Congratulations! You have already given your baby the most wonderful gift by choosing to breastfeed. Now you may be wondering what to do when you return to work. Here are some answers to common concerns.

• When should I introduce a bottle?
• Bottle refusal?
• Can I maintain my supply at work?
• Which pump?
• Should I store milk now to use when I return to work?
• Can I wean the feedings when I will be away from my baby, and still breastfeed when I am at home?
• When do I prepare for returning to work?
• How much milk should I leave for my baby?
• Which formula is better?
• Which bottle should I use?
• Books
• Classes

When should I introduce a bottle?

Wait until your baby is between two and four weeks old before offering a bottle. Then you should offer at least four bottles each week to help your baby stay familiar with the bottle. An 8-week-old baby may scream angrily when offered a bottle that he or she liked at three weeks but has not seen since.
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Bottle refusal?

When some babies become self-aware (between four and eight weeks), they choose not to take bottles. This can be a big problem if mom is about to return to work. If you notice your baby becoming more reluctant to take a bottle, you probably should increase the number of bottles offered until the baby is enthusiastic once again.
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Can I maintain my supply at work?

This depends on the hours you work, the number of times a day you can pump, and the type of pump you use. Some women have a flexible schedule and a pleasant, private space, and can pump two or more times a day. This schedule may allow them to maintain a full milk supply.
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Which pump?

It is a good idea to look at the different pumps available before you buy one. Take a trip to a large retail store specializing in nursery items and look at the choices. Medela's Pump In Style has become very popular with the nursing and working mother. This pump is fully automatic and empties both breasts at once. Speed and efficiency are important at work.
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Should I store milk now to use when I return to work?

Only if it is easy to do so. Most mothers find the baby is taking all the milk they make and that it is very stressful to attempt to pump extra milk to freeze. It is better to relax and enjoy your baby now.
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Can I wean the feedings when I will be away from my baby, and still breastfeed when I am at home?

Some mothers decide that pumping at work is not possible, but would like to continue to breastfeed before and after work. These mothers can choose to wean those feedings that take place during their work hours.

How successful you are at maintaining a partial supply depends on the baby and how well established your supply is. Some babies do decide a bottle is more fun than the breast, while other babies always prefer the breast. You are more likely to maintain a partial supply if you are able to wait until twelve weeks before doing any weaning.
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When do I prepare for returning to work?

When deciding how soon to prepare for the return to work, remember that you want your milk supply adjusted (if necessary), and the baby comfortable with any bottles required, ahead of time.

If you are planning to wean some feedings, then allow three days for your breasts to adjust the supply downward for each feeding you plan to skip. Replace one breastfeeding at a time with a bottle of formula. Wait until your breasts are comfortable before replacing the next feeding.

If you are planning to maintain some or all of your supply by pumping, then start pumping your milk as if you were at work, and bottle-feed the baby during what will be your work hours. Do this at least a week before returning and give yourself enough time to allow for any weaning you might need to do.
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How much milk should I leave for my baby?

You will answer this question as you prepare for your return and start to bottle-feed the baby. By the time you return you will know just how much expressed milk and/or formula to leave with the baby's caregiver.
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Which formula is better?

Formulas are very similar in terms of nutrition, but small differences in the manufacturing process or content can affect the baby.

There is no one "best" formula.

Let your baby tell you which one he or she likes. Most parents start with a dairy-based formula such as Enfamil, Carnation Good Start or Similac. If the baby is obviously distressed, report this to your baby's doctor and try a soy-based formula such as Isomil or Prosobee. Occasionally a baby cannot tolerate either soy or dairy, in which case you can use a hypo allergenic formula such as Alimentum or Nutramigen.

Give your baby a few days before switching formulas. The problems you are seeing may not be related to the type of formula.

You can purchase formula as powder (the cheapest alternative), liquid concentrate or ready-to-feed liquid. All have the same nutritional value. Most formula-feeding families rely on powder. Do not use the low-iron formulas which can result in iron-deficiency anemia. Make sure you carefully follow the manufacturer's directions for adding water to concentrated or powder formulas.
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Which bottle should I use?

Once your baby has learned to breast feed well, you should be able to use any bottle that your baby enjoys. The problems you may have heard about with "nipple confusion" usually occur only when a bottle is introduced too soon.
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Books

There are many wonderful books written to help you make the right decisions for you and your baby, and to help you make a smooth adjustment when returning to work. Here are a couple:

The Working Woman's Guide to Breastfeeding. Dana and Price.

Breastfeeding and the Working Mother. Mason and Ingersoll.

You should browse through several books to obtain a broad perspective on the various strategies available to you.
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Classes

Stanford University Hospital's Perinatal Education program includes a Working Mothers' Group as part of their New Family Program Series. Call 650-723-4600 for more information.

El Camino Hospital offers a Returning to Work and Breastfeeding class. Call 650-988-8287 for more information.

If you live closer to another hospital, check with their perinatal education department for suitable programs.
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