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Friday, April 22, 2016

MiM Mail: Pumping while on call

Dear MiM,

I am nearing the end of my glorious maternity leave. As my first day back in the OR draws near, I would love any and all advice on how to make breastfeeding work while having to do 24-28 hour calls. Obviously I will be pumping as much as possible while on call, but have been warned by all (including lactation consultant and pediatrician) of the likelihood of dwindling milk supply given the long times away from my baby.

Thanks in advance!

18 comments:

  1. I wish I had a positive experience to share with you. I just didn't produce via pumping. I even was doing an "easy" fellowship with a lot of office time inbetween consults.

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  2. Don't beat yourself up regardless of what happens. Your child will thrive with breastmilk or formula. How you should handle the transition back probably depends on the culture of where you work, but I hope you work somewhere you won't be punished for asserting your needs.

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  3. Feed as much as possible in between shifts, can someone bring little one down mid on-call? Good luck-it's hard to find the time when there are always more jobs to do and patients to see but look after yourself. It isn't impossible, I've done it twice (shorter on call periods though) and they have not suffered from lack of milk. Did always have formula back up in case it was needed though and one took it better than the other. Go with what works for you and your family, best of luck x

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  4. I work 24s as a very busy Certified Nurse Midwife. There is an archived post here by Mom's Tinfoil Hat that I found extremely helpful. I would also recommend investing in a hands free bra (Simple Wishes on amazon) or the Freemie cup system. Medela's Free Style pump can be used without plugging it in but burns batteries. Always pack extra batteries, seals (white silicone flapper things for Medela's pumps), Target brand storage bags (trust me they're awesome!), & water. **Medela pump seals (small white flappy thing on vslves) should get replaced monthly to keep suction optimal. Hydrate/Dictate while you pump. Pump q 2-4hrs x 15 mins when you can. Milk savers in your bra (many brands available) when you can't or have a long case. I do not wash or sterilize equipment with every pumping session. I have about four sets i can use & then wash all at one time each week. I pump & then immediately put milk in a tiny lunchbag/cooler in the staff fridge. Breastfed babies eat 2-5 oz max depending on age. You will never need to feed more than 5oz, much less under 3-4 months. Hang in there!!

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    1. I also pump once each morning I am home with baby- keeps stash nice & high in the freezer.

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    2. I also pump once each morning I am home with baby- keeps stash nice & high in the freezer.

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  5. I did not have 24h calls but did have days when I left early and got home late and therefore did not see my baby for 24h. I couldn't pump very often but when I did, I pumped FULLY (25-30min, getting about 5-6oz/side), and was able to keep up a good supply. I could get by w/ 4 sessions a day, around 6am, noon, 5pm, 10pm. It worked out, except for getting mastitis 5 times... :(

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  6. I pump 3x/day at work and you can refrigerate your parts in between pumping times during the same day (no rinsing or anything) then I wash and steam at the end of every workday. Pump often (even q1hr) if you are heading into a case- and always have a hand pump ready- so much easier to set up really quick and pump each side 5mins each. It takes some determination but worth every ounce! And agree with above- don't drive yourself crazy because your baby will be perfect no matter how you feed em!

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  7. Bean's advice about is great. I had waxing/waning supply when I was back at work and pumping. About once a month I took fenugreek and blessed thistle supplements to help keep my supply up.

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  8. After working hard to squeeze in an extra pumping session for months I realized that drinking an extra 24 oz of water made more of a difference.

    Also unfortunately stressing about it really does make it worse, my favorite line to myself during a weekend on call is, "if she was sick and not interested in eating for a few days my supply would recover just fine, so one day/weekend/week of not emptying enough milk is not a big deal." Yes I do say this to myself all the time but whatever it takes to not worry or be stressed while pumping.

    Good luck!

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  9. All of the above is true (especially not to beat yourself up about it!). I'd add that on the weekend, when my supply had gotten really low, I would put the baby on one side and the pump on the other, and then refrigerate what I pumped so that the baby would eat again in another hour. Again, feed on the full side, pump the other... after an overnight or 24 hours like that, my body was convinced I was nursing twins, and my supply perked right up. Made for bad sleep, but good milk. Hang in there!

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  11. Just don't be too hard on yourself no matter how things go. If you delve into the primary literature on 'breast is best' it's weak at best. Feeding your child is best. Taking care of your own mental health is best. Everything else is style points.

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  12. Agree w all of the above! I found batteries for my medala pump really important as it gave me flexibility to pump anywhere regardless of available electricity. udder cover are awesome if you may need to express in shared spaces. As mentioned above, proper hydration and food are essential for a good milk supply. I always drank 16-24 oz water and had a snack while expressing. Good luck!!

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  13. 1. Always have an entire set of spare parts in your bag just in case of malfunction
    2. Get a car adapter. Pump in the car on way to work.
    3. Get a hands free pumping bra and a cover up . Pump in the work room while writing your notes. If it bothers other people tell them to bug off.
    4. HYDRATE HYDRATE HYDRATE. Water bottle at all times. Dehydration will kill your milk supply.
    5. Pack food in your pumping bag. Everytime you pump, eat. protein bars, nuts, dense nutritious food.
    6. Make pumping a priority. If a patient isn't dying you can take 15 min to pump.
    7. More frequent pumping is better than longer pumping sessions.

    Good luck!

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  14. Oh and nurse as much as possible when you are with your baby. Consider cosleeping if that feels right to you.

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  15. I found that 24h calls were not nearly as bad as taking trips--after a four day trip away from my baby, my milk supply really dwindled. I made it through the calls just fine, though.

    My best tip for pumping on call is to get a sports bra (or two), mark out exactly where your nipples are and then cut verticle slits in just the right spot. You can put nursing pads in the sports bra and wear it under scrubs, and then when it's time to pump the pads come out and the flanges go in, and you've got hands free pumping without having to get undressed (maybe size-up your scrub top).

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  16. I agree with the above comments. I did these shifts during residency while pumping. I would pump 4 or more times - on my commute in with a hands-free pump, my gaps in between were very variable (sometimes 1, 3, or 7 hours - just depended on the patient flow), and then again on the commute home. I would let my team know in advance. I only had to do it for 3 months before my peanut turned 1 and it was SOO HARD! But also nice to have 20-30 minutes of time away from the team to collect myself. When 1 years old rolled around I chucked that pump so quickly into storage!!!

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