with breastfeeding/pumping break times during work. The location cannot be in a bathroom and must be shielded from view and intrusion from the public and employees while a mother is breastfeeding/pumping. These breaks can be unpaid, which you may choose to discuss prior to returning to work. Employers should have a Breastfeeding in the Workplace sign posted.

Federal law requires employers of 50 or more employees to provide breastfeeding/pumping breaks for hourly employees (salaried employees are exempt). Hawaii state law supercedes our federal law as it is more inclusive.

A recent federal law, Fairness for Breastfeeding Mothers Act (H.R.866) was enacted requiring all federal buildings open to the public to have a lactation room available to employees and the public.

What are some tips for pumping while at work?

Start planning where you will pump before you go on maternity leave or shortly after. Make sure your employer is aware that you will be pumping. Discuss the locations available to you and how you plan to organize your day to fit pumping into your schedule. Be prepared to offer suggestions as to how pumping can be worked into your day. You may need to alter breaks and/or stagger lunchtime in order to pump about every 3 hours.

We generally recommend trying out your pump around 1 month postpartum, unless there’s a medical reason to use it sooner. Ensure that you have the correct flange sizes for your nipples, as this is key to maintaining good milk supply and avoiding nipple damage. You can check recommended flange sizes for Ameda, Medela, and Spectra. Consider making or altering a bra that allows you to have your hands free while you pump. This can allow you to do “hands on pumping” which can maximize the amount of milk you can pump at a session. Plan how you will transport your pump, supplies and expressed milk back and forth from work.

Factor your commute into your schedule. If it is going to be a couple of hours from the time you pump or feed at home until you arrive at work, you may need to pump before you start work and do the same before you leave at the end of the day.

Put pumping time on your schedule. Block out time for pumping as you would for any other task and let others know to allow for this time every day you are at work. Nothing precludes you from doing some work while you pump if YOU want to, like making phone calls or working on the computer. Taking time to consciously relax, having a snack and some fluids while you pump are also great options. Some women find having some soothing music, a picture or video of their baby around while they pump helps them let down their milk.

Have a plan for how you will keep your pumping supplies easily available to make it convenient to pump and move on to the rest of your day. Some women carry extra pump parts so they can avoid stopping to clean parts between feedings. Some pump directly into milk storage bags rather than into bottles. Sterilizing bags can go into the microwave at work. Some pump and put the pump parts and milk into a gallon storage bag, refrigerate the whole bag and then reuse the pump parts so they only need one set per day. Chill the newly pumped milk before adding it to the other refrigerated pumped milk saved from earlier in the day.

Help! My baby is refusing the bottle! How is my baby going to eat when I go back to work/school?

If you are offering the bottle in the first 1-3 months of the baby’s life, they will be more likely to accept the bottle. Ideally start offering the bottle a couple of times a week, 1-2 weeks before you return to work or school. Have another person offer your baby a bottle while you are away from the room (can’t be seen or heard). Have them introduce the bottle when the baby is calm and not too hungry. If baby is not taking the bottle, try different bottle nipples to see if that will help baby accept the bottle. Some may do well with a nipple that is similar to their mothers shape and size. Some babies may be overwhelmed with a fast flowing nipple and need a slower flow that requires more effort, like breastfeeding, to get the milk flowing. The caregiver can offer the bottle in the same positions you usually nurse, or while walking baby in or out of a carrier. If baby still refuses a bottle, other options include feeding milk from a cup, spoon or finger. Some babies still refuse to eat while their mother is away and feed more frequently to compensate while their mother is at home.

Breastfeeding was going fine and now my baby won’t latch well. What can I do?

Ask yourself some questions -

1) Is my baby ill? Do they have a temperature? Are they tugging on their ear? Talk to your Lactation Consultant or provider for more ideas on what to do.

Try different feeding positions. If your baby is not latching well or is not feeding, it’s important to ensure baby is still being fed and you are maintaining your milk supply. You can temporarily give the baby some of your milk in a soft cup or bottle, you can try some of these tips and see your Lactation Consultant or provider for an evaluation of the situation.

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Click here to read the first installment of our breastfeeding series, which is all about the first two weeks.

Check back next week for the next installment of our breastfeeding series!