Expressing at work and leaving bodily fluids in the communal fridge

man-opening-refrigeratorWhen C was 6 months old, I had to go back to work. Although I was returning full time (a part time position in my job would mean working full time for a lower salary), I was able to spend two days a week working from home. C would go to nursery while I was in the office, and I would juggle her and my job the rest of the time. (I say ‘the rest of the time’ rather than ‘the other two days’ as this kind of arrangement inevitably spills over into evenings and weekends.)

Her tender age meant that milk was still her main source of nutrition, and I quickly realised I was faced with a dilemma: express milk at work, or switch to formula during the day. If I didn’t pump in the office, my supply could drop to the extent that I’d struggle to feed her myself on the days I was a home, and I’d also find it hard to express enough milk to give her for nursery.

I appreciated that pumping at work wasn’t necessarily an easy option, however. The most pressing concern was the location – where on earth was I going to do it? I didn’t really fancy a toilet or shower cubicle, and I couldn’t think of any obvious alternatives. I was aware that recent legislation requires employers to provide a suitable space for nursing mothers to express, but I seriously doubted that this had been tested in my (predominantly male) workplace before. Although I was right about this, it turned out that I needn’t have worried. The head of admin had breastfed herself, and was completely sympathetic to my predicament. Admittedly, she had to think for quite a while before she came up with what was basically a broom cupboard, but as it was a lockable broom cupboard, I wasn’t going to complain.

So far, I’ve been managing to express milk virtually every day I’ve been at work, although scuttling in and out of the pump cupboard makes me somewhat self-conscious, as there is no obvious reason why I would want to spend 20 minutes in there every lunchtime. I question myself regularly about why I’m so worried about being ‘caught’ going in there, and have come to the conclusion that it’s basically because I don’t want to encourage anyone at work to think about my boobs, especially not in the inescapably undignified process of being milked. I don’t mind people knowing I breastfeed C, but I’d rather not have to explain about the pump.

Storing the milk therefore requires a certain amount of nonchalance. Whilst my colleagues are all liberal, intelligent people, I’m not really inclined to advertise the fact that I’m keeping my bodily fluids in the communal food storage area. Instead, I simply walk in each afternoon avoiding eye-contact and put an odd-looking package directly in the refrigerator. (To disguise the bottle, I’ve ended up wrapping it in several layers of plastic grocery bags, and although this does effectively obscure its appearance, it also looks rather strange.) Whether anyone has guessed what I’m doing I don’t know, but as yet, they’ve been too polite to ask.

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The antibacterial properties of breast milk

lab_technicianMany years ago, breast milk was thought to be sterile. While this is far from being the case (it actually contains all manner of germs1), the role it plays in helping keep babies free from harmful disease means it does display some pretty impressive bug-busting capacities.

The immunological components of breast milk help to protect both a mother’s breast and her baby from infection during feeding, as well as aiding the development of the baby’s immune system2. They also have another useful consequence, however: protecting breast milk from disease for some time after it has been expressed, enabling it to be stored. Several studies have examined whether it is safe to keep expressed milk for short periods, and there is general agreement that it can be stored for 8 hours at room temperature (25 degrees C), for three days in the fridge (4 degrees C) and for up to a year in the freezer (-20 degrees C) without any increase in the levels of pathogens (harmful bacteria) it contains3.

Not only does breast milk inhibit the growth of pathogens, however – it actively reduces them. This was convincingly demonstrated in a piece of research examining what happened to milk during short term storage4. Milk was collected from 9 mothers and divided into three samples: the first was analyzed the same day; the second was refrigerated (at 4 to 6 degrees C) for 48 hours; and the third was refrigerated for 72 hours. Each sample was then contaminated with an E.coli solution (the kind of nasty bacteria that dwells in toilets) and left for two hours. When the samples were tested, levels of E.coli had reduced by 80% in both the milk that was fresh and the milk that was 48 hours old. Levels had also diminished in the 3 day-old milk, but only by around 10%, indicating that the antibacterial properties, whilst still present, had started to degrade by this point.

If your baby needs to feed from a bottle or cup, a considerable body of research indicates that it’s safe to give him breast milk that has been stored in the fridge for up to three days, or in the freezer for several months. There is also evidence that if the milk you express does come into contact with germs (keeping pumping equipment sterile in your bag at work isn’t always easy), then the bactericidal components of breast milk should be able to take care of them, providing the milk is under two days old. There may still be potential issues associated with feeding stored, rather than fresh breast milk to your baby: various chemical changes occur in milk once it has left the body, and it’s possible some of these may affect its nutritional value3,5,6. Nevertheless, expressed breast milk remains a healthy alternative to formula, and as a result of its antibacterial qualities, you can rest assured that if your baby can’t feed from you directly, he still has a safe source of food and drink.

  1. Mastitis: causes and management. World Health Organization; 2000.
  2. Adv Food Nutr Res. 2008;54:45-80.
  3. Acta Paediatr Suppl. 1999 Aug;88(430):14-8.
  4. J Pediatr Gastroenterol Nutr. 2007 Aug;45(2):275-7.
  5. Acta Paediatr. 2001 Jul;90(7):813-5.
  6. Biofactors. 2004;20(3):129-37.

Battle with the bottle: persistence pays off

bottle_2When C was about 10 weeks old, she started refusing to feed from a bottle. Initial reluctance rapidly turned into violent resistance, and if I actually managed to get the teat near her mouth, it was met only by screams.

My despair at the situation was tempered only by the fact that it turned out not to be particularly unusual. Two mothers I knew had had the same experience – trouble free bottle feeding morphing into complete refusal – and several others (including, ahem, my own mother) had never managed to get their babies to feed from a bottle.

On the web, several discussion forums were devoted to the topic, and here I found a glimmer of hope: many parents who had experienced similar problems had eventually been able to get their babies to accept bottles. Reading the advice was nevertheless confusing. There were a multitude of conditions that apparently dictated whether infants would feed from a bottle: mothers needed to be around to provide comfort/mothers needed to be completely out of the house; babies shouldn’t be really hungry (they might get too upset)/babies should be really hungry (they won’t let themselves starve); silicon teats were better than rubber/rubber teats were better than silicon…

The only thing that all the success stories had in common was that the parents persisted in offering their children bottles. This in itself is not a great revelation – if a bottle isn’t offered, then it cannot be accepted – but it was reassuring to know that just because a baby resolutely refuses a bottle at one point, it doesn’t necessarily mean she always will.

Keeping this in mind, we started to offer C a bottle everyday, containing just an ounce of expressed milk to start with. I abandoned my frustration, and decided not to worry too much whether she took it or left it. Perhaps because I was no longer anxious, C stopped crying when the bottle was near her. Sometimes she drank a little bit of milk, sometimes she just chewed on the teat, sometimes she spat it out. Eventually, she became so comfortable feeding this way that she’d grab the bottle with both hands and help push it into her mouth! Whether it was decoupling the stress from the situation, the increasing familiarity of the bottle, or a sudden turnaround that would have happened regardless of what we had done is impossible to know, but for now at least, bottle refusal is thankfully in the distant past.

Battle with the bottle

bottleWhen C was a few weeks old, and I was expressing to take the pressure off my beleagured nipple, she would gulp down whatever ended up near her mouth – even milk straight from the fridge. I didn’t enjoy feeding her bottles, but it was a necessary evil, and as the health visitor told me, if I wanted her to take a bottle later on, I needed to introduce it at that point anyway. She also mentioned that if I wanted C to carry on accepting bottles, I’d need to keep it up, giving her at least one per week. I endeavoured to do this, more or less, although I was reluctant to do it really frequently as it seemed to make her windy and more likely to be sick. I have to admit that part of it was laziness as well. Since breastfeeding had become less painful, it was proving to be amazingly convenient, whereas expressing and bottle feeding was a bit of a hassle.

On my husband J’s birthday, we went out for a meal without C for the first time. My sister came over to look after her, and even though we were only going to be a couple of hours, I wanted to have a bit of wine, so thought it would be better to give her a bottle that evening. I expressed milk in the morning, and defrosted some frozen stuff just in case. My sister didn’t need to use the milk in the end (C had a substantial meal just before we left), but I thought my blood-alcohol content was probably a bit high when I got back, so I decided I ought to leave it an hour or so. C seemed pretty peckish, so J settled down to bottle-feed her. Half an hour and a lot of agitation later, very little had gone down, and we ended up trying to distract her until I could feed her again. I wasn’t particularly worried by this turn of events, but realised that we were going to have to make this bottle thing a lot more regular to ensure that C would take one readily when I wasn’t available to feed her.

The plan was for J, who would normally be feeding her in my absence, to give her a bottle of expressed milk each evening. Simple. Except that rather than making bottles appear more desirable, it transformed her into a small bundle of rage who wouldn’t have them anywhere near her. She turned her head and pushed them away with her hand (at least it was helping her motor coordination), refusing to swallow even the milk that happened to leak into her mouth by chance.

After a few nights of this, I was at my wit’s end. I hadn’t really considered that she might refuse to feed from a bottle in my absence. It had been so easy! Now I realised that I might have to accept that she’d reached the point where she might flat out refuse, even if she was really hungry. It wasn’t that she didn’t know how to do it (a couple of times she’d sleepily suckled for a few seconds), but rather that she didn’t want to. C had realised that she could decide what to take into her mouth, and unfortunately for me, milk from a bottle simply wasn’t on the approved list…

Nipple solutions 3: pumping

bottleIn addition to using a nipple shield, both the health visitor and the NCT helpline lady suggested I try expressing milk and feeding it from a bottle, to give my nipples a bit of a rest. C’s response to the shield was not encouraging, so using a breast pump was really the only option I had left if I wanted to carry on. So far I’d just about been able to put up with the pain: if I gritted my teeth through the initial agony, the remainder of the feed was just about bearable. The sight of my nipples, however, was really quite perturbing. The open wound on the outside edge of one was so deep it looked as if the nipple were in danger of detaching. The psychological effects of seeing this type of damage were considerably worse than the pain. I could only assume it was getting worse with each feed, and therefore that I was mutilating myself further.

Despite the obvious arguments for using a pump, and possessing one that was bought before C even arrived, it took me another couple of days to get around to using it. I don’t know quite why I was so reticent, but I think it had something to do with feeling guilty and inadequate not being able to get it right on my own. The turning point was speaking to my friend Zara. It turned out that she’d had exactly the same problem – right down to the fissures in the same place – and had pumped to help with the healing. She’d also had the same feelings of guilt and inadequacy, but had come through the other side and said that it made a massive difference. I wasn’t going to get any extra points for prolonging the pain, so I should just get on with it.

Some women find expressing milk easier than others. The key is prompting the letdown reflex – after that getting milk out is reasonably straight forward. Without your baby actually suckling, however, letdown isn’t always that easy to initiate. Looking at a picture of your baby (or indeed your baby herself) is one way of getting the vital oxytocin flowing. The solution for me was pumping from the really mangled left hand side, while C fed from the slightly less injured right hand side. For about four days, I expressed on the left and fed on the right, feeding C the expressed milk in a bottle if she was still hungry.

Using the pump and feeding simultaneously gave me an interesting way to monitor the extent to which the expressing helped. I had the same injury on both sides (albeit not as badly on the right), but only used the pump on one. It definitely provided me with some relief – expressing was much less painful than feeding – and the nipple did heal eventually, but the right side also healed completely, without any intervention. The healing actually occurred slightly faster on the right hand side, although this might be expected, as the injury wasn’t quite so serious. It seemed that the midwife who told me that things would eventually improve of their own accord was right after all. I think the problem for me was caused by the fact that my nipples weren’t quite the right shape initially (for C’s mouth at any rate – I don’t know if it would be different with another baby) and the skin broke so they could be stretched into a better one. Certainly, they now look quite different to how they did originally – pointy where they were once quite flat. When they healed, extra skin grew over the fissures where they’d stretched, rather than the skin knitting together at the point where it was originally joined, providing further evidence that my nipples were simply going through a (very painful!) transitional process.

Although it seems that both nipples would probably have recovered of their own accord if I’d continued feeding C as normal, I would strongly recommend using a pump if your nipples are suffering. It really helps to relieve the pain, and if you plan to bottle feed later on (whether with expressed milk or formula), introducing it early (and continuing regularly) means you should meet less resistance later on. Even if you take into account the constant pump dismantling, sterilizing and constructing, it’s a win-win situation!